Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"The posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA): A precise indicator of knee decompensation in skeletally immature anterior cruciate ligament-injured patients","authors":"Robin N. J. Voskuilen,&nbsp;Martijn Dietvorst,&nbsp;Marieke C. van der Steen,&nbsp;Annika B. Ito,&nbsp;Maximiliano Ibañez,&nbsp;Joan Carlos Monllau,&nbsp;Romain Seil,&nbsp;Caroline Mouton,&nbsp;Rob P. A. Janssen","doi":"10.1002/ksa.70032","DOIUrl":"10.1002/ksa.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to determine the most reliable and precise method for measuring the buckling phenomenon of the posterior cruciate ligament (PCL) in skeletally immature patients on magnetic resonance imaging (MRI). The posterior cruciate ligament (PCL)-line sign, PCL angle (PCLA), PCL inclination angle (PCLIA) and PCL-posterior cortex angle (PCL-PCA) were considered. Secondary aims were to (1) compare PCL buckling between healthy and ACL-injured patients to establish a discrimination threshold, (2) assess its validity against other MRI parameters. The hypothesis was that the PCL-PCA is the most reliable and precise method to detect knee decompensation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-five ACL-injured patients with open physes were matched with 51 controls by gender and skeletal age. The PCL buckling phenomenon was measured on MRI using four methods, each repeated after two weeks. The presence of a lateral collateral ligament (LCL) sign, medial/lateral anterior tibial translation (ATT) and meniscal bone angle (MBA) were considered. Intra- and inter-observer reliability were assessed using Cohen's Kappa and intra-class correlation coefficients (ICCs). Standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Group comparisons used <i>t</i>-tests and chi-square tests; receiver-operating characteristic curves identified optimal thresholds, and Pearson correlations assessed relationships between PCL measures and knee decompensation indicators.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PCL-line, PCLA and PCL-PCA showed excellent intra- and inter-observer reliability (ICCs &gt; 0.90), while PCLIA was rated good (ICC = 0.75–0.90). PCL-PCA showed the highest precision (SEM = 2.0°) and best discrimination between healthy and ACL-injured patients (sensitivity: 80%, specificity 74.1%, cut-off ≤ 31.5°) It correlated with medial/lateral MBA (0.36; <i>p</i> &lt; 0.001, 0.37; <i>p</i> &lt; 0.001, respectively) and ATT (−0.59; <i>p</i> &lt; 0.001, −0.52; <i>p</i> &lt; 0.001, respectively), yet did not differ between positive and negative LCL signs (n.s.).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PCL-PCA showed the highest reliability/precision to measure the PCL buckling phenomenon. Its correlation with other indicators of knee decompensation confirms that PCL-PCA can be used to detect knee decompensation in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2710-2720"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986500","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":"Robotics in revision knee arthroplasty: Solution, support tool or new source of complexity?","authors":"Roland Becker,&nbsp;Max Ettinger,&nbsp;Michael T. Hirschmann,&nbsp;Michael Salzmann,&nbsp;Antonia F. Chen","doi":"10.1002/ksa.70337","DOIUrl":"10.1002/ksa.70337","url":null,"abstract":"<p>Robotic-assisted knee arthroplasty has gained popularity throughout the globe due to high accuracy of three-dimensional component placement. The next step in the utilization of robotic-assisted knee arthroplasty is its application in revision surgery or in complex primary cases with bony defects. This will be a challenge because bony defects and/or component malposition need to be taken into account when planning to achieve good outcomes. Three-dimensional planning can be utilized for appropriate component placement, while considering the placement of revision components, spacers, cones/sleeves and intramedullary stems. Improvement in surgical planning prior and during surgery using robotic assistance can help surgeons significantly during revision total knee arthroplasty procedures.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2694-2697"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215321","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":"A single intra-articular stromal vascular fraction with platelet-rich plasma injection yields superior clinical outcomes than a hyaluronic acid injection in patients with knee osteoarthritis: A prospective comparative study","authors":"Trifon Totlis,&nbsp;Vlasios Achlatis,&nbsp;Panagiotis-Konstantinos Emfietzis,&nbsp;Theodorakys Marín Fermín,&nbsp;Theodoros Pettas,&nbsp;Aristotelis Sideridis,&nbsp;Ioannis Terzidis","doi":"10.1002/ksa.70068","DOIUrl":"10.1002/ksa.