Editorial

3 pages, 187 KiB

Open AccessEditorial

Balancing in Unicompartmental Knee Arthroplasty: Balancing in Flexion or in Extension?

by Riccardo D’Ambrosi, Raju Vaishya and Francesco Verde

J. Clin. Med. 2022, 11(22), 6813; https://doi.org/10.3390/jcm11226813 - 17 Nov 2022

Cited by 4 | Viewed by 1192

Unicompartmental knee arthroplasty (UKA) is an established procedure for the treatment of predominant single compartmental femorotibial osteoarthritis (OA) or osteonecrosis [...] Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

Research

Jump to: Editorial, Review, Other

10 pages, 5867 KiB

Open AccessArticle

The Presence of a ‘Sentinel’ Vessel as an Anatomical Reference during Hamstring Tendon Harvesting—A Prospective Study

by Radu Prejbeanu, Mihail Lazar Mioc, Silviu Jebelean, Andrei Balanescu, Andrei-Marian Feier, Tudor Sorin Pop and Octav Russu

J. Clin. Med. 2023, 12(16), 5426; https://doi.org/10.3390/jcm12165426 - 21 Aug 2023

Viewed by 659

Abstract

Background: The identification of the branch of the inferior medial genicular artery (bIMGA) in anterior cruciate ligament reconstructions (ACLRs) has previously been considered a landmark by some surgeons, but its consistency remains debated. The aim of this investigation was to evaluate the variability [...] Read more.

Background: The identification of the branch of the inferior medial genicular artery (bIMGA) in anterior cruciate ligament reconstructions (ACLRs) has previously been considered a landmark by some surgeons, but its consistency remains debated. The aim of this investigation was to evaluate the variability in the appearance and location of bIMGA and to assess its validity as a reliable landmark during hamstring tendon harvesting procedures. Methods: This prospective, single-center study comprised 213 patients who underwent ACLR over a period of two years. The surgical procedures were conducted by the same surgical team, maintaining uniformity in the approach. The study sought correlations between patient demographics, level of activity, and the potential for successful identification of the bIMGA. Results: A statistically significant association between patient activity levels and successful identification of the bIMGA (p = 0.035) was observed. No significant correlations were found concerning patient demographic characteristics. bIMGA demonstrated a substantial degree of anatomical variability, rendering its consistent identification in the surgical field challenging. Conclusions: Given the observed variability and the associated difficulty in its identification, the use of the bIMGA as a dependable anatomical reference during ACL graft harvesting is not recommended. This study confirms the inconsistency of bIMGA as a traditional landmark, underscoring the need for research aimed at identifying more consistent and reliable anatomical references to enhance the precision of surgical interventions in ACLR. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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14 pages, 2263 KiB

Open AccessFeature PaperArticle

Knee Arthrodesis with a Modular Silver-Coated Endoprosthesis for Infected Total Knee Arthroplasty with Extensive Bone Loss: A Retrospective Case-Series Study

by Olga D. Savvidou, Angelos Kaspiris, Stavros Goumenos, Ioannis Trikoupis, Dimitra Melissaridou, Athanasios Kalogeropoulos, Dimitris Serenidis, Jim-Dimitris Georgoulis, Ioanna Lianou, Panagiotis Koulouvaris and Panayiotis J. Papagelopoulos

J. Clin. Med. 2023, 12(10), 3600; https://doi.org/10.3390/jcm12103600 - 22 May 2023

Cited by 2 | Viewed by 1315

Abstract

Introduction: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. Methods: [...] Read more.

