Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Lateral meniscal tear, medial femoral and tibial condyles bone bruise, posterolateral tibial plateau fracture, and lateral collateral ligament injury are correlated with Segond fracture associated with anterior cruciate ligament injury","authors":"Xiangqin Yang,&nbsp;Wei Tian,&nbsp;Mao Yuan,&nbsp;Bingbing Li,&nbsp;Jia Li,&nbsp;Furong Lv,&nbsp;Yurou Chen","doi":"10.1002/ksa.70117","DOIUrl":"10.1002/ksa.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare measurements and concomitant injuries between anterior cruciate ligament (ACL)-injured patients with Segond fracture (Segond fracture group) and ACL-injured patients without Segond fracture (isolated ACL tear group) to determine the risk factors of the Segond fracture and identify the concomitant injuries pattern of Segond fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 838 patients who underwent ACL reconstruction in two institutions. Forty-five ACL-injured patients with Segond fracture, 45 ACL-injured patients without Segond fracture, and 45 controls were included. Three groups were matched for age and gender. Posterior tibial slope including lateral and medial bony, cartilaginous and meniscal slope, the status of medial and lateral meniscus, the presence of ramp lesion, posterolateral tibial plateau fracture and lateral and medial collateral ligament injury, and bone bruise severity of lateral and medial femoral condyle, tibial condyle, and patella were determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Factors associated with Segond fracture were lateral meniscus posterior horn tear (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.01–0.51, <i>p</i> = 0.01), bone bruise ≥ Grade 2 on the medial femoral condyle (OR, 14.28; 95% CI, 1.31–155.25, <i>p</i> = 0.03) and medial tibial condyle (OR, 13.55; 95% CI, 1.01–182.14, <i>p</i> = 0.049), posterolateral tibial plateau fracture (OR, 5.84; 95% CI, 1.02–33.42, <i>p</i> = 0.047), and lateral collateral ligament injury (OR, 20.93; 95% CI, 2.58–169.89, <i>p</i> = 0.004). Medial meniscus body tear, ramp lesion, posterolateral tibial plateau fracture, and lateral collateral ligament injury were strongly correlated with each other (all <i>φ</i> = 1.00, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The risk factors for ACL-injured patients with Segond fracture included lateral meniscus posterior horn tear, bone bruise ≥ Grade 2 on the medial femoral condyle and medial tibial condyle, posterolateral tibial plateau fracture, and lateral collateral ligament injury. The medial meniscus body tear, ramp lesion, posterolateral tibial plateau fracture and lateral collateral ligament injury were strong-correlated concomitant injury combinations in ACL injury with Segond fracture.</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 10","pages":"3530-3541"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380561","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":"Spheroid-based matrix-induced autologous chondrocyte implantation combined with autologous bone grafting restores physiological cartilage and subchondral bone properties in osteochondral knee defects—An MRI-based analysis","authors":"Stephan Oehme,&nbsp;Benjamin Bartek,&nbsp;Janne Callsen,&nbsp;Jessica Schallock,&nbsp;Tobias Winkler,&nbsp;Thorsten Diekhoff,&nbsp;Tobias Jung,&nbsp;Danko Dan Milinkovic","doi":"10.1002/ksa.70091","DOIUrl":"10.1002/ksa.70091","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 study aimed to evaluate the radiological and patient-reported outcome measures (PROMs) following spheroid-based matrix-induced autologous chondrocyte implantation combined with autologous bone grafting (MABCI) for the treatment of osteochondral defects of the knee.&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;In this retrospective cohort analysis of prospectively collected data, 28 consecutive patients with 29 defects of the femoral condyle (male: 15, female: 13, mean age 27.3 ± 9.8 years, mean defect size 3.7 ± 1.6 cm²) treated with MABCI were included. Radiological assessments were performed using 3T magnetic resonance imaging (MRI) to evaluate cartilage thickness, T2 relaxation times and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores. Clinical outcomes were assessed using validated PROMs, including the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm scale and the Patient-Reported Outcomes Measurement Information System 29-Item Profile (PROMIS-29). Correlation analyses were conducted to evaluate associations between radiological parameters and PROMs.