OBJECTIVE: To review the research progress of injection sites of local infiltration analgesia (LIA) in total knee arthroplasty (TKA). METHODS: The relevant domestic and foreign literature in recent years was extensively reviewed. The neuroanatomy of the knee, and the research progress of the selection and the difference of effectiveness between different injection sites of LIA in clinical studies were summarized. RESULTS: Large concentrations of nociceptors are present throughout the various tissues of the knee joint. Patellar tendon, subpatellar fat pad, lateral collateral ligament insertions, iliotibial band insertions, suprapatellar capsule, and posterior capsule were more sensitive to pain. Most current studies support injections into the lateral capsule, collateral ligament, retinaculum, quadriceps tendon, fat pad, and subcutaneous tissue. Whether to inject into the back of the knee and subperiosteum is controversial. CONCLUSION The relative difference of knee tissue sensitivity to pain has guiding significance for the selection of LIA injection site after TKA. Although researchers have conducted clinical trials on injection site and technique of LIA in TKA, there are certain limitations. The optimal scheme has not been determined yet, and further studies are needed.
Humans ; Arthroplasty, Replacement, Knee/methods* ; Pain, Postoperative/prevention & control* ; Pain Management/methods* ; Analgesia/methods* ; Knee Joint/anatomy & histology* ; Anesthesia, Local/methods*

BACKGROUNDDiscoid lateral meniscus was a common meniscal dysplasia and was predisposed to tear. There were some anatomical knee variants in patients with discoid lateral meniscus. The aim of this study was to analyze the relationship between anatomical knee variants and discoid lateral meniscal tears.

METHODSThere were totally 125 cases of discoid lateral meniscus enrolled in this study from February 2008 to December 2013. Eighty-seven patients who underwent arthroscopic surgery for right torn discoid lateral meniscus were enrolled in the torn group. An additional 38 patients who were incidentally identified as having intact discoid lateral menisci on magnetic resonance imaging (MRI) findings were included in the control group. All patients were evaluated for anatomical knee variants on plain radiographs, including lateral joint space distance, height of the lateral tibial spine, height of the fibular head, obliquity of the lateral tibial plateau, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau, lateral femoral condylar notch, and condylar cutoff sign. The relationship between anatomical variants and meniscal tear was evaluated. These anatomical variants in cases with complete discoid meniscus were also compared with those in cases with incomplete discoid meniscus.

RESULTSThere were no significant differences between the two groups in lateral joint space distance (P = 0.528), height of the lateral tibial spine (P = 0.927), height of the fibular head (P = 0.684), obliquity of the lateral tibial plateau (P = 0.672), and the positive rates of squaring of the lateral femoral condyle (P = 0.665), cupping of the lateral tibial plateau (P = 0.239), and lateral femoral condylar notch (P = 0.624). The condylar cutoff sign was significantly different between the two groups, with the prominence ratio in the torn group being smaller than that in the control group (0.74 ± 0.11 vs. 0.81 ± 0.04, P = 0.049). With the decision value of the prominence ratio (0.78) in predicting discoid lateral meniscal tear, the sensitivity and specificity of the cutoff sign were 66% and 71%, respectively. There were no significant differences in radiographic variants between the complete and incomplete discoid lateral meniscal groups.

CONCLUSIONSThe condylar cutoff sign observed on the tunnel view of the radiograph is helpful in predicting meniscal tear in adult patients with discoid lateral meniscus. As for these patients, further MRI test is recommended.

Adolescent ; Adult ; Aged ; Arthroscopy ; Child ; Female ; Humans ; Knee Injuries ; diagnosis ; Knee Joint ; anatomy & histology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult

PURPOSE: The purpose of this study was to evaluate the anatomical similarity of three-dimensional (3D) morphometric parameters between right and left knees. MATERIALS AND METHODS: Ten fresh-frozen paired cadaveric knees were tested. Following dissection, footprint areas of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were measured. Surface scanning was performed using a 3D scanner. Scanned data were reproduced and morphometric parameters were measured on specialized software. After making mirror models, we compared footprint center positions of the ACL and PCL of both sides and calculated the average deviation of 3D alignment between the right- and left-side models. RESULTS: No significant side-to-side differences were found in any morphometric parameters. Bony shapes displayed a side-to-side difference of < 1 mm. Distal femoral and proximal tibial volumes did not present side-to-side differences, either; the average 3D deviations of alignment between the right and left sides were 0.8±0.4/1.1±0.6 mm (distal femur/proximal tibia). Center-to-center distances between the right and left ACL footprints were 2.6/2.7 mm (femur/tibia) for the anteromedial bundle and 2.4/2.8 mm for the posterolateral bundle. They were 1.9/1.5 mm for the anterolateral bundle and 2.2/1.8 mm for the posteromedial bundle of the PCL. CONCLUSIONS: There was a remarkable 3D morphometric similarity between right and left knees. Our results might support the concept of obtaining morphologic reference data from the uninvolved contralateral knee.
Anatomy, Comparative ; Anterior Cruciate Ligament ; Cadaver ; Imaging, Three-Dimensional ; Knee Joint ; Knee ; Posterior Cruciate Ligament

OBJECTIVETo observe the effects of warm needling moxibustion on body mass, knee cartilage andmorphology in rats with knee osteoarthritis (KOA).

