Potential financial loss and risk factors for hamstring muscle injuries in elite male Brazilian soccer players: a season-long prospective cohort pilot study.

Purpose: The aim of this pilot study was to analyze the potential financial loss and a range of potential risk factors for hamstring muscle injuries in elite Brazilian soccer. Methods: Thirty-four male players (age: 25 ± 6 years; stature: 180 ± 8 cm; body mass: 78 ± 9 kg; minutes played in matches: 2243 ± 1423 min) from an elite professional soccer club were monitored during a 12-month season. Muscle injury was identified by magnetic resonance imaging and the severity was defined according to the number of days away: minimal (1-3 days), mild (4-7 days), moderate (8-28 days), severe (>28 days). Potential financial loss due to the team's under achievements was determined. Dorsiflexion range of motion, eccentric knee flexor strength and isokinetic tests were performed during the pre-season. Association between dependent variables and the occurrence of injury was evaluated. Results: Nine hamstring muscle injuries with moderate severity were found in 8 athletes. Recovery time was 22 days off the field on average. Potential financial loss was $-43.2 million USD and earnings on merit money was 21%. Previous injury, increased flexor deficit 60°â€…/sec and increased flexor fatigue index 300°/sec were all associated with a greater chance of hamstring muscle injury. Ankle dorsiflexion range of motion was significantly lower in the injured group (35.6 ± 3° vs. 39.1 ± 4.9°; p = 0.017, effect size = -0.74). Conclusion: High financial burden was found in elite Brazilian soccer during one full season. Injured athletes had high hamstring fatigue index, knee flexor strength deficit, ankle range of motion restriction and previous hamstring muscle injury when compared to non-injured athletes. Therefore, preventive approaches in professional soccer players with previous hamstring injuries should be a priority.

Minimally Invasive Quadricepsplasty Using the Adolphson-Cerqueira Technique: A Retrospective Study after 1-Year of Follow-up.

Aim: Knee stiffness limits activities of daily living with treatment having no gold standard technique currently. We present follow-up data 1-year after quadricepsplasty using the Adolphson-Cerqueira technique for the treatment of knee stiffness in a Brazilian population sample. Materials and methods: This retrospective study included patients who underwent a quadricepsplasty using the Adolphson-Cerqueira technique between January 2006 and March 2023 at our institution. The inclusion criteria were: (1) Knee stiffness with a range of motion <70°; (2) Patellar excursion ≥2 mm on physical examination; (3) Available knee radiography in the anteroposterior and lateral views; and (4) A follow-up at 1 year postoperatively. The Judet Classification was used to assess the outcome of the quadricepsplasty. Results: Sixty-seven patients were included. The results were 6% poor, 31.3% fair, 44.8% good, and 17.9% excellent according to the Judet Classification. A correlation was observed between age and the gain in range of motion at the 1-year postoperative follow-up, and between the gain in range of motion intraoperatively and that at the 1-year follow-up. There were five cases of complications (7.46%): one of patellar fracture, three of quadriceps tendon rupture, and one of avulsion fracture in the superior pole of the patella. Conclusion: Quadricepsplasty using the Adolphson-Cerqueira technique produced satisfactory results overall for improving knee joint stiffness and had a complication rate comparable with other currently used techniques. Clinical significance: Loss of knee range of motion remains a difficult problem without there being a clear gold standard in treatment. Many different options are described in the literature. We provide a further option with follow-up results. How to cite this article: Cerqueira FS, Silva L, Kropf LL, et al. Minimally Invasive Quadricepsplasty Using the Adolphson-Cerqueira Technique: A Retrospective Study after 1-Year of Follow-up. Strategies Trauma Limb Reconstr 2024;19(2):87-93.

Advanced therapy with mesenchymal stromal cells for knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials.

Background: Advanced cell therapies emerged as promising candidates for treatment of knee articular diseases, but robust evidence regarding their clinical applicability is still lacking. Objective: To assess the efficacy and safety of advanced mesenchymal stromal cells (MSC) therapy for knee osteoarthritis (OA) and chondral lesions. Methods: Systematic review of randomized controlled trials conducted in accordance with Cochrane Handbook and reported following PRISMA checklist. GRADE approach was used for assessing the evidence certainty. Results: 25 randomized controlled trials that enrolled 1048 participants were included. Meta-analyses data showed that, compared to viscosupplementation (VS), advanced MSC therapy resulted in a 1.91 lower pain VAS score (95 % CI -3.23 to -0.59; p < 0.00001) for the treatment of knee OA after 12 months. Compared to placebo, the difference was 0.99 lower pain VAS points (95 % CI -1.94 to -0.03; p = 0.76). According to the GRADE approach, the evidence was very uncertain for both comparisons. By excluding studies with high risk of bias, there was a similar size of effect (VAS MD -1.54, 95 % CI -2.09 to -0.98; p = 0.70) with improved (moderate) certainty of evidence, suggesting that MSC therapy probably reduces pain slightly better than VS. Regarding serious adverse events, there was no difference from advanced MSC therapy to placebo or to VS, with very uncertain evidence. Conclusion: Advanced MSC therapy resulted in lower pain compared to placebo or VS for the treatment of knee OA after 12 months, with no difference in adverse events. However, the evidence was considered uncertain. The Translational Potential of this Article: Currently, there is a lack of studies with good methodological structure aiming to evaluate the real clinical impact of advanced cell therapy for knee OA. The present study was well structured and conducted, with Risk of Bias, GRADE certainty assessment and sensitivity analysis. It explores the translational aspect of the benefits and safety of MSC compared with placebo and gold-standard therapy to give practitioners and researchers support to expand this therapy in their practice. PROSPERO registration number: CRD42020158173. Access at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158173.

