Search Results (22)

Psychological distress and musculoskeletal pain are interconnected with poor functional outcomes. This study sought to classify common phenotypes of psychological distress in an orthopaedic sports population and assess differences in functional outcomes using the Prediction of Referral and Outcome (OSPRO-YF) tool. This was a cross-sectional study on 411 operative patients from a single sports surgeon’s clinical practice with completed OSPRO-YF questionnaires. Latent class analysis was employed to construct distress phenotypes based on binary measures for 11 single-construct psychological questionnaires, spanning two negative and one positive domains of pain-associated psychological distress. Functional outcome measures, including numerical pain scores, the Patient-Reported Outcomes Measurement Information System (PROMIS), the Single Assessment Numeric Evaluation (SANE) American Shoulder and Elbow Surgeons Score (ASES), and the International Knee Documentation Committee Subjective Knee Form (IKDC), were compared. Four psychological distress clusters were derived: low distress (LD-1; n = 111), low self-efficacy (LS-2; n = 101), negative pain coping, low self-efficacy (NP-3; n = 99), and high distress (HD-4; n = 100), with increasing yellow flags proceeding from LD-1 to HD-4. The mean numerical pain scores were highest in HD-4 and lowest in LD-1 and LS-2 (4.6 vs. 2.7 and 2.0, respectively; p < 0.001). The PROMIS depression scores were highest in HD-4 compared to NP-3, LS-2, and LD-1 (57.0 vs. 48.9 vs. 45.6 vs. 46.0; p < 0.001). Phenotyping patients based on OSPRO-YF distress indicators provides an initial framework of the psychological distress burdening the average orthopaedic sports surgical patient population and may aid in targeted psychological treatments. Full article

Anterior cruciate ligament reconstruction with concurrent lateral extra-articular tenodesis enhances rotational stability. However, not many studies describe radiological features following the abovementioned procedure. The purpose of this study was to evaluate the visibility and describe the sonographic morphology of the iliotibial band strip harvested during the modified Lemaire technique and to establish a correlation between these findings and clinical outcomes. Thirty-two consecutive patients underwent primary or revision anterior cruciate ligament reconstruction with the addition of lateral extra-articular tenodesis by the mini-open modified Lemaire technique. All individuals completed the following preoperative and postoperative questionnaires: the KOOS-pain, KOOS-symptoms, KOOS-ADL, KOOS-sport, KOOS-quality, IKDC, Lysholm, and WOMAC. Each patient underwent a postoperative ultrasound examination to evaluate the lateral extra-articular procedure, especially the harvested iliotibial band strip. The most common ultrasound findings of the iliotibial band strip were its hyperechoic appearance (87.1%), location at the level of the femur (58.1%), no surrounding effusion (83.9%), and no power Doppler signal (100%). Effusion seen in sonographic images was correlated with KOOS-symptoms postoperative scores (p = 0.0115). However, there were no correlations between other iliotibial band strip sonographic features and clinical outcomes. The functional score value increased in each patient compared to preoperative measurements. This is the first study that evaluated the sonographic features of the iliotibial band strip after the lateral extra-articular procedure by the mini-open modified Lemaire technique. Our study indicates that ultrasonography is a useful tool in identifying the iliotibial band strip after the mentioned procedure. Effusion observed around the strip on ultrasound was significantly associated with worse KOOS-symptoms scores, suggesting potential clinical relevance. Full article

Background/Objectives: Multiligament knee injuries, involving damage to multiple stabilizing structures, present a significant challenge in orthopedic surgery, often resulting in knee instability and compromised function. While anatomic ligament reconstruction has been traditionally advocated, non-anatomic techniques may provide effective alternatives, particularly for patients with moderate functional demands who do not require high-level athletic performance. Material and methods: In this study, we assessed the outcomes of a non-anatomic, hybrid surgical approach involving combined arthroscopic and open non-anatomic ligament reconstruction in 60 patients with multiligament knee injuries. Using simplified reconstruction methods for the medial collateral ligament (MCL) and lateral collateral ligament (LCL), we tailored the procedures to the needs of active, non-professional patients. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) Questionnaire, Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Results: Postoperative improvements were significant, with the total IKDC score increasing from a median of 39.1 preoperatively to 75.9 postoperatively, Lysholm from 61.0 to 87.0, and KOOS from 47.6 to 85.7 (p < 0.01). The results demonstrated significant improvements across all scoring systems, with enhanced knee stability, reduced pain, and better quality of life. Conclusions: These findings support the feasibility of non-anatomic reconstructions as a practical solution for patients seeking a return to daily activities and recreational sports without the complexity of full anatomic reconstruction. Full article

