Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Open surgical repair as gold standard for acute Achilles tendon ruptures: Systematic review and network meta-analysis","authors":"Alessandro Pisano,&nbsp;Matias Boxler,&nbsp;Edoardo Gambuti,&nbsp;Francesco Falco,&nbsp;Mathieu Trierweiler,&nbsp;Antonio Vinci,&nbsp;Dorian Bardhi,&nbsp;Gian Loreto D'Alò,&nbsp;Rosa Maria Malerba,&nbsp;Alberto Grassi,&nbsp;Fabio Ingravalle,&nbsp;Massimo Maurici","doi":"10.1002/ksa.12686","DOIUrl":"10.1002/ksa.12686","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Both surgical and non-surgical treatments for acute Achilles tendon ruptures (aATRs) exist, but the optimal management strategy, especially regarding weight-bearing timing, remains unclear. This study investigates combinations of primary treatment (open surgical repair, percutaneous/minimally invasive repair and non-surgical treatment) and rehabilitation strategies (Early Weight Bearing [EWB] vs. Late Weight Bearing [LWB]) for aATRs, analysing re-rupture risk, complication rates and recovery outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Systematic review and network meta-analysis registered in PROSPERO (CRD42023389413). Medline, Scopus, Web of Science, CINAHL, ClinicalTrials.gov, and Cochrane Library were searched for studies assessing primary treatments and rehabilitation strategies for aATR in adults (&gt;18 years old) with at least six months of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one studies (23 randomised-controlled-trials, 17 non-randomised-studies-of-intervention) comprising 5566 patients and 82 treatment arms were included. Network meta-analysis was performed for re-rupture risk and other outcomes, reporting odds ratios and treatment rankings. Open surgical repair combined with LWB has the lowest re-rupture risk (2%, 95%CI 1%–3%). EWB facilitates faster recovery but marginally increases complication risks, though not statistically significant. Non-surgical treatment shows a higher re-rupture rate than surgical options (12% vs. 2%/4%, <i>p</i> &lt; 0.001). Major wound complications are rare (2.8%), with percutaneous repair having a higher risk of sural nerve injury (4% vs. 1%, <i>p</i> = 0.02). Deep vein thrombosis/pulmonary embolism risk is higher with non-surgical treatment (2% vs. 1%, <i>p</i> = 0.04). EWB leads to faster return-to-sport and higher Achilles Tendon Rupture Scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Open surgical repair with LWB reduces re-rupture risk, while EWB offers faster recovery and higher patient satisfaction. Non-surgical treatment has the highest re-rupture and DVT/PE risk. Percutaneous repair increases sural nerve injury risk compared to open surgery, with no significant difference in wound complications. In patients with no contraindications, open surgical repair should be considered the gold standard, with no statistical difference in major and minor wound complications when compared to percutaneous treatment.</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":"33 7","pages":"2664-2683"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096764","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":"Hip arthroscopy and periacetabular osteotomy generally improve sexual function in patients, but have a risk of iatrogenic pudendal nerve injury that can temporarily worsen sexual function: A systematic review","authors":"Madeline Hubbard,&nbsp;Darya Pascarel,&nbsp;Prushoth Vivekanantha,&nbsp;Mahmoud Almasri,&nbsp;Shahbaz Malik,&nbsp;Amit Meena,&nbsp;Darren de SA","doi":"10.1002/ksa.12700","DOIUrl":"10.1002/ksa.12700","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To summarise how orthopaedic hip sports medicine procedures affect patients' sexual function so that surgeons can better counsel their patients on this topic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three databases (MEDLINE, EMBASE and PubMed) were searched on 27 April 2024 with search terms relating to sexual activity and orthopaedic procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews of Interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies with a total of 5976 patients (6275 joints) were included in this study. Hip arthroscopies were performed in 5812 patients for a total of 6087 surgeries, and 164 patients received 188 osteotomies. Nine of 17 studies reported iatrogenic nerve injury (103/1854; 5.6%), mainly of the pudendal nerve (64/103, 62.1%). All of male, female, and combined male and female sexual function tended to be compromised prior to hip sports medicine surgery