Knee Surgery and Related Research最新文献

{"title":"Response to Matters arising: comments on \"Radiological risk factors in different patterns of patellar instability\".","authors":"Devendra Kumar Chouhan, Supreeth Kumar","doi":"10.1186/s43019-026-00323-7","DOIUrl":"10.1186/s43019-026-00323-7","url":null,"abstract":"","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical properties of an all-soft tissue quadriceps tendon autograft compared with a quadrupled semitendinosus autograft: a cadaveric study.","authors":"Thomas Sator, Lorenz Pichler, Gyula Kiss, Nicole Binder, Stephan Payr, Marcus Hofbauer, Thomas Koch, Sam Augustine Kandathil, Lena Hirtler, Thomas Manfred Tiefenboeck","doi":"10.1186/s43019-026-00337-1","DOIUrl":"10.1186/s43019-026-00337-1","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries are among the most frequent ligament injuries, with autograft reconstruction considered to be the gold standard treatment. The all-soft-tissue quadriceps tendon (ASTQT) autograft has gained popularity because of its favorable graft size, reliable biomechanical strength, and reduced donor site morbidity. However, graft strength depends on the preparation, fixation, and construct stiffness. Emerging techniques, such as suture tape augmentation, may further influence biomechanical outcomes. The aim of this study was to investigate the biomechanical properties of tape-augmented ASTQT construct compared with quadrupled semitendinosus construct (QST) for anterior cruciate ligament reconstruction (ACLR) using an established cadaveric biomechanical test protocol.</p><p><strong>Methods: </strong>A total of nine human cadaveric ASTQTs and 11 QSTs were obtained from the knees of body donors. For the ASTQTs, both ends were secured using a suture tape-integrated adjustable loop suspensory fixation device. For the QSTs, the semitendinosus tendons were quadrupled and attached to two adjustable loops and stitched using the buried-knot technique described by Lubowitz. Cyclic biomechanical testing was performed following an established protocol, and load-to-failure, mode of failure, and stiffness were reported.</p><p><strong>Results: </strong>QSTs revealed a significantly higher load-to-failure (806.1 N versus 577.9 N, P < 0.001), initial (120.7 N/mm versus 93.3 N/mm, P < 0.001) and final (153.9 N/mm versus 117.1 N/mm, P = 0.001) dynamic stiffness and higher stiffness at failure (173.8 N/mm versus 120.1 N/mm, P < 0.001) compared with ASTQTs. All ASTQTs exhibited suture tape cut-through (cheese wiring) at the proximal fixation site as their mode of failure. Conversely, suture rupture was the predominant failure mode in the QST group.</p><p><strong>Conclusions: </strong>In an established cadaveric test setting, the QST construct exhibited higher load-to-failure and stiffness compared with the tape-augmented ASTQT construct. The consistent cheese-wiring failure at the proximal fixation site of the ASTQT indicates that the tape-tendon interface-not the substance itself-was the limiting structural element. These findings should be interpreted as construct-specific limitations of tape augmentation in degenerated tendon tissue, rather than as evidence of intrinsic inferiority of the quadriceps tendon graft.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementary roles of standing, supine, and valgus-stress whole-leg radiographs in medial open-wedge high tibial osteotomy planning: supine minimizes bias, whereas standing and valgus-stress reduce outliers.","authors":"Geunwu Gimm, Hyunjeong Ra, Seok Gyun Yang, Byung Sun Choi, Du Hyun Ro, Hyuk-Soo Han","doi":"10.1186/s43019-026-00340-6","DOIUrl":"10.1186/s43019-026-00340-6","url":null,"abstract":"<p><strong>Background: </strong>Accurate alignment correction is essential in medial open-wedge high tibial osteotomy (MOWHTO). However, conventional planning based on standing radiographs may not reflect postoperative intra-articular alignment changes. While differences between standing and supine radiographs have been investigated, the role of valgus-stress whole-leg radiographs in preoperative planning remains largely unexplored. This study evaluated the predictive accuracy of standing, supine, and valgus-stress whole-leg radiographs in MOWHTO planning and determined whether integrating these modalities improves alignment prediction compared with single-modality planning.</p><p><strong>Methods: </strong>This retrospective study included 71 patients who underwent MOWHTO. Preoperative standing, supine, and valgus-stress whole-leg radiographs, along with 1-year postoperative standing radiographs, were analyzed. To minimize the influence of surgical execution error and allow the analysis to focus on planning error, the achieved wedge angle was back-calculated from postoperative bony correction and reapplied to each preoperative modality to simulate the postoperative weight-bearing line ratio (Post-WBLR). Accuracy was assessed by comparing simulated and actual Post-WBLR. Multivariable regression was performed to identify predictors of actual Post-WBLR and to compare a multimodal model with the best-performing single-modality simulation.