Journal of Experimental Orthopaedics最新文献

{"title":"Graft orientation using the over-the-top technique in anterior cruciate ligament reconstruction: Magnetic resonance imaging-based study.","authors":"Ying Ren Mok, Alberto Grassi, Giulio Maria Marcheggiani Muccioli, Andrea Pierangeli, Lidia Ana Martín Domínguez, Claudio Rossi, Stefano Zaffagnini","doi":"10.1002/jeo2.70744","DOIUrl":"https://doi.org/10.1002/jeo2.70744","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify sagittal and coronal inclination angles following over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI), to compare these measurements with the native ACL, and to evaluate graft alignment relative to the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) consensus.</p><p><strong>Methods: </strong>Thirty-five patients underwent single-bundle OTT ACL reconstruction combined with lateral plasty and underwent postoperative MRI evaluation at a minimum of 6 months. The reference group consisted of 28 patients with knee pain and an intact ACL on MRI. Sagittal and coronal inclination angles were measured using standardised tibial-axis-based MRI definitions. Measurements were performed independently by two examiners, and mean values were used for analysis. Group comparisons were conducted using independent-samples <i>t</i>-tests. Interexaminer reliability was assessed using intraclass correlation coefficients (ICC).</p><p><strong>Results: </strong>OTT reconstruction demonstrated a mean sagittal inclination angle (SIA) of 53.2° ± 5.1° and a mean coronal inclination angle (CIA) of 71.3° ± 5.9°. Compared with the native ACL cohort, OTT reconstructions showed significantly greater sagittal (mean difference 3.6°, <i>p</i> = 0.007) and coronal (mean difference 8.2°, <i>p</i> < 0.001) inclination angles. Most reconstructions fell within ESSKA consensus sagittal (<60°) and coronal (<75°) MRI thresholds (85.7% and 71.4%, respectively). Interexaminer agreement was excellent for both sagittal and coronal measurements (ICC > 0.90).</p><p><strong>Conclusion: </strong>OTT ACL reconstruction produces graft inclination angles that differ significantly from native ACL orientation but frequently fall within consensus-recommended MRI thresholds for sagittal alignment. MRI-based inclination assessment provides objective structural characterisation of this technique and complements previously reported long-term clinical outcomes. However, these imaging findings do not establish full anatomic replication or clinical equivalence.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70744"},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843969","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":"Combined trochleoplasty and medial patellofemoral ligament reconstruction reduces patellar height.","authors":"Felix Riechelmann, Alexa Schaufler, Nadja Gasser, Paul Nardelli, Rohit Arora, Wolfgang Hackl","doi":"10.1002/jeo2.70742","DOIUrl":"https://doi.org/10.1002/jeo2.70742","url":null,"abstract":"<p><strong>Purpose: </strong>This study assessed whether trochleoplasty combined with medial patellofemoral ligament reconstruction (MPFLR) reduces patellar height, potentially obviating the need for distalizing tibial tubercle osteotomy (TTO).</p><p><strong>Methods: </strong>Patellar height was evaluated in 73 knees before and at a median of 6 months after patellar stabilisation using the Caton-Deschamps (CDI), Insall-Salvati (ISI) and Blackburne-Peel (BPI) indices.</p><p><strong>Results: </strong>MPFL reconstruction with trochleoplasty resulted in a sustained 8.1% postoperative reduction in the CDI (95% confidence interval [CI]: -14.1% to -2.1%; <i>p</i> < 0.001). The reduction was greater with MPFLR plus TTO (16.5%; -23.7% to -9.3%; <i>p</i> < 0.001) and maximal when MPFLR, trochleoplasty and TTO were performed together (22.9%; -33.1% to -12.6%; <i>p</i> < 0.001). ISI and BPI showed comparable reductions. While strong Pearson correlations among the indices (<i>r</i> = 0.6-0.9; all <i>p</i> < 0.001) were observed preoperatively, Bland-Altman analyses revealed a substantial bias of up to 25%. Inter-index agreement for clinical classification (alta, normal, baja) was inconsistent, achieving at best a 'moderate' level (Weighted Cohen's kappa 0.36-0.60).</p><p><strong>Conclusion: </strong>Combined MPFL reconstruction and trochleoplasty reduce patellar height by approximately 10%. The interaction effect of various surgical procedures for PFI on patellar height, coupled with methodological inconsistencies in index-based patellar height classification, challenges the validity of rigid cut-off values for distalizing TTO.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70742"},"PeriodicalIF":2.