Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Deltoid ligament injuries: When and how to repair.","authors":"Emanuel Cortesão Seiça, Daniel Mendes, Manuel Resende Sousa, João Vide","doi":"10.1002/ksa.12576","DOIUrl":"https://doi.org/10.1002/ksa.12576","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to illustrate the assessment and treatment strategies of acute and chronic deltoid ligament injuries, providing a treatment algorithm for each scenario.</p><p><strong>Methods: </strong>A retrospective review was conducted on 39 patients, who had either an acute deltoid ligament injury or suffered chronic deltoid ligament insufficiency. All patients were operated on between January 2016 and December 2022. The cases represent a range of different clinical scenarios, including acute trauma, chronic insufficiency or instability situations. Clinical and imaging evaluation, surgical techniques and clinical outcomes are presented.</p><p><strong>Results: </strong>The mean follow-up time was 21.3 months (±4.5). Acute trauma represented 18 (46%) of the ankles, while 21 (54%) had chronic instability. Treatment options were tailored according to the aetiology, patient characteristics, injury pattern and associated lesions. In 11 of the 18 acute deltoid ruptures (64%), repair was performed using suture anchors, while the remaining 7 cases were treated with direct suture. In chronic deltoid insufficiency, re-tensioning with suture anchor was performed in 14 (67%) ankles, suture imbrication in 5 (24%) and reconstruction in 6 (9%). The most common associated injuries were syndesmotic injuries (n = 12, 56%) and osteochondral lesions (n = 13, 36%). The complication rate was 18% (n = 7), the majority related to persistent stiffness (n = 4, 10%).</p><p><strong>Conclusion: </strong>The decision on when and how to repair the deltoid ligament should be guided by the characteristics of the injury and the individual patient. The current treatment rationale may serve as a working basis for evaluating and treating these ankles.</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":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909863","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 use of an imageless robotic system in revision of unicompartmental knee arthroplasty.","authors":"Luca Andriollo, Francesco Benazzo, Virgina Cinelli, Rudy Sangaletti, Calogero Vellutto, Stefano Marco Paolo Rossi","doi":"10.1002/ksa.12574","DOIUrl":"https://doi.org/10.1002/ksa.12574","url":null,"abstract":"<p><strong>Purpose: </strong>The application of robotics in revision arthroplasty particularly from unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA), is underexplored. The purpose of this study is to describe the surgical technique of an imageless robotic system used in the revision of UKA to TKA and to evaluate short- to mid-term outcomes.</p><p><strong>Methods: </strong>This prospective study includes 35 patients treated from May 2020 to July 2023. Demographic data of the patients were gathered and the reasons for needing revision surgery were assessed. All patients were clinically evaluated preoperatively and at the final follow-up of 31.3 ± 12.1 months, using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), Numerical Rating Scale (NRS) and range of motion (ROM). Additionally, a radiographic evaluation was performed, and implant survival was assessed by analyzing complications at final follow-up.</p><p><strong>Results: </strong>In 88.6% of the patients, a primary Posterior Stabilized (PS) or Constrained Posterior Stabilized prosthetic implant was used, with 11.4% of patients requiring a varus-valgus constraint implant. In 71.4% of the cases, a thinnest size liner of 10 mm was used. The use of the robotic system was never aborted for any reason. At final follow-up, the implant survival rate was 97.14%. Average OKS increased from 31.4 ± 9.4 to 41.5 ± 4.3, FJS-12 from 47.3 ± 19.3 to 80.7 ± 8.9; WOMAC at final follow-up was 17.8 ± 8.7, from 53.5 ± 21.3 preoperatively. Analyzing ROM, NRS and patient-reported outcome measures, there were significant differences in each parameter between prerevision surgery and final follow-up.</p><p><strong>Conclusions: </strong>This study highlights that in a cohort of patients undergoing robotic-assisted conversion from UKA to TKA, the use of an imageless procedure incorporating intraoperative bone morphing and alignment based on a functional philosophy has proven to be safe and has yielded excellent clinical and radiographic outcomes.