Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Tobacco's toll: Comparable anterior cruciate ligament graft failure rates and inferior functional outcomes in smokers compared to non-smokers: A systematic review and meta-analysis","authors":"Jean-Paul S. Rinne,&nbsp;Roderick J. M. Vossen,&nbsp;Gaby V. ten Noever de Brauw,&nbsp;Jelle P. van der List,&nbsp;Roel J. H. Custers,&nbsp;Andrew D. Pearle,&nbsp;Hendrik A. Zuiderbaan","doi":"10.1002/ksa.70146","DOIUrl":"10.1002/ksa.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Anterior cruciate ligament reconstruction (ACLR) is among the most performed orthopaedic procedures. Evaluating the effect of smoking on postoperative outcomes following ACLR could benefit many patients. This study investigated the impact of smoking on graft failure and functional outcomes following ACLR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, MEDLINE, and Embase were searched up until March 9, 2025. The primary outcome was ACL graft failure after ACLR. Inclusion criteria were: age ≥18 years, ≥1-month follow-up (FU), ACL reconstruction, and articles in English. Exclusion criteria were: cadaveric studies, ACL repair, ≤5 participants, reviews, and case reports. Meta-analysis results were reported as odds ratios (ORs) and proportions with 95% confidence intervals (CIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12 studies were included (92,208 patients) (mean FU: 42.8 ± 17.0 months; mean age: 35.9 ± 6 years; 6.8% smokers; 57.9% male). The quality of included studies was moderate, (MINORS score range: 9 to 21). In smoker's reoperation rate was 7.6% (FU 59.4 months). For non-smokers the reoperation rate was 5.2% (59.9 months FU). Three studies (2,823 patients) compared ACL graft failure rates, with similar pooled failure rates of 5.0% and 5.5% in smokers and non-smokers, respectively (OR 1.12 [95% CI: 0.38–3.29]). Four studies (1285 patients) compared postoperative IKDC scores with mean scores of 79.6 ± 10.3 in smokers and 84.0 ± 9.5 in non-smokers, respectively (OR 5.12 [95% CI: 3.59–6.65]). One study reported Tegner scores that were not different between smokers (5.0) and non-smokers (5.4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This systematic review demonstrated that ACL graft failure and all-cause reoperation rates did not differ significantly between smokers and non-smokers. Nonetheless, non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction.</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 1","pages":"114-127"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380542","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":"Treatment of isolated injuries of the posterior cruciate ligament—A 2025 Delphi-based structured expert statement by the ligament injury committee of the German Knee Society","authors":"Christian Eberle,&nbsp;Danko Dan Milinkovic,&nbsp;Andrea Achtnich,&nbsp;Raymond Best,&nbsp;Philipp-Johannes Braun,&nbsp;Lena Eggeling,&nbsp;Andree Ellermann,&nbsp;Martin Häner,&nbsp;Mirco Herbort,&nbsp;Jürgen Höher,&nbsp;Andreas Imhoff,&nbsp;Christoph Kittl,&nbsp;Julian Mehl,&nbsp;Natalie Mengis,&nbsp;Peter Müller,&nbsp;Daniel Niederer,&nbsp;Daniel Günther,&nbsp;Wolf Petersen,&nbsp;Thomas Pfeiffer,&nbsp;Sven Scheffler,&nbsp;Christian Schoepp,&nbsp;Thomas Stein,&nbsp;Thomas Stoffels,&nbsp;Amelie Stöhr,&nbsp;Tobias Gensior,&nbsp;Tobias Jung","doi":"10.1002/ksa.70187","DOIUrl":"10.1002/ksa.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary ‘agree/disagree’ in the final third round. Levels of evidence were assigned to each statement using standardized A–E and GRADE grading systems based on the available data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%–100%), whereas for 7 agreement was &lt;80% (range 63%–74%). The highest levels of agreement were reached for imaging modalities, treatment of PCL tibial avulsions, and preservation of native PCL fibres in reconstruction techniques, whereas the greatest divergence was observed regarding the role of leg axis and slope analyses and indications for corrective osteotomies, use of augmentation in reconstruction and post-operative rehabilitation protocols. The available level of evidence across studies in the literature was predominantly low to moderate. Of the 31 statements, 17 were graded as expert opinion (E, GRADE: very low), 12 as case series (C; GRADE: low), and only 2 achieved higher levels of evidence (B2, GRADE: moderate).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Expert survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"128-139"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534994","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":"Periprosthetic joint infection: Time to think outside the box","authors":"Min-Cong He,&nbsp;Augusto Ferrini,&nbsp;Javad Parvizi","doi":"10.1002/ksa.70056","DOIUrl":"10.1002/ksa.