Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Measuring osteotomy wedge angle is more important than measuring wedge height in open wedge osteotomies around the knee in preoperative planning","authors":"Julius Watrinet,&nbsp;Johannes Schlaich,&nbsp;Romed Vieider,&nbsp;Marco-Christopher Rupp,&nbsp;Julian Mehl,&nbsp;Sebastian Siebenlist,&nbsp;Armin Runer","doi":"10.1002/ksa.12609","DOIUrl":"10.1002/ksa.12609","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Preoperative planning for medial open wedge high tibial osteotomies (HTOs) and lateral open wedge distal femur osteotomies (DFOs) commonly uses wedge height to guide accurate correction. However, it is unclear if this parameter is influenced by intraoperative variations in osteotomy entry point or length. This study hypothesized that wedge angle remains constant during planning, while wedge height varies depending on hinge or entry points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Whole leg radiographs of 40 patients who underwent HTO or DFO (2018–2024) were analysed using digital planning software. For each HTO and DFO case, 27 and 21 osteotomy variants were created, respectively, by altering entry and hinge points, resulting in 960 simulations. Wedge angle, wedge height and osteotomy depth were measured for each variant. Correlations and regression analyses assessed the relationships among these variables, and a mathematical formula was developed to predict wedge height from wedge angle and osteotomy depth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Wedge angle remained consistent across variants (mean deviation: 0.1 ± 0.1°), while wedge height showed variability (mean deviation: 0.7 ± 0.5 mm) influenced by entry and hinge points. Significant correlations were found between wedge height and opening angle (<i>R</i> = 0.83, <i>p</i> &lt; 0.001) and osteotomy depth (<i>R</i> = 0.60, <i>p</i> &lt; 0.001). Predicted wedge height closely matched actual values (<i>R</i> = 0.998, <i>p</i> &lt; 0.001), with minimal error (−0.01 ± 0.1°).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights that relying solely on wedge height for osteotomy planning in HTO and DFO is insufficient due to variations in entry and hinge points. The hinge angle proved to be the most reliable parameter. Intraoperative osteotomy depth measurements can help adjust wedge height for accurate limb alignment when deviations occur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V, simulation study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 4","pages":"1443-1451"},"PeriodicalIF":3.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399478","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":"AKIRA: Deep learning tool for image standardization, implant detection and arthritis grading to establish a radiographic registry in patients with anterior cruciate ligament injuries.","authors":"Yining Lu, Linjun Yang, Kellen Mulford, Austin Grove, Ellie Kaji, Ayoosh Pareek, Bruce Levy, Cody C Wyles, Christopher L Camp, Aaron J Krych","doi":"10.1002/ksa.12618","DOIUrl":"https://doi.org/10.1002/ksa.12618","url":null,"abstract":"<p><strong>Purpose: </strong>Developing large-scale, standardized radiographic registries for anterior cruciate ligament (ACL) injuries with artificial intelligence (AI) tools can enhance personalized orthopaedics. We propose deploying Artificial Intelligence for Knee Imaging Registration and Analysis (AKIRA), a trio of deep learning (DL) algorithms, to automatically classify and annotate radiographs. We hypothesize that algorithms can efficiently organize radiographs based on laterality, projection, identify implants and classify osteoarthritis (OA) grade.</p><p><strong>Methods: </strong>A collection of 20,836 knee radiographs from all time points of treatment (mean orthopaedic follow-up 70.7 months; interquartile range [IQR]: 6.8-172 months) were aggregated from 1628 ACL-injured patients (median age 26 years [IQR: 19-42], 57% male). Three DL algorithms (EfficientNet, YOLO [You Only Look Once] and Residual Network) were employed. Radiograph laterality and projection (anterior-posterior [AP], lateral, sunrise, posterior-anterior, hip-knee-ankle and Camp-Coventry intercondylar [notch]) were labelled by a DL model. Manually provided labels of metal fixation implants were used to develop a DL object detection algorithm. The degree of OA, both as measured by specific Kellgren-Lawrence (KL) grades, as well as based on a binarized label of OA (defined as KL Grade ≥2), on standing AP radiographs were classified using a DL algorithm. Individual model performances were evaluated on a subset of images prior to the deployment of AKIRA to registry construction using all ACL radiographs.