Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Towards trustworthy artificial intelligence in musculoskeletal medicine: A narrative review on uncertainty quantification","authors":"Amir M. Vahdani,&nbsp;Moein Shariatnia,&nbsp;Pranav Rajpurkar,&nbsp;Ayoosh Pareek","doi":"10.1002/ksa.12737","DOIUrl":"10.1002/ksa.12737","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Deep learning (DL) models have achieved remarkable performance in musculoskeletal (MSK) medical imaging research, yet their clinical integration remains hindered by their black-box nature and the absence of reliable confidence measures. Uncertainty quantification (UQ) seeks to bridge this gap by providing each DL prediction with a calibrated estimate of uncertainty, thereby fostering clinician trust and safer deployment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a targeted narrative review, performing expert-driven searches in PubMed, Scopus, and arXiv and mining references from relevant publications in MSK imaging utilizing UQ, and a thematic synthesis was used to derive a cohesive taxonomy of UQ methodologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>UQ approaches encompass multi-pass methods (e.g., test-time augmentation, Monte Carlo dropout, and model ensembling) that infer uncertainty from variability across repeated inferences; single-pass methods (e.g., conformal prediction, and evidential deep learning) that augment each individual prediction with uncertainty metrics; and other techniques that leverage auxiliary information, such as inter-rater variability, hidden-layer activations, or generative reconstruction errors, to estimate confidence. Applications in MSK imaging, include highlighting uncertain areas in cartilage segmentation and identifying uncertain predictions in joint implant design detections; downstream applications include enhanced clinical utility and more efficient data annotation pipelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Embedding UQ into DL workflows is essential for translating high-performance models into clinical practice. Future research should prioritize robust out-of-distribution handling, computational efficiency, and standardized evaluation metrics to accelerate the adoption of trustworthy AI in MSK medicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3418-3437"},"PeriodicalIF":5.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736583","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":"Do we need a robot in total knee arthroplasty? Yes! No! Not sure!—A well balanced perspective","authors":"Antonio Klasan,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12798","DOIUrl":"10.1002/ksa.12798","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3067-3069"},"PeriodicalIF":5.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736581","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":"Technology-assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review","authors":"Matteo Innocenti,&nbsp;Filippo Leggieri,&nbsp;Simon N. van Laarhoven,&nbsp;Tommy de Windt,&nbsp;Roberto Civinini,&nbsp;Gijs G. van Hellemondt","doi":"10.1002/ksa.12748","DOIUrl":"10.1002/ksa.12748","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; statistic.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip–knee–ankle angle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6% [95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15–24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3606-3620"},"PeriodicalIF":5.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700954","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":"Lower psychological readiness to return to sport after revision ACL surgery","authors":"Magdalena Tarchala,&nbsp;Matthew D. Milewski,&nbsp;Emma C. Gossman,&nbsp;Ryan P. Coene,&nbsp;Danielle L. Cook,&nbsp;Mininder S. Kocher,&nbsp;Dennis E. Kramer,&nbsp;Lyle J. Micheli,&nbsp;Yi-Meng Yen,&nbsp;Melissa A. Christino","doi":"10.1002/ksa.12797","DOIUrl":"10.1002/ksa.12797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate psychological readiness and psychological stress in young patients after revision anterior cruciate ligament reconstructions (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Revision ACLR patients were evaluated 6-months post-operatively with patient reported outcomes (PROs): Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI), PROMIS-Psychological Stress Experience (PROMIS-PSE), International Knee Documentation Committee (IKDC/Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Patient reported outcomes (PROs) of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching between primary and revision cohorts (2:1) was performed for age, sex, and graft type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Matching resulted in 90 ACLR patients (60 primary