Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Older age and a non-sporting injury mechanism are associated with re-injury and the need for revision surgery over a minimum 2-year follow-up following proximal hamstring tendon repair","authors":"Jay R. Ebert,&nbsp;Peter K. Edwards,&nbsp;Elias Ammann,&nbsp;Adam Farrier,&nbsp;Lorcan Gavin,&nbsp;Method Kabelitz,&nbsp;Ross Radic,&nbsp;Antony Liddell,&nbsp;Peter Annear","doi":"10.1002/ksa.12767","DOIUrl":"10.1002/ksa.12767","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate revision rates and factors associated with the need for revision following proximal hamstring tendon repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 243 patients who underwent proximal hamstring tendon repair due to an acute (<i>n</i> = 176) or chronic (<i>n</i> = 67) tear. Complications, re-injuries and re-operations were reviewed. Risk factor analysis for re-rupture within 2 years of surgery was conducted using Cox proportional hazards regression, with variables including age, body mass index (BMI), sex, mechanism of injury (sport-related or other), time from injury to surgery and comorbidities including hypertension, hypercholesterolaemia and Type 2 diabetes. Receiver operating characteristic analysis explored time-to-surgery thresholds in relation to revision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 19 (10.8%) of the acute cohort and 11 (16.4%) of the chronic cohort underwent revision surgery due to re-tearing and recurrence of symptoms. In the acute cohort, an increased risk of re-injury was associated with a non-sporting (versus sporting) injury (hazard ratio [HR] = 3.38; 95% confidence interval [CI], 1.10–10.39; <i>p</i> = 0.033) and an older age (HR = 1.04 per year; 95% CI, 1.00–1.08; <i>p</i> = 0.031). In the chronic cohort, there were no significant associations between age, BMI, sex or comorbidities, with revision surgery. The optimal threshold for surgery for acute repairs was 30.5 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 10.8% and 16.4% revision rate was observed over a minimum 2-year follow-up following proximal hamstring repair for acute and chronic tears, respectively. For chronic tears, no variables were associated with the need for revision. However, older age and non-sporting injury were associated with a higher risk of re-injury in the acute cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2984-2993"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The metaverse in orthopaedics: Virtual, augmented and mixed reality for advancing surgical training, arthroscopy, arthroplasty and rehabilitation","authors":"Mahmut Enes Kayaalp,&nbsp;Efstathios Konstantinou,&nbsp;Bedri Karaismailoglu,&nbsp;Gian Andrea Lucidi,&nbsp;Mehmet Kaymakoglu,&nbsp;Romed Vieider,&nbsp;Joseph D. Giusto,&nbsp;Jumpei Inoue,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12723","DOIUrl":"10.1002/ksa.12723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The metaverse and extended reality (XR), which includes augmented reality (AR), virtual reality (VR) and mixed reality (MR), are transforming orthopaedic surgery by enhancing training, procedural accuracy and rehabilitation. However, a literature review of these new virtual tools is lacking. The purpose of this narrative review is to summarise available evidence about the metaverse and discuss current and future clinical applications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review of the current literature was performed for studies evaluating XR tools and their respective clinical and educational utility. Studies from all orthopaedic subspecialties were eligible for inclusion. The XR tools evaluated in each study were categorised according to the reality spectrum and future research or clinical applications were discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>XR is a technological spectrum that includes AR, VR and MR to create immersive and interactive surgical training environments. VR-based simulators may improve surgical education by allowing trainees to refine their skills in a risk-free setting. AR may enhance intraoperative guidance and has been studied within orthopaedics to improve implant positioning accuracy and reduce complications in procedures including arthroscopy and total joint arthroplasty. In rehabilitation, AR and VR have been implemented to facilitate patient engagement and adherence, promoting functional recovery through gamified therapy and remote telerehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There has been a paradigm shift in orthopaedic