</p><p><strong>Results: </strong>In the postoperative valgus subgroup (n = 48), supine-based simulation showed no significant difference from actual Post-WBLR (mean difference, 0.0% ± 6.9%; root mean square error [RMSE], 6.8%). In contrast, standing-based simulation underestimated alignment (-9.3% ± 7.8%; RMSE, 12.1%), whereas valgus-stress simulation overestimated it (15.2% ± 6.7%; RMSE, 16.6%). A multimodal regression model incorporating simulated Post-WBLR from standing and valgus-stress radiographs demonstrated significantly improved predictive accuracy compared with the supine-only simulation (R², 0.606 versus 0.080; RMSE, 4.5% versus 6.8%). Notably, in patients with a preoperative standing-to-supine joint line convergence angle difference (∆JLCA_{standing-supine}) ≥ 2.7°, the multimodal model significantly reduced prediction errors (absolute error: 3.2% versus 6.8%; RMSE: 4.0% versus 9.0%; all P < 0.015).</p><p><strong>Conclusions: </strong>Supine radiographs generally provided the most accurate single-modality basis for MOWHTO planning. Standing and valgus-stress radiographs offered complementary information, and their integration improved prediction accuracy and reduced planning outliers. While further validation is required, a stepwise planning workflow-using supine radiographs as the default modality and multimodal integration when ∆JLCA_{standing-supine} ≥ 2.7°-may serve as an exploratory framework for reducing the risk of planning-related under- or overcorrection.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction model for abnormal joint line obliquity after open wedge high tibial osteotomy using knee radiographic parameters.","authors":"Kritsada Sukha, Witoon Thremthakanpon, Burin Sutthapakti, Kriangkamol Benjawongsathien, Thanawut Hirunthanawiwat, Wiboon Wanitcharoenporn, Thisayapong Inta-Ngam, Artit Laoruengthana","doi":"10.1186/s43019-026-00333-5","DOIUrl":"10.1186/s43019-026-00333-5","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to identify key preoperative radiographic parameters and develop a predictive model for abnormal knee joint line obliquity (KJLO) following medial open-wedge high tibial osteotomy (MOWHTO) in patients with medial compartment knee osteoarthritis.</p><p><strong>Methods: </strong>This retrospective observational cohort study included 81 patients (100 knees) treated with MOWHTO. All patients had symptomatic medial knee osteoarthritis with varus alignment and underwent preoperative and postoperative long-standing radiographs under a standardized protocol. Radiographic parameters including preoperative hip-knee angle (HKA), mechanical axis deviation, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line congruence angle (JLCA), and KJLO were measured. Multivariable logistic regression analysis was used to identify strong predictors of abnormal postoperative KJLO, defined as an angle > 4°. The final model was selected on the basis of backward elimination method. Model's discrimination performance was analyzed by using sensitivity, specificity, and area under the receiver operating characteristic curve (AuROC). Model stability was demonstrated by calibration plot and Hosmer-Lemeshow goodness of fit. Bootstrapping internal validation was performed to estimate model accuracy.</p><p><strong>Results: </strong>Of 81 patients (100 knees), there were 65 female and 16 male patients with an average age of 50.1 years and mean body mass index (BMI) of 27.8 kg/m²; 61 knees were found post-KJLO > 4°. According to the performance of logistic regression, sensitivity, specificity, and ROC were calculated to select the best formula for postoperative KJLO prediction. The final predictive model included preoperative HKA, MPTA, and KJLO, and the planned correction angle. The model demonstrated strong performance with an AuROC of 0.876 (95% CI 0.808-0.945). Calibration plot illustrated calibration-in-the-large (CITL) of 0.00, E:O of 1.00, slope of 1.00. Following internal validation, the model remained robust with AuROC of 0.875. The model demonstrated a sensitivity of 80.30%, specificity of 87.20%, positive predictive value of 90.70%, and negative predictive value of 73.90%.</p><p><strong>Conclusions: </strong>This predictive model incorporating preoperative HKA, MPTA, and KJLO, and the planned correction angle, demonstrates high internal validity and serves as a robust tool for individualized surgical planning in MOWHTO. By identifying high-risk patients preoperatively, surgeons can proactively tailor treatment strategies, such as modifying the target correction angle or opting for other surgical options.</p><p><strong>Trial registration: </strong>TCTR20251003003.