Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Increased prevalence and severity of femoral bone wear in Japanese patients with varus knee osteoarthritis.","authors":"Manabu Akagawa, Hidetomo Saito, Yasuhiro Takahashi, Hiroaki Kijima, Yuji Kasukawa, Koji Nozaka, Naohisa Miyakoshi","doi":"10.1002/ksa.12697","DOIUrl":"https://doi.org/10.1002/ksa.12697","url":null,"abstract":"<p><strong>Purpose: </strong>The calliper technique in kinematic alignment total knee arthroplasty assumes nearly identical medial and lateral femoral condylar radii and negligible subchondral bone wear. However, racial differences were not considered. This study aimed to assess the degree and severity of bone wear in Japanese patients with varus knee osteoarthritis.</p><p><strong>Methods: </strong>This cross-sectional study included 155 knees from 130 patients who underwent total or unicompartmental knee arthroplasty for primary varus-type knee osteoarthritis between April 2020 and March 2024. Preoperative computed tomography scans were used to measure the femoral condylar radii via a circle-fitting technique. Bone wear was assessed at 0° and 90° by measuring the distance between the best-fit circle and the subchondral bone periphery, with additional measurements at the peak wear angle, if present.</p><p><strong>Results: </strong>Among 155 knees, 16 (10.3%) exhibited bone wear. Bone wear >1 mm at 0° was observed in 3.2% of the cases. The peak wear angle was 43.1 ± 5.0°, with a mean depth of 2.0 ± 0.7 mm. The medial and lateral condylar radii were nearly identical (18.3 ± 1.2 mm vs. 18.2 ± 1.2 mm, p = 0.002), with a strong correlation (R² = 0.94, p < 0.001).</p><p><strong>Conclusion: </strong>Bone wear exceeding 1 mm at 0° was observed in 3.2% of cases, while overall bone wear was present in 10.3% of knees. Although the difference in radii between the medial and lateral femoral condyles was statistically significant, it was clinically negligible. This finding supports the reliability of the cylindrical axis as a reference for surgical techniques. These results highlight the importance of recognizing potential racial differences in bone wear and underscore the need for accurate assessment to achieve anatomic restoration in kinematic alignment total knee arthroplasty.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden.","authors":"Yaara Berkovich, Ela Cohen Nissan, David Maman, Michael Tobias Hirschmann, Yaniv Yonai, Yaniv Steinfeld, Yaron Berkovich","doi":"10.1002/ksa.12696","DOIUrl":"https://doi.org/10.1002/ksa.12696","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.</p><p><strong>Methods: </strong>This retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>Following PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, p < 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, p < 0.001) and higher total hospital charges ($101,457 vs. $96,614, p = 0.015).</p><p><strong>Conclusions: </strong>Diabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes.</p><p><strong>Levels of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher surgeon volume reduces early failure in first time revision of non-infected total knee arthroplasty: An analysis using data from the United Kingdom National Joint Registry.","authors":"Alexander H Matthews, William K Gray, Jonathan P Evans, Jonathan T Evans, Sarah E Lamb, Andrew Porteous, Tim Briggs, Shiraz A Sabah, Abtin Alvand, Andrew D Toms, Andrew J Price","doi":"10.1002/ksa.12690","DOIUrl":"https://doi.org/10.1002/ksa.12690","url":null,"abstract":"<p><strong>Purpose: </strong>Revision total knee replacement (RevKR) is an increasingly common procedure. It is hypothesised that higher surgical volume is linked to lower levels of adverse outcomes. The aim was to estimate the association of surgical volume on patient outcomes following first single-stage RevKR for non-infected indications.</p><p><strong>Methods: </strong>This population-based cohort study used data from the United Kingdom National Joint Registry, Hospital Episode Statistics and National Patient Reported Outcome Measures. Patients undergoing procedures between 1 January 2009 and 30 June 2019 were included. The primary outcome measure was re-revision within 2 years; chosen to reflect the quality of the surgical provision. Fixed effect multivariable regression models were used to examine the association between surgeon and surgical unit annual caseload and the risk of adverse outcomes.</p><p><strong>Results: </strong>A total of 8695 patients underwent first time single stage revision for aseptic loosening, instability, or malalignment across 389 surgical units and 1204 surgeons. Following adjustment for age, gender, ASA grade, year of surgery and operation funder, higher surgeon volume was associated with a lower risk of re-revision at 2 years. The risk of re-revision decreased amongst surgeons performing ≥9 annual revisions (OR 0.77, 95% CI 0.62-0.95, p-value = 0.02) compared to those performing <9 annual revisions.