Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Prehabilitation prior to anterior cruciate ligament reconstruction is a safe and effective intervention for short- to long-term benefits: A systematic review.","authors":"Alexander Zakharia, Kailai Zhang, Fares Al-Katanani, Preksha Rathod, Abhilash Uddandam, Jeffrey Kay, Ben Murphy, Dan Ogborn, Darren de Sa","doi":"10.1002/ksa.12631","DOIUrl":"https://doi.org/10.1002/ksa.12631","url":null,"abstract":"<p><strong>Purpose: </strong>Comprehensively explore current practices in preoperative rehabilitation (prehabilitation) for anterior cruciate ligament reconstruction (ACLR) and assess corresponding clinical outcomes and complication rates.</p><p><strong>Methods: </strong>A systematic search of EMBASE, MEDLINE, Cochrane and PubMed was conducted from inception to 1 November 2024. All studies reporting outcomes and/or complications following prehabilitation and ACLR were included. Screening and data abstraction were designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Revised Assessment of Multiple Systematic Reviews guidelines.</p><p><strong>Results: </strong>Thirty-six studies with 2326 patients undergoing prehabilitation and ACLR were included. Weighted averages of all clinical outcomes met or surpassed patient acceptable symptom state (PASS) thresholds and return to sports (RTS) criteria. There were no preoperative complications following prehabilitation. Major post-operative complications included graft failure (4.6%), contralateral ACL rupture (1.0%), surgical site infection (0.6%), deep infection (0.4%), non-ACL ligament injury (0.5%), reoperation for hardware removal (0.3%), muscle rupture (0.1%), patellar subluxation (0.1%) and patellar rupture (0.1%).</p><p><strong>Conclusion: </strong>Current prehabilitation practices for ACLR emphasize impairment resolution, ROM restoration, and neuromuscular exercises. Safety of current practices is supported by the absence of preoperative complications and similar post-operative complication rates compared to patients undergoing standard care. Clinical outcomes of patients undergoing prehabilitation were shown to meet and surpass PASS thresholds and RTS criteria, expedite post-operative recovery, and maintain functional improvements up to 10 years post-operation, suggesting that prehabilitation is a safe and effective intervention yielding short- to long-term benefits. There is a need for further high-quality randomized controlled trials and large prospective cohort studies comparing the effect of prehabilitation on post-operative outcomes, reporting specific exercise details and protocol progression.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974949","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 single root repair and centralisation tunnel best restores tibiofemoral contact mechanics and extrusion following a medial meniscus posterior root tear: An in vitro biomechanical study.","authors":"Khalis Boksh, Duncan E T Shepherd, Daniel M Espino, Christos Plakogiannis, Arijit Ghosh, Randeep Aujla, Michael E Hantes, Tarek Boutefnouchet","doi":"10.1002/ksa.12683","DOIUrl":"https://doi.org/10.1002/ksa.12683","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate what tunnel combination, with respect to anatomical transtibial pull-through root repair (ATPR) and transtibial centralisation (TTC), best restores tibiofemoral contact mechanics and meniscal extrusion following a medial meniscus posterior root tear (MMPRT).</p><p><strong>Methods: </strong>Meniscal extrusion and contact mechanics were measured using two-dimensional imaging and pressure films in 10 porcine knee joints. The posterior root was tested under six states: (1) intact; (2) MMPRT; (3) one tunnel ATPR and one tunnel TTC (1-ATPR + 1-TTC); (4) two tunnel ATPR and one tunnel TTC (2-ATPR + 1-TTC); (5) 1-ATPR + 2-TTC; and (6) 2-ATPR + 2-TTC. The testing protocol loaded knees with 200-N axial compression at 4 flexion angles (30°, 45°, 60° and 90°). At each angle and state, meniscal extrusion was measured as the difference in its position under load to that of the unloaded condition in the intact state. Contact area and pressure were recorded for all states at all angles and were analysed using a MATLAB programme.</p><p><strong>Results: </strong>MME was significantly reduced with both the 1-ATPR + 2-TTC and 2-ATPR + 2-TTC tunnels in comparison to the 1-ATPR + 1-TTC and 2-ATPR + 1-TTC tunnels at 60° and 90° (p < 0.05). The intact meniscus and 1-ATPR + 1-TTC technique had higher contact area at 60° (p = 0.01 and 0.04, respectively) and lower contact pressure at 90° (p = 0.01 and 0.04, respectively) compared to the 2-ATPR + 2-TTC technique. Otherwise, all tunnel combinations were similar to one another for contact mechanics and restored the loading profile to that of an intact meniscus (p > 0.05).