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Bayerl D, Moser LB, Neubauer M, Neugebauer J, Dammerer D, Winnisch M, Schabus R. Influence of a Concomitant Medial Meniscus Injury on Knee Joint Function and Osteoarthritis Presence after Anterior Cruciate Ligament Reconstruction. J Clin Med 2024; 13:2433. [PMID: 38673706 PMCID: PMC11050906 DOI: 10.3390/jcm13082433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) "isolated (ACLR)" (n = 20) and (ii) "ACLR with medial meniscal injury" (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren-Lawrence score was used. (3) Results: The "isolated ACLR" study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the "ACLR with medial meniscus injury" group (mean: 81). The KOOS category "activities of daily living" showed significantly better results in the isolated ACLR group (p < 0.05). The "ACLR with medial meniscus injury" group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery.
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Affiliation(s)
- Darian Bayerl
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
- Medical Practice Sport&Trauma, Pelikangasse 15 A/5, 1090 Vienna, Austria
| | - Lukas B. Moser
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
- Center for Regenerative Medicine, Danube University Krems, 3500 Krems, Austria
| | - Markus Neubauer
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
- Center for Regenerative Medicine, Danube University Krems, 3500 Krems, Austria
| | - Johannes Neugebauer
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Dietmar Dammerer
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Division of Orthopaedics and Traumatology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Markus Winnisch
- Medical Practice Sport&Trauma, Pelikangasse 15 A/5, 1090 Vienna, Austria
| | - Rudolf Schabus
- Medical Practice Sport&Trauma, Pelikangasse 15 A/5, 1090 Vienna, Austria
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Moser LB, Bauer C, Otahal A, Kern D, Dammerer D, Zantop T, Nehrer S. Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing. J Exp Orthop 2023; 10:97. [PMID: 37768416 PMCID: PMC10539273 DOI: 10.1186/s40634-023-00661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE The study aimed to compare the effect of mincing bovine articular cartilage with different shaver blades on chondrocyte viability. METHODS Bovine articular cartilage was harvested either with a scalpel or with three different shaver blades (2.5 mm, 3.5 mm, or 4.2 mm) from a commercially available shaver. The cartilage harvested with a scalpel was then minced into fragments smaller than 1 mm3 with a scalpel. All four conditions were cultivated in a culture medium for seven days. After Day 1 and Day 7, the following measurements were performed: metabolic activity, RNA isolation, and gene expression of anabolic (COL2A1 and ACAN) and catabolic genes (MMP1 and MMP13), live/dead staining and visualization using confocal microscopy, and flow cytometric characterization of minced cartilage chondrocytes. RESULTS Mincing the cartilage with shavers significantly reduced metabolic activity after one and seven days compared to scalpel mincing (p < 0.001). Gene expression of anabolic genes (COL2A1 and ACAN) was reduced, while catabolic genes (MMP1 and MMP13) were increased after day 7 in all shaver conditions. Confocal microscopy showed a thin line of dead cells at the lesion side with viable cells beneath for the scalpel mincing and a higher number of dead cells diffusely distributed in the shaver conditions. After seven days, there was a significant decrease in viable cells in the shaver conditions compared to scalpel mincing (p < 0.05). Flow cytometric characterization revealed fewer intact cells and proportionally more dead cells in all shaver conditions compared to the scalpel mincing. CONCLUSION Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing immediately after harvest and after seven days in culture. This suggests that mincing cartilage with a shaver should be considered a matrix rather than a cell therapy. LEVEL OF EVIDENCE Level II therapeutic study.
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Affiliation(s)
- Lukas B Moser
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria.
