Transcutaneous Pulsed Radiofrequency Treatment in Patients With Painful Knee Awaiting Total Knee Joint Replacement Knee Arthroplasty With a Medially Conforming Ball-and-Socket Tibiofemoral Articulation Provides Better Function Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. Fixation stability of opening- versus closing-wedge high tibial osteotomy: a randomised clinical trial using radiostereometry. Kinematics of Three Variations of the Freeman-Samuelson Total Knee Prosthesis Dynamic Stabilization Time After Isokinetic and Functional Fatigue. Contact Kinematic Differences Between Gap Balanced vs Measured Resection Techniques for Single Radius Posterior-Stabilized Total Knee Arthroplasty. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol The Bisurface Total Knee Replacement: A Unique Design for Flexion Four-to-Nine-Year Follow-up Study* Stress radiographical measurement of the anteroposterior, medial and lateral stability of the knee joint. Prospective randomized comparison of anatomic single- and double-bundle anterior cruciate ligament reconstruction Mobile vs. fixed bearing unicondylar knee arthroplasty: A randomized study on short term clinical outcomes and knee kinematics. Gait analysis after total knee arthroplasty. Comparison of posterior cruciate retention and substitution In vivo kneeling biomechanics after posterior stabilized total knee arthroplasty Does ligament balancing technique affect kinematics in rotating platform, PCL retaining knee arthroplasties? Knee joint distraction compared with high tibial osteotomy: a randomized controlled trial Higher dynamic medial knee load predicts greater cartilage loss over 12 months in medial knee osteoarthritis How Effective are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature Gait analysis after bi-compartmental knee replacement. Comparison of a novel porous titanium construct (Regenerex®) to a well proven porous coated tibial surface in cementless total knee arthroplasty - A prospective randomized RSA study with two-year follow-up. Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review Quality of Life and Clinical Outcome After Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Graft or Quadrupled Semitendinosus Graft
Objective Our study was design ed to determine if transcutaneous-pulsed radiofrequency treatment ( TCPRFT ) was able to reduce the pain experienced by patients awaiting total knee joint replacement ( TKJR ) . We conducted a r and omized , double-blinded , placebo controlled trial of TCPRFT in patients referred for TKJR to our hospital 's Orthopedic Outpatient Clinic . Methods Patients on the waiting list for assessment for TKJR were invited to participate and were examined in the clinic if they satisfied the inclusion criteria . Patients were r and omized to receive active or sham TCPRFT . The alteration in pain and function of the treated knee after a single TCPRFT was assessed at examination at 1 and 4 weeks using visual analog pain score ( VAS ) at rest and after 20 and 400 m walks . Results The results of 50 patients showed a statistically significant reduction in VAS at 1 and 4 weeks compared with baseline in the group who received active treatment . We also demonstrated what is considered a clinical ly significant improvement in this group that became more pronounced at week 4 compared with week 1 and also more after a 400 m walk compared with a 20 m walk . Maximum improvement observed in group data was 19/100 VAS . Patients receiving sham treatment showed no statistically significant improvement . Discussion We believe this to be the first report of a controlled study of TCPRFT . This pilot study shows a benefit of the technique that justifies future research Background A knee design with a ball- and -socket articulation of the medial compartment has a femoral rollback profile similar to the native knee . Compared to a conventional , posterior-stabilized knee design , it provides AP stability throughout the entire ROM . However , it is unclear whether this design difference translates to clinical and functional improvement . Questions / purpose sWe asked whether the medially conforming ball- and -socket design differences would be associated with ( 1 ) improved ROM ; and ( 2 ) improved American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores compared to a conventional , fixed-bearing posterior-stabilized TKA . Patients and Methods We enrolled 82 patients in a single-center , single-blinded , r and omized , controlled trial comparing the medially conforming ball- and -socket design knee prosthesis to a posterior-stabilized total knee prosthesis .  Our primary end point was ROM . Our secondary end points were American Knee Society , WOMAC , Oxford Knee , SF-36 , and Total Knee Function Question naire scores . All patients were followed at 1 and 2 years . Results The mean ROM was 100.1 ° and 114.9 ° in the posterior-stabilized and medially conforming ball- and -socket groups , respectively . The physical component scores of SF-36 and Total Knee Function Question naire were better in the medially conforming ball- and -socket group . We found no difference in American Knee Society , WOMAC , and Oxford Knee scores . Conclusions Both implant design s similarly relieved pain and improved function . The medially conforming ball- and -socket articulation provided better high-end function as reflected by the Total Knee Function Question naire . