Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Age-specific over-the-top techniques for physeal sparing anterior cruciate ligament (ACL) reconstruction in skeletally immature patients: Current concepts for prepubescents to older adolescents.","authors":"Alberto Grassi, Kyle A Borque, Mitzi S Laughlin, Matthew A Tao, Stefano Zaffagnini","doi":"10.1002/ksa.12607","DOIUrl":"https://doi.org/10.1002/ksa.12607","url":null,"abstract":"<p><p>Tailored surgical strategies for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients are presented, emphasizing techniques to minimize growth plate damage and ensure stability. As ACL injuries in youth increase, delaying surgery can lead to joint damage and poor recovery outcomes. Using magnetic resonance imaging-based assessments of skeletal maturity, the authors propose the 'over-the-top (OTT)' approach with lateral tenodesis, adapted for three growth stages: prepubescents, young adolescents and older adolescents. For prepubescents, the extra-physeal approach avoids growth plate drilling; for young adolescents, the supra-physeal technique places tunnels above the growth plate; and for older adolescents, the trans-physeal method mirrors adult techniques, as growth plates are closing. The minimally invasive OTT technique preserves hamstring insertion, ensures isometric graft placement, and allows for combined intra- and extra-articular procedures to improve rotational control and protect the graft. Clinical outcomes highlight high return-to-sport rates, minimal growth disturbances, and low failure rates, although older adolescents show higher graft failures due to activity levels. Various adaptations of the OTT and lateral tenodesis techniques utilizing hamstring tendons provide promising solutions for addressing ACL injuries in skeletally immature patients, ranging from prepubescence to late adolescence. Assessing skeletal age and estimating remaining bone growth are essential for selecting the most appropriate surgical method. The biomechanical principles and positive clinical results observed across different patient groups highlight these techniques as effective, safe and attractive options for managing these challenging cases. LEVEL OF EVIDENCE: Level IV.</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":"143123180","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":"Pain-related fear induces aberrant drop jump landing biomechanics in healthy and anterior cruciate ligament reconstructed females.","authors":"Robert I Dudley, Everett B Lohman, Lida Gharibvand, Christopher S Patterson","doi":"10.1002/ksa.12604","DOIUrl":"https://doi.org/10.1002/ksa.12604","url":null,"abstract":"<p><strong>Purpose: </strong>Rupture of the anterior cruciate ligament (ACL) is a prevalent and debilitating injury typically arising from aberrant biomechanics during landing or deceleration tasks. Pain-related fear, a component of kinesiophobia, has been associated with poor functional outcomes and altered movement patterns in individuals with ACL reconstruction (ACLr), however, the influence of pain-related fear on landing mechanics remains unclear. The purpose of this investigation was to examine the effects of pain-related fear on landing movement patterns in a population of ACLr and healthy females.</p><p><strong>Methods: </strong>Thirty-two females (15 recreationally active with a history of ACLr and 17 recreationally active with no history of ACLr) took part. Participants performed five trials of a drop jump (DJ) task (Baseline), underwent a pain stimulus (PS) familiarization task utilizing an electrical stimulus to induce pain-related fear, and performed a subsequent round of DJs while under threat of PS (PS-threat). Lower extremity and trunk kinematics, ground reaction force (GRF) data and muscle activation were analyzed.</p><p><strong>Results: </strong>At baseline, ACLr participants scored higher (21 ± 5.5) on the TSK-11 compared to healthy participants (17 ± 3.4) (p = 0.007). For both groups, the PS intervention significantly increased pain-related fear (ACLr p < 0.001; Healthy p < 0.001). When comparing baseline to PS-threat trials, ACLr participants experienced a significant increase in peak GRF (p = 0.005), decreases in hip (p = 0.003) and knee (p = 0.005) flexion, decreased contact time (p = 0.006) and decreased muscle preactivation for all muscles tested (p < 0.05). Healthy participants experienced significant increases in peak GRF (p = 0.014) and decreased hip (p = 0.005) and trunk peak (p = 0.004) flexion.</p><p><strong>Conclusions: </strong>Pain-related fear alters landing biomechanics in healthy and ACLr females. This may implicate pain-related fear as a contributor to movement alterations commonly associated with ACL injury risk.