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Gencer B, Yiğit A, Çamoğlu C, Çulcu A, Dogan O. Can Anterior Knee Pain Be Explained by Patella Position After Infrapatellar Tibia Intramedullary Nailing? Cureus 2023; 15:e47334. [PMID: 38021528 PMCID: PMC10657199 DOI: 10.7759/cureus.47334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate the postoperative position of the patella and its relationship with anterior knee pain in patients operated with infrapatellar reamed tibia intramedullary nailing (IMN). MATERIALS AND METHODS Patients who underwent tibia IMN between 2019 and 2022 and who had anterior knee pain in their postoperative follow-up at least two outpatient clinic controls with an interval of at least one month were examined. Patellar height indices (Insall-Salvati, Blackburne-Peel, Caton-Deschamps, and modified Insall-Salvati) and sagittal angulation (patella-patellar tendon angles) were measured on the lateral direct radiographs of the patients in semi-flexion. As a control group, measurements were made on the contralateral intact extremity radiographs of the same patients. RESULTS There was no significant difference in patellar height indices between the fractured and intact sides in any of the patients (p = 0.588; p = 0.747; p = 0.446; p = 0.573, respectively). When the sagittal angulations were analyzed, a significant difference was found between the fractured and intact sides of the patients (p = 0.048), resulting in an approximate three-degree change. CONCLUSION Patellar sagittal balance has been identified as one of the contributing factors to the development of anterior knee pain following reamed tibial IMN. Further biomechanical and comprehensive clinical studies are needed on this subject.
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Affiliation(s)
- Batuhan Gencer
- Department of Orthopaedics and Traumatology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, TUR
| | - Alperen Yiğit
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Can Çamoğlu
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Ahmet Çulcu
- Department of Orthopaedics and Traumatology, Yüksekova State Hospital, Hakkâri, TUR
| | - Ozgur Dogan
- Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, TUR
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Zha J, Zhang G, Wang X, Li J, Di J, Guo J. Use of a Minimally Invasive Traction Repositor versus Conventional Manual Traction for the Treatment of Tibial Fractures: A Comparative Study from a Tertiary Hospital in China. Ther Clin Risk Manag 2022; 18:945-954. [PMID: 36176542 PMCID: PMC9514298 DOI: 10.2147/tcrm.s379135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Closed reduction and intramedullary nail fixation of tibial fractures may not utilize a fracture table or reduction aids like a femoral distractor, and only manual traction will help aid the reduction process. This study aimed to describe and further investigate the effectiveness of an originally designed minimally invasive traction repositor (MITR) for the treatment of tibial fractures. Methods From January 2018 to April 2021, a total of 119 eligible patients with tibial shaft fractures were included and retrospectively assigned to two groups according to different reduction methods: MITR group vs conventional manual traction (CMT) group. The baseline characteristics between the two groups were comparable, including age, gender, BMI, residence, smoking history, drinking history, injury mechanism, fracture type, ASA, method of anesthesia, and surgical delay (all P > 0.05). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of intraoperative fluoroscopies, VAS, HSS, fracture healing time, and complications were compared. Results All patients completed the follow-ups with an average of 18.5 months (range 12-42 months). The operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, and number of fluoroscopies were significantly decreased in the MITR group (all P < 0.05). At one month postoperatively, the VAS score was statistically lower in the MITR group (1.8±0.8) than in the CMT group (2.6±1.5). At 6 months postoperatively, the HHS score was statistically higher in the MITR group (90.8±2.3) than in the CMT group (86.4±3.8). We observed no statistical difference in the mean fracture healing time, bone nonunion, implant failure, and infection between the two groups (all P > 0.05). Conclusion Compared with CMT, MITR facilitates the minimally invasive treatment of tibial fractures and has the advantages of operation time, fracture reduction duration, intraoperative blood loss, fluoroscopy time, number of fluoroscopies, and satisfactory VAS and HSS scores.
