Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Smaller hamstrings autograft size after primary ACL reconstruction is associated with higher odds for graft failure: A meta-analysis on autografts sizes covering 46,268 patients","authors":"Rebecca Hamrin Senorski,&nbsp;Johan Högberg,&nbsp;Kevin Teow,&nbsp;Anna Nordenholm,&nbsp;Janina Kaarre,&nbsp;Thorkell Snaebjörnsson,&nbsp;Volker Musahl,&nbsp;Kristian Samuelsson,&nbsp;Eric Hamrin Senorski","doi":"10.1002/ksa.70069","DOIUrl":"10.1002/ksa.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate the association between autograft size and graft failure for hamstrings tendon (HT), patellar tendon (PT) and quadriceps tendon (QT) autografts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medline, PubMed, Cochrane Library, Embase, Amed and Web of Science were searched at four separate time points, with the most recent search in February 2025. Eligible studies included patients with primary anterior cruciate ligament reconstruction (ACLR) with (graft failures) or without (survivals) graft failure who had specified autograft size for primary ACLR. Graft failure was defined as a re-rupture of the reconstructed ACL and/or positive pivot shift. Standardised mean differences were calculated for continuous variables, and odds ratios expressed with 95% confidence interval for dichotomous variables of autograft size for survivals versus graft failures. Risk of bias was assessed with RoBANS 2/RoB2 and certainty of evidence with GRADE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 46,268 patients, of which 43,660 HT autograft, 2410 PT autograft and 198 QT autograft were covered in 35 studies. An HT autograft size of &lt; 7 mm had 81% greater odds for a graft failure compared to ≥ 7 mm (<i>p</i> = 0.01), &lt;8 mm HT autograft size had 46% greater odds for a graft failure compared to ≥ 8 mm (<i>p</i> &lt; 0.0001), &lt;9 mm HT autograft size had 34% greater odds for a graft failure compared to ≥ 9 mm (<i>p</i> = 0.001). No significant odds for a graft failure were observed for patients with ≥ 10 mm HT autograft size compared to &lt; 10 mm, or for patients with PT autograft. Only two of the included studies provided data on the QT autograft where none presented standard deviation, thus these studies could not be pooled and were presented qualitatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients treated with a smaller HT autograft size have greater odds for a graft failure compared to patients with a greater autograft size. There was no association between autograft size for patients treated with PT autograft and graft failure. Surgeons should consider autograft size when performing ACLR as the size of HT autografts influences the risk of a graft failure.</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 9","pages":"3212-3232"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116078","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":"Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes","authors":"Scott D. Semelsberger,&nbsp;Vanessa J. Boggiano,&nbsp;Kassidy Webber,&nbsp;Julia M. Balboni,&nbsp;James Butler,&nbsp;Arielle Richey Levine,&nbsp;IFASC Committee,&nbsp;Arianna L. Gianakos","doi":"10.1002/ksa.70244","DOIUrl":"10.1002/ksa.70244","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;Lisfranc injuries present diagnostic and therapeutic challenges, particularly in elite athletes. The 2024 International Foot and Ankle Sports Consensus (IFASC) conducted an expert consensus and systematic review to establish evidence-based guidelines for the identification, classification and nonoperative management of these injuries in high-performance athletes.&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;A modified Delphi process involving 32 international orthopaedic foot and ankle surgeons was conducted through four iterative survey rounds. Consensus thresholds were general (75%–85%), strong (86%–99%) and unanimous (100%). A concurrent systematic review was performed, encompassing clinical studies reporting outcomes for bony and ligament Lisfranc injuries in athletes.&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;Seven consensus statements were unanimous, and six were strong. Diagnostic agreement included: (1) mechanism of injury via axial compression or twisting through a plantarflexed foot; (2) midfoot tenderness, pain with squeeze test and inability to bear weight; (3) bilateral weight-bearing radiographs for initial imaging and (4) computed tomography (CT) or magnetic resonance imaging (MRI) for low-grade instability. Experts unanimously agreed that stable, nondisplaced injuries with intact ligaments on MRI may be managed nonoperatively with close monitoring. Systematic review findings demonstrated that ligament injuries predominated in male athletes, with 96.8% returning to sport at 2.8 versus 4.5 months for bony injuries.