Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Increased internal tibiofemoral rotation is associated with anterolateral ligament injury and high-grade pivot-shift in ACL-injured patients.","authors":"Chilan Bou Ghosson Leite, Alexander Bumberger, Andre Giardino Moreira da Silva, Gergo Merkely, Richard Smith, Paulo V P Helito, Peter Asnis, Camilo P Helito, Christian Lattermann","doi":"10.1002/ksa.12632","DOIUrl":"https://doi.org/10.1002/ksa.12632","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether tibiofemoral rotation is associated with a concurrent anterolateral ligament (ALL) injury and pivot-shift grading in patients with a primary anterior cruciate ligament (ACL) tear.</p><p><strong>Methods: </strong>In this multicenter cross-sectional study constituting a secondary analysis of previous studies, medical records and magnetic resonance imaging (MRI) scans of patients with unilateral primary ACL injury were reviewed. Demographics and pivot-shift grading were collected. ALL was identified on MRI coronal images and categorized as intact or injured. Tibiofemoral rotation angle (TFA) was measured on axial MRI. Optimal TFA cut-off associated with ALL injury was identified by a receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Of 206 included patients, 152 (73.8%) exhibited signs of ALL injury. Pivot-shift tests were predominantly graded as 2 (71.4%), and notably, all Grade 3 pivot-shift assessments were associated with ALL injury. Mean TFA was significantly higher in cases with ALL injury (5.2 ± 3.6°) compared to intact ALL cases (2.7 ± 3.5°; p < 0.001). A positive correlation was observed between pivot-shift grading and TFA (r = 0.204, p = 0.003). Optimal TFA cut-off value, based on the absolute measurement, for predicting ALL injury was 2.5° (sensitivity: 0.77; specificity: 0.55). Patients with TFA ≥ 2.5° had a significantly higher risk of ALL injury (odds ratio: 3.34, 95% confidence interval [CI]: 1.74-6.42, p < 0.001); when combined with pivot-shift Grade 2 or 3, this risk substantially increased to 13.68 (95% CI: 6.29-29.84, p < 0.001).</p><p><strong>Conclusion: </strong>Higher TFA was associated with an increased prevalence of ALL injuries and a high-grade pivot-shift in ACL-deficient patients. Patients with a TFA ≥ 2.5° showed a threefold higher likelihood of ALL injuries, and this risk further escalated with a higher-grade pivot-shift.</p><p><strong>Level of evidence: </strong>Level 3 cross-sectional study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625397","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":"Transforming orthopaedics with AI: Insights from a custom ChatGPT on ESSKA osteotomy consensus","authors":"Tamer Sweed,&nbsp;Ahmed Mabrouk,&nbsp;Matthew Dawson","doi":"10.1002/ksa.12653","DOIUrl":"10.1002/ksa.12653","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 5","pages":"1557-1559"},"PeriodicalIF":3.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12653","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625450","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":"Low confidence in the cumulative evidence for the existence of a volume-outcome relationship after revision total knee replacement: A systematic review and meta-analysis.","authors":"Alexander H Matthews, Thomas Stringfellow, Hayley Redman, William K Gray, Jonathan P Evans, Jonathan T Evans, Sarah E Lamb, Tim Briggs, Andrew Price, Andrew D Toms","doi":"10.1002/ksa.12641","DOIUrl":"https://doi.org/10.1002/ksa.12641","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review and meta-analysis aimed to establish the relationship between the number of procedures a hospital or surgeon performs with outcomes following revision knee replacement (RevKR).</p><p><strong>Methods: </strong>MEDLINE and Embase were searched using Ovid silver platter up to December 2024 for randomised controlled trials and cohort studies that reported RevKR volumes, in at least two categories, performed by hospitals and surgeons and their relationship to patient and provider level outcomes. The primary outcome was re-revision rate. Secondary outcomes included mortality, post-operative complications, patient-reported outcomes measures (PROMs), emergency readmissions and hospital length of stay. The effect estimates were pooled and plotted using a random-effects, non-linear dose-response meta-analysis (DRMA). Where limitations in the data prohibited DRMA, a narrative approach was utilised. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively.</p><p><strong>Results: </strong>A total of 10 cohort studies with data from 1993 to 2021 were included. The confidence in the cumulative evidence exploring the relationship between surgeon/hospital volume and all outcomes after RevKR was very low. An inconsistent relationship was seen between hospital and surgeon volume and re-revision at any point. There was a non-linear dose-response relationship between higher hospital volume and lower odds of adverse post-operative events (p < 0.05, n = 3 studies, n = 35,524 patients). There was no association between increased surgeon volumes and improvements in PROMs (n = 2 studies, n = 2289).