</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":"143122734","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":"Robotic functional alignment in knee arthroplasty minimizes impact on ankle alignment: Role of MPTA and LDFA preservation.","authors":"Rudy Sangaletti, Alice Montagna, Giulio Calandra, Luca Andriollo, Claudio Bna, Francesco Benazzo, Stefano Marco Paolo Rossi","doi":"10.1002/ksa.12615","DOIUrl":"https://doi.org/10.1002/ksa.12615","url":null,"abstract":"<p><strong>Purpose: </strong>Alignment strategies in knee arthroplasty have a profound influence not only on knee biomechanics but also on the biomechanics of adjacent joints, particularly the ankle. Functional alignment (FA) represents a flexible alignment strategy aimed at achieving patient-specific balance. However, predefined boundaries are often applied to ensure mechanical stability, leading to adjustments in the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) while still respecting the patient's native alignment as much as possible. FA is a patient-specific strategy that seeks to respect the patient's preoperative phenotype or constitutional alignment while achieving a balanced and stable knee. The hypothesis is that FA strategies can protect the ankle from excessive biomechanical stress.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on 300 consecutive patients who underwent robotic-assisted knee arthroplasty. Preoperative and 6-month post-operative radiographic evaluations measured key ankle parameters, tibial plafond inclination (TPI), talar inclination (TI) and Talar Tilt (TT). Statistical analyses evaluated the influence of alignment strategies on these parameters, with particular focus on whether MPTA and LDFA crossed the 90° threshold, indicating a shift from varus to valgus or vice versa.</p><p><strong>Results: </strong>FA demonstrated smaller changes in ankle parameters compared to mechanical alignment (MA). In the FA group, mean changes were 1.8° for KTPA (standard deviation [SD] = 1.1°, p = 0.03), 2.4° for TPI (SD = 1.0°, p = 0.04), 2.1° for TI (SD = 1.3°, p = 0.05) and 1.7° for TT (SD = 0.9°, p = 0.04). The MA group showed greater deviations: 3.9° for KTPA (SD = 1.5°, p = 0.01), 5.2° for TPI (SD = 1.2°, p = 0.02), 4.8° for TI (SD = 1.4°, p = 0.03) and 3.6° for TT (SD = 1.1°, p = 0.04). Alterations in LDFA and MPTA exceeding 2° were significantly associated with worsening ankle alignment. Furthermore, FA, with its goal of maintaining Coronal Plane Alignment of the Knee (CPAK) classification, was associated with minimal modifications to ankle angles, suggesting potential biomechanical benefits as reported in the literature.</p><p><strong>Conclusions: </strong>FA was associated with smaller changes in ankle alignment parameters, indicating its ability to better preserve native joint positioning. Future research should focus on longitudinal studies to confirm these benefits and further establish the FA strategy as a standard in knee arthroplasty, particularly its capacity to maintain CPAK classification alignment.</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":"143189672","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":"3D kinematics of noncontact and indirect contact ACL injuries in elite male football players.","authors":"Alice Ranzini, Cristiano Alessandro, Monica Nitri, Alessandro Pellegrini, Fabio Esposito, Francesco Della Villa, Matteo Zago","doi":"10.1002/ksa.12612","DOIUrl":"https://doi.org/10.1002/ksa.12612","url":null,"abstract":"<p><strong>Purpose: </strong>Our primary goal was to deepen the understanding of the mechanisms leading to anterior cruciate ligament (ACL) injuries by reconstructing the three-dimensional (3D) joint kinematics of ACL injuries that occurred in professional male football matches. In particular, we aimed to compare the time courses of trunk and injured limb joint angles between noncontact and indirect contact injury mechanisms.</p><p><strong>Methods: </strong>In this cross-sectional observational study, we analysed a total of 27 cases (18 noncontact, 9 indirect contact). Whole-body 3D kinematics preceding and during ACL injuries was reconstructed using the Model-Based Image-Matching technique, implemented in Blender. For each injury, television footage from multiple perspectives (≥2, nine frames per view) were used, and Euler's joint angles across all the anatomical planes were extracted. The joint angle time courses of both the trunk and the injured limb, comprising 12 waveforms in total, were compared between injury mechanisms and Statistical Parametric Mapping was used to detect significant clusters.