Background: Little is known about the threshold of patient-reported outcomes (PROs) at which patients perceive to have attained a substantial clinical benefit (SCB) after anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the SCB value of PROs 1 year after ACLR in the general population and to determine factors that predict SCB attainment. Study Design: Case series; Level of evidence, 4. Methods: The Lysholm, International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), Tegner, and Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores were examined postoperatively in 88 patients who underwent ACLR. At the 12-month follow-up visit, the patients answered 2 independent anchor questions about daily discomfort and functional recovery. Receiver operating characteristic (ROC) curve analysis was used to differentiate PRO scores between patients who responded as having no difficulty versus some difficulty with daily knee discomfort (anchor question 1) and between patients with substantial recovery versus nonsubstantial recovery of knee function (anchor question 2). The area under the ROC curve (AUC) was calculated to assess reliability, and the differences between the AUC values were compared. Multivariate logistic regression analyses were performed to determine predictors affecting SCB attainment. Results: There were 76 patients enrolled in this study. The 12-month Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores that corresponded to the SCB were 88.0, 85.1, 6.5, and 64.2 for anchor question 1 and 84.5, 77.7, 5.5, and 57.1 for anchor question 2, respectively. The AUC values obtained from the ROC curve analyses showed acceptable to excellent reliability (anchor question 1: Lysholm, 0.90; IKDC-SKF, 0.86; Tegner, 0.71; ACL-RSI, 0.92; anchor question 2: Lysholm, 0.80; IKDC-SKF, 0.90; Tegner, 0.82; ACL-RSI, 0.82) and were all statistically significant ( P < .001 to P = .028). For all PROs, younger age (Odds Ratio (OR), 0.88-0.94; P < .001 to P = .027) and greater muscle strength (OR, 1.03-1.07; P < .001 to P = .023) were predictive factors of SCB attainment. Conclusion: The postoperative Lysholm, IKDC-SKF, Tegner, and ACL-RSI scores showed acceptable to excellent reliability in predicting the SCB after ACLR in the general population. Age at surgery and thigh muscle strength influenced SCB attainment for all PROs.
PurposeTibiofemoral synchronization technique matches the rotational alignment of the tibial component to the femoral component during the total knee arthroplasty (TKA). The rotational axis of the proximal tibia can be changed by this technique, which affects tibial torsion postoperatively. The purpose of this study was to investigate whether the tibiofemoral synchronization technique affect the tibial torsion, and the lower limb rotation after primary TKA. It was hypothesised that the tibial torsion would change after primary TKA. MethodsNinety‐three posterior stabilised TKAs from 89 patients were included from January 2017 to December 2018. Mechanical hip–knee–ankle axis (mHKA), in plain radiographs, femoral anteversion, tibial torsion, femoral neck‐malleolar angle (FNMA), and rotational alignment of the femoral and the tibial components in pre‐ and postoperative CT scans were measured by two blinded observers. The primary outcome was a postoperative change in femoral anteversion, tibial torsion and FNMA. Clinical outcomes were evaluated using the American Knee Society Knee Score (AKSKS)/Function Score (AKSFS), and Oxford Knee Score (OKS) preoperatively and at 1 year after TKA. Patients’ perception of changes in the foot progression angle after TKA was investigated. Statistical significance was set at p < 0.05. ResultsThe mean rotational mismatch between the femoral and the tibial component was 0.6 ± 3.2°. There was a significant decrease in femoral anteversion (9.5 ± 6.7° vs. 5.2 ± 6.6°, p < 0.001), and a significant increase in the FNMA (17.6 ± 9.7° vs. 21.8 ± 10.5°, p = 0.005) after TKA, while no significant change in tibia torsion was observed (25.4 ± 8.8° vs. 24.9 ± 9.3°, p = 0.739). AKSS (37.8 ± 15.1 vs. 92.8 ± 8.8, p < 0.001), AKSFS (53.9 ± 18.1 vs. 89.9 ± 5.3, p < 0.001), and OKS (18.0 ± 7.3 vs. 39.9 ± 4.8, p < 0.001) were significantly improved at 1 year after TKA. Ten knees (11%) had changes in tibial torsion greater than ± 10° postoperatively. Four of five patients who had changes in FNMA greater than 15° perceived the external rotation of the foot progression angle after TKA. All four patients had an increase in tibial torsion larger than 10°. ConclusionOur study shows that the tibiofemoral synchronization technique less likely affects the tibial torsion after primary TKA.
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