全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Formation process of extension knee joint contracture following external immobilization in rats

BACKGROUND Current research lacks a model of knee extension contracture in rats.AIM To elucidate the formation process of knee extension contracture.METHODS We developed a rat model using an aluminum external fixator.Sixty male Sprague-Dawley rats with mature bones were divided into the control group(n=6)and groups that had the left knee immobilized with an aluminum external fixator for 1,2,and 3 d,and 1,2,3,4,6,and 8 wk(n=6 in each group).The passive extension range of motion,histology,and expression of fibrosis-related proteins were compared between the control group and the immobilization groups.RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization.After 2 wk,the contracture gradually changed from myogenic to arthrogenic.The arthrogenic contracture progressed slowly during the 1^(st) week,rapidly progressed until the 3^(rd) week,and then showed a steady progression until the 4^(rd) week.Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time.Correspondingly,the level of transforming growth factor beta 1(TGF-β1)and phosphorylated mothers against decapentaplegic homolog 2(p-Smad2)in the anterior joint capsule also increased with the immobilization time.Over time,the cross-sectional area of muscle fibers gradually decreased,while the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was increased.Unexpectedly,the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was decreased during the late stage of immobilization(6-8 wk).The myogenic contracture was stabilized after 2 wk of immobilization,whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk.CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.

Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Two-stage revision in periprosthetic knee joint infections

Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.

Complex knee injuries treated in acute phase: Long-term results using Ligament Augmentation and Reconstruction System artificial ligament

AIM To present the long-term results of complex knee injuries, treated early using the Ligament Augmentation and Reconstruction System(LARS) artificial ligament to reconstruct posterior cruciate ligament(PCL).METHODS From September 1997 to June 2010, thirty-eight complex knee injuries were treated, where early arthroscopic PCL reconstructions were undergone, using the LARS(Surgical Implants and Devices, Arc-sur-Tille, France) artificial ligament. Exclusion criteria were: Late(> 4 wk) reconstruction, open technique, isolated PCL reconstruction, knee degenerative disease, combinedfracture or vascular injury and use of allograft or autograft for PCL reconstruction. Clinical and functional outcomes were assessed with IKDC Subjective Knee Form, KOS-ADLS questionnaire, Lysholm scale and SF-12 Health Survey. Posterior displacement(PD) was measured with the Telos Stress Device. RESULTS Seven patients were excluded; two because of coexisting knee osteoarthritis and the remaining five because of failure to attend the final follow-up. The sample consisted of 31 patients with mean age at the time of reconstruction 33.2 ± 12.5 years(range 17-61). The postoperative follow-up was on average 9.27 ± 4.27 years(range 5-18). The mean average IKDC and KOS scores were 79.32 ± 17.1 and 88.1 ± 12.47% respectively. Average PD was 3.61 ± 2.15 mm compared to 0.91 ± 1.17 mm in the uninjured knees(one with grade 1+ and two with grade 2 +). Dial test was found positive in one patient, whereas the quadriceps active drawer test was positive in three patients. None was tested positive on the reverse-pivot shift test. The range of motion(ROM) was normal in thirty knees, in comparison with the contralateral one. There was no extension deficit. Osteoarthritic changes were found in three knees(9.6%).CONCLUSION Early treatment of complex knee injuries, using LARS artificial ligament for PCL reconstruction sufficiently reduces posterior tibia displacement and provides satisfactory long-term functional outcomes.

Shock-wave impact on the knee joint affected with osteoarthritis and after arthroplasty

Degenerative diseases significantly reduce the quality of human life.Non-invasive treatments are used in the initial stages of osteoarthritis(OA).Total knee arthroplasty is used in the late stages of osteoarthritis of the knee joint.Non-invasive methods based on mechanical action are also used for the rehabilitation of a patient after arthroplasty.This paper presents numerical models of the knee joint with degenerative OA changes and arthroplasty.Using these models,a computational study was made of the influence of the intensity of shock-wave exposure on the conditioning for the regeneration of bone and cartilage tissues.Based on the modeling results,it was found that in the knee joint with degenerative OA changes,conditions for the regeneration of cartilage and meniscus tissues were fulfilled under medium and highintensity loading.Under high-intensity loading(up to 0.9 m J/mm^(2)),the stress level was significantly below the ultimate value required for fracture.At knee arthroplasty,the conditions for bone tissue regeneration around the tibia component are fulfilled only under high-intensity loading.

