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Advances in Knee Surgery and Musculoskeletal Rehabilitation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (15 February 2024) | Viewed by 7529

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Prof. Dr. Giulio Maria Marcheggiani Muccioli

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Guest Editor

1. 2nd Orthopedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
2. Faculty of Medicine, University of Bologna, 40126 Bologna, Italy
Interests: knee; knee prostheses; sports medicine; arthroscopy

Dr. Giada Lullini

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Guest Editor

SC Rehabilitation and Neurorehabilitation, IRCCS Istituto delle scienze neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy
Interests: rehabilitation; neurorehabilitation; Orthopaedics; gait analysis; telemedicine; virtual reality

Special Issue Information

Dear Colleagues,

Knee osteoarthritis is a dominant source of disability. This condition is a leading contributor to the rapid increase in Total Knee Arthroplasty (TKA).

Given the increased life expectancy and the limited resources devoted to public health, the demand for effective and sustainable surgical care and rehabilitation services seems mandatory in order to cope with the needs of the aging population.

Nowadays, new surgical tools (such as Computer Assisted Surgical Navigation, Smart Cutting Guides and Robotic Assisted Surgery) and techniques (improved Fast-Track protocols) have dramatically reduced the hospital length of stay after TKA.

New technologies are promising in the treatment of the most dangerous complications after TKA (loosening and periprosthetic infection).

Recently, innovative technologies have brought affordability and convenience to the healthcare consumers, such as eHealth, telemedicine, wearables, virtual reality (VR) and online educational tools. A growing body of literature supports the use of telerehabilitation in improving patient satisfaction and health outcomes for a diverse range of clinical conditions.

Prof. Dr. Giulio Maria Marcheggiani Muccioli
Dr. Giada Lullini
Guest Editors

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Keywords

computer assisted surgical navigation
smart cutting guides
robotic assisted surgery
fast-track
telemedicine
telerehabilitation
virtual reality

Published Papers (7 papers)

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11 pages, 355 KiB

Open AccessArticle

A High-Grade Lachman’s Exam Predicts a Ramp Tear of the Medial Meniscus in Patients with Anterior Cruciate Ligament Tear: A Prospective Clinical and Radiological Evaluation

by Filippo Familiari, Luke V. Tollefson, Antonio Izzo, Michele Mercurio, Robert F. LaPrade and Giovanni Di Vico

J. Clin. Med. 2024, 13(3), 683; https://doi.org/10.3390/jcm13030683 - 24 Jan 2024

Viewed by 606

Abstract

Background: Medial meniscus ramp tears are present in 22.9–40.8% of anterior cruciate ligament tears. The diagnosis of ramp tears is difficult on MRI, with sensitivity reported around 48%, which has recently emphasized the importance of proper arthroscopic probing for ramp tears. Methods: A prospective evaluation was performed on patients undergoing a single bundle ACL reconstruction to assess patient demographics, posterior tibial slope, posterior cruciate ligament angle, Lachman’s exam, and rotational instability to determine secondary findings associated with medial meniscal ramp tears. Results: A total of 96 patients underwent ACL reconstruction, of these, 63 patients had an isolated ACL tear, and 33 patients had an ACL tear with a concomitant medial meniscus ramp tear. A high-grade Lachman’s exam and male sex were associated with medial meniscus ramp tears. There were no differences in posterior tibial slope, posterior cruciate ligament angle, or rotational instability between groups. Conclusions: This study found that a high-grade Lachman’s exam and male sex were significantly associated with patients with an ACL tear with a concomitant medial meniscus ramp tear. These findings suggest that an ACL tear with concomitant medial meniscus ramp tear may be better diagnosed based upon the clinical evaluation rather than other secondary radiological findings. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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10 pages, 918 KiB

Open AccessArticle

Low Response Rate to Follow-Up Using Telemedicine after Total Knee Replacement during the COVID-19 Pandemic in Italy

by Eugenio Cammisa, Matteo La Verde, Federico Coliva, Antongiulio Favero, Iacopo Sassoli, Stefano Fratini, Domenico Alesi, Giada Lullini, Stefano Zaffagnini and Giulio Maria Marcheggiani Muccioli