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Affiliation(s)
- Junpu Zha
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Orthopaedic Institute of Hebei Province, Shijiazhuang, People's Republic of China
| | - Guolei Zhang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Orthopaedic Institute of Hebei Province, Shijiazhuang, People's Republic of China
| | - Xiaoqing Wang
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Jie Li
- Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Jun Di
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Orthopaedic Institute of Hebei Province, Shijiazhuang, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedics Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.,Orthopaedic Institute of Hebei Province, Shijiazhuang, People's Republic of China
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Kröger I, Müßig J, Brand A, Pätzold R, Wackerle H, Klöpfer-Krämer I, Augat P. Recovery of gait and function during the first six months after tibial shaft fractures. Gait Posture 2022; 91:66-72. [PMID: 34653876 DOI: 10.1016/j.gaitpost.2021.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial shaft fractures require surgical stabilization preferably by intramedullary nailing. Recovery is often unsatisfactory due to limited knee function and pain, resulting in reduced quality of life. The extent of these functional limitations with respect to gait deficits has not been sufficiently recognized. RESEARCH QUESTION Are there functional limitations during gait and squat performance during the first six months after surgically treated tibial shaft fractures? METHODS Twenty-three patients (BMI: 24 ± 3, Age:39 ± 15) with tibial shaft fractures and 23 healthy, matched controls (BMI: 24 ± 3, Age: 40 ± 14) were assessed using instrumented motion analysis two, three and six months after surgery. Kinematic and kinetic data of the lower extremities were collected during level walking and squat performance. Data were compared among follow-up time intervals and between groups. RESULTS Significant improvements were found for all spatiotemporal parameters and most kinetic parameters. Even six months after surgery functional deficits persisted when compared to healthy controls. There were only slight improvements in sagittal knee and ankle kinematics as well as knee moments and power within the follow-up period. A significant difference compared to the healthy controls can still be observed in these parameters. SIGNIFICANCE Although patients with tibia fractures demonstrated functional improvements over the early course of healing, some residual deficits in lower extremity movement biomechanics were identified at six months post surgery. In particular knee kinematics in squatting as well as knee kinematics and kinetics during walking only recovered incompletely. This result can help explain the often-reported functional limitations. CLINICAL TRIAL REGISTRATION NUMBER German register for clinical trials (DRKS00023790).
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Affiliation(s)
- Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria.
| | - Janina Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Robert Pätzold
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Germany
| | - Hannes Wackerle
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
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Ceyhan E, İnci F, Yavuz İA, Gürhan U, Yıldırım AÖ, Öken ÖF. Effects of morphological changes in the patellar tendon on the development of anterior knee pain after intramedullary nailing for tibial shaft fractures: A retrospective comparative study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:634-638. [PMID: 33423998 DOI: 10.5152/j.aott.2020.20232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of morphological changes of the patellar tendon (length, width, and thickness) on the development of anterior knee pain (AKP) after intramedullary nailing (IMN) of tibial shaft fractures. METHODS A total of 39 patients, treated by IMN using the transpatellar approach for tibial shaft fractures, were retrospectively reviewed and included in the study. The patients were then divided into 2 groups based on the presence of AKP: group A, patients who developed AKP (9 men, 9 women; mean age=35.39±9.32 years), and group B, patients without AKP (13 men, 8 women; mean age=41.38±14.78 years). To assess the morphological changes in the patellar tendon, magnetic resonance imaging was performed on the operated and unoperated, contralateral knees of the patients. The patellar tendon index (PTI) was calculated using the length, width, and thickness of the patellar tendon, and a set of variables was established to be a proportion of the measurements of the operated knees to those of the unoperated ones (operated/healthy PTI ratio). PTI ratios were compared between both the groups. Furthermore, the morphological features of the patellar tendon, including the length, width, and thickness, were examined within the groups as independent variables. To assess pain intensity in group A, a 10-cm visual analogue scale (VAS) was used. To evaluate functional status, the Lysholm knee scoring system was used. RESULTS The PTI ratio was significantly higher in group A (1.37±0.12) than in group B (1.03±0.08) (p<0.001). In group A, the mean VAS score was 5.35±1.11, and a moderate linear correlation was found between PTI ratios and VAS scores (r=0.494, p=0.044). The mean Lysholm score was significantly lower in group A (80.17±3.05) than in group B (89.76±3.05) (p<0.001). In group A, the width and thickness of the patellar tendon were found to be significantly different between the operated and unoperated knees (p=0.024 and p=0.002, respectively). In group B, there was no difference between the operated and unoperated knees in terms of the 3 measurements (length, width, and thickness) (p=0.762, p=0.753, and p=0.118, respectively). CONCLUSION Evidence from this study revealed that morphological changes occurring in the patellar tendon after IMN for tibial shaft fractures using a transpatellar approach may have a significant role in the development of AKP. The increase in the tendon width and thickness may be the cause of pain and insufficient knee function in such patients. LEVEL OF EVIDENCE Level III, Therapeutic study.
