Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Approximately two-thirds of adolescent male soccer players had increased lateral ankle laxity with functional ankle impairments","authors":"Takuji Yokoe,&nbsp;Tsubasa Kawaguchi,&nbsp;Aya Kubo,&nbsp;Naosuke Kamei,&nbsp;Atsushi Teramoto,&nbsp;Masato Takao,&nbsp;Hélder Pereira","doi":"10.1002/ksa.70184","DOIUrl":"10.1002/ksa.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The primary purpose of this study was to evaluate the prevalence of increased lateral ankle laxity (ILAL) in adolescent male soccer players. The secondary purpose was to investigate functional ankle impairments and muscle strengths related to chronic lateral ankle instability (CLAI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The anterior talofibular ligament (ATFL) lengths of adolescent male soccer players were measured in the stress and non-stress positions using ultrasonography. The ATFL ratio, the ratio of stress ATFL length to non-stress ATFL length, was calculated as an indicator of lateral ankle laxity. The Cumberland Ankle Instability Tool (CAIT), Ankle Instability Instrument (AII) and static balance tests were used to assess functional ankle impairments related to CLAI. Isometric hip abduction and ankle eversion muscle strengths, and ankle dorsiflexion angle were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred twenty ankles from 60 male soccer players (mean age, 16.4 ± 0.7 years; mean duration of playing soccer, 9.8 ± 2.4 years) were included. ILAL was detected in 63.3% (38/60) of soccer players; 28 with ipsilateral ILAL (group I) and 10 with bilateral ILAL (group Bi). Seventeen participants (28.3%; 10 from group I, 3 from group Bi, and 4 from those without ILAL) showed a CAIT score of ≤24, and 5 (8.3%; 4 from group I and 1 from group Bi) showed an AII score of ≥5. The eversion muscle strength of the ankle with ILAL was significantly weaker than the contralateral side in group I (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ILAL was detected in approximately two-thirds of adolescent male soccer players with relatively low CAIT and AII scores. In addition, the eversion muscle strength of the ankle with ILAL was significantly weaker than that of the contralateral side in subjects with ipsilateral ILAL. These findings suggest the possible importance of preventive interventions for soccer players with ILAL.</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 1","pages":"320-328"},"PeriodicalIF":5.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524989","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":"Biomechanical influence of hinge wire application and removal in medial opening wedge high tibial osteotomy: A cadaveric study","authors":"Takaaki Hiranaka,&nbsp;Adam Garry Redgrift,&nbsp;Adia Shadd,&nbsp;Jason Bednarek,&nbsp;Ryan Willing,&nbsp;Alan Getgood","doi":"10.1002/ksa.70150","DOIUrl":"10.1002/ksa.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare tensile strain changes on the lateral tibial cortex during the opening procedure of medial opening wedge high tibial osteotomy (MOWHTO) with and without hinge wire, and to evaluate strain changes after hinge wire removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MOWHTO was performed on five pairs of fresh-frozen human cadaveric knees (10 knees in total), which were allocated into two groups: with a hinge wire (<i>n</i> = 5) and without a hinge wire (<i>n</i> = 5). A uniaxial strain gauge was attached to the lateral tibial cortex to measure tensile strain, with negative values indicating compression and positive values indicating tension. All procedures were guided by a 3D-printed patient-specific cutting guide with a target opening gap of 9 mm, and fixation was completed using a locking plate. Tensile strain during the opening procedure was compared between groups, and strain before and after wire removal was assessed in the hinge wire group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In four out of five matched pairs, the hinge wire group exhibited smaller tensile strain changes during opening than the contralateral group without a hinge wire. During the opening procedure, the median tensile strain change was −267 με (range: −2390 to −213 με) in the hinge wire group and −753 με (range: −1889 to −383 με) in the without hinge wire group (<i>p</i> = 0.345). Following hinge wire removal, the median strain change was minimal (44 με; range: 21–72 με).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The hinge wire group showed smaller tensile strain changes during the opening procedure in most specimens, though the difference was not statistically significant. These findings provide preliminary biomechanical evidence suggesting that the hinge wire may serve as a protective method against fracture of the lateral hinge during MOWHTO, and that its removal after the plate fixation does not compromise lateral cortex stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"640-646"},"PeriodicalIF":5.