Introduction: Knee arthrodesis is a limb salvage intervention for persistent periprosthetic joint infection (PJI) when revision total knee arthroplasty fails. Conventional arthrodesis techniques are associated with the increased rate of complications, especially in patients with extensive bone loss and extensor tendon deficiency. Methods: Eight patients with a modular silver-coated arthrodesis implant after failed exchange arthroplasty for infection, were retrospectively reviewed. All patients had significant bone loss, while 5 displayed extensor tendon deficiency. Survivorship, complications, leg length discrepancy, median Visual Analogue Scale (VAS) and Oxford Knee score (OKS) were evaluated. Results: The median follow up was 32 months (range 24–59 months). The survivorship rate of the prosthesis was 86% during the minimum time of follow up of 24 months. In one patient recurrence of the infection was observed and above-knee amputation was performed. The median postoperative leg length discrepancy was 2.07 ± 0.67 cm. Patients were able to ambulate with mild or no pain. The median VAS and OKS was 2.14 ± 0.9 and 34.7 ± 9.3, respectively. Conclusions: The results of our study demonstrated that knee arthrodesis with a silver coated arthrodesis implant, performed for persistent PJI in patients with significant bone loss and extensor tendon deficit, provided a stable construct, allowed eradication of infection and was associated with good functional outcome. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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12 pages, 2198 KiB

Open AccessArticle

Prediction of Subsequent Contralateral Patellar Dislocation after First-Time Dislocation Based on Patellofemoral Morphologies

by Jiaxing Chen, Qiaochu Li, Sizhu Liu, Lin Fan, Baoshan Yin, Xinyu Yang, Linbang Wang, Zijie Xu, Jian Zhang, Zhengxue Quan and Aiguo Zhou

J. Clin. Med. 2023, 12(1), 180; https://doi.org/10.3390/jcm12010180 - 26 Dec 2022

Cited by 2 | Viewed by 1451

Abstract

The subsequent dislocation of a contralateral patellofemoral joint sometimes occurs after a first-time lateral patellar dislocation (LPD). However, the anatomic risk factors for subsequent contralateral LPD remain elusive. This study included 17 patients with contralateral LPD and 34 unilateral patellar dislocators. The anatomic [...] Read more.

The subsequent dislocation of a contralateral patellofemoral joint sometimes occurs after a first-time lateral patellar dislocation (LPD). However, the anatomic risk factors for subsequent contralateral LPD remain elusive. This study included 17 patients with contralateral LPD and 34 unilateral patellar dislocators. The anatomic parameters of the contralateral patellofemoral joints were measured using CT images and radiographs that were obtained at the time of the first dislocation. The Wilcoxon rank-sum test was performed, and a binary regression model was established to identify the risk factors. The receiver operating characteristic curves and the area under the curve (AUC) were analyzed. The tibial tubercle-Roman arch (TT-RA) distance was significantly different between patients with and without contralateral LPD (24.1 vs. 19.5 mm, p < 0.001). The hip–knee–ankle (HKA) angle, patellar tilt, congruence angle, and patellar displacement were greater in the study group than in the control group (p < 0.05). The TT-RA distance revealed an OR of 1.35 (95% CI (1.26–1.44]), p < 0.001) and an AUC of 0.727 for predicting contralateral LPD. The HKA angle revealed an OR of 1.74 (95% CI (1.51–2.00), p < 0.001) and an AUC of 0.797. The Patellar tilt, congruence angle, and patellar displacement had AUC values of 0.703, 0.725, and 0.817 for predicting contralateral LPD, respectively. In conclusion, the contralateral patellofemoral anatomic parameters were significantly different between patients with and without subsequent contralateral LPD. Increased TT-RA distance and excessive valgus deformity were risk factors and could serve as predictors for contralateral LPD. At first-time dislocation, the abnormal position of the patella relative to the trochlea may also be an important cause of subsequent LPD. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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12 pages, 1332 KiB

Open AccessArticle

Pre- and Post-Operative Hamstring Autograft ACL Reconstruction Isokinetic Knee Strength Assessments of Recreational Athletes

by Nizamettin Güzel, Ali Kerim Yılmaz, Ahmet Serhat Genç, Emre Karaduman and Lokman Kehribar

J. Clin. Med. 2023, 12(1), 63; https://doi.org/10.3390/jcm12010063 - 21 Dec 2022

Cited by 3 | Viewed by 1438

Abstract

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare [...] Read more.

