Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Functional deficits and significant patellofemoral chondral deterioration two years after trochleoplasty and medial patellofemoral ligament reconstruction","authors":"Lara Pozzi,&nbsp;Jakob Ackermann,&nbsp;Peter Brem,&nbsp;Michel Schläppi,&nbsp;Samuel Blatter,&nbsp;Simon Rauch,&nbsp;Peter Philipp Koch,&nbsp;Jean-Romain Delaloye","doi":"10.1002/ksa.70043","DOIUrl":"10.1002/ksa.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Patellofemoral instability is a common knee condition and often associated with trochlear dysplasia. Sulcus-deepening trochleoplasty is a surgical option to reshape the trochlear groove and stabilise the patella. Although this procedure is considered safe and effective, the development of postoperative patellofemoral chondral lesions remains a topic of concern. The aim of this study was to evaluate the clinical and radiological outcomes following combined trochleoplasty and medial patellofemoral ligament reconstruction with a minimum follow-up of 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed 23 patients (24 knees) who underwent trochleoplasty with concomitant medial patellofemoral ligament reconstruction between January 2014 and July 2018 at our institution. Follow-up consisted of clinical assessment, patient related outcome measurements (Kujala, Tegner, and IKDC score), standardised strength assessment using the VALD Performance system and radiological assessment with conventional radiographs and magnetic resonance imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No recurrent patellar dislocation occurred postoperatively. The median postoperative Tegner, Kujala, and IKDC subjective scores were 4 (range 2–8), 87 (range 60–100) and 83 (range 49–98), respectively. Maximal isometric quadriceps (<i>p</i> &lt; 0.001) and hamstring (<i>p</i> &lt; 0.001) strength, as well as performance on the side hop test (<i>p</i> = 0.01), were significantly reduced on the operated side. Postoperative magnetic resonance imaging showed no evidence of chondrolysis or subchondral necrosis. However, chondropathy in the patellofemoral joint significantly worsened. While cartilage status remained stable in six knees, deterioration was observed in 18 knees and it was not significantly associated with the duration of follow-up (<i>p</i> = 0.96) or the preoperative status of the cartilage (<i>p</i> = 0.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Trochleoplasty with concomitant medial patellofemoral ligament reconstruction is an effective and safe treatment option for patellofemoral instability in the setting of high-grade trochlear dysplasia. However, functional deficits and significant patellofemoral chondral deterioration were observed with a minimum 2-year follow-up.</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":"2721-2730"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995105","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":"Autograft anterior cruciate ligament reconstruction results in improved graft synovial coverage and stability, while remnant-preserving techniques further enhance synovialization: A systematic review and meta-analysis","authors":"Lika Dzidzishvili,&nbsp;Udit Dave,&nbsp;Jared Rubin,&nbsp;David J. Madden,&nbsp;Andrew S. Bi,&nbsp;Etienne Cavaignac,&nbsp;Jorge Chahla","doi":"10.1002/ksa.70052","DOIUrl":"10.1002/ksa.70052","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;To compare graft synovialization and tear rates between autograft and allograft anterior cruciate ligament (ACL) reconstruction based upon second-look arthroscopy (SLA), along with joint stability, subjective and objective clinical outcomes.&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;A systematic search of PubMed, Embase and the Cochrane Library was conducted on 7 March 2025, to identify studies reporting graft synovial coverage and tear rates on SLA following primary ACL reconstruction. Meta-analyses were conducted using a random-effects model with logit transformation. Study weights were calculated via the inverse variance method. Heterogeneity was assessed using Cochran's &lt;i&gt;Q&lt;/i&gt; and the &lt;i&gt;I&lt;/i&gt;² statistic. Forest plots were created to display individual and pooled estimates with 95% confidence intervals.&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;A total of 26 clinical studies comprising 2891 patients were included in this systematic review. Of these, 2164 patients underwent ACL reconstruction with autografts and 727 with allografts. SLA was performed in 2009 patients, including 1570 in the autograft group (78.1%) and 481 in the allograft group (23.9%). Good synovial coverage (&gt;50% of the graft) was observed in 1303 autograft cases (83%) and 341 allograft cases (70.9%) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Poor synovial coverage (&lt;50%) was seen in 146 autografts (9.3%) and 93 allografts (19.3%) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Torn grafts were found in 125 autografts (8%) and 25 allografts (10%) (n.s.). No significant differences in synovial coverage or graft tear rates were observed when comparing single bundle versus double bundle ACL reconstructions. Mean anterior tibial translation was significantly lower in the autograft group compared to the allograft group (1.23 ± 0.68 vs. 2.00 ± 0.38 mm; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). No significant differences were noted in postoperative Lachman (n.s.) and pivot shift tests (n.s.), or in subjective outcomes based on Lysholm (&lt;i&gt;p&lt;/i&gt; = 0.05) and Tegner scores (n.s.). However, significantly more patients in the autograft group achieved normal (A) or nearly normal (B) International Knee Documentation Committee (IKDC) objective scores (&lt;i&gt;p&lt;/i&gt; = 0.02), whereas higher rates of abnormal or severely abnormal (grades C and D) IKDC scores were observed in the allograft group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Remnant-preserving ACL reconstruction resulted in significantly better synovial coverage, fewer graft tears and improved knee stability compared to conventional ACL reconstruction (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with no difference in cyclops lesion incidence (n.s.).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2766-2788"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995090","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":"Estimation of the patient acceptable symptom state (PASS) threshold for the Banff Patellofemoral Instability Instrument 2.0","authors":"Per Arne Skarstein Waaler,&nbsp;Eivind Inderhaug,&nbsp;Thomas Birkenes,&nbsp;Asle Birkeland Kjellsen,&nbsp;Trine Hysing-Dahl","doi":"10.1002/ksa.70061","DOIUrl":"10.1002/ksa.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>There is a paucity of studies reporting patient acceptable symptom state (PASS) thresholds for patient reported outcome measures validated for patellar instability. The aim of this study was to determine the PASS threshold for the Banff Patellofemoral Instability Instrument 2.0 (BPII) following surgery for recurrent patellar instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent patellar stabilisation surgery between 2013 and 2022 were included if they were ≥16 years of age and had ≥12 months of follow-up. The participants completed the BPII and a dichotomous PASS anchor question. The PASS threshold was then calculated using both the adjusted predictive modelling method and receiver operating characteristic (ROC) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Complete data were available for 218 knees of 182 patients, with a median follow-up time of 46 months. The PASS threshold was 62.4 (95% confidence interval [CI]: 58.8–65.9) using the adjusted predictive modelling method, and 66.3 (95% CI: 58.1–80.0) using ROC analysis. Overall, 173 patients (79.4%) reported satisfactory symptom states, while 72.9% and 70.6% achieved the respective PASS thresholds. The adjusted predictive modelling method yielded narrower 95% confidence intervals with minimal threshold variation across different approaches for handling bilateral cases compared to ROC analysis (1.3 vs. 8.1 points).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The PASS threshold for BPII after patellar stabilisation surgery was 62.4 (out of 100 points). The adjusted predictive modelling method demonstrated superior precision and robustness in the PASS threshold calculation compared with the ROC analysis. This threshold provides a disease-specific reference for clinical decision making and research in patellofemoral instability.</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":"2789-2795"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002764","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":"Sensor-guided robot-assisted TKA more precisely achieves targeted functional knee phenotypes than conventional robotic-assisted technique","authors":"Jin Wang,&nbsp;Boyong Wang,&nbsp;Hao Shen,&nbsp;Yunsu Chen","doi":"10.1002/ksa.70174","DOIUrl":"10.1002/ksa.70174","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study conducted a comparison between sensor-guided robotic-assisted (SGR) total knee arthroplasty (TKA) and conventional robotic-assisted (ConR) TKA. The objective was to determine whether the SGR protocol yields superior restoration of targeted knee phenotypes and clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 77 primary TKAs (July 2023–March 2024) were analyzed, comprising the SGR group (<i>n</i> = 40) and ConR group (<i>n</i> = 37) on the same platform. The SGR group followed a planned asymmetric gap target of 17 mm (medial) and 18 mm (lateral) through bony resection, with subsequent sensor-guided soft-tissue release to achieve L‑FKPext‑neutr/L‑FKPflex‑neutr, medial pressure &gt; lateral pressure and ICPD 0–66.0 N. In contrast, the ConR group targeted symmetric 18 mm gaps and used the sensor for data collection only, without feedback. Bony and laxity phenotypes were recorded. Outcomes included VAS, KSS and a 5‑item satisfaction survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The SGR group achieved higher L-FKPext-neutr/L-FKPflex-neutr rates (<i>p</i> &lt; 0.001) and required more soft tissue releases (85% vs. 43.2%, <i>p</i> &lt; 0.001). At 12 months, SGR group demonstrated superior pain relief (VAS: 1.3 ± 0.9 vs. 1.7 ± 0.6, <i>p</i> = 0.013) and functional outcomes (KSS: 89.2 ± 5.1 vs. 86.9 ± 5.3, <i>p</i> = 0.042). Both groups showed comparable alignment with no complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The SGR protocol was successful in precisely targeting specific intraoperative bony and laxity phenotypes, without increasing complication risks. Further research is needed to determine if these improvements reach the minimal clinically important difference for long-term postoperative outcomes.