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Despite undisputed success of orthopaedic procedures, surgical site infections (SSI) such as periprosthetic joint infection (PJI) continues to compromise the outcome and result in major clinical and economic burden. The overall rate of infection is expected to rise in the future resulting in significant associated mortality and morbidity. Traditional concepts have largely attributed the source of PJI to exogenous pathogens. However, recent studies indicate that pathogens from the patient's own microbiome, colonizing the skin, nasal passages, gut microbiota, and even the surgical site play a major role in causing SSIs. Immune cell-mediated ‘Trojan Horse’ pathways have been posited as the mechanism of how bacteria reach and persist at the surgical site. In light of these developing insights, novel therapeutic strategies are under investigation. Some exciting developments include the use of membrane-permeable antibiotics, bacteriophage therapy targeting intracellular pathogens as well as probiotics, prebiotics or faecal microbiota transplantation. Overall, targeting the endogenous microbiome represents a promising frontier for improving the prevention and management of PJI in the era of rapidly increasing total joint arthroplasty procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"14-16"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025204","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":"Alignment philosophy in total knee arthroplasty has more impact on trochlear anatomy restoration as the lateral distal femoral angle decreases","authors":"Britt Ollivier,&nbsp;Alexander D. Orsi,&nbsp;Christopher Plaskos,&nbsp;Hilde Vandenneucker,&nbsp;Stefan Kreuzer,&nbsp;Thomas Luyckx","doi":"10.1002/ksa.12784","DOIUrl":"10.1002/ksa.12784","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Most implants currently used in total knee arthroplasty (TKA) were designed based on mechanical alignment (MA) principles. Modern alignment philosophies alter the orientation of these classic designs by following each individual's knee phenotype, which may have important implications on trochlear restoration. This study aims to compare the influence of different alignment strategies on trochlear anatomy recreation within predefined lateral distal femoral angle (LDFA) groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 147 robotic-assisted, functionally aligned (FA) TKAs, performed with a digital ligament tensioner, were reviewed. Simulated femoral component positions were generated according to different alignment techniques; kinematic alignment (KA), restricted KA (rKA), restricted inverse KA (riKA), gap balancing (GB) and MA. Changes in trochlear angle (∆TA), mediolateral sulcus offset and trochlear over/understuffing were calculated relative to native. Alignment philosophies were compared across following LDFA groups: &lt;84°(<i>n</i> = 22), 84°–87° (<i>n</i> = 57), 87°–90° (<i>n</i> = 50) and &gt;90° (<i>n</i> = 18). Paired Wilcoxon-rank-sum tests were performed with Bonferroni corrections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the lower LDFA groups more significant differences in ∆TA were identified between strategies with FA, KA and rKA showing lower values than riKA, GB and MA (<i>p</i> &lt; 0.01). The LDFA &lt; 84° group had the greatest range in mean ∆TA (2.8° ± 3.4 to 9° ± 3.2). At 10° flexion, MA and GB led to a significantly more lateral sulcus position in each LDFA group compared to the more native sulcus offset obtained with KA, rKA and FA (<i>p</i> &lt; 0.05). All alignment strategies understuffed the trochlea in each LDFA group (3 mm ± 1.2 to 5.3 mm ± 1.5), with KA and rKA creating the least understuffing (<i>p</i> ≥ 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>KA, rKA and FA more closely recreate trochlear anatomy than riKA, MA and GB. The difference between strategies, especially in ∆TA, becomes more pronounced as the LDFA decreases.