Knee Surgery and Related Research最新文献

{"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":"<p><strong>Background: </strong>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).</p><p><strong>Purpose: </strong>To assess whether adding ALLR to HT autograft ACLR reduces rotatory instability and re-tear rates, and to compare associated complications.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 < 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 < 0.00001). Athletic activity, body mass index, sex distribution, complications, and PROMs were comparable between the two groups (p > 0.05).</p><p><strong>Conclusions: </strong>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}

{"title":"Increased joint line obliquity is associated with lateral cartilage degeneration after medial opening wedge high tibial osteotomy: a quantitative MRI analysis.","authors":"Takaaki Hiranaka, Giacomo Dal Fabbro, Kieran O'Brien, James Linklater, David A Parker","doi":"10.1186/s43019-026-00322-8","DOIUrl":"10.1186/s43019-026-00322-8","url":null,"abstract":"<p><strong>Background: </strong>Joint line obliquity (JLO) often increases after medial opening wedge high tibial osteotomy (MOWHTO), and excessive JLO may adversely affect the lateral compartment. However, its effects on cartilage tissue and postoperative outcomes remain unclear. This study investigated whether increased postoperative JLO is associated with early cartilage changes on quantitative MRI T2 mapping and differences in clinical outcomes.</p><p><strong>Methods: </strong>A total of 33 knees undergoing MOWHTO were retrospectively reviewed. Radiographic parameters-hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and JLO-were assessed preoperatively and at 6 months. Based on postoperative radiographic measurements, patients were classified as increased JLO/MPTA (Group I: JLO > 5° and/or MPTA > 94°) or acceptable range JLO/MPTA (Group A: JLO < 5° and MPTA < 94°). Quantitative MRI T2 mapping was performed preoperatively and at 12 months to measure T2 relaxation times (T2 values) and ΔT2 values (postoperative-preoperative) in the patella, trochlea, lateral femoral condyle (LFC), and lateral tibial plateau (LTP), analyzing superficial, deep, and total cartilage layers. Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed at both time points.</p><p><strong>Results: </strong>Group I included 13 patients and group A included 20 patients. Postoperative HKA was similar between groups (p = 0.326). No significant intergroup differences were observed in preoperative or postoperative T2 values in the patellofemoral or lateral compartments. However, ΔT2 values in the LTP were significantly higher in group I than in group A in the superficial (3.3 ± 6.5 versus -1.7 ± 5.9 ms, p = 0.022) and total (4.5 ± 5.7 versus - 0.6 ± 5.0 ms, p = 0.012) layers. Group I also had worse KOOS-Symptoms (p = 0.016), QOL (p = 0.022), and Sport/Rec (p = 0.040).</p><p><strong>Conclusions: </strong>Even with similar postoperative limb alignment, increased JLO/MPTA was associated with early degenerative changes in lateral tibial cartilage and worse clinical outcomes. Maintaining postoperative JLO within the acceptable range during MOWHTO may help maintain lateral compartment cartilage health and optimize clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13238126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164930","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":"Large-sized grafts versus standard-sized grafts combined with anterolateral ligament reconstruction in ACL-deficient knees: a randomized controlled trial.","authors":"Mohamed Ali, Omar Abdelkarim, Yasser Soroor, Wael Salama, Moustafa Elsayed, Hossam El-Azab","doi":"10.1186/s43019-026-00321-9","DOIUrl":"10.1186/s43019-026-00321-9","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries are highly prevalent among athletes and continue to pose challenges owing to persistent instability and variable return-to-sport outcomes following reconstruction. Anterolateral ligament (ALL) reconstruction and has been introduced to improve outcomes. Increasing graft diameter was described to enhance biomechanical properties. This study hypothesis was, that ACL reconstruction (ACL-R) combined with ALL reconstruction is superior to a large-sized graft ACL-R.</p><p><strong>Purpose: </strong>To compare outcomes of large-sized (six-strand) hamstring grafts with those of standard-sized (four-strand) grafts combined with anterolateral ligament (ALL) reconstruction in ACL-deficient knees.