Abstract Purpose Restoration of medial soft-tissue restraint is essential in the surgical treatment of lateral patellofemoral instability. While anatomic medial patellofemoral ligament reconstruction (MPFLR) has become the preferred technique, non-anatomic procedures such as vastus medialis advancement (VMA) are still used in selected clinical scenarios. However, controlled biomechanical data comparing these techniques remain limited. This study aimed to evaluate and compare the tensile behavior of VMA and MPFL reconstruction using a cadaveric biomechanical model. Methods Ten fresh-frozen human cadaveric knees were mounted in a custom-designed biomechanical testing apparatus that simulated physiological quadriceps loading. Progressive lateral force was applied to reproduce patellar dislocation, and the failure load of the native medial patellofemoral ligament was recorded. Specimens were then randomized into two groups: MPFL reconstruction (n = 5) and vastus medialis advancement (n = 5). Tensile testing was repeated following each procedure, and the forces required to produce 10, 20, 30 and 40 mm of lateral patellar displacement were measured and analyzed. Results Following reconstruction, the MPFLR group demonstrated numerically higher tensile force values at 10, 20, and 30 mm of lateral patellar displacement compared with the native condition, whereas the VMA group exhibited lower tensile force values across this physiologically relevant displacement range. At 40 mm displacement, which exceeds physiological patellar translation and reflects failure behavior rather than functional stability, a reduction in tensile force was observed in both groups. Overall, mean tensile force values tended to be higher in the MPFLR group than in the VMA group; however, no statistically significant differences were observed between the two techniques in either the medial soft-tissue injury induction test or the post-reconstruction tensile rupture test (p > 0.05 for all comparisons). Conclusion In this cadaveric biomechanical study, medial patellofemoral ligament reconstruction and vastus medialis advancement demonstrated different construct behavior patterns, with no statistically significant differences in the tensile force required to achieve lateral patellar displacement.

Introduction Converting previously operated knees with high tibial osteotomy (HTO) to total knee arthroplasty (TKA) poses significant technical challenges due to the altered anatomy and geometry of the proximal tibia. Objectives This study compared prosthetic component positioning in TKAs performed after closed wedge HTO (CWHTO) versus those performed after dome HTO (DHTO). Methods A total of 36 TKAs performed with a history of HTO (19 CWHTO and 17 DHTO) were retrospectively reviewed. Demographic variables, anatomical femorotibial angle, and TKA components alignment were assessed. Patellar position was assessed using the Insall–Salvati ratio. Additionally, joint line height and posterior tibial slope were recorded. Tibial tubercle osteotomy, and perioperative complications were evaluated. Results There were no differences in the demographic variables between both groups. The femorotibial angle and prosthesis alignment was comparable between the CWHTO and DHTO groups (P > .05). Tibial tubercle osteotomy was performed in the CWHTO group in 1 knee (5%) and in the DHTO group in 4 knees (24%), with no statistically significant difference between the groups (P = .17). The Insall–Salvati ratio was comparable between both groups preoperatively and postoperatively (P = .85, P = .58). No significant differences were observed between the groups in terms of joint line height, posterior tibial slope, or complication rates. Tibial augmentation utilized only in DHTO group (P = .04, ). Conclusions Radiological outcomes and prosthesis alignment of TKA following both HTO were comparable; however, the intraoperative approach appeared to be more technically demanding in the DHTO group.

29 Mayis 2010 TOTBID-TOTEK Ortopedi ve Travmatoloji Uzmanlik Egitimi Gelisim Sinavi (UEGS) Degerlendirme Raporu

Purpose: This study aimed to evaluate the efficacy of carboxymethylcellulose (Seprafilm®) for the prevention and treatment of arthrofibrosis in rabbit knees, as well as to investigate its underlying mechanisms of action against fibrosis and adhesion formation. Methods: Sixteen male New Zealand white rabbits were randomly divided into two groups: a control group and a treatment group that received Seprafilm® following surgically induced arthrofibrosis in the knee joint. Macroscopic and histological assessments were performed to evaluate adhesion, fibrosis, inflammation, and edema. Results: In the control group, macroscopic adhesion was severe in five rabbits (62.5%), moderate in two (25%), and minimal in one (12.5%). No macroscopic adhesion was observed in the Seprafilm® group. The mean adhesion score was 2.5 ± 0.75 in the control group versus 0 in the treatment group (p < 0.001). Histologically, five rabbits (62.5%) in the control group showed significant fibrosis, and three (37.5%) showed moderate fibrosis, whereas all rabbits in the Seprafilm® group exhibited only minimal fibrosis (p < 0.001). Conclusions: Seprafilm® was effective in reducing both macroscopic and histological signs of adhesion and fibrosis in a rabbit arthrofibrosis model. These findings suggest its potential as a preventive and therapeutic agent in managing arthrofibrosis.