and improved after surgery as per International Index of Erectile Function (IIEF) (<i>p</i> = 0.009) and Female Sexual Function Index (FSFI) (<i>p</i> &lt; 0.001) scores. Improvements after surgery were largely due to decreased hip pain and stiffness during sexual activity. Return to sexual activity was reported to be 29.2 ± 20.1 days after hip arthroscopy. Only three studies discussed preoperative counselling on sexual activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hip sports medicine surgeries can improve sexual function for patients; however, they have a risk of pudendal nerve damage that can temporarily interfere with sexual function. Surgeons should counsel their patients on the risks and benefits of hip sports orthopaedic surgeries to sexual function.</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":"33 7","pages":"2642-2654"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096763","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":"Early MCID achievement is associated with better long-term outcomes following arthroscopy for femoroacetabular impingement","authors":"Karen Mullins,&nbsp;David Filan,&nbsp;Patrick Carton","doi":"10.1002/ksa.12695","DOIUrl":"10.1002/ksa.12695","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine whether early improvement is associated with long-term outcomes following arthroscopy for femoroacetabular Impingement and establish a threshold above which would indicate sustained improvement. It was hypothesised that those who display improvements early would report better long-term outcomes than those who did not report meaningful change at 1 year, allowing further targeted intervention where necessary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An examination of patients (Tonnis 0,1) undergoing primary arthroscopy between January 2009 and March 2014, with 10-year review, was conducted. Four hundred and fifteen hip arthroscopy cases in 355 patients were included. The minimal clinically important difference (MCID) for the modified Harris Hip score (mHHS) at 1 year was calculated using the percentage of possible improvement (POPI) method. Patients were grouped as early improvers (EI) or non-improvers (NI) based on whether they achieved MCID at 1 year or not. Survival, revision rate, and the patient acceptable symptom state (PASS) were compared between groups using a Kaplan–Meier curve and chi-squared analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One year MCID achievement required an improvement from pre-operative mHHS of at least 47%; 79% of cases achieved MCID (EI), and 21% did not (NI). At 10 years, there were six total hip replacements in the EI group compared to 16 in the NI group (survival 98% vs. 82%, <i>p</i> &lt; 0.001). Revision rates were lower in the EI group (6% vs. 12%, <i>p</i> = 0.005), and the EI group had higher levels of PASS achievement (86% vs. 68%, <i>p</i> &lt; 0.001). Regression models indicated that MCID achievement at 1 year, reduced the odds of replacement and revision surgery while increasing the odds of PASS achievement at 10 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher survival rates, higher PASS rates and lower revision procedures were observed in EI. When accounting for other known confounding factors, improving by a minimum of 47% of what a patient could achieve in the mHHS at 1 year predicts superior outcomes long-term. For those patients failing to achieve this important improvement threshold, clinicians could consider introducing additional rehabilitation or interventions that may further improve recovery and potentially increase the likelihood of a better longer-term outcome.</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":"33 7","pages":"2633-2641"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096812","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":"Age and sex-specific differences of the intrafemoral and intratibial morphology using the Citak classification in patients undergoing total knee arthroplasty","authors":"Maximilian Budin,&nbsp;Stephanie Huber,&nbsp;Sebastian Simon,&nbsp;Jennyfer Mitterer,&nbsp;Mustafa Citak,&nbsp;Jochen G. Hofstaetter","doi":"10.1002/ksa.12691","DOIUrl":"10.1002/ksa.12691","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Unlike established knee phenotype classifications, the recently introduced Citak classifications describe the intrafemoral and intratibial knee morphology. The aim of this study was to evaluate the distribution of Citak types A, B and C of the distal femur and proximal tibia in a large cohort