</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":"2866-2876"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440533","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":"Revision from unicompartmental knee arthroplasty to total knee arthroplasty: An analysis of 118 cases at midterm follow-up","authors":"Marius Jonathan Ibach,&nbsp;Oscar Torney,&nbsp;Christoph E. Horn,&nbsp;Alexander Frenzel,&nbsp;Christoph Hubertus Lohmann,&nbsp;Jonas Sina,&nbsp;Daniel Schrednitzki,&nbsp;Andreas Matthias Halder,&nbsp;Nils Meißner","doi":"10.1002/ksa.70156","DOIUrl":"10.1002/ksa.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Aseptic failure of unicompartmental knee arthroplasty (UKA) often requires revision to a total knee arthroplasty (TKA). However, outcomes following revision from UKA to TKA remain controversial. The purpose of this study was to analyze a large cohort of revisions from UKA to TKA, with emphasis on implant survivorship, clinical outcomes and radiographic results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 118 aseptic revisions from UKA to TKA performed at a single surgical center between 2016 and 2022. Of these, 50 were required due to progression of osteoarthritis (42%), and 44 for aseptic loosening (37%). The mean age was 67 years, 65% were female, and the mean body mass index was 31 kg/m². Tibial stem extensions were used in 30% of cases, augments in 9%, and a constrained implant in a single patient. The mean follow-up was 6 years (range, 2.7–10.9).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 8-year survivorship free of any re-revision and reoperation was 94% and 92%, respectively. Progression of osteoarthritis was associated with reduced odds of re-revision (odds ratio [OR]: 0.09; <i>p</i> = 0.025) and reoperation (OR: 0.20; <i>p</i> = 0.04). Knee Society Function Scores (KSS-F) improved from 53 to 82 (<i>p</i> &lt; 0.001), with no correlation to implant type, demographics or radiographic patella height. At final follow-up, the mean Oxford Knee and Forgotten Joint Scores were 33 and 54, respectively. The mean modified Insall-Salvati Ratio was 1.56 preoperatively compared to 1.52 at last follow-up (<i>p</i> = 0.07).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aseptic revision from UKA to TKA provides excellent midterm implant survivorship, clinical outcomes, and radiographic results, particularly when performed for the progression of osteoarthritis.</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":"2842-2850"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423887","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":"The silver tsunami and the elective arthroplasty crisis: How geriatric trauma overruns public surgical capacity","authors":"Patrick Sadoghi,&nbsp;Maximilian Budin,&nbsp;Elmar Herbst,&nbsp;Giuseppe Milano,&nbsp;Volker Musahl,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.70316","DOIUrl":"10.1002/ksa.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Across Europe, orthopaedic departments face a growing disequilibrium: the sharply rising volume of geriatric trauma requiring urgent intervention versus the continued necessity for high-value elective total joint arthroplasty to restore mobility, independence and quality-adjusted life years. In most public systems, the escalation in proximal femoral fractures—driven by demographic shifts —absorbs operative capacity previously allocated to elective arthroplasty. Although trauma surgery should, by definition, be prioritised, the resulting displacement of elective total joint arthroplasty increasingly undermines the principles of value-based care. This editorial discusses the drivers of this development, highlights the clinical and health-economic consequences and outlines practical strategies that European health systems should consider to maintain timely trauma care without sacrificing access to elective arthroplasty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2683-2687"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088811","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":"Preoperative knee laxity is not associated with subjective knee function or revision surgery after primary anterior cruciate ligament reconstruction: An analysis of 5425 patients","authors":"Riccardo Cristiani,&nbsp;Christoffer von Essen,&nbsp;Eric Hamrin Senorski,&nbsp;Camilo P. Helito,&nbsp;Kristian Samuelsson,&nbsp;Karl Eriksson,&nbsp;Magnus Forssblad,&nbsp;Anders Stålman","doi":"10.1002/ksa.70058","DOIUrl":"10.1002/ksa.70058","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;To determine whether preoperative knee laxity, as measured by the KT-1000 arthrometer, was associated with subjective knee function preoperatively and at 1, 2 and 5 years, or with revision anterior cruciate ligament (ACL) reconstruction (ACLR) within 5 years of the primary surgery.