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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.
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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]
Is limb overcorrection following total knee arthroplasty compromising functional outcome?
No full textPurpose: Many patients remain unsatisfied after total knee arthroplasty (TKA). Personalized alignment strategies have gained popularity in the search to improve patient satisfaction and function. This study aimed to examine the impact of limb overcorrection in the coronal plane on patient satisfaction and functional outcome. The secondary aim was to investigate how a change in knee phenotype following TKA affects clinical outcome. Methods: A retrospective matched case-control study was designed between patients with limb overcorrection (N = 37) and a control group (N = 104). Mean follow-up was 68 months. Satisfaction and function were compared by means of the new 2011 Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Radiological evaluation was performed on weight-bearing full-leg radiographs. Overcorrection was defined as a mechanical HKA (mHKA) angle of 2 degrees or more and opposite to the preoperative alignment. The control group consisted of TKAs that were corrected to neutral or left in slight undercorrection. Finally, component alignment (lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA)) and Coronal Plane Alignment of the knee (CPAK) phenotypes were evaluated. Results: The overcorrection group performed better than the control group in terms of KSS subscores satisfaction and functional activities, total KSS score, all KOOS subcategories, and total KOOS score. Subdivision of the control group into a neutral and undercorrection group, and the overcorrection group into mild and severe overcorrection, revealed similar findings. A chance in knee phenotype as per aHKA, JLO or CPAK did not result in worse clinical outcomes. Conclusion: Accidental limb overcorrection after TKA does not result in inferior clinical outcomes or patient satisfaction at midterm follow-up. The present study could not identify an optimal coronal alignment target. This suggests that coronal alignment as a predictor of patient satisfaction and function is likely less important than previously believed. Level of evidence: Level III, retrospective case-control study.Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
We would like to thank Liesbeth Bruckers, statistician of the Uni versity of Hasselt, for all statistical analyses. Furthermore, we would also like to thank Veerle De Ridder, study nurse of the department of Or thopaedic Surgery and Traumatology, for guidance and administrative help. Finally, we would like to thank Kaat De Brauw for providing lan guage help and a final spell check
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
Combined lateral extra-articular tenodesis and anterior cruciate ligament reconstruction : risk of osteoarthritis
No full textPurpose Lateral extra-articular tenodesis (LET) procedure, combined with an intra-articular reconstruction of the anterior cruciate ligament (ACL), is used to reduce rotational laxity and the risk of graft failure. However, concern of overtightening of the lateral compartment and subsequent osteoarthritis remains. The aim of this study is to evaluate the degenerative changes in the lateral compartment and to compare the clinical and radiographical results between two LET techniques. Methods Eighty-three patients (86 knees) were retrospectively reviewed at a mean of 67.7 months (range 49-85 months). Forty-two knees had an ACL reconstruction combined with a LET procedure according to the modified Lemaire technique and 44 knees according to the modified Coker-Arnold technique. IKDC, Lysholm, Tegner and VAS scores were used. Osteoarthritis was radiographically evaluated by the Kellgren-Lawrence classification. Results There were 12 patients (28.6%) in the modified Lemaire subgroup and 13 patients (29.5%) in the modified Coker-Arnold subgroup that had doubtful or mild radiologic signs of osteoarthritis. No patients had moderate or severe signs at final follow-up. There was no significant difference in radiological signs of osteoarthritis. In the modified Lemaire subgroup, we report a mean IKDC of 86.31 (+/- 13.794), a mean Lysholm of 87.83 (+/- 12.802) and a mean Tegner of 5.38 (+/- 2.556). In the modified Coker-Arnold subgroup, a mean IKDC of 87.27 (+/- 11.653), a mean Lysholm of 91.89 (+/- 8.035) and a mean Tegner of 5.16 (+/- 2.420) were reported. There were no statistical significant differences between both techniques. In eight patients, a complication was identified, 3 of which had a failure of the ACL reconstruction. Conclusions The chosen LET-technique seems to have minimal effect on both the clinical and the radiographic results. The LET is a safe procedure, and it does not increase the risk of osteoarthritis in the lateral compartment