and to examine the influence of age, body mass index (BMI) and knee phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 8739 patients undergoing primary total knee arthroplasty (TKA) were included in this study. The coronal plane alignment of the knee (CPAK) and functional knee phenotypes were assessed on standardised preoperative long leg radiographs (LLR) using a validated artificial intelligence (AI) software. The Citak classification was measured manually, and BMI, sex and age were compared between the different Citak types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most common morphotypes were Citak type B of the distal femur (men: 1362 (46.5%); women 3042 (52.4%)) and Citak type C of the proximal tibia (men: 2605 (88.9%); women 5406 (93.0%)). Women with Citak type C of the distal femur (mean age 71.45a; <i>p</i> &lt; 0.001) and proximal tibia (mean age 69a; <i>p</i> &lt; 0.001) were significantly older, while no age differences were observed among men. Citak type A of the distal femur and proximal tibia had an overall higher BMI in both men and women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The Citak types of the distal femur and the proximal tibia are age, sex and BMI dependent in patients undergoing primary TKA. Recognising these morphological variations might improve preoperative planning and implant selection in TKA, potentially improving patient outcomes. The Citak classification is useful to further characterise various knee morphotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3298-3309"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronal plane alignment of the knee phenotypes distribution varies significantly as a function of geographic, osteoarthritic and sex-related factors: A systematic review and meta-analysis","authors":"Giancarlo Giurazza,&nbsp;Andrea Tanzilli,&nbsp;Edoardo Franceschetti,&nbsp;Stefano Campi,&nbsp;Pietro Gregori,&nbsp;Francesco Rosario Parisi,&nbsp;Michele Paciotti,&nbsp;Giovanni Perricone,&nbsp;Biagio Zampogna,&nbsp;Rocco Papalia","doi":"10.1002/ksa.12704","DOIUrl":"10.1002/ksa.12704","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The coronal plane alignment of the knee (CPAK) classification is a nine-phenotype matrix based on limb alignment and joint line obliquity. This study aimed to provide a global overview of CPAK distribution, hypothesising significant geographic, osteoarthritic and sex-related variations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search (Embase, Medline/PubMed and Cochrane Library) following PRISMA guidelines was conducted, utilising the search terms “Coronal Plane Alignment of the Knee” OR “CPAK”. Studies considering image modalities other than long-leg radiographs were excluded. A random-effects meta-analysis of proportions was performed, and statistical significance was defined as <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 38 studies comprising 46,966 knees were analysed. The most common phenotypes worldwide were CPAK I (33.1%), II (25.9%) and III (14.4%) in the osteoarthritic population and CPAK II (34.9%), I (21.5%) and III (19.3%) in the healthy population. Among osteoarthritic populations, CPAK type I was predominant in Europe (29.2%), Asia (41.9%) and America (33.6%), type II in Australia (32.6%) and type III in Africa (28.6%). In healthy populations, type II was predominant in Europe (42.8%) and Asia (35.3%), whereas type I was most common in South America (44.8%). Significant regional differences were observed among both osteoarthritic and healthy knees, and between osteoarthritic and healthy knees in individual countries. In Europe, significant sex differences were observed in the distribution of types I (39.1% M; 23.5% F) and III (11.4% M; 24.6% F) in the osteoarthritic population, and in the distribution of types I (26.7% M; 9.4% F), II (43.9% M; 34.4% F) and III (11.3% M; 20.6% F) in the healthy population. In Asia, significant sex differences were found for type III in osteoarthritic knees (6.3% M; 11.4% F).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CPAK distribution varies significantly as a function of geographic, osteoarthritic, and sex-related factors. A personalised approach to TKA may be desirable to better accommodate these differences.</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":"33 10","pages":"3592-3605"},"PeriodicalIF":5.