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909826","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 specificity of an AI-powered framework in cross-checking male professional football anterior cruciate ligament tear reports in public databases.","authors":"Pedro Diniz, Bernd Grimm, Caroline Mouton, Christophe Ley, Thor Einar Andersen, Romain Seil","doi":"10.1002/ksa.12571","DOIUrl":"https://doi.org/10.1002/ksa.12571","url":null,"abstract":"<p><strong>Purpose: </strong>While public databases like Transfermarkt provide valuable data for assessing the impact of anterior cruciate ligament (ACL) injuries in professional footballers, they require robust verification methods due to accuracy concerns. We hypothesised that an artificial intelligence (AI)-powered framework could cross-check ACL tear-related information from large publicly available data sets with high specificity.</p><p><strong>Methods: </strong>The AI-powered framework uses Google Programmable Search Engine to search a curated, multilingual list of websites and OpenAI's GPT to translate search queries, appraise search results and analyse injury-related information in search result items (SRIs). Specificity was the chosen performance metric-the AI-powered framework's ability to accurately identify texts that do not mention an athlete suffering an ACL tear-with SRI as the evaluation unit. A database of ACL tears in male professional footballers from first- and second-tier leagues worldwide (1999-2024) was collected from Transfermarkt.com, and players were randomly selected for appraisal until enough SRIs were obtained to validate the framework's specificity. Player age at injury and time until return-to-play (RTP) were recorded and compared with Union of European Football Associations (UEFA) Elite Club Injury Study data.</p><p><strong>Results: </strong>Verification of 231 athletes yielded 1546 SRIs. Human analysis of the SRIs showed that 335 mentioned an ACL tear, corresponding to 83 athletes with ACL tears. Specificity and sensitivity of GPT in identifying mentions of ACL tears in a player were 99.3% and 88.4%, respectively. Mean age at rupture was 26.6 years (standard deviation: 4.6, 95% confidence interval [CI]: 25.6-27.6). Median RTP time was 225 days (interquartile range: 96, 95% CI: 209-251), which is comparable to reports using data from the UEFA Elite Club Injury Study.</p><p><strong>Conclusion: </strong>This study shows that an AI-powered framework can achieve high specificity in cross-checking ACL tear reports in male professional football from public databases, markedly reducing manual workload and enhancing the reliability of media-based sports medicine research.</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":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895740","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-grade trochlear dysplasia increases patellofemoral joint pressure and decreases the knee extension torque, and tibial tubercle anteriorisation does not correct these effects: Biomechanical study in vitro.","authors":"Michael Dan, Maria Moralidou, Isabelle Kuder, Richard J van Arkel, David Dejour, Andrew A Amis","doi":"10.1002/ksa.12570","DOIUrl":"https://doi.org/10.1002/ksa.12570","url":null,"abstract":"<p><strong>Purpose: </strong>High-grade femoral trochlear dysplasia is associated with anterior knee pain, patellar maltracking, instability and the development of osteoarthritis. Scientific studies have signified the importance of trochlear resection on the knee extensor mechanism, and dysplasia can be addressed by a groove-deepening trochleoplasty. Alternatively, tibial tubercle anteriorisation has been proposed to reduce patellofemoral joint (PFJ) pressure and alleviate pain from osteoarthritis. However, the relative contributions of articular changes in the sagittal and axial planes remain unknown. This study aimed to better understand the effect of these different osteotomies, that alter the sagittal plane geometry, on PFJ biomechanics.</p><p><strong>Methods: </strong>Seven cadaveric knees were used to measure the following factors: (1) PFJ contact pressure; (2) Knee extension torque (KET); and (3) Patellar kinematics at 60°, 45°, 30°, 15° and 0° of knee flexion among four different osteotomy states: native, anteriorised trochlea, combined anteriorised trochlea and anteriorised tibial tubercle, and anteriorised tibial tubercle. Analysis was made using a two-way repeated-measures analysis of variance.