4,327 results match your criteria Lower Extremity Reconstruction Knee

Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries.

Am J Sports Med 2021 Jun 11:3635465211017147. Epub 2021 Jun 11.

Julius Wolff Institute, Berlin Institute of Health and Charité-Universitätsmedizin Berlin, Berlin, Germany.

Background: It remains unclear how posterior cruciate ligament (PCL) reconstruction influences long-term lower extremity joint biomechanics.

Purpose: To determine whether patients who underwent PCL reconstruction exhibited long-term alterations in lower limb gait mechanics.

Study Design: Controlled laboratory study. Read More

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Repair of severe peri-knee soft tissue defect using an anterolateral thigh flap with the descending genicular vessels as the recipient pedicle: a case series of 14 patients.

Ann Palliat Med 2021 May;10(5):5341-5350

Department of Orthopaedics, Wuxi No.9 People's Hospital affiliated to Soochow University, Wuxi, China.

Background: The application of free skin flaps to repair severe peri-knee soft tissue defects is a common clinical approach. This article aims to investigate clinical efficacy and precautions of using a free anterolateral thigh flap with the descending genicular vessels as a recipient pedicle for repairing Gustilo IIIB and IIIC soft tissue defects around the knee.

Methods: We retrospectively analyzed the data of the patients with severe peri-knee Gustilo IIIB or IIIC soft tissue defects operated on from January 2015 to December 2019. Read More

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Has the Threshold for Epiphysiodesis Versus Lengthening Changed in the Era of Magnetically Controlled Nails?

J Pediatr Orthop 2021 Jul;41(Suppl 1):S24-S32

Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

Introduction: Limb length discrepancy (LLD) is common in both the pediatric and adult population. Length inequalities can be due to a multitude of etiologies including congenital, developmental, and acquired causes. There has been little consensus on the morbidity of LLD and, as a result, the threshold necessary for treatment of LLD to prevent morbidity. Read More

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Sex differences in postural orientation errors and association with objective and patient-reported function in patients with ACL injury: an exploratory cross-sectional study.

BMJ Open Sport Exerc Med 2021 19;7(2):e001045. Epub 2021 May 19.

Health Sciences, Lund University, Lund, Sweden.

Objectives: There is limited research on sex differences in postural orientation (ie, alignment between body segments) in people with knee injury measured with a clinically applicable method. An understanding of the relationship between postural orientation and physical function may help guide decision making in rehabilitation. The aims were to evaluate (1) sex differences in visual assessment of Postural Orientation Errors (POEs) and (2) the association between POEs and objective and patient-reported physical function, in men and women with anterior cruciate ligament reconstruction (ACLR). Read More

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Medicare bundles for arthroplasty : a journey back to fee for service?

Bone Joint J 2021 Jun;103-B(6 Supple A):119-125

Healthcare Outcomes Performance Company (HOPCo), Phoenix, Arizona, USA.

Aims: There is concern that aggressive target pricing in the new Bundled Payment for Care Improvement Advanced (BPCI-A) penalizes high-performing groups that had achieved low costs through prior experience in bundled payments. We hypothesize that this methodology incorporates unsustainable downward trends on Target Prices and will lead to groups opting out of BPCI Advanced in favour of a traditional fee for service.

Methods: Using the Centers for Medicare and Medicaid Services (CMS) data, we compared the Target Price factors for hospitals and physician groups that participated in both BPCI Classic and BPCI Advanced (legacy groups), with groups that only participated in BPCI Advanced (non-legacy). Read More

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Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques.

Bone Joint J 2021 Jun;103-B(6 Supple A):74-80

Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.

Aims: Robotic-assisted total knee arthroplasty (RA-TKA) is theoretically more accurate for component positioning than TKA performed with mechanical instruments (M-TKA). Furthermore, the ability to incorporate soft-tissue laxity data into the plan prior to bone resection should reduce variability between the planned polyethylene thickness and the final implanted polyethylene. The purpose of this study was to compare accuracy to plan for component positioning and precision, as demonstrated by deviation from plan for polyethylene insert thickness in measured-resection RA-TKA versus M-TKA. Read More

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Measurement of femoral posterior condylar offset and posterior tibial slope in normal knees based on 3D reconstruction.