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Lisfranc injuries in elite athletes remain challenging to diagnose and manage due to low-grade injury presentations and high return-to-play demands. This consensus and systematic review establish clear diagnostic and nonoperative treatment guidelines, emphasizing the importance of mechanism-based suspicion, thorough physical examination and early weight-bearing imaging. Stable, nondisplaced ligament injuries without significant MRI findings can be treated nonoperatively, with most athletes safely returning to sport within 6–10 weeks and minimal complications. In contrast, unstable or displaced injuries continue to require surgical fixation to restore alignment and prevent long-term dysfunction. Collectively, these findings provide a standardized framework that supports accurate diagnosis, evidence-based decision-making and efficient recovery in athletes with Lisfranc injuries.&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","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3079-3088"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835912","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":"Anatomy of the Lisfranc joint complex: An illustrated review with surgical approach","authors":"Xiuqi Liu,&nbsp;Choon Chiet Hong,&nbsp;Josep Torrent,&nbsp;Javier Del Vecchio,&nbsp;Enric Alcolea-Madera,&nbsp;Miki Dalmau-Pastor","doi":"10.1002/ksa.70260","DOIUrl":"10.1002/ksa.70260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>This manuscript presents a detailed anatomical review of the Lisfranc joint complex, which includes the tarsometatarsal joints, the intertarsal joints and the proximal intermetatarsal joints. From the bony anatomy to the ligamentous structures reaching the base of the second metatarsal and the surgical anatomy relevant to fix the joint complex, this manuscript provides a comprehensive text for those treating Lisfranc injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3178-3185"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021101","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 addition of a lateral extra-articular procedure to a primary anterior cruciate ligament reconstruction is associated with an increased rate of further surgery for cyclops lesions and restricted range of motion","authors":"Timothy Voskuijl,&nbsp;Kate E. Webster,&nbsp;Timothy S. Whitehead,&nbsp;Haydn J. Klemm,&nbsp;Lachlan M. Batty,&nbsp;Julian A. Feller","doi":"10.1002/ksa.70089","DOIUrl":"10.1002/ksa.70089","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;There has been a resurgence in the use of a lateral extra-articular procedure (LEAP) in association with anterior cruciate ligament (ACL) reconstruction to reduce the risk of graft failure. The aim of this study was to examine whether the use of a LEAP in the setting of a primary ACL reconstruction was associated with an increased rate of reoperation for loss of range of motion or a symptomatic cyclops lesion.&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;A consecutive cohort of patients aged less than 30 years who received a primary hamstring or quadriceps tendon autograft ACL reconstruction between January 2016 and December 2021 was retrospectively analysed. The usage of a modified Ellison LEAP in this cohort increased from 0% in 2016 to 51% in 2021. Reoperation rates for loss of motion or a symptomatic cyclops lesion during the first year after surgery, as well as knee extension deficits at 12 months, were compared between LEAP and no-LEAP patients. Contingency analyses with risk ratio (RR) were calculated.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 1076 patients were included in this study [59.6% male, mean age 21.6 (SD 4.4) years, 84.9% hamstring tendon autografts]. In 17.3% (186/1076) of the patients the ACL reconstruction was augmented with a modified Ellison procedure. Of this group [67.2% male, mean age 18.8 (SD 3.7) years, 79.6% hamstring tendon autografts], 8.1% (confidence interval (CI) 4.2%–12%) required further surgery for restricted motion or a cyclops lesion in the first year after surgery, compared to 3.8% (CI 2.6%–5.1%) in the no-LEAP group (risk ratio (RR) 2.1, &lt;i&gt;p&lt;/i&gt; = 0.012). The difference in reoperation rates between those with and those without LEAP was more marked for patients who received a quadriceps tendon autograft (13.2% vs. 3.2%, RR 4.1, &lt;i&gt;p&lt;/i&gt; = 0.019), compared to patients treated with a hamstring tendon autograft (6.8% vs. 3.9%, RR 1.8, &lt;i&gt;p&lt;/i&gt; = 0.122). There was no significant difference in extension deficit at 12 months between patients with and those without a LEAP (mean 1.02 ± SD 2.6 degrees vs. mean 0.97 ± SD 2.4 degrees, &lt;i&gt;p&lt;/i&gt; = 0.85).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Surgical intervention for a loss of range of motion or symptomatic cyclops lesion in the first postoperative year after primary ACL reconstruction was more common in patients who had an additional LEAP than in those who did not. The higher intervention rate was more apparent in patients who had a quadriceps tendon autograft ACL reconstruction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3269-3278"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282583","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":"Vascularized pedicle bone grafting for chronic navicular stress fractures with non-union in elite athletes provided good bony union and ability to return to sports","authors":"Choon Chiet Hong,&nbsp;Jon Simmons,&nbsp;James Calder","doi":"10.1002/ksa.70195","DOIUrl":"10.1002/ksa.