Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Early anterior cruciate ligament reconstruction within 14 days is safe and effective: Favourable clinical outcomes in 203 consecutive patients with a minimum 2-year follow-up","authors":"Alessandro Carrozzo,&nbsp;Gianluca Ciccarelli,&nbsp;Edoardo Monaco,&nbsp;Pierfrancesco Orlandi,&nbsp;Alessandro Annibaldi,&nbsp;Andrea Ferretti,&nbsp;Nicola Maffulli","doi":"10.1002/ksa.70099","DOIUrl":"10.1002/ksa.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to evaluate the clinical outcomes of acute anterior cruciate ligament reconstruction (ACLR) performed within 14 days of injury with a minimum follow-up of 2 years. The hypothesis was that early ACLR would result in favourable clinical outcomes without a significant increase in complications. The secondary aim was to identify predictors of graft failure and complications, with the hypothesis that younger age and higher activity level would be associated with increased risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on patients who underwent ACLR within 14 days at a single institution. Potential risk factors for graft rupture and other post-operative complications were analyzed. Knee stability was assessed using KT-1000 and pivot shift test, and range of motion (ROM) with a goniometer. Patient-reported outcome measures (PROMs), including IKDC (International Knee Documentation Committee), Lysholm, Tegner activity scale and KOOS (Knee injury and Osteoarthritis Outcome Score), were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The final population consisted of 203 patients. At a mean follow-up of 53.4 months (range: 24–85), the graft rupture rate was 1.9%. Age 20 years or younger was the only significant risk factor for graft rupture (odds ratio = 6.02, <i>p</i> = 0.013). Post-operative negative pivot shift was achieved in 93.6%. The mean post-operative KOOS was 91.7 ± 8.8, the mean IKDC score was 88.1 ± 13.4, and the mean Lysholm score was 93.2 ± 9.9. In addition, 75% of patients returned to their pre-injury level of sports activity or higher. The mean loss of side-to-side extension was 1.3°, and flexion was 4.6°. The overall complication rate was 10.2%, with an incidence of post-operative stiffness requiring re-intervention of 1.5% and a 3.4% incidence of septic arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Early ACLR resulted in favourable clinical outcomes, including high rates of return to sport, minimal ROM deficits, and high PROM scores, with a low graft failure rate (1.9%), despite a 3.4% incidence of septic arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3483-3491"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380520","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":"Giving-way episodes during preoperative waiting period increase associated injury in anterior cruciate ligament injury: A multicentre observational study","authors":"Takuya Sakamoto,&nbsp;Shotaro Watanabe,&nbsp;Nobuaki Hayashi,&nbsp;Tsuyoshi Hamada,&nbsp;Manato Horii,&nbsp;Yuta Muramatsu,&nbsp;Masahiko Saito,&nbsp;Ryuichiro Akagi,&nbsp;Yusuke Sato,&nbsp;Taisuke Fukawa,&nbsp;Takuro Moriya,&nbsp;Ryosuke Nakagawa,&nbsp;Hiroaki Hosokawa,&nbsp;Koichi Nakagawa,&nbsp;Kan Tsuchiya,&nbsp;Junichi Iwasaki,&nbsp;Hiroko Hoshi,&nbsp;Takahiro Enomoto,&nbsp;Seiji Kimura,&nbsp;Satoshi Yamaguchi,&nbsp;Seiji Ohtori,&nbsp;Takahisa Sasho","doi":"10.1002/ksa.70118","DOIUrl":"10.1002/ksa.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to investigate the impact of giving-way episodes (GWEs) during the preoperative waiting period on intra-articular associated injuries in patients with anterior cruciate ligament (ACL) injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre retrospective cohort study reviewed consecutive patients who underwent primary ACL reconstruction between October 2022 and August 2024. Patients were divided into two groups based on GWE frequency during the waiting period: Group A (one giving-way episode) and Group B (two or more giving-way episodes). Data collected included demographic data, preoperative waiting time, preoperative knee instability (Lachman and pivot shift tests), and arthroscopically confirmed meniscal and cartilage injuries. Univariate analyses were used to compare intra-articular injury incidence between groups, followed by multivariate logistic regression to identify independent risk factors for medial meniscus (MM) tears. Covariates included age, sex, body mass index, GWE frequency, preoperative waiting time, instability grades, and activity level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 239 enrolled patients, 136 and 103 were assigned to Groups A and B, respectively. Patient demographics (age, sex and BMI) showed no significant differences between the two groups. The mean preoperative waiting time was significantly longer in Group B (5.0 vs. 2.0 months, <i>p</i> &lt; 0.001). Additionally, Group B showed a significantly higher incidence of MM tears compared to Group A (48.5% vs. 24.3%, <i>p</i> &lt; 0.001). No significant differences were observed in lateral meniscus tears or cartilage damage. Multivariate analysis identified ≥2 GWEs (odds ratio (OR): 3.09, 95% confidence interval (CI): 1.64–5.84) and higher pivot shift grade (OR: 1.92, 95% CI: 1.02–3.62) as independent predictors of MM tears.