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing perioperative systemic dexamethasone use in total knee arthroplasty: a narrative review on current evidence.","authors":"Jisu Park, Tae Woo Kim, Moon Jong Chang, Seung-Baik Kang","doi":"10.1186/s43019-026-00336-2","DOIUrl":"10.1186/s43019-026-00336-2","url":null,"abstract":"<p><strong>Background: </strong>Perioperative corticosteroids, particularly dexamethasone, have become a widely adopted component of multimodal pain management in total knee arthroplasty (TKA). While clinical practice guidelines strongly recommend their use, detailed guidance on optimal dosing, frequency, and safety in special populations, especially patients with diabetes mellitus, is still limited.</p><p><strong>Main text: </strong>This narrative review synthesizes the current evidence on systemic perioperative dexamethasone use in TKA, focusing on clinical questions: agent and route selection, dose optimization, dosing frequency, and safety, including considerations for patients with diabetes. A literature search of PubMed, EMBASE, and the Cochrane Library was conducted for studies published between January 2015 and April 2026. Randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and observational studies addressing systemic corticosteroid use in primary TKA were included. Recent evidence supports intravenous (IV) dexamethasone as the most commonly studied and clinically practical systemic agent. A 16 mg dose provides greater early analgesic and antiemetic benefit than lower doses, and repeat dosing through postoperative day (POD) 1 is supported, with extension to POD 2 emerging but not yet definitive. Perioperative dexamethasone has not been associated with increased infection or wound complications. In patients with well-controlled diabetes, it appears safe with appropriate glycemic monitoring, although safety data are largely limited to doses of 8-10 mg.</p><p><strong>Conclusions: </strong>Current evidence supports IV dexamethasone as an effective component of multimodal analgesia after TKA. In the general TKA population, 16 mg appears more effective than lower doses for early postoperative pain, opioid consumption, and postoperative nausea and vomiting (PONV)-related outcomes. Repeat dosing through POD 1 is supported by available evidence, whereas extension to POD 2 remains promising but requires further validation. In patients with well-controlled diabetes, perioperative dexamethasone appears safe with appropriate glycemic monitoring, although safety data are largely limited to doses of 8-10 mg, and the safety of the 16 mg dose in this population remains insufficiently defined.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-stratified risk of major systemic complications following unicompartmental versus total knee arthroplasty: a nationwide cohort study.","authors":"Manabu Kawata, Shotaro Aso, Kohei Kawaguchi, Ryota Yamagami, Kenichi Kono, Shuji Taketomi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Sakae Tanaka","doi":"10.1186/s43019-026-00330-8","DOIUrl":"10.1186/s43019-026-00330-8","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for knee arthroplasty remains under debate regarding reducing systemic complications. Although unicompartmental knee arthroplasty (UKA) is generally considered less invasive than total knee arthroplasty (TKA), it remains unclear whether this advantage persists across age groups. This study aimed to compare the risk of major systemic complications between UKA and TKA across age categories using a large-scale nationwide database.</p><p><strong>Methods: </strong>Patients who underwent UKA or TKA between July 2010 and March 2022 were identified from the Diagnosis Procedure Combination database in Japan. The primary outcome was a composite of postoperative in-hospital death and major systemic complications requiring additional interventions. Rates of postoperative red blood cell (RBC) transfusion were also evaluated as a secondary outcome. Stabilized inverse probability of treatment weighting (IPTW) using propensity scores was applied to compare outcomes between the groups.</p><p><strong>Results: </strong>The cohort included 36,235 UKA and 322,424 TKA cases. After stabilized IPTW adjustment, the composite outcome occurred less frequently after UKA than after TKA (risk ratio [RR] 0.65; 95% confidence interval [CI] 0.50-0.85; p = 0.001). The RBC transfusion rate was also reduced in the UKA group (RR, 0.09; 95% CI 0.08-0.11; p < 0.001). In subgroup analyses stratified by age (≤ 79 and ≥ 80 years), UKA was associated with a lower incidence of the composite outcome compared with TKA in patients aged ≤ 79 years (RR 0.48; 95% CI 0.34-0.68; p < 0.001), whereas no significant difference between UKA and TKA was observed among patients aged ≥ 80 years (RR 0.92; 95% CI 0.62-1.35; p = 0.670). The rate of RBC transfusion was lower in the UKA group across age groups (for ≤ 79 years, RR 0.07; 95% CI 0.05-0.09; p < 0.001; for ≥ 80 years, RR 0.12; 95% CI 0.10-0.14; p < 0.001).</p><p><strong>Conclusions: </strong>RBC transfusion rates were consistently lower following UKA across age groups. While UKA was associated with fewer major systemic complications than TKA in patients aged ≤ 79 years, no such difference was observed in patients aged ≥ 80 years. In very elderly patients, careful perioperative risk assessment remains essential when considering UKA, similar to that for TKA.