</p><p><strong>Results: </strong>The classification algorithms showed excellent performance in classifying radiographic laterality (F1 score: 0.962-0.975) and projection (F1 score: 0.941-1.0). The object detection algorithm achieved high precision-recall (area under the precision-recall curve: 0.695-0.992) for identifying various metal fixations. The KL classifier reached concordances of 0.39-0.40, improving to 0.81-0.82 for binary OA labels. Sequential deployment of AKIRA following internal validation processed and labelled all 20,836 images with the appropriate views, implants, and the presence of OA within 88 min.</p><p><strong>Conclusion: </strong>AKIRA effectively automated the classification and object detection in a large radiograph cohort of ACL injuries, creating an AI-enabled radiographic registry with comprehensive details on laterality, projection, implants and OA.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382654","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":"Comparison of double bundle semitendinosus technique and pedicled quadriceps technique in patellar instability.","authors":"Tayfun Özel, Semih Yaş, Hayati Hürol Türkoğlu, Asim Ahmadov, Muhammet Baybars Ataoğlu, Ulunay Kanatlı","doi":"10.1002/ksa.12619","DOIUrl":"https://doi.org/10.1002/ksa.12619","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical and functional outcomes of medial patellofemoral ligament (MPFL) reconstruction using a minimally invasive pedicled quadriceps tendon (QT) or patella double tunnel technique with semitendinosus tendon (ST) graft in patients with recurrent patella dislocation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 51 patients who underwent MPFL reconstruction between 2014 and 2022, with a minimum 2-year post-operative follow-up. Patients were grouped as QT (n = 24) and ST (n = 27), alongside a control group of 24 healthy individuals. Kujala, Lysholm and Visual Analogue Scale (VAS) scores were evaluated. Isokinetic tests at 60° angular velocity were performed to calculate the limb symmetry index (LSI) and hamstring/quadriceps (H/Q) ratio.</p><p><strong>Results: </strong>No significant differences were found between groups regarding age, sex, body mass index, time to surgery, or number of dislocations (n.s). Mean Kujala (QT: 89.2 ± 8.9, ST: 85.4 ± 11.4), Lysholm (QT: 90.6 ± 9.4, ST: 87.9 ± 10.7), and VAS (QT: 0.83 ± 1.3, ST: 0.9 ± 1.1) scores showed no statistically significant differences between the groups (n.s). Extension LSI was significantly higher in QT (92.2 ± 10.0%) than ST (81.4 ± 16.4%, p = 0.024), as was flexion LSI (QT: 94.2 ± 10.9%, ST: 83.3 ± 17.5%, p < 0.01). H/Q ratios showed no significant differences between operated and non-operated sides (n.s). No redislocations or patellar fractures occurred. Apprehension signs were positive in two patients (7.4%) in ST and one patient (4.1%) in QT.</p><p><strong>Conclusion: </strong>MPFL reconstruction with both ST and pedicled QT grafts yields successful results in well-selected patient groups. Unlike ST, reconstruction with QT results in extension and flexion strength in the operated extremity that is closer to the non-operated side and to the healthy control group.</p><p><strong>Level of evidence: </strong>Level III, retrospective case-control study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382717","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":"A three-dimensional scoring system for assessment of individual bony and laxity phenotype restoration (knee SIPR) in personalised TKA as a base for treatment guidance.","authors":"Heiko Graichen, Thomas Grau, Rüdiger von Eisenhart-Rothe, Sebastien Lustig, Tilman Calliess, Mark Clatworthy, Michael T Hirschmann","doi":"10.1002/ksa.12601","DOIUrl":"https://doi.org/10.1002/ksa.12601","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Although personalised alignment has become popular in total knee arthroplasty (TKA), it is unclear which workflow and alignment strategy best restores the bony and laxity phenotype and whether this varies between knee phenotypes. The aim of this study was, therefore, to develop a three-dimensional (3D) scoring system which assesses bony anatomy, laxity and alignment parameters for TKA. This novel 3D scoring system was tested using a validated TKA simulator on three different knee phenotypes with various alignment workflows. 3D scores were compared between phenotypes and workflows.