Commentary on“The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes”

1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.

Application Effect of Chinese Medicine Rehabilitation in the Treatment of Adolescent Ankle Sports Injuries

Objective:To analyze the clinical effect of traditional Chinese medicine rehabilitation in treating adolescent ankle sports injuries.Methods:From December 2020 to December 2022,adolescent patients with ankle joint sports injuries admitted to our hospital were selected as observation objects,and 67 patients were divided into a control group(n=33,routine rehabilitation treatment)and an experimental group(n=34,traditional Chinese medicine rehabilitation treatment)according to the computer grouping method.Compare the treatment results.Results:(i)The treatment received in the experimental group had an efficacy of 94.11%,which was higher than that of the control group(75.75%),and statistical significance was established(P<0.05).(ii)Before treatment,there was no difference in ankle joint pain,ankle joint activity,and ankle joint function scores between the control group and the experimental group(P>0.05);after treatment,the ankle joint pain,ankle joint activity,and ankle joint function scores in the experimental group were significantly higher than those in the control group(P<0.05).(iii)The experimental group had higher scores on physiological function,physiological function,physical pain,general health status,energy,social function,emotional function,and mental health compared to the control group(P<0.05).Conclusion:Traditional Chinese medicine rehabilitation is effective in treating ankle injuries caused by sports in adolescents and improve their quality of life.Therefore,it should be popularized.

Effect of weight-adjusted antimicrobial antibiotic prophylaxis on postoperative dosage and surgical site infection incidence in total joint arthroplasty

Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.

A Mesh Meta-Analysis of the Effectiveness of Different Warm-Up Exercises to Prevent Knee Injuries in Young Child Soccer Players

Objective: A mesh Meta-analysis was used to evaluate the effectiveness of four warm-up exercises to prevent knee injuries in juvenile soccer players. Method: They are a randomized controlled trial (RCT) on FIFA 11+ integrated warm-up, FIFA 11+ Kids integrated warm-up, and neuromuscular training (NMT) warm-up for the prevention of knee joint in juvenile soccer players by a computer search of CNKI, CBMdisc, WanFangdata, Pubmed, Web of science, and SPORTDicus database. The search period was from the establishment of each database to February 2022. Two investigators screened the literature, extracted data, and assessed risk bias for the included studies according to the pre-defined inclusion and exclusion criteria, and finally analyzed the data using Stata 14.0 software and OpenBUGS software. Results: A total of 10 RCT studies with 17,143 subjects, spanning the age range of 7 to 19 years, were included. The results of the reticulated Meta-analysis showed that all three warm-up modalities were effective in reducing the incidence of knee injuries in junior soccer players compared to conventional warm-up, with the optimality in descending order of FIFA 11+ Kids comprehensive warm-up (SUCRA = 85.3), neuromuscular training warm-up (SUCRA = 66.7), and FIFA 11+ combined warm-up (SUCRA = 44). Conclusion: The FIFA 11+ Kids comprehensive warm-up is the most effective warm-up exercise for the prevention of knee injuries in junior and child soccer players, but the above findings need further validation due to the quantity and quality of the literature and the quality of the evidence.

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non-Operatively

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

The Immediate Analgesic Effect and Impact on Gait Function of Transcutaneous Electrical Nerve Stimulation in Late-Stage Elderly Individuals with Knee Pain: Examination of Gait Function Using an IoT-Based Gait Analysis Device

Purpose: This study verified the effects of transcutaneous electrical nerve stimulation (TENS), which can be worn during walking and exercise, in elderly individuals with late-stage knee pain who exercise regularly. Methods: Thirty-two late-stage elderly individuals were evaluated for knee pain during rest, walking, and program exercises, with and without TENS. Gait analysis was performed using an IoT-based gait analysis device to examine the effects of TENS-induced analgesia on gait. Results: TENS significantly reduced knee pain during rest, walking, and programmed exercises, with the greatest analgesic effect observed during walking. The greater the knee pain without TENS, the more significant the analgesic effect of TENS. A comparison of gait parameters revealed a significant difference only in the gait cycle time, with a trend towards faster walking with TENS;however, the effect was limited. Conclusion: TENS effectively relieves knee pain in late-stage elderly individuals and can be safely applied during exercise. Pain management using TENS provides important insights into the implementation of exercise therapy in this age group.