</p><p><strong>Conclusion: </strong>When there are concerns of extrusion following a MMPRT, a combination of one centralisation and one root repair tunnel may provide better biomechanical properties compared to the addition of extra tunnels.</p><p><strong>Level of evidence: </strong>Not applicable (laboratory study).</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979059","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":"Indications and contraindications to platelet-rich plasma injections in musculoskeletal diseases in case of infectious, oncological and haematological comorbidities: A 2025 formal consensus from the GRIIP (International Research Group on Platelet Injections)","authors":"Florent Eymard,&nbsp;Karine Louati,&nbsp;Éric Noel,&nbsp;Redouane Abouqal,&nbsp;Philippe Adam,&nbsp;Fadoua Allali,&nbsp;Gabriel Antherieu,&nbsp;Jo Caers,&nbsp;Fabrice Cognasse,&nbsp;Hervé Collado,&nbsp;Christelle Darrieutort-Laffite,&nbsp;Corinne Frère,&nbsp;Alain Frey,&nbsp;Mathilde Gavillet,&nbsp;Vincent Gremeaux,&nbsp;Mael Heiblig,&nbsp;Guy Jerusalem,&nbsp;Charlotte Joly,&nbsp;Jean-François Kaux,&nbsp;Martin Lamontagne,&nbsp;Mathieu Leclerc,&nbsp;Philippe Léonard,&nbsp;Raphaël Lepeule,&nbsp;Daniel Lopez-Trabada-Ataz,&nbsp;Jérémy Magalon,&nbsp;Fabrice Michel,&nbsp;Paul Ornetti,&nbsp;Cécile Oury,&nbsp;Elvire Pons-Tostivint,&nbsp;Fernando Real,&nbsp;Ghislaine Robert,&nbsp;Mikel Sanchez,&nbsp;Alain Silvestre,&nbsp;Hervé Bard","doi":"10.1002/ksa.12682","DOIUrl":"10.1002/ksa.12682","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Platelet-rich plasma (PRP) could be a vector for certain diseases, and its composition may vary by pathologic condition. The main comorbidities that could affect PRP composition are infectious, oncologic and haematologic. In addition to potential alteration of clinical response, these pathologies could have a significant impact on the local tolerance of PRP as well as a risk of disease dissemination to the injection site. To date, there are few specific recommendations related to these comorbidities to guide clinicians. Therefore, the International Research Group on Platelet Injections (GRIIP) supported a consensus project to develop these recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the ‘recommendations by formal consensus’ methodology, a steering committee performed a literature review and drafted an initial set of recommendations. They were evaluated by an international rating group (15 specialists in musculoskeletal [MSK] diseases, five haematologists, four oncologists, three infectiologists and four scientists specialising in platelet physiology). From this rating, the first set of recommendations was discussed in a plenary meeting and then modified by the steering committee. Finally, four overarching principles and 23 recommendations were re-evaluated by the rating group. Recommendations were classified as appropriate or not, with strong or relative agreement, or uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the 23 recommendations, 10 concerned infectious diseases (viral and bacterial infections; dialysis; immunosuppressive drugs; dental care…), five oncologic diseases (local tumour; cured, active or in remission cancer…) and eight haematologic diseases (cytopenia; cured, active or stabilised cured hemopathy; monoclonal gammopathy…). All were considered appropriate by the experts (median = 9; range = 8–9), with strong or relative agreement. Due to the paucity of literature data, the recommendations are mainly based on expert opinion (Grade D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This consensus project provides four overarching principles and 23 recommendations related to contraindications of PRP injections in case of infectious, oncologic or hematologic diseases, validated by an international expert group.</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 6","pages":"2293-2306"},"PeriodicalIF":3.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032402","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":"Prevention of ACL injury is better than repair or reconstruction—Implementing the ESSKA-ESMA ‘Prevention for All’ ACL programme","authors":"Robert Prill,&nbsp;Joseph Janosky,&nbsp;Lisa Bode,&nbsp;Nicky van Melick,&nbsp;Francesco Della Villa,&nbsp;Roland Becker,&nbsp;Jon Karlsson,&nbsp;Rimtautas Gudas,&nbsp;Alli Gokeler,&nbsp;Henrique Jones,&nbsp;Romain Seil,&nbsp;Philippe Tscholl,&nbsp;Thomas Patt","doi":"10.1002/ksa.12681","DOIUrl":"10.1002/ksa.12681","url":null,"abstract":"<p>\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 6","pages":"1954-1958"},"PeriodicalIF":3.