</p><p><strong>Conclusions: </strong>Annual surgeon case volume of ≥9 first single-stage RevKR for non-infected indications is independently associated with reductions in early re-revision. This evidence supports the setting of minimum volume targets to improve outcomes for patients.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study of prospectively collected data.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The formal EU-US meniscus rehabilitation 2024 consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction).","authors":"Nicolas Pujol, Airelle O Giordano, Stephanie E Wong, Philippe Beaufils, Juan Carlos Monllau, Elanna K Arhos, Roland Becker, Francesco Della Villa, J Brett Goodloe, James J Irrgang, Jitka Klugarova, Emma L Klosterman, Aleksandra Królikowska, Aaron J Krych, Robert F LaPrade, Robert Manske, Nicky van Melick, Jill K Monson, Marko Ostojic, Mark V Paterno, Tomasz Piontek, Simone Perelli, Alexandre Rambaud, James Robinson, Laura C Schmitt, Eric Hamrin Senorski, Thorkell Snaebjornsson, Adam J Tagliero, C Benjamin Ma, Robert Prill","doi":"10.1002/ksa.12674","DOIUrl":"https://doi.org/10.1002/ksa.12674","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of part one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Prevention programmes, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures will be presented in a part II article.</p><p><strong>Methods: </strong>This consensus followed the European Society for Sports Traumatology and Arthroscopy (ESSKA)'s 'formal consensus' methodology. For this combined ESSKA, American Orthopedic Society for Sports Medicine and American Academy of Sports Physical Therapy initiative, 67 experts (26 in the steering group and 41 in the rating group) from 14 countries (US and 13 European countries), including orthopaedic surgeons, sports medicine doctors and physiotherapists were involved. Steering group members established guiding questions, searched the literature and proposed statements. Rating group members assessed the statements according to a Likert scale and provided grades of recommendations, reaching a final agreement about rehabilitation of the knee after meniscus surgery. Final documents were then assessed by a peer review group to address the geographical adaptability.</p><p><strong>Results: </strong>The overall level of evidence in the literature was low. Of the 19 questions (leading to 29 statements), 1 received a Grade A of recommendation, 2 a Grade B, 9 a Grade C and 17 a Grade D. Nevertheless, the mean median rating of all questions was 8.2/9 (9 being the highest rating on a scale of 1-9). The global mean rating was 8.4 ± 0.2, indicating a high agreement. Rehabilitation depends on the type of lesion, the treatment performed and is the same after medial or lateral meniscus surgery. Rehabilitation after meniscectomy should follow a criterion-based rehabilitation protocol, based on milestones rather than a time-based protocol. After meniscus repair and reconstruction, rehabilitation should be progressed according to both time and criterion-based milestones.</p><p><strong>Conclusion: </strong>Rehabilitation after meniscus surgery is a debated topic that may influence surgical outcomes if not optimally performed. This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery.</p><p><strong>Level of evidence: </strong>Level I, consensus.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A semitendinosus with adjustable button graft construct in patients undergoing hamstring ACL reconstruction results in improved knee flexor strength symmetry and less donor site pain and morbidity: Outcomes from the DOSTAR randomized controlled trial.","authors":"Adam M Lawless, Jay R Ebert, Peter K Edwards, Shahbaz S Malik, Peter S E Davies, Peter A D'Alessandro","doi":"10.1002/ksa.12698","DOIUrl":"https://doi.org/10.1002/ksa.12698","url":null,"abstract":"<p><strong>Purpose: </strong>To compare donor site morbidity and patient-reported outcome measures (PROMs), knee laxity and early strength and functional outcomes, following anterior cruciate ligament reconstruction (ACLR) using a semitendinosus (ST) tendon autograft with suspensory adjustable button tibial fixation or semitendinosus-gracilis (STG) autograft with tibial screw fixation.