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this 3D scoring system, analyses of bony resections of all six joint planes were included (maximum score for anatomical resections ± 1 mm) as well as joint laxity/gap analysis (maximum score for balanced extension/flexion gap, medial and lateral side ± 2 mm). Additional alignment parameters (hip-knee-ankle angle, medial proximal tibial angle, lateral distal femoral angle, Tibia slope and coronal plane alignment of the knee) were integrated. All data points were obtained from preoperative long leg x-rays, intraoperative gap analysis with CAS and intraoperative cartilage measurements. The maximum score for all categories was 27 points (12/10/5). The 3D scores were analysed for nine knees with three knee phenotypes (neutral, varus and valgus) with six different alignment workflows (mechanical alignment-femur first, adjusted mechanical alignment-femur first, unrestricted kinematic alignment, restricted kinematic alignment, inverse kinematic alignment and functional alignment-tibia first) using the Knee-computational alignment trainer simulator. Comparison between workflows in all phenotypes was performed for each category.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In neutral phenotypes, all alignment workflows, including mechanical alignment, showed similar high mean scores. In varus and valgus phenotypes, personalised alignment workflows scored higher than systematic workflows. While in varus phenotypes, scoring of personalised alignment workflows was similarly high to that in straight knees phenotypes, it showed lower means in valgus phenotypes. Measured-resection workflows restored bony phenotypes in a higher percentage while gap-balanced workflows performed better in the category of laxity/gap balance. None of the personalised workflows performed best in all knees.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The new 3D scoring system for individual knee phenotype restoration in TKA allowed a quantitative analysis of the individual reconstruction of the bony and laxity anatomy in different knee phenotypes. First preliminary results show that personalised alignment workflows perform better than systematic mechanical alignment in varus and valgus phenotypes, while in neutral phenotypes, the difference was minimal. None of the personalised workflows scored best in all knees, showing the potential for a 3D phenotype workflow incl","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382633","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":"Magnetic resonance imaging provides additional utility in the preoperative cartilage assessment of patients undergoing medial unicompartmental knee arthroplasty.","authors":"Mei Lin Tay, Scott M Bolam, Tyler Campbell, Laura Hill, Lydia Lin, Hayley Wong, David Dow, Jacob T Munro, Simon W Young, A Paul Monk","doi":"10.1002/ksa.12611","DOIUrl":"https://doi.org/10.1002/ksa.12611","url":null,"abstract":"<p><strong>Purpose: </strong>For unicompartmental knee arthroplasty (UKA), patient selection using correct indications can optimise postsurgical outcomes. The current gold standard for assessing eligibility is with radiographs; however, magnetic resonance imaging (MRI) may allow for more accurate assessments of cartilage damage. This study aimed to evaluate the utility of MRI for preoperative assessment of medial UKA patients by (1) comparing osteoarthritis severity of the medial, lateral and patellofemoral (PF) compartments when assessed using MRI compared with standard radiographs, and (2) investigating associations of these two assessments with postoperative clinical outcomes.</p><p><strong>Methods: </strong>This study had ethical approval. A retrospective review was performed for 88 primary medial UKA between 1 January 2017 and 31 December 2021. The main outcome measures were preoperative cartilage loss and patient-reported clinical outcomes. Preoperative cartilage loss was recorded using the International Cartilage Repair Society (ICRS) classification using MRI, and Kellgren-Lawrence (K-L) scores from radiographs. Patient-reported clinical outcomes were measured using preop, early (6-week) and late (1- or 2-year) Oxford Knee Score (OKS) change scores.</p><p><strong>Results: </strong>The use of MRI has improved accuracy over radiographs. In the medial compartment, 37 (44%) patients had less severe radiographic K-L scores (1-3); however, all patients had the most severe MRI ICRS scores (4). For patients with mild K-L scores (0 and 1), 20 (43%) and 7 (78%) patients had more severe ICRS scores (3 and 4) within their lateral and PF compartments, respectively. No associations were found between ICRS or K-L scores and OKS for any compartments.</p><p><strong>Conclusions: </strong>Assessment of medial cartilage thickness loss using MRI provides additional utility over standard radiographs in preoperative assessments of medial UKA patients. However, evidence of disease in the PF compartment assessed using MRI should not be considered a contraindication for UKA.