Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Clinical Results of the Arthroscopic “Multiple Pulled Suture” Technique for Large or Comminuted Bony Bankart Lesion

BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.

Concomitant Osteochondral Autograft Transplantation and Fixation of Osteochondral Fragment for Treatment of a Massive Osteochondritis Dissecans: A Report of 8-Year Follow-up Results

Numerous procedures exist to treat osteochondritis dissecans (OCD); however, it remains a topic of debate which procedure is most ideal. When restoring a massive osteochondral defect, the use of only one procedure may not always allow complete filling of the defect. This case report presents a massive OCD with displaced osteochondral fragment and loose body in the knee joint that occupied almost all of the weight bearing area of the medial femoral condyle and was treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. To our knowledge, this is a rare report on OCD treated with concomitant osteochondral autograft transplantation and fixation of displaced osteochondral fragment. At 8 years after surgery, the clinical outcome was excellent, and radiographs revealed congruence of the medial femoral condyle. The patient returned to sports activities. In massive and complex OCD lesions, individual techniques have limitations. Two or more techniques are needed to increase the rate of success.

Comparison of Magnetic Resonance Imaging of Remnant Preserving versus Remnant Sacrificing Technique after Anterior Cruciate Ligament Reconstruction; Clinical Results and Second-Look Arthroscopic Findings: Pilot Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to clarify the difference between the remnant-preserving and remnant-sacrificing techniques in anterior cruciate ligament (ACL) reconstruction using stress test, functional score, 2nd look arthroscopy and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Among 66 patients having anatomical ACL reconstruction with the fourstrand hamstring autograft using outside-in technique (FlipCutter(R)) for the femoral tunnel from April 2012 to April 2014, 23 patients who underwent 2nd look arthroscopy and MRI were included. The remnant-preserving group included 12 patients and the remnant-sacrificing group included 11 patients. The two groups were compared and analyzed with regard to stability (Stress test using GNRB(R), pivot shift test), functional assessment (International Knee Documentation Committee [IKDC] scale, Lysholm score, one leg hoop test), and the result of second-look arthroscopy and signal to noise quotient (SNQ) ratio of the graft in MRI. RESULTS: The two groups did not differ significantly in the stability test, IKDC scale, and Lysholm test. The remnant-preserving group showed significant improvement in one leg hoop test compared with the remnant-sacrificing group (p0.05). CONCLUSION: More than 12 months after surgery, the graft of the remnant-preserving group showed lower signal intensity compared to that of the remnant-sacrificing group by MRI evaluation. The remnant preserving technique has biological difference compared with the remnant sacrificing technique in human study.

Rupture of the Pectoralis Major Muscle during Exercise / 대한스포츠의학회지

Rupture of the pectoralis major muscle may occur in youngers or athletes associated with extreme sports, especially during the weight training. It is uncommon, but the incidence is increased by the recent growth of athletic population. In young active individuals, ruptures of the pectoralis major muscle have the best results after surgical repair. However, if diagnosis of the pectoralis major muscle rupture is missed or delayed, the patient will be limited to return to sport activity. The object of this paper is to report our experience of pectoralis major muscle rupture in 3 cases.

Recurred Multiple Intraarticular Synovial Hemangioma of the Knee: Case Report / 대한정형외과연구학회지

Synovial hemangioma is a rare benign intraarticular tumor. Synovial hemangioma of the knee joint has unspecific symptoms, which are pain, limitation of motion and hemarthrosis, often seen as an internal derangement of the knee. A 24-year-old woman presented with intermittent joint effusion and pain of the left knee joint and physical examination revealed slight atrophy of the quadriceps and tenderness around lateral joint line of knee. The patient was performed arthroscopic surgery due to synovial hemangioma about 17-years ago. Magnetic resonance imaging (MRI) showed the synovial hemangioma from Hoffa fat pad to anterior aspect of lateral meniscus, and thus surgical treatment was planned. Arthroscopic excision was performed and additional lesion was observed in lateral gutter, suprapatellar pouch of the knee. The biopsy confirmed the diagnosis of synovial hemangiomas. After 3 year, the patient was completely asymptomatic and showed no signs of recurrence.

Treatment of Scapula Fractures of the Inferior Angle Causing Pseudowinging Scapula / 대한정형외과학회잡지

Nonoperative treatment of scapular body fractures has shown good clinical results. Although scapula fractures of the inferior angle, particularly with oblique lines from the medial proximal to lateral distally, are very rare, we believe that such a fracture pattern would be regarded as an avulsion fracture of the serratus anterior muscle requiring surgery. We have experienced three cases demonstrating pseudowinging of the scapula due to displacement of the inferior angle fracture of the scapula. Surgical repair or plating showed satisfactory clinical results. Through these cases, we describe the cause of winging scapula and the problems resulting from an avulsion fracture of the serratus anterior muscle with a review of the relevant literature and explain the reason that an operation is needed for this fracture pattern.