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries with a high incidence among people with high physical activity levels. Therefore, ACL reconstruction (ACLR) is one of the most common surgical procedures performed in sports medicine. This study aims to compare the pre- and 6-month post-operative isokinetic knee strengths in healthy (HK) and ACL knees of patients who underwent semitendinous/gracilis (ST/G) ACLR. Materials and Methods: A retrospective cohort of 21 recreational athletes who underwent ST/G ACLR by the same surgeon were evaluated. The pre- and 6-month post-operative isokinetic knee extension (Ex) and flexion (Flx) strengths of the HK and ACLR patients were evaluated in a series consisting of three different angular velocities (60, 180 and 240°/s). Of all the findings, peak torque (PT) and hamstring/quadriceps (H/Q) parameters were evaluated. Results: There was a significant improvement in post-operative Lysholm, Tegner and IKDC scores compared to pre-operative scores (p < 0.05). There were significant differences in pre-operative and post-operative knee Ex and Flx strengths at angular velocities of 60°, 180° and 240°/s in both the ACLR and HK groups (p < 0.001). There was no significance at 240°/s Flx for ACLR (p > 0.05). As for H/Q ratios, there was a significant difference between pre- and post-operative values only at 60°/s angular velocity in both ACLR and HC (p < 0.005). Conclusions: The pre-operative and 6-month post-operative results of the ST/G ACLR showed that there was a high level of recovery, particularly in quadriceps strength, while the increase in strength was less in the hamstring. The significance observed at 60°/s in H/Q ratios was within normal ranges. It can be argued that the ST/G ACLR method is feasible for people with high physical activity levels and for athletes. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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11 pages, 2655 KiB

Open AccessArticle

At the Edge of Orthopaedics: Initial Experience with Transarterial Periarticular Embolization for Knee Osteoarthritis in a Romanian Population

by Octav Russu, Florin Bloj, Andrei Marian Feier, Vlad Vunvulea, Stefan Mogoș, Vlad Predescu and Tudor Sorin Pop

J. Clin. Med. 2022, 11(21), 6573; https://doi.org/10.3390/jcm11216573 - 05 Nov 2022

Cited by 1 | Viewed by 2051

Abstract

Background: Transarterial embolization (TAE) of genicular artery branches is a relatively new technique that has emerged as a promising method for delaying invasive knee surgery in patients suffering from degenerative knee osteoarthritis (OA). In mild to moderate OA, invasive major surgery can be [...] Read more.

Background: Transarterial embolization (TAE) of genicular artery branches is a relatively new technique that has emerged as a promising method for delaying invasive knee surgery in patients suffering from degenerative knee osteoarthritis (OA). In mild to moderate OA, invasive major surgery can be safely postponed, and patients with major risk factors now have an alternative. Our aim was to examine the impact of TAE on clinical outcomes in individuals with degenerative knee OA over a 12-month period. Methods: A case series of 17 patients diagnosed with knee OA and treated with TAE was included in the study. Every patient was clinically evaluated at different timeframes according to the Western Ontario and McMaster Universities’ arthritis index, knee injury, and osteoarthritis outcome scores, and the 36-item short-form survey (WOMAC, KOOS, and SF-36). Results: At the first follow-up (1 month), KOOS and WOMAC improved from 46.6 ± 13.2 (range 27.3–78.2) to 56.5 ± 13.9 (range 32.3–78.4; p = 0.023) and 49.5 ± 13.2 (range 29.3–82.3) to 59.8 ± 12.6 (range 39.3–83.5, p = 0.018), respectively. Physical SF-36 improved significantly from 42.1 ± 7.75 (range 30.3–57.3) to 50.5 ± 9.9 (range 35.6–67.9; p = 0.032). No significant changes in scores were observed at three, six, or twelve months after TAE. Conclusions: TAE provided early pain reduction and considerable improvement in quality of life without complications for a consecutive sample of Romanian patients with mild to severe knee OA. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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12 pages, 428 KiB

Open AccessArticle

Isometric Knee Muscle Strength and Patient-Reported Measures Five Years after Anterior Cruciate Ligament Reconstruction: Comparison of Single versus Dual Autograft Hamstring Tendon Harvesting

by Ignacio Manchado, Luci M. Motta, Gustavo Blanco, Jesús González and Gerardo L. Garcés

J. Clin. Med. 2022, 11(19), 5682; https://doi.org/10.3390/jcm11195682 - 26 Sep 2022

Viewed by 1111

Abstract

There is some controversy regarding the use of one or two hamstring tendons for anterior cruciate ligament reconstruction (ACLR). In this study, two cohorts of 22 male patients underwent an ACLR with hamstring tendon autografts. One cohort was reconstructed through an all-inside technique [...] Read more.

