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대한슬관절학회> Knee Surgery and Related Research (Knee Surg Relat Res)> Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review

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Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review

Suraj Kohli , Jonas Schwenck , Ian Barlow
  • : 대한슬관절학회
  • : Knee Surgery and Related Research (Knee Surg Relat Res) 34권0호
  • : 연속간행물
  • : 2022년 08월
  • : 1-9(9pages)
Knee Surgery and Related Research (Knee Surg Relat Res)

DOI


목차

Introduction
Methods
Outcomes
Results
Discussion
Conclusion
Declarations
References

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Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds.
Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature.
Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3-31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0-11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI.
Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.

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간행물정보

  • : 의약학분야  > 정형외과학
  • : KCI등재
  • :
  • : 월간
  • : 2234-0726
  • : 2234-2451
  • : 학술지
  • : 연속간행물
  • : 1989-2023
  • : 1335


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1Acceptable clinical outcomes despite high reoperation rate at minimum 12-month follow-up after concomitant arthroscopically assisted anterior cruciate ligament reconstruction and medial meniscal allograft transplantation

저자 : Dhruv S. Shankar , Kinjal D. Vasavada , Amanda Avila , Brittany Declouette , Hadi Aziz , Eric J. Strauss , Michael J. Alaia , Laith M. Jazrawi

발행기관 : 대한슬관절학회 간행물 : Knee Surgery and Related Research (Knee Surg Relat Res) 35권 0호 발행 연도 : 2023 페이지 : pp. 1-12 (12 pages)

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Background Single-stage medial meniscus allograft transplantation (MAT) with concomitant anterior cruciate ligament reconstruction (ACLR) is a technically challenging procedure for management of knee pain and instability in younger patients, but clinical and functional outcomes data are sparse. The purpose of this study was to assess surgical and patient-reported outcomes following concomitant ACLR and medial MAT.
Methods We conducted a retrospective case series of patients who underwent medial MAT with concomitant primary or revision ACLR at our institution from 2010 to 2021 and had minimum 12-month follow-up. Complications, reoperations, visual analog scale (VAS) pain, satisfaction, Lysholm score, return to sport, and return to work outcomes were assessed. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Pain Intensity, and Physical Function Scores were used to measure patients' functional status relative to the US population. P-values < 0.05 were considered significant.
Results The cohort consisted of 17 knees of 16 individual patients. The cohort was majority male (82.4%) with mean age of 31.9 years (range 19-49 years) and mean body mass index (BMI) of 27.9 kg/m2 (range 22.5-53.3 kg/m2). Mean follow-up time was 56.8 months (range 13-106 months). Most patients underwent revision ACLR (64.7%). The 1-year reoperation rate was high (23.5%), with two patients (11.8%) tearing their meniscus graft. Patient-reported outcomes indicated low VAS pain (mean 2.2), high satisfaction (mean 77.9%), and fair Lysholm score (mean 81.1). Return to work rate was high (92.9%), while return to sport rate was low (42.9%). Postoperative PROMIS scores were comparable or superior to the national average and correlated significantly with patient satisfaction (p < 0.05).
Conclusions The concomitant ACLR and MAT procedure is associated with excellent knee pain and functional outcomes and high rate of return to work after surgery, though the 1-year reoperation rate is high and rate of return to sport is low.

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2Radiographic measurement of the congruence angle according to Merchant: validity, reproducibility, and limits

저자 : M. Severyns , J. Mallet , B. Santoni , T. Barnavon , A. Germaneau , T. Vendeuvre , M. Drame

발행기관 : 대한슬관절학회 간행물 : Knee Surgery and Related Research (Knee Surg Relat Res) 35권 0호 발행 연도 : 2023 페이지 : pp. 1-6 (6 pages)