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria.
| | - Christoph Bauer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Alexander Otahal
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria
| | - Thore Zantop
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Sporthopaedicum Straubing, Straubing, Germany
- Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, 3500, Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education Krems, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500, Krems, Austria
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Bauer C, Moser LB, Kern D, Jeyakumar V, Nehrer S. The Combination of Glucocorticoids and Hyaluronic Acid Enhances Efficacy in IL-1β/IL-17-Treated Bovine Osteochondral Grafts Compared with Individual Application. Int J Mol Sci 2023; 24:14338. [PMID: 37762639 PMCID: PMC10531904 DOI: 10.3390/ijms241814338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with knee osteoarthritis often receive glucocorticoid (GC) or hyaluronic acid (HA) injections to alleviate symptoms. This study evaluated the impact of Triamcinolone Hexacetonide (a GC), HA, and a combination of both on bovine osteochondral grafts exposed to IL-1β and IL-17 in an ex vivo culture. Metabolic activity increased with GC treatment. GCs and GCs/HA counteracted cytokine effects, with gene expressions similar to untreated controls, while HA alone did not. However, HA improved the coefficient of friction after two weeks. The highest friction values were observed in GC-containing and cytokine-treated groups. Cytokine treatment reduced tissue proteoglycan content, which HA could mitigate, especially in the GC/HA combination. This combo also effectively controlled proteoglycan release, supported by reduced sGAG release. Cytokine treatment led to surface cell death, while GCs, HA, or their combination showed protective effects against inflammation. The GC/HA combination had the best overall results, suggesting its potential as a superior treatment option for osteoarthritis.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Lukas B. Moser
- Department of Orthopedics, University Hospital Krems, 3500 Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Vivek Jeyakumar
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
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Neubauer M, Reinberger EM, Dammerer D, Moser LB, Neugebauer J, Gottsauner-Wolf F, Nehrer S. Unicompartmental Knee Arthroplasty Provides Superior Clinical and Radiological Outcomes Compared to High Tibial Osteotomy at a Follow-Up of 5-8 Years. J Clin Med 2023; 12:5387. [PMID: 37629429 PMCID: PMC10455152 DOI: 10.3390/jcm12165387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a debilitating disease. Initially, the medial compartments are affected in most cases. For this pathology, joint preservation is preferable. Two surgical procedures aim to meet this goal: high-tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). The aim was to compare clinical and radiological outcomes of HTO versus UKA in patients with unicompartmental, medial OA. METHOD Retrospective case series. A total of 86 (61 UKA, 25 HTO) patients that received either treatment at a single, specialized center were assessed pre-operatively and at a single follow-up examination at 77.13 months (±8.170). The Knee Society Score (KSS), range of motion (ROM), SF36 questionnaire and the Tegner score were used. The Kellgren-Lawrence score was assessed pre- and post-surgically. Survivorship with the endpoint "revision" was assessed. RESULTS The UKA group showed significantly better improvements in KSS scores for pain (p < 0.006) and function (p < 0.001). OA progression (p < 0.02) and survivorship (p < 0.018) differed, significantly favoring UKA. ROM, SF36 and Tegner score did not differ significantly. CONCLUSIONS The presented mid-to long-term data suggest that UKA provides superior results in selected outcomes. Nevertheless, significant differences in the demographics of treatments indicate the challenge of comparing these two treatments.
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Affiliation(s)
- Markus Neubauer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Eva-Maria Reinberger
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Dietmar Dammerer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Lukas B. Moser
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Johannes Neugebauer
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Florian Gottsauner-Wolf
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
| | - Stefan Nehrer
- Center for Regenerative Medicine and Orthopaedics, University for Continuing Education Krems, Dr. Karl-Dorrek-Str. 30, 3500 Krems, Austria; (M.N.); (D.D.); (L.B.M.)
- Department of Orthopaedics & Traumatology, Karl Landsteiner University of Health Sciences, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria; (E.-M.R.); (J.N.); (F.G.-W.)