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral and tibial attachment positions of the anterolateral ligament graft are associated with anterior instability after combined anterior cruciate ligament and anterolateral ligament reconstruction.","authors":"Se-Han Jung, Min Jung, Kwangho Chung, Hyun-Soo Moon, Byeong-Hun Jeon, Jun-Young Lim, So-Heun Lee, Sung-Hwan Kim","doi":"10.1186/s43019-026-00342-4","DOIUrl":"10.1186/s43019-026-00342-4","url":null,"abstract":"<p><strong>Background: </strong>While numerous studies have examined the benefits of combining anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction on clinical outcomes, detailed investigations into the relationship between reconstructed ALL femoral and tibial attachment positions and outcomes remain limited. The purpose of this study is to analyze the association between ALL graft attachment positions and clinical outcomes in patients undergoing combined ACL and ALL reconstruction.</p><p><strong>Methods: </strong>Patients who underwent combined ACL and ALL reconstruction between 2019 and 2023 were retrospectively reviewed. Postoperative computed tomography was performed and reconstructed three-dimensionally to quantify the femoral and tibial graft attachment positions of the ALL. Clinical outcomes were assessed at 1- and 2-year follow-ups using objective and subjective measures, including anterior-posterior (AP) and rotational instability, range of motion, and several patient-reported outcomes. The associations between three-dimensionally measured graft attachment positions and clinical outcomes were analyzed.</p><p><strong>Results: </strong>A total of 52 patients were included. At 1 year, a more proximal and posterior ALL femoral position correlated with reduced AP instability measures including KT-2000 and Lachman stress radiograph side-to-side difference (SSD) (r = -0.305 to -0.354) and lower likelihood of a positive Lachman test (r = -0.414 and -0.586). Posterior femoral position was associated with greater extension deficit (r = 0.281, P = 0.043). Regression analysis showed that femoral AP position was associated with KT-2000 SSD (B = -0.327, P = 0.011) and Lachman positivity (posterior OR 0.60, P = 0.005; proximal OR 0.77, P = 0.032). At 2 years, posterior femoral AP position remained associated with reduced anterior translation (B = -0.301, P = 0.012), while the tibial AP position was positively associated with Lachman SSD (B = 0.297, P < 0.001), indicating that a more anterior tibial position, represented by a lower AP ratio, was associated with lower Lachman SSD. ACL tunnel position showed no significant association with clinical outcomes. Significant range of motion (ROM) deficits occurred in 21.2% at 1 year but declined to 5.7% (extension) and 11.4% (flexion) at 2 years. Anatomical femoral positioning was associated with reduced anterior instability (Lachman SSD at 1 year, P = 0.032; at 2 years, P = 0.008) but was also associated with greater early ROM deficits, which resolved by 2 years.</p><p><strong>Conclusions: </strong>The femoral and tibial attachment positions of the ALL graft were associated with AP instability after combined ACL and ALL reconstruction. A more horizontal graft course was associated with reduced AP instability and mild, transient early ROM deficits.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13410599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of change in limb length following correction of coronal and sagittal plane deformities in patients undergoing total knee arthroplasty: a retrospective study.","authors":"Soutrik Kundu, Hyuck Min Kwon, Byung-Woo Cho, Jun Young Park, Woo-Suk Lee, Kwan Kyu Park","doi":"10.1186/s43019-026-00334-4","DOIUrl":"10.1186/s43019-026-00334-4","url":null,"abstract":"<p><strong>Background: </strong>Limb length discrepancy (LLD) following total knee arthroplasty (TKA) may affect functional outcomes and patient satisfaction. However, relative impact of coronal and sagittal plane deformity correction on change in limb length (CLL) following TKA are still not fully understood. The aim of this study is to guide the surgeon regarding the expected change in limb lengths following correction of coronal and sagittal plane deformities.</p><p><strong>Methods: </strong>This retrospective study comprised 237 primary TKAs conducted by a single surgeon from August 2024 to July 2025. Preoperative deformities consisted of 215 varus and 22 valgus knees. Standing anteroposterior radiographs of full length were used to assess the hip-knee-ankle (HKA) angle and limb length before and after the operation. Flexion contracture was assessed through clinical measurement. Correlation and multivariable regression analyses were conducted to ascertain predictors of limb length alteration, while adjusting for possible confounders such as patient height and polyethylene insert thickness. A regression-based predictive model was subsequently developed.