Knee Surgery and Related Research最新文献

{"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}

{"title":"Utilizing supplementary high-strength suture tying over a bone bridge enhances the effectiveness of interference screw as tibial fixation method in anterior cruciate ligament reconstruction.","authors":"Alvaro Arriaza, Pablo Miragaya, Juan Mora-Macías, Esther Reina-Romo, Pablo Blázquez-Carmona, Fernando Marco, Rafael Arriaza","doi":"10.1186/s43019-026-00325-5","DOIUrl":"10.1186/s43019-026-00325-5","url":null,"abstract":"<p><strong>Background: </strong>Tibial fixation is the biomechanical weak point in anterior cruciate ligament (ACL) reconstruction, with numerous techniques proposed to address this challenge. This study evaluates the utility of a simple, cost-effective system: high-strength suture tying over a bone bridge (BB). Its effectiveness as standalone fixation and as a supplement to standard interference screw (IS) fixation is compared with IS alone and supplemented with other commercial systems.</p><p><strong>Methods: </strong>A biomechanical study was conducted using six fixation methods tested on 61 specimens with bovine extensor tendons in porcine tibial models. Groups included BB alone, IS alone, and four hybrid fixation methods: IS + BB, IS + a cortical screw post (CSP), IS + a PushLock^® anchor, and IS + a SwiveLock^® anchor, with at least nine specimens per group. Specimens underwent cyclic load testing (500 cycles at 100-200 N) and pull-to-failure tests (20 mm/min) to measure displacement, ultimate load to failure, and stiffness.</p><p><strong>Results: </strong>Standalone BB fixation showed limited performance, with an ultimate load to failure of 357.81 ± 90.53 N and cyclic displacement of 14.88 ± 3.28 mm, insufficient for early rehabilitation. When combined with IS, BB significantly improved performance, achieving an ultimate load to failure of 500.55 ± 151.24 N, comparable to commercial systems, and reducing cyclic displacement to 4.82 ± 0.83 mm. Hybrid fixation methods lowered early failure rates to 10%, compared with 30-40% in single-method fixations, confirming enhanced stability.</p><p><strong>Conclusions: </strong>Hybrid fixation methods are more reliable than simple ones for tibial fixation. Combining IS with BB provides a biomechanically robust and cost-effective solution for ACL reconstruction. This simple, ecological and affordable method reduces early failure rates, minimizes cyclic displacement, and achieves outcomes comparable to commercial systems, offering a practical choice for improving ACL repair outcomes.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449632","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":"Knee-specific bone quality assessment for cementless total knee arthroplasty candidate selection: a narrative review.","authors":"Dong Hwan Lee, Dai-Soon Kwak, Sheen-Woo Lee, Sung-Min Kim, Yong Deok Kim, In Jun Koh","doi":"10.1186/s43019-026-00331-7","DOIUrl":"10.1186/s43019-026-00331-7","url":null,"abstract":"<p><p>Cementless total knee arthroplasty (TKA) has regained attention in younger, active, and obese patients, supported by advances in implant design, porous coating, and 3D printing technologies. However, the success of cementless fixation depends on adequate initial mechanical stability and subsequent osseointegration, making the assessment of bone quality at the implant-bone interface essential. Although central dual-energy X-ray absorptiometry (DXA) is useful for evaluating systemic bone health, it has been reported to inadequately reflect the localized peripheral bone quality of the distal femur and proximal tibia. Therefore, cementless TKA candidate selection requires direct evaluation of the bone quality around the knee joint, particularly at the bone resection site. This narrative review summarizes the preoperative and intraoperative methods available for knee-specific bone quality assessment in the context of cementless TKA selection. Various X-ray-based methods are accessible but limited by two-dimensional projection and protocol variability. Peripheral DXA allows localized bone mineral density measurement but lacks standardization and remains two-dimensional. Magnetic resonance imaging (MRI) has potential for assessing marrow composition and trabecular microarchitecture, but evidence supporting its use in cementless TKA selection remains limited. By contrast, computed