Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Letter to the Editor regarding ‘Anterior cruciate ligament primary repair revision rates are increased in skeletally mature patients under the age of 21 compared to reconstruction, while adults (>21 years) show no significant difference: A systematic review and meta-analysis’","authors":"Hanrong Rao, Xiaosheng Yang","doi":"10.1002/ksa.12736","DOIUrl":"10.1002/ksa.12736","url":null,"abstract":"<p>We read with great interest the recent article by Rilk et al. addressing the critical influence of age on the outcomes of anterior cruciate ligament (ACL) repair techniques [<span>9</span>]. The authors should be commended for their rigorous methodology and thought-provoking findings, particularly identifying the age of 21 years as a key age threshold for ACL repair efficacy. This finding holds significant promise in guiding personalised treatment strategies. However, we believe that certain limitations warrant further discussion to enhance the clinical applicability of the conclusions.</p><p>First, the methodological constraints of the study deserve attention. The limited number of included studies (12), which were predominantly retrospective, led to a relatively low level of evidence. The small sample size may have affected the robustness of the effect size estimation, increasing the risk of false-positive or false-negative results. Consequently, the current evidence may be insufficient to definitively support the 21-year age cutoff. Moreover, significant heterogeneity existed among the included studies regarding ACL reconstruction techniques, graft types, and fixation methods. The lack of adequate subgroup analysis or adjustment during meta-analysis may have affected the reliability of the results. Additionally, the included populations varied in age, sex, and preoperative activity level, with only 30% of the non-randomised studies performing cohort matching, making it difficult to exclude the influence of selection and confounding biases. Future meta-analyses should expand the literature search, including more high-quality prospective studies, and employ meta-regression, Egger's test, and sensitivity analyses to explore the sources of heterogeneity and assess the impact of bias [<span>8</span>].</p><p>Second, the authors' interpretation of certain unexpected findings lacks depth. Regarding the higher revision rate of repair techniques compared to reconstruction in patients aged ≤21 years, the authors speculate that this may be related to the higher risk of re-injury in young individuals. However, they did not thoroughly explore the potential mechanisms underlying the age-efficacy relationship. Based on the literature, we propose the following hypotheses for the authors' consideration: (1) younger individuals may have more severe ACL degeneration at the time of injury, hindering repair; [<span>5, 12</span>] (2) higher postoperative weight-bearing and activity levels in younger patients may increase early stress, leading to re-injury at the repair site; [<span>1, 13, 14</span>] and (3) although younger individuals have more robust ligament cell metabolism, metabolic derangements after repair may affect tissue healing quality [<span>2, 7</span>]. These factors could collectively influence the repair outcomes and increase the risk of revision.</p><p>Similarly, the authors attributed the higher reoperation rate of dynamic intraligamentary stabi","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3055-3056"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12736","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor regarding the meta-analytic evidence on age-stratified ACL repair outcomes, with a commentary on reporting beyond the evidence hierarchy","authors":"Sebastian Conner-Rilk, Jelle P. van der List, Gregory S. DiFelice","doi":"10.1002/ksa.12735","DOIUrl":"10.1002/ksa.12735","url":null,"abstract":"<p>We would like to thank Rao and Yang for their interest in our article, ‘Anterior cruciate ligament primary repair revision rates are increased in skeletally mature patients under the age of 21 compared to reconstruction, while adults (>21 years) show no significant difference: a systematic review and meta-analysis’ [<span>19</span>]. We appreciate their recognition of our methodology and the clinical relevance of our findings.</p><p>While we welcome their critique, many of the points raised in their letter to the editor [<span>32</span>] reflect limitations we acknowledged and addressed in our manuscript. Some concerns appear to rise from incorrect interpretations or may not fully consider aspects of our analysis. In this response, we aim to clarify key points and further explain our rationale in a constructive scientific exchange.