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Purpose The objective of this study was to analyze the intra- and interobserver variability of this measurement according to a strict methodology and on a representative sample of the general population, as well as to identify the possible difficulties of measurement in case of patellar or trochlear dysplasia.
Methods This observational study involved radiographic analysis by three independent observers of a total of 50 patients who had a loaded patellofemoral X-ray taken with the knee flexed to 45°. An initial reading was taken to measure the angle of the trochlear sulcus, the Merchant angle, and to classify the knees according to a possible trochlear dysplasia and/or patellar dysplasia according to Wiberg. A second measurement was then performed to analyze intraobserver agreement. Interobserver agreement was measured on all radiographic measurements (n = 100).
Results The Merchant patellofemoral congruence angle showed good intraobserver concordance ranging from 0.925 (95% CI 0.868-0.957) to 0.942 (95% CI 0.898-0.967), as well as interobserver concordance ranging from 0.795 (95% CI 0.695-0.862) to 0.914 (95% CI 0.872-0.942). Poor results were found in terms of interobserver concordance on the measurement of the Merchant angle in case of stage 3 Wiberg patella ranging from 0.282 (95% CI -0.920 to 0.731) to 0.611 (95% CI 0.226-0.892).
Conclusion Congruence angle is one of most commonly used measurements for patellar tracking. However, the convexity of the patellar surface makes it difficult to identify the patellar apex on its intraarticular facet, making the measurement of the Merchant congruence angle unreliable and not very reproducible in cases of stage 3 Wiberg patella.

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1Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation

저자 : Jussi P. Repo , Mikko M. Uimonen , Mika T. Nevalainen , Heikki Nurmi , Ville T. Ponkilainen , Antti Tuominen , Juha Paloneva

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Purpose: We examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation.
Methods: Patients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS).
Results: During 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures.
Conclusion: The removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The shortterm outcomes are encouraging.
Level of evidence: Level IV, retrospective case series.

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2The use of tantalum cones and diaphyseal-engaging stems in tibial component revision: a consecutive series

저자 : P. Spinello , R. A. Ruberte Thiele , K. Zepeda , N. Giori , P. F. Indelli

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Introduction: Revision knee arthroplasty presents a number of challenges, including management of bone loss. The goal in managing moderate to large bone defects is fixation that is sufficient enough to allow early weight-bearing. The purpose of this study was to describe the surgical technique and clinical and radiographic outcomes of patients treated with porous tantalum metaphyseal cones in combination with long uncemented diaphyseal-engaging stems to manage tibial bone loss in revision total knee arthroplasty (TKA).
Materials and methods: Thirty-six aseptic revision TKAs were performed at our institution between 2016 and 2019 by two senior authors. A single trabecular metal tantalum cone combined with a long (100 or 155 mm) press fit, diaphyseal- engaging stem was used in all cases to reconstruct metaphyseal bone defects and to augment tibial fixation. Cemented stems were excluded. The tibiofemoral angle was measured along the tibial and femoral shaft axes on the weight-bearing anteroposterior radiograph at final follow-up (range 15-56 months). All clinical and surgical complications, reoperations, and revisions of any component were recorded. Survivorship free of revision was evaluated at the time of the latest follow-up.
Results: The mean Knee Society Score (KSS) and Knee Society Function Score (KSS-F) improved significantly from 29.7 points preoperatively (range 11-54 points) to 86 points (range 43-99 points) and from 20.4 points preoperatively (range 0-55 points) to 72.3 points (range 30-90 points) (p < 0.05), respectively. Eleven tibial constructs (30.5%) had incomplete, nonprogressive radiolucent lines (≤ 2 mm). All tibial cones demonstrated osteointegration. One patient underwent a full revision for periprosthetic joint infection, and survivorship free of any component revision was 91.7% at final follow-up.
Conclusions: Hybrid fixation with uncemented diaphyseal-engaging stems and porous tantalum metaphyseal cones resulted in radiographic lack of osteolysis, good clinical outcomes, and survivorship of 91.7% at a median follow-up of 33 months when considering all-cause revision as the endpoint.

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3Agreement and accuracy of radiographic assessment using a decision aid for medial Oxford partial knee replacement: multicentre study

저자 : Takafumi Hiranaka , Ryosuke Furuhashi , Kenichiro Takashiba , Takao Kodama , Kazuhiko Michishita , Hiroshi Inui , Eita Togashi

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Indication for mobile-bearing partial knee replacement (PKR) is made on the basis of a radiological decision aid. This study aimed to reveal the inter-rater reproducibility and accuracy of the decision aid when used by experienced surgeons.
Patients and methods: Anonymised radiographic image sets (anteroposterior, lateral, varus/valgus stress in 20° knee flexion, and skyline views) from 20 consecutive patients who underwent knee replacement were assessed by 12 experienced surgeons. Agreements of each section and accuracy were compared by intra-operative inspection of the status of the anterior cruciate ligament (ACL) and medial and lateral cartilage according to the protocol of Radiographic Assessment for Medial Oxford PKR. Fleiss' kappa (κ) values were used as a statistical measure.
Results: Full-thickness medial cartilage had the best agreement between the surgeons (κ = 94.7%) and best accuracy (94.2%). Although functioning ACL (90.8%), intact cartilage (91.7%) and full-thickness lateral cartilage defects (86.1%) were accurately diagnosed, diagnoses of deficient ACL (up to 42.5%) and partial-thickness lateral cartilage defects (11.7%) were poor; they were sometimes misdiagnosed as being intact. Moreover, agreement of lateral and valgus stress radiographs regarding intact MCL function, as well as the overall decision, was considered to be inadequate (κ = 0.47, 0.58 and 0.51, respectively).
Conclusions: Although the radiological aid is useful for selection of patients who are likely to be suitable for PKR, surgeons should still carefully assess the lateral weight-bearing area for partial-thickness loss and deficiency of the ACL because they were sometimes overlooked by surgeons using radiographs. MRI will be helpful to improve the accuracy of determination of Oxford PKR indication.

