Combined lateral extra-articular tenodesis and anterior cruciate ligament reconstruction: risk of osteoarthritis.

PURPOSE: Lateral extra-articular tenodesis (LET) procedure, combined with an intra-articular reconstruction of the anterior cruciate ligament (ACL), is used to reduce rotational laxity and the risk of graft failure. However, concern of overtightening of the lateral compartment and subsequent osteoarthritis remains. The aim of this study is to evaluate the degenerative changes in the lateral compartment and to compare the clinical and radiographical results between two LET techniques. METHODS: Eighty-three patients (86 knees) were retrospectively reviewed at a mean of 67.7 months (range 49-85 months). Forty-two knees had an ACL reconstruction combined with a LET procedure according to the modified Lemaire technique and 44 knees according to the modified Coker-Arnold technique. IKDC, Lysholm, Tegner and VAS scores were used. Osteoarthritis was radiographically evaluated by the Kellgren-Lawrence classification. RESULTS: There were 12 patients (28.6%) in the modified Lemaire subgroup and 13 patients (29.5%) in the modified Coker-Arnold subgroup that had doubtful or mild radiologic signs of osteoarthritis. No patients had moderate or severe signs at final follow-up. There was no significant difference in radiological signs of osteoarthritis. In the modified Lemaire subgroup, we report a mean IKDC of 86.31 (± 13.794), a mean Lysholm of 87.83 (± 12.802) and a mean Tegner of 5.38 (± 2.556). In the modified Coker-Arnold subgroup, a mean IKDC of 87.27 (± 11.653), a mean Lysholm of 91.89 (± 8.035) and a mean Tegner of 5.16 (± 2.420) were reported. There were no statistical significant differences between both techniques. In eight patients, a complication was identified, 3 of which had a failure of the ACL reconstruction. CONCLUSIONS: The chosen LET-technique seems to have minimal effect on both the clinical and the radiographic results. The LET is a safe procedure, and it does not increase the risk of osteoarthritis in the lateral compartment.

The biomechanical fingerprint of hip and knee osteoarthritis patients during activities of daily living.

BACKGROUND: Osteoarthritis is a highly prevalent disease affecting the hip and knee joint and is characterized by load-mediated pain and decreased quality of life. Dependent on involved joint, patients present antalgic movement compensations, aiming to decrease loading on the involved joint. However, the associated alterations in mechanical loading of the ipsi- and contra-lateral lower limb joints, are less documented. Here, we documented the biomechanical fingerprint of end-stage hip and knee osteoarthritis patients in terms of ipsilateral and contralateral hip and knee loading during walking and stair ambulation. METHODS: Three-dimensional motion-analysis was performed in 20 hip, 18 knee osteoarthritis patients and 12 controls during level walking and stair ambulation. Joint contact forces were calculated using a standard musculoskeletal modelling workflow in Opensim. Involved and contralateral hip and knee joint loading was compared against healthy controls using independent t-tests (p < 0.05). FINDINGS: Both hip and knee cohorts significantly decreased loading of the involved joint during gait and stair ambulation. Hip osteoarthritis patients presented no signs of ipsilateral knee nor contralateral leg overloading, during walking and stair ascending. However, knee osteoarthritis patients significantly increased loading at the ipsilateral hip, and contralateral hip and knee joints during stair ambulation compared to controls. INTERPRETATION: The biomechanical fingerprint in knee and hip osteoarthritis patients confirmed antalgic movement strategies to unload the involved leg during gait. Only during stair ambulation in knee osteoarthritis patients, movement adaptations were confirmed that induced unbalanced intra- and inter-limb loading conditions, which are known risk factors for secondary osteoarthritis.

The initial learning curve for the ROSA® Knee System can be achieved in 6-11 cases for operative time and has similar 90-day complication rates with improved implant alignment compared to manual instrumentation in total knee arthroplasty.

PURPOSE: The purpose of this study was to determine the learning curve for total operative time using a novel cutting guide positioning robotic assistant for total knee arthroplasty (raTKA). Additionally, we compared complications and final limb alignment between raTKA and manual TKA (mTKA), as well as accuracy to plan for raTKA cases. METHODS: We performed a retrospective cohort study on a series of patients (n = 180) that underwent raTKA (n = 90) using the ROSA Total Knee System or mTKA (n = 90) by one of three high-volume (> 200 cases per year) orthopaedic surgeons between December 2019 and September 2020, with minimum three-month follow-up. To evaluate the learning curve surgical times and postoperative complications were reviewed. RESULTS: The cumulative summation analysis for total operative time revealed a change point of 10, 6, and 11 cases for each of three surgeons, suggesting a rapid learning curve. There was a significant difference in total operative times between the learning raTKA and both the mastered raTKA and mTKA groups (p = 0.001) for all three surgeons combined. Postoperative complications were minimal in all groups. The proportion of outliers for the final hip-knee-ankle angle compared to planned was 5.2% (3/58) for the mastered raTKA compared to 24.1% (19/79) for mTKA (p = 0.003). The absolute mean difference between the validated and planned resections for all angles evaluated was < 1 degree for the mastered raTKA cases. CONCLUSION: As the digital age of medicine continues to develop, advanced technologies may disrupt the industry, but should not disrupt the care provided. This cutting guide positioning robotic system can be integrated relatively quickly with a rapid initial learning curve (6-11 cases) for operative times, similar 90-day complication rates, and improved component positioning compared to mTKA. Proficiency of the system requires additional analysis, but it can be expected to improve over time. LEVEL OF EVIDENCE: Level III Retrospective Therapeutic Cohort Study.

Rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament reconstruction: An online survey.

OBJECTIVES: The primary objective of the study was to investigate rehabilitation strategies of Flemish physical therapists before and after anterior cruciate ligament (ACL) reconstruction. Secondly, we aimed to investigate physical therapists' preferences on continuing education and evaluate their self-rated confidence and competence when treating patients before and after ACL reconstruction. DESIGN: Survey-based study. SETTING: Online survey platform. PARTICIPANTS: Flemish physical therapists (n = 283). MAIN OUTCOME MEASURES: The online survey consisted of a combination of 40 open- and closed-ended questions, divided across 5 sections: (1) participant demographics and clinical practice information, (2) patient population information, (3) continued education practices, (4) rehabilitation strategies, and (5) physical therapist self-rated confidence and competence to treat patients with ACL reconstruction. RESULTS: A wide variability in rehabilitation strategies were found across the whole ACL rehabilitation continuum, which were in general not in line with best available evidence. Nevertheless, the overall self-rated confidence and competence of physical therapists treating patients before and after ACL reconstruction were high. CONCLUSION: Our findings indicate a need to improve rehabilitation practices before and after ACL reconstruction. Advanced research dissemination and implementation are required to achieve better rehabilitation outcomes.

Functional movement assessment by means of inertial sensor technology to discriminate between movement behaviour of healthy controls and persons with knee osteoarthritis.

BACKGROUND: Apart from biomechanical alterations in movement patterns, it is known that movement limitations in persons with knee osteoarthritis (PwKOA) are related to an individual's perception and belief regarding pain and disability. To gain more insights into the functional movement behaviour of PwKOA in a clinical setting, inertial sensor technology can be applied. This study first aims to evaluate the ability of inertial sensors to discriminate between healthy controls (HC) and PwKOA. Secondly, this study aims to determine the relationship between movement behaviour, pain-related factors and disability scores. METHODS: Twelve HC and 19 PwKOA were included. Five repetitions of six functional movement tasks (walking, forward lunge, sideward lunge, ascent and descent stairs, single leg squat and sit-to-stand) were simultaneously recorded by the inertial sensor system and a camera-based motion analysis system. Statistically significant differences in angular waveforms of the trunk, pelvis and lower limb joints between HC and PwKOA were determined using one-dimensional statistical parametric mapping (SPM1D). The Knee injury and Osteoarthritis Outcome Score and TAMPA scale for Kinesiophobia were used to evaluate the relationship between discriminating joint motion, pain-related factors and disability using spearman's correlation coefficients. RESULTS: PwKOA had significantly less trunk rotation, internal pelvis rotation and knee flexion ROM during walking. Additionally, the reduced knee flexion (i.e. at the end of the stance phase and swing phase) was related to increased level of perceived pain. During the sideward lunge, PwKOA had significantly less knee flexion, ankle plantarflexion and hip abduction. This decreased hip abduction (i.e. during stance) was related to higher fear of movement. Finally, PwKOA had significantly less knee flexion during the forward lunge, single leg squat and during ascent and descent stairs. No significant correlations were observed with disability. CONCLUSIONS: Inertial sensors were able to discriminate between movement characteristics of PwKOA and HC. Additionally, significant relationships were found between joint motion, perceived pain and fear of movement. Since inertial sensors can be used outside the laboratory setting, these results are promising as they indicate the ability to evaluate movement deviations. Further research is required to enable measurements of small movement deviations in clinically relevant tasks.

Test-retest reliability and discriminative ability of forward, medial and rotational single-leg hop tests.

