Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Synovial absolute polymorphonuclear neutrophil cell count: A simple and inexpensive marker for diagnosing periprosthetic hip and knee joint infections","authors":"Sujeesh Sebastian,&nbsp;Jennyfer A. Mitterer,&nbsp;Youssef Ahmed,&nbsp;Bernhard J. H. Frank,&nbsp;Sebastian Simon,&nbsp;Jochen G. Hofstaetter","doi":"10.1002/ksa.12652","DOIUrl":"10.1002/ksa.12652","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to establish the optimal cutoff value for synovial absolute polymorphonuclear neutrophil (APMN) count in distinguishing between septic and aseptic hip and knee revision arthroplasties. We also investigated its effectiveness as an indicator in revision arthroplasties with challenging microbiological findings, including (i) aseptic cases with a single unexpected positive intraoperative culture (UPICs), (ii) septic cases with unexpected negative ICs (UNICs) and (iii) infections caused by high- and low-virulent pathogens.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 616 revision arthroplasties (177:hip, 439:knee) included. Using European Bone and Joint Infection Society (EBJIS) criteria, 325 (52.8%) were classified as infection confirmed, 271 (44%) infection unlikely and 20 (3.2%) as infection likely. International Consensus Meeting (ICM) 2018 criteria classified 308 (50%) as infected, 269 (43.7%) not infected, and 39 (6.3%) as inconclusive. Diagnostic accuracy was assessed through receiver operating characteristic curves and area under the curve (AUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Optimal APMN count thresholds using EBJIS criteria in hip and knee joints were 783.6 cells/µL (AUC: 0.92) and 549 cells/µL (AUC: 0.91), respectively. With the ICM criteria, its optimal cutoff values remained unchanged, except for the knee, which shifted to 594.2 cells/µL. Comparing UPICs to other aseptic cases showed no significant median APMN count differences when both criteria's applied, potentially ruling out infection suspicion. In septic cases, APMN counts differed between UNICs and culture positives but were statistically significant with EBJIS criteria (Hip:<i>p</i> = 0.01, Knee:<i>p</i> = 0.03) but not with ICM (<i>p</i> = 0.08). Median APMN counts were significantly elevated in high-virulent compared to low-virulent organisms, with similar trends in most of the other markers. Compared to alpha-defensin, APMN count exhibited better AUC, sensitivity and negative predictive value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The APMN count represents a simple and inexpensive method that may serve as a complementary diagnostic marker in hip and knee revision arthroplasties with challenging microbiological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2905-2916"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657631","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":"A new parameter in the era of robotic total knee arthroplasty: Coronal alignment at 90° of flexion impacts clinical outcomes","authors":"Luca Andriollo,&nbsp;Christos Koutserimpas,&nbsp;Pietro Gregori,&nbsp;Elvire Servien,&nbsp;Cécile Batailler,&nbsp;Sébastien Lustig","doi":"10.1002/ksa.12648","DOIUrl":"10.1002/ksa.12648","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Alignment strategies in total knee arthroplasty (TKA) have predominantly emphasized coronal alignment in extension, with minimal focus on dynamic alignment during flexion. This study aims to identify the predictors of the intraoperative robotic hip–knee–ankle angle at 90° of flexion (rHKA-90F) and assess its clinical significance in postoperative outcomes, proposing that rHKA-90F may be a critical factor in enhancing functional results in TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 180 patients with varus deformity undergoing robotic-assisted TKA under the functional alignment principles. Clinical outcomes were assessed using the Knee Society Score (KSS), Forgotten Joint Score (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS) score. Predictors for final rHKA-90F and its intraoperative changes were identified using multiple linear regression models. Initial and intraoperative robotic measurements were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant predictors of the final rHKA-90F included femoral rotation, tibial varus/valgus alignment, initial rHKA-90F and the final robotic axis in extensions. Patients with a final rHKA-90F ≥ 5° of varus demonstrated superior KSS function and KSS knee compared to those with a final rHKA-90F between 0° and 4° of varus. Furthermore, patients with intraoperative changes of rHKA-90F &gt; 2.5° neutralization (varus reduction or with a valgus value) achieved better FJS and AKPS score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the clinical relevance of rHKA-90F as an intraoperative tool in robotic knee arthroplasty, emphasizing the need to balance the correction of varus deformity with the maintenance of slight varus alignment in flexion. Personalized alignment strategies tailored to patient-specific anatomy and kinematics are crucial to optimizing outcomes. There is still a need for future research on the long-term effects of dynamic alignment.