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대한슬관절학회> Knee Surgery & Related Research(구 대한슬관절학회지)> Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy

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Radiologic results of additional single screw fixation with lateral locking plate after hybrid closed-wedge high tibial osteotomy

Nobuyuki Hiraoka , Shuji Nakagawa , Eigo Otakara , Hiroaki Inoue , Kenji Takahashi , Yuji Arai
  • : 대한슬관절학회
  • : Knee Surgery & Related Research(구 대한슬관절학회지) 33권0호
  • : 연속간행물
  • : 2021년 11월
  • : 1-8(8pages)
Knee Surgery & Related Research(구 대한슬관절학회지)

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Background
Methods
Results
Discussion
Conclusions
References

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Background: Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) is an effective surgical treatment for medial compartment osteoarthritis of the knee. Our study investigated whether the combination of a lateral locking plate and a single medial screw promoted bone union after hybrid CWHTO.
Methods: The study cohort consisted of 30 patients (15 men and 15 women) who underwent hybrid CWHTO for medial compartment osteoarthritis or spontaneous osteonecrosis of the knee. Sixteen knees were fixed with a lateral locking plate (LP group), and 17 were fixed with both a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia (LPS group). The times to bone union, radiolucency, and callus formation at the osteotomy site were evaluated radiographically.
Results: The mean postoperative time to radiographic confirmation of bone union was 5.5 ± 2.6 months in the LP group and 3.4 ± 1.5 months in the LPS group. Radiolucency at the osteotomy site and excess callus formation on the posterior side of the tibia were lower in the LPS group than in the LP group.
Conclusions: This modified hybrid CWHTO combining a lateral locking plate and a cannulated cancellous screw on the medial side of the tibia improves the stability of the osteotomy site and shortens the period of bone union.

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간행물정보

  • : 의약학분야  > 정형외과학
  • : KCI등재
  • :
  • : 월간
  • : 2234-0726
  • : 2234-2451
  • : 학술지
  • : 연속간행물
  • : 1989-2021
  • : 1283


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33권0호(2021년 11월) 수록논문
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1Tibial-graft fixation methods on anterior cruciate ligament reconstructions: a literature review

저자 : Vitor Luis Pereira , João Victor Medeiros , Gilvan Rodrigues Silva Nunes , Gabriel Taniguti De Oliveira , Alexandre Pedro Nicolini

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-8 (8 pages)

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Introduction: Anterior cruciate ligament (ACL) reconstruction is the most performed orthopedic surgical procedure.
The result of ACL reconstructions depends on multiple technical variables, including tension to be applied to the graft for fixation, knee-flexion angle during fixation and the type of fixation to the bone.
Objective: To carry out a survey of the literature with the best evidence on these themes.
Methods: Literature review about methods of tibial-graft fixation in ACL reconstructions - tension applied at the time of fixation, type of graft fixation, and knee-flexion degree during tibial fixation.
Results: Thirty studies on the selected topics were found. Most studies point to graft-tension levels close to 90 N to obtain the best results. Regarding the knee-flexion angle, multiple studies suggest that fixation at a 30° angle would bring superior biomechanical advantages. Regarding the type of implant for fixation, it is not possible to affirm the superiority of one method over another in clinical outcomes.
Conclusions: There is no consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension, type of implant and knee-flexion angle. However, the analysis of the studies pointed to certain trends and allowed the drawing of specific conclusions.

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2Clinical outcomes of two-stage revision total knee arthroplasty in infected cases with antibiotic-loaded cement spacers produced using a handmade silicone mold

저자 : Takashi Hoshino , Toshifumi Watanabe , Yusuke Nakagawa , Hiroki Katagiri , Nobutake Ozeki , Toshiyuki Ohara , Mikio Shioda , Yuji Kono , Ichiro Sekiya , Hideyuki Koga

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Purpose: This study assessed the clinical outcomes of periprosthetic joint infection patients who underwent twostage revision total knee arthroplasty with antibiotic-loaded cement spacers fabricated using a handmade silicone mold.
Materials and methods: This study included seven patients (average age 77 years, average follow-up time 54 months) who underwent surgery at our hospital between 2009 and 2013. Clinical outcomes including knee scores, function scores, knee range of motion, and walking ability at the final observation, period from the primary total knee arthroplasty to implant removal, period from implant removal to revision total knee arthroplasty, and followup period after revision total knee arthroplasty were investigated.
Results: At the final follow-up, the average knee range of motion was 99°, with no significant differences at each stage; average knee and function scores were 84 and 77, respectively. With cement spacers, five patients were able to walk with a t-cane. No recurrence of infection was observed.
Conclusions: The clinical outcomes of the current case series demonstrated good knee function with preserved walking ability, without any recurrence of periprosthetic joint infection. This study suggests that using a handmade silicone mold could be an effective option for periprosthetic joint infection after a total knee arthroplasty.