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515465","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 contrastive learning improves identification of early-stage knee osteoarthritis across multicohort X-ray datasets","authors":"Ligan Jia,&nbsp;Guangyuan Du,&nbsp;Zijuan Fan,&nbsp;Xiaoke Li,&nbsp;Haifeng Liu,&nbsp;Jing Zhang,&nbsp;Dijun Li,&nbsp;Lei Yan,&nbsp;Jingwei Jiu,&nbsp;Ruoqi Li,&nbsp;Songyan Li,&nbsp;Yiqi Yang,&nbsp;Huachen Liu,&nbsp;Yijia Ren,&nbsp;Xuanbo Liu,&nbsp;Jiao Jiao Li,&nbsp;Yuqing Zhang,&nbsp;Jianhao Lin,&nbsp;Bin Wang","doi":"10.1002/ksa.70191","DOIUrl":"10.1002/ksa.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop a Kellgren–Lawrence (K–L) grading recognition framework for knee osteoarthritis (KOA) with enhanced capability for early-stage detection and to validate its transferability across three independent cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Weight-bearing anteroposterior knee radiographs were obtained from three datasets: the osteoarthritis initiative (OAI), Wuchuan and Shunyi. The OAI dataset included baseline, 72-month, and 96-month follow-up images, while the Wuchuan and Shunyi datasets were collected from Wuchuan (China) and Shunyi District (Beijing), respectively. Contrastive learning was incorporated into model training to construct the Augmented Dataset-Wide-ResMRnet-Contrastive Loss-Cross Entropy (AW2C) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AW2C framework achieved overall classification accuracies of 83.0%, 82.0% and 80.5% on the OAI, Wuchuan and Shunyi datasets, respectively, with corresponding area under the curve (AUC) of 97.0%, 96.7% and 95.6%. Compared with the baseline model, accuracy for K–L grade 2 improved from 64% to 80%, and discrimination between K–L grades 1 and 2 was notably enhanced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The proposed AW2C framework demonstrated robust and transferable performance for automated radiographic K–L grading of KOA, particularly improving recognition of early-stage and suspected disease. With further optimisation, it holds promise as a reliable tool for large-scale studies and clinical decision support.</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 1","pages":"362-369"},"PeriodicalIF":5.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515520","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":"Precision medicine in orthopaedics: A review of current technologies and future directions","authors":"Patrick Sadoghi,&nbsp;Amir Koutp,&nbsp;Elmar Herbst,&nbsp;Giuseppe Milano,&nbsp;Volker Musahl,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.70168","DOIUrl":"10.1002/ksa.70168","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;To synthesise the paradigm shift towards precision medicine in orthopaedics, where individual anatomical, biomechanical, molecular and kinematic characteristics are integrated into clinical decision-making. Unlike traditional approaches applying uniform protocols, this review outlines how precision orthopaedics aims to tailor surgical techniques, implant selection, component positioning and rehabilitation strategies to the unique profile of each patient, thereby improving outcomes and predictability.&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;This narrative review synthesises current concepts and evidence supporting patient-specific care. The methods discussed encompass a wide range of technological and biological innovations, including advanced imaging, robotic-assisted surgery, artificial intelligence (AI), molecular diagnostics, functional assessment tools and personalised therapeutic platforms that are shaping modern orthopaedic practice across multiple subspecialties.&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;In total knee arthroplasty, personalised alignment restores native joint lines, while robotic systems execute plans with submillimetre accuracy, reducing alignment outliers and potentially improving functional outcomes. In total hip arthroplasty, spinopelvic analysis mitigates instability risk, a critical factor for patients with spinal stiffness. Intraoperative technologies like robotics, patient-specific instruments and augmented reality improve the precision of implant placement and reduce radiation exposure in trauma. Beyond arthroplasty, AI accelerates early diagnosis of osteoarthritis, while molecular biomarkers (e.g., alpha-defensin) offer &gt;95% accuracy in diagnosing periprosthetic joint infection. Finally, AI-guided digital platforms and motion tracking are used to deliver personalised rehabilitation protocols.&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;Precision medicine encompasses a wide range of powerful tools, many of which are already in clinical use. However, their full and effective integration requires continued research, long-term validation, cost-effectiveness analyses and interdisciplinary collaboration. The future of orthopaedics is anchored in delivering the right intervention for the right patient at the right time, guided by robust, individualised data and sound clinical judgement.