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4Correction to: Botulinum toxin injections as a salvage therapy is beneficial for management of patellofemoral pain syndrome

저자 : Yuval Kesary , Vivek Singh , Tal Frenkel , Rutenberg , Arie Greenberg , Shmuel Dekel , Ran Schwarzkopf , Nimrod Snir

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-2 (2 pages)

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5Failure rates and clinical outcomes of synthetic meniscal implants following partial meniscectomy: a systematic review

저자 : Suraj Kohli , Jonas Schwenck , Ian Barlow

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-9 (9 pages)

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Background: Meniscal injury is one of the most common indications for knee surgery. The advent of meniscal repair techniques has facilitated meniscal preservation in suitable cases. Meniscal substitution with scaffolds may be advantageous following partial meniscal resection. There are three main scaffolds in current clinical use; Collagen Meniscal Implant (CMI Stryker Corporation, Kalamazoo, MI, USA), Actifit (Actifit, Orteq Ltd, London, UK) and NUsurface (Active Implants, LLC). The purpose of this systematic review was to compare clinical outcomes and failure rates of patients who have had implantation with these meniscal scaffolds.
Methods: MEDLINE and EMBASE databases were searched for studies that included patients who had surgical implantation with Actifit or CMI. Eligibility criteria included papers that described both clinical outcomes and failure rates of these implants, a mean follow up of 5 years and studies published in English. A Google search was also performed to identify any grey literature.
Results: Five Level IV studies were found for Actifit. One Level II, one Level III and four Level IV studies were found for the CMI implant. One Level II study was identified for the NUsurface scaffold with a follow-up 12 months and was included for completeness. Overall, 262 patients were treated with Actifit, 109 with CMI and 65 with NUsurface. Failure rates for Actifit were 18% (range 6.3-31.8%) with a mean follow up of 66.8 months, and for CMI 6.5% (range 0-11.8%) with a mean follow up of 97.1 months. The NUsurface failure rate was 16.9% at 12 months. Clinical outcomes such as VAS, Tegner and Lysholm scores improved significantly post-operatively. However, there was a high volume of concurrent procedures, such as anterior cruciate ligament reconstructions and high tibial osteotomies in each study group; 118 (45%) for Actifit and 53 (45%) for CMI.
Conclusion: The evidence for meniscal scaffold use is insufficient to suggest that they could potentially improve clinical outcomes in patients post-meniscal resection. This is largely due to the high proportion of concurrent procedures performed at index procedure for both CMI and Actifit. On the basis of current evidence, the use of meniscal scaffolds as a sole treatment for partial meniscal defects cannot be recommended, owing to the relatively high failure rate and paucity of clinical data.

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6A comparison of healing and complication rates between common flaps utilized in total knee arthroplasty: a review of the literature

저자 : Akhil A. Chandra , Filippo Romanelli , Alex Tang , Luke Menken , Maximilian Zhang , Adam Feintisch , Frank A. Liporace , Richard S. Yoon

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-14 (14 pages)