</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 1","pages":"164-173"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577601","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":"Open and arthroscopic deepening trochleoplasty improves post-operative outcomes: A systematic review of the literature reveals lack of comparability between techniques","authors":"Signe Høj,&nbsp;Johanne Kofoed Lundegaard,&nbsp;Lars Blønd,&nbsp;Peter Lavard,&nbsp;Anke Simone Rechter,&nbsp;Christian Dippmann,&nbsp;Kristoffer W. Barfod","doi":"10.1002/ksa.12647","DOIUrl":"10.1002/ksa.12647","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Deepening trochleoplasty improves outcomes in patients with trochlear dysplasia. The aim of this systematic review was to present the outcomes after open thin-flap, open thick-flap and arthroscopic deepening trochleoplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted using the PRISMA guidelines. Literature was searched in the PubMed, EMBASE and Cochrane databases on 16 December 2024. All studies from the inception of the databases to the date of the search were included in the search. Studies were included if they examined patients with patellar instability and trochlear dysplasia treated with either open or arthroscopic deepening trochleoplasty and reported pre- and post-operative outcomes. Two independent reviewers screened titles and abstracts, reviewed the full text and performed the quality assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32 studies, consisting of 1435 trochleoplasty cases in 1310 patients, were included. Of the included studies, 21 concerned open thin-flap trochleoplasty, 8 concerned open thick-flap trochleoplasty and 3 concerned arthroscopic trochleoplasty. The most used patient-reported outcome measures were the Kujala score, International Knee Documentation Committee score, visual analogue scale pain score, Lysholm Knee Score and Tegner Activity Scale; and the most reported radiological outcome measures were trochlear sulcus angle, trochlear bump, trochlear depth, tibial tubercle-trochlear groove distance, Caton–Deschamps index and patellar tilt. All three trochleoplasty techniques lead to improvements in post-operative outcome measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deepening trochleoplasty improves post-operative outcome using both open thin-flap, open thick-flap and arthroscopic deepening technique. Comparison between the techniques is challenging due to low methodological quality of studies. Further research is needed to document treatment effect and improve patient outcome.</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 1","pages":"34-51"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649548","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":"Rehabilitation guidelines after autograft anterior cruciate ligament reconstruction need more graft-specific exercise recommendations—A scoping review","authors":"Kristín Briem,&nbsp;Mette Kreutzfeldt Zebis,&nbsp;Bjarki Þór Haraldsson,&nbsp;Jesper Bencke,&nbsp;Linda Fernandes","doi":"10.1002/ksa.12666","DOIUrl":"10.1002/ksa.12666","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Autografts for anterior cruciate ligament reconstruction (ACLR) are primarily harvested from the quadriceps, patellar, and semitendinosus tendons. The purpose of this scoping review was to describe available recommendations for exercise-based rehabilitation following primary ACLR with a quadriceps tendon (QT), semitendinosus tendon (ST), or bone-patellar-tendon-bone (BPTB) autograft and determine whether these recommendations included graft-specific clinical practice guidelines (CPGs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A search was conducted via three electronic databases, using variations of three main strings: ‘anterior cruciate ligament reconstruction’, ‘rehabilitation’ and ‘guideline’. To be considered eligible, publications had to be published between 2014 and 2024, target patients 16 or older, and include exercise-based recommendations for rehabilitation after primary ACLR using QT, BPTB or ST autografts. Identified papers were screened for title, abstract and full text in accordance with a pre-registered protocol, with specific inclusion and exclusion criteria. Charting of data found within eligible publications was done according to their overall exercise-based content, as well as any graft-specific considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1083 publications were imported for screening, but after the removal of duplicates and subsequent screening of titles, abstracts and 98 full texts, 17 remained for inclusion. The timeline and implementation of different exercise modalities involving knee joint loading varied during the earliest phases of rehabilitation. Sixteen papers included one or more graft-specific considerations, the majority of which focused on protecting the graft and/or considerations relating to the BPTB harvest site. Few focused on the ST or QT harvest sites, and only one publication provided guidelines that considered all three autografts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CPGs providing exercise recommendations and post-surgical considerations for all three autograft types are needed. These would provide a comprehensive and valuable resource for