Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Introduction: Medial parapatellar arthrotomy is the standard approach for total knee replacement (TKR) but usually requires adequate arthrotomy repair to allow for early rehabilitation. Nonetheless, no previous studies have clarified the postoperative outcome as quadriceps strength (QS) and functional recovery after using the other simple suture technique for the arthrotomy repair, continuous locking suture (CLS). Methods: 80 patients were randomly assigned into a CLS group (n=40) and an interrupted horizontal mattress (IHM) group (n=40). With the same surgical and rehabilitation protocol, and all arthrotomy repair used only the traditional braided suture. QS was calculated into normalized quadriceps strength (N-QS) and operative leg quadriceps strength compared with contralateral QS (OL-QS). QS, visual analog scale (VAS), modified timed up and go (TUGT) test, Western Ontario and McMasters Universities Osteoarthritis Index [WOMAC] and Knee Society Score [KSS] were followed for 6 months’ period. Results: No significant difference in demographic and perioperative data, except a significant shorter capsular closure time in CLS (233±40 seconds) compared to IHM (388±47 seconds) (p<0.0001). There was no significant difference in N-QS and OL-QS between both groups during the 6-month follow-up period (p>0.05 all). Both groups also did not show any significant difference in the postoperative VAS, TUGT, WOMAC, and KSS (p>0.05 all). Finally, no wound complications or infections manifested during this study. Conclusion: Arthrotomy repair with the CLS technique in TKR and using only the braided suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to the standard IHM technique. Trial registration: This study was registered in Thai Clinical Trials Registry on December 2015 (https://www.clinicaltrials.in.th). The registration number was TCTR20151208003.

Detection of meniscal tears by arthroscopy and arthrotomy in dogs with cranial cruciate ligament rupture

SummaryObjectives: To evaluate and compare detection of meniscal tears associated with cranial cruciate ligament insufficiency by either arthroscopy or arthrotomy.Methods: A retrospective, cohort study was completed with stifles (n = 531) of dogs with cranial cruciate ligament rupture. Either a medial parapatellar arthrotomy or an arthroscopy procedure was performed and groups were compared for significant differences in meniscal tears detected using logistic regression analysis.Results: Arthroscopy was performed on 58.8% and arthrotomy on 41.2% of the stifles. In total, 44.4% of the examined stifles had meniscal tears. Meniscal tears were found in 38.8% of the stifles examined by arthrotomy, and 48.4% of those examined by arthroscopy. Overall, the rate of detection of a meniscal tear was significantly different (p = 0.019) between the groups, and meniscal tears were observed more frequently by arthroscopy than by arthrotomy (odds ratio 1.54; 95% confidence interval 1.07 – 2.22).Clinical significance: These results suggest that arthroscopy may be more sensitive than arthrotomy for detection of meniscal pathology in clinical patients. However, these results must be interpreted with caution since this was a retrospective study. Randomized prospective clinical studies are required to further test this hypothesis.