Demographic characteristics and clinical-radiological correlation in patients with indications for Total Knee Arthroplasty: A cross-sectional study.

OBJECTIVE: The objective of this study is to correlate clinical symptoms and functionality, using the KOOS (Knee Injury and Osteoarthritis Outcome Score) and KSS (Knee Society Score System) scores, with the radiographic changes, using the Kellgren-Lawrence classification, in patients with knee osteoarthritis and indications for Total Knee Arthroplasty (TKA). METHODS: 120 patients (189 knees) with gonarthrosis and indications for TKA were included in the study. Demographic questionnaires were applied, and clinical and functional assessment was carried out using the KOOS and KSS scores. Knee radiographs were taken and graded according to Kellgren-Lawrence. The clinical scores were compared with the radiographic classification to establish a correlation between these two measurements. Statistical analysis was performed using the τ-Kendall correlation test. RESULTS: Weak and inversely proportional correlations were found between the clinical scores and the radiographic classification. Among clinical scores evaluated, KSS showed the highest correlation with Kellgren-Lawrence classification (τ = -0.356; p < 0.001), followed by KOOS-quality of life (τ = -0.176; p = 0.004), KOOS-total score (τ = -0.166; p = 0.004), KOOS-function in daily living (τ = -0.160; p = 0.005) and KOOS-symptoms (τ = -0.159; p = 0.006). KOOS-pain (τ = -0.149; p = 0.01) and KOOS-sport and recreation function (τ = -0.142; p = 0.025) scores had the weakest correlations. CONCLUSION: There is a weak correlation between the clinical-functional scores of TKA candidates and their radiographic classification by Kellgren-Lawrence. Among clinical scores evaluated, KSS had the strongest negative correlation with the radiographic classification.

Revision knee arthroplasty using a modular system manufactured in Brazil. Clinical and radiographic results with a mean nine-year follow-up.

OBJECTIVE: To demonstrate the clinical and radiographic results of revision knee arthroplasty using a modular system manufactured in Brazil. METHODS: Between November 2010 and January 2017, 31 revision knee arthroplasties were performed in 30 patients, using the MB-V system. Patients were assessed clinically and radiographically after a minimum follow-up of two years using the following scores: Knee Society Score (KSS), Knee Society Score ‒ Function (KSS ‒ Function), and Knee Society Roentgenographic Evaluation System (KSRES). RESULTS: Among the patients, 19 were women. The mean age at surgery was 68 years. The mean follow-up was 9.1 years. There was no aseptic loosening in this period. The mean values of KSS, KSS-function, and KSRES were, respectively, 82, 77, and less than 4. One patient evolved with postoperative flexion instability. Two knees became infected, requiring the removal of the prosthesis and implantation of spacers loaded with antibiotics. One patient developed arthrofibrosis. One patient had a dislocation with full medial collateral avulsion and had to be re-operated with an insert exchange to a CCK liner and medial collateral reconstruction as proposed by Krakow. CONCLUSION: This implant had 93.5 % survivorship (no cases of aseptic failure) and good results in 27 out of 31 knees (87 % of the surgeries).

[Total knee replacement in patients under 60 years with high functional demand: functional outcomes and return to sports after an average 2-year follow-up]. / Reemplazo total de rodilla en pacientes menores de 60 años con demanda funcional elevada: resultados funcionales y retorno al deporte después de un promedio de dos años de seguimiento.

INTRODUCTION: a common concern in presurgical medical appointment of total knee replacement medical appointment is return to exercise. The purpose of this study was to analyze functional results and return to sport in patients under 60 years of age after this surgery. MATERIAL AND METHODS: we retrospectively analyzed 41 total knee replacements in 36 athletic patients (average age: 53 years [46-60]). Average follow-up of two years (6 months-5 years). Diagnoses: 37 osteoarthritis, three sequelae of Rheumatoid Arthritis, 1 extra-articular deformity. Functional and radiographic outcomes assessed using modified Knee Society and High Activity Arthroplasty Scores. RESULTS: average improvement from 31.95 to 91.61 in KSS and average from 7.95 to 13.73 in HAAS. Return to sport in 3.5 months average (range 2-6 months). Three patients did not return to sport. CONCLUSIONS: we consider that delaying surgery in these patients will cause progression in their osteoarthritis pathology and cessation of their sports activities. This makes the surgical technique difficult in addition to reducing the patient's physical performance. Analyzing the survival rate of implants in young patients, more than 80% is reported in a 25-year follow-up.

