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Knee Exam

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981. Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report. Full Text available with Trip Pro

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report. Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care (...) . The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO).Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs.Unstable pelvic fractures

2017 Medicine

982. Oxidation, Damage Mechanisms, and Reasons for Revision of Sequentially Annealed Highly Crosslinked Polyethylene in Total Knee Arthroplasty. Full Text available with Trip Pro

Oxidation, Damage Mechanisms, and Reasons for Revision of Sequentially Annealed Highly Crosslinked Polyethylene in Total Knee Arthroplasty. Sequentially annealed, highly crosslinked polyethylene (HXLPE) has been used clinically in total knee arthroplasty (TKA) for over a decade. However, little is known about the revision reasons; its surface damage mechanisms; or its in vivo oxidative stability relative to conventional polyethylene. We asked whether retrieved HLXPE tibial inserts exhibited: (1 (...) ) similar revision reasons; (2) improved resistance to surface damage; and (3) improved oxidative stability, when compared with conventional gamma inert sterilized polyethylene inserts.A total of 456 revised tibial inserts were collected in a multicenter retrieval program between 2000 and 2016. The implantation time for the HXLPE components was 1.8 ± 1.8 years, and for the control inserts it was 3.4 ± 2.7 years. Revision reasons were assessed based on medical records, radiographs, and examinations

2017 Journal of Arthroplasty

983. Posterolateral Corner Injuries of the Knee at the National Football League Combine: An Imaging and Outcomes Analysis. (Abstract)

Posterolateral Corner Injuries of the Knee at the National Football League Combine: An Imaging and Outcomes Analysis. (1) To determine the epidemiology, examination findings, imaging findings, and associated injuries of posterolateral corner (PLC) injuries in players participating in the National Football League (NFL) Combine and (2) to evaluate the impact of PLC injuries on performance compared with matched controls.All PLC injuries identified at the NFL Combine between 2009 and 2015 were (...) with matched controls.Of the 2,285 players assessed at the NFL Combine, 16 (0.7%) were identified with a history of a grade II or III PLC tear and surgical management whereas 7 additional players (0.3%) had a PLC injury diagnosed on clinical examination, for 23 total PLC injuries (1%). On examination, 13 of 22 knees (59%) were shown to be stable; however, most of those managed surgically had significantly improved stability (13 of 15 stable) versus none of those managed nonsurgically (0 of 7 stable

2017 Arthroscopy

984. Efficacy of Intravenous Acetaminophen for Postoperative Analgesia in Primary Total Knee Arthroplasty. (Abstract)

Efficacy of Intravenous Acetaminophen for Postoperative Analgesia in Primary Total Knee Arthroplasty. The use of intravenous acetaminophen has seen recent enthusiasm as one component of a multimodal approach to pain management. However, there is a lack of literature examining the efficacy of intravenous acetaminophen for pain control in total joint arthroplasty. The purpose of this study was to evaluate the efficacy of intravenous acetaminophen following primary total knee arthroplasty.This (...) is a retrospective review of 38 patients undergoing primary total knee arthroplasty by a single surgeon at one institution. Twenty-five patients received 1 gram of intravenous acetaminophen every 6 hours for 24 hours postoperatively. Thirteen patients received no additional intervention. Exclusion criteria were bilateral or concomitant procedures, allergy to medications included in the standard postoperative protocol, neuropathy or sensory disturbances, history of opioid dependence or abuse, deviations from

2017 Journal of Arthroplasty

985. Concurrent one-stage total knee and hip arthroplasty due to sequel of juvenile rheumatoid arthritis: A case report. Full Text available with Trip Pro

of both THA and TKA in a patient with RA simultaneously.History of juvenile rheumatoid arthritis (JRA), deterioration of signs and symptoms in history and physical examinations and radiography were lead to making decision for her surgery.Concurrent total hip replacement and total knee arthroplasty were performed for patient.After more than a 2-year follow-up time, the patient showed excellent clinical function and remained satisfied with the surgical outcome. Multiple simultaneous total joint (...) Concurrent one-stage total knee and hip arthroplasty due to sequel of juvenile rheumatoid arthritis: A case report. Rheumatoid arthritis is a chronic systemic connective tissue disease. Total hip and knee arthroplasties are common major orthopaedic procedures worldwide.To date, no studies have presented 1-stage concurrent total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). We reported a case which is, to our knowledge, the first description