</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 7","pages":"2581-2591"},"PeriodicalIF":5.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657464","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":"Open and arthroscopic deepening trochleoplasty improves post-operative outcomes: A systematic review of the literature reveals lack of comparability between techniques.","authors":"Signe Høj, Johanne Kofoed Lundegaard, Lars Blønd, Peter Lavard, Anke Simone Rechter, Christian Dippmann, Kristoffer W Barfod","doi":"10.1002/ksa.12647","DOIUrl":"https://doi.org/10.1002/ksa.12647","url":null,"abstract":"<p><strong>Purpose: </strong>Deepening trochleoplasty improves outcomes in patients with trochlear dysplasia. The aim of this systematic review was to present the outcomes after open thin-flap, open thick-flap and arthroscopic deepening trochleoplasty.</p><p><strong>Methods: </strong>A systematic review was conducted using the PRISMA guidelines. Literature was searched in the PubMed, EMBASE and Cochrane databases on 16 December 2024. All studies from the inception of the databases to the date of the search were included in the search. Studies were included if they examined patients with patellar instability and trochlear dysplasia treated with either open or arthroscopic deepening trochleoplasty and reported pre- and post-operative outcomes. Two independent reviewers screened titles and abstracts, reviewed the full text and performed the quality assessment.</p><p><strong>Results: </strong>A total of 32 studies, consisting of 1435 trochleoplasty cases in 1310 patients, were included. Of the included studies, 21 concerned open thin-flap trochleoplasty, 8 concerned open thick-flap trochleoplasty and 3 concerned arthroscopic trochleoplasty. The most used patient-reported outcome measures were the Kujala score, International Knee Documentation Committee score, visual analogue scale pain score, Lysholm Knee Score and Tegner Activity Scale; and the most reported radiological outcome measures were trochlear sulcus angle, trochlear bump, trochlear depth, tibial tubercle-trochlear groove distance, Caton-Deschamps index and patellar tilt. All three trochleoplasty techniques lead to improvements in post-operative outcome measures.</p><p><strong>Conclusion: </strong>Deepening trochleoplasty improves post-operative outcome using both open thin-flap, open thick-flap and arthroscopic deepening technique. Comparison between the techniques is challenging due to low methodological quality of studies. Further research is needed to document treatment effect and improve patient outcome.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649548","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":"Comparable outcomes between cruciate-substituting and posterior-stabilized inserts in robotic total knee arthroplasty under the functional alignment principles","authors":"Christos Koutserimpas,&nbsp;Pietro Gregori,&nbsp;Luca Andriollo,&nbsp;Elvire Servien,&nbsp;Cécile Batailler,&nbsp;Sébastien Lustig","doi":"10.1002/ksa.12654","DOIUrl":"10.1002/ksa.12654","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Functional alignment (FA) has emerged as a personalized strategy in total knee arthroplasty (TKA) to optimize outcomes by accounting for patient-specific anatomical and soft tissue characteristics. Limited evidence exists on how polyethylene insert type, specifically cruciate-substituting (CS) versus posterior-stabilized (PS), impacts clinical outcomes and complications in this context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective comparative study included 329 patients who underwent robotic-assisted TKA with FA principles with a minimum 2-year follow-up. Patients were divided into two groups: CS or PS implants. CS inserts were selected for patients with an intact posterior cruciate ligament (PCL), while PS inserts were used in cases of PCL insufficiency or significant flexion contractures. Preoperative and post-operative outcomes, including Knee Society Scores (KSS), Forgotten Joint Scores (FJS), range of motion (ROM) and complications, were assessed. Implant survivorship was analyzed using the Kaplan–Meier method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At a median follow-up of 36 months, no significant differences were observed between CS and PS groups in KSS (knee: <i>p</i> = 0.45; function: <i>p</i> = 0.4), FJS (<i>p</i> = 0.7) or ROM (median flexion: 130° in both groups, <i>p</i> = 0.52). Specific complications included intraoperative lateral condyle fractures in the PS group and femoral component revisions due to instability in the CS group. The overall complication rates and implant survivorship were comparable (<i>p</i> = 0.55 and <i>p</i> = 0.85, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to evaluate polyethylene insert type in FA and demonstrates that both CS and PS inserts provide comparable outcomes and safety profiles in robotic-assisted TKA. These findings underscore the importance of patient-specific implant selection, with further research needed to assess long-term results.