</p><p><strong>Methods: </strong>A total of 82 patients (18-45 years) undergoing ACL reconstruction were randomized to either a large (six-strand) hamstring graft group (group A, n = 41) or a standard-sized (four-strand) graft plus ALL reconstruction group (group B, n = 41). Primary outcomes were knee stability (pivot-shift and Lachman tests) and functional scores [Lysholm and International Knee Documentation Committee (IKDC) scores]. Secondary measures included pain scores, return to sport, and complication rates, with follow-up at 24 months.</p><p><strong>Results: </strong>The mean diameter of the large-sized graft was 9.5 ± 2.5 mm, while the mean diameter of the standard-sized graft was 8.0 ± 2.0 mm. Both groups demonstrated significant gains in stability and function. Lysholm scores improved from 51 to 94 in group A and from 56 to 98 in group B with no significant difference between both groups (p = 0.418), while IKDC scores rose from 37 to 88 and from 37 to 91, respectively and it was significantly higher in group B (p = 0.036). Negative pivot-shift was observed in 87.8% of group A and 90.2% of group B with no significant intergroup difference (p = 0.841). Return-to-sport at 12 months was 93.5% and 96.1%, respectively with no significant difference (p = 1.00). Graft rupture occurred in 4.8% of group A and 2.4% of group B. Overall complications were low and statistically comparable (p = 1.00).</p><p><strong>Conclusions: </strong>Both large hamstring grafts and standard grafts augmented with ALL reconstruction provided significant functional and stability improvements, with no major differences between techniques.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857353","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":"Clinical outcomes of quadriceps, hamstring, and bone-patellar tendon-bone autografts for ACL reconstruction: a meta-analysis of randomized controlled trials.","authors":"Riccardo D'Ambrosi, Luca Farinelli, Piero Franco, Andrea Marchetti, Amit Meena, Danko Dan Milinkovic, Srinivas Bs Kambhampati, Luca Maria Sconfienza, Thomas Patt, Chiara Ursino, Elisabeth Abermann, Christian Fink","doi":"10.1186/s43019-026-00320-w","DOIUrl":"10.1186/s43019-026-00320-w","url":null,"abstract":"<p><strong>Background: </strong>The quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects-particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates-when evaluated against hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>The MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots.</p><p><strong>Results: </strong>Eleven RCTs (mean follow-up, 2-10 years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9-87.9) and Lysholm scores averaged 93.1 (95% CI 91.6-94.6), with no significant differences between QT and either comparator (P > 0.05). Side-to-side anterior tibial translation averaged 1.2 mm (95% CI 0.99-1.54 mm) across all grafts, also without significant differences (P > 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0-1.9%) and 2.3% (95% CI 0.6-4.7%), respectively, again with no between-graft differences (P > 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6-19.83]; P > 0.05).</p><p><strong>Conclusion: </strong>This meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone-patellar tendon-bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types. Level of evidence Systematic review and meta-analysis; level of evidence, 1 and 2.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13154517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843836","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":"AI-based knee osteoarthritis progression prediction: a comprehensive global bibliometric and hotspot evolution analysis (2010-2025).","authors":"Ekrem Özdemir, Fatih Emre Topsakal","doi":"10.1186/s43019-026-00319-3","DOIUrl":"10.1186/s43019-026-00319-3","url":null,"abstract":"<p><strong>Background: </strong>Knee osteoarthritis (OA) is a leading global cause of disability, yet conventional tools lack sensitivity for early detection and precise prognostication. Artificial intelligence (AI) and machine learning (ML) offer powerful means to enhance prediction of knee OA onset and progression. This bibliometric study maps global research trends and thematic evolution rather than evaluating the clinical effectiveness of individual AI tools.</p><p><strong>Objective: </strong>This study systematically maps the global research landscape on AI-based knee OA progression prediction from 2010 to November 2025, highlighting key contributors, collaboration networks, methodological trends, and evolving research hotspots.</p><p><strong>Methods: </strong>A comprehensive bibliometric analysis was performed using Web of Science, Scopus, PubMed, and IEEE Xplore. Embase was not included due to substantial overlap (>90%) with PubMed/MEDLINE. Search terms included \"artificial intelligence,\" \"machine learning,\" \"deep learning,\" \"knee osteoarthritis,\" and '\"progression prediction.