Hypertrophied medial parapatellar plica: a case of a medial plica anatomical variation with insertion to the inter-meniscal ligament in an adolescent athlete treated arthroscopically.

PURPOSE: The present study aims to report the arthroscopic, radiological and clinical appearance of a rare anatomical variation of a hypertrophied medial parapatellar plica with its response to arthroscopic treatment. CASE PRESENTATION: A 14-year-old female handball athlete presented with a history of left knee injury during her participation in a handball training session and subsequent locked knee at 20º flexion. Tenderness was located at the medial joint line. Plain radiographs of the injured knee were normal. The magnetic resonance imaging revealed a hypertrophic medial parapatellar plica and a horizontal tear of the medial meniscus. A standard knee arthroscopy was performed. An extremely hypertrophied medial plica was identified, covering a great part of the medial femoral condyle extending up to the femoral trochlea. Distally, it was attached into the inter-meniscal ligament. The plica was excised and the medial meniscus tear was repaired. At 1-month post-operatively, the patient was completely asymptomatic and at 3-months she returned to her weekly training routine. CONCLUSIONS: This study presented a rare anatomical variation of a hypertrophied medial parapatellar plica with atypical course in the medial patellofemoral compartment and insertion into the inter-meniscal ligament. In combination with a medial meniscus tear led to a locked knee. Arthroscopic medial meniscus repair and plica excision resulted in complete resolution of symptoms.

Midvastus Versus Medial Parapatellar Approach in Simultaneous Bilateral Total Knee Arthroplasty.

BACKGROUND: The purpose of this study was to compare the postoperative outcomes over a period of 3 years in patients who underwent bilateral total knee arthroplasty (TKA) using midvastus (MV) versus medial parapatellar (MPP) approaches. METHODS: In this retrospective study, 2 propensity-matched cohorts of patients who underwent simultaneous bilateral TKA via MV (n = 100) and MPP (n = 100) approaches from January 2017 to December 2018 were compared. Surgical parameters compared were surgery time and the incidence of lateral retinacular release (LRR). Clinical parameters including the visual analog score for pain, time for straight leg raise (SLR), range of motion, the Knee Society Score, and the Feller patellar score were assessed in the early postoperative and follow-up periods up to 3 years. Radiographs were evaluated for alignment, patellar tilt, and displacement. RESULTS: LRR was performed on 17 knees (8.5%) in the MPP group and 4 knees (2%) in the MV group which was significant (P = .03). The time to SLR was significantly lower in the MV group. There was no statistically significant difference in the length of hospital stay between the groups. The visual analog score, range of motion, and Knee Society Score were better in the MV group within 1 month (P < .05), but no statistically significant differences were found later. Patellar scores, radiographic patellar tilt, and displacements were similar at all follow-up periods. CONCLUSION: In our study, the MV approach had faster SLR, less LRR, and better pain and function scores in the first few weeks after TKA. However, its effect on different patient outcomes has not been sustained at 1 month and further follow-up points. We recommend that surgeons use the surgical approach with which they are most familiar.

Novel classification system for periprosthetic distal femoral fractures: a consideration for comminution.

PURPOSE: Comminution is an aspect of periprosthetic distal femoral fractures (PDFFs) that can influence postoperative outcomes and treatment selection, but is not included in current classification systems. We propose a new classification system for PDFFs based on comminution and cortical reads. This study aims to prove its reliability and efficacy to predict fracture severity and guide treatment. METHODS: A retrospective chart review of patients treated with single or dual locking plates for PDFFs was performed. Two fellowship-trained orthopedic joint reconstruction specialists used available imaging to classify each PDFF as either type 1 (minimal or no comminution allowing for reconstruction of medial and lateral cortices), type 2 (comminution reasonably allowing for reconstruction of either medial or lateral cortex), and type 3 (extensive comminution not allowing reasonable reconstruction of medial or lateral cortex). Each PDFF was then analyzed for radiographic outcomes including lateral distal femoral angle (LDFA) and the posterior distal femoral angle (PDFA). RESULTS: Interobserver reliability assessed by Cohen's Kappa statistic was 0.707, and average intraobserver reliability was 0.843, showing substantial reliability. Type 3 PDFFs had greater varus deformity than type 1 (p = 0.0457) or 2 (0.0198). CONCLUSION: The proposed classification system accounts for comminution, demonstrates strong interobserver and intraobserver reliability, and can be used to guide treatment in regard to single versus dual plating. LEVEL OF EVIDENCE: Retrospective comparative study, Level IV.

