Research Progress in Application of Patient-Reported Outcome Measures in Total Knee Arthroplasty / 中国医学科学院学报

To summarize the clinical application of patient-reported outcome measures (PROM) in total knee arthroplasty (TKA) and provide reference for the application of PROM in perioperative evaluation of the patients receiving TKA,we reviewed the recent studies about the application of PROM in TKA and analyzed the contents and application characteristics of the PROM.The common PROM in TKA,such as the Western Ontario and McMaster Universities Osteoarthritis Index,Oxford Knee Score,and Forgotten Joint Score,principally focus on patients' subjective feelings about pain,function and other aspects of their knees.However,they have diverse ranges of application and each of them has their own advantages and disadvantages.There is a variety of PROM applied in TKA,which makes it challenging to select the proper measurement for evaluation.The PROM in TKA remains to be improved for broader use.

Muscle function, Lysholm score and hop performance in individuals with clinical indications for the combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: A cross-sectional study

Abstract Objective To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. Design Cross-sectional study. Methods The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. Results The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. Conclusion Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.

Clinical and functional comparison of two different fixation techniques in anterior cruciate ligament reconstruction: all-inside versus anteromedial / Comparação clínica e funcional da reconstrução do ligamento cruzado anterior com duas técnicas de fixação diferentes: portal anteromedial versus all-inside

ABSTRACT Objective: To compare the clinical and functional outcomes of two different graft fixation methods, all-inside and anteromedial (AM), for single-bundle anterior cruciate ligament (ACL) reconstruction techniques. Methods: Comparing the mid-term results of two groups, the prospectively recorded data of patients diagnosed with isolated ACL rupture between 2015 and 2016 were reviewed retrospectively. Two groups of patients who underwent unilateral isolated ACL reconstruction via two different tibial fixation techniques (19 patients with all-inside [Group 1]; 20 patients with AM portal [Group 2]) from the same institution were enrolled as the study group. The patients were called for the final follow-up and evaluated for symptoms, knee stability (Lachman test, pivot shift test, and KT-1000 arthrometer analysis), and functional scores (Tegner and Lysholm knee scoring scale, International Knee Documentation Committee [IKDC] subjective knee score, and visual analog scale [VAS]). Results: The mean age and follow-up period were statistically equal between the two groups. The functional comparison of patients with Tegner and Lysholm knee and IKDC scores, showed no statistical difference at the mid-term follow-up period. In the clinical assessment of the operated knees, based on the Lachman test and KT-1000 arthrometer, the anterior translation results in group 1 were better than those in group 2, which was statistically significant. However, we obtained similar pivot shift test results in both groups. Conclusion: The study showed that ACL reconstruction via the all-inside had functionally better anterior translation and similar rotational stability results compared with the AM portal technique. Level of Evidence III, Case Control Study.

RESUMO Objetivo: Comparar desfechos clínicos e funcionais de dois métodos de fixação do enxerto, all-inside e anteromedial (AM), em técnicas de reconstrução do ligamento cruzado anterior (LCA). Métodos: Comparação dos resultados de médio prazo de dois grupos, os dados obtidos prospectivamente de pacientes diagnosticados com ruptura isolada do LCA entre 2015 e 2016 foram retrospectivamente analisados. Doisgrupos de pacientes submetidosà reconstrução unilateral isolada do LCA por duas diferentes técnicas de fixação tibial (19 pacientes por all-inside [Grupo 1]; 20 pacientes por portal AM [Grupo 2]) da mesma instituição foram registrados como grupo de estudo. Os pacientes foram convocados para o último acompanhamento e avaliados sobre sintomas, estabilidade do joelho (teste de Lachman, teste de pivot-shift, e análise com artrômetro KT-1000), e escores funcionais (escore de Tegner e Lysholm para joelho, escala subjetiva de joelho do International Knee Documentation Committee (IKDC), e escala visual analógica [EVA]). Resultados: A idade média e período de acompanhamento foram estatisticamente iguais entre osdoisgrupos. A comparação funcional de pacientespelosescore de Tegner and Lysholm para joelho e do IKDC, não revelou diferenças estatísticas no acompanhamento de médio prazo. Na avaliação clínica dos joelhos operados, baseada no teste de Lachman e no artrômetro KT-1000, os resultados de translação anterior no grupo 1 foram melhores do que os do grupo 2, o que foi estatisticamente significante. Entretanto, obtivemos resultados similares do teste de pivot-shift em ambos os grupos. Conclusão: O estudo mostro que a reconstrução do LCA pela técnica all-inside apresentou melhor translação anterior functional e resultados de estabilidade rotacional similares aos da técnica do portal AM. Nível de Evidência III, Estudo de Caso Controle.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores / Medidas de desfechos clínicos na meniscectomia artroscópica: Pontuações de joelho segundo médicos e pacientes