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Bauer C, Moser LB, Jeyakumar V, Niculescu-Morzsa E, Kern D, Nehrer S. Increased Chondroprotective Effect of Combining Hyaluronic Acid with a Glucocorticoid Compared to Separate Administration on Cytokine-Treated Osteoarthritic Chondrocytes in a 2D Culture. Biomedicines 2022; 10:biomedicines10071733. [PMID: 35885038 PMCID: PMC9313299 DOI: 10.3390/biomedicines10071733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Intra-articular injections of glucocorticoids (GC) or hyaluronic acid (HA) are commonly used interventions for patients suffering from knee osteoarthritis (OA). Both substances are combined to achieve a chondroprotective and anti-inflammatory effect. Clinical studies have shown benefits, but data on the cellular level are still lacking. This study aimed to investigate the effect of the GC triamcinolone hexacetonide, HA, and a mix of both substances on cytokine-treated chondrocytes in vitro. Chondrocytes isolated from human articular cartilage were seeded on 6- and 24-well plates. Mimicking OA’s inflammatory state, cells were treated with IL-1β and IL-17 for six days, whereby, after three days, test substances (10%) were added to the culture medium. Chondrocytes were analyzed on days three and six concerning their actin polymerization, expression of anabolic and catabolic genes, metabolic activity, cytokine release, and reactive oxygen species (ROS). Adding HA or GC/HA to the inflammatory culture medium increased the metabolic activity of chondrocytes, while groups containing GC reduced catabolic gene expression and the release of TNF-α. In addition, enhanced F-actin content was shown supplementing HA or GC/HA to the culture medium. Supplementing GC with HA leads to an anti-inflammatory and chondroprotective effect by diminishing the side effects of GC supplementation alone.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
- Correspondence: ; Tel.: +43-2622-893-2609
| | - Lukas B. Moser
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
- Department of Orthopedics, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
| | - Vivek Jeyakumar
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
| | - Eugenia Niculescu-Morzsa
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
| | - Daniela Kern
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
| | - Stefan Nehrer
- Center for Regenerative Medicine, Department for Health Sciences, Medicine and Research, University for Continuing Education, 3500 Krems, Austria; (L.B.M.); (V.J.); (E.N.-M.); (D.K.); (S.N.)
- Department of Orthopedics, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria
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Moser LB, Koch M, Hess S, Prabhakar P, Rasch H, Amsler F, Hirschmann MT. Stress Radiographs in the Posterior Drawer Position at 90° Flexion Should Be Used for the Evaluation of the PCL in CR TKA with Flexion Instability. J Clin Med 2022; 11:jcm11041013. [PMID: 35207284 PMCID: PMC8880224 DOI: 10.3390/jcm11041013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study was to define a cut-off value for the posterior drawer position in stress radiography that confirms an insufficiency of the posterior cruciate ligament (PCL) in cruciate-retaining (CR) total knee arthroplasty (TKA). In this retrospective study, 20 symptomatic patients with flexion instability and suspected PCL insufficiency in CR TKA were included. Asymptomatic patients served as an age- and sex-matched control group. All of the patients had undergone stress radiography, and the posterior translation was measured in a posterior drawer position at 30° and 90° flexion. The two groups were compared using t-tests and chi-square tests. The stress radiographs showed significantly more posterior translation in the symptomatic group (p < 0.01). Stress radiographs at 90° flexion more effectively discriminated between the patients with and without PCL insufficiency compared with those carried out at 30° flexion. Sensitivity and specificity testing revealed the best sensitivity (90.5%) and the best specificity (94.7%) at 90° posterior drawer radiographs at a cut-off value of 10 mm. Stress radiographs including the posterior drawer position at 90° flexion should be part of the diagnostic algorithm in patients with suspected flexion instability. A posterior translation of more than 10 mm in CR TKA strongly indicates an insufficiency of the PCL.
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Affiliation(s)
- Lukas B. Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
- Correspondence:
| | - Matthias Koch
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Department of Trauma Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Silvan Hess
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
| | - Ponnaian Prabhakar
- Department of Orthopaedics, Trauma and Arthroplasty, Care Superspeciality Hospitals, Nampally, Hyderabad 500 001, India;
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Liestal, Switzerland;
| | | | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, CH-4101 Basel, Switzerland; (M.K.); (M.T.H.)
- Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, Department of Clinical Research, University of Basel, CH-4001 Basel, Switzerland;
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Hothi H, Cerquiglini A, Büel L, Henckel J, Moser LB, Hirschmann MT, Hart A. SPECT/CT Assessment of In-Vivo Loading of the Knee Correlates with Polyethylene Deformation in Retrieved Total Knee Arthroplasty. Tomography 2022; 8:180-188. [PMID: 35076625 PMCID: PMC8788541 DOI: 10.3390/tomography8010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: SPECT/CT distribution patterns in patients with total knee replacements have previously been correlated with factors such as time of implantation, implant type and alignment. It is unknown, however, if an increased and more extended bone tracer uptake (BTU) in SPECT/CT, representing loading of the joint, correlates with findings from retrieval studies. The aim of this study was to further understand this subject. Materials and Methods: 62 retrieved TKA were included. SPECT/CT was performed prior to revision. Quantitative and qualitative medio-lateral comparisons of BTU intensity and distribution in the tibia were performed. Retrieval analysis was performed with a micro-CT method to assess the thickness differences between medial and lateral sides of polyethylene inserts with symmetrical designs. Results: In the subgroup of TKA with asymmetrical SPECT/CT distribution, there was a significant correlation between retrieval and medical imaging data (p = 0.0355): patients showing a more extended BTU in the medial compartment also had a significantly thinner insert in the medial compartment, and vice versa in the lateral side. Conclusion: This is the first study comparing BTU distribution patterns and retrieval findings. Our results support the hypothesis that SPECT/CT is able to identify bone activity due to implant position and loading.
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Affiliation(s)
- Harry Hothi
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
- Correspondence:
| | - Arianna Cerquiglini
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
| | - Lukas Büel
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
- Department of Orthopaedics, University of Basel, 4001 Basel, Switzerland
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
| | - Lukas B. Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
| | - Alister Hart
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
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Hess S, Fromm T, Schiapparelli F, Moser LB, Robertson E, Amsler F, Rasch H, Hirschmann MT. Change of tibial tuberosity-trochlear groove (TT-TG) distance during total knee arthroplasty had no influence on clinical outcome and anterior knee pain. Int Orthop 2021; 45:3069-3074. [PMID: 34075477 PMCID: PMC8626385 DOI: 10.1007/s00264-021-05074-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
Purpose The main purpose of this study was to determine whether there is a correlation between the change of tibial tuberosity-trochlear groove (TT-TG) distance and clinical outcomes after total knee arthroplasty (TKA). Methods A total of 52 knees undergoing TKA due to primary osteoarthritis were included in this retrospective study. All patients had pre- and postoperative CT scans. TT-TG distance was measured by two independent observers and the following alignment parameters were measured: hip-knee ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA), and posterior condylar angle (PCA). Clinical outcome was assessed using Knee Society Score (KSS) pre- and post-operatively and at a minimum of 12-month follow-up. Evidence of AKP was noted from follow-up reports. Pre- and postoperative scores were compared using a paired Student t-test. Pearson correlations were calculated to assess the influence of TT-TG on clinical outcome and of alignment parameters on the change in TT-TG. TT-TG between patients with and without AKP was compared using unpaired Student’s t-test (p < 0.05). Results Neither the absolute postoperative TT-TG nor the amount of change in TT-TG correlated with the post-operative KSS or the change in KSS. Post-operative TT-TG and change in TT-TG did not differ significantly between patients with and patients without AKP. Only the change in FMA showed a correlation with the change in TT-TG (p = 0.01, r = 0.36). Conclusion Despite a missing correlation between outcomes and TT-TG distance in this study, excessive TT-TG distance should be avoided. Furthermore, surgeons need to be aware that changes in femoral joint line orientation might affect TT-TG distance.
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Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
- University of Bern, Berne, Switzerland
| | - Timo Fromm
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
- University of Basel, CH-4051, Basel, Switzerland
| | - Filippo Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
| | - Emma Robertson
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
| | | | - Helmut Rasch
- University of Basel, CH-4051, Basel, Switzerland
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland.
