Following two years post-surgery, CaP patients' KOOS, JR scores were statistically higher than those observed in patients who underwent knee arthroscopy. Knee arthroscopy, combined with CaP injection of OA-BML, demonstrated significantly improved functional outcomes compared to arthroscopy alone for non-OA-BML diagnoses, as the results indicate. Retrospectively examining the data, we observe a discernible contrast between the positive effects of knee arthroscopy accompanied by intraosseous CaP injection and those of knee arthroscopy alone.
For posterior-stabilized (PS) total knee arthroplasty (TKA), a smaller posterior tibial slope (PTS) is often considered the optimal choice. Postoperative outcomes in posterior stabilized total knee arthroplasty (PS TKA) may be affected by an unwanted anterior tibial slope (ATS), which can result from imprecise surgical instruments and techniques, combined with the high degree of inter-patient variability. Using the identical prosthesis, we examined midterm clinical and radiographic results from PS TKA procedures, correlating them with ATS and PTS procedures on matched knees. A retrospective analysis of 124 patients who had total knee replacements with ATTUNE posterior stabilized prostheses on matched knees displaying anterior tibial slope (ATS) and posterior tibial slope (PTS) was performed after a minimum observation period of 5 years. An average of 54 years was the length of the follow-up period. Evaluations encompassed the Knee Society Knee and Function scores, the Western Ontario and McMaster Universities Osteoarthritis Index, the Feller and Kujalar scores, and range of motion (ROM). The study investigated the selection criteria for the most desirable total knee arthroplasty (TKA), considering both ATS and PTS procedures. The hip-knee-ankle angle, component positions, tibial slope, posterior femoral offset, Insall-Salvati ratio, and knee sagittal angle were assessed using radiography as the primary measurement method. At both the preoperative stage and the final follow-up, total knee arthroplasties (TKAs) employing anterior tibial slope (ATS) and posterior tibial slope (PTS) methods demonstrated no substantial differences in clinical results, specifically regarding range of motion (ROM). Custom Antibody Services Patient satisfaction with knee replacement procedures revealed 58 patients (46.8%) happy with bilateral knees, 30 (24.2%) preferring knees fitted with ATS, and 36 (29.0%) choosing knees with PTS. The preference rate for TKAs with ATS and PTS techniques was not significantly different, with a p-value of 0.539. Radiographic findings, with the exception of the postoperative tibial slope, revealing a disparity of -18 degrees compared to 25 degrees (p < 0.0001), showed no significant differences between the preoperative and final follow-up assessments, including the knee sagittal angle. Midterm outcomes for PS TKAs featuring ATS and PTS techniques, when performed on corresponding knees with a minimum five-year follow-up, displayed comparable results. In PS TKA, midterm outcomes were not compromised by nonsevere ATS when soft tissue balancing and the improved prosthesis were properly executed. To establish the long-term safety of non-severe ATS in primary total knee arthroplasty (PS TKA), a longitudinal follow-up study is mandatory. Evidence assessment indicates a level III.
Anterior cruciate ligament (ACL) reconstruction graft failure has been empirically linked to the limitations of the fixation techniques employed. For ACL reconstruction, interference screws, though widely used, do not guarantee a complication-free outcome. Though previous studies have scrutinized the use of bone void filler in fixation, no biomechanical comparison with soft tissue grafts and interference screws has been reported, based on our current knowledge. To compare the fixation strength of a calcium phosphate cement bone void filler with screw fixation, this study employs an ACL reconstruction bone replica model supplemented with human soft tissue grafts. Ten ACL grafts were fabricated, each employing semitendinosus and gracilis tendons, sourced from ten unique donors. Graft attachment to open-celled polyurethane blocks was achieved using either 8-10mm x 23mm polyether ether ketone interference screws (5 grafts) or approximately 8mL of calcium phosphate cement (5 grafts). Graft construct failure was induced by cyclic loading under displacement control, accomplished at a rate of 1 mm per second. Cement construction, relative to screw construction, demonstrated a 978% higher load at yield, a 228% higher load at failure, a 181% higher displacement at yield, a 233% greater work at failure, and a 545% higher stiffness. reactive oxygen intermediates Analyzing data normalized to cement constructs from the same donor, screw constructs exhibited a 1411% load at yield, 5438% load at failure, and 17214% graft elongation. This investigation's conclusions point towards the possibility that cement fixation of ACL grafts could yield a more substantial construct compared to the established interference screw method. The use of this method might lead to a decrease in the rate of interface screw placement-related complications, such as bone tunnel widening, screw migration, and screw breakage.