and 30 revision). The revision cohort's mean age was 19.0 (SD ± 3.46) and 63% female. A negative correlation was detected between IKDC and PROMIS-PSE (<i>r</i> = −0.32; 95% confidence interval [CI] = −0.49 to −0.12; <i>p</i> = 0.002) and positive correlation was detected between IKDC and ACL-RSI scores (<i>r</i> = 0.50; 95% CI = 0.32–0.64; <i>p</i> &lt; 0.001). There was a weak positive correlation between Pedi-FABS and ACL-RSI scores (<i>r</i> = 0.25; 95% CI = 0.05–0.43; <i>p</i> = 0.02). Revision ACLR patients had lower ACL-RSI/psychological readiness scores (43.4 vs. 58.7, <i>p</i> = 0.001) and lower Pedi-FABS scores (22 vs. 25, <i>p</i> = 0.02), compared to primary ACLR patients. Regression analysis showed revision patients had a 17-point decrease in ACL-RSI scores compared to primary patients (<i>β</i> = −17.1; 95% CI = −27.32 to −6.79; <i>p</i> = 0.001), controlling for age at primary surgery, meniscus repair, and propensity score. Revision patients had a 17% increase in the time to return to sports clearance compared to primary ACLR patients (95% CI = 1.02–1.34; <i>p</i> = 0.03). No differences were noted in Pedi-IKDC/IKDC or PROMIS-PSE scores between the cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients 6-months post revision ACLR had lower psychological readiness, inferior knee outcomes, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in revision ACLR patients is important to optimise post-operative care and outcomes.</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":"33 10","pages":"3697-3706"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661767","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":"Elite athletes return to sport faster and more often than non-elite athletes with low complication rates following proximal hamstring repair: A systematic review","authors":"Udit Dave,&nbsp;Trevor Poulson,&nbsp;Jared Rubin,&nbsp;Jacob T. Morgan,&nbsp;Nicole Chang,&nbsp;Myles Atkins,&nbsp;Luc Fortier,&nbsp;Johnathon R. McCormick,&nbsp;Andrew S. Bi,&nbsp;Nikhil N. Verma,&nbsp;Jorge Chahla","doi":"10.1002/ksa.12759","DOIUrl":"10.1002/ksa.12759","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate patient-reported outcomes, return to sport (RTS) rates and complications following proximal hamstring (PH) repair in elite and non-elite athletes. We hypothesized that PH repair leads to improved patient-reported and clinical outcomes and high RTS rates with relatively few associated complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, PubMed, Embase and Cochrane Library databases were searched in August 2024. Studies were included if they evaluated athletes at various levels of competition who underwent PH repair and reported RTS rates, complication rates or patient-reported outcomes. Due to high heterogeneity between studies, qualitative comparative analysis was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial screen identified 1398 studies; 22 were included. Each study had non-comparative study design with low risk of bias. Overall, 168 patients across 6 studies were included in the elite athlete cohort, and 759 patients across 16 studies were included in the non-elite athlete cohort. Elite athletes had overall RTS rate of 95.6% with time to RTS from 3.0 to 7.0 months, and RTS at pre-injury level between 90.0% and 98.4%. RTS rate in non-elite athletes was 64.8%. Mean lower extremity functional scale scores were 77.9–78.0 in elite athletes and 73.8-89.0 in non-elite athletes. The overall complication rate in the elite athlete cohort was 11.6%, and in the non-elite cohort was 14.2%. Nerve-related symptoms were the most common complication in both cohorts, with rates of 2.9% and 10.9%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elite athletes are more likely to RTS following PH repair and do so faster compared to their non-elite counterparts. Minor neurologic complications account for the majority of complications in both patient cohorts, with minimal incidence of operative failure or other complications. This can guide preoperative decision-making and patient counselling based on a patient's athletic status and desire to RTS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, systematic review of Levels III and IV studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3389-3404"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661763","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":"Resident participation does not affect outcomes or complications after arthroscopic Bankart repair surgery","authors":"Alex Quok An Teo,&nbsp;Hoi Pong Nicholas Wong,&nbsp;Sherlyn Yen Yu Tham,&nbsp;Fucai Han,&nbsp;Zavier Yongxuan Lim,&nbsp;Qai Ven Yap,&nbsp;Veerasingam Prem Kumar","doi":"10.1002/ksa.12782","DOIUrl":"10.1002/ksa.12782","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We