INTRODUCCIÓN: una inquietud frecuente en consultas prequirúrgicas de reemplazo total de rodilla es el regreso al ejercicio. El propósito de este estudio fue analizar resultados funcionales y retorno al deporte en pacientes menores de 60 años posterior a esta cirugía. MATERIAL Y MÉTODOS: analizamos retrospectivamente 41 reemplazos totales de rodilla en 36 pacientes deportistas (edad promedio: 53 años [46-60]). Seguimiento promedio de dos años (6 meses-5 años). Diagnósticos: 37 gonartrosis, tres secuelas de artritis reumatoidea, una deformidad extraarticular. Resultados funcionales y radiográficos evaluados mediante Knee Society modificado y High Activity Arthroplasty Score. RESULTADOS: mejoría promedio de 31.95 a 91.61 en KSS y promedio de 7.95 a 13.73 en HAAS. Retorno al deporte en 3.5 meses promedio (rango: 2-6 meses). Tres pacientes no retornaron al deporte. CONCLUSIONES: consideramos que el retraso de la cirugía en estos pacientes producirá progresión en su patología artrósica y cese de sus actividades deportivas. Esto dificulta la técnica quirúrgica además de disminuir el rendimiento físico del paciente. Analizando la tasa de supervivencia de implantes en pacientes jóvenes, se reporta más de 80% en seguimientos de 25 años.

Efficacy of periarticular local infiltrative anaesthesia (modified Ranawat cocktail regimen) for postoperative pain control and reducing morbidity in total knee arthroplasty: a tertiary centre retrospective study.

INTRODUCTION: surgical pain is managed with multi-modal anesthesia in total knee arthroplasty (TKA). It is dubious whether including local infiltrative anaesthesia (LIA) before wound closure provides adequate pain control and decreases morbidity. MATERIAL AND METHODS: this was a retrospective conducted to assess postoperative pain control, morbidity index, and opioid consumption in 116 patients who underwent TKA and were divided into two groups based on LIA (Modified Ranawat Regimen) or normal saline infiltration in the wound. RESULTS: the mean NRS score was significantly lower in LIA group (3.2) as compared to the control group (3.9) in the first 24 hours. Functional milestones were relatively achieved earlier in LIA group but the values were not significant. Tramadol consumption was remarkably higher in the control group as compared to LIA group on day 1 and 2. As per the morbidity index the mean score on day one was 16.18 and 23.40 which decreased to 6.37 and 9.21 by day three in LIA and control group respectively indicating morbidity has decreased but more so in LIA group. CONCLUSION: our study concludes that use of modified cocktail regimen in the knee effectively decreased morbidity with excellent to good results, declining NRS score, minimal rescue analgesia requirement, early ambulation with better safety.

INTRODUCCIÓN: el dolor quirúrgico se trata con anestesia multimodal en la artroplastia total de rodilla (ATR). Es dudoso que incluir anestesia local infiltrativa (LIA) antes del cierre de la herida proporcione un control adecuado del dolor y disminuya la morbilidad. MATERIAL Y MÉTODOS: se realizó una retrospectiva para evaluar el control del dolor posoperatorio, el índice de morbilidad y el consumo de opioides en 116 pacientes sometidos a ATR y se dividieron en dos grupos según el LIA (régimen de Ranawat modificado) o la infiltración de solución salina normal en la herida. RESULTADOS: la puntuación media NRS fue significativamente menor en el grupo LIA (3.2) en comparación con el grupo control (3.9) en las primeras 24 horas. Los hitos funcionales se alcanzaron relativamente antes en el grupo LIA, pero los valores no fueron significativos. El consumo de tramadol fue notablemente mayor en el grupo de control en comparación con el grupo de LIA los días 1 y 2. Según el índice de morbilidad, la puntuación media el día uno fue 16.18 y 23.40, que disminuyó a 6.37 y 9.21 en el día tres en el grupo de LIA y control, respectivamente, lo que indica que la morbilidad ha disminuido, pero más en el grupo LIA. CONCLUSIÓN: nuestro estudio concluye que el uso de un régimen de cóctel modificado en la rodilla disminuyó efectivamente la morbilidad con resultados excelentes a buenos, una disminución de la puntuación NRS, un requisito mínimo de analgesia de rescate y una deambulación temprana con mayor seguridad.

Insights into complications after unicompartmental knee arthroplasty.

