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Showing papers in "Knee Surgery, Sports Traumatology, Arthroscopy in 2012"


Journal ArticleDOI
TL;DR: The anterolateral ligament may play a role in preventing anterior tibial translation and the role, if any, of this structure in meniscal stability and the pathology of meniscal tears remain unclear.
Abstract: Purpose The functional anatomy of the knee is frequently studied but remains incompletely understood. Numerous authors have described a structure in the lateral knee connecting the lateral femoral condyle with the lateral meniscus and tibial plateau. The goal of this study is to define the incidence, anatomy, and histology of this structure, the anterolateral ligament.

368 citations


Journal ArticleDOI
TL;DR: Although PRP injections produced more pain and swelling reaction with respect to that produced by PRGF, similar results were found at the follow-up times, with a significant clinical improvement withrespect to the basal level.
Abstract: Purpose To compare the safety and efficacy of two different approaches of platelet-rich plasma (PRP) production methods as intra-articular injection treatment for knee cartilage degenerative lesions and osteoarthritis (OA).

334 citations


Journal ArticleDOI
TL;DR: A review examines the available basic science, preclinical and clinical evidence regarding several such unfavorable biomechanical conditions about the knee: malalignment, loss of meniscal tissue, cartilage defects and joint instability or laxity.
Abstract: Osteoarthritis is the most common joint disease and a major cause of disability. Distinct biological processes are considered crucial for the development of osteoarthritis and are assumed to act in concert with additional risk factors to induce expression of the disease. In the classical weightbearing joints, one such risk factor is an unfavourable biomechanical environment about the joint. While the elbow has long been considered a non-weightbearing joint, it is now assumed that the tissues of the upper extremity may be stressed to similar levels as those of the lower limb, and that forces across the elbow are in fact very high when the joint is extended from a flexed position. This review examined the available basic science, preclinical and clinical evidence regarding the role of several unfavourable biomechanical conditions about the elbow on the development of osteoarthritis: post-traumatic changes, osteochondritis dissecans, instability or laxity and malalignment. Post-traumatic osteoarthritis following fractures is well recognized, however, the role of overload or repetitive microtrauma as risk factors for post-traumatic osteoarthritis is unclear. The natural course of untreated cartilage defects in general, and osteochondritis dissecans at the elbow in particular, remains incompletely understood to date. However, larger lesions and older age seem to be associated with more symptoms and radiographic changes in the long term. Instability seems to play a role, although the association between instability and osteoarthritis is not yet clearly defined. No data are available on the association of malalignment and osteoarthritis, but based on force estimations across the elbow joint, it seems reasonable to assume an association.

329 citations


Journal ArticleDOI
TL;DR: Computer-assisted surgery does improve mechanical leg axis and component orientation in TKAs, however, high-quality RCTs are necessary to determine whether surgeons could use computer-assisted techniques to achieve a targeted tibial slope in TKA.
Abstract: Computer-assisted surgery has been proposed as a technique to improve implant alignment during total knee arthroplasty (TKA). However, there is still a debate over the accuracy of placing the femoral and tibial components using computer-assisted systems in TKA. The aim of this study is to establish whether computer-assisted surgery leads to superior mechanical leg axis and implant positioning than conventional technique in patients with primary TKA. Major electronic databases were systematically searched to identify relevant studies without language restriction. A meta-analysis of 41 randomized controlled trials (RCTs) or quasi-RCTs was performed in a random effects model. A subgroup analysis was conducted by type of navigation system to explore the clinical heterogeneity between these trials. The following radiographic parameters were used to compare computer-assisted surgery with conventional technique: (1) mechanical leg axis, (2) femoral component coronal alignment, (3) tibial component coronal alignment, (4) femoral component sagittal alignment, and (5) tibial component sagittal alignment. For the mechanical leg axis and coronal positioning of femoral and tibial components, there are statistically significant reductions in the number of patients with malalignment in the CAS group if the outlier cutoff value is ±3 or 2° in the coronal and sagittal planes, respectively. Subgroup analysis demonstrates that CT-free navigation systems provide better alignment than conventional techniques in the coronal and sagittal alignment of femoral components within ±3 and 2°. If the outlier cutoff value for the tibial sagittal alignment is ±2°, the outlier percentages are higher in the CT-free navigation group than in the conventional group. However, there was no significant difference in the tibial sagittal alignment at ±3°. Computer-assisted surgery does improve mechanical leg axis and component orientation in TKAs. However, high-quality RCTs are necessary to determine whether surgeons could use computer-assisted techniques to achieve a targeted tibial slope in TKA. Therapeutic study (Systematic review of Level I/II studies), Level II.