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Experiencing two or more GWEs during the preoperative waiting period independently triples the risk of MM tears. Preventing GWEs before ACL reconstruction may be critical to minimising secondary intra-articular damage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, prognostic studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3542-3550"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380534","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":"Deep learning methods for automated orthopaedic measurements in radiographs","authors":"Atif Abedeen,&nbsp;Bryan Soth,&nbsp;Alessandro Bensa,&nbsp;Nora Cao,&nbsp;Kristian Samuelsson,&nbsp;Michael T. Hirschmann,&nbsp;Amir Daliliyazdi,&nbsp;Richard Smith,&nbsp;Jorge Chahla,&nbsp;Ayoosh Pareek","doi":"10.1002/ksa.70429","DOIUrl":"10.1002/ksa.70429","url":null,"abstract":"<p>Radiography remains central to orthopedic diagnosis and surgical planning, yet many clinically important measurements (angles, offsets, alignment indices, and grading scores) are time-consuming to obtain and show intra- and inter-observer variability, especially in early or borderline disease. A reader-friendly overview of deep learning methods for the automation of orthopedic measurements on radiographs is provided in this article. Four common approaches are summarized: segmentation networks through which masks are generated and geometry-based measurements are derived; key point or heatmap-based landmark detection models through which automated angle and distance calculation is enabled; two-step object detection plus classification pipelines in which regions of interest are localized before downstream prediction; and direct regression models through which measurements are output directly from images. Representative applications are highlighted across major regions, including hip dysplasia angles, knee alignment and osteoarthritis assessment, and shoulder measurements such as the critical shoulder angle. Practical limitations and implementation considerations are also discussed, including generalizability across sites, performance drift, bias and fairness, and the need for human oversight and interpretable outputs to support safe deployment.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3474-3482"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990753","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":"Deleterious effect of sex mismatch between donor and recipient after meniscus allograft transplantation","authors":"Gian Andrea Lucidi,&nbsp;Giovanni Balboni,&nbsp;Stefano Di Paolo,&nbsp;Leonardo Vivarelli,&nbsp;Marco Govoni,&nbsp;Lucia de Franceschi,&nbsp;Iacopo Romandini,&nbsp;Giuseppe Filardo,&nbsp;Alberto Grassi,&nbsp;Dante Dallari,&nbsp;Stefano Zaffagnini","doi":"10.1002/ksa.70106","DOIUrl":"10.1002/ksa.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to investigate the effect of meniscal allograft freezing-time, demographical characteristics of the donor and the effect of mismatch of those parameters between donor and recipient on the survivorship of meniscal allograft transplantation (MAT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study consist of a retrospective analysis of 375 consecutive MAT procedures Inclusion criteria were complete demographic data for both the donor and recipient, minimum 2 years of follow-up (FU) and age &gt;18 years old; exclusion criteria were incomplete data, FU time of less than 2 years, body mass index (BMI) over 40 and age &lt;18 years old. Failure was defined as the need for graft removal for any reason. Statistical analysis was performed to compare the graft survivorship based on sex mismatch and blood group mismatch between patients and donors. A receiver operating curve (ROC) was performed to evaluate the association and the difference between the demographical parameters between donors and recipients with MAT failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 360 procedures fulfilled the inclusion criteria, mean age at surgery was 39.6 ± 11.4 years and mean FU time was 8.8 ± 3.6 years. Female patients who received MAT from a male donor had a failure rate of 39%, which was significantly higher when compared with the other groups. The failure rate in both the female-to-male and male-to-male groups was 7%, while in the female-to-female group was 9%. No association with failure was found for graft freezing time, age, sex, BMI of the donor, difference in age, BMI and blood group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mismatch between donor and recipient sex had a negative effect on MAT survival only when a meniscus from a male donor was transplanted in a female patient. Other parameters investigated like age and BMI of the patients, as well as blood group mismatch, did not affect the outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective comparative study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3511-3519"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350993","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":"Management of increased posterior tibial slope in ACL deficiency: A narrative review and recommendation of the Osteotomy Committee of the German Knee Society","authors":"Philipp Mayer,&nbsp;Julian Fürmetz,&nbsp;Gerrit Bode,&nbsp;Peter Angele,&nbsp;Marc-Daniel Ahrend,&nbsp;Sebastian Leutheuser,&nbsp;Christoph Lutter,&nbsp;Svea Faber,&nbsp;Maximilian Michael Mueller,&nbsp;Jörg Harrer,&nbsp;Felix