Analysis of The Value of Multi-Slice Spiral CT and Magnetic Resonance Imaging in The Diagnosis of Carpal Joint Injury

Objective:To analyze the value of multi-slice spiral computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of carpal joint injury.Methods:A total of 130 patients with suspected wrist injuries admitted to the Department of Orthopedics of our hospital from January 2023 to January 2024 were selected and randomly divided into a single group(n=65)and a joint group(n=65).The single group was diagnosed using multi-slice spiral CT,and the joint group was diagnosed using multi-slice spiral CT and magnetic resonance imaging,with pathological diagnosis as the gold standard.The diagnostic results of both groups were compared to the gold standard,and the diagnostic energy efficiency of both groups was compared.Results:The diagnostic results of the single group compared with the gold standard were significant(P<0.05).The diagnostic results of the joint group compared with the gold standard were not significant(P>0.05).The sensitivity and accuracy of diagnosis in the joint group were significantly higher than that in the single group(P<0.05).The specificity of diagnosis in the joint group was higher as compared to that in the single group(P>0.05).Conclusion:The combination of multi-slice spiral CT and MRI was highly accurate in diagnosing wrist injuries,and the misdiagnosis rate and leakage rate were relatively low.Hence,this diagnostic program is recommended to be popularized.

3D Finite Element Model of Human Knee Injuries in the Traffic Accident

Objective To explore the injury mechanism of the human knee in a traffic accident by establishing a 3D finite element(FE) model. Methods The FE model, composed of femur, tibia, fibula, patella, meniscus, knee ligaments and surrounding soft tissues, was reconstructed by CT scanning data from a male volunteer. Validation was performed by the lateral impact simulation, and the stress and strain results were obtained to be compared with those previously reported for injury prediction. Results The results derived from the FE model were found to be similar with those previously reported, most of the ligaments and meniscus wounded at 40 m/s collision, which was readily observed. Conclusion The simulation results generated by FE model can be effectively used for the injury mechanism analysis of initial contact.

The Knee Joint Design and Control of Above-knee Intelligent Bionic Leg Based on Magneto-rheological Damper

The above-knee intelligent bionic leg is very helpful to amputees in the area of rehabilitation medicine. This paper first introduces the functional demand of the above-knee prosthesis design. Then, the advantages of the four-bar link mechanism and the magneto-rheological （MR） damper are analyzed in detail. The fixed position of the MR damper is optimized and a virtual prototype of knee joint is given. In the end, the system model of kinematics, dynamics, and controller are given and a control experiment is performed. The control experiment indicates that the intelligent bionic leg with multi-axis knee is able to realize gait tracking of the amputee＇s healthy leg based on semi-active control of the MR damper.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

THREE-DIMENSIONAL FINITE ELEMENT SIMULATION OF TOTAL KNEE JOINT IN GAIT CYCLE

Based on CT scanning pictures from a volunteer＇s knee joint, a three-dimensional finite element model of the healthy human knee joint is constructed including complete femur, tibia, fibular, patellar and the main cartilage and ligaments. This model was validated using experimental and numerical results obtained from other authors. The pressure distribution of contact surfaces of knee joint are calculated and analyzed under the load action of ‘heel strike＇, ‘single limb stance＇ and ‘toe-off＇. The results of the gait cycle are that the contact areas of medial cartilage are larger than that of lateral cartilage; the contact force and contact areas would grow larger with the load increasing; the pressure of lateral meniscus is steady, relative to the significant variation of peak pressure in medial meniscus; and the peak value of contact pressure on all components are usually found at about 4570 of the gait cycle.

Dynamic knee valgus kinematics and their relationship to pain in women with patellofemoral pain compared to women with chronic hip joint pain

Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.

Acute syndesmotic injuries in ankle fractures:From diagnosis to treatment and current concepts

A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship,and it is essential for normal motion of the ankle joint.The disruption of this joint is frequently accompanied by rotational ankle fracture,such as pronation-external rotation,and rarely occurs without ankle fracture.The diagnosis is not simple,and ideal management of the various presentations of syndesmotic injury remains controversial to this day.Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes.In such an injury,including inadequately treated,misdiagnosed and correctly diagnosed cases,a chronic pattern characterized by persistent ankle pain,function disability and early osteoarthritis can result.This paper reviews anatomical and biomechanical characteristics of this syndesmosis,the mechanism of its acute injury associated to fractures,radiological and arthroscopic diagnosis and surgical treatment.

Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.