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843965","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":"Non-detached hamstring tendon anterior cruciate ligament reconstruction demonstrates comparable outcomes to the traditional detached hamstring tendon technique: A systematic review and meta-analysis.","authors":"Khaled Skaik, Helena Son, Benjamin Blackman, Marc Daniel Bouchard, Prushoth Vivekanantha, Amit Meena, Shahbaz S Malik, Darren de Sa","doi":"10.1002/jeo2.70705","DOIUrl":"https://doi.org/10.1002/jeo2.70705","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical and radiological outcomes of anterior cruciate ligament reconstruction (ACLR) using non-detached hamstring tendon (NDHT) versus conventional detached hamstring tendon (DHT) technique.</p><p><strong>Methods: </strong>Embase, PubMed, Ovid Medline and CINAHL databases were searched from inception to October 2025. Inclusion criteria included comparative studies of clinical or radiographic outcomes between NDHT and DHT. Studies were excluded if they were non-comparative or if they involved extra-articular procedures. The primary outcome was the post-operative International Knee Documentation Committee (IKDC) score. Secondary outcomes included Lysholm, Tegner, KT-1000 (knee testing 1000 [laxity arthrometer]) scores, rate of return-to-sport (RTS), retear rate and graft maturation. Data were pooled using random-effects models with significance set at <i>p</i> < 0.05. Sensitivity analyses included randomized trials only.</p><p><strong>Results: </strong>A total of 11 studies (<i>n</i> = 731; 354 NDHT, 377 DHT patients) met inclusion criteria. IKDC scores at ≥12 months (mean difference [MD] = 0.67, 95% confidence interval [CI]: -2.67 to 3.94, <i>p</i> = 0.69), Lysholm scores at ≥6 months (MD = -1.02, 95% CI: -2.52 to 0.49, <i>p</i> = 0.19), Tegner scores at ≥6 months (MD = 0.18, 95% CI: -0.19 to 0.55, <i>p</i> = 0.34), KT-1000 arthrometer at ≥24 months (MD = -0.29, 95% CI: -0.67 to 0.30, <i>p</i> = 0.14), RTS rates at ≥12 months (risk ratio [RR] = 1.00, 95% CI: 0.94 to 1.07, <i>p</i> = 0.89) and retear rates at ≥12 months (RR = 0.63, 95% CI: 0.17 to 2.40, <i>p</i> = 0.50). None of these findings changed in sensitivity analysis. The NDHT demonstrated significantly better graft maturation at 6 and 12 months (<i>p</i> < 0.05), but these differences disappeared by 24 months.</p><p><strong>Conclusions: </strong>Preserving the tibial insertion of the hamstring graft in ACLR (NDHT) resulted in comparable clinical outcomes to those of the detached technique (DHT), with no significant differences observed between the two approaches. Future studies should assess potential cost and time benefits of NDHT.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70705"},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843980","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":"Cemented versus uncemented stems in total hip arthroplasty: No independent effect on transfusion or complications despite reduced total blood loss.","authors":"Nikolai Ramadanov, Dakota Fuchs, Maximilian Heinz, Robert Prill, Roland Becker","doi":"10.1002/jeo2.70734","DOIUrl":"https://doi.org/10.1002/jeo2.70734","url":null,"abstract":"<p><strong>Purpose: </strong>The impact of femoral stem fixation on perioperative blood loss and transfusion in total hip arthroplasty (THA) remains controversial. To compare cemented and uncemented stem fixation in elective primary THA regarding perioperative blood loss, transfusion requirements and postoperative complications. We hypothesized that stem fixation would not independently influence transfusion or complication risk after adjustment for patient-related factors.</p><p><strong>Methods: </strong>This retrospective cohort study analysed data from a institutional registry including THAs performed between 2016 and 2023. Patients were stratified according to femoral stem fixation (cemented vs. uncemented). Outcomes included intraoperative, total and hidden blood loss (HBL), allogeneic red blood cell transfusion and postoperative complications. Multivariable linear and logistic regression analyses assessed the independent effect of stem fixation, adjusting for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, operative time and preoperative haemoglobin.</p><p><strong>Results: </strong>A total of 648 patients were included (uncemented <i>n</i> = 548; cemented <i>n</i> = 100). Patients in the cemented group were older (79.8 ± 7.4 vs. 72.4 ± 9.1 years) and more frequently female (76.0% vs. 65.8%). Transfusion rates were higher in the cemented group. After multivariable adjustment, cemented fixation was independently associated with lower total blood loss (adjusted mean difference -146 mL; 95% confidence interval [CI] -271 to -21), whereas no independent associations were observed for intraoperative and HBL. Stem fixation was not independently associated with transfusion requirement (adjusted odds ratio [OR] 1.06; 95% CI 0.56-1.99) or postoperative complications (adjusted OR 0.64; 95% CI 0.21-1.98).