Non-compressive sleeves versus compression stockings after total knee arthroplasty: A prospective pilot study.

Background: Compression stockings are routinely prescribed after total knee arthroplasty (TKA). Non-compressive sleeves embedded with semiconductor elements (Incrediwear) are designed to enhance blood flow. The objective of this investigation is to compare compression stockings and Incrediwear on post-TKA measures. Methods: In this single-center prospective clinical pilot study, patients undergoing TKA were assigned to either the compression stocking (control) or Incrediwear (experimental) group. Subjects were evaluated preoperatively and postoperative at 3 weeks for pain, knee effusion, knee range of motion (ROM), thigh and calf circumferences. Results: Incrediwear subjects had slightly higher preoperative effusion than controls (mean effusion 1.38 vs. 1.16, p = .28); however, by week 3, Incrediwear subjects had lower levels of effusion than controls (1.12 vs. 1.56, p = .015). At week 3, when compared to pre-op, Incrediwear subjects experienced a 19% decrease in effusion while controls experienced a 35% increase in effusion (p = .003). Preoperatively, there were no differences observed between Incrediwear subjects and controls flexion ROM (mean ROM 117 vs. 116, p = .67); however, by week 3, Incrediwear subjects had greater flexion ROM than controls (113 vs. 108, p = .02). Incrediwear subjects experienced only a 3% decrease in flexion ROM while controls experienced a 7% decrease in ROM (p = .07). Incrediwear subjects reported higher preoperative pain than controls (mean pain 4.2 vs. 3.2, p = .051); however, by week 3, there was no difference observed between these groups (2.9 vs. 3.0, p = .440). Discussion: Non-compressive sleeves embedded with semiconductor elements (Incrediwear) appeared to reduce effusion and improve knee flexion better than traditional compression stockings 3 weeks after total knee arthroplasty.

Identification of Cartilage Microbial DNA Signatures and Associations With Knee and Hip Osteoarthritis.

OBJECTIVE: Alterations of the gut microbiota have been implicated in many forms of arthritis, but an examination of cartilage microbial patterns has not been performed. This study was undertaken to characterize the microbial DNA profile of articular cartilage and determine changes associated with osteoarthritis (OA). METHODS: We performed 16S ribosomal RNA gene deep sequencing on eroded and intact cartilage samples from knee OA patients (n = 21 eroded and 21 intact samples) and hip OA patients (n = 34 eroded and 33 intact samples) and cadaver controls (n = 10 knee samples and 10 hip samples). Microbial DNA diversity was assessed, groups were compared, and metagenomic profiles were reconstructed. Confirmation was performed in an independent cohort by clade-specific quantitative polymerase chain reaction. Findings in human cartilage were compared to those in cartilage from OA-susceptible C57BL/6 (B6) mice and OA-resistant MRL/MpJ (MRL) mice. Germ-free B6 mouse cartilage was analyzed as a methodologic control. RESULTS: Alpha diversity was reduced in human OA versus control samples (P < 0.0001), and in hip versus knee samples (P < 0.0001). Numerous clades were different in human OA versus control samples, and similar findings were noted in comparisons of murine B6 versus MRL mice. Hip samples were microbiologically distinct from knee samples. OA microbial DNA demonstrated increased gram-negative constituents (P = 0.02). Functional analysis demonstrated increases in lipopolysaccharide production (P = 9.9 × 10-3 ), phosphatidylinositol signaling (P = 4.2 × 10-4 ), and nitrogen metabolism (P = 8 × 10-3 ) and decreases in sphingolipid metabolism (P = 7.7 × 10-4 ) associated with OA. CONCLUSION: Our study reveals a microbial DNA signature in human and mouse cartilage. Alterations in this signature, including increases in gram-negative constituents, occur during the development and progression of human OA. Furthermore, our findings indicate that strain-specific signatures exist within mouse cartilage that mirror human patterns. Further study of the establishment and potential pathogenic role of these DNA signatures is needed.

Elbow arthrodesis: a novel technique and review of the literature.