</p><p><strong>Results: </strong>Anteriorising the trochlea increased mean PFJ contact pressures ×2.9 at 0° (p = 0.024) and ×2.2 (p = 0.029) at 15° flexion compared to the native state. Peak pressures increased ×4.9 at 0° and ×3.3 at 15° (n.s.). Anteriorising the trochlea reduced KET 18% (p = 0.001) at 40° flexion and 19% (p = 0.009) at 50°. The patella was anteriorised 8 mm in the extended knee (p < 0.001) and flexed 8° at 45° knee flexion (p < 0.001) compared to the native state. Elevating the tibial tubercle, alone or combined with an anteriorised trochlea, did not have a significant effect on the respective outcome measurements.</p><p><strong>Conclusion: </strong>An anteriorised trochlea elevated PFJ contact pressure, reduced KET and altered patellar position during knee flexion/extension movement, while a tibial tubercle anteriorisation had a negligible opposite effect. These findings indicate that symptoms associated with high grade trochlear dysplasia may be addressed better at the trochlea, rather than at the tibial tubercle.</p><p><strong>Level of evidence: </strong>Basic science.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885905","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":"Pros and cons of sub-specialisation in orthopaedics and traumatology-Is the general orthopaedic and trauma surgeon a relic of the past?","authors":"Marko Ostojic, Hassan Tarek Hakam, Srecko Sabalic, Pier Francesco Indelli, Michael T Hirschmann, Mislav Jelic, Nanni Allington, David Limb, Roland Becker","doi":"10.1002/ksa.12564","DOIUrl":"https://doi.org/10.1002/ksa.12564","url":null,"abstract":"<p><p>The evolution of orthopaedics has witnessed a pronounced shift from generalist practice to subspecialisation, a trend that has fundamentally reshaped the field over the past century. Originally, orthopaedic surgeons were trained to address a broad spectrum of musculoskeletal conditions. However, increasing complexity and specialization in knowledge have driven a progressive narrowing of focus within orthopaedics. This editorial explores the rise of subspecialty training and fellowship programs in orthopaedics, particularly in North America, where over 90% of orthopaedic surgeons now pursue subspecialty fellowships. While subspecialisation has improved surgical outcomes and created experts in specific anatomical regions and techniques, it has also led to challenges. Surgeons with highly focused expertise may face difficulties in managing conditions outside their niche, and subspecialisation may inadvertently limit comprehensive patient care, especially for those with complex, multi-faceted needs. The career paths of orthopaedic trainees are increasingly shaped by both personal interests and market demands, with subspecialists seeking greater professional and economic benefits. Additionally, orthopaedic training models in Europe vary, further complicating a unified approach to subspecialisation. This editorial calls for a balanced perspective that values both subspecialty excellence and the broad-based skills of orthopaedic generalists, particularly as the future of generalist orthopaedic practice faces uncertainty amidst ongoing subspecialisation trends.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885926","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":"Thin flap sulcus-deepening trochleoplasty in patellar instability yields good functional outcomes without progressive cartilage deterioration in the short-term follow-up-A retrospective single-surgeon cohort study.","authors":"Jannik Frings, Eva Janssen, Matthias Krause, Karl-Heinz Frosch, Eik Vettorazzi, Andreas Weiler, Arno Schmeling","doi":"10.1002/ksa.12566","DOIUrl":"https://doi.org/10.1002/ksa.12566","url":null,"abstract":"<p><strong>Purpose: </strong>Sulcus-deepening trochleoplasty (TP) effectively treats patellofemoral (PF) instability (PFI) caused by high-grade trochlear dysplasia (TD), but current evidence is based on small case series. We hypothesised, that TP would result in significant functional improvements and a low re-dislocation rate but would not accelerate the progression of PF cartilage deterioration.</p><p><strong>Methods: </strong>We retrospectively reviewed all TP cases performed by a single surgeon between 2015 and 2021. Inclusion criteria were postoperative Magnetic resonance imaging (MRI) >6 and >12 months and a clinical follow-up >12 months. Patients with simultaneous cartilage repair, open physes or incomplete records were excluded. Clinical outcomes were assessed using pre- and postoperative scores, postoperative Banff Patellofemoral Instability Instrument (BPII) 2.0 and Knee Injury and Osteoarthritis Outcome Score (KOOS), re-dislocation rate and patient satisfaction. PF cartilage was evaluated via Area Measurement and Depth & Underlying Structures (AMADEUS) scores preoperatively, at 6 months and at the final follow-up.