</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 7","pages":"2605-2613"},"PeriodicalIF":5.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625383","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":"PRP or not PRP: Is the debate surrounding platelets-based blood-derived products evolving?","authors":"Enrico Ragni,&nbsp;Michela Maria Taiana,&nbsp;Tomislav Čengić,&nbsp;Laura de Girolamo,&nbsp;Marko Ostojić","doi":"10.1002/ksa.12655","DOIUrl":"10.1002/ksa.12655","url":null,"abstract":"<p>The increasing interest in biologic treatments for musculoskeletal disorders has led to the advancement of orthobiologics, particularly in non-operative care through injectable therapies. However, defining these treatments clearly is crucial for proper clinical application. Orthobiologics include biologic substances that enhance healing, such as cell-based therapies and blood-derived products. Among these, platelet-rich plasma (PRP) is widely used, but its classification remains complex due to variations in preparation methods, platelet concentration, leucocyte content, and activation techniques. Strictly, the term ‘PRP’ refers to plasma enriched in platelets relative to baseline blood levels. Yet, scientific debate persists regarding whether platelet count or enrichment is more significant in clinical outcomes. Additionally, leucocyte-rich and leucocyte-poor PRPs offer different therapeutic advantages depending on the target tissue, complicating standardization. Similarly, the presence of red blood cells is generally discouraged, given their association with joint inflammation. Beyond the classical ‘PRP’ formulations, alternative blood-derived products offer distinct biological effects. A standardized classification system is therefore essential for research and clinical application, emphasizing precise documentation of products' characteristics, including platelet count, activation state and bioactive molecule interactions. Understanding these variables and their impact on patient-specific conditions will refine orthopaedic regenerative strategies and optimize treatment efficacy.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 5","pages":"1920-1924"},"PeriodicalIF":5.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12655","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625446","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":"Increased internal tibiofemoral rotation is associated with anterolateral ligament injury and high-grade pivot-shift in ACL-injured patients.","authors":"Chilan Bou Ghosson Leite, Alexander Bumberger, Andre Giardino Moreira da Silva, Gergo Merkely, Richard Smith, Paulo V P Helito, Peter Asnis, Camilo P Helito, Christian Lattermann","doi":"10.1002/ksa.12632","DOIUrl":"https://doi.org/10.1002/ksa.12632","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether tibiofemoral rotation is associated with a concurrent anterolateral ligament (ALL) injury and pivot-shift grading in patients with a primary anterior cruciate ligament (ACL) tear.</p><p><strong>Methods: </strong>In this multicenter cross-sectional study constituting a secondary analysis of previous studies, medical records and magnetic resonance imaging (MRI) scans of patients with unilateral primary ACL injury were reviewed. Demographics and pivot-shift grading were collected. ALL was identified on MRI coronal images and categorized as intact or injured. Tibiofemoral rotation angle (TFA) was measured on axial MRI. Optimal TFA cut-off associated with ALL injury was identified by a receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Of 206 included patients, 152 (73.8%) exhibited signs of ALL injury. Pivot-shift tests were predominantly graded as 2 (71.4%), and notably, all Grade 3 pivot-shift assessments were associated with ALL injury. Mean TFA was significantly higher in cases with ALL injury (5.2 ± 3.6°) compared to intact ALL cases (2.7 ± 3.5°; p < 0.001). A positive correlation was observed between pivot-shift grading and TFA (r = 0.204, p = 0.003). Optimal TFA cut-off value, based on the absolute measurement, for predicting ALL injury was 2.5° (sensitivity: 0.77; specificity: 0.55). Patients with TFA ≥ 2.5° had a significantly higher risk of ALL injury (odds ratio: 3.34, 95% confidence interval [CI]: 1.74-6.42, p < 0.001); when combined with pivot-shift Grade 2 or 3, this risk substantially increased to 13.68 (95% CI: 6.29-29.84, p < 0.001).</p><p><strong>Conclusion: </strong>Higher TFA was associated with an increased prevalence of ALL injuries and a high-grade pivot-shift in ACL-deficient patients. Patients with a TFA ≥ 2.5° showed a threefold higher likelihood of ALL injuries, and this risk further escalated with a higher-grade pivot-shift.