care in which digital tools are integrated with patient care to optimise patient outcomes. However, challenges to the widespread implementation of promising XR technology include high costs, steep learning curves and limited clinical validation. Ethical concerns, including data security and patient privacy, further complicate its use in clinical settings. Future research must focus on cost-effectiveness, standardisation and improving accessibility to ensure seamless integration into clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3039-3050"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to ‘Comment on “Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis”’","authors":"Simon Talbot","doi":"10.1002/ksa.12738","DOIUrl":"10.1002/ksa.12738","url":null,"abstract":"&lt;p&gt;We thank the authors of the Letter to the Editor for their commentary regarding our publication and their appreciation of the importance of quadriceps malalignment [&lt;span&gt;1&lt;/span&gt;]. The concerns raised in the letter highlight some of the common confusions around the subtle differences between patella instability and patella arthritis. Trochlear dysplasia is a known risk factor for patella instability, and patients with instability and subsequent chondral damage have a high rate of patellofemoral joint osteoarthritis (PFJOA).&lt;/p&gt;&lt;p&gt;Our study identified a biomechanical deformity in the quadriceps mechanism due to an external rotation of the proximal quadriceps muscle around the shaft of the femur. To determine if this was a clinically relevant cause of patella maltracking we assessed it in a group of patients with severe patella maltracking leading to Lateral Facet PFJOA. None of these patients had a history of patella instability. Therefore, their arthritis is likely due to an imbalance in the forces acting on the patella rather that a history of previous injury. Indeed, this was demonstrated, with a strong association between quadricep malalignment and the presence of Lateral Facet PFJOA. In this study, the objective measures of trochlear anatomy (trochlear groove alignment and coronal orientation, trochlear ridge heights and lateralisation of the trochlear sulcus) were not significantly associated with Latera Facet PFJOA. This does not exclude the possibility that trochlear dysplasia may be present in patients with other patterns of PFJOA or in patients with a history of instability.&lt;/p&gt;&lt;p&gt;The letter further states that ‘papers have highlighted the (sic) trochlear dysplasia is the main aetiology of PFJOA’. While our research did not aim to answer this question, the statement requires examination. Upon reviewing the cited papers [&lt;span&gt;3, 4, 7&lt;/span&gt;], it is evident this statement is not supported. None of the papers claim that trochlear dysplasia is the aetiology of PFJOA. Regarding the largest case series [&lt;span&gt;3&lt;/span&gt;], it is important to note that the authors do not claim a causative effect of trochlear dysplasia on patella osteoarthritis. Rather, they highlight as a limitation that the research is a cross-sectional study and that ‘a longitudinal study is needed to better characterize the relationship between trochlear dysplasia and OA’. Furthermore, they state that ‘Patellofemoral OA could potentially lead to secondary trochlear remodeling, resulting in abnormal trochlear depth, abnormal facet ratio, and abnormal sulcus angle.’ It is interesting to note that [&lt;span&gt;3&lt;/span&gt;] also concluded that there was a strong association between trochlear dysplasia and medial tibiofemoral degeneration, and a negative association with lateral tibiofemoral degeneration.&lt;/p&gt;&lt;p&gt;Mofidi et al. [&lt;span&gt;4&lt;/span&gt;] examined trochlear dysplasia in patients undergoing isolated patellofemoral replacement (&lt;i&gt;n&lt;/i&gt; = 18) and found a flatter trochlear angle (149° v","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3053-3054"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding ‘Anterior cruciate ligament primary repair revision rates are increased in skeletally mature patients under the age of 21 compared to reconstruction, while adults (>21 years) show no significant difference: A systematic review and meta-analysis’","authors":"Hanrong Rao,&nbsp;Xiaosheng Yang","doi":"10.1002/ksa.12736","DOIUrl":"10.1002/ksa.12736","url":null,"abstract":"&lt;p&gt;We read with great interest the recent article by Rilk et al. addressing the critical influence of age on the outcomes of anterior cruciate ligament (ACL) repair techniques [&lt;span&gt;9&lt;/span&gt;]. The authors should be commended for their rigorous methodology and thought-provoking findings, particularly identifying the age of 21 years as a key age threshold for ACL repair efficacy. This finding holds significant promise in guiding personalised treatment strategies. However, we believe that certain limitations warrant further discussion to enhance the clinical applicability of the conclusions.