3,133 research outputs found
A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions
No full textA new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft, leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament.Smeets, K (corresponding author), GRIT Belgian Sports Clin, Engels Pl 35-103, B-3000 Leuven, Belgium.
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A revisited technique for combined anterior cruciate ligament and anterolateral ligament reconstructions
No full textA new technique for combined anterior cruciate ligament and anterolateral ligament reconstructions is described. An iliotibial band strip is used as an ALL graft, leaving the distal insertion intact and fix it with a knotless anchor on the femoral origin, after tunneling it under the lateral collateral ligament.Smeets, K (corresponding author), GRIT Belgian Sports Clin, Engels Pl 35-103, B-3000 Leuven, Belgium.
[email protected]
Deviations From Optimal Alignment in TKA: Is There a Biomechanical Difference Between Femoral or Tibial Component Alignment?
No full textRestoration of neutral mechanical alignment is one of the prerequisites for long-term TKA survival. This study aimed to investigate the effect of deviations from neutral alignment on bone and implant stress and on ligament strain. Using a previously validated finite element model, a neutrally aligned TKA model was compared to 3 different varus and valgus configurations induced by tibial or by femoral component only and by both component simultaneously. Each model underwent a 2500 N vertical load simulating the peak walking force. Varus and valgus alignment increased polyethylene and bone stress, and altered ligament strains, as compared to the neutral aligned model. Changes in alignment of the tibial component were always associated with more detrimental effects compared to the one of the femoral component
Coronal Plane Alignment of the Knee (CPAK) classification A NEW SYSTEM FOR DESCRIBING KNEE PHENOTYPES
No full textAimsA comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA).MethodsA radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10 degrees of flexion within each type. Secondary outcomes assessed balance at 45 degrees and 90 degrees and bone recuts required to achieve final knee balance within each CPAK type.ResultsThere was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001).ConclusionCPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies.The author or one of more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non-profit organization with which one or more of the authors are associated.
ICMJE COI statement J. Bellemans reports personal fees from Stryker, outside the submitted work. W. Griffiths-Jones reports personal fees from Stryker, outside the submitted work, and a patent pending (PCT/AU2018/000241). D. B. Chen reports fellowship funding from Smith and Nephew and Zimmer Biomet, consulting fees from Amplitude SAS, personal fees from Stryker, a patent pending (PCT/AU2018/000241), all outside the submitted work. S. J.MacDessi reports fellowship funding from Smith and Nephew and Zimmer Biomet, consulting fees from Amplitude SAS, personal fees from Stryker, a patent pending (PCT/AU2018/000241), all outside the submitted work.
We are sincerely appreciative of the efforts of Ms Jil Wood, MSN, Clinical Research Manager at Sydney Knee Specialists, for her assistance with editing the manuscript and oversight of the study. We also wish to acknowledge Dr William Colyn, Consulting Surgeon at the General Hospital of Turnhout, Belgium, and Dr Sol Han and Dr Nikolas Fountas, Orthopaedic Registrars at The Canterbury Hospital, for performing radiographic measurements in this study
Hinged versus CCK revision arthroplasty for the stiff total knee
No full textBackground: Total knee arthroplasty (TKA) remains the gold standard for end-stage knee osteoarthritis. The prevalence of stiffness after this procedure described in literature varies from 13% to 5.3%. The causes of arthrofibrosis after total knee arthroplasty are multifactorial. Revision TKA is a successful procedure when performed for loosening, instability, mechanical implant failure, or infection. The results of revision TKA for idiopathic arthrofibrosis and stiffening are however less favorable. Purpose: It has been the authors' impression that the poor results in arthrofibrosis could be in part related to the use of traditional PS or CCK-type revision implants. Our hypothesis is that better results can be achieved in case a rotating hinge design (RHK) is used. The reason could be that RHK designs allow for much more aggressive capsuloligament debridement and therefore more adequate fibrosis removal, while securing optimal implant stability, tibiofemoral rotational freedom, and flexion-extension space stability. The purpose of our study was to investigate in our database whether this hypothesis is correct. Methods: Retrospectively, 40 patients with the defined range of knee motion were identified. Patients with underlying mechanical malalignment, component malposition, soft-tissue imbalance or infections were excluded. Twenty-two patients received a hinged-type prosthetic device (18 Zimmer RHK, four Stryker RHK) and 18 patients received a less constrained condylar type prosthetic device (17 Legion CCK, one Vanguard CCK). Results: Preoperative data were similar for RHK as CCK-type implants except for knee pain score, which was significantly worse for the RHK group (36 vs 44, p = 0.049). At two years of follow-up, compared to CCK, the RHK group demonstrated significantly better postoperative results for knee function scores (68.9 vs 54.2, p = 0.0015), knee function improvement (22.8 vs 4.8, p = 0.0015), knee pain improvement (26.4 vs 9.4, p = 0.0050), greater maximal flexion (99.9 degrees vs 81.4 degrees, p = 0.0005), better maximal extension (-1.9 degrees vs -6.2 degrees, p = 0.0447), greater flexion gain (35.8 degrees vs 14.2 degrees, p = 0.0002), and greater extension gain (8.6 degrees vs 2.0 degrees, p = 0.0083). Conclusion: Our data show that revision arthroplasty of the stiff knee using a rotating hinged device can provide excellent results in selected cases. To date, this is the first study to describe the difference in outcome between revision total knee arthroplasty for idiopathic arthrofibrosis using a hinged or a constrained condylar knee device. (C) 2018 Elsevier B.V. All rights reserved