&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;The analysis was conducted at a mean follow-up of 44.4 ± 21.6 months. Cartilage thickness in the repair tissue exceeded that of the reference cartilage (3.4 ± 0.9 mm vs. 3.0 ± 0.5 mm; &lt;i&gt;p&lt;/i&gt; = 0.036), while T2 relaxation times in the repair tissue were within physiological range (50.5 ± 40.0 ms vs. 41.3 ± 5.4 ms; n.s.). The mean MOCART 2.0 score was 61.3 ± 13.0 (volume fill: 16.1 ± 3.7, integration with adjacent cartilage: 12.9 ± 3.3), reflecting satisfactory repair quality. All clinical scores showed significant improvement compared to the preoperative condition (IKDC: 70.6 ± 13.2 vs. 54.8 ± 17.5, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; KOOS: pain 78.7 ± 16.9 vs. 66.1 ± 18.6, &lt;i&gt;p&lt;/i&gt; = 0.002, symptoms 75.6 ±  16.0 vs. 65.8 ± 19.1, &lt;i&gt;p&lt;/i&gt; = 0.006, ADL 86.8 ± 14.0 vs. 77.6 ± 16.8, &lt;i&gt;p&lt;/i&gt; = 0.003, sport 63.0 ± 24.2 vs. 47.3 ± 26.9, &lt;i&gt;p&lt;/i&gt; = 0.009, quality of life (QoL) 51.0 ± 22.7 vs. 39.6 ± 17.5, &lt;i&gt;p&lt;/i&gt; = 0.014; numeric pain rating scale: 3.0 ± 2.2 vs. 5.2 ± 2.4, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). A greater cartilage thickness was associated with reduced pain intensity (&lt;i&gt;r&lt;/i&gt; = −0.457, &lt;i&gt;p&lt;/i&gt; = 0.013) and improved QoL (&lt;i&gt;r&lt;/i&gt; = 0.429, &lt;i&gt;p&lt;/i&gt; = 0.020), indicating that better structural repair is associated with improved patient satisfaction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;MABCI results in satisfactory","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3564-3574"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower 3- and 6-month postoperative patient-reported outcome measures are associated with treatment failure 2 years following osteochondral allograft transplantation in the knee","authors":"Kylee Rucinski,&nbsp;James P. Stannard,&nbsp;Clayton W. Nuelle,&nbsp;Cory R. Crecelius,&nbsp;Renee Stucky,&nbsp;James L. Cook","doi":"10.1002/ksa.70105","DOIUrl":"10.1002/ksa.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The reliability of patient-reported outcome measures (PROMs) as a predictive tool for delayed recovery at 2 years and long-term outcomes following osteochondral allograft transplantation (OCAT) remains uncertain. The objective of this study was to evaluate baseline and 3- to 6-month PROMs for association with 2-year treatment outcomes in primary OCAT patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients were prospectively enrolled in a dedicated OCAT registry at a single institution. Preoperative, 3-, 6-month and annual PROMs for function, pain and global health were analysed for associations with recovery and treatment failure, defined as conversion to a total knee arthroplasty (TKA) or revision surgery within 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred and seventeen primary OCAT patients were included for analyses; 34 patients experienced treatment failure with 8 undergoing revision and 26 undergoing TKA at a mean timepoint of 15.5 months. Changes in PROMIS Physical Health, PROMIS Physical Function and PROMIS Pain Interference scores from preoperative status were significantly different between 2-year success versus failure cohorts. Absence of mental health history (odds ratio [OR] 2.9, <i>p</i> = 0.033) and lower preoperative International Knee Documentation Committee (IKDC) scores (<i>p</i> = 0.001) were associated with meeting visual analog scale and IKDC minimal clinically important differences at 1 year. Male sex (<i>p</i> = 0.055), nonadherence (<i>p</i> ≤ 0.001, OR: 4.03) and surgery type (tibiofemoral bipolar) (&lt;0.001, OR: 11.3) were significantly associated with increased risk for treatment failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative and 3–6 months PROMs may be useful for identifying patients at-risk for delayed recovery or early failure 2 years following OCAT in the knee in combination with other known risk factors. These findings have significant implications for shared decision-making regarding OCAT indications, timing, patient education and expectations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, cross-sectional analysis of prospectively collected registry data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3502-3510"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380683","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":"Own the turf or lose it: Ultrasound-guided procedures and the future of shoulder repair","authors":"Alexandre Lädermann,&nbsp;Danilo Vukanic,&nbsp;Giuseppe Milano","doi":"10.1002/ksa.70405","DOIUrl":"10.1002/ksa.70405","url":null,"abstract":"<p>To highlight why the current arthroscopy-centred