Abstract Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [p< 0.001], Lysholm [p= 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [p< 0.001], but not in the IKDC Examination [p= 0.332]. However, the IKDC Subjective score (p= 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Resumo Objetivo O objetivo do presente estudo foi investigar a diferença entre instrumentos de desfechos preenchidos por médicos e pacientes na detecção de melhora após a meniscectomia artroscópica para tratamento de rupturas de menisco. Métodos Trinta e quatro pacientes com rupturas de menisco foram avaliados de forma prospectiva usando 9 medidas de desfechos clínicos. Os cinco instrumentos de avaliação de joelho respondidos por médicos foram o Escore de Atividade de Tegner, o Escore de Joelho de Lysholm, o Escore de Joelho de Cincinnati, o Escore de Exame do Joelho do International Knee Documentation Committee (IKDC, na sigla em inglês) e o Escore de Classificação do Menisco de Tapper e Hoover. Os quatro instrumentos de avaliação do joelho respondidos por pacientes foram o Escore Subjetivo do Joelho do IKDC, a Pesquisa de Desfecho de Joelho - Escala de Atividades de Vida Diária (KOS-ADLS, na sigla em inglês), o Formulário Curto de Pesquisa em Saúde de 12 Itens (SF-12, na sigla em inglês) e o Escore de Desfecho de Osteoartrite e Lesões no Joelho (KOOS, na sigla em inglês). Vinte e nove dos 34 pacientes foram submetidos a uma meniscectomia artroscópica e reavaliados com todos os 9 instrumentos na sua consulta de acompanhamento. Resultados Uma melhora longitudinal significativa foi observada em 4 dos 5 instrumentos respondidos por médicos (Tegner [p< 0,001], Lysholm [p= 0,004], Cincinnati [p= 0,002] e Tapper e Hoover [p< 0,001], mas não no IKDC [p= 0,332]). Por outro lado, o Escore Subjetivo do Joelho do IKDC (p= 0,021) foi o único instrumento respondido por pacientes a demonstrar melhora pós-operatória significativa. Conclusão De modo geral, os instrumentos respondidos por médicos foram considerados inconsistentes em relação àqueles respondidos por pacientes. O modo de administração dos instrumentos pode ter influência significativa nos resultados, tanto para fins de pesquisa quanto para a prática clínica. A combinação de um instrumento respondido pelo médico com um instrumento respondido pelo paciente pode ser uma abordagem mais equilibrada para a avaliação e a quantificação das rupturas do menisco e do desfecho após a meniscectomia artroscópica.

Comparison of femoral tunnel and early curative effect analysis between arthroscopic three approach and traditional anteromedial portal for reconstruction of anterior cruciate ligament / 中国骨伤