The initial learning curve for the ROSA® Knee System can be achieved in 6-11 cases for operative time and has similar 90-day complication rates with improved implant alignment compared to manual instrumentation in total knee arthroplasty
No full textPurpose The purpose of this study was to determine the learning curve for total operative time using a novel cutting guide positioning robotic assistant for total knee arthroplasty (raTKA). Additionally, we compared complications and final limb alignment between raTKA and manual TKA (mTKA), as well as accuracy to plan for raTKA cases. Methods We performed a retrospective cohort study on a series of patients (n = 180) that underwent raTKA (n = 90) using the ROSA Total Knee System or mTKA (n = 90) by one of three high-volume (> 200 cases per year) orthopaedic surgeons between December 2019 and September 2020, with minimum three-month follow-up. To evaluate the learning curve surgical times and postoperative complications were reviewed. Results The cumulative summation analysis for total operative time revealed a change point of 10, 6, and 11 cases for each of three surgeons, suggesting a rapid learning curve. There was a significant difference in total operative times between the learning raTKA and both the mastered raTKA and mTKA groups (p = 0.001) for all three surgeons combined. Postoperative complications were minimal in all groups. The proportion of outliers for the final hip-knee-ankle angle compared to planned was 5.2% (3/58) for the mastered raTKA compared to 24.1% (19/79) for mTKA (p = 0.003). The absolute mean difference between the validated and planned resections for all angles evaluated was < 1 degree for the mastered raTKA cases. Conclusion As the digital age of medicine continues to develop, advanced technologies may disrupt the industry, but should not disrupt the care provided. This cutting guide positioning robotic system can be integrated relatively quickly with a rapid initial learning curve (6-11 cases) for operative times, similar 90-day complication rates, and improved component positioning compared to mTKA. Proficiency of the system requires additional analysis, but it can be expected to improve over time.Zimmer Biomet, Inc
The pre-diseased coronal alignment can be predicted from conventional radiographs taken of the varus arthritic knee
No full textIntroduction The concept of restoring the constitutional, pre-diseased alignment has gained lots of interest among knee surgeons. Previous attempts to use the contralateral limb to bridge the gap between the arthritic and the constitutional alignment were unsuccessful. We investigated the usability of a mathematical formula to predict the constitutional (pre-diseased) coronal alignment once arthritis has occurred. It is our hypothesis that by using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the pre-diseased coronal alignment could be predicted. Material and methods Hundred arthritic patients with consecutive X-rays were used to determine a mathematical formula. Five alignment parameters were determined on full-length X-rays: HKA angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and the tibial joint line angle (TJLA). A refinement of the algorithm was implemented based on a reference cohort, consisted of 250 young adults aged between 20 and 27 years. Moreover, all knees were subdivided based on their CPAK-phenotype and the Kellgren-Lawrence scale (KL scale). An independent arthritic cohort of 289 patients scheduled for primary total knee arthroplasty was included to verify the accuracy of the predicted HKAs (HKA(PRED)). Results In CPAK type 1, the HKA(PRED) was 3.86 degrees varus (STD 1.39) and the HKA(YHA) was 4.0 degrees varus. In CPAK type 2, the HKA(PRED )was 1.68 degrees varus (STD 1.95) compared to a HKA(YHA) of 1.34 degrees (STD 0.81). The average constitutional HKA is not different in both CPAK 1 (p = 0.61) and CPAK 2 (p = 0.25), and the difference in the mean is estimated to be equal to - 0.14 (95CI - 0.68 to 0.40) in CPAK 1 and 0.35 (95CI - 0.06 to 0.75) in CPAK 2. Conclusion Using the KL grade, CPAK classification and four radiographic measurements of the arthritic knee, the prediseased coronal alignment can be predicted in 80% of the varus knees with an accuracy of <= 0.5 degrees. The predicted HKA (HKA(PRED)) can be very useful in the current and future clinical practice.This study is part of Limburg Clinical Research Center supported by Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.
We wish to acknowledge Dr Elizabeth Flesher for her help in reviewing and revising the manuscript for grammar and syntax
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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