Reduplicated medial parapatellar plica: a case of a medial plica anatomical variation recalcitrant to conservative treatment.

PURPOSE: The current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment. CASE PRESENTATION: This report portrays a 29-year-old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee was extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At 4 weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at 1 year follow-up. CONCLUSIONS: The current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.

Better outcomes after mini-subvastus approach for primary total knee arthroplasty: a Bayesian network meta-analysis.

INTRODUCTION: Alternatives to the classical medial parapatellar (MPP) approach for total knee arthroplasty (TKA) include the mini-medial parapatellar (MMPP), mini-subvastus (MSV), mini-midvastus (MMV) and quadriceps-sparing (QS) approaches. The best approach has been not fully clarified. The purpose of the present study was to conduct a Bayesian network meta-analysis comparing these approaches. MATERIALS AND METHODS: The present analysis was carried out according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. The databases search was performed in October 2019. All clinical trials comparing two or more approaches for primary TKA were considered for inclusion. The baseline comparability was evaluated through the analysis of variance (ANOVA) test. The statistical analysis was performed through the STATA software/MP. A Bayesian hierarchical random-effects model analysis was adopted in all the comparisons. RESULTS: Data from 52 articles (4533 patients) were collected. The mean follow-up was 20.38 months. With regard to diagnosis, gender, age and BMI, adequate baseline comparability was detected. The MSV approach ranked better concerning clinical scores (the lowest visual analogic scale, the higher KSS and KSFS) and functional outcomes (the shortest straight leg raise, the greatest degree of flexion and range of motion). Concerning perioperative data, the MSV evidenced the shortest hospital stay, while the MPP the shortest surgical duration and lowest estimated blood loss. CONCLUSION: According to the main findings of the present study, the mini-subvastus approach for total knee arthroplasty demonstrated superior overall compared to the other approaches. Orthopaedic surgeons should consider this approach in the light of the evidence and limitations of this Bayesian network meta-analysis.

Quadriceps-sparing versus traditional medial parapatellar approaches for total knee arthroplasty: a meta-analysis.

BACKGROUND: There is still controversy regarding whether Quadriceps-sparing (QS) approach for total knee arthroplasty (TKA) lead to better earlier recovery as well as compromising low limb alignment and prosthesis position compared with conventional medial parapatellar (MP) approach. To overcome the shortcomings and inaccuracies of single studies, the clinical outcomes and radiographic assessments of QS approach and MP approach were evaluated through meta-analysis. METHODS: We performed this meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A literature search was conducted in the PubMed, EMBase, Cochrane Collaboration Library and Web of Science databases. Our search strategy followed the requirements of the Cochrane Library Handbook. The study selection, data extraction and assessment of methodological quality were independently completed by four authors. And subgroup analysis and publication bias were also performed in the study. RESULTS: Eight prospective randomized controlled trials (RCTs) and eight retrospective studies were identified. Overall meta-analysis and subgroup meta-analysis of RCTs identified the QS approach mainly was associated with increased Knee Society function score beyond 24 months postoperatively (weighted mean difference [WMD] 1.78, P = 0.0004) (WMD 1.86, P = 0.0002), and improved range of motion 1-2 weeks postoperatively (WMD 5.84, P < 0.00001) (WMD 4.87, P = 0.002). Besides, lower visual analogue scale on postoperative day 1 (WMD -0.91, P = 0.02), shorter hospital stay (WMD -0.88, P = 0.02) and shorter incision (extension) (WMD -4.62, P < 0.00001) were indicated in overall meta-analysis. However, surgical and tourniquet time was significantly longer in QS group by both overall and subgroup meta-analysis. CONCLUSIONS: QS approach may accelerate early recovery without increasing the risk of malalignment of low limb and malposition of prosthesis.

Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach?

BACKGROUND: As the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate visual field in R-TKA. Therefore, we compared the clinical and radiological results between the extensile medial parapatellar (EMP) approach and tibial tubercle osteotomy (TTO) for R-TKA. METHODS: Between March 1, 2000, and December 31, 2015, we compared 35 patients who underwent the EMP approach and 31 who underwent the TTO approach for R-TKA. In this study, the preoperative range of motion (ROM) was an important criterion for the choice of approach in R-TKA. The EMP approach was applied to patients with a ROM above 60°. The TTO approach was applied to patients with knee flexion limited to 0°-30°. We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up. We radiographically measured femorotibial alignment and patellar height. We also examined the complication rates. The average length of the TTO was 1.0 × 2.5 cm × 10 cm. We used 3 or more 3.5-mm half-threaded screws. RESULTS: The mean postoperative ROM of the knee joint at the time of the last follow-up was 103° (flexion contracture 5° and further flexion 108°) in the group that underwent the EMP approach and 101° (flexion contracture 4° and further flexion 109°) in the group that underwent the TTO approach. The mean Knee Society scores were 86 (71-96) and 85 (72-94), and the mean Hospital for Special Surgery scores were 82 (70-93) and 83 (68-92) for the 2 groups, respectively, with no statistically significant difference. The mean femorotibial angles were 0.6° (±3.3°) and 0.1° (±2.9°), and the mean Insall-Salvati ratios were 1.0 (±0.34) and 0.8 (±0.14), respectively, with no statistically significant difference. The group that underwent TTO achieved bone union at an average of 11.8 weeks after surgery. In the group that underwent the EMP approach, 2 patients had extensor lag of more than 10°. In the group that underwent TTO, 2 subjects had skin necrosis at the operative site. CONCLUSION: The clinical and radiological outcomes were similar in the 2 groups after R-TKA. To increase the ROM and obtain adequate exposure, TTO is also considered a useful surgical approach. However, complications related to TTO should be minimized. LEVEL OF EVIDENCE: Therapeutic level III, retrospective comparative study.

The location of the medial parapatellar arthrotomy influences intraoperative patella tracking.

PURPOSE: The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated. METHODS: Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction. Patellae were resurfaced in the standard fashion. All patellae tracked normally with the first arthrotomy placed at the junction of the VMO-quadriceps tendon using the "no touch" technique. Measurement of patellar lift-off from the implant surface of the medial aspect of the trochlea on the femoral component was made at 50°, 75°, and 90° of flexion and a merchant view radiograph taken to evaluate radiographic patellar tilt. To simulate a more lateral placement of the MPPA, a 5-6 mm slice of quadriceps tendon was then removed from the lateral aspect of the tendon from the patellar insertion to the most proximal portion of the arthrotomy. This simulated a 5-6 mm more lateral placement of the parapatellar arthrotomy. The same measurements and radiographs were taken as described previously. Two more times the same size slices was removed from the quadriceps tendon with subsequent measurements and radiographs obtained. RESULTS: The mean patellar lift-off with the first arthrotomy was 0 ± 0 mm for 50°, 75°, and 90° of flexion. The mean lift with the second arthrotomy was 2 ± 2, 3 ± 3, and 4 ± 3 mm respectively. The third arthrotomy had a mean patellar lift-off of 3 ± 2, 4 ± 3, and 8 ± 2 mm respectively, while the fourth arthrotomy had a mean lift-off of 6 ± 2, 8 ± 2, and 9 ± 4 mm. There was a significant correlation between percentage of quadriceps cut at 1 cm above the superior pole of the patella and patellar lift-off at 50° (R 2 = 0.70; p < 0.0001), 75° (R 2 = 0.68; p < 0.0001), and 90° (R 2 = 0.68; p < 0.0001) of flexion. CONCLUSION: The location of the MPPA has a significant influence on intraoperative assessment of patellar tracking. An MPPA more lateral in the quadriceps tendon may independently influence the patellar tilt observed intraoperatively and should be taken into consideration when evaluating intraoperative patella tracking. An understanding of the independent influence the MPPA has on patellar tracking may decrease the need for lateral release if the surgeon notes the MPPA was made more than 5-10 mm from the junction of the VMO-quadriceps tendon junction.