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Level V.&lt;/p&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"633-639"},"PeriodicalIF":5.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423874","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":"Compromised quadriceps and hamstring force control, not maximal strength, is associated with gait biomechanics at 9 months following anterior cruciate ligament reconstruction","authors":"Beyza Tayfur,&nbsp;Alexa K. Johnson,&nbsp;Riann M. Palmieri-Smith","doi":"10.1002/ksa.70129","DOIUrl":"10.1002/ksa.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To understand the changes in muscle force control ability and its association to gait biomechanics following anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-five participants, 9 months following ACLR, performed isometric quadriceps (20%, 40% and 100% maximum voluntary isometric contraction [MVIC]) and hamstring (20% and 40% MVIC) contractions on an isokinetic dynamometer, tracing a target line. Torque variability using coefficient of variation, and complexity using sample entropy were calculated. Knee moments and knee flexion excursion were calculated from walking gait. Two-way mixed model analyses of variance were used for between-limb comparisons and Pearson's correlations to evaluate the associations between force variables and gait biomechanics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Quadriceps and hamstring torque variability changed depending on the limb and the effort level. Quadriceps variability was higher in the ACLR limb only at maximum effort (<i>p</i> = 0.039, Cohen's <i>d</i> = 0.437). Hamstring variability showed no differences at 40% but lower torque variability (<i>p</i> = 0.035, Cohen's <i>d</i> = −0.448) at 20%. Muscle force complexity was consistently higher in the ACLR limb compared to the noninjured limb, regardless of effort level. Additionally, as effort increased, muscle force became less complex in both limbs.</p>\u0000 \u0000 <p>Quadriceps variability was negatively associated with knee moments (<i>r</i> = −0.410, <i>p</i> = 0.042, better force control = higher knee extension moments). Hamstring complexity was positively associated with knee flexion excursion (<i>r</i> = 0.417, <i>p</i> = 0.038). Maximal strength was not associated with any gait biomechanics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Quadriceps and hamstring force control ability are altered and associated with gait biomechanics at 9 months post-ACLR. Rehabilitation should include exercises focused on force control to potentially help restore gait biomechanics.</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":"33 12","pages":"4466-4474"},"PeriodicalIF":5.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380277","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":"Digital rehabilitation after anterior cruciate ligament reconstruction—A systematic review","authors":"Leonard Fricke,&nbsp;Wolf Petersen,&nbsp;Martin Häner,&nbsp;Amelie Klaumünzer,&nbsp;Thomas Tischer","doi":"10.1002/ksa.70141","DOIUrl":"10.1002/ksa.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this systematic review was to analyze the implementation of digital rehabilitation in the rehabilitation of patients undergoing anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature research was carried out on multiple platforms. Articles that fit our criteria were selected and analysed. We created a narrative synthesis of the extracted data, categorised by the type of digital application (sensor or no sensor), clinical characteristics and type of outcome. A formal meta-analysis was not planned as the studies were probably not homogeneous enough in terms of participants, interventions and outcomes to provide a meaningful summary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This systematic review analysed seven articles with 952 patients studying digital applications in rehabilitation⁠ after ACLR. Seven different digital applications were investigated, with three using sensors. The results showed that digital interventions were at least as effective as standard physiotherapy, with some studies showing even better outcomes in terms of Patient-Reported Outcome Measures (PROMs), muscle strength, and range of motion⁠. Patient engagement and better adherence to the rehabilitation plan was another positive finding. Importantly, no adverse events were reported in any of the studies⁠.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This systematic review highlights the potential of digital applications as valuable tools for rehabilitation after ACL reconstruction by enhancing patient adherence, engagement, and recovery outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"351-361"},"PeriodicalIF":5.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380471","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":"Effectiveness of digital health technologies in postoperative rehabilitation following anterior cruciate ligament reconstruction: A systematic review and meta-analysis","authors":"Qing Sun,&nbsp;Hang Yin,&nbsp;Liyuan Guan,&nbsp;Limin Cui","doi":"10.1002/ksa.70134","DOIUrl":"10.1002/ksa.