Does arthroscopic resection of a too-long anterior process improve static disorders of the foot in children and adolescents?

PURPOSE: A too-long anterior process of the calcaneus is a common cause of pain and hind-foot instability. Our goal was to evaluate the early results of arthroscopic resection in terms of static foot disorders in children and adolescents. METHODS: We retrospectively studied 11 ft (10 patients). The inclusion criteria were treatment of TLAP by arthroscopic resection and a minimum follow-up period of six months. Surgery was indicated in cases with persistent symptomatic TLAP resistant to orthopaedic treatment. RESULTS: The mean age at surgery was 11 (range, 7-15) years. The mean follow-up duration was 15 (range, 8-28) months. Pre-operatively, we diagnosed four flat feet, two cavus feet and five feet with normal footprints, but loss of physiological hind-foot valgus. All patients presented with subtalar joint stiffness. At the last follow-up, four feet with no hind-foot valgus were normal, two were unchanged and the other feet had improved. The mean AOFAS increased from 61.9 (range, 47-73) to 89.1 (range, 71-97; P = 0.009). The mean radiological angles were near normal, exhibiting significant improvements in the lateral talo-metatarsal and Djian-Annonier angles. CONCLUSIONS: Arthroscopic resection of a TLAP is safe. In the short term, the restoration of subtalar mobility reduces pain, and improves instability and static disorders. Longer follow-up of a larger patient series is required.

Are modern knee outcomes scores appropriate for evaluating anterior knee pain and symptoms after total knee arthroplasty?

BACKGROUND: Up to 45% of patients who undergo primary total knee arthroplasty (TKA) with contemporary implants have residual anterior knee pain. While a specific evaluation of anterior knee symptoms is mandatory, little is known about the capability of patellofemoral scores to be used individually. This study aimed to assess the distribution of patellofemoral scores after TKA from a uniform cohort and to investigate their external validity and ability to detect anterior knee symptoms using floor and ceiling effects. HYPOTHESIS: Patellofemoral scores have high construct validity and fewer floor/ceiling effects than general knee scores. METHODS: We prospectively included 113 consecutive patients who underwent primary TKA for primary osteoarthritis at a single University Hospital. Clinical outcomes included patellofemoral scores (HSS Patella, Kujala and Lille scores) and general knee scores (KOOS and new KSS) at 1-year follow-up. The floor and ceiling effects were considered as significant when greater than 15%. These were determined for each score individually and for composite scores (combination of patellofemoral scores and new KSS). The construct validity of each score and their ability to detect anterior knee pain was evaluated. RESULTS: Patellofemoral scores showed no floor effect but a significant ceiling effect (from 25% to 65%). This ceiling effect decreased when composite scores were used. The convergent validity test showed strong correlation between patellofemoral scores (from 0.741 to 0.819, p<0.00001) and a better ability to discriminate anterior knee pain than the general knee scores. CONCLUSIONS: Patellofemoral scores showed no floor effect and a very good construct validity for anterior knee pain after TKA. However, studies aiming to monitor anterior knee symptoms after TKA should combine scoring systems to included patellofemoral-related items rather than use patellofemoral scores alone due their ceiling effects. LEVEL OF EVIDENCE: III; prospective study.

Are modern knee outcomes scores appropriate for evaluating patellofemoral degeneration in osteoarthritis? Evaluation of the ceiling and floor effects in knee outcomes scores.

INTRODUCTION: Patellofemoral (PF) degeneration plays an important role in knee function in the context of osteoarthritis. A specific evaluation of PF symptoms is needed to better understand the initial functional status of the knee before surgery. The aim of this study was to assess the validity of patient-related outcome measures (PROMs) for knee scores and PF scores in knee osteoarthritis. HYPOTHESIS: PF scores are more reliable for evaluating anterior knee pain than global knee scores in the context of PF degeneration in osteoarthritis. MATERIAL AND METHODS: We performed a prospective single-center study of continuous patients included between January 2017 and January 2018 in our surgical department for total knee arthroplasty (TKA) for primary knee osteoarthritis. The analysis used global knee PROMs (KOOS and new IKS) and PF-specific PROMs (HSS Patella score, Kujala score and Lille score). Floor and ceiling effects were determined for each score based on tibiofemoral and PF degeneration on radiographic views; it was considered significant when greater than 15%. RESULTS: We included 114 TKA procedures in 113 consecutive patients. According to the Iwano classification, no significant floor or ceiling effect was found for the PF preoperative scores (0-12%). The KOOS ADL and QOL scores were particularly affected by the ceiling and floor effects, whatever the patellofemoral degeneration (23-88%). In cases of severe PF degeneration (Iwano grade 3 and 4), no significant differences in the distribution of the functional scores were found. DISCUSSION: Modern knee outcome scores used to evaluate knee function do not monitor PF degeneration and related symptoms in the context of knee osteoarthritis according to the Iwano classification. PF scores do not have a floor and ceiling effects even if the severity of the PF degeneration is difficult to identify preoperatively. Physicians should be aware of this effect on the preoperative functional evaluation before TKA. LEVEL OF EVIDENCE: III, comparative prospective study.

Return to sport after total or unicompartmental knee arthroplasty: An informative guide for residents to patients.

Knee arthroplasty survival rate - either UKA or TKA - is currently 95%, greater than it was ten years ago, but has not been specifically evaluated in very active patients practicing sport at a high intensity.The terms and conditions of return to physical activities are decided by the surgeon, the rehabilitation or Sports Medicine doctor, who needs to make sure that postoperative rehabilitation has been conducted optimally. Specifically, range of movement must be complete, muscular strengthening has to be sufficient and balance must be recovered by proprioception. Only after this stage (i.e. three to six months after surgery) can physical activities be resumed.Return to sport must be gentle and progressive, with moderate activities limited to short sessions. Progressively the patient will be able to return to intermediate activities, provided that he/she possesses the adequate level of technique for the sport.This up-to-date review for young surgeons and residents aims to provide an informative guide for patients regarding sport following knee arthroplasty. Cite this article: EFORT Open Rev 2017;2:496-501. DOI: 10.1302/2058-5241.2.170037.