Lateral parapatellar and subvastus approaches are superior to the medial parapatellar approach in terms of soft tissue perfusion.

PURPOSE: The arthrotomy techniques of knee surgery may cause varying degrees of disruption to the tissue blood supply. The aim of this study was to investigate the effects of the medial parapatellar (MPPa), midvastus (MVa), subvastus (SVa) and lateral parapatellar (LPPa) approaches on regional tissue perfusion of the knee. METHODS: In this experimental study, a total of 28 female rabbits were applied with four different arthrotomy techniques as Group MPPa, Group MVa, Group SVa and Group LPPa. The blood supply of the tissue around the knee was examined by scintigraphic imaging including the perfusion reserve and T max, and biochemical alteration of the oxidative stress parameters including malondialdehyde (MDA), fluorescent oxidation products (FlOPs), and histopathological findings were evaluated on tissue samples after 3 weeks. RESULTS: The perfusion reserve was increased in all four groups compared to the healthy, contralateral knees. In the Group LPPa, the vascularity was significantly increased compared to the Group MPPa (p = 0.006). In the examination of biochemical parameters, the increase in MDA levels was statistically significant in the Group MPPa compared with the Group LPPa (p = 0.004), and in the Group MVa compared with the Group LPPa (p = 0.006). The increase in the value of MDA levels was striking in the Group MPPa and Group MVa compared with the control group (p = 0.004, p = 0.004, respectively). The increase in another oxidative stress parameter, the tissue FlOPs levels, was statistically significant in the Group MPPa compared with the control group (p = 0.035). CONCLUSION: The LPPa and SVa caused less oxidative stress and less disruption of the muscle blood supply, in biochemical and scintigraphic parameters, compared to the MPPa and MVa. Therefore, in clinical practice, the SVa is preferable to the MPPa and MVa in total knee arthroplasty and the LPPa should be preferred more frequently in selected cases with critical soft tissue viability.

Comparison of Quadriceps-Sparing and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The quadriceps-sparing (QS) technique for total knee arthroplasty (TKA) was introduced to improve outcomes associated with the medial parapatellar (MP) approach. There is no clear consensus on what advantages, if any, QS provides. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) comparing the QS and MP techniques. PubMed, Ovid, and Scopus were assessed for relevant literature. Long-term (primary) outcomes and short-term (secondary) outcomes from 8 RCTs (579 TKAs) were analyzed using OpenMetaAnalyst (2016). RESULTS: The QS approach did not demonstrate clinically significant advantages, but was associated with statistically and clinically significant increases in the primary outcomes of femoral (odds ratio [OR] 4.92, P = .005), tibial (OR 4.34, P = .01), and mechanical axis outliers (OR 4.77, P = .004). Secondary outcome assessments demonstrated increased surgical (mean differences [MD] 19.54, P < .001) and tourniquet time (MD 23.30, P < .001) for QS. Although statistically significant advantages for QS were identified in Knee Society Function scores at 1.5-3 months (MD 2.31, P = .004) and 2 years (MD 1.86, P < .001), these were not clinically significant (fell below the 6-point minimal clinically important difference). CONCLUSION: The QS approach to TKA fails to demonstrate clinically significant advantages, but shows increased malalignment. This increased incidence of implant malalignment may predispose QS patients to early prosthesis failure. Because the QS approach may increases the risk of malalignment while providing no clear benefit compared to MP, we recommend against the routine use of the QS TKA approach.