229 citations


Journal ArticleDOI
TL;DR: To better identify the patients at risk and responders to certain treatments, it is of use to define and most importantly classify patients with “early osteoarthritis”.
Abstract: With the emerging interest in regenerative medicine and tissue engineering, new treatment modalities being developed for joint disorders including joint surface lesions and articular cartilage defects. The clinical outcome of these novel approaches appears rather unpredictable and is due to many reasons but definitely also linked to the patient profile. As a typical example, symptomatic articular cartilage lesions can be presented in an otherwise normal joint, or associated with several other joint tissue alterations including meniscal lesions and abnormalities of the underlying bone. The outcome of novel treatments may well be influenced by the status of the whole joint, and the potential to develop osteoarthritis. To better identify the patients at risk and responders to certain treatments, it is of use to define and most importantly classify patients with "early osteoarthritis". Here, classification criteria for this group of patients are presented, allowing a more defined and accurate inclusion in clinical trials in the future.

228 citations


Journal ArticleDOI
TL;DR: The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease.
Abstract: Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures. The aim of this review is to highlight the molecular basis and histopathological features of early OA. Selective review of literature. Risk factors for developing early OA include, but are not limited to, a genetic predisposition, mechanical factors such as axial malalignment, and aging. In early OA, the articular cartilage surface is progressively becoming discontinuous, showing fibrillation and vertical fissures that extend not deeper than into the mid-zone of the articular cartilage, reflective of OARSI grades 1.0–3.0. Early changes in the subchondral bone comprise a progressive increase in subchondral plate and subarticular spongiosa thickness. Early OA affects not only the articular cartilage and the subchondral bone but also other structures of the joint, such as the menisci, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad. Genetic markers or marker combinations may become useful in the future to identify early OA and patients at risk. The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease. Systematic review, Level II.

226 citations


Journal ArticleDOI
TL;DR: Within the testing conditions of this study, the PL bundle does not affects anterior translation and rotation of the knee; the AM bundle is the primary restraint of the anterior translation but does not affect rotation ofThe knee while the lesion of the LCL increases tibial rotation and could be related to the pivot shift phenomenon.
Abstract: Purpose The purpose of this study is to evaluate the kinematics changes of the knee after cutting of the ACL with or without injury of the anterolateral structures.

214 citations


Journal ArticleDOI
TL;DR: Implantation of BMMC in rotator cuff sutures appears to be a safe and promising alternative to other biological approaches currently used to enhance tissue quality in affected tendons.
Abstract: Purpose To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC).

