Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"Reasoning-optimised large language models reach near-expert accuracy on board-style orthopaedic exams: A multi-model comparison on 702 multiple-choice questions","authors":"Pedro Diniz,&nbsp;Takuji Yokoe,&nbsp;Felix C. Öttl,&nbsp;Hélder Pereira,&nbsp;Rui Henriques,&nbsp;Kristian Samuelsson","doi":"10.1002/ksa.70222","DOIUrl":"10.1002/ksa.70222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to compare the accuracy, calibration, reproducibility and operating cost of seven large language models (LLMs)—including four newer models capable of using advanced <i>reasoning</i> techniques to analyse complex medical information and generate accurate responses—on text-only orthopaedic multiple-choice questions (MCQs) and to quantify gains over GPT-4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From Orthobullets, 702 unique, non-image MCQs (drawn from AAOS Self-Assessment Examinations, Self-Assessment-Based Questions and Orthopaedic In Training Examination-Based Questions banks) were extracted. Each question was submitted to the following LLMs: OpenAI o3, Anthropic Claude Sonnet 4, Claude Opus 4 (with/without ‘Extended Thinking’) and Google Gemini 2.5 Pro. Additionally, OpenAI's GPT-4, GPT-4o and the open-weight Gemma 3 27B served as comparators. The primary outcome was overall accuracy. The secondary outcomes were topic and difficulty-stratified accuracy, calibration (expected calibration error [ECE] and Brier score), reproducibility (flip rate on a retest question subset), latency, token use and cost. Statistical tests included paired McNemar, Cochran <i>Q</i>, ordinal logistic regression and Fleiss <i>κ</i> (Bonferroni-adjusted <i>α</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>GPT-4 achieved 69.7% accuracy (95% CI = 66.2–72.9). All four reasoning-optimised models scored ≥14 percentage points higher (<i>p</i> &lt; 3.3 × 10⁻¹⁵); OpenAI o3 led with 93.6% (95% CI = 91.5–95.2), which represents a 34% relative error reduction. Accuracy tended to decline with question difficulty, yet the <i>reasoning</i> advantage persisted in every difficulty stratum. Claude Opus 4 showed the best calibration (ECE = 0.023), while GPT-4 exhibited overconfidence (ECE = 0.215). All models except Gemma 3 27B exhibited non-zero flip rates. Median query time: 0.9 s (Gemma) to 15.9 s (Gemini 2.5 Pro). Cost: 0 to 29.9 USD per 1000 queries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reasoning-optimised LLMs now answer text-based orthopaedic exam questions with high accuracy and substantially better confidence calibration than earlier models. However, persistent stochasticity and large latency-cost disparities may limit clinical deployment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"752-762"},"PeriodicalIF":5.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770092","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":"Response to Letter to the Editor: “The overlay ACI technique: Good old wine in new bottle”","authors":"Stephan Oehme,&nbsp;Tobias Jung","doi":"10.1002/ksa.70199","DOIUrl":"10.1002/ksa.70199","url":null,"abstract":"&lt;p&gt;On behalf of all coauthors, we would like to sincerely thank Vishwesh D. Chudasama for their thoughtful correspondence [&lt;span&gt;1&lt;/span&gt;] regarding our recently published article [&lt;span&gt;4&lt;/span&gt;]. We greatly appreciate the contributions to the field of cartilage repair by Dr. Deepak Goyal and in particular, the valuable work on the overlay autologous chondrocyte implantation (ACI) technique. The recent technical note [&lt;span&gt;2&lt;/span&gt;] is indeed a very elegant and valuable contribution to the literature, and we are grateful for the opportunity to acknowledge it here. Allow us to clarify that our manuscript was conceived and submitted as an original study rather than a technical note. The principle of the combination of autologous chondrocyte implantation with autologous bone grafting has been described in several publications in the last decades [&lt;span&gt;3&lt;/span&gt;]. Our intention was not to introduce a new surgical technique or terminology. The aim of our study was to report the clinical and biomechanical outcomes of a procedure that we have routinely applied in a comparatively large cohort of patients. For this purpose, we felt it important to describe our technique in sufficient detail to allow reproducibility. In the context of the publication of a clinical outcome study, it is unfortunately not possible to include every technical note or book chapter related to the topic. Our discussion was therefore directed towards the interpretation of the clinical and biomechanical results. As the cited technical note did not provide directly comparable outcome data, it was not directly applicable for a systematic comparison, while we sincerely acknowledge its merit as a valuable technical contribution.