\" Following systematic deduplication and dual-reviewer screening (Cohen's κ = 0.89), 1087 publications were included in the final analytic corpus. Extracted data covered publication and citation metrics, authorship, institutional and national contributions, and keyword co-occurrence. Network and overlay visualizations were used to characterize international collaboration and temporal evolution of research themes.</p><p><strong>Results: </strong>Among the 1087 included publications, annual output increased from 3 in 2010 to 198 in 2025 (partial year through November), accumulating more than 18,000 citations. The USA was the leading contributor (42%), followed by China (26%) and the United Kingdom (15%). Harvard University and the University of California, San Francisco, emerged as the most productive institutions. Methodological focus shifted from traditional ML approaches (2010-2016) to deep learning, particularly convolutional neural networks (2017-2021), and more recently to multimodal and interpretable AI (2022-2025). Research hotspots evolved from automated radiographic grading to comprehensive progression prediction integrating imaging, clinical variables, patient-reported outcomes, and pain trajectories.</p><p><strong>Conclusions: </strong>This bibliometric analysis demonstrates that AI-driven knee OA progression prediction has developed into a dynamic, globally collaborative field with growing translational focus. Emerging research hotspots suggest increasing interest in multimodal, interpretable, and patient-centered models. Key gaps include limited external validation, heavy reliance on few cohorts (OAI/MOST), and insufficient research on clinical implementation, which should be prioritized to realize AI's potential for improving patient outcomes.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821494","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":"Influence of platelet-rich plasma composition on pain and functional performance in knee osteoarthritis: a systematic review and network meta-analysis.","authors":"Eduardo Anitua, Sabino Padilla, Roberto Prado, Roberto Tierno, Mohammad Hamdan Alkhraisat","doi":"10.1186/s43019-026-00318-4","DOIUrl":"10.1186/s43019-026-00318-4","url":null,"abstract":"<p><strong>Background: </strong>Pain, decreased quality of life, and functional impairment are common symptoms of knee osteoarthritis (KOA), a degenerative joint disease. Surgery is reserved for advanced cases, and conservative treatment is primarily palliative. Although platelet-rich plasma (PRP) therapy is a novel regenerative strategy, the influence of PRP composition on its effectiveness remains unclear. The aim of this review is to determine whether PRP activation and platelet and leukocyte enrichment are associated with improved pain and functional outcomes in KOA at 6 and 12 months.</p><p><strong>Methods: </strong>The systematic review included 56 randomized controlled trials (RCTs), involving a total of 5251 patients. Of these, 53 RCTs involving 5031 participants were included in the network meta-analysis. PRP treatments were compared with other nonsurgical interventions and placebo. Primary outcomes included Western Ontario and McMaster Universities Arthritis Index Score (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS), while International Knee Documentation Committee Score (IKDC), Lequesne Index, and EuroQol (EQ)-VAS were assessed as secondary outcomes. PRP formulations were categorized on the basis of activation status and Mishra's classification system. Both direct and indirect comparisons were performed using a frequentist network meta-analysis approach.</p><p><strong>Results: </strong>Comparing PRP with different activation states at 6 and 12 months revealed that PRP activation exerted significant benefits in specific KOOS domains at 12 months (KOOS Activities of Daily Living, KOOS Sport and Recreation Function, and KOOS Knee-Related Quality of Life). Generally, the performance of high-platelet PRP was not statistically different from that of low-platelet PRP in most of the assisted questionnaires and domains. Considering activated PRP, no significant variation was detected between Mishra's categories, indicating that increased leukocyte and platelet enrichment ratios confer no additional benefit.</p><p><strong>Conclusions: </strong>Overall, the data suggest that PRP activation could play a key role in the treatment outcomes of KOA and could compensate for variation in both platelet and leukocyte enrichment. There is a need for RCTs to assess the effect of platelet composition and activation status in the clinical performance of PRP in KOA.</p><p><strong>Level of evidence: </strong>Level I, systematic review and network meta-analysis.