&lt;/p&gt;&lt;p&gt;First, the methodological constraints of the study deserve attention. The limited number of included studies (12), which were predominantly retrospective, led to a relatively low level of evidence. The small sample size may have affected the robustness of the effect size estimation, increasing the risk of false-positive or false-negative results. Consequently, the current evidence may be insufficient to definitively support the 21-year age cutoff. Moreover, significant heterogeneity existed among the included studies regarding ACL reconstruction techniques, graft types, and fixation methods. The lack of adequate subgroup analysis or adjustment during meta-analysis may have affected the reliability of the results. Additionally, the included populations varied in age, sex, and preoperative activity level, with only 30% of the non-randomised studies performing cohort matching, making it difficult to exclude the influence of selection and confounding biases. Future meta-analyses should expand the literature search, including more high-quality prospective studies, and employ meta-regression, Egger's test, and sensitivity analyses to explore the sources of heterogeneity and assess the impact of bias [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, the authors' interpretation of certain unexpected findings lacks depth. Regarding the higher revision rate of repair techniques compared to reconstruction in patients aged ≤21 years, the authors speculate that this may be related to the higher risk of re-injury in young individuals. However, they did not thoroughly explore the potential mechanisms underlying the age-efficacy relationship. Based on the literature, we propose the following hypotheses for the authors' consideration: (1) younger individuals may have more severe ACL degeneration at the time of injury, hindering repair; [&lt;span&gt;5, 12&lt;/span&gt;] (2) higher postoperative weight-bearing and activity levels in younger patients may increase early stress, leading to re-injury at the repair site; [&lt;span&gt;1, 13, 14&lt;/span&gt;] and (3) although younger individuals have more robust ligament cell metabolism, metabolic derangements after repair may affect tissue healing quality [&lt;span&gt;2, 7&lt;/span&gt;]. These factors could collectively influence the repair outcomes and increase the risk of revision.&lt;/p&gt;&lt;p&gt;Similarly, the authors attributed the higher reoperation rate of dynamic intraligamentary stabi","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3055-3056"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor regarding the meta-analytic evidence on age-stratified ACL repair outcomes, with a commentary on reporting beyond the evidence hierarchy","authors":"Sebastian Conner-Rilk,&nbsp;Jelle P. van der List,&nbsp;Gregory S. DiFelice","doi":"10.1002/ksa.12735","DOIUrl":"10.1002/ksa.12735","url":null,"abstract":"&lt;p&gt;We would like to thank Rao and Yang for their interest in our article, ‘Anterior cruciate ligament primary repair revision rates are increased in skeletally mature patients under the age of 21 compared to reconstruction, while adults (&gt;21 years) show no significant difference: a systematic review and meta-analysis’ [&lt;span&gt;19&lt;/span&gt;]. We appreciate their recognition of our methodology and the clinical relevance of our findings.&lt;/p&gt;&lt;p&gt;While we welcome their critique, many of the points raised in their letter to the editor [&lt;span&gt;32&lt;/span&gt;] reflect limitations we acknowledged and addressed in our manuscript. Some concerns appear to rise from incorrect interpretations or may not fully consider aspects of our analysis. In this response, we aim to clarify key points and further explain our rationale in a constructive scientific exchange.