The elbow is a complex joint that is the mechanical link in the upper extremity between the hand and the shoulder. Loss of elbow function can severely affect activities of daily living. Arthrodesis of the elbow results in greater functional disability than arthrodesis of the ankle, hip, or knee joints. Arthrodesis is mainly performed for severe joint destruction most commonly due to posttraumatic arthrosis, instability, or infection. The authors describe a new technique of elbow arthrodesis using a step-cut osteotomy that has not been previously reported. They believe that this can increase the surface area for healing with the outcome of a higher fusion rate. It is most important, however, to achieve good compression with lag screws across the fusion site after the desired angled has been achieved. Elbow arthrodesis is not a common orthopedic procedure, but the authors believe that their novel technique provides a reproducible and reliable way to achieve a high fusion rate and desired fusion angle.

Proximal Biceps Tenodesis: An Anatomic Study and Comparison of the Accuracy of Arthroscopic and Open Techniques Using Interference Screws.

PURPOSE: To (1) better define the anatomy of the proximal shoulder in relation to the long head of the biceps tendon, (2) compare the length-tension relationship of the biceps tendon in the native shoulder with that after arthroscopic and open tenodesis techniques using interference screws, and (3) provide surgical recommendations for both procedures based on study findings. STUDY DESIGN: Descriptive laboratory study. METHODS: Twenty fresh-frozen cadaveric shoulders were dissected for analysis. Initial anatomic measurements involving the proximal long head of the biceps tendon (BT) were made, which included: the labral origin to the superior bicipital groove (LO-SBG), the total tendon length (TTL), the musculotendinous junction (MTJ) to the inferior pectoralis major tendon border, the MTJ to the superior pectoralis major tendon border, and the biceps tendon diameter (BTD) at 2 different tenodesis locations. These same measurements were made again after completing a simulated suprapectoral arthroscopic and open subpectoral tenodesis, both with interference screw fixation. Statistical comparisons were then made between the native anatomy and that after tenodesis, with the goal of assessing the accuracy of re-establishing the normal length-tension relationship of the long head of the BT after simulated arthroscopic suprapectoral and open subpectoral tenodesis with tenodesis screws. RESULTS: For all cadavers, the mean TTL was 104.1 mm. For the arthroscopic suprapectoral technique, the mean LO-SBG was 33.6 mm, and the mean tendon resection length was 12.8 mm in males and 5.0 mm in females. The mean BTD was 6.35 mm at the arthroscopic suprapectoral tenodesis site and 5.75 mm at the open subpectoral tenodesis site. Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively). In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis major tendon were 23.8 and 31.7 mm, respectively. No statistically significant differences were found in the location of the MTJ after simulated arthroscopic or open tenodesis with tenodesis screws as compared with the native shoulder. Mean hole depth in the open subpectoralis tenodesis was 22.4 mm (males) and 18.6 mm (females), with a mean of 20.5 mm for both sexes. CONCLUSION: This study better defines the anatomy of the proximal shoulder in relationship to the long head of the BT. Using our surgical techniques and recommendations, both arthroscopic and open tenodesis procedures adequately restored the native length-tension relationship of the long head of the biceps. Surgical recommendations are as follows: For arthroscopic suprapectoral tenodesis with tenodesis screws, the anatomic landmark of the SBG should be used. The tendon resection length should be approximately 1 cm in males and 5 mm in females when using a 25-mm tunnel. For subpectoral tenodesis, the site of tenodesis should be placed approximately 3 cm above the inferior border of the pectoralis major tendon in the bicipital groove; whipstitching and preserving approximately 2 cm of the biceps tendon above the MTJ is also recommended. The diameter of the screws in either location should be based on patient anatomy. However, this study shows the need for slightly longer screws for the subpectoral tenodesis, as the average hole depth was 20.5 mm. The system used in this study has 7 × 10-mm and 8 × 12-mm screws available. Based on study findings, a screw length of 15 to 18 mm may be needed.

Periosteal avulsion of the posterolateral corner of the knee in an adolescent: an unreported case.

Isolated injuries of the posterolateral corner of the knee are uncommon injuries in adults and are relatively unheard of in the pediatric population. This article reports a case of a 13-year-old boy who sustained an external rotation injury to his proximal tibia on a slightly flexed knee while playing football. Radiographs showed an avulsed fragment from the lateral femoral condyle. A magnetic resonance image was read as an avulsion of the femoral insertion of the lateral collateral ligament with associated bone bruise of the lateral femoral condyle. At operation, the fragment consisted of the femoral insertion of the popliteus tendon and the lateral collateral ligament, which was anatomically reduced and internally fixed with a screw and soft tissue washer. Six weeks postoperatively, the patient had full range of motion. To our knowledge, this injury has not been reported in the pediatric population.