</p><p><strong>Level of evidence: </strong>Level 3 cross-sectional study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625397","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":"Transforming orthopaedics with AI: Insights from a custom ChatGPT on ESSKA osteotomy consensus","authors":"Tamer Sweed,&nbsp;Ahmed Mabrouk,&nbsp;Matthew Dawson","doi":"10.1002/ksa.12653","DOIUrl":"10.1002/ksa.12653","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 5","pages":"1557-1559"},"PeriodicalIF":5.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12653","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625450","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":"Low confidence in the cumulative evidence for the existence of a volume–outcome relationship after revision total knee replacement: A systematic review and meta-analysis","authors":"Alexander H. Matthews,&nbsp;Thomas Stringfellow,&nbsp;Hayley Redman,&nbsp;William K. Gray,&nbsp;Jonathan P. Evans,&nbsp;Jonathan T. Evans,&nbsp;Sarah E. Lamb,&nbsp;Tim Briggs,&nbsp;Andrew Price,&nbsp;Andrew D. Toms","doi":"10.1002/ksa.12641","DOIUrl":"10.1002/ksa.12641","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;This systematic review and meta-analysis aimed to establish the relationship between the number of procedures a hospital or surgeon performs with outcomes following revision knee replacement (RevKR).&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;MEDLINE and Embase were searched using Ovid silver platter up to December 2024 for randomised controlled trials and cohort studies that reported RevKR volumes, in at least two categories, performed by hospitals and surgeons and their relationship to patient and provider level outcomes. The primary outcome was re-revision rate. Secondary outcomes included mortality, post-operative complications, patient-reported outcomes measures (PROMs), emergency readmissions and hospital length of stay. The effect estimates were pooled and plotted using a random-effects, non-linear dose–response meta-analysis (DRMA). Where limitations in the data prohibited DRMA, a narrative approach was utilised. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively.&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 10 cohort studies with data from 1993 to 2021 were included. The confidence in the cumulative evidence exploring the relationship between surgeon/hospital volume and all outcomes after RevKR was very low. An inconsistent relationship was seen between hospital and surgeon volume and re-revision at any point. There was a non-linear dose–response relationship between higher hospital volume and lower odds of adverse post-operative events (&lt;i&gt;p&lt;/i&gt; &lt; 0.05, &lt;i&gt;n&lt;/i&gt; = 3 studies, &lt;i&gt;n&lt;/i&gt; = 35,524 patients). There was no association between increased surgeon volumes and improvements in PROMs (&lt;i&gt;n&lt;/i&gt; = 2 studies, &lt;i&gt;n&lt;/i&gt; = 2289).&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;There is a lack of high-quality studies establishing the relationship between the number of procedures a hospital or surgeon performs and outcomes following RevKR. Studies are limited to observational designs and are difficult to effectively power due to the rarity of outcomes. Pooling data from multiple studies provides valuable insights but highlights significant heterogeneity and limitations in the existing literature.&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 III, systematic review—lowest level of evidence analysed—was from retrospective cohort study of prospectively collected data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 7","pages":"2555-2570"},"PeriodicalIF":5.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12641","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597345","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":"Prospective, randomised controlled trial comparing robotic arm-assisted bi-unicompartmental knee arthroplasty to total knee arthroplasty","authors":"Omer M. Farhan-Alanie,&nbsp;James Doonan,&nbsp;Philip J. Rowe,&nbsp;Matthew S. Banger,&nbsp;Bryn G. Jones,&nbsp;Angus D. MacLean,&nbsp;Mark J. G. Blyth","doi":"10.1002/ksa.12644","DOIUrl":"10.1002/ksa.12644","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The objective of this study was to compare the clinical outcomes 2 years following surgery between robotic-arm assisted bi-unicompartmental knee arthroplasty (bi-UKA) compared with conventional mechanically aligned total knee arthroplasty (TKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single-centre, double-blinded, randomised controlled trial comparing bi-UKA and TKA. Patient-reported outcome measures (PROMs) were collected from 60 patients (27 bi-UKA and 33 TKA patients) 2 years following surgery, including Oxford Knee Score (OKS), New Knee Society Score (NKSS), Forgotten Joint Score, EQ-5D-3L, UCLA activity scale, Hospital Anxiety and Depression Scale, Pain and Stiffness Visual Analogue