paradigm may be insufficient for rotator cuff disease and to propose a surgeon-led transition towards office-based, ultrasound-guided ‘micro’ interventions. The central question is whether earlier, less invasive image-guided procedures can preserve tissue biology and improve value while maintaining patient safety. This commentary synthesises five decades of arthroscopic shoulder surgery principles with contemporary rotator cuff care pathways and the rapid expansion of musculoskeletal ultrasound outside the operating room. Emerging enabling technologies, including navigation, dedicated micro-instruments, and standardised procedural workflows, are considered to outline a plausible near-term shift in first-line procedural care. Arthroscopy has transformed shoulder surgery, yet its foundational approach has changed little: fluid distension for visualisation, tissue ablation to create a view, and dependence on costly operating-room infrastructure. In rotator cuff disease, clinical practice often tolerates prolonged delay, during which imaging, injections, and adjunctive therapies repeatedly consume resources while tendon and muscle degeneration progress. This delay can culminate in complex salvage procedures once reparative biology is compromised. In parallel, ultrasound has become ubiquitous and increasingly capable of supporting interventional solutions beyond diagnosis and injections. As barriers to adoption decrease, first-line procedures may move upstream, potentially shifting the scope of practice away from surgeons unless they actively shape standards and evidence. The appropriate response is not territorialism but leadership. Shoulder surgeons should treat ultrasound literacy as foundational, adopt a deliberate micro-interventional mindset, develop and validate safety-first workflows, and generate comparative evidence that patients and health systems require. If surgeons lead this transition, earlier intervention may preserve biology and value; if not, the next paradigm will be defined elsewhere.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3470-3473"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680185","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":"Patient-reported outcomes are comparable between imageless robotic-assisted and computer-navigated total knee arthroplasty: A retrospective cohort study","authors":"Jacob O'Brien,&nbsp;David Parker,&nbsp;Pradyumna Raval,&nbsp;Harbeer Ahedi,&nbsp;Myles Coolican","doi":"10.1002/ksa.70266","DOIUrl":"10.1002/ksa.70266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The benefits of computer-navigated total knee arthroplasty (CN-TKA) are well established, and although early studies have demonstrated some benefits of robotic-assisted total knee arthroplasty (RA-TKA), there is limited evidence on the clinical and patient-reported outcome measures (PROMs) directly compared to CN-TKA. As RA-TKA continues to gain popularity, it is important to compare outcomes with the more established technique to justify its use. This study compares PROMs for imageless RA-TKA versus CN-TKA, and between RA-TKA performed with either ROSA or CORI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study of prospectively collected data of patients who underwent primary TKA for osteoarthritis (OA). The study included consecutive surgeries between December 2021 and April 2023, utilising imageless RA-TKA (ROSA or CORI) or CN-TKA. PROMs were obtained preoperatively, at 3 months, and at 12 months, including the Oxford knee score (OKS), Forgotten Joint Score (FJS), Veterans Rand 12-item mental and physical health survey (VR-12), pain (visual analogue scale [VAS]) and patient satisfaction scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 399 patients were recruited: 212 underwent RA-TKA (CORI: <i>n</i> = 104; ROSA: <i>n</i> = 108), and 187 underwent CN-TKA. There were no significant differences between groups at baseline. At 12 months, patient satisfaction with medical care favoured CN-TKA (adjusted mean difference: –3.94; 95% CI: –7.44, –0.45). Between ROSA and CORI systems, patients' subjective knee normality score favoured CORI (adjusted mean difference: –8.44; 95% CI: –16.0, –0.90). No other meaningful differences were observed in either comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study showed no difference in PROMS (OKS and FJS) between CN-TKA and RA-TKA; however, a modest benefit was seen in patient satisfaction with medical care favouring CN-TKA. Similarly, only a modest difference was identified between ROSA and CORI, with knee joint normality favouring the CORI system. These findings demonstrate no clear short-term benefit for well-established navigation surgeons to change to robotic techniques, although further investigations would be valuable.