</p><p><strong>Results: </strong>We included 113 patients (25.8 ± 8.3 years) with high-grade TD (Dejour B-D; mean lateral inclination angle: -2.9 ± 9.1°), 85% of whom had advanced cartilage lesions. All underwent TP, lateral retinacular lengthening (LRL) and medial patellofemoral ligament reconstruction (MPFL-R). After 34.8 ± 20.9 months, function, pain levels and Tegner scores improved significantly (p < 0.001). KOOS dimensions were: symptoms 79.9 ± 13.5, pain 86.4 ± 12.1, activity 91.9 ± 8.3, sports 71.7 ± 22.2 and quality-of-life 58.1 ± 23.8. BPII 2.0 was 64.3 ± 31.4. Preoperative AMADEUS scores (55.2 ± 17.4) remained stable at 6 months (p = 0.343) but improved to 58.4 ± 16.0 at 28.6 (12-89) months (p = 0.004). Complication and re-dislocation rates were 5.3% and 1.8%, with 93% patient satisfaction.</p><p><strong>Conclusion: </strong>Sulcus-deepening TP with MPFL-R and LRL yields good to excellent short-term results without progressive chondral deterioration, enabling patients to return to their prior or higher activity levels despite advanced preoperative chondral lesions. TP can be considered a safe, joint-preserving technique for PF stabilisation.</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":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885933","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":"Poor knee strength is associated with higher incidence of knee injury in adolescent female football players: The Karolinska football injury cohort.","authors":"Anne Fältström, Martin Asker, Nathan Weiss, Victor Lyberg, Markus Waldén, Martin Hägglund, Ulrika Tranaeus, Eva Skillgate","doi":"10.1002/ksa.12567","DOIUrl":"https://doi.org/10.1002/ksa.12567","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.</p><p><strong>Methods: </strong>Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference.</p><p><strong>Results: </strong>376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile.</p><p><strong>Conclusions: </strong>Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885909","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":"Recentering the humeral head does not necessarily improve glenohumeral abduction: A cadaveric biomechanical study.","authors":"Qingxiang Hu, Chenkai Li, Di Wu, Zian Gu, Hui Xu, Shi Zhan, Xiaofeng Zhang, Zhekun Zhou, Yaohua He","doi":"10.1002/ksa.12569","DOIUrl":"https://doi.org/10.1002/ksa.12569","url":null,"abstract":"<p><strong>Purpose: </strong>To explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).</p><p><strong>Methods: </strong>Nine fresh-frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four 'recenter' interventions were then sequentially applied: subacromial interposition (SI) using 4- and 8-mm spacers and superior capsule reconstruction (SCR) using two- and four-layer fascia lata grafts. Dynamic biomechanical experiments were performed for each condition. The primary outcomes were glenohumeral abduction angle (GAA). The secondary outcomes were acromiohumeral distance (AHD) and subacromial contact pressure.</p><p><strong>Results: </strong>In the intact condition, the GAA was significantly greater compared to the IMRCT condition at most deltoid force levels (p < 0.05 for all except at 80 N). IMRCT significantly increased maximum contact pressure (MCP) compared to intact (Δ +0.09 MPa, p = 0.029). For recentering interventions, neither SI nor SCR improved GAA (p > 0.05). The 8-mm spacer and four-layer SCR condition significantly increased MCP compared to the intact condition (Δ +0.22 MPa, p = 0.048, Δ +0.24 MPa, p = 0.012, respectively).</p><p><strong>Conclusion: </strong>Both SCR and SI could effectively recenter the humeral head, but neither technique improved shoulder abduction, with both even significantly increasing subacromial contact pressures. These findings suggest that surgical goals focusing solely on recentering humeral head may need re-evaluation, particularly, for patients with high functional demands on shoulder abduction.</p><p><strong>Level of evidence: </strong>N/A.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872197","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 association between revision ACL reconstruction and preoperative, intraoperative and post-operative factors at primary ACL reconstruction in children and adolescents.","authors":"Riccardo Cristiani, Frida Hansson, Eric Hamrin Senorski, Camilo P Helito, Kristian Samuelsson, Karl Eriksson","doi":"10.1002/ksa.12568","DOIUrl":"https://doi.org/10.1002/ksa.12568","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR in children and adolescents.