tomography (CT)-based assessment is considered the most practical modality, offering three-dimensional evaluation and region-specific analysis. Hounsfield unit analysis on conventional CT can be readily integrated into the routine preoperative workflow, while quantitative CT and dual-energy CT provide more quantitative evaluation through volumetric bone mineral density measurement. Intraoperative assessment has the advantage of directly evaluating the implant bed; however, conventional tactile assessment remains subjective, and visual grading systems and device-based assessments have been proposed to overcome this limitation. Nevertheless, no standardized method has yet been established, and further research is needed. CT-based assessment is the most practical current modality, and intraoperative assessment is gaining objectivity. The integration of these methods with artificial intelligence-driven multi-modal assessment is expected to enable more precise and patient-specific cementless TKA candidate selection.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424663","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":"Perioperative risk stratification for periprosthetic joint infection after primary total knee arthroplasty: a case-matched cohort study incorporating serum albumin, glycemic status, and intraoperative hypothermia.","authors":"Yung-Fong Tsai, Yu-Hong Ng, Shu-Yu Yeh, Yu-Hsun Sun, Huan-Tang Lin, Yu-Fang Liu, Shao-Chun Wu","doi":"10.1186/s43019-026-00335-3","DOIUrl":"10.1186/s43019-026-00335-3","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) remains a serious complication of primary total knee arthroplasty (TKA). This study investigated independent and combined associations of serum albumin, preoperative blood glucose, and intraoperative lowest body temperature (LBT) with PJI within 1 year after primary TKA.</p><p><strong>Materials and methods: </strong>This retrospective case-matched cohort study enrolled 312 patients (57 PJI cases, 255 controls) from 4319 screened undergoing primary TKA. Cases were matched 1:5 to controls by operating surgeon and year of surgery (frequency matching). Infection was defined by 2018 International Consensus Meeting criteria. Multivariable logistic regression (seven covariates, events-per-variable = 8.1) and receiver operating characteristic (ROC) analysis identified independent predictors and assessed discrimination. Two composite models were constructed using ROC-derived cutoffs: a two-factor preoperative model (serum albumin ≤ 4.1 g/dL + blood glucose ≥ 147 mg/dL) and a three-factor perioperative model additionally incorporating LBT ≤ 35.5 °C.</p><p><strong>Results: </strong>Of 4319 patients, 57 (1.3%) developed PJI. Lower serum albumin was associated with higher infection odds (odds ratio (OR) 0.87 per 0.1 g/dL, 95% confidence interval (CI) 0.78-0.97; p = 0.010); blood glucose with increased risk (OR 1.01 per mg/dL, 95% CI 1.00-1.02; p = 0.014); and LBT ≤ 35.5 °C with significantly increased risk (OR 2.65, 95% CI 1.40-5.02; p = 0.003). The two-factor (area under the curve (AUC) = 0.63) and three-factor (AUC = 0.69) models showed stepwise PJI gradients across cumulative strata; the adjusted multivariable model achieved AUC = 0.71 (95% CI 0.63-0.79).</p><p><strong>Conclusions: </strong>Serum albumin, blood glucose, and intraoperative LBT are independent modifiable predictors of PJI after primary TKA. A two-factor preoperative model (albumin + glucose) supports preoperative screening; a three-factor model adding LBT provides intraoperative surveillance for structured normothermia protocols. These exploratory cutoffs were derived from a single-center cohort and require external multicenter validation before clinical implementation.