The journal of knee surgery
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Comparative Study
Comparison of Synovial Fluid Cytokine Levels between Traumatic Knee Injury and End-Stage Osteoarthritis.
Degenerative osteoarthritis (OA) has been associated with elevated synovial fluid cytokines. It is unclear whether traumatic knee injuries are a trigger to the chemical process that leads to OA. The purpose of this study was to compare the synovial fluid cytokine levels between knees undergoing arthroscopy due to a documented inciting injury and knees undergoing primary arthroplasty due to end-stage OA without a previous inciting injury. ⋯ Granulocyte-macrophage colony-stimulating factor, interferon gamma, IL-1β, IL-12p70, IL-2, IL-10, and tumor necrosis factor alpha were not statistically different between the groups. A similar synovial fluid cytokine profile was found between the two groups. The elevation of IL-6 and IL-8 in the end-stage OA group indicates the potential role that these proinflammatory cytokines may have in long-term cartilage damage.
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Review Case Reports
Diagnosis and Treatment of Anterior Tibial Plateau Fracture-Dislocation: A Case Series and Literature Review.
Anterior tibial plateau fracture is fairly common. This study was aimed at introducing a type of severe anterior tibial plateau fracture (anterior tibial plateau fracture-dislocation) and evaluating its clinical characteristics and treatment strategies. In this study, 18 patients with severe anterior tibial plateau fracture (study group) were enrolled between November 2006 and August 2014, and their data were compared with those of 21 patients treated for normal Schatzker type VI tibial plateau fracture (control group) between January 2010 and August 2014. ⋯ Our findings also showed a significantly higher rate (22.2%) of popliteal artery injury in the study group than in the control group. Anterior tibial plateau fracture-dislocation is a special type of Schatzker type VI fracture with very low incidence and most commonly characterized by the anterior subsidence of the tibial component, irreducible dislocation of the knee joint, and varying degrees of neurovascular and knee-joint peripheral ligaments injuries, as well as high incidence of complications during fixation surgery. The treatment of anterior tibial plateau fracture-dislocation is challenging even for experienced surgeons.
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The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life-disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. ⋯ There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.
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Comparative Study
Are Locked Plates Needed for Split Depression Tibial Plateau Fractures?
Displaced tibial plateau fractures often require surgical treatment and plate and screw constructs are the most common method of fixation. There has been increased usage of locking plate technology for both complex and simple fracture patterns without any evidence demonstrating their advantage. The purpose of this study was to compare the clinical use of locked versus nonlocked plating for repair of displaced Schatzker type-II (OTA Type 41B) tibial plateau fractures. ⋯ In terms of cost, the cost of locked construct was $905 more than the nonlocked construct. Based on clinical outcomes and cost per implant, we found no evidence to support the routine use of locked plating for simple split depression fractures of the lateral tibial plateau. The use of standard nonlocked, precontoured implants provides adequate fixation for these fracture patterns.
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Randomized Controlled Trial
Do the Effects of Transcutaneous Electrical Nerve Stimulation on Knee Osteoarthritis Pain and Function Last?
Transcutaneous electrical nerve stimulation (TENS) has been shown to decrease pain associated with knee osteoarthritis, which potentially leads to better function, improved quality of life, and postpones the need for surgical intervention. The purpose of this study was to perform a 1-year follow-up of a previous prospective group of patients with knee osteoarthritis, randomized to TENS or standard of care, who were asked to rate their changes in: (1) patient pain perception; (2) subjective medication use; (3) subjective functional abilities; (4) quality of life; (5) device use; and (6) conversion to TKA. A population of 70 patients were randomized to receive either a TENS device or a standard conservative therapy regimen. ⋯ Additionally, a large portion of the patients assigned to the TENS group continue to use the device, after completion of the trial. This study demonstrated the benefit of TENS for improving subjective outcomes in patients with pain due to knee osteoarthritis, compared with standard conservative treatments. The results of the study suggest that TENS is a safe and effective adjunct as part of the spectrum of current nonoperative treatment methods for knee osteoarthritis.