KCI등재

3Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

저자 : Tamer Sweed , Mohamed Mussa , Ahmed El-bakoury , Guido Geutjens , Andrew Metcalfe

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Purpose: The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported.
Methods: A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
Results: A total of nine studies were eligible for review. All nine studies assessed the outcome of arthroscopic debridement of MDACL. A total of 313 knees in 292 patients were included. The mean follow up ranged from 13 to 72 months. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The rate of simultaneous meniscectomy ranged from 13 to 44%. Postoperative pain relief ranged from 53.8 to 95%. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The mean MINORS score was 9.5 out of 16 (4-12).
Conclusions: Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed.
Level of evidence: IV

KCI등재

4Outcomes of human umbilical cord bloodderived mesenchymal stem cells in enhancing tendon-graft healing in anterior cruciate ligament reconstruction: an exploratory study

저자 : Sang Won Moon , Sinhyung Park , Minkyung Oh , Joon Ho Wang

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-10 (10 pages)

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Background: The study investigated whether allogeneic human umbilical cord blood-derived MSCs (hUCB-MSCs) could be safely used without treatment-related adverse events, reducing tunnel enlargement, and improve clinical results in human anterior cruciate ligament (ACL) reconstruction.
Methods: Thirty patients were enrolled consecutively. They were divided into three groups by randomization. In the negative control group, ACL reconstruction surgery without additional treatment was performed. In the experimental group, a hUCB-MSC and hyaluronic acid mixture was applied to the tendon-bone interface of the femoral tunnels during ACL reconstruction surgery. In the positive control group, only hyaluronic acid was applied. Finally, 27 patients were analyzed after the exclusion of three patients. The incidence of treatment-related adverse events, clinical outcomes, including second-look arthroscopic findings, and the amount of tunnel enlargement, were evaluated.
Results: There were no treatment-related adverse events in the treatment groups. Tunnel enlargement in the experimental group (579.74 ± 389.85mm3) was not significantly different from those in the negative (641.97 ± 455.84mm3) and positive control (421.96 ± 274.83 mm3) groups (p = 0.6468). There were no significant differences between the groups in clinical outcomes such as KT-2000 measurement (p = 0.793), pivot shift test (p = 0.9245), International Knee Documentation Committee subjective score (p = 0.9195), Tegner activity level (p = 0.9927), and second-look arthroscopic findings (synovial coverage of the graft, p = 0.7984; condition of the graft, p = 0.8402).
Conclusions: Allogeneic hUCB-MSCs were used safely for ACL reconstruction without treatment-related adverse event in a 2-year follow-up. However, our study did not suggest any evidence to show clinical advantage such as the prevention of tunnel enlargement postoperatively and a decrease in knee laxity or improvement of clinical outcomes.
Trial registration: CRIS, Registration Number: KCT0000917. Registered on 12 November 2013; https://cris.nih.go.kr/ cris/index.jsp

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5Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up

저자 : Müjgan Yilmaz , Christina Enciso Holm , Thomas Lind , Gunnar Flivik , Anders Odgaard , Michael Mørk Petersen

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-13 (13 pages)