clinicians to plan rehabilitation for patients who have undergone ACLR, mindful of graft choice and surgical procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"83-101"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative flexion contracture does not impair outcomes or early revision rates following robotic total knee arthroplasty with functional alignment","authors":"Christos Koutserimpas,&nbsp;Giovan Giuseppe Mazzella,&nbsp;Luca Andriollo,&nbsp;Emanuele Diquattro,&nbsp;Pietro Gregori,&nbsp;Elvire Servien,&nbsp;Cécile Batailler,&nbsp;Sébastien Lustig","doi":"10.1002/ksa.12799","DOIUrl":"10.1002/ksa.12799","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Preoperative flexion contracture remains a challenging deformity in total knee arthroplasty (TKA). This study aimed to evaluate whether the presence of preoperative flexion contracture influences outcomes and early revision rates following robotic-assisted TKA performed with functional alignment (FA) principles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective comparative study analysed 190 patients who underwent robotic-assisted TKA using a computed tomography-based FA strategy. Patients were grouped based on intraoperative measurement of flexion contracture: ≥10° (study group; 43 patients) and &lt;10° (control group; 147 patients). Clinical outcomes, intraoperative data, and early revision rates were assessed at a minimum 24-month follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study group exhibited significantly more varus alignment intraoperatively and required greater lateral tibial and posterior medial femoral resections. Preoperative knee flexion was lower in the contracture group (110° vs. 120°, <i>p</i> = 0.0018), and postoperative flexion remained slightly reduced (120° vs. 130°, <i>p</i> = 0.05). Flexion contracture at follow-up was 1° in the study group versus 0° in controls (<i>p</i> = 0.04). However, no significant differences were observed in Knee Society Scores, Forgotten Joint Score, Kujala score, or early revision rates. All-cause revision rates were similar (97.67% vs. 98.64%, <i>p</i> = 0.66), with a hazard ratio of 1.85 (95% CI: 0.12–27.72). Aseptic survivorship was 100% in the contracture group versus 99.32% in controls (<i>p</i> = 0.59).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with preoperative flexion contracture ≥ 10° achieved comparable mid-term outcomes and early survivorship to those without contracture following robotic-assisted TKA using FA. These findings support FA as a reliable strategy to manage complex deformities without the need for soft tissue releases.</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 1","pages":"183-191"},"PeriodicalIF":5.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677133","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":"Expert-based studies benefit from formal consensus methodology and balanced expert representation: Reconsidering the role of primary ACL repair","authors":"Jasper Vandenrijt,&nbsp;Jelle P. van der List,&nbsp;Roy A. G. Hoogeslag,&nbsp;Clemens Kösters,&nbsp;Etienne Cavaignac,&nbsp;Edoardo Monaco,&nbsp;Christiaan H. W. Heusdens","doi":"10.1002/ksa.70254","DOIUrl":"10.1002/ksa.70254","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"776-779"},"PeriodicalIF":5.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835908","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":"ChatGPT models provide higher-quality but lower-readability responses than Google Gemini regarding anterior shoulder instability, with no added benefit of the orthopaedic expert plugin","authors":"Khaled Skaik,&nbsp;Sean Omoseni,&nbsp;Danielle Dagher,&nbsp;Darshil Shah,&nbsp;Theodorakys Marín Fermín,&nbsp;Piero Agostinone,&nbsp;Ashraf Hantouly,&nbsp;Moin Khan","doi":"10.1002/ksa.70255","DOIUrl":"10.1002/ksa.70255","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The purpose is to analyze and compare the quality and readability of information regarding anterior shoulder instability and shoulder stabilization surgery from three LLMs: ChatGPT 4o, ChatGPT Orthopaedic Expert (OE) and Google Gemini.&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;ChatGPT 4o, ChatGPT OE and Google Gemini were used to answer 21 commonly asked questions from patients on anterior shoulder instability. The responses were independently rated by three fellowship-trained orthopaedic surgeons using the validated Quality Analysis of Medical Artificial Intelligence (QAMAI) tool. Assessors were blinded to the model, and evaluations were performed twice, 3 weeks apart. Readability was measured using Flesch Reading Ease Score (FRES) and Flesch–Kincaid Grade Level (FKGL). This study adhered to TRIPOD-LLM. Statistical analysis included the Friedman test, the Wilcoxon signed-rank tests and inter-class coefficients.