&lt;/p&gt;&lt;p&gt;We fully agree that there are conceptual similarities between our approach and the overlay ACI technique. At the same time, there are also important distinctions. In our technique, we consistently use autologous corticocancellous bone plugs harvested from the proximal tibia or distal femur with the aim of providing stable osseous support and creating an optimized interface for osteochondral integration. In contrast, the overlay ACI technique bears closer resemblance to the earlier and highly valuable work of Zellner et al., which likewise used autologous iliac crest bone grafts and described the procedure as bone augmentation combined with matrix-guided autologous chondrocyte transplantation (MACT) [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Finally, we totally agree with the statement that the variability in terminology and technical details across publications has the potential to cause confusion. As we emphasized in our recent systematic review, there is considerable heterogeneity in reported approaches combining autologous bone grafting and autologous chondrocyte implantation [&lt;span&gt;3&lt;/span&gt;]. We strongly support the effort to establish a unified nomenclature, which will undoubtedly improve scientific clarity, comparability of outcomes and communication within the carti","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"782-783"},"PeriodicalIF":5.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770059","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 overlay ACI technique: Good old wine in new bottle","authors":"Vishwesh D. Chudasama","doi":"10.1002/ksa.70198","DOIUrl":"10.1002/ksa.70198","url":null,"abstract":"&lt;p&gt;The manuscript titled “Autologous bone grafting combined with spheroid-based matrix-induced autologous chondrocyte implantation for osteochondral defects of the knee: Good clinical outcomes alongside abnormal postoperative gait patterns” by Dr. Oehme et al. [&lt;span&gt;6&lt;/span&gt;] presents a valuable contribution to the treatment of osteochondral defects of the knee. The authors describe an approach wherein bone grafting addresses subchondral bone defects, followed by cartilage restoration using autologous chondrocyte implantation (ACI). This technique, although infrequently detailed in the English literature, has been well-cited in the manuscript [&lt;span&gt;3-5&lt;/span&gt;] and is of significant clinical relevance.&lt;/p&gt;&lt;p&gt;However, I would like to respectfully point out that the authors have overlooked an important aspect of previously published work. Specifically, they did not reference the established nomenclature of the 'Overlay Autologous Chondrocyte Implantation (Overlay ACI) technique', which has already been described in two English-language publications by Deepak Goyal [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The overlay ACI technique was first detailed in the book chapter titled 'The Illustrative Overlay Autologous Chondrocyte Implantation (Overlay ACI) Technique for Repair of the Extra-Large Osteochondral Defects' in &lt;i&gt;The Illustrative Book of Cartilage Repair&lt;/i&gt; [&lt;span&gt;2&lt;/span&gt;]. A subsequent peer-reviewed article, “Treatment of large chondral lesions with big bony defects: the overlay autologous chondrocyte implantation technique”, further elaborated the step-by-step surgical procedure [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The approach described by Oehme et al. [&lt;span&gt;6&lt;/span&gt;] closely mirrors the Overlay ACI technique in terms of surgical methodology. The primary difference lies in the choice of ACI product: the authors utilised spheroid-based ACI, whereas the overlay ACI technique uses gel-based ACI. It is important to recognise that while the commercial forms of ACI—such as spheroids, MACI and gel-based ACI—may vary across countries due to regulatory and logistical factors, the underlying biological principle of third-generation ACI remains consistent. Interestingly, the authors cite studies utilising MACI [&lt;span&gt;3, 4&lt;/span&gt;] and gel-based ACI [&lt;span&gt;5&lt;/span&gt;], yet omit references to the overlay ACI publications [&lt;span&gt;1, 2&lt;/span&gt;], which specifically name and detail this very technique. Recognising and citing established nomenclature is critical for scientific clarity, continuity and academic integrity—especially when the procedural similarities are so apparent. Given the similarities between the described surgical approach and the previously published overlay ACI technique [&lt;span&gt;1, 2&lt;/span&gt;], it would have been appropriate and academically rigorous to reference the existing nomenclature and literature.