</p><p><strong>Methods: </strong>Children and adolescents (age <20 years at surgery) who underwent primary hamstring tendon ACLR at the Capio Artro Clinic, Stockholm, Sweden, between January 2005 and December 2018 were identified. Revision ACLR within 5 years of primary ACLR was captured in the Swedish National Knee Ligament Registry. Univariable and multivariable logistic regression analyses were used to evaluate the associations between revision ACLR and preoperative (age, sex, body mass index, time from injury to surgery, pre-injury Tegner activity level, medial collateral ligament injury, passive contralateral knee hyperextension [≤-5°]), intraoperative (medial meniscus and lateral meniscus [LM] resection or repair, cartilage injury and graft diameter) and post-operative (KT-1000 side-to-side anterior knee laxity, limb symmetry index for extension and flexion strength and single-leg-hop (SLH) test performance at 6 months) factors at primary ACLR.</p><p><strong>Results: </strong>A total of 1888 patients (mean age: 16.0 ± 2.0, range: 8-19 years) who underwent primary ACLR were included. The overall incidence of revision ACLR within 5 years was 9.0% (170 out of 1888). Univariable analysis revealed that a time from injury to primary ACLR of <5 months (odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.61-2.35, p < 0.001) and LM resection (OR: 1.49, 95% CI: 1.00-2.20, p = 0.04) increased the odds of revision ACLR. Multivariable analysis showed that revision ACLR was significantly associated only with a time from injury to primary ACLR of <5 months (OR: 2.56, 95% CI: 1.72-3.70, p < 0.001).</p><p><strong>Conclusion: </strong>There was a lack of association between revision ACLR and preoperative, intraoperative and post-operative factors at primary ACLR in children and adolescents. A time from injury to primary ACLR of <5 months was the only factor associated with revision ACLR within 5 years.</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":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854652","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":"Superior pain relief and quality of life with autografts using semitendinosus or patellar ligament compared to allografts in meniscal reconstruction: A 2-year prospective comparative study.","authors":"Maher Ghandour, Ayoosh Pareek, Shintaro Onishi, Christophe Jacquet, Jean Noel Argenson, Mathieu Ollivier","doi":"10.1002/ksa.12562","DOIUrl":"https://doi.org/10.1002/ksa.12562","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the 2-year clinical outcomes of meniscal reconstructions using allograft versus autograft tissue, with a focus on patient-reported outcomes, complication rates and surgical revision rates.</p><p><strong>Methods: </strong>This prospective comparative cohort study included 60 patients (ages 18-60 years) undergoing meniscal reconstruction. Patients were divided into an allograft group (n = 31) and an autograft group (n = 29; Hamstring tendon = 25 and patellar tendons = 4). Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) score and EuroQol-5D (EQ-5D) score. Surgical revision rates, reoperation rates and complication rates were recorded. Time-to-reoperation was analyzed using Kaplan-Meier survival curves and a Cox hazards model was used to identify predictors of time-to-reoperation/revision (failure).</p><p><strong>Results: </strong>At 2 years, the autograft group had higher KOOS pain scores (89.93 vs. 86.87, p = 0.002) and EQ-5D scores (0.884 vs. 0.802, p = 0.002) compared to the allograft group. There were no differences in KOOS sports, symptoms, activities of daily living or UCLA scores between the groups. The allograft group had a higher complication (relative risk [RR] = 2.34, 95% confidence interval [CI]: 0.49-11.13, p = 0.266), reoperation (RR = 1.87, 95% CI: 0.51-6.80, p = 0.329) and revision surgery rates (RR = 2.81, 95% CI: 0.31-25.48, p = 0.334), although not statistically significant. Cox modelling identified autograft as a significant predictor of reduced reoperation risk (hazards ratio = 0.057, 95% CI: 0.004-0.036, p = 0.036), with higher preoperative KOOS pain and sports scores also associated with reduced reoperation risk.</p><p><strong>Conclusion: </strong>These preliminary results show that meniscal reconstruction using autograft tissue is associated with better clinical outcomes in terms of pain relief and quality of life, as well as lower reoperation and complication rates, compared to allograft tissue. However, these observations need to be validated by well-powered research.</p><p><strong>Level of evidence: </strong>Level III prospective.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837330","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}