Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"When sample size is tiny, outcomes rare and clinical pictures fuzzy—Practical ways to survive statistical pitfalls","authors":"Łukasz Lewandowski, Aleksandra Królikowska, Jon Karlsson, Mahmut Enes Kayaalp, Roland Becker, Robert Prill","doi":"10.1002/ksa.70194","DOIUrl":"10.1002/ksa.70194","url":null,"abstract":"<p>Modern research guidelines recommend that investigators plan their sample size before initiating a study. This not only increases the chance of detecting a real effect but also helps us be confident when concluding that an effect is truly absent. In other words, to avoid the common Type-II statistical error. Yet even the best-planned study can falter. In this editorial, we explore what ‘small sample size’ truly means, why it matters, and how researchers can navigate these treacherous waters without sinking their study.</p><p>We often assume that a small sample size is a headcount problem. It is not. It is primarily an information problem. Small datasets distort the true picture. A few unusual cases can easily skew averages, make variability look misleading, and render routine checks, such as ‘normal distribution’ or ‘equal variance’, almost meaningless. Power erodes, but so does interpretability; you don't just risk missing true effects—you also risk believing in false, precise-sounding nonsense.</p><p>Crucially, a small sample size is not a moral failing. In many surgical or rehabilitation settings, outcomes are genuinely rare. Periprosthetic joint infections, catastrophic complications, or specific adverse events happen infrequently within the study period. Add real-world attrition and protocol drift, and even a carefully planned study can find itself navigating a statistical fog.</p><p>The fog thickens in multivariable territory. Generalised linear models (GLMs)—logistic for binary outcomes, Poisson for counts, and ordinal for scales—can adjust for many factors at once, but they require enough information to be reliable. When events are rare, each added parameter struggles for too few data points. Estimates then become unstable; risk jumps between extremes, uncertainty increases and sometimes the model is unable to calculate a result.</p><p>And events per variable (EPV) in the multivariate model isn't the whole story. Covariate imbalance quietly drains the data of usable signals. You might plan to adjust for age, sex, body mass index (BMI), smoking, diabetes, implant type, surgical approach and rehabilitation pathway—only to discover mid-study that two of these factors are rare or highly skewed. A predictor like immunosuppression may occur in only 4% of patients, or prior infection might cluster in one site. The model will fit, but it may learn more from missing data than from real patterns. Adding interactions, such as age × implant type, quickly splits the sample into tiny, uninformative subgroups. Even with more common variables, an imbalance between groups can confuse interpretation. Sometimes, purely mathematical quirks of logistic regression make adjusted effects look very different from unadjusted ones—and with a small sample, even tiny modelling changes can reverse the direction of the result. Model selection further accelerates this instability; with limited events, each additional degree of freedom is like a lottery ticket, and ov","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 5","pages":"1563-1566"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70194","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515536","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":"Posterior tibial slope measurements show a high degree of variability","authors":"Wahid Abdul,&nbsp;Mary Jones,&nbsp;David Haslhofer,&nbsp;Arman Motesharei,&nbsp;Emmanouil Astrinakis,&nbsp;Justin Lee,&nbsp;Simon V. Ball,&nbsp;Andy Williams","doi":"10.1002/ksa.12733","DOIUrl":"10.1002/ksa.12733","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Posterior tibial slope (PTS) ≥ 12° is regarded as the strongest predictor of anterior cruciate ligament (ACL) reconstruction graft failure. Several methods to measure PTS have been reported with varying degrees of accuracy. We investigate whether the sagittal plane on the axial slice of magnetic resonance imaging (MRI) and computed tomography (CT) scans, with respect to the axial series, either parallel to the ACL or perpendicular to the posterior femoral condylar axis (PFCA), affects PTS measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty patients undergoing ACL revision surgery between November 2019 and September 2022 were included. Medial PTS (MPTS) and lateral PTS (LPTS) were