Knee
Elsiddig Elhadi Mahmoud; Mohamedalmontazar Moawia Malik; Khalid Elfadil Husein
Abstract
Background: Acquiring knowledge about anatomic and geometric measurement of bone is among the most vital parameters in knee arthroplasty and has a significant effect on the subsequent outcomes. The aim of this study is to obtain anthropometric measurements of the distal femur of adult Sudanese Population ...
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Background: Acquiring knowledge about anatomic and geometric measurement of bone is among the most vital parameters in knee arthroplasty and has a significant effect on the subsequent outcomes. The aim of this study is to obtain anthropometric measurements of the distal femur of adult Sudanese Population and to compare the results with other populations.Methods: This descriptive study conducted at Alamal hospital in Khartoum, Sudan, between Sep. 2020 and Feb. 2021, included all adult patients attending the radiology clinic for CT scan with normal knees. The Femoral medio-lateral (ML) and anteroposterior (AP) dimensions of the distal femora were measured. The collected data was analysed using statistical package for social science (SPSS).Results: 385 adult Sudanese were studied. The mean age was 59.1±18.5 years (Range 20-86 years). 69.9% were male and 30.1% female. 45% were left knees and 55% right. The mean ML diameter was 76.6±6.0mm (rang 66.7-88.2mm), and the mean of AP was 45.640±4.9 mm (range 37.2-54mm). The anthropometric measurements of the distal femur of Sudanese people fall between Greek and Korean.Conclusion: There were differences in mean ML and AP dimensions between the Sudanese population and other ethnic groups which should be kept in mind when designing Total Knee Arthroplasty implants.
mohammad fakor; mohammad sakiani; maryam hadad shoshtari; mohammad ghasem hanafi
Abstract
AbstractBackground: Postoperative Deep Vein Thrombosis (DVT), a subtype of Venous Thromboembolism (VTE), is a significant preventable cause of morbidity and mortality worldwide. VTE is estimated to occur at a rate of one per 1,000 people per year, with DVT accounting for approximately two-thirds of these ...
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AbstractBackground: Postoperative Deep Vein Thrombosis (DVT), a subtype of Venous Thromboembolism (VTE), is a significant preventable cause of morbidity and mortality worldwide. VTE is estimated to occur at a rate of one per 1,000 people per year, with DVT accounting for approximately two-thirds of these events. DVT continues to be a common complication of knee arthroscopy. The purpose of this study is to determine the prevalence of DVT in patients who have undergone arthroscopic knee surgery.Methods: Patients over the age of 18 years who underwent arthroscopic knee surgery in a teaching hospital were evaluated for VTE clinically and via lower limb Doppler ultrasonography prior to, three days after, and four weeks after surgery. The incidence of DVT was determined and associated with risk factors such as age, sex, duration of immobility, and duration of surgery. Afterward, statistical analysis was performed on the data.Results: The prevalence of DVT was 3.1% in 318 patients undergone knee arthroscopy with a mean age of 34.31 years. The mean duration of surgery was 96.30 minutes across all patients. In 96.9% of patients, there was no evidence of DVT. Additionally, there was no significant association between DVT prevalence and gender, age, surgery type, duration of surgery, or presence of edema in patients (p = 0.551). The patients' mean duration of absolute rest was 61.89 hours. Absolute rest time was significantly longer in patients with positive DVT than in patients with negative DVT (p = 0.001).Conclusion: While knee arthroscopy can be performed as an outpatient procedure, the risk of postoperative DVT is unknown. The incidence of DVT following arthroscopic knee surgery was 3.1% in this study, a necessary precondition for perioperative thromboprophylaxis.
Knee
Alireza Naseri; Abbasali Dehghani; Mohammad Reza Moharrami
Abstract
Introduction: Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee ...
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Introduction: Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee replacement surgery in patients with a history of chemotherapy.Methods: This descriptive-analytical study was performed on 189 candidates for knee replacement surgery who had a history of chemotherapy during 36 months ending in March 2016 and referred to Shohada and Imam Reza hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. After surgery, patients were evaluated for the incidence of DVT and the factors, influecing it based on the instrument of determining DVT and Doppler ultrasound. Statistical analysis was completed by Spearman’s correlation and regression tests.Results: The mean standard deviation of DVT score was 43.49 ± 6.66, which indicates that after knee replacement surgery, patients with a history of chemotherapy are at high risk for DVT. The prevalence of DVT was 25.92% (N=49) and the number of chemotherapy sessions (P=0.001) correlated with the occurrence of DVT.Conclusion: The prevalence of DVT following knee replacement surgery in people with a history of chemotherapy is above the normal mean reported in the literature. Consequently, further therapeutic and preventive measures are required.
Knee
amir salari; Mehran Soleymanha; zahra ahmadnia; arsalan salari; tolou hasandokht
Abstract
Introduction: According to the literature, cardiovascular diseases are highly prevalent globally, while there is an increased risk of cardiovascular-related death in osteoarthritic patients. Therefore, the present study intended to investigate the cardiovascular risk factor prevalence in osteoarthritic ...