</p><p><strong>Results: </strong>Compared to noncontact injuries, indirect contact cases showed a lower hip abduction (-16°, p = 0.003), knee internal rotation (~3°, p < 0.001) at the initial contact with the ground, and ankle dorsiflexion (~7°, p = 0.035) at instants before the initial ground contact. These differences resulted from the player's adaptation to the sudden (yet variable) mechanical perturbation due to the contact with the opponent.</p><p><strong>Conclusion: </strong>Mechanical interactions with other players impact segmental kinematics before and during ACL injuries in professional male football. These findings reinforce the importance of considering the sport-specificity of mechanisms in injury prevention.</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":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123179","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":"Improving predictability of post-operative knee joint line obliquity in high tibial osteotomy: A new radiographic parameter correcting for foot position.","authors":"M Mertens, N van Beek, T Claes, W J Vleugels, Y Nys, S Claes, S Bartholomeeusen","doi":"10.1002/ksa.12598","DOIUrl":"https://doi.org/10.1002/ksa.12598","url":null,"abstract":"<p><strong>Purpose: </strong>Joint line obliquity is crucial for the long-term success of a high tibial osteotomy (HTO), particularly when large corrections are made. The relationship between the size of correction and changes in joint line obliquity (KJLO) is complex, often leading to the preference for a double-level osteotomy to manage significant post-operative obliquity. We aim to improve the prediction of knee joint line orientation changes and correction size by examining the influence of foot position. The goal is to develop a linear model to predict post-operative KJLO, which could assist in determining whether a single- or double-level osteotomy is necessary to prevent excessive post-operative joint line obliquity.</p><p><strong>Methods: </strong>A retrospective radiographic analysis was conducted on patients who underwent HTO surgery between April 2016 and April 2017. Ninety-one patients were randomly selected for radiographic measurements on long-leg radiographs pre- and 3-month post-operative. A novel radiographic parameter was introduced to realign the foot of the operated side to the midline. The foot position relative to the midline was assessed by determining the angle formed when rotating the natural foot position onto the midline using the centre of the hip as a rotation point. The angle obtained by subtracting this from the KJLO results in a corrected KJLO for midline foot position (aKJLO).</p><p><strong>Results: </strong>Predictive model of differences between pre- and post-operative values of MPTA (ΔMPTA [medial proximal tibial angle]) and KJLO (ΔKJLO) was less predictive (0.185 [p < 0.001]) than ΔMPTA and ΔKJLO corrected for foot position, namely ΔaKJLO (0.688 [p < 0.001]). Adding more parameters did not significantly improve the linear model's predictions.</p><p><strong>Conclusion: </strong>Predictability of aKJLO could be significantly enhanced. With this new parameter, inter- and intra-variability of foot position is bypassed. A safe MPTA position of 91° can be presumed; however, inter-individual variability in limb adaptation following correction remains uncertain.</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":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080319","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":"Robotic-assisted partial knee surgery performances: A 10-year follow-up retrospective study.","authors":"Piergiuseppe Perazzini, Paolo Sembenini, Francesco Alberton, Andrea Cochetti, Bernardo Innocenti, Edoardo Bori","doi":"10.1002/ksa.12599","DOIUrl":"https://doi.org/10.1002/ksa.12599","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic surgery has emerged as an advanced technique for facilitating knee prosthesis implantation, especially in cases requiring high precision. However, due to the recent introduction and implementation of this approach, long-term data on its outcomes remain limited in the literature. This study aims to assess implant survival, complications and reoperation rates resulting from robotic arm-assisted partial knee arthroplasties, with a long-term follow-up period.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 236 patients who underwent robotic arm-assisted partial knee arthroplasty, with a minimum follow-up of 10 years. Clinical outcomes were evaluated, focusing on implant survival, complications, reoperation rates, and overall patient satisfaction. The study primarily examined medial unicompartmental knee arthroplasty (UKA), with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS) Part 1 and KSS Function scores assessed preoperatively and at the last follow-up.