Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Operative treatment of Lisfranc injuries in elite athletes: 2024 International Foot and Ankle Sports Consensus and systematic review","authors":"Julia M. Balboni,&nbsp;Arielle Richey Levine,&nbsp;Vanessa J. Boggiano,&nbsp;Kassidy J. Webber,&nbsp;Scott D. Semelsberger,&nbsp;Sebastian Krebsbach,&nbsp;James Butler,&nbsp;M. Diane Essis,&nbsp;Brendan Conroy,&nbsp;IFASC Committee,&nbsp;Arianna L. Gianakos","doi":"10.1002/ksa.70261","DOIUrl":"10.1002/ksa.70261","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Lisfranc injuries are potentially career-threatening for athletes, yet optimal management of unstable ligament and fracture-dislocation injury patterns remains debated. This study integrates an international expert consensus with a systematic review to evaluate current surgical strategies and outcomes, aiming to establish evidence-based recommendations for the treatment of elite athletes and to optimize recovery and return to play.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review evaluated post-operative outcomes following suture button fixation (SBF), open reduction internal fixation (ORIF) and arthrodesis of unstable ligament and fracture-dislocation Lisfranc injuries. In addition, a consensus process was conducted using a modified Delphi technique. All consensus questions were generated by an initial survey sent to the expert panel. General consensus was defined as 75%–85% agreement, strong consensus as 86%–99% agreement and unanimous consensus as 100% agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies (<i>n</i> = 406 athletes) were included. In the unstable ligament group, SBF (<i>n</i> = 46) versus ORIF (<i>n</i> = 203) yielded higher American Orthopaedic Foot and Ankle Society (95.5 vs. 89.4), lower complications (10.9% vs. 18.2%), zero failures (0% vs. 4.9%) and fewer secondary procedures (0% vs. 30.5%), with 93.5% of ORIF reoperations being hardware removal. In fracture-dislocation injury patterns, ORIF (<i>n</i> = 123) and arthrodesis (<i>n</i> = 31) showed similar complication (30.8% vs. 35.5%) and failure rates (13.8% vs. 12.9%), with secondary procedures more frequent after ORIF (90.2% vs. 22.6%). The consensus process generated 16 statements: 12 achieved unanimous agreement and 4 achieved strong consensus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elite athletes who present with unstable ligament Lisfranc injuries and indications for surgical intervention should undergo fixation rather than fusion. For bony and fracture-dislocation Lisfranc injuries, ORIF is preferred when joint surfaces are salvageable and arthrodesis when long-term preservation is not feasible. However, the findings of this study underscore the importance of individualized treatment strategies to optimize surgical outcomes and functional recovery.</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":"3089-3105"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129237","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":"Anticoagulant and anti-inflammatory effects of fondaparinux sodium during anterior cruciate ligament reconstruction in high risk VTE patients: A randomised controlled, triple blinded, prospective study","authors":"Pai Zheng,&nbsp;Guangwei Che,&nbsp;Xueer Zhang,&nbsp;Haoming You,&nbsp;Jiayuan Peng,&nbsp;Yong Huang,&nbsp;Lihan Shi","doi":"10.1002/ksa.70081","DOIUrl":"10.1002/ksa.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the anticoagulant and anti-inflammatory effects of fondaparinux sodium in patients at high risk of venous thromboembolism (VTE) undergoing anterior cruciate ligament (ACL) reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-centre, triple-blinded, randomised, controlled study enroled high-risk VTE patients (Caprini score ≥ 5) undergoing ACL reconstruction. Patients were randomised to receive either fondaparinux sodium (2.5 mg daily for 14 days) or enoxaparin sodium (4000 AxaIU daily for 14 days). Coagulation parameters, inflammatory markers, thromboelastography (TEG) and duplex ultrasound of the lower limbs were assessed at predefined time points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 72 patients were included. Baseline demographic characteristics, including age, gender and preoperative health status, were similar between the two groups. No cases of deep vein thrombosis (DVT) or pulmonary embolism (PE) were reported in either group. Group A showed significantly lower D-dimer levels on postoperative days 3, 7, and 13 and higher activated partial thromboplastin time (APTT) on Day 7 (<i>p</i> &lt; 0.05). TEG showed that reaction time (R) was longer in Group A, and maximum amplitude (MA) increased postoperatively (<i>p</i> &lt; 0.05). Inflammatory markers (ESR, CRP and IL-6) were significantly lower in Group A at multiple time points (<i>p</i> &lt; 0.05). Knee circumference also decreased significantly in Group A on Days 3 and 7 (<i>p</i> &lt; 0.05). No significant differences were found between the groups regarding pain, blood loss or postoperative complications (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In high-risk VTE patients undergoing ACL reconstruction, fondaparinux sodium exhibited superior anticoagulant and anti-inflammatory effects compared to enoxaparin sodium, with reduced knee swelling. No significant differences were observed in major postoperative VTE events or bleeding risks, suggesting fondaparinux sodium may be a preferable option for postoperative thromboprophylaxis.