The journal of knee surgery
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The effect of residual varus on survival rate and function in patients with varus knee osteoarthritis (OA) was considered an important issue for successful primary total knee arthroplasty (TKA). In this study, we compared the midterm clinical and functional outcomes in patients with different residual varus. A retrospective review of 175 patients (219 knees) with varus OA was > 3° for the hip-knee-ankle (HKA) who underwent primary TKA after exclusions and loss to follow-up from 237 patients (281 knees). ⋯ The postoperative HKA angle was significantly changed in valgus group between first and at the last follow-up when compared with the other three groups (p < 0.05). Leaving an HKA angle at < 6° varus had the same excellent functional outcome as neutral mechanical alignment after TKA for varus-type OA in the 5-year follow-up, using mechanically aligned technique. Caution is advised when leaving valgus or leaving severe varus after TKA.
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Knee osteoarthritis (OA) is a highly prevalent disease and treatment options for early stages of OA are needed. Intraosseous injections of bone substitute and biologic materials have been proposed to expand the therapeutic arsenal by potentially halting OA progression and delaying the need for knee arthroplasty in patients with early/moderate-stage disease. Therefore, the goal of this study was assessed the efficacy and safety of subchondral intraosseous injection for the treatment of knee OA. ⋯ However, the current studies investigating these treatments exhibited high degree of heterogeneity in both measurement of outcomes and delivery of treatment, with a high risk of bias. This procedure should not be utilized in advanced knee OA. In light of the limitations of the current literature, advising in favor or against this therapy for early to moderate knee OA is challenging.
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Compared with nonelective total knee arthroplasties (TKAs), elective procedures have more time for preoperative planning, which allows for potentially improved patient optimization, risk factor modification, and patient education. The purpose of this study was to (1) determine nationwide trends in operative times and (2) evaluate associations between surgery type, elective or nonelective, with respect to (a) operative times, (b) length of stay (LOS), (c) discharge dispositions, (d) 30-day postoperative complications, (e) reoperations, and (f) readmissions. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all primary TKAs performed between 2011 and 2016. ⋯ These associations remained significant with multivariate logistic regression. This study demonstrated that preoperative planning can help shorten operative times and LOS as well as reduce complication and reoperation rates. Alongside the direct advantages identified in this study, potential greater effects include superior patient outcomes and reduced health care costs.
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The incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. ⋯ For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.
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Comparative Study
Onlay Reconstruction of the Posterior Cruciate Ligament: Biomechanical Comparison of Unicortical and Bicortical Tibial Fixation.
Posterior cruciate ligament (PCL) injuries are generally associated with high-energy trauma. There are many controversies regarding optimal surgical technique in regard to graft selection and fixation methods. The recently described onlay technique allows for direct fixation of a hamstring autograft to the posterior aspect of the tibia with cancellous screw and spiked washer, while protecting the neurovascular structures and avoiding the so-called "killer turn." The objective of this study was to compare immediate postimplantation biomechanics of unicortical versus bicortical tibial fixation of onlay PCL grafts. ⋯ Regarding stiffness, there were no significant differences between unicortical and bicortical, and both were superior to PCL-deficient and inferior to PCL-intact knees. Based on cadaveric biomechanical testing, none of the reconstructed PCL knees was able to replicate the intact native PCL, but both techniques were superior to PCL-deficient knees. The bicortical tibial fixation technique appears to have biomechanical advantages when opting for onlay PCL reconstruction.