Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"All-inside meniscal repair using polyether ether ketone versus all-suture anchors: No difference in failure rates at three-follow-up in a retrospective cohort of 2253 patients","authors":"Christoffer von Essen, Riccardo Cristiani, Alexander Sandon, Anders Stålman","doi":"10.1002/ksa.70026","DOIUrl":"10.1002/ksa.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare mid-term failure rates of next-generation all-inside meniscal repair using polyether ether ketone (PEEK) anchors versus all-suture anchors in a large patient cohort. The null hypothesis was that there would be no difference in failure rates between PEEK and all-suture anchors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted on all consecutive patients who underwent arthroscopic all-inside meniscal repair between January 2015 and June 2022 at Capio Artro Clinic, Stockholm, Sweden. Patients were included if they had isolated or anterior cruciate ligament reconstruction (ACLR) associated medial or lateral meniscal repairs using either PEEK or all-suture devices. Revision meniscal repairs were excluded to ensure a homogeneous cohort. The primary outcome was failure of meniscal repair, defined as reoperation with partial or total meniscectomy or re-suture within 3 years. Logistic regression was used to identify predictors of failure. Between-group comparisons were performed using chi-square and <i>t</i>-tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the total cohort of 2253 patients, 271 patients received all-suture anchors and 1982 received PEEK anchors. The overall reoperation rate was 17.3% (47/271) in the all-suture group and 20.7% (410/1982) in the PEEK group, with no statistically significant difference. Subgroup analysis by laterality (medial [21.5%, 28/271] vs. lateral meniscus repair [27.1%, 324/1982]), or isolated repair versus ACLR with repair did not reveal significant differences in failure rates for the different devices. Logistic regression further revealed that isolated meniscal repair (odds ratio [OR]: 3.01; 95% confidence Interval [CI]: 2.41–3.76; <i>p</i> < 0.001), female gender (OR: 1.30, 95% CI: 1.05–1.61; <i>p</i> = 0.017), and medial meniscus repair (OR: 2.89; 95% CI: 2.27–3.69; <i>p</i> < 0.001) were significant predictors of meniscal repair failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>All-suture and PEEK-based all-inside meniscal repair devices demonstrated comparable failure rates within 3 years. Device type was not associated with increased risk of failure, whereas isolated repair, medial meniscal repair, and female gender were significant predictors. These findings support the clinical effectiveness of both anchor types, allowing device selection to be based on surgeon preference and tear characteristics rather than concerns over differential failure risk.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2427-2432"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The art of letting go: Recognising limits in joint-preserving ligament surgery—The enemy of good is better","authors":"Sebastian Kopf, Nicolas Pujol, Horacio Rivarola Etcheto, Adil Ajuied","doi":"10.1002/ksa.70306","DOIUrl":"10.1002/ksa.70306","url":null,"abstract":"<p>As the knee surgery community continues to evolve, there is increasing pressure to innovate, sometimes ahead of the evidence base and potentially to the detriment of our patients and their outcomes. This over-enthusiasm has several drivers: the medical device industry's desire to expand revenue and market share, an arguably excessive number of conferences and meetings, and the continuous pressure on key opinion leaders to generate new topics and insights.</p><p>While the vast majority of surgeons who rapidly adopt new techniques are motivated by a genuine commitment to improving patient care, others may also be influenced by professional ambition or commercial opportunity.</p><p>For these reasons, high-volume key opinion leaders who consult for industry, teach on courses, and lecture at conferences must remain acutely aware that many of their peers who look to them for guidance have lower-volume or more generalist practices. These leaders carry a moral and ethical responsibility to ensure that their advice is strictly evidence-based, and to recognise that what may represent a worthwhile change in practice for a high-volume specialist could pose a potential risk when applied in a lower-volume or generalist setting.</p><p>All too often, our community seeks <i>the</i> answer to a surgical problem; the best graft, the best technique, the best device, as if there were a single, universal solution. This notion is flawed. Most of the time, there are multiple valid solutions to a given clinical problem, and no single ‘Correct’ answer applicable to all scenarios or all surgeons.