METHODSForty SD rats were randomly divided into a normalgroup, a model group, a medication group and a warm needling group, 10 rats in each one. Except the normalgroup, the rats in the remaining three groups were injected with papain to establish the model of KOA. After themodeling, rats in the model group did not receive any treatment; rats in the warm needling group were treated withwarm needling moxibustion at bilateral "Xiqian"; rats in the medication group were treated with intragastric administration of meloxicam; rats in the normal group were treated with 0. 9% NaCl solution (identical dose as medication group) and immobilized as the warm needling group. The treatment was given once a day for consecutive20 days. The body mass, scale of knee cartilage and morphological changes were observed in each group after'treatment.

RESULTSThe increasing of body mass in the medication group and warm needling group was faster than!that in the model group, but slower than that in the normal group (all P<0. 05); the difference between medication group and warm needling group was not statistically significant (P>0. 05). The scale of knee cartilage in thewarm needling group and medication group was significantly lower than that in the model group (both P<0. 05),while the scale in the warm needling group was lower than that in the medication group (P<. 05). Regarding theknee morphology under micro-CT, the relief of knee degeneration and improvement of knee recovery in the warm needlinggroup were superior to those in the medication group.

CONCLUSIONThe warm needling moxibustion could effectively reduce the knee pain, improve the recovery of knee cartilage, which is a safe and effective treatment.

Acupuncture Points ; Animals ; Cartilage ; anatomy & histology ; Disease Models, Animal ; Humans ; Knee Joint ; anatomy & histology ; Male ; Moxibustion ; Osteoarthritis, Knee ; therapy ; Rats ; Rats, Sprague-Dawley ; Treatment Outcome

BACKGROUNDAccuracy of implant placement in total knee arthroplasty (TKA) is crucial. Traditional extramedullary alignment instruments are fairly effective for achieving the desired mean tibial component coronal alignment. We modified the traditional tibial plateau resection technique and evaluated its effect on alignment restoration.

METHODSTwo hundred and eighty-two primary TKAs in our hospital between January 2013 and December 2014 were enrolled in this retrospective study. Group A consisted of 128 primary TKAs performed by one senior surgeon. Preoperative measurement of the tibial resection was conducted on radiographs, and the measured thicknesses of the lateral and medial plateau resection were used to place the tibial alignment guide. Group B consisted of 154 primary TKAs performed by the other senior surgeon, using a traditional tibial plateau resection technique. In all patients, an extramedullary guide was used for tibial resection, and preoperative and postoperative full-leg standing radiographs were used to assess the hip-knee-ankle angle (HKA), femoral component alignment angle (FA), and tibial component alignment angle (TA). A deviation ≥3° was considered unsatisfactory. Data were analyzed by unpaired Student's t-test.

RESULTSThe mean postoperative HKA and TA angles were significantly different between Groups A and B (178.2 ± 3.2° vs. 177.0 ± 3.0°, t = 2.54, P = 0.01; 89.3 ± 1.8° vs. 88.3 ± 2.0°, t = 3.75, P = 0.00, respectively). The mean postoperative FA was 88.9 ± 2.5° in Group A and 88.9 ± 2.6° in Group B, and no significant difference was detected (t = 0.10, P = 0.92). There were 90 (70.3%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 38 (29.7%) outliers (>3° deviation) in Group A, whereas there were 89 (57.8%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 65 (42.2%) outliers (>3° deviation) in Group B. The severity of the preoperative alignment deformity was a strong predictor for postoperative alignment.

CONCLUSIONSUsing conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.

Aged ; Arthroplasty, Replacement, Knee ; methods ; Bone Malalignment ; prevention & control ; Female ; Humans ; Knee Joint ; surgery ; Male ; Postoperative Period ; Retrospective Studies ; Tibia ; anatomy & histology ; surgery