</p><p>We acknowledge the general limitations of meta-analyses, especially in a field like anterior cruciate ligament (ACL) repair where clinical adoption is evolving and high-level evidence remains limited. Accordingly, sound study design and transparent reporting are essential. Our study aimed to navigate the challenges of synthesising data from a developing field and acknowledged the predominance of retrospective designs and demographic heterogeneity. To address these limitations, we: (1) restricted inclusion to Level I–III for greater evidence homogeneity; (2) contacted all study authors for unpublished demographic and outcome data, improving data quality and enabling subgroup analyses and (3) performed an extensive risk-of-bias analysis to support a balanced discussion of current strengths and limitations. Despite these efforts, as stated in our manuscript, selection and publication bias remain possible. However, a systematic review by two independent reviewers ensured comprehensive inclusion of eligible recent studies. In response to the suggestion that ‘future meta-analyses should expand the literature search, including more high-quality prospective studies’, we would have welcomed references to specific overlooked studies to improve future analyses and the ongoing scientific dialogue.</p><p>Regarding the critique that the meta-analysis did not adequately explore heterogeneity and bias, and tools such as Egger's test [<span>7</span>] should have been included, we refer readers to our results section ‘Level of Evidence and Risk of Bias Assessment’, specifically figs. 6–7 and tabs. 9–10, which include funnel plots, Egger's test, and assessments using both RoB 2 [<span>23</span>] and MINORS tools [<span>22</span>]. The risk of bias analysis was even performed by two evaluators and to assess reliability of the rating the inter-rater reliability was calculated and presented as excellent for both the MINORS and Rob 2 assessments, with 0.8 and 0.9, respectively. We believe the authors have missed this in our study.</p><p>Rao and Yang also state that ‘the interpretation of certain unexpected findings lacks depth’.","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3057-3059"},"PeriodicalIF":5.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12735","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546820","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":"Bony alignment decisions affect patient-specific laxity phenotype patterns significantly, independent of the deformity","authors":"Heiko Graichen,&nbsp;George M. Avram,&nbsp;Francesco Zambianchi,&nbsp;Niklas M. Graichen,&nbsp;Fabio Catani,&nbsp;Sebastien Lustig,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12730","DOIUrl":"10.1002/ksa.12730","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>While bony alignment phenotype reconstruction became an important part of personalised knee arthroplasty, the knowledge on laxity phenotypes (LPs) is still limited. This study aimed to calculate individual LPs and assess their changes based on bony decisions from different alignment workflows.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Radiographs and computer-assisted surgery data of 86 knees were imported into a validated knee alignment simulator. Individual bony parameters (medial proximal tibial angle, lateral distal femoral angle and posterior condyle axis) were first introduced. By that, the patient-specific bony phenotype (B-FKP) was implemented, and based on these simulations, the patient-specific laxity phenotype (L-FKP) was defined, calculated and analysed for the total group, as well as for all Coronal Plane Alignment of the Knee (CPAK) subgroups. CPAK I and IV were summarised as varus group; II and V as neutral, and III, VI and IX as valgus group. Identical calculations were then compared for the MA and L-FKP of both workflows. LP was calculated in both extension (L-FKPext) and flexion (L-FKPflex), and a pattern matrix was constructed for all possible L-FKP combinations, enabling a comprehensive distribution analysis. Statistical differences between subgroups and B-FKP and mechanical alignment (MA) workflows were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>B-FKP showed a minimal, non-significant difference for L-FKPext in all subgroups; however, a huge variability in L-FKP pattern analysis. In contrast, MA showed a significant difference for L-FKPext in all subgroups, with a high correlation between L-FKPext and hip–knee–ankle angle. While in MA, 98% of knees showed lateral laxity (L-FKPflex-latlax), in B-FKP, only 56% were L-FKPflex-latlax, with a large variability (31% L-FKPflex-neutr and 13% L-FKPflex-medlax).