&lt;/p&gt;&lt;p&gt;Acknowledging prior work helps maintain scientific continuity and avoids potential misunderstandings or duplications in the evolving field of cartilage repair. A ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"780-781"},"PeriodicalIF":5.0,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770374","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":"Reliable pain and function outcomes but limited sport performance after high tibial osteotomy for medial knee osteoarthritis in the grey zone between osteotomy and unicompartmental replacement","authors":"Tomas Pineda,&nbsp;Antoine Piercecchi,&nbsp;Christophe Jacquet,&nbsp;Nicolás Gaggero,&nbsp;Kristian Kley,&nbsp;Matthieu Ollivier","doi":"10.1002/ksa.70223","DOIUrl":"10.1002/ksa.70223","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 evaluate mid-term outcomes of high tibial osteotomy (HTO) in patients with medial knee osteoarthritis presenting borderline indication between osteotomy and unicompartmental knee arthroplasty (UKA) and to identify clinical and radiographic factors associated with success in pain, function and sport.&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;Retrospective multicentre cohort of consecutive HTOs performed between 2005 and 2015 with ≥2 years of follow-up, including patients classified within the grey zone according to the AKUMA framework. Preoperative and postoperative long-leg radiographs were obtained to measure hip–knee–ankle (HKA) angle, mechanical lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA). Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner and modified Weiss (mW) scores; secondary outcomes included satisfaction, sports relevance, symptom-free return to sport and forgotten-knee. Success thresholds were WOMAC ≥ 80, Tegner ≥5 and mW ≥6. Univariate analyses compared successes versus non-successes, and multivariable logistic regression was performed for WOMAC.&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;Eighty-four patients were analysed with a mean follow-up 8.0 ± 3.2 (2.0–14.3) years. Success rates were 72.0% for WOMAC, 6.8% for Tegner and 7.5% for mW. Postoperative MPTA was higher in WOMAC successes than in non-successes. In multivariable analysis, Ahlbäck Grade 3 lowered the odds of achieving WOMAC ≥ 80 (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04–0.94). Tegner success was associated with greater LDFA and with rating sport as very important. mW success was associated with lower preoperative MPTA, lower LDFA, higher tibial extra-articular deformity (TEAD) and very high sport priority. Higher Ahlbäck and Kellgren–Lawrence (KL) grades were linked to worse satisfaction; the forgotten-knee endpoint showed no significant associations.&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;In medial OA knees within the AKUMA grey zone, HTO provides reliable pain relief and functional improvement, while sport success remains limited. Osteoarthritis burden reduces the probability of high pain and function-related scores, while sport-oriented outcomes depend more on coronal alignment features and the patient′s sport priority.&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","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"654-659"},"PeriodicalIF":5.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702586","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":"Significant changes of the mechanical medial proximal tibial angle in dependence of internal and external rotation of the hinge axis in slope correcting infratuberositary tibial deflexion osteotomy","authors":"Lukas Jud,&nbsp;Malte Kölle,&nbsp;Georgios Neopoulos,&nbsp;Lazaros Vlachopoulos,&nbsp;Sandro F. Fucentese","doi":"10.1002/ksa.70219","DOIUrl":"10.1002/ksa.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Tibial deflexion osteotomy (TDO) is performed to correct an increased posterior tibial slope (PTS). Unintended rotation of the osteotomy and the hinge axis (HA) orientation can result in a postoperative deviation of the mechanical medial proximal tibial angle (mMPTA). This study aimed to investigate how internal and external HA rotations affect postoperative mMPTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three-dimensional (3D) bone models of ten patients with increased PTS were used to simulate infratuberositary TDO with different HA orientations and closing distances. Postoperative changes in mMPTA were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 440 TDOs were simulated. The PTS changed by 0.9 ± 0.0° per mm of closing distance. TDO perpendicular to the coronal plane of the long-leg radiograph showed no significant change in the postoperative mMPTA. Internal and external rotation of the HA resulted in significant changes in postoperative mMPTA, with absolute changes up to 4.5° ± 0.5°.