Meniscus injuries are prevalent in orthopedic diagnosis. The reconstruction of the structural inhomogeneity and anisotropy of the meniscus is a major challenge in clinical practice. Meniscal tissue ...engineering has emerged as a potential alternative for the treatment of various meniscal diseases and injuries. In this study, we developed three-dimensional (3D) cell-printed meniscus constructs using a mixture of polyurethane and polycaprolactone polymers and cell-laden decellularized meniscal extracellular matrix (me-dECM) bioink with high controllability and durable architectural integrity. The me-dECM bioink provided 3D cell-printed meniscus constructs with a conducive biochemical environment that supported growth and promoted the proliferation and differentiation of encapsulated stem cells toward fibrochondrogenic commitment. In addition, we investigated the in vivo performance of the 3D cell-printed meniscus constructs, which exhibited biocompatibility, excellent mechanical properties, and improved biological functionality. These attributes were similar to those of the native meniscus. Collectively, the 3D cell-printing technology and me-dECM bioink facilitate the recapitulation of meniscus tissue specificity in the aspect of the shape and microenvironment for meniscus regeneration. Further, the developed constructs can potentially be applied in clinical practice.
Purpose
To investigate progressive tunnel widening and its correlation with postoperative outcomes after anterior cruciate ligament (ACL) reconstruction using allografts.
Methods
Sixty-five patients ...who underwent ACL reconstruction using a tibialis anterior allograft between 2015 and 2017 were enrolled. Femoral and tibial tunnel widths were measured on anteroposterior (AP) and lateral radiographs immediately and at 3, 6, 12, and 24 months postoperatively. Average femoral and tibial tunnel widths in AP and lateral views were calculated at three different measurement points. Tunnel widening was calculated as the difference in tunnel width immediately and 2 years postoperatively. The correlation between tunnel widening and the postoperative results was analysed.
Results
Tunnel width changes between immediate and 2 years postoperatively were as follows, in AP and lateral views, respectively: femur, 3.0 mm ± 1.5 mm and 2.4 mm ± 1.4 mm; and tibia, 2.8 mm ± 1.4 mm and 2.9 mm ± 1.5 mm. Femoral tunnel widths significantly increased until 1 year, but not from 1 to 2 years postoperatively. Tibial tunnel width significantly increased until 2 years postoperatively. In all tunnels, the increments in tunnel widening decreased over time. Increased knee laxity significantly correlated with greater femoral tunnel widening in AP (
r
= 0.346,
P
= 0.006) and lateral views (
r
= 0.261,
P
= 0.049).
Conclusion
Femoral tunnel widths gradually increased until 1 year postoperatively, and tibial tunnel widths increased until 2 years after ACL reconstruction with allografts. The tunnel widening rate gradually decreased over time. Femoral tunnel widening of 3.7 mm and 3.2 mm on AP and lateral views, respectively, were the cut-off values for postoperative knee laxity.
Level of evidence
Level III.
Purpose
Coronal correction errors after medial opening wedge high tibial osteotomy (MOWHTO) occasionally occur even with the assistance of navigation. The purpose of the present study was to ...determine the navigation accuracy in MOWHTO and to identify factors that affect the coronal correction error after navigation-assisted MOWHTO.
Methods
A total of 114 knees treated with navigation-assisted MOWHTO were reviewed retrospectively. Mechanical axis (MA) on standing radiograph and medial proximal tibial angle (MPTA) were measured preoperatively and at 6 months postoperatively, and the differences (ΔMA and ΔMPTA) were calculated. Joint line convergence angle (JLCA) on supine and standing radiographs was measured preoperatively, and their difference (ΔJLCA) was calculated. To assess the navigation accuracy, ΔMA and ΔMPTA were compared with the coronal correction by navigation (ΔNMA) using intraclass correlation coefficients (ICCs). Univariable and multivariable regression analyses were used to identify factors that affect coronal correction discrepancy (ΔMA − ΔNMA).
Results
The reliability of navigation was good in terms of bony correction (ICC between ΔNMA and ΔMPTA, 0.844) and fair in terms of MA correction (ICC between ΔNMA and ΔMA, 0.706). The mean coronal correction discrepancy was 2.0° ± 2.4°. In the multivariable analysis, ΔJLCA was shown to be a predictive factor of coronal correction discrepancy (unstandardized coefficient, 1.026;
R
2
, 0.470).
Conclusion
Navigation in MOWHTO provided reliable information about bony correction; however, MA tended to be overcorrected. The difference in JLCA between the supine and standing radiographs was the most important preoperative factor that predicted the coronal correction discrepancy after MOWHTO. In patients with larger ΔJLCA, each degree of ΔJLCA should be subtracted from the planned amount of correction angle when preoperative planning is performed using standing radiographs.
Level of evidence
IV.
Background:
Previous studies have reported various healing rates (0%-100%) as evaluated by second-look arthroscopy after repair of medial meniscal root tears (MMRTs). Such variable results might ...provoke suspicion of the necessity for repair. Furthermore, the effect of meniscal healing on the clinical outcomes has not been reported.