Aim: Septic arthritis among adults most commonly affects the knee, hip, and shoulder joints, and is often treated with urgent surgical intervention. Although certain laboratory findings are considered definitive for diagnosis, a broad range of clinical and laboratory parameters can be observed. In this study, we evaluated the clinical and laboratory characteristics of adult patients who underwent joint aspiration with a preliminary diagnosis of septic arthritis. Materials and Methods: A retrospective chart review was conducted to identify patients who underwent knee joint arthrocentesis for suspected septic arthritis between January 2020 and March 2024. Demographic data, synovial fluid analyses, laboratory parameters, physical examination findings, empirically initiated and culture-guided antibiotic treatments were recorded. Results: Total of 159 patients included. Of those, 81 (50.9%) were male and 78 (49.1%) were female. Median age was 58 years (range 18-88). Mean WBC count was 10,366/mL (SD+ 4051.1), and the mean CRP was 106.84 mg/L (SD +87.2). 71 (44.6%) were clinically diagnosed with septic arthritis. Positive cultures were obtained in 36 patients. The most frequently isolated organisms were Staphylococcus aureus (n=20). Among the physical examination findings, pain was the most frequently observed, present in 92 of 159 patients (57.8%). Swelling was the second most common finding, identified in 90 patients (56.6%), followed by limitation of movement in 68 patients (42.7%). Discussion: Septic arthritis of the knee may present with a wide spectrum of clinical and laboratory findings. Diagnosis should rely on the synthesis of these parameters and remain essentially clinical, rather than being based on a single variable.

BACKGROUND:Various functional and radiological systems have been developed to evaluate joint health and the severity of arthropathy in hemophilic patients. Clinical relevance of these radiological systems has received minimal attention. METHODS:Through a retrospective chart review, 84 patients with end-stage hemophilic arthropathy of the knee were included. Pettersson and Arnold-Hilgartner scores were assessed by two observers. Correlation between radiological stage and range of motion (ROM), KSS function subscores, KSS pain subscores, total KSS, and surgical time were analyzed. RESULTS:Interobserver correlation was found to be very strong for Pettersson score, with a value of 0.84 (95% CI: 0.75-0.89) and moderate for the Arnold-Hilgartner with kappa value of 0.4 (95% CI: 0.17-0.62). Correlation between Pettersson score and clinical variables revealed a very weak inverse correlation with ROM (r = -0.12, 95% CI: -0.33 to 0.10), KSS pain (r = -0.09, 95% CI: -0.31 to 0.12), and KSS function (r = -0.16, 95% CI: -0.36 to 0.06), and weak inverse correlation with KSS (r = -0.24, 95% CI: -0.44 to 0.2). Regarding the correlation between Arnold-Hilgartner score, a weak inverse correlation was observed with ROM (r = -0.21, 95% CI: -0.41 to 0.00), and very weak inverse correlations with KSS pain (r = -0.06, 95% CI: -0.16 to 0.27), KSS function (r = -0.00, 95% CI: -0.22 to 0.21), and KSS (r = -0.04, 95% CI: -0.25 to 0.18). CONCLUSION:Radiologic staging systems demonstrate weak correlation with clinically meaningful variables in patients with end-stage hemophilic arthropathy of knee, an important consideration in the management of hemophilic arthropathy.