Zhao's study, offers a comprehensive analysis of unicompartmental knee arthroplasty (UKA) revision indications. The study provides a detailed, case-by-case analysis of the factors leading to knee revision surgery in 13 patients. Not only elucidates the complexities of UKA revisions but also underscores the importance of continuous improvement in surgical techniques and the adoption of innovative technologies.

[Efficacy of transdermal lidocaine 5% patches in postoperative analgesia following knee arthroscopy]. / Efectividad del parche transdérmico de lidocaína 5% en la analgesia postoperatoria después de la artroscopía de rodilla.

INTRODUCTION: knee arthroscopy is a common orthopedic procedure associated with postoperative pain, so optimizing pain management is essential for patient recovery and satisfaction. Lidocaine, a local anesthetic with well-established safety profiles, offers a potential alternative to traditional analgesic methods. Research regarding lidocaine patches has been conducted in several types of surgeries (laparoscopy, gynecological surgery, prostatectomy, etc.) showing promising results for some. This study investigates the effectiveness of transdermal lidocaine 5% patches as a novel approach to postoperative analgesia after knee arthroscopy. MATERIAL AND METHODS: a randomized, single-blind, placebo-controlled trial was conducted with participants undergoing knee arthroscopy. Patients were divided into two groups: one receiving transdermal lidocaine 5% patches and the other a placebo, both along traditional postoperative pain management, and using opioid only in cases with moderate-severe pain. Pain scores, opioid consumption, and patient-reported outcomes were assessed at various postoperative intervals. RESULTS: there was a significant reduction in pain scores and opioid consumption in the lidocaine patch group compared to the placebo group. CONCLUSIONS: transdermal lidocaine 5% patches emerge as a promising adjunct to postoperative pain management in knee arthroscopy patients. Their ease of application, minimal side effects, and opioid-sparing effects contribute to a multifaceted analgesic approach. This study underscores the potential of transdermal lidocaine patches in enhancing the overall postoperative experience for knee arthroscopy patients, advocating for their consideration in clinical practice.

INTRODUCCIÓN: la artroscopía de rodilla es un procedimiento ortopédico común asociado con dolor postoperatorio, por lo que optimizar el manejo del dolor es esencial para la recuperación y la satisfacción del paciente. La lidocaína, un anestésico local con perfiles de seguridad bien establecidos, ofrece una alternativa potencial a los métodos analgésicos tradicionales. Se ha llevado a cabo investigación sobre los parches de lidocaína en diversos tipos de cirugías (laparoscopía, cirugía ginecológica, prostatectomía, etcétera), mostrando resultados prometedores en algunos casos. MATERIAL Y MÉTODOS: se realizó un ensayo clínico aleatorizado, ciego simple y controlado con placebo que incluyó participantes sometidos a artroscopía de rodilla. Los pacientes fueron divididos en dos grupos: uno recibió parches transdérmicos de lidocaína al 5% y otro un placebo, ambos junto con el manejo tradicional del dolor postoperatorio y utilizando opioides sólo en casos de dolor moderado a severo. Se evaluaron las puntuaciones de dolor, el consumo de opioides y los resultados informados por los pacientes en varios intervalos postoperatorios. RESULTADOS: se registró una reducción significativa en las puntuaciones de dolor y el consumo de opioides en el grupo de parches de lidocaína en comparación con el grupo de placebo. CONCLUSIONES: los parches transdérmicos de lidocaína al 5% emergen como un complemento prometedor para el manejo del dolor postoperatorio en pacientes sometidos a artroscopía de rodilla. Su facilidad de aplicación, mínimos efectos secundarios y efectos ahorradores de opioides contribuyen a un enfoque analgésico multifacético. Este estudio destaca el potencial de los parches de lidocaína transdérmica para mejorar la experiencia postoperatoria general de los pacientes con artroscopía de rodilla, abogando por su consideración en la práctica clínica.

Analysis of the Biomechanical Behavior of an Animal Model of Triple Hamstring Graft Configuration for Combined ACL and ALL Reconstruction with a Single Femoral Tunnel and a Single Strand for ALL Reconstruction.

Objective To describe and biomechanically test a configuration, in an animal model that simulates the triple hamstring graft for combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, with a single femoral tunnel and a single strand for ALL reconstruction. Methods Deep flexor porcine tendons were used as the graft and fixed with titanium interference screws in a polyurethane block. The samples were divided into 3 groups: group 1 (control) - with a quadruple graft; group 2-with a simple triple graft; and group 3-with a braided triple graft. The tests were conducted using an EMIC DL 10000 (Instron Brasil Equipamentos Científicos Ltda., São José dos Pinhais, PR, Brazil) electromechanical universal testing machine. Results The samples in groups 1, 2, and 3 obtained mean peak forces of 816.28 ± 78.78 N, 506.95 ± 151.30 N, and 723.16 ± 316.15 N, respectively. In Group 3, braiding increased graft diameter by 9% to 14%, and caused a shortening of 4% to 8% compared with group 1, with an average peak force increase of ∼ 200 N ( p < 0.05). Regarding peak forces, there was no statistically significant difference between groups 1 and 3, indicating that quadruple and braided triple grafts showed similar strength results. Conclusion The triple-braided hamstring graft configuration for combined ACL and ALL reconstruction with a single femoral tunnel and a single strand for ALL reconstruction may become a biomechanically viable solution, with potential clinical application.