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Navicular stress fractures are difficult to treat with high risks of non-union, and there are few studies evaluating treatment strategies and outcomes for chronic navicular stress fractures with non-union, particularly in professional elite athletes. Hence, the aim of this study is to evaluate the outcomes of vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes while reporting on the complications, rate of reoperations and ability to return to sports (RTS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventeen elite athletes with isolated chronic navicular stress fracture non-union treated with vascularized pedicle bone grafting from 2018 to 2023 were reviewed. Demographic details, intraoperative findings, return to training (RTT), ability to RTS, player status at last visit and complications were analyzed and reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen out of 17 elite athletes were males (88.2%), and the average age was 22.4 years (standard deviation [SD] = 3.7). More than 75% of them had a failed prior surgical fixation, with only four athletes (23.5%) who had no prior surgical intervention but failed conservative management for an average duration of 8.7 months before the vascularized pedicle bone grafting. These athletes had an average follow-up duration of 42.8 months (SD = 13.5). All of them achieved bony union with no major complications or reoperations. The average time taken to RTT was 16.1 weeks (SD = 1.8). There was one case of superficial wound infection and another with deep peroneal nerve sensory injury. Sixteen out of 17 athletes were able to RTS to their preinjury level. One rugby player failed to return to competitive sports due to persistent pain in the navicular despite union on CT scan and had developed early arthritic changes at his final follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes yielded good bony union and ability to RTS without significant complications.</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 9","pages":"3150-3161"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961000","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":"Peroneus longus tendon harvest for ACL reconstruction yields good functional outcome of the ankle: A systematic review and meta-analysis","authors":"Mehran Soleymanha,&nbsp;Amirali Soleymani Nejad,&nbsp;Sohrab Keyhani,&nbsp;Fardis Vosoughi,&nbsp;Robert F. LaPrade,&nbsp;Luke V. Tollefson","doi":"10.1002/ksa.70079","DOIUrl":"10.1002/ksa.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The peroneus longus tendon (PLT) has emerged as a promising autograft option for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding donor-site morbidity and ankle functional outcomes. This systematic review and meta-analysis aimed to evaluate ankle performance following PLT harvest for ACL reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review and meta-analysis performed by searching five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Library) up to March 2025. Inclusion criteria included: ACL reconstruction using PLT autograft, ≥6-month follow-up, and validated ankle outcomes (American Orthopaedic Foot And Ankle Society [AOFAS]/Foot and Ankle Disability Index [FADI] scores). Pooled effect sizes were calculated using random-effects models using R software (version 4.4.3). Heterogeneity was assessed via <i>I</i>² statistics, and risk of bias was evaluated using JBI checklists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty articles (1024 patients) were identified, comprising eleven prospective cohort studies and nine randomised clinical trials (RCT), based on title, abstract, and quality assessments. Meta-analysis demonstrated excellent postoperative ankle function, with pooled AOFAS scores of 96.0 (95% confidence interval [CI]: 92.6–99.3) at 6 months, 96.1 (93.9–98.2) at 12 months, and 97.2 (93.9–100.6) at 24 months. FADI scores similarly improved to 97.4 (96.0–98.9) by 6 months and 99.4 (98.7–100.1) at 24 months. Meta-regression revealed no significant association between age and AOFAS outcomes (<i>β</i> = −0.23, <i>p</i> = 0.36). Minor complications (e.g., transient hypaesthesia) occurred in 13%–23% of patients but resolved within months. No studies reported major nerve injuries or ankle instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Peroneus longus tendon harvest for ACL reconstruction yields minimal donor-site morbidity, with consistently high AOFAS/FADI scores across all age groups. These findings support the safety of PLT autografts, though heterogeneity is evident, and the predominance of male participants and the regional focus of studies, mainly Asian populations, may affect generalisability.