208 citations


Journal ArticleDOI
TL;DR: Evaluating pre-operative risks factors associated with recurrent instability and delineate possible indications for revision surgery allows surgeons to provide appropriate preoperative counselling to patients and support more realistic expectations.
Abstract: Arthroscopic Bankart repair of anterior shoulder instability is a common practice in orthopedics. The aim of this study was to evaluate pre-operative risks factors associated with recurrent instability and to delineate possible indications for revision surgery. A systematic review was performed including the following keywords: arthroscopy, Bankart repair, anterior shoulder instability, recurrence of instability, suture anchors and treatment outcome. Studies eligible for inclusion in the review were clinical trials published in the last 10 years investigating patients with anterior shoulder instability managed by an arthroscopic repair technique with suture anchors. The studies had to report data about recurrence of instability and investigational parameters (risk factors) that influenced the results referred to the rate of recurrence. Twenty-four articles were identified that met the inclusion criteria and underwent further review. Data from these studies were collected, and the risk of treatment failure was statistically recalculated. An estimate of the overall recurrence rate was obtained by pooling data about failure from the trials. The rate of recurrent instability at 10 years of follow-up ranged from 3.4 to 35 %. Epidemiological parameters significantly associated with the recurrence of instability were age below 22 years old, male gender, the number of preoperative dislocations and participation in competitive sports. Surgical parameters significantly associated with recurrence of instability were repair with fewer than three anchors and the use of knotless anchors. The patho-anatomical factors significantly associated with recurrences were substantial associated glenoid or humeral head bone loss and the presence of anterior labroligamentous periosteal sleeve avulsion. Knowledge of risk factors for post-operative outcomes allows surgeons to provide appropriate preoperative counselling to patients and support more realistic expectations. An accurate analysis of causes of failure should enable the correct revision strategy to be adopted. II.

203 citations


Journal ArticleDOI
TL;DR: The pivot shift test is an important test following ACL reconstruction, and it correlates with functional outcomes.
Abstract: To identify and evaluate the evidence for the pivot shift test as an outcome measure following ACL reconstruction. Achieving rotatory control of the knee post anterior cruciate ligament (ACL) reconstruction has been shown to increase patient satisfaction, decrease functional instability and potentially delay the development of osteoarthritis. The pivot shift is able to assess this rotatory component of knee laxity and appears to have the potential to become a benchmark in gauging the success of ACL surgery. Multiple confounding factors and discrepancies in performing the maneuver itself however put its usefulness in question. Thus, the literature was reviewed to assess whether the pivot shift was able to correlate with final functional outcomes. Two reviewers searched two databases (MEDLINE and EMBASE) for randomized control trials that involved anterior cruciate ligament reconstruction in the last 5 years. All non-clinical studies were excluded. A quality assessment of the included studies was performed using the Jadad scale by a reviewer. The number of studies using the Pivot Shift Test as well as the test’s relationship with functional outcome was evaluated. The literature search yielded 274 studies, of which 65 papers were included. The average Jadad quality score for papers reporting pivot shift as an outcome measure was 2.4, with the most frequent score being 3. Forty seven of 65 studies described the Pivot Shift Test as an outcome measure following ACL reconstruction. Of the 47 studies that included pivot shift as an outcome measure, 40 (85%) correlated with the final functional outcomes. The pivot shift test is an important test following ACL reconstruction, and it correlates with functional outcomes.

198 citations


Journal ArticleDOI
TL;DR: Exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified, and physical therapies are emerging as viable treatment options, and novel biological approaches are under study.
Abstract: Conservative approach is usually the first choice for the management of the knee degeneration processes, especially in the phase of the disease recognized as early osteoarthritis (OA) with no clear lesions or associated abnormalities requiring to be addressed surgically. A wide spectrum of treatments is available, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as minimally invasive procedures involving injections of various substances aiming to restore joint homeostasis and provide clinical improvement and possibly a disease-modifying effect. Numerous pharmaceuticals have been proposed, but since no therapy has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level, the use of pharmacological agents should be considered with caution by assessing the risk/benefit ratio of the drugs prescribed. Both patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. A combination of these therapeutic options is a more preferable scenario, in particular considering the evidence available for non-pharmacological management. In fact, exercise is an effective conservative approach, even if long-term effectiveness and optimal dose and administration modalities still need to be clarified. Finally, physical therapies are emerging as viable treatment options, and novel biological approaches are under study. Further studies to increase the limited medical evidence on conservative treatments, optimizing results, application modalities, indications, and focusing on early OA will be necessary in the future.