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Bicondylar tibial plateau fractures are complex injuries , historically associated with high complication rates . The purpose of this study was : 1 ) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures . 2 ) To compare the biomechanics of this plating system with a double plate construct . METHODS AND MATERIAL S Thirty-eight patients who sustained a complex tibial plateau fracture ( OTA type 41C ) at one of three level-one trauma centers were stabilized using the Less Invasive Stabilization System ( L.I.S.S. ) . The cohort of patients was evaluated clinical ly and radiographically for outcomes at a mean 15 months . In phase 2 of this study a model of a bicondylar tibial plateau fractures was made in six matched pairs of embalmed , human tibia and r and omized to fixation with either a L.I.S.S plate or a st and ard double plate construct . The tibias were then subjected to an axial cyclic load of 500N for 10 cycles ( 3Hz ) to approximate 2 months in vivo and displacements measured . RESULTS Thirty-six of /38 ( 95 % ) patients united at 4 months after surgery with no loss of fixation nor infection . Two patients underwent prophylactic autogenous bone grafting for bone loss and united by 3 months postgrafting . Significant loss of knee range of motion ( < 90 ) was seen in five patients .Biomechanically , no differences in permanent inferior displacement of the medial fragment were found in initial axial loading and after 10 cycles between the two plate constructs . However , when loaded to 500N the L.I.S.S plate construct demonstrated almost twice the displacement of the medial fragment compared with the dual plate construct . No specimen lost fixation during cycling . CONCLUSION The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results Valgus high tibial osteotomy for osteoarthritis of the medial compartment of the knee can be performed using medial opening- and lateral closing-wedge techniques . The latter have been thought to offer greater initial stability . We measured and compared the stability of opening- and closing-wedge osteotomies fixed by TomoFix plates using radiostereometry in a series of 42 patients in a prospect i ve , r and omised clinical trial . There were no differences between the opening- and closing-wedge groups in the time to regain knee function and full weight-bearing . Pain and knee function were significantly improved in both groups without any differences between them . All the osteotomies united within one year . Radiostereometry showed no clinical ly relevant movement of bone or differences between either group . Medial opening-wedge high tibial osteotomy secured by a TomoFix plate offers equal stability to a lateral closing-wedge technique . Both give excellent initial stability and provide significantly improved knee function and reduction in pain , although the opening-wedge technique was more likely to produce the intended correction The effect of changes in the articulating surfaces on the kinematics of the Freeman-Samuelson total knee replacement was evaluated . Twenty-two patients ( 22 knees ) ( median age , 69 years ) were r and omized to a st and ard design with a fixed polyethylene bearing , a design with a mobile bearing , or a new design with a spherical medial femoral condyle with a fixed bearing . The patients were studied with radiostereometry and film-exchangers at 0 ° nonweightbearing and during active weightbearing extension from 45 ° to 15 ° . The center of the tibial tray with a mobile-bearing prosthesis occupied a more anterior position than observed in the design s with a fixed bearing . The medial femoral condyle center had a more posterior position in the st and ard design than in the design with a spherical medial condyle . From a distally displaced position at 45 ° , the medial condylar center displaced a mean of 1.8 mm proximally during extension in the st and ard design and had a constant position in the meniscal design . In the spherical design the medial condyle was displaced proximally at 45 ° and displaced a mean of 1.6 mm distally during extension . The reduced anteroposterior and proximodistal translations in the meniscal design are compatible with improved congruency between the components . The design with a spherical medial condyle stabilized anteroposterior motions , but showed more pronounced proximodistal displacement medially than did the other two design OBJECTIVE : To compare the effects of an isokinetic fatigue protocol and a functional fatigue protocol on time to stabilization ( TTS ) , ground reaction force ( GRF ) , and joint kinematics during a jump l and ing . DESIGN AND SETTING : Subjects were assessed on 2 occasions for TTS , GRF , and joint kinematics immediately before and after completing a fatigue protocol . One week separated the 2 sessions , and the order of fatigue protocol s was r and omly assigned and counterbalanced . SUBJECTS : Twenty healthy male ( n = 8 , age = 21.8 + /- 1.4 years , height = 180.6 + /- 7.6 cm , and mass = 74.1 + /- 13.0 kg ) and female ( n = 12 , age = 22.2 + /- 2.1 years , height = 169.3 + /- 9.8 cm , and mass = 62.5 + /- 10.1 kg ) subjects volunteered to participate . MEASUREMENTS : Subjects performed 2-legged jumps equivalent to 50 % of maximum jump height , followed by a single-leg l and ing onto the center of a forceplate 70 cm from the starting position . Peak vertical GRF and vertical , medial-lateral , and anterior-posterior TTS were obtained from forceplate recordings . Maximum ankle dorsiflexion , knee-flexion , and knee-valgum angles were determined using 3-dimensional motion analysis . RESULTS : A 2-way analysis of variance with repeated measures revealed no significant differences when comparing TTS , GRF , and joint kinematics after isokinetic and functional fatigue protocol s. CONCLUSIONS : No difference was noted between isokinetic and functional fatigue protocol s relative to dynamic stability when l and ing from a jump BACKGROUND Measured resection ( MR ) and gap balancing ( GB ) are common surgical techniques for total knee arthroplasty ( TKA ) . Controversy has arisen as each conceptually differs in how the knee is balanced through bone and soft tissue management . The objective of the present study was to compare both the frequency of condylar liftoff and the location of femorotibial contact from extension through midflexion between patients undergoing GB or MR TKA . METHODS A total of 24 knees ( 23 patients ) were r and omly assigned at referral to either a surgeon performing MR or GB TKA  with the same single radius , posterior-stabilized implant ( 12 per cohort ) . At 1-year postoperation , patients underwent biplanar radiographic imaging at 0 ° , 20 ° , 40 ° , and 60 ° of flexion  . Condylar liftoff , contact location , and magnitude of excursion on each condyle were measured . Preoperative and postoperative clinical outcome scores were also collected . RESULTS There was no difference ( P = .41 ) in the frequency of liftoff between cohorts . The MR cohort had more posterior contact on the medial condyle ( P < .01 ) and more anterior contact on the lateral condyle ( P < .01 ) throughout flexion . Motion patterns were similar between cohorts , with similar medial ( P = .48 ) and lateral ( P = .44 ) excursion , which was equal in magnitude between condyles for both MR ( P = .48 ) and GB ( P = .73 ) . There was no difference in clinical outcome scores between groups . CONCLUSION For this particular implant system , GB and MR appear to produce similar kinematic and patient-reported outcome results Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people , giving rise to pain and loss of function . Many people experience progressive worsening of the disease over time , particularly those with varus malalignment and increased medial knee joint load . Therefore , interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression . Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load . A neuromuscular exercise program , emphasising optimal alignment of the trunk and lower limb joints relative to one another , as well as quality of movement performance , while dynamically and functionally strengthening the lower limb muscles , may be able to reduce medial knee load . Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature . This r and omised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading , pain and function in individuals with medial knee joint osteoarthritis . We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program . Methods / Design 100 people with medial knee pain , radiographic medial compartment osteoarthritis and varus malalignment will be recruited and r and omly allocated to one of two 12-week exercise programs : quadriceps strengthening or neuromuscular exercise . Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home . The primary outcomes are medial knee load during walking ( the peak external knee adduction moment from 3D gait analysis ) , pain , and self-reported physical function measured at baseline and immediately following the program . Secondary outcomes include the external knee adduction moment angular impulse , electromyographic muscle activation patterns , knee and hip muscle strength , balance , functional ability , and quality -of-life . Discussion The findings will help determine whether neuromuscular exercise is superior to traditional quadriceps strengthening regarding effects on knee load , pain and physical function in people with medial knee osteoarthritis and varus malalignment . Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background : The Bisurface knee prosthesis was design ed in 1989 to improve knee flexion without affecting the durability of the prosthesis . The prosthesis has a unique ball- and -socket joint in the midposterior portion of the femoral and tibial components , which functions as a posterior stabilizing cam mechanism and causes femoral rollback . The femoral component was made of alumina ceramic . The purpose of this study was to review the clinical results of the first 223 arthroplasties performed with this prosthesis in order to assess whether this new implant had achieved its design objectives . Methods : From December 1989 to May 1994 , all patients who were scheduled for primary total knee arthroplasty were enrolled in a prospect i ve study of the Bisurface knee . The patients were evaluated clinical ly according to The Hospital for Special Surgery knee-rating system and with a self-administered question naire , and they were evaluated radiographically according to the system of the Knee Society . Kaplan-Meier survivorship analysis was performed with revision of the knee or recommendation for revision as the end point . Results : One hundred and sixty-six patients treated with a total of 223 consecutive primary total knee arthroplasties were enrolled in the study , and 182 knees were followed for 3.9 to 9.0 years ( mean , 5.8 years ) . Preoperatively , the mean Hospital for Special Surgery knee score was 44.5 points . At the time of latest follow-up , the mean knee score was 86.3 points . The mean preoperative and postoperative ranges of flexion were 119 and 124 degrees , respectively . The patients , even those with a good preoperative range of motion , rarely lost deep flexion of the knee after the procedure . A revision operation was performed in eight knees ( because of infection in five , instability in two , and breakage of the peg of the patellar component in one ) . Two knees had recurrent medial-lateral subluxations of the femorotibial articulation , which were treated nonoperatively . No prosthesis had loosened aseptically and no alumina ceramic femoral component had broken by the time of latest follow-up . The rate of survival of the implant was 94 percent ( 95 percent confidence interval , 90 to 98 percent ) at six years . According to the patient question naires , 20 percent of the knees sometimes felt loose in daily living activities , which prompted us to improve the intrinsic stability of the prosthesis by improving the congruity of the ball- and -socket joint . Conclusions : Total knee arthroplasty with the Bisurface prosthesis result ed in an excellent range of motion and a high level of satisfaction with the operation ; the durability of the prosthesis is promising A hydraulically operated machine for applying well-defined forces to the knee joint is described . The measurement of anteroposterior as well as lateral and medial stability in the knee joint is based upon roentgenograms exposed while the forces are being exerted on the patient . The advantage of the radiological measuring method over methods using external measurements is the elimination of inaccuracies due to displacements of the soft tissues of the limb . The accuracy was evaluated by test/retest examination of 50 healthy subjects . The radiographs were measured at r and om after cessation of examinations in the gonylaxometer . The accuracy is + /- 1.2 nm for medial/lateral , + /- 2.4 nm for drawer sign . Diagnostically the difference between the two knees must exceed 2.0 nm ( collateral instability ) or 3.1 nm ( drawer ) to exceed st and ard values . The st and ard values for the different ligament laxities are given . The applied force to be used for evaluation of medial/lateral stability is recommended to be 9 kg , and for anteroposterior stability between 20 and 30 kg Purpose To determine if anatomic double-bundle anterior cruciate ligament ( ACL ) reconstruction  is superior to anatomic single-bundle reconstruction in restoring the stabilities and functions of the knee joint . Methods A prospect i ve r and omized clinical study was done to compare the results of 32 cases of anatomic single-bundle ACL reconstruction and 34 cases of anatomic double-bundle ACL reconstruction with average follow-up of 16.3 ± 3.1 months . Tunnel placements of all the cases were measured on 3D CT . Clinical results were collected after reconstruction ; graft ’s appearance , meniscus status and cartilage state under arthroscopy were compared and analysed too . Results Tunnel placements , confirmed with 3D CT , were in the anatomic positions as described in literature both in SB and DB group . No differences were found between SB and DB groups in clinical outcome scores , pivot shift test and KT 1000 measurements ( average side-to-side difference for anterior tibial translation was 0.7 mm in SB group and 1.0 mm in DB group ) . More than 70 % of the single-bundle graft and AM bundle graft in DB group appeared excellent , but only 44.1 % of PL bundle grafts in DB group were excellent and 11.8 % were in poor state . No new menisci tear was found either in SB or DB group , however , in DB group cartilage damages in medial patella-femoral joint occurred in 38.2 % cases . This rate was significantly higher than in the SB group which is only 9.3 % . Conclusion Both single- and double-bundle anatomic ACL reconstruction can restore the knee ’s stability and functions very well . However , more incidences of poor PL status and medial patellar-femoral cartilage damage may occur in double-bundle ACL reconstruction . Level of evidence R and omized controlled trial , Level The literature contains limited yet controversial information regarding whether a fixed or a mobile bearing implant should be used in unicompartmental knee arthroplasty ( UKA ) . This r and omized study was to further document the performance and comparison of the two design s. Fifty-six knees in 48 patients ( mean age of 72 years ) undergoing medial UKA were r and omized