Reconstrucción del ligamento cruzado anterior desde el portal anteromedial; evaluación de la fijación femoral en un modelo cadavérico

Objectiu. Valorar el risc de lesió de les estructures posterolaterals del genoll realitzant una reconstrucció del Lligament Encreuat Anterior (LEA) mitjançant plàstia d'isquiotibials i fixació femoral am sistema Cross-Pin. Material. 10 genolls cadavèrics frescs. Reconstrucció artroscòpica del LEA mitjançant túnel anatòmic des del portal anteromedial. Dissecció anatòmica del genoll mesurant distàncies del Cross-Pin al Lligament Col·lateral Lateral (LCL), tendó popliti, nervi peroneo i tendó gastroecnemi lateral. Resultats. LCL i gastroecnemi tenen un alt risc de ser lesionats mitjançant aquest sistema Conclusió. El sistema de fixació Cross-Pin, com l'hem utilitzat, té un alt risc de lesionar les estructures laterals del genoll.Objetivo. Valorar el riesgo de lesión de las estructuras posterolaterales de la rodilla al realizar una reconstrucción del ligamento cruzado anterior (LCA) mediante plastia isquiotibiales y fijación femoral con sistema Cross-Pin. Material. 10 rodillas cadavéricas frescas. Reconstrucción artroscópica del LCA mediante túnel anatómico desde portal anteromedial. Disección rodilla midiendo distancias Cross-Pin a Ligamento Colateral Lateral (LCL), tendón poplíteo, nervio peroneo y tendón gastroecnemio lateral. Resultados. LCL y gastroecnemio tienen un alto riesgo de ser lesionados mediante este sistema. Conclusiones. El sistema de fijación Cross-Pin, tal como lo hemos descrito, tiene un alto riesgo de lesionar las estructuras laterales de la rodilla

Fibronectin-coating enhances attachment and proliferation of mesenchymal stem cells on a polyurethane meniscal scaffold

Partial meniscectomy is one of the most common surgical strategy for a meniscal injury, but sometimes, patients complain of knee pain due to an overload in the ablated compartment. In these cases, implantation of tissue engineering scaffold could be indicated. Currently, two commercial scaffolds, based on collagen or polycaprolactone-polyurethane (PCL-PU), are available for meniscus scaffolding. In short term follow-up assessments, both showed clinical improvement and tissue formation. However, long-term studies carried out in PCL-PU showed that the new tissue decreased in volume and assumed an irregular shape. Moreover, in some cases, the scaffold was totally reabsorbed, without new tissue formation. Mesenchymal stem cells (MSCs) combined with scaffolds could represents a promising approach for treating meniscal defects because of their multipotency and self-renewal. In this work, we aimed to compare the behaviour of MSCs and chondrocytes on a PCL-PU scaffold in vitro. MSCs express integrins that binds to fibronectin (FN), so we also investigate the effect of a FN coating on the bioactivity of the scaffold. We isolated rabbit bone marrow MSCs (rBM-MSCs) from two skeletally mature New Zealand white rabbits and stablished the optimum culture condition to expand them. Then, they were seeded over non-coated and FN-coated scaffolds and cultured in chondrogenic conditions. To evaluate cell functionality, we performed an MTS assay to compare cell proliferation between both conditions. Finally, a histologic study was performed to assess extracellular matrix (ECM) production in both samples, and to compare them with the ones obtained with rabbit chondrocytes (rCHs) seeded in a non-coated scaffold. A culture protocol based on low FBS concentration was set as the best for rBM-MSCs expansion. The MTS assay revealed that rBM-MSCs seeded on FN-coated scaffolds have more cells on proliferation (145%; 95% CI: 107%-182%) compared with rBM-MSCs seeded on non-coated scaffolds. Finally, the histologic study demonstrated that rCHs seeded on non-coated scaffolds displayed the highest production of ECM, followed by rBM-MSCs seeded on FN-coated scaffolds. Furthermore, both cell types produced a comparable ECM pattern. These results suggest that MSCs have low capacity attachment to PCL-PU scaffolds, but the presence of integrin alpha5beta1 (FN-receptor) in MSCs allows them to interact with the FN-coated scaffolds. These results could be applied in the design of scaffolds, and might have important clinical implications in orthopaedic surgery of meniscal injuries