&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;Patients who underwent primary ACLR using a hamstring tendon autograft at the Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, and had no associated ligament injuries, were identified. The KT-1000 arthrometer (134-N) was used to assess knee laxity preoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained preoperatively and at 1-, 2- and 5-year follow-ups. Patients who underwent revision ACLR at any hospital or clinic nationwide within 5 years of their primary surgery were identified via the Swedish Knee Ligament Registry. KOOS subscale scores between groups were compared using analysis of covariance (ANCOVA), while differences in revision ACLR rates were evaluated using Cox regression analysis.&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;A total of 5425 patients (54.0% male) with available preoperative KT-1000 arthrometer measurements were included: side-to-side (STS) ≤ 2 mm, 1833 (33.8%); STS 3–5 mm, 2387 (44.0%); STS &gt; 5 mm, 1205 (22.2%). The only significant differences in subjective knee function among the groups were observed in the preoperative KOOS Symptoms (STS ≤ 2 mm: 75.0 ± 17.4; STS 3–5 mm: 75.1 ± 17.5; STS &gt; 5 mm: 76.4 ± 17.1; &lt;i&gt;P&lt;/i&gt; = 0.03) and Pain (STS ≤ 2 mm: 78.9 ± 15.9; STS 3–5 mm: 79.4 ± 15.9; STS &gt; 5 mm: 80.4 ± 15.2; &lt;i&gt;p&lt;/i&gt; = 0.02) subscale. No additional significant differences were observed between the groups in any of the KOOS subscales at the preoperative assessment or at the 1-, 2- or 5-year postoperative follow-ups. At 5 years postoperatively, the revision ACLR rates were 4.8% (89/1833) in the STS ≤ 2 mm group, 4.9% (118/2387) in the STS 3–5 mm group and 6.0% (73/1205) in the STS &gt; 5 mm group. The hazard of revision ACLR within 5 years did not differ significantly from the reference group (STS ≤ 2 mm) for either the STS 3–5 mm group (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.69–1.35; &lt;i&gt;p&lt;/i&gt; = n.s.) or the STS &gt; 5 mm group (HR, 1.19; 95% CI, 0.89–1.60; &lt;i&gt;P&lt;/i&gt; = n.s.). The incidence of medial meniscus injury increased progressively across the laxity groups from 20.7% in the STS ≤ 2 mm group, to 25.0% in the STS 3-5 mm group and 31.9% in the STS &gt; 5 mm group.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Co","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 8","pages":"2814-2822"},"PeriodicalIF":5.5,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995131","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":"Delayed reconstruction is associated with higher rates of medial meniscus and chondral injury following anterior cruciate ligament (ACL) injury: A New Zealand ACL registry study","authors":"Richard Rahardja,&nbsp;Hamish Love,&nbsp;Mark G. Clatworthy,&nbsp;Simon W. Young","doi":"10.1002/ksa.70002","DOIUrl":"10.1002/ksa.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Early reconstruction for anterior cruciate ligament (ACL) rupture may be controversial, with some clinicians opting for a trial of non-operative management first. The impact of delayed surgery on outcomes is unclear, but it may be associated with an increase in secondary intra-articular pathology involving the menisci and cartilage. This study aimed to analyze the association between the timing of surgery and outcomes, including revision ACL reconstruction, concomitant meniscal and chondral injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and December 2022 were included. Timing of surgery was categorized into five groups: ≤6 weeks, 6 weeks to 3 months, 3–6 months, 6–12 months and &gt;12 months. Revision rates and incidence of concomitant meniscal and chondral injury were compared between the five groups of surgical timing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15,586 primary ACL reconstructions were analyzed, of which 1263 were performed within 6 weeks (8%), 3718 between 6 weeks to 3 months (24%), 5129 between 3 and 6 months (33%), 3223 between 6 and 12 months (21%) and 2253 more than 12 months (14%). The incidence of medial meniscal tears was greatest when surgery was delayed 6–12 months (40%, adjusted odds ratio [aOR] = 1.1, <i>p</i> = 0.01) and more than 12 months after injury (53%, aOR = 2.0, <i>p</i> &lt; 0.001). Delayed surgery more than 3 months was associated with an increasing incidence of chondral injury (aOR &gt; 1.3, <i>p</i> &lt; 0.001). Revision rates were lowest in patients who underwent delayed surgery more than 12 months after injury (adjusted hazard ratio [HR] = 0.6, <i>p</i> &lt; 0.001), but differences in activity levels, age, sex and graft choice were noted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Delayed ACL reconstruction is associated with a greater incidence of concomitant medial meniscal and chondral injury and should be considered when trialling non-operative management for ACL rupture.</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 7","pages":"2392-2399"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878011","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":"Lateral meniscus injuries have more impact on pivot shift than anterolateral complex injuries in anterior cruciate ligament-injured knees","authors":"Lukas Willinger,&nbsp;Armin Runer,&nbsp;Romed P. Vieider,&nbsp;Andrea Achtnich,&nbsp;Julian Mehl,&nbsp;Sebastian Siebenlist,&nbsp;Philipp Winkler","doi":"10.1002/ksa.70027","DOIUrl":"10.1002/ksa.70027","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 purpose of this prospective study was to investigate the effect of Kaplan fibres (KF), anterolateral ligament (ALL) and lateral meniscus (LM) injuries on preoperative anterolateral rotational instability (ALRI) in anterior cruciate ligament (ACL)-injured knees. It was hypothesised that injuries to the ALC (i.e., KF and ALL) and to the LM would increase the preoperative anterolateral rotatory knee instability (ALRI) quantified by the pivot shift (PS) test.