Efficacy of Taurolidine Irrigation in Primary Total Knee Arthroplasty.

PURPOSE: Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis. The aim of this study was to evaluate the efficacy of taurolidine irrigation in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: All patients who underwent TKA at our institute from January 2015 to March 2017 were eligible. There were 300 patients in the taurolidine irrigation group and 300 patients in the control group. The patients in the taurolidine irrigation group were irrigated after implantation with a mix of 250 mL of taurolidine and 750 mL of normal saline. The patients in the control group were not irrigated after implantation. We compared postoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and infection rate between groups. RESULTS: The taurolidine irrigation group had a significantly lower CRP (5.39 mg/dL vs. 7.55 mg/dL; p＜0.001) and ESR (53.21 mm/hr vs. 58.74 mm/hr; p=0.003) on postoperative day 3 after TKA, as compared with the control group. However, there was no difference between the two groups on postoperative days 6, 13, and 20. Periprosthetic joint infection occurred in one patient in the taurolidine irrigation group. CONCLUSIONS: We believe that it is not necessary to use taurolidine for patients who undergo primary TKA.

Dynamic Three-Dimensional Analysis of Lachman Test for Anterior Cruciate Ligament Insufficiency: Analysis of Anteroposterior Motion of the Medial and Lateral Femoral Epicondyles.

PURPOSE: To evaluate dynamic three-dimensional (3D) kinematic properties of the anterior cruciate ligament (ACL)-insufficient knees and healthy contralateral knees in awake patients during the Lachman test using biplane fluoroscopy. MATERIALS AND METHODS: Ten patients with unilateral ACL-insufficient knees and healthy contralateral knees were enrolled in this study. Each patient underwent the Lachman test three times in the awake state. The knee joint motions were captured using biplane fluoroscopy. After manual registration of 3D surface data from 3D-computed tomography to biplane images, dynamic 3D kinematic data were analyzed. RESULTS: The average anteroposterior (AP) translation of the medial femoral epicondyle of the ACL-insufficient knees (11.5±4.2 mm) was significantly greater than that of the contralateral knees (7.7±3.5 mm) (p<0.05). However, there was no statistically significant side-to-side difference in the average AP translation of the lateral femoral epicondyle. During the Lachman test, the distal femur was more externally rotated than the proximal tibia, which showed significant difference between both sides. CONCLUSIONS: During the Lachman test, the medial femoral epicondyle of the ACL-insufficient knee exhibited greater AP motion than that of the contralateral knee, whereas there was no significant side-to-side difference with regard to the AP motion of the lateral femoral epicondyle.

High Axial Loads While Walking Increase Anterior Tibial Translation in Intact and Anterior Cruciate Ligament-Deficient Knees.

PURPOSE: To evaluate the effect of high axial loading (AL) on anterior tibial translation (ATT) according to the increase in knee flexion and the effect of valgus stress (VS) and internal rotation (IR) combined with high AL in intact and anterior cruciate ligament (ACL)-deficient knees according to the increase in knee flexion. METHODS: We used 10 fresh-frozen, human cadaveric knees. Different loading conditions (134-N anterior drawer, 1,000-N AL, 10-Nm VS, and 5-Nm IR) were sequentially combined, and ATT was measured at 0°, 15°, 30°, 45°, and 60° of flexion in the intact and ACL-deficient knees. RESULTS: ATT increased significantly by adding high AL in intact knees (P = .001) and ACL-deficient knees (P < .0001) according to the change in flexion angle (P < .0001). Under high AL, ATT in the ACL-deficient knees was significantly larger than that in the intact knees for all loading conditions, and it also increased gradually according to the increase in knee flexion (P = .0001). ATT increased significantly after adding IR or VS with high AL in intact knees (VS, P = .002; VS/IR, P = .03) and ACL-deficient knees (VS, P = .0004) at some of the flexion angles. CONCLUSIONS: The added high AL increased ATT in intact and ACL-deficient knees from 0° to 60° of flexion. The effect of high AL on ATT became greater in ACL-deficient knees than in intact knees, and ATT also gradually increased according to the increase in knee flexion from 0° to 60°. In both the intact and ACL-deficient knees, ATT increased significantly after valgus stress or IR from 0° to 60°. CLINICAL RELEVANCE: ATT during weight bearing increases stress to the ACL, which worsens with valgus stress and/or IR forces. This finding should be considered when one is studying ACL injury mechanisms, as well as prescribing rehabilitation after ACL surgery.

Treatment of patella infera by patellar tendon lengthening and augmentation with tibialis anterior tendon allograft.

Management of patella infera remains a difficult therapeutic endeavor. We report a case of a 21-year-old man, who had development of patella infera and knee flexion contracture after a patella fracture. Patella infera was treated by patellar tendon lengthening and augmentation with a tibialis anterior tendon allograft fixed with bioabsorbable cross-pins. The patient regained an anatomic patellar position and full range of motion at two years after surgery.