- University of Basel, CH-4051, Basel, Switzerland.
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Hirschmann MT, Hess S, Behrend H, Amsler F, Leclercq V, Moser LB. Phenotyping of hip-knee-ankle angle in young non-osteoarthritic knees provides better understanding of native alignment variability. Knee Surg Sports Traumatol Arthrosc 2019; 27:1378-1384. [PMID: 30968238 DOI: 10.1007/s00167-019-05507-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE There is a lack of knowledge about the native coronal knee alignment in 3D. The currently used classification system (neutral, valgus and varus) oversimplifies the coronal knee alignment. The purpose of this study was therefore (1) to investigate the coronal knee alignment in non-osteoarthritic knees using 3D-reconstructed CT images and (2) to introduce a classification system for the overall knee alignment based on phenotypes. METHODS The hospital registry was searched for patients younger than 45 years and older than 16, who received a CT according to the Imperial Knee Protocol. Patients with prosthesis, osteoarthritis, fractures or injury of the collateral ligaments were excluded. Finally, 308 non-osteoarthritic knees of 160 patients remained (102 males and 58 females, mean age ± standard deviation (SD) 30 ± 7 years). The overall lower limb alignment was defined as the hip-knee-ankle angle (HKA), which is formed by lines connecting the centers of the femoral head, the knee and the talus. The angle was measured using a commercially planning software (KneePLAN 3D, Symbios, Yverdon les Bains, Switzerland). Descriptive statistics, such as means, ranges, and measures of variance (e.g., standard deviations) are presented. Based on these results, the currently used classification system was evaluated and a new system, based on phenotypes, was introduced. These phenotypes consist of a phenotype-specific mean value (a HKA value) and cover a range of ± 1.5° from this mean (e.g., 183° ± 1.5°). The mean values represent 3° increments of the angle starting from the overall mean value (mean HKA = 180°; 3° increments = 183° and 177°, 186° and 174°). The distribution of these limb phenotypes was assessed. RESULTS The overall mean HKA was 179.7° ± 2.9° varus and values ranged from 172.6° varus to 187.1° valgus. The mean HKA values for male and female were 179.2° ± 2.8° and 180.5° ± 2.8°, respectively, which implied a significant gender difference (r2 = 0.23). The most common limb phenotype in males was NEUHKA0° (36.4%), followed by VARHKA3° (29.2%) and VALHKA3° (23.1%). The most common limb phenotype in females was NEUHKA0° (36.4%), followed by VALHKA3° (22.1%) and VARHKA3° (15.0%). CONCLUSION The measurements using 3D-reconstructed CT images confirmed the great variability of the overall lower limb alignment in non-osteoarthritic knees. However, the currently used classification system (neutral, varus, valgus) oversimplifies the coronal alignment and therefore the introduced classification system, based on limb phenotypes, should be used. This will help to better understand individual coronal knee alignment. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Bern, Bern, Switzerland
| | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | | | | | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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Lampart M, Behrend H, Moser LB, Hirschmann MT. Due to great variability fixed HKS angle for alignment of the distal cut leads to a significant error in coronal TKA orientation. Knee Surg Sports Traumatol Arthrosc 2019; 27:1434-1441. [PMID: 29961097 DOI: 10.1007/s00167-018-5041-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE For coronal alignment in total knee arthroplasty (TKA) most surgeons use the patient's individual hip-knee shaft (HKS) angle (angle between the anatomical axis and the mechanical axis of the femur). The major problem of the sole use of HKS angle is that the individual patient's distal femoral asymmetry is not considered. The purpose of this study was to determine the variability of the HKS angle, the mechanical femoral angle (FMA) and to evaluate whether or not one of the two angles is more important for TKA alignment strategy. It was the hypothesis that HKS and FMA are not directly related to each other and hence HKS should not be considered as guide for coronal alignment. METHODS Prospectively collected CT data of 1480 consecutive patients who underwent 3D reconstructed CT scans before TKA was used for this retrospective registry study [882 women and 598 men, mean age ± standard deviation 71 ± 9 years (34-99 years)]. The CT protocol was modified according to the Imperial Knee Protocol, which is a lowdose CT protocol that includes high-resolution 0.75-mm slices of the knee and 3-mm slices of the hip and ankle joints. All measurements were done using Symbios® 3D knee preoperative planning's software (Symbios, Yverdon les Bains, Switzerland). The HKS, FMA and hip-knee-ankle (HKA) angles were measured. Angles measured were displayed as mean, standard deviation (SD) and range. In addition, the angles were shown as percentages after categorization. The HKS was categorized between 3° and 9° in 1° increments. The FMA was categorized between 83.5° and 98.5° in 3° increments. The HKA was categorized between 12.5° varus 5.5° valgus in 3° increments. Pearson correlations were used to investigate correlation of HKS and FMA (p < 0.05). RESULTS The HKS angle was not constant at 7° but averaged 6°, and ranged from 2.5° to 9°. The FMA angle was on average 93° but varied more than 20°, ranging from 75° (varus) to 104° (valgus). The mean HKA ± SD was - 3.4° ± 5.7° (range - 23.0° to 15.0°). The mean HKSSD was 5.6° ± 0.9° (range 2.5°-8.8°). The mean FMASD was 92.6° ± 2.8° (range 75.2°-103.5°). The Pearson correlations of all measured angles are presented in Table 1. HKS significantly correlated negatively with HKA and FMA (p < 0.001). FMA and HKA were strongly correlated with each other (p < 0.0001). Considering the HKS angle as a constant angle can induce a deviation of up to 5° with respect to an orthogonal distal femoral cutting objective. The great variability of the FMA angle implies that the FMA seems more relevant than the HKS angle to define the strategy of realignment of the lower limb. However, then patient specific instrumentation has to be used to precisely transfer the planning to the surgical technique. Having the aim of a more personalized TKA alignment in mind the individual constitutional knee phenotype should be taken into account.
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Affiliation(s)
- Maurin Lampart
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.
- University of Basel, Basel, Switzerland.
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Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S. Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:1394-1402. [PMID: 30976825 DOI: 10.1007/s00167-019-05509-z] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The currently used system to classify the lower limb alignment (neutral, varus, valgus) does not consider the orientation of the joint line or its relationship to the overall lower limb alignment. Similarly, current total knee arthroplasty (TKA) alignment concepts do not sufficiently consider the variability of the native coronal alignment. Therefore, the purpose of this study was (1) to introduce a new classification system for the lower limb alignment, based on phenotypes, and (2) to compare the alignment targets of different TKA alignment concepts with the native alignment of non-osteoarthritic patients. METHODS Two recent articles phenotyped the lower limb, the femur and tibia of 308 non-osteoarthritic knees of 160 patients [male to female ratio = 102:58, mean age ± standard deviation 30 ± 7 years (16-44 years)]. The present study introduces functional knee phenotypes, which are a combination of all previously introduced phenotypes. The functional knee phenotypes therefore enable an evaluation of all parameters in relation to each other and thus a comprehensive analysis of the coronal alignment. The existing functional knee phenotypes in the female and male population were investigated. In addition, how many non-osteoarthritic knees had an alignment within the range of current TKA alignment targets (mechanical, anatomical and restricted kinematic alignment) was investigated. Therefore, it was defined which functional knee phenotypes represented a target of the TKA alignment concepts and which percentage of the population had such a phenotype. RESULTS Out of 125 possible functional knee phenotypes, 43 were found (35 male, 26 and 18 mutual). The most common functional knee phenotype in males was NEUHKA0° + NEUFMA0° + NEUTMA0° (19%), followed by VARHKA3° + NEUFMA0° + VARTMA0° (8.2%). The most common functional knee phenotype in females was NEUHKA0° + NEUFMA0° + NEUTMA0° (17.7%), closely followed by NEUHKA0° + NEUFMA0° + VALTMA0° (16.6%). The functional knee phenotype representing a mechanical alignment target was found in 5.6% of the males and 3.6% of the females. The phenotype representing an anatomical alignment target