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424802","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":"Cerebrovascular disease and postoperative cognitive-related complications after knee arthroplasty: evidence from a nationwide cohort.","authors":"Yu Mori, Kunio Tarasawa, Hidetatsu Tanaka, Naoko Mori, Kiyohide Fushimi, Toshimi Aizawa, Kenji Fujimori","doi":"10.1186/s43019-026-00329-1","DOIUrl":"10.1186/s43019-026-00329-1","url":null,"abstract":"<p><strong>Background: </strong>Patients with a history of cerebrovascular disease may be at an increased risk for postoperative complications following knee arthroplasty; however, previous studies have been limited by small sample sizes and insufficient adjustment for confounding variables. This study aimed to evaluate whether cerebrovascular disease is associated with postoperative complications using a nationwide Japanese database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using Japan's Diagnosis Procedure Combination database from April 2016 to March 2023. Patients who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) were identified, and postoperative complications-including deep vein thrombosis, pulmonary embolism, cerebrovascular events, surgical site infection, cognitive-related complications, and periprosthetic fractures-were evaluated. Cerebrovascular disease was defined using ICD-10 codes I60-I69. Propensity score matching (1:1) was performed using demographics, comorbidities, anesthesia type, and surgical procedure. Multivariate logistic regression was conducted to account for residual confounding.</p><p><strong>Results: </strong>Among 259,319 eligible patients, 8298 had cerebrovascular disease. After matching, 8269 pairs were analyzed. Before matching, patients with cerebrovascular disease showed higher rates of thromboembolic and infectious complications, longer hospital stays, and greater transfusion volume. After matching, only cognitive-related complications remained significantly more frequent in the cerebrovascular disease group. Cerebrovascular disease was associated with postoperative cognitive-related complications (odds ratio (OR) 1.70; 95% confidence interval (CI) 1.28-2.26; p = 0.0003), with a risk difference of 0.62% (95% CI 0.28-0.95). Sensitivity analyses excluding patients with preoperative dementia or cognitive impairment and analyses limited to TKA cases demonstrated directionally consistent findings, although these associations did not reach the prespecified stringent significance threshold.</p><p><strong>Conclusions: </strong>Cerebrovascular disease does not increase the risk of recurrent cerebrovascular events after knee arthroplasty; however, it elevates the risk of postoperative cognitive-related complications, despite a low absolute incidence. Although the overall incidence was low, this finding may have implications for postoperative recovery and functional outcomes.</p><p><strong>Level of evidence: </strong>III (retrospective cohort study).</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13340325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399706","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":"Associations of muscle coactivation patterns with gait, muscle strength, and symptoms across different stages of knee osteoarthritis.","authors":"Lihang Zhang, Peiyao Liang, Hang Yu, Shaochen Qu, Liming Liu, Liufeng Xiao, Shiyi Tong, Dianwei Li, Shibo Xu, Xing Xing, Lin Guo","doi":"10.1186/s43019-026-00326-4","DOIUrl":"10.1186/s43019-026-00326-4","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate associations between neuromuscular activation patterns, symptoms, muscle strength, and gait parameters across different stages of knee osteoarthritis (KOA).</p><p><strong>Methods: </strong>In this cross-sectional study, 165 unilateral KOA patients and 32 healthy controls underwent synchronized gait analysis, isokinetic strength testing, surface electromyography, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Muscle coactivation was quantified as the normalized electromyographic (EMG) ratio of antagonist to agonist muscles during gait phases and isokinetic contractions. Group comparisons were performed using one-way ANOVA with Bonferroni correction. Spearman correlations and multiple linear regression models examined relationships between muscle activation, biomechanical parameters, and WOMAC scores.</p><p><strong>Results: </strong>Compared with controls, patients with KOA showed progressively deteriorating gait patterns and strength performance with increasing K-L grades (p < 0.05). A distinct compensatory neuromuscular pattern, characterized by excessive coactivation of the hamstrings (particularly the lateral hamstring) and the vastus lateralis, was identified (p = 0.002-0.048). This pattern was significantly associated with reduced knee flexion moment and elevated knee adduction moment (p = 0.004-0.038). These changes were observable from K-L II and became more pronounced in advanced KOA (K-L ≥ III), correlating with higher WOMAC pain, stiffness, and functional scores (p < 0.001-0.046). Significant inter-limb asymmetry was observed between affected and contralateral limbs (asymmetry index [ASI] = 1.72-13.84; limb symmetry index [LSI] = 56.3-92.7%).