OBJECTIVE@#To study the three-approach and traditional anterior medial technique to establish the femoral tunnel of position, length, and coronal angle and the early efficacy of anterior cruciate ligament reconstruction.@*METHODS@#Through retrospective research, from December 2018 to June 2019, a total of 36 patients diagnosed with simple anterior cruciate ligament tear and undergoing surgery were collected. All patients had a clear history of knee sprains and were divided into two groups. A group of 16 patients, including 11 males and 5 females, with an average age of (30.13±6.54) years and an injury time of 7 to 60 (30.19±15.78) days, three-approach technique was used to drill the femoral tunnel to reconstruct the anterior cruciate ligament. Another group of 20patients, including 15 males and 5 females, with an average age of (30.80±8.60) years, and an injury time of 7 to 60 (27.35±15.50) days, the traditional anterior medial approach was used to drill the femoral tunnel to reconstruct anterior cruciate ligament. CT 3D reconstruction technique was used to evaluate the femoral tunnel and the knee joint function was evaluated by Lysholm score of the knee joint.@*RESULTS@#All patients achieved primary healing after the surgical incision. No femoral tunnel fracture, vascular and nerve damage, difficulty in graft passage during the operation, and venous thrombosis occurred. All 36 patients were followed up on an outpatient basis, with a follow up period of 9 to 15 (12.00±2.83) months. Three-dimensional CT reconstruction was used to evaluate the femoral tunnel of the patients. The position of the femoral tunnel was described using the quartile method as the three-approach group:the lower (27.83±1.97) % of the femoral condyle and the posterior (25.57±3.20) %;the traditional approach group:the lower (28.38±3.21) % of the femoral condyle and the posterior (26.23±3.20) %. Bone tunnel length, three-approach group:(35.20±5.52) mm in total length, (23.20±2.07) mm in thick bone tunnel;traditional approach group:(34.60±4.26) mm in total length, (22.56±2.50) mm in thick bone tunnel. Coronal plane angle, three-approach group:(47.93±5.98) °;traditional approach group:(41.78±6.62) °. Knee joint Lysholm score, three-approach group:48.67±4.18 before surgery;97.00±2.48 at last follow up;traditional approach group:49.75±5.33 before surgery, 97.30±2.68 at last follow up, there were significant differences before and after surgery, no significant statistical difference between two groups.@*CONCLUSION@#The positions of the femoral tunnel drilled by the two methods were within the range of the anatomic stop of the anterior cruciate ligament, and there was no statistical difference. Compared with the traditional anterior medial approach, the coronal plane angle of the femoral tunnel drilled by the three-approach approach is relatively large, and there were no statistical differences in the length of the tunnel, the early postoperative effect of the two surgical methods, and the operation time. But the three approach has a wider and clearer vision. In addition, the knee flexion angle required for drilling the femoral tunnel during surgery is significantly smaller than that of traditional approach technology, which reduces the difficulty of surgery.

Outcome Analysis of Dual Plating in Management of Unstable Bicondylar Tibial Plateau Fracture - A Prospective Study

@#Introduction: Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions. Materials and methods: The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system. Result: All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The postoperative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union. Conclusion: The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.

Adaptación transcultural al Español y Validación de la Escala de Lysholm para evaluar la funcionalidad de la rodilla / Cross-cultural adaptation to Spanish and Validation of Lysholm knee Score

Introducción La escala de Lysholm fue desarrollada en 1982 y modificada en 1985 con el fin de evaluar la funcionalidad de los pacientes con lesiones ligamentarias; desde entonces ha sido ampliamente utilizada para evaluar subjetivamente a los pacientes en relación con su capacidad funcional. El propósito de este estudio fue realizar su traducción y adaptación transcultural al español colombiano y desarrollar la validación psicométrica a través de la evaluación de la consistencia interna y fiabilidad test-retest. Materiales y métodos Previa identificación de la escala original de interés, se realizó traducción (inglés-español), adaptación cultural y re-traducción (español-inglés) por expertos lingüistas nativos, quienes valoraron la similitud del contenido de ambos productos (original y retraducido). Asimismo, dicha última versión fue valorada por 40 pacientes con enfermedad de rodilla (lesión meniscal, ruptura de ligamento cruzado anterior, condromalacia y gonartrosis), quienes confirmaron comprender el texto. Posteriormente fue evaluada la consistencia interna mediante la prueba de alfa de Cronbach para todos los ítems, y el coeficiente correlación intraclase­puntaje total del sub-constructo a través de una muestra aleatoria (n=93), la cual validó la estructura factorial de la escala. Resultados El alfa de Cronbach fue de 0,737 y el coeficiente de correlación interclase fue de 0,844, asociado a una concordancia inter-observador alta (Gamma=0,752). El gráfico de Bland-Altman no demostró diferencias sistemáticas entre las mediciones Discusión La presente versión al español (colombiano) de la escala Lysholm es una herramienta válida para medir la funcionalidad en pacientes con lesiones meniscales del ligamento cruzado anterior, condromalacia patelofemoral y gonartrosis en países de habla hispana (preferentemente en Colombia).