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12681","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979133","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":"Off-season beach handball participation lowers injury incidence among handball players—A cross-sectional survey on 641 athletes","authors":"Hannes Degenhardt,&nbsp;Maximilian Hinz,&nbsp;Benjamin D. Kleim,&nbsp;Marco-Christopher Rupp,&nbsp;Alexander-Stephan Henze,&nbsp;Sebastian Siebenlist,&nbsp;Romed P. Vieider,&nbsp;Yannick J. Ehmann","doi":"10.1002/ksa.12677","DOIUrl":"10.1002/ksa.12677","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To assess the effect of beach handball training during the indoor handball off-season on the incidence of indoor handball injuries over three seasons. It was hypothesised that off-season beach handball training would be associated with a lower injury incidence in indoor handball season.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An online survey of indoor handball athletes was distributed between 04-06/2023. Athletes' demographics, activity level, beach handball training during indoor handball off-season, indoor handball injuries in the previous three years, injury mechanisms and time to return to sport were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 641 athletes (22 years [interquartile range [IQR]: 19–26]; 62.1% female) from 36 different countries were included. 50.1% (<i>n</i> = 321) played beach handball in the off-season. The majority of athletes (92.7%, <i>n</i> = 594) played at a competitive (70.0%, <i>n</i> = 449) or a semi-professional (22.6%, <i>n</i> = 145) level. During the three-year period, 374 athletes (58.4%) reported a total of 501 injuries during indoor handball (incidence rate: 260.5 per 1000 athletes and year). The lower (66.1%) and upper extremity (26.3%) were the most frequently injured body parts. Overall, 87.0% (<i>n</i> = 436) of all athletes returned to indoor handball after injury. If participated in beach handball, a lower incidence of indoor handball injuries (odds ratio 0.60; [95% CI 0.42–0.87]; <i>p</i> = 0.006) and a lower injury rate in beach-and-indoor handball athletes was observed (225.3 vs. 295.8 injuries per 1000 athletes and year, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Participation in beach handball during indoor handball off-season was associated with a significantly lower injury incidence during indoor handball. Beach handball may serve as a preventative training method to reduce injuries during breaks between indoor handball seasons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective comparative study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 6","pages":"2307-2316"},"PeriodicalIF":3.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969726","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":"Synthetic augmentation in ACL reconstruction may reduce re-rupture rates and increase return-to-sport rates: A systematic review and meta-analysis.","authors":"Yufei Jiang, Seyran Naghdi, Nick Smith, Toby Smith, Andrew Metcalfe, Hema Mistry","doi":"10.1002/ksa.12680","DOIUrl":"https://doi.org/10.1002/ksa.12680","url":null,"abstract":"<p><strong>Purpose: </strong>Synthetic augmentation (SA) in anterior cruciate ligament reconstruction (ACLR) aims to enhance graft durability, but its benefits remain unclear. To evaluate whether SA in ACLR improves return-to-sport (RTS) rates, reduces graft failure, enhances patient-reported outcomes (PROs) and varies in effectiveness across materials and techniques.</p><p><strong>Methods: </strong>A systematic search of five databases was conducted until February 2025. Comparative studies were pooled using Hedges' random-effects meta-analysis with subgroup analysis based on materials and publication year. Non-comparative studies were analysed narratively. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk-of-bias tools for randomised studies. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.