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OBJECTIVE: There is not a standard for rotational alignment of the tibial component in total knee arthroplasty (TKA). For now, the most commonly methods are tibial-tubercle -landmark technique (TTL) and range-of-motion technique (ROM). The study is aimed to compare clinical outcomes and radiographic data of patients who undergone primary TKA with TTL or ROM technique. METHODS: This single-surgeon retrospective cohort study includes 60 patients with TTL technique and 60 with ROM technique from December 2017 to January 2019. All patients were evaluated clinically using Hospital for Special Surgery Knee Score (HSS), Feller patellar score, visual analogue scale (VAS) and maximum knee flexion and extension angle before and after surgery at both 6 months and 12 months postoperatively. Radiographic data contain hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), posterior slope angle (PSA) on pre and postoperative X-ray and rotation angle of femoral component (relative to surgical trans-epicondylar axis) and tibial component (relative to surgical trans-epicondylar axis, tibial posterior condylar line and Akagi') on postoperative computed tomography (CT) scan. Clinical outcomes and radiological data were compared between the two groups. RESULTS: One hundred twenty patients (120 knees) were enrolled in this study, including 38 males and 82 females, aged from 58 to 78, with an average of 65.7 years. There was no significant difference in demographics and preoperative X-ray data between the two groups (P > 0. 05). Clinical scores of the TTL group were better than those in the ROM group at 6 and 12 months after surgery, when comparing HSS (83.57 ± 5.00 vs 75.90 ± 4.89, F = 59.004, P < 0.001; 90.53 ± 4.31 vs 82.83 ± 4.98, F = 54.509, P < 0.001), Feller patellar score (21.43 ± 2.54 vs 19.10 ± 2.52, F = 14.864, P = 0.001; 26.27 ± 1.98 vs 23.20 ± 2.31, F = 42.204, P < 0.001) and VAS (3.70 ± 0.62 vs 4.38 ± 0.92, F = 14.508, P = 0.001; 2.10 ± 0.90 vs 2.79 ± 0.80, F = 11.554, P = 0.002). But there was no significant difference in the flexion and extension angle between the two groups. In imaging evaluation, no statistical difference was found in pre- and postoperative HKA, mLDFA, mMPTA and PSA. Rotational angles of tibial component only did relative to Akagi' have statistical difference in two groups (2.33 ± 4.3 vs 4.41 ± 3.2, t = 2.143, P < 0.05) (Positive value represented external rotation). CONCLUSION: The results of our study showed that both methods were reliable, and TTL technique provided better clinical scores and larger external angle of tibial component, compared to ROM technique.
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Arthroplasty, Replacement, Knee , Humans , Retrospective StudiesABSTRACT
Objective:To explore the risk factors of primary anterior cruciate ligament (ACL) reconstruction failure.Methods:From November 2015 to May 2017, a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years. Twenty-five patients (post-operative failure group) who underwent completely ruptured ACL graft confirmed by MRI, positive pivot-shift test, more than 5 mm side-to-side difference (SSD) measured by KT-1000 arthrometer, more than 5 mm static anterior tibial translation (ATT) measured on MRI were determined to be ACL reconstruction failure. They were matched in a 1∶2 fashion to 50 non-failure patients (post-operative non-failure group), who showed intact ACL graft 2 years after ACL reconstruction. The sex, age, body mass index (BMI), affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration, posterior tibial slope (PTS) and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis. Moreover, the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results:Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group (17.21°±2.20° vs 14.36°±2.72°, t=4.395, P<0.001; 8.29±3.42 mm vs 4.09±3.06 mm, t=5.504, P<0.001). The sex, age, BMI, affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration between the two groups showed no significant difference ( P>0.05). Multivariable Logistic regressions indicated that PTS≥17° ( OR=15.62, P=0.002) and ATT≥6 mm ( OR=9.91, P=0.006) were independent risk factors for primary ACL reconstruction failure. However, sex, age, BMI, meniscal lesions, degree of pivot shift test, KT-1000 SSD were not the independent risk factors. Conclusion:PTS≥17° and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.
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Objective:To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction.Methods:From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m 2 (range 19.4-36.7 kg/m 2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. Results:After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively ( F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ 2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm ( t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm ( t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group ( t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm ( t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). Conclusion:In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.
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Objective To evaluate the impact of sub-stage on the clinical prognosis of T 1 G3 and evaluate the feasibility of the T1me system in pT1G3 sub-staging.Methods The clinical data,pathological specimen and follow-up data were collected from 56 patients out of 87 patients diagnosed with initial high-grade T1 bladder urothelial carcinoma .The patients were divided into Group A [ T1-microinvasive (T1m),17 cases] and group B [T1-extensive-invasive (T1e),39 cases] according to pathological evaluation after transurethral resection.Clinical parameters were analyzed with Chi-square test,and recurrence-free and progression free survival were obtained by Kaplan-Meier analysis and Log-rank test.Results Age,tumor size,number and intravesical instilled medication showed no significant differences between the 2 groups ( P>0.05 ) .There were significant differences of 5-year recurrence-free rate ( P =0.037 ) and progression-free survival rate ( P =0.045 ) between the 2 groups, and the prognosis of group A was significantly better than that of group B .Conclusion The pathological sub-stage is an important predictor in initial high-grade T1 bladder urothelial carcinoma patients , and the T1me system is objective and feasible.