</p><p>The concept of individualised patient care, often referred to as an ‘<i>à la carte’</i> approach, has gained popularity in the sports orthopaedics community, with individualised graft choice for anterior cruciate ligament (ACL) reconstruction being a prime example. While high-volume surgeons may indeed achieve superior results through individualisation, this is not necessarily true for low-volume practices. In fact, it may further dilute experience and consistency.</p><p>For instance, applying an <i>à la carte</i> graft philosophy in a practice performing around 20 ACL reconstructions (ACL-R) per year could result in fewer than 10 cases per graft type, insufficient to maintain technical proficiency. In such settings, a more standardised or ‘set-menu’ approach may be preferable, maximising procedural volume, reproducibility and team familiarity. Alternatively, healthcare systems must decide whether certain procedures should be restricted to high-volume centres/surgeons, as already implemented in countries such as Denmark, thereby concentrating experience and theoretically enhancing outcomes.</p><p>It has long been suggested that surgical volume correlates with outcome in orthopaedics, but until recently, supporting evidence was limited. Rizvanovic et al. [<span>9</span>] analysed the Norwegian registry and found that high-volume surgeons had shorter time to surgery, reduce","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2330-2333"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088789","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":"Posterior tibial slope varies across functional tibial phenotypes but not CPAK categories: A radiographic analysis from the FP-UCBM Knee Study Group","authors":"Edoardo Franceschetti,&nbsp;Giancarlo Giurazza,&nbsp;Alessandro Del Monaco,&nbsp;Marco Spatuzzi,&nbsp;Stefano Campi,&nbsp;Andrea Tanzilli,&nbsp;Pietro Gregori,&nbsp;Matteo Formica,&nbsp;Michele Paciotti,&nbsp;Rocco Papalia","doi":"10.1002/ksa.70135","DOIUrl":"10.1002/ksa.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The relationship between the coronal and sagittal planes of the knee remains largely unexplored. The aim of this study was to evaluate the correlation between Posterior Tibial Slope (PTS), Hirschmann's functional tibial phenotypes, CPAK categories, and their defining parameters, hypothesising that coronal and sagittal tibial parameters are interrelated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on preoperative radiographs from 204 patients (217 knees) undergoing primary TKA for end-stage osteoarthritis between January 2023 and September 2023. PTS was measured on weight-bearing true lateral radiographs with strict quality criteria. Coronal alignment variables—including arithmetic Hip-Knee-Ankle Angle (aHKA), Joint Line Obliquity (JLO) and Tibial Mechanical Angle (TMA)—were derived from full-length standing radiographs, and CPAK categories and functional tibial phenotypes were assigned accordingly. Statistical analysis included Kruskal–Wallis tests and Spearman's correlations. Statistical significance was set at <i>p</i> &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences in PTS were observed across CPAK categories (<i>p</i> = 0.501), aHKA categories (<i>p</i> = 0.103), or JLO categories (<i>p</i> = 0.906). In contrast, PTS differed significantly among functional tibial phenotypes (<i>p</i> = 0.004), with the highest values in VAR_TMA6 (8.2° ± 3.4), VAL_TMA6 (8.0° ± 2.7), and NEU_TMA0 (7.7° ± 2.8), and lowest values in VAR_TMA3 (5.7° ± 2.6) and VAL_TMA3 (6.2° ± 2.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PTS varies significantly across functional tibial phenotypes but not CPAK categories, suggesting that functional tibial phenotypes may better capture sagittal alignment variability. Incorporating PTS into phenotype-based preoperative planning could help refine patient-specific strategies in total knee arthroplasty.</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 7","pages":"2462-2468"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380698","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":"Knee injury mechanism varies by injury category: Video analysis of multi-ligament knee injuries in the National Football League","authors":"Ethan Ruh,&nbsp;Tyler Kallman,&nbsp;Elizabeth Lyden,&nbsp;Justin Greiner","doi":"10.1002/ksa.70025","DOIUrl":"10.1002/ksa.