</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":"34 9","pages":"3233-3246"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194190","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":"Narrative over numbers: How testimonial medicine erodes safe practice","authors":"Antonio Klasan,&nbsp;Kohei Kawaguchi,&nbsp;Michael T. Hirschmann,&nbsp;Joaquin Moya-Angeler","doi":"10.1002/ksa.70363","DOIUrl":"10.1002/ksa.70363","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>We aim to examine the growing influence of testimonial-based and marketing-driven practices in orthopaedics, particularly in joint arthroplasty, and to highlight how these trends threaten scientific integrity, patient safety and the responsible adoption of novel techniques and technologies. This editorial synthesizes current evidence, regulatory conditions and economic pressures shaping orthopaedic practice. By drawing on published research, examples of marketed surgical approaches and cross-regional comparisons of health-care environments, it critically evaluates how innovations are introduced, promoted and adopted. The discussion emphasizes the contrast between evidence-based processes and commercially driven strategies, including trademarked surgical approaches and subscription-based certification models. A shift from evidence-based to endorsement-driven decision-making is increasingly evident, especially in the United States, where high health-care expenditures and marketing permissiveness enable rapid proliferation of branded surgical approaches. In hip and knee arthroplasty, well-established techniques are frequently rebranded without accompanying scientific validation, while aggressive marketing and certification schemes create misleading perceptions of novelty and superiority. Regulatory constraints in Europe, although imperfect, slow the spread of unproven innovations and require more rigorous evaluation. The combined effects of market pressure, inconsistent oversight and uneven global innovation pathways contribute to a widening gap between marketed claims and actual clinical evidence. Testimonial-driven medicine and commercially motivated rebranding pose substantial risks to patient safety and undermine scientific progress in orthopaedics. Robust regulatory frameworks, adherence to peer-reviewed evidence and active collaboration across institutions and regions are essential to counterbalance market forces. Innovations—whether drugs, devices or surgical techniques—must undergo rigorous preclinical and clinical evaluation before broad implementation. The profession must remain vigilant against practices that bypass scientific scrutiny, ensuring that patient care is guided by validated evidence rather than marketing narratives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3186-3189"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147314513","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":"Navicular and fifth metatarsal base stress fractures: An illustrated anatomical review","authors":"Xiuqi Liu,&nbsp;Choon Chiet Hong,&nbsp;Francisco Reina,&nbsp;Anna Carrera,&nbsp;Enric Alcolea-Madera,&nbsp;Jorge Javier Del Vecchio,&nbsp;Miki Dalmau-Pastor","doi":"10.1002/ksa.70413","DOIUrl":"10.1002/ksa.70413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>The navicular bone and the proximal fifth metatarsal (M5) play a vital role in maintaining the structural integrity and biomechanical stability of the foot's medial and lateral columns, respectively. Both bones' unique anatomical configuration, intricate mechanical environment and limited vascular supply make specific locations particularly vulnerable to stress fractures. Moreover, the combination of mechanical loading patterns and restricted perfusion in the navicular and proximal M5 further contributes to delayed healing, nonunion and refracture. Therefore, finding suitable treatment options for the different damage patterns involving both bones is critical for reducing complications and improving clinical results. This paper aims to clarify the anatomical and biomechanical features underlying these fractures to improve diagnosis, prevention, and clinical management in high-risk populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3135-3149"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990748","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":"Editorial commentary: Anatomical insights, diagnostic challenges and evolving treatment strategies for midfoot sporting injuries in elite athletes","authors":"Choon Chiet Hong,&nbsp;Christopher Pearce,&nbsp;James Calder,&nbsp;Miki Dalmau-Pastor,&nbsp;Jordi Vega,&nbsp;Gino Kerkhoffs,&nbsp;Jon Karlsson,&nbsp;Pietro Spennacchio","doi":"10.1002/ksa.70564","DOIUrl":"https://doi.org/10.1002/ksa.70564","url":null,"abstract":"&lt;p&gt;The ability to return to sports (RTS) is of utmost importance for professional elite athletes [&lt;span&gt;1-3, 11-16, 21, 24, 25&lt;/span&gt;]. Delayed treatment can lead to prolonged downtime, which also can seriously affect the performance, function, future activity level and livelihood of these professional elite athletes [&lt;span&gt;1-3, 11-16, 21, 24, 25&lt;/span&gt;]. This is particularly prevalent in high-level competitive sports, where sports-related injuries of the foot can make a significant difference between achieving optimal performance versus facing premature retirement. With this in mind, some of the most challenging and career-altering foot injuries in athletes include Lisfranc injuries, Jones fractures and navicular stress fractures. Although these injuries are distinctively different from both anatomical and biomechanical perspectives, they share several commonalities such as frequent misdiagnosis, delayed treatment, prolonged recovery time with high risk of complications such as non-union, malunion, midfoot deformities, chronic pain and finally post-traumatic osteoarthritis [&lt;span&gt;6-10, 14, 19-21, 23, 24&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Therefore, it is an excellent moment to find a specially themed issue on sports-related injuries in professional elite athletes dedicated to the midfoot comprising of Lisfranc injuries, Jones fractures and navicular stress fractures. This issue highlights the anatomical intricacies, diagnostic challenges and the evolving treatment strategies in managing these clinically relevant injuries in the athletic population.