Reconstrucción del ligamento cruzado anterior desde el portal anteromedial; evaluación de la fijación femoral en un modelo cadavérico

Objectiu. Valorar el risc de lesió de les estructures posterolaterals del genoll realitzant una reconstrucció del Lligament Encreuat Anterior (LEA) mitjançant plàstia d’isquiotibials i fixació femoral am sistema Cross-Pin. Material. 10 genolls cadavèrics frescs. Reconstrucció artroscòpica del LEA mitjançant túnel anatòmic des del portal anteromedial. Dissecció anatòmica del genoll mesurant distàncies del Cross-Pin al Lligament Col•lateral Lateral (LCL), tendó popliti, nervi peroneo i tendó gastroecnemi lateral. Resultats. LCL i gastroecnemi tenen un alt risc de ser lesionats mitjançant aquest sistema Conclusió. El sistema de fixació Cross-Pin, com l’hem utilitzat, té un alt risc de lesionar les estructures laterals del genoll.Objetivo. Valorar el riesgo de lesión de las estructuras posterolaterales de la rodilla al realizar una reconstrucción del ligamento cruzado anterior (LCA) mediante plastia isquiotibiales y fijación femoral con sistema Cross-Pin. Material. 10 rodillas cadavéricas frescas. Reconstrucción artroscópica del LCA mediante túnel anatómico desde portal anteromedial. Disección rodilla midiendo distancias Cross-Pin a Ligamento Colateral Lateral (LCL), tendón poplíteo, nervio peroneo y tendón gastroecnemio lateral. Resultados. LCL y gastroecnemio tienen un alto riesgo de ser lesionados mediante este sistema. Conclusiones. El sistema de fijación Cross-Pin, tal como lo hemos descrito, tiene un alto riesgo de lesionar las estructuras laterales de la rodilla

Evaluación de la fijación femoral en la reconstrucción del ligamento cruzado anterior. Estudio experimental en modelo cadavérico