Background The Lysholm scale was developed in 1982 and modified in 1985 in order to assess the functionality of patients with knee ligament injuries; since then it has been widely used to subjectively evaluate patients in relation to their functional capacity. The purpose of the study was to carry out its translation and cross-cultural adaptation to Colombian Spanish and to develop psychometric validation through the evaluation of internal consistency and test-retest reliability. Methods After identifying the original scale of interest, translation (English-Spanish), cultural adaptation and re-translation (Spanish-English) were carried out by native linguist experts, who assessed the similarity of the content of both products (original and retranslated). Likewise, this latest version was evaluated by 40 patients with knee disease (meniscal injury, anterior cruciate ligament rupture, chondromalacia and gonarthrosis), who confirmed that they understood the text. Subsequently, the internal consistency was evaluated using Cronbach's alpha test for all items, and the intraclass correlation coefficient ­ ??total score of the sub-construct through a random sample (n=93), which validated the factorial structure of the scale. Results Cronbach's alpha was 0.737 and the interclass correlation coefficient was 0.844, associated with a high inter-observer agreement (Gamma=0.752). The Bland-Altman plot did not show systematic differences between the measurements Discussion This Spanish (Colombian) version of the Lysholm scale is a valid tool to measure functionality in patients with meniscal lesions of the anterior cruciate ligament, patellofemoral chondromalacia and gonarthrosis in Spanish-speaking countries (preferably in Colombia).

Beneficial role of Avocado oil orally used in Osteoarthritis: experience in a tertiary care hospital of Bihar, India

Background: Osteoarthritis is the most common type of joint disease. It represents a heterogeneous group of conditions resulting in common histopathologic and radiologic changes. It is a degenerative disorder arising from biochemical breakdown of articular (hyaline) cartilage in the synovial joints.Methods: Total of 90 patients were randomly selected from outdoor and indoor of Orthopaedics department (IGIMS Patna). Study was done in Department of Pharmacology & Orthopaedics at IGIMS Patna. Three groups A, B and C were taken. Each group was consist of 30 patients of both sexes and age groups between 18 to 65 years. Group A was received Multivitamin with Exercise. Group B was received NSAIDS only. Group C was received Avocado oil orally along with Exercises as Muscle strengthening exercises of Quadriceps, Hamstrings, Abductor and Adductor muscles of thigh. We had compared pain thresholds among all these three groups with the help of Visual analogue scale and Oxford Knee score.Results: After 3 months of treatment the patients belonging to group C showed better response as compared to group A and B. When we compared pain threshold among group A, B and C on the basis of Oxford Knee score group C had occupied maximum score, which meant satisfactory joint functions and did not require any formal treatment. we also compared average visual analogue scale and average oxford knee score, Group C showed better response.Conclusions: Avocado oil is a food supplement and does not contain any side effects as compared to NSAIDS [Non-steroidal anti inflammatory drugs], glucosamine sulfate, chondroitin sulfate, sulfasalazine etc so avocado oil can be used for long duration in case of osteoarthritis.

Comparative Study of Function and Quality of Life in Patients with Fracture of the Tibial Plateau Operated with Locked or Conventional Plates / Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo

Abstract Objective To compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare the costs of these implants. Methods This was a comparative cross-sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients < 18 years old, those unable to answer the questionnaires or to attend the outpatient reassessment, polytrauma patients, those with associated injuries on the ipsilateral limb, and patients who had not undergone treatment with bone plates were excluded. The present study compared the costs of the implants for the hospital, quality of life (with the 12-Item Short Form Health Survey [SF-12]), Lysholm score, pain scale, and clinical and radiological parameters. Results A total of 45 patients with tibial plateau fractures were admitted, and 11 cases were excluded. Two cases were lost to follow-up; therefore, 32 remained for the analysis (94%). The mean follow-up time was of 15.1 months (standard deviation [SD] = 4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of BRL 4,125.39/patient (SD = 1,634.79/patient) for the implants. In group B (conventional plates) there were 10 patients (31%), at an average cost of BRL 438.53 (SD = 161.8/patient) (p < 0.00001). For the other parameters, no differences were observed, except for a greater articular depression in group A (2.7 mm ± 3.3 mm versus 0.5 mm ± 1.6 mm; p = 0.02; TE = 0.90). Conclusion The costs of locked implants for the treatment of tibial plateau fractures are significantly higher than those of conventional implants, without any clinical, quality of life, radiological, or functional advantages of the locked implants demonstrated in the present series.