&lt;/p&gt;&lt;p&gt;A comprehensive understanding of the midfoot anatomy is essential to early diagnosis and initiation of accurate management plan. In the Lisfranc joint, for instance, subtle, isolated ligamentous Lisfranc injuries are increasingly reported in athletes, yet they are commonly overlooked at the initial presentation due to the subtlety of the imaging findings. Liu et al. illustrated the complex, but unique architecture of the tarsometatarsal joints in their review on Lisfranc joint anatomy including the base of fifth metatarsal and the navicular bone in this themed issue [&lt;span&gt;17, 18&lt;/span&gt;]. They have also addressed the age-old question related to the very existence of the Lisfranc joint itself [&lt;span&gt;18&lt;/span&gt;]. Moreover, their study examined the anatomy of the intercuneiform joints, which is crucial for understanding the variants of ligamentous Lisfranc injuries, often with proximal extension, particularly reported in competitive athletes [&lt;span&gt;18, 21&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Following that, the distinctive features of the base of the fifth metatarsal bone and the navicular bone with its respective vascular supplies were reviewed to highlight the anatomical basis for risk of avascular necrosis, prolonged healing time, leading to extended delay in RTS [&lt;span&gt;10, 14, 17, 19, 23&lt;/span&gt;]. These structures are exceptionally vulnerable due to the watershed areas and tenuous nature of their blood supply, underscoring the importance","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3075-3078"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70564","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807679","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":"Kaplan fibres of the knee revisited: Anatomical variants, MRI identification and surgical implications for ACL reconstruction and rotational instability","authors":"Ingrid C. Landfald,&nbsp;Robert F. LaPrade,&nbsp;Łukasz Olewnik","doi":"10.1002/ksa.70078","DOIUrl":"10.1002/ksa.70078","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Kaplan fibres (KFs) are distinct capsulo-osseous connections between the iliotibial band and the distal femur that have re-emerged as critical contributors to anterolateral knee stability and the pivot shift phenomenon. This narrative review synthesises contemporary anatomical, radiological, biomechanical, and surgical data to clarify KF morphology, variants, and their implications in the setting of anterior cruciate ligament (ACL) injury. Anatomical studies consistently demonstrate a bipartite architecture composed of superficial and deep fibres, with variable femoral insertions and occasional accessory slips that help resist tibial internal rotation. These features may explain why some patients experience residual rotatory laxity even after anatomically positioned ACL reconstructions. On magnetic resonance imaging, KFs are best assessed with high-resolution 3 T protocols, fat-suppressed proton density or T2 sequences, and oblique planes aligned to the lateral femoral cortex. However, deep fibres are inconsistently visualised and interobserver agreement remains moderate. Clinically, KF disruption occurs in up to 60% of acute ACL tears and is strongly correlated with high-grade pivot shift. Biomechanical models confirm that KFs function as secondary stabilisers, particularly between 30° and 90° of flexion, complementing but not duplicating the roles of the ACL and anterolateral ligament. While no direct KF reconstruction technique exists, lateral extra-articular tenodesis (LET), notably the modified Lemaire procedure, replicates their tension vectors and reduces failure rates when combined with ACL reconstruction in young athletes, revision cases, or patients with generalised ligamentous laxity. Based on available evidence, we propose a preliminary Kaplan Fibre Injury Classification (KFIC) that integrates MRI and intraoperative features, and we outline a pragmatic decision-making algorithm linking KF injury patterns to augmentation strategies. Key gaps include a lack of standardised terminology, validated MRI grading, and prospective outcome studies stratified by KF status. By integrating anatomy, radiology, biomechanics, and operative perspectives, this review emphasises the critical role of KFs in rotational knee stability and provides a framework to improve preoperative planning, guide selective use of extra-articular augmentation, and optimise long-term outcomes after ACL reconstruction.</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":"34 9","pages":"3196-3211"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234781","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}