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Personalised bony resections reduce gap differences for LPext and LPflex independent of the deformity. MA showed a high correlation between deformity and LPext in extension and a uniform lateral laxity in flexion. L-FKP analysis can help to understand the individuality of knees from a soft tissue aspect.</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":"3637-3645"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532834","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":"Coronal plane alignment of the knee classification system does not reliably predict tibiofemoral joint gaps in arthritic knees undergoing total knee arthroplasty","authors":"Ishaan Jagota,&nbsp;Rami M. A. Al-Dirini,&nbsp;Mark Taylor,&nbsp;Joshua Twiggs,&nbsp;Brad Miles,&nbsp;David Liu","doi":"10.1002/ksa.12734","DOIUrl":"10.1002/ksa.12734","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Achieving optimal mediolateral balance in extension and flexion is critical for improving outcomes in total knee arthroplasty (TKA). Knee classification tools, like coronal plane alignment of the knee (CPAK), do not directly consider the soft tissue profile of the joint. This study evaluated the variation in tibiofemoral gap measurements across CPAK phenotypes and examined the relationships between preoperative tibiofemoral joint gaps and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO), important for TKA planning and execution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 433 knees from the Joint Dynamics Registry computed tomography (CT) database was performed. Patients received preoperative long-leg CT scans and extension and flexion distracted radiographs. The CT scans were segmented and landmarked to produce three-dimensional bone models and derive anatomical measurements, including aHKA and JLO. The models were registered to the two distracted radiographs, and an osteophyte correction algorithm was applied to calculate the medial and lateral joint gaps in extension and flexion. Composite gap measurements (mean and difference) were also determined. Pearson's correlation and multivariate regression assessed the relationships between joint gaps and aHKA and JLO. ANOVA compared joint gaps across CPAK groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Small but statistically significant differences in joint gap measurements were observed between CPAK groups I and III, and II and III. Weak univariate correlations were observed between aHKA and joint gaps (<i>r</i> ≤ |0.32 |), with fewer statistically significant relationships for JLO (<i>r</i> ≤ |0.15 |). Multivariate regression explained only 10.2% and 1.4% of aHKA and JLO variance, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While useful for describing coronal alignment, CPAK displayed limited predictive capability for preoperative tibiofemoral joint gaps in TKA patients. Direct assessment of joint gaps remains crucial for surgical planning. Future research should focus on integrating joint gap measurements with bony morphology in preoperative planning workflows to improve TKA personalisation.</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":"3675-3685"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532835","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":"Comment on ‘Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis’","authors":"Michael J. Dan,&nbsp;Nicolas Cance,&nbsp;Bruce F. Caldwell,&nbsp;David H. Dejour","doi":"10.1002/ksa.12739","DOIUrl":"10.1002/ksa.12739","url":null,"abstract":"&lt;p&gt;We have read the paper by Talbot et al. “Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis” that appeared in the December 2023 issue of KSSTA [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We would like to congratulate the authors on their work describing this novel measurement and bringing to light the importance of quadriceps malalignment. We look forward to further works examining patellofemoral joint (PFJ) instability (PFJI) and pain (PFJP), along with optimising patellofemoral kinematics post total joint arthroplasty.&lt;/p&gt;&lt;p&gt;However, we think it is important to highlight in writing some of the potential concerns with this study, else the conclusions from the paper may go unchallenged with future literature.&lt;/p&gt;&lt;p&gt;The paper draws the conclusion that quadriceps tendon malalignment (QTA) is independent of bony morphology and the dominant predictor of lateral Patella femoral joint osteoarthritis (PFJOA).