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study aimed to compare the efficacy and safety of a combined injection of stromal vascular fraction (SVF) and platelet rich plasma (PRP) versus a high molecular weight (HMW) hyaluronic acid (HA) injection in patients with knee osteoarthritis (KOA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective comparative analysis was conducted for patients with KOA who underwent either a single intra-articular mechanical SVF combined with PRP injection (Group A) or a single intra-articular injection of HMW HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) and the EuroQol EQ-5D (EQ-5D-5L) were assessed at baseline, 3, 6 and 12 months postinjection. PRP was coded according to the DEPA classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 108 knees from 67 patients (Group A: 31; Group B: 36). The VAS, KOOS total and EQ-5D-5L scores significantly improved within each group in every timepoint compared to baseline. The SVF-PRP group significantly outperformed the HMW-HA group in VAS, KOOS total and EQ-5D-5L scores at 6 months and 12 months follow-up. The proportion of patients who achieved Minimal Clinically Important Difference (MCID) at 12 months was 87.0% versus 57.4% (<i>p</i> = 0.0003) in KOOS, 74.1% versus 61.1% in VAS (<i>p</i> = 0.152) and 64.8% versus 40.7% (<i>p</i> = 0.005) in EQ-5D-5L, for the SVF-PRP vs HA group, respectively. No serious adverse events were reported in either group. Minor local adverse events were more common in the SVF-PRP group and spontaneously resolved within days. The implemented PRP was coded as CCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both SVF-PRP and HA injections are safe treatments, with no serious adverse events, and significantly improve pain, function and quality of life in patients with KOA. The SVF-PRP outperformed the HA group in all three PROMs at 6 months and 12 months follow-up, and in the proportion of patients who achieved MCID at 12 months postinjection.</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 8","pages":"2698-2709"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056620","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":"Dynamic coronal plane knee alignment: Femoral anatomy determines kinematic curve morphology, tibial anatomy determines curve position","authors":"Petros Ismailidis,&nbsp;Anthony Leicht,&nbsp;Kenji Doma,&nbsp;Peter McEwen","doi":"10.1002/ksa.70152","DOIUrl":"10.1002/ksa.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>A single hip–knee–ankle angle (HKA) angle does not reflect the biomechanics of native, arthritic or prosthetic knees. Since HKA varies throughout flexion, dynamic coronal alignment is best represented by a kinematic curve plotting HKA against the range of motion. This study aimed to evaluate the relationship between kinematic HKA curves and the bony morphology of the distal femur and proximal tibia. We hypothesised that variations in distal femoral and proximal tibial anatomy are associated with distinct patterns of dynamic coronal alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an experimental study using a non-weight-bearing articulated surgical education bone model including hemipelvis, femur and tibia. Articular surfaces and bony landmarks were registered with a computer navigation system. Using medial opening wedge femoral and tibial osteotomies and a rotational femoral osteotomy, 70 morphotypes were created by altering distal femoral angle (DFA), proximal tibial angle (PTA) and femoral axial angle (FAA). For each configuration, a coronal kinematic curve was recorded from 0° to 120° of flexion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five curve morphotypes were identified: straight, drift, inverse drift, C-shaped and inverse C-shaped. DFA and FAA differed significantly among morphotypes (<i>p</i> &lt; 0.001), whereas PTA had no effect (<i>p</i> = 0.084). Paired comparisons confirmed significant differences in DFA and FAA across curve types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this sawbone model, dynamic coronal plane alignment curve morphology was determined by distal femoral coronal and torsional anatomy, while tibial anatomy shifted the curve position without altering morphology. Restoring the pre-arthritic curve in TKA requires restoring DFA and FAA, whereas achieving a neutral straight curve requires individualised FAA adjustment. Consistently producing a neutral straight curve is not possible without computer-assisted or robotic surgery. These findings require validation in cadaveric or clinical studies but may guide surgical strategies aiming to reproduce native knee kinematics.