Ferner,&nbsp;Björn Vogt,&nbsp;Florian B. Imhoff,&nbsp;Philipp Schuster","doi":"10.1002/ksa.70549","DOIUrl":"10.1002/ksa.70549","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Increased posterior tibial slope (PTS) is a known risk factor for anterior cruciate ligament (ACL) deficiency and graft failure after ACL reconstruction (ACLR). Although many studies investigated different aspects related to the PTS, there is still a lack of comprehensive recommendations and practical guidelines, especially with regard to radiographic analysis, surgical indication and surgical technique. The aim of this narrative review is to present such recommendations, based on the existing literature (evidence Level 3–4), supplemented by the expert opinions of the Osteotomy Committee of the German Knee Society. A review of the literature was conducted to summarize the current evidence concerning biomechanical background, radiological measurement, indication for surgical correction and surgical techniques. Results were presented to a panel of surgeons with recognized expertise in the treatment of ACL injuries and wide experience in surgical correction of the PTS, and consensus was formed by informal discussion. These recommendations were developed and included: (1) measuring the PTS should be performed on long lateral radiographs using the mechanical axis, with attention to a correct rotational alignment (exact superimposition of the posterior tibial condyles). (2) Indication for surgical correction does not depend on a single fixed cut-off value of the PTS. It should be based on an individual risk assessment (e.g., degree of anterior tibial translation and instability, meniscal integrity, number and quality of previous ACLR, trauma mechanism: contact vs. non-contact, contralateral injury). (3) For correction of pathologic PTS, different surgical techniques of anterior tibial closing wedge osteotomies have been reported without clear superiority of one technique. However, an infratuberositary approach is recommended, because it has been shown to be technically easier and safer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V, narrative review and expert opinion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3586-3604"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70549","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671878","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":"Non-linear, compartment-specific gap widening with rising distraction forces highlights the need for individualised, force-guided soft-tissue balancing in total knee arthroplasty","authors":"Jonathan Lettner,&nbsp;Mikhail Salzmann,&nbsp;Nikolai Ramadanov,&nbsp;Robert Prill,&nbsp;Roland Becker","doi":"10.1002/ksa.70269","DOIUrl":"10.1002/ksa.70269","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Achieving balanced soft tissue tension is crucial for successful total knee arthroplasty (TKA), yet remains challenging. This study investigated the effect of standardised distraction forces on medial and lateral femorotibial gap sizing during robotic-assisted TKA, with particular attention to specific patient characteristics like gender and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective single-center cohort study, 238 patients (83 males, 155 females; mean age 70 ± 9.6 years) undergoing primary robotic-assisted TKA were enroled. A force-controlled ligament tensioner applied distraction forces of 100, 150, 200 and 250 N at 5° and 90° of flexion. Medial and lateral joint gaps were recorded intraoperatively via the MAKO® Robotic-Arm Assisted Surgery System. Subgroup analyses were performed for gender and age categories, and stiffness was calculated as the slope of force–displacement curves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Gap widening increased non-linearly with higher distraction forces, with greater expansion in the lateral compartment, particularly in flexion. Female patients demonstrated significantly larger medial gap increases at forces ≥ 150 N compared to males (<i>p</i> &lt; 0.01; small effect sizes). Age had a comparatively minor influence, with statistically significant differences limited to older subgroups (80–90 years). Gender-based differences were found in gap behaviour. Female patients showed greater gap increases and lower medial stiffness, particularly at higher distraction force between 150–250 N than males.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results underline the need for individualised, force-adaptive balancing, where robotic real-time gap analysis may help to optimise stability and reduce the risk of postoperative instability (caused by under-tensioning), stiffness (caused by over-tensioning), or pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3617-3626"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000435","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":"Synovial interleukin-6 point-of-care testing, alone and combined with D-dimer, supports rapid diagnosis of periprosthetic joint infection","authors":"Sujeesh Sebastian,&nbsp;Hibah Abdulwahab Abusulaiman,&nbsp;Veronika Achatz,&nbsp;Matteo Spadini,&nbsp;Tobias Josef Niedrist,&nbsp;Markus Herrmann,&nbsp;Jochen Gerhard Hofstaetter","doi":"10.1002/ksa.70289","DOIUrl":"10.1002/ksa.