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096808","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":"Increased prevalence and severity of femoral bone wear in Japanese patients with varus knee osteoarthritis","authors":"Manabu Akagawa,&nbsp;Hidetomo Saito,&nbsp;Yasuhiro Takahashi,&nbsp;Hiroaki Kijima,&nbsp;Yuji Kasukawa,&nbsp;Koji Nozaka,&nbsp;Naohisa Miyakoshi","doi":"10.1002/ksa.12697","DOIUrl":"10.1002/ksa.12697","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The calliper technique in kinematic alignment total knee arthroplasty assumes nearly identical medial and lateral femoral condylar radii and negligible subchondral bone wear. However, racial differences were not considered. This study aimed to assess the degree and severity of bone wear in Japanese patients with varus knee osteoarthritis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included 155 knees from 130 patients who underwent total or unicompartmental knee arthroplasty for primary varus-type knee osteoarthritis between April 2020 and March 2024. Preoperative computed tomography scans were used to measure the femoral condylar radii via a circle-fitting technique. Bone wear was assessed at 0° and 90° by measuring the distance between the best-fit circle and the subchondral bone periphery, with additional measurements at the peak wear angle, if present.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 155 knees, 16 (10.3%) exhibited bone wear. Bone wear &gt;1 mm at 0° was observed in 3.2% of the cases. The peak wear angle was 43.1 ± 5.0°, with a mean depth of 2.0 ± 0.7 mm. The medial and lateral condylar radii were nearly identical (18.3 ± 1.2 mm vs. 18.2 ± 1.2 mm, <i>p</i> = 0.002), with a strong correlation (<i>R</i>² = 0.94, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bone wear exceeding 1 mm at 0° was observed in 3.2% of cases, while overall bone wear was present in 10.3% of knees. Although the difference in radii between the medial and lateral femoral condyles was statistically significant, it was clinically negligible. This finding supports the reliability of the cylindrical axis as a reference for surgical techniques. These results highlight the importance of recognizing potential racial differences in bone wear and underscore the need for accurate assessment to achieve anatomic restoration in kinematic alignment total knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3261-3268"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001138","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":"Diabetes and total knee arthroplasty: A nationwide analysis of complications, hospitalization outcomes and revision burden","authors":"Yaara Berkovich,&nbsp;Ela Cohen Nissan,&nbsp;David Maman,&nbsp;Michael Tobias Hirschmann,&nbsp;Yaniv Yonai,&nbsp;Yaniv Steinfeld,&nbsp;Yaron Berkovich","doi":"10.1002/ksa.12696","DOIUrl":"10.1002/ksa.12696","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) is a frequently performed surgical procedure aimed at reducing pain, improving mobility, and restoring function in patients with advanced knee osteoarthritis. As patients undergoing TKA age, the prevalence of comorbidities, particularly diabetes, continues to rise. This study assesses post-operative complications, healthcare costs and hospital length of stay (LOS) among diabetic patients undergoing primary and revision TKA using nationwide data from the NIS database, employing propensity score matching (PSM) to minimize confounding variables. We hypothesized that diabetic patients undergoing TKA would experience higher complication rates, greater healthcare costs and longer hospital stays compared to non-diabetic controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort analysis utilized data from the Nationwide Inpatient Sample from 2016 to 2019, including a total of 2,602,484 TKA patients: 561,340 with type 2 diabetes and 2,041,144 without diabetes. PSM was applied to create balanced cohorts, adjusting for baseline demographic and clinical differences. Outcomes analyzed included LOS, total hospitalization charges, post-operative complications and revision surgery rates. Statistical significance was set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following PSM, diabetic patients exhibited significantly higher risks for post-operative complications, including sepsis, heart failure and surgical site infections, compared to matched non-diabetic controls. Diabetic patients also incurred significantly greater hospital charges ($64,694 vs. $59,952, <i>p</i> &lt; 0.001). In revision TKA cases, diabetic patients demonstrated slightly longer LOS (3.5 days vs. 3.0 days, <i>p</i> &lt; 0.001) and higher total hospital charges ($101,457 vs. $96,614, <i>p</i> = 0.015).