</p><p><strong>Methods: </strong>While 153 patients were prospectively recruited and randomized to an ST or STG autograft, 131 (62 ST and 69 STG) were retained following ACLR and followed post-surgery. Standardized surgical techniques were employed, varying only in graft selection and fixation. The primary study outcomes were early hamstring pain, donor site morbidity and strength recovery. However, several outcomes were assessed pre-surgery and at 3 and 6 months, encompassing the Donor-site-related Functional Problems following Anterior Cruciate Ligament Reconstruction (DFPACLR) score, Visual Analogue Scale (VAS) for hamstring pain and other commonly employed PROMs, anteroposterior laxity (KT-1000), isokinetic hamstring and quadriceps strength, hop testing, complications and re-operations. Intention-to-treat analysis was performed using linear mixed models for continuous data and Mann-Whitney U tests where appropriate.</p><p><strong>Results: </strong>At 6 months, ST patients reported significantly lower hamstring pain (p < 0.001) and DFPACLR (p < 0.001) scores. A significantly higher (p < 0.001) peak knee flexor strength limb symmetry index (LSI) was observed for the ST group, though no other group differences in side-to-side laxity, hop tests or other normalized strength measures or LSIs were observed.</p><p><strong>Conclusions: </strong>ACLR using an ST autograft resulted in less donor site pain and morbidity, and improved knee flexor strength symmetry at 6 months, while demonstrating comparable functional outcomes to the STG autograft.</p><p><strong>Level of evidence: </strong>Level 1 prospective, double-blinded, randomized controlled trial.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction.","authors":"Benjamin Dutaillis, Tyler Collings, Philip Bellinger, Ryan G Timmins, Morgan D Williams, Mathew N Bourne","doi":"10.1002/ksa.12694","DOIUrl":"https://doi.org/10.1002/ksa.12694","url":null,"abstract":"<p><strong>Purpose: </strong>To (1) investigate how lower limb strength, vertical jump metrics, and patient reported outcome measures (PROMs) change in the initial 3- to 12-months of recovery following ACLR; and (2) explore which strength and vertical jump metrics best differentiate between lower and higher Knee Osteoarthritis Outcome Score (KOOS) and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scores.</p><p><strong>Methods: </strong>Thirty recreationally active athletes undergoing unilateral primary ACLR underwent field-based assessments of knee flexion and extension strength, hip adduction and abduction strength, and double and single leg countermovement (CMJ) and drop vertical jump (DVJ) kinetics at 3-, 6-, 9- and 12-months following surgery. The KOOS and ACL-RSI were also completed. Mixed models were used to investigate how measures of lower limb strength, vertical jump metrics and PROMs change across the first 12-months of rehabilitation. Mixed model decision trees were used to determine which strength and vertical jump measures best discriminated between lower and higher PROMs.</p><p><strong>Results: </strong>Vertical jump height and reactive strength index (RSI) improved significantly over time (p < 0.001), with reductions in contraction and contact times (p < 0.05). Isometric knee extension and eccentric knee flexion strength increased significantly (p < 0.001), as did KOOS and ACL-RSI scores (p < 0.001). Surgically reconstructed limbs displayed deficits in most vertical jump and strength measures compared to the uninjured contralateral limb, although deficits reduced over time with between limb asymmetry deceasing in 70% of these variables (p range: 0.05 to <0.001). Single leg CMJ jump height < 8.4 cm best discriminated between lower and higher ACL-RSI scores (r² = 0.67, d = 0.8), whilst knee extension peak force asymmetry < 38.3% best discriminated between lower and higher KOOS scores (r² = -0.78, d = 0.9) across the time-course of rehabilitation.</p><p><strong>Conclusion: </strong>Most measures of lower limb strength and vertical jump metrics change in both the ACLR and uninjured contralateral limbs across the first 12-months of recovery following primary ACLR. A strong relationship was found between measures of lower limb strength and vertical jump performance with PROMs.</p><p><strong>Level of evidence: </strong>Level II, lower quality prospective cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic fractures of the tibia in knee arthroplasty have a high risk of treatment failure: A systematic review.","authors":"Georgios Kalifis, Theodorakys Marin Fermin, Angelo V Vasiliadis, Georgios Tsinaslanidis, Christopher Gee, Michael Hantes","doi":"10.1002/ksa.12692","DOIUrl":"https://doi.org/10.1002/ksa.12692","url":null,"abstract":"<p><strong>Purpose: </strong>Tibial periprosthetic fractures (PPF) are rare but potentially devastating complications following knee arthroplasty. Despite the increasing number of knee replacements worldwide, there is limited data in the literature regarding these injuries. This systematic review aimed to add up-to-date, evidence-based data on tibial PPF that may lead to a more standardised approach and improved outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Virtual Health Library and Cochrane Library databases was performed in accordance with PRISMA guidelines, including studies published from January 2015 to January 2025. Studies were eligible if they reported tibial PPF in knee arthroplasty with at least three patients, describing the treatment approach and follow-up. Data extracted included patient demographics, fracture classification, treatment method, outcomes and methodological quality.