The Influence of High Physical Demand on the Occurrence of Major Muscle and Ligament Injuries in Professional Soccer Athletes: A Systematic Review.

Objective The present systematic review aimed to investigate the influence of high physical demand on the increase in muscle and ligament injuries in professional soccer athletes. Methods We analyzed scientific publications to determine the incidences of the main injuries, their causes and mechanisms, and their association with high physical demand. We compared amateur and professional players and assessed the effectiveness of FIFA11+ as a prevention alternative. Searches occurred on Scielo, Pubmed, and Google Scholar databases. The filters were the topic, publication date (last 5 years), and study relevance. The indexing terms were the following: Overuse , Calendar , Injuries , Muscular , Ligament , Athletes , Soccer , Football . We described the main data obtained to compare and analyze the results. This study complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Results The query resulted in 24 articles published from 2019 to 2023. The high physical demand increased the risk of injuries. Most injuries occurred in the lower limbs. The most common injuries were strains, sprains, contractures, and ligament ruptures. FIFA11+ presented itself as a viable prevention alternative. Conclusion We concluded that high physical demand increases the most frequent muscle and ligament injuries in professional soccer players, that is, strains, sprains, contractures, and ligament rupture, suggesting the FIFA11+ program as a prevention alternative.

Bicruciate Reconstruction with Bilateral Hamstring Autografts: Technique and Functional Results.

Objective The purpose of this study was to evaluate the clinical and functional results of simultaneous reconstruction of the ACL and PCL with bilateral hamstring autografts. We hypothesized that this reconstruction technique results in less morbidity and has similar results to the ones published in the previous literature. Methods Eighteen patients with bicruciate lesions were selected and treated by arthroscopic surgery with autologous hamstring tendons in a single-stage procedure. The thicker semitendinosus tendon (ST) and the two gracilis tendons (G) were used for a 6-strand PCL reconstruction. The thinner ST was used for a 3-strand ACL reconstruction. The average patient age at surgery was 31 years, and the minimum follow-up was 2 years. Function of the operated knee was evaluated according to the Lysholm scale. Anterior knee laxity was examined with a KT-1000 arthrometer. Posterior laxity was evaluated using stress radiographies. Results Statistically significant improvements were found for all three measurements ( p < 0.001). Knee function by the Lysholm score increased from 43.8 ± 4.1 to 89.9 ± 3.8 post-surgery. The average anterior knee laxity improved from 5.2 + -0.8 mm initially to 2.4 + - 0.5 mm post-surgery. The posterior translation of the tibia relative to the femur decreased from 10 ± 3.4 mm to 3 ± 1.6 mm post-surgery. No patient showed loss of motion in extension or knee flexion. Conclusion The simultaneous bicruciate reconstruction with bilateral hamstring autograft is a valuable option to achieve good functional outcomes and ligamentous stability.

[Navigated total knee arthroplasty: an alternative surgical technique for patients with gonarthrosis in Mexico]. / Artroplastía total de rodilla navegada: una técnica quirúrgica alternativa para pacientes con gonartrosis en México.

Total knee arthroplasty consists of the artificial replacement of the knee joint in its three compartments. One of its main challenges is the anatomical restoration of the joint line. The relief of inappropriate postoperative pain can lengthen the recovery time and increase the days of intrahospital stay and readmission. Total Navigated Knee Arthroplasty is considered one of the most innovative procedures in the treatment of knee osteoarthritis. It was introduced in the late 90s and there is currently good evidence, that navigation has greater precision in the position of the prosthetic components, compared to a manual instrumentation, especially the reduction of the atypical alignment values of the mechanical axis. The supporters of (TNKA) have argued that this technique can improve the score of functional scales, the alignment of the prosthetic components, revision rates and survival, because it reduces the percentage of atypical radiographic values in the alignment of the coronal and sagittal plane, greater precision in axial rotation of the components, improvement of the flexion gap and the extension gap and the soft tissue balance. In general, experience is gained, learning curves are improved and the complication rate is decreased with acceptable costs.