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Diabetic patients undergoing TKA experience significantly higher complication rates, hospital charges and revision surgery burden. Orthopaedic surgeons and perioperative teams should implement personalized perioperative management strategies, including optimized glycaemic control, cardiovascular risk assessment and infection prevention measures, to mitigate these risks and improve clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Levels of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3250-3260"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001136","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":"Higher surgeon volume reduces early failure in first time revision of non-infected total knee arthroplasty: An analysis using data from the United Kingdom National Joint Registry","authors":"Alexander H. Matthews,&nbsp;William K. Gray,&nbsp;Jonathan P. Evans,&nbsp;Jonathan T. Evans,&nbsp;Sarah E. Lamb,&nbsp;Andrew Porteous,&nbsp;Tim Briggs,&nbsp;Shiraz A. Sabah,&nbsp;Abtin Alvand,&nbsp;Andrew D. Toms,&nbsp;Andrew J. Price","doi":"10.1002/ksa.12690","DOIUrl":"10.1002/ksa.12690","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Revision total knee replacement (RevKR) is an increasingly common procedure. It is hypothesised that higher surgical volume is linked to lower levels of adverse outcomes. The aim was to estimate the association of surgical volume on patient outcomes following first single-stage RevKR for non-infected indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This population-based cohort study used data from the United Kingdom National Joint Registry, Hospital Episode Statistics and National Patient Reported Outcome Measures. Patients undergoing procedures between 1 January 2009 and 30 June 2019 were included. The primary outcome measure was re-revision within 2 years; chosen to reflect the quality of the surgical provision. Fixed effect multivariable regression models were used to examine the association between surgeon and surgical unit annual caseload and the risk of adverse outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 8695 patients underwent first time single stage revision for aseptic loosening, instability, or malalignment across 389 surgical units and 1204 surgeons. Following adjustment for age, gender, ASA grade, year of surgery and operation funder, higher surgeon volume was associated with a lower risk of re-revision at 2 years. The risk of re-revision decreased amongst surgeons performing ≥9 annual revisions (OR 0.77, 95% CI 0.62–0.95, <i>p</i>-value = 0.02) compared to those performing &lt;9 annual revisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Annual surgeon case volume of ≥9 first single-stage RevKR for non-infected indications is independently associated with reductions in early re-revision. This evidence supports the setting of minimum volume targets to improve outcomes for patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort study of prospectively collected data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3286-3297"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I—Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)","authors":"Nicolas Pujol,&nbsp;Airelle O. Giordano,&nbsp;Stephanie E. Wong,&nbsp;Philippe Beaufils,&nbsp;Juan Carlos Monllau,&nbsp;Elanna K. Arhos,&nbsp;Roland Becker,&nbsp;Francesco Della Villa,&nbsp;J. Brett Goodloe,&nbsp;James J. Irrgang,&nbsp;Jitka Klugarova,&nbsp;Emma L. Klosterman,&nbsp;Aleksandra Królikowska,&nbsp;Aaron J. Krych,&nbsp;Robert F. LaPrade,&nbsp;Robert Manske,&nbsp;Nicky van Melick,&nbsp;Jill K. Monson,&nbsp;Marko Ostojic,&nbsp;Mark V. Paterno,&nbsp;Tomasz Piontek,&nbsp;Simone Perelli,&nbsp;Alexandre Rambaud,&nbsp;James Robinson,&nbsp;Laura C. Schmitt,&nbsp;Eric Hamrin Senorski,&nbsp;Thorkell Snaebjornsson,&nbsp;Adam J. Tagliero,&nbsp;C. Benjamin Ma,&nbsp;Robert Prill","doi":"10.1002/ksa.12674","DOIUrl":"10.1002/ksa.12674","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The aim of part one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Prevention programmes, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures will be presented in a part II article.