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Orthopaedic Surgery Feb 2021The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The effect of patellar denervation with electrocautery (PD) on anterior knee pain (AKP) after total knee arthroplasty (TKA) is still debated. The aim of this meta-analysis was to evaluate the current evidence regarding the use of PD in TKA without patellar resurfacing.
METHODS
A computerized search of published studies was performed in the PubMed, Embase and Cochrane Library databases in December 2019. Eligible studies were randomized controlled trials (RCTs) comparing clinical outcomes of the PD group and the non-PD group. Subgroup analyses were carried out according to the follow-up time (3, 12 months, and over 12 months) to evaluate whether the clinical effect of PD changed with time.
RESULTS
Ten RCTs were included in this meta-analysis. Pooled results showed a lower rate of AKP (Risk Ratio [RR] = 0.70; 95% confidence interval [CI], 0.50 to 0.97; P = 0.03) and a reduction in visual analogue scale (VAS) for AKP (mean difference, -0.37; 95% CI, -0.69 to -0.05; P = 0.02) in the PD group when compared to the non-PD group. Subgroup analyses found the differences in AKP incidence and VAS for AKP were significant at 3- and 12-month follow-up but not after 12-month follow-up. No significant difference was observed in functional scores between the two groups. No specific complication directly or indirectly related to PD was found.
CONCLUSION
PD can decrease the incidence and severity of AKP within 12 months after TKA, but the effect cannot be maintained after 12-month follow-up. Without significant associated complication and reoperation, the use of PD is still recommended in TKA without patellar resurfacing.
Topics: Arthralgia; Arthroplasty, Replacement, Knee; Denervation; Electrocoagulation; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Patella; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 33354916
DOI: 10.1111/os.12735 -
The Journal of Knee Surgery May 2023The purpose of this study was to investigate whether differences exist in preventing lateral patellar translation between three distinct medial patellofemoral complex...
The purpose of this study was to investigate whether differences exist in preventing lateral patellar translation between three distinct medial patellofemoral complex (MPFC) reconstruction procedures at varying knee flexion angles. Six cadaveric knee specimens were dissected, potted, and placed in a customized jig for testing. Lateral patellar displacement was measured at intervals between 0 and 90 degrees of knee flexion using a tensile testing machine with a 20 N lateral force applied to the patella. Each specimen was tested with the MPFC intact, sectioned, and after each of the three reconstruction techniques: MPFL, hybrid, and medial quadriceps-tendon femoral (MQTFL) reconstructions. There was significantly increased lateral patellar displacement following MPFC sectioning when compared with the intact state in early degrees of flexion (10-30 degrees) ( < 0.05). All three reconstruction groups restored patella stability and reduced lateral patellar displacement following sectioning from 0 to 30 degrees of flexion ( < 0.05). When compared with the intact group, all three reconstruction groups demonstrated reduced patella translation at full knee extension, while the MPFL and hybrid reconstruction groups additionally demonstrated significant reduction in patella translation at 10 degrees of flexion ( < 0.05). No significant differences were observed between the three reconstruction groups. This biomechanical study demonstrates the efficacy of three MPFC reconstruction techniques in patella stabilization following sectioning. Our results suggest that MPFL reconstruction may provide the most robust patella stabilization, whereas MQTFL reconstruction may be the most forgiving construct. This study suggests that MQTFL and hybrid reconstructions provide adequate resistance to lateral translation and may be used as an alternative to MPFL reconstruction.
Topics: Humans; Patella; Patellofemoral Joint; Ligaments, Articular; Biomechanical Phenomena; Cadaver; Knee Joint
PubMed: 35144302
DOI: 10.1055/s-0041-1741549 -
Knee Surgery, Sports Traumatology,... Sep 2022The diagnostic process in patients after painful total knee arthroplasty (TKA) is challenging. The more clinical and radiological information about a patient with pain...
PURPOSE
The diagnostic process in patients after painful total knee arthroplasty (TKA) is challenging. The more clinical and radiological information about a patient with pain after TKA is included in the assessment, the more reliable and sustainable the advice regarding TKA revision can be. The primary aim was to investigate the position of TKA components and evaluate bone tracer uptake (BTU) using pre-revision SPECT/CT and correlate these findings with previously published pain patterns in painful patients after TKA.