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to characterize the mechanism of multi-ligament knee injury (MLKI) sustained during a National Football League (NFL) game through video analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective video analysis of official NFL game footage spanning 1997–2022 was performed. Players with MLKIs were identified from publicly available injury surveillance data. Player and game demographic information was collected. Athletes were categorized based on ligament injury patterns. Videos including MLKI were analyzed to categorize injuries based on non-contact, indirect or direct contact mechanisms and determine the hip, knee and ankle position at the time of injury. Differences across MLKI groups were identified by Fisher's exact test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-five MLKIs were identified. MLKIs most commonly occurred from direct contact to the limb (80%), with the second most common injury mechanism being indirect contact (14.3%). The most common MLKI was injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) (65%), while the second most common was the ACL and lateral collateral ligament (LCL) (15%). Direct contact MLKI most often resulted in a valgus and external rotational force about a flexed knee (58%). There were statistically significant differences when comparing the direction of contact, hip and knee position between injury MLKI groups. Combined ACL and MCL injury commonly occurs with knee flexion, valgus and external rotation. Combined ACL/posterior cruciate ligament (PCL) or ACL/LCL injuries occurred most commonly with varus and internal rotational forces on an extended knee. Multiligament injuries involving three ligaments occurred only from direct contact mechanisms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Various injury mechanisms and characteristics result in different types of MLKI in NFL athletes, though the vast majority of MLKIs occur from direct contact forces to the knee. Combined ACL and MCL injury occurred most frequently, resembling the mechanism and lower extremity position for isolated ACL injury, though it frequently occurs due to direct contact with the knee.</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 7","pages":"2400-2407"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995124","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":"Postural coronal alignment shift after total knee arthroplasty diminishes with age and becomes negligible in elderly patients","authors":"Komson Plangsiri,&nbsp;Bhumin Chotiwatanadilok,&nbsp;Pruk Chaiyakit,&nbsp;Pinkawas Kongmalai","doi":"10.1002/ksa.70085","DOIUrl":"10.1002/ksa.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate whether patient age moderates the change in coronal hip–knee–ankle (HKA) alignment between supine and standing positions following total knee arthroplasty (TKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional study, 113 consecutive patients after primary TKA for osteoarthritis underwent standardized full-length radiographs in both supine and standing positions. The postural shift (ΔHKA) was defined as standing minus supine alignment. Associations between age and ΔHKA were examined using a linear mixed-effects model with restricted cubic splines, adjusting for body mass index (BMI), sex, preoperative alignment and time since surgery. Equivalence testing (±1° margin) was performed in patients aged ≥60 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Younger patients demonstrated a standing varus drift of approximately 2–3°, whereas the effect progressively diminished with advancing age. The age–position interaction was significant (<i>p</i> = 0.011), while BMI, sex, preoperative alignment and time since surgery were not. In patients ≥60 years, the mean ΔHKA was −0.01° (90% confidence interval = −0.55° to +0.53°), meeting statistical equivalence to 0 (<i>p</i> = 0.008). Collateral ligament laxity on stress radiography showed no association with ΔHKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Postural coronal alignment change after TKA is strongly age dependent. Younger patients show a measurable varus drift, whereas older patients demonstrate negligible change within radiographic error. Age should be considered when tailoring intraoperative alignment strategies to ensure durable functional 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 7","pages":"2455-2461"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254236","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":"Similar graft failure rates in low-activity patients (Tegner activity scale ≤ 4) undergoing anterior cruciate ligament reconstruction with or without lateral extra-articular augmentation","authors":"Ali Alayane,&nbsp;Mohamad K. Moussa,&nbsp;Maher Ghandour,&nbsp;Mohamad Ayari,&nbsp;Alain Meyer,&nbsp;Olivier Grimaud,&nbsp;Frédéric Khiami,&nbsp;Nicolas Lefèvre,&nbsp;Yoann Bohu,&nbsp;Alexandre Hardy","doi":"10.1002/ksa.70031","DOIUrl":"10.1002/ksa.70031","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 the outcomes of isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR + lateral extra-articular procedures (LEAPs) at mid-term follow-up in a low activity population based on the Tegner activity scale (TAS ≤ 4).