Clinical relevance of active straight leg raising, standing up, and walking after total knee arthroplasty in a cross-sectional study.

BACKGROUND: Active straight leg raising (ASLR) is used to assess restoration of the quadriceps muscle immediately after total knee arthroplasty (TKA). This study aimed to (1) compare the times required to accomplish ASLR, standing up, and walking after TKA, and (2) evaluate the correlation between the time required to accomplish ASLR and perioperative patient-related factors. METHODS: This cross-sectional study included 271 patients (335 primary TKAs performed using the conventional medial parapatellar approach). Postoperative times required until each activity was accomplished were confirmed. Various factors that might impact ASLR, including prosthetic design, were also evaluated. RESULTS: Post-TKA, it took 1.5 ± 0.5 days to accomplish ASLR, 1.3 ± 0.6 days to accomplish standing up, and 1.4 ± 0.7 days to accomplish walking. There were no significant correlations between any factor and ASLR. Strong correlations were found between the times required to accomplish standing up and walking (p < 0.0001, r = 0.804). There were no significant correlations between the times required to accomplish ASLR and standing up/walking. A longer time was necessary for ASLR accomplishment than for standing up (p < 0.001) and walking (p < 0.001). Standing up was accomplished earlier than walking (p = 0.008). CONCLUSIONS: There was no delay in post-TKA ASLR accomplishment compared with previous reports. No factors affecting ASLR during the perioperative period suggested that ASLR was controlled by factors other than knee joint-related factors. ASLR was not correlated with standing up/walking; hence, the clinical significance of ASLR immediately after TKA for early ambulation is unclear. LEVEL OF EVIDENCE: Prognostic study, Level II.

The Patient's Perception Does Not Differ Following Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty: A Simultaneous Bilateral Randomized Study.

This simultaneous bilateral randomized study investigated whether patients would perceive the difference between the subvastus approach (SVA) and the medial parapatellar approach (MPA) after total knee arthroplasty (TKA). In 50 patients scheduled to undergo same-day bilateral TKA, one knee was randomly assigned to SVA and the other to MPA. Patient-reported measures (pain, Western Ontario McMaster University Osteoarthritis Index score, and side preference) and physician-assessed measures (isokinetic muscle strength, range of motion, and Knee Society score) were compared. No differences were observed in the patient-reported measures and physician-assessed measures, with the exception of greater quadriceps strength at postoperative 1 week in knees that underwent SVA. Patients receiving contemporary perioperative management after same-day bilateral TKA do not perceive any difference between knees that underwent SVA or MPA.

Comparative Analysis Of Anterior Knee Pain In Transpatellar And Medial Parapatellar Tendon Approaches In Tibial Interlocking Nailing.

BACKGROUND: Anterior knee pain is the most common complaint after intramedullary nail of the tibia. The incidence of anterior knee pain ranges from 10-86% and the exact ethology is unclear. Transpatellar tendon approach is commonly used for tibial intramedullary interlocking nailing but it can also be done through medial parapatellar tendon approach. The objective of the study was to compare post-operative anterior knee pain after intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. METHODS: This randomized controlled trial was carried out in Department of Orthopaedic and Spine Surgery, Ghurki trust teaching hospital, Lahore from 20th February to 19th Nov 2015. Sixty patients who presented at emergency department for the treatment of simple tibial shaft fractures were included in the study. They were divided into two groups with 30 patients in each group, Group A containing patients operated through transpatellar tendon approach while group B containing patients operated through medial parapatellar tendon approach. RESULTS: In Group A, 27 patients were male and 3 patients were female with a mean age of 28.667±9.63 while in Group B, 28 were male and 2 were female with a mean age of 34.63±15.82. The main causes of tibial shaft fractures were RTA followed by fall. In Group A mean anterior knee pain was 4.4 while in Group B, it was was 2.5 with a p-value of .000. CONCLUSIONS: This study shows that medial parapatellar tendon approach causes less pain as compared to transpatellar approach.