The effect of anti-gravity training after meniscal or chondral injury in the knee. A systematic review
No full textReduced impact loading or anti-gravity training has recently been introduced as a new tool in the rehabilitation of orthopaedic conditions that require restricted weight bearing. The purpose of this strategy is to speed up the functional rehabilitation while at the same time protect the healing structures from harmful effects associated with impact loading. Anti-gravity treadmills (AlterG ®) and harness suspension devices seem to be the two most promising techniques. It is however today unclear how effective these devices are. The purpose of our study was therefore to perform a systematic literature review on the actual technology available and its effect on impact load reduction, as well as its effectiveness in accelerating functional recovery after meniscal and chondral injury to the knee. The results from our work demonstrate that only a limited number of studies are available, usually of moderate quality. The data suggest a variable effect on cartilage regeneration, and a potential for accelerated functional recovery in gait and running dynamics both with anti-gravity treadmill as well as suspension harness systems.No benefits or funds were received in support of this study
The effect of anti-gravity training after meniscal or chondral injury in the knee. A systematic review
No full textReduced impact loading or anti-gravity training has recently been introduced as a new tool in the rehabilitation of orthopaedic conditions that require restricted weight bearing. The purpose of this strategy is to speed up the functional rehabilitation while at the same time protect the healing structures from harmful effects associated with impact loading. Anti-gravity treadmills (AlterG ®) and harness suspension devices seem to be the two most promising techniques. It is however today unclear how effective these devices are. The purpose of our study was therefore to perform a systematic literature review on the actual technology available and its effect on impact load reduction, as well as its effectiveness in accelerating functional recovery after meniscal and chondral injury to the knee. The results from our work demonstrate that only a limited number of studies are available, usually of moderate quality. The data suggest a variable effect on cartilage regeneration, and a potential for accelerated functional recovery in gait and running dynamics both with anti-gravity treadmill as well as suspension harness systems.No benefits or funds were received in support of this study
Report of Governor Johan Rising, 1655, on New Sweden
No full textGovernor Johan Rising reports to the Swedish government and royalty on the status of New Sweden (present-day New Jersey). He also reports on other Swedish colonies in the area. He asks that single women and skilled tradesmen be sent to the colonies. Rising also reports that attacks from neighboring Indian tribes are increasing. He has found some protection by forming an alliance with English settlers, but the cost is high, and his colony owes the English money and supplies. Rising asks that Sweden send them money so that they can pay off their debts, build ships that would establish a trading dominance with the West Indies, and cultivate land and crops to gain more profit. Reports from New World governors were sent back to their native countries via ships. Rising sent this report in June of 1655, but Sweden did not recieve the report until November of 1655. This article is part of a Primary Source Material collection compiled by the New Sweden Commemorative Commission in 1988
Report of Governor Johan Printz, 1647, on New Sweden
No full textGovern Johan Printz, the governor of New Sweden (later to become New Jersey), reports on the status of the colony and the settlers. Many freemen have arrived to settle in New Sweden, but the criminals and military men who were conscripted to the colony want to return to Sweden. Of the freemen, very few are skilled, so Governor Printz asks that blacksmiths, tanners, tailors, carpenters, and butchers be sent to the colony. Additionally, he asks for single women. Printz also reports on two new Swedish colonies that have been established along the Delaware River. However, Dutch settlers have become very aggressive by re-purchasing land from the Indians that the Swedish had already bought. They are also interrupting trade between the Swedes and the Indians, as well as instigating the Indians to attack the Swedes. Printz directed the construction of some storage houses along common trade routes to win back trade from the Indians. However, fighting has erupted between different Native tribes as each tries to establish dominance in trading with the colonies. This article is part of a Primary Source Material collection compiled by the New Sweden Commemorative Commission in 1988
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