BACKGROUND:The aim of our study is to compare the efficacy of epoprostenol and viscum album in the treatment of femoral head avascular necrosis with an experimental study. Our hypothesis is that viscum album, which has similar properties to epoprostenol on the vascular system, is as effective as epoprostenol in the treatment of avascular necrosis. METHODS:Avascular necrosis was created on the femoral heads of 45 New Zealand type rabbits by surgical vascular deprivation method. The rabbits were divided into 3 groups. Group 1 was designed as a control group, in group 2 Ilomedin (epoprostenol analogue) was administrated to subjects and in group 3, Helixor (viscum album extract) was administrated. At the end of the study, there were nine subjects in each group. Osteocyte necrosis, bone marrow necrosis, new bone formation and cartilage degeneration were evaluated microscopically. The extent of bone necrosis and repair and involvement of epiphysis, the bone marrow cellularity ratio and trabecular bone volume were investigated. RESULTS:Subchondral necrosis was seen in more animals in the control group (p=0.03). Osteoblastic and osteoclastic activity were more prominent in the Ilomedin group (p=0.25 and 0.07, respectively). It was seen that the cartilages of the subjects in the Helixor and Ilomedin groups were less damaged. In the Ilomedin group, more animals were seen in the chronic phase of the repair process than in the other groups (p=0.07). Bone marrow cellularity was higher in treatment groups (22% and 20,6% for Ilomedin and Helixor, respectively, p=0,04). Trabecular volume was found to be increased in damaged femoral heads in the treatment groups, the highest increased observed in the Helixor group (p=0.01). CONCLUSION:Viscum album seems to be effective in decreasing the extention of necrosis and protecting the articular cartilage, and epoprostenol in increasing repair and regeneration.

BACKGROUND:Intraoperative challenges and complications and their course over experience in total knee arthroplasty (TKA) applications in hemophilic arthropathy have seldom been studied. Our study aimed to analyze the learning dynamics and the evolving perspective of a single arthroplasty surgeon in hemophilic knees. METHODS:The study encompassed all primary TKAs performed on hemophilic patients by a single experienced arthroplasty surgeon from May 2002 to October 2023. A total of 90 knees from 63 patients were included in the final analysis. Demographic characteristics, range of motion (ROM), degree of flexion contracture, and hip-knee angle (HKA) were noted. Anesthesia type, tourniquet duration, surgical approach, need for bone graft use, and lateral retinacular release (LRR) were also documented. Cases were categorized into three groups: the initial 30 cases (Group A), the subsequent 30 cases (Group B), and the final 30 cases (Group C). RESULTS:All groups were homogenous in terms of age (P = 0.102), HKA (P = 0.696), ROM (P = 0.582), and degree flexion contracture (P = 0.546). Extended approaches were needed in seven cases (23.3%) in Group A, and in two cases (6.7%) in Group B. There was no need for extended exposure in Group C. LRR application rate and tourniquet time showed no differences across groups (P = 0.401, P = 0.482). The intraoperative problem rate exhibited a statistically significant decrease throughout the series (P = 0.016). CONCLUSIONS:Arthroplasty in hemophilic knees poses unique challenges which require their own learning process. Intraoperative complication rate and need for utilizing extended approaches decreases after the initial 30 cases and decreases further after the subsequent 30 cases.

Abstract Introduction Medial open wedge high tibial osteotomy is a biological procedure for treating unicompartmental knee osteoarthritis. The literature repeatedly highlights the significance of preserving an intact lateral hinge during this procedure. We investigated the temporal course of distraction forces during distraction at the osteotomy site, aiming to quantitatively measure and analyse temporal changes in distraction forces at different distraction points for intact and fractured lateral hinges. Materials and Methods This biomechanical study was conducted on 10 human cadavers, which were divided into two groups: one with preserved 1 cm intact lateral cortexes (ILCs) and the other with completely osteotomised fractured lateral cortexes (FLCs). An experimental setup was custom designed to facilitate the required force measurement during distraction. The distraction forces were recorded with a force gauge at 0.5‐mm intervals throughout the distraction. Results There was a significant difference between the ILC and FLC groups in distraction forces at all points (8–15 mm). The ILC group consistently exhibited higher distraction force values, with FLC recording values ranging from 8.8% to 13.2% of ILC's. Lateral hinge fractures caused an 86.7% reduction in the initial required force for distraction, significantly impacting the force required for distraction. The ILC group displayed a linear increase in the required distraction force up to 12.5 mm of distraction, which reached 3.7 times the initial value at 12.5 mm of distraction. The FLC group had lower baseline required distraction forces, following a relatively linear trend with more limited increases. Conclusion FLCs in medial opening wedge osteotomy are associated with significant reductions in the force required for distraction, and a sudden decrease in distraction force during distraction may indicate a lateral hinge fracture. Force measurement devices for use during distraction could offer valuable insights and provide surgeons with immediate warnings for LHFs. Level of Evidence Level IV.