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A TDO oriented perpendicular to the leg's coronal plane preserves the preoperative mMPTA and therefore avoids unintended coronal correction. The mMPTA changed significantly with a rotation of the HA of only 5° and exceeded a postoperative change of ≥2° with 15° of HA rotation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"647-653"},"PeriodicalIF":5.0,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703080","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":"Retrieval-augmented ChatGPT-4o improves accuracy but reduces readability in hip arthroscopy patient education","authors":"Onur Gültekin,&nbsp;Erdem Aras Sezgin,&nbsp;Oğuzhan Cakır,&nbsp;Hilmi Burak Sengul,&nbsp;Bekir Eray Kilinc,&nbsp;Barış Yılmaz,&nbsp;Baris Kocaoglu,&nbsp;Mahmut Enes Kayaalp","doi":"10.1002/ksa.70207","DOIUrl":"10.1002/ksa.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare the accuracy, readability and patient-centeredness of responses generated by standard ChatGPT-4o and its retrieval-augmented ‘deep research’ mode for hip arthroscopy education, addressing the current uncertainty about the reliability of large language models in orthopaedic patient information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty standardised patient questions were derived through structured searches of reputable orthopaedic health information websites. Both ChatGPT configurations independently generated responses. Two fellowship-trained orthopaedic surgeons assessed each response independently, using 5-point Likert scales (1 = poor, 5 = excellent) for accuracy, clarity, comprehensiveness and readability. Intra- and interrater reliabilities were calculated, and readability metrics were also evaluated using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Deep Research outperformed the standard model in accuracy (4.7 ± 0.4 vs. 4.0 ± 0.5; <i>p</i> = 0.012) and comprehensiveness (4.8 ± 0.3 vs. 3.9 ± 0.6; <i>p</i> &lt; 0.001). The standard model performed better in clarity (4.6 ± 0.4 vs. 4.4 ± 0.5; <i>p</i> = 0.048). Readability Likert scores were comparable (<i>p</i> = 0.729), but FKGL and FRES favoured the standard model (both <i>p</i> &lt; 0.001). Interrater intraclass correlation coefficients (ICC) ranged from 0.57 to 0.83; intrarater ICCs from 0.63 to 0.79.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deep research provides superior scientific rigour, whereas the standard model offers better readability. A hybrid approach combining model strengths may maximise educational effectiveness, though clinical oversight remains essential to mitigate misinformation risks. The observed differences were modest in magnitude, aligning with previously reported accuracy–readability trade-offs in LLMs. These results should be interpreted as exploratory and hypothesis-generating.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cross-sectional, comparative simulation study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"660-665"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650766","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":"Return to performance criteria in soccer after musculoskeletal injury: A scoping review","authors":"Peter Eppinga,&nbsp;Wouter Welling,&nbsp;Rienk Dekker,&nbsp;Hans Zwerver","doi":"10.1002/ksa.70180","DOIUrl":"10.1002/ksa.70180","url":null,"abstract":"<p>Return to performance (RTPe), the final stage of the return to sport (RTS) continuum remains poorly defined in current soccer-related musculoskeletal (MSK) research, with limited identification and application of physical and/or psychological performance-based indicators. This scoping review aimed to systematically identify and synthesise currently used RTPe criteria, with a specific focus on facilitating return to competitive soccer at the same or higher level than pre-injury and identify gaps in relation to sport-specific demands. A scoping review was conducted in accordance with the PRISMA-ScR guidelines, using comprehensive Boolean search strategies across PubMed, CINAHL, and Web of Science databases. A total of twenty-nine peer reviewed studies met the inclusion criteria. Reported RTPe criteria encompassed the following domains: clinical examination, strength assessment, functional testing, performance-based testing, time elapsed since injury, and patient-reported outcome measures (PROMs). Most studies concentrated on the second stage of the three-stage RTS continuum, that is, ‘Return to Sports’, with