La artroplastía total de rodilla consiste en el reemplazo artificial de la articulación de la rodilla en sus tres compartimientos. Uno de sus principales desafíos es la restauración anatómica de la línea articular. El alivio de dolor postoperatorio inadecuado puede alargar el tiempo de recuperación y aumentar los días de hospitalización y reingreso. La artroplastía total de rodilla navegada (ATRN) es considerada uno de los procedimientos más novedosos en el tratamiento de la artrosis de rodilla. Se introdujo a finales de los años 90 y actualmente existe una buena evidencia de que la navegación tiene mayor precisión en la colocación de los componentes protésicos, en comparación con la instrumentación manual, especialmente en la reducción de los valores atípicos de alineación del eje mecánico. Los defensores de ATRN han argumentado que esta técnica puede mejorar la puntuación de escalas funcionales, la alineación de los componentes, tasas de revisión y supervivencia, debido a que reduce el porcentaje de valores atípicos radiográficos en la alineación del plano coronal y sagital, mayor precisión en rotación axial de los componentes, mejora de la brecha en flexión y extensión y el balance de ligamentos. Se gana experiencia, se mejoran las curvas de aprendizaje y se disminuyen la tasa de complicaciones, con costos aceptables.

Analysis of correlation between medial joint line change and lower limb coronal alignment after Oxford unicompartmental knee arthroplasty.

BACKGROUND: Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty (UKA) result. The tibial bony resection and implant position lead to joint line change postoperatively. Analysis was done to find out the correlation between these factors. METHODS: From 2019 to 2021, 90 medial Oxford UKA were implanted by a single surgeon. Hip Knee Ankle Angle (HKAA), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and intraoperative bony resection thickness were measured. The medial joint line change was calculated. The correlation between joint line change and alignment change was evaluated. RESULTS: The mean tibial resection thickness was 4.3 mm. The mean tibial joint line was elevated by 2.3 mm, while the mean femoral joint line proximalized by 0.8 mm. HKAA changed from 8.4° varus preoperatively to 3.6° varus postoperatively. LDFA changed from 89.0° to 86.7°. MPTA changed from 85.6° to 86.6°. Preoperative HKAA showed a strong correlation with postoperative HKAA (p < 0.001), and preoperative MPTA showed a positive correlation with postoperative HKAA (p < 0.001). While preoperative LDFA had a negative correlation with postoperative HKAA (p < 0.001). The femoral joint line change and LDFA change had a significant correlation with HKAA change (p < 0.05). CONCLUSION: The change of joint line had no correlation with postoperative HKAA in Oxford UKA. Preoperative HKAA strongly correlated with postoperative HKAA; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA. The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change.

"I feel more confident": a mixed methods evaluation of the influence of Good Life with osteoarthritis Denmark (GLA:D®) on physical activity participation, capability, barriers, and facilitators in people with knee osteoarthritis.

BACKGROUND: A mixed methods study which aimed to evaluate the influence of Good Life with osteoArthritis Denmark (GLA:D®) on physical activity participation, including perceived capability, barriers, and facilitators in people with knee osteoarthritis. OBJECTIVE: Quantify changes in physical activity participation at 3- and 12-months for people with knee osteoarthritis who participated in an education and exercise-therapy program (GLA:D®). METHODS: A mixed-methods study involving 44 participants with knee osteoarthritis who completed GLA:D®. Guided by the Theoretical Domains Framework, 19 were interviewed, with transcripts analysed using reflexive thematic analysis. University of California Los Angeles physical activity scores were dichotomised as 'more' (≥7) or 'less' active (≤6), and compared between baseline and 3- and 12-months using McNemar's test. Motivation and confidence to exercise (0-10 scale); fear of knee joint damage with exercise (yes/no); and Knee Osteoarthritis Outcome Scores (KOOS) were evaluated. RESULTS: Four overarching themes were identified: prior to GLA:D® 1) fear of knee joint damage, and scarcity of exercise and physical activity information prior to GLA:D®; and following GLA:D® 2) varied exercise-therapy and physical activity participation; 3) facilitators including reduced fear of knee damage, increased confidence, routine, strategies, and support; and 4) ongoing barriers including persistent knee pain, comorbidities, cost, and lack of opportunity and motivation. There was no difference in the proportion of 'more' active participants between baseline (41%) and at 3-months (37%, p = 0.774) or 12-months (35%, p = 0.375). The proportion with fear of damage reduced from baseline (50%) to 3-months (5%) and 12-months (21%). Self-reported motivation (9.1/10) and confidence (9.1/10) to exercise at 3-months were high, and all KOOS subscales improved from baseline to 3-months (effect sizes = 0.41-0.58) and 12-months (effect sizes = 0.29-0.66). CONCLUSION: Varied and often inadequate physical activity participation following GLA:D® indicates more targeted interventions to address ongoing barriers may be required.

Plasma metabolites associated with biopsychosocial parameters in overweight/obese women with severe knee osteoarthritis.