</p><p><strong>Conclusion: </strong>In elective primary THA, cemented femoral stem fixation is associated with a modest reduction in total blood loss but does not independently influence transfusion rates or postoperative complication risk. Clinically, these findings indicate that fixation should not be selected based on expectations of reduced transfusion risk. Instead, perioperative blood management should focus on patient-related factors, particularly preoperative haemoglobin optimization.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative cohort study.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70734"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844026","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":"Long-term outcomes of arthroscopic Bankart repair with additional posteroinferior capsular plication in patients with anterior shoulder instability and hyperlaxity: Minimum 10-year follow-up.","authors":"Anh Do, Agahan Hayta, Philipp Moroder, Markus Scheibel, Rony-Orijit Dey Hazra, Alp Paksoy, Doruk Akgün","doi":"10.1002/jeo2.70735","DOIUrl":"https://doi.org/10.1002/jeo2.70735","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the long-term outcomes of arthroscopic Bankart repair with additional posteroinferior capsular plication in patients with anterior shoulder instability and hyperlaxity, and to compare the outcomes of posteroinferior capsular plication using suture-only fixation versus suture anchor fixation.</p><p><strong>Methods: </strong>In this retrospective study, patients were included who underwent arthroscopic Bankart repair and additional posteroinferior capsular plication for anterior shoulder instability and hyperlaxity (type B3) between 2006 and 2014 at our institution. Primary outcome was recurrent instability. Secondary outcomes were Subjective Shoulder Value (SSV), visual analog scale (VAS), Constant score (CS), Western Ontario Shoulder Instability Index (WOSI) and Rowe score, as well as return to sport.</p><p><strong>Results: </strong>Of 54 included shoulders, 33 shoulders in 32 patients (61.1%) were evaluated after a mean follow-up of 13.2 ± 2.3 years. The overall recurrence rate was 18.2% (6/33). The total revision rate was 9.1%, with two revisions due to recurrent instability and one due to posteroinferior knot impingement. The number of preoperative dislocations correlated negatively with the CS (<i>ρ</i> = -0.425, <i>p</i> = 0.019) and the WOSI (<i>ρ</i> = -0.471, <i>p</i> = 0.009). A total of 97% of all patients returned to sports, with 57.6% returning to 90%-100% of their preoperative sports activity. Posteroinferior capsular plication using suture-only fixation was associated with a higher recurrence rate (3/6, 50%), compared to the use of suture anchor fixation (3/27, 11.1%; <i>p</i> = 0.025).</p><p><strong>Conclusion: </strong>Arthroscopic Bankart repair combined with posteroinferior capsular plication provided durable long-term shoulder function and reliable return to sport in patients with anterior instability and hyperlaxity. Performing the posteroinferior plication with suture anchor fixation might be associated with lower recurrence rates compared to suture-only plication. Clinical outcomes declined with an increasing number of preoperative dislocations.</p><p><strong>Level of evidence: </strong>Level III, cohort study.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70735"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843963","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":"No significant side-to-side differences in retropatellar load distribution using more than 7.5 years after isolated MPFL reconstruction: A CT-osteoabsorptiometry pilot study in nine patients.","authors":"Lukas Kampik, Friedemann Schneider, Julius Martin Hofner, Rohit Arora, Johannes Dominikus Pallua, Armin Runer","doi":"10.1002/jeo2.70728","DOIUrl":"https://doi.org/10.1002/jeo2.70728","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate long-term retropatellar load distribution after isolated medial patellofemoral ligament (MPFL) reconstruction using computed tomography-osteoabsorptiometry (CT-OAM).