</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 8","pages":"2823-2832"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447088","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":"Functional alignment: Defined personalized alignment strategy with promising outcomes and room for improvement","authors":"Luca Andriollo,&nbsp;Pietro Gregori,&nbsp;Christos Koutserimpas,&nbsp;Sébastien Lustig","doi":"10.1002/ksa.70384","DOIUrl":"10.1002/ksa.70384","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Functional alignment (FA) has emerged as a patient-specific alternative to traditional alignment philosophies in total knee arthroplasty (TKA), aiming to restore native knee biomechanics while respecting individual soft-tissue behaviour. Although recently described as an ‘umbrella term’, FA has evolved through structured and reproducible workflows supported by image-based robotic technology, enabling three-dimensional planning and dynamic intraoperative assessment. This editorial summarizes the evolution of FA from its original definition to its current interpretation as functional knee positioning, emphasizing its dynamic and three-dimensional nature. Key aspects, including workflow principles, sagittal and coronal alignment during flexion, application in valgus knees, management of the anterior compartment (‘third space’), and the influence of implant- and patient-related factors, are discussed. Current clinical evidence supports FA as a safe and effective strategy across different knee phenotypes, highlighting the importance of individualized alignment targets rather than fixed coronal goals. By contextualizing recent biomechanical and clinical data, this editorial aims to clarify fundamental concepts and promote consistent application and reporting of FA in contemporary TKA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2688-2693"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795411","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":"Primary repair versus reconstruction of the anterior cruciate ligament: Functional outcomes and postural stability compared with healthy controls","authors":"Murat Çiçeklidağ,&nbsp;İnci Hazal Ayas,&nbsp;Ethem Burak Oklaz,&nbsp;Furkan Aral,&nbsp;Muhammed Furkan Tosun,&nbsp;Ulunay Kanatlı","doi":"10.1002/ksa.70050","DOIUrl":"10.1002/ksa.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare functional outcomes and postural stability in patients undergoing primary anterior cruciate ligament (ACL) repair or hamstring tendon reconstruction, using healthy individuals as a reference. We hypothesized that primary ACL repair would result in superior subjective knee function and postural stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This comparative case–control study assessed pain, function, single-leg hop performance and postural stability were assessed using the Visual Analogue Scale (VAS), Lysholm Knee Score, International Knee Documentation Committee (IKDC) Score and Biodex Biosway indices (OSI: overall stability index, API: anteroposterior index, MLI: mediolateral index) in bipedal and single-leg stance. Statistical analyses included one-way analysis of variance (ANOVA) or Kruskal–Wallis tests for group comparisons, with paired <i>t</i>-tests or Wilcoxon signed-rank tests for within-group comparisons, depending on data distribution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 113 participants were analyzed: primary repair (primary repair group [PRG], <i>n</i> = 40), reconstruction (reconstruction group [RG], <i>n </i>= 38), and control (control group [CG], <i>n</i> = 35) groups. Mean follow-up was 43.2 ± 10.1 months in PRG and 43.9 ± 11.7 months in RG. VAS scores were 1.37 ± 1.56 in PRG and 1.89 ± 1.62 in RG (mean difference [MD] = 0.51, 95% confidence interval [CI]: −0.19 to 1.23, <i>p</i> = 0.15). Lysholm scores were 92.6 ± 6.95 in PRG and 89.5 ± 9.09 in RG (MD = −3.02, 95% CI: −6.66 to 0.61, <i>p</i> = 0.10). IKDC scores were significantly higher in PRG (88.2 ± 9.01) than RG (82.6 ± 12.1) (MD = 5.63, 95% CI: 0.84 to 10.42, <i>p</i> = 0.02). On the operated side, MLI was lower in PRG (0.2 ± 0.3) than RG (0.3 ± 0.2) (MD = −0.05, 95% CI: 0.008 to 0.11, <i>p</i> = 0.02), indicating better mediolateral stability. Single-leg hop distance was shorter in RG (1.40 ± 0.28 m) and PRG (1.43 ± 0.27 m) compared with CG (1.62 ± 0.18 m) (CG vs. RG: MD = 0.22, 95% CI: 0.07 to 0.36; CG vs. PRG: MD = 0.18, 95% CI: 0.03 to 0.33; <i>p</i> = 0.001), despite LSI values exceeding 90% (RG: 93.1 ± 8.5%; PRG: 95.1 ± 6.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Primary anterior cruciate ligament repair provides comparable functional and postural outcomes to reconstruction and may offer superior subjective knee function and mediolateral balance in selected patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2756-2765"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986508","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":"Global, regional and national burden of osteoarthritis in women of childbearing age from 1990 to 2021, with projected trends up to 2045","authors":"Jianye Tan,&nbsp;Yinsong Sun,&nbsp;Jinping Chen,&nbsp;Dehua Wang,&nbsp;Jiacheng Liu,&nbsp;Zhenxin Wang,&nbsp;Pengcheng Xiao,&nbsp;Lu Zhou,&nbsp;Yiting Lei,&nbsp;Wei Huang,&nbsp;Ke Li","doi":"10.1002/ksa.70045","DOIUrl":"10.1002/ksa.