Objective To explore the feasibility and clinical value of ultrasonography in evaluating the morphology and function of medial collateral ligaments (MCL) after total knee arthroplasty (TKA). Methods Totally 38 patients undergoing routine KTA (group A) and 22 patients undergoing constrained condylar knee arthroplasty KTA with MCL injury (group B) were included. Long axis views of MCL were taken and the MCL thickness was measured on femur side and tibial side 1 cm away from the joint line, respectively. The thicknesses were compared between the two groups. Subsequently, the gap between the metal part of the femoral prosthesis and the spacer after dynamic valgus stress was measured. The distribution and composition of the gap between the two groups were compared. Results High-frequency ultrasound clearly showed the prosthesis and MCL after TKA. MCL fiber structures of both groups were intact. The MCL thickness on the tibial side in group B was (0.25±0.06)cm, which was significantly thinner than group A [(0.32±0.14)cm] (t=2.12, P=0.040).For the femur side, there was no significant difference (t=1.65, P=0.110) between these two groups [(0.37±0.09) cm in group B versus (0.42±0.12)cm in group A]. Under the condition of valgus stress, the gaps between the metal part of the femoral prosthesis and the spacer could be found in 11 cases in group B but only in 1 case in group A. The proportion of gaps in group B was significantly higher than that in group A (Fisher's exact test, P=0.000). Conclusions High-frequency ultrasound can clearly show the prosthesis and MCL after TKA. The injured MCL can be well joined but the thickness is thinner. Under the condition of valgus stress of the knee, the stability of the TKA can be evaluated according to the gap between the prosthesis and the spacer.
Arthroplasty, Replacement, Knee ; Femur ; Humans ; Knee Joint ; Medial Collateral Ligament, Knee ; anatomy & histology ; diagnostic imaging ; physiology ; Tibia ; Ultrasonography

BACKGROUND: The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. METHODS: Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. RESULTS: Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. CONCLUSIONS: Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*instrumentation/statistics & numerical data ; Asian Continental Ancestry Group/*statistics & numerical data ; Cohort Studies ; Female ; Femur/*anatomy & histology/*surgery ; Humans ; Knee Joint/surgery ; Middle Aged ; Prosthesis Design ; Republic of Korea

OBJECTIVETo study the relationship between knee osteoarthritis (OA) and intercondylar notch narrowing based on the notch width index.

METHODSMagnetic resonance (MR) images were collected from middle-aged and elderly patients with a definite diagnosis of knee OA, including 42 with mild OA and 37 with moderate to severe OA, with 70 healthy individuals serving as the control group. The notch width indexes NWI, NWI-A, and NWI-P on the coronal images at different levels were calculated, and the intercondylar notch was classified, according to the features on axial MR images, into types A, U, and W. The association of OA with NWI, NWI-A, NWI-P, and notch type was determined, and the cutoff values were obtained based on the ROC curves at different levels as indicators for diagnosis of intercondylar notch stenosis.

RESULTSIn the control, mild OA, moderate to severe OA groups, the NWI value on coronal MR images were 0.252±0.019, 0.251±0.017, and 0.240±0.020, NWI-A were 0.261±0.024, 0.259±0.023, and 0.245±0.023, and NWI-P were 0.271±0.026, 0.270±0.024, and 0.254±0.022, respectively. Patients with moderate to severe OA had significantly smaller NWI, NWI-A, and NWI-P than the other two groups (P<0.05), and a significant association was found between NWI values at each level and the occurrence of moderate to severe OA (P<0.01). A NWI value<0.248, NWI-A<0.256, and NWI-P<0.266 supported a diagnosis of intercondylar notch narrowing. Type A intercondylar notch was found in the majority of patients with intercondylar notch narrowing (P<0.05).

CONCLUSIONPatients with moderate to severe OA have significant intercondylar notch narrowing, and patients with a type A intercondylar notch are more likely to have intercondylar notch narrowing than those with type U notch.

Aged ; Case-Control Studies ; Constriction, Pathologic ; Humans ; Knee Joint ; anatomy & histology ; Magnetic Resonance Imaging ; Middle Aged ; Osteoarthritis, Knee ; pathology ; ROC Curve

PURPOSE: The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. MATERIALS AND METHODS: The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. RESULTS: In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. CONCLUSION: The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.
Aged ; Anterior Cruciate Ligament/*anatomy & histology/surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; *Bone Wires ; Cadaver ; Female ; Femur/*anatomy & histology/surgery ; Humans ; Knee Joint/surgery ; Male ; Middle Aged ; Tibia/*anatomy & histology/surgery ; Tomography, X-Ray Computed

PURPOSE: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. MATERIALS AND METHODS: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identified using a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically, tunnel length and distance from the medial femoral condyle to a virtual cylinder of the femoral tunnel were measured. RESULTS: In tunnels drilled at a coronal angle of 45degrees, an axial angle of 45degrees, and a sagittal angle of 45degrees, the mean femoral tunnel length was 39.5+/-3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4+/-2.6 mm. The tunnel length at a coronal angle of 30degrees, an axial angle of 60degrees, and a sagittal angle of 45degrees, was 34.0+/-2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7+/-1.3 mm, which was significantly shorter than the standard angle (p<0.001). CONCLUSION: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidence of cartilage damage. We recommend that angles in proximity to standard angles be chosen during femoral tunnel drilling through the anteromedial portal.
Aged ; Anterior Cruciate Ligament/*surgery ; Anterior Cruciate Ligament Reconstruction/instrumentation/*methods ; Cadaver ; Computer Simulation ; Female ; Femur/anatomy & histology/*surgery ; Humans ; Imaging, Three-Dimensional ; Knee Joint/radiography/*surgery ; Male ; Middle Aged ; Osteotomy/*methods ; Outcome and Process Assessment (Health Care) ; Patient Positioning ; Surgical Instruments ; Tomography, X-Ray Computed