Mini-midvastus versus mini-medial parapatellar approach for minimally invasive total knee arthroplasty: outcomes pendulum is at equilibrium.

Comparisons between mini-midvastus (mMV) and mini-medial parapatellar approach (mMPP) for total knee arthroplasty (TKA) have reported variable results. We compared two approaches with minimum two year follow up. Forty consecutive patients who underwent staged bilateral TKA were prospectively randomized for mMPP approach in one knee and mMV approach in the other. Clinical parameters (muscle strength, pain, ROM, Knee Society Score) and surgic.l parameters (duration of surgery, blood loss, lateral releases) were assessed at 2, 6, 12 weeks and 6, 12, 24 months postoperatively. Clinical outcomes revealed inconsistent pattern of differences at various intervals. Surgical outcomes were not different. There were no major differences in outcomes between the two approaches. We recommend someone use surgical approach with which they are most familiar.

Surgical approaches in total knee arthroplasty: a meta-analysis comparing the midvastus and subvastus to the medial peripatellar approach.

Subvastus, midvastus and medial parapatellar approaches are the most popular approaches in total knee arthroplasty (TKA). However, the superior approach in TKA still remains controversial. We therefore conducted a meta-analysis to quantitatively compare the midvastus and subvastus approaches to the medial parapatellar approach in TKA. A total of 32 randomized controlled trials (RCTs) with 2451 TKAs in 2129 patients were included in this study. The meta-analysis suggested that, when compared with the medial parapatellar approach, the midvastus approach showed better outcomes in pain and knee range of motion at postoperative 1-2weeks but also was associated with longer operative time; the subvastus approach showed better outcomes in knee range of motion at postoperative 1week, straight leg raise and lateral retinacular release.

[Comparison of effectiveness of tibial intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in treatment of multiple tibial fractures].

Objective: To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of multiple tibial fractures. Methods: The clinical data of 43 patients with multiple tibial fractures treated with intramedullary nailing fixation between July 2018 and December 2022 were retrospectively analyzed, including 23 patients treated with suprapatellar approach in semi-extended position (group A) and 20 patients with medial parapatellar approach in semi-extended position (group B). There was no significant difference in gender, age, cause of injury, time from injury to operation, AO/Orthopaedic Trauma Association (AO/OTA) classification, preoperative visual analogue scale (VAS) score, and range of motion (ROM) of the knee joint between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared. The VAS score and ROM of the knee joint were analyzed at 4, 8, and 12 weeks after operation, and the incidence of postoperative complications was observed; knee function was evaluated by Lysholm score at last follow-up. Results: The operations were successfully completed in both groups, and there was no complication such as nerve and blood vessel injury during operation, and all incisions healed by first intention. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05), but the incision length in group B was significantly longer than that in group A ( P<0.05). Patients in both groups were followed up 12-30 months, with an average of 21.1 months. The VAS score decreased and ROM increased gradually in both groups with time after operation, showing significant differences between different time points ( P<0.05). The VAS score of group B was significantly lower than that of group A at 4 and 8 weeks after operation ( P<0.05); there was no significant difference in VAS score and ROM between the two groups at other time points ( P>0.05). There was no significant difference in fracture healing time between the two groups ( P>0.05). During the follow-up, there was no complication such as internal fixator loosening, breakage, and loss of fracture reduction. At last follow-up, the Lysholm score in group B was significantly better than that in group A ( P<0.05). Conclusion: Both the suprapatellar approach and the medial parapatellar approach in semi-extended position can achieve satisfactory results in the treatment of multiple tibial fractures. The medial parapatellar approach has lower symptoms of early knee pain and better long-term function.