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This was a retrospective analysis comparing patients with a pre-injury TAS ≤ 4 who underwent primary isolated ACLR versus ACLR + LEAPs between 2012 and 2022. Propensity score matching based on age, sex, and presence of meniscal injury was used to establish two groups: ACLR alone and ACLR with LEAP. The primary outcome was the graft failure rate, compared between both groups as diagnosed by clinical instability and radiological rupture of the graft. No formal a priori sample size calculation was performed. Secondary outcomes included return to sport (RTS) metrics and Lysholm score, TAS, International Knee Documentation Committee (IKDC) score, ACL return to sport after injury scale (ACL-RSI) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at the final follow-up for each patient.&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;In the ACLR group, 170 patients were included, while in the ACLR + LEAPs group, 112 patients met the inclusion criteria. The mean age of patients was 30.9 years (standard deviation [SD] = 10.8) for ACLR and 27.8 years (SD = 10.5) for ACLR + LEAP, with similar demographics and injury characteristics across both groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). The mean follow-up period was 42.74 (34.28) months for the ACLR group and 34.98 (29.32) months for the ACLR + LEAP group. Graft failure rates were similar between groups: 4.2% (6/140) in ACLR versus 5.3% (5/93) in ACLR + LEAP (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). No significant differences were observed in post-operative IKDC scores (ACLR: 73.9 ± 24.5 vs. LEAP: 75.4 ± 22.7), Lysholm scores (86.5 ± 15.1 vs. 88.6 ± 11.0), ACL-RSI scores (55.0 ± 33.4 vs. 58.3 ± 32.9) or KOOS subscales: Pain (88.5 ± 15.2 vs. 90.3 ± 9.1), Symptoms (83.1 ± 17.4 vs. 80.8 ± 15.2), ADL (92.7 ± 13.9 vs. 94.5 ± 8.2), Sport (76.4 ± 25.5 vs. 75.0 ± 22.8) and QoL (72.2 ± 27.4 vs. 72.1 ± 24.6). However, the ACLR + LEAP group showed a greater improvement in activity level, with TAS increasing from 2.8 ± 1.3 to 5.2 ± 2.0, compared to 3.0 ± 1.2 to 4.4 ± 1.9 in the ACLR group (&lt;i&gt;p&lt;/i&gt; = 0.004). RTS was achieved by 74.2% of ACLR patients and 77.4% of ACLR + LEAP patients (&lt;i&gt;p&lt;/i&gt; &gt; 0.05), with 5.8% vs. 12.6% returning to a higher level than preinjury, respectively.&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;Patients with a low TAS ≤ 4 who underwent isolated ACLR have a similar graft failure rate ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2433-2444"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025161","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":"Unrestricted kinematic alignment on the sagittal plane: Posterior tibial slope and combined flexion do not have boundaries to respect in terms of short-term clinical outcomes and safety","authors":"Edoardo Franceschetti,&nbsp;Pietro Gregori,&nbsp;Stefano Campi,&nbsp;Marco Spatuzzi,&nbsp;Giancarlo Giurazza,&nbsp;Andrea Tanzilli,&nbsp;Biagio Zampogna,&nbsp;Matteo Formica,&nbsp;Umile Giuseppe Longo,&nbsp;Rocco Papalia","doi":"10.1002/ksa.70136","DOIUrl":"10.1002/ksa.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Personalized alignment in total knee arthroplasty (TKA) is gaining traction as a surgical philosophy. True personalization, however, must encompass not only the coronal plane but also the sagittal and axial planes. This study evaluates influence of the Tibial Slope (PTS) and combined flexion (CF) on outcomes in TKA performed using unrestricted kinematic alignment (KA). The aim of the study was to examine the relationship between PTS or CF and both functional outcomes and complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted on 137 patients who underwent primary TKA using KA between November 2022 and June 2023. CF was calculated by combining PTS and DFF values. Patients were categorized into groups based on CF angle (≤7.5° vs. &gt;7.5°) and PTS (&lt;5, between 5 and 10, &gt;10). Clinical outcome measures (KSS, OKS, SF12 and FJS), radiographic alignment parameters and complication rates were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no statistically significant differences between groups regarding implant survivorship, revision rates, mechanical failure, or clinical outcome scores. CF or PTS did not correlate with postoperative coronal alignment parameters or with patient-reported outcome measures (PROMs). Additionally, the change in clinical scores from preoperative to postoperative assessments did not differ significantly between groups, indicating comparable clinical improvement regardless of CF or PTS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that restoration of native femoral and tibial flexion within a kinematic alignment does not adversely affect outcomes or increase complication rates, providing similar clinical benefits regardless the prearthritic CF or tibial slope of the patients, supporting the short-term safety of this “unrestricted” approach in the sagittal plane.