</p><p><strong>Results: </strong>Among the 236 patients, 212 were available at the last follow-up; satisfaction rates were overall positive, with 210 patients reporting being 'satisfied' or 'very satisfied'. Both WOMAC score and KSS showed statistically significant improvement postoperatively, both globally and in UKA patients specifically.</p><p><strong>Conclusions: </strong>The study demonstrates excellent long-term satisfaction rates, improved clinical outcomes and implant survival with minimal surgical morbidity. These findings offer valuable insights into the effectiveness of robotic arm-assisted knee arthroplasty.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080331","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":"Lack of validated patient-reported outcome tools persists in paediatric and adolescent hip arthroscopy-A systematic review.","authors":"Ayomide Michael Ade-Conde, Brendan Amoyaw, Yoan Bourgeault-Gagnon, Hassaan Abdel Khalik, Nicole Simunovic, Olufemi R Ayeni","doi":"10.1002/ksa.12603","DOIUrl":"https://doi.org/10.1002/ksa.12603","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aimed to (1) identify commonly used patient-reported outcome (PRO) tools in paediatric hip arthroscopy and (2) assess whether the PROs used in this population have been formally validated.</p><p><strong>Methods: </strong>Two systematic searches of MEDLINE, Embase and CENTRAL, from inception to 31 March 2024 and 22 August 2024, respectively, followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The first search identified PRO instruments used in studies on hip arthroscopy in patients aged 19 and under. The second focused on the clinimetric properties of these tools in paediatric hip arthroscopy. PRO utilization was stratified by pathology, trends over time and publication type. Use of the Consensus-based Standards for the Selection of Health Measurement Instruments tool, and a descriptive analysis, were planned to assess the eligible clinimetric studies.</p><p><strong>Results: </strong>Fifty-seven studies were included, identifying 10 hip-specific and 5 nonspecific PROs. The second search did not identify any clinimetric studies on these tools used in paediatric patients. The most commonly reported hip-specific PRO were the modified Hip Harris Score (n = 48), the Hip Outcome Score-Sport-Specific Subscale (n = 25) and the Non-Arthritic Hip Score (n = 20). Hip arthroscopy was used to treat over seven different conditions, with femoroacetabular impingement being the most common (n = 41, 77%). Between 2005 and 2024, the variety of hip-specific PROs increased, with seven new ones introduced by 2019-2024. Additionally, this study found a relatively equal distribution of outcomes across presentation abstracts and manuscripts.</p><p><strong>Conclusions: </strong>The key finding of this study is the ongoing lack of hip-specific PRO tools in the paediatric hip arthroscopy literature, with reliance on adult-derived instruments. The absence of clinimetric studies and heterogeneity in PRO use emphasises the need for standardized, paediatric-specific tools. Developing and validating such instruments should be prioritized to ensure accurate, age-appropriate outcome assessment and care.</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":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High failure rate in meniscal repair when preceding anterior cruciate ligament reconstruction: An analysis of two-stage surgery for concomitant ACL injury and traumatic meniscus tear.","authors":"Adolfo López Personat, Riccardo Cristiani, Anders Stålman, Johan Wänman, Christoffer Von Essen","doi":"10.1002/ksa.12593","DOIUrl":"https://doi.org/10.1002/ksa.12593","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the failure rate, predictive factors associated with failure and clinical outcomes after a two-stage surgery; meniscus repair followed by subsequent anterior cruciate ligament (ACL) reconstruction (ACLR).</p><p><strong>Methods: </strong>Patients with a concomitant traumatic meniscus tear and ACL injury who underwent a two-stage surgery between January 2015 and January 2021 were identified. The primary outcome was meniscal repair failure, defined as a reoperation (re-repair or resection). A Cox-regression analysis was used in order to analyse factors associated with meniscal repair failure within 3 years after the primary surgery for a meniscal repair. Secondary outcomes were range of motion (ROM), anterior knee laxity and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 1- and 2-year follow-up. The thresholds of patient acceptable symptom state (PASS), treatment failure (TF) and minimum important change (MIC) were applied to KOOS4 (mean score of the KOOS Pain, Symptoms, Sports/Rec and QoL subscales).