Total Knee Replacement in a Young Patient with Valgus Knee Osteoarthritis: A Case Report.

Introduction: Valgus deformity is characterized by an outward angulation of the knee joint. The most common cause of valgus deformity is osteoarthritis (OA), a prevalent progressive joint disease that causes chronic pain and functional limitations. Total knee replacement (TKR) is rarely done in patients with grade-I valgus deformity and young age. To the best of our knowledge, this is the first case report of its kind. Case Report: A 34-year-old man presented to us with 15 years of persistent, progressively worsening right knee pain that was interfering with his daily activities. No non-operative treatment could alleviate his severe pain. Physical examination revealed a positive valgus stress test, limited knee extension, and an asymmetrical gait. He was diagnosed with a grade-I valgus deformity of the right osteoarthritic knee. History, physical examination, and radiological findings confirmed the diagnosis. In consideration of severe pain and impaired quality of life, we opted to perform TKR using a medial parapatellar approach. Regular follow-ups were done after the procedure. He experienced no pain or recurrence of deformity. He was very satisfied with the result. His Western Ontario and McMaster Universities OA Index score at 12 months following surgery was 5, indicating a favorable outcome. Conclusion: This case exhibits the effectiveness of TKR in treating grade-I valgus deformity of the osteoarthritic knee with severe pain in a young adult, resulting in improved pain alleviation, mobility, joint alignment, and overall quality of life.

Functional Outcome of Subvastus versus Medial Parapatellar Approaches for Total Knee Replacement in Patients with Knee Osteoarthritis: A Prospective Cohort Study.

Background: Subvastus approach and medial parapatellar approach are two major approaches for total knee replacement (TKR). There is no global consensus on the superiority of either approach in terms of functional outcomes. Objective: The present study aimed to evaluate the functional outcome of TKR through subvastus approach and medial parapatellar approach by using patient-reported scores at 3-, 6-, and 12-month post-operative follow-ups. Methods: This prospective cohort follow-up study included patients with knee osteoarthritis who underwent elective primary TKR either through the subvastus or medial parapatellar approaches at King Abdullah Medical City, Makkah city, Kingdom of Saudi Arabia, from January 2019 to December 2022. Scores from the self-reported Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared in the two groups of patients at 3-, 6-, and 12-month post-operative follow-ups. Results: A total of 98 patients were included, of which 37 underwent TKR through the subvastus approach and 61 through the medial parapatellar approach. There was an overall significant change over time in both WOMAC and OKS scores (P < 0.001). Patients who underwent the subvastus approach had significantly higher mean of WOMAC and OKS than patients with the medial parapatellar approach at the 3- and 6-month follow-ups (P < 0.05), but not at the 12-month follow-up. Conclusions: For TKR, the medial parapatellar approach results in better functional outcomes at the 3- and 6- month follow-up periods compared with the subvastus approach.

Appraisal of Clinical Improvement With Total Knee Arthroplasty in Valgus Knee Deformities: A Case Series.