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Introduction: According to the literature, cardiovascular diseases are highly prevalent globally, while there is an increased risk of cardiovascular-related death in osteoarthritic patients. Therefore, the present study intended to investigate the cardiovascular risk factor prevalence in osteoarthritic patients.Methods: This cross-sectional, descriptive study was performed at the orthopedics clinics of the Guilan University of Medical Sciences in 2017. The inclusion criteria were the 40-75-year-old patients who were selected using the convenience sampling method. They were diagnosed with osteoarthritis, and gave informed consent for participation. The study data included demographics, cardiovascular risk factors, medical history, and anthropometric measurements. After a qualitative analysis, the data were analyzed using the SPSS software version 16.Results: A total of 100 patients with knee osteoarthritis, including 79 female and 21 male patients with the mean age of 53.9±11.9 years, were included in the study. The prevalence of diabetes, hypertension, obesity, metabolic syndrome, and smoking in the participants was 31%, 33%, 45%, 51%, and 9%, respectively. 12% reported a history of previous heart attacks. Moreover, the prevalence of diabetes, obesity, hypertension, and metabolic syndrome was higher in women than men. Also, the mean age of the male patients was significantly higher than women (P = 0.03).Conclusion: Given the high prevalence of cardiovascular risk factors in osteoarthritis patients, it is essential to notice the early cardiovascular disease detection in patients with knee osteoarthritis, especially in female patients.
Knee
mohamad sheibani; mahmoud karimi.mobarake; hamid karimifard
Abstract
Introduction: The most common cause of knee pain is knee osteoarthritis, many surgical and non-surgical treatments have been proposed but the preferred treatment remains unknown. One of the non-surgical treatments was PRP (plasma reach platate) injection in these patients. Various studies have shown ...
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Introduction: The most common cause of knee pain is knee osteoarthritis, many surgical and non-surgical treatments have been proposed but the preferred treatment remains unknown. One of the non-surgical treatments was PRP (plasma reach platate) injection in these patients. Various studies have shown the improvement of the effect of PRP injection with substances such as calcium gluconate, so the aim of this study was to evaluate the effectof PRP with and without calcium gluconate on the clinical results of intra-articular injection of this substance in patients with knee osteoarthritis.Methods: This was a cohort study in which patients were divided into two groups: PRP injection and PRP injection with calcium gluconate. The results of the study were evaluated by KOOS questionnaire and pain by VAS. A significance level of 0.05 was considered.Result: Generally, during the study, the pain level in patients after receiving both treatments significantly decreased during the six-month period, while the pain in the case group significantly decreased. (P Value <0.05).Discussion: From the results of this study, it can be concluded that simultaneous injection of PRP and calcium gluconate can further improve the results of injection.
ehsan yasrebi; iman zabbah; morteza ramezani; hamid valeh; setare salarniya
Abstract
Abstract
Background: Knee osteoarthritis is one of the common diseases in humans and due to its increasing spread, early diagnosis of this disease is very important. Consideration of cartilage volume in knee osteoarthritis studies from radiological images is very necessary. The aim of this study is ...
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Abstract
Background: Knee osteoarthritis is one of the common diseases in humans and due to its increasing spread, early diagnosis of this disease is very important. Consideration of cartilage volume in knee osteoarthritis studies from radiological images is very necessary. The aim of this study is to help improve the diagnosis of knee osteoarthritis with the help of artificial intelligence and image processing techniques.
Methods: This is a diagnostic study that has been evaluated on 957 MRI images. Images were collected from Tehran Hospital database, such that 111 samples were related to healthy individuals and 48 samples to people with knee osteoarthritis. In this study, in order to diagnose osteoarthritis automatically, a new method called “image distinguishing and teaching it to artificial neural network”,using MATLAB software was used. MRI images were received and after pre-processing they were processed to diagnose osteoarthritis conditions with the help of artificial neural networks.
Findings: Experiments show acceptable performance of the proposed method, such that using this technique the diagnose of knee osteoarthritis was possible, with 93% accuracy.
Results: the proposed model can be used in screening plans in order to identify people in danger of developing osteoarthritis and can serve as doctor assistants.
ساراسادات نبوی زاده; محسن احمدی زارعی; کامبیز ایرجی; آیدا ایرجی; پروین قایم مقام; امید کوهی حسین آبادی; آیدا حسن پور; مریم مجاهد; مهشید جمشیدی; سجاد دانشی; نادر تنیده
Abstract
Background: Osteoarthritis is a major public health consideration which leads to disability because of chronic pain, stiffness, sleeping disorder and depression. Among the herbal products Psidium Guajava L. fruit could be regarded as a potential natural remedy due to its anti-oxidant characteristics. ...