was found in 18% of the males and 17% in females. Five of the nine phenotypes representing a restricted kinematic alignment target were found in this population (male 5, female 4, mutual 4). They represented 31.3% of all males and 45.1% of all females. CONCLUSION A more individualized approach to TKA alignment is needed. The functional knee phenotypes enable a simple, but detailed assessment of a patient's individual anatomy and thereby could be a helpful tool to individualize the approach to TKA. LEVEL OF CLINICAL EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | | | - Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclercq V, Hess S. Phenotyping the knee in young non-osteoarthritic knees shows a wide distribution of femoral and tibial coronal alignment. Knee Surg Sports Traumatol Arthrosc 2019; 27:1385-1393. [PMID: 30980119 DOI: 10.1007/s00167-019-05508-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE There is a lack of knowledge about the joint line orientation of the femur and tibia in non-osteoarthritic knees. The primary purpose of the present study was to evaluate the orientation of the joint lines in native non-osteoarthritic knees using 3D-reconstructed CT scans. The secondary purpose was to identify knee phenotypes to combine the information of the femoral and tibial alignment. METHODS A total of 308 non-osteoarthritic knees of 160 patients (male to female ratio = 102:58, mean age ± standard deviation 30 ± 7 years (16-44 years) were retrospectively included from our registry. All patients received CT of the knee according to the Imperial Knee Protocol. The orientation of the femoral and tibial joint line was measured in relation to their mechanical axis (femoral mechanical angle, FMA, and tibial mechanical angle, TMA) using a commercially planning software (KneePLAN 3D, Symbios, Yverdon les Bains, Switzerland). The values of FMA and TMA were compared between males and females. Descriptive statistics, such as means, ranges, and measures of variance (e.g. standard deviations), were presented. Based on these results, phenotypes were introduced for the femur and tibia. These phenotypes, based on FMA and TMA values, consist of a mean value and cover a range of ± 1.5° from this mean (3° increments). The distribution of femoral and tibial phenotypes, and their combinations (knee phenotypes) were calculated for the total group and for both genders. RESULTS The overall mean FMA ± standard deviation (SD) was 93.4° ± 2.0° and values ranged from 87.9° varus to 100° valgus. The overall mean TMA ± SD was 87.2° ± 2.4° with a range of 81.3° varus to 94.6° valgus. FMA and TMA showed significant gender differences (p < 0.01). Females showed more valgus alignment than males. The most common femoral phenotype was neutral in both genders. The most common tibial phenotype was neutral in the male knees (62.8%) and valgus (41.6%) in the female knees. In males, the most frequent combination (knee phenotype) was a neutral phenotype in the femur and a neutral phenotype in the tibia (25.6%). In females, it was a neutral femoral phenotype and a valgus tibial phenotype (28.3%). CONCLUSION 3D-reconstructed CT scans confirmed the great variability of the joint line orientation in non-osteoarthritic knees. The introduced femoral and tibial phenotypes enable the evaluation of the femoral and tibial alignment together (knee phenotypes). The variability of knee phenotypes found in this young non-osteoarthritic population clearly shows the need for a more individualized approach in TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | | | - Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Bern, Bern, Switzerland
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Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT. Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:1368-1377. [PMID: 30989273 DOI: 10.1007/s00167-019-05506-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE There is a lack of knowledge about coronal alignment variability in osteoarthritic knees. Therefore, the purpose of this article was to systematically review the literature and collect data about the lower limb alignment including hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and the joint line convergence angle (JLCA) in osteoarthritic knees. METHODS A systematic review was performed using the electronic databases MEDLINE (PubMed), EMBASE and Google Scholar. The following keywords were used: (morphology OR geometr* OR anatomy OR alignment OR phenotypes), (coronal OR neutral OR varus OR valgus), (knee OR lower limb OR femur OR