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Background: Flap reconstruction with perforator, fasciocutaneous, muscular, and/or free microvascular flaps is utilized to cover wound defects and improve vascularization and antibiotic/nutrient delivery. Flap use in revision procedures for total knee arthroplasty has been explored previously; however, current data are limited and studies comparing healing and complication rates between different flap types are lacking.
Methods: A literature review was performed using PubMed on 13 January 2022. Studies were included if they reported healing and complication rates for either gastrocnemius, rectus abdominis, latissimus dorsi, fasciocutaneous, chimeric, or gracilis flaps in the setting of revision total knee arthroplasty (TKA).
Results: The final cohort included gastrocnemius (n = 421, healing rate 73.8%, complication rate 59.9%), gracilis (n = 9, healing rate 93%, complication rate 55.6%), latissimus dorsi (n = 41, healing rate 67%, complication rate 46.3%), rectus abdominis (n = 3, healing rate 100%, complication rate 0%), fasciocutaneous (n = 78, healing rate 70%, complication rate 19.2%), and chimeric flaps (n = 4, healing rate 100%, complication rate 25%). There was no significant difference when comparing healing rates across flap types (p = 0.39). There was a significant difference when comparing complication rates across flap types (p < 0.0001), with a significant difference being noted between gastrocnemius and fasciocutaneous complication rates (p < 0.0001). All other comparisons between flap types by complication rate were not significantly different.
Conclusions: Gastrocnemius flaps are the workhorse flap in the setting of revision TKA, as evidenced by this review. Healing rates did not vary significantly across flap types, which suggests that determining the appropriate flap for coverage of soft-tissue defects in revision TKA should be driven by defect size and location as well as physician experience and patient tolerance.

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7Implant survivorship, functional outcomes and complications with the use of rotating hinge knee implants: a systematic review

저자 : Joshua Xu , Lennart Von Fritsch , Shiraz A. Sabah , Andrew J. Price , Abtin Alvand

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-11 (11 pages)

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Background: With more complex primary and revision total knee arthroplasty procedures there is often the need to use more constrained prostheses. This study aims to investigate patient-relevant outcomes following primary and revision rotating-hinged total knee arthroplasty.
Methods: Electronic searches were performed using four databases from their date of inception to January 2021. Relevant studies were identified, with data extracted and analysed using PRIMSA guidelines.
Results: Nineteen studies were included, producing a cohort of 568 primary and 413 revision rotating hinge total knee arthroplasties (TKAs). Survival was assessed at 1-, 5-, and 10-year post-implantation. Sensitivity analyses based on person-time incidence ratios (PTIRs) were prespecified for studies not reporting survival at these timepoints. From the primary hinge TKA cohort, the median survival at 1 year was 93.4% and at 10 years it was 87%. The PTIR at long-term follow-up of this primary cohort was 1.07 (95% CI 0.4-1.7) per 100 person-years. From the revision hinge TKA cohort, the median survival at 1 year was 79.6%, and at 10 years it was 65.1%. The PTIR at long term-follow-up of this revision cohort was 1.55 (95% CI 0.9-2.3) per 100 person-years. Post-operative flexion range of motion (ROM) was 110° for primary hinge TKA and 103° for revision hinge TKA. Compared with baseline, the Knee Society Score (KSS) and Knee Society Function Score (KSFS) improved for both groups post-operatively (primary: KSS 17 to 86, KSFS 28 to 58; revision: KSS 37 to 82, KSFS 34 to 61).
Conclusion: The quality of the evidence for patient-relevant outcomes following hinged knee arthroplasty was limited. While there is the potential for high early revision rates, where successful, large functional benefits may be achieved.

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8Evaluation of the flexion gap with a distal femoral trial component in posterior-stabilized total knee arthroplasty

저자 : Goki Kamei , Shigeki Ishibashi , Koki Yoshioka , Satoru Sakurai , Hiroyuki Inoue , Yu Mochizuki , Masakazu Ishikawa , Nobuo Adachi

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Purpose: A distal femoral trial component was manufactured, and flexion gap size and inclination were evaluated with or without the distal femoral trial component in total knee arthroplasty (TKA). This study aimed to evaluate the effect of the distal femoral trial component on flexion gap size and joint inclination in posterior-stabilized (PS)-TKA.
Materials and methods: A total of 84 patients with medial osteoarthritis who underwent mobile-bearing PSTKA using modified gap techniques were included in this retrospective study. The flexion gap size and inclination before and after setting the distal femoral trial component were evaluated and compared with the final gap size and inclination.
Results: The joint gap size and inclination were significantly lower in those with than in those without the distal femoral trial component (P = 0.005, P < 0.001). The final gap size and inclination were similar to the gap size and inclination with the distal trial component (P = 0.468, P = 0.158).
Conclusions: The joint gap size and medial tension in PS-TKA were significantly reduced after setting the distal femoral trial component. The flexion gap measured using the distal femoral trial component was similar to that when the final trial component was set. To more accurately perform the gap technique TKA, the flexion gap should be measured using the distal femoral trial component.