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Background: Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years.
Methods: This was a prospective longitudinal cohort study of 29 patients (number of female/male patients 17/12, mean age 65.2 years), received a hybrid Persona® TKA (Zimmer Biomet, Warsaw, IN, USA) consisting of a cemented tibial, an all-polyethylene patella, and uncemented trabecular metal femoral components. Follow up: preoperative, 1 week, and 3, 6, 12 and 24 months after surgery, and double examinations for RSA and DXA were performed at 12 months. RSA results were presented as maximal total point of motion (MTPM) and segmental motion (translation and rotation), and DXA results were presented as changes in BMD in different regions of interest (ROI).
Results: MTPM at 3, 6, 12, and 24 months was 0.65 mm, 0.84 mm, 0.92 mm, and 0.96mm for the femoral component and 0.54 mm, 0.60 mm, 0.64 mm, and 0.68 mm, respectively, for the tibial component. The highest MTPM occurred within the first 3 months. Afterwards most of the curves flattened and stabilized. Between 12 and 24 months after surgery, 16% of femoral components had migrated by more than 0.10mm and 15% of tibial components had migrated by more than 0.2 mm. Percentage change in BMD in each ROI for distal femur was as follows: ROI I 26.7%, ROI II 9.2% and ROI III 3.3%. BMD and at the proximal tibia: ROI I 8.2%, ROI II 8.6% and ROI III 7.0% after 2 years compared with 1 week postoperative results. There was no significant correlation between maximal percentwise change in BMD and MTPM after 2 years.
Conclusion: Migration patterns and changes in BMD related to femoral components after TKA in our study correspond well with previous studies; we observed marginally greater migration with the tibial component.

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7The association between bone mineral density and postoperative drainage volume following cruciate-substituting primary total knee arthroplasty: a cross-sectional study

저자 : Yuthasak Peerakul , Jirapong Leeyaphan , Karn Rojjananukulpong

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Background: The prevalence of osteoporosis in patients who undergo a primary total knee arthroplasty (TKA) is increasing. Low bone mineral density (BMD) is related to unfavorable outcomes following TKA such as migration of uncemented tibial components. Postoperative blood loss in TKA is an important complication. Non-modifying predicting factors for postoperative blood loss in patients undergoing primary TKA need further elucidation. Studies on the association between BMD and blood loss after TKA are limited. We aimed to demonstrate the relationship between BMD and postoperative drainage volume following primary TKA.
Methods: A cross-sectional study was conducted between January 2014 and August 2020. A total of 119 primary varus osteoarthritis knees with BMD results were included in the study. Patients with secondary causes of osteoporosis were excluded.
Results: The median postoperative drainage volume of participants in the normal total hip BMD group and the normal trochanter BMD group was higher than that of patients in the low total hip BMD group and the low trochanter BMD group (285.0 ml vs 230.0 ml, P = 0.003; 282.5 ml vs 240.0 ml, P = 0.013, respectively). Multivariate regression analyses showed that operative time, spinal anesthesia, and normal total hip BMD status were significant predictive factors associated with increased postoperative drainage volume (P = 0.014, 0.022, and 0.013, respectively). No association was identified between the lumbar spine BMD status and postoperative drainage volume.
Conclusions: The relationship between BMD and postoperative blood loss in primary TKA was identified in this study. Normal total hip BMD was found to be associated with an increased postoperative drainage volume after primary TKA compared with low BMD.

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8Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

저자 : Satit Thiengwittayaporn , Nicolaas Budhiparama , Chotetawan Tanavalee , Saran Tantavisut , Rami M. Sorial , Cao Li , Kang-il Kim

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-12 (12 pages)

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9A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus

저자 : Eui Yub Jung , Seongmin Jeong , Sun-kyu Kim , Sung-sahn Lee , Dong Jin Ryu , Joon Ho Wang

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-9 (9 pages)

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Purpose: The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment.
Materials and Methods: We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups.
Results: The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05).
Conclusions: Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.

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10Risk factors for deep vein thrombosis even using low-molecular-weight heparin after total knee arthroplasty

저자 : Joon Kyu Lee , Kee Byoung Lee , Joong Il Kim , Gun Tae Park , Young Chang Cho

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Background: With an increase in deep vein thrombosis (DVT) following total knee arthroplasty (TKA) in the Asian population, most surgeons today use a form of prophylactic anticoagulant agents in patients after TKA. Nevertheless, DVT occasionally develops even in these patients with prophylaxis. The purpose of this study was to identify the risk factors for DVT after TKA in cases of postoperative low-molecular-weight heparin (LMWH) use.
Methods: We designed a retrospective study with 103 patients who underwent primary TKA. From the second postoperative day, 60 mg of LMWH was subcutaneously injected into the patients daily. On the seventh postoperative day, patients had computed tomography angiography to check whether they had DVT. Regarding risk factors, we investigated patients' gender, age, surgical site (unilateral/bilateral), body mass index, method of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status, and prothrombin time/international normalized ratio from electronic medical records. We analyzed the statistical significance of these risk factors.
Results: Statistically significant factors in the single-variable analysis were surgical site (unilateral/bilateral), body mass index, preoperative hypertension status, and anesthesia method. Multiple logistic regression analysis with these factors revealed that the surgical site (unilateral/bilateral, p = 0.024) and anesthesia method (p = 0.039) were significant factors for the occurrence of postoperative DVT after TKA.
Conclusions: Patients undergoing simultaneous bilateral TKAs and patients undergoing TKA with general anesthesia need more attention regarding DVT even with chemoprophylaxis using LMWH after TKA.