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the effectiveness of digital health technology (DHT) in postoperative rehabilitation following anterior cruciate ligament reconstruction (ACLR) and to explore intervention characteristics influencing outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed, CNKI and Wan Fang) were searched from inception to 15 March 2025 for randomized controlled trials on DHT (e.g., wearable devices, virtual reality, robotics) for ACLR rehabilitation. Outcomes included rehabilitation adherence, knee function, proprioception, muscle strength, walking ability and pain. Meta-analysis using a random effects model was conducted to determine the standardized mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This review included 16 RCTs with a total of 1064 ACLR patients. The meta-analysis results indicated that DHT improved rehabilitation adherence (SMD = 0.29, 95% CI = 0.02–0.56, <i>p</i> = 0.04), pain (SMD = −0.79, 95% CI = −1.38 to −0.19, <i>p</i> = 0.009), proprioception (MD = −0.99, 95% CI = −1.47 to −0.50, <i>p</i> &lt; 0.0001), muscle strength (extensor peak torque: MD = 11.43, 95% CI = 6.26–16.61, <i>p</i> &lt; 0.0001; flexor peak torque: MD = 12.03, 95% CI = 6.54–17.52, <i>p</i> &lt; 0.0001) and walking ability (MD = 0.41, 95% CI = 0.32–0.49, <i>p</i> &lt; 0.00001). Subgroup analyses indicated that virtual reality-based DHT improved knee function (MD = 3.88, 95% CI = 0.95–6.81, <i>p</i> = 0.010). Short-term interventions (&lt;3 months) showed greater efficacy in functional recovery (MD = 3.57, 95% CI = 0.93–6.20, <i>p</i> = 0.008).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DHT is a feasible and effective approach for post-ACLR rehabilitation. Our findings demonstrate that DHT enhances adherence, improves knee function and alleviates pain, and restores muscle strength, proprioception and walking ability. These results support the integration of DHT into standardized rehabilitation protocols for ACLR patients.</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 2","pages":"709-723"},"PeriodicalIF":5.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380494","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":"Objective clinical tests to inform decision-making prior to return to sport in athletes with shoulder instability: A scoping review","authors":"Johan Högberg,&nbsp;Aleksandra Królikowska,&nbsp;Robert Prill,&nbsp;Alex Fails,&nbsp;Adam Popchak,&nbsp;Eric Hamrin Senorski","doi":"10.1002/ksa.70107","DOIUrl":"10.1002/ksa.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This review systematically maps the existing research on objective return to sport criteria for shoulder injuries, with a focus on clinical tests that inform decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review was performed. The following databases were searched from inception up to July 2025: Cochrane Library, Embase, Medline, PEDRo, Cinahl and AMED. All studies, regardless of design, which assessed any kind of shoulder function with regard to return to sport decision-making in individuals participating in sports and presented with a shoulder injury were included. The result was qualitatively presented in free text, tables and figures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eleven studies were identified that reported objective shoulder tests prior to return to sport in athletes after shoulder instability surgery. The tests evaluated various parameters, including range of motion, muscular strength, muscular endurance, power, plyometrics, movement quality and trunk control. The passing rates of isokinetic shoulder strength tests ranged from 40% to 70%, the isometric shoulder strength tests from 28% to 100%, for shoulder endurance tests from 70% to 81% and shoulder performance tests from 29% to 100%. These assessments were conducted within a time frame of 4–21 months following surgery. The rate of subsequent shoulder instability or re-dislocation ranged from 5% to 10% after returning to sport.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Passing rates for objective shoulder tests, including muscular strength and endurance, as well as performance tests, varied widely, with re-dislocation rates between 5% and 10% after returning to sport. However, the predominance of case series limits the ability to draw definitive conclusions about the effectiveness of these tests in reducing the risk of subsequent shoulder instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, scoping review of level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"268-283"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380654","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":"Effects of postoperative knee bracing on knee function and stability after anterior cruciate ligament reconstruction: A systematic review and meta-analysis","authors":"Qitai Lin,&nbsp;Zehao Li,&nbsp;Meiming Li,&nbsp;Xueding Wang,&nbsp;Qian Li,&nbsp;Xingguang Hou,&nbsp;Yongsheng Ma,&nbsp;Wenming Yang,&nbsp;Yugang Xing,&nbsp;Donglin Wang,&nbsp;Fan Yang,&nbsp;Wangping Duan,&nbsp;Xiaochun Wei","doi":"10.1002/ksa.70098","DOIUrl":"10.1002/ksa.70098","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 use of knee braces following anterior cruciate ligament reconstruction (ACLR) remains contentious. Although frequently prescribed in clinical settings, their effectiveness in enhancing postoperative recovery is uncertain. This study aimed to determine whether postoperative bracing after ACLR confers clinical benefits regarding knee function scores, pain, muscle strength, and joint stability, through a systematic review and meta-analysis.