Los estudios de esta tesis analizan la fijación femoral de la plastia de isquiotibiales para la reconstrucción del ligamento cruzado anterior. Hasta ahora el concepto de isometría ha sido predominante a la hora de realizar el túnel femoral, de manera en que se intentaba dar la misma tensión a la plastia en todos los grados de flexión de la rodilla. Por esto, el túnel se realizaba alto y profundo en el cóndilo femoral lateral. En los últimos años, la localización de este túnel ha cambiado buscando una localización más anatómica (más bajo y superficial). Uno de los métodos de fijación femoral de la plastia de isquiotibiales más usado en los últimos años ha sido el sido el sistema Cross-Pin (Stryker). Este sistema fue inicialmente diseñado para la realización del túnel en una localización no anatómica. Sin embargo, el uso de este sistema en una ubicación anatómica se empezó a realizar sin estudios que comprobasen la seguridad del sistema con respecto a las estructuras posterolaterales de la rodilla. La hipótesis del primero de los trabajos incluidos en esta tesis era que el uso del sistema de fijación Cross-Pin, cuando es colocado en un túnel femoral realizado en su ubicación anatómica, pone en peligro las estructuras posterolaterales de la rodilla. Para ello, se diseñó un estudio con 10 rodillas de cadáver humano en donde se reconstruyó por vía artroscópica el ligamento cruzado anterior. A continuación, las rodillas se disecaron y se estudió la distancia desde el Cross-Pin a varias estructuras anatómicas de la región posterolateral de la rodilla así como a diferentes estructuras osas. Se vió que la variación de la técnica quirúrgica ponía en peligro las estructuras posterolaterales de la rodilla, sobre todo el ligamento colateral lateral y el tendón del músculo poplíteo. Se diseñó a continuación un segundo estudio en donde se introdujo un cambio en la técnica quirúrgica con la finalidad de disminuir este riesgo de lesión. Se hipotetizó que si se realiza un túnel mayor de 30 mm (recomendación de la técnica quirúrgica), el riesgo de dañar estas estructuras sería menor. Para ello se diseñó un estudio por vía artroscópica con 22 rodillas humanas divididas en 2 grupos. A las rodillas del primer grupo se les realizó un túnel de 30 mm de longitud y en el segundo grupo el túnel realizado fue tan largo como el cóndilo lateral permitía. Las rodillas fueron disecadas y se realizaron las mediciones a las diferentes estructuras anatómicas que se habían realizado en el primer trabajo. Se concluyó que el túnel femoral debe ser realizado tan largo como permita el cóndilo femoral externo para no poner en peligro las estructuras posterolaterales de la rodilla. El tercer estudio incluido en esta tesis compara dos guías para la iniciación del túnel femoral. Se comparó la clásica guía de offset con la recientemente diseñada guía BullsEye (Linvatec). Par ello se diseñó un trabajo con 14 rodillas humanas pareadas de mismo donante. Cada una de la rodilla del mismo donante se asignó a un grupo. En cada grupo el túnel fue iniciado con cada una de las guías. Al mismo tiempo, se estudió si el grado de flexión de la rodilla cuando se realiza el túnel estaba relacionado con la longitud del túnel realizado. Se concluyó que la guía BullsEye realizaba un túnel femoral en una posición más anatómica que la otra guía. Además la guía de offset de 5 mm realizaba unos túneles más cortos y con un mayor de ruptura de la pared posterior. Por otro lado, se pudo concluir que el grado de flexión de la rodilla no estaba relacionado con la longitud del túnel con independencia de la guía usada.The studies in this thesis analyze femoral fixation of a hamstring graft for reconstruction of the anterior cruciate ligament (ACL). So far, the concept of isometry has been predominant when making the tunnel, in such a way that what was sought after was the graft having the same tension in all degrees of knee flexion. For this, the tunnel was located high and deep in the lateral femoral condyle. In recent years, the location of this tunnel has varied in the search for a more anatomic location for it (lower and more superficial). In recent years, one of the most used methods of fixation at the femoral level to fix this graft has been a system like the Cross-Pin (Stryker). It was originally designed for the realization of the tunnel in a non-anatomical location. However, the use of this system with an anatomical location was being done without studies that affirmed its safety with respect to the posterolateral structures of the knee. The first working hypothesis was that the use of the Cross-Pin fixation system, when a femoral tunnel was done in its anatomic location, endangered the posterolateral structures of the knee. In order to do it, a study with 10 human cadaver knees was conceived in which an ACL reconstruction was performed via arthroscopy. Subsequently, the knee was dissected and the distance from the Cross-Pin to various anatomical structures in the posterolateral region of the knee and the different bone structures was precisely measured. It was possible to objectify that this variation in the surgical technique jeopardized the posterolateral knee structures, primarily the lateral collateral ligament and the tendon of the popliteus muscle. The second study was aimed at introducing a change in the surgical technique that decreased this risk. It was hypothesized that if a tunnel longer than 30 mm (recommendation of the surgical technique) were made, the risk of damaging these structures would be less. A work, via arthroscopy, with 22 human cadaver knees divided into two groups was also designed. The knees in the first group had a tunnel of 30 mm in length done. On the other hand, the tunnel was as long as the condyle permitted in the second group. The knees were dissected and the measurements were performed as in the previous work. The conclusion was that the hamstring graft fixation from the anteromedial portal with a 30 mm femoral tunnel presents a higher risk of injury of the posterolateral structures of the knee. The femoral tunnel should be drilled as long as possible. Finally, a third study in which 2 guides for the initiation of femoral tunnel were compared was designed. The classical offset guide was compared to the newly designed BullsEye (Linvatec) guide. Fourteen paired human knees were used for it. Each of the 2 knees from the same donor was assigned to a group: the tunnel was made with one guide in the first group and the other guide with the other group. At the same time, whether the degree of flexion might be related to a greater length of the femoral tunnel was also compared. It was concluded that the BullsEye guide is more accurate in situating the femoral tunnel of the ACL in an anatomical position. In addition, the tunnels drilled with the 5 mm-offset guide produced shorter tunnels and had a greater risk of a rupture of the posterior wall of the tunnel. On the other hand, it might be concluded that the degree of knee flexion was unrelated to the length of the tunnel regardless of the guide used