performed a retrospective cohort study to assess the impact of resident participation on Bankart repair surgical outcomes over a 2-year mean follow-up period, by comparing clinical and patient-reported outcomes (PROs) between surgeries primarily performed by residents in training and those primarily performed by fellowship-trained attending shoulder surgeons. We hypothesised that there would be no difference in outcomes between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All consecutive patients who underwent primary arthroscopic Bankart repair surgery for shoulder instability over a 4-year window in our institution were included. They were divided into two cohorts depending on whether they were performed primarily (&gt;75% of the cases) by residents or attending surgeons. Standard preoperative, intraoperative and post-operative follow-up clinical (rates of recurrent instability and revision surgery) and PRO (Constant–Murley Score, American Shoulder and Elbow Surgeons, Short Form Health Survey-36 and visual analogue scale) data were collected. Data were collected manually and analysed using logistic regression and linear mixed model analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three hundred twenty patients met the inclusion criteria and were enroled into the present study. The mean age was 25.08 ± 8.43, with 290 males (90.6%). One hundred fifty-three cases (47%) were performed primarily by residents. Operative times were similar with no significant difference (<i>p</i> = 0.08). Both cohorts demonstrated significant improvements in both shoulder-specific and global outcomes post-operatively. The stability sub-score of the ASES score was lower in the residents group by a mean of 0.31 points (<i>p</i> = 0.027). All the other PROs were not significantly different between the two cohorts. The rate of recurrence was also low, with no significant difference between the two cohorts (5.9% vs 4.8%, <i>p</i> = 0.903).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that resident involvement in arthroscopic Bankart repair as primary surgeons did not adversely affect recurrence and revision surgery rates as well as PRO measures at 2 years post-operatively, provided they were adequately supervised by attending surgeons.</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 10","pages":"3707-3714"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661792","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":"High tibial osteotomy and concurrent medial meniscus root repair provides improved objective outcomes compared to high tibial osteotomy alone for knee osteoarthritis: A systematic review","authors":"Fardis Vosoughi,&nbsp;Pouya Vahedi,&nbsp;Mobina Taghva Nakhjiri,&nbsp;Sohrab Keyhani,&nbsp;Mehran Soleymanha,&nbsp;Robert F. LaPrade,&nbsp;Luke V. Tollefson,&nbsp;Iman Menbari Oskouie","doi":"10.1002/ksa.12796","DOIUrl":"10.1002/ksa.12796","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>High tibial osteotomy (HTO) is a cornerstone treatment for medial compartment osteoarthritis (OA) in active patients with varus deformity. However, managing the combination of varus alignment and the medial meniscus posterior root tears (MMPRT) remains controversial. The purpose of this systematic review was to synthesise data from recent comparative studies and evaluate whether adding an MMPRT repair to an HTO enhances outcomes, particularly with respect to meniscal healing, cartilage preservation, and patient function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched MEDLINE, Embase, Scopus, and Web of Science through April 2025 for studies comparing isolated HTO with HTO plus MMPRT repair. Outcomes included meniscal healing, cartilage status, and patient-reported measures. Risk of bias was assessed using ROBINS-I.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six studies (506 knees) were included, with 260 undergoing HTO plus MMPRT repair. The reported mean difference in complete meniscus healing ranged from 12.5% to 40% in the HTO plus MMPRT repair group, while it ranged from 0% to 15% in the isolated HTO group. Joint space width (JSW) was reported in three studies, with one study reporting a significant improvement in the HTO plus MMPRT repair group. Cartilage outcomes were superior in three of six studies. One study reported significant functional improvement with a concomitant repair. Despite methodological heterogeneity, all studies had a moderate risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While short-term subjective outcomes were similar between isolated HTO and HTO plus MMPRT repair, objective measures, namely higher meniscal healing rates and more stable cartilage scores, consistently favoured the combined approach. In the younger population, even short-term subjective outcomes showed significant improvements along with objective measures and return to sports. Long-term clinical trials are required to determine if these biological advantages translate into a delay in the progression of knee osteoarthritis, particularly in younger, active patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, systematic review.