</p><p><strong>Conclusion: </strong>There is a lack of high-quality studies establishing the relationship between the number of procedures a hospital or surgeon performs and outcomes following RevKR. Studies are limited to observational designs and are difficult to effectively power due to the rarity of outcomes. Pooling data from multiple studies provides valuable insights but highlights significant heterogeneity and limitations in the existing literature.</p><p><strong>Level of evidence: </strong>Level III, systematic review-lowest level of evidence analysed-was from retrospective cohort study of prospectively collected data.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597345","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":"Prospective, randomised controlled trial comparing robotic arm-assisted bi-unicompartmental knee arthroplasty to total knee arthroplasty.","authors":"Omer M Farhan-Alanie, James Doonan, Philip J Rowe, Matthew S Banger, Bryn G Jones, Angus D MacLean, Mark J G Blyth","doi":"10.1002/ksa.12644","DOIUrl":"https://doi.org/10.1002/ksa.12644","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to compare the clinical outcomes 2 years following surgery between robotic-arm assisted bi-unicompartmental knee arthroplasty (bi-UKA) compared with conventional mechanically aligned total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>This is a single-centre, double-blinded, randomised controlled trial comparing bi-UKA and TKA. Patient-reported outcome measures (PROMs) were collected from 60 patients (27 bi-UKA and 33 TKA patients) 2 years following surgery, including Oxford Knee Score (OKS), New Knee Society Score (NKSS), Forgotten Joint Score, EQ-5D-3L, UCLA activity scale, Hospital Anxiety and Depression Scale, Pain and Stiffness Visual Analogue Scales, Satisfaction and Range of Motion. Complications were also recorded at each visit.</p><p><strong>Results: </strong>TKA and bi-UKA continue to offer comparable PROMs. The clinical NKSS demonstrated a significant difference between the two interventions, TKA 59.5 (37-65) versus bi-UKA 26.0 (22-40) (p < 0.001). There were no significant differences shown between the interventions across all time points and remaining outcome measures (OKS at 2-year follow-up; TKA-42.0 [34.0-45.5] vs. bi-UKA-41.0 [28.0-45.0]) or the proportion of participant achieving bi-phasic gait at 2 years following surgery (p = 0.429). There was no difference in complication rates following surgery at 2 years.</p><p><strong>Conclusion: </strong>Robotic arm-assisted, cruciate-sparing bi-UKA and mechanically aligned TKA offer similar clinical outcomes 2 years following surgery with no difference in complication rates. Further, follow-up is required to monitor patients as they enter mid/long-term follow-up and determine whether patients will gain long-term benefits from the cruciate-sparing bi-UKA approach.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586234","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":"Response to the Editorial “Robotic-assisted surgery in sports medicine—A broader vision for the future”","authors":"David Ferguson,&nbsp;Ayoosh Pareek,&nbsp;Joshua Lee,&nbsp;Jaison Patel,&nbsp;Nicholas Colyvas","doi":"10.1002/ksa.12622","DOIUrl":"10.1002/ksa.12622","url":null,"abstract":"&lt;p&gt;We extend our great appreciation to Richards et al. [&lt;span&gt;6&lt;/span&gt;] for advancing the critical discussion on the application of robotic-assisted surgery in sports medicine. Their editorial is both timely and highly relevant, focussing on the rapidly expanding potential for robotic systems to address key challenges in the world of sports medicine. However, whilst the analysis remains insightful and expands the discussion, we feel it is limited to extrapolating current arthroplasty-oriented robotic systems to soft tissue or arthroscopy applications [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;To advance the conversation, we believe orthopaedic surgeons must look more broadly, gaining insights from not only the current generation of orthopaedic robots, but also the decades of experience gained with soft tissue robots in other disciplines (such as general surgery, urology, obstetrics/gynaecologist, cardiothoracic surgery, and neurosurgery). With this vision, we can prepare our practice and patients for a future where robotics may be a transformative force.