</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 7","pages":"2469-2478"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380564","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":"Kinematic alignment, but not mechanical alignment, preserves the knee–ankle relationship after total knee arthroplasty: A retrospective radiographic analysis from the FP-UCBM Knee Study Group","authors":"Edoardo Franceschetti,&nbsp;Giancarlo Giurazza,&nbsp;Marco Donantoni,&nbsp;Stefano Campi,&nbsp;Andrea Tanzilli,&nbsp;Pietro Gregori,&nbsp;Michele Paciotti,&nbsp;Biagio Zampogna,&nbsp;Andrea Marinozzi,&nbsp;Umile Giuseppe Longo,&nbsp;Rocco Papalia","doi":"10.1002/ksa.70138","DOIUrl":"10.1002/ksa.70138","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;Several alignment strategies have been proposed in total knee arthroplasty (TKA), with the two extremes being mechanical alignment (MA) and unrestricted kinematic alignment (KA). While MA standardises coronal knee parameters to achieve a neutral alignment, KA reproduces each patient's native joint lines. The impact of these strategies on the ankle joint remains poorly understood. The aim of this study was to compare the effects of MA and KA on coronal ankle alignment, hypothesising that MA induces greater alterations than KA.&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;In this retrospective cohort study, 208 consecutive TKA cases, performed with either MA (&lt;i&gt;n&lt;/i&gt; = 104) or unrestricted KA (&lt;i&gt;n&lt;/i&gt; = 104) were included. Preoperative and 1-year postoperative full-length standing radiographs were analysed for lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip–knee–ankle angle (HKA), Coronal-Plane-Alignment-of-the-Knee (CPAK) categories and ankle-specific parameters: talar inclination (TI), tibial plafond inclination (TPI), and talar tilt (TT). Changes in radiographic parameters (Δ) were calculated as the difference between 1-year postoperative and preoperative values. Within-group and between-group changes were assessed with paired and independent t-tests, respectively, and correlations between knee and ankle changes were calculated. Statistical significance was set at &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;MA resulted in significant postoperative changes in TI (–3.21 ± 3.28°; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and TPI (–2.62 ± 3.16°; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), whereas KA produced no significant changes (TI: –0.60 ± 3.54°, TPI: –0.18 ± 3.23°; &lt;i&gt;p&lt;/i&gt; &gt; 0.05). No significant changes were observed for TT in either group. In the MA group, ΔTPI correlated moderately with ΔHKA, ΔLDFA, and ΔMPTA. Pre/postoperative changes in CPAK category did not show any impact on coronal ankle parameters following TKA (&lt;i&gt;p&lt;/i&gt; &gt; 0.05)&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Coronal ankle alignment is preserved by unrestricted KA but altered by MA. These findings suggest that KA minimises unintended ankle alterations, maintaining the patient-specific knee–ankle relationship and potentially reducing the risk of secondary ankle malalignment or degeneration following TKA.&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 IV retrospective analysis.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2479-2485"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380619","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":"Surgical caseload and annual volume influence cartilage treatment strategies in primary anterior cruciate ligament reconstruction","authors":"Dzan Rizvanovic,&nbsp;Markus Waldén,&nbsp;Magnus Forssblad,&nbsp;Anders Stålman","doi":"10.1002/ksa.12776","DOIUrl":"10.1002/ksa.12776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate how surgeon and clinic volume, along with patient-, injury- and surgery-related factors, influence cartilage injury management in primary anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analysed cartilage treatment (debridement, microfracture, other methods or left in situ) in patients undergoing primary ACLR (2008–2022) using data from the Swedish Knee Ligament Registry. Surgeons and clinics were categorised by registry caseload (low [LC]: &lt;50 ACLRs/surgeon, &lt;500/clinic; high [HC]: ≥50, ≥500) and annual volume (low [LV]: &lt;29 