&lt;/p&gt;&lt;p&gt;In contrast, other papers have highlighted the trochlear dysplasia is the main aetiology of PFJOA [&lt;span&gt;8, 10, 13&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Talbot et al. measured trochlear morphology using a number of methods and utilising multiple locations from proximal to distal along the trochlea. Trochlear dysplasia relates to the morphology in the most proximal portion of the trochlear, even in patients with high-grade trochlear dysplasia, the sulcus angle will normalise as you move distally along the trochlea [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We have concerns that their measurements for trochlear dysplasia involve measuring the trochlea at a positions too distal to correctly diagnose and quantify the trochlear dysplasia accurately.&lt;/p&gt;&lt;p&gt;There is no utilisation of the Dejour V2 classification for trochlear dysplasia, which is based on CT [&lt;span&gt;5&lt;/span&gt;]. The Dejour V2 classification was of landmark importance because it highlighted importance of the supratrochlear spur. The supratrochlear spur is the anteriorization of the trochlea floor relative to the anterior femoral cortex. This has recently been proven in biomechanical literature to increase the patellofemoral joint reaction forces independent of the axial shape of the trochlea, via an anti-Maquet effect [&lt;span&gt;4&lt;/span&gt;]. The decreased congruence of the patella with the dysplastic trochlea, due to changes to the trochlea morphology in the axial plan, has also been shown to increase PFJ pressures [&lt;span&gt;14&lt;/span&gt;] and PFJOA [&lt;span&gt;11&lt;/span&gt;], and has been the clinical rationale to treat trochlear dysplasia in patients with anterior knee pain [&lt;span&gt;3, 7, 15&lt;/span&gt;]. In PFJ arthroplasty, success is influenced by the ability to reduce the trochlear offset with respect to the anterior femoral cortex [&lt;span&gt;2&lt;/span&gt;], again highlighting the importance of trochlear bony anatomy to outcomes with respect to PFJ surgery for PFJOA. In trochlear dysplasia, there is also coronal plan malalignment of the trochlear sulcus with re","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3051-3052"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532839","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 ACL Café Menu: Individualised treatment of anterior cruciate ligament injuries—From prevention to conservative treatment, repair and reconstruction","authors":"John Nyland","doi":"10.1002/ksa.12727","DOIUrl":"10.1002/ksa.12727","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"2707-2712"},"PeriodicalIF":5.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532841","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":"Femoral cartilage variability affects the accuracy of kinematic alignment and imageless navigation in total knee arthroplasty: A prospective study from the FP-UCBM Knee Study Group","authors":"Stefano Campi,&nbsp;Giancarlo Giurazza,&nbsp;Edoardo Franceschetti,&nbsp;Andrea Tanzilli,&nbsp;Pietro Gregori,&nbsp;Michael T. Hirschmann,&nbsp;Michele Paciotti,&nbsp;Biagio Zampogna,&nbsp;Umile Giuseppe Longo,&nbsp;Rocco Papalia","doi":"10.1002/ksa.12725","DOIUrl":"10.1002/ksa.12725","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Kinematic alignment (KA) and imageless computer-assisted surgery in total knee arthroplasty (TKA) typically compensate for cartilage wear by applying a standard 2-mm adjustment. However, recent concerns have emerged regarding the accuracy of this assumption. This study aimed to assess, for the first time in vivo, the femoral cartilage thickness on the unworn side in a consecutive series of TKA patients. The hypothesis was that significant inter-individual variability exists, thereby challenging the fundamentals of the calipered KA technique and imageless computer-assisted TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study analysed intraoperative femoral cartilage thickness in 182 patients (189 knees) with end-stage knee osteoarthritis undergoing TKA. Measurements were taken from the unworn distal and posterior femoral condyles. Correlations with demographic factors and coronal plane angular measurements of the lower limb were assessed, and a significance level of <i>p</i> &lt; 0.05 was used for all tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean cartilage thickness was 2.6 ± 0.7 mm, with significant variability among individuals (range: 1.5–5 mm). Intra-individual cartilage thickness within the unworn compartment remained consistent (93% of cases differed by ≤0.5 mm). Men exhibited a thicker mean cartilage (2.8 ± 0.7 mm) compared to women (2.5 ± 0.6 mm) (<i>p</i> = 0.041). Weak correlations were found between cartilage thickness and height, weight, and age (<i>p</i> &lt; 0.05). The posterior lateral condyle in valgus knees was more frequently worn than the posterior medial condyle in varus knees (65.8 vs. 40.3%; <i>p</i> = 0.043). Varus osteoarthritis patterns significantly influenced cartilage wear at the posterior medial femoral condyle, with wear being more prevalent in postero-medial osteoarthritis than in antero-medial or centro-medial osteoarthritis (<i>p</i> = 0.029).