Resumo Objetivos Comparar resultados clínicos, funcionais e de qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional e comparar os custos hospitalares dos implantes. Métodos Estudo comparativo de coortes transversal, retrospectivo, em uma série consecutiva de pacientes com fratura do planalto tibial tratados cirurgicamente entre agosto de 2015 e junho de 2016. Foram excluídos: menores de 18 anos; indivíduos incapazes de responder os questionários ou de comparecer para reavaliação; politraumatizados ou comlesões associadas no mesmomembro; pacientes não tratados complaca ou conservadoramente. Os autores compararam os custos dos implantes, a qualidade de vida (SF-12), o escore de Lysholm, a escala visual de dor e os parâmetros clínicos e radiográficos. Resultados Foramobservadas 45 fraturas no período, das quais 11 foramexcluídas. Dos 34 pacientes, dois não compareceram à entrevista (seguimento de 94%). O tempo de seguimento foi 15,1 ± 4,8 meses.Ogrupo A (placa bloqueada) incluiu 22 pacientes (69%), comcusto hospitalarmédio dos implantes de R$ 4.125,39 (dp = R$1.634,79/paciente). O grupo B (placa convencional) incluiu dez pacientes (31%), a um custo médio de R$ 438,53 (dp = R$ 161,8/paciente; p < 0,00001). Para os demais parâmetros avaliados, não foram observadas diferenças significativas entre os grupos, exceto por ummaior degrau articular no grupo A (2,7 mm ± 3,3 mm vs. 0,5 mm ± 1,6 mm; p = 0,02; TE = 0,90). Conclusão O custo dos implantes bloqueados para o tratamento das fraturas do planalto tibial é significativamente superior aos implantes convencionais, embora não tenham apresentado vantagem clínica, radiográfica, funcional ou de qualidade de vida, nos pacientes dessa amostra.

The role of microfractures with tibial osteotomy in the treatment of knee osteoarthritis with a varus deformity / O papel das microfraturas associadas a osteotomia tibial no tratamento da gonartrose com geno varo

ABSTRACT Objective: To evaluate the microfracture intervention with tibial valgus osteotomy associated in the treatment of varus gonarthrosis. Methods: From November 2005 to May 2013, 129 patients with medial gonarthrosis, varus deformity (8°-12°), and range of movement greater than 90° were evaluated. Patients with advanced gonarthrosis (Alhbäck 3, 4, and 5), Outerbridge lesion inferior to IV, previous knee surgery, body mass index greater than 35 kg/m2, and/or cruciate ligament injuries were not included. All patients were treated with videoarthroscopy followed by tibial valgus osteotomy. In the group osteotomy associated with microfracture (n = 56, mean age = 39.3), tibial valgus osteotomy and microfracture techniques to address chondral defects were used. In the isolated osteotomy group (n = 73, mean age = 41.4), only this procedure was performed. Post-surgical follow-up was 24 months, with four evaluations in the first 6 months, proceeding to biannual twice-a-year evaluation in the subsequent period. The Lysholm scale was used for functional monitoring. Results: There was a significant improvement in the pain, limping, and squatting domains of the Lysholm scale but only in the isolated osteotomy group. A greater variance of results was observed in the osteotomy group associated to microfracture, in addition to an increased risk of functional deterioration (OR = 8.64). Conclusion: The association of microfractures and tibial valgus osteotomy was correlated to lower functional outcomes than tibial valgus osteotomy alone, and may be related to the risk of worsening in the first two postoperative years.