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Background: Osteoarthritis is a major public health consideration which leads to disability because of chronic pain, stiffness, sleeping disorder and depression. Among the herbal products Psidium Guajava L. fruit could be regarded as a potential natural remedy due to its anti-oxidant characteristics. The aim of this study was to evaluate the healing effect of Psidium Guajava L. fruit on osteoarthritis of the knee in rats.Methods: Forty male Sprague-Dawley rats with induced osteoarthritis by intra-articular injection of 500U of type 2 collagenase in the left knee were recruited in four treatment groups (n=10): (A) control, (B) Piascledine (10mg/kg) as positive control, (C) oral administration of hydro-alcoholic extract of Psidium Guajava L. fruit (500mg/kg), and (D) oral administration hydro-alcoholic extract of Psidium Guajava L. fruit (1000mg/kg). After 8 weeks of daily administration, the outcome was evaluated by histopathological and radiographic assessments. The data were analyzed using Kruskal-Wallis nonparametric in SPSS version 23.00, and P<0.05 was considered statistically significant.Results: Psidium Guajava extract exhibited good radical scavenging activities with IC50 of 0.46 ± 0.13 mg/mL (quercetin as a positive control). Histopathological assessments of the cartilage showed smooth and continuous articular surface with columnar cell distribution in the experimental group that received 1000mg/kg Psidium Guajava L. fruit hydro-alcoholic extract which healed better than others, especially in the control group (p-value =0.02). The radiological assessments of the knee joints showed similar findings in histopathological assessment. Conclusion: Psidium Guajava L. fruit hydro-alcoholic extract might be regarded as an effective complementary and alternative treatment for osteoarthritis of the knee in rats.
nader tanideh; Mohammad Amin Rostami Nasab; Ida Hasssanpour; Omid Koohi Hosseinabadi; Maryam Mojahed; Sara Sadat Nabavizadeh
Abstract
Background: Osteoarthritis (OA) is widespread degenerative joint disease. Although many therapeutic policies exist, no clear preventive remedy exists. Due to various side effects caused by conventional medication; we aim to evaluate the effect of leaf of Psidium guajava essential oil on animal model ...
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Background: Osteoarthritis (OA) is widespread degenerative joint disease. Although many therapeutic policies exist, no clear preventive remedy exists. Due to various side effects caused by conventional medication; we aim to evaluate the effect of leaf of Psidium guajava essential oil on animal model of OA.Methods: This 8-week animal model study was conducted on 25 male rats with induced osteoarthritis with collagenase. The rats were divided into 5 groups randomly, the first group that serves as negative control group and received intra-articular injections of saline, the second group received olive oil, the third group intra articular(IA)Hyalgan, the fourth group received low dosage (25 λ) essential oil of Psidium guajava L. leaf, and the last group which received high dosage (50 λ) essential oil of Psidium guajava L. leaf. All groups received their medication for 4 weeks. After 8 weeks from beginning of study, all of the animals were euthanized with CO2 and samples harvested. All the samples underwent histopathological and radiological evaluation and data were collected and analyzed by Kruskal-Wallis nonparametric test (distribution free) by SPSS version 23.00.Results: In histopathological findings illustrate a considerable difference between high dose (50λ) treatment group and the control group. Moreover; in radiographic findings, significant difference was observed between groups in evaluation of distribution in joint space width. (P value =0.0001)Conclusion: Essential oil of Psidium guajava L. leaf has a considerable positive effect on osteoarthritis.Trial registration: 94-01-01-9732
S Saravani; N Tanideh; M Fazeli; N Azarpira; E Nadimi; M Lotfi; Ayda Iraji; Sh Zareh
Abstract
Background: Osteoarthritis (OA) recognized, as degenerative arthritis. Synthetic drugs available to treat the OA have, the dangerous side effects and low efficacy. Therefore, using of herbal medicines is an important component of alternative and complementary medicine, Mesenchymal stem cells have ...
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Background: Osteoarthritis (OA) recognized, as degenerative arthritis. Synthetic drugs available to treat the OA have, the dangerous side effects and low efficacy. Therefore, using of herbal medicines is an important component of alternative and complementary medicine, Mesenchymal stem cells have a special site in the treatment of diseases. drugs.Psidium guajava Leaves used as antioxidant, anti-inflammatory antinociceptive and analgesic. The goals of scientific research of this study were to the evaluate the regeneration articular cartilage effect of injection of the hydroalcoholic extract of leave of Psidium Guajava with Stem Cell into the knee joints of rats.
Methods: Firstly, ninety male rats were choosen, and collagenase type II was prepared for an intra-articular knee injection, for them to induce OA in the animal models. Then, they were divided into nine treatment groups. (N = 10): (a) Sham, (b) Control, (c) injection of hyaluronic Acid intra-articular, (d) Injections of Stem Cell intra-articular, (e) Injections of PRP, (f): Injections of the extract Psidium guajava leaves (g) Injections of the extract Psidium guajava leave with PRP, (h) Injections of the extract Psidium guajava leaves with Stem Cell (i) Injections of the extract Psidium guajava leaves with Stem Cell and PRP. After 5 months, the results were assessments by a Radiologist and Histopathologist.