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13101336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783835","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":"Cross-cultural adaptation and psychometric validation of the first Arabic KOOS-12: a reliable tool for assessing knee outcomes in Arabic-speaking populations.","authors":"Marc Boutros, Guy Awad, Caren Hassan, Shaza Hammad, Julia Assi, Gaby Haykal, Toni Mansour","doi":"10.1186/s43019-026-00316-6","DOIUrl":"10.1186/s43019-026-00316-6","url":null,"abstract":"<p><strong>Background: </strong>The Knee injury and Osteoarthritis Outcome Score-12 (KOOS-12) is a widely used patient-reported outcome measure assessing pain, function, and quality of life (QOL) in individuals with knee osteoarthritis or injury. However, the absence of validated short-form knee instruments in Arabic necessitates cross-cultural adaptation.</p><p><strong>Methods: </strong>A prospective cross-sectional validation of the Arabic KOOS-12 (KOOS-12 AR) was conducted following established guidelines for translation and adaptation (independent forward translations, reconciliation, blinded back-translation, expert review, pilot testing, and proofreading). Adults > 40 years with knee osteoarthritis were consecutively recruited from two outpatient clinics and completed the KOOS-12 AR and the validated Arabic WOMAC (WOMAC-AR). A total of 201 patients were enrolled, and a clinically stable subset of 91 participants (the retest subgroup) completed a retest after 5-10 days. Psychometric evaluation included interpretability, internal consistency (Cronbach's α), test-retest reliability using intraclass correlation coefficients (ICC(2,1)), and measurement error indices such as standard error of measurement (SEM), minimal detectable change (MDC), and content, structural, and convergent validity.</p><p><strong>Results: </strong>Internal consistency was excellent across domains (Cronbach's α = 0.93). Test-retest reliability was likewise excellent (ICC(2,1) = 0.990 for Pain, 0.992 for Function, 0.989 for QOL, and 0.987 for the Total score). SEM values were small (2.1-2.3 points), yielding MDC_individual ≈6 points across subscales. Bland-Altman analyses showed minimal bias (-0.36 to -0.02) and narrow limits of agreement (approximately ± 6-7 points). Structural validity was supported by principal component analysis (PCA): each subscale demonstrated a clear one-factor solution (Pain eigenvalue 2.50, 62.5% variance; Function 2.72, 67.9%; QOL 2.48, 62.1%). When all 12 items were analyzed together, the dominant first component explained 50.6% of total variance (Kaiser-Meyer-Olkin (KMO) = 0.91). Convergent validity with WOMAC-AR was strong, with Spearman's ρ = 0.879 for total scores (p < 0.0001).</p><p><strong>Conclusion: </strong>The KOOS-12 AR demonstrated excellent reliability, validity, structural coherence, and measurement reproducibility. It represents a robust, culturally appropriate, and feasible instrument for evaluating knee pain, function, and QOL among Arabic-speaking patients.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655077","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":"Artificial intelligence in orthopedics: current applications, challenges, and future directions.","authors":"Sang Yoon Kim, Byung Sun Choi, Hyuk-Soo Han, Du Hyun Ro","doi":"10.1186/s43019-026-00317-5","DOIUrl":"10.1186/s43019-026-00317-5","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence research in orthopedics has grown rapidly, yet a substantial gap remains between technical development and clinical translation. This narrative review summarizes current applications of artificial intelligence in orthopedic practice and highlights barriers to implementation.</p><p><strong>Main body: </strong>Current work converges on three domains: machine learning for structured perioperative risk prediction, deep learning for standardized musculoskeletal imaging, and large language models for workflow and decision support. Applications such as automated fracture detection, Kellgren-Lawrence grading for osteoarthritis, and transfusion risk modeling are approaching clinical maturity. However, routine adoption is limited by algorithmic opacity, performance degradation in new clinical environments, and poor fit within existing workflows. We argue that progress should shift from increasing model complexity toward rigorous evaluation, including external validation on independent cohorts. In addition, probability calibration and uncertainty estimation are important for trustworthy risk communication. Future directions may include multimodal \"digital twin\" approaches that integrate electronic medical records, imaging phenotypes, and intraoperative data into patient-specific trajectories.</p><p><strong>Conclusions: </strong>The clinical impact of artificial intelligence in orthopedics will depend on life-cycle governance and demonstrated net benefit, prioritizing reliability and implementation science over retrospective benchmark performance.