measured and compared using the method of Hudek et al. on sagittal MRI, initial sagittal CT acquisition, sagittal CT reconstructed to correspond to the MRI and sagittal CT reconstructed perpendicular to the PFCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MRI produced greater mean PTS measurements compared to the different CT reconstructions. Mean LPTS measurements were greater than MPTS measurements across all imaging modalities, but only significant for MRI studies (<i>p</i> = 0.01). There was no significant difference between the PTS measurements for CT as per MRI and perpendicular to PFCA. Intraclass correlation coefficient demonstrated good agreement (0.64) for LPTS measurements on MRI but poor agreement for CT oriented to MRI (MPTS: 0.52, LPTS: 0.15) and perpendicular to PFCA (MPTS: 0.35, LPTS: 0.16).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PTS measurements vary widely between imaging modalities and raters, with no difference in measurements according to different CT reconstructions. Therefore, one must take great care with PTS measurements when considering slope-changing osteotomy during ACL revision surgery.</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 5","pages":"1606-1615"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532838","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":"Evaluating outcomes of revision anterior cruciate ligament reconstruction with rectangular tunnel technique using a bone-patellar tendon-bone graft: A propensity score matching analysis indicating comparable results to primary reconstruction","authors":"Shinichiro Okimura,&nbsp;Tomoyuki Suzuki,&nbsp;Miki Kuroda,&nbsp;Yasutoshi Ikeda,&nbsp;Kousuke Shiwaku,&nbsp;Atsushi Teramoto","doi":"10.1002/ksa.12741","DOIUrl":"10.1002/ksa.12741","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to investigate whether one-stage revision anterior cruciate ligament reconstruction (ACLR) using the rectangular tunnel (RT) technique with a bone-tendon-bone (BTB) graft can achieve outcomes comparable to primary ACLR. It was hypothesized that both one-stage revision and primary ACLR using the RT technique with a BTB graft would provide comparable clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enroled 935 patients who underwent primary or revision ACLR by a single surgeon between 2012 and 2022. A 1:1 matching analysis was performed to balance demographic and clinical factors between the primary and revision ACLR groups. Matching factors included age, sex, body mass index, follow-up period, pre-injury Tegner activity scale and the presence of meniscus injury. Clinical evaluations were performed both preoperatively and at the final follow-up, including physical examinations and clinical outcome scores (Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] Knee Examination Form 2000). Knee joint laxity was assessed using the Lachman and pivot shift tests, along with the knee arthrometer. Continuous and categorical variables were analyzed using an independent <i>t</i> test and Fisher's exact probability test, respectively. Survivorship was assessed by plotting the Kaplan‒Meier survival curves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, 128 patients were assigned to each group, with mean follow-up periods of 41.7 and 44.5 months in the primary and revision groups, respectively. Post-operative assessments showed no significant between-group differences in knee joint laxity or KOOS subscale scores. Based on the IKDC grading, patients were classified as either normal or nearly normal. Kaplan‒Meier survival analysis showed no significant between-group differences in survival rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Comparable post-operative knee stability and clinical outcomes were observed in both the one-stage revision and primary ACLR groups, highlighting the importance of precise surgical techniques in achieving consistent revision ACLR outcomes and suggesting that the RT technique may contribute to more reliable results in this challenging setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 5","pages":"1647-1654"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556536","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":"Transitioning between medical equipment suppliers does not affect ACL reconstruction outcomes in a high-volume setting","authors":"Dzan Rizvanovic,&nbsp;Anders Stålman,&nbsp;Christoffer von Essen","doi":"10.1002/ksa.12775","DOIUrl":"10.1002/ksa.12775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate whether changing medical equipment suppliers in anterior cruciate ligament reconstruction (ACLR) influences surgical time, revision