Restricted kinematic alignment in primary total knee arthroplasty: A systematic review of radiographic and clinical data

Risitano, Salvatore; Cacciola, Giorgio; Sabatini, Luigi; Capella, Marcello; Bosco, Francesco; Giustra, Fortunato; Massè, Alessandro; Vaishya, Raju

doi:10.1016/j.jor.2022.06.014

Cited by 27 publications

(18 citation statements)

References 32 publications

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“…KA TKA aims to recreate the natural knee joint-line pre-arthritic alignment by restoring the three axes, resulting in natural knee kinematics [ 21 ]. Despite KA’s theoretical advantages, literature results are contradictory because some studies reported improved PROMs [ 22 , 23 ], while others described no significant differences between KA and MA TKA [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

Giustra

Bosco

Cacciola

et al. 2022

JCM

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In the last decades, several surgical techniques, such as medial pivot (MP) philosophy and kinematic alignment (KA), have been introduced in total knee arthroplasty (TKA) to improve patients’ outcomes. This retrospective study aims to evaluate the clinical, radiographic, and functional results of PCL preservation or sacrifice in KA MP-TKA. A consecutive series of 147 patients older than 60, with a minimum follow-up of two years, were treated with TKA for severe primary knee osteoarthritis (OA) at the Department of Orthopedics and Traumatology between 1 January 2019, and 1 July 2020. After excluding those not meeting the inclusion criteria, 64 patients were included in the study analysis. Regarding radiographic outcomes, no statistically significant difference was observed between patients with preserved or sacrificed PCL (p > 0.05). A slight improvement in Knee Society Score (KSS), knee and function score, and FJS was observed for the PCL-preserved group, although this superiority tendency was not statistically significant (p > 0.05). PCL-preserved MA MP-TKA reported a statistically significant result in only two questions on the FJS questionnaire (p < 0.05). A slight, non-statistically significant improvement in active ROM was found in the PCL-sacrificed group (p > 0.05). No interventions or revisions were reported in this case series for all treated patients at the final follow-up. No significant differences were described in clinical, radiographic, and functional outcomes in preserved or sacrificed PCL KA MP-TKA. Although not significant, a slight trend toward better clinical outcomes was reported in PCL-preserved KA MP-TKA.

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Section: Introductionmentioning

confidence: 99%

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

Giustra

Bosco

Cacciola

et al. 2022

JCM

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“…This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 35 – 38 ]. The PICO(TS) algorithm was preliminary pointed out: P (population): ACL tears; I (intervention): ACL repair; C (comparison): ACL reconstruction; O (outcomes): laxity, PROMs, failures.…”

Section: Methodsmentioning

confidence: 99%

Reduced knee laxity and failure rate following anterior cruciate ligament reconstruction compared with repair for acute tears: a meta-analysis

et al. 2023

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Background Following anterior cruciate ligament (ACL) tears, both repair and reconstruction may be performed to restore joint biomechanics and proprioception. The present study compared joint laxity, patient-reported outcome measures (PROMs), and rate of failure following primary repair versus reconstruction for ACL ruptures. Methods This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Google scholar, Embase, and Web of Science were accessed in September 2022. All the clinical investigations comparing repair versus reconstruction for primary ACL tears were accessed. Studies reporting data on multiple ligament injuries settings were not eligible. Results Data from eight articles (708 procedures) were collected. The mean length of the follow-up was 67.3 ± 119.4 months. The mean age of the patients was 27.1 ± 5.7 years. Thirty-six percent (255 of 708 patients) were women. The mean body mass index (BMI) was 24.3 ± 1.1 kg/m2. The mean time span from injury to surgery was 36.2 ± 32.3 months. There was comparability at baseline with regards to instrumental laxity, Lachman test, International Knee Document Committee (IKDC), and Tegner Scale (P > 0.1). Similarity between ACL reconstruction and repair was found in IKDC (P = 0.2) and visual analog scale (VAS) satisfaction (P = 0.7). The repair group demonstrated greater mean laxity (P = 0.0005) and greater rate of failure (P = 0.004). Conclusion ACL reconstruction may yield greater joint stability and lower rate of failure compared with surgical repair. Similarity was found in PROMs. Level of evidence: III

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“…The WOMAC, which is widely used in patients with knee arthritis (intraclass correlation coefficient, ICC = 0.92), consists of 24 subjective questions about knee joint pain and functional limitations that can be felt daily [ 34 , 35 ]. The evaluation consisted of three subscales: pain, stiffness, and body function.…”

Section: Methodsmentioning

confidence: 99%

“…The evaluation consisted of three subscales: pain, stiffness, and body function. Therefore, compared to other evaluation tools, the questions were formed on a simple and detailed scale such that knee joint pain and functional impairment can be evaluated very effectively [ 35 ]. In this study, the items on the pain scale ranged from 0–20 points, those on the stiffness scale ranged from 0–8 points, and those on the physical function scale ranged from 0–68 points.…”

Section: Methodsmentioning

confidence: 99%

Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

Son

Lee

2023

IJERPH

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Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. However, evidence of combined kinematic chain exercise (CCE) in early-phase rehabilitation after TKA remains lacking. This study investigated the effects of CCE training on physical function, balance ability, and gait in 40 patients who underwent TKA. Participants were randomly assigned to the CCE (n = 20) and open kinematic chain exercise (OKCE) groups (n = 20). The CCE and OKCE groups were trained five times a week (for 4 weeks) for 30 min per session. Physical function, range of motion (ROM), balance, and gait were assessed before and after the intervention. The time × group interaction effects and time effect as measured with the Western Ontario and McMaster Universities Osteoarthritis Index, ROM, Knee Outcome Survey-Activities of Daily Living, balancing ability (e.g., confidence ellipse area, path length, and average speed), and gait parameters (e.g., timed up-and-go test, gait speed, cadence, step length, and stride length) were statistically significant (p < 0.05). In the group comparison of pre- and postintervention measurements for all variables, the CCE group showed substantial improvements compared to the OKCE group (p < 0.05). Both groups showed significant within-group improvement from baseline to postintervention. Our results suggest that CCE training positively affects physical function, balance ability, and gait as an early intervention for patients undergoing TKA.

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Restricted kinematic alignment in primary total knee arthroplasty: A systematic review of radiographic and clinical data

Cited by 27 publications

References 32 publications

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

No Significant Differences in Clinical and Radiographic Outcomes between PCL Retained or Sacrificed Kinematic Aligned Medial Pivot Total Knee Arthroplasty in Varus Knee

Reduced knee laxity and failure rate following anterior cruciate ligament reconstruction compared with repair for acute tears: a meta-analysis

Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

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