Background and Objectives: Patellofemoral pain (PFP) is frequent in the young and active population. The effect of muscle strength in the lower extremities after aerobic activity in patients with this condition has yet to be detailed. Our objective was to determine if patients with PFP show alterations in lower extremity muscle strength measurements after performing a session of ten minutes of aerobic activity on a treadmill compared to people without patellofemoral pain. Materials and Methods: We conducted a prospective experimental study with a stratified, non-randomized, and non-blinded population sample with group matching, including an experimental group with PFP and a control group with no pain. Subjects completed self-reported functional questionnaires (IKDC, Kujala, KOOS, SF-12), underwent radiographic studies, and were evaluated by measuring the strength of hip and knee muscles and the Single-Leg Triple-Hop (SLTH) test before and after ten minutes of exercise on a treadmill. Results: Seventeen subjects diagnosed with PFP and seventeen control subjects were evaluated. Both groups were homogeneous and had no significant differences in the demographic variables. A wider sulcus angle at 30° (136.8 ± 3.8° vs. 132.5 ± 5.6°, p = 0.0140), a decrease strength post-exercise in the hip abductor (37.9 ± 7.1 N⋅m vs. 45.6 ± 7.7 N⋅m, p < 0.05) and knee extensor (36.0 ± 9.1 N⋅m vs. 47.7 ± 14.0 N⋅m, p < 0.05), and a shorter distance in the SLTH test (337.9 ± 74.9 cm vs. 438.6 ± 65.8 cm, p < 0.01) was recorded in subjects with patellofemoral pain. Conclusions: Subjects with PFP had an overall lower strength of hip and knee muscles, showing significant differences in the hip abductors and knee extensors between people with PFP and healthy matched controls after aerobic exercise. Full article

Background: Anterior cruciate ligament (ACL) rupture is a frequent injury among athletes, particularly women. Various techniques have shown effectiveness, but their impact on laxity and clinical outcomes varies. This study aims to compare the rupture rates of patellar tendon (PT) reconstruction versus hamstring reconstruction (HR) combined with anterolateral ligament reconstruction (ALLR) in young women. The secondary objectives include comparing functional ACL-RSI and subjective IKDC scores, as well as the Tegner scale, between these two groups. The hypothesis is that adding ALLR to HR will result in rupture rates and functional scores similar to those of PT reconstruction. Methods: Between 2015 and 2019, 96 patients were treated at two facilities, with 70 having an average follow-up of 44 ± 14.5 months: 35 underwent PT reconstruction, and 35 had HR combined with ALLR. Patients were re-evaluated remotely after at least 2 years using a standardised questionnaire and assessing subjective IKDC, ACL-RSI, and Tegner scores. Results: Rupture rates were 5.7% in both groups. The mean subjective IKDC score was 81% for the HR + ALLR group versus 80.8% for the PT group (p = 0.09). The mean ACL-RSI score was 66% for HR + ALLR versus 68% for PT (p = 0.78). The HR + ALLR group lost an average of 0.4 points on the Tegner scale postoperatively, while the PT group lost an average of 0.77 points (p = 0.09). Conclusions: Hamstring surgery combined with anterolateral surgery provides subjective results, as assessed by patients using subjective scales and questionnaires, that are as good as those obtained with PT surgery in young women. Notwithstanding, the results are not corroborated by clinical or radiological examination. Full article