</p><p><strong>Conclusions: </strong>KOA is associated with an adaptive neuromuscular strategy characterized by excessive hamstring coactivation. While this pattern may aim to stabilize the joint, it correlates with biomechanical inefficiency, symptom worsening, and functional decline. This coactivation pattern may serve as a promising biomechanical marker for better understanding KOA manifestations and warrants further investigation as a potential therapeutic target.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399696","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":"Tibial plateau depression and widening as predictors of meniscal and ligamentous injuries: a systematic review and meta-analysis.","authors":"Sina Javidmehr, Muhammad Parsa Pashazadeh, Mohammad Reza Ramezanpour, Armin Akbarzadeh, Behnaz Behzadi, Robert F LaPrade","doi":"10.1186/s43019-026-00332-6","DOIUrl":"10.1186/s43019-026-00332-6","url":null,"abstract":"<p><strong>Background: </strong>Tibial plateau fractures are complex knee injuries frequently accompanied by meniscal and ligamentous injuries. Although radiography and computed tomography (CT) are routinely used to evaluate fracture patterns, their ability to predict associated soft-tissue injuries has not been well established. This systematic review investigated the diagnostic value of tibial plateau depression and widening as radiographic predictors of meniscal and ligamentous injuries in patients with tibial plateau fractures.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. MEDLINE, Scopus, Embase, and Web of Science were searched up to July 2025. Studies evaluating the association between tibial plateau depression or widening and meniscal or major ligamentous injuries (cruciate and collateral ligaments) in adults were included. Random-effects models were used to pool mean differences (MDs) and diagnostic accuracy estimates.</p><p><strong>Results: </strong>A total of 17 studies encompassing 1348 patients were included. Patients with lateral meniscus (LM) injuries had significantly greater lateral plateau depression (LPD) than those without (MD 5.03 mm, 95% CI 3.94-6.12). The pooled diagnostic odds ratio (DOR) of LPD for detecting LM injury was 9.80, with a sensitivity of 84%, specificity of 63%, and an area under the sROC curve (AUC) of 0.724. Lateral plateau widening (LPW) was also significantly higher in patients with LM injuries (MD 1.37 mm, 95% CI 0.29-2.45), with a pooled DOR of 7.97, sensitivity of 71%, specificity of 71%, and AUC of 0.758. Associations between LPD/LPW and medial meniscus or cruciate ligament injuries were more heterogeneous, although LPD had consistent relationships with lateral collateral ligament injury and LPW showed a significant pooled association with anterior cruciate ligament (ACL) injury (MD = 3 mm).</p><p><strong>Conclusions: </strong>LPD was the most consistent radiographic predictor of LM injury, with injured patients demonstrating, on average, 5 mm greater depression, while LPW provided complementary value with a pooled MD of 1.37 mm in patients with LM injury and also showed a significant, though more heterogeneous, association with ACL injury. These routinely available CT- or radiograph-based parameters can help stratify the risk of soft-tissue injury and guide selective use of MRI or arthroscopic inspection with tibial plateau fractures.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399711","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":"Significance of a 4-week home-based prehabilitation program in accelerating 3-month recovery post total knee arthroplasty: a retrospective cohort study.","authors":"Haiqi Ding, Guoyu Yu, Long Chen, Xiang Luo, Guiguan Wang, Hanhao Dai, Chen Chen, Jun Luo, Yuan Lin, Jie Xu, Fenqi Luo","doi":"10.1186/s43019-026-00315-7","DOIUrl":"10.1186/s43019-026-00315-7","url":null,"abstract":"<p><strong>Background: </strong>Preoperative rehabilitation is one of the strategies for enhanced recovery after surgery (ERAS) following total knee arthroplasty (TKA), but the optimal duration remains inconclusive. This study aims to evaluate the impact of a 4-week home-based prehabilitation program on accelerating postoperative recovery in patients undergoing TKA.