Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

Purpose: Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA. Methods: In 50 patients (21 men, 29 women) undergoing TKA, we compared patellar blood flow at flexions 0° to 30°, 60°, 90°, and 110° before and after medial parapatellar arthrotomy to pre- and postoperative anterior knee pain scores by means of a laser Doppler flowmeter (LDF) probe. Anterior knee pain was assessed using the pain intensity numeric rating scale (NRS) of 0-10 (0-no, 10-worst pain). Based on the NRS pain values, patients were divided into two main groups: group A (n=34) with no pain or discomfort (NRS range 0-4) and group B (n=16) with anterior knee pain (NRS range 5-10). Results: Patients of group B demonstrated a significant decrease in blood flow before arthrotomy at flexions from 0° to 90°, and 110° and from 0° to 60°, 90°, and 110° after arthrotomy. For group A, a significant decrease in blood flow was detected at flexions from 0° to 90°, and 110° before and after arthrotomy. For both groups, medial arthrotomy did not have a statistically significant influence on patellar blood flow (margin of significance P<0.05). Prior to TKA, 16 of the 50 patients of group B (32%) complained of anterior knee pain (mean NRS 7.1±1.7). At 2-year follow-up, pain significantly decreased (NRS 3.1±2.1) and only 4 of the 16 patients (25%) complained of moderate anterior pain (average NRS 5.7±0.5), while 8 of 16 (50%) patients reported discomfort (mean NRS 3.5±1.8) around the patella. Patients in group A also demonstrated a significant decrease in pain intensity (from NRS 1.5±1.4 preoperatively to NRS 0.4±1.5 at 2-year follow-up). Statistical analysis demonstrated no statistically significant correlation between pre-arthrotomy/post-arthrotomy patellar blood flow and the presence of preoperative and postoperative anterior knee pain. Only the degree of flexion had an influence on patellar blood flow. Conclusion: Medial arthrotomy had no direct significant effect on patellar blood flow, and the diminished blood flow did not correlate with postoperative anterior knee pain. However, a significant correlation was revealed between patellar blood flow and the degree of flexion: in almost a quarter of patients, blood flow dropped to zero at flexions of 100° and above. Level of evidence: I

Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique

Purpose: Surgery involving arthroscopic reconstruction of the injured ligament is the gold standard treatment for torn anterior cruciate ligament (ACL). Recent studies support the hypothesis of biological self-healing of ruptured ACL. The aim of the study is to evaluate, in an animal model, the efficacy of a new technique, dynamic intraligamentary stabilization that utilizes biological self-healing for repair of acute ACL ruptures. Methods: The ACL in 11 adult female white alpine sheep was transected and in 8 sheep reconstructed by dynamic intraligamentary stabilization. To enhance the healing potential, microfracturing and collagen were used in all animals. The contralateral, non-operated knees served as controls. At 3months postkilling, all animals were submitted to magnetic resonance imaging and biomechanical and histological evaluation. Results: No surgery-related complications were observed. Postoperatively, all animals regularly used the operated leg with full weight bearing and no lameness. At the time of killing, all animals exhibited radiological and histological healing of the transacted ACL. Biomechanical tests confirmed successful restoration of anteroposterior translation in the dynamic intraligamentary stabilization knees. Histological examination revealed dense scar tissue at the ends of the transected ligaments exhibiting hypercellularity and hypervascularization. Conclusion: The dynamic intraligamentary stabilization technique successfully induced self-healing of ruptured ACL in a sheep model. Knee joints remained stable during the healing period allowing free range of motion and full weight bearing, and no signs of osteoarthritis or other intraarticular damage in the follow up were observe

[Burden and need for psychosocial intervention of glioblastoma patients]

Glioblastoma patients should be provided with a professional health care system that helps reduce their psychosocial burden. The aim of this study was to identify patients in need of psychosocial intervention. In addition, it was examined whether physicians' assessments adequately address the burden patients are under and their need for intervention. During their visit to one of two neurosurgery outpatient departments, n = 49 glioblastoma patients filled out the short version of the Hornheider questionnaire (HFK). Consulting physicians also rated their patients' burdens in a specially adapted version of the questionnaire (HFK-F). The results of the psychometric evaluation with both instruments were satisfactory. The majority of the patients (76 %) were identified as in need of psychosocial intervention. All of them were correctly categorized with the physicians' ratings. Physicians overestimated some aspects of the patients' burden, particularly in regard to their problems with relaxing and fear of living with the illness. The patients' ratings concerning the quality of the information physicians provided and their overall state of health only corresponded with the physicians' ratings in roughly half of the cases

Use of a Negative-Pressure Wound Dressing to Prevent Surgical Site Complications after Revision Knee Arthroplasty—A Randomized Controlled Trial

The aim of this study was to determine if a negative pressure wound therapy (NPWT) system can facilitate wound healing and withstand mechanical stress owing to the high range of motion of the knee joint in total knee arthroplasty. The benefits of NPWT include aiding wound granulation and a reduction in wound edema and secretion; our goal is to investigate its benefits in primary wound closure. Within an eight-day duration of treatment, we compared standard wound dressing (gauze and compression) with the disposable NPWT system (PICO)TM. A total of 79 patients were recruited in a controlled, randomized, prospective, single-institution clinical trial. A total of 40 patients were allocated to the study group and 39 to the control group. In terms of blood loss and infection parameters, there was no significant difference between both groups. In the NPWT group, we determined a significant reduction in wound edema but none in wound secretion. While the NPWT dressings survived the mechanical effects of movement during postoperative physiotherapy, conventional compressive dressings were often renewed. Even though the risk factors that could lead to delayed wound healing were reduced in the test group, we could not identify any significant difference pertaining to delayed wound healing that required surgical treatment