</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 10","pages":"3605-3616"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961223","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":"Varus tibial component alignment enhances bearing orbit safety in Oxford unicompartmental knee arthroplasty","authors":"Tomoyuki Kamenaga,&nbsp;Takafumi Hiranaka,&nbsp;Yoshihito Suda,&nbsp;Masanori Tsubosaka,&nbsp;Naoki Nakano,&nbsp;Yuichi Kuroda,&nbsp;Shinya Hayashi,&nbsp;Ryosuke Kuroda,&nbsp;Tomoyuki Matsumoto","doi":"10.1002/ksa.70295","DOIUrl":"10.1002/ksa.70295","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Abnormal bearing movements, including bearing contact with or separation from the vertical wall (VW) of the tibial component, can cause bearing dislocation or spin-out in Oxford mobile-bearing unicompartmental knee arthroplasty. This study aimed to evaluate the influence of varus placement of the tibial component on the bearing orbit in Oxford unicompartmental knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 75 knees that underwent Oxford unicompartmental knee arthroplasty. The conventional group comprised 43 knees where tibial cuts were made orthogonally to the tibial axis. The varus group included 32 knees where tibial cuts were made slightly varus (targeting 3°). Intraoperative bearing movement was assessed at various knee flexion angles and compared between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both groups, the mobile bearing shifted posteriorly during knee flexion, tracing a rough C-shaped orbit that was closest to the VW at 60° of flexion. The varus group bearings had shorter mediolateral (ML) movements from 0° to 60° of flexion (1.75 ± 1.10 mm vs. 0.93 ± 1.98 mm, <i>p</i> = 0.008) and were less likely to impinge against the VW (odds ratio = 3.20, <i>p</i> = 0.034). The incidence of bearings separating from the VW (&gt;4 mm) did not differ between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Varus placement of the tibial component reduces intraoperative bearing ML translation during 0–60° of knee flexion and decreases the risk of impingement with the VW, compared with neutral placement along the mechanical axis.</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 10","pages":"3637-3645"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069617","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":"Holding the line: Ethics and surgical decision-making in an era of financial pressure in health care systems around the globe","authors":"Romain Seil,&nbsp;Elmar Herbst,&nbsp;Giuseppe Milano,&nbsp;Volker Musahl,&nbsp;Robert Prill,&nbsp;M. Enes Kayaalp,&nbsp;Natalie Mengis,&nbsp;Olufemi R. Ayeni,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.70414","DOIUrl":"10.1002/ksa.70414","url":null,"abstract":"&lt;p&gt;Contemporary knee surgery operates at the intersection of scientific progress, clinical judgement, ethical responsibility and increasingly stringent economic constraints [&lt;span&gt;4, 5&lt;/span&gt;]. Advances in imaging, biomechanics, biologics and implant technology have expanded the range of surgical options available to patients and healthcare providers. Concurrently, health care systems worldwide face growing financial pressure.&lt;/p&gt;&lt;p&gt;This convergence creates an unavoidable tension: how can surgeons ensure that care remains evidence-based and ethically sound when reimbursement models and budgetary constraints increasingly shape clinical decision-making?&lt;/p&gt;&lt;p&gt;Recent events underscore the urgency of this discussion. They raise a fundamental and troubling question for the orthopaedic community: where should the boundary be drawn between acceptable clinical interpretation and unjustifiable surgical indication in elective practice?&lt;/p&gt;&lt;p&gt;Surgical indication is rarely binary. Final recommendations are derived from a synthesis of symptoms, imaging findings, patient preferences, activity demands, psychosocial context and shared decision-making. In elective procedures such as ACL reconstruction, meniscal surgery, cartilage repair or realignment osteotomies, surgeons must consider biological pathology, functional impairment, risk tolerance and nonoperative alternatives. However, when surgery is proposed in the absence of structural pathology or without a compelling pathophysiological rationale, the profession risks eroding public trust and undermining its ethical foundations.