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to systematically quantify the global burden of osteoarthritis (OA) in women of childbearing age (WCBA) and analyze its temporal trends and regional disparities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study utilized the Global Burden of Disease 2021 data to assess the incidence and years lived with disability (YLDs) spanning from 1990 to 2021. The Bayesian age-period-cohort (BAPC) model was adopted to forecast trends up to 2045. An analysis was conducted on the disparities across various age subgroups and regions with different socio-demographic index (SDI) levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2021, the global incidence of OA among WCBA stood at 8,222,896 cases. Age-standardized rates for both incidence and YLDs were most elevated in the High-income Asia Pacific, East Asia and High-income North America. That year, the global OA burden within this demographic was predominantly driven by knee and hand OA, with hand OA notably surpassing hip OA to rank second only to knee OA. In Eastern Europe and Central Asia, hand OA even overtook knee OA as the most prevalent type of OA. From 1990 to 2021, hand OA demonstrated the most rapid incidence growth with an estimated annual percentage change of 0.79 (95% confidence intervals: 0.72–0.86), with particularly marked surges in East Asia, High-income Asia Pacific and Southeast Asia. The 45–49 age bracket carried the greatest burden across all types of OA. Projections through 2045 suggest that cases of hand and hip OA will undergo substantial growth, whereas knee OA cases will increase more moderately. Despite a potential minor downturn in its age-standardized incidence and YLD rate, knee OA is poised to remain the primary culprit. Throughout the analysis, striking regional and socioeconomic disparities in the OA burden were readily apparent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study reveals a growing global burden of OA among WCBA, driven primarily by knee and hand OA. These findings underscore the need to integrate WCBA into OA prevention strategies and musculoskeletal health policies tailored to age, region and joint type.</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 8","pages":"2741-2755"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002744","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":"Pre-resection ligament balance more frequently reproduces joint line orientation compared to inverse-kinematic workflow in robotic total knee arthroplasty","authors":"Gwo-Chin Lee,&nbsp;Alexander D. Orsi,&nbsp;Christopher Plaskos,&nbsp;Jeffrey M. Lawrence","doi":"10.1002/ksa.70178","DOIUrl":"10.1002/ksa.70178","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Robotic total knee arthroplasty (TKA) enables the acquisition of ligament balance data at various stages in the surgical workflow to inform implant planning. This study aims to compare pre-resection joint balancing versus inverse-kinematic workflows on implant positioning, joint line obliquity and coronal plane alignment of the knee (CPAK) phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-surgeon single-institution series of 422 primary posterior-cruciate sacrificing TKAs using a digital ligament tensioner was reviewed. The first 213 cases assessed gaps after tibial and before femoral resections (tibia-first group) in an inverse-kinematic alignment (iKA) workflow. The subsequent 174 cases assessed gaps before any bone resections (pre-resection group) in a femur-first kinematic alignment (KA) workflow. Native and postoperative medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) were compared using Wilcoxon rank-sum tests, and CPAK phenotype distributions were compared using chi-square tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean preoperative MPTA and LDFA were within 0.5° between groups. Postoperative measurements differed between tibia-first and pre-resection for both MPTA (88.3° ± 1.5° vs. 86.7° ± 1.7°, <i>p</i> &lt; 0.001) and LDFA (90.7° ± 2.1° vs. 89.4° ± 2.4°, <i>p</i> &lt; 0.001). The tibia-first group had greater preoperative to postoperative change in MPTA (0.7° ± 1.3° vs. −0.5° ± 1.7°, <i>p</i> &lt; 0.001), LDFA (2.5° ± 1.7° vs. 1.4° ± 1.5°, <i>p</i> &lt; 0.001) and joint line obliquity (3.2° ± 2.5° vs. 0.9° ± 2.6°, <i>p</i> &lt; 0.001). The pre-resection group had more patients whose CPAK phenotype did not change postoperatively (35% vs. 25%, <i>p</i> &lt; 0.05), and fewer patients with CPAK changes &gt; 1 (9% vs. 29%, <i>p</i> &lt; 0.001). Final mediolateral balance was within 1 mm of neutral for both groups throughout flexion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While both techniques achieved a similar balance, a pre-resection ligament balancing workflow better restored native joint line obliquity and CPAK phenotype compared to an iKA workflow.