</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":"34 9","pages":"3257-3268"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188251","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":"ACL injuries in elite alpine skiing reliably allow athletes to return to competition and perform at or above their pre-injury level","authors":"Jakub Oronowicz,&nbsp;Viacheslav Malinovskiy,&nbsp;Alexander Bumberger,&nbsp;Andrzej Jasina,&nbsp;Christoph Lutter,&nbsp;Romain Seil,&nbsp;Thomas Tischer","doi":"10.1002/ksa.70090","DOIUrl":"10.1002/ksa.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Anterior cruciate ligament (ACL) injuries are frequently observed in alpine skiing. However, available data regarding post-injury performance levels remain scarce. This study aimed to investigate whether ACL injuries in elite-level alpine skiers limit performance levels after ACL reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Male and female elite-level alpine skiers from national A-teams who sustained an ACL injury were retrospectively identified through media reports and the Fédération Internationale de Ski database, across all disciplines (downhill, super G, giant slalom and slalom [SL]). World Cup (WC) results and time out of competition before injury and after ACLR were analyzed. Inclusion criteria were injury during or after the 2003/2004 season and participation in at least one WC event pre-injury. Performance levels from two seasons before the injury through the 2022/2023 season were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight elite alpine skiers (28 males and 20 females) met the inclusion criteria. Of these, 97.9% returned to professional competition after ACLR. One female athlete had not yet returned due to a recent injury. The mean return-to-competition (RTC) time was 11.9 ± 4.5 (range: 7–25) months for males and 11.3 ± 1.8 (8–16) months for females. Post-ACLR, athletes demonstrated similar or improved mean WC placements, regardless of discipline. A decline in performance was observed only in SL. A corresponding trend was observed in the top three placements following ACLR. Among skiers returning to competition, 80.8% of males and 63.1% of females reached their pre-injury performance levels. Athletes with multiple injuries or nonoperative treatment showed variable outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Elite alpine skiers can successfully return to WC competition following ACL injury, with many reaching or surpassing pre-injury performance. Performance variability underscores the need for individualized therapy and rehabilitation to optimize recovery in this specific population.</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":"3279-3286"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305208","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":"Jones fractures in elite athletes—2025 International Foot and Ankle Sports Consensus and systematic review","authors":"Julia M. Balboni,&nbsp;Scott D. Semelsberger,&nbsp;Vanessa J. Boggiano,&nbsp;Kassidy Webber,&nbsp;Jay Moran,&nbsp;Paul Mast,&nbsp;Alberto Vasquez,&nbsp;Lekha Yaramada,&nbsp;IFASC Committee,&nbsp;Arianna L. Gianakos","doi":"10.1002/ksa.70241","DOIUrl":"10.1002/ksa.70241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Jones fractures are complex injuries with highly variable treatment paradigms. This study aims to establish an expert consensus with support from a systematic review to guide management of Jones fractures in elite athletes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A consensus process was conducted using a modified Delphi technique with two rounds of questionnaires. Consensus was defined as 75%–85% agreement, strong consensus as 86%–99% agreement, and unanimous consensus as 100% agreement. In addition, a systematic review was conducted to evaluate nonoperative versus operative management of Jones fractures in athletes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 37 total consensus statements, 15 achieved unanimous consensus, 21 achieved strong consensus, and 1 reached consensus. The systematic review included 27 studies consisting of 1056 patients. The majority of fractures with a stress aetiology were treated with open reduction internal fixation (86.4%), with a mean return to sport time of 13.3 ± 4.5 weeks and a complication rate of 8.4%. Treatment failure was highest for stress fractures that were treated nonoperatively (8.2%). Traumatic Jones fractures were treated surgically in 62.7% of cases, with the remaining 37.3% managed conservatively. All patients with traumatic fractures successfully returned to sport at an average of 11.6 ± 2.2 weeks regardless of treatment modality. Treatment failure following traumatic fractures was highest for those treated conservatively (16.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The average time to return to sport following Jones fracture was shorter among athletes who were treated surgically compared to those who were treated nonoperatively, regardless of injury aetiology or degree of chronicity. This consensus process reached unanimous agreement with respect to the use of MRI for nondisplaced fractures, the use of CT for comminuted or displaced fractures, indications for minimally invasive techniques, and use of adjunctive bone grafting.