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KCI등재

1Tibial-graft fixation methods on anterior cruciate ligament reconstructions: a literature review

저자 : Vitor Luis Pereira , João Victor Medeiros , Gilvan Rodrigues Silva Nunes , Gabriel Taniguti De Oliveira , Alexandre Pedro Nicolini

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-8 (8 pages)

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Introduction: Anterior cruciate ligament (ACL) reconstruction is the most performed orthopedic surgical procedure.
The result of ACL reconstructions depends on multiple technical variables, including tension to be applied to the graft for fixation, knee-flexion angle during fixation and the type of fixation to the bone.
Objective: To carry out a survey of the literature with the best evidence on these themes.
Methods: Literature review about methods of tibial-graft fixation in ACL reconstructions - tension applied at the time of fixation, type of graft fixation, and knee-flexion degree during tibial fixation.
Results: Thirty studies on the selected topics were found. Most studies point to graft-tension levels close to 90 N to obtain the best results. Regarding the knee-flexion angle, multiple studies suggest that fixation at a 30° angle would bring superior biomechanical advantages. Regarding the type of implant for fixation, it is not possible to affirm the superiority of one method over another in clinical outcomes.
Conclusions: There is no consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension, type of implant and knee-flexion angle. However, the analysis of the studies pointed to certain trends and allowed the drawing of specific conclusions.

KCI등재

2Clinical outcomes of two-stage revision total knee arthroplasty in infected cases with antibiotic-loaded cement spacers produced using a handmade silicone mold

저자 : Takashi Hoshino , Toshifumi Watanabe , Yusuke Nakagawa , Hiroki Katagiri , Nobutake Ozeki , Toshiyuki Ohara , Mikio Shioda , Yuji Kono , Ichiro Sekiya , Hideyuki Koga

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Purpose: This study assessed the clinical outcomes of periprosthetic joint infection patients who underwent twostage revision total knee arthroplasty with antibiotic-loaded cement spacers fabricated using a handmade silicone mold.
Materials and methods: This study included seven patients (average age 77 years, average follow-up time 54 months) who underwent surgery at our hospital between 2009 and 2013. Clinical outcomes including knee scores, function scores, knee range of motion, and walking ability at the final observation, period from the primary total knee arthroplasty to implant removal, period from implant removal to revision total knee arthroplasty, and followup period after revision total knee arthroplasty were investigated.
Results: At the final follow-up, the average knee range of motion was 99°, with no significant differences at each stage; average knee and function scores were 84 and 77, respectively. With cement spacers, five patients were able to walk with a t-cane. No recurrence of infection was observed.
Conclusions: The clinical outcomes of the current case series demonstrated good knee function with preserved walking ability, without any recurrence of periprosthetic joint infection. This study suggests that using a handmade silicone mold could be an effective option for periprosthetic joint infection after a total knee arthroplasty.

KCI등재

3Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

저자 : Tamer Sweed , Mohamed Mussa , Ahmed El-bakoury , Guido Geutjens , Andrew Metcalfe

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Purpose: The purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported.
Methods: A systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
Results: A total of nine studies were eligible for review. All nine studies assessed the outcome of arthroscopic debridement of MDACL. A total of 313 knees in 292 patients were included. The mean follow up ranged from 13 to 72 months. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The rate of simultaneous meniscectomy ranged from 13 to 44%. Postoperative pain relief ranged from 53.8 to 95%. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The mean MINORS score was 9.5 out of 16 (4-12).
Conclusions: Arthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed.
Level of evidence: IV

KCI등재

4Outcomes of human umbilical cord bloodderived mesenchymal stem cells in enhancing tendon-graft healing in anterior cruciate ligament reconstruction: an exploratory study