&lt;/p&gt;&lt;p&gt;At the same time, an equally concerning trend is emerging in several healthcare systems. In countries such as Germany, economic constraints and reimbursement frameworks increasingly discourage the adoption of novel, and often more costly, technologies—even when evidence suggests superior biological healing or lower complication rates. Surgeons may feel compelled to revert to older, less expensive and sometimes less effective methods. Meniscal surgery exemplifies this dilemma: despite accumulating evidence supporting tissue preservation and long-term joint health, financial pressures may inadvertently favour partial meniscectomy or discourage modern repair strategies due to higher immediate cost.&lt;/p&gt;&lt;p&gt;These two phenomena, overtreatment at one extreme and inhibited innovation at the other, are not opposites. They are parallel manifestations of the same systemic pressures. When financial incentives, institutional metrics or regulatory frameworks start to shape clinical decision-making, the central ethical principle of medicine is threatened: acting in the patient's best interest.&lt;/p&gt;&lt;p&gt;Where, then, should the line be drawn? It must be grounded in clearly defined, evidence-based indications, continuous outcome monitoring and intellectual integrity [&lt;span&gt;1, 3&lt;/span&gt;]. This approach requires acknowledging uncertainty, resisting commercial and institutional pressures and engaging pati","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 10","pages":"3467-3469"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665562","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":"Anatomical risk mapping in ACL reconstruction: Radiological predictors of graft rerupture","authors":"Yusuf Sülek,&nbsp;Abdurrahman Demirhan,&nbsp;Yusuf Altuntaş,&nbsp;Enver İpek,&nbsp;Raffi Armağan,&nbsp;Osman Tuğrul Eren","doi":"10.1002/ksa.70119","DOIUrl":"10.1002/ksa.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to compare the anatomical parameters in patients with anterior cruciate ligament (ACL) rerupture after reconstruction with those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included patients who underwent primary ACL reconstruction using a quadrupled semitendinosus and gracilis tendon autograft between January 2017 and January 2021. Patients who required revision due to rerupture (<i>n</i> = 51) were then compared with age- and sex-matched controls without rerupture (<i>n</i> = 52). Radiological parameters were measured using standard lateral knee radiographs and magnetic resonance imaging (MRI). Measurements included femoral/tibial tunnel angles (FTA/TTA), tibial tunnel anteroposterior position (TTAPL), posterior tibial slope (PTS), lateral tibial plateau subluxation (LTPSu), lateral femoral condyle index (LFCI), as well as various other anatomical parameters such as tibial plateau morphology, meniscal pathology, and notch dimensions. Correlation and logistic regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences were observed between the rerupture and control groups in TTA (71.7 ± 9.2 vs. 78.4 ± 12.8; <i>p</i> = 0.046), TTAPL (0.4 ± 0.1 vs. 0.4 ± 0.1; <i>p</i> = 0.043), LTPS (8.0 ± 4.7 vs. 5.8 ± 4.2; <i>p</i> = 0.015), MTPSu (2.1 ± 2.2 vs. 1.5 ± 2.4; <i>p</i> = 0.029), and LFCI (0.8 ± 0.1 vs. 0.7 ± 0.0; <i>p</i> &lt; 0.001). In the final logistic regression model (<i>χ</i>² = 52.969; Nagelkerke <i>R</i>² = 0.536), TTA (OR = 0.93, <i>p</i> = 0.007), TTAPL (OR = 1.088, <i>p</i> = 0.088), LTS (OR = 1.116, <i>p</i> = 0.043), and LFCI (OR = 6.36 × 10¹⁰⁰, <i>p</i> = 0.001) remained as independent predictors. The overall classification accuracy of the model was 79.6%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Several anatomical parameters—including a smaller TTA, more anterior tibial tunnel positioning, increased lateral tibial plateau slope, and a higher lateral femoral condyle index—were found to be independently associated with ACL graft rerupture. These radiological risk factors should be carefully evaluated during surgical planning and postoperative follow-up to reduce the likelihood of graft failure.</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":"34 10","pages":"3551-3563"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380185","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":"Vertical jump asymmetries from 6 to 9 months following anterior cruciate ligament reconstruction with hamstring tendon autograft in non-elite athletes","authors":"Peter Edwards,&nbsp;Nicholas Blackah,&nbsp;Ross Radic,&nbsp;Jay Ebert","doi":"10.1002/ksa.70112","DOIUrl":"10.1002/ksa.