METHODS
A prospectively collected cohort of 83 painful primary TKA patients was retrospectively evaluated. All patients followed a standardized diagnostic algorithm including 99m-Tc-HDP-SPECT/CT, which led to a diagnosis indicating revision surgery. Pain character, location, dynamics and radiation were systematically assessed as well as TKA component position in 3D-CT. BTU was anatomically localized and quantified using a validated localization scheme. Component positioning and BTU were correlated with pain characteristics using non-parametric Spearman correlations (p < 0.05).
RESULTS
Based on Spearman's rho, significant correlations were found between pain and patients characteristics and SPECT/CT findings resulting in nine specific patterns. The most outstanding ones include: Pattern 1: More flexion in the femoral component correlated with tender/splitting pain and patella-related pathologies. Pattern 3: More varus in the femoral component correlated with dull/heavy and tingling/stinging pain during descending stairs, unloading and long sitting in patients with high BMI and unresurfaced patella. Pattern 6: More posterior slope in the tibial component correlated with constant pain.
CONCLUSION
The results of this study help to place component positioning in the overall context of the "painful knee arthroplasty" including specific pain patterns. The findings further differentiate the clinical picture of a painful TKA. Knowing these patterns enables a prediction of the cause of the pain to be made as early as possible in the diagnostic process before the state of pain becomes chronic.
LEVEL OF EVIDENCE
Level III.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Pain; Patella; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography
PubMed: 33864469
DOI: 10.1007/s00167-021-06567-y -
Cartilage Dec 2021This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following...
PURPOSE
This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery.
METHODS
This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality.
RESULTS
Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes.
CONCLUSION
Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics.
LEVEL OF EVIDENCE
Level IV, systematic review of level II to IV studies.
Topics: Adult; Aged; Cartilage Diseases; Cartilage, Articular; Chondrocytes; Female; Humans; Male; Middle Aged; Patella; Transplantation, Autologous
PubMed: 31845590
DOI: 10.1177/1947603519893076 -
Journal of Orthopaedic Surgery and... Jan 2021Only a few studies have described the effect of full arthroscopic surgery in treatment of excessive lateral pressure syndrome (ELPS). Therefore, the purpose of this...
BACKGROUND
Only a few studies have described the effect of full arthroscopic surgery in treatment of excessive lateral pressure syndrome (ELPS). Therefore, the purpose of this study was to assess the clinical efficacy and experience of total arthroscopic lateral retinacular (LR) release and lateral patelloplasty for the treatment of ELPS.
METHODS
A total of 73 patients (88 knees) with ELPS underwent arthroscopic LR release and lateral patelloplasty. The visual analogue scale (VAS), Kujala score, Lysholm scores, patella medial pushing distance, patellar tilt angle (PTA), and lateral patellofemoral angle (LPFA) were measured and evaluated before and after surgery.
RESULTS
Follow-up ranged from 12 to 36 months with an average of 24 ± 5.8 months. The VAS was significantly lower at the last follow-up than before surgery (P < 0.01). The patella medial pushing distance, Kujala score, Lysholm score, PTA, and LPFA were significantly higher at the last follow-up than before surgery (P < 0.01, respectively). Years and lateral patella Outerbridge classification at the last follow-up have negative correlation with Kujala score, Lysholm score, Patella medial pushing distance, PTA, and LPFA (P < 0.01, respectively) and have positive correlation with VAS (P < 0.01, respectively). Related complications were not reported.
CONCLUSIONS
Full arthroscopic LR release combined with lateral patelloplasty in the treatment of ELPS is an effective minimally invasive method, which can effectively correct anomalies of force line and skeleton of patella, relieve pain, and restore knee joint motor function with less complications.
Topics: Adult; Arthroscopy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patella; Patellofemoral Joint; Patellofemoral Pain Syndrome; Pressure; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33482854
DOI: 10.1186/s13018-021-02229-4 -
Knee Surgery, Sports Traumatology,... May 2022Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature... (Review)
Review
Good clinical outcomes after patellar cartilage repair with no evidence for inferior results in complex cases with the need for additional patellofemoral realignment procedures: a systematic review.
PURPOSE
Focal, patellar cartilage defects are a challenging problem as most cases have an underlying multifactorial pathogenesis. This systematic review of current literature analysed clinical results after regenerative cartilage repair of the patella with a special focus on the assessment and treatment of existing patellofemoral malalignment.
