Preoperative muscle thickness influences muscle activation after arthroscopic knee surgery.

PURPOSE: The aim of this study was to compare the correlation between preoperative quadriceps femoris muscle thickness and postoperative neuromuscular activation and quadriceps femoris strength in patients with and without patellofemoral pain after arthroscopic partial meniscectomy. METHODS: A series of 120 patients were prospectively analysed in a longitudinal cohort study of patients scheduled for arthroscopic partial meniscectomy. The patellofemoral pain group included patients who developed anterior knee pain after surgery while the control group included those who had not done so. Patients with preoperative patellofemoral pain, previous knee surgeries as well as those on whom additional surgical procedures had been performed were excluded. Of the 120 initially included in the study, 90 patients were analysed after the exclusions. RESULTS: There is a direct correlation between preoperative quadriceps femoris muscle thickness and the neuromuscular activity values and the strength of the muscle at 6 weeks after surgery. These results were seen exclusively in the group of patients who do not develop patellofemoral pain (0.543, p = 0.008). The group of patients who developed anterior knee pain in the postoperative period did not show this correlation (n.s.). CONCLUSION: In patients without patellofemoral pain after meniscectomy, the greater the preoperative thickness of the quadriceps femoris, the more postoperative neuromuscular activation and strength they had. This correlation did not occur in those patients who develop patellofemoral pain after meniscal surgery. LEVEL OF EVIDENCE: II.

Positioning of the metaglene in reverse shoulder arthroplasty: deltopectoral versus anterosuperior approach: a prospective randomized trial.

BACKGROUND: The primary objective of this study was to determine whether there are differences in metaglene positioning related to the approach used (deltopectoral vs. anterosuperior) in primary reverse shoulder prosthesis (reverse shoulder arthroplasty) implantation. The hypothesis was that there would be no differences in metaglene positioning between the 2 approaches. METHODS: A prospective randomized trial was designed to evaluate metaglene positioning in primary reverse shoulder arthroplasty. The patients included were allocated to either the deltopectoral approach (group I) or the anterosuperior approach (group II). Glenosphere overhang and glenosphere tilt were assessed using the methods described by Lévigne et al, Simovitch et al, and Kempton et al, and the beta angle was assessed as described by Maurer et al. The functional outcome was assessed with the Constant score at 2 years' follow-up. Scapular notch development and complication rates were also recorded. RESULTS: A total of 98 patients (77 women and 21 men) were randomized and allocated to group I (49 patients) or group II (49 patients). The mean age of the patients was 74.4 years (standard deviation, 6.3 years). Glenosphere overhang did not show significant differences between groups (6.5 mm in group I vs. 6.1 mm in group II by the Lévigne method, P = .482; 2.2 mm in group I vs. 2.1 mm in group II by the Simovitch method, P = .08). Glenosphere tilt was significantly different between groups (94.6° in group I vs. 86.8° in group II by the Lévigne method, P < .001; 125.9° in group I vs. 119.4° in group II by the Kempton method, P = .002). This was also the case for the prosthesis-scapular neck angle (94.6° in group I vs. 86.8° in group II, P < .001). Moreover, the postoperative beta angle was significantly different between groups (78.6° in group I vs. 73.8° in group II, P = .001). No significant differences were noted in terms of functional outcomes as measured with the Constant score (P = .16). No significant differences between groups were noted relative to scapular notch development and the overall complication rate. DISCUSSION: The deltopectoral and anterosuperior approaches do not differ relative to the craniocaudal positioning of the metaglene, but a slight superior tilt can be expected when using the anterosuperior approach. Both approaches yield comparable functional outcomes, scapular notch development, and complication rates at 2 years' follow-up.

Patellofemoral Pain After Arthroscopy: Muscle Atrophy Is Not Everything.

BACKGROUND: It remains unclear as to why patellofemoral pain (PFP) appears in some patients after knee arthroscopy and what influence the quadriceps muscle has on its onset. PURPOSE: To compare muscle thickness, neuromuscular contractility, and quadriceps femoris muscle strength between patients who develop PFP after arthroscopic partial meniscectomy and a control group and to compare functional outcomes between these entities. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A prospective longitudinal cohort study was carried out on patients scheduled for arthroscopic partial meniscectomy. Patients were excluded if they had preoperative PFP, previous knee surgery, or additional surgical procedures (eg, meniscal repair or microfracture). The following were performed preoperatively: magnetic resonance imaging to quantify muscle thickness, surface electromyography to analyze electrical contractility, and an isokinetic study to assess the strength of the quadriceps femoris muscle. Patients also completed a Lysholm functional questionnaire. Six weeks after the index procedure, patients were questioned about the presence of PFP, and the same tests were repeated. The PFP group included patients who developed anterior knee pain postoperatively, while the control group included those who did not develop pain. RESULTS: Of 90 initial study patients, 20 were included in the PFP group (23.8%) and 64 in the control group (76.2%); 6 patients were lost to follow-up. Both study groups were comparable on all of the analyzed preoperative variables. Patients in the PFP group had worse results in terms of muscle thickness (9.67 vs 16.55 cm2), electrical contractility (1226.30 vs 1946.11 µV), and quadriceps strength (12.27 vs 20.02 kg; all P < .001). They also presented worse functional results on the Lysholm score (63.05 vs 74.45; P < .001). CONCLUSION: Patients who developed PFP after arthroscopic partial meniscectomy had more quadriceps femoris muscle atrophy as well as a greater decrease in electrical contractility and muscle strength at 6 weeks postsurgically as compared with a control group. The PFP group also had worse postoperative functional results.

Depressed patients feel more pain in the short term after total knee arthroplasty.

PURPOSE: The hypothesis of this study was that depressive patients feel more pain in the immediate TKA postoperative period in comparison with non-depressed patients. METHODS: The diagnosis of depression was made with the Geriatric Depression Scale Short Form. The Visual Analogic Score (VAS) was registered each 8 h during the first 3 days. The mean and maximum VAS and the number of analgesic rescues required in this period were calculated in 803 consecutive TKAs. The Knee Society Score (KSS), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) scores were obtained preoperatively and at the 1-year follow-up. RESULTS: Forty-eight (6%) of these patients were considered depressed. The results obtained in the depressed patients and non-depressed were, respectively, mean VAS (2.0 vs 1.0, p = 0.00), maximum VAS (5.3 vs 1.6, p = 0.00), and number of rescues needed (4.4 vs 1.8, p = 0.00). Although depressed patients scored worse in the functional and quality of life scores in the preoperative period, the improvement obtained (1-year outcomes minus preoperative outcomes) in the different scores was similar in both groups with the exception of the mental domain of the SF-36, which improved further in depressed patients (p = 0.00). CONCLUSION: Depressed patients feel more pain in the immediate postoperative period. However, the improvement obtained in functional and referred quality of life scores is similar to non-depressed patients. LEVEL OF EVIDENCE: II.