&lt;/p&gt;&lt;p&gt;Robotic systems in other fields of soft tissue surgery offer interesting sources of inspiration. Platforms such as the Da Vinci Surgical System (Intuitive) have set new benchmarks in precision, dexterity, and ergonomics for laparoscopic procedures [&lt;span&gt;5, 8&lt;/span&gt;]. These systems have reliably demonstrated that robotics has the potential not only to enhance dexterity and execution, but also enhance visibility and exposure, safety, training, and competence, as well as surgeon ergonomics. Aptly translating these capabilities to sports medicine has the potential to revolutionise arthroscopic practice on multiple levels.&lt;/p&gt;&lt;p&gt;Examples of these potential advances and applications are numerous. Presently, we typically use a large rigid fixed 30-degree scope due to the manual demands of current arthroscopy. With robotics, much smaller, highly flexible, thin scopes that are robotically controlled will enable much easier and expanded access and clear visualisation in the tight joint spaces we work with [&lt;span&gt;4&lt;/span&gt;]. Robotics would also allow easy use of a second scope for further visual enhancement—for example, viewing both sides of a rotator cuff tear during repair. Even more so, one can imagine that in the future, a variable angle arthroscope may be best when controlled by an automatic machine to provide the best view.&lt;/p&gt;&lt;p&gt;With robotic control of the scope, the surgeon's hand is then freed to return them to the natural advantages of two-handed surgery. Robotic control of the accuracy and precision of the instruments can assist with the avoidance of surface cartilage damage seen too frequently in hip and knee arthroscopy, and elsewhere [&lt;span&gt;3&lt;/span&gt;]. As seen in other soft tissue robots, the capability and advantages of 3D visualisation can be introduced to arthroscopy. Beyond visual enhancement, robotic control with AI enhancement can provide joint mapping capabilities via simultaneous localisation and ma","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 5","pages":"1933-1934"},"PeriodicalIF":3.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12622","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586244","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":"Image-based robotic total knee arthroplasty preserves the knee joint line level even in advanced fixed flexion deformities when combined with functional alignment principles: A retrospective comparative cohort study.","authors":"Giacomo Pacchiarotti, Alessandro Todesca, George Mihai Avram, Giovanni Longo, Domenico Paolicelli, Stefano Gumina","doi":"10.1002/ksa.12643","DOIUrl":"https://doi.org/10.1002/ksa.12643","url":null,"abstract":"<p><strong>Purpose: </strong>Fixed flexion deformity (FFD) is traditionally addressed in total knee arthroplasty (TKA) with extensive soft tissue release and distal femoral recut, which increases bone stock consumption and raises the knee joint line (JL). This study aimed to evaluate differences in the anatomical restoration of the JL and bone stock preservation between FFD knees and a control group during robotic-assisted (RA) TKA combined with functional alignment (FA).</p><p><strong>Methods: </strong>A retrospective comparative cohort study examined 120 knees undergoing RA TKA. The knees were categorised into two groups: the study group, with FFD > 5°, and the control group, without FFD. Further analysis stratified the study group based on the severity of the deformity: mild (5-9°), intermediate (10-14°) and advanced (>15°). The Mann-Whitney U test was utilised to investigate the differences between the control and study groups.</p><p><strong>Results: </strong>The study group comprised 64 knees, presenting an average flexion contracture and range of motion (ROM) of 11.3 ± 4.7° and 112.7 ± 11.6°, respectively. The control group comprised 56 knees, with an extension deficit and ROM of 1.6 ± 2.1° and 123.5 ± 8.3°, respectively. The JL was proximally displaced on average by 0.1 ± 1.2 mm in the study group and lowered by 0.7 ± 0.9 mm in the control group. Analysis of JL in the subgroups showed a lowering of 0.3 ± 1.2 mm in the mild deformity subgroup and a rise of 0.08 ± 1.3 mm and 0.8 ± 0.8 mm in the intermediate and advanced FFD subgroups, respectively, showing no statistical significance. The combined thickness of tibial proximal and femoral distal bone cuts measured 12.3 ± 1.6 mm in the study group and 11.4 ± 1.4 mm in the control group.</p><p><strong>Conclusions: </strong>FA in RA-assisted TKA can correct FFD, minimising bone cuts while preserving anatomical JL level.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575716","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":"Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 2.","authors":"Peter Balcarek, Lars Blønd, Philippe Beaufils, Marie Askenberger, Joanna M Stephen, Ramazan Akmeşe, Rene El Attal, Vasileios Chouliaras, Paolo Ferrua, Joan Minguell Monart, Geert Pagenstert, Petri Sillanpää, Manuel Vieira Da Silva, Florian Dirisamer, Jacek Walawski","doi":"10.1002/ksa.12637","DOIUrl":"https://doi.org/10.1002/ksa.12637","url":null,"abstract":"<p><strong>Purpose: </strong>To provide recommendations for the treatment of patients with first-time patellar dislocation (FTPD). Part 2 focused on nonoperative treatment, bracing, rehabilitation, indications for surgery and surgical strategies.