Preoperative glycaemic control, number of pain locations, structural knee damage, self-reported central sensitisation, satisfaction and personal control are predictive of 1-year postoperative pain, and change in pain from pre- to 1-year posttotal knee arthroplasty.

PURPOSE: The aim of this study was to identify preoperative predictors for 1-year posttotal knee arthroplasty (TKA) pain and pre- to post-TKA pain difference in knee osteoarthritis (KOA) patients. METHODS: From March 2018 to July 2023, this prospective longitudinal cohort study enrolled KOA patients awaiting TKA from four hospitals in Belgium and the Netherlands. Different biopsychosocial predictors were assessed preoperatively by questionnaires and physical examinations (input variables). The Knee injury and Osteoarthritis Outcome Score (KOOS) subscale pain was used to measure pain intensity. The absolute KOOS subscale pain score 1-year post-TKA and the difference score (ΔKOOS = 1-year postoperative - preoperative) were used as primary outcome measures (output variables). Two multivariable linear regression analyses were performed. RESULTS: Two hundred and twenty-three participants were included after multiple imputation. Worse absolute KOOS subscale pain scores 1-year post-TKA and negative or closer to zero ΔKOOS subscale pain scores were predicted by self-reported central sensitisation, lower KOA grade and preoperative satisfaction, and higher glycated haemoglobin, number of pain locations and personal control (adjusted R2 = 0.25). Additional predictors of negative or closer to zero ΔKOOS subscale pain scores were being self-employed, higher preoperative pain and function (adjusted R2 = 0.37). CONCLUSION: This study reports different biopsychosocial predictors for both outcomes that have filtered out other potential predictors and provide value for future studies on developing risk assessment tools for the prediction of chronic TKA pain. PROTOCOL REGISTRATION: The protocol is registered at clinicaltrials.gov (NCT05380648) on 13 May 2022. LEVEL OF EVIDENCE: Level II.

Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care.

BACKGROUND: Preoperative rehabilitation (hereafter called "prehabilitation") has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA). PURPOSE: We aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life. METHODS: A systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting "(randomized controlled) clinical trials or prospective cohort studies" (S) related to the key words "total knee arthroplasty" (P), "preoperative conservative interventions" (I), "pain, function, quality of life and/or satisfaction" (O) were included. RESULTS: After screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a"stratified prehabilitation care" and 12 "non-stratified prehabilitation care". Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals' needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies). CONCLUSION: More research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA. REGISTRATION NUMBER: This systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).

The posterior transtriceps approach for intra-articular elbow diagnostics, definitely not forgotten.

BACKGROUND/AIMS: The elbow is among the most common joints that are aspirated and/or injected. An intra-articular approach should be a convenient and a safe procedure with minimal risk of complications. Several approaches to access the elbow joint have been outlined in the literature, but a comparative study is lacking. This study evaluates the technical feasibility of the lesser-performed posterior transtriceps approach with MR arthrography and compares it to the classic lateral radiocapitellar approach. PATIENTS AND METHODS: Using fluoroscopy guidance, MR arthrographies of the elbow were performed in 51 consecutive patients from 2006 to 2011. A classical lateral radiocapitellar approach was performed in 29 and a posterior transtriceps approach in 22 elbows. Studies were retrospectively reviewed with special attention to the extent of extra-articular contrast extravasation. This was a level IV diagnostic study. RESULTS: Contrast leakage occurred in 12 radiocapitellar approaches, which caused a diagnostic dilemma in one subject. There was only a minimal amount of contrast leakage in five subjects using the transtriceps approach and no diagnostic dilemmas occurred. Results show no significant differences between the approaches. No complications occurred in the posterior transtriceps group and all MR arthrographies were diagnostic. CONCLUSIONS: The posterior transtriceps approach is a technical feasible procedure, is easy to perform, and avoids a diagnostic dilemma in presumed injuries to the lateral collateral ligament complex. Our results show a tendency of even lesser amount of contrast leakage, further promoting a more widespread usage of the posterior transtriceps approach.

Long-term results after ulnar collateral ligament reconstruction of the elbow in European athletes with interference screw technique and triceps fascia autograft.