METHODS
A systematic review was conducted to identify articles reporting clinical results after cartilage regenerative surgeries of the patella using the PubMed and Scopus database. The extracted data included patient-reported outcome measures (PROMS) and whether cartilage repair was performed alone or in combination with concomitant surgeries of underlying patellofemoral co-pathologies. In cases of isolated cartilage repair, specific exclusion criteria regarding underlying co-pathologies were screened. In cases of concomitant surgeries, the type of surgeries and their specific indications were extracted.
RESULTS
A total of 35 original articles were included out of which 27 (77%) were cohort studies with level IV evidence. The most frequently used technique for cartilage restoration of the patella was autologous chondrocyte implantation (ACI). Results after isolated cartilage repair alone were reported by 15 (43%) studies. Of those studies, 9 (60%) excluded patients with underlying patellofemoral malalignment a priori and 6 (40%) did not analyse underlying co-pathologies at all. Among the studies including combined surgeries, the most frequently reported concomitant procedures were release of the lateral retinaculum, reconstruction of the medial patellofemoral ligament (MPFL), and osteotomy of the tibial tubercle. In summary, these studies showed lower preoperative PROMS but similar final PROMS in comparison with the studies reporting on isolated cartilage repair. The most frequently used PROMS were the IKDC-, Lysholm- and the Modified Cincinnati Score.
CONCLUSION
This comprehensive literature review demonstrated good clinical outcomes after patellar cartilage repair with no evidence of minor results even in complex cases with the need for additional patellofemoral realignment procedures. However, a meaningful statistical comparison between isolated patellar cartilage repair and combined co-procedures is not possible due to very heterogeneous patient cohorts and a lack of analysis of specific subgroups in recent literature.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Osteotomy; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 34510221
DOI: 10.1007/s00167-021-06728-z -
The Knee Oct 2023Recurrent patella instability is a common and debilitating condition which affects mainly adolescents and young adults. Medial patellofemoral ligament (MPFL)...
BACKGROUND
Recurrent patella instability is a common and debilitating condition which affects mainly adolescents and young adults. Medial patellofemoral ligament (MPFL) reconstruction is the most popular surgical treatment for recurrent patella instability. The most common graft choice in the literature is ipsilateral hamstring tendon (gracilis or semitendinosis) but the complication rate remains high (11-26%). Conversely, there are very few papers on the use of modern, synthetic grafts.
METHODS
A total of 85 patients who underwent MPFL reconstruction using a modern, synthetic graft (Xiros, UK) from 2014 to 2022 were retrospectively reviewed. Exclusion criteria were patella alta, malalignment, trochlea dysplasia and significant pain between episodes of instability. The author has developed an operative technique which is anatomic, minimally invasive and reproducible. Pre- and post-operative Kujala and Oxford knee scores were collected and analysed.
RESULTS
The male to female ratio was 27:58, the average age was 28 years, and the follow up range was 1-9 years (mean follow up 4.84 years). We found a statistically significant improvement in mean Kujala and Oxford knee scores (P < 0.001) postoperatively. No major complications such as knee stiffness, soft tissue reaction, re-dislocation, patella fracture were identified in the series. There were nine minor complications (10.6%): five cases of medial knee pain, two cases of residual instability and two of superficial infection.
CONCLUSION
This study demonstrates that modern, synthetic graft is a viable option for MPFL reconstruction. The technique described, achieves good clinical outcomes with low complication rates when compared with the published literature.
Topics: Adolescent; Young Adult; Humans; Male; Female; Infant; Child, Preschool; Child; Patellar Dislocation; Patellofemoral Joint; Retrospective Studies; Patella; Ligaments, Articular; Joint Instability; Pain; Treatment Outcome
PubMed: 37672914
DOI: 10.1016/j.knee.2023.08.004 -
International Orthopaedics Jun 2021Alteration of patellar height is commonly encountered in total knee arthroplasty (TKA), and failure to address patella baja can result in suboptimal functional outcomes....
BACKGROUND
Alteration of patellar height is commonly encountered in total knee arthroplasty (TKA), and failure to address patella baja can result in suboptimal functional outcomes. It may therefore be prudent to evaluate pre-operative patellar height (PPH) and to seek risk factors for patella baja.