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382724","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":"Anterior cruciate ligament reconstruction rehabilitation: Decades of change","authors":"Nicky van Melick,&nbsp;Eric Hamrin Senorski,&nbsp;Aleksandra Królikowska,&nbsp;Robert Prill","doi":"10.1002/ksa.12600","DOIUrl":"10.1002/ksa.12600","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Current anterior cruciate ligament reconstruction (ACLR) rehabilitation practice guidelines lack updates in key areas: open kinetic chain (OKC) quadriceps strengthening, neurocognitive training and psychological interventions. Recent research shows that OKC exercises, when combined with closed kinetic chain exercises, improve strength without compromising graft integrity, though careful monitoring for knee pain and effusion is essential. Neurocognitive training, targeting reaction times, visual attention and dual-tasking, is promising for reducing reinjury risk but remains underutilized. Similarly, psychological responses, often assessed via patient-reported outcomes, are a critical part of the recovery process after ACLR, but how to address these responses for the individual patient remains unclear, emphasizing the need for individualized support. The European Society for Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA) is developing an ACL rehabilitation consensus to integrate these insights into actionable, evidence-based guidelines, ensuring tailored, patient-centered care that optimizes recovery and reduces reinjury risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 4","pages":"1178-1182"},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382786","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 posterior tibial slope leads to altered pressure distribution in the lateral tibial plateau-A biomechanical in-vitro study.","authors":"Kai Hoffeld, Luis Göker, David Grevenstein, Jan Philipp Hockmann, Benjamin Rosswinkel, Peer Eysel, Johannes Oppermann","doi":"10.1002/ksa.12613","DOIUrl":"https://doi.org/10.1002/ksa.12613","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to investigate the impact of increased posterior tibial slope (PTS) on pressure distribution in the medial and lateral tibial plateau. The focus is on compartment-specific effects and potential correlations with cartilage damage, due to altered anterior tibial translation caused by increased PTS.</p><p><strong>Method: </strong>Ten freshly frozen knee specimens were prepared and subjected to biomechanical testing. PTS was modified by inserting 5°, 10°, 15° and 20° polylactic acid wedges into osteotomy gaps. Pressure distribution was measured using Tekscan's Pressure Mapping Sensor 5040™ beneath the menisci at varying PTS angles. The kinetic data were tracked using the Optotrak Certus® system. Statistical analyses were employed to evaluate the pressure shifts and their significance.</p><p><strong>Results: </strong>The study revealed that increased PTS significantly shifted the pressure point anteriorly on the lateral tibial plateau, while no significant changes were observed on the medial plateau. The analysis of tibial translation showed a corresponding rise in anterior translation with increasing PTS, especially at higher angles.</p><p><strong>Conclusion: </strong>Increased PTS, particularly above 10°, induces significant anterior translation and altered pressure distribution, primarily affecting the lateral tibial plateau. These findings support the hypothesis that elevated PTS contributes to biomechanical stresses in the knee, potentially increasing the risk of lateral compartment cartilage degeneration. These results highlight the importance of considering PTS in clinical assessments and interventions aimed at optimizing knee joint health.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256115","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":"New KSSTA associate editor and ambassador for China-Welcoming Dr. Li Ke.","authors":"Michael T Hirschmann, Elmar Herbst, Giuseppe Milano, Volker Musahl","doi":"10.1002/ksa.12616","DOIUrl":"https://doi.org/10.1002/ksa.12616","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256133","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":"Knee malalignment and laterality influence 2-year meniscus tear repair outcomes: A pilot study.","authors":"Benjamin Tschopp, Patrick Omoumi, John Nyland, Aziz Chaouch, Valentine Schneebeli, Roland Jakob, Robin Martin","doi":"10.1002/ksa.12602","DOIUrl":"https://doi.org/10.1002/ksa.12602","url":null,"abstract":"<p><strong>Purpose: </strong>To analyse biomechanical determinants for radiological and clinical outcomes of posterior horn longitudinal vertical meniscal tear (LVMT) repairs.