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Affiliation(s)
- Erman Ceyhan
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Fatih İnci
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - İbrahim Alper Yavuz
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Utku Gürhan
- Clinic of Orthopaedics and Traumatology, Silopi State Hospital, Şırnak, Turkey
| | - Ahmet Özgür Yıldırım
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Özdamar Fuad Öken
- Clinic of Orthopaedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Schulze-Tanzil G, Silawal S, Hoyer M. Anatomical feature of knee joint in Aachen minipig as a novel miniature pig line for experimental research in orthopaedics. Ann Anat 2019; 227:151411. [PMID: 31394168 DOI: 10.1016/j.aanat.2019.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/08/2019] [Accepted: 07/11/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The pig is a commonly used large animal model, since pigs share anatomical and physiological similarities with humans. In contrast to other experimental pig lines the Aachen minipig, as a robust novel minipig does not require housing with any barrier. To estimate transferability of results to human conditions, pig lines should be thoroughly characterized. PURPOSE Therefore, we analyzed the anatomical pecularities of the knee joint of the novel "Aachen minipig" line raised for experimental conditions. METHODS Eight knee joints of four adult Aachen minipigs were dissected measuring the dimensions of typical landmarks using a digital caliper. Hybrid pig and human knee joints served as controls. Cartilage of the Aachen minipig (trochlear groove, femoral condyles, menisci) were assessed histologically. RESULTS The Aachen minipig shared its knee joint anatomy with the hybrid pig. In comparison to humans, peculiarities of the pig were demonstrated in the Aachen minipig: the lateral meniscus and the lateral tibial joint surface were significantly longer than the medial counterparts. The fibular head was covered by fibrocartilage and completely integrated into the lateral lower joint surface. The cartilage at the joint areas usually used for cartilage repair studies was in average 0.66±0.04mm thick. The porcine anterior cruciate ligament (ACL) attached with two bundles at the anterior tibial plateau separated from each other by the lateral anterior meniscotibial ligament. Aachen minipig articular and meniscal cartilage presented the typical histoarchitecture. CONCLUSIONS The Aachen minipig reflects porcine anatomical peculiarities, which should be considered, especially for meniscus and ACL reconstruction.
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Affiliation(s)
- Gundula Schulze-Tanzil
- Department of Anatomy, Paracelsus Medical University, Salzburg and Nuremberg, Prof. Ernst Nathan Str. 1, Nuremberg, 90419, Germany.
| | - Sandeep Silawal
- Department of Anatomy, Paracelsus Medical University, Salzburg and Nuremberg, Prof. Ernst Nathan Str. 1, Nuremberg, 90419, Germany
| | - Mariann Hoyer
- amedes MVZ für Laboratoriumsdiagnostik und Mikrobiologie Halle/Leipzig GmbH, 06112 Halle, Germany
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