</p><p><strong>Results: </strong>Mean limb length showed a notable increase after TKA (10.4 ± 9.1 mm; p < 0.0001). The preoperative HKA angle showed a significant positive correlation with CLL in both varus and valgus knees and remained the strongest independent predictor (p < 0.001 for varus; p = 0.046 for valgus). Preoperative flexion contracture did not show a significant independent association with CLL. Patient height and the thickness of the polyethylene insert did not have a notable effect on changes in limb length.</p><p><strong>Conclusions: </strong>TKA leads to consistent limb lengthening, mainly caused by the correction of coronal plane deformities. Estimating limb length changes before surgery can aid in surgical planning and patient counseling, especially in cases of unilateral or staged bilateral TKA. Level of evidence III, Retrospective comparative cohort study.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does a failure in anterior cruciate ligament reconstruction really mean? An integrative view.","authors":"Ruben Dario Arias Pérez, Victor Alfonso Avendaño Arango, German Alejandro Jaramillo Quiceno, Paula Andrea Sarmiento Riveros, Camilo Partezani Helito, João Espregueira-Mendes, Renato Andrade, Margarita Maria Pilonieta Gonzalez","doi":"10.1186/s43019-026-00339-z","DOIUrl":"10.1186/s43019-026-00339-z","url":null,"abstract":"<p><p>Anterior cruciate ligament reconstruction (ACLR) is among the most frequently performed and successful procedures in orthopedic surgery. Nevertheless, a substantial proportion of patients experience postoperative \"failure,\" a term that remains inconsistently defined throughout the literature. This narrative review critically analyzes the heterogeneity of definitions applied to ACLR failure, underscoring persistent gaps, contradictions, and their implications for clinical practice and research. We subsequently propose an integrative definition that aligns with both the clinical and functional objectives of reconstruction. Failure may result from multiple factors, including but not limited to technical, biological, traumatic, and patient-related, and inconsistencies arise when definitions rely exclusively on graft rupture, revision surgery, laxity thresholds, or isolated patient-reported symptoms. Although current consensus statements acknowledge this variability, they fail to provide operational definitions. Consequently, reported failure rates vary considerably, limiting comparability across studies. We advocate defining ACLR failure, as the presence of any of the following: objective or subjective post-operative instability, persistent knee pain, functional limitation including restricted range of motion, documented graft rupture, or new symptomatic meniscal injury in the absence of significant trauma. This multidimensional, patient-centered framework reflects the fundamental goals of ACLR and may serve as a foundation for standardized reporting criteria in future clinical and research endeavors.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of the platelet-to-lymphocyte ratio (PLR) for periprosthetic joint infection after total hip and knee arthroplasty: a systematic review and meta-analysis.","authors":"Alireza Sadeghpour Teymourlou, Amin Moradi, Hossein Akbari Aghdam, Hooman Yahyazadeh, Mohamm Ali Jafari Zare, Asghar Elmi, Mohammad Reza Aslani","doi":"10.1186/s43019-026-00314-8","DOIUrl":"10.1186/s43019-026-00314-8","url":null,"abstract":"<p><strong>Background: </strong>Research has investigated the function of biomarkers, such as the platelet-lymphocyte ratio (PLR), in identifying periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study aimed to conduct an updated systematic review and meta-analysis in order to assess the diagnostic efficacy of PLR for PJI.</p><p><strong>Methods: </strong>Reviews of databases including PubMed, Scopus, and Web of Science were conducted to identify studies related to the use of PLR in diagnosing PJI. The evaluations covered the diagnostic performance of PLR for PJI. Furthermore, because of the significant heterogeneity across the studies, subgroup analyses were conducted focusing on geographic region (China versus other countries), site surgery (unseparated hip and knee versus separated hip and knee), and patient numbers (more than 200 versus less than 200).</p><p><strong>Results: </strong>A total of 4892 TKA and THA patients from 17 studies were included in the meta-analysis. Of the total patients, 1980 (40.5%) were diagnosed with PJI. Diagnostic sensitivity and specificity combined were 0.70 (95% CI 0.62-0.77) and 0.73 (95% CI 0.65-0.79), respectively. Results from the subgroup analysis indicated enhanced sensitivity and specificity concerning geographic differences, surgical site variances, and studies with fewer than 200 patients.</p><p><strong>Conclusions: </strong>PLR demonstrated moderate diagnostic accuracy and could function as an accessible supplementary marker in the evaluation process of PJI; additional research is necessary to establish optimal thresholds and its benefit alongside current diagnostic standards.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}