into a fixed bearing ( Miller/Galante ) or a mobile bearing ( Oxford ) UKA . The 2 year clinical outcomes ( clinical scores ) , radiographic findings , and weight bearing knee kinematics ( assessed using RSA ) were compared between the two groups . The mobile bearing knees displayed a larger and an incrementally increased tibial internal rotation ( 4.3 degrees , 7.6 degrees , 9.5 degrees vs. 3.0 degrees , 3.0 degrees , 4.2 degrees respectively at 30 degrees , 60 degrees , 90 degrees of knee flexion ) compared to the fixed ones . The medial femoral condyle in the mobile bearing knees remained 2 mm from the initial position vs. a 4.2 mm anterior translation in the fixed bearing knees during knee flexion . The contact point in the mobile bearing implant moved 2 mm posteriorly vs. a 6 mm anterior movement in the other group . The mobile bearing knees had a lower incidence of radiolucency at the bone implant interface ( 8 % vs. 37 % , p < 0.05 ) . The incidence of lateral compartment OA and progression of OA at patello-femoral joint were equal . No differences were found regarding Knee Society Scores , WOMAC , and SF-36 scores ( p > 0.05 ) . This study indicates that mobile bearing knees had a better kinematics , a lower incidence of radiolucency but not yet a better knee function at 2 years Abstract : The objective of this study was to measure three-dimensional knee motion during gait in patients with total knee replacements which either retained the posterior cruciate ligament ( n = 11 ) , or required sacrifice of the posterior cruciate ligament and replacement of its function with a posterior stabilizing articular surface ( n = 9 ) . Clinical ly meaningful translations ( anterior and posterior , medial and lateral , proximal and distal ) and rotations ( flexion and extension , internal and external rotation , abduction and adduction ) were measured using an instrumented spatial linkage . Although patients from both groups were able to achieve passive full extension and a minimum of 95 ° flexion , some of their translations and rotations during free speed walking were consistently less than those in a group of healthy controls . Motion during the swing phase of gait was similar for both knee replacement groups . However , abduction and adduction and proximal and distal translation were larger ( but neither difference was significant ) for the patients with implants with a posterior stabilizing surface , which suggests that the stabilizing surface may not reliably provide as much stability in these directions as does retention of the posterior cruciate ligament Background Kneeling is one of the activities sought by patients after total knee arthroplasty ( TKA ) . This study investigated the six degrees of freedom ( DOF ) kinematics and three-dimensional ( 3D ) contact during weight-bearing kneeling . Methods A total of 16 South Korean female patients ( 22 knees ) after posteriorly stabilized ( PS ) TKA ( LPS-Flex ) were r and omly recruited and had the same surgeon . The patients were imaged using a dual fluoroscopic technique while they kneeled from initial to maximum flexion . The acquired images and 3D models were then used to recreate the in vivo pose of the components . Contact was determined by locating the surface intersections in the tibiofemoral and cam/post ( between the femoral cam and tibial post ) articular compartments . Results Patients flexed , on average , from 107.3 ° to 128.0 ° during the kneeling activity . Changes in kinematics included 1.0 mm of proximal , 0.9 mm of medial , and 7.6 mm of posterior translation and 1.7 ° of varus rotation ( P < 0.04 ) . A difference in internal tibial rotation was not detected . Articular contact moved posteriorly by 5.9 mm and 6.4 mm in the medial and lateral compartments , respectively . Contact also moved medially by 3.2 mm and 5.8 mm in the medial and lateral compartments . A decrease in articular contact was observed in both condyles , and lateral condylar lift-off increased with flexion ( P = 0.0001 ) . More than 80 % of the patients demonstrated cam/post engagement , which always occurred in the distal portion of the post . Conclusions In this patient cohort , the knee joint was constrained during the weight-bearing activity such that femoral subluxation and dislocation were not observed . Furthermore , posterior cam/post engagement occurred only in the distal portion of the tibial post , which may improve the longevity of the post . The tibiofemoral and cam/post articular contact data presented in this study further suggest that kneeling may be performed by patients after clinical ly successful PS TKA who feel comfortable with the activity and are free of pain The goal of this prospect i ve , r and omized , blinded trial was to determine if ligament balancing techniques for rotating platform TKA affect postoperative knee kinematics .  Sixteen patients with unilateral rotating platform TKA consented to participate in this institutional review board approved study . Eight patients were r and omly selected to receive ligament balancing with an instrumented joint spreader device and eight patients received ligament balancing using fixed thickness spacer blocks .  