</p><p><strong>Methods: </strong>The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology.</p><p><strong>Results: </strong>The consensus comprised 32 questions and statements, 19 of which will be presented in this part. Eight statements achieved strong agreement (median 9; range 7-9), and 11 statements achieved relative agreement (median 9; range 5-9). None were Grade A, 2 were Grade B, 11 were Grade C and 5 were Grade D. In summary, treatment decisions for FTPD should prioritize individualized care, balancing patient-specific risks and demands. Surgical options are increasingly considered for skeletally immature patients and those with increased recurrence risk. Medial patellofemoral ligament (MPFL) reconstruction is the preferred surgical technique for addressing medial soft tissue stabilizers, offering better outcomes than repair methods. Combining MPFL reconstruction with corrections of relevant bony risk factors might further reduce the risk of recurrence and revision surgery, although specific thresholds for intervention remain debated. Physical therapy is recommended as an essential complement to both operative and nonoperative treatments, but bracing offers no clear long-term benefit. Chondral or osteochondral lesions should be repaired when the defect is at least 1 cm² in the patellofemoral joint contact area. Fragment refixation or other cartilage restoration techniques are preferred, and delayed repair is favoured over fragment removal when immediate surgery is not needed.</p><p><strong>Conclusion: </strong>The consensus consists of recommendations for evaluation and treatment strategies for managing FTPD. High levels of agreement were reached by experts throughout Europe. In areas without clear scientific evidence, this consensus aimed at providing recommendations and guidance on the basis of expert opinion and pointed out areas where further studies are necessary.</p><p><strong>Level of evidence: </strong>Level I consensus.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575719","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":"Minced cartilage for focal cartilage defects-A comprehensive systematic review of surgical techniques in clinical studies, animal studies and basic research studies.","authors":"Lukas B Moser, Stefan Fickert, Sophie Pitzek, Christoph Bauer, Markus Neubauer, Dietmar Dammerer, Thore Zantop, Stefan Landgraeber, Stefan Nehrer","doi":"10.1002/ksa.12608","DOIUrl":"https://doi.org/10.1002/ksa.12608","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine whether the minced cartilage procedure for treating focal cartilage defects is already a standardized technique.</p><p><strong>Methods: </strong>A systematic literature review was conducted in MEDLINE (PubMed), EMBASE and Google Scholar to include all relevant studies (clinical studies, animal studies and basic research) investigating minced cartilage for treating focal cartilage defects.</p><p><strong>Results: </strong>A total of 8 clinical studies, 14 animal studies and 17 basic research studies met the inclusion criteria. Among the eight clinical studies, one was a randomized controlled trial (minced cartilage vs. microfracture), one was a matched-cohort study (minced cartilage vs. autologous matrix-induced chondrogenesis), while the other six studies were case series with a small number of patients (maximum 28). Defect localization varied among the studies: most frequently femoral condyle defects were treated, followed by trochlea/patella. In three studies, cartilage was harvested and minced with a scalpel; in two studies, cartilage was harvested and minced with a shaver. The other clinical studies used a mixture of a curette, a scalpel or a shaver. Six studies used fibrin glue to seal the implanted cartilage. In three studies, a matrix was used for defect coverage. In two studies, cartilage was additionally augmented with autologous blood products. All animal and basic research studies observed similar differences regarding each surgical step.</p><p><strong>Conclusion: </strong>A standardized minced cartilage procedure has not yet emerged. There are differences in the methods of cartilage mincing, cartilage fixation, cartilage coverage using matrices and augmentation with autologous blood products.