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9Outside-in technique versus inside-out semitendinosus graft harvest technique in ACLR: a randomised control trial

저자 : Silvampatti Ramasamy Sundararajan , Rajagopalakrishnan Ramakanth , Amit Kumar Jha , Shanmuganathan Rajasekaran

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-8 (8 pages)

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Background: Paraesthesia after hamstring graft harvest is a ubiquitous complication in the early post-operative period, and its correlation with vertical versus horizontal skin incision are well documented. The purpose of the study is to evaluate the incidence and extent/area of sensory loss of saphenous nerve branches occurring with the outsidein (OI) versus inside-out technique (IO) of semitendinosus graft harvest from the sartorius fascia and to determine a better method of graft harvest.
Methods: Sixty patients who underwent isolated semitendinosus graft harvest during anterior cruciate ligament reconstruction (ACLR) between 2016 and 2017. Patients were randomised into two groups depending on the graft harvest technique: 30 in the OI group and 30 in the IO group. The area of sensory loss was mapped on the patients' skin using tactile feedback from the patients at each follow-up (10 days, 1 month, 3 months, 6 months and 1 year). Then, the area of sensory changes for the infrapatellar branch (IPBSN) and sartorial branch (SBSN) of the saphenous nerve, incision length, graft harvest duration, and graft length were analysed statistically between the groups.
Results: In groups 1 and 2, 18/30 (60%) and 19/30 (63%) of patients, respectively, developed sensory changes, with no significant difference between the groups (p = 0.79). Isolated SBSN and IPBSN paraesthesia occurred in 2/60 (3%) and 19/60 (32%), respectively. Combined SBSN and IPBSN paraesthesia was present in 16/60 (27%) of patients. There was no significant difference in the area of the sensory deficit between OI and IO groups on the 10th post-operative day or at 1-month, 3-month or 1-year follow-up (p = 0.723, p = 0.308, p = 0.478, p = 0.128, respectively). However, at 6-month follow-up, the area of paraesthesia was significantly higher in the IO group (p = 0.009). The length of incision and duration of graft harvest was higher in the OI group than in the IO group (p = 0.002 and p = 0.007, respectively), and the total length of the graft was greater in the IO group (p = 0.04).
Conclusion: Incidence is equally distributed, area of iatrogenic saphenous nerve injury gradually decreases, and recovery is seen in the majority of the patients in both graft harvest techniques. IO graft harvesting technique is better in terms of graft harvest time and cosmetics and yields longer graft; however, area of paraesthesia, though not significant, was two-fold higher than the OI technique at 1-year follow-up.
Clinical relevance: IO graft harvest technique would enable the surgeon to adopt quicker graft harvest, smaller surgical scar and lengthier graft than the OI technique.
Level of evidence: Therapeutic randomised controlled prospective study, Level II.

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10Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

저자 : Moon Jong Chang , Du Hyun Ro , Tae Woo Kim , Yong Seuk Lee , Hyuk-soo Han , Chong Bum Chang , Seung-baik Kang , Myung Chul Lee

발행기관 : 대한슬관절학회 간행물 : Knee Surgery & Related Research(구 대한슬관절학회지) 34권 0호 발행 연도 : 2022 페이지 : pp. 1-7 (7 pages)

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Background: We sought to determine (1) the success rate of debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) of the knee in patients with acute postsurgical infection and in those with acute hematogenous infection via a multicenter study, (2) the factors related to the failure of DAIR for overall acute PJI and acute hematogenous PJI via subgroup analysis, and (3) whether the PJI recurrence patterns differed between the two groups over time after DAIR.
Methods: This retrospective multicenter study included 101 acute knee PJI. Acute postsurgical PJI was defined as PJI diagnosed < 3 months following initial knee arthroplasty surgery. DAIR was performed for 34 cases of acute postsurgical PJIs (postsurgical group) and 67 cases of acute hematogenous PJIs (hematogenous group). The success rates between groups were compared, and factors related to DAIR failure were analyzed.
Results: The overall success rate of DAIR was 77%. The success rate tended to be higher in the postsurgical group than in the hematogenous group (p = 0.060). However, there was no significant factor related to DAIR failure in the subgroup analysis of acute hematogenous PJIs. In the postsurgical group, the recurrence of PJI occurred until 3 months, whereas in the hematogenous group, recurrence occurred for up to 2 years.
Conclusions: The failure rate tended to be higher in the acute hematogenous PJI group than in the acute postsurgical PJI group. Since acute hematogenous infections may recur for a longer period than postsurgical infections, careful follow-up is required after DAIR.

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