A single plane shape matching technique was used for kinematic analysis of static deep knee flexion and dynamic stair activities . There were no differences in knee kinematics between groups during static deep flexion activities . The spreader group demonstrated kinematics more similar to the normal knee during the ascending phase of the dynamic stair activity . Knee kinematics in static knee flexion were unaffected by ligament balancing technique , while knees balanced with the spreader demonstrated a medial pivot motion pattern during stair ascent . This medial pivot motion pattern may improve long-term results by more closely replicating normal knee kinematics Purpose Both , knee joint distraction as a relatively new approach and valgus-producing opening-wedge high tibial osteotomy ( HTO ) , are knee-preserving treatments for knee osteoarthritis ( OA ) . The efficacy of knee joint distraction compared to HTO has not been reported . Methods Sixty-nine patients with medial knee joint OA with a varus axis deviation of < 10 ° were r and omized to either  knee joint distraction ( n = 23 ) or HTO ( n = 46 ) . Question naires were assessed at baseline and 3 , 6 , and 12 months . Joint space width ( JSW ) as a surrogate measure for cartilage thickness was determined on st and ardized semi-flexed radiographs at baseline and 1-year follow-up . Results All patient-reported outcome measures ( PROMS ) improved significantly over 1 year ( at 1 year p < 0.02 ) in both groups . At 1 year , the HTO group showed slightly greater improvement in 4 of the 16 PROMS ( p < 0.05 ) . The minimum medial compartment JSW increased 0.8 ± 1.0 mm in the knee joint distraction group ( p = 0.001 ) and 0.4 ± 0.5 mm in the HTO group ( p < 0.001 ) , with minimum JSW improvement in favour of knee joint distraction ( p = 0.05 ) . The lateral compartment showed a small increase in the knee joint distraction group and a small decrease in the HTO group , leading to a significant increase in mean JSW for knee joint distraction only ( p < 0.02 ) . Conclusion Cartilaginous repair activity , as indicated by JSW , and clinical outcome improvement occurred with both , knee joint distraction and HTO . These findings suggest that knee joint distraction may be an alternative therapy for medial compartmental OA with a limited mechanical leg malalignment . Level of evidence R and omized controlled trial , Level Objective Mechanical factors , in particular increased medial knee joint load , are believed to be important in the structural progression of knee osteoarthritis . This study evaluated the relationship of medial knee load during walking to indices of structural disease progression , measured on MRI , in people with medial knee osteoarthritis . Methods A longitudinal cohort design utilising a subset of participants ( n=144 , 72 % ) enrolled in a r and omised controlled trial of lateral wedge insoles was employed .  Medial knee load parameters including the peak knee adduction moment ( KAM ) and the KAM impulse  were measured at baseline using three-dimensional gait analysis during walking . MRI at baseline and at 12 months was used to assess structural indices . Multiple regression with adjustment for covariates assessed the relationship between medial knee load parameters and the annual change in medial tibial cartilage volume . Binary logistic regression was used for the dichotomous variables of progression of medial tibiofemoral cartilage defects and bone marrow lesions ( BML ) . Results A higher KAM impulse , but not peak KAM , at baseline was independently associated with greater loss of medial tibial cartilage volume over 12 months ( β=29.9 , 95 % CI 6.3 to 53.5 , p=0.01 ) . No significant relationships were seen between medial knee load parameters and the progression of medial tibiofemoral cartilage defects or BML . Conclusion This study suggests knee loading , in particular the KAM impulse , may be a risk factor for loss of medial tibial cartilage volume . As knee load is modifiable , load-modifying treatments may potentially slow disease progression Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent review s suggest that lateral wedges do not affect disease progression . We performed a systematic review to analyse the recent literature and define how effective , if at all , lateral wedges are in the management of medial compartment osteoarthritis of the knee . The inclusion criteria were defined as any study published within the last decade , using a sample size of at least twenty patients , and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis . The st and ardised keyword term ‘ lateral*wedge*OR insole*OR orthotic * OR medial compartment OR varus OR osteoarthri * OR knee * ’ was used . We identified 10 studies that fitted our inclusion criteria . Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee  , there is some evidence to suggest that they do have some symptomatic effect .  Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI . The literature is unclear as to what the optimal duration for the use of lateral wedges is , but does support the prolonged use of the wedges as the benefits at one month are maintained at one year . Future studies should be r and omised controlled trials with a large sample size with long follow-up , and use objective clinical , biomechanical and radiological outcome measures BACKGROUND It is reported that a majority of the patients with knee osteoarthritis have cartilage degeneration in medial and patellofemoral compartments . A bi-compartmental knee replacement system was design ed to treat osteoarthritis at medial and patellofemoral compartments . To date , there is very little information regarding the knee mechanics during gait after bi-compartmental knee replacement . The purpose of the study was to evaluate knee strength and mechanics during level walking after knee replacement . METHODS Ten healthy control subjects and eight patients with unilateral bi-compartmental knee replacement participated in the study .  Maximal isokinetic concentric knee extension strength was evaluated . 3D kinematic and kinetic analyses were conducted for level walking . Paired Student t-test was used to determine difference between surgical and non-involved limbs . One way MANOVA was used to determine difference between surgical and control groups . FINDINGS The surgical knee exhibited less peak torque and initial abduction moment than both the non-involved and control limbs ( P<0.05 ) . The non-involved limb had less knee extension at stance and greater knee extensor moment during push-off than both the surgical and control limbs ( P<0.05 ) . No differences were found for other typical knee mechanics among the surgical , non-involved , and control limbs during walking ( P>0.05 ) . INTERPRETATIONS Patients with bi-compartmental knee replacement exhibited good frontal plane knee mechanics and were able to produce the same level of knee extensor moment as healthy control limbs during walking . While showing some compensatory patterns during walking , patients with bi-compartmental knee replacement largely exhibited normal gait patterns and knee mechanics BACKGROUND Regenerex is a novel porous titanium construct with a three-dimensional porous structure and biomechanical characteristics close to that of normal trabecular bone . The aim of this study was to compare this novel construct to a well-proven porous plasma sprayed tibial ( PPS ) implant after total knee arthroplasty . METHODS Sixty-one patients scheduled for an uncemented TKA were r and omized to receive either a novel highly porous titanium construct Regenerex or the PPS tibial component . Radiostereometric analysis of the tibial components was performed postoperatively and at three , six , 12 , and 24months with measurements of migration ( segment motion and maximum total point motion ( MTPM ) ) . RESULTS Knee and function scores improved significantly from preoperatively to two-year follow-up . For both the Regenerex and the PPS the majority of migration appeared during the first three months and then stabilized . No statistically significant differences in MTPM were found in any follow-up between three and 24months . The Regenerex group had a lower migration rate between 12 and 24months compared with the PPS implants ( p=0.03 ) but the PPS group had an initial significantly lower subsidence ( p=0.04 ) . CONCLUSION In conclusion the Regenerex implant could prove an effective scaffold material for coating of uncemented implants but did no better than the PPS component at 24months of follow-up . Clinical Trials.gov identifier : NCT01936415 Abstract Purpose Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants . From a patient-centred view , bicruciate-retaining models provide a more natural feeling knee . However , there is no evidence of functional advantage for these implants . The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty . Methods A prospect i ve , controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis . We compared patients with a bicruciate-retaining knee arthroplasty ( BCR group ) to a control group of patients with a medial unicompartmental knee arthroplasty ( UKA group ) and another control group of patients with a posterior stabilized total knee arthroplasty ( PS group ) . The patient population comprised 30 women ( 50.0 % ) and 30 men in three cohorts of 20 each . The mean age was 62.1 ± 8.0 years ( range 43–78 ) . Patients were evaluated preoperatively and 9 months post-operatively . The evaluation included clinical , radiological , and balance testing — a single-leg stance with eyes closed compared to eyes open . The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty . Results Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence . There was a decreased post-operative knee extension 9 months post-operative in the BCR group , which was not clinical ly relevant in any case . We recorded a lower difference in the area of sway between eyes closed and eyes open ( ΔA(ec – eo ) ) for the BCR group ( p = 0.01 ) and the UKA group ( p = 0.04 ) compared to the PS group . Conclusions This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee , indicating superior proprioceptive function . Hence , BCR implants could provide improved functional properties . Superior proprioceptive function of bicruciate-retaining implants can be an important factor in implant selection . Further prospect i ve , r and omized studies to investigate kinematics and long-term survivorship of bicruciate-retaining implants are needed . Level of