Results: Radiological and histopathological findings were in which the improvement of the articular cartilage was better in the leaves with Stem Cell and PRP compared with the control group(P<0.05).
Conclusions: It seems that Psidium guajava leaves can be suggested as an effective complementary and alternative treatment for OA of the knee. Because it has a lot of polyphenol compounds.
Fardin Mirzatolouei, MD; Nasrin Navaeifar, MD; Ali Tabrizi, MD; Shiva Ghayuor, MD
Abstract
Background: Bone bruise is a signal change in MRI and could be the result of bleeding or edema with microfractures in trabecular bone system. Analysis of the location of bone bruise could be a clue for mechanism of trauma. Awareness of pattern, severity and location of bone bruise and pain gives a better ...
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Background: Bone bruise is a signal change in MRI and could be the result of bleeding or edema with microfractures in trabecular bone system. Analysis of the location of bone bruise could be a clue for mechanism of trauma. Awareness of pattern, severity and location of bone bruise and pain gives a better understanding of its nature and the related concomitant injuries. In this research the relation between pain and its severity with bone bruise is investigated.
Methods: In a prospective study, 22 patients (20 males, 2 female) with mean age of 34 years old and with isolated bone bruise after a knee trauma was studied in a trauma center in Urmia, Iran. Patients scored their pain using Visual Analogue Scale (VAS). For volumetric calculation of bone bruise we used A*B*C vectors multiplication and for severity of bone bruise we used software that measures the resotution of pictures. The locations of bone bruise were also determined and recorded. Finally, the relationship between these parameters and patients’ pain were statistically analyzed.
Results: The mean pain score were 4.40±1.56 in males and 7±2.82 in females. Mean bone bruise intensity was 176.4±42.47. There was no relationship between patient's age and pain severity. There was also no significant correlation between volume or location of bone bruise and severity of pain score (p < /em>≥.05). The mean bone bruise volume was 8.77±8.12 and the mean pain sc ore was 4.63±1.78.
Conclusions: Among the multiple characteristics of bone bruise, the intensity has the most direct correlation with severity of pain.
Saeid Tabatabaei, MD; Miremad Miremarati, MD
Abstract
Background: Rupture of the anterior cruciate ligament (ACL) is the most common knee injury during sport activities. The purpose of this study was to investigate the results of ACL reconstruction using middle 1/3 of the autologous patellar ligament by miniarthrotomy approach in young patients.
Methods: ...
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Background: Rupture of the anterior cruciate ligament (ACL) is the most common knee injury during sport activities. The purpose of this study was to investigate the results of ACL reconstruction using middle 1/3 of the autologous patellar ligament by miniarthrotomy approach in young patients.
Methods: In a descriptive study, 57 patients (55 male, 2 female) at age of 20 to 45 years old, who were referred with ACL rupture and treated with ACL reconstruction using autograft bone-patellar-bone during a 2-year period in a training hospital in Ahvaz, Iran, were studied. The clinical results were investigated with an 11.7 months (7-28 months) follow-up, using Lysholm Knee Score, and physical re-evaluation.
Results: In 33 cases, right knee and in 24 left knee was affected. Eighty-six percent of the patients had no limitation in knee motion after surgery, and 82 percent had no knee instability. Ninety-six percent of the patients could return to the pre-injury sport activity. The mean Lysholm knee score was 83.63 (69-93).
Conclusions: Reconstruction of the anterior cruciate ligament using autograft bone-patellar-tendon with miniarthrotomy has clinically acceptable results.
Fardin Mirzatolouei, MD; Hossein Alizadeh, MD
Abstract
Background: Wrong placement of the ACL transplant especially in femoral site can result in early graft failure. Anatomical placement of the femoral tunnel results in restoration of knee kinematics closer to those of the intact knee. This placement could be performed by either using “aimer device” ...
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Background: Wrong placement of the ACL transplant especially in femoral site can result in early graft failure. Anatomical placement of the femoral tunnel results in restoration of knee kinematics closer to those of the intact knee. This placement could be performed by either using “aimer device” or with “free hand” methods. We compare the geometric position of femoral canal created by these two techniques.
Methods: In a prospective study, 22 patients were devided into two groups (11 patients) and operated by using femoral aimer instrument and “Free hand” techniques. Intra-operative fluoroscopy for femoral guide pin position was performed to determine the guide pin position. Vertical and horizontal coordinates of guide pins in both groups were outlined and compared with standard anatomical point of guide pins.
Results: in “aimer” group the coordinates of the guide pin location was 41.33% vertically and 33.49% horizontally and the difference with anatomic location in both vertical (p < /em>=.03) and horizontal (p < /em>=.02) vectors was significant. The coordinates for the location of the guide pin in the “free hand” group were 35.33% and 33.07% respectively and the difference between anatomical location and guide pin width was significant (p < /em>=.04), and in this group, difference in the height was observed. The sum errors in width and height plane in “aimer” and “free hand” groups were 13.82 and 7.4 respectively.
