Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial.

BACKGROUND: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). OBJECTIVE: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. METHOD: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. RESULTS: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05). CONCLUSION: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.

The anterolateral ligament of the human knee: an anatomic and histologic study.

PURPOSE: The functional anatomy of the knee is frequently studied but remains incompletely understood. Numerous authors have described a structure in the lateral knee connecting the lateral femoral condyle with the lateral meniscus and tibial plateau. The goal of this study is to define the incidence, anatomy, and histology of this structure, the anterolateral ligament. METHODS: The incidence of the ligament was determined in 30 consecutive patients undergoing total knee arthroplasty (TKA) for medial compartment osteoarthritis. The anatomy and histology were evaluated using 10 cadaveric knees. RESULTS: The anterolateral ligament was noted to be present in all 40 knees. In all cases, it was noted to take origin near or on the popliteus tendon insertion and insert into the lateral meniscus and tibial plateau 5 mm distal to the articular surface and posterior to Gerdy's Tubercle. The average width of the relatively flat structure was 8.2 ± 1.5 mm, and the average length was 34.1 ± 3.4 mm. Histologic analysis revealed a discreet structure with a fibrous core surrounded by synovium. Fibers blended with the popliteus at its origin and with the lateral meniscus as it passed distally. CONCLUSIONS: The anterolateral ligament may play a role in preventing anterior tibial translation. The role, if any, of this structure in meniscal stability and the pathology of meniscal tears remain unclear. LEVEL OF EVIDENCE: Not applicable-Descriptive Anatomic Study.

Distraction osteogenesis using a longitudinal corticotomy.

PURPOSE: The purpose of this study was to evaluate whether the use of a longitudinal corticotomy (S-Z osteotomy) results in more rapid consolidation following distraction osteogenesis of short tibiae. METHODS: Sixty-seven lengthening procedures were performed in 51 patients ranging in age from nine to 38 (mean 25) years. Diagnoses included short stature (32 tibiae), postpolio limb deformity (22 tibiae), osteomyelitis (three tibiae), trauma (two tibiae) and other diagnoses (eight tibiae). Forty-five lengthenings were performed via a longitudinal corticotomy, and 22 were performed via a transverse corticotomy. Patients were followed until consolidation of the regenerated bone was noted radiographically (consolidation time). The healing index (consolidation time per centimetre of lengthening) was calculated for each patient and compared between groups. RESULTS: The healing index was significantly lower in the S-Z group (30.8 ± 9.6 days/cm) than in the transverse corticotomy group (46.8 ± 20.2 days/cm) (p < 0.0001). Mean lengthening was 6.6 (range 2.5-12.5) cm in the S-Z group and 5.8 (range 2.0-12.0) cm in the transverse group (p = 0.28). Mean consolidation time was 6.3 ± 2.8 (range 3-16) months in the S-Z group and 8.1 ± 3.8 (range 3-13.5) months in the transverse group (p = 0.03). CONCLUSION: The S-Z osteotomy safely reduces consolidation time of regenerative bone during distraction osteogenesis in the tibia relative to a transverse corticotomy.