BACKGROUND: In the last decade, there has been increasing interest in medial ulnar collateral ligament (MUCL) reconstruction techniques for MUCL insufficiency of the elbow. All case series are based on American and Asian Athletes and use primarily a palmaris longus tendon or gracilis tendon as an autograft in reconstructions. A new technique is the interference screw fixation. Evidence that supports the use of this technique is mainly from controlled laboratory studies. The purpose was to evaluate the interference screw technique for MUCL reconstructions in a European, clinical setting, with a triceps tendon fascia autograft. METHODS: Twenty consecutive athletes with diagnosed MUCL insufficiency who underwent a MUCL reconstruction using the interference screw technique were reviewed retrospectively. Indications for reconstruction were medial elbow pain and/or instability caused by insufficiency of the MUCL that prevented the athlete from sport activity after a minimum of 3 months of conservative treatment. RESULTS: At a mean follow-up of 55 months (range, 36-94), the mean Mayo Elbow Performance Index (MEPI) score improved from 82 to 91 points (range, 80-100); P < .001. In the end, 6 patients (30%) quit the sport activities they were preoperatively participating in, all because of reasons unrelated to the MUCL reconstruction. There were excellent results on the Conway scale in 18 patients. CONCLUSION: Good results are reported based on the postoperative MEPI and Conway scores with clinically stable MUCL reconstructions without signs of break-out or fractures on radiographic follow-up. However, the dropout, even after successful reconstruction in European athletes, is high.

Arthroscopic treatment of posterior impingement of the elbow in athletes: a medium-term follow-up in sixteen cases.

HYPOTHESIS: Evaluate the effectiveness of arthroscopic treatment of posterior impingement in the athletes elbow. MATERIALS AND METHODS: 16 elbows were included. An arthroscopic debridement of the posterior fossa of the elbow was performed. All Patients were evaluated preoperatively and after an average of 38 (30-53) months using range of motion, the Modified Andrews Elbow Scoring System (MAESS), VAS in rest and after provocation. RESULTS: The average flexion increased from 138 degrees to 140 degrees . The extension deficit of 8 degrees preoperatively increased to a deficit of average 2 degrees (P < 0.05). The MAESS increased from average preoperative to excellent postoperative (P < 0.05). The average VAS in rest decreased from 3 to 0 and during sporting activities the VAS decreased from 7 to 2 (P < 0.05). DISCUSSION AND CONCLUSION: In this series, arthroscopic debridement of the posterior fossa in athletes with posterior impingement is a procedure that showed excellent mid term results and can therefore be recommended. LEVEL OF EVIDENCE: Level 4; Retrospective case series, no control group.

Treatment of sequelae of radial head fractures with a bipolar radial head prosthesis: good outcome after 1-4 years follow-up in 11 patients.

BACKGROUND: In the presence of additional disruption of the distal radioulnar ligaments, the interosseous membrane, or the lateral- and/or medial collateral ligament, radial head fractures treated by resection will result in valgus elbow instability, proximal radial migration and/or posterolateral rotatory instability. Radial head replacement has been used to treat or prevent this. We report our experience with the Judet CRF II radial head prosthesis. PATIENTS AND METHODS: We treated 11 patients with a bipolar radial head prosthesis because of elbow instability after previous treatment for Mason-Johnston type III or IV radial head fractures. The outcome was assessed clinically using two standardized elbow function assessment scales, and radiographically after a mean follow-up of 2 years. RESULTS: Clinical outcome was either good or excellent in all patients; all elbows were stable. Radiographically, there were no signs of loosening, fracture or heterotopic ossification. 2 patients required reoperation for subluxation of the prosthesis; both were treated by reducing the size of the modular head of the prosthesis. There was erosion of the capitellum in 1 patient. INTERPRETATION: Bipolar radial head replacement can be used successfully for treatment of the sequelae of radial head fractures. The long-term outcome is, however, unknown.

Nonsteroidal anti-inflammatory drugs and acetaminophen in the treatment of an acute muscle injury.