tibia) and (osteoarthritis OR arthritis). Out of 110 full-text articles retrieved, 15 studies were included. Demographic information included author's names, year of publication, imaging modality, sample size and patient demographics (i.e. sex, age, etc.). Descriptive statistics, such as means, ranges, and measures of variance [e.g. standard deviations, 95% confidence intervals (CI)] for all angles (HKA, FMA, TMA, JLCA) are presented. RESULTS Thirteen studies reported mean overall HKA angles ranging from 163.5° ± 2.3° to 179.9° ± 4.8°. The mean HKA angles in females were between 164.1° ± 7.2° and 178.8° ± 4.8°, and in males between 163.4° ± 5.5° and 177.4° ± 3.9°. The lowest and highest reported HKA angles were - 27.7° and + 22.0°, respectively. Seven studies reported mean FMA angles. Mean values ranged from 92.7° ± 2.7° valgus to 88.6° ± 2° varus. The reported mean FMAs for male were 87.9° ± 0.5° to 90.7° ± 3° and for female 89.91° ± 2.8° to 92.9° ± 3.1°. Six studies reported mean TMA values. TMA ranged from 81.7° ± 3.9° varus to 87.7° ± 4.1° varus. Only three studies reported mean JLCA angles, which ranged from - 4.3° to - 6.4° ± 3.8°. CONCLUSION Osteoarthritic knees showed a huge variation in overall coronal limb alignment as well as in femoral and tibial coronal alignment. Current total knee arthroplasty (TKA) alignment philosophies and preoperative planning do not sufficiently consider these variation, which might be one reason for unhappy knees after TKA. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
- Silvan Hess
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Bern, Bern, Switzerland.
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Henrik Behrend
- Department of Orthopaedic Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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Ammann N, Schiapparelli FF, Moser LB, Rasch H, Amsler F, Hirschmann MT. Good correlation between bone tracer uptake in SPECT/CT and intraoperative findings of chondral lesions graded with the ICRS scoring. J Orthop Res 2019; 37:522-528. [PMID: 30378184 DOI: 10.1002/jor.24171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/15/2018] [Indexed: 02/04/2023]
Abstract
The question if bone tracer uptake in SPECT/CT reflects the intraoperative cartilage status of the knee is still unanswered. In this study, thirty-three consecutive patients (male:female = 11:22; mean age ± standard deviation 61 ± 15) with bi- or tri-compartmental knee osteoarthritis who underwent SPECT/CT before total knee arthroplasty (TKA) were collected. The knee was graded in eleven different anatomical regions. In each region, the maximal relative bone tracer uptake (mrBTU) was measured twice by two observers with a six weeks interval. The intraclass correlation coefficients (ICC) showed excellent correlations and mean values were used. Intraoperatively every region was assessed with the macroscopic International Cartilage Repair Society (ICRS) scoring. A factorial analysis and a non-parametrical Spearman's correlation were calculated among the 11 knee regions on both mrBTU and ICRS scores and significant correlations were seen between regions belonging to the same knee compartment (p < 0.05). A non-parametrical Spearman's correlation was also performed to investigate the correlation between rmBTU in SPECT/CT and intraoperative ICRS cartilage grading. Significant correlations were seen on the medial compartment, on the proximal femoral trochlea and on the medial patellar facet (p < 0.05). A significant correlation between SPECT/CT and intraoperative findings was so demonstrated in several regions. The low accuracy of the macroscopic ICRS scoring system on grade I-II lesions could have affected the missing correlations on the lateral compartment since the selected presented mainly a varus gonarthrosis. The use of an objective measure as the rmBTU could overcome the limit of the subjectivity of MRI findings in early osteoarthritis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:522-528, 2019.
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Affiliation(s)
- Nora Ammann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Filippo-Franco Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Lukas B Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland
| | - Helmut Rasch
- Institute of Radiology and Nuclear Medicine, Kantonsspital Baselland, CH-4101 Bruderholz, Switzerland
| | | | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101 Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
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