The anterior cruciate ligament (ACL) is crucial for knee stability and is often injured in sports, leading to significant issues like degenerative changes and meniscal tears. ACL tears are prevalent in high-school sports injuries, accounting for 50% of knee injuries in the U.S. Surgical reconstruction, often involving bone-patellar tendon-bone (BPTB) or hamstring autografts, is common, with varying success rates and complications. Emerging alternatives like the peroneus longus tendon show promise but require further comparative studies. This prospective and multicentric study included 110 patients who underwent ACL reconstruction from 2020 to 2022. Fifty-five patients received hamstring tendon autografts (Group H) and fifty-five received peroneus longus tendon autografts (Group P). Surgeries were performed by experienced surgeons using standardized techniques. Patients were evaluated using clinical tests and functional scores including the Lysholm Knee Questionnaire and IKDC-2000 at various postoperative intervals up to 24 months. Data were analyzed using SPSS with a significance level set at p < 0.05. Group H showed superior knee function preoperatively and at 24 months postoperatively compared to Group P. Group H had higher Lysholm and IKDC scores consistently throughout the study period. The anterior drawer and Lachman’s tests indicated better knee stability for Group H. Complications were comparable between groups, with specific issues related to donor site morbidity and muscle weakness observed in each. The six-strand hamstring tendon autograft (Group H) demonstrated superior functional outcomes and knee stability compared to the peroneus longus tendon autograft (Group P) for ACL reconstruction. Despite some donor site morbidity, the hamstring tendon showed better long-term recovery and fewer complications. Future studies should explore larger, multicentric cohorts and integrate regenerative medicine techniques to further enhance ACL reconstruction outcomes. Full article

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient’s knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19–56 years) were enrolled. The average postoperative follow-up was 35.4 months (27–53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8–10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23–100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0–90°. The group’s mean flexion range of motion was 123 ± 16° (90–150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures. Full article

Background: Anterior cruciate ligament (ACL) injury is one of the most prevalent factors contributing to knee instability worldwide. This study aimed to evaluate modified metal fixation techniques for ACL reconstruction compared to factory-made implants, such as polyether ether ketone (PEEK) screws, bioabsorbable screws, and modified metal implants. Methods: A retrospective cohort analysis was conducted to assess the functional outcomes of ACL using various fixation methods. Patients who underwent arthroscopic ACL reconstruction at several healthcare facilities were included in the study. The functional outcomes were evaluated using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) score questionnaire at 6- and 12 months post-surgery. Statistical analyses, including the Shapiro–Wilk test and analysis of variance, were performed to compare outcomes among the fixation groups. Results: Thirty-three patients who underwent ACL reconstruction surgery with varying distributions across the three fixation groups (modified metal implants, PEEK screws, and bioabsorbable screws) were included in the study. As measured by the Lysholm and IKDC scores at 6- and 12 months post-surgery, the PEEK group demonstrated the highest average scores. Nevertheless, these functional outcomes were not significantly different between the groups (p = 0.140, 0.770, 0.150, and 0.200). These findings align with those of meta-analyses comparing different fixation methods for ACL reconstruction. Conclusions: While acknowledging the small sample size as a limitation, this study suggests that modified metal implants represent viable options for ACL reconstruction. The selection of fixation methods should consider patient characteristics and preferences, emphasizing biomechanical stability and long-term outcomes. Further research is needed to validate these findings and explore their biomechanical properties and cost-effectiveness. Full article

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) “isolated (ACLR)” (n = 20) and (ii) “ACLR with medial meniscal injury” (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren–Lawrence score was used. (3) Results: The “isolated ACLR” study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the “ACLR with medial meniscus injury” group (mean: 81). The KOOS category “activities of daily living” showed significantly better results in the isolated ACLR group (p < 0.05). The “ACLR with medial meniscus injury” group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery. Full article