J. Clin. Med. 2024, 13(2), 360; https://doi.org/10.3390/jcm13020360 - 09 Jan 2024

Viewed by 646

Abstract

Background: This study aimed to evaluate the survival rate and medium-term outcomes of patients after cemented posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) using a telemedicine platform during the COVID-19 pandemic in Italy. Methods: A total of 100 consecutive patients (mean age 73.5 ± 13.2 years) who received a cemented PS MB TKA were enrolled. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. A dedicated software that makes it possible to perform video calls, online questionnaires, and acquire X-rays remotely was used. Subjective clinical scores and objective range-of-motion (ROM) measurements were observed at an average follow-up of 54 ± 11.3 months. Results: A total of 42 of 100 enrolled patients (mean age 70.3 ± 8.4 years) completed the telemedicine follow-up. The mean age of patients who did not complete the telemedicine follow-up (58%) was 75.8 ± 9.7 years. Age was found to be a statistically significant difference between the group that completed the telemedicine follow-up and the one that did not (p < 0.004). KOOS scores improved from 56.1 ± 11.3 to 77.4 ± 16.2, VAS scores decreased from 7.2 ± 2.1 to 2.8 ± 1.6, KSSf scores increased from 47.2 ± 13.3 to 77.1 ± 21.1, FJS scores improved from 43.4 ± 12.3 to 76.9 ± 22.9, and OKS scores increased from 31.9 ± 8.8 to 40.4 ± 9.9. All the differences were statistically significant (p < 0.05). The mean flexion improved from 88° ± 8° to 120° ± 12°. A radiographic evaluation showed a mean pre-operative mechanical axis deviation of 5.3 ± 8.0 degrees in varus, which improved to 0.4 ± 3.4 degrees of valgus post-operation. The survivorship at 5 years was 99%. Conclusions: Subject to small numbers, telemedicine presented as a useful instrument for performing remote monitoring after TKA. The most important factor in telemedicine success remains the patient’s skill, which is usually age-related, as older patients have much more difficulty in approaching a technological tool. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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13 pages, 3696 KiB

Open AccessArticle

Initial Learning Curve for Robot-Assisted Total Knee Arthroplasty in a Dedicated Orthopedics Center

by Serban Dragosloveanu, Mihnea-Alexandru Petre, Bogdan Sorin Capitanu, Christiana Diana Maria Dragosloveanu, Romica Cergan and Cristian Scheau

J. Clin. Med. 2023, 12(21), 6950; https://doi.org/10.3390/jcm12216950 - 06 Nov 2023

Cited by 2 | Viewed by 821

Abstract

Background and objectives: Our study aimed to assess the learning curve for robot-assisted (RA) total knee arthroplasty (TKA) in our hospital, compare operative times between RA-TKAs and manual TKAs, and assess the early complications rate between the two approaches. Methods: We included 39 patients who underwent RA-TKA and 45 control patients subjected to manual TKA in the same period and operated on by the same surgical staff. We collected demographic and patient-related data to assess potential differences between the two groups. Results: No statistical differences were recorded in regard to age, BMI, sex, Kellgren–Lawrence classification, or limb alignment between patients undergoing RA-TKA and manual TKA, respectively. Three surgeons transitioned from the learning to the proficiency phase in our study after a number of 6, 4, and 3 cases, respectively. The overall operative time for the learning phase was 111.54 ± 20.45 min, significantly longer compared to the average of 86.43 ± 19.09 min in the proficiency phase (p = 0.0154) and 80.56 ± 17.03 min for manual TKAs (p < 0.0001). No statistically significant difference was recorded between the global operative time for the proficiency phase TKAs versus the controls. No major complications were recorded in either RA-TKA or manual TKA groups. Conclusions: Our results suggest that experienced surgeons may adopt RA-TKA using this platform and quickly adapt without significant complications. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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11 pages, 1342 KiB

Open AccessArticle

Evaluation of Isokinetic Knee Strengths after ACL Reconstruction with Quadrupled Semitendinosus Suspensory Femoral and Tibial Fixation versus Four-Strand Semitendinosus and Gracilis Suspensory Femoral and Tibial Screw Fixation

by Mehmet Halis Cerci, Ali Kerim Yilmaz, Lokman Kehribar, Serkan Surucu, Mahmud Aydin and Mahir Mahirogullari

J. Clin. Med. 2023, 12(12), 4004; https://doi.org/10.3390/jcm12124004 - 12 Jun 2023

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Abstract

Introduction: The purpose of this study was to demonstrate that patients undergoing ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable results in muscle strength and knee function to those undergoing ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw fixation. Materials and Methods: Between 2017 and 2019, 64 patients who were operated on by the same surgeon were included. Patients underwent ACL reconstruction technique with quadrupled semitendinosus suspensory femoral and tibial button fixation in Group 1, and patients underwent ACL reconstruction with coupled four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw in Group 2. Evaluation of patients was performed with the Lysholm and Tegner activity scale preoperatively and at the 1st and 6th months postoperatively. At the 6-month visit, isokinetic testing of the operated and non-operated limbs was performed in both groups. Results: There was no significant difference in the age, weight, and BMI values of the patients in Groups 1 and 2 (p < 0.05). According to the strength values of the operated sides of the patients in Group 1 and Group 2, there was no significant difference in the angular velocities of 60° s⁻¹, 180° s^−1, and 240° s⁻¹ in both extension and flexion phases between the operated sides of Groups 1 and 2 (p < 0.05). Conclusions: Patients who have ACL reconstruction with quadrupled semitendinosus suspensory femoral and tibial fixation have comparable muscle strength and knee function to those who undergo ACL reconstruction with four-strand semitendinosus-gracilis suspensory femoral fixation and a bioabsorbable tibial interference screw. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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11 pages, 824 KiB