</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":"3120-3134"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835678","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":"Routine neutral glenoid version targets in reverse shoulder arthroplasty: Time for a patient-specific, fixation-oriented approach","authors":"Amir Koutp,&nbsp;Igor Shirinskiy,&nbsp;Thibault Lafosse,&nbsp;Laurent Lafosse,&nbsp;Giuseppe Milano,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.70391","DOIUrl":"10.1002/ksa.70391","url":null,"abstract":"<p>Routine correction of glenoid retroversion to neutral remains common practice in reverse total shoulder arthroplasty (rTSA), despite increasing uncertainty about whether strict neutralization is clinically necessary. This editorial synthesizes current biomechanical, clinical and imaging-based evidence on glenoid version in rTSA, with particular attention to functional outcomes, implant fixation and the growing role of precision technologies such as three-dimensional (3D) planning and patient-specific instrumentation. Contemporary clinical studies do not show consistent associations between residual glenoid retroversion and patient-reported outcomes, range of motion, complication rates or revision risk when key biomechanical parameters are maintained. Available biomechanical data further support a functional ‘safe window’ of roughly 0°–20° of combined component retroversion. In this context, routine correction to neutral may drive avoidable bone removal, increase implant cost and compromise fixation without a clear clinical advantage. Neutral glenoid version, therefore, should not be viewed as a universal surgical target in rTSA. A patient-specific, fixation-aware strategy that respects pre-arthritic anatomy and leverages accurate 3D planning may be more rational than rigid angular correction paradigms.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3190-3195"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641258","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":"Return to sport following Lisfranc injuries in elite athletes—2024 International Foot and Ankle Sports Consensus and systematic review","authors":"Kassidy J. Webber,&nbsp;Julia M. Balboni,&nbsp;Scott D. Semelsberger,&nbsp;Vanessa J. Boggiano,&nbsp;Arielle Richey Levine,&nbsp;James Butler,&nbsp;Arianna L. Gianakos,&nbsp;IFASC Committee","doi":"10.1002/ksa.70285","DOIUrl":"10.1002/ksa.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Lisfranc injuries, also referred to as tarsometatarsal joint injuries, are relatively uncommon within the general population and can possess profound clinical implications, especially for elite athletes. Existing follow-up and return to sport (RTS) protocols remain poorly defined and variable based on surgeon preference or institutional protocols. The purpose of this study was to both perform a systematic review and determine if consensus on postoperative protocols and RTS timelines could be reached among an expert panel of orthopaedic foot and ankle surgeons who manage Lisfranc injuries in the elite athlete.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The systematic review evaluated the post-operative management of sports-related Lisfranc injuries. A consensus process was then conducted using a modified Delphi technique with four rounds of questionnaires. General consensus was defined as 75%–85% agreement, strong consensus as 86%–99% agreement and unanimous consensus as 100% agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The systematic review found patients with ligament Lisfranc injuries were permitted to begin weightbearing at an average of 3.5 weeks. The mean time for these athletes to RTS was 8.9 months. Those with bony Lisfranc injuries were allowed to partially weightbear at 4.5 weeks, on average. Bony Lisfranc injuries treated with open reduction and internal fixation (ORIF) allowed the athlete to RTSs at a median of 8 weeks (range 3–12 weeks). There are nine consensus statements presented that illustrate the expected follow-up and RTS milestones. There was unanimous agreement that the athlete can expect to return to their sport 4–6 months postoperatively and athletes with unstable ligament injuries can expect to return to full weightbearing 8–12 weeks postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study integrates expert consensus and systematic review findings to establish evidence-based guidelines for returning athletes to sport following Lisfranc injuries. Consensus and literature findings aligned, indicating that most athletes progress to full weightbearing by 8–12 weeks and RTS within 4–6 months postoperatively. Over 90% of athletes successfully resumed play, underscoring the effectiveness of structured, phase-based rehabilitation. These data provide a standardised framework to guide clinicians in optimising recovery and ensuring a safe, efficient RTS.