limited integration of on-field, sport specific, or ecologically valid performance assessments. In addition, studies frequently neglect recommendations advocating a multidimensional and standardised test battery. Moreover, psychological readiness and performance-level demands—critical components of RTPe in elite soccer—were seldom addressed or often lacked standardised definitions. Female athletes were underrepresented despite higher injury incidence (6.77 vs. 5.70/1000 h in males). Anterior cruciate ligament (ACL) injuries were overrepresented, whereas more frequently occurring injuries like posterior thigh and groin injuries received less attention. More than half of the studies focused on elite athletes, limiting generalisability to recreational level. These findings underscore the urgent need for more robust, operationalized, and sport-specific RTPe criteria to support clinical decision-making and optimise outcomes following musculoskeletal injury in soccer. Existing criteria do not reliably capture readiness to pre-injury performance levels, addressing performance metrics, sport specific demands, and sex-specific considerations.</p><p><b>Level of Evidence:</b> N/A.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"724-751"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650807","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":"Return to sport and work after multiligament knee injury","authors":"Ingrid Trøan,&nbsp;Tone Bere,&nbsp;Inger Holm,&nbsp;Sverre Løken,&nbsp;Robert F. LaPrade,&nbsp;Lars Engebretsen,&nbsp;Gilbert Moatshe","doi":"10.1002/ksa.70175","DOIUrl":"10.1002/ksa.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Multiligament knee injuries (MLKIs) are complex and often associated with significant functional impairments. Data on return to sport (RTS) and return to work (RTW) remain limited, particularly for recreational athletes and the general population. The purpose of the study was to evaluate RTS, RTW and physical activity levels after surgical treatment of MLKIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients surgically treated for MLKI at a single Level 1 Trauma centre from 2013 to 2020 were included. Patient-reported outcomes included the Tegner score and work status before and after injury. Physical activity was assessed using the activity questionnaire from the Nord-Trøndelag Health Study (HUNT 1). Health-related quality of life was measured with the EuroQol 5-Dimension Questionnaire (EQ-5D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 191 eligible patients, 124 (65%) participated (mean age 37 ± 13.7 years, range 17–70). RTS: 77% (<i>n</i> = 84) returned to some level of sport, 37% (<i>n</i> = 31) returned to their pre-injury sport at any level, and only seven of 28 (25%) resumed high-level pivoting sports. The mean Tegner score declined from 5.2 to 3 (<i>p</i> &lt; 0.001). RTW: 90% (<i>n</i> = 112) returned to work, but 15% required task modifications or became disabled. Work participation significantly declined (2.1–1.9, <i>p</i> &lt; 0.04). Patients with single cruciate injuries had better outcomes, including higher Tegner (3.6 vs. 3, <i>p</i> = 0.043) and EQ-5D scores (0.931 vs. 0.893, <i>p</i> = 0.012) than those with bicruciate injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A significant number of patients with an MLKI were unable to return to their former sports activities, with only 37% returning to the same level as before the injury. Although most patients were able to return to their pre-injury work levels, 15% had to adapt to less demanding tasks or became disabled due to the injury. Despite significant reductions in activity levels, most patients reported good health-related quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cross-sectional cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"329-337"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650772","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":"Medial closing wedge high tibial osteotomy for lateral osteoarthritis in valgus knee offers good long-term outcomes in patients with normal body mass index","authors":"Pierre-Jean Lambrey,&nbsp;Merwane Ayata,&nbsp;Hichem Abid,&nbsp;Pierre Chambat,&nbsp;Nicolas Jan,&nbsp;Thais Dutra Vieira,&nbsp;Jean-Marie Fayard","doi":"10.1002/ksa.70176","DOIUrl":"10.1002/ksa.