BMC Musculoskelet Disord 2021 May 27;22(1):486. Epub 2021 May 27.

Division of orthopaedic surgery, Department of orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.

Background: Femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) are important for postoperative range of motion after total knee arthroplasty (TKA). However, normative data of PCO and PTS and the correlation between them among healthy populations remain to be elucidated. The purpose of this study was to determine PCO and PTS in normal knees, and to identify the correlation between them. Read More

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[Reliability of tibial anterior crest as the anatomical reference of rotating alignment for tibial component in total knee arthroplasty].

Zhongguo Gu Shang 2021 May;34(5):417-24

Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi, China.

Objective: This study aimed to research whether anterior tibial crest is a reliable anatomical reference for rotational alignment of tibial component in TKA.

Methods: The study included 122 patients who underwent computed tomography angiography (CTA) examination for unilateral lower extremity trauma with normal contralateral lower extremities, including 89 males and 33 females, with an average age of(51.4±16. Read More

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[Follow-Up Study of Joint Function and Quality of Life in Patients After Total Hip Arthroplasty].

Hu Li Za Zhi 2021 Jun;68(3):44-53

EdD, RN, Professor, Department of Nursing, Meiho University, Taiwan, ROC.

Background: The number of patients with osteoarthritis has gradually increased with population aging. Total hip replacement is typically required in patients with severe arthritis. Because hospitals are reducing the allowable length of hospital stays, joint function recovery and quality of life after surgery are issues of increasing concern in this population. Read More

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Comparing myofascial meridian activation during single leg vertical drop jump in patients with anterior cruciate ligament reconstruction and healthy participants.

Gait Posture 2021 May 12;88:66-71. Epub 2021 May 12.

Department of Kinesiology, University of North Carolina at Charlotte Charlotte, NC, United States. Electronic address:

Background: Muscles work synergistically to support the body during landing. Myofascial meridians have been described to classify muscles into functional synergies. The role that these functional lines plays in positioning the trunk and lower extremity of patients with anterior cruciate ligament reconstruction (ACLR) and healthy athletes during drop landing tasks remains unclear. Read More

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[Short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament injuries].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021 May;35(5):556-561

Department of Knee Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China.

Objective: To investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries.

Methods: A clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Read More

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Linked kinematic knee balancing in unicompartmental knee arthroplasty.

J Orthop 2021 Mar-Apr;24:182-185. Epub 2021 Feb 20.

Department of Orthopaedic Surgery, Georgetown University School of Medicine, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.

The traditional approach of restoring a neutral mechanical axis to the lower extremity during total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) has long been favored due its consistency and reproducibility. The kinematic alignment approach, which accounts for the patient's natural knee alignment and is commonly a few degrees varus to the mechanical axis, has gained popularity in recent years as a technique which reestablishes a more anatomic alignment. Linked Anatomic Kinematic Arthroplasty (LAKA), an extension of the kinematic approach that employs computer-assisted surgical (CAS) navigation, can improve the accuracy and precision of kinematic measurements in unicompartmental knee arthroplasties. Read More

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February 2021

Infiltration between the popliteal artery and the capsule of the knee (IPACK) block in knee surgery: a narrative review.

Reg Anesth Pain Med 2021 May 14. Epub 2021 May 14.

Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK

Background: The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain.

Objective: Our aim was to perform a narrative review to examine the place and value that the IPACK block has in comparison to and in conjunction with other regional anesthesia modalities.

Evidence Review: Following an extensive search of electronic databases, we included anatomical studies, letters, comparative observational studies, and non-randomized and randomized controlled trials that examined the IPACK block in relation to surgery on the knee under general or neuraxial anesthesia. Read More

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Functional repair of the great saphenous vein by external valvuloplasty reduces the vein's diameter: 6-month results of a multicentre study.

J Int Med Res 2021 May;49(5):3000605211014364

Department of Vascular Surgery, St. Josef Hospital Bochum, Katholisches Klinikum Bochum Department of the Ruhr University Bochum, Bochum, Germany.