Journal ArticleDOI
TL;DR: Meta-analysis indicates that TXA may reduce post-operative, total blood loss and transfusion in patients undergoing TKA, and led to a significant reduction in the proportion of patients requiring blood transfusion.
Abstract: Studies have shown that tranexamic acid (TXA) reduces blood loss and transfusion need in patients undergoing total knee arthroplasty (TKA). However, no single study has been large enough to definitively determine whether the drug is safe and effective. We report a systematic review and meta-analysis of randomised controlled trials evaluating the efficacy and safety of TXA in reducing blood loss and transfusion in TKA. A comprehensive literature search was done in Cochrane Library, MEDLINE, EMBASE, and CNKI. Two reviewers independently identified the eligible studies, assessed their methodological quality, and extracted data. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. The relevant data were analyzed using RevMan 5.0. Fifteen randomized controlled trials involving 842 patients were included. The use of TXA reduced total blood loss by a mean of 487 ml [95% confidence interval (CI) −629 to −344], intra-operative blood loss by a mean of 127 ml (95% CI −313–59), and post-operative blood loss by a mean of 245 ml (95% CI −410 to −80). TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk difference −0.4). There were no significant differences in deep-vein thrombosis (DVT), pulmonary embolism, or other complications among the study groups. Meta-analysis indicates that TXA may reduce post-operative, total blood loss and transfusion in patients undergoing TKA. TXA led to a significant reduction in the proportion of patients requiring blood transfusion. Therapeutic study (Systematic review of Level I studies with inconsistent results), Level II.

Journal ArticleDOI
TL;DR: The Muscle function outcome 1 and 2 years after ACL reconstruction is satisfactory in the present study and on a par with the results presented in the literature, however, when using more demanding criteria for a successful muscle function outcome, using batteries of tests or increasing the acceptable LSI level from ≥90% to ≥95% or ≥100%, the results are considered to be poor.
Abstract: Purpose The purpose of this prospective study was to describe the variability in leg muscle power and hop performance up to 2 years among patients following ACL reconstruction and specifically to i ...

Journal ArticleDOI
TL;DR: Posterior ankle arthroscopy by means of a two-portal hindfoot approach is a safe procedure with a complication rate that compares favourably to that of anterior ankle ar Throscopy, and the use of the dorsiflexion method for anterior ankles can prevent a significant number of complications.
Abstract: A prospective registration of 1,300 patients demonstrated a low complication rate of 35 % for the dorsiflexion method for anterior ankle arthroscopy This compares favorably to other methods The historical approach of using routine distraction is not only unnecessary, but it is related with a higher complication rate It should be considered a method from the past When it comes to posterior ankle arthroscopy by means of the two-portal hindfoot approach, it was shown to be safe with a complication rate comparing favorable to that of anterior ankle arthroscopy

Journal ArticleDOI
TL;DR: Physical training, and particularly eccentric training, appears to be the treatment of choice for patients suffering from patellar tendinopathy; other treatment methods, such as surgical treatment, sclerosing injections, and shockwave therapy, must be investigated further before recommendations can be made regarding their use.
Abstract: Patellar tendinopathy is a common, painful, overuse disorder. Although many different treatment methods have been described, there is no consensus regarding the optimal treatment for this condition. The purpose of this study was to systematically review, summarize, and compare treatments for patellar tendinopathy from published randomized controlled trials. Database searches were performed for randomized prospective controlled trials comparing treatment methods for patellar tendinopathy. The thirteen articles considered relevant were scrutinized according to quality assessment guidelines and levels of evidence. Strong evidence was found for the use of eccentric training to treat patellar tendinopathy. Moderate evidence was found for conservative treatment (heavy slow resistance training) as an alternative to eccentric training. Moderate evidence suggests that low-intensity pulsed ultrasound treatment did not influence treatment outcomes. Limited evidence was found for surgery, sclerosing injections, and shockwave therapy. Physical training, and particularly eccentric training, appears to be the treatment of choice for patients suffering from patellar tendinopathy. However, type of exercise, frequency, load, and dosage must also be analyzed. Other treatment methods, such as surgical treatment, sclerosing injections, and shockwave therapy, must be investigated further before recommendations can be made regarding their use. Ultrasound can likely be excluded as a treatment for patellar tendinopathy. There is a persistent lack of well-designed studies with sufficiently long-term follow-up and number of patients to draw strong conclusions regarding therapy. II.