</p><p><strong>Methods: </strong>In this retrospective cohort analysis, 176 patients undergoing primary unilateral TKA were categorized into two groups: those who completed a 4-week home-based prehabilitation program (training group, n = 72) and those who did not (control group, n = 104). Baseline demographics, perioperative data, pain scores, and functional outcomes were collected. Patients were followed for over 1 year. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and secondary outcomes included visual analog scale (VAS), knee range of motion (ROM), Knee Society Score (KSS), timed up-and-go (TUG) test, and stair climbing test. Assessments were performed at baseline, before surgery, and multiple time points after TKA.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. The training group demonstrated significantly earlier first postoperative ambulation (median 9 versus 12 h, P = 0.003) and shorter hospital stays (median 7 versus 10 days, P = 0.002). Pain scores (VAS) were significantly lower in the training group at 1 day and 1 week postoperatively (P < 0.05). Functional outcomes including ROM, KSS, TUG, and stair test were superior in the training group at 1 and 3 months (P < 0.05). WOMAC total scores and its subscales (pain, stiffness, function) also showed significant improvements in the Training group at 1 and 3 months (P < 0.05). While advantages in ROM and TUG persisted up to 6 months, no significant between-group differences were observed at 12 months for any outcome measure.</p><p><strong>Conclusions: </strong>A 4-week home-based prehabilitation program significantly enhances early recovery after TKA, as evidenced by reduced hospital stay, lower early postoperative pain, and improved functional outcomes within the first 3 months. Although benefits in certain functional measures persist up to 6 months, outcomes converge by 12 months. These findings support the integration of structured 4-week home-based prehabilitation program into ERAS pathways.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362739","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":"Effect of intravenous hydrocortisone and periarticular triamcinolone acetonide injection on quadriceps strength recovery in patients undergoing total knee arthroplasty: a prospective randomised controlled trial.","authors":"Kulapat Chulsomlee, Thitiphol Wanitchanont, Chattrapat Asavakunalai, Sorawut Thamyongkit, Nithid Sri-Utenchai, Siwadol Wongsak, Chavarat Jarungvittayakon, Paphon Sa-Ngasoongsong","doi":"10.1186/s43019-026-00328-2","DOIUrl":"10.1186/s43019-026-00328-2","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain management is crucial for optimising recovery after total knee arthroplasty. Adequate pain control facilitates early rehabilitation, enhances quadriceps muscle recovery, improves knee function and improves patient satisfaction. Corticosteroids are widely used for postoperative pain management. However, studies comparing the efficacy of periarticular (PA) and intravenous (IV) corticosteroid injection are limited. Therefore, this study aimed to evaluate the effect of PA and IV corticosteroid injections on quadriceps strength (QS) recovery in patients undergoing total knee arthroplasty.</p><p><strong>Methods: </strong>A total of 59 patients were included in this study. Patients were randomly assigned to two groups: the PA triamcinolone group (n = 29) and the IV hydrocortisone group (n = 30). Patients were followed up for 6 months and their QS, Visual Analogue Scale score, Modified Timed Up and Go (MTUGT) score, Western Ontario and McMaster Universities Osteoarthritis Index score, Knee Society Score and inflammatory marker levels were assessed.</p><p><strong>Results: </strong>On postoperative day 3, the PA group exhibited a significantly lower reduction in QS (-43.11% ± 23.36% versus -63.7% ± 17.67%, p = 0.02) and significantly lower changes in MTUGT scores than the IV group (153.3% versus 301.3%, p < 0.01). Additionally, the knee flexion angle was significantly greater in the PA group than in the IV group on postoperative day 3 (91° ± 11° versus 82.6° ± 10.9°, p < 0.01) and at week 2 (103.2° ± 12.2° versus 97.4° ± 8.7°, p = 0.04). C-reactive protein levels were significantly lower in the PA group than in the IV group on postoperative day 1 (10.4; IQR: 5.3-17.2 versus 15.4; IQR: 9.4-28.6, p = 0.01), on day 3 (65.5; IQR: 38.3-96 versus 119.1; IQR: 69.6-146.1, p < 0.01) and at week 2 (3.9 versus 8.9, p = 0.01). On postoperative day 3, the PA group had significantly higher glucose levels than the IV group (115; IQR: 106-127 versus 106; IQR: 93-122, p = 0.02). No wound complications were observed in both groups.