&lt;/p&gt;&lt;p&gt;We acknowledge the general limitations of meta-analyses, especially in a field like anterior cruciate ligament (ACL) repair where clinical adoption is evolving and high-level evidence remains limited. Accordingly, sound study design and transparent reporting are essential. Our study aimed to navigate the challenges of synthesising data from a developing field and acknowledged the predominance of retrospective designs and demographic heterogeneity. To address these limitations, we: (1) restricted inclusion to Level I–III for greater evidence homogeneity; (2) contacted all study authors for unpublished demographic and outcome data, improving data quality and enabling subgroup analyses and (3) performed an extensive risk-of-bias analysis to support a balanced discussion of current strengths and limitations. Despite these efforts, as stated in our manuscript, selection and publication bias remain possible. However, a systematic review by two independent reviewers ensured comprehensive inclusion of eligible recent studies. In response to the suggestion that ‘future meta-analyses should expand the literature search, including more high-quality prospective studies’, we would have welcomed references to specific overlooked studies to improve future analyses and the ongoing scientific dialogue.&lt;/p&gt;&lt;p&gt;Regarding the critique that the meta-analysis did not adequately explore heterogeneity and bias, and tools such as Egger's test [&lt;span&gt;7&lt;/span&gt;] should have been included, we refer readers to our results section ‘Level of Evidence and Risk of Bias Assessment’, specifically figs. 6–7 and tabs. 9–10, which include funnel plots, Egger's test, and assessments using both RoB 2 [&lt;span&gt;23&lt;/span&gt;] and MINORS tools [&lt;span&gt;22&lt;/span&gt;]. The risk of bias analysis was even performed by two evaluators and to assess reliability of the rating the inter-rater reliability was calculated and presented as excellent for both the MINORS and Rob 2 assessments, with 0.8 and 0.9, respectively. We believe the authors have missed this in our study.&lt;/p&gt;&lt;p&gt;Rao and Yang also state that ‘the interpretation of certain unexpected findings lacks depth’.","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3057-3059"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12735","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on ‘Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis’","authors":"Michael J. Dan,&nbsp;Nicolas Cance,&nbsp;Bruce F. Caldwell,&nbsp;David H. Dejour","doi":"10.1002/ksa.12739","DOIUrl":"10.1002/ksa.12739","url":null,"abstract":"&lt;p&gt;We have read the paper by Talbot et al. “Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis” that appeared in the December 2023 issue of KSSTA [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We would like to congratulate the authors on their work describing this novel measurement and bringing to light the importance of quadriceps malalignment. We look forward to further works examining patellofemoral joint (PFJ) instability (PFJI) and pain (PFJP), along with optimising patellofemoral kinematics post total joint arthroplasty.&lt;/p&gt;&lt;p&gt;However, we think it is important to highlight in writing some of the potential concerns with this study, else the conclusions from the paper may go unchallenged with future literature.&lt;/p&gt;&lt;p&gt;The paper draws the conclusion that quadriceps tendon malalignment (QTA) is independent of bony morphology and the dominant predictor of lateral Patella femoral joint osteoarthritis (PFJOA).&lt;/p&gt;&lt;p&gt;In contrast, other papers have highlighted the trochlear dysplasia is the main aetiology of PFJOA [&lt;span&gt;8, 10, 13&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Talbot et al. measured trochlear morphology using a number of methods and utilising multiple locations from proximal to distal along the trochlea. Trochlear dysplasia relates to the morphology in the most proximal portion of the trochlear, even in patients with high-grade trochlear dysplasia, the sulcus angle will normalise as you move distally along the trochlea [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We have concerns that their measurements for trochlear dysplasia involve measuring the trochlea at a positions too distal to correctly diagnose and quantify the trochlear dysplasia accurately.