</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":"3106-3119"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047689","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":"Navicular fractures in elite athletes—2025 International Foot and Ankle Sports Consensus and systematic review","authors":"Kassidy J. Webber,&nbsp;Vanessa J. Boggiano,&nbsp;Julia M. Balboni,&nbsp;Scott D. Semelsberger,&nbsp;Jay Moran,&nbsp;Paul Mast,&nbsp;Alberto Vasquez,&nbsp;Arianna L. Gianakos,&nbsp;IFASC Committee Members","doi":"10.1002/ksa.70243","DOIUrl":"10.1002/ksa.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Navicular injuries are a significant concern in athletics, often leading to prolonged recovery periods and risks of further complications. Navicular stress fractures, in particular, have gained recognition as common injuries among athletes, especially in high-impact sports. The management of navicular injuries remains controversial, lacking standardised treatment protocols. The purpose of the present systematic review and consensus process was to provide up-to-date recommendations on workup and diagnosis, operative and nonoperative treatments, and the return-to-sport (RTS) for elite athletes with navicular fractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A consensus process was conducted using a modified Delphi technique with two rounds of questionnaires. ‘General consensus’ was defined as 75%–85% agreement, ‘strong consensus’ as 86%–99% agreement, and ‘unanimous consensus’ as 100% agreement. In addition, a systematic review was conducted evaluating the workup, treatment and postoperative management of Navicular injuries in athletes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-four consensus statements were established regarding the diagnosis, management and RTS following navicular fractures in elite athletes; 10 achieved unanimous consensus, 21 reached strong consensus and 2 did not reach consensus. Across 319 athletes identified in the systematic review, those treated surgically returned to sport at a mean of 8.2 weeks postoperatively, with 98.7% resuming competition. The panel reached a strong consensus that athletes should remain nonweightbearing for 4–6 weeks following surgery and may expect to return to full sport within 4–6 months, supported by corresponding timelines in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Athletes sustaining navicular fractures can typically expect a functional recovery, with most returning to play within 4–6 months after surgery. The consensus recommendations provide the first standardised, evidence-based framework for postoperative progression, including a 4–6 week nonweightbearing phase and structured rehabilitation milestones. These findings guide clinicians in optimising recovery and RTS outcomes in elite 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":"34 9","pages":"3162-3177"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835816","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":"Steep tibial slope correlates with inferior patient‑reported knee function independent of tunnel widening","authors":"Anel Dracic,&nbsp;Domagoj Zeravica,&nbsp;Semin Becirbegovic,&nbsp;Marcus Jäger,&nbsp;Sascha Beck","doi":"10.1002/ksa.70096","DOIUrl":"10.1002/ksa.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to evaluate any association between posterior tibial slope (PTS), graft failure, clinical outcome and bone tunnel widening following anterior cruciate ligament reconstruction (ACLR) using a hamstring autograft.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective, case–control study was conducted comparing 350 revision ACL reconstructions (ACL-RRs) with 350 primary ACL reconstructions (ACL-Rs). A hamstring autograft was used for reconstruction in all cases. PTS and femoral/tibial tunnel diameters were measured on plain anteroposterior (AP) and on lateral radiographs after surgery, prior to ACL revision surgery and at follow-up (FU). Clinical outcome was assessed at FU using the Lysholm score. Associations between PTS and Lysholm score were tested with linear regression (adjusted for age, sex and body mass index [BMI]). Tunnel enlargement was analyzed using Welch's test and correlated with PTS. The study demonstrated 97% power for the primary Lysholm model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ACL graft failure was significantly associated with a higher PTS (7.9 ± 1.8° in ACL-R vs. 10.0 ± 2.1° in ACL-RR, <i>p</i> &lt; 0.001). At FU (35.5 ± 9.2 months), no significant widening of bone tunnels related to tibial inclination occurred, whereas subjective outcome was significantly affected (<i>p</i> &lt; 0.001) by a steep PTS. In knees exceeding a PTS threshold of 10°, each degree increase in PTS was associated with a 1.1-point decrease in Lysholm score. The difference in clinical outcome of knees with a PTS &lt; 10° and  those ≥10° measured 5–6 points and exceeded the established minimal clinically important difference (≈5.5 pts). The proportion of patients reaching a patient acceptable symptom state (≥80 pts) lowered from ≈85% to ≈60%. Adjusted for sex and age, in subjects with a PTS ≥ 10°, the Lysholm score was approximately 4.3 points lower than in those with a PTS &lt; 10°. Regardless of PTS, BMI had a negative effect on clinical outcome (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An elevated PTS was not only associated with ACL graft failure but also contributed to poorer outcomes following ACLR. However, no association between PTS and bone tunnel expansion could be detected, suggesting other mechanisms for graft failure and reduced knee function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective comparative study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 9","pages":"3287-3297"},"PeriodicalIF":5.