Open AccessArticle

A 1RM Strengthening and Exercise Programme for the Treatment of Knee Osteoarthritis: A Quality-Improvement Study

by James Creasey, Jo Masterman, Gregory Turpin, Richard Stanley, Tikki Immins, Louise Burgess and Thomas W. Wainwright

J. Clin. Med. 2023, 12(9), 3156; https://doi.org/10.3390/jcm12093156 - 27 Apr 2023

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Abstract

Background: The Kneefit programme is a 12-week strengthening and exercise programme, personalised using body-weight ratios, for people with knee osteoarthritis. Objectives and Design: This quality-improvement study was conducted to evaluate the effectiveness of the programme for managing symptomatic knee osteoarthritis. Methods: The Kneefit programme was delivered between 20 August 2013 and 7 January 2014 and included six weeks of supervised strengthening, balance, and cardiovascular exercise in a group at the local hospital, followed by six weeks of unsupervised exercise. Leg-press and knee-extension 1RM scores were assessed at baseline, six weeks, and twelve weeks. In addition, patient-reported outcome measures (Oxford Knee Score, EQ5D, Patient Specific Function Score (PSFS)) were assessed. Wilcoxon Signed Rank tests were used to evaluate the changes from week 1 to week 6 and week 12. Results: Thirty-six patients were included at baseline and at six weeks, and 31 patients completed their twelve-week assessment. Statistically significant improvements were found at 6 and 12 weeks for change for the Oxford Knee Score (median change: 4.0, IQR 4.0 to 9.0, p < 0.001 and 4.0, IQR 0 to 8.0, p < 0.001), EQ5D-5L (median change: 0.078, IQR 0.03 to 0.20, p < 0.001 and 0.071, IQR 0.02 to 0.25, p < 0.001) and the PSFS (median change: 1.3 IQR 0 to 2.6, p = 0.005 and 2.3 IQR −0.3 to 3.3, p = 0.016). In addition, significant improvements were found for 1RM leg-press and knee-extension scores on both the affected and unaffected legs. Conclusion: The Kneefit programme was successful at improving both functional and strength-related outcome measures in patients with knee osteoarthritis. Our findings suggest that tailoring strength exercises based on the 1RM strength-training principles is feasible in this population. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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14 pages, 2749 KiB

Open AccessArticle

Femoral Tunnel Position Affects Postoperative Femoral Tunnel Widening after Anterior Cruciate Ligament Reconstruction with Tibialis Anterior Allograft

by Sung-Sahn Lee, Il Su Kim, Tae Soo Shin, Jeounghun Lee and Dae-Hee Lee

J. Clin. Med. 2023, 12(5), 1966; https://doi.org/10.3390/jcm12051966 - 02 Mar 2023

Cited by 3 | Viewed by 1656

Abstract

This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October 2017. TW was calculated as the difference in tunnel widths between the immediate and 2-year postoperative measurements. The risk factors for TW, including demographic data, concomitant meniscal injury, hip–knee–ankle angle, tibial slope, femoral and tibial tunnel position (quadrant method), and length of both tunnels, were investigated. The patients were divided twice into two groups depending on whether the femoral or tibial TW was over or less than 3 mm. Pre- and 2-year follow-up outcomes, including the Lysholm score, International Knee Documentation Committee (IKDC) subjective score, and side-to-side difference (STSD) of anterior translation on stress radiographs, were compared between TW ≥ 3 mm and TW < 3 mm. The femoral tunnel position depth (shallow femoral tunnel position) was significantly correlated with femoral TW (adjusted R² = 0.134). The femoral TW ≥ 3 mm group showed greater STSD of anterior translation than the femoral TW < 3 mm group. The shallow position of the femoral tunnel was correlated with the femoral TW after ACL reconstruction using a tibialis anterior allograft. A femoral TW ≥ 3 mm showed inferior postoperative knee anterior stability. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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12 pages, 6666 KiB

Open AccessTechnical Note

Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device

by Marco Bechis, Federica Rosso, Davide Blonna, Roberto Rossi and Davide Edoardo Bonasia

J. Clin. Med. 2024, 13(2), 377; https://doi.org/10.3390/jcm13020377 - 10 Jan 2024

Viewed by 790

Abstract

Background: The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. Methods: This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. Conclusions: This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button. Full article

(This article belongs to the Special Issue Advances in Knee Surgery and Musculoskeletal Rehabilitation)

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