Clinical success following cruciate-retaining total knee arthroplasty (CR-TKA) in the context of posterior tibial slope (PTS) remains a subject of debate. Our objective was to scrutinize (1) the effect of PTS modification on clinical outcomes, encompassing patient satisfaction and joint cognizance, and (2) the correlation between patient-reported outcomes, the PTS, and compartmental loading. Post-CR-TKA PTS alterations resulted in the stratification of 39 patients into the increased PTS group and 16 patients into the decreased PTS group. Using the Knee Society Score (KSS) 2011 and the Forgotten Joint Score-12 (FJS-12), a clinical evaluation was conducted. The loading of compartments was evaluated intraoperatively. The increased PTS group demonstrated significantly higher KSS 2011 scores (symptoms, satisfaction, total score; p=0.0018, 0.0023, 0.0040 respectively) compared to the decreased PTS group. Conversely, FJS (climbing stairs?) scores were significantly lower (p=0.0025) in the increased PTS group. Significantly greater reductions in medial and lateral compartment loading—at 45, 90, and full extension—were observed in the increased PTS group compared to the decreased PTS group (p < 0.001 for both comparisons). Loading in the medial compartment, at 45, 90, and full levels, exhibited a statistically significant correlation with the 2011 KSS scores for symptom severity (r = -0.4042, -0.4164, and -0.4010, respectively; p = 0.00267, 0.00246, and 0.00311, respectively). A significant correlation was observed between PTS and medial compartment loading differentials for 45, 90, and full levels (r = -0.3288, -0.3792, and -0.4424, respectively; p = 0.00358, 0.001558, and 0.00043, respectively). Patients with elevated PTS post-CR-TKA experienced superior outcomes in symptoms and patient satisfaction compared to those with decreased PTS, potentially due to a substantial decrease in compartmental loading during knee flexion. Level of evidence: Therapeutic case series, level IV.
A month-long journey to North American joint replacement and knee surgery centers, hosted by Knee Society members, is awarded to four international orthopaedic surgeons chosen for the John N. Insall Knee Society Traveling Fellowship, who are fellowship-trained in arthroplasty or sports medicine. To cultivate research and education, the fellowship facilitates the sharing of ideas amongst fellows and Knee Society members. PI3K/AKT-IN-1 A deeper exploration of the connection between surgeon preferences and these travelling fellowships is still warranted. Four 2018 Insall Traveling Fellows, following both the commencement and completion of their fellowship program, finalized a 59-question survey. This survey covered patient selection, preoperative planning, intraoperative approaches, and postoperative protocols, in order to assess any adjustments to their practice (such as initial excitement) related to their fellowship experience. An assessment of the implementation of anticipated practice changes was conducted four years after the traveling fellowship's completion using the identical survey. The survey's questions were categorized into two groups, each reflecting different levels of evidentiary support from the published literature. After the fellowship, a median of 65 (3 to 12) shifts in consensus issues and 145 (5 to 17) shifts in contentious issues were projected. A lack of statistically significant difference was found in the motivation to alter opinions on consensus or controversial subjects (p = 0.921). A traveling fellowship's conclusion four years past, brought forth the implementation of a median of 25 topics agreed upon by all (ranging from 0 to 3) and 4 topics characterized by disagreement (a range of 2 to 6). The implementation of consensus and contentious topics showed no statistically different outcomes (p=0.709). Compared to the initial high level of excitement, there was a statistically significant reduction in the execution of changes across consensus and contentious preferences (p=0.0038 and 0.0031, respectively). Following the John N. Insall Knee Society Traveling Fellowship, a palpable anticipation surrounds potential shifts in practice regarding consensus and contentious issues in total knee arthroplasty. However, the practice changes that initially sparked considerable enthusiasm failed to see widespread adoption after a four-year follow-up period. Ultimately, the interplay of time, practice's inertia, and institutional friction usually counteracts the expected modifications fostered by a traveling fellowship.
A portable accelerometer-based navigation system provides a helpful means for accomplishing target alignment. Despite the usual reliance on the medial and lateral malleoli for tibial registration, locating these landmarks can present challenges in obese patients (BMI above 30 kg/m^2), where the bones may be less readily palpable on the skin's surface. This study evaluated tibial component alignment using a portable accelerometer-based navigation system, Knee Align 2 (KA2), in obese and control groups. Validation of bone cut accuracy in obese patients was also a key objective.