bluuebunny/crossref_metadata_2025_split huggingface dataset:
X-RAY IDENTIFIED LIPO-HAEMARTHROSIS IN THE ACUTELY INJURED KNEE IS A POOR PREDICTOR OF THE PRESENCE OF INTRA-ARTICULAR FRACTURE OR THE NEED FOR URGENT SURGERY
Authors: Lewis Andrew , Bucknall Kristen , Davies Andrew , Evans Abbie , Jones Lisa , Triscott James , Hutchison Anne-Marie 
Published: August 2023

AbstractIntroductionA lipohaemarthrosis seen on Horizontal beam lateral X-ray in acute knee injury is often considered predictive of an intra-articular fracture requiring further urgent imaging.MethodologyWe retrospectively searched a five-year X-ray database for the term “lipohaemarthrosis”. We excluded cases if the report concluded “no lipohaemarthrosis” or “lipohaemarthrosis” AND “fracture”. All remaining cases were reviewed by an Orthopaedic Consultant with a special interest in knee injuries (AD) blinded to the report. X-rays were excluded if a fracture was seen, established osteoarthritic change was present, a pre-existing arthroplasty present or no lipohaemarthrosis present. Remaining cases were then studied for any subsequent Radiological or Orthopaedic surgical procedures.Results136 cases were identified and reviewed by an Orthopaedic Consultant. 31 were excluded for no lipohaemarthrosis (n= 11), for degenerative change (n=9), for fracture (n=4), for existing arthroplasty (n=4) and for data errors (n=3). The remaining 105 patients had a mean age of 32, and range 5–90 years. 66 patients underwent further imaging in the form of MRI scan (n=47), CT Scan (n=9) repeat x-rays (n=9) and ultrasound (n=1). 27 fractures were identified.Surgery was performed in 12 cases (11%). Two (2%) urgently (One ACL reconstruction plus meniscus repair, one for ORIF of tibial plateau fracture). Ten (10%) had elective surgery (6 for ACL reconstruction, 2 for ACL reconstruction plus meniscus repair, 2 for loose body removal.ConclusionThe presence of a lipohaemarthrosis on x-ray following acute knee injury was a poor predictor of intra-articular fracture (26%) or need for urgent surgery (2%).
SUPPORT AND TREATMENT AFTER JOINT REPLACEMENT (STAR): TRANSLATING TRIAL FINDINGS INTO NHS PRACTICE
Authors: Bertram Wendy , Wylde Vikki , Woodward Tom , Gooberman-Hill Rachael , Whitehouse Michael , Howells Nick 
Published: August 2023

AbstractIntroductionTotal knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR.The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs).There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation.MethodologyTrial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.ResultsThe STAR care pathway was successfully implemented into NHS practice with a screening response rate of 83%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of availability of STAR trained ESPs as a barrier to implementation. The trial manual and training session were adapted for online delivery in partnership with Health Education England.ConclusionThe STAR care pathway has been successfully embedded into NHS care. A toolkit and online clinician training package enables national implementation.
PHYSICAL ACTIVITY AND HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH CHRONIC KNEE PAIN AFTER TOTAL KNEE ARTHROPLASTY: ANALYSIS OF THE PEP-TALK TRIAL
Authors: Fabiano Gianluca , Smith Toby , Parsons Scott , Ooms Alex , Dutton Susan , Fordham Beth , Hing Caroline , Pinedo-Villanueva Rafael , Lamb Sallie 
Published: August 2023

AbstractINTRODUCTIONThis study aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after total knee replacement (TKR) for patients with and without post-operative chronic knee pain.METHODS83 adults participating in the PEP-TALK, a RCT testing the effectiveness of a behaviour change physiotherapy intervention versus usual rehabilitation post-primary TKR, were analysed. UCLA Activity Score and EQ-5D-5L values for participants with and without chronic knee pain (14 points or lower in the Oxford Knee Score Pain Subscale at six months post-TKR) were compared at six and 12 months post-TKR. We evaluated recovery trajectory those with or without chronic pain at these time points.RESULTSParticipants with chronic knee pain, UCLA Activity Score remained unchanged between baseline to six months (mean: 3.8 to 3.8), decreasing at 12 months (mean: 3.0). Those without post-operative chronic knee pain reported a improvement in physical activity from baseline to six months (mean: 4.0 vs 4.9), plateauing at 12 months (mean: 4.9). Participants with chronic knee pain reported lower baseline HRQoL, although both groups improved mean health utility over one year. Of participants who were not defined as being in chronic pain at six months, 8.5% returned to a chronic pain categorisation by 12 months.CONCLUSIONPeople with chronic knee pain post-TKR report poorer physical activity and HRQoL scores post-operatively. Monitoring outcomes longer than six months may be indicated as those without chronic knee pain initially post-TKR remain at risk of reverting to chronic knee pain 12 months post-TKR.
PATIENT SATISFACTION FOLLOWING DOUBLE-LEVEL OSTEOTOMY: A SUCCESSFUL INTERVENTION FOR KNEE OSTEOARTHRITIS?
Authors: Wright Esther , Andrews Nicole , Thakrar Raj , Chatoo Minhal 
Published: August 2023

AbstractIntroductionOsteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs).MethodologyAll patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals.Results24 patients underwent DLO; a medial opening wedge high tibial osteotomy and lateral closing wedge distal femoral osteotomy. The cohort comprised 21 males, 3 females with an average age of 54.09 (38–77) years. Preoperative pain scores graded from 0–10 improved from 6.86 to 2.0 at 2 years. OKS improved from 23.94 to 47.88, as did KOOS 43.55 to 87.51, over the same duration.ConclusionDLO was associated with improvements in pain and functional outcomes, compared to pre-operative levels. In patients for whom arthroplasty may be unfavourable, this provides an alternative to non-operative management, the options for which are frequently exhausted early in the disease process.
LONG-TERM RESULTS OF PER-OPERATIVE KNEE ARTHROSCOPY IN CONFIRMING SUITABILITY FOR UNICOMPARTMENTAL KNEE ARTHROPASTY
Authors: Gill James , Brimm Daniel , McMeniman Peter , McMeniman Timothy , Myers Peter 
Published: August 2023

AbstractIntroductionPatient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision. Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, MRI, and visualisation at the time of surgery. Arthroscopy is another means of assessing the integrity of the lateral compartment.MethodsWe used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. This study reports the long-term results of a previously published cohort of knees. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3).ResultsThe 14-year cumulative percentage revision (CPR) was 18.5% (95% CI 12.7, 26.4) for group 1, 19.7% (95% CI 18.8, 20.6) for group 2, and 19.2% (95% CI 18.5, 19.8) for group 3. There was no statistically significant difference in the (CPR) for the entire period when group 1 was compared to groups 2 or 3. Progression of arthritis was the indication for revision in similar proportions for the three groups (Group 1: 32.3%, Group 2: 35.7% and Group 3: 33.5%). Following per-operative arthroscopy 21.6% (77/356) of knees underwent a change of surgical plan from UKA to TKA.ConclusionPer-operative arthroscopy may improve medium-term medial unicompartmental knee survivorship but does not improve long-term survivorship nor reduce revision due to progression of arthritis.
LONG-TERM BIOMECHANICAL OUTCOMES OF A HIGH FLEXION DESIGN TOTAL KNEE ARTHROPLASTY
Authors: Tawy Gwenllian , McNicholas Michael , Biant Leela 
Published: August 2023

AbstractIntroductionThis study compared biomechanical and functional parameters of a total knee arthroplasty (TKA) implant (Cemented Zimmer Hi-Flex) against healthy older adults to determine whether knee biomechanics was restored in this patient population.MethodologyPatients with a primary TKA and healthy adults >55 years old with no musculoskeletal deficits or arthritis participated. Bilateral knee range of motion (RoM) was assessed with a goniometer, then gait patterns were analysed with a 3D motion-capture system. An arthrometer then quantified anterior-posterior laxity of each knee. Statistical analyses were performed in SPSS (α=0.05; required sample size: n=21 per group).Results25 knees were replaced in 21 patients. Nine presented with fixed flexion deformities (FFD) (13.3±5.6°). FFDs were abolished intraoperatively, and the average flexion increased from 124.8±9.1° to 130.9±5.8°. At 9.6±3.2 years postoperatively, the patients achieved poorer RoM than healthy controls (n=23); p<0.0001. These differences were due to limited flexion in the knee. Patients also failed to achieve the same degree of flexion as controls bilaterally during gait. No differences were observed during mid-flexion; a state that has been associated with instability (p=0.614). There were no differences between groups in knee laxity.ConclusionPatients in this study had similar gait patterns to healthy older adults during mid-flexion, and were no more likely to exhibit anterior-posterior translation of the knee >7mm; a known risk factor of instability. However, the flexion range was poorer. This led to bilateral pathological knee flexion patterns during gait. Further research should identify the cause of these limitations.
A COMPARISON OF RETURN-TO-PLAY RATES IN DIFFERENT ELITE SPORTS AFTER PRIMARY AUTOGRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Jones Mary , Pinheiro Vitor Hugo , Balendra Ganesh , Borque Kyle , Williams Andy 
Published: August 2023