Objectives: External valvuloplasty (eVP) is a reconstructive surgical method to repair the function of the terminal and preterminal valves. We evaluated the 6-month outcomes of eVP regarding the diameter of the great saphenous vein (GSV).

Methods: Patients from five vein centres were included in this observational study. Read More

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Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow-through anterolateral thigh perforator flap transfer.

Microsurgery 2021 May 14. Epub 2021 May 14.

Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.

Background: Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow-through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft-tissue defects is described.

Methods: From January 2012 to September 2018, 12 patients (six men and six women) aged 6-37 years, sustained injuries in road traffic accidents with large soft-tissue defects in the lower extremities. Read More

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Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study.

Clin Orthop Relat Res 2021 05 10. Epub 2021 May 10.

C. E. Holm, A. Villadsen, M. S. Sørensen, M. M. Petersen, Musculoskeletal Tumor Section, Department of Orthopedic Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark.

Background: Patients with a bone sarcoma who undergo limb-sparing surgery and reconstruction with a tumor prosthesis in the lower extremity have been shown to have reduced self-reported physical function and quality of life (QoL). To provide patients facing these operations with better expectations of future physical function and to better evaluate and improve upon postoperative interventions, data from objectively measured physical function have been suggested.

Questions/purposes: We sought to explore different aspects of physical function, using the International Classification of Functioning, Disability, and Health (ICF) as a framework, by asking: (1) What are the differences between patients 2 to 12 years after a bone resection and reconstruction surgery of the hip and knee following resection of a bone sarcoma or giant cell tumor of bone and age-matched controls without walking limitations in ICF body functions (ROM, muscle strength, pain), ICF activity and participation (walking, getting up from a chair, daily tasks), and QoL? (2) Within the patient group, do ICF body functions and ICF activity and participation outcome scores correlate with QoL?

Methods: Between 2006 and 2016, we treated 72 patients for bone sarcoma or giant cell tumor of bone resulting in bone resection and reconstruction with a tumor prosthesis of the hip or knee. Read More

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Effects of a neuromuscular training program using external focus attention cues in male athletes with anterior cruciate ligament reconstruction: a randomized clinical trial.

BMC Sports Sci Med Rehabil 2021 May 8;13(1):49. Epub 2021 May 8.

Orthopedic Department Chair, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Athletes who have undergone anterior cruciate ligament (ACL) reconstruction often exhibit persistent altered biomechanics and impaired function. Neuromuscular training programs appear to be effective for reducing high-risk landing mechanics and preventing primary ACL injuries; however, there have been few attempts to examine their effects in athletes who have undergone ACL reconstruction. The purpose of our study was to examine the effects of a neuromuscular training program that emphasizes external focus of attention cuing on biomechanics, knee proprioception, and patient-reported function in athletes who had undergone ACL reconstruction and completed conventional post-operative rehabilitation. Read More

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A Cadaveric Anatomical Study of the Relationship between Proximal Tibial Slope and Coronal Plane Deformity.

J Knee Surg 2021 Apr 28. Epub 2021 Apr 28.

Division of Pediatric Orthopaedic Surgery, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio.

Medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) are commonly used to characterize the geometry of proximal tibia and are important considerations in lower extremity realignment procedures and total knee arthroplasty. This study utilized a large cadaveric collection to explore relationships between tibial slope and coronal plane deformity of the tibia. We utilized 462 well-preserved skeletons (924 tibiae), excluding any with fracture or obvious rheumatologic or infectious findings. Read More

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High Biofidelity 3D Biomodel Reconstruction from Soft and Hard Tissues (Knee), FEM, and 3D Printing: A Three-Dimensional Methodological Proposal.

Biomed Res Int 2021 3;2021:6688164. Epub 2021 Apr 3.

Instituto Politécnico Nacional, Escuela Superior de Ingeniería Mecánica y Eléctrica, Sección de Estudios de Posgrado e Investigación, Unidad Profesional Adolfo López Mateos "Zacatenco", Avenida Instituto Politécnico Nacional s/n, Edificio 5, 2do. Piso, Col, Lindavista, C.P. 07320 Ciudad de, Mexico.