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Femoral cartilage thickness varies significantly across patients, while remaining nearly uniform within the unworn compartment of the same patient. Relying on the 'one-cartilage-fits-all' paradigm may compromise the accurate restoration of individual anatomy in calipered KA total knee arthroplasty (TKA) and surgical planning in imageless computer-assisted TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3668-3674"},"PeriodicalIF":5.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304319","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":"Establishing ‘normal’ career longevity in professional footballers allows comparison to that of players with injuries and surgery","authors":"Mary Jones,&nbsp;Arman Motesharei,&nbsp;Simon V. Ball,&nbsp;J. Samuel Church,&nbsp;James D. F. Calder,&nbsp;Andy Williams","doi":"10.1002/ksa.12722","DOIUrl":"10.1002/ksa.12722","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine the ‘normal’ career longevity of male professional footballers and the factors that affect this in order to provide a baseline against which career longevity after injury can be measured. To demonstrate how these results can be used by comparing them with published career longevity rates after anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Match play data for the entire careers of 4117 male footballers playing in the top four English football leagues between 1992 and 2023 was utilised. Players were grouped into ability levels and their “still playing” rates, and career trajectory tracked according to age. Univariate and multivariate analyses were used to determine differences by playing position and ability and Kaplan–Meier survival curves were generated. The findings were compared with published results after ACLR according to the comparable age and league level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Goalkeepers had a longer overall career length than outfield players (12.4 ± 4.9 vs. 11.6 ± 4.7 years, <i>p</i> = &lt;0.01).Outfield players in the English Premier League (EPL) and those also playing internationally (EPL + I) play for longer overall and longer at their highest level (14.8 ± 3.3 and 7.5 ± 5.0 years) than lower league players (League 2: 6.2 ± 4.1 and 2.9 + 2.2 years). At 5 years, EPL + I and EPL outfield players have a 60% and 40% probability of continuing to play at their highest level respectively compared to less than 20% in The Championship and below. At 10 years this is 40% and 18% respectively compared to &lt;2% in the lower leagues. 'Still playing' rates after ACLR are up to 12.9% lower than average for 30 year old footballers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Career duration in footballers is affected by the position played and ability level. Career longevity and performance data is provided in a usable format for easy comparisons with studies reporting career longevity outcomes in professional footballers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3375-3388"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12722","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278119","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 formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II—Prevention, non-operative treatment and return to sport","authors":"Robert Prill,&nbsp;C. Benjamin Ma,&nbsp;Stephanie E. Wong,&nbsp;Philippe Beaufils,&nbsp;Juan Carlos Monllau,&nbsp;Elanna K. Arhos,&nbsp;Roland Becker,&nbsp;Francesco Della Villa,&nbsp;J. Brett Goodloe,&nbsp;James J. Irrgang,&nbsp;Jitka Klugarova,&nbsp;Emma L. Klosterman,&nbsp;Aleksandra Królikowska,&nbsp;Aaron J. Krych,&nbsp;Robert F. LaPrade,&nbsp;Robert Manske,&nbsp;Nicky van Melick,&nbsp;Jill K. Monson,&nbsp;Marko Ostojic,&nbsp;Mark V. Paterno,&nbsp;Tomasz Piontek,&nbsp;Simone Perelli,&nbsp;Alexandre Rambaud,&nbsp;James Robinson,&nbsp;Laura C. Schmitt,&nbsp;Eric Hamrin Senorski,&nbsp;Thorkell Snaebjornsson,&nbsp;Adam J. Tagliero,&nbsp;Airelle O. Giordano,&nbsp;Nicolas Pujol","doi":"10.1002/ksa.12689","DOIUrl":"10.1002/ksa.12689","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Part two of this consensus aimed to provide recommendations for the prevention of meniscus injuries, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This consensus followed the European Society of Knee Surgery, Sports Traumatology and Arthroscopy (ESSKA) formal