Pulmonary Embolism Complication after Surgical Treatment of Patella Fracture: A Case Report

Deep vein thrombosis and pulmonary embolism are serious and fatal complications in orthopedic surgery. Most cases of symptomatic pulmonary embolism in knee surgery have been reported after total knee arthroplasty, but rarely after patella fracture. We report on a case of symptomatic pulmonary embolism after surgical treatment of a patella fracture in a 42-year-old female patient.

Spinal Canal Migration of a K-Wire Used for Fixation of a Distal Clavicular Fracture / 대한정형외과학회잡지

We report on migration of the K-wire, which is used in fixation of a distal clavicular fracture, to the spinal canal. A 39-year-old male was admitted to our hospital with pain in his right shoulder. He had undergone surgery for a right distal clavicular fracture (in another hospital) ten years ago. Plain radiographs showed an old right distal clavicle fracture fixed with three K-wires. One of the three K-wires had broken, and the broken K-wire had migrated to the spinal canal. Fortunately, the patient exhibited no neurological symptoms, however, there was a possibility of fatal complications, such as spinal cord injury. Therefore, we recommend close follow-up for patients who undergo repair of a distal clavicular fracture is fixed using a K-wire, with use of x-ray until the K-wire has been removed.

Sarcoidosis Presenting as Knee Pain / 대한정형외과학회잡지

Sarcoidosis is a multisystem granulomatous disease of unknown etiology with variable manifestations, which may affect virtually any organ. Muscular sarcoidosis is a rare entity, and among this group of muscular lesions, the mass-like muscular sarcoidosis type is extremely rare. We reported a muscular sarcoidosis case that presented with right knee pain and described the clinical results with an added review of the relevant literature.

Partial Rupture of Semitendinosus Muscle at Satba (Thigh Band) Wearing Area in a Ssireum Athlete / 대한정형외과학회잡지

High load is concentrated on Satba wearing area of Ssireum athletes during the tournament. Muscular injuries in this area may seriously affect the athletic performance. We report a case of a 21-year-old Ssireum athlete who was experiencing pain in his left thigh (Satba wearing area) during a tournament due to the migrating mass effect of a partial ruptured semitendinosus muscle occurred approximately 6 months before. Herein is described the clinical results after surgical intervention with an added review of the relevant literature.

Postoperative Mortality and the Associated Factors in Elderly Patients with Hip Fracture / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the mortality and factors that are related to the mortality in elderly patients with hip fracture. MATERIALS AND METHODS: Between March 2006 and December 2009, 304 patients who were 65 years or older underwent surgery for hip fracture. Among them, 261 patients were available and 43 patients excluded from this study, as they were unable to be evaluated for one year mortality. We analyzed the relationship between the postoperative mortality and the associated factors (age, gender, the type of operation, the type of fracture, method of anesthesia, comorbidity, operation delay). RESULTS: The one year mortality rate for elderly patients with hip fracture was 10.7%. There was no relationships between the postoperative mortality and the type of operation, the type of fracture, and method of anesthesia. However, age, gender, the number of comorbidity, operation delay, and dementia of comorbidity were factors associated with the mortality rate for elderly patients with hip fracture. CONCLUSION: The one year mortality rate for elderly patients with hip fracture was 10.7%. Age, gender, the number of comorbidity, operation delay, and dementia of comorbidity were factors associated with the mortality rate in elderly patients with hip fracture.

Arthroscopic Resection of the Chondroma in the Supraspinatus of the Shoulder / 대한정형외과학회잡지

Soft-tissue chondroma is rare a benign soft-tissue tumor that occurs mainly in hands and feet. There have been no reports of a chondroma in the supraspinatus tendon. We describe the clinical, histological and radiological features of the intratendinous chondroma of the supraspinatus occurring in a 30-year-old man who was managed arthroscopically and a review of the relevant literature review.

Comparison of Clinical Results in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft and Using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon- bone autograft and using fresh-frozen Achilles tendon allograft. MATERIALS AND METHODS: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. RESULTS: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 mm+/-3.0 to 3.2 mm+/-1.9 in the bone-patellar tendon-bone group, and from 7.6 mm+/-3.1 to 2.9 mm+/-2.0 in the Achilles tendon allograft group (p<0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 mm+/-2.5 to 2.0 mm+/-2.1 in the bone-patellar tendon-bone group, and from 6.0 mm+/-3.4 to 2.2 mm+/-2.1 in the Achilles tendon allograft group (p<0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p<0.001). CONCLUSION: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.