</p><p><strong>Results: </strong>Forty-seven studies were included (n = 4289): 7 randomised and 40 non-randomised studies (21 comparative; 19 non-comparative). SA systems included InternalBrace (FiberTape, 16 studies), Ligament Augmentation and Reconstruction System (polyester, 5), Ligament Augmentation Device (polyethylene, 18) and other materials (8). GRADE assessment showed moderate-certainty evidence for improved mid-term RTS rate from eight studies (odds ratio [OR]: 1.58; 95% confidence interval (CI): 1.12-2.22; N = 716; I² = 0%; p = 0.01). Internal brace showed a reduction in re-rupture rates in the long-term (OR: 0.17, 95% CI: 0.04-0.64; N = 218; I² = 0%; p = 0.01); however, pooled analysis of all techniques showed no statistically significant difference. Contemporary studies showed a better return to sport rates with SA. PROs showed no clinically meaningful differences. Non-comparative studies showed low graft failure rates (<8.7% for InternalBrace; <16.4% for other SA), high RTS rates (>90% for InternalBrace; >56.7% for other SA) and satisfactory PROs.</p><p><strong>Conclusions: </strong>SA, particularly InternalBrace, may improve RTS rates and reduce re-rupture risk, though PROs remain inconclusive. Findings are limited by a moderate-to-serious risk of bias, emphasising the need for high-quality research.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031355","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 structured framework for standardized 3D leg alignment analysis: An international Delphi consensus study","authors":"Quinten W. T. Veerman,&nbsp;Gabriëlle J. M. Tuijthof,&nbsp;Nico Verdonschot,&nbsp;Reinoud W. Brouwer,&nbsp;Peter Verdonk,&nbsp;Annemieke van Haver,&nbsp;Hugo C. van der Veen,&nbsp;Peter A. J. Pijpker,&nbsp;Judith olde Heuvel,&nbsp;Roy A. G. Hoogeslag,&nbsp;the 3D Leg Alignment Consensus Expert Group","doi":"10.1002/ksa.12676","DOIUrl":"10.1002/ksa.12676","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni- and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross-study comparability.</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":"33 6","pages":"2276-2292"},"PeriodicalIF":3.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016022","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":"Wearable technology identifies differences in change of direction kinetics and kinematics in soccer players with a history of anterior cruciate ligament reconstruction.","authors":"Joao Belleboni Marques, Vasileios Sideris, Rodney Whiteley, Paul James Read, Matheus Machado Gomes, Paulo Roberto Pereira Santiago","doi":"10.1002/ksa.12679","DOIUrl":"https://doi.org/10.1002/ksa.12679","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates change of direction (COD) performance and biomechanics using wearable technology in athletes with a history of anterior cruciate ligament reconstruction (ACL-R) compared to healthy controls.</p><p><strong>Methods: </strong>A within and between subjects' cross-sectional design was used. The sagittal plane kinematics of the hip, knee, and ankle during 90° side-step cutting were measured with inertial measurement units, while the vertical force was recorded with insoles in the players' boots. Twenty-six professional soccer players participated (mean age 22.7 ± 3.7 years, height 177.8 ± 5.1 cm, weight 69.4 ± 8.5 kg). Sixteen players were healthy controls, and 10 were in a full-time ACL-R rehabilitation programme, assessed 9 months post-surgery. Mixed model analysis and statistical parametric mapping were used to compare COD completion time, kinetics, and kinematics between limbs (involved vs. uninvolved) and groups (ACL-R vs. controls) during the penultimate and final foot contacts.</p><p><strong>Results: </strong>No significant differences in COD completion time were found between limbs (p = 0.52, d = 0.22) or groups (p = 0.65, d = 0.51). However, during the penultimate foot contact, the involved limb exhibited greater ankle dorsiflexion compared to the uninvolved and controls from 48% to 100% of stance (p = 0.002, d = 0.94-1.86), with lower vertical force production (p > 0.05, d = 0.81-0.95). During the plant step, lower knee flexion angles were noted compared to the uninvolved limb and controls from 2% to 69% of stance (p = 0.011, d = 1.26-1.31).</p><p><strong>Conclusion: </strong>The findings suggest that soccer players with ACL-R can restore COD completion time at the time to return to sport. However, they used compensatory movement strategies on the involved side to achieve similar performance, and this must be considered from a rehabilitation standpoint.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023298","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":"Wearable health technology finds improvements in daily physical activity levels following total knee arthroplasty: A prospective study.","authors":"Kevin A Wu, David N Kugelman, Rahul K Goel, Eric S Dilbone, Devika Shenoy, Sean P Ryan, Samuel S Wellman, Michael P Bolognesi, Thorsten M Seyler","doi":"10.1002/ksa.12675","DOIUrl":"https://doi.org/10.1002/ksa.12675","url":null,"abstract":"<p><strong>Purpose: </strong>Wearable technologies, like the Apple Watch, offer new possibilities for collecting objective data on physical activity post-operatively following total knee arthroplasty (TKA). This study aims to describe changes in daily physical activity levels using objective metrics over different time points following TKA.