Conclusions: Anatomic positioning of guide pin is possible through both free hand and instrument techniques. The percentage of error in instrument technique is more than free hand method.
Amir Mohammad Navali, MD; Mehraban Mehraeen, MD
Abstract
Background: Anterior cruciate ligament (ACL) is a critical element in the biomechanics of knee joint stability. ACL tear increases the risk of meniscal and articular cartilage injury. This study evaluated the occurrence of meniscal and chondral injuries and the results of ACL reconstruction with more ...
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Background: Anterior cruciate ligament (ACL) is a critical element in the biomechanics of knee joint stability. ACL tear increases the risk of meniscal and articular cartilage injury. This study evaluated the occurrence of meniscal and chondral injuries and the results of ACL reconstruction with more than 7 years delay in ACL reconstruction.
Methods: In a cross sectional study, 43 patients (39 men, 4 women) at mean age of 38 years, who underwent ACL reconstruction with a delay of more than 7 years, were studied. The Lysholm, IKDC, Tenger and KOOS scores were evaluated before surgery and at the last follow up. The observed meniscal or chondral lesions were collected from the patients’ arthroscopic records. The mean follow-up was 34 months.
Results: The mean time interval between primary trauma and ACL reconstruction surgery was 121 months. A total of 39 cases (90/7%) had chondral lesions which include 20 cases of grade I/II and 19 cases of grade III/IV lesions. In 35 patients (81.4%) meniscal tear was observed. Only two cases (4.6%) had isolated ACL tear. A statistically significant improvement in IKDC, Lysholm, KOOS, and Tegner score was observed following surgical treatment (p < /em><.001).
Conclusions: Longstanding ACL tear leads to increase the occurrence of meniscal and cartilage injuries. Delayed ACL reconstruction in this group of patients can improve IKDC, Lysholm and KOOS knee scores and Tegner activity level.
Mina Iravani, MSc; Farzam Farahmand, PhD; Soheil Mehdipour, MD
Abstract
Background: High tibial osteotomy (HTO) is a common surgical procedure for treatment of patients with varus malalignment. The success rate of the procedure is strongly dependent on the quality of correction. The purpose of this study was to simulate the HTO in a patient with varus deformity in order ...
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Background: High tibial osteotomy (HTO) is a common surgical procedure for treatment of patients with varus malalignment. The success rate of the procedure is strongly dependent on the quality of correction. The purpose of this study was to simulate the HTO in a patient with varus deformity in order to explore the interactions between the wedge angle, the mechanical axis, and the knee joint configuration.
Methods: A finite-element model of the knee joint of a patient with varus deformity was developed. The geometry was obtained using the whole limb CT scans and the knee MR images. The bones were assumed as rigid bodies, the articular cartilage and the meniscus as elastic solids, and the ligaments as nonlinear springs. A 600N force was applied at the femoral head in the line of the mechanical axis and the resulting knee configuration was investigated. The HTO was simulated by insertion of wedges with different angles beneath the tibial plateau and application of the resulting alteration of the loading axis in the model.
Results: The results indicated that the actual change of the mechanical axes was always smaller than was predicted by a geometric pre-planning approach that does not consider the effect of soft tissue on the post-operative configuration of the knee joint.
Conclusions: It was suggested that subject-specific models can improve the results of the HTO by simulating the operation before surgery and determining the optimal wedge angle that locates the mechanical axis in the middle of the knee.
Mahmoud Karimi Mobarakeh, MD; Mohsen Mardani Kivi, MD; Masoud Hadjikhani, MD
Abstract
Background: Knee arthroplasty has been traditionally based on mechanical alignment restoration. In the newer, “Kinematically aligned knee replacement”, the eroded bone and joint surfaces in addition to saw-blade thickness are removed and replaced by the components. This study compared the ...
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Background: Knee arthroplasty has been traditionally based on mechanical alignment restoration. In the newer, “Kinematically aligned knee replacement”, the eroded bone and joint surfaces in addition to saw-blade thickness are removed and replaced by the components. This study compared the results of two techniques of knee arthroplasty.
Methods: In a clinical trial study, 90 patients who were candidates for knee arthroplasty were divided into 2 groups: 45 cases received knee arthroplasty by “mechanically aligned” and 45 by “Kinematically aligned” technique. The two groups were compared after 1 year by Lysholm score, hospitalization period, subjective satisfaction, and period of need for ambulatory aid.
Results: 73 patients referred for follow up: 37 patients in the kinematic and 36 in the mechanical group. The mean hemoglobin drop was not significantly different between the two kinematic and mechanical groups; while the post operation mean hemoglobin drop difference was significant (p < /em>=.001). No significant difference in the patient satisfaction of the operation was observed between two groups. The difference of mean Lyshlom score was different between two groups (p < /em>=.000).