The modelling of biological structures has allowed great advances in Engineering, Biology, and Medicine. In turn, these advances are seen from the design of footwear and sports accessories, to the design of prostheses, accessories and rehabilitation treatments. The reproduction of the various tissues has gone through an important evolution thanks to the development of computer systems and programs. Read More

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[Multivariate analysis of varus after Oxford unicompartmental knee arthroplasty].

Beijing Da Xue Xue Bao Yi Xue Ban 2021 Mar;53(2):293-297

Department of Adult Joint Reconstruction Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.

Objective: To analyze the preoperative influencing factors of varus after Oxford unicompartmental knee arthroplasty.

Methods: A total of 660 patients (767 knees) undergoing Oxford unicompartmental knee arthroplasty in adult joint reconstruction surgery department of Beijing Jishuitan Hospital from January 2018 to December 2019 were retrospectively analyzed. Inclusive criteria: diagnosis was osteoarthritis, single compartment lesions in the medial side of the knee; preoperative flexion deformity was less than 10°, active range of motion was greater than 90°; preoperative X-ray full-length images of both lower limbs showed less than 15° varus (Noyes method); anterior cruciate ligament was well functioned, The cartilage of lateral compartment of knee joint was intact. Read More

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[Clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography in repairing skin and soft tissue defects around the knee or in proximal lower leg].

Zhonghua Shao Shang Za Zhi 2021 Apr;37(4):356-362

Department of Orthopedics, Jizhong Energy Xingtai Mig General Hospital, Xingtai 054000, China.

To investigate the clinical effects of retrograde anterolateral thigh perforator flaps assisted with computed tomography angiography (CTA) in repairing skin and soft tissue defects around the knee or in proximal lower leg. A retrospective cohort study was conducted. From May 2015 to October 2019, 17 patients with skin and soft tissue defects around the knee or in proximal lower leg were admitted to the Department of Orthopedics of Jizhong Energy Xingtai Mig General Hospital, including 12 males and 5 females, aged 16-65 years, with an average age of 35 years. Read More

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Comparison of plantar pressure distribution during walking and lower limb alignment between modified kinematically and mechanically aligned total knee arthroplasty.

J Biomech 2021 05 13;120:110379. Epub 2021 Mar 13.

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. Electronic address:

Lower extremity alignment is very important after total knee arthroplasty (TKA). This study aimed to compare the plantar pressure distribution while walking and the overall limb alignment, including the hindfoot, between kinematically (KA) and mechanically aligned (MA) TKA. The plantar pressure distribution was investigated using a pressure plate during walking and one-leg standing among four groups: patients one year after KA-TKA (KA group; n = 25), patients one year after MA-TKA (MA group, n = 25), patients with osteoarthritis (OA) undergoing non-surgical care (OA group, n = 25), and healthy controls (Healthy group; n = 25). Read More

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[Total knee arthroplasty in the young patient-an update].

Orthopade 2021 May 9;50(5):395-401. Epub 2021 Apr 9.

Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland.

The absolute number of total knee arthroplasties (TKA) continues to rise every year. About 10% of the patients are less than 55 years of age, although it is known that functional results and patient satisfaction are lower combined with an increased likelihood of revision compared to older patients. Higher physical activity and patient expectations are a major challenge in this age group. Read More

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Long-term follow-up of Bologna-Oxford (BOX) total ankle arthroplasty.

Int Orthop 2021 05 6;45(5):1223-1231. Epub 2021 Apr 6.

Department of Orthopedics, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100, Milan, Italy.

Purpose: The purpose of this retrospective study was to evaluate the long-term results with a minimum of ten years follow-up of primary Bologna-Oxford (BOX) TAA.

Methods: Between December 2004 and December 2009, 80 patients (82 ankles) underwent a primary BOX TAA performed by a single senior surgeon, expert in foot and ankle surgery. Pain and functional outcomes were analysed using Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) scoring system, Foot Functional Index Disability and Pain (FFI-Disability, FFI-Pain) score for comparative analysis. Read More

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Commonly used clinical criteria following ACL reconstruction including time from surgery and isokinetic limb symmetry thresholds are not associated with between-limb loading deficits during running.