METHODS
Two hundred eighty-five patients who underwent TKA were included. Patient's age, gender, body mass index (BMI), and history of prior arthroscopy were recorded. PPH was measured using plateau-patella angle (PPA) as well as the Blackburn-Peel (BP), Caton-Deschamps (CD), and Insall-Salvati (IS) ratios.
RESULTS
The average patients' age was 71 years with a mean BMI of 30.45. There were 191 female and 94 male patients. One-fourth of the cases had at least one prior knee arthroscopy. Multivariate linear regression analysis identified gender and BMI as variables significantly affecting the IS ratio (p: < 0.05). Gender also had a significant correlation with PPA. Male patients were likely to have lower PPA (p: < 0.03). Though increasing age had a positive correlation with patellar height, this was not statistically significant. History of prior arthroscopy had no significant effect on any of the four PPH measurements.
CONCLUSION
Lower patellar height is significantly correlated to male gender and high BMI. We suggest that obese male patients be screened for pre-operative patella baja. This can help in surgical planning and optimizing results in TKA.
Topics: Aged; Arthroplasty, Replacement, Knee; Body Mass Index; Female; Humans; Knee Joint; Male; Patella; Radiography
PubMed: 33277664
DOI: 10.1007/s00264-020-04890-6 -
Orthopaedic Surgery Feb 2022The study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow-"8" suture fixation (AS) and K-wire...
OBJECTIVE
The study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow-"8" suture fixation (AS) and K-wire fixation in patients with distal pole patellar fractures.
METHODS
Twenty-eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow-"8" suture fixation (AS group) was applied in 10 patients and 18 patients underwent K-wire fixation (K-wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K-wire group, with comparable demographic characteristics. All patients underwent regular follow-up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture.
RESULTS
A total of 28 eligible patients were included in this study. The mean follow-up was similar for the AS and the K-wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K-wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K-wire group (P < 0.05). The final follow-up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion-extension angle was slightly better in the AS group than in the K-wire group. The Bostman patella fracture functional score of AS group were better than K-wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K-wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re-operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation.
CONCLUSIONS
Anchor and Krackow-"8" suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures.
Topics: Adult; Aged; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Middle Aged; Patella; Retrospective Studies; Sutures; Treatment Outcome
PubMed: 34964263
DOI: 10.1111/os.13124 -
Journal of Orthopaedic Surgery and... Jan 2021Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs).... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Whether resurface the patella or not in total knee arthroplasty (TKA) was controversial. In 2013, we conducted a meta-analysis of randomized controlled trials (RTCs). After that, plenty of studies have been carried out, but there still existed a great deal of controversy. In order to update our previous study, we conducted this update meta-analysis to evaluate the efficacy of patellar resurfacing in TKA.
METHODS
Databases were searched for RCTs comparing the outcomes of patellar resurfacing and nonresurfacing in TKA. Outcomes of knee relevant indicators were analysed. To see the short- and long-term effects, we calculated the data in total and divided the patients who were followed up for ≤ 3 years and ≥ 5 years into two subgroups as well.
RESULTS
Thirty-two trials assessing 6887 knees were eligible. There was a significant difference in terms of reoperation (in total and ≥ 5 years), Knee Society Score (KSS), function score (in total and ≥ 5 years) and noise. While no significant difference was found in the following items: reoperation (≤ 3 years), anterior knee pain (AKP), function score (≤ 3 years), range of motion (ROM), Oxford score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analogue score (VAS), Feller score, patellar tilt and the patients' satisfaction.
CONCLUSIONS
We found that patellar resurfacing could reduce the occurrence of reoperation and noise after surgery, as well as increase the KSS and function score, while it might not influence the outcomes such as AKP, ROM, Oxford score, KOOS, VAS, Feller score, patellar tilt and the patients' satisfaction. The results are different from our previous finding in the meta-analysis. In conclusion, we prefer patellar resurfacing in TKA.
Topics: Arthroplasty, Replacement, Knee; Female; Follow-Up Studies; Humans; Male; Patella; Randomized Controlled Trials as Topic; Reoperation; Time Factors; Treatment Outcome
PubMed: 33494774
DOI: 10.1186/s13018-020-02185-5