저자 : Sang Won Moon , Sinhyung Park , Minkyung Oh , Joon Ho Wang

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-10 (10 pages)

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Background: The study investigated whether allogeneic human umbilical cord blood-derived MSCs (hUCB-MSCs) could be safely used without treatment-related adverse events, reducing tunnel enlargement, and improve clinical results in human anterior cruciate ligament (ACL) reconstruction.
Methods: Thirty patients were enrolled consecutively. They were divided into three groups by randomization. In the negative control group, ACL reconstruction surgery without additional treatment was performed. In the experimental group, a hUCB-MSC and hyaluronic acid mixture was applied to the tendon-bone interface of the femoral tunnels during ACL reconstruction surgery. In the positive control group, only hyaluronic acid was applied. Finally, 27 patients were analyzed after the exclusion of three patients. The incidence of treatment-related adverse events, clinical outcomes, including second-look arthroscopic findings, and the amount of tunnel enlargement, were evaluated.
Results: There were no treatment-related adverse events in the treatment groups. Tunnel enlargement in the experimental group (579.74 ± 389.85mm3) was not significantly different from those in the negative (641.97 ± 455.84mm3) and positive control (421.96 ± 274.83 mm3) groups (p = 0.6468). There were no significant differences between the groups in clinical outcomes such as KT-2000 measurement (p = 0.793), pivot shift test (p = 0.9245), International Knee Documentation Committee subjective score (p = 0.9195), Tegner activity level (p = 0.9927), and second-look arthroscopic findings (synovial coverage of the graft, p = 0.7984; condition of the graft, p = 0.8402).
Conclusions: Allogeneic hUCB-MSCs were used safely for ACL reconstruction without treatment-related adverse event in a 2-year follow-up. However, our study did not suggest any evidence to show clinical advantage such as the prevention of tunnel enlargement postoperatively and a decrease in knee laxity or improvement of clinical outcomes.
Trial registration: CRIS, Registration Number: KCT0000917. Registered on 12 November 2013; https://cris.nih.go.kr/ cris/index.jsp

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5Bone remodeling and implant migration of uncemented femoral and cemented asymmetrical tibial components in total knee arthroplasty - DXA and RSA evaluation with 2-year follow up

저자 : Müjgan Yilmaz , Christina Enciso Holm , Thomas Lind , Gunnar Flivik , Anders Odgaard , Michael Mørk Petersen

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-13 (13 pages)

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Background: Aseptic loosening is one of the major reasons for late revision in total knee arthroplasty (TKA). The risk of aseptic loosening can be detected using radiostereometric analysis (RSA), whereby micromovements (migration) can be measured, and thus RSA is recommended in the phased introduction of orthopedic implants. Decrease in bone mineral density (BMD), as measured by dual-energy x ray absorptiometry (DXA), is related to the breaking strength of the bone, which is measured concurrently by RSA. The aim of the study was to evaluate bone remodeling and implant migration with cemented asymmetrical tibial and uncemented femoral components after TKA with a follow up period of 2 years.
Methods: This was a prospective longitudinal cohort study of 29 patients (number of female/male patients 17/12, mean age 65.2 years), received a hybrid Persona® TKA (Zimmer Biomet, Warsaw, IN, USA) consisting of a cemented tibial, an all-polyethylene patella, and uncemented trabecular metal femoral components. Follow up: preoperative, 1 week, and 3, 6, 12 and 24 months after surgery, and double examinations for RSA and DXA were performed at 12 months. RSA results were presented as maximal total point of motion (MTPM) and segmental motion (translation and rotation), and DXA results were presented as changes in BMD in different regions of interest (ROI).
Results: MTPM at 3, 6, 12, and 24 months was 0.65 mm, 0.84 mm, 0.92 mm, and 0.96mm for the femoral component and 0.54 mm, 0.60 mm, 0.64 mm, and 0.68 mm, respectively, for the tibial component. The highest MTPM occurred within the first 3 months. Afterwards most of the curves flattened and stabilized. Between 12 and 24 months after surgery, 16% of femoral components had migrated by more than 0.10mm and 15% of tibial components had migrated by more than 0.2 mm. Percentage change in BMD in each ROI for distal femur was as follows: ROI I 26.7%, ROI II 9.2% and ROI III 3.3%. BMD and at the proximal tibia: ROI I 8.2%, ROI II 8.6% and ROI III 7.0% after 2 years compared with 1 week postoperative results. There was no significant correlation between maximal percentwise change in BMD and MTPM after 2 years.
Conclusion: Migration patterns and changes in BMD related to femoral components after TKA in our study correspond well with previous studies; we observed marginally greater migration with the tibial component.