</p><p><strong>Methods: </strong>Patients undergoing primary repair of vascular zone traumatic full-thickness posterior horn LVMT were enroled. We hypothesized four potential factors would influence mid-term outcomes: malalignment (varus/valgus ≥5° for medial/lateral tears), meniscal laterality (medial vs. lateral), concomitant anterior cruciate ligament reconstruction (ACLR) and cartilage damage (Outerbridge grade ≥ II). The primary outcome was posterior horn nonhealing rate 6 months postoperatively (T1), evaluated using computed tomography arthrography (CTA) and Henning's criteria. Secondary outcomes were patient-reported outcomes measures (PROMs) assessed at T1 and ≥24 months postoperatively (T2). Univariate and multivariate logistic regression models estimated the marginal relative risk (MRR) of nonhealing for each determinant, while fractional logit regression assessed determinants' impact on PROMs at T1 and T2.</p><p><strong>Results: </strong>Seventy-eight patients (median age 29 years, interquartile range [IQR]: [21-37]); 76% male), were followed for ≥2 years (median 2.5 years, IQR: [2.1-3.6]). LVMTs extended to the middle horn in 81% and to the anterior horn in 52%. Posterior horn nonhealing rates (53%) were higher than in the middle (35%, p = 0.013) and anterior horn (7%, p < 0.001). Malalignment was present in 14%, medial meniscal involvement in 77%, ACLR in 55% and cartilage damage in 37%. Malalignment (MRR = 1.48, 95% confidence interval (CI): [0.84, 2.09]) and medial laterality (MRR = 1.7, 95% CI: [0.93, 3.6]) were independently identified as potential nonhealing risk factors. But it is the combination of varus malalignment and medial laterality that significantly increased the risk of nonhealing (MRR = 2.54, 95% CI: [1.09, 6.01], p = 0.033) and negatively impacted all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and International Knee Documentation Committee (IKDC) score at T1 and/or T2.</p><p><strong>Conclusion: </strong>Combined varus malalignment and medial meniscus involvement strongly predicted repair nonhealing and poorer outcomes after posterior horn LVMT repair.</p><p><strong>Study design: </strong>Prospective cohort pilot study.</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":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256119","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":"Autologous bone grafting combined with spheroid-based matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: Good clinical outcomes alongside abnormal postoperative gait patterns.","authors":"Stephan Oehme, Danko Dan Milinkovic, Azzurra Paolucci, Sophie Krafzick, Stephen Fahy, Philipp Damm, Tobias Winkler, Tobias Jung, Benjamin Bartek","doi":"10.1002/ksa.12605","DOIUrl":"https://doi.org/10.1002/ksa.12605","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the clinical and functional outcomes of autologous bone grafting with spheroid-based matrix-induced autologous chondrocyte implantation (MABCI) for osteochondral defects of the knee by analysing pre- and postoperative patient-reported outcome measures (PROMs). Postoperative gait analysis was conducted and compared with a matched healthy control group to investigate biomechanical deviations.</p><p><strong>Methods: </strong>A total of 35 patients (m: 21, f: 14; mean defect size: 4.2 ± 2.4 cm², localisation: femoral condyle: 31, patellofemoral: 5) were analysed. The mean follow-up was 42.6 ± 22.8 months. International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), PROMIS 29 profile, and a questionnaire on patient perception of treatment success were assessed to evaluate PROMs. 3D-instrumented gait analysis (GRAIL, Motek) was used to assess lower extremity kinematics, kinetics and vertical ground reaction forces, compared to sex-, age- and body mass index-matched healthy controls.</p><p><strong>Results: </strong>All clinical scores showed significant improvement compared to the preoperative condition (IKDC: 73.1 ± 10.1 vs. 56.6 ± 17.2, p < 0.01; KOOS subcategories: pain 82.0 [±12.7] vs. 70.7 [±16.7] [p < 0.01], symptoms 79.1 [±20.3] vs. 68.9 [±13.9] [p < 0.01], activities of daily living 90.1 [±11.2] vs. 80.5 [±15.6] [p < 0.01], sport and recreational function: 65.3 [±19.3] vs. 51.3 [±26.29] [p < 0.01], quality of life 52.2 [±18.6] vs. 42.6 [±18.6] [p < 0.01]; numeric pain rating scale: 2.7 ± 2.0 vs. 5.0 ± 2.5, p < 0.01). The analysed patients reported a high satisfaction rate (94.3%). Self-selected walking speed was significantly lower than in healthy controls (1.17 ± 0.17 m/s vs. 0.98 ± 0.18 m/s, p < 0.01). Peak knee flexion angle (PKA) during loading response was significantly smaller (9.6° ± 7.0 vs. 17.7° ± 4.6, p < 0.01), and knee extension moment was significantly reduced (0.1 Nm/kg ± 0.2 vs. 0.4 Nm/kg ± 0.2, p < 0.01).</p><p><strong>Conclusion: </strong>MABCI is an effective treatment for osteochondral knee defects, showing significant improvements in all evaluated PROMs. Postoperative gait analysis revealed abnormal gait patterns, including reduced PKA and lower knee extension moment, suggesting a need for further rehabilitation to optimise functional recovery.</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":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122563","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}