rates and subjective outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted using data from the Swedish Knee Ligament Registry (SKLR). On 1 September 2016, Capio Artro Clinic, Stockholm, Sweden, changed its supplier for all medical equipment, from Smith &amp; Nephew (SN) to Arthrex (AR). Patients who underwent primary ACLR during the preceding year (from 1 September 2015) formed group SN and were compared with patients operated between 1 September 2016 and 1 September 2017, divided into three consecutive 4-month cohorts (AR1–3) for temporal comparison. Primary outcome was surgical time. Secondary outcomes were revision rates at 2 and 5 years, and the aggregate Knee injury and Osteoarthritis Outcome Score (KOOS₄) at 2 years using thresholds for minimal important change (MIC), Patient Acceptable Symptom State (PASS), treatment failure (TF) and perioperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1175 patients underwent a primary ACLR during the study period. Group SN included 521 patients, and Groups AR1–3, 654. Of the 521 patients in Group SN, 488 (93.7%) had surgical time recorded, with a median of 61 (interquartile range [IQR]: 50–73) min. In Groups AR1–3, 560 patients (85.6%) had surgical time recorded, with median times of 63 (IQR: 52–78), 60 (IQR: 50–70) and 60 (IQR: 50–70) min, respectively, showing no significant differences. Of the included patients, 573 (48.8%) completed KOOS at the 2-year follow-up, with no significant differences between groups regarding MIC, PASS or TF. Within 2 years, 31 patients (2.6%) underwent revision ACLR, and after 5 years, an additional 21 patients, totalling 52 (4.4%), with no significant group differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Experienced ACL surgeons can transition between suppliers with acceptable outcomes, comparable surgical times and low complication rates.</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 5","pages":"1674-1681"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621751","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":"Weight-bearing after ACL reconstruction with or without concomitant injuries: Defining the limits of early mobilisation and safe rehabilitation","authors":"Marko Ostojic,&nbsp;David Glavas Weinberger,&nbsp;Branimir Bradaric Slujo,&nbsp;Thomas Patt,&nbsp;Pier Francesco Indelli,&nbsp;Aleksandra Królikowska,&nbsp;Mahmut Enes Kayaalp,&nbsp;Robert Prill","doi":"10.1002/ksa.70248","DOIUrl":"10.1002/ksa.70248","url":null,"abstract":"<p>Early weight-bearing (WB) after anterior cruciate ligament reconstruction has become a quasi-dogma, largely extrapolated from isolated cohorts with low posterior tibial slope and intact menisci. This editorial argues that such ‘early for all’ practice is no longer defensible. Instead, weight bearing should be prescribed according to a stratified, lesion- and patient-specific framework. Steep posterior tibial slope, elevated static anterior tibial translation, meniscal root or radial repair, cartilage procedures, and combined procedures fundamentally change the loading vectors acting on the graft and secondary stabilisers. In these scenarios, a short non-WB or protected WB phase appears to improve static laxity without compromising functional recovery. We propose a pragmatic decision model and a simple traffic-light checklist (green/yellow/red) to guide WB timing and magnitude, with patient factors (age, BMI, activity level, compliance) modulating progression within each category. Early weight bearing remains appropriate – and should be pursued boldly – in ‘green’ isolated ACL knees, but becomes a potentially graft-threatening choice in complex or ‘decompensated’ knees. Finally, the field must urgently standardise what ‘partial’ and ‘early’ WB actually mean and align future trials with quantitative loading, imaging, and functional metrics to move from tradition-based to criterion-based rehabilitation.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 5","pages":"1577-1581"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70248","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835842","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":"Long-term clinical and MRI outcomes of a polyurethane meniscal scaffold implantation for the treatment of partial meniscal deficiency: A minimum 10-year follow-up study","authors":"Vasileios S. Akrivos,&nbsp;George A. Komnos,&nbsp;Bela Ujvari,&nbsp;Artemis Hante,&nbsp;Eleftheria Adaktylidou,&nbsp;Theofilos Karachalios,&nbsp;Michael Hantes","doi":"10.1002/ksa.12724","DOIUrl":"10.1002/ksa.12724","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the clinical and magnetic resonance imaging (MRI) results after implantation of a polyurethane scaffold for chronic segmental meniscus deficiency following partial meniscectomy in a long-term follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty-two knees received arthroscopic implantation of an Actifit® polyurethane meniscal implant for deficiency of the meniscus. Clinical outcomes were assessed using patient-reported outcome scores, including Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner Activity Scale and visual analogue scale (VAS) for pain and satisfaction. Preoperative MRI scans and final follow-up radiographs and MRI evaluations were performed to assess scaffold morphology, tissue integration and the status of the articular cartilage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up was 11.4 years. Significant improvements were observed in clinical outcomes, with KOOS improving from a preoperative mean of 47.75 (standard deviation [SD]: 16.88) to a 78.62 (SD: 15.45), Lysholm scores from 46.62 (SD: 16.96) to 84.62 (SD: 13.03), Tegner Activity Scale improving from 1.8 to 4.1 at the final follow-up. The VAS for pain decreased from a preoperative mean of 5.62 (SD: 2.54) to 2.12 (SD: 2.02). MRI evaluations using the Genovese classification showed 23 knees with Type II scaffolds, 0 with Type III and 9 with Type I. Bone oedema was not present in 27 knees, with 5 knees showing Type I bone oedema. Meniscal extrusion was observed in 24 knees with partial extrusion and 8 knees with complete extrusion. The contralateral meniscus was normal in 28 knees and graded as Reicher Grade 1 in 2 knees. The Kellgren–Lawrence classification revealed 15 knees with Type I osteoarthritic changes, 10 with Type II changes and 7 with Type III changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Arthroscopic treatment for patients with chronic segmental meniscal loss using a polyurethane meniscal implant can achieve sustainable long-term results regarding pain reduction and knee function. However, the MRI did not reveal normal menisci in all cases.</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 5","pages":"1597-1605"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304322","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":"Medial parapatellar surgical approach leads to greater loss of postural sway complexity compared to mid-vastus approach in women undergoing total knee arthroplasty","authors":"Vasileios Mylonas,&nbsp;Stylianos Grigoriadis,&nbsp;Dimitris Metaxiotis,&nbsp;Eleftherios Kellis,&nbsp;Nick Stergiou,&nbsp;Thomas Nikodelis","doi":"10.1002/ksa.70057","DOIUrl":"10.1002/ksa.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) is associated with acute postoperative effects that increase the risk of falls. These effects differ between the medial parapatellar (PP) and mid-vastus (MV) surgical techniques but have not been evaluated in terms of postural sway complexity. Loss of this complexity leads to increased randomness in the center of pressure and higher fall risk. This exploratory comparative analysis addresses this knowledge gap by examining how PP and MV techniques affect postural sway complexity in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty women with osteoarthritis (OA) were randomly assigned to TKA via the PP or MV approach. Postural sway data were collected at: 1 day before the surgery (Pre), 5 days (Post), 2 weeks, and 1 month post-surgery. We also included an age- and sex-matched healthy control group (<i>n</i> = 11) with a single assessment of their postural sway. The temporal structure of variability was evaluated in terms of its complexity. We quantified the complexity of postural sway using detrended fluctuation analysis (DFA) and multi-scale entropy (MSE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The α exponent (DFA) and MSE values showed significant effects of time in both axes, with both surgical groups exhibiting a shift towards more random patterns following TKA. When compared to controls, the PP group exhibited a significantly lower α exponent, indicative of more random patterns, at 2 weeks and 1 month but not at Pre and Post, while no such differences were observed for the MV group. Lower α exponent and higher MSE values reflect reduced sway complexity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings suggest that TKA leads to loss of complexity in women during the postoperative stage, with the PP approach resulting in more pronounced reductions relative to healthy controls than the MV approach. Future studies should explore the long-term effects of TKA on postural sway complexity and the impact of rehabilitation protocols.