Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing-wedge distal femoral osteotomy in valgus knees at 8-year follow-up","authors":"Alessio Maione,&nbsp;Pierrenzo Pozzi,&nbsp;Alessandra Menon,&nbsp;Filippo Calanna,&nbsp;Riccardo Compagnoni,&nbsp;Paolo Ferrua,&nbsp;Massimo Berruto,&nbsp;Pietro Simone Randelli","doi":"10.1002/ksa.12795","DOIUrl":"10.1002/ksa.12795","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [<i>p</i> = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [<i>p</i> = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [<i>p</i> = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [<i>p</i> = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, case–control study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3686-3696"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621747","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":"Postoperative changes in CPAK-classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty: A randomised controlled trial","authors":"Peter Bollars,&nbsp;Hans Feyen,&nbsp;Dinesh Nathwani,&nbsp;Ali Albelooshi,&nbsp;Max Ettinger,&nbsp;Ronny De Corte,&nbsp;Martijn G. M. Schotanus","doi":"10.1002/ksa.12740","DOIUrl":"10.1002/ksa.12740","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved (“In-the-box”) or altered (“Out-of-the-box”) in both surgical techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.</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 9","pages":"3333-3340"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621692","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":"Lower body mass index and symptom burden in modern hip arthroscopy patients: Updated epidemiology and trends from the MASH multicenter cohort","authors":"Robert B. Baldwin,&nbsp;Samarth V. Menta,&nbsp;Mark Kurapatti,&nbsp;Dominic Carreira,&nbsp;Shane Nho,&nbsp;Andrew Wolff,&nbsp;John Christoforetti,&nbsp;John Salvo,&nbsp;Dean Matsuda,&nbsp;Anil S. Ranawat","doi":"10.1002/ksa.12745","DOIUrl":"10.1002/ksa.12745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient-reported outcome measures (International Hip Outcome Tool 12-item [iHOT-12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12-item Short Form Health Survey, Patient-Reported Outcomes Measurement Information System).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US-based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well-being, with a mean iHOT-12 score of 38.7 and a mHHS of 56.0. At 2-year follow-up, 85.9% and 76.4% of patients reached our distribution-based minimal clinically important difference value for mHHS and iHOT-12, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3405-3417"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621728","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 validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy","authors":"Takaaki Hiranaka,&nbsp;Christopher Davey,&nbsp;Samuel Grasso,&nbsp;Giacomo Dal Fabbro,&nbsp;Harbeer Ahedi,&nbsp;Brett Fritsch,&nbsp;David Parker","doi":"10.1002/ksa.12713","DOIUrl":"10.1002/ksa.12713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error &gt;1°), and this information was used to create a method to minimize it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; <i>p</i> &lt; 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; <i>p</i> = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; <i>p</i> &lt; 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (<i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3341-3349"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621724","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":"Total knee arthroplasty revision with primary implants: Could the kinematic alignment technique be a game changer?","authors":"Charles Riviere,&nbsp;Loïc Villet","doi":"10.1002/ksa.12794","DOIUrl":"10.1002/ksa.12794","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3454-3456"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621750","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":"The metaverse in orthopaedics: Virtual, augmented and mixed reality for advancing surgical training, arthroscopy, arthroplasty and rehabilitation","authors":"Mahmut Enes Kayaalp,&nbsp;Efstathios Konstantinou,&nbsp;Bedri Karaismailoglu,&nbsp;Gian Andrea Lucidi,&nbsp;Mehmet Kaymakoglu,&nbsp;Romed Vieider,&nbsp;Joseph D. Giusto,&nbsp;Jumpei Inoue,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12723","DOIUrl":"10.1002/ksa.12723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The metaverse and extended reality (XR), which includes augmented reality (AR), virtual reality (VR) and mixed reality (MR), are transforming orthopaedic surgery by enhancing training, procedural accuracy and rehabilitation. However, a literature review of these new virtual tools is lacking. The purpose of this narrative review is to summarise available evidence about the metaverse and discuss current and future clinical applications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review of the current literature was performed for studies evaluating XR tools and their respective clinical and educational utility. Studies from all orthopaedic subspecialties were eligible for inclusion. The XR tools evaluated in each study were categorised according to the reality spectrum and future research or clinical applications were discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>XR is a technological spectrum that includes AR, VR and MR to create immersive and interactive surgical training environments. VR-based simulators may improve surgical education by allowing trainees to refine their skills in a risk-free setting. AR may enhance intraoperative guidance and has been studied within orthopaedics to improve implant positioning accuracy and reduce complications in procedures including arthroscopy and total joint arthroplasty. In rehabilitation, AR and VR have been implemented to facilitate patient engagement and adherence, promoting functional recovery through gamified therapy and remote telerehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There has been a paradigm shift in orthopaedic care in which digital tools are integrated with patient care to optimise patient outcomes. However, challenges to the widespread implementation of promising XR technology include high costs, steep learning curves and limited clinical validation. Ethical concerns, including data security and patient privacy, further complicate its use in clinical settings. Future research must focus on cost-effectiveness, standardisation and improving accessibility to ensure seamless integration into clinical practice.