&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 comprehensive search of PubMed, EMBASE, and the Cochrane Library was conducted through March 2025 to identify randomized controlled trials and case-control studies evaluating postoperative bracing after ACLR. Meta-analyses were performed using Review Manager (version 5.3) for the following outcomes: International Knee Documentation Committee (IKDC) objective score, Lysholm score, Tegner activity score, visual analogue scale (VAS) pain score, single-leg hop test, and side-to-side knee laxity. Bias risk evaluation was performed applying the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.&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;A total of 785 participants across 11 studies were included, with 387 allocated to bracing and 388 to non-bracing groups. Meta-analysis revealed no significant differences between groups in IKDC objective score (odds ratio [OR] = 1.18; 95% confidence interval [CI], 0.65–2.14; &lt;i&gt;p&lt;/i&gt; = 0.58), Lysholm score (mean difference [MD] = −0.30; 95% CI, −0.72 to 0.11; &lt;i&gt;p&lt;/i&gt; = 0.15), Tegner score (MD = −0.22; 95% CI, −0.46 to 0.02; &lt;i&gt;p&lt;/i&gt; = 0.07), VAS pain score (MD = 0.08; 95% CI, −0.15 to 0.32; &lt;i&gt;p&lt;/i&gt; = 0.49), single-leg hop test (MD = 1.06; 95% CI, −0.01 to 2.14; &lt;i&gt;p&lt;/i&gt; = 0.05), and anterior–posterior knee laxity (MD = −0.30; 95% CI, −0.72 to 0.11; &lt;i&gt;p&lt;/i&gt; = 0.15). Subgroup analyses indicated significantly better Lysholm and Tegner scores among individuals without bracing when follow-up exceeded 2 years. No consistent differences were observed by graft type.&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;Postoperative bracing did not yield significant improvements in function, pain, strength, or stability following ACLR. Mid- to long-term outcomes (follow-up &gt;2 years, up to 5 years) may favour non-bracing, indicating that routine brace use after ACLR is not warranted.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Level II, systematic review.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4398-4411"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380485","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":"Is orthopaedics entering the age of generative AI?—A narrative review of current applications challenges and future directions","authors":"Felix C. Oettl,&nbsp;James A. Pruneski,&nbsp;Balint Zsidai,&nbsp;Yinan Yu,&nbsp;Ting Cong,&nbsp;Thomas Tischer,&nbsp;Michael T. Hirschmann,&nbsp;Kristian Samuelsson","doi":"10.1002/ksa.70145","DOIUrl":"10.1002/ksa.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Artificial intelligence (AI) in medicine is undergoing a pivotal transformation, evolving from discriminative models that classify data to generative AI systems capable of creating novel content. Generative AI is a type of artificial intelligence that can learn from and mimic large amounts of data to create content such as text, images, music, videos, code, and more. The generative AI paradigm relies on advanced architectures, including large language models (LLMs), which are likely to redefine key processes in the practice of clinical medicine. The imaging- and procedure-heavy specialty of orthopaedic surgery is uniquely positioned to benefit from innovations in spatial reasoning, biomechanical analysis, and procedural planning using generative AI. Key applications are rapidly emerging, like streamlining clinical workflows through automated documentation, the mediation of patient-provider communication and enhanced interpretability of complex medical information. While an exciting field the current evidence base is quite limited. The continued integration of these technologies promises to enhance surgical precision, democratise access to advanced planning, and ultimately improve patient outcomes. However, realising this potential requires overcoming significant challenges related to the ‘black box’ nature of models, data bias, and evolving regulatory oversight. Rigorous clinical validation through prospective trials will be essential to ensure the safe, effective, and equitable implementation of generative AI in the future of orthopaedic care.</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":"34 1","pages":"370-377"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380477","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}