Evaluación de la fijación femoral en la reconstrucción del ligamento cruzado anterior. Estudio experimental en modelo cadavérico

Los estudios de esta tesis analizan la fijación femoral de la plastia de isquiotibiales para la reconstrucción del ligamento cruzado anterior. Hasta ahora el concepto de isometría ha sido predominante a la hora de realizar el túnel femoral, de manera en que se intentaba dar la misma tensión a la plastia en todos los grados de flexión de la rodilla. Por esto, el túnel se realizaba alto y profundo en el cóndilo femoral lateral. En los últimos años, la localización de este túnel ha cambiado buscando una localización más anatómica (más bajo y superficial). Uno de los métodos de fijación femoral de la plastia de isquiotibiales más usado en los últimos años ha sido el sido el sistema Cross-Pin (Stryker). Este sistema fue inicialmente diseñado para la realización del túnel en una localización no anatómica. Sin embargo, el uso de este sistema en una ubicación anatómica se empezó a realizar sin estudios que comprobasen la seguridad del sistema con respecto a las estructuras posterolaterales de la rodilla. La hipótesis del primero de los trabajos incluidos en esta tesis era que el uso del sistema de fijación Cross-Pin, cuando es colocado en un túnel femoral realizado en su ubicación anatómica, pone en peligro las estructuras posterolaterales de la rodilla. Para ello, se diseñó un estudio con 10 rodillas de cadáver humano en donde se reconstruyó por vía artroscópica el ligamento cruzado anterior. A continuación, las rodillas se disecaron y se estudió la distancia desde el Cross-Pin a varias estructuras anatómicas de la región posterolateral de la rodilla así como a diferentes estructuras osas. Se vió que la variación de la técnica quirúrgica ponía en peligro las estructuras posterolaterales de la rodilla, sobre todo el ligamento colateral lateral y el tendón del músculo poplíteo. Se diseñó a continuación un segundo estudio en donde se introdujo un cambio en la técnica quirúrgica con la finalidad de disminuir este riesgo de lesión. Se hipotetizó que si se realiza un túnel mayor de 30 mm (recomendación de la técnica quirúrgica), el riesgo de dañar estas estructuras sería menor. Para ello se diseñó un estudio por vía artroscópica con 22 rodillas humanas divididas en 2 grupos. A las rodillas del primer grupo se les realizó un túnel de 30 mm de longitud y en el segundo grupo el túnel realizado fue tan largo como el cóndilo lateral permitía. Las rodillas fueron disecadas y se realizaron las mediciones a las diferentes estructuras anatómicas que se habían realizado en el primer trabajo. Se concluyó que el túnel femoral debe ser realizado tan largo como permita el cóndilo femoral externo para no poner en peligro las estructuras posterolaterales de la rodilla. El tercer estudio incluido en esta tesis compara dos guías para la iniciación del túnel femoral. Se comparó la clásica guía de offset con la recientemente diseñada guía BullsEye (Linvatec). Par ello se diseñó un trabajo con 14 rodillas humanas pareadas de mismo donante. Cada una de la rodilla del mismo donante se asignó a un grupo. En cada grupo el túnel fue iniciado con cada una de las guías. Al mismo tiempo, se estudió si el grado de flexión de la rodilla cuando se realiza el túnel estaba relacionado con la longitud del túnel realizado. Se concluyó que la guía BullsEye realizaba un túnel femoral en una posición más anatómica que la otra guía. Además la guía de offset de 5 mm realizaba unos túneles más cortos y con un mayor de ruptura de la pared posterior. Por otro lado, se pudo