Journal ArticleDOI
TL;DR: Modern ACL surgery is united in the common goal of re-establishing joint homoeostasis with normal knee kinematics and function which may ultimately assist in reducing the prevalence of post-operative joint degeneration.
Abstract: The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed was a period of startling ingenuity which created an amazing variety of different surgical procedures often based more on surgical fashion and the absence of a satisfactory alternative than any indication that continued refinements were leading to improved results. It is hence not surprising that real inventors were forgotten, good ideas discarded and untried surgical methods adopted with uncritical enthusiasm only to be set aside without further explanation. Over the past 100 years, surgeons have experimented with a variety of different graft sources including xenograft, and allografts, whilst autologous tissue has remained the most popular choice. Synthetic graft materials enjoyed temporary popularity in the 1980 and 1990s, in the misguided belief that artificial ligaments may be more durable and better equipped to withstand stresses and strains. Until the 1970s, ACL reconstructions were considered formidable procedures, often so complex and fraught with peril that they remained reserved for a chosen few, never gaining the level of popularity they are enjoying today. The increasing familiarity with arthroscopy, popularised through Jackson and Dandy, and enhancements in surgical technology firmly established ACL reconstruction as a common procedure within the realm of most surgeons’ ability. More recently, the principle of anatomic ACL reconstruction, aiming at the functional restoration of native ACL dimensions and insertion sites, has been introduced, superseding the somewhat ill-advised concept of isometric graft placement. Double-bundle reconstruction is gaining in popularity, and combined extra- and intra-articular procedures are seeing a revival, but more accurate and reliable pre- and post-operative assessment tools are required to provide customised treatment options and appropriate evaluation and comparability of long-term results. Modern ACL surgery is united in the common goal of re-establishing joint homoeostasis with normal knee kinematics and function which may ultimately assist in reducing the prevalence of post-operative joint degeneration. This review hopes to provide an insight into the historical developments of ACL surgery and the various controversies surrounding its progress. Level of evidence V.

Journal ArticleDOI
TL;DR: An imaging nomenclature is described, which considers the anatomical site, pattern and severity of the lesion in the acute stage of acute muscle strain injuries, and distinguishes intramuscular, myofascial, my ofascial/perifascial and musculotendinous injuries.
Abstract: Purpose To better define and classify acute muscle strain injuries. Methods Historically, acute muscle strains have been classified as grade I, II and III. This system does not accurately reflect the anatomy of the injury and has not been shown to reliably predict prognosis and time for return to sport. Results We describe an imaging (magnetic resonance or ultrasound) nomenclature, which considers the anatomical site, pattern and severity of the lesion in the acute stage. By site of injury, we define muscular injuries as proximal, middle and distal. Anatomically, based on the various muscular structures involved, we distinguish intramuscular, myofascial, myofascial/perifascial and musculotendinous injuries. Conclusions This classification system must be applied to a variety of muscle architectures and locations to determine its utility; additional studies are therefore needed prior to its general acceptance. Level of evidence V.

Journal ArticleDOI
TL;DR: A high-grade pivot shift in the ACL-deficient knee is often associated with incompetence of the lateral soft tissue envelope, andRotatory laxity as assessed by the pivot shift may also be falsely underestimated by concomitant injuries.
Abstract: The pivot shift is the most specific clinical test to assess pathological knee joint rotatory laxity following ACL injury. This article attempts to describe the anatomic structures responsible for creating a high-grade pivot shift and their potential role in customizing ACL reconstruction. A review of the literature demonstrates that disruption of the secondary stabilizers of anterior translation of the lateral compartment including the lateral meniscus, anterolateral capsule, and IT band contributes to a high-grade pivot shift in the ACL-deficient knee. The morphology of the lateral tibial plateau, including increased posteroinferior tibial slope and small size, can also contribute to high-grade pivot shift. Factors that may decrease the grade of the pivot shift include medial compartment injury, MCL injury, patient guarding, and osteoarthritis. In conclusion, a high-grade pivot shift in the ACL-deficient knee is often associated with incompetence of the lateral soft tissue envelope. Rotatory laxity as assessed by the pivot shift may also be falsely underestimated by concomitant injuries. Level of evidence IV.