Conclusions: kinematically aligned” knee replacement is associated with less pain, earlier return to daily activity, lesser intra operative bleeding and more patient satisfaction.
Amir Mohammad Navali, MD; Amin Moradi, MD; Abolfazl Mokhtari, MD
Abstract
Background: Post-operative pain control is an important issue in orthopaedics. Narcotics do not properly control pain and may have many complications. The non-steroidal anti-inflammatory drugs can, however, play an important role in postoperative pain management. This study evaluates the effect ...
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Background: Post-operative pain control is an important issue in orthopaedics. Narcotics do not properly control pain and may have many complications. The non-steroidal anti-inflammatory drugs can, however, play an important role in postoperative pain management. This study evaluates the effect of intra-articular Ketorolac injection on pain control after knee arthroscopy.
Methods: In a randomized double blind clinical trial study, 60 age and sex-matched patients of around 45 years of age were divided into two groups of 30. Tirthy mg of intra-articular ketorolac in one group and 30 millimeters of saline in the control group were injected at the end of arthroscopic knee surgery. The postoperative pain control and need for other pain medications were compared between the two groups.
Results: In the Ketorolac group the pain at 4 hours and 8 hours after surgery was significantly lower than the control group. At 12, and 24 hours after surgery, no significant difference in severity of pain was observed. The need for the use of opioid drugs was not significantly different between the two groups. The Sleep disturbance of 42.8% in the Ketorolac and 57.1% in the saline group was not significantly different.
Conclusions: Intra-articular ketorolac is effective in pain reduction only in the first few hours after knee arthroscopy, and does not reduce the need for other analgesics.
Roshanak Jazayeri, MD; Mohammad Qoreishi, MD; Hamid Reza Seyyed Hoseinzadeh, MD; Mojgan Babanejad, MS; Enayatollah Bakhshi, PhD; Hossein Najmabadi, PhD; Seyyed Mohammad Jazayeri, MD
Abstract
Background: Osteoarthritis (OA) is a degenerative disease of the joints. The asporin (ASPN) gene encodes a cartilage extracellular protein belonging to the small leucine-rich proteoglycan family. Polymorphisms in the aspartic acid (D) repeat are associated with OA susceptibility. The D14 allele is associated ...
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Background: Osteoarthritis (OA) is a degenerative disease of the joints. The asporin (ASPN) gene encodes a cartilage extracellular protein belonging to the small leucine-rich proteoglycan family. Polymorphisms in the aspartic acid (D) repeat are associated with OA susceptibility. The D14 allele is associated with increased OA susceptibility in the Japanese and the Han Chinese but is not an important factor in OA etiology among Caucasians, though the D15 allele is a risk factor for the Greek population. In this study, the effect of ASPN on Iranian with knee OA is investigated.
Methods: 100 knee OA patients (72 female, 28 male) in a training hospital in Tehran, Iran were compared with 100 controls with no sign of OA, and the allelic association of the D-repeat polymorphism was studied in two groups.
Results: There were some minor differences in the frequencies of the D14 and D15 alleles between patient and control groups. These differences were, however, significant only for females. In Iranian females, D15 allele was significantly associated with KOA (p < /em>=.045), and D14 allele was significantly protective from KOA (p < /em>=.032).
Conclusions: D15 allele could be considered a risk allele only for women (p=.045, OR=1.73, 95% CI=1.01-2.94) in the Iranian population. This association is in part similar to that finding for the Greek population.
Sajad Fakoor, MD; Afshin Farhadi, MD; Mohammad Fakoor, MD
Abstract
Background: Knee osteoarthritis is a common joint disorder in the older age patients. This study was performed to compare the efficacy of injection of methyl-prednisolone versus sodium-hyaluronate in symptomatic mild to moderate knee osteoarthritis.Methods: In a randomized clinical trial, 53 patients ...
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Background: Knee osteoarthritis is a common joint disorder in the older age patients. This study was performed to compare the efficacy of injection of methyl-prednisolone versus sodium-hyaluronate in symptomatic mild to moderate knee osteoarthritis.Methods: In a randomized clinical trial, 53 patients with knee osteoarthritis were assigned to receive either methyl-prednisolone (26 patients) or sodium-hyaluronate (27 patients) in a hospital in Tehran, Iran. Sodium-hyaluronate three injections within 2-weeks interval and a single injection of 40 mg of methyl-prednisolone were given. The improvement rate was compared after one and six months.Results: The total score significantly improved in both groups (p < /em>=.001). There was no significant difference between the two groups after the first month (p < /em>≥.05) but the results were better after six months in sodium-hyaluronate injection group (p < /em>=.001).Conclusions: Intra-articular injection of sodium-hyaluronate in comparison with methyl-prednisolone has longer efficacy in treatment of symptoms of mild to moderate knee osteoarthritis.
Soheil Mehdipour, MD; Farid Abbaszadeh, MSc; Morad Karimpour, PhD; Farzam Farahmand, PhD; Zahra Saghaie, MSc
Abstract
Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: ...