consensus methodology. For this combined ESSKA—American Orthopedic Society for Sports Medicine (AOSSM)—American Academy of Sports Physical Therapy (AASPT) initiative, 67 experts from 14 countries, including orthopedic surgeons and physiotherapists, were involved. The 26 Steering Group members established guiding questions, screened the existing evidence, and proposed statements, and provided Grades of recommendations. The 41 Rating Group members assessed the statements according to a Likert scale (1–9). Final documents were assessed by an international peer review group for geographical adaptability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Low to moderate scientific level of evidence was available, so that grades of recommendations were low (three Grade A ratings, four Grade B, three Grade C and 13 Grade D), underlining the relevance of this consensus. One strong and 17 relative agreements with overall median of 8 (8–9) and a mean of 7.92 ± 0.37 were achieved for 23 statements on 18 questions. Prevention of meniscus injuries is possible with general knee injury reduction programmes and through avoidance of certain activities. Non-operative treatment including physical therapy is the first line approach for degenerative meniscus lesions and may be an option for some acute tears. Return to sports after meniscus tear surgery should be both criterion-based and time-based. Patient reported outcomes in combination with performance-based measures are recommended to evaluate the rehabilitation process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. These updated and structured recommendations may be applied by surgeons and physiotherapists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I, consensus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3014-3024"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12689","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278121","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":"Performance and return to sport outcomes following hip arthroscopy in National Hockey League players","authors":"David Slawaska-Eng,&nbsp;Marc Daniel Bouchard,&nbsp;Luigi Del Sordo,&nbsp;Alexander E. Weber,&nbsp;Olufemi Ayeni","doi":"10.1002/ksa.12720","DOIUrl":"10.1002/ksa.12720","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Intra-articular hip disorders, such as femoroacetabular impingement syndrome (FAIS), labral tears and chondral damage are common in ice hockey players, particularly in the National Hockey League (NHL). However, evidence on return-to-sport (RTS) rates and performance outcomes post-hip arthroscopy remains limited. This study evaluates RTS rates, career longevity, and performance metrics, including games played, points per game (PPG), save percentage, and performance scores (PS), following hip arthroscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NHL players who underwent hip arthroscopy for intra-articular pathology between 2000 and 2024 were identified using public records. RTS rates, career duration, and performance metrics were analysed pre- and post-surgery. Paired <i>t</i>-tests and analyses of variance (ANOVA) were performed across positions (forwards, defensemen and goaltenders).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 92 NHL players (103 hips) met inclusion criteria. The overall RTS rate was 79.3%, increasing to 84.9% when excluding players still recovering. RTS was significantly higher in players &lt;30 years (90.0% vs. 64.3%, <i>p</i> = 0.003). The average number of post-operative seasons played was 2.7, with no positional differences. Forwards showed significant declines in PPG (pre: 0.63 ± 0.38; post: 0.51 ± 0.37; <i>p</i> = 0.013) and PS (pre: 0.60 ± 0.74; post: 0.37 ± 0.69; ∆PS = −0.23; <i>p</i> = 0.026). Defensemen showed no significant change in PPG (<i>p</i> = 0.648) or PS (<i>p</i> = 0.509). Goaltenders had a decline in save percentage (pre: 0.91 ± 0.01; post: 0.89 ± 0.03; <i>p</i> = 0.038), while wins per season were unchanged (<i>p</i> = 0.205). RTS did not significantly differ by position.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NHL players undergoing hip arthroscopy have high RTS rates and often resume multi-season careers. However, forwards experience greater declines in performance, while defensemen and goaltenders are less affected. These results underscore position-specific recovery trends and may inform rehabilitation strategies in elite hockey athletes.</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":"2994-3001"},"PeriodicalIF":5.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12720","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278120","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}