AbstractIntroductionThe study aims were to demonstrate rates, level, and time taken to RTP in elite sports after ACL reconstruction (ACL-R) and compare football and rugby.MethodsA retrospective review of a consecutive series of ACL-R between 2005 and 2019 was undertaken. Patients were included if they were elite athletes and were a minimum of 2 years post primary autograft ACL-R. The outcomes measured were return to play (RTP), (defined as participation in a professional match or in national/ international level amateur competition), time to RTP after surgery, and RTP level (Tegner score).ResultsThree hundred and ninety four elite athletes with 420 ACL-Rs (235 in footballers, 125 in rugby players and 60 in other sports) were included. 95.7% of all athletes returned to competition at a mean of 10.3 months after ACL-R with 90.1% at the same / higher level. There was no difference in RTP rates between rugby and football. Rugby players RTP faster than footballers (9.6 vs 10.6 months, (p=0.027). Overall re-rupture rate within 2 years was 6.4% but not significantly different between football (8.1%) and rugby (7.2%).Footballers were more likely to rupture their ACL during jumping / landing manoeuvres and to receive a PT graft than rugby players. There were no significant differences between football and rugby regarding patient characteristics, intraoperative findings and re-operation rates.ConclusionOver 95% of all elite athletes RTP after primary ACL-R with 90% able to play at the same level. Rugby players RTP significantly faster than footballers.
NOVEL ROBOTIC TECHNIQUE TO INVESTIGATE TOTAL KNEE ARTHROPLASTY STABILITY
Authors: Holthof Sander , Amis Andrew , Van Arkel Richard , Rock Mick 
Published: August 2023

AbstractIntroductionMid-flexion instability may cause poor outcomes following TKA. Surgical technique, patient-specific factors, and implant design could all contribute to it, with modelling and fluoroscopy data suggesting the latter may be the root cause. However, current implants all pass the preclinical stability testing standards, making it difficult to understand the effects of implant design on instability. We hypothesized that a more physiological test, analysing functional stability across the range of knee flexion-extension, could delineate the effects of design, independent of surgical technique and patient-specific factors.MethodsUsing a SIMvitro-controlled six-degree-of-freedom robot, a dynamic stability test was developed, including continuous flexion and reporting data in a trans-epicondylar axis system. 3 femoral geometries were tested: gradually reducing radius, multi-radius and single-radius, with their respective tibial inserts. 710N of compression force (body weight) was applied to the implants as they were flexed from 0–140° with three levels of anterior/posterior (AP) tibial force applied (−90N,0N,90N).ResultsWhile in static tests, the implants performed similarly, functional stability testing revealed different paths of motion and AP laxities throughout the flexion cycle. Some designs exhibited mid-flexion instability, while others did not: the multi-radius design allowed increased AP laxity as it transitioned to each arc of reduced femoral component radius; the single-radius design had low tibial bearing conformity, allowing 16mm difference in the paths of mid-flexion versus extension motion.ConclusionsPreclinical lab testing reveals functional differences between different design philosophies. Implant design impacts kinematics and mid-flexion stability, even before factoring in surgical technique and patient-specific factors.
DETERMINANTS OF PERFORMANCE IN 200 PROFESSIONAL FOOTBALLERS AT TWO AND FIVE YEARS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Jones Mary , Pinheiro Vitor Hugo , Laughlin Mitzi , Bourque Kyle , Williams Andy 
Published: August 2023

AbstractIntroductionThe aim of this study was to determine which factors affect a professional footballer's return to play performance level after ACL reconstruction (ACL-R). Additionally, to report their playing performance at 2 and 5 years post ACL-R compared to their preinjury performance.MethodsA retrospective review of a consecutive series of primary ACL-R undertaken in professional footballers between 2005 and 2019 was undertaken. Performance was determined by the number of minutes played and the league level compared to their pre-injury baseline. Playing time (minutes) was classified as same (within 20%), more, or less playing time for each season compared to the one year prior to surgery.ResultsTwo hundred footballers (mean age 24.1 ± 4.2 years) were included. 194 (97%) returned to professional football.At 2-years after ACL-R 61% of footballers were playing in the same/ higher league, 29% were playing in a lower league and 10% were not playing. At 5-years this was 35%, 37% and 28% respectively.Forty-six percent of footballers were playing the same or more minutes as pre-injury at 2 years post-surgery, 51% were at 3 and 4 years but this reduced to 45% at 5 years.The presence of >50% thickness chondral pathology, ACL-R lacking lateral extra-articular tenodesis and age over 25 years at surgery were all significant risk factors of worse performance rates after ACL-R.ConclusionWhile professional footballers achieved high initial RTP rates after ACL-R, with the majority returning to pre-operative levels of competition, significant decreases in performance rates were noted over time.
THE USE OF A MULTIMEDIA POSTOPERATIVE REPORT FOR PATIENTS UNDERGOING ARTHROSCOPIC KNEE SURGERY: IMPROVING COMMUNICATION WHILE SIMULTANEOUSLY REDUCING FACE-TO-FACE CLINICAL FOLLOW-UP APPOINTMENTS. A QUALITATIVE STUDY
Authors: Ross-Thriepland Stephen , Duffy David 
Published: August 2023

AbstractIntroductionTransforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex)MethodologySingle District Hospital using a 3 Phase studyPhase 1 – Assessment of cost and environmental impact of outpatient follow up appointmentsPhase 2 – Bench marking of existing pathways and patient experience.Phase 3 – Qualitative assessment of multimedia report feedback of 30 patientsResultsPhase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2.Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments.Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery.ConclusionsReducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU.
PATIENT-REPORTED OUTCOME MEASURES AFTER ELECTIVE REVISION TOTAL KNEE ARTHROPLASTY IN ELDERLY PATIENTS (>85 YEARS)
Authors: Downie Samantha , Haque Seraj , Ridley David , Nicol Graeme , Dalgleish Stephen 
Published: August 2023

AbstractIntroductionRevision total knee arthroplasty (rTKA) in elderly patients (>85 years) is associated with increased mortality, hospital stay and a high rate (55%) of complications. The objective was to assess PROMs in elderly patients undergoing rTKA.MethodsA retrospective cohort study of consecutive patients undergoing rTKA at an arthroplasty centre from 2001–2022 were compared to a control group (aged 50–79y) matched for gender, diagnosis & surgery year. The commonest reasons for revision in elderly patients was aseptic loosening (53/100), infection (21/100) and fracture (7/100). One-year patient-reported outcome data was available for 64%.Results100 patients underwent rTKA with a mean age of 84 years (range 80–97 years, SD 3) compared to a matched control group of younger patients (mean age 69y). Preoperative function was poor, with a mean Oxford knee score (OKS) of 40/100 in elderly and 43/100 in younger patients (p=0.164).At one-year postop, mean OKS was comparable between elderly and young patients (81 and 84/100 respectively, p=0.289). The number of patients with severe pain at one year was also comparable (4% elderly and 7% young respectively, p=0.177).The improvement in OKS for elderly patients was sustained at three (82 95% CI 58–100, 14/100 known) and five years.Overall complication rate was 54%. 14% were dead at 1 year and 56% were dead at five-years.ConclusionElderly patients undergoing elective revision TKA show a mean improvement in Oxford knee score of +38 at one year. This is the same as younger patients and is sustained at three and five years.
OPTIMIZING KNEE JOINT REHABILITATION USING ROBOTIC ASSISTIVE TECHNOLOGY IN AN INTELLIGENT WEARABLE KNEE BRACE
Authors: Liu Aiqin , Qian Kun , Dorzi Rafic , Alabdullah Meernah , Anand Sanjeev , Maher Niall , Kingsbury Sarah , Conaghan Philip , Xie Shane 
Published: August 2023

AbstractIntroductionKnee braces are limited to providing passive support. There is currently no brace available providing both continuous monitoring and active robot-assisted movements of the knee joint. This project aimed to develop a wearable intelligent motorised robotic knee brace to support and monitor rehabilitation for a range of knee conditions including post-surgical rehabilitation. This brace can be used at home providing ambulatory continuous passive movement obviating the need for hospital admissions.MethodologyA wearable sensing system monitoring knee range of motion was developed to provide remote feedback to clinicians and real-time guidance for patients. A prototype of an exoskeleton providing dynamic motion assistance was developed to help patients complete their exercise goals and strengthen their muscles. The accuracy and reliability of those functions were validated in human participants during exercises including knee flexion/extension (FE) in bed and in chair, sit-to-stand and stand-to-sit.ResultsThe knee FE measurement from the sensing system showed high accuracy (correlation coefficient of 0.99°) in human participants. The real-time FE data during exercises showed that the desired exoskeleton rotation fitted well with the participant's knee rotation. This indicated the exoskeleton could coordinate with the participant's knee motion by providing consistent motion assistance. The development of user interfaces to provide feedback is currently underway.ConclusionA wearable robotic knee brace to monitor and support knee rehabilitation exercises was successfully developed. Further development of this device with the use of artificial intelligence has the potential to aid patient rehabilitation in a variety of knee conditions.