Purpose:
To more precisely determine the healing rate of MMRTs repaired through the transseptal portal, which could provide objective visualization of the healed meniscus, and to identify the effect of meniscal healing on the clinical and radiological outcomes.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between June 2010 and April 2015, 56 patients underwent pullout suture for MMRT. Lysholm score, Hospital for Special Surgery score, International Knee Documentation Committee subjective score, medial joint space height, and Kellgren-Lawrence (K-L) grade were evaluated. Thirty-three patients underwent second-look arthroscopy and were divided into a “stable healed group” and “unhealed group” according to their healing status, as evaluated through the transseptal portal. The intraoperative, clinical, and radiological outcomes of the 2 groups were compared.
Results:
All other clinical outcomes improved. However, medial joint space became significantly narrower (P < .001), and 23 patients (41%) showed K-L grade progression. On the basis of second-look arthroscopy, 23 patients (69.7%) were classified into a stable healed group and 10 (30.3%) into a unhealed group. The stable healed group showed a higher Hospital for Special Surgery score (P = .023), International Knee Documentation Committee subjective score (P = .031), and successful microfracture rate (P = .023), with less progression of medial joint space narrowing (P < .001) and K-L grade (P < .001).
Conclusion:
Despite degenerative change progression, clinical outcomes were improved. The successful healing rate was 69.7% after repair of MMRTs. Compared with the unhealed group, the stable healed group showed better clinical outcomes and less degenerative change progression.
Background:
Achieving the postoperative mechanical axis passing through 62.5% of the tibial plateau is considered successful osteotomy surgery. Despite precise preoperative planning and surgical ...techniques, some procedures result in under- or overcorrection. Few studies have investigated the relationship between clinical outcomes and unintentional under- or overcorrection after open wedge high tibial osteotomy (OWHTO) using whole-leg standing radiographs.
Purpose:
To investigate the relationship between postoperative alignment using whole-leg standing radiographs and clinical outcomes after OWHTO.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 89 knees (72 patients) that underwent OWHTO between October 2013 and September 2018 were included. Patients with postoperative weightbearing line (WBL) ratios within 57% to 67% were classified as appropriate correction (group A; 45 cases), whereas ratios <57% and >67% were classified as undercorrection (group U; 20 cases) and overcorrection (group O; 24 cases), respectively. The following patient-reported outcomes (PROs) were investigated: International Knee Documentation Committee (IKDC) subjective score, Kujala score, and Knee injury and Osteoarthritis Outcome Score (KOOS). The correlation between postoperative WBL and PROs was analyzed. PROs were compared among the 3 groups.
Results:
Regarding the correlation between postoperative WBL ratio and PROs, a larger postoperative WBL ratio was significantly correlated with a poor IKDC subjective score (P = .002), Kujala score (P = .009), and KOOS. Group O showed inferior postoperative PRO scores when compared with group A or U, whereas group U showed a similar result to group A (mean IKDC subjective scores: group U, 62.0; group A, 61.2; group O, 47.6; P = .004).
Conclusion:
Overcorrection after OWHTO surgery correlated with inferior PROs; therefore, overcorrected alignment should be avoided for patient satisfaction. Knees with an undercorrected alignment showed clinical results similar to those with appropriate correction.
To compare the accuracy of plain radiography and computed tomography (CT) in detecting lateral hinge fractures and to identify predictive factors of the lateral hinge fractures after open wedge high ...tibial osteotomy (HTO).
This study included patients who underwent isolated primary open wedge HTO for medial compartment degenerative arthritis from 2015 to 2016 and were evaluated by postoperative CT scans and followed for a minimum of 1 year. This study involved 48 patients (48 knees) undergoing open wedge HTO for primary medial osteoarthritis. Lateral hinge fractures were evaluated on immediate plain radiographs and CT scans according to the Takeuchi classification. Predictive factors of plain radiograph-based hinge fracture and CT-based hinge fracture were investigated.
The detection rate of lateral hinge fracture was significantly higher on CT scans than on plain radiographs (50% vs 14.6%; P < .001). Seven knees (14.6%) showed lateral hinge fractures on postoperative plain radiographs, including 6 with type I and 1 with type III fractures; 24 (50.0%) showed lateral hinge fractures on postoperative CT scans, including 20 with type I, 2 with type II, and 2 with type III fractures. CT scans detected 14 type I, 2 type II, and 1 type III hinge fractures not detected by plain radiographs. The medial opening gap width was the only predictor of lateral hinge fracture on CT scans (adjusted odds ratio, 1.565; P =.034).
The incidence of lateral hinge fracture of the knee after open wedge HTO was higher on CT scans than on plain radiographs. The medial opening gap width was the only predictor of lateral hinge fractures, suggesting a need for care when spreading the gap to avoid lateral hinge fractures.
Level III, cross-sectional study.
Background:
Time-dependent postoperative changes in knee joint line obliquity (KJLO) and subsequent adaptational changes in the hip and ankle joints have not been fully proven after medial open wedge ...high tibial osteotomy (MOWHTO).
Purpose:
To investigate the serial postoperative changes in KJLO and subsequent adaptational changes in the hip and ankle joints over time after MOWHTO.
Study design:
Case series, Level of evidence, 4.
