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A Novel Implant System for Unloading the Medial Compartment of the Knee by Lateral Displacement of the Iliotibial Band.

ABSTRACT: BACKGROUND:Medial knee osteoarthritis (OA) typically occurs with excessive mechanical load within the medial compartment, resulting in degeneration of the articular cartilage. PURPOSE:A novel extracapsular implant (Latella Knee Implant) has been developed to unload the medial compartment of the knee. The implant displaces the iliotibial band (ITB) over the lateral femoral condyle, thereby increasing its effective moment arm, resulting in a transfer of load from the medial compartment to the lateral compartment of the knee. A cadaveric study was performed to evaluate the effect of altering the moment arm of the ITB on knee biomechanics. STUDY DESIGN:Controlled laboratory study. METHODS:A 6-degrees-of-freedom robotic testing system was utilized to measure medial and lateral compartment loads in 8 fresh-frozen cadaveric knees at various ITB loads and knee flexion angles. Measurements were made with and without the implant in place. The system measured the compartment forces at flexion angles between 0° and 30° under 3 simulated loading conditions (300 N quadriceps, 100 N hamstrings, and [1] 0 N ITB, [2] 50 N ITB, [3] 100 N ITB). RESULTS:Lateral displacement of the ITB between 15 and 20 mm resulted in medial compartment unloading between 34% and 65%. CONCLUSION:Unloading the medial compartment with this novel implant has the potential to address the treatment gap for patients with medial knee OA. CLINICAL RELEVANCE:Currently, there exists a treatment gap for patients with medial compartment OA who have exhausted conservative management but whose disease and symptoms do not warrant more invasive surgical procedures. An extracapsular implant to unload the medial compartment could fill this treatment gap by providing patients and surgeons with a less invasive option for early to mid-stage OA. Unloading the medial compartment may alleviate pain and improve function, allowing patients with early-stage medial OA to remain active longer prior to considering more invasive options such as arthroplasty.

SUBMITTER: Shenoy VN

PROVIDER: S-EPMC5347431 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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A Novel Implant System for Unloading the Medial Compartment of the Knee by Lateral Displacement of the Iliotibial Band.

Shenoy Vivek N VN Gifford Hanson S HS Kao John T JT

Orthopaedic journal of sports medicine 20170303 3

<h4>Background</h4>Medial knee osteoarthritis (OA) typically occurs with excessive mechanical load within the medial compartment, resulting in degeneration of the articular cartilage.<h4>Purpose</h4>A novel extracapsular implant (Latella Knee Implant) has been developed to unload the medial compartment of the knee. The implant displaces the iliotibial band (ITB) over the lateral femoral condyle, thereby increasing its effective moment arm, resulting in a transfer of load from the medial compartm ...[more]

PMID: 28321432

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Project description:PurposeTo quantify intraoperative joint space widening afforded by the outside-in, percutaneous release of the medial collateral ligament (MCL) and to evaluate its impact on medial compartment width and functional outcomes at 6-week follow-up for patients undergoing a partial medial meniscectomy without postoperative bracing.MethodsPatients with posteromedial meniscus tears and no evidence of ipsilateral knee pathology, undergoing partial medial meniscectomy, were enrolled. Intraoperatively, medial compartment width was quantified with fluoroscopy before and after the percutaneous MCL release with an 18-gauge spinal needle proximal to the joint line. At 6-week follow-up, valgus stress radiographs re-evaluated medial compartment width. International Knee Documentation Committee (IKDC) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were completed preoperatively and at 6-week follow-up to evaluate functional outcomes. A paired sample t test performed at a 95% confidence interval (CI) was used to compare these variables.ResultsForty-two patients, mean (± standard deviation) age 55.3 ± 10.7 years, were available for analysis of intraoperative medial compartment widening. Medial compartment width increased from 5.95 ± 1.32 to 11.09 ± 1.74 mm intraoperatively after MCL release. At 6-week follow-up, radiographic assessment demonstrated a mean medial compartment width of 5.85 ± .99 mm, which represented an insignificant change compared with the preoperative value (CI -0.68 to .33, P = .474). PROMIS and IKDC scores significantly improved from baseline, with increases of 6.9 ± 12.4 (CI 2.0 to 11.8, P = .008) and 11.7 ± 17.8 (CI 4.7 to 18.8, P = .002), respectively.ConclusionsPercutaneous MCL release during knee arthroscopy improves visualization and facilitates instrumentation by providing an almost 2× wider working space within the medial tibiofemoral joint. In this study, the performance of percutaneous MCL release did not result in any complications. Radiographic and clinical resolution of iatrogenic laxity was demonstrated by 6-weeks postoperatively, without the use of postoperative bracing.Level of evidenceIV, therapeutic case series.

Project description:ObjectiveTo determine the comparative prevalence, associations with selected patient characteristics, and clinical outcomes of medial and lateral compartment patellofemoral (PF) joint osteoarthritis (OA).MethodsInformation was collected by questionnaires, clinical assessment, and radiographs from 745 eligible community-dwelling symptomatic adults age ≥50 years. PF joint space narrowing (JSN) and osteophytes were scored from skyline radiographs using the Osteoarthritis Research Society International atlas. Multilevel models were used to assess associations of compartmental PF joint OA with age, sex, body mass index (BMI) and varus-valgus malalignment, while median regression was used to examine associations with clinical outcomes (current pain intensity on a numeric rating scale [0-10] and the function subscale of the Western Ontario and McMaster Universities Osteoarthritis Index [0-68]).ResultsIsolated lateral PF joint OA was more common than isolated medial PF joint OA, particularly at higher severity thresholds. Irrespective of severity threshold, age (≥2 odds ratio [OR] 1.19 [95% confidence interval (95% CI) 1.12, 1.26]), BMI (≥2 OR 1.15 [95% CI 1.07, 1.24]), and valgus malalignment (≥2 OR 2.58 [95% CI 1.09, 6.07]) were associated with increased odds of isolated lateral JSN, but isolated medial JSN was only associated with age (≥2 OR 1.20 [95% CI 1.14, 1.27]). The pattern of association was less clear for PF joint osteophytes. Isolated lateral PF joint OA, defined by JSN or osteophytes, was associated with higher pain scores than isolated medial PF joint OA, but these differences were modest and were not significant. A similar pattern of association was seen for functional limitation but only when PF joint OA was defined by JSN.ConclusionIsolated lateral PF joint OA is more common than isolated medial PF joint OA, and it is more consistently associated with established OA risk factors. It is also associated with higher, but clinically nonsignificant, pain and function scores than isolated medial PF joint OA, particularly when PF joint OA is defined using JSN.

Dataset Information

A Novel Implant System for Unloading the Medial Compartment of the Knee by Lateral Displacement of the Iliotibial Band.

Publications

A Novel Implant System for Unloading the Medial Compartment of the Knee by Lateral Displacement of the Iliotibial Band.

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