</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 5","pages":"1700-1712"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025129","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":"Outcomes of combined anterior cruciate ligament and medial collateral ligament reconstruction of the anterior cruciate ligament and medial collateral ligament with ‘floating meniscus sign’: A minimum 2-year FU study","authors":"Luis F. Z. Funchal,&nbsp;Eric Pasqualotto,&nbsp;Rafael Ortiz,&nbsp;Diego C. Astur,&nbsp;Moises Cohen","doi":"10.1002/ksa.12770","DOIUrl":"10.1002/ksa.12770","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This cohort study aimed to evaluate the outcomes of patients with combined anterior cruciate ligament (ACL) and grade II medial collateral ligament (MCL) injuries who exhibited the floating meniscus sign during arthroscopy and were treated with ACL and medial compartment reconstruction surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with combined ACL and grade II MCL injuries who underwent ACL and MCL reconstruction surgery between January 2019 and December 2022 were included in this study. The instability was classified as a grade II MCL injury, based on findings from magnetic resonance imaging and clinical examination. The Tegner activity scale and Lysholm score were collected preoperatively, 6, 12, 24, 36, 48 and 60 months postoperatively. Additionally, the number of patients with ACL reconstruction failure or residual MCL laxity at each follow-up time point was recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 197 patients underwent simultaneous reconstruction of the ACL and grade II MCL injuries. The mean age was 29 ± 9 years, and 83% were male. Six cases of ACL reconstruction failure were observed over 60 months, with no residual MCL valgus laxity at the final follow-up. Significant improvements in both the Tegner activity scale and Lysholm knee scoring scale were noted at all follow-up points compared to preoperative scores (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The floating meniscus sign proved to be a valuable finding in guiding the surgical management of combined ACL and grade II MCL injuries. Our results suggest that, in physically active patients presenting with this sign, performing both ACL and MCL reconstruction leads to excellent mid-term outcomes, with significant functional improvement and a low rate of graft failure or residual valgus instability. This supports the surgical indication of MCL reconstruction in selected grade II injuries when the floating meniscus sign is present, potentially preventing long-term instability and suboptimal recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 5","pages":"1665-1673"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12770","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621732","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":"KSSTA leadership update: Welcoming Nikolai Ramadanov as new Associate Editor for hip surgery","authors":"Michael T. Hirschmann,&nbsp;Elmar Herbst,&nbsp;Robert Prill,&nbsp;M. Enes Kayaalp,&nbsp;Giuseppe Milano","doi":"10.1002/ksa.70390","DOIUrl":"10.1002/ksa.70390","url":null,"abstract":"&lt;p&gt;It is with great pleasure that we welcome Dr. Nikolai Ramadanov as new Associate Editor for Hip Surgery for &lt;i&gt;Knee Surgery, Sports Traumatology, Arthroscopy&lt;/i&gt; (&lt;i&gt;KSSTA&lt;/i&gt;).&lt;/p&gt;&lt;p&gt;Dr. Ramadanov is currently a Senior Physician in Orthopaedics and Trauma Surgery at the University Hospital Brandenburg/Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany. He completed his specialist training in Orthopaedics and Trauma Surgery and holds additional board certifications in Emergency Medicine, General Surgery, and Special Trauma Surgery. This broad and comprehensive training reflects both the depth and versatility of his clinical expertise.&lt;/p&gt;&lt;p&gt;His clinical practice is primarily focused on joint replacement surgery, where he serves as a principal surgeon for primary hip and knee arthroplasty as well as complex revision procedures. In addition, he has extensive experience in complex trauma care and hip preservation surgery, with particular expertise in pelvic and acetabular pathology. This combination of elective reconstructive surgery and high-level trauma care provides him with a unique and comprehensive perspective on hip pathology across the full spectrum of disease.