Introduction: The selection of an appropriate PROM is a crucial aspect in assessing outcomes. Questionnaires that have not been designed or validated for a paediatric population are routinely used. Using a questionnaire requires translation, cultural adaptation, and testing the psychometric properties of the translated questionnaire. There is no applicable questionnaire in our country for children with knee-specific conditions in sports orthopaedics. Therefore, this study aims to translate, culturally adapt, and assess the psychometric properties of the Paediatric IKDC (Pedi-IKDC) questionnaire within the Lithuanian paediatric population. Methods: The translation was conducted in accordance with international standards. Patients aged 11–17 years with various knee disorders participated in three surveys and completed the Pedi-IKDC, Lysholm, and PedsQL questionnaires. Interviews with patients following the translation process, in addition to floor and ceiling effects, were used to assess content validity. Cronbach alpha (α) statistics and the intraclass correlation coefficient (ICC) were applied to measure internal consistency and reproducibility, respectively. The standard error of measurement (SEM) and smallest detectable change (SDC) were calculated to assess reliability. Pearson correlations were calculated between Pedi-IKDC and Lysholm PedsQL scores to determine criteria validity. The effect size (ES) and standardised response mean (SRM) were calculated to assess the responsiveness to change. Results: Cronbach’s alpha (α) was 0.91 for the total score, 0.75 for symptoms, and 0.92 for the sport/function component. The ICC for overall scores was 0.98, with each question ranging from 0.87 to 0.98. The SEM was 2.97, and the SDC was 8.23. Lysholm and PedsQL physical functioning domain scores had moderate correlations (0.8 > r > 0.5), and the overall PedsQL score had a weak correlation (0.5 > r > 0.2) to the Pedi-IKDC score. The floor and ceiling effects were 3.3% and 1.6%, respectively. The SRM was 1.72 and the ES was 1.98. Conclusions: The Lithuanian Pedi-IKDC version is an appropriate evaluation instrument for assessing outcomes in children with knee disorders. All of the psychometric features produced acceptable results. Full article

Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients’ satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients’ satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren–Lawrence grades 1–2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee. Full article

Background: The aim of this study is to compare the mid-term outcomes of primary tear of the anterior cruciate ligament (ACL) reconstruction via the use of peroneus longus tendon (PLT) and bone–patellar tendon–bone (BPTB) autografts. Methods: 53 patients (group 1) received ACL reconstruction via BPTB, whereas 55 patients (group 2) received arthroscopic ACL reconstruction using PLT autograft. Results: In group 1, the mean preoperative and postoperative scores on the Lysholm Knee Questionnaire (LKQ) scale resulted in 69.2 ± 10.7 points and −92.2 ± 6.4 points, respectively. The average preoperative and postoperative value on the International Knee Documentation Committee (IKDC) scale was 68.2 ± 10.6% and −90.1 ± 9.5%, respectively. For KT-1000, according to the results of surgical treatment, it is −3.7 ± 1.4 mm, and for the American Orthopaedic Foot & Ankle Society (AOSAF) it is −95.3 ± 4.5%. The autograft ruptured within 2 years after operation in 4 of 50 patients. In group 2, the mean score on the LKQ scale before the operation was 70.2 ± 11.6 points, after −94.3 ± 0.5 points. The average value on the IKDC scale before surgery was 68.6 ± 8.7%, after −91.5 ± 8.2%. KT-1000 −3.4 ± 1.2 mm. Conclusion: The results in both groups can be assessed as good; peroneus longus muscle tendon autograft is an alternative graft for the primary reconstruction of ACL, preserving the dynamic stabilizers of the knee and has no effect on the formation of flat feet and other disease in the postoperative period. Full article

The aim of this study was to evaluate osteoarthritis (OA) patients with infrared thermography to investigate imaging patterns as well as demographic and clinical characteristics that influence knee inflammation. Forty patients with one-sided symptomatic knee OA were included and evaluated through knee-specific PROMs and the PainDETECT Questionnaire for neuropathic pain evaluation. Thermograms were captured using a thermographic camera FLIR-T1020 and temperatures were extracted using the software ResearchIR for the overall knee and the five ROIs: medial, lateral, medial patella, lateral patella, and suprapatellar. The mean temperature of the total knee was 31.9 ± 1.6 °C. It negatively correlated with age (rho = −0.380, p = 0.016) and positively correlated with BMI (rho = 0.421, p = 0.007) and the IKDC objective score (tau = 0.294, p = 0.016). Men had higher temperatures in the knee medial, lateral, and suprapatellar areas (p = 0.017, p = 0.019, p = 0.025, respectively). Patients with neuropathic pain had a lower temperature of the medial knee area (31.5 ± 1.0 vs. 32.3 ± 1.1, p = 0.042), with the total knee negatively correlating with PainDETECT (p = 0.045). This study demonstrated that the skin temperature of OA symptomatic knees is influenced by demographic and clinical characteristics of patients, with higher joint temperatures in younger male patients with higher BMI and worst objective knee scores and lower temperatures in patients affected by neuropathic pain. Full article