RESUMO Objetivo: Avaliar a intervenção de microfratura associada a osteotomia tibial valgizante no tratamento de gonartrose medial com geno varo. Métodos: Entre novembro de 2005 e maio de 2013, foram avaliados 129 pacientes portadores de gonartrose medial, geno varo entre 8° e 12° e arco de movimento superior a 90°. Não foram incluídos pacientes com gonartrose avançada (Alhbäck 3, 4 e 5), lesão Outerbridge inferior a IV, cirurgia prévia na articulação, índice de massa corpórea superior a 35 kg/m2 e/ou lesão de ligamentos cruzados. Todos os pacientes foram submetidos a videoartroscopia do joelho seguida de osteotomia tibial valgizante. No grupo osteotomia tibial valgizante associado a microfratura (n = 56, média de idade = 39,3) foram associadas as técnicas de osteotomia tibial valgizante e microfratura nos defeitos condrais. No grupo osteotomia tibial valgizante isolada (n = 73, média de idade = 41,4), apenas esse procedimento foi feito. O acompanhamento pós-cirúrgico foi de 24 meses, com quatro avaliações ambulatoriais nos primeiros seis meses, passou-se a avaliações semestrais no período subsequente. A escala de Lysholm foi usada no acompanhamento funcional. Resultados: Uma melhoria significativa nos domínios dor, claudicação e agachamento da escala de Lysholm foi observada apenas no grupo osteotomia tibial valgizante isolada. Maior variância de resultados foi observada no grupo osteotomia tibial valgizante associada a microfratura e uma razão de chances de pioria de 8,64. Conclusão: A associação das microfraturas e osteotomia tibial valgizante tem resultado funcional inferior à osteotomia tibial valgizante isolada, pode ainda estar relacionada ao risco de pioria nos primeiros dois anos de pós-operatório.

Efficacy Observation of Fire Filiform-needle Therapy in Treating Elderly Knee Osteoarthritis / 上海针灸杂志

Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.

Efficacy Observation of Fire Filiform-needle Therapy in Treating Elderly Knee Osteoarthritis / 上海针灸杂志

Objective To observe the efficacy of fire filiform-needle therapy in treating knee osteoarthritis (KOA) in the elderly.Method Eighty-one elderly KOA patients were randomized into a treatment group of 42 cases and a control group of 39 cases following registration order. The treatment group was intervened by fire filiform-needle therapy, while the control group was treated with ordinary acupuncture. The two groups were treated once every other day, 15 sessions as a treatment course. The Lysholm knee score and short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) were adopted to observe the activities of daily living and quality of life before and after the treatment, and the clinical efficacies of the two groups were compared.Result The total effective rate was 92.9％ in the treatment group, versus 82.1％ in the control group, and the total effective rate in the treatment group was significantly superior to the control group (P<0.05). Except for the squatting item of the Lysholm knee score in the control group, the Lysholm knee score and AIMS2-SF score were significantly changed after the treatment in both groups (P<0.05,P<0.01); except for the support item of the Lysholm knee score, the treatment group was superior to the control group in comparing the Lysholm knee score and AIMS2-SF score after the treatment (P<0.01).Conclusion Fire filiform- needle therapy can significantly enhance the activities of daily living and quality of life in elderly KOA patients.

Usefulness of the Korean Knee Score for Evaluation of the Results of Total Knee Arthroplasty