There is some controversy regarding the use of one or two hamstring tendons for anterior cruciate ligament reconstruction (ACLR). In this study, two cohorts of 22 male patients underwent an ACLR with hamstring tendon autografts. One cohort was reconstructed through an all-inside technique with the semitendinosus tendon (ST group) and the other with the semitendinosus and gracilis tendons (ST-G group). Anterior tibial translation (ATT), Lysholm, and IKDC scores were assessed preoperatively and five years postoperation. Additionally, isometric knee muscle strength was manually measured in both groups and in another cohort of 22 uninjured control male subjects five years after the operation. There were no significant differences in ATT and Lysholm scores between the operated groups. The IKDC score was lower in the ST-G group than in the ST group—9.57 (CI 14.89–4.25) (p < 0.001). No significant differences between injured and uninjured knees were detected in hamstring to quadriceps ratio strength and quadriceps limb symmetry index of the two operated groups, but the hamstring limb symmetry index was significantly lower in the ST-G group than in the ST and control groups. This study shows that using an ST-G autograft for ACLR yielded less flexor strength and worse results in some patient-reported outcome measures (PROM) than using an ST autograft five years after the operation. The observed results let us suggest that the use of one autograft hamstring tendon for ACLR is clinically preferable to the use of two hamstring tendons. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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14 pages, 2751 KiB

Open AccessArticle

Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation

by Pei Zhao, Jiaxing Chen, Yi Feng, Hao Tan, Baoshan Yin, Hua Zhang, Jian Zhang and Aiguo Zhou

J. Clin. Med. 2022, 11(17), 5072; https://doi.org/10.3390/jcm11175072 - 29 Aug 2022

Cited by 1 | Viewed by 1730

Abstract

Background: The tibial tubercle to trochlear groove (TT-TG) distance is currently considered as an indication for tibial tubercle osteotomy. While the influence of femoral condylar morphology on such measurement remains unclear. Methods: A total of 86 patients with patellar dislocation (PD) and 86 [...] Read more.

Background: The tibial tubercle to trochlear groove (TT-TG) distance is currently considered as an indication for tibial tubercle osteotomy. While the influence of femoral condylar morphology on such measurement remains unclear. Methods: A total of 86 patients with patellar dislocation (PD) and 86 healthy individuals were enrolled. Femoral condylar morphology and the TT-TG distance measured by anatomical transepicondylar axis (TT-TGa), by surgical transepicondylar axis (TT-TGs), and by posterior condylar reference line (TT-TGp) were assessed by MRI. Unpaired t-test, Spearman, and Pearson correlation analysis were conducted. We determined the pathological value of the parameters and established a binary regression model. Results: The interclass correlation coefficients of all the TT-TG distances were greater than 0.75 in all types of trochlear dysplasia. The lateral/posterior femoral condyle was shorter and the medial/posterior condyle was longer in the study group (28.5 ± 3.3 and 35.2 ± 2.8, respectively) than in the control group (30.9 ± 2.7 and 33.5 ± 2.3, respectively). In the study group, the TT-TGp distance was greater than TT-TGs and TT-TGa distance (p < 0.001). The pathological value of the TT-TG distance was 13.0 mm. Each TT-TG distance revealed a significant OR with regard to PD. Conclusion: The TT-TGa, TT-TGs, and TT-TGp distance can be reliably measured by MRI even in patients with trochlear dysplasia. While the TT-TGp distance may overestimate the lateralization deformity of the tibial tubercle. Posterior femoral condylar dysplasia may be a reason for such overestimating. These findings have not been correlated to clinical outcomes and further studies are required. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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9 pages, 1354 KiB