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7The association between bone mineral density and postoperative drainage volume following cruciate-substituting primary total knee arthroplasty: a cross-sectional study

저자 : Yuthasak Peerakul , Jirapong Leeyaphan , Karn Rojjananukulpong

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Background: The prevalence of osteoporosis in patients who undergo a primary total knee arthroplasty (TKA) is increasing. Low bone mineral density (BMD) is related to unfavorable outcomes following TKA such as migration of uncemented tibial components. Postoperative blood loss in TKA is an important complication. Non-modifying predicting factors for postoperative blood loss in patients undergoing primary TKA need further elucidation. Studies on the association between BMD and blood loss after TKA are limited. We aimed to demonstrate the relationship between BMD and postoperative drainage volume following primary TKA.
Methods: A cross-sectional study was conducted between January 2014 and August 2020. A total of 119 primary varus osteoarthritis knees with BMD results were included in the study. Patients with secondary causes of osteoporosis were excluded.
Results: The median postoperative drainage volume of participants in the normal total hip BMD group and the normal trochanter BMD group was higher than that of patients in the low total hip BMD group and the low trochanter BMD group (285.0 ml vs 230.0 ml, P = 0.003; 282.5 ml vs 240.0 ml, P = 0.013, respectively). Multivariate regression analyses showed that operative time, spinal anesthesia, and normal total hip BMD status were significant predictive factors associated with increased postoperative drainage volume (P = 0.014, 0.022, and 0.013, respectively). No association was identified between the lumbar spine BMD status and postoperative drainage volume.
Conclusions: The relationship between BMD and postoperative blood loss in primary TKA was identified in this study. Normal total hip BMD was found to be associated with an increased postoperative drainage volume after primary TKA compared with low BMD.

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8Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

저자 : Satit Thiengwittayaporn , Nicolaas Budhiparama , Chotetawan Tanavalee , Saran Tantavisut , Rami M. Sorial , Cao Li , Kang-il Kim

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-12 (12 pages)

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9A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus

저자 : Eui Yub Jung , Seongmin Jeong , Sun-kyu Kim , Sung-sahn Lee , Dong Jin Ryu , Joon Ho Wang

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-9 (9 pages)

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Purpose: The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment.
Materials and Methods: We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups.
Results: The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05).
Conclusions: Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.

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10Risk factors for deep vein thrombosis even using low-molecular-weight heparin after total knee arthroplasty

저자 : Joon Kyu Lee , Kee Byoung Lee , Joong Il Kim , Gun Tae Park , Young Chang Cho

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 33권 0호 발행 연도 : 2021 페이지 : pp. 1-7 (7 pages)

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Background: With an increase in deep vein thrombosis (DVT) following total knee arthroplasty (TKA) in the Asian population, most surgeons today use a form of prophylactic anticoagulant agents in patients after TKA. Nevertheless, DVT occasionally develops even in these patients with prophylaxis. The purpose of this study was to identify the risk factors for DVT after TKA in cases of postoperative low-molecular-weight heparin (LMWH) use.
Methods: We designed a retrospective study with 103 patients who underwent primary TKA. From the second postoperative day, 60 mg of LMWH was subcutaneously injected into the patients daily. On the seventh postoperative day, patients had computed tomography angiography to check whether they had DVT. Regarding risk factors, we investigated patients' gender, age, surgical site (unilateral/bilateral), body mass index, method of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status, and prothrombin time/international normalized ratio from electronic medical records. We analyzed the statistical significance of these risk factors.
Results: Statistically significant factors in the single-variable analysis were surgical site (unilateral/bilateral), body mass index, preoperative hypertension status, and anesthesia method. Multiple logistic regression analysis with these factors revealed that the surgical site (unilateral/bilateral, p = 0.024) and anesthesia method (p = 0.039) were significant factors for the occurrence of postoperative DVT after TKA.
Conclusions: Patients undergoing simultaneous bilateral TKAs and patients undergoing TKA with general anesthesia need more attention regarding DVT even with chemoprophylaxis using LMWH after TKA.

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