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Background: Conventional X-rays, due to 2D viewing, may not have accuracy in assessing lower limb deformities. The aim of this study was to analyze the deformities in 3D and simulated the corrective surgery in virtual space and to built patient-specific guide to achieve the precise correction.Methods: In this descriptive study, 10 lower limbs with various deformities around the knee were studied. Weight bearing alignment x-rays and CT scans were processed digitally to produce 3D weight bearing models.The landmarks were determined and lower limb indices were calculated to determine the deformities in 3 dimensions Under surgeon's supervision, virtual correction of the deformity was performed, based on which, a patient-specific guide was designed and printed in 3D. The guide was then used in the surgery.Results: The deformity and deviation from standard angles was obsereved in frontal plane in 6 cases, frontal and sagittal planes in one, frontal and axial planes in two, and a three planar deformity in one cases. The results showed that this method is effective in achieving the precise correction of the deformity. In all the patients who underwent surgery, the correction was the same or very close to what had been planned in frontal and sagittal planes (±1). Clinical assessment was used for rotational correction in the absence of postoperative CT-scan.Conclusions: The computer-assisted pre-op planning and patient-specific guide usage can highly optimize the results of corrective osteotomies, especially in difficult deformities around the knee.
Niloofar Namazi, MD; Fereydoon Mojtahed Jaberi, MD; Sara Pakbaz, MD; Amir-Reza Vosooghi, MD; Mehrad Mojtahed Jaberi, MD
Abstract
Background: Destruction of pain receptors around patella by electrocauterization is commonly used during total knee arthroplasty. Its effect on cartilage was the goal of this survey.Methods: In a clinical trail study, 20 rabbits, divided into two equality sized groups (experimental-control) and experimental ...
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Background: Destruction of pain receptors around patella by electrocauterization is commonly used during total knee arthroplasty. Its effect on cartilage was the goal of this survey.Methods: In a clinical trail study, 20 rabbits, divided into two equality sized groups (experimental-control) and experimental group underwent surgery via medial parapatellar arthrotomy of the knee joint. Electrocauterization denervation at a depth of 1 mm and a distance of 3 mm from border of patella performed in the cases animals. No patellar denervation was done in the control group. Range of motion of joint, macroscopic evaluation using modified outerbridge score, and histopathologic scoring were assessed after twelve weeks. Results: Finally, nine cases and eight control animals were included due to death of three animals. Full range of motion was seen in all rabbits. Statistically significant difference in outerbridge score (p < /em>=.002), cellularity (p < /em>=.016), loss of matrix (p < /em>=.004), and clustering of chondrocytes (p < /em>=.008) were obtained.Conclusions: Cartilage destruction may be the result of electrocauterization of patellar rim. So, routine electrocauterization should be discouraged.
Fardin Mirzatolouei, MD; Majid Mohseni Kabir, MD
Abstract
Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning ...
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Background: Perfect rotational positioning of femoral component in total knee arthroplasty is mandatory for good outcome, particularly in knees with severe varus. Posterior condylar line (PCL) and transepicondylar axis TEA are the two current methods used to determine the appropriate rotational positioning of femoral component. The aim of this study was to compare the accuracy of femoral component rotation after TKA, using either PCL or TEA reference points. Methods: In a retrospective study, 42 consecutive TKA candidates with severe varus knees were divided into two groups: In group I posterior condylar line, and in group II transepicondylar axis was considered as the primary landmark for rotational positioning. Erosion of medical femoral condylar was recorded in millimeters. One year after operation all the patients underwent CT scan and the angles between TEA and PCL of the prosthesis was meausured. The degree of knee flexion and also WOMAC scores were recorded. Results : The female gender was prominent in both groups (81% in group 1, 85.7% in group II). There was no significant femoral condylar erosion in either group. The mean Womac score in group 1 was 71.4±17.51 and 72.07±15.48 in group II (p < /i>=.9). The degree of external rotation according to condylar twisting angle was 3.35±1.74 in group 1 and 1.9±1.7 in group 2 (p < /i>=.009). Conclusions: In severe Knee-varus deformity, TEA landmark gives more external rotation position for femoral component, despite of lack of significant erosion in femoral condyle.
Sohrab Keyhani, MD; Arash Sherafat Vaziri, MD; Mohammad Hossein Nabian, MD
Abstract
Background: The objective of this study was to evaluate the results of repairing root and para-root radial tears of lateral meniscus during cruciate ligament reconstruction. Methods: In a retrospective study, from the 60 patients who had been treated for root or para-root injury of the lateral meniscus ...