</p><p><strong>Methods: </strong>This study analyzed data from a prospective cohort of 152 patients undergoing a unilateral TKA. Patients wore an Apple Watch and used a digital care management application for data collection. Step count, steadiness, standing duration, gait speed and performance on a 6-min walk test were collected from Apple HealthKit at multiple time points: pre-operative, 6 weeks post-operatively, 6 months post-operatively and 12 months post-operatively. Statistical analyses were performed using R software, including descriptive statistics and paired t tests to compare outcomes at different time points post-operatively.</p><p><strong>Results: </strong>Participants demonstrated significant improvements in daily physical activity levels over the course of 12 months post-operative. At 6 months post-operative, participants showed the highest average daily step count (mean ± SD: 5293 ± 236 steps; p < 0.001), with improvements persisting at 12 months post-operative (5180 ± 260 steps; p < 0.001) compared to preoperative values. Gait speed increased from 0.88 ± 0.01 m/s preoperatively to 1.01 ± 0.01 m/s (p = 0.006) at 12 months post-operative. Standing hours increased from 9.99 ± 0.30 to 11.47 ± 0.31 h at 6 months post-operative and persisted. Steadiness and the estimated 6-minute walk test showed recovery trends, though variability remained at 12 months post-operative, suggesting the need for additional longitudinal assessment CONCLUSION: This study provides one of the first longitudinal analyses of post-operative functional recovery using Apple HealthKit, offering continuous real-world gait and activity tracking beyond traditional patient-reported measures. These findings highlight the value of wearable technology in monitoring post-operative activity and offering insights into TKA recovery patterns. The study suggests a critical recovery window at 6 months post-operative and emphasizes the need for ongoing support to maintain improvements. The integration of wearable technology in post-operative monitoring offers a promising approach to tracking patient progress and optimizing functional outcomes following TKA.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007793","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":"The projected economic burden and complications of revision hip and knee arthroplasties: Insights from national registry studies.","authors":"Patrick Sadoghi, Amir Koutp, Daniel Perez Prieto, Martin Clauss, M Enes Kayaalp, Michael T Hirschmann","doi":"10.1002/ksa.12678","DOIUrl":"https://doi.org/10.1002/ksa.12678","url":null,"abstract":"<p><p>The rising volume of primary hip and knee arthroplasties has led to a parallel increase in revision surgeries, creating significant clinical and economic challenges for healthcare systems worldwide. This study synthesizes national arthroplasty registry data to evaluate trends in revision aetiology, associated costs and regional disparities. While advancements in prosthetic design have reduced aseptic loosening rates (declining to 35.1% for hips and 18.3% for knees), septic complications now account for a growing proportion of revision cases, rising to 18.2% for hips and 21.6% for knees. Additionally, instability and malalignment persist at 15.9% and 14.1%, respectively. Revision procedures are 76% more costly than primary surgeries, with two-stage septic revisions incurring costs of up to $37,297 per case. Beyond direct surgical costs, prolonged recovery and productivity loss contribute to a broader economic impact. Regional variations, such as higher periprosthetic fracture rates in England and Wales, highlight inconsistencies in data reporting and healthcare practices. Addressing these challenges requires standardized infection definitions, enhanced registry collaboration and investment in infection prevention strategies. The role of referral centres in improving outcomes and reducing costs through multidisciplinary care is increasingly recognized. By integrating evidence-based infection management protocols and leveraging emerging technologies, the orthopaedic community can optimize patient outcomes and reduce the financial burden of revising arthroplasties. LEVEL OF EVIDENCE: Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001112","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}