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616850","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":"Primary versus rerupture of the anterior cruciate ligament: rupture site patterns and graft elongation-a systematic review and meta-analysis.","authors":"Riccardo D'Ambrosi, Beata Ciszkowska-Łysoń, Luca Maria Sconfienza, Christian Fink, Robert Śmigielski","doi":"10.1186/s43019-026-00313-9","DOIUrl":"10.1186/s43019-026-00313-9","url":null,"abstract":"<p><strong>Background: </strong>While the rupture pattern of the native anterior cruciate ligament (ACL) has been well characterized-most frequently occurring in the proximal third of the ligament-there is limited consensus on whether reconstructed ACLs fail in a similar fashion. The purpose of this meta-analysis is to compare rupture localization patterns between first ruptures and reruptures.</p><p><strong>Materials and methods: </strong>MEDLINE (PubMed), Embase, and the Cochrane Library databases were searched to identify studies analyzing rupture locations after both first rupture and rerupture. The main extracted outcome was the anatomical site of ACL rupture, categorized as proximal, mid-substance, distal, or elongation. A random-effects meta-analysis was performed to calculate pooled proportions and odds ratios (ORs), with between-study heterogeneity assessed using the I² statistic.</p><p><strong>Results: </strong>The pooled meta-analysis revealed no significant differences (p > 0.05) in the distribution of proximal, mid-substance, or distal rupture locations between the first rupture and rerupture groups. However, graft elongation was significantly more frequent in reruptures (p < 0.05). Using first rupture as the reference, the odds of elongation were 1.63-fold higher in the rerupture group (OR 1.63, 95% CI 1.46-1.83; p < 0.001).</p><p><strong>Conclusions: </strong>This meta-analysis found no statistically significant differences in rupture-site localization between first ruptures and reruptures, indicating that reconstructed ACLs tend to fail in anatomical patterns resembling those of the native ligament. However, the markedly higher incidence of graft elongation observed in the rerupture cohort suggests a distinct mode of failure. These findings highlight graft elongation as a specific mechanism that may be influenced by surgical or biological factors, warranting further investigation.</p><p><strong>Level of evidence: </strong>Systematic review and meta-analysis of Level 4 studies.</p><p><strong>Study registration: </strong>PROSPERO Registry CRD420251073835.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13049893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616917","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":"MRI-based classification of lateral hinge fractures in medial opening wedge high tibial osteotomy.","authors":"Woon-Hwa Jung, Minish Katkar, Min-Seok Seo, Dong-Hyun Kim, Ryohei Takeuchi","doi":"10.1186/s43019-026-00312-w","DOIUrl":"10.1186/s43019-026-00312-w","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the variants of lateral hinge fracture and its outcome, as well as to develop a MRI based classification on the fracture line pattern.</p><p><strong>Methods: </strong>This retrospective study analyzed 250 knees from 227 patients (169 females, 58 males) who underwent medial opening wedge high tibial osteotomy. Lateral hinge fractures were detected using MRI and classified into four types on the basis of the fracture line pattern: type A (proximal to the tibiofibular joint), type B (into the proximal tibiofibular joint), type C (distal to the tibiofibular joint), and type D (proximal into the joint). Patients were followed up with radiographs and computed tomography (CT) scans to monitor outcome.</p><p><strong>Results: </strong>Type A fractures had a shorter union time (3.66 months) than type B (5.17 months), type C (6.24 months), and type D (5.75 months). Type B had a delayed union rate of 20%, higher than that of type A (2.46%). Statistical analysis confirmed that type A fractures had significantly better outcomes than types B, C, and D. Type B fractures are by definition Takeuchi type I fractures but exhibit clinical characteristics similar to type II fractures, including longer union times and a higher risk of delayed union.</p><p><strong>Conclusions: </strong>Type A fracture has union rates similar to those in non-fracture groups, whereas type B fracture has clinical similarities to Takeuchi type II fractures and therefore should be considered and managed as a subtype of Takeuchi type II fractures.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349333","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}