</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 8","pages":"3039-3050"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577607","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":"Older age and a non-sporting injury mechanism are associated with re-injury and the need for revision surgery over a minimum 2-year follow-up following proximal hamstring tendon repair","authors":"Jay R. Ebert,&nbsp;Peter K. Edwards,&nbsp;Elias Ammann,&nbsp;Adam Farrier,&nbsp;Lorcan Gavin,&nbsp;Method Kabelitz,&nbsp;Ross Radic,&nbsp;Antony Liddell,&nbsp;Peter Annear","doi":"10.1002/ksa.12767","DOIUrl":"10.1002/ksa.12767","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate revision rates and factors associated with the need for revision following proximal hamstring tendon repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study included 243 patients who underwent proximal hamstring tendon repair due to an acute (<i>n</i> = 176) or chronic (<i>n</i> = 67) tear. Complications, re-injuries and re-operations were reviewed. Risk factor analysis for re-rupture within 2 years of surgery was conducted using Cox proportional hazards regression, with variables including age, body mass index (BMI), sex, mechanism of injury (sport-related or other), time from injury to surgery and comorbidities including hypertension, hypercholesterolaemia and Type 2 diabetes. Receiver operating characteristic analysis explored time-to-surgery thresholds in relation to revision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 19 (10.8%) of the acute cohort and 11 (16.4%) of the chronic cohort underwent revision surgery due to re-tearing and recurrence of symptoms. In the acute cohort, an increased risk of re-injury was associated with a non-sporting (versus sporting) injury (hazard ratio [HR] = 3.38; 95% confidence interval [CI], 1.10–10.39; <i>p</i> = 0.033) and an older age (HR = 1.04 per year; 95% CI, 1.00–1.08; <i>p</i> = 0.031). In the chronic cohort, there were no significant associations between age, BMI, sex or comorbidities, with revision surgery. The optimal threshold for surgery for acute repairs was 30.5 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A 10.8% and 16.4% revision rate was observed over a minimum 2-year follow-up following proximal hamstring repair for acute and chronic tears, respectively. For chronic tears, no variables were associated with the need for revision. However, older age and non-sporting injury were associated with a higher risk of re-injury in the acute cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2984-2993"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12767","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577568","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":"Neutral and constitutional coronal alignment yield similar outcomes in total knee arthroplasty at mid-term follow-up using the coronal plane alignment of the knee classification","authors":"Eran Keltz,&nbsp;Saud Almaslmani,&nbsp;Eugenie Ng,&nbsp;Oren Tirosh,&nbsp;Libby Spiers,&nbsp;Sara Vogrin,&nbsp;Phong Tran","doi":"10.1002/ksa.12742","DOIUrl":"10.1002/ksa.12742","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Achieving neutral coronal mechanical alignment in knee arthroplasty is traditionally considered crucial for implant longevity and function. However, recent studies suggest alternative alignment strategies. This study examines the correlation between preoperative and postoperative coronal alignment and patient-reported outcome measures (PROMs) at midterm follow-up. We hypothesised that preserving a patient's constitutional alignment would yield superior results, whereas overcorrection toward neutral alignment would lead to poorer outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 369 knee arthroplasties in 335 patients at a tertiary hospital, all performed aiming for mechanical alignment, was analysed. Coronal alignment and joint line obliquity were measured pre- and postoperatively using long-leg radiographs. coronal plain alignment of the knee (CPAK) classification was determined. PROMs, including the Oxford knee score (OKS), pain visual analogue scale (VAS) and EuroCol 5-dimensions (EQ.5D) VAS scores, were collected with a mean (standard deviation) follow-up period of 5.7 (1.6) years. Logistic regression was used to assess the association between coronal radiological measurements, CPAK classification, and PROMs, adjusting for age, sex and body mass index (BMI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant association was observed between maintaining the same coronal CPAK phenotype at the mid-term follow-up and patient outcomes. Patients who achieved postoperative neutral coronal alignment had a comparable mean OKS yet demonstrated a higher likelihood of reporting an excellent OKS. In cases where coronal alignment was over-corrected and crossed over from valgus to varus or vice versa, the OKS was 5.3 points lower (−9.3, −1.2, 95% confidence interval [CI]: <i>p</i> = 0.011), with an odds ratio [OR] of 3.1 (1.5, 6.7, 95% CI: <i>p</i> = 0.003) for a poor OKS, comparing patients who did not cross over to the opposite coronal alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>At the mid-term follow-up, patients with postoperative neutral coronal alignment demonstrated similar outcomes to those who maintained their preoperative constitutional alignment. Patients who had crossover from varus to valgus or vice versa exhibited significantly poorer results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3629-3636"},"PeriodicalIF":5.