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Data on the reliability of point-of-care (POC) tests for the rapid diagnosis of periprosthetic joint infections (PJI) using synovial fluid (SF) D-dimer (DD), interleukin 6 (IL-6) and procalcitonin (PCT) are limited. This study aimed to address this issue by evaluating the diagnostic accuracy of POC tests for SF DD, IL-6 and PCT in comparison to standard laboratory devices for diagnosing PJI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 273 patients who underwent 300 revision arthroplasties were included in this study. According to the European Bone and Joint Infection criteria, 123 were classified as infected, 145 as aseptic revisions and 32 as likely infected. SF DD, IL-6 and PCT levels were quantified using both POC and standard laboratory tests. The diagnostic accuracy was assessed using receiver operating characteristic curves and area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among POC tests, IL-6 demonstrated the highest AUC 0.83 (95% confidence interval CI 0.77–0.89), followed by DD (0.66, 95% CI 0.59–0.72), while PCT performed poorly (AUC 0.26, 95% CI 0.20–0.33). Laboratory-based IL-6 test outperformed all other markers (AUC 0.94, 95% CI 0.90–0.97). When using both POC and standard laboratory methods, significant differences were noted for IL-6 and DD (<i>p</i> &lt; 0.001). Combining the POC test results for IL-6 and DD showed better diagnostic performance than either alone (AUC 0.92). In patients with PJI, biomarker levels differed by pathogen virulence, except for POC IL-6 (<i>p</i> = 0.631), POC DD (<i>p</i> = 0.080) and laboratory DD (<i>p</i> = 0.053).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POC tests for SF, particularly those for IL-6, support the rapid PJI diagnosis, and combining POC IL‑6 with DD further improves diagnostic accuracy. These findings suggest that POC IL-6, either independently or in conjunction with DD, could be useful in situations where rapid decisions are required. However, its inferior performance compared to that of laboratory assays highlights the need for further optimisation and validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, development of diagnostic criteria in a consecutive series of patients and a universally applied ‘gold’ standard.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3627-3636"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000418","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":"Robotic arm-assisted patellofemoral joint arthroplasty achieves good short-term survival and functional outcomes: A systematic review and meta-analysis","authors":"Thomas R. Williamson,&nbsp;Steve Robins,&nbsp;Jonathan T. Super,&nbsp;Sam Oussedik,&nbsp;Nick Clement","doi":"10.1002/ksa.70301","DOIUrl":"10.1002/ksa.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Robotic arm-assisted (RA) surgery is associated with improved accuracy and outcomes in medial unicompartmental knee arthroplasty, but the role in patellofemoral arthroplasty (PFA) remains less well defined. This review aimed to evaluate the functional outcomes and implant survivorship of RA-PFA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of PubMed, Embase and the Cochrane Library was performed in November 2025. All studies reporting clinical outcomes for RA-PFA were included. The primary outcome was survival at final follow-up; secondary outcomes included patient-reported outcomes, reoperation frequency and radiographic outcomes. Meta-analyses of survival and nonconversion reoperation rates, and comparative analyses with other PFA techniques were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies (893 patients; 72.4% female, mean age 56.6 years [SD 7.7]) assessing RA-PFA were included. Survivorship was 93.6% (95% confidence interval [CI]: 91.2–95.8) at a mean follow-up of 3.3 years (SD 1.1). Meta-analysis of studies comparing survivorship of RA-PFA (<i>n</i> = 713) with manual PFA (<i>n</i> = 1580) showed reduced risk of revision for RA-PFA (RR = 0.75, 95% CI = 0.562–0.995, <i>p</i> = 0.048). The wide CI indicate uncertainty around the estimate. No survivorship difference was observed between robotic techniques. No randomised studies were identified. Reporting of PROMs following RA-PFA was limited to three studies (<i>n</i> = 112), all of which demonstrated excellent postoperative functional outcomes, with only one assessing postoperative health-related quality of life. Radiological outcomes and implant positioning were reported in only two studies (<i>n</i> = 66): one reporting improvements in patellar tilt compared with manual PFA following RA-PFA, comparable to other robotic systems, and one reported strong correlations between implant positioning and preoperative templating.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>RA-PFA achieves good short-term survivorship and functional outcomes that are comparable to manual techniques. However, the small number of available studies, short follow-up and lack of randomised trials preclude definitive conclusions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, systematic review and meta-analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3646-3654"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088801","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":"Satisfactory midterm clinical results and low incidence of patellofemoral arthritis after MPFL reconstruction for patellar instability, in patients with low-grade trochlear dysplasia","authors":"Theodoros Mylonas,&nbsp;Vasileios Raoulis,&nbsp;Efstathios Konstantinou,&nbsp;Alexandros Koskiniotis,&nbsp;Georgios Komnos,&nbsp;Michael Hantes","doi":"10.1002/ksa.70101","DOIUrl":"10.1002/ksa.