Subjective assessment reported by patients shows differences between single-bundle and double-bundle anterior cruciate ligament reconstruction, systematic review and meta-analysis

To determine the functional recovery, active reincorporation, and anteroposterior and rotational stability of patients undergoing anterior cruciate ligament (ACL) reconstruction using arthroscopy techniques with simple-bundle (SB) or double-bundle (DB). The following databases were searched: PubMed, Embase (Elsevier platform), the Cochrane Central Register of Controlled Trials (Wiley platform), Web of Science, and CINAHL. Level I and II studies involving anterior cruciate ligament arthroscopy were included in the search. Records were screened by title and abstract and assessed the risk of bias of selected studies. Meta-analyses using RevMan 5.3 software were conducted on the following outcomes: knee functionality, objective measurements of knee stability, rotational knee stability and knee anterior stability, sports reincorporation, and subjective assessments. Twenty-four studies of patients undergoing ACL reconstruction were included in the qualitative and quantitative synthesis (1707 patients) for Lysholm score, Subjective International Knee Documentation Committee (IKDC) score, Tegner score, KT-1000/2000, Lachman test, Objective IKDC score, and Pivot-Shift test. A return to pre-injury level showed a significant decrease in the Lysholm score (mean difference, − 0.99; 95% CI − 1.71 to − 0.40; P = 0.007) and Tegner score (mean difference, − 0.07; 95% CI, − 0.13 to − 0.01; P = 0.02) at DB reconstruction, similar to the knee functionality outcome of the subjective IKDC score (mean difference − 1.42; 95% CI − 2.46 to − 0.38; P = 0.007). There is no clear or significant difference in clinical stability and knee function or in sports incorporation with the true difference occurring in the subjective assessment.

AB0601 COMPARISON OF THE EFFECT OF DIFFERENT PHYSICAL THERAPY PROGRAM IN THE REHABILITATION OF KNEE OSTEOARTHRITIS PATIENTS

Background:Knee osteoarthritis (OA) is an increasingly common and disabling problem in worldwide. Exercises are considered the cornerstone of non-surgical management of knee OA and is recommended in all current clinical guidelines. The diversity of exercise programs determines the need to compare their efficiency, in order to recommend the best option for the patient.Objectives:The aim of the present study was to compare the effect on knee functionality of conventional exercises program and combinate with manual therapy in patients with knee osteoarthritis.Methods:164 patients that fulfilled the ACR classification criteria for knee osteoarthritis (127 females and 37 males) ranging in age from 42 to 84 years (mean 62,2 SD 8,76), participated in a 10 days two-arm randomized trial. One group (Gr.1) received an exercises program, the other group additionally manual therapy methods (Gr.2). Pain and function were measured with a Visual Analogue Scale (VAS, mm) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) with 5 domains (Pain, Symptoms, Activity in Daily Living (ADL), Sport and recreation (Sport/rec.) and Quality of life (QoL)).Results:In the Gr.1 were 82 patients mean age 61,8±9,2 years and in Gr.2 – 82 patients 62,7±8,3 years (p>0.05). The initial level of pain (63,4±14,2 vs 60,2±18,8mm) and knee functionality according to KOOS (Tab1.) were similar in both groups, p>0.05. After 10 days rehabilitation program, VAS in Gr.1 was 39,6±14,8 mm, in Gr.2- 28,5±11,6 mm, (p<0.01). The KOOS results at the end of the rehabilitation program were with improvement, statistically significative in the Gr.2 (p<0,05).Table 1.The KOOS results at baseline and after 10 days of rehabilitation program.KOOS scales(M±SD), %Group 1Group 2BaselineAfter 10 daysBaselineAfter 10 daysPain55,5 ±13,863,4±13,653,0±22,364,3±19,1Symptoms59,0±18,765,6±18,156,6±19,069,0±15,9ADL46,3±15,554,5±16,043,0±19,955,1±18,2Sport/rec15,6±17,323,1±19,616,0±24,330,5±23,6QoL29,3±22,236,5± 22,934,8±23,950,6±18,9Conclusion:The reduction of pain and recovery of function were found in both groups, with better results in patients who received manual therapy and exercises program. This study supports the routine manual therapy in rehabilitation program in patients with knee osteoarthritis.Disclosure of Interests:None declared.

Similar Outcomes and Satisfaction of the Proprioceptive Versus Standard Training on the Knee Function and Proprioception, Following the Anterior Cruciate Ligament Reconstruction

Background: Patients with anterior cruciate ligament (ACL) injuries have poorer proprioception than people without such injuries. The effects of proprioceptive training on knee functionality and proprioceptive improvement after ACL reconstruction is still unclear. Methods: The research material consisted of 40 patients after ACL reconstruction. Of the 40 patients, 20 of them were rehabilitated with a standard program and 20 with additional proprioceptive exercises. The subjective and the objective scores were evaluated. Results: No differences were found between the proprioceptive versus the conservative postoperative rehabilitation in the functional nor in the proprioception outcomes of the operated limbs. Conclusions: There is no advantage to function in doing proprioceptive rehabilitation exercises following the ACL reconstruction, when compared with a traditional strengthening program.

Does the Difference in Leukocyte Concentration of PRP Affect the Short-Term Follow-Up Results in Cases Diagnosed with Early Stage Knee Osteoarthritis?