ACLRs/year/surgeon, &lt;56/year/clinic; high [HV]: ≥29, ≥56), yielding four groups: LCLV, LCHV, HCLV, and HCHV. Factors influencing cartilage treatment were assessed using adjusted multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More than one in four patients (11,729, 26.4%) had cartilage injuries at the time of primary ACLR; 17.9% underwent debridement, 7.1% microfracture and 1.4% other treatments. A higher proportion of HCHV surgeons had performed debridement (81.2% vs. 48.8%–64.3%), microfracture (78.6% vs. 24.4%–51.0%) and other methods (32.5% vs. 3.8%–13.4%) during ACLR compared to all other surgeon groups (all <i>p</i> &lt; 0.001). HCHV clinics were more likely to treat cartilage injuries, leaving fewer in situ (79.2% vs. 80.3%–85.2%, <i>p</i> &lt; 0.001) Adjusted logistic regression analyses showed that LCLV/LCHV clinics had 43.4%–68.5% higher odds of performing microfracture, and that LCHV/HCLV clinics had 41.3%–48.1% lower odds of performing debridement compared to HCHV clinics, all <i>p</i> ≤ 0.023. Microfracture and debridement odds increased with ICRS 3–4 lesions and decreased with non-medial femoral condyle injuries and delayed surgery. Age &gt; 30 years and recent surgery year increased debridement odds, while lesion size ≥ 2 cm² lowered microfracture odds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgeons with the highest caseload and volume performed the broadest range of cartilage treatment techniques, yet treatment strategies appeared driven more by clinic caseload and volume. Cartilage management was also influenced by injury location, size, depth, patient age, time to surgery and year of surgery.</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 7","pages":"2340-2351"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577606","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":"Tranexamic acid lowers transfusions and readmissions in high-risk total knee arthroplasty patients, but neurologic risks remain in patients with seizures or visual disturbances","authors":"Joshua R. Porto,&nbsp;Monish S. Lavu,&nbsp;Christian J. Hecht II,&nbsp;Olivia G. Asimakis,&nbsp;David C. Kaelber,&nbsp;Atul F. Kamath","doi":"10.1002/ksa.70124","DOIUrl":"10.1002/ksa.70124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Tranexamic acid (TXA) is widely used in total knee arthroplasty (TKA) to reduce perioperative blood loss and transfusions. However, its safety in high-risk patients remains uncertain. This study evaluates TXA's safety and efficacy in TKA patients with a history of (1) thromboembolic events, (2) renal failure, (3) atrial fibrillation, (4) seizures and (5) visual disturbances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of the US Collaborative Network within TriNetX examined TKA patients from 2017 to 2023 (<i>n</i> = 59,057). High-risk patients were categorised by preexisting risk factors and propensity-score matched into TXA and non-TXA groups. Postoperative outcomes, including thromboembolic events, transfusions, renal failure, seizures, visual disturbances, infections, revisions, readmissions and mortality, were compared using odds ratios (OR) with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TXA was associated with lower transfusion rates, revisions, readmissions and emergency visits across multiple risk groups. No increased risk of deep vein thrombosis (DVT) or (PE) was observed in patients with prior thrombosis, renal failure, or atrial fibrillation, though ischaemic stroke/transient ischaemic attack (TIA) was higher in those with prior thrombosis (5.6% vs. 3.9%, OR: 1.44, 95% CI: 1.24–1.68). Patients with seizures had higher rates of postoperative seizures (10.4% vs. 7.1%, OR: 1.53, 95% CI: 1.18–1.99) and pulmonary embolism (1.9% vs. 1.0%, OR: 2.02, 95% CI: 1.06–3.85). In those with visual disturbances, TXA was linked to increased postoperative seizures (0.9% vs. 0.4%, OR: 1.97, 95% CI: 1.21–3.19) and visual disturbances (4.2% vs. 3.3%, OR: 1.29, 95% CI: 1.07–1.57).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TXA reduced transfusions, readmissions and revisions in high-risk TKA patients without increasing DVT or PE risk, though there was a modest increase in stroke/TIA for patients with prior thromboembolism. However, higher postoperative neurologic complications in patients with seizures or visual disturbances warrant further investigation. While TXA can provide benefits across several outcomes, discretion is advised in patients with neurological risk factors to optimise safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III retrospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 7","pages":"2445-2454"},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380596","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}