PURPOSE: The Korean Knee score (KKS) was designed to reflect the floor-sitting lifestyle that necessitates high knee flexion. The purpose of this study is to assess whether the KKS reflects the floor-sitting lifestyle more accurately than the previously developed Knee Society clinical rating system. In addition, the presence of ceiling effects was compared between the two rating systems. MATERIALS AND METHODS: Eighty-one consecutive patients (120 knees) who were assessed regularly after total knee arthroplasty (TKA) on an outpatient basis between January 2012 and December 2012 were enrolled. All patients were asked to complete a questionnaire to assess the Knee Society Knee score (KSKS), Knee Society Function score (KSFS), and KKS. RESULTS: At the final follow-up, the mean KSKS, KSFS, and KKS were 91.2, 86.0, and 70.1, respectively, and the scores were similar between the > or =125degrees maximum flexion group and 125degrees maximum flexion group (15.13 vs. 11.24, p=0.001). The number of cases with the highest possible score was 24 (20%) for the KSKS and 47 (39%) for the KSFS, whereas none of the cases obtained the highest possible KKS. According to the standard deviation method, more substantial ceiling effects were present in the KSKS (83 cases, 69.1%) and KSFS (67 cases, 55.8%) than in the KKS (23 cases, 19.2%). CONCLUSIONS: Although, the KKS was effective in reducing the ceiling effect, it demonstrated limited improvement in assessing the ability to perform high knee flexion after TKA. However, the 'floor life' subdomain of KSS appeared to be valid for evaluating high flexion of the knee.

The Effect of a Lumbar Spinal Lesion on the Clinical Results of Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Patients with osteoarthritis of knee joint often concomitantly suffer from degenerative disease of the spine. Furthermore, resulting spinal problems could influence function and pain after total knee arthroplasty (TKA), and hence, cause the results of TKA to be misinterpreted. The purpose of this prospective study was to evaluate the effect of spinal disorders, as assessed by Swiss Spinal Stenosis score (SSS scores), on knee function as assessed by knee scores, the Hospital for Special Surgery scale (HSS scale) and Western Ontario & McMaster Osteoarthritis Index scores (WOMAC scores) in patients that after TKA. MATERIALS AND METHODS: One hundred and forty nine osteoarthritic knees of 87 patients were enrolled in this study. All patients received TKA by single surgeon (W-S Cho) from August 2009 to May 2010. Preoperative and postoperative 1- and 2-years HSS scale, Knee, WOMAC, and SSS scores were recorded and analyzed. RESULTS: Postoperative HSS scale, Knee, and WOMAC scores showed marked improvements versus preoperative scores, and scores at 2 years postoperatively were better than at 1 year postoperatively. No significant correlation was found between postoperative Knee scores and SSS scores. On the other hand, statistically significant correlations were found between HSS and SSS scores and between WOMAC and SSS scores. Interestingly, differences between Knee scores and HSS scores were found to be significantly correlated with SSS scores. CONCLUSION: When evaluating outcome after TKA, spinal problems should be investigated concomitantly. SSS scores appear to provide a suitable means of assessing spinal problems.

Early mobilization with double elbow crutches on stability and functional knee score in patients with anterior cruciate ligament repair.

Objective: Anterior Cruciate Ligament (ACL) is the most commonly torned ligament in the sporting activities, athletes desiring to return to physical activities that require use of the ACL need surgical reconstruction and proper rehabilitation. In the recent years, there have been advancements in the surgical techniques as the femoral tunnel positioning has been shifted from vertical position to more stable oblique position, thus it is a necessary to investigate the effect of early mobilization with the double elbow crutches and its outcome responses. Methods: Total 40 subjects of day one post ACL oblique repair with mean age of 30±3.6 yrs. were participated in the study. Subjects were divided into Group-A and Group-B for rehabilitation with double elbow crutches and walker respectively, along with conventional exercises for 6 weeks. At 4th week both crutches and walker were discarded in both groups. Rehabilitation outcomes were assessed by static, dynamic stability and lysholm knee functional score were assessed at 4th, 6th weeks post operatively for both groups. Results: There was significant difference between static, dynamic stability and lysholm knee functional score at 4th and 6th weeks when compared within each group (p<0.001). Between group comparison showed insignificant difference in outcomes such as static stability (p=0.18; p=0.55) dynamic stability (p=0.09; p=0.06) and lysholm score (p=0.51; 0.65) at 4th and 6th week post repair respectively. Conclusion: It is concluded that knee Stability and lysholm functional knee score was significantly improved by early mobilization with double elbow crutches and walker independently although there is no significant difference between double elbow crutches and walker in post oblique ACL surgical repair rehabilitation.