Journal ArticleDOI
TL;DR: This in vitro study helps quantify the actions of the MPFL, the VMO, and the MPML/MPTL respectively, and identify areas of joint motion where these structures have the most significant influence, and confirms the importance of reconstruction in the treatment of chronic patellar instability.
Abstract: The influence of the medial patellar ligamentous structures on patellar tracking has rarely been studied. Thus the main purpose of this cadaveric biomechanical study was to determine the influence of the medial patellofemoral (MPFL), medial patellomeniscal (MPML) and medial patellotibial (MPTL) ligaments on the three-dimensional patellar tracking during knee flexion. This study was conducted using a validated cadaveric optoelectronic protocol for analysis of patellar kinematics. For each cadaveric knee study, four successive acquisitions were performed; first was studied patellar tracking in healthy knees, then the junction between MPFL and vastus medialis obliquus (VMO) was sectioned, the MPFL was released at its patellar attachment and finally was released the insertion of the MPML and MPTL. In this study, the MPFL accounts for 50–60% of the medial stabilization forces of the lateral patellar shift during patellar engagement in the femoral trochlea. This work confirm and clarify the role of the MPFL as the primary stabilizer of the patella during the initial 30° of knee flexion. Moreover, this study shows no significant results regarding the stabilizing action of the VMO on the patella during knee flexion. This in vitro study, conducted with an experimental protocol previously validated in the literature, helps quantify the actions of the MPFL, the VMO, and the MPML/MPTL respectively, and identify areas of joint motion where these structures have the most significant influence. This confirms the importance of reconstruction in the treatment of chronic patellar instability. During its reconstruction, care should be taken to adjust the MPFL balance during the initial 20°–30° of flexion.

Journal ArticleDOI
TL;DR: AMIC is a safe procedure and leads to clinical improvement of symptomatic full-thickness chondral and osteochondral defects and to regenerative defect filling and the value of AMIC relative to other cartilage repair procedures and to the natural course remains undefined.
Abstract: Purpose The purpose of this study is to evaluate clinical and radiological outcomes of patients treated with autologous matrix-induced chondrogenesis (AMIC) for fullthickness chondral and osteochondral defects of the femoral condyles and patella. Method A retrospective evaluation of clinical and radiographic outcomes of patients treated with AMIC for chondral and osteochondral full-thickness cartilage defects of the knee was performed with a mean follow-up of 28.8 ± 1.5 months (range, 13–51 months). Results Significant improvements in clinical outcome scores (IKDC, Lysholm, Tegner, and VAS pain score) were noted. The largest improvements were seen in the osteochondral subgroup (mean age 25.9 years), whereas patients treated for chondral defects in the patellofemoral joint and on the femoral condyles improved less. Patients in all groups were generally satisfied with their results. MRI evaluation showed that tissue filling was present but generally not complete or homogenous. Conclusions AMIC is a safe procedure and leads to clinical improvement of symptomatic full-thickness chondral and osteochondral defects and to regenerative defect filling. The value of AMIC relative to other cartilage repair procedures and to the natural course remains undefined. Level of evidence Case series, Level IV.

Journal ArticleDOI
TL;DR: A systematic review of the literature shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers areassociated with a lower recurrence of infections than static spacers at a comparable mean duration of follow-up.
Abstract: Purpose The best method for treating chronic periprosthetic knee infection remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures.