This prospective study was conducted for the clinical evaluation of pain severity and knee functionality following PRP injections with different leukocyte (WBC) concentrations applied to cases diagnosed with knee osteoarthritis. A total of 109 patients were included in the study. According to the leukocyte content the PRP injections were prepared as low-leukocyte content PRP (PPRP) and high concentration leukocyte content PRP (L-PRP). Patients were divided into 2 groups. Group 1 (n=44) received low-leukocyte content PRP and Group II (n =65) received high-leukocyte content PRP. The patients were evaluated clinically with Visual Analog Scale (VAS) and Knee Society Score (KSS). The changes in the PLT levels of the L-PRP group after the procedure compared to the levels prior to the procedure were found to be statistically significantly greater than the changes in the PPRP group. The mean VAS score of all the cases before treatment was 9.05±0.91 and this score decreased to 3.71±1.46 within 12 months. The increases in the mean Knee Society Score (KSS) values were determined as 16.92±1.97 within 6 months and 16.89±2.97 within 12 months in the P-PRP group and 19.71±1.24 within 6 months and 19.86±0.42 within 12 months in the L-PRP group. The most important aspect of this study is that, in contrast to many other studies, the results continued after the 6th month and were reported to be good in the 12th month. It was also recorded that L-PRP was clinically superior to P-PRP in the treatment of early stage knee osteoarthritis.

The Effect of Total Knee Arthroplasty on Physical Activity and Body Mass Index: An Analysis of the Osteoarthritis Initiative Cohort

Introduction: Preliminary analysis of accelerometry measurements has shown physical activity may not increase significantly after total knee arthroplasty (TKA). This study evaluates the effect of TKA on physical activity accelerometry measurements and body mass index (BMI). Methods: Using the multicenter Osteoarthritis Initiative (OAI) database, a cohort of patients with physical activity level accelerometry measurements and BMI before and after TKA was identified. Physical activity levels and BMI were acquired at pre-TKA and post-TKA accelerometry visits 2 years apart. Survey scores pertaining to knee functionality and quality of life were also analyzed before and after knee surgery. Each patient included in the study had a unilateral TKA completed between these 2 accelerometry visits. Accelerometry measurements, BMI of the patients, and survey scores relating to knee functionality and pain relief from before and after TKA were compared using paired samples t tests. Results: Twenty-three patients from the OAI database were identified for the paired analysis. They were evaluated at a mean postoperative follow-up of 15 months. There were no statistically significant differences between the post-TKA group and pre-TKA group for the accelerometry variables and BMI, though patients experienced a significant improvement in knee function and pain relief measures included in this analysis. Discussion: Although TKA can successfully restore function and relieve pain, there remains no good evidence that neither physical activity nor BMI improve postoperatively. Conclusion: No significant differences in physical activity and BMI were observed after TKA in this study.

A new hydrogel for the conservative treatment of meniscal lesions: a randomized controlled study

Purpose:this study aimed to investigate the efficacy of intra-articular (IA) administration of a hydrogel formulation obtained from a hyaluronic acid (HA) derivative (HYADD4®) in the management of meniscal tears and in meniscal tear repair. Methods: fifty subjects with degenerative meniscal tears were enrolled into this single-site, observer-blind, parallel-group study. Clinical evaluations were performed at baseline and after 14, 30 and 60 days. Clinical outcomes included: pain reduction (Visual Analog Scale), improvement of knee functionality (WOMAC questionnaire), reduction in length and depth of the meniscal lesion (MRI-confirmed) and SF-36 questionnaire scores. Local tolerability and safety were also investigated. Results: a significant reduction in VAS pain (p<0.001) in favor of HYADD4® was recorded at day 14 and maintained at all the follow-up assessments. Data on knee functionality were in line with the VAS pain assessment results. A significant reduction in length and depth of the meniscal lesion, assessed using MRI, was found in the HYADD4® group compared to the control group (p<0.001). Conclusions: the results of this study may indicate a new treatment option in the conservative management of patients complaining of pain due to meniscal tears. The MRI data suggest that the hydrogel formulation of HA used in this study may also play a role in the healing process of the lesion. Level of evidence: Level I, prospective randomized clinical trial.

Design Principles for the Conceptual Design of Low-Cost Prosthetic Knee

The objective of this paper is to document design lessons learned in the development of low-cost lower-limb prosthetic devices. Four design principles are introduced based on the authors′ experience redesigning a low-cost prosthetic knee mechanism. These design principles are valuable sources to complete the conceptual design of the knee mechanism in the absence of a unique or exact methodology that comprises all the aspects concerning engineering design. The paper defines the motivation to improve life quality by restoring knee functionality in terms of mobility and stability. Subsequent sections explore the state of the art, design constraints, gait analysis, and 3-D modeling using CAD. The model is validated using kinematic and structural simulation in NX 7.5™ covering basic geometric parameters and motion assumptions. The four conceptual design principles are: Hybrid Design Model, Simultaneous Modeling, Multidisciplinary Pulses, and Built-in and Post-design Optimization. Each principle is presented to exemplify its contribution in the knee mechanism redesign. Finally, the design principles are intended to assist the designer with empirical guidelines in the development of prosthetic devices.