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the long-term functional outcomes and survivorship of medial closing wedge high tibial osteotomy (MCWHTO) in treating lateral femorotibial osteoarthritis (OA) and factors associated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 1997 and 2018, 65 patients (67 knees) who underwent an MCWHTO were longitudinally assessed. Inclusion criteria were symptomatic lateral femorotibial OA in valgus knees with no signs of medial compartment OA. The primary outcome was osteotomy survivorship with a failure endpoint defined by the necessity for total knee arthroplasty (TKA). Clinical and functional outcomes, including Knee injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) activity scale and patient satisfaction, as well as radiological evaluation, including hip-knee-ankle angle (HKA), mechanical proximal tibial angle (mPTA) and mechanical lateral distal femoral angle (mLDFA), were assessed both preoperatively and at final follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up was 11.5 ± 6.3 years [3.3–24.5]. Three patients were lost at final follow-up. Overall, 25 (39.1%) patients progressed to TKA. Median time to TKA was 12.7 years [95% CI: 10.6–17.1]. Risk of TKA conversion before 10 years was 7.4 times higher in patients with body mass index (BMI) &gt; 30 (<i>p</i> = 0.004). Among the 39 remaining patients, significant postoperative improvements were observed in the KOOS from 40.8 ± 14.7 to 68.2 ± 19.2 (<i>p</i> &lt; 0.0001) and the UCLA activity scale from 4.6 ± 2.1 to 7.0 ± 1.8 (<i>p</i> &lt; 0.0001). Radiological evaluations showed a shift toward varus alignment (HKA: 184.5 ± 2.5 vs. 178.8 ± 2.8; <i>p</i> &lt; 0.0001). There was a significant evolution of the mPTA from 89.5 ± 2.6 preoperatively to 84.0 ± 2.3 postoperatively (<i>p</i> &lt; 0.0001). There was no significant difference in the measurement of mLDFA. More than 80% of patients were very satisfied or would recommend the surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MCWHTO offers reliable long-term outcomes in valgus knees with lateral OA. Patient selection, particularly regarding BMI, is essential to achieve optimal survivorship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"248-256"},"PeriodicalIF":5.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535021","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":"ACL injury prevention content on TikTok: Untapped outreach potential for youth athletes","authors":"Ameer A. Haider,&nbsp;Siddhant Bhat,&nbsp;Hamza Jalal,&nbsp;Andrew W. Kuhn","doi":"10.1002/ksa.70128","DOIUrl":"10.1002/ksa.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the overall quality and extent of viewership of primary anterior cruciate ligament (ACL) injury prevention content on <i>TikTok</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The social media platform <i>TikTok</i> was queried using ACL injury prevention terms, and the 89 most-viewed English-language videos demonstrating primary preventative ACL injury exercises were included. This sample size was determined a priori via power analysis to detect a moderate effect. Two authors independently extracted video characteristics and engagement metrics and scored content quality using DISCERN, Principles for Health-related Information on Social Media (PRHISM) and ACL Exercise Education Score (ACLEES) scoring systems. Disputes were resolved via author consensus. Interrater reliability was assessed using Cohen's <i>κ</i>. Statistical analyses included linear regression, <i>t</i>-tests and Fisher's exact tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Collectively, the included posts garnered 5,988,018 views, 569,486 likes and 28,385 shares. Median scores were 30 (interquartile range [IQR] 24–38) for DISCERN, 13 (IQR 10–16) for PRHISM and 10 (IQR 6–15) for ACLEES, all indicating poor overall quality. Domain analysis revealed that content was generally accessible and relevant yet lacked citation of evidence and follow-up information. Post length significantly correlated with all three scoring systems. Self-identified healthcare professionals achieved significantly higher PRHISM scores than general users in authorship, authority and financial disclosure domains. No differences were found in engagement metrics or in DISCERN and ACLEES scores between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Primary ACL injury prevention content on <i>TikTok</i> is widely viewed, accessible and relevant, but generally of poor quality among both healthcare professionals and general users. Both post author groups inadequately provided condition-specific guidance, treatment rationale and references. <i>TikTok</i> may represent an important avenue for orthopaedic professionals to establish a presence and disseminate high-quality, evidence-based information regarding ACL injury prevention to youth and adolescent athletes in hopes of decreasing injury rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"698-708"},"PeriodicalIF":5.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534987","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}