</p><p><strong>Results: </strong>Seventeen studies met the inclusion criteria, including 473 patients with a mean age of 67.6 ± 2.5 years. Felix classification was used for 172 patients, Type 3 being the most common (48%). Overall union rate was 87%. While 29% of fractures were managed conservatively, 71% underwent operative management, with open reduction and internal fixation (ORIF) being the most common at 55%. The complication rate was 38%, with infection being the most common standing at 13%. The secondary intervention rate was 28%, most commonly due to failure of initial management and soft-tissue-related complications.</p><p><strong>Conclusion: </strong>Tibial PPF is a rare but demanding complication of knee arthroplasty, associated with high complication (38%) and reoperation (28%) rates. Optimisation of surgical techniques is crucial to prevent iatrogenic fractures. Provided that the implant is stable, fracture fixation is effective following the appropriate principles depending on the personality of the fracture. Revision TKA may also be effective as a first-line option. Considering the scarce evidence in the literature and the high volume of worldwide knee arthroplasties performed, further high-quality studies are crucial to improve outcomes.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data beats dogma-Valgus knees are not associated with a hypoplastic lateral femoral condyle: A CT-based analysis from a high-volume institution.","authors":"Fabio Mancino, Joshua G Twiggs, Ishaan Jagota, Brett A Fritsch","doi":"10.1002/ksa.12688","DOIUrl":"https://doi.org/10.1002/ksa.12688","url":null,"abstract":"<p><strong>Purpose: </strong>Observations following the mechanical alignment principle have led to the concept that the lateral femoral condyle (LFC) is hypoplastic in valgus knee. This study aimed to investigate if this assumption is correct-the hypothesis was that there is no relationship between the radius of curvature of the LFC and coronal alignment.</p><p><strong>Methods: </strong>This is a retrospective study of prospectively collected patients who underwent primary robotic TKA between 2021 and 2023. Segmentation of the preoperative computerised tomography scan was performed to obtain a three-dimensional model of the knee. A semi-automated algorithm was used to create a circle of best fit to obtain the radius of each femoral condyle. The size of the condyles was expressed as the lateral-to-medial (L2M) condylar radii ratio. Patients were stratified based on hip-knee-ankle (HKA) angle and L2M ratio, and the association with the alignment was analysed. Distal and posterior offset were investigated and analysed. Significance was for p values < 0.05.</p><p><strong>Results: </strong>Overall, 498 consecutive knees were investigated. The mean HKA was 4.1 ± 5.4° varus. The mean L2M condylar ratio was 0.95 in patients with neutral alignment, 0.98 in varus alignment and 0.96 in valgus alignment. The L2M ratio was <1 in all alignment groups, with no significant differences between varus and valgus. The knees with a hypoplastic LFC (L2M ratio <0.9) showed a similar HKA distribution to those with L2M > 0.9. No differences in posterior offset of the LFC were noted between valgus, neutral and varus knees. The lateral distal offset was greater in valgus than neutral knees (27.1 ± 2.7 mm vs. 25.9 ± 2.9 mm).</p><p><strong>Conclusion: </strong>The LFC is on average smaller than the MFC regardless of the coronal alignment, with no correlation with the HKA. These findings add evidence against the concept of a hypoplastic LFC in valgus knees.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current practice of biologic augmentation techniques to enhance the healing of meniscal repairs: A collaborative survey within the Meniscus International Network (MenIN) Study Group.","authors":"James Robinson, Iain R Murray, Gilbert Moatshe, Jorge Chahla, Luke V Tollefson, David A Parker, Filippo Familiari, Robert F LaPrade, Nicholas N DePhillipo","doi":"10.1002/ksa.12685","DOIUrl":"https://doi.org/10.1002/ksa.12685","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate practices and preferences among expert sports knee surgeons regarding biologic augmentation techniques in meniscal repair.