&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;Inter-rater reliability between three surgeons was good or excellent reliability in all LLMs. ChatGPT OE and ChatGPT 4o demonstrated comparable overall performance, each achieving a median QAMAI score of 22 with interquartile ranges (IQRs) of 5.25 and 6.75, respectively, with median (IQR) domain scores for accuracy 4 (1) and 4 (1), clarity 4 (1) and 4 (1), relevance 4 (1) and 4 (1), completeness 4 (1) and 4 (1), provision of sources 1 (0) for both and usefulness 4 (1) and 4 (1), respectively. Google Gemini showed lower scores across these domains (accuracy 3 [1], clarity 3 [1], relevance 3 [1.25], completeness 3 [0.25], sources 3 [3] and usefulness 3 [1.25]), with a median QAMAI score of 19 (5.25) (&lt;i&gt;p&lt;/i&gt; &lt; 0.01 vs. each ChatGPT model). Readability was higher for Google Gemini (FRES = 36.96, FKGL = 11.92) than for ChatGPT OE (FRES = 21.90, FKGL = 14.94) and ChatGPT 4o (FRES = 24.24, FKGL = 15.11), indicating easier-to-read content (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). There was no significant difference between ChatGPT 4o and OE in overall quality or readability.&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;ChatGPT 4o and ChatGPT OE provided statistically higher-quality responses than Google Gemini, though all models showed good-quality responses overall. However, responses generated by ChatGPT 4o and OE were more difficult to read than those generated by Google Gemini.&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 V, expert opinion.&lt;/p&gt;\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"763-775"},"PeriodicalIF":5.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835801","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":"Achilles tendon ruptures in National Basketball Association players: A sequential video analysis of injury mechanisms and biomechanical patterns","authors":"Ogün Köyağasıoğlu,&nbsp;Yavuz Lima","doi":"10.1002/ksa.70249","DOIUrl":"10.1002/ksa.70249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Achilles tendon ruptures (ATR) are severe injuries in professional basketball, yet in-game mechanisms and biomechanical patterns remain insufficiently described. The purpose of the study is to characterise biomechanical patterns and basketball-specific contexts of ATR using sequential video analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search identified 27 confirmed ATR cases between 1970 and 2025 in the NBA league. Contextual factors (court location, playing situation, movement and speed) were analysed for all cases. Frame-by-frame biomechanical assessment was conducted for 17 injuries (63%) with adequate video quality, documenting trunk, hip, knee and ankle angles of the injured limb at initial contact (IC) and the injury frame (IF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All ruptures occurred during closed-chain movements, mostly with noncontact mechanisms (81.5%), during offensive play actions (85.2%), at low horizontal speeds (63%) and moderate vertical speeds (44.4%). The most frequent action was the take-off/acceleration phase of running (74%), followed by the beginning jump (14.8%) and landing (7.4%). At the IC, players were in forefoot contact, the sagittal plane orientation of the trunk was 18.2° flexed, while the hip was 12.3° extended, the knee was 42.2° flexed and the ankle was 5.6° plantar flexed on the injured side. At IF, players displayed a more flexed torso (27.5°, 9.3° change from IC; <i>p</i> &lt; 0.001), a more extended hip (26.8°, 14.5° change from IC; <i>p</i> = 0.001), a less flexed knee (26.7°, 15.5° change from IC; <i>p</i> = 0.004) and a more dorsiflexed ankle (41.6°, 47.2° change from IC; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study described basketball-specific movement patterns among NBA players who sustained ATRs. Supported the observations of forefoot loading and rapid dorsiflexion of the ankle joint, and introduced new concepts, extension movement of lower limb elements proximal to the ankle joint and proximal elongation of the musculotendinous complex. These findings enhance understanding of basketball-specific ATR mechanisms and may inform targeted prevention strategies such as combining eccentric calf training with functional exercises focusing on lumbopelvic and knee stability, while targeting explosive forefoot contact acceleration manoeuvres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"684-697"},"PeriodicalIF":5.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835859","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}