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575721","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":"Post-operative joint stiffness after Bereiter trochleoplasty does not affect 2-year improvement in patient-reported outcomes. A prospective cohort study of 374 Bereiter trochleoplasties.","authors":"Christian Dippmann, Christos Soleas, Anke Simone Rechter, Volkert Siersma, Kristoffer Weisskirchner Barfod, Peter Lavard","doi":"10.1002/ksa.12645","DOIUrl":"https://doi.org/10.1002/ksa.12645","url":null,"abstract":"<p><strong>Purpose: </strong>Bereiter trochleoplasty (TP) is a well-described procedure to address trochlear dysplasia (TD). Post-operative joint stiffness with reduced range of motion (ROM) is a common complication usually requiring arthroscopically assisted manipulation (AAM) with the removal of adhesions and scar tissue. Inferior clinical outcomes after TP have been reported for patients with subsequent surgery. We hypothesised that a 2-year improvement in patient-reported outcomes would be lower in patients treated with AAM.</p><p><strong>Methods: </strong>This was a retrospective cohort study of prospectively collected data comparing subgroups of patients with and without post-operative joint stiffness from a consecutive cohort of 374 knees with high-grade TD who underwent TP according to the Copenhagen patello-femoral instability (PFI) algorithm. All patients received supervised training exercises led by a physiotherapist. At 3-month follow-up, patients with an extension deficit >10° and/or flexion <120° were diagnosed with post-operative joint stiffness and treated with AAM. Outcomes were mean differences from baseline in Kujala, Knee injury and Osteoarthritis Outcome Score (KOOS) and Lysholm scores 1 and 2 years after surgery.</p><p><strong>Results: </strong>Forty-nine (38 females, 11 males) of the 374 knees (12%) had post-operative joint stiffness and underwent AAM. Nine patients underwent subsequent AAMs. Full extension and flexion >135° were achieved in 37 out of 49 cases (75%). In 11 cases, flexion remained reduced, while data on ROM could not be retrieved in one case. While both patients with and without AAM showed clinically relevant improvements in the Kujala, KOOS and Lysholm scores, no statistically significant between-group differences were seen in these improvements.</p><p><strong>Conclusions: </strong>Post-operative joint stiffness was a common complication after Bereiter TP following the Copenhagen PFI algorithm. Twenty-five per cent of the AAM patients, or 3% of the study population, did not regain full ROM. We did not find that post-operative joint stiffness was associated with inferior improvements in patient-reported outcomes 1 and 2 years after surgery.</p><p><strong>Level of evidence: </strong>Level IV, a retrospective cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575730","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":"High identification and positive-negative discrimination but limited detailed grading accuracy of ChatGPT-4o in knee osteoarthritis radiographs","authors":"Jiesheng Zhu,&nbsp;Yilun Jiang,&nbsp;Daosen Chen,&nbsp;Yi Lu,&nbsp;Yijiang Huang,&nbsp;Yimu Lin,&nbsp;Pei Fan","doi":"10.1002/ksa.12639","DOIUrl":"10.1002/ksa.12639","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To explore the potential of ChatGPT-4o in analysing radiographic images of knee osteoarthritis (OA) and to assess its grading accuracy, feature identification and reliability, thereby helping surgeons to improve diagnostic accuracy and efficiency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 117 anterior‒posterior knee radiographs from patients (23.1% men, 76.9% women, mean age 69.7 ± 7.99 years) were analysed. Two senior orthopaedic surgeons and ChatGPT-4o independently graded images with the Kellgren–Lawrence (K–L), Ahlbäck and International Knee Documentation Committee (IKDC) systems. A consensus reference standard was established by a third radiologist. ChatGPT-4o's performance metrics (accuracy, precision, recall and F1 score) were calculated, and its reliability was assessed via two evaluations separated by a 2-week interval, with intraclass correlation coefficients (ICCs) determined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ChatGPT-4o achieved a 100% identification rate for knee radiographs and demonstrated strong binary classification performance (precision: 0.95, recall: 0.83, F score: 0.88). However, its detailed grading accuracy (35%) was substantially lower than that of surgeons (89.6%). Severe underestimation of OA severity occurred in 49.3% of the cases. Interrater reliability for surgeons was excellent (ICC: 0.78–0.91), whereas ChatGPT-4o showed poor initial consistency (ICC: 0.16–0.28), improving marginally in the second evaluation (ICC: 0.22–0.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ChatGPT-4o has the potential to rapidly identify and binary classify knee OA on radiographs. However, its detailed grading accuracy remains suboptimal, with a notable tendency to underestimate severe cases. This limits its current clinical utility for precise staging. Future research should focus on optimising its grading performance and improving accuracy to enhance diagnostic reliability.</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":"33 5","pages":"1911-1919"},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575712","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}