concluir que el grado de flexión de la rodilla no estaba relacionado con la longitud del túnel con independencia de la guía usada.The studies in this thesis analyze femoral fixation of a hamstring graft for reconstruction of the anterior cruciate ligament (ACL). So far, the concept of isometry has been predominant when making the tunnel, in such a way that what was sought after was the graft having the same tension in all degrees of knee flexion. For this, the tunnel was located high and deep in the lateral femoral condyle. In recent years, the location of this tunnel has varied in the search for a more anatomic location for it (lower and more superficial). In recent years, one of the most used methods of fixation at the femoral level to fix this graft has been a system like the Cross-Pin (Stryker). It was originally designed for the realization of the tunnel in a non-anatomical location. However, the use of this system with an anatomical location was being done without studies that affirmed its safety with respect to the posterolateral structures of the knee. The first working hypothesis was that the use of the Cross-Pin fixation system, when a femoral tunnel was done in its anatomic location, endangered the posterolateral structures of the knee. In order to do it, a study with 10 human cadaver knees was conceived in which an ACL reconstruction was performed via arthroscopy. Subsequently, the knee was dissected and the distance from the Cross-Pin to various anatomical structures in the posterolateral region of the knee and the different bone structures was precisely measured. It was possible to objectify that this variation in the surgical technique jeopardized the posterolateral knee structures, primarily the lateral collateral ligament and the tendon of the popliteus muscle. The second study was aimed at introducing a change in the surgical technique that decreased this risk. It was hypothesized that if a tunnel longer than 30 mm (recommendation of the surgical technique) were made, the risk of damaging these structures would be less. A work, via arthroscopy, with 22 human cadaver knees divided into two groups was also designed. The knees in the first group had a tunnel of 30 mm in length done. On the other hand, the tunnel was as long as the condyle permitted in the second group. The knees were dissected and the measurements were performed as in the previous work. The conclusion was that the hamstring graft fixation from the anteromedial portal with a 30 mm femoral tunnel presents a higher risk of injury of the posterolateral structures of the knee. The femoral tunnel should be drilled as long as possible. Finally, a third study in which 2 guides for the initiation of femoral tunnel were compared was designed. The classical offset guide was compared to the newly designed BullsEye (Linvatec) guide. Fourteen paired human knees were used for it. Each of the 2 knees from the same donor was assigned to a group: the tunnel was made with one guide in the first group and the other guide with the other group. At the same time, whether the degree of flexion might be related to a greater length of the femoral tunnel was also compared. It was concluded that the BullsEye guide is more accurate in situating the femoral tunnel of the ACL in an anatomical position. In addition, the tunnels drilled with the 5 mm-offset guide produced shorter tunnels and had a greater risk of a rupture of the posterior wall of the tunnel. On the other hand, it might be concluded that the degree of knee flexion was unrelated to the length of the tunnel regardless of the guide used