2017 Medicine

986. Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty. (Abstract)

Varus tibial alignment is associated with greater tibial baseplate migration at 10 years following total knee arthroplasty. To examine implant migration and articular behavior of primary total knee arthroplasty (TKA) at 10 years after index surgery and correlate to implant alignment.Thirty-five patients underwent a cemented posterior stabilized total knee arthroplasty with a surgical objective of neutral alignment and were enrolled in a long-term radiostereometric analysis (RSA) study. At 10 (...)  years after surgery, patients were analyzed for implant migration using RSA as well as radiographic assessment of articular behavior at four positions of knee flexion. Implant position and alignment was measured on full-length radiographs. Patient demographics and reported outcomes were also collected.No difference between patient demographics or patient-reported outcomes were found. When categorized into neutral and varus groupings, no difference in migration was present. If alignment

2017 Knee Surgery, Sports Traumatology, Arthroscopy

987. Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review. Full Text available with Trip Pro

Open repair of intraoperative popliteal artery injury during total knee arthroplasty in a patient with severe hemophilia A: A case report and literature review. Arterial injuries during total knee arthroplasty (TKA) though rare may occur. Hemophilia may further challenge the management of such injury.A 48-year-old male patient with severe hemophilia type A and stiff knee arthropathy underwent bilateral TKAs. Left popliteal artery injury was detected at the end of the left TKA.Urgent angiography (...) confirmed the diagnosis of the left popliteal artery transection.With clotting factor VIII replacement treatment, open repair was performed by end-to-end vascular bypass with the autograft of the large saphenous vein. No anticoagulant and antiplatelet treatment was administered postoperatively. Doses of the factor VIII were decreased step by step postoperatively.Left lower limb was reperfused 4 hours after the onset of the ischemia. The patient recovered uneventfully. Postoperative Doppler examination

2017 Medicine

988. Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015. (Abstract)

Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015. There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics (...) increase in the number of published articles and the number of Level I and II studies (P < 0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P < 0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6

2017 Knee Surgery, Sports Traumatology, Arthroscopy

989. Diagnostic validity and triage concordance of a physiotherapist compared to physicians' diagnoses for common knee disorders. Full Text available with Trip Pro

Diagnostic validity and triage concordance of a physiotherapist compared to physicians' diagnoses for common knee disorders. Emergence of more autonomous roles for physiotherapists warrants more evidence regarding their diagnostic capabilities. Therefore, we aimed to evaluate diagnostic and surgical triage concordance between a physiotherapist and expert physicians and to assess the diagnostic validity of the physiotherapist's musculoskeletal examination (ME) without imaging.This (...) is a prospective diagnostic study where 179 consecutive participants consulting for any knee complaint were independently diagnosed and triaged by two evaluators: a physiotherapist and one expert physician (orthopaedic surgeons or sport medicine physicians). The physiotherapist completed only a ME, while the physicians also had access to imaging to make their diagnosis. Raw agreement proportions and Cohen's kappa (k) were calculated to assess inter-rater agreement. Sensitivity (Se) and specificity (Sp

2017 BMC Musculoskeletal Disorders

990. Understanding the Relationship Between 3-Month and 2-Year Pain and Function Scores After Total Knee Arthroplasty for Osteoarthritis. (Abstract)

Understanding the Relationship Between 3-Month and 2-Year Pain and Function Scores After Total Knee Arthroplasty for Osteoarthritis. Research to understand predictors of poor outcomes after total knee arthroplasty (TKA) has largely focused on presurgery factors. We examined whether pain and function 3-month postsurgery were predictive of longer-term outcomes ascertained 2 years after TKA.Western Ontario McMaster University Osteoarthritis Index pain and physical function scores (scaled 0-20 (...) and 0-68; higher = worse) were recorded pre-TKA and 3, 12, and 24 months post-TKA. A sequential series of regression models was used to examine the relative contribution of baseline score and baseline to 3-month and 3 to 12-month change score to explaining variability (R2) in 2-year pain and function scores, with consideration for presurgery covariates.Data from 560 patients were analyzed. Mean pain and function scores improved significantly presurgery to 2 years postsurgery; 10-4 and 33-16 (P