&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;A prospective registry study was conducted and patients who underwent primary unilateral ACL reconstruction were included. The PS test was preoperatively performed and quantified using the PIVOT iPad application. The anterior translation of the lateral tibia plateau (ATLT) was measured and the side-to-side difference (SSD) was calculated. The PS test was additionally graded according to IKDC criteria. Injuries to the KF, ALL and LM were diagnosed on acute preoperative magnetic resonance imaging (MRI) scans. Student's &lt;i&gt;t&lt;/i&gt;-test was used to compare means and binary regression analysis was used to calculate odds ratio (OR). Statistical significance was set to &lt;i&gt;p&lt;/i&gt; &lt; 0.05.&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;One hundred and twenty-four patients with a mean age of 29.9 ± 11.2 years were included in this study (61% male, 61% right knees). Patients with a LM injury showed a higher likelihood of having a high-grade PS (odds ratio [OR] = 2.5, &lt;i&gt;p&lt;/i&gt; = 0.045). Complete radial meniscus tears of the LM significantly increased the ATLT in the quantified PS test compared to patients with an intact meniscus (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Injuries to the ALL, to the KF or a combination of both were not associated with high-grade PS or an increased ATLT.&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;Concomitant LM tears were associated with a clinical high-grade PS. Complete radial meniscus tears of the lateral meniscus significantly increased the ATLT compared to intact meniscus. Injuries to the ALL or to the KF were not associated with high-grade PS or an increased ATLT. This study provides new clinical evidence that concomitant LM injuries contributes to increased ALRI, highlighting the importance of addressing these structures during ACL reconstruction to optimise rotational instability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Level III diagnostic studies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2418-2426"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025180","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":"Microfracture for full-thickness chondral lesions of the knee in elite athletes leads to high return-to-play rates","authors":"David J. Haslhofer,&nbsp;Jobe Shatrov,&nbsp;Mary Jones,&nbsp;Wahid Abdul,&nbsp;Arman Motesharei,&nbsp;Simon V. Ball,&nbsp;Andy Williams","doi":"10.1002/ksa.12808","DOIUrl":"10.1002/ksa.12808","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Injuries to the knee are common in elite athletes and often involve damage to the articular cartilage. Given the high demands of elite sport, full-thickness articular cartilage defects in the knee can be career-limiting or threatening. Microfracture can promote cartilage repair, but the resultant mixed fibrocartilaginous tissue is believed to be less resilient than the native hyaline cartilage. Doubts remain as to whether it can withstand prolonged and intensive sporting activity, and it has become less popular. Also, there is a view that microfracture compromises the results of subsequent chondral resurfacing surgery options. The aim of this study was to determine the factors affecting return-to-play (RTP) and continued participation in elite sport by athletes after microfracture in the knee.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture by the lead surgeon between 2011 and 2020 was undertaken. RTP was defined as competing in at least one match at a professional level or national/international level in amateur sport.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty athletes with a mean age of 24.7 years (±4.0 years) were included. Thirty (60%) footballers, 13 (26%) rugby players and 7 (14%) other elite athletes were treated. Forty-seven (94%) athletes RTP at a mean time of 9.3 months (±4.1 months) with 43 (86%) still playing at 2 years, and of the 44 with 5-year follow-up, 24 (54.5%) were still playing. The lateral femoral condyle was the most common location for the chondral lesion (56%). Larger lesions (over 2 cm diameter) significantly reduced RTP (<i>p</i> = 0.048), and the ability to continue to play at 5 years (<i>p</i> = 0.051 and <i>p</i> = 0.002), but this was not significant at 2 years. Multiple lesions significantly reduced playing at 2 and 5 years (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The rate of RTP of professional athletes after microfracture in the knee is high but takes a long time, and the ability to continue playing reduces over time and is affected by the size and number of lesions requiring microfracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2352-2358"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12808","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839913","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}