INTRODUCTION:In total knee arthroplasty (TKA), choosing the correct implant size is important. There is lack of data on accuracy of templating on haemophilic knees. Our aim was to test the accuracy of 2D digital templating for TKA on haemophilic arthropathy (HA) of knee. MATERIALS AND METHODS:TKAs performed on HA between January 2011 and January 2022 were screened. Osteoarthritis (OA) group was created as control group by a one-to-one matching regarding type of implant used. Intra- and interobserver correlations were measured in HA, then correlation between templated and implanted sizes was investigated in four assessments (femur AP, femur lateral, tibia AP, tibia lateral), then compared with OA group. Fifty-eight knees in each group included. RESULTS:Regarding intraobserver correlation in HA, there was excellent correlation for femur AP [.93 (.73-.98)], femur lateral [.98 (.91-.99)], and tibia AP (1.0) templating. Regarding interobserver correlation in HA, excellent correlation was observed for femur lateral [.93 (.74-.98)] and tibia AP templating [.90 (.65-.97)]. Regarding correlation of templated and applied sizes in HA; tibia AP, tibia lateral and femur lateral templating showed good correlation [.81 (.70-.89), .86 (.77-.91), .79 (.67-.87) while femur AP templating showed moderate correlation [.67 (.50-.79)]. Comparing HA and OA, there was no difference in correlation levels regarding femur AP, femur lateral, tibia AP and tibia lateral templating (p = .056, p = .781, p = .761, p = .083, respectively). CONCLUSION:Although 2D digital templating shows comparable correlation in HA and OA, clinical applicability of templating on HA appears to be limited in its current state.

INTRODUCTION:Knees affected by haemophilic arthropathy exhibit distinct differences in both bone morphology and soft tissue behaviour. This study aims to analyse the morphological characteristics of the distal femur and patellofemoral joint in patients with haemophilia in comparison to normal healthy population.MATERIAL AND METHODS:Study was conducted as pair-matched case-control study with 43 individuals in both the haemophilia group and the control group. Patellar luxation, patellar tilt (PT), length of the patella in both axis (pAP, pML), depth and angle of trochlear sulcus (SD, SA), lateral trochlear inclination (LTI), medial and lateral femoral facet length (mFL, LFL), intercondylar depth (ID), transepicondylar axis (TEA) and lateral condyle length (LCL) were assessed on knee MRI. Correlation between Pettersson score and measured variables were also analysed.RESULTS:PT was medial sided in 10 (23.2%) cases in haemophilic group. Mean values of pAP, pML, PT were significantly lower in haemophilia group (p < .001, p: .007, p = .001 respectively). There were no significant changes in SA (p = .628), SD (p = .340), LTI (p = .685), LFL (p = .241) and MFC-LFC (p = .770) whilst mFL was significantly longer in haemophilia group (p = .009). ID (p < .001), TEA (p = .007) and LCL (p = .001) were all shorter in haemophilia group. Pettersson score was inversely correlated with pAP, pML, ID, TEA, LCL, pML/SA and ID/LCL.CONCLUSION:Morphological changes in haemophilic arthropathy involve a smaller and medially-tilted patella, narrowed lateral condyle and transepicondylar axis, combined with reduced intercondylar depth. These alterations must keep in mind especially in pre- and intraoperative assessments for arthroplasty procedures.

Objective:This study aimed to compare preoperative and postoperative measures in haemophiliacs who had simultaneous total hip and knee arthroplasties. Methods:A retrospective database search identified five patients with severe factor 8 deficiencies who underwent simultaneous hip and knee joint replacement surgery between 2002-2018. Preoperative and postoperative evaluations included Harris Hip Score (HHS), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion, flexion contracture (FC), Visual Analog Scale (VAS), hip-knee angle, and leg length discrepancy. Results:The mean age of the patients was 50.8 years, with a mean follow-up duration of 60 months. Preoperative knee ROM was 55 degrees, improving to 73.8 degrees postoperatively. Preoperative knee FC was 13.7 degrees, improving to 10 degrees postoperatively. HHS increased from 45.6 to 75.7, KSS increased from 36 to 69.3, and KOOS total score increased from 34.4 to 82.7. VAS scores decreased from 6.3 to 1.3. One patient experienced prolonged bleeding and subsequent complications, while the others showed significant improvements. Conclusion:Simultaneous hip and knee arthroplasties in hemophiliacs may provide benefits in terms of physical and functional gains. However, the increased risk of complications necessitates careful patient selection. For patients with comorbidities, staged surgeries may be advisable to avoid potential complications. Level of Evidence:Level IV, Therapeutic study.