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This consensus followed the &lt;i&gt;European Society for Sports Traumatology and Arthroscopy&lt;/i&gt; (ESSKA)'s ‘formal consensus’ methodology. For this combined ESSKA, &lt;i&gt;American Orthopedic Society for Sports Medicine&lt;/i&gt; and &lt;i&gt;American Academy of Sports Physical Therapy&lt;/i&gt; initiative, 67 experts (26 in the steering group and 41 in the rating group) from 14 countries (US and 13 European countries), including orthopaedic surgeons, sports medicine doctors and physiotherapists were involved. Steering group members established guiding questions, searched the literature and proposed statements. Rating group members assessed the statements according to a Likert scale and provided grades of recommendations, reaching a final agreement about rehabilitation of the knee after meniscus surgery. Final documents were then assessed by a peer review group to address the geographical adaptability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The overall level of evidence in the literature was low. Of the 19 questions (leading to 29 statements), 1 received a Grade A of recommendation, 2 a Grade B, 9 a Grade C and 17 a Grade D. Nevertheless, the mean median rating of all questions was 8.2/9 (9 being the highest rating on a scale of 1–9). The global mean rating was 8.4 ± 0.2, indicating a high agreement. Rehabilitation depends on the type of lesion, the treatment performed and is the same after medial or lateral meniscus surgery. Rehabilitation after meniscectomy should follow a criterion-based rehabilitation protocol, based on milestones rather than a time-based protocol. After meniscus repair and reconstruction, rehabilitation should be progressed according to both time and criterion-based milestones.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Rehabilitation after meniscus surgery is a debated topic that may influence surgical outcomes if not optimally performed. This international formal consensus established clear, updated and structured recommendations for both surgeons and","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 8","pages":"3002-3013"},"PeriodicalIF":5.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006661","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 semitendinosus with adjustable button graft construct in patients undergoing hamstring ACL reconstruction results in improved knee flexor strength symmetry and less donor site pain and morbidity: Outcomes from the DOSTAR randomized controlled trial.","authors":"Adam M Lawless, Jay R Ebert, Peter K Edwards, Shahbaz S Malik, Peter S E Davies, Peter A D'Alessandro","doi":"10.1002/ksa.12698","DOIUrl":"https://doi.org/10.1002/ksa.12698","url":null,"abstract":"<p><strong>Purpose: </strong>To compare donor site morbidity and patient-reported outcome measures (PROMs), knee laxity and early strength and functional outcomes, following anterior cruciate ligament reconstruction (ACLR) using a semitendinosus (ST) tendon autograft with suspensory adjustable button tibial fixation or semitendinosus-gracilis (STG) autograft with tibial screw fixation.</p><p><strong>Methods: </strong>While 153 patients were prospectively recruited and randomized to an ST or STG autograft, 131 (62 ST and 69 STG) were retained following ACLR and followed post-surgery. Standardized surgical techniques were employed, varying only in graft selection and fixation. The primary study outcomes were early hamstring pain, donor site morbidity and strength recovery. However, several outcomes were assessed pre-surgery and at 3 and 6 months, encompassing the Donor-site-related Functional Problems following Anterior Cruciate Ligament Reconstruction (DFPACLR) score, Visual Analogue Scale (VAS) for hamstring pain and other commonly employed PROMs, anteroposterior laxity (KT-1000), isokinetic hamstring and quadriceps strength, hop testing, complications and re-operations. Intention-to-treat analysis was performed using linear mixed models for continuous data and Mann-Whitney U tests where appropriate.</p><p><strong>Results: </strong>At 6 months, ST patients reported significantly lower hamstring pain (p < 0.001) and DFPACLR (p < 0.001) scores. A significantly higher (p < 0.001) peak knee flexor strength limb symmetry index (LSI) was observed for the ST group, though no other group differences in side-to-side laxity, hop tests or other normalized strength measures or LSIs were observed.</p><p><strong>Conclusions: </strong>ACLR using an ST autograft resulted in less donor site pain and morbidity, and improved knee flexor strength symmetry at 6 months, while demonstrating comparable functional outcomes to the STG autograft.</p><p><strong>Level of evidence: </strong>Level 1 prospective, double-blinded, randomized controlled trial.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989480","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}