</p><p><strong>Results: </strong>A total of 150 patients were included. The meniscal repair failure rate after 3 years was 36.7%. Failure of meniscal repair was significantly associated with a time interval >1 year between the meniscal repair to the ACLR (hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.2-5.5; p < 0.01), medial meniscus repair (HR = 2.3; 95% CI = 1.6-3.4; P < 0.01), and female sex (HR = 1.42; 95% CI = 1.0-1.9; p = 0.01). The age of the patient was not associated with meniscal repair failure. At the 6-month follow-up, most patients (72.5%) showed less than 2 mm of knee laxity; four patients (6.7%) experienced loss of extension and four patients (1.7%) experienced loss of flexion. On the KOOS4, at the 2-year follow-up, PASS was achieved in 53.4%, TF occurred in 1.7%, and MIC was reached in 36.4% of patients.</p><p><strong>Conclusion: </strong>The meniscus repair failure rate after the staged procedure was 36.7% at 3 years. A longer time interval from meniscal repair to ACLR, medial meniscus repair, and female sex were associated with an increased risk of meniscal repair failure. Age was not associated with meniscal repair failure.</p><p><strong>Level of evidence: </strong>Level IV case series retrospective study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059728","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":"Welcoming Dr. Hany Bedair as an Associate Editor for KSSTA","authors":"Michael T. Hirschmann,&nbsp;Elmar Herbst,&nbsp;Giuseppe Milano,&nbsp;Volker Musahl","doi":"10.1002/ksa.12606","DOIUrl":"10.1002/ksa.12606","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 3","pages":"802"},"PeriodicalIF":3.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052459","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":"Combined use of cleft and truncated triangle signs helps improve the preoperative MRI diagnosis of lateral meniscus posterior root tears in patients with ACL injuries.","authors":"Aritoshi Yoshihara, Caroline Mouton, Renaud Siboni, Tomomasa Nakamura, Ichiro Sekiya, Hideyuki Koga, Romain Seil, Yusuke Nakagawa","doi":"10.1002/ksa.12597","DOIUrl":"https://doi.org/10.1002/ksa.12597","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate whether combining the analysis of different magnetic resonance imaging (MRI) signs enhances the diagnostic accuracy of lateral meniscus posterior root tears (LMPRTs) in patients with anterior cruciate ligament (ACL) injuries. We hypothesised that analysing the cleft, ghost and truncated triangle signs and lateral meniscus extrusion (LME) measurement together would improve the preoperative MRI-based diagnosis of LMPRTs.</p><p><strong>Methods: </strong>This retrospective study used prospectively collected registry data from two academic centres, including patients undergoing primary or revision ACL reconstruction (ACLR) and LMPRT repair. The control group included age- and sex-matched (1:1) patients undergoing ACLR without any lateral meniscus tears. LME (mm) and the presence of cleft, ghost and/or truncated triangle signs were evaluated using preoperative MRI.</p><p><strong>Results: </strong>In total, 252 patients (126 per group) were included. Individually, the cleft and truncated triangle signs achieved the highest sensitivity (60% and 62%, respectively) and accuracy (>89%). The presence of either sign increased sensitivity to 79% and enabled the correct classification of 93% of ACL injuries as having or not having an LMPRT, with high specificity (95%) and good positive predictive value (74%). This combination was considered the most efficient in reducing false positives and false negatives. The LME (cutoff value: 2.2 mm) and ghost sign had lower sensitivities (50% and 14%, respectively) and accuracies (83% and 87%) and were not part of the optimal combination.</p><p><strong>Conclusion: </strong>The cleft and/or truncated triangle signs on preoperative MRI reliably detected 79% of LMPRTs in this cohort, with high specificity (95%) and good positive predictive value (74%). This combination provides an effective method for achieving reasonable sensitivity while minimising false positives, aiding surgeons in preoperative diagnosis and planning for LMPRT repair.</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":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047038","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}