Good clinical outcomes can be expected after meniscal allograft transplantation at 15 years of follow-up

Purpose: The aim of this study was to evaluate graft survivorship and report the functional and radiographic results of Meniscal allograft transplantation (MAT) throughout a minimum 15-year follow-up period. Methods: Fifty-one patients that had undergone an isolated MAT procedure during the period studied were included. The results were assessed with the Lysholm and Tegner scores as well as the Visual Analog Scale. Magnetic resonance imaging and a complete radiographic series were carried out to determine the degree of meniscal extrusion and joint space narrowing. A comparison was made between the radiological findings of the last follow-up, the 5-year mid-term follow-up and those from the preoperative period. Results: Thirty-eight patients were available for the final follow-up. The mean follow-up was 17.4 years. There were 23 (60.5%) medial menisci and 15 lateral menisci (39.4%). Meniscal extrusion increased from the 29.7% ± 14.9 obtained at the 5-year follow-up to the 72.5% ± 22.5 seen at the end of the follow-up (p = 0.0001). The joint space distance was almost unchanged from the initial evaluation (3.3 ± 1.5 mm) to the 5-year follow-up measurement (3.1 ± 1.7 mm, n.s.). However, it did decrease at the last follow-up (1.9 ± 1.5 mm, p < 0.05). The functional outcomes improved from the preoperative period to the mid-term follow-up and later worsened at the final follow-up. The mean preoperative Lysholm score at the initial follow-up was 61.5 ± 9.6, 86.9 ± 10.9 for the 5-year evaluation and stood at 77.4 ± 11.5 (p = 0.0001) at the final follow-up. Regarding the Tegner score, those pre-operative scores were compared to the ones at the last follow-up (median: 3; range 0-6 vs. 5.5; 3-6, respectively; p = 0.0001). The VAS went down from 6.6 ± 1.7 at the initial evaluation to 2.5 ± 1.9 at the final follow-up (p = 0.0001). The joint-space width remained unchanged from the initial evaluation (3.35 ± 1.5 mm) up to the 5-year follow-up measurement (3.1 ± 1.7 mm, n.s.). However, this joint-space distance had decreased by the last evaluation in the long-term follow-up (1.9 ± 1.4 mm, p < 0.05). Five patients (13.1%) presented with a MAT failure at 5 years, which was followed by extirpation of the meniscal graft. At the final follow-up, a total of 16 patients (42.1%) presented with a failure. At that time, there were 4 more MAT removals and seven patients that required a total knee replacement. The mean time to failure of the meniscal graft was 206.2 months ± 13.4 (18.0 years). Conclusions: Meniscal allograft transplantation produces good functional results at a minimum 15-year follow-up. However, degenerative arthritis in the affected compartment progressed during that period

A new score assessing the surgical wound of a TKA and its relation with pain, infection and functional outcomes.

The aim of this study was to describe a new score to measure the aspect of the TKA surgical wound and to correlate it with postoperative pain, infection and functional outcomes at 1 year of follow-up. This score, ranging from 0 to 10, assessed 5 parameters; swelling, haematoma, erythema, blood draining and blisters. 159 consecutive TKA were prospectively evaluated.             Intra and inter-rate reliability was superior to 0.9. No differences were obtained comparing the aspect of the surgical wound with postoperative pain or functional outcomes. Incidence of deep infection is directly related with an increased score (p=0.0025).

Reconstrucción del ligamento cruzado anterior desde el portal anteromedial; evaluación de la fijación femoral en un modelo cadavérico

Objectiu. Valorar el risc de lesió de les estructures posterolaterals del genoll realitzant una reconstrucció del Lligament Encreuat Anterior (LEA) mitjançant plàstia d'isquiotibials i fixació femoral am sistema Cross-Pin. Material. 10 genolls cadavèrics frescs. Reconstrucció artroscòpica del LEA mitjançant túnel anatòmic des del portal anteromedial. Dissecció anatòmica del genoll mesurant distàncies del Cross-Pin al Lligament Col·lateral Lateral (LCL), tendó popliti, nervi peroneo i tendó gastroecnemi lateral. Resultats. LCL i gastroecnemi tenen un alt risc de ser lesionats mitjançant aquest sistema Conclusió. El sistema de fixació Cross-Pin, com l'hem utilitzat, té un alt risc de lesionar les estructures laterals del genoll.Objetivo. Valorar el riesgo de lesión de las estructuras posterolaterales de la rodilla al realizar una reconstrucción del ligamento cruzado anterior (LCA) mediante plastia isquiotibiales y fijación femoral con sistema Cross-Pin. Material. 10 rodillas cadavéricas frescas. Reconstrucción artroscópica del LCA mediante túnel anatómico desde portal anteromedial. Disección rodilla midiendo distancias Cross-Pin a Ligamento Colateral Lateral (LCL), tendón poplíteo, nervio peroneo y tendón gastroecnemio lateral. Resultados. LCL y gastroecnemio tienen un alto riesgo de ser lesionados mediante este sistema. Conclusiones. El sistema de fijación Cross-Pin, tal como lo hemos descrito, tiene un alto riesgo de lesionar las estructuras laterales de la rodilla