&lt;/p&gt;&lt;p&gt;There is no utilisation of the Dejour V2 classification for trochlear dysplasia, which is based on CT [&lt;span&gt;5&lt;/span&gt;]. The Dejour V2 classification was of landmark importance because it highlighted importance of the supratrochlear spur. The supratrochlear spur is the anteriorization of the trochlea floor relative to the anterior femoral cortex. This has recently been proven in biomechanical literature to increase the patellofemoral joint reaction forces independent of the axial shape of the trochlea, via an anti-Maquet effect [&lt;span&gt;4&lt;/span&gt;]. The decreased congruence of the patella with the dysplastic trochlea, due to changes to the trochlea morphology in the axial plan, has also been shown to increase PFJ pressures [&lt;span&gt;14&lt;/span&gt;] and PFJOA [&lt;span&gt;11&lt;/span&gt;], and has been the clinical rationale to treat trochlear dysplasia in patients with anterior knee pain [&lt;span&gt;3, 7, 15&lt;/span&gt;]. In PFJ arthroplasty, success is influenced by the ability to reduce the trochlear offset with respect to the anterior femoral cortex [&lt;span&gt;2&lt;/span&gt;], again highlighting the importance of trochlear bony anatomy to outcomes with respect to PFJ surgery for PFJOA. In trochlear dysplasia, there is also coronal plan malalignment of the trochlear sulcus with re","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3051-3052"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The ACL Café Menu: Individualised treatment of anterior cruciate ligament injuries—From prevention to conservative treatment, repair and reconstruction","authors":"John Nyland","doi":"10.1002/ksa.12727","DOIUrl":"10.1002/ksa.12727","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2707-2712"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532841","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 II—Prevention, non-operative treatment and return to sport","authors":"Robert Prill,&nbsp;C. Benjamin Ma,&nbsp;Stephanie E. Wong,&nbsp;Philippe Beaufils,&nbsp;Juan Carlos Monllau,&nbsp;Elanna K. Arhos,&nbsp;Roland Becker,&nbsp;Francesco Della Villa,&nbsp;J. Brett Goodloe,&nbsp;James J. Irrgang,&nbsp;Jitka Klugarova,&nbsp;Emma L. Klosterman,&nbsp;Aleksandra Królikowska,&nbsp;Aaron J. Krych,&nbsp;Robert F. LaPrade,&nbsp;Robert Manske,&nbsp;Nicky van Melick,&nbsp;Jill K. Monson,&nbsp;Marko Ostojic,&nbsp;Mark V. Paterno,&nbsp;Tomasz Piontek,&nbsp;Simone Perelli,&nbsp;Alexandre Rambaud,&nbsp;James Robinson,&nbsp;Laura C. Schmitt,&nbsp;Eric Hamrin Senorski,&nbsp;Thorkell Snaebjornsson,&nbsp;Adam J. Tagliero,&nbsp;Airelle O. Giordano,&nbsp;Nicolas Pujol","doi":"10.1002/ksa.12689","DOIUrl":"10.1002/ksa.12689","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Part two of this consensus aimed to provide recommendations for the prevention of meniscus injuries, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This consensus followed the European Society of Knee Surgery, Sports Traumatology and Arthroscopy (ESSKA) formal consensus methodology. For this combined ESSKA—American Orthopedic Society for Sports Medicine (AOSSM)—American Academy of Sports Physical Therapy (AASPT) initiative, 67 experts from 14 countries, including orthopedic surgeons and physiotherapists, were involved. The 26 Steering Group members established guiding questions, screened the existing evidence, and proposed statements, and provided Grades of recommendations. The 41 Rating Group members assessed the statements according to a Likert scale (1–9). Final documents were assessed by an international peer review group for geographical adaptability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Low to moderate scientific level of evidence was available, so that grades of recommendations were low (three Grade A ratings, four Grade B, three Grade C and 13 Grade D), underlining the relevance of this consensus. One strong and 17 relative agreements with overall median of 8 (8–9) and a mean of 7.92 ± 0.37 were achieved for 23 statements on 18 questions. Prevention of meniscus injuries is possible with general knee injury reduction programmes and through avoidance of certain activities. Non-operative treatment including physical therapy is the first line approach for degenerative meniscus lesions and may be an option for some acute tears. Return to sports after meniscus tear surgery should be both criterion-based and time-based. Patient reported outcomes in combination with performance-based measures are recommended to evaluate the rehabilitation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. These updated and structured recommendations may be applied by surgeons and physiotherapists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I, consensus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3014-3024"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance and return to sport outcomes following hip arthroscopy in National Hockey League players","authors":"David Slawaska-Eng,&nbsp;Marc Daniel Bouchard,&nbsp;Luigi Del Sordo,&nbsp;Alexander E. Weber,&nbsp;Olufemi