Scales, Satisfaction and Range of Motion. Complications were also recorded at each visit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TKA and bi-UKA continue to offer comparable PROMs. The clinical NKSS demonstrated a significant difference between the two interventions, TKA 59.5 (37–65) versus bi-UKA 26.0 (22–40) (<i>p</i> &lt; 0.001). There were no significant differences shown between the interventions across all time points and remaining outcome measures (OKS at 2-year follow-up; TKA—42.0 [34.0–45.5] vs. bi-UKA—41.0 [28.0–45.0]) or the proportion of participant achieving bi-phasic gait at 2 years following surgery (<i>p</i> = 0.429). There was no difference in complication rates following surgery at 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robotic arm-assisted, cruciate-sparing bi-UKA and mechanically aligned TKA offer similar clinical outcomes 2 years following surgery with no difference in complication rates. Further, follow-up is required to monitor patients as they enter mid/long-term follow-up and determine whether patients will gain long-term benefits from the cruciate-sparing bi-UKA approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 7","pages":"2571-2580"},"PeriodicalIF":5.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12644","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Editorial “Robotic-assisted surgery in sports medicine—A broader vision for the future”","authors":"David Ferguson,&nbsp;Ayoosh Pareek,&nbsp;Joshua Lee,&nbsp;Jaison Patel,&nbsp;Nicholas Colyvas","doi":"10.1002/ksa.12622","DOIUrl":"10.1002/ksa.12622","url":null,"abstract":"&lt;p&gt;We extend our great appreciation to Richards et al. [&lt;span&gt;6&lt;/span&gt;] for advancing the critical discussion on the application of robotic-assisted surgery in sports medicine. Their editorial is both timely and highly relevant, focussing on the rapidly expanding potential for robotic systems to address key challenges in the world of sports medicine. However, whilst the analysis remains insightful and expands the discussion, we feel it is limited to extrapolating current arthroplasty-oriented robotic systems to soft tissue or arthroscopy applications [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;To advance the conversation, we believe orthopaedic surgeons must look more broadly, gaining insights from not only the current generation of orthopaedic robots, but also the decades of experience gained with soft tissue robots in other disciplines (such as general surgery, urology, obstetrics/gynaecologist, cardiothoracic surgery, and neurosurgery). With this vision, we can prepare our practice and patients for a future where robotics may be a transformative force.&lt;/p&gt;&lt;p&gt;Robotic systems in other fields of soft tissue surgery offer interesting sources of inspiration. Platforms such as the Da Vinci Surgical System (Intuitive) have set new benchmarks in precision, dexterity, and ergonomics for laparoscopic procedures [&lt;span&gt;5, 8&lt;/span&gt;]. These systems have reliably demonstrated that robotics has the potential not only to enhance dexterity and execution, but also enhance visibility and exposure, safety, training, and competence, as well as surgeon ergonomics. Aptly translating these capabilities to sports medicine has the potential to revolutionise arthroscopic practice on multiple levels.&lt;/p&gt;&lt;p&gt;Examples of these potential advances and applications are numerous. Presently, we typically use a large rigid fixed 30-degree scope due to the manual demands of current arthroscopy. With robotics, much smaller, highly flexible, thin scopes that are robotically controlled will enable much easier and expanded access and clear visualisation in the tight joint spaces we work with [&lt;span&gt;4&lt;/span&gt;]. Robotics would also allow easy use of a second scope for further visual enhancement—for example, viewing both sides of a rotator cuff tear during repair. Even more so, one can imagine that in the future, a variable angle arthroscope may be best when controlled by an automatic machine to provide the best view.&lt;/p&gt;&lt;p&gt;With robotic control of the scope, the surgeon's hand is then freed to return them to the natural advantages of two-handed surgery. Robotic control of the accuracy and precision of the instruments can assist with the avoidance of surface cartilage damage seen too frequently in hip and knee arthroscopy, and elsewhere [&lt;span&gt;3&lt;/span&gt;]. As seen in other soft tissue robots, the capability and advantages of 3D visualisation can be introduced to arthroscopy. Beyond visual enhancement, robotic control with AI enhancement can provide joint mapping capabilities via simultaneous localisation and ma","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 5","pages":"1933-1934"},"PeriodicalIF":5.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12622","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586244","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}