Increased posterior translation but similar clinical outcomes using ultracongruent instead of posterior stabilized total knee arthroplasties in a prospective randomized trial

Data de publicació electrònica: 26-08-2021Purpose: The aim of this study was to compare the posterior tibial translation after ultracongruent (UC) and posterior-stabilized (PS) total knee arthroplasty (TKA) with two different UC with different heights in the anterior lip, and two different PS designs. This study also aimed to compare the range of motion (ROM) and outcomes scores after the use of these TKA models. It was hypothesised less posterior tibial translation after PS than after UC TKA, and less posterior tibial translation with a higher anterior lip in the UC insert than with a lower one. Methods: It was designed as a prospective randomized study of a group of 120 patients operated with a cemented TKA. To clarify the main purpose of the study, four groups were analysed using different polyethylene designs: Triathlon PS insert in group one, Triathlon UC insert in group two, U2 PS insert in group three and U2 UC insert in group four. One year after surgery, a forced posterior drawer with a Telos Stress applying 15 kg of force posteriorly on the proximal tibia at 90° of knee flexion was analysed in the lateral radiograph. Limb alignment, tibial posterior slope and posterior condylar offset were also studied. Results: 30 patients were included in each group. The average age was 73 years. There were 72.2% female and 27.8% male patients. There were no significant differences in any demographic or radiographic studied variables, preoperative range of motion (ROM) or preoperative Knee Society Scores (KSS) among the different groups. One year after surgery, the average postoperative ROM and the postoperative KSS Knee and KSS Function scores improved in respect of the preoperative values in all the groups. There were no significant differences in the postoperative outcome scores among the different groups (p = n.s.). Postoperative alignment of the limb, tibial posterior slope and posterior condylar offset were similar in the 4 study groups (p = n.s.). The postoperative posterior tibial translation was different between groups: the PS groups (groups 1 and 3) showed significant inferior values (p < 0.001) in respect of the UC groups (groups 2 and 4). There were no differences between both groups of PS models, but there was a significant increase in the posterior tibial translation of the Triathlon UC insert (11.2 mm SD 3.2) in respect of the U2 UC insert (6.1 mm SD 4.5) (p = 0.004). Conclusions: UC inserts restrict the posterior tibial translation after TKA less than PS inserts, but a design with a high anterior lip in the polyethylene UC insert can better control the posterior tibial translation than an insert with a small anterior lip

Barbed sutures in total knee arthroplasty: are they really useful? a randomized controlled trial

Data de publicació electrónica: 20-05-2019Bidirectional barbed sutures (BBSs) have recently been investigated in total knee arthroplasty (TKA). The contrasting results from the scarce literature suggest that BBSs are safe, save time and money, and give results comparable to traditional sutures. The purpose of the study is to test the real effect of BBSs on closure time in TKA and assess the functional results as well as the complications related to them. It was a randomized controlled trial. Eighty-five patients undergoing primary TKA were assigned to receive traditional closure with Vicryl (V-group) or with BBSs (Q-group). The exclusion criteria were significant coronal deformity, flexion contracture, or the need for stem and/or augmentation. The closure time for the capsule and that for the subcutaneous layer were registered separately. Intraoperative incidences were recorded. The follow-up was up to 1 month, during which the range of motion (ROM), superficial or deep infection, and wound dehiscence were assessed. There was a significant reduction in the capsule layer (27 seconds; p = 0.02) and global time closure (51 seconds; p = 0.01) in the Q-group. No differences were found in the subcutaneous layer (24 seconds; p = 0.055). There were more intraoperative suture breakages in the Q-group, mainly in the subcutaneous layer (p < 0.001). No differences in terms of dehiscence, infection, and ROM were observed at the 1-month follow-up. BBSs allow for slightly faster wound closure than Vicryl during a TKA. However, the differences observed have minimal clinical repercussions. Moreover, no differences in the infection rate (deep or superficial), dehiscence, or ROM were found