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3361-3374"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661764","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":"Effect of the patient-specific instrumentation guidance on the accurate positioning of the baseplate and screws in reverse total shoulder arthroplasty: Multicenter comparative study","authors":"Jong Pil Yoon,&nbsp;Myung Sun Kim,&nbsp;Hyun Tae Kim,&nbsp;Dong Hwan Lee,&nbsp;Sung Wook Hong,&nbsp;Jong Ho Kim,&nbsp;Seok Won Chung","doi":"10.1002/ksa.12781","DOIUrl":"10.1002/ksa.12781","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the accuracy of implant placement using patient-specific instrumentation (PSI) in reverse total shoulder arthroplasty (RTSA) compared to conventional techniques, and to determine whether PSI enhances the precision of glenoid component and screw positioning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, multi-centre comparative study included 135 patients who underwent primary RTSA across four tertiary medical centres. Patients were divided into two groups: 65 received RTSA with PSI, and 70 underwent conventional RTSA. PSI employed 3D-printed guides, based on preoperative CT scans, to precisely guide the placement of the glenoid component and peripheral screws. Postoperative imaging was used to assess screw trajectory and length, as well as baseplate version, inclination, and entry point trajectory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PSI demonstrated significantly greater accuracy in baseplate positioning compared to conventional methods, with improved outcomes in version (mean deviation: 1.5 ± 1.1° vs. 6.7 ± 5.4°, <i>p</i> &lt; 0.001), inclination (2.8 ± 1.5° vs. 5.3 ± 3.7°, <i>p</i> = 0.012), and entry point location (1.9 ± 1.2 mm vs. 3.2 ± 1.5 mm, <i>p</i> = 0.037). Although mean postoperative screw lengths were greater in all directions in the PSI group, the differences were not statistically significant (all <i>p</i> &gt; 0.05). Similarly, deviations from planned screw lengths were lower in the PSI group but did not reach statistical significance (all <i>p</i> &gt; 0.05). Notably, PSI significantly improved the precision of peripheral screw trajectories, particularly in the superior and inferior screws across superior–inferior (S/I: <i>p</i> = 0.037 and <i>p</i> = 0.012) and anterior–posterior directions (A/P: <i>p</i> = 0.043 and <i>p</i> = 0.015), as well as in anterior (<i>p</i> = 0.004) and posterior screws (<i>p</i> = 0.008) in the A/P direction. The PSI group also had significantly fewer cases of screw prominence (9 vs. 23), and no cases of screw insertion failure or notch involvement were observed. No major complications occurred in either group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSI significantly improves the accuracy of implant placement in RTSA compared to conventional techniques, potentially reducing postoperative complications.</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 10","pages":"3715-3727"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661762","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":"High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity","authors":"Alessio Maione,&nbsp;Filippo Calanna,&nbsp;Alessandro Napolitano,&nbsp;Matteo Davide Parmigiani,&nbsp;Giuseppe Fedele,&nbsp;Alessandra Menon,&nbsp;Riccardo Compagnoni,&nbsp;Paolo Ferrua,&nbsp;Massimo Berruto,&nbsp;Pietro Simone Randelli","doi":"10.1002/ksa.12793","DOIUrl":"10.1002/ksa.12793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients &gt; 4°; FEM-Var: five patients &gt; 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; <i>p</i> &lt; 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (<i>p</i> &lt; 0.01), with no osteoarthritis progression at the last follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3350-3360"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661765","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":"Critical considerations in the selection between knee osteotomy and unicompartmental knee arthroplasty in younger patients with varus alignment and early-stage knee osteoarthritis","authors":"Matthieu Ollivier,&nbsp;Kristian Kley,&nbsp;Ayoosh Pareek,&nbsp;Sebastien Parratte,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12801","DOIUrl":"10.1002/ksa.12801","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3445-3453"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661761","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}