Methods:
A total of 92 patients who underwent MOWHTO between April 2015 and December 2020 were evaluated. Radiographic parameters, including KJLO, ankle joint line obliquity (ALO), hip abduction angle (HAA), joint line convergence angle, weightbearing line ratio, and hip-knee-ankle angle, were analyzed in time sequence (preoperatively and 3, 6, 12, and 24 months postoperatively). Repeated-measures analysis of variance and post hoc analysis were used to demonstrate alterations and the statistical significance of KJLO and other related radiographic parameters over time.
Results:
The mean KJLO values were –1.9°, –2.1°, –2.7°, and –3.2° at 3, 6, 12, and 24 months postoperatively, respectively, indicating that there was consistent increase in valgus tilting of KJLO from 6 to 24 months (P < .001 for both 6-12 months and 12-24 months). ALO and HAA showed significant changes from 6 to 12 months (ALO, P < .001; HAA, P = .002), but not between 12 and 24 months (ALO: –3.0°, –2.7°, –1.9°, and −1.6°; HAA: –0.8°, –0.9°, –1.5°, and −1.8° at 3, 6, 12, and 24 months, respectively). The mean joint line convergence angle, weightbearing line ratio, and hip-knee-ankle angle did not change significantly from 3 months to 24 months postoperatively.
Conclusion:
There was a consistent increase in valgus tilting of the postoperative KJLO from 6 to 24 months after MOWHTO. The adaptive ALO and HAA significantly changed between 6 and 12 months and were maintained until 24 months after MOWHTO. It is necessary to consider the adaptive change when hip or ankle surgery is planned within this period.
Background and Objectives: The TomoFix anatomical plate was developed to improve plate position, proximal screw direction, and post-correction tibial contouring. The purpose of this study was to ...compare postoperative configurations between the TomoFix anatomical plate and the TomoFix conventional plate. It was hypothesized that the new modified plate provides a better fixative coaptation than the conventional plate. Materials and Methods: A total of 116 cases (112 patients) were enrolled in this study from March 2015 to February 2021. Among them, 63 patients underwent surgery using the TomoFix conventional plate, and 53 underwent surgery using the TomoFix anatomical plate. The radiographic outcomes, including the hip−knee−ankle (HKA) angle, medial proximal tibial angle (MPTA), tibial slope, plate angle, proximal screw angles, and plate-to-cortex distance at #1 hole (just below the osteotomy site) were compared between the two groups. Results: Patients with the TomoFix anatomical plate showed similar results in terms of the pre- and postoperative HKA angle, MPTA, and tibial slope. The TomoFix anatomical group showed a significantly greater plate angle (39.2° ± 8.1° vs. 31.7° ± 7.0°, p < 0.001) and less screw angles, indicating that the TomoFix anatomical plates allowed a more posterior plate position than the conventional plate. The plate-to-cortex distance was significantly less in the TomoFix anatomical group than in the TomoFix conventional group (p < 0.001). Conclusion: The TomoFix anatomical plate showed a more posteromedial plating position, better proximal screw direction to the lateral hinge, and improved post-correction tibial contour compared to the TomoFix conventional plate.
There have been many efforts to find modifiable risk factors for venous thromboembolism (VTE) in the perioperative period of total knee arthroplasty (TKA), while no study has investigated the ...relationship between the muscle mass and deep vein thrombosis (DVT) or pulmonary embolism frequency following TKA. This study aimed to evaluate the relationship between muscle volume and the prevalence of symptomatic and radiologically confirmed venous thromboembolism (VTE) after total knee arthroplasty (TKA).
A total of 261 consecutive patients who underwent primary TKA between 2013 and 2015 were enrolled. Computed tomographic venography with pulmonary angiography (CTVPA) was performed between the 5th and 7th postoperative days to assess the presence of VTE. Four parameters of muscle volume at three levels were evaluated on CTVPA: (i) the cross-sectional area of all skeletal muscles (skeletal muscle index) and total psoas area at the level of the third lumbar vertebrae; (ii) the vastus lateralis muscle at the thigh level; and (iii) the posterior crural muscle at the lower leg level. The relationship between the muscle volume at each level and the prevalence of VTE after TKA was evaluated with multivariate adjusted logistic regression models.
The CTVPA scan showed no proximal DVT, and all thrombi were located in muscular, peroneal, and posterior tibial veins. In unilateral TKA, patients with lower muscle volume of the vastus lateralis at the thigh level in the nonoperated limb had significantly higher prevalence of distal DVT in the operated limb (adjusted OR: 2.97 at subclinical DVT revealed by CTVPA and adjusted OR: 2.68 at symptomatic DVT). This finding was also discovered in patients who underwent simultaneous bilateral TKA (adjusted OR: 1.73-2.97 at subclinical DVT and adjusted OR:1.76-1.86 at symptomatic DVT).
The relative muscle volume of the vastus lateralis at the thigh level was negatively associated with the prevalence of symptomatic and radiologically confirmed DVT, suggesting that low thigh muscle mass is an independent risk factor for VTE in the postoperative period of TKA.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Approximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the ...hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia.
We retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups.
The transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016).
Patients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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