Introduction This case series explores the efficacy of unassisted total knee arthroplasty (TKA) in addressing valgus knee deformity secondary to osteoarthritis. The study aims to evaluate functional outcomes pre- and post-surgery using the Knee Society Score (KSS) and radiological assessments in short-term follow-up. Six patients underwent TKA and were evaluated retrospectively. Statistical analysis revealed significant improvements in the angle of deformity, KSS, and range of motion postoperatively. The study underscores the success of TKA in correcting valgus deformity, improving knee function, and enhancing patient satisfaction. TKA is a highly successful treatment for osteoarthritis, providing functional recovery and improved quality of life. However, valgus knee deformity presents a challenge in TKA, affecting approximately 10% of patients. This study aims to assess the functional outcomes of TKA for valgus deformity using KSS and radiological evaluation in short-term follow-up. Materials and methods A retrospective observational study was conducted from November 2022 to December 2023, involving six patients with valgus knee deformity secondary to osteoarthritis. TKA was performed with no technological assistance, and patients were assessed pre- and post-surgery using KSS and radiological measurements. Statistical analysis was performed using paired t-tests. Case description Six patients with grade two valgus deformity underwent technology-unassisted TKA. The postoperative assessment revealed significant improvements in the tibiofemoral angle, KSS, and range of motion. The medial parapatellar approach for TKA was utilized with a standard unconstrained primary TKA prosthesis, resulting in successful correction of deformity and improved knee alignment. Discussion TKA is a widely performed and reliable surgical intervention, with valgus knee deformity posing specific challenges. This study demonstrates the effectiveness of conventional TKA in correcting valgus deformity, improving knee function, and enhancing patient satisfaction in a very small case series. Comparison with previous studies supports the findings of the pre-existing literature, highlighting the importance of appropriate surgical approach and patient selection. Conclusion TKA utilizing a medial parapatellar approach proved effective in our small case series in correcting valgus deformity, improving knee function, and enhancing patient satisfaction. Short-term follow-up reveals significant improvements in stability, posture, and KSS scores. Further assessments and longer-term follow-up are warranted to confirm the long-term effectiveness of this approach.

Minimally invasive medial femoral approach to total knee arthroplasty improves short-term outcomes compared to the standard medial parapatellar approach: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to conduct a comprehensive evaluation of the effectiveness of the medial parapatellar approach via the vastus medialis obliquus muscle in comparison with the standard medial parapatellar approach for total knee arthroplasty, using a systematic approach. METHODS: A computer search was conducted on PubMed, EMBASE, Medline, Cochrane libraries, and Web of Science databases to comprehensively collect randomized controlled studies on minimally invasive (MMV) approaches for knee arthroplasty, specifically the vastus and medial parapatellar (MP) approaches. Two authors independently screened the literature based on inclusion and exclusion criteria, evaluated the quality of the included studies using the Cochrane systematic review method, and performed a meta-analysis using RevMan 5.3 software. RESULTS: A total of twelve randomized controlled studies were ultimately included, comprising 788 knees. The small incision medial femoral muscle approach (MMV) group consisted of 398 cases, while the traditional parapatellar approach (MP) group consisted of 390 cases. Data analysis showed that in the comparison of KSS, VAS, and ROM score at 3 months after surgery, MMV approach was superior to MP approach [MD = 2.89, 95%CI (0.33, 5.46), P = 0.03], [MD = - 0.22, 95%CI (- 0.36, - 0.09), P = 0.001], and [MD = 1.08, 95%CI (0.04, 2.12), P = 0.04]. However, there was no significant difference in the postoperative KSS, VAS, and ROM score between the MMV and MP approaches at 6 and 12 months after surgery. The operation time of the MMV group was longer than that of the MP group [MD = 8.98, 95%CI (4.64, 13.32), P < 0.0001], and the number of days of straight leg raising after surgery was shorter in the MMV group than in the MP group [MD = - 1.91, 95%CI (- 3.45, - 0.37), P = 0.01], with statistically significant differences. There was no significant difference in the lateral support band release rate [OR = 0.72, 95%CI (0.23, 2.28), P = 0.58], length of hospital stay [MD = 0.07, 95%CI (- 0.18, 0.31), P = 0.58], postoperative complications [MD = 0.62, 95%CI (0.33, 1.18), P = 0.15], and intraoperative blood loss [MD = 70.50, 95%CI (- 57.51, 198.72), P = 0.28]. CONCLUSION: Most of the approaches have similar length of stay and incidence of complications compared to standard approaches. However, the minimally invasive midvastus approach has shown potential to improve short-term outcomes. STUDY REGISTRATION: PROSPERO registration number CRD42023410583.