</p><p><strong>Conclusions: </strong>PA corticosteroid injection improves knee function in terms of muscle recovery, faster ambulation, increased knee flexion and reduced inflammation for up to 2 weeks after surgery compared with IV corticosteroid injection. A transient increase in serum glucose was observed but is unlikely to be clinically significant.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13317222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362797","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":"Addition of anterolateral ligament reconstruction to primary hamstring autograft ACLR improves objective rotatory stability and reduces re-tear rates: a systematic review and meta-analysis.","authors":"Assala Abu Mukh, Elsayed Ahmed Abdelatif, Shengdong Yang, Hyeon Seok Hong, Lael Kang, Hye Chang Rhim, Ki-Mo Jang","doi":"10.1186/s43019-026-00327-3","DOIUrl":"10.1186/s43019-026-00327-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anterior cruciate ligament reconstruction (ACLR) aims to restore knee stability following anterior cruciate ligament (ACL) rupture. Although hamstring tendon (HT) autografts are the most used, no meta-analysis has specifically evaluated failure rates following primary ACLR with HT in comparisons between standalone ACLR and ACLR combined with anterolateral ligament reconstruction (ALLR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To assess whether adding ALLR to HT autograft ACLR reduces rotatory instability and re-tear rates, and to compare associated complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic electronic search was conducted between January and February 2025 using the Nested Knowledge platform (AutoLit, Nested Knowledge), including data from Cochrane, PubMed, Europe PubMed Central, ClinicalTrials.gov, and the Directory of Open Access Journals, along with supplementary manual searches. Search terms included combinations of \"Anterior Cruciate Ligament,\" \"ACL,\" \"Anterolateral Ligament,\" \"Antero-Lateral Ligament,\" and \"ALL.\" Two independent researchers performed screening, and eligible articles underwent full-text review. Inclusion criteria were comparative studies of patients receiving primary single-bundle HT autograft ACLR versus those receiving combined HT ACLR and ALLR. Collected and analyzed data included baseline characteristics; outcomes of pivot shift (PS), laxity measurements, Lachman, and Anterior Drawer tests; complications; re-tear; patient-reported outcome measures (PROMs); and return to athletic activity. The meta-analysis included both prospective and retrospective studies comparing primary HT autograft ACLR with and without ALLR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4373 studies were screened, and 12 studies comprising 1274 participants were included. The follow-up duration was 31.87 ± 13.36 months in the ACLR group and 31.01 ± 13.25 months in the ACLR-ALLR group. The mean age was 27.08 ± 3.37 years in the ACLR group and 25.00 ± 3.19 years in the ACLR-ALLR group. The injury-to-surgery interval was 6.86 ± 5.41 months and 6.20 ± 5.49 months in the ACLR and ACLR-ALLR groups, respectively. A postoperative PS odds ratio of 0.20 was observed in the ACLR-ALLR group compared with the ACLR group (p &lt; 0.0001), reflecting a relative risk reduction of 81.86% and a number needed to treat of 11.74 to prevent a single event of high-grade pivot shift. Re-tear rates were significantly lower in the ACLR-ALLR group (2.58%) compared with the ACLR group (11.37%) (p &lt; 0.00001). Athletic activity, body mass index, sex distribution, complications, and PROMs were comparable between the two groups (p &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This meta-analysis demonstrates that the addition of ALLR to single-bundle ACLR using HT significantly improves both translational and rotatory stability, reduces the incidence of high-grade pivot shift by 81.86%, and lowers re-tear rates from 11.37% to 2.58%. Notably, these ","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148266234","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}