Open AccessArticle

Comparison of Operative Times in Primary Bilateral Total Knee Arthroplasty Performed by a Single Surgeon

by Yoshinori Ishii, Hideo Noguchi, Junko Sato, Ikuko Takahashi, Hana Ishii, Ryo Ishii, Kei Ishii and Shin-ichi Toyabe

J. Clin. Med. 2022, 11(16), 4867; https://doi.org/10.3390/jcm11164867 - 19 Aug 2022

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Abstract

Purpose: Prolonged operative time (OT) is associated with adverse complications after total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative factors, such as sex, age, body mass index, body weight (BW), body height, American Society of Anesthesiologists grade, [...] Read more.

Purpose: Prolonged operative time (OT) is associated with adverse complications after total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative factors, such as sex, age, body mass index, body weight (BW), body height, American Society of Anesthesiologists grade, tibiofemoral angle, hospital for special surgery scores, surgical side, surgical order, and calendar year of surgery, affect OT. Methods: One hundred and nineteen patients (238 knees) with osteoarthritis who underwent staged bilateral primary TKA performed by a single surgeon were evaluated. The medical records of 15 males and 104 females were retrospectively reviewed. All variables were expressed as median (interquartile range). Results: The OT for all TKAs was 57 min (51, 65). The OT on the left side (59 min (52–67)) was longer than that on the right side (55 min (50–62)) (p = 0.015). Multiple regression analysis revealed that longer OT was related to BW (β = 0.488, p < 0.001), calendar year of surgery (β = −0.218, p< 0.001), and operative side (β = −0.151, p = 0.007). The Jonckheere–Terpstra test showed a trend toward decreasing OT with calendar year on the left side (p = 0.037) (surgeon’s non-dominant side), but not on the right (p = 0.795). Body height, BW, and body mass index showed weak correlations (r = 0.212, p = 0.001; r = 0.352, p < 0.001; r = 0.290, p < 0.001, respectively) with OT. Conclusion: Patients with a large physique, and especially obesity, with an affected knee on the surgeon’s non-dominant side may require a longer OT; OT decreased over time. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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10 pages, 841 KiB

Open AccessArticle

Octogenarians Are the New Sexagenarians: Cruciate-Retaining Total Knee Arthroplasty Is Not Inferior to Posterior-Stabilized Arthroplasty in Octogenarian Patients

by Riccardo D’Ambrosi, Prem Haridas Menon, Abhijeet Salunke, Ilaria Mariani, Giovanni Palminteri, Giuseppe Basile, Nicola Ursino, Laura Mangiavini and Michael Hantes

J. Clin. Med. 2022, 11(13), 3795; https://doi.org/10.3390/jcm11133795 - 30 Jun 2022

Cited by 5 | Viewed by 1569

Abstract

Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive [...] Read more.

Purpose: The primary goal of this study was to compare survivorship and functional results in individuals aged 80 and over who underwent total knee arthroplasty (TKA) with cruciate-retaining (CR) or posterior-stabilized (PS) implants. Methods: We prospectively analyzed the clinical records of two consecutive cohorts for a total of 96 implants in patients aged 80 years or over. The first cohort consisted of 59 consecutive cemented PS cases, while the second cohort comprised 37 consecutive cemented CR cases. The decision to either perform a PS or CR arthroplasty was taken based on preoperative magnetic resonance imaging and intraoperative findings. The clinical evaluation entailed evaluating each patient’s visual analogue scale for pain (VAS), range of motion (flexion and extension), Knee Society Score (KSS), and Oxford Knee Score (OKS). Each patient was clinically evaluated the day before surgery (T₀) and at two consecutive follow-ups at least 1 (T₁) and 2 (T₂) years after surgery. Implant survival was calculated using the Kaplan–Meier method. Results: Both groups showed statistically significant improvements at each follow-up compared with the preoperative values (p < 0.05). The CR group showed a higher flexion degree at T₁ than the PS group (116.14 ± 5.57° versus 113.16 ± 7.66°; p = 0.048). No differences were found between the two groups regarding survival rate (chi-squared test p-value = 0.789). Three failures were noted in the CR group, while there were four in the PS group. Conclusions: This prospective clinical study demonstrates that CR and PS TKA had similar clinical outcomes in octogenarians with regard to knee function, postoperative knee pain, and other complications. Prosthesis survivorship for CR and PS TKA were both satisfactory, and in selected octogenarian patients, CR TKA should always be considered because of the reduced surgical time. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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8 pages, 414 KiB