BACKGROUND: Nonsteroidal anti-inflammatory drugs are frequently used to treat muscle injuries in athletes. It is not known whether the anti-inflammatory effects of these drugs are important or whether their effectiveness is a result of their central analgesic effect. HYPOTHESIS: The effects of nonsteroidal anti-inflammatory drugs are no different than the effects of an analgesic (acetaminophen) without anti-inflammatory action in an experimental, acute muscle contusion model. STUDY DESIGN: Controlled animal study. METHODS: A standardized, unilateral, nonpenetrating injury was created to the tibialis anterior muscle of 96 adult male mice. Four treatment groups were used: group 1, placebo treatment; group 2, treatment with rofecoxib, a nonsteroidal anti-inflammatory drug with cyclooxygenase-2 selectivity, and treatment after the injury; group 3, rofecoxib treatment starting 24 hours before the injury; and group 4, acetaminophen treatment after the injury. The muscle and the contralateral normal muscle were evaluated at 2, 5, and 7 days after injury by grading of gait, wet weight as a measure of edema, and histologic evaluation. RESULTS: Group 1 had significantly more gait disturbances at day 2 than all other groups (P < .05). No differences were found at days 5 and 7. Wet weights showed an increase at day 2 in group 1 (P < .01). Again, no differences were found at days 5 and 7. Histology revealed similar inflammatory changes at day 2 in all groups, with regeneration of muscle fibers at days 5 and 7. CONCLUSIONS: The results indicate that rofecoxib as a nonsteroidal anti-inflammatory drug and acetaminophen as a non-nonsteroidal anti-inflammatory drug analgesic have similar effects. The lack of differences in wet weights and histology suggests that the anti-inflammatory effects of rofecoxib are not an important feature of its action. CLINICAL RELEVANCE: The routine use of nonsteroidal anti-inflammatory drugs in muscle injuries may need to be critically evaluated because low-cost and low-risk analgesics may be just as effective.

Knee stability following anterior cruciate ligament rupture and surgery. The contribution of irreducible tibial subluxation.

BACKGROUND: Knee stability after anterior cruciate ligament reconstruction is generally determined by measuring total anteroposterior tibial motion. In spite of a decrease in excessive anteroposterior tibial motion after anterior cruciate ligament reconstruction, problems can still develop. In the present study, we sought to define the tibiofemoral relationship more accurately with use of stress radiographs of human knees after anterior cruciate ligament rupture and after anterior cruciate ligament reconstruction. METHODS: A previously described radiographic technique was used to evaluate the position of the tibia relative to the femur with the application of an anteriorly directed tibial force and subsequently with the application of a posteriorly directed tibial force. Tibial position and total tibial translation were calculated from these radiographs. In addition, KT-1000 measurements were obtained. Three groups of patients were studied: Group 1 included twenty-eight patients with an untreated anterior cruciate ligament rupture, Group 2 included nineteen patients who had undergone a clinically successful anterior cruciate ligament reconstruction, and Group 3 included twenty-five control subjects with normal knees. RESULTS: KT-1000 testing showed that the average side-to-side differences in Group 1 (5.8 mm) and Group 2 (2.7 mm) were significantly different from that in Group 3 (0.8 mm) (p < 0.01 and p < 0.05, respectively). Stress radiographs showed that the average total tibial translation in Group 1 (9.8 mm) was significantly different from those in Group 2 (5.6 mm) and Group 3 (4.3 mm) (p < 0.05 and p < 0.001, respectively). Within Group 1, knees with radiographic signs of osteoarthritis were more stable, with an average total tibial excursion of 6.8 mm. The improved stability of the reconstructed knees in Group 2 and the osteoarthritic knees in Group 1 was not entirely the result of decreased anterior tibial translation; it was, in part, due to an irreducible anterior subluxation of the tibia. A posteriorly directed stress in these knees did not reduce the tibia to the anatomic position relative to the femur; the osteoarthritic knees in Group 1 were 9.9 mm short of full reduction and the knees in Group 2 were 3.1 mm short of full reduction (p < 0.01) CONCLUSIONS: Irreducible tibial subluxation can be present in the knee following surgical reconstruction of the anterior cruciate ligament. Osteoarthritic changes following an untreated anterior cruciate ligament rupture are also associated with uncorrectable tibial subluxation along with a decrease in instability. The irreducible tibial subluxation could explain why osteoarthritic changes still may develop in stable, reconstructed knees in spite of the improved stability. Currently used arthrometric measurements, such as KT-1000 scores, do not measure this phenomenon.