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Background: The objective of this study was to evaluate the results of repairing root and para-root radial tears of lateral meniscus during cruciate ligament reconstruction. Methods: In a retrospective study, from the 60 patients who had been treated for root or para-root injury of the lateral meniscus from 2007 to 2011 in 3 centers in Tehran-Iran. Only 40 patients were studied with an average followe-up of 32.4 months (24-48 months). The patients were evaluated by International Knee Documentation Committee (IKDC), Lysholm and Tegner scoring systems subjectively, and by objective Lachman and McMurray tests. Results: 34 patients were operated for ACL reconstruction and 6 for ACL and PCL reconstruction and lateral meniscus tears were repaired simultaneously. On the final follow-up, all the patients had firm end-points tested by Lachman. None reported popping or clicking. The mean IKDC score was 75.25 (range: 54-92), the mean Lysholm score was 94.4 (excellent) in 22 patients and the mean Tegner score was 7.15. From the 16 patients who were professional soccer players, 14 were still playing competitively at the time of follow-up. Conclusions: The midterm results of lateral meniscus repair - at root or para-root level - in association with ACL or / and PCL reconstruction, are acceptable.
Mohammad Mehdi Sarzaeem, MD; Mohammad Razi, MD; Farideh Najafi, MD; Mohammad Amin Najafi
Abstract
Background: The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograftfixed with interference screws. This prospective study, aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw, over a 12 months follow-up interval.Methods: ...
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Background: The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograftfixed with interference screws. This prospective study, aimed to compare two method of fixation for BPTB grafts: press fit fixation vs. interference screw, over a 12 months follow-up interval.Methods: In a randomized clinical trial study, 158 patients with an average age of 29.8 years were treated for torn ACL with BPTB autograft in a teaching hospital in Tehran, Iran. In 82 patients press fit fixation technique, and in 76 cases an interference-screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference-screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications.Results: In the final follow-up, 59 cases in interference screw and 55 in press-fit screw group had good-to-excellent IKDC score (p < /em>≥.05). The mean laxity assessed improved to 2.7 mm and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift tests, there was a statistically significant improvement in the integrity of the ACL in both groups, with no significant difference (p < /em>≥.05).Conclusions: the press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.
Mikaeil Tafkiki Alamdari; Ahmadreza Afshar
Abstract
Background: Knee dislocation, although a rare injury, is a severe injury which can endanger the limb viability or cause a significant impairment in the knee function. The purpose of this study was to evaluate the knee function and knee osteoarthritis in the patients who had sustained an acute traumatic ...
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Background: Knee dislocation, although a rare injury, is a severe injury which can endanger the limb viability or cause a significant impairment in the knee function. The purpose of this study was to evaluate the knee function and knee osteoarthritis in the patients who had sustained an acute traumatic knee dislocation . Methods: In a retrospective study, 19 consecutive patients with knee dislocation who were treated by different therapies were studied during 5 years in a teaching hospital in Urmia, Iran. Vascular injuries lead to amputation in 3 patients. The follow-up study was performed on the remaining 16 patients within 37±13 months. The patients were evaluated for knee stability, range of motion and the "Tegner-Lysholm" knee function scores. The development of knee osteoarthritis was classified according to Kellgren and Lawrence classification . Results: The knee function was excellent in one, good in 3, fair in 9, and poor in 3 cases. The younger patients and knees with wider range of motion had better "Tegner-Lysholm" scores. The knee scores had significant correlation with the severity in the class of dislocation. The time of surgical reconstruction, whether early or delayed, had no significant effect on the outcome. The mean knee range of motion for the 12 patients who were treated surgically was 120±15 degrees and for the 4 patients who were treated non-surgically was 115±28 degrees. There was a significant correlation between the "Tegner-Lysholm" scores and knee range of motion. Conclusions: Knee dislocation is a very severe complex trauma and normal knee functional outcome is not often achieved. The knees with the more extensive ligament injuries have less favorable outcomes. Younger patients and knees with larger range of motion had better functional outcomes.
Seyyed Morteza KazemiSeyyed Morteza Kazemi; Seyyed Mohammad Qoreishi; Mahdi Bahari Mehrabani; Farshad Safdari
Abstract
Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with ...
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Background: It has been suggested that double-level osteotomy can prevent the occurrence of joint line obliquity, as one of the complications following high tibial osteotomy. In this study, we compared the preoperative distal femoral and proximal tibial obliquity in patients with primary genu varum with a group of normal subjects.
Methods: 75 patients with primary genu varum and 75 normal persons, contributed to a case-control study. The medial distal femoral mechanical angle (MDFMA), medial proximal tibial mechanical angle (MPTMA) and joint diversion angle (JDA) were measured and compared between the two groups. The percentage of patients with >3 degrees in both distal of femur and proximal of tibia were determined.
Results: The mean of MDFMA and MPTMA was significantly lower and the mean of JDA was significantly higher in genu varum group compared to normal group (p < /em>3 degrees.
Conclusions: The alignment of distal femur and proximal tibia is significantly different in patients with primary genu varum and normal controls. Abnormal alignment of joint line is a common finding in both primary genu varum and normal people but more commonly in the cases of genu varum. As double level osteotomy may be required in many patients with genu varum, it is important to investigate distal of femur alignment before high tibial osteotomy