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577567","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":"All-polyethylene tibial components are associated with an increased rate of failure compared to metal-backed unicompartmental knee arthroplasty: A meta-analysis of 34,647 reconstructed individualised patient data","authors":"Mohammad Poursalehian,&nbsp;Sina Hajiaghajani,&nbsp;Ali S. Farsani,&nbsp;Christian J. Hecht,&nbsp;Atul F. Kamath","doi":"10.1002/ksa.12749","DOIUrl":"10.1002/ksa.12749","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The comparative survivorship of all-polyethylene (AP) versus metal-backed (MB) tibial components in unicompartmental knee arthroplasty (UKA) remains unclear, as previous studies mainly used relative risk without comprehensive time-to-event analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, a systematic review and meta-analysis were performed. Databases (PubMed, Scopus, Embase and Web of Science) were searched without restrictions. Included studies compared MB and AP tibial components in UKA. Risk of bias was assessed using ROBINS-I and RoB-2 tools. Hazard ratios (HRs) were derived from reconstructed Kaplan–Meier data. Analyses used both IPD reconstruction (Log-rank test) and meta-analysis methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After screening 2577 records, 18 studies comprising 35,639 knees (21,610 MB; 14,029 AP) were included. Eleven studies found no difference in survivorship, six favoured MB and one favoured AP. However, pooled IPD analysis of 34,647 knees showed a survival advantage for MB (HR for AP vs. MB = 1.55, 95% confidence interval [CI]: 1.45–1.65, <i>p</i> &lt; 0.0001). Revision rates at 2, 5 and 10 years were lower for MB (3.0%, 5.9% and 11.1%) compared to AP (4.4%, 9.2% and 17.2%). Aseptic loosening was the most common cause of failure, typically occurring after 5 years of implantation. The meta-analysis of reconstructed HRs indicated moderate-to-high heterogeneity (<i>I</i>² = 60%), with a pooled HR of 1.70 (95% CI: 1.28–2.27, <i>p</i> &lt; 0.001). No publication bias was detected, and sensitivity analyses confirmed the robustness of the results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MB tibial components in fixed-bearing UKA show a lower risk of revision compared to AP components. Despite limited data on exact failure times and variations in implant design, the findings suggest that AP components in fixed-bearing UKA are less favourable.</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 10","pages":"3654-3664"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546815","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":"Reply to ‘Comment on “Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis”’","authors":"Simon Talbot","doi":"10.1002/ksa.12738","DOIUrl":"10.1002/ksa.12738","url":null,"abstract":"&lt;p&gt;We thank the authors of the Letter to the Editor for their commentary regarding our publication and their appreciation of the importance of quadriceps malalignment [&lt;span&gt;1&lt;/span&gt;]. The concerns raised in the letter highlight some of the common confusions around the subtle differences between patella instability and patella arthritis. Trochlear dysplasia is a known risk factor for patella instability, and patients with instability and subsequent chondral damage have a high rate of patellofemoral joint osteoarthritis (PFJOA).&lt;/p&gt;&lt;p&gt;Our study identified a biomechanical deformity in the quadriceps mechanism due to an external rotation of the proximal quadriceps muscle around the shaft of the femur. To determine if this was a clinically relevant cause of patella maltracking we assessed it in a group of patients with severe patella maltracking leading to Lateral Facet PFJOA. None of these patients had a history of patella instability. Therefore, their arthritis is likely due to an imbalance in the forces acting on the patella rather that a history of previous injury. Indeed, this was demonstrated, with a strong association between quadricep malalignment and the presence of Lateral Facet PFJOA. In this study, the objective measures of trochlear anatomy (trochlear groove alignment and coronal orientation, trochlear ridge heights and lateralisation of the trochlear sulcus) were not significantly associated with Latera Facet PFJOA. This does not exclude the possibility that trochlear dysplasia may be present in patients with other patterns of PFJOA or in patients with a history of instability.&lt;/p&gt;&lt;p&gt;The letter further states that ‘papers have highlighted the (sic) trochlear dysplasia is the main aetiology of PFJOA’. While our research did not aim to answer this question, the statement requires examination. Upon reviewing the cited papers [&lt;span&gt;3, 4, 7&lt;/span&gt;], it is evident this statement is not supported. None of the papers claim that trochlear dysplasia is the aetiology of PFJOA. Regarding the largest case series [&lt;span&gt;3&lt;/span&gt;], it is important to note that the authors do not claim a causative effect of trochlear dysplasia on patella osteoarthritis. Rather, they highlight as a limitation that the research is a cross-sectional study and that ‘a longitudinal study is needed to better characterize the relationship between trochlear dysplasia and OA’. Furthermore, they state that ‘Patellofemoral OA could potentially lead to secondary trochlear remodeling, resulting in abnormal trochlear depth, abnormal facet ratio, and abnormal sulcus angle.’ It is interesting to note that [&lt;span&gt;3&lt;/span&gt;] also concluded that there was a strong association between trochlear dysplasia and medial tibiofemoral degeneration, and a negative association with lateral tibiofemoral degeneration.&lt;/p&gt;&lt;p&gt;Mofidi et al. [&lt;span&gt;4&lt;/span&gt;] examined trochlear dysplasia in patients undergoing isolated patellofemoral replacement (&lt;i&gt;n&lt;/i&gt; = 18) and found a flatter trochlear angle (149° v","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3053-3054"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546819","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}