BACKGROUND: Single-leg hop tests are commonly performed in the forward direction to evaluate functional performance. However, athletes move in multiple directions during pivoting sports. The first aim of this study was to examine test-retest reliability of single-leg hop tests in the forward, medial and rotational direction in non-injured athletes. Second, the discriminative ability to detect leg asymmetries with these hop tests in anterior cruciate ligament (ACL) reconstructed athletes was determined. METHODS: Sixteen recreational non-injured participants (eight females, eight males; 22.4 ±â€¯1.9 years) were tested twice (one-week interval) and performed the single hop for distance (SH), triple hop for distance (TH), medial side triple hop for distance (MSTH) and 90° medial rotation hop for distance (MRH). Intraclass correlation coefficients (ICCs), standard errors of measurement (SEM) and smallest detectable differences (SDD) were calculated. Discriminative ability was determined in 32 ACL-reconstructed participants (four females, 28 males; 24.4 ±â€¯4.6 years; six months postoperative) who performed the same hop tests once. RESULTS: The ICCs ranged between 0.93 and 0.98. The SEM and SDD were respectively 2.6-4.1% and 7.2-11.3% of the mean hop distance of the group. The proportion (%) of ACL-reconstructed participants passing the ≥90% limb symmetry cut-off was 62.5 (SH), 59.4 (TH), 40.6 (MSTH) and 46.9 (MRH). CONCLUSION: Excellent test-retest reliability of forward, medial and rotational hop tests was found. This allows clinicians to make informed interpretations of changes in hop test distances when retesting athletes. Medial and rotational hop tests are more likely to show limb asymmetries in ACL-reconstructed participants compared to forward hop tests.

The Role of the Posterolateral Tibial Slope in the Rotational Instability of the Knee in Patients Affected by a Complete Isolated Anterior Cruciate Ligament Injury: Its Value in the Decision-Making Process during the Anterolateral Ligament Reconstruction.

Purpose The aim of this retrospective, multicenter study was to investigate the correlation between a high degree of rotatory instability, posterolateral tibial slope (PLTS), and anterolateral ligament (ALL) injury. Methods The study population consisted of 76 adults with isolated, complete noncontact anterior cruciate ligament (ACL) tear. The sample was divided into two groups according to the preoperative degree of rotator instability (group A: pivot-shift test grades 2 and 3; group B: pivot-shift test grade 1). Preoperative magnetic resonance imaging (MRI) assessment included angle of PLTS, posterior shift of the lateral femoral condyle (16 mm) on the tibial plateau, and the presence/absence of ALL injury. The two groups were compared for differences. Results There was a statistically significant association between pivot-shift test grades 2 and 3 (group A), PLTS slope angle > 9 degrees, and ALL injury ( p < 0.05). Group A also demonstrated a greater posterior shift of lateral femoral condyle (>11 mm), which was, however, not statistically significant when evaluated as an isolated variable. Conclusion Our study indicates that an increased PLTS is associated with an increased incidence of ALL injury and an increased grade of pivot shift in patients with ACL tear. Assessment of posterolateral tibial slope on MRI can therefore play a key adjunct role in the surgical planning of ALL reconstruction, especially in cases when ALL damage is radiologically difficult to detect or doubtful. Level of Evidence This is a retrospective comparative level III study.

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study.

BACKGROUND: The objective of this study was to describe changes in cerebral tissue oxygen saturation (SctO2) due to changes in body position in healthy volunteers and in patients undergoing surgery under general anesthesia in the beach chair position (BCP) and lateral decubitus position (LDP). METHODS: In this prospective observational study, SctO2 was measured in 85 awake volunteers serially positioned every 15 min, beginning with the supine position (SP) and followed by the beach chair, supine, and lateral decubitus positions. Cerebral tissue oxygen saturation was also measured supine and in either the BCP or the LDP in 195 patients (according to surgical preference) undergoing elective arthroscopic shoulder surgery. We measured the lowest stable SctO2 values in each position as well as changes in blood pressure and heart rate. RESULTS: In healthy volunteers, the median (interquartile range [IQR]) lowest stable SctO2 value in the SP was 69 [66-71] %. A change in position to the BCP caused a small but statistically significant decrease in the median [IQR] lowest SctO2 value to 67 [65-70] % (P = 0.028 compared with baseline). This decrease was associated with an increase in median [IQR] arterial pressure from 83 [78-88] mmHg in the SP to 85 [81-93] mmHg in the BCP (P < 0.001 compared with baseline). In patients undergoing surgery in the BCP, the median [IQR] lowest stable SctO2 value was 55 [51-59] %, which was significantly lower (P < 0.001) than the median [IQR] lowest SctO2 value in patients in the LDP (66 [62-69] %). More patients in the BCP group (57%) showed SctO2 values ≤ 55% and/or a decrease of ≥ 20% from baseline (57%) compared with the LDP group (5% and 6%, respectively; P < 0.001 for each comparison). CONCLUSIONS: More than 55% of patients undergoing arthroscopic shoulder surgery in the BCP experience cerebral desaturation events. In volunteers without anesthesia, no desaturation events were observed. The clinical importance of these findings needs further investigation.

High-energy bilateral knee dislocations in a young man: a case report.

Bilateral knee dislocations are rare. We report one such case in a 22-year-old man. His clinical presentation, radiographical findings, and the operative and non-operative treatments are discussed, with emphasis on the timing of treatment and rehabilitation.

The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate.

In a retrospective study, 12 patients with acute acromioclavicular dislocation Tossy stage III were reviewed after operative treatment with a clavicle hook plate. Mean follow-up time was 20 months. Clinical and radiographic results were reviewed. Clinical outcome was superior to the radiographic results. Some questions about this technique remain open.