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2858-2865"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447024","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":"Thresholds for minimum clinically important difference, minimal important change and patient acceptable symptom state for the ACL-RSI and the K-SES in patients after anterior cruciate ligament reconstruction","authors":"Ramana Piussi,&nbsp;Jakob Lindskog,&nbsp;Rebecca Hamrin Senorski,&nbsp;Roland Thomeé,&nbsp;Kristian Samuelsson,&nbsp;Eric Hamrin Senorski","doi":"10.1002/ksa.70044","DOIUrl":"10.1002/ksa.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to calculate and provide Patient Acceptable Symptom State (PASS) thresholds, Minimum Clinically Important Difference (MCID), and Minimal Important Change (MIC) values for the ACL-Return to Sport after Injury (ACL-RSI) scale and the Knee Self-Efficacy Scale (K-SES) in patients treated with ACL reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Data were extracted from a rehabilitation specific registry, Project ACL. The registry prospectively collects patient-reported outcomes (PROs). PASS, MCID and MIC were calculated using receiver operating characteristic (ROC) curve analysis and anchor-based methods. Calculations were made for patients who completed the ACL-RSI and K-SES₁₈ at follow-up points 4 (K-SES₁₈ only), 8, 12 and 18 months post-surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 704 patients aged 15–50 year, who underwent ACL reconstruction were included. The PASS thresholds increased over time, with AUC values indicating acceptable discrimination at all follow-ups, especially at 18 months. The MCID values ranged from 1.6 to 4.1 for the K-SES₁₈ and 13.6–30.4 for the ACL-RSI. The MIC values varied between follow-ups, with negative or near-zero values observed at certain intervals, particularly for K-SES₁₈ future.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The PASS, MCID and MIC values for the K-SES₁₈ and the ACL-RSI vary over time. Practical thresholds are provided for clinicians to better interpret scores and to determine if meaningful improvements have been achieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2731-2740"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995109","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":"Visual inspection provides precise intraoperative evaluation of tibial slope during unicompartmental knee arthroplasty","authors":"Harun Hawi,&nbsp;Humam Hawi,&nbsp;Emmanouil Liodakis,&nbsp;Nael Hawi,&nbsp;Rüdiger von Eisenhart-Rothe,&nbsp;Georg Matziolis","doi":"10.1002/ksa.70169","DOIUrl":"10.1002/ksa.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Accurate reconstruction of the posterior tibial slope (PTS) is essential for successful unicompartmental knee arthroplasty (UKA), yet intraoperative assessment remains challenging without advanced navigation tools. This study evaluated the accuracy of visual intraoperative assessment of PTS changes after tibial resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Resection blocks from total knee arthroplasty (TKA) were processed to simulate UKA resections, providing a wide range of slope variations. PTS changes were measured radiographically and via optical scans of resection blocks from 55 patients with severe osteoarthritis. Three experienced surgeons visually estimated PTS changes, which were compared to reference measurements using intraclass correlation coefficients (ICCs), Pearson correlation, analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Optical scan and radiographic measurements showed near-perfect agreement (ICC = 0.99). The mean deviation between surgeon estimates and radiographic measurements was 1.0° ± 0.7° (range 0°–3.0°). Examiner ICCs ranged from 0.88 to 0.96, and Pearson correlations were strong (0.77–0.87). ANOVA and HSD tests showed no significant differences between visual and reference measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Visual inspection by experienced surgeons provides a sufficiently accurate and reliable method for intraoperative assessment of PTS during UKA.</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 8","pages":"2851-2857"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70169","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439615","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}