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351358","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":"Step-by-step insight into gait analysis: A narrative review unlocking knee biomechanics","authors":"Giovanni Spallone,&nbsp;Letizia Mancini,&nbsp;Arianna Carnevale,&nbsp;Stefano Campi,&nbsp;Alessandro de Sire,&nbsp;Emiliano Schena,&nbsp;Pieter D'Hooghe,&nbsp;Michael T. Hirschmann,&nbsp;Rocco Papalia,&nbsp;Umile Giuseppe Longo","doi":"10.1002/ksa.70067","DOIUrl":"10.1002/ksa.70067","url":null,"abstract":"<p>Gait analysis offers a powerful tool for clinical and orthopaedic decision-making. By quantifying spatiotemporal, kinematic and kinetic parameters during walking, it provides a dynamic window into joint function that static imaging cannot capture. Despite its potential, gait analysis remains largely confined to specialised centres, with limited integration in clinical pathways, mainly due to its perceived complexity and lack of standardisation. This narrative review aims to bridge that gap through a step-by-step approach to guide orthopaedic surgeons, sports medicine physicians and musculoskeletal clinicians in understanding and interpreting key biomechanical markers relevant to common knee pathologies, such as osteoarthritis and anterior cruciate ligament injury. Particular attention is given to how deviations in parameters like joint angles and moments, dynamic alignment and centre of pressure trajectories can offer actionable insights into disease progression, treatment response and surgical planning. The urgent need for standardised protocols, encompassing marker placement, biomechanical modelling and data processing, is also underscored, as they are essential to ensure reproducibility and facilitate clinical translation. By clarifying the clinical meaning of gait metrics, this review empowers healthcare professionals to integrate dynamic functional data into everyday decision-making and move towards more personalised, biomechanically informed care.</p><p><b>Level of Evidence:</b> Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2796-2813"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071637","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":"Prior osteosynthesis—unlike osteotomy—raises revision risk after total knee arthroplasty, predominantly via periprosthetic infection","authors":"Nele Wagener,&nbsp;Yinan Wu,&nbsp;Alexander Grimberg,&nbsp;Christian Hipfl,&nbsp;Sebastian Hardt","doi":"10.1002/ksa.70153","DOIUrl":"10.1002/ksa.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Previous knee surgery is discussed as a risk factor for total knee arthroplasty (TKA), yet most reports do not distinguish between osteotomy and osteosynthesis. The German Operationen- und Prozedurenschlüssel (OPS)-based classification was used to compare the impact of these procedures on implant survival, mortality and complications after primary TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the German Arthroplasty Registry (2012–2024) were used. Patients with prior osteosynthesis (<i>n</i> = 10,078) and prior osteotomy (<i>n</i> = 96,782) were each 1:1 Mahalanobis-matched to controls without prior knee surgery (matching on age, sex, Elixhauser score, body mass index [BMI], fixation, arthroplasty type and bearing mobility). Primary endpoints were all-cause revision and mortality; secondary endpoints were periprosthetic joint infection (PJI), periprosthetic fracture and aseptic loosening. Kaplan–Meier with 95% log–log confidence intervals (CI) and log-rank tests were used; Cox proportional hazards models estimated hazard ratios (HRs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All-cause revision differed for osteosynthesis versus controls (log-rank <i>p</i> &lt; 0.001) but not for osteotomy (<i>p</i> = 0.972). In Cox models, prior osteosynthesis was associated with a higher revision hazard (HR 1.81, 95% CI 1.52–2.15; <i>p</i> &lt; 0.001). For osteotomy, no increased revision hazard was observed across age (&lt;65/≥65 years) or comorbidity (Elixhauser &lt; 3/≥3) strata. Mortality was higher after osteosynthesis (HR 1.48, 95% CI 1.34–1.64; <i>p</i> &lt; 0.001), while osteotomy showed no overall increase; PJI occurred more often after osteosynthesis (HR 1.62, 95% CI 1.21–2.19). Periprosthetic fracture (HR 8.54, 95% CI 3.02–24.1) and aseptic loosening (HR 2.38, 95% CI 1.24–4.59) were likewise increased after osteosynthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prior osteosynthesis increases revision risk after TKA—predominantly via infection—whereas prior osteotomy does not. These findings support extended perioperative infection workup, staged hardware removal when indicated and careful implant selection in patients with prior osteosynthesis; outcomes after osteotomy are comparable to primary osteoarthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective observational study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2833-2841"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380696","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}