evidence II Background Injury to the anterior cruciate ligament ( ACL ) of the knee is common . Following complete rupture of the ACL , insufficient re-vascularization of the ligament prevents it from healing completely , creating a need for reconstruction . A variety of grafts are available for use in ACL reconstruction surgery , including synthetic grafts . Over the last two decades new types of synthetic ligaments have been developed . One of these synthetic ligaments , the Ligament Advanced Reinforcement System ( LARS ) , has recently gained popularity . The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic , anterior cruciate ligament rupture in terms of graft stability , rehabilitation time and return to pre-injury function . Method This systematic review included studies using subjects with symptomatic , ACL ruptures undergoing LARS reconstruction .  A range of electronic data bases were search ed in May 2010 . The method ological quality of studies was appraised with a modified version of the Law critical appraisal tool . Data relating to study characteristics , surgical times , complication rates , outcomes related to knee stability , quality of life , function , and return to sport as well as details of rehabilitation programs and timeframes were collected . Results This review identified four studies of various design s , of a moderate method ological quality . Only one case of knee synovitis was reported . Patient satisfaction with LARS was high . Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods . The time frames of rehabilitation periods were poorly reported and at times omitted . Return to pre-injury function and activity was often discussed but not reported in results . Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques , and high patient satisfaction scores . However , this systematic review has highlighted several important gaps in the existing literature that require future prospect i ve investigation . The findings of this review were equivocal with regards to other measures such as graft stability and long term functional outcomes . While the importance of rehabilitation following LARS is well recognised , there is limited evidence to guide rehabilitation protocol Background : R and omized controlled trials after anterior cruciate ligament reconstructions with long-term follow-up including assessment of health-related quality of life are rare . Purpose : To compare clinical outcome and health-related quality of life 8 years after  anterior cruciate ligament reconstruction  using 2 types of graft . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Long-term follow-up of 164 patients with anterior cruciate ligament injury r and omized to arthroscopic reconstruction with a quadrupled semitendinosus graft or a bone – patellar tendon – bone graft was undertaken . After a mean 8 years , 153 patients were available for follow-up , including instrumented laxity , 1-legged hop test , a knee-walking test , and assessment with International Knee Documentation Committee , Lysholm , Tegner , and patellofemoral pain score . Health-related quality of life was assessed with Knee Osteoarthritis Outcome Score and Short Form–36 . Results : Patients in both graft groups retained the same stability , knee function , and health-related quality of life . The patellofemoral pain score was similar for both groups ; the bone – patellar tendon – bone group had more donor site morbidity from kneeling and knee walking . In the bone – patellar tendon – bone group , 19 patients had no kneeling problems , 23 slight problems , 31 moderate problems , and 5 unable to kneel . Corresponding figures for the semitendinosus group were 25 , 32 , 16 , and 2 ( P < .001 ) . Patients with early reconstructions ( < 5 months ) had a lower risk for meniscal injuries ( 37 % ) than did later reconstructed ( 62 % , P = .008 ) . Health-related quality of life regarding physical functioning in Short Form–36 was better for the early-reconstructed patients than for the later reconstructed ( 92 vs 85 ; P = .014 ) . Patients without medial meniscal surgery had higher Knee Osteoarthritis Outcome Scores for all subscales than did patients with medial meniscal surgery , with most significant difference for sport and recreation ( 63 vs 75 , P = .008 ) . Conclusion : In the long term , the semitendinosus graft provided similar stability , knee function , and health-related quality of life but with less kneeling morbidity than did the bone – patellar tendon – bone graft
Conclusion Based on the small number of studies with appropriate statistical analysis , we are unable to reach a clear conclusion in the clinical performance of medial stabilized knee replacement construct .
Background Medial stabilized  total knee joint replacement ( TKJR ) construct is design ed to closely replicate the kinematics of the knee .
Little is known regarding comparison of clinical functional outcomes of patients utilising vali date d patient reported outcome measures ( PROM ) after medial stabilized TKJR and other construct design s. Purpose To perform a systematic review of the available literature related to the assessment of clinical functional outcomes following a  TKJR  employing a medial stabilized construct design .