Introduction: Obesity aligned with quadriceps muscle weakness contributes to the high incidence of knee osteoarthritis (KOA), which is prevalent in women. Although molecular signatures of KOA have been suggested, the association between biopsychosocial responses and the plasma metabolomic profile in overweight/ obese women with KOA remains in its early stages of investigation. This study aims to associate the plasma metabolome with biopsychosocial parameters of overweight/obese women diagnosed with KOA. Methods: Twenty-eight overweight/obese women (Control-n = 14; KOA-n = 14) underwent two visits to the laboratory. Functional tests and questionnaires assessing biopsychosocial parameters were administered during the first visit. After 48 h, the participants returned to the laboratory for blood collection. Specific to the KOA condition, the Numerical Pain Rating Scale (NPRS), Tampa Scale for Kinesiophobia (TSK), and Knee injury and Osteoarthritis Outcome Score (KOOS) were applied. Results: Thirteen molecules were different between groups, and four correlated with KOA's biopsychosocial parameters. DG 22:4-2OH and gamma-Glutamylvaline were inversely associated with KOSS leisure and TSK score, respectively. LysoPE 18:0 and LysoPE 20:5 were positively associated with KOSS symptoms and TSK score, respectively. Discussion: While the correlations of LysoPE 18:0 and gamma-Glutamylvaline are supported by existing literature, this is not the case for DG 22:4-2OH and LysoPE 20:5. Further studies are recommended to better elucidate these correlations before dismissing their potential involvement in the biopsychosocial factors of the disease.

ULTRASOUND-GUIDED GENICULAR NERVE BLOCK FOR KNEE OSTEOARTHRITIS: A CASE SERIES.

Objective: Knee genicular nerve blocks have been a topic of discussion among various types of treatment for knee osteoarthritis. This study aims to evaluate the pain and function of patients diagnosed with knee osteoarthritis after undergoing ultrasound-guided genicular nerve blockade using pharmacological agents. Methods: The study included 36 patients diagnosed with knee osteoarthritis, comprising 17 bilateral cases, totaling 53 knees undergoing UGNB using a mixture of triamcinolone, ropivacaine, and lidocaine under ultrasound guidance. Epidemiological data, pain outcomes measured by the Visual Analog Scale (VAS), and function assessed using the Western Ontario and McMaster Universities (WOMAC) score were evaluated before and after 12 weeks of the procedure. Results: The mean age was 75.5 years (standard deviation of 9.4 years), with a predominance of females and right-sided involvement. There was a mean reduction of 3.0 points in VAS (p < 0.001) and 15.4 points in WOMAC (p < 0.001). Two cases reported only minor and transient complications related to the procedure (skin anesthesia and edema). Conclusion: Ultrasound-guided genicular nerve blockade using pharmacological agents demonstrated pain reduction and improved function with a low complication rate after 12 weeks in patients with knee gonarthrosis. Level of Evidence IV, Case Series.

Objetivo: Os bloqueios geniculares do joelho têm sido tema de discussão entre os diversos tipos de tratamento da gonartrose. Este estudo tem por objetivo avaliar a dor e a função dos pacientes com diagnóstico de osteoartrose do joelho, após realização do procedimento de bloqueio farmacológico dos nervos geniculares (BFNG) guiado por ultrassom. Métodos: O estudo incluiu 36 pacientes com diagnóstico de gonartrose, sendo 17 casos bilaterais, totalizando 53 joelhos submetidos ao BFNG, com a mistura de triancinolona, ropivacaína e lidocaína guiado por ultrassom. Avaliou-se dados epidemiológicos, desfechos de dor pela Escala Visual Analógica (EVA) e função com escore Western Ontario and Mcmaster Universities (WOMAC) antes e após 12 semanas do procedimento. Resultados: A idade média encontrada foi de 75,5 anos (desvio padrão de 9,4 anos), com predominância do sexo feminino e do lado direito. Houve uma redução média na EVA de 3,0 pontos (p < 0,001) e no WOMAC de 15,4 (p < 0,001). Em dois casos, relataram apenas complicações menores e transitórias relacionadas ao procedimento (anestesia da pele e edema). Conclusão: O bloqueio farmacológico dos nervos geniculares guiado por ultrassom demonstrou redução da dor e melhora na função, com baixa taxa de complicação após 12 semanas nos pacientes com gonartrose. Nível de evidência IV, Série de Casos.

SHORT-TERM EVALUATION BETWEEN POLYETHYLENE THICKNESS IN PRIMARY TOTAL KNEE ARTHROPLASTY.