The Effect of Intraoperative Periarticular Local Injection in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To assess the effect of intraoperative periarticular local injection in total knee arthroplasty. MATERIALS AND METHODS: We studied 36 patients (72 knees) that underwent bilateral simultaneous primary total knee replacement between October, 2005 and December, 2006. The study group (36 ipsilateral knees) received a 60 ml intraoperative periarticular injection containing a mixture of bupivacaine, epinephrine, morphine, ketorolac, and saline. The injection was made in the posterior capsule and surrounding soft tissues, muscles, and subcutaneous tissues. The control group (36 contralateral knees) did not receive this injection. Postoperative pain levels were evaluated at 2, 8, 24, 48, and 72 hours and 7 and 14 days using the Visual Analogue Scale (VAS). Hemo-vac drains were evaluated at postoperative days 1, 2, 3, 4, and 5. RESULTS: There was no side-to-side difference of VAS in both the study group and the control group according to the side chosen. Preoperative VAS was not significantly different between the two groups. There was a significant decrease in the VAS of the study group patients at 2, 8, 24, 48, and 72 hours postoperative, with the most significant decrease seen at 2 hours. Postoperative bleeding was significantly lower in the study group on the first day, with no difference seen thereafter between the two groups. CONCLUSION: Intraoperative periarticular local injection provides better immediate postoperative pain control in total knee arthroplasty.

Correlation Analysis between Navigation and Radiographic Measurementfor Component Position of Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To examine the correlation between the Navigation and radiographic measurements for the postoperative mechanical axis and component position in total knee arthroplasty. MATERIALS AND METHODS: From December 2005 to May 2006, Navigation assisted MIS TKA was performed on 46 knees of 34 patients. After fixing the components, the mechanical axis (MA) of the lower extremity, femoral component position to the mechanical axis in the coronal plane (theta), tibial component position in the coronal (beta) and sagittal (sigma) planes was measured using the Navigation. Two observers measured the same angles using the postoperative follow-up radiographs. The measurements were compared and the correlation between the Navigation and radiographic measurement was analyzed. RESULTS: The average Navigation measurements were valgus 0.02+/-1.09 degrees for MA, varus 0.05+/-0.96 degrees for theta, valgus 0.02+/-0.86 degrees for beta and 4.03+/-1.25 degrees for sigma. The mean radiographic measurements of observer 1 were valgus 0.71+/-3.73 degrees for MA, valgus 1.14+/-1.72 degrees for theta, valgus 0.90+/-1.47 degrees for beta and 4.51+/-2.03 degrees for sigma. Those of observer 2 were valgus 0.12+/-3.39 degrees, valgus 0.16+/-1.96 degrees, valgus 0.30+/-1.65 degrees and 3.85+/-1.60 degrees, respectively. CONCLUSION: The average of measurement for the component position showed a statistically significant difference in the MA (p=0.001), theta (p=0.000) and beta (p=0.000) among three groups. There were a relatively high correlation between observer 1 and 2 for the radiographic measurements (r=0.67-0.96). However there was a very low correlation between the Navigation and radiographic measurements (r=0.10-0.39). Therefore, the possibility of a difference between the Navigation and radiographic measurement need to be considered when evaluating the component position.

Multiple Rice Bodies in Subacromial Space: A Case Report

Multiple rice bodies are a rare disorder that is most commonly observed in chronic rheumatoid arthritis patients and as a complication of chronic inflammation in the bursa. However, it can occur in the absence of an underlying systemic disorder. Although it resembles synovial chondromatosis clinically and on imaging, the condition can be discriminated by an analysis of the radiographic and MR appearances. We encountered a case of multiple rice body formation with subacromial bursitis on the shoulder of a 37-year old man suffering from pain and motion limitation. The patient was treated by arthroscopic removal of the multiple rice bodies and a subacromial bursectomy. We present this case with a review of the relevant literature.

Mechanoreceptors in the Remnants of Ruptured Anterior Cruciate Ligaments in Human Knees / 대한정형외과학회잡지

PURPOSE: This study was performed to identify the presence of mechanoreceptors in the tibial remnants of injured anterior cruciate ligaments (ACLs) in human knees by immunohistochemistry. MATERIALS AND METHODS: Twenty-one specimens of tibial remnants of ACLs from patients with ACL ruptures were obtained during arthroscopic ACL reconstruction procedures. As a control, two normal ACL specimens were taken from healthy men at the time of traumatic above the knee amputations. The ACL specimens were serially frozen-sectioned at a thickness of 40micrometer. The average number of sections from each specimen was 71.5 (total 1,502) in the remnant group and 132 (total 264) in the control group. Immunohistochemical staining was used for detection of the neural elements. The mechanoreceptors were identified under a light microscope and their locations and amounts were recorded. An independent sample t-test was used for analysis. RESULTS: In the remnants of the ACLs, ten mechanoreceptors were identified in 7 (33.3%) out of 21 cases. Nineteen mechanoreceptors were detected in the two normal ACLs, which demonstrated an even distribution at both the tibial and femoral attachments. There was no significant difference between the MR-present group (7 cases) and the MR-absent group (14 cases) with respect to the number of sections, age, and time from injury to surgery. CONCLUSION: The identification of mechanoreceptors in the remnants of ruptured ACL specimens could support the necessity for the preservation of the tibial remnant during ACL reconstruction to improve joint proprioception.