During the previous two decades, patient-reported outcome measures (PROMs) have been well tested, and the tools were validated in different languages across the globe. This systematic review aimed to identify the knee disease-specific outcome tools in Arabic and evaluate their methodological quality of psychometric properties of the most promising tools based on the COSMIN checklist and PRISMA guidelines. Articles published in English, from the inception of databases until the date of search (10 August 2022), were included. Articles without at least one psychometric property (reliability, validity, and responsiveness) evaluation, and articles other than in the English language, were excluded from the study. The key terms [“Arabic” AND “Knee” AND (“Questionnaire” OR “Scale”)] were used in three databases, i.e., PubMed, Scopus, and Web of Science (WoS) in the advanced search strategy. Key terms were either in the title or abstract for PubMed. Key words were in the topic (TS) for WoS. COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) risk of bias checklist was used to evaluate the methodological quality of psychometric properties of the Arabic knee-related outcome measures. A total of 99 articles were identified in PubMed, SCOPUS, and WoS. After passing inclusion and exclusion criteria, 20 articles describing 22 scales from five countries were included in this review. The instruments validated in the Arabic language are Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee injury and osteoarthritis outcome score (KOOS), knee outcome survey- activities of daily living scale (KOS-ADLS), Oxford knee score (OKS), anterior knee pain scale, osteoarthritis of knee and hip health-related quality of life (OAKHQoL) scale, Lysholm knee score (LKS), international documentation committee subjective knee form (IKDC), intermittent and constant osteoarthritis pain (ICOAP) questionnaire, Kujala patellofemoral pain scoring system (PFPSS), anterior knee pain scale (AKPS) and osteoarthritis quality of life questionnaire (OAQoL),. All were found to have good test-retest reliability (Intra Correlation Coefficient), internal consistency (Cronbach’s alpha), and construct validity (Visual Analog Scale, Short Form-12, RAND-36, etc.). Of 20 instruments available to assess self-reported knee symptoms and function, 12 were validated in the Saudi Arabian population. Among them, KOS-ADLS is the best PROM to be used in various knee conditions, followed by KOOS and WOMAC. The assessed methodological quality of evidence says that the knee Arabic PROMs are reliable instruments to evaluate knee symptoms/function. Full article

(1) Background: In adolescents, fractures of the femoral shaft that are not suitable for elastic-stable-intramedullary-nailing (ESIN), are challenging. We aimed to evaluate the health-related quality of life (HRQoL) and complications in adolescents treated with intramedullary rodding using the adolescent lateral trochanteric entry femoral nail (ALFN), and to assess if HRQoL was associated with additional injuries. (2) Methods: We followed-up on 15 adolescents with a diaphyseal femoral fracture who were treated with an ALFN from 2004 to 2017. Patients were asked to fill in a questionnaire that includes the iHOT, Peds-QL, and the Pedi-IKDC. (3) Results: The ALFN was used as a primary method of fixation in 13 patients, and as a fixation for failed ESIN in two cases. All 15 fractures healed radiographically. One distal locking screw broke. After a mean follow-up of 2.8 years, the mean iHOT-12 was 14.0 (SD 15.4), PedsQL-function was 85.7 (SD 19.3), PedsQL-social-score was 86.2 (SD 12.5), and the mean Pedi-IKDC was 77.2 (SD 11.3). In patients where the femoral fracture was an isolated injury, the HRQoL-scores were consistently higher compared with patients who sustained additional injures. (4) Conclusions: Treating diaphyseal fractures in adolescents with an ALFN resulted in good radiographic outcomes in all our cases. HRQoL, as measured by the iHOT, PedsQL, and Pedi-IKDC, was good to excellent; but it was consistently inferior in patients with additional injuries. These results suggest that the ALFN is a good alternative when patients are not suitable for ESIN, and that the HRQoL of adolescents who were treated with an ALFN is mainly influenced by the presence of additional injures, and less by the fracture of the femur itself. Full article