Page 8 - ISAKOS 2020 Newsletter Volume 2
P. 8

The medical records of all patients who underwent ascending biplanar OWHTO between July 2008 and March 2017 were retrospectively assessed, and 26 patients were included. Five parameters of the patellofemoral joint—tibial tubercle-trochlear groove distance (TT-TG), patellofemoral (PF) axial engagement index, lateral patellar tilt, Blackburne-Peel index (BPI), and Caton-Deschamps index (CDI)—were measured by two blinded independent observers on preoperative and postoperative MRI scans. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC), preoperative and postoperative measurements were compared with use of the paired t test, and the association of the amount of HTO opening and the PF joint parameters was assessed with Pearson correlation coefficient. Postoperatively, the authors reported significant increases in the TT-TG distance and small but significant decreases in patellar height that were correlated with the amount of axis correction.
Current Evidence on Patellar Tendon Grafts for ACLR for High-Risk Patients
Jérôme Murgier, Donald Hansom, Mark Clatworthy
Current Concepts Review
Hamstrings and patellar tendon (PT) are the most common autografts used to perform anterior cruciate ligament reconstruction (ACLR), and the debate regarding which type of graft is superior has been going on for decades. The purpose of this study was providing a current review based on recent scientific publications with high level of evidence. As noted by the authors, Joint Registries have provided conclusive information. The Scandinavian registry (>45,000 patients) showed lower a failure rate for bone-patellar tendon-bone (BPTB) graft than for hamstring tendon (HT) graft at 5 years (2.8% vs. 4.2%; p < 0.001). Similarly, the Norwegian registry (12,643 patients) showed higher revision rates for HT graft than for BPTB graft at both 2 years (2.8% vs. 0.7%) and 5 years (5.1% vs. 2.1%); the difference was even more significant among high-risk patients. This trend was confirmed in a study of young females, in which the failure rate was 6.4% in the PT group and 17.5% in the HT group at 3.7 years (p=0.02). The authors noted that ACL graft selection should be based on a discussion between the physician and the patient, taking into consideration age, activity level, and occupation. Within the high-risk patient group, however, scientific evidence supports the PT as the gold standard for ACLR.
Functional Improvement and Low Recurrence Rate After Combined Staged Synovectomy and External Radiotherapy for DPVNS of the Knee
Mohamed ElAttar, Hossam Fathi, Fahmy Samir Fahmy
Prospective Case Series
Treatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee is problematic and controversial, with a high rate of morbidities and local recurrence. The purpose of this study was to perform a functional evaluation of patients with DPVNS who were managed with combined surgical and external radiosynovectomy. Between June 2011 and May 2015, 12 patients (4 males and 8 females) with DPVNS of the knee were managed with staged surgical synovectomy (arthroscopic anterior and open posterior) followed by low- dose external radiation. After a mean duration of follow- up of 46.7 ± 15 (range, 25 to 72 months), there were significant improvements in terms of range of motion and function. Three mild complications were encountered (superficial wound infection, repeated effusion, and transient neuropraxia). On the basis of their findings, the authors concluded that combined staged synovectomy and external radiotherapy provides improved function and quality of life with low rate of recurrence for patients with DPVNS of the knee.
Patients with Different Patellofemoral Disorders Display Distinct Ligament Stiffness Patterns Under Instrumented Stress-Testing
Ana Leal, Renato Andrade, Betina Hinckel, Marc Tompkins, Ricardo Bastos, Paulo Flores, Filipe Samuel,
Joao Espreguieira-Mendes, Elizabeth Arendt
Case Series
The purpose of this study was to investigate the patellar force-displacement profile (ligament stiffness) in patients with patellofemoral disorders. Fifty-two knees in 34 consecutive patients (mean age, 31.6 years; 53% male) were analyzed; of these, 24 knees had patellofemoral pain (PFP), 19 had potential patellofemoral instability (PPI), and 9 had objective patellofemoral instability (OPI). Physical examination, patient- reported outcome measures (Kujala and Lysholm scores), standard radiography, and MRI or CT were performed in all patients. Instrumented stress testing with use of the Porto Patella testing device concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness. The force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that in the PFP group. Patients in the PPI group showed higher ligament stiffness (a higher force was required to displace the patella) than those in the OPI group. Patients with OPI had a significantly shallower trochlear groove and increased lateral tilt.

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