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Tibiofemoral synchronization technique matches the rotational alignment of the tibial component to the femoral component during the total knee arthroplasty (TKA). The rotational axis of the proximal tibia can be changed by this technique, which affects tibial torsion postoperatively. The purpose of this study was to investigate whether the tibiofemoral synchronization technique affect the tibial torsion, and the lower limb rotation after primary TKA. It was hypothesised that the tibial torsion would change after primary TKA. Ninety-three posterior stabilised TKAs from 89 patients were included from January 2017 to December 2018. Mechanical hip–knee–ankle axis (mHKA), in plain radiographs, femoral anteversion, tibial torsion, femoral neck-malleolar angle (FNMA), and rotational alignment of the femoral and the tibial components in pre- and postoperative CT scans were measured by two blinded observers. The primary outcome was a postoperative change in femoral anteversion, tibial torsion and FNMA. Clinical outcomes were evaluated using the American Knee Society Knee Score (AKSKS)/Function Score (AKSFS), and Oxford Knee Score (OKS) preoperatively and at 1 year after TKA. Patients’ perception of changes in the foot progression angle after TKA was investigated. Statistical significance was set at p

Unlike postoperative changes in posterior tibial slope after medial open-wedge high tibial osteotomy, sagittal osteotomy inclination has not been examined. It has been recommended that the osteotomy line in the sagittal plane be parallel to the medial posterior tibial slope. The purpose of this study was to determine the frequency of parallel osteotomy in medial open-wedge high tibial osteotomy. To determine the sagittal osteotomy inclination, the angle between the medial joint line and the osteotomy line was measured in the lateral radiograph. A positive angle value indicates that the osteotomy is anteriorly inclined relative to the medial posterior tibial slope. Correlation between the sagittal osteotomy inclination and posterior tibial slope was also evaluated. The mean sagittal osteotomy inclination was 15.1 ± 7.5°. The majority 87.1 % of knees showed an anterior-inclined osteotomy. There was a significantly positive correlation between the postoperative posterior tibial slope and the sagittal osteotomy inclination (r, 0.33; 95 % confidence interval (CI) 0.19–0.46; P

Using second-look arthroscopy, graft maturation was investigated and compared between hamstring (HA) autografts and tibialis anterior (TA) allografts after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR). Fifty-six patients who underwent second-look arthroscopy after anatomic single-bundle ACLR with either HA autografts (26, HA group) or TA allografts (30, TA group) from 2007 to 2016 were retrospectively reviewed. Graft maturation on second-look arthroscopy was evaluated in terms of four parameters: graft integrity (tear), synovial coverage, graft tension, and graft vascularization. Each parameter received a maximum of two points, depending on the status of the reconstructed graft. The total graft maturation score was calculated as the sum of the parameter scores. The total graft maturation and individual parameter scores were compared between the two groups. The mean time from ACLR to second-look arthroscopy was 22.5 ± 7.8 months. The maturation scores in the HA group were significantly better in terms of graft integrity (p = 0.041), graft tension (p = 0.010), and graft vascularization (p = 0.024), whereas the graft synovial coverage score was not significantly different. The total graft maturation score of the HA group was significantly higher than that of the TA group (6.3 ± 0.4 vs. 4.9 ± 0.3, p = 0.013). This study shows the superior graft maturation of HA autografts compared with that of TA allografts at a mean follow-up of 22.5 ± 7.8 months after anatomic single-bundle ACLR. When anatomic ACLR using soft tissue graft is planned, HA autograft is recommended rather than soft tissue allograft, especially in young and active patients. Retrospective cohort review, Level III.

Descriptive laboratory study. The femoral anatomic insertion site and the optimal isometric point of popliteus tendon for posterolateral reconstruction are not well known. Purpose of this study was to determine the relative relationship between the femoral anatomic insertion and isometric point of popliteus muscle–tendon complex with the lateral epicondyle of femur. Thirty unpaired cadaveric knees were dissected to determine the anatomic femoral insertion of the popliteus tendon. The distance and the angle from the lateral epicondyle of femur to the center of the anatomic insertion of the popliteus tendon were measured using digital caliper and goniometer. Eight unpaired fresh cadaveric knees were examined to determine the optimal isometric point of femoral insertion of popliteus tendon using computer-controlled motion capture analysis system (Motion Analysis, CA, USA). Distances from targeted tibial tunnel for popliteus tendon reconstruction to the 35 points gained on the lateral surface of femur were recorded at 0, 30, 60, 90, and 120° knee flexion. A point with the least excursion (

We reviewed thirty patients with degenerative posterior root tear of the medial meniscus to investigate clinical results of non-operative treatment retrospectively. There were 3 men and 27 women at a median age of 59 years old (range, 51-65). The median follow-up period was 36 months (range, 24-51). Non-operative treatments included non-steroidal anti-inflammatory drugs daily for 8-12 weeks and supervised physical therapy twice a week at least during a period of 8 weeks. The symptoms, physical signs, the Visual Analog Scale pain, the Lysholm Knee Scoring scale and IKDC subjective activity level were analyzed at the time of pre-intervention, 6 months, 12 months and the final follow-ups. Most patients had intense mechanical pain initially, but the severity and frequency of pain was decreased within 3 months. Clinical outcome was improved at 12 months follow-up and then declined to a level that was still improved over initial scores at final follow-up. Two patients with Kellgren-Lawrence grade 2 progressed to grade 3 at the median follow-up of 36 months. In conclusion, this study demonstrated that non-operative treatment provided symptomatic relief in most patients with the degenerative posterior root tear of the medial meniscus and functional improvements in a short term follow-up.

The purpose of this study was to assess the clinical results of arthroscopic double-bundle posterior cruciate ligament (PCL) reconstruction using double cross-pin fixation on the tibial side. Twenty-two patients who underwent PCL reconstruction using an Achilles tendon allograft with double cross-pins for tibial fixation were evaluated. There were 19 men and 3 women with mean age 36 years (range 18-59), and the average follow-up period was 33 months (range 24-60). Preoperative and postoperative knee functions were evaluated in all patients using Lysholm knee scores, the 2000 International Knee Documentation Committee (IKDC) grades, and Tegner activity scores. Median Lysholm knee scores were 64 (50-75) preoperatively and 88 (82-96), 89.9 +/- 6.5 postoperatively (P < 0.001). Median side-to-side differences, determined using Telos stress radiographs, were 11 mm (8-14) preoperatively, and 3 mm (1-7) at final follow-up visits (P < 0.01). According to KT-2000 arthrometer measurements, mean side-to-side differences were 11 mm (8-13) preoperatively and 3 mm (1-6, P < 0.01) at final follow-up visits (P < 0.01). Preoperatively the 2000 IKDC evaluation system rated all patients as abnormal or severely abnormal (C or D), and at final follow-up visits, 20 patients (88%) were rated as normal or nearly normal (A or B) and 2 patients (12%) were rated as abnormal (C). Median preinjury and preoperative Tegner scores were 7 (range 5-9) and 3 (range 2-5), respectively, and the mean postoperative Tegner score was 6 (range 3-9). There were no intraoperative or postoperative complications. Our study shows that arthroscopic double-bundle PCL reconstruction using an Achilles allograft with double cross-pins for tibial fixation provides satisfactory clinical results given a mean follow-up of 33 months. We believe that this method provides a reliable alternative technique of PCL reconstruction.