Purpose: The aim of this study was to perform a systematic review of the literature to determine whether there are any clinical or radiological differences in mechanically aligned Total Knee Arthroplasty (TKA) compared with kinematically aligned TKA. Methods: This study included retrospective cohort studies, prospective randomized controlled trials (PRCTs) and prospective cohort studies comparing clinical and radiological outcomes, and complications in TKA with kinematic alignment (KA) and mechanical alignment (MA). All studies had a minimum follow-up of 2 years. Results: Five PRCTs published between 2014 and 2020 were included. These studies showed a low risk of bias and were of very high quality. We did not find a superiority of KA compared to MA technique for clinical and radiological outcomes, except in one study which showed a significant difference favoring KA between the two groups for all clinical scores. Conclusion: We found that KA in TKA achieved clinical and radiological results similar to those of MA. The complication rate was not increased for KA TKAs. Studies with longer follow-up and larger cohorts are required to prove any benefit of KA technique over MA technique.
Objectives: Loss of osteochondral substances resulting from osteochondritis dissecans (OCD) of the knee are arthrogenic in the long term. When they exceed 2 cm2, the Autologous Matrix Induced Chondrogenesis (AMIC®) technique is one of the methods used in France. The objective of this study was to evaluate the medium-term results of the AMIC® technique. Methods: This was a consecutive, prospective, single-center, single-operator series of 22 patients (13 men, 9 women, mean age 28 years (15-51)) treated by AMIC® (spongy bone graft + sutured collagen membrane) between September 2011 and November 2016. Previous surgery had been performed on 17 patients. According to the ICRS classification, the lesion was stage IV in 21 cases and stage III in 1 case. The sites were: condylar: 19 cases, patellar: 2 cases and trochlear: 1 case. The mean surface area was 3.6 cm2 (2-8) and the depth was 0.5 mm (0.4-0.8). All the patients were functionally assessed by an independent examiner using validated functional scores for these indications (KOOS, subjective IKDC). Student’s T tests were used. Results: At a mean follow-up of 4 years (minimum 2 years) all but 2 patients had significantly improved (In preop. IKDC: 44±14 and KOOS: 56±17). In these 2 cases, the postoperative scores remained unchanged over the years: one patient had had several surgeries before the graft and a 51-year-old female patient had an extensive lesion of 6.9 cm2. The mean IKDC and KOOS scores were 73±18 and 78±15 and then 77±16 and 81±14 respectively, at 1 and 4 years (p> 0.05 for IKDC and KOOS). Regrettably there were 2 complications: 1 arthrolysis 1 year after surgery and 1 algodystrophy. Conclusion: Few techniques are available in France for extensive symptomatic osteochondral lesions. AMIC® is a reliable, one-step, reproducible, inexpensive technique for loss of substance due to OCD with stable results as of 1 year after surgery.
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