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Purpose: The aim of this meta-analysis was to evaluate differences in functional outcomes between simultaneous bi-unicompartmental knee arthroplasty (Bi-UKA) and total knee arthroplasty (TKA) for the treatment of medial and lateral knee osteoarthritis. Material and Methods: According to the PRISMA statement, a comprehensive search was conducted to identify studies reporting comparative results of the Bi-UKA versus the TKA. Of 953 titles, 6 studies met the inclusion criteria. Results: A total of 286 patients were identified, of which 137 underwent Bi-UKA and 149 TKA. TKA reported a mean hip-knee-ankle (HKA) angle of 179.4 ± 2.4 compared to that in Bi-UKA measuring 177.2 ± 2.7 (p = 0.0001, 95% CI − 3.02 to − 1.38). No difference was found in the Western Ontario and McMaster Universities (WOMAC) pain (4 ± 1.6 and 4.2 ± 1.3 for Bi-UKA and TKA, respectively; p = 0.4996, 95% CI − 0.86 to 0.43). Bi-UKA was favorable in terms of WOMAC function (7.5 ± 1.9 and 9 ± 1.9 for Bi-UKA and TKA, respectively; p = 0.001, 95% CI − 2.29 to − 0.61) and WOMAC stiffness (1.6 ± 1 and 2.4 ± 0.7 for Bi-UKA and TKA, respectively; p = 0.0001, 95% CI − 1.18 to − 0.42). Bi-UKA showed a better Knee Society Score (KSS) in comparison to TKA (79.7 ± 7.8 and 75.4 ± 10.5 for Bi-UKA and TKA, respectively; p = 0.0021, 95% CI 1.58–7.02). The differences in postoperative outcomes scores between Bi-UKA and TKA were lower than their respective minimum clinically important differences. Conclusions: When Bi-UKA and TKA are compared for the treatment of medial and lateral knee osteoarthritis, Bi-UKA are favorable in terms of WOMAC and KSS even though these values are lower than the minimum clinically important differences; moreover, similar postoperative hip-knee-ankle angle can be expected 3 years after Bi-UKA and TKA. [ABSTRACT FROM AUTHOR]

• Is the first study to conduct matching between open and closed fractures to avoid bias that could increase the infection risk owing to factors other than open fracture. • Open fractures were found to be a risk factor associated with fracture related infection with a 5.48 times higher probability of FRI than closed fractures (odds ratio 5.41 (95% confidence interval [CI] 1.55–18.85). • Multivariate analysis showed that the OKS score was 3 points lower for open fractures (95% CI -5.530–-0.478) than closed ones, the minimal clinical difference for the OKS is 5 points so this statistical difference does not represent a clinical difference. • Comparing functional outcome between infected and uninfected patients we got that the median OKS decreased 9,69 points IC 95% [ (-14,13–(-5,25)], P = 0,000 this is a clinical and statistically significant difference. Open tibial plateau fractures are complex injuries that require specialized management to prevent complications. The objective of this study was to compare the infection risk and functional outcomes between open and closed tibial plateau fractures. In this multicenter cohort study the propensity score matching was used to pair participants according to age, sex, and Schatzker classification. 190 patients were followed for 1 year postoperatively. The Fracture-Related Infection (FRI) Consensus Group criteria was used to diagnose infection. Knee functionality was measured using the Oxford Knee Score scale (OKS). The proportion of open fractures was 5.1%, and the overall incidence rate of FRI was 8% with 14% of them represented by open fractures and 4% for closed fractures (p = 0.014). Open fractures were found to be a risk factor associated with FRI, with a 5.48 times higher probability of FRI than closed fractures (odds ratio 5.41, 95% confidence interval [CI] 1.55–18.85). Among the study population, 50% had satisfactory functional outcomes of the knee (median OKS 45, IQR = 3). The median OKS was 44 (IQR = 11) in open fractures and 46 (IQR = 7) in closed ones (p = 0.03). Multivariate analysis showed that the OKS was 3 points lower for open fractures (95% CI -5.530–-0.478) than closed ones, and the score was 9.7 points lower for FRI. Open TPF is a risk factor that increases the probability of fracture related infections. Functional outcomes were excellent for both open and closed TPF, with a slight difference numerical that was under the minimal clinical difference (MCID). The presence of FRI significantly decreases the functional outcome. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the isokinetic, eccentric and isometric hamstring/quadriceps (HQ) ratios in patients before and after ACL reconstruction (ACLR) using bone-patellar tendon grafts and to establish the relationships between HQ ratio and knee function.Methods: Forty-four patients (mean age of 26.6 years) underwent isokinetic testing of quadriceps and hamstring muscles before and after ACLR and HQ ratios were calculated. Lysholm, IKDC and Cincinnati Scores were used to assess function. Isokinetic concentric and eccentric peak torque (Nm/kg) was measured at three different speeds: 60, 120, and 180°/s. Isometric strength was tested at 30° and 60° of knee flexion.Results: For the isometric tests, the HQ ratio between the involved and non-involved limb was not different for the ACLD knee (p = 0.28) at 30° knee flexion, but significant at the 60° flexion angle (p = 0.02) and for the ACLR knees at 30° and 60° (p = 0.02). For the isokinetic tests, the ratio between involved and non-involved limb was significant for ACL-deficient knees at both 60 (p = 0.039) and 120°/s (p = 0.05). There were significant differences between limbs for all speeds in ACLR knees (p = 0.0003-0.01). For the eccentric tests, the HQ ratio between the involved and non-involved limbs was not significant for both the ACLD (p = 0.19) and ACLR knees (p = 0.29) at the speed of 60°/s. At 120 and 180°/s, there were significant differences between limbs for both the ACLD (p = 0.02) and ACLR knees (p = 0.003). Linear regression did not reveal significant relationships between Cincinnati, Lysholm, and IKDC scores and HQ ratios in the ACLD (R2 = 0.35, p = 0.58; R2 = 0.34, p = 0.63; R2 = 0.38, p = 0.49). In contrast, there were significant correlations between the Lysholm and IKDC scores and HQ ratios in the ACLR knees (R2 = 0.84, p = 0.002; R2 = 0.86, p = 0.001).Conclusions: The findings of this study suggest that the HQ ratio in ACLD patients was not a predictor, but an indicator of patient-perceived knee function following ACLR.Level Of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the incidence of oxidative stress on the severity of knee osteoarthritis (OA). Data were obtained from a previous pilot controlled trial among patients, diagnosed with OA in one or both knees, that were randomly assigned into two different treatment groups and were either supplemented with ascorbic acid and Vitamin E daily per os or treated with meloxicam. The following markers were estimated: A. Clinical markers: functionality of the knee (WOMAC index), pain (using a pain visual analogue scale) and severity of OA (Kellgren-Lawrence grading scale) B. Laboratory markers: total antioxidant capacity (TAC) and malonyldialdehyde (MDA) levels in the synovial fluid. The TAC of the knees was moderately correlated with the severity of OA and the level of pain whilst MDA concentration was weekly correlated. An average change of 5mM of a-tocopherol in TAC (4.6-5.5mM of a-tocopherol) defines the shift among stages of OA and the level of pain experienced by the patients. Neither TAC nor MDA were correlated with the Kellgren-Lawrence grading scale. Alleviation of oxidative stress should be a key objective for the therapeutic interventions (pharmacological and nonpharmacological) in knee OA. Even small improvements in antioxidant capacity of the synovial fluid may contribute to the patient's quality of life and to the deceleration of the disease progression. [ABSTRACT FROM AUTHOR]

Purpose: Knee function, whether anterior cruciate ligament (ACL)-deficient or ACL-reconstructed, is related to many conditions, and no single biomechanical variable can be used to definitively assess knee performance. The purpose of this study was to investigate the relationship between extension and flexion muscle strength and knee function in patients prior and following ACL reconstruction. Methods: 44 ACL-deficient patients with a mean age of 26.6 years were tested between 3 and 6 months following an acute injury and 2 years following ACL reconstruction. All reconstructed patients underwent surgical reconstruction within 6 months of ACL injury using bone-patellar tendon and interference screws. The Cincinnati knee rating system was used to assess knee function. Muscle strength was assessed with the Biodex™ Dynamometer. Isokinetic concentric and eccentric flexion and extension peak torque (Nm/kg) was tested at three different speeds: 60°/s, 120°/s and 180°/s. Isometric strength was tested in 30° and 60° of knee flexion. Both the involved and non-involved