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Patella dislocation is among the most common knee pathologies in the young population. The anatomical structure getting injured in these cases is the medial patellofemoral ligament (MPFL), leading to patella instability. This study aims to evaluate the medium to long-term clinical results of our double-bundle technique for isolated MPFL reconstruction with hamstring autograft, mainly focusing on the incidence of subsequent patellofemoral arthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 35 patients (39 patellae) with patella instability treated with isolated MPFL reconstruction surgery by the same orthopaedic surgeon between 2010 and 2020 was conducted. Patients were assessed using the following patient reported outcome measures: International Knee Documentation Committee (IKDC), Lysholm, Kujala and Modified Cincinnati, both pre and postoperatively. Additionally, the development of posttraumatic patellofemoral arthritis based on the Iwano classification was assessed by evaluating X-rays performed before surgery and at the final follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean patients' age at the time of the first dislocation was 16.1 years (range, 10–21 years), and the mean age at the time of surgery was 20.3 years (range, 18–26). Females were 56,2% of the patients, and 43.8% were males; 75% of the injuries occurred during sport activities, while the rest after a direct hit. The mean follow-up was 7.3 years (5–13). All scores demonstrated significant melioration postoperatively. At the final follow-up, the IKDC score increased from 49.2 to 84.5, Lysholm from 53 to 88.2, Kujala from 61 to 88.5, and modified Cincinnati from 49.2 to 83.6. No immediate postoperative complication was reported, and no redislocation was recorded. Radiological evaluation indicated only mild signs of patellofemoral arthritis in eight patients (20%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The double-bundle technique for MPFL reconstruction with hamstring autograft is a safe and reliable option for treating patella dislocation in patients with low-grade trochlear dysplasia. It provides satisfactory outcomes without remarkable arthritic changes at a mid term follow-up.</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":"34 10","pages":"3520-3529"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351345","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":"Proximal anatomical axes show bidirectional variability: Accurate tibial slope requires mechanical axis measurement","authors":"Barbara C. Boer,&nbsp;Quinten W. T. Veerman,&nbsp;Reinoud W. Brouwer,&nbsp;Judith olde Heuvel,&nbsp;Tony G. van Tienen,&nbsp;Wolf Petersen,&nbsp;Roy A. G. Hoogeslag","doi":"10.1002/ksa.70093","DOIUrl":"10.1002/ksa.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine whether posterior tibial slope (PTS) measured to proximal anatomical axes can serve as a reliable proxy for PTS measured to the mechanical tibial axis (mTA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In patients ≥18 years with failed anterior cruciate ligament reconstruction, medial and lateral PTS were measured relative to the mTA on a lateral lower-leg radiograph, and relative to the proximal tibial anatomical axis (PTAA), anterior tibial cortical axis (ATC) and posterior tibial cortical axis (PTC) on a lateral knee radiograph. Agreement was assessed using correlation coefficients, measurement error and Bland–Altman analysis. Diagnostic accuracy of the conventional ≥12° PTAA-based PTS cut-off for slope-reducing osteotomy was determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-nine knees were analyzed. Correlation between proximal anatomical axes and mTA-based PTS measurements was strong (<i>r</i> ≥ 0.71), but agreement was poor. Mean measurement error for PTAA was 0.1 ± 2.4° (range: −5.7° to 7.6°) and −0.5 ± 2.4° (range: −6.6° to 5.2°), for ATC −3.4 ± 2.6° (range: −8.6° to 5.9°) and −3.7 ± 2.6° (range: −9.9° to 2.7°) and for PTC 3.0 ± 2.6° (range: −2.9° to 10.4°) and 2.7 ± 2.4° (range: −3.6° to 7.8°) for the medial and lateral plateau, respectively. For PTAA, absolute measurement error ≥2° occurred in approximately 50% of knees. Bland–Altman analysis showed 95% levels of agreement ranging from −4.89° to 4.62° (medial) and −5.11° to 4.11° (lateral). Using the ≥12° cut-off on PTAA-based PTS values misclassified approximately one in three knees (19.5% false-positive and 13.2% false-negative) relative to the mTA-based PTS reference values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite strong correlation, proximal anatomical axes-based PTS measurements on routine lateral knee radiographs show substantial, bidirectional measurement error outside clinically acceptable limits of agreement compared to mTA-based PTS measurements on full-length lateral lower-leg radiographs. Single-exposure, full-length lateral lower-leg radiographs should be obtained to measure PTS relative to the mTA when considering slope-reducing osteotomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3575-3585"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350985","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}