What Symptoms Are More Important for Korean Patients in Knee Osteoarthritis? Development and Validation of the Korean Knee Score

PURPOSE: The purpose of this study was to develop and validate a novel knee evaluation instrument, the Korean Knee Score (KKS), to reflect a floor life style with high knee flexion. In addition, we aimed to assess the importance of high knee flexion activity for Korean patients. MATERIALS AND METHODS: The KKS was developed following the guidelines of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. During development step, generated items were asked to 50 patients to determine importance and obtain an impact score for each item. A total of 634 patients were included in the validation survey. RESULTS: Forty one items were generated and impact scores of each item about floor life style were higher than other items. The KKS exhibited excellent reliability (intraclass correlation coefficient=0.931) and strong internal consistency (Cronbach's alpha=0.973). The content validity was good, with no ceiling or floor effect. The construct, convergent, and divergent validities were good. Moderate responsiveness was evident, with a standardized response mean of 0.74. CONCLUSIONS: The KKS, has good validity, reliability, and responsiveness. The KKS includes items for floor life style, which are thought more important for Korean patients. The KKS can be used as a good evaluation questionnaire for Korean knee osteoarthritis patients.

Total Knee Replacement: 12 Years Retrospective Review and Experience

This retrospective study was undertaken to evaluate the outcome of primary total knee arthroplasty (TKA) performed from January 1986 to December 1997 at this institution. Case review included Knee Society scores and functional knee score. The records of 94 patients (128 knees) were available for analysis with the sample comprised of 76 females (80.9%) and 18 males (19.1%) and a mean age was 61.4 years. TKA was performed for osteoarthritis (OA) in 96 knees (75%) and rheumatoid arthritis (RA) in 32 knees (25

A study on function of knee and quality of life in patients with knee osteoarthritis / 中国康复医学杂志

Objective: To investigate the effect of function of knee on quality of life (QOL) in patients with knee osteoarthritis (OA). Method: Forty patients with knee OA were recruited. Their function, pain and range of motion (ROM) of knee were assessed with Lequesne index, Lysholm knee score (LKSS), visual analogue scale (VAS) and protractor measure respectively. QOL was evaluated with arthritis impact measurement scale (AIMS). Result: The scores of AIMS, Lequesne and VAS in female were significantly higher than that in male. And the LKSS in female was significantly lower than that in male (P<0.05). There was a positive correlation between AIMS score and Lequesne index, VAS score and limit of ROM, but a negative correlation between AIMS and LKSS (P<0.05). Conclusion: The function of knee and QOL in female patients with OA were worse than that in male patients. Pain, limited ROM and weaken function in knee could effect QOL in OA patients to some extent. Health education and clinical treatment should be provided to improve the function of knee and QOL in OA patients.

The Factors associated with Postural Control after Anterior Cruciate Ligament Reconstruction

PURPOSE: We analyzed the correlation of the Lysholm score, anterior displacement of tibia on stress radiography and muscle strength around the knee with postural control after anterior cruciate ligament reconstruction and also compared them with the normal subjects. MATERIALS AND METHODS: Twenty-five patients after ACL reconstruction were evaluated with Lysholm knee score, anterior displacement on stress radiography with Telos, muscle strength around the knee with Biodex dynamometer and postural control with posturography. RESULTS: The postural control had significant correlation with the Lysholm knee score & anterior displacement on stress radiography(r=0.565, r=0.783, p0.05). Patients group with 5mm instability under anterior displacement on stress radiography showed no significance compared with normal control group, while the group with instability more than 6mm showed significant differences in some conditions com- pared with control group. CONCLUSION: Postural control after ACL reconstruction have significant correlation with Lysholm score and we presumed that the acquisition of mechanical stability of the knee after ACL reconstruction may be one of the important factors associated with the recovery of postural control by improvement of the proprioception.

Treatment of posterior shearing tibial plateau fractures by modified posteromedial and posterolateral approaches / 中国矫形外科杂志

0.05).According to the HSS system,the mean score was 92.1(ranged from 76-97) one year after operation.No complication occurred,such as deep infection,necrosis of skin incision or loosening and breakage of internal fixators.[Conclusion]This modified posteromedial and posterolateral approaches could reduce the complications in incision successfully for the direct reduction and buttress fixation of articular fragments,as well as and soft tissue.