Ayeni","doi":"10.1002/ksa.12720","DOIUrl":"10.1002/ksa.12720","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Intra-articular hip disorders, such as femoroacetabular impingement syndrome (FAIS), labral tears and chondral damage are common in ice hockey players, particularly in the National Hockey League (NHL). However, evidence on return-to-sport (RTS) rates and performance outcomes post-hip arthroscopy remains limited. This study evaluates RTS rates, career longevity, and performance metrics, including games played, points per game (PPG), save percentage, and performance scores (PS), following hip arthroscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHL players who underwent hip arthroscopy for intra-articular pathology between 2000 and 2024 were identified using public records. RTS rates, career duration, and performance metrics were analysed pre- and post-surgery. Paired <i>t</i>-tests and analyses of variance (ANOVA) were performed across positions (forwards, defensemen and goaltenders).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 92 NHL players (103 hips) met inclusion criteria. The overall RTS rate was 79.3%, increasing to 84.9% when excluding players still recovering. RTS was significantly higher in players &lt;30 years (90.0% vs. 64.3%, <i>p</i> = 0.003). The average number of post-operative seasons played was 2.7, with no positional differences. Forwards showed significant declines in PPG (pre: 0.63 ± 0.38; post: 0.51 ± 0.37; <i>p</i> = 0.013) and PS (pre: 0.60 ± 0.74; post: 0.37 ± 0.69; ∆PS = −0.23; <i>p</i> = 0.026). Defensemen showed no significant change in PPG (<i>p</i> = 0.648) or PS (<i>p</i> = 0.509). Goaltenders had a decline in save percentage (pre: 0.91 ± 0.01; post: 0.89 ± 0.03; <i>p</i> = 0.038), while wins per season were unchanged (<i>p</i> = 0.205). RTS did not significantly differ by position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NHL players undergoing hip arthroscopy have high RTS rates and often resume multi-season careers. However, forwards experience greater declines in performance, while defensemen and goaltenders are less affected. These results underscore position-specific recovery trends and may inform rehabilitation strategies in elite hockey athletes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2994-3001"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent isokinetic knee flexion strength deficits at the time of return to sport are not associated with a second ACL injury","authors":"Axel Sundberg,&nbsp;Rebecca Hamrin Senorski,&nbsp;Johan Högberg,&nbsp;Ramana Piussi,&nbsp;Kristian Samuelsson,&nbsp;Roland Thomeé,&nbsp;Eric Hamrin Senorski","doi":"10.1002/ksa.12718","DOIUrl":"10.1002/ksa.12718","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate the rate of a second anterior cruciate ligament (ACL) injury based on different levels of knee flexion strength limb symmetry index (LSI) at the time of return to sport (RTS) after ACL reconstruction with hamstring tendon autograft.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data was extracted from a rehabilitation registry for patients aged 15–40 years, who participated in knee-strenuous sports pre-injury (Tegner ≥ 6) and underwent ACL reconstruction with hamstring tendon autograft. Isokinetic knee flexion strength was analysed and reported as LSI. Patients were categorised into three groups (≥90%, 80%–89.9% and &lt;80%) based on their LSI at reported time of RTS. Patients were followed for 2 years after ACL reconstruction to record a second ACL injury, and hazard ratios (HR) were calculated using a Cox proportional hazards model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 526 patients (48% female, mean age 22 ± 6) were included, with 51 (9.7%) second ACL injuries recorded within 2 years after ACL reconstruction. Among patients with LSI ≥ 90% (71%), 43 second ACL injuries (11.0%) occurred. The LSI 80%–89.9% group had 4 second ACL injuries (4.0%), and the LSI &lt; 80% group had four injuries (8.2%). Persistent knee flexion strength asymmetry did not significantly influence the hazard of a second ACL injury. The LSI 80%–89.9% group had a lower hazard (HR 0.34, confidence interval [CI]: 0.12–0.94), while the LSI &lt; 80% group showed no significant difference (HR 0.70, CI: 0.25–1.97) compared with the LSI ≥ 90% group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Persistent isokinetic concentric knee flexion strength asymmetry at RTS were not associated with a second ACL injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2971-2983"},"PeriodicalIF":5.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}