2017 Journal of Arthroplasty

991. Association between metabolic syndrome and knee osteoarthritis: a cross-sectional study. Full Text available with Trip Pro

Association between metabolic syndrome and knee osteoarthritis: a cross-sectional study. Osteoarthritis (OA) is the most prevalent chronic joint disease in China. The aim of this study was to examine the association between metabolic syndrome (MetS) and knee OA in a population-based Chinese study.Data included in this analysis is from a cross-sectional study, i.e., the Xiangya Hospital Health Management Center Study. MetS was diagnosed according to the criteria defined by the Chinese Diabetes (...) Society. Radiographic knee OA was defined as changes equivalent to Kellgren-Lawrence (K-L) grade 2 or above at least one side. Associations between MetS and its components with OA were evaluated by conducting multivariable adjusted logistic regression.A total of 5764 participants were included in the present study. The unadjusted OR (1.27, 95%CI: 1.10-1.47, P = 0.001), age-sex adjusted OR (1.17, 95%CI: 1.01-1.36, P = 0.041) and multivariable adjusted OR (1.17, 95%CI: 1.01-1.36, P = 0.043) all

2017 BMC Musculoskeletal Disorders

992. Synovial inflammation plays a greater role in post-traumatic osteoarthritis compared to idiopathic osteoarthritis in the Hartley guinea pig knee. Full Text available with Trip Pro

Synovial inflammation plays a greater role in post-traumatic osteoarthritis compared to idiopathic osteoarthritis in the Hartley guinea pig knee. The objective of this study was to evaluate the extent of stromal cell-derived factor-1's (SDF-1) involvement in the pathogenesis of idiopathic versus post-traumatic OA by comparing differences in synovial membrane morphology, SDF-1 synovial fluid (SF) concentrations, and matrix metalloproteinase-13 (MMP-13) SF concentrations.Thirty-six 3-month-old (...) of post-traumatic versus idiopathic osteoarthritis and calls for a more thorough examination of the sole of the synovial membrane in the pathogenesis of post-traumatic osteoarthritis.

2017 BMC Musculoskeletal Disorders

993. Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series). (Abstract)

history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.© 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine. (...) Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series). Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review

2017 Emergency medicine Australasia

994. Factors influencing cane use for the management of knee osteoarthritis: a cross sectional survey. Full Text available with Trip Pro

Factors influencing cane use for the management of knee osteoarthritis: a cross sectional survey. To investigate demographic, symptom-related, and cognitive determinants of cane use for knee osteoarthritis (OA) and prioritize the factors that could facilitate cane use in people with no previous cane use.A survey of people ages ≥45 years with a clinical diagnosis of knee OA was conducted. The survey consisted of the following two sections: 1) demographic and cognitive determinants of cane use (...) assessed via subscales of the Cane Cognitive Mediator Scale, and 2) 19 statements, underpinned by the Behaviour Change Wheel theoretical framework, relating to factors that could facilitate regular cane use. Logistic regression was used to examine determinants of cane use, while a priority pairwise ranking activity (1000minds software) determined the rank order of the 19 statements that could facilitate cane use.A total of 529 people completed Part 1 (80% females; 35% cane users) and 231 people

2017 Arthritis care & research

995. Increased Incidence of Vascular Injury In Obese Patients with Knee Dislocations. (Abstract)

with noncongenital closed knee dislocations were included. Examined variables included patient age, sex, vascular injury, and obesity status.Outcome measures included hospital length of stay, amputation, and inpatient hospitalization charge.From 2000 to 2012, a total of 19,087 knee dislocations were identified, including 2265 in overweight/obese patients (11.9%). The annual incidence of knee dislocations reported in patients diagnosed as either obese or morbidly obese increased over the 13-year period (P (...) Increased Incidence of Vascular Injury In Obese Patients with Knee Dislocations. With rising rates of obesity in the United States, the burden of knee dislocations in this population remains unknown. This national epidemiologic study was designed to analyze the association of obesity with closed knee dislocation and vascular complications.Retrospective cohort study.The deidentified Nationwide Inpatient Sample database was used to access the US inpatient data from 2000 to 2012.Patients