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate how bilateral vertical jump performance and kinetic asymmetries change from 6 to 9–12 months following anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety-one non-elite athletes who underwent ACLR via hamstring tendon autograft performed bilateral countermovement jumps (CMJs) and drop jumps (DJs) on dual force plates at 6 and 9–12 months post-surgery. Performance outcomes and kinetic variables, including asymmetry indices (AIs), were analysed using mixed models to investigate changes between the two time points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Jump height and reactive strength for both the CMJ and DJ improved between the two time points (<i>p</i> ≤ 0.001). Concentric impulse of the CMJ was the only variable to show a significant between-limb change over time (<i>p</i> ≤ 0.05), which was mainly due to a reduction in the nonoperative limb while the operated limb remained unchanged for both. No significant between-limb changes over time for any DJ variables (<i>p</i> &gt; 0.05). AIs for concentric and eccentric impulse, for both the CMJ and DJ, reduced over time (<i>p</i> ≤ 0.05), except for peak landing force in the CMJ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Non-elite athletes after ACLR demonstrated improvements in jump height and reactive strength from 6 to 9–12 months post-surgery, while improvements in eccentric and concentric between-limb asymmetries for both the CMJ and DJ were primarily due to a reduction in the nonoperated limb.</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 10","pages":"3492-3501"},"PeriodicalIF":5.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380652","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":"MOCART 2.0 score of 60 or greater measured at 1 year post-operatively predicts favourable clinical outcomes after surgical repair of tibiofemoral cartilage lesions","authors":"Hyun-Soo Moon,&nbsp;Sungjun Kim,&nbsp;Chong-Hyuk Choi,&nbsp;Min Jung,&nbsp;Kwangho Chung,&nbsp;Se-Han Jung,&nbsp;Jin-Gyu Kim,&nbsp;Min-Cheol Park,&nbsp;Sung-Hwan Kim","doi":"10.1002/ksa.70086","DOIUrl":"10.1002/ksa.70086","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;(1) To evaluate the relationship between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and post-operative clinical outcomes following surgical repair of cartilage lesions in the tibiofemoral joint, and (2) to determine threshold values of the 1-year MOCART 2.0 score associated with favourable patient-reported outcome measures (PROMs).&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;Medical records of patients who underwent surgical repair for tibiofemoral joint cartilage lesions from 2010 to 2022 were retrospectively reviewed, and those who had magnetic resonance imaging and clinical assessments 1 year post-operatively were included. Outcomes were assessed using the International Knee Documentation Committee subjective score, Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS), with respective clinically important difference (CID) and substantial clinical benefit (SCB) values used to evaluate clinically significant improvement. Relationships between MOCART 2.0 scores and PROMs were analyzed, with cut-off values determined via receiver operating characteristic (ROC) analysis, followed by group comparisons.&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;Eighty-six patients were included (mean age, 51.9 ± 14.3 years; males/females, 16/70; mean lesion size, 3.1 ± 1.5 cm&lt;sup&gt;2&lt;/sup&gt;). The MOCART 2.0 score showed positive correlations with most PROMs at 1 year post-operatively. Logistic regression revealed significant associations between MOCART 2.0 scores and clinical improvements beyond CID and SCB values for the Lysholm score and SCB values for KOOS symptoms, which showed similar trends even when threshold values were adjusted by ±5 points in analyses. Subsequent ROC curve analyses identified statistically significant cut-off points ranging from 56 to 61 points. Comparative analysis, classified using a threshold of 60 considering its scoring system, demonstrated that patients with scores ≥60 showed generally higher PROMs and lower osteoarthritis grades at 1 year post-operatively and final follow-ups.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The MOCART 2.0 score, assessed 1 year after surgical repair for cartilage lesions in the tibiofemoral joint, positively correlates with PROMs, with scores of ≥60 expected to be associated with favourable clinical outcomes.&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 IV.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3247-3256"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305147","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}