Objective: The objective of the research was to carry out a comparative study between Smith & Nephew ® or Zimmer ® prostheses with thick versus thin polyethylene, in patients undergoing primary total knee arthroplasty, during a short-term follow-up. Thus, the objective was to analyze the survival of the implants in question under the clinical and radiographic aspect. Methods: The sample was divided into two groups: Group 1 with thick polyethylene and group 2 with thin polyethylene. A clinical analysis of the patients was carried out and the implants were checked for loosening. Results: The groups were similar when compared. According to the Ahlbäck classification, 83% of the patients were in groups IV and V. The median functional score in the postoperative period was similar between the two groups. Postoperatively, the tibiofemoral angle fluctuated between 5 and 6 0 valgus on average. Two complications were observed in each group. None of the evaluated patients presented implant loosening. Conclusion: Patients treated with thick polyethylene had the same functional score as the control group, as well as the absence of radiographic changes in this short-term follow-up, with implant survival and a similar rate of complications between both groups. Level of evidence III, Retrospective study.

Objetivo: O objetivo desta pesquisa foi realizar um estudo comparativo entre as próteses Smith & Nephew ® e Zimmer ®, com polietileno espesso versus o fino, em pacientes submetidos à artroplastia total primária do joelho, durante um seguimento de curto prazo. Dessa forma, foi analisada a sobrevida dos implantes em questão sob o aspecto clínico e radiográfico. Métodos: A amostra foi dividida em dois grupos: grupo 1 com polietileno espesso e grupo 2 com polietileno fino. Foi realizada análise clínica dos pacientes e verificado se ocorreu soltura dos implantes. Resultados: Os grupos tiveram resultados semelhantes quando comparados. Segundo a classificação de Ahlbäck, 83% dos pacientes eram dos grupos IV e V. A mediana do escore funcional no pós-operatório foi similar entre os grupos. No pós-operatório o ângulo tíbio-femoral oscilou na média entre 5 e 6 0 de valgo. Foram observadas duas complicações em cada grupo. Nenhum dos pacientes avaliados apresentou soltura do implante. Conclusão: Os pacientes tratados com o polietileno espesso apresentaram o mesmo escore funcional do grupo controle, assim como ausência de alterações radiográficas nesse seguimento de curto prazo, com sobrevida do implante e índice de complicações similar entre ambos os grupos. Nível de evidência III, Estudo retrospectivo.

Effect of fatigue on knee biomechanics during the sidestep cutting manoeuvre: A modelling approach.

Loading both lateral and medial compartments is crucial to understanding the effect of muscle fatigue during sidestep cutting. The present study investigated the changes in tibiofemoral contact forces in the medial and lateral compartments and the muscle force contributions during the sidestep-cutting manoeuvre after a handball-specific fatigue protocol. Twenty female handball athletes performed three trials of the sidestep-cutting manoeuvre before (baseline) and after the fatigue protocol. Motion capture and ground reaction forces were measured, and the data were processed in OpenSim. The variables were compared using statistical parametric mapping (SPM), with a significance level of p < 0.05. The results showed a decreased knee flexion angle during fatigue in the early stance phase. In addition, the post-fatigue analysis demonstrated significantly reduced forces in vasti muscles. Similarly, during fatigue, the SPM analysis showed decreased tibiofemoral contact forces in the vertical and anterior directions. Vertical force applied to both medial and lateral condyles demonstrated a significant reduction after the fatigue protocol. These results indicated that forces applied to the tibiofemoral joint were reduced following the fatigue protocol compared to the baseline values. However, no consistent evidence exists that fatigue increases the risk of knee injuries.

Functional and radiological outcomes of total knee arthroplasty using posterior-stabilized U2 knee system: A retrospective study in 560 cases at five years of follow-up.

PURPOSE: The purpose of this study was to assess clinical and functional outcomes as well as the prosthesis survival rates of the U2 Knee system in primary total knee arthroplasty (TKA) with a minimum follow-up of four years. METHODS: We retrospectively analyzed 560 consecutively primary TKA performed between 2015 and 2019 due to osteoarthritis with a mean follow-up of 5.4 ± 1.1 years. The clinical outcomes were assessed using the knee society score (KSS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic outcomes were assessed using the American knee society's roentgenographic evaluation system. Prosthetic survival was calculated using the Kaplan-Meier method. RESULTS: Postoperative KSS showed significant improvement at one year (Clinical: 37.4 ± 4.1 vs. 91.9 ± 3.7; p < 0.01; Functional: 41.2 ± 3.3 vs. 90.6 ± 4.8; p = < 0.01), with these improvements maintained throughout the follow-up period. The WOMAC score improved from 60 ± 10.1 preoperatively to 10.9 ± 8.3 (p = 0.02) at the end of the follow-up. There were 20 (3.7%) knees with radiolucent lines around the implant (< 2 mm), and none showed evidence of loosening. There were six (1.1%) revisions-four due to prosthetic joint infections and two due to periprosthetic femur fracture. The prosthetic survival was 97.8% at the study closure. CONCLUSION: The U2 knee system demonstrates effective and safe performance for primary TKA with significant improvements in functional scores, patient-reported outcomes, and a promising prosthesis survival rate at mid-term follow-up. We will continue with the series analysis to assess the long-term outcomes.