Phys Ther Sport 2021 May 23;49:236-242. Epub 2021 Mar 23.

Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports, Medicine Hospital, Doha, Qatar; La Trobe University, Discipline of Podiatry, College of Science, Health and Engineering, La Trobe Sport and Exercise Medicine Research Centre, Victoria, Australia. Electronic address:

Objectives: We included objective measures of gait and functional assessments to examine their associations in athletes who had recently commenced running after ACL reconstruction.

Design: Cross-sectional.

Setting: Sports medicine. Read More

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Association between Kinesiophobia and Gait Asymmetry after ACL Reconstruction: Implications for Prevention of Reinjury.

Int J Environ Res Public Health 2021 03 22;18(6). Epub 2021 Mar 22.

Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran 1587958711, Iran.

Gait asymmetries have been documented in individuals after anterior cruciate ligament (ACL) reconstruction (ACLR). The relationship between gait asymmetry and associated psychological factors, however, is not yet known. This study aimed to examine the relationship between kinesiophobia (fear of reinjury) and asymmetry of vertical ground reaction force (vGRF) and lower-extremity muscular activity in individuals after ACLR during gait. Read More

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Validated Ultrasound Speckle Tracking Method for Measuring Strains of Knee Collateral Ligaments In-Situ during Varus/Valgus Loading.

Sensors (Basel) 2021 Mar 8;21(5). Epub 2021 Mar 8.

Development and Regeneration Department, Institute for Orthopaedic Research and Training (IORT), KU Leuven, 3000 Leuven, Belgium.

Current ultrasound techniques face several challenges to measure strains when translated from large tendon to in-situ knee collateral ligament applications, despite the potential to reduce knee arthroplasty failures attributed to ligament imbalance. Therefore, we developed, optimized and validated an ultrasound speckle tracking method to assess the in-situ strains of the medial and lateral collateral ligaments. Nine cadaveric legs with total knee implants were submitted to varus/valgus loading and divided into two groups: "optimization" and "validation". Read More

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The Use of a Tetraminos Chimeric Free Flap in Lower Limb Trauma.

Cureus 2021 Feb 18;13(2):e13427. Epub 2021 Feb 18.

Plastic and Reconstructive Surgery, Southmead Hospital, Bristol, GBR.

Major trauma care has improved in the UK since the evolution and acceptance of specialist centers . A mission statement for major trauma care is "reduction in mortality and disability following trauma." The care for extremity trauma has benefited from this specialization. Read More

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February 2021

The Versatility of the Pedicled Medial Sural Artery Perforator Flap: From Simple to Its Chimeric Pattern and Clinical Experience with 37 Cases.

Plast Reconstr Surg 2021 04;147(4):960-969

From the Department of Hand- and Plastic Surgery, Luzerner Kantonsspital; and Heidelberg Medical Faculty, Heidelberg University.

Background: Defects in the knee area, popliteal fossa region, and upper third of the lower extremity can pose a challenge for reconstructive plastic surgeons. The purpose of this article is to report the authors' experience with the use of the pedicled medial sural artery perforator flap in its simple and chimeric form for reconstruction of defects in three different regions: knee, popliteal fossa, and proximal lower leg.

Methods: From April of 2018 to April of 2019, 37 patients (29 men and eight women) with a mean age of 51 years (range, 18 to 78 years) underwent reconstruction with 37 pedicled medial sural artery perforator flaps. Read More

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Interrater and Intrarater Reliability and Discriminant Validity of a Pediatric Lower Extremity Physical Therapy Clearance Test.

Orthop J Sports Med 2021 Feb 26;9(2):2325967120983827. Epub 2021 Feb 26.

Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, San Diego, California, USA.

Background: Few studies have validated when an athlete can safely return to sports, and even fewer have identified when he or she no longer requires physical therapy after surgery. Discontinuing physical therapy is often dictated by insurance restrictions, but most studies have suggested that the decision should be multifactorial, stemming from patient-derived subjective outcome questionnaires, clinical examination, and isokinetic and functional testing.

Purpose/hypothesis: The purpose of this study was to establish discriminant validity and reliability of an objective physical therapy clearance (PTC) test in a clinical setting. Read More

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February 2021