legs were tested to calculate symmetry indices. Results: The mean Cincinnati score in the ACL-deficient patient was 62.0 ± 14.5 (range 36-84) and increased to 89.3 ± 9.5 (range 61-100) in the ACL-reconstructed patient. Significant relationships between knee function and muscle strength in the ACL-deficient group were observed for knee symmetry indices (r = 0.38-0.50, p = 0.0001-0.05). In the ACL-reconstructed group significant relationships between knee functionality were observed for isometric and isokinetic peak torque of the involved limb (r = 0.46-0.71, p = 0.0001-0.007). Conclusion: The findings of this study suggest that neither extension nor flexion peak torque were correlates of knee function in the ACL-deficient knee. However, leg symmetry indices were correlated to knee function. In the ACL-reconstructed knee, knee symmetry indices were not related to knee function but extension and flexion isokinetic concentric and isometric peak torque were. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to elucidate the most successful feed-forward strategies responsible for enhancing dynamic restraint following anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR). Ten male ACL deficient (ACLD) subjects (18–35years) together with 27 matched males who had undergone ACLR (14 using a patella tendon graft and 13 using a combined semitendinosus and gracilis graft) and 22 matched-control subjects were recruited. After their knee functionality (0- to 100-point scale) was rated using the Cincinnati Knee Rating System, each subject performed a maximal, countermovement hop for distance on their involved limb while EMG data were collected from the vastus lateralis (VL), vastus medialis (VM), semitendinosus (ST) and biceps femoris (BF) muscles. Acceleration transients at the proximal tibia were recorded using a uniaxial accelerometer mounted at the level of the tibial tuberosity. Whilst pre-programmed muscle activation strategies and tibial acceleration transients when landing from a single-leg long hop for distance were not contingent upon ACL status, a number of significant correlations were identified between neuromuscular variables and knee functionality of ACLD and ACLR subjects. Increased hamstring preparatory activity together with a greater ability to control tibial motion during dynamic deceleration was associated with higher levels of knee functionality in the ACLD subjects. Successful feed-forward strategies following ACLR were related to graft selection; STGT subjects with superior knee function activated their quadriceps earlier and were better able to synchronise peak hamstring muscle activity closer to initial ground contact whilst more functional PT subjects demonstrated enhanced tibial control despite a lack of evidence supporting modified pre-programmed muscular activation patterns. Our conclusion was that more functional individuals used sensory feedback to build treatment-specific, feed-forward strategies to enhance dynamic restraint when performing a task known to stress the ACL. [Copyright &y& Elsevier]

Background: Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approach that aims to investigate the relationship between joint function and soft tissue status before and after ACL reconstruction. Methods: Thirteen consecutive patients who underwent ACL reconstruction were preliminarily enrolled in this study. Joint laxity assessment as well as magnetic resonance imaging with T2 mapping were performed in the pre-operative stage, at four and 18 months after surgery to acquire objective information to correlate knee function and soft tissue condition. Results: Correlations were found between graft and cartilage T2 signal, suggesting an interplay between these tissues within the knee joint. Moreover, graft maturation resulted in being connected to joint laxity, as underlined by the correlation between the graft T2 signal and the temporal evolution of knee function. Conclusions: This preliminary study represents a step forward in assessing the effects of ACL graft maturation on knee biomechanics, and vice versa. The presented integrated framework underlines the possibility to quantitatively assess the impact of ACL reconstruction on trauma recovery and cartilage homeostasis. Moreover, the reported findings—despite the preliminary nature of the clinical impacts—evidence the possibility of monitoring the surgery outcomes using a multi-parametric prognostic investigation tool. [ABSTRACT FROM AUTHOR]