2017 Journal of Orthopaedic Trauma

996. Contact Versus Noncontact Anterior Cruciate Ligament Injuries: Is Mechanism of Injury Predictive of Concomitant Knee Pathology? (Abstract)

of meniscal or chondral damage was determined from operative records, while collateral ligament injuries were determined by the treating surgeon's diagnosis after physical examination and their review of magnetic resonance imaging findings. Patients with inadequate documentation, history of a subsequent instability episode following the initial injury, or prior history of knee pathology were excluded.Six hundred eighty-seven patients (169 contact and 518 noncontact) were included. A 2-fold increase (...) Contact Versus Noncontact Anterior Cruciate Ligament Injuries: Is Mechanism of Injury Predictive of Concomitant Knee Pathology? To determine if mechanism of injury is predictive of concomitant knee pathology found at the time of anterior cruciate ligament (ACL) reconstruction.All patients aged 16 to 35 who underwent ACL reconstruction at our institution between January 2009 and December 2015 were retrospectively reviewed. Mechanism of injury was determined from patient history. The presence

2017 Arthroscopy

997. Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury. (Abstract)

Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury. To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees.Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including (...) was intact.ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL

2017 Arthroscopy

998. Anatomical and radiological evaluation of less invasive stabilisation system (LISS) in correlation with knee lateral collateral ligament insertion. (Abstract)

Anatomical and radiological evaluation of less invasive stabilisation system (LISS) in correlation with knee lateral collateral ligament insertion. The Less Invasive Stabilisation System (LISS) is an angle-stable plate that enables treatment of distal femoral comminuted and periprosthetic fracture. As it is placed through a minimally-invasive lateral approach, lateral knee pain is a commonly described symptom after its application. This study investigates knee lateral collateral ligament (LCL (...) ) iatrogenic injury during LISS plate fixation. A cadaver study was performed and a retrospective radiological investigation with the analysis of its clinical application was conducted to evaluate possible knee LCL damage.The cadaver study included 13 human lower extremities, treated with LISS. After application, lateral knee side was dissected, implants were removed and distances between the drill holes and LCL origin were measured. In the retrospective radiological evaluation, postoperative X-rays

2017 Injury

999. The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis. (Abstract)

The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis. The aim of this study was to investigate the effectiveness of two different interventions on pain and disability in patients with knee osteoarthritis (KOA). Forty-one individuals (Mean ± SD: Age 52.1 ± 8.9 years, Height 172.8 ± 6.6 cm, Weight 80.2 ± 6.9 kg) with KOA were randomly allocated into Pilates (N = 14), conventional therapeutic exercise (CTE (...) ) (N = 14), and control (N = 13) groups. Joint position sense (JPS), functional performance, pain, and disability were examined using Biodex system, aggregate time of four daily activities, and Lequesne Index. One-Way ANOVA, and Post Hoc Scheffe test were administrated to analyze the data (P < 0.05). There was a significant (P < 0.001) difference between the experimental groups in all measured outcomes compared to the control. While, regarding pain and disability, more significant (P = 0.003

2017 Complementary Therapies in Clinical Practice Controlled trial quality: uncertain

1000. Contact Kinematics Correlates to Tibial Component Migration Following Single Radius Posterior Stabilized Knee Replacement. (Abstract)

Contact Kinematics Correlates to Tibial Component Migration Following Single Radius Posterior Stabilized Knee Replacement. Contact kinematics between total knee arthroplasty components is thought to affect implant migration; however, the interaction between kinematics and tibial component migration has not been thoroughly examined in a modern implant system.A total of 24 knees from 23 patients undergoing total knee arthroplasty with a single radius, posterior stabilized implant were examined (...) . Patients underwent radiostereometric analysis at 2 and 6 weeks, 3 and 6 months, and 1 and 2 years to measure migration of the tibial component in all planes. At 1 year, patients also had standing radiostereometric analysis examinations acquired in 0°, 20°, 40°, and 60° of flexion, and the location of contact and magnitude of any condylar liftoff was measured for each flexion angle. Regression analysis was performed between kinematic variables and migration at 1 year.The average magnitude of maximum

2017 Journal of Arthroplasty

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