Journal ArticleDOI
TL;DR: This review of cartilage repair techniques will discuss currently available procedures, specifically pertaining to experiences in the setting of early OA, with the hope of delaying or obviating the need for joint replacement.
Abstract: Young patients with early osteoarthritis (OA) represent a challenging population due to a combination of high functional demands and limited treatment options. Conservative measures such as injection and physical therapy can provide short-term pain relief but are only palliative in nature. Joint replacement, a successful procedure in the older population, is controversial in younger patients, who are less satisfied and experience higher failure rates. Therefore, while traditionally not indicated for the treatment of OA, cartilage repair has become a focus of increased interest due to its potential to provide pain relief and alter the progression of degenerative disease, with the hope of delaying or obviating the need for joint replacement. This review of cartilage repair techniques will discuss currently available procedures, specifically pertaining to experiences in the setting of early OA.

Journal ArticleDOI
TL;DR: There are no evidence-based arguments to recommend a systematic surgical reconstruction to any patient who tore his ACL, and studies comparing surgical and conservative treatments confirm that ACL reconstruction is not the pre-requisite for returning to sporting activities.
Abstract: Is it rational to recommend surgical reconstruction of the torn anterior cruciate ligament to every patient? Is conservative management still a valid option? Through a literature review, we looked for the arguments from each side and checked their validity. Unfortunately results of most studies cannot be compared because of the following reasons not exhaustively cited: studied populations differed with respect to age, sex, professional and sports activity level, lesions associated with ACL rupture, patient recruitment methods, time from injury to treatment and different therapeutic modalities. Furthermore, various methods were used to evaluate the clinical and radiological results and there was no consensus of their interpretation. Some authors assumed that the incidence of further meniscus lesions could probably be reduced if the torn ACL was surgically reconstructed. But, we have no evidence to believe that this would be due to the surgical repair rather than to a decrease of involvement in strenuous activities. At present it is not demonstrated that ACL-plasty can prevent osteoarthritis. Numerous factors could explain evolution to arthrosis whatever the treatment for the ACL-ruptured knee. Studies comparing surgical and conservative treatments confirm that ACL reconstruction is not the pre-requisite for returning to sporting activities. More recent and scientifically well-designed studies demonstrate that conservative treatment could give satisfactory results for many patients. They suggest some methods to help them choose the best treatment. At present there are no evidence-based arguments to recommend a systematic surgical reconstruction to any patient who tore his ACL. Knee stability can be improved not only by surgery but also by neuromuscular rehabilitation. Whatever the treatment, fully normal knee kinematics are not restored. While the patients wish to go back to their sport and want everything possible done to prolong their ability to perform these activities, they should be informed that the risk of further knee lesions and osteoarthritis remains high, whatever the treatment, surgical or conservative. Systematic review of Level I, II, III and IV studies, Level IV.

Journal ArticleDOI
TL;DR: The study shows the usefulness of PRP in reducing subjective pain at the donor-site level after ACL reconstruction with BPTB, but this approach deserves further investigations to confirm PRP efficacy and to elucidate its mechanism of action.
Abstract: Purpose Bone-patellar tendon–bone technique (BPTB) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity. To evaluate whether platelet-rich plasma (PRP), due to its anti-inflammatory properties and capacity to stimulate tissue regeneration, was able to reduce the anterior knee pain, the kneeling pain, and donor-site morbidity, as evidenced by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect, we performed a clinical randomized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB.

Journal ArticleDOI
TL;DR: Tissue engineering has emerged as an excellent approach for the repair and regeneration of damaged tissue, with the potential to circumvent all the limitations of autologous and allogeneic tissue repair.
Abstract: Purpose Osteochondral defects (i.e., defects which affect both the articular cartilage and underlying subchondral bone) are often associated with mechanical instability of the joint and therefore with the risk of inducing osteoarthritic degenerative changes. This review addresses the current surgical treatments and most promising tissue engineering approaches for articular cartilage and subchondral bone regeneration.