</p><p><strong>Methods: </strong>A 12-question multiple-choice survey was distributed to the Meniscus International Network (MenIN) Study Group. It covered biologic augmentation techniques for various meniscal tear types, both in isolation and with anterior cruciate ligament reconstruction (ACLR). Eight options were assessed: no augmentation, trephination, rasping, marrow venting, fibrin clot, platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and meniscal wrapping. Surgeons could select multiple techniques per scenario.</p><p><strong>Results: </strong>Forty-two surgeons participated: 42% from Europe, 18% from North America, 10% from Latin America, 21% from Asia and 9% from Africa/Oceania. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons used at least one biologic augmentation technique. For meniscal tears associated with ACLR, 66% of surgeons used at least one biologic augmentation technique. The most utilized techniques were rasping (19%-69%), trephination (7%-43%), and marrow venting (0%-74%). PRP (2%-19%), BMAC (0%-14%) and meniscal wrapping (0%-10%) were least used. Biologic augmentation was most frequent for isolated radial (93%), isolated bucket-handle (86%), isolated vertical (86%) and isolated horizontal tears (98% for younger patients, 86% for degenerative tears). ACLR-associated repairs had lower augmentation rates, and meniscal root tears showed the highest percentage of non-augmented repairs. Over 50% of surgeons use a single augmentation technique, while 20% use two techniques depending on tear type. Overall, 33.3% (n = 14) of surgeons reported utilizing PRP and/or BMAC for meniscal repair augmentation, with the highest use observed in South America (12%) based on geographic usage.</p><p><strong>Conclusions: </strong>This survey provides insights into current meniscal repair practices among expert orthopaedic sports medicine surgeons. The findings reveal variability in approaches based on tear patterns and associated procedures, with a general preference for simpler mechanical augmentation techniques over more advanced biologics. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons in this cohort report using one or more biological augmentation techniques.</p><p><strong>Level of evidence: </strong>Level V expert opinion.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large variability in minimal clinically important difference, substantial clinical benefit and patient acceptable symptom state values among literature investigating patellar stabilization surgery: A systematic review.","authors":"Ahmed Bilgasem, Prushoth Vivekanantha, Lauren Gyemi, Zackariyah Hassan, David Slawaska-Eng, Amit Meena, Shahbaz Malik, Darren de Sa","doi":"10.1002/ksa.12684","DOIUrl":"https://doi.org/10.1002/ksa.12684","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS) values for patient-reported outcome measures (PROMs) after patellar stabilization surgery for patellar instability. Secondary outcomes included to describe methods to calculate clinically significant outcomes (CSOs), and to report on the achievement of these metrics.</p><p><strong>Methods: </strong>On 31 July 2024, three databases were searched. Information on whether studies calculated MCID, SCB or PASS values or used previously established values was recorded. Data on study characteristics, CSO values, and the method of MCID quantification (e.g., distribution vs. anchor) were extracted.</p><p><strong>Results: </strong>A total of 17 articles with 1447 patients (1462 knees) were included. A total of 18 unique outcome measures were reported. Six out of 15 (40%), 2 out of 5 (40%), and zero studies used prior established values for MCID, SCB and PASS, respectively. MCID ranged widely (e.g., International Knee Documentation Committee [IKDC]: 5.6-20.5; Kujala Anterior Knee Pain Scale: 5.38-11.9 and Lysholm: 5.6-11.1). Fourteen out of 15 utilized a distribution-based method to calculate MCID, with only one study using an anchor-based method. SCB values ranged widely as well (e.g.</p><p><strong>, ikdc: </strong>14.5-23.6; Knee Osteoarthritis and Outcome Score [KOOS] symptoms: 4.2-14.2 and KOOS activities of daily living [ADLs]: 6.5-25.7). Large variability was found among percentages of patients that achieved MCID values (e.g.</p><p><strong>, ikdc: </strong>28%-98.6%, Kujala: 38%-100%, Lysholm: 44%-98.4% and Tegner: 84%-95%).</p><p><strong>Conclusion: </strong>The significant heterogeneity in reported thresholds for MCID, SCB and PASS across studies highlights critical challenges in interpreting results after patellar stabilization surgery, specifically regarding what constitutes a clinically relevant outcome. MCID was the most commonly reported metric and calculated predominantly with distribution-based methods, with over half of the studies using previously established thresholds. PASS and SCB were widely underreported as well, suggesting a need for studies investigating patellar stabilization to prioritize the calculation of all three metrics, using anchor-based techniques.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}