&lt;/p&gt;&lt;p&gt;Dr. Ramadanov's research profile is equally distinguished. His scientific interests include hip and knee arthroplasty, hip preservation surgery, pelvic and acetabular trauma, perioperative outcomes and evidence synthesis [&lt;span&gt;1, 4, 6, 7&lt;/span&gt;]. A central focus of his work lies in clinical decision-making and the methodological quality of orthopaedic research—areas that are essential for the continued advancement of evidence-based hip surgery. Besides data-driven clinical research, he is an expert in conducting high-level systematic reviews with meta-analysis, including umbrella reviews, multilevel and network meta-analysis, shaping new standards in the field [&lt;span&gt;2, 3, 5&lt;/span&gt;]. He has authored more than 80 peer-reviewed publications, contributed to academic book chapters and remains actively engaged in research at the University Hospital Brandenburg/Havel, Brandenburg Medical School.&lt;/p&gt;&lt;p&gt;Within &lt;i&gt;KSSTA&lt;/i&gt;, Dr. Ramadanov already plays an important role. As a very active reviewer, he has already contributed to the journal's mission through rigorous manuscript evaluation and thoughtful editorial decision-making. His structured, analytical approach and commitment to scientific integrity align perfectly with the journal's standards and ambitions.&lt;/p&gt;&lt;p&gt;As the flagship journal of the European Society of Sports Traumatology, Knee Surgery &amp; Arthroscopy (ESSKA), &lt;i&gt;KSSTA&lt;/i&gt; continues to strengthen its position as a leading platform for high-quality orthopaedic research. The field of hip surgery is evolving rapidly—from hip preservation and biologic strategies to complex arthroplasty and trauma reconstruction—and strong editorial leadership is essential to guide this progress. Dr. Ramadanov's clinical excellence, academic productivity and editorial ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 5","pages":"1582-1583"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147523636","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":"Preoperative anxiety before anterior cruciate ligament reconstruction is a risk factor of post-operative pain","authors":"Louis Idier,&nbsp;Mohamad K. Moussa,&nbsp;Nicolas Lefèvre,&nbsp;Yoann Bohu,&nbsp;Antoine Gerometta,&nbsp;Frédéric Khiami,&nbsp;Olivier Grimaud,&nbsp;Alain Meyer,&nbsp;Eugénie Valentin,&nbsp;Alexandre Hardy","doi":"10.1002/ksa.12760","DOIUrl":"10.1002/ksa.12760","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The study investigates whether preoperative anxiety, measured by the Surgical Fear Questionnaire (SFQ), influences post-operative pain following anterior cruciate ligament (ACL) reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of prospective data was performed, including 628 patients operated on for primary ACL reconstruction between October 2023 and July 2024. Patients were classified as low anxiety (SFQ &lt; 30) and high anxiety (SFQ ≥ 30). Two groups were created for comparison and paired for age, sex and preoperative Lysholm score. The primary outcome was post-operative pain evaluated by the visual analogue scale (VAS) at different intervals (Days 0–3). The secondary outcome measure was the percentage of patients who crossed the Patient Acceptable Symptom State (PASS) threshold for the VAS in both groups at the same points in time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 628 patients were evaluated, and after one-to-one propensity score matching based on age, sex, and preoperative Lysholm score, 334 patients (167 in the low SFQ group and 167 in the high SFQ group) were included in the final analysis. The mean age was 31.6 (9.6) years. The VAS scores were significantly different between the two groups. The high anxiety group had a higher level of post-operative pain at all time points (Day 0: <i>p</i> = 0.002; Day 1: <i>p</i> &lt; 0.001; Day 2: <i>p</i> &lt; 0.001; Day 3: <i>p</i> &lt; 0.001). A significantly greater proportion (<i>p</i> &lt; 0.005) of patients in the low SFQ group crossed the PASS threshold compared to the high SFQ group at all times. The greatest difference was observed on Day 3 with 64.1% of the patients in the low SFQ group crossing the PASS threshold, compared to only 45.5% in the high SFQ group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>High preoperative anxiety is a risk factor for post-operative pain following ACL reconstruction. These results highlight the importance of preoperative anxiety screening and targeted psychological support as part of prehabilitation protocols to reduce early post-operative pain and potentially enhance recovery following ACL reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Cohort study.</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 5","pages":"1616-1622"},"PeriodicalIF":5.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577569","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}