Journal ArticleDOI
TL;DR: The association of a lateral extra-articular tenodesis with the intra-artsicular graft increases knee stability after revision ACL reconstruction; however, this additional procedure does not significantly alter the IKDC score at follow-up.
Abstract: Purpose The aims of this article were to report the objective results of revision ACL reconstruction and to assess the influence of an associated lateral extra-articular tenodesis on knee stability and IKDC score.

Journal ArticleDOI
TL;DR: MR diagnosis of a partial ACL tear is difficult because various tear patterns may be seen, and many partial tears demonstrate MR features that are indistinguishable from complete ACL tear, mucoid ACL degeneration or normal ACL.
Abstract: Purpose To describe rupture patterns of partial anterior cruciate ligament (ACL) tears on magnetic resonance (MR) imaging.

Journal ArticleDOI
TL;DR: Evidence concerning the use of ACI for osteochondral and chondral defects of the talus is still elusive and although clinical outcome as described in the studies available seems promising, a superiority or inferiority to other techniques such as osteochondrals transplantation or microfracturing cannot be estimated.
Abstract: Purpose While autologous chondrocyte implantation (ACI) has become an established surgical treatment for cartilage defects of the knee, only little is known about the clinical outcome following ACI for chondral or osteochondral lesion of the ankle. To evaluate efficiency and effectiveness of ACI for talar lesions was aim of the present meta-analysis.

Journal ArticleDOI
TL;DR: Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements.
Abstract: The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous. However, the mechanism of action of the tranexamic acid points towards the possible effectiveness it may have following local/intra-articular application. This prospective, double-blinded, randomized preliminary study evaluated the efficacy of intra-articular tranexamic acid in reducing TKA-associated post-operative blood loss. Fifty consenting patients with osteoarthritis of the knee scheduled for primary unilateral cemented-TKA were randomly allocated to one of the two groups: Tranexamic Acid (TA) group (n = 25, 500 mg/5 ml tranexamic acid) and the control group (n = 25, 5 ml 0.9% saline). The drug and control solution were administered intra-articularly through the drain tube immediately after the wound closure. Parameters related to blood loss (drop in haemoglobin, haematocrit differential) and the drain output [volume (ml)] were compared between the two groups. On a comparative basis, TA-group obtained significant reduction in the drain output [95% CI: 360.41–539.59, p < 0.001] at 48 h post-operatively. Even though the control group received sixfold more blood transfusion than TA-group, it showed a greater drop in haemoglobin and haematocrit (p < 0.05). Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements. Therapeutic study, Level II.

Journal ArticleDOI
TL;DR: Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design.
Abstract: Both patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) are successful in treating isolated patellofemoral osteoarthritis, but the complication rates after PFA are concerning. We performed a meta-analysis to compare the incidence of complications, re-operations, and revision following PFA and TKA for patellofemoral osteoarthritis. We systematically identified publications with patients who underwent PFA or TKA for patellofemoral osteoarthritis with minimum 1.5 year follow-up. Demographics, implant (TKA, first [1G] or second-generation [2G] PFA), complications, and cause of re-operations were extracted. Random-effects meta-analysis was used to pool incidence data, which was compared between groups using logistic regression to adjust for length of follow-up. Twenty-eight observational studies and no randomized trials were included in this meta-analysis, which limits its generalizability. There was a higher likelihood of any re-operation (odds ratio 8.06) and revision (OR 8.11) in PFA compared to TKA. Re-operation (OR 4.33) and revision (OR 4.93) were more likely in 1G-PFA than 2G-PFA. When comparing 2G-PFA to TKA, there was no significant difference in re-operation, revision, pain, or mechanical complications. Patients who undergo PFA rather than TKA are more likely to experience complications and require re-operation or revision, but subgroup analysis suggests a relation to implant design. There is no significant difference in re-operation, revision, pain, or mechanical complications between 2G-PFA and TKA. Systematic review of Level III therapeutic studies, Level III.