Open AccessArticle

Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years

by Mohammad Jesan Khan, Naiyer Asif, Mohd Hadi Aziz, Ariz Raza, Shahzad Anwar, Shibili Nuhmani, Ahmad H. Alghadir and Masood Khan

J. Clin. Med. 2022, 11(13), 3648; https://doi.org/10.3390/jcm11133648 - 24 Jun 2022

Cited by 4 | Viewed by 1670

Abstract

Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a [...] Read more.

Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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Review

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10 pages, 588 KiB

Open AccessReview

Spontaneous Osteonecrosis of the Knee: State of the Art

by Daniel Veloz Serrano, Samundeeswari Saseendar, Saseendar Shanmugasundaram, Rohan Bidwai, Diego Gómez and Riccardo D’Ambrosi

J. Clin. Med. 2022, 11(23), 6943; https://doi.org/10.3390/jcm11236943 - 25 Nov 2022

Cited by 6 | Viewed by 3027

Abstract

Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment [...] Read more.

Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article’s goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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Other

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9 pages, 257 KiB

Open AccessBrief Report

Role of Doxycycline as an Osteoarthritis Disease-Modifying Drug

by Saseendar Shanmugasundaram, Ketansinh Solanki, Samudeeswari Saseendar, Vijay K. Chavada and Riccardo D’Ambrosi

J. Clin. Med. 2023, 12(8), 2927; https://doi.org/10.3390/jcm12082927 - 18 Apr 2023

Cited by 1 | Viewed by 3513

Abstract

Doxycycline is a drug that has been proposed to modify osteoarthritis (OA) progression, in addition to its role as an antibiotic. However, available evidence thus far comprises sporadic reports, with no consensus on its benefits. Hence, this review attempts to analyze the evidence [...] Read more.

Doxycycline is a drug that has been proposed to modify osteoarthritis (OA) progression, in addition to its role as an antibiotic. However, available evidence thus far comprises sporadic reports, with no consensus on its benefits. Hence, this review attempts to analyze the evidence available thus far on the role of doxycycline as a disease-modifying osteoarthritis drug (DMOAD) in knee osteoarthritis. The earliest evidence of doxycycline in OA appeared in 1991 when doxycycline was found to inhibit the type XI collagenolytic activity of extracts from the human osteoarthritic cartilage, and gelatinase and tetracycline were found to inhibit this metalloproteinase activity in articular cartilage in vivo, which could modify cartilage breakdown in osteoarthritis. Apart from the inhibition of cartilage damage by metalloproteinases (MMPs) and other cartilage-related mechanisms, doxycycline also affects the bone and interferes with many enzyme systems. The most significant finding after reviewing various studies was that doxycycline has a definitive role in structural changes in osteoarthritis progression and radiological joint space width, but its role in the improvement of clinical outcomes as a DMOAD has not been established. However, there is much of a gap and lack of evidence in this regard. Doxycycline, as an MMP inhibitor, has theoretical advantages for clinical outcomes, but the present studies reveal only beneficial structural changes in osteoarthritis and very minimal or nonexistent advantages in clinical outcomes. Current evidence does not favor the regular use of doxycycline for the treatment of osteoarthritis as an individual treatment option or in combination with others. However, multicenter large cohort studies are warranted to determine the long-term benefits of doxycycline. Full article

(This article belongs to the Special Issue Clinical Advances in Knee Surgery)

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