</p><p><strong>Methods: </strong>A retrospective single-centre pilot study (<i>n</i> = 9) was conducted, including patients with isolated MPFL reconstruction with a minimum follow-up of 7.5 years and without any contralateral knee injury or surgery. Bilateral patellae were analysed using CT-OAM. Maximum-intensity projections were subdivided into four patellar regions: medial facet (MF), central ridge (CR), medial portion of the lateral facet (MLF) and lateral portion of the lateral facet (LLF). High-density area (HDA) fractions were defined as >1000 Hounsfield units (HU). Operated and contralateral patellae were compared using paired Wilcoxon signed-rank tests with Holm correction and effect sizes were reported as rank-biserial correlation (<i>r</i>). Interregional differences were analysed using Friedman tests followed by pairwise Wilcoxon post hoc comparisons with Bonferroni correction. Sensitivity analyses were repeated using HU thresholds of 900 and 1100.</p><p><strong>Results: </strong>No significant differences in HDA fractions were detected in any patellar region between the operated and contralateral knee (all adjusted <i>p</i> > 0.05; rank-biserial <i>r</i> = 0.02-0.08). Interregional variation was significant (<i>p</i> < 0.001), with highest HDA fractions in MLF, followed by LLF, CR and MF. Varying HU thresholds (900 and 1100) yielded similar regional rankings and unchanged inferential outcomes.</p><p><strong>Conclusion: </strong>At a minimum of 7.5 years after anatomically executed, isolated MPFL reconstruction, CT-OAM showed no statistically significant side-to-side differences in retropatellar subchondral mineralization patterns and the regional distribution remained consistent with physiological loading. While these preliminary findings provide no CT-OAM-based evidence of altered long-term mechanical adaptation or pathological medial overload, the small sample size (<i>n</i> = 9) precludes definitive conclusions about equivalence. CT-OAM demonstrated feasibility of characterizing load-bearing adaptations after patellofemoral stabilization surgery.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70728"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843990","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 sagittal alignment on patient outcomes following total knee replacement: A systematic review and correlation analysis.","authors":"Prakrit R Kumar, Daya K Sumra, Aurora Segre Carnell, Ranya V Kumar, Umar Said, Amr Selim, Muhamed M Farhan-Alanie, Helen Parsons, Andrew Metcalfe","doi":"10.1002/jeo2.70731","DOIUrl":"https://doi.org/10.1002/jeo2.70731","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;With enhanced implant precision facilitated by robotic technologies, there is renewed attention on the contribution of total knee replacement (TKR) alignment to the 20% post-operative dissatisfaction rate. Although coronal alignment has been extensively studied, the impact of post-operative sagittal alignment on patient-reported outcome measures (PROMs) remains unclear. This review addresses this gap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched five electronic databases (inception-15 February 2025) for studies reporting post-TKR sagittal alignment and PROMs. Case-weighted regression models examined sagittal alignment-PROM relationships at individual post-operative timepoints, across pooled timepoints and using time-adjusted aggregated analyses. Risk of Bias was assessed using ROB2 and ROBINS-I V2 tools.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 622 studies, 52 were included (&lt;i&gt;n &lt;/i&gt;= 11,180 TKRs, 9431 patients). Most (92%) studies reported only one or two sagittal parameters, with fewer than five assessing more than two, and measurement protocols varied widely. Higher posterior-tibial-slope (PTS) was associated with improved visual analogue scale pain scores at 1 month (regression-coefficient [RC] = 1.00, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;n&lt;/i&gt; = 90 TKR, PTS range: 6.80-6.90), Oxford-knee-score (OKS) at 6 months (RC = 3.28, &lt;i&gt;p&lt;/i&gt; = 0.009, &lt;i&gt;n&lt;/i&gt; = 117, PTS range: -5.00 to 4.38) and pooled OKS across all timepoints. Higher femoral flexion (FF) was associated with improved OKS at 24 months (RC = 4.05, &lt;i&gt;p&lt;/i&gt; = 0.004, &lt;i&gt;n&lt;/i&gt; = 539, FF range: 3.00-4.96) and improved knee-society-score-overall (KSS-overall), KSS-function, short-form-survey-12 and knee-injury-and-osteoarthritis-outcome-score. Lower femoral-sagittal-angle (FSA; range: 1.30-3.80) was significantly associated with improved KSS-knee at 12 months (RC = -6.20, &lt;i&gt;p&lt;/i&gt; = 0.008, &lt;i&gt;n&lt;/i&gt; = 160), and when pooled across timepoints (RC = -5.32, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;n&lt;/i&gt; = 280), and in time-adjusted aggregated analysis (RC = -6.09, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;n&lt;/i&gt; = 280). Higher posterior-condylar-offset (PCO) was associated with improved KSS-overall at 12 months (RC = 42.945, &lt;i&gt;p&lt;/i&gt; = 0.002, &lt;i&gt;n&lt;/i&gt; = 613, PCO range: 30.40-33.60 mm), higher KSS-knee (RC = 0.67, &lt;i&gt;p&lt;/i&gt; = 0.019, &lt;i&gt;n&lt;/i&gt; = 175, PCO range: 24.5-33.6 mm) in pooled analysis, and improved KSS-overall (RC = 31.64, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;n&lt;/i&gt; = 2338, PCO range: 24.0-33.6 mm) in time-adjusted analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This review provides the first quantitative synthesis linking post-operative sagittal alignment parameters with PROMs. Higher posterior-tibial-slope, femoral flexion, and posterior-condylar offset, and lower femoral-sagittal angle were each significantly associated with improved PROMs, underscoring the importance of sagittal alignment beyond the coronal plane. However, heterogeneity in measurement protocols, underreporting of parameters limit comparability and generalisability. Standard","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70731"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843994","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":"Quadriceps tendon autograft with patellar bone block and semitendinosus augmentation demonstrates predictable midterm outcomes for patellar tendon disruption following primary total knee arthroplasty.","authors":"Ashok Rajgopal, Saksham Tripathi, Manish Kumar Singh, Kalpana Aggarwal","doi":"10.1002/jeo2.70730","DOIUrl":"https://doi.org/10.1002/jeo2.70730","url":null,"abstract":"<p><strong>Purpose: </strong>Patellar tendon (PT) disruption following primary total knee arthroplasty (TKA) is an uncommon but devastating complication, with current available surgical options reporting fair to poor long-term results. We report our experience using the quadriceps tendon autograft with patellar bone block and semitendinosus augmentation (QTPBSTA) as an alternate graft option, at a mean follow-up of 6.9 ± 3.6 years.</p><p><strong>Methods: </strong>This retrospective study cohort included 29 patients with isolated PT ruptures following primary TKA with unresurfaced patellae, between January 2010 and December 2023, treated using the QTPBSTA technique. The diagnosis was confirmed using ultrasonography in 21 patients and magnetic resonance imaging in 8 patients. All the patients were retrospectively evaluated for outcomes at a midterm follow-up. Data collection included pre- and post-operative extensor lag, Oxford Knee Score (OKS), Knee Society Score (KSS), pre- and post-operative ambulatory status and post-operative complications. All evaluations were done by an independent physiotherapist.</p><p><strong>Results: </strong>Patients treated with this technique achieved reproducible and predictable midterm outcomes with no reported failures and minimal donor site morbidity at a mean follow-up of 6.9  <math> <mrow> <mrow><mrow><mo>±</mo></mrow> </mrow> </mrow> </math>  3.6 years. Of the 29 patients, 8 had no extensor lag, and 21 had a mean lag of 4.2 ± 3.2°. This was a significant improvement from a mean preoperative lag of 66.2 ± 36.4° (<i>p</i> value < 0.001). Patients with PT ruptures operated within 3 months (early) of the index surgery demonstrated less extensor lag compared with those where intervention was undertaken after 3 months (late) (3.3 ± 2.4° vs. 9.0 ± 2.2°). This graft construct did not deteriorate over time.</p><p><strong>Conclusion: </strong>QTPBSTA is a viable alternative for reconstruction of the ruptured PT following primary TKA. Midterm follow-up at 6.9 ± 3.6 years demonstrated good outcomes, and it may be considered as a reliable option in PT disruption following TKA. The biggest strength of this technique has been a significant reduction in extensor lag.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70730"},"PeriodicalIF":2.7,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843992","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":"Reduced workload demand with handheld robotic-assisted revision knee arthroplasty: A multi-centre NASA Task Load Index analysis.","authors":"Andrew Porteous, James Murray, Max Ettinger, Peter Savov, Matteo Innocenti, Gijs van Hellemondt, Koen DeFoort, Juan Carlos Martinez-Pastor, Peter Bollars, Francesco Zambianchi, Alberto Belluati, Catherine Whittall","doi":"10.1002/jeo2.70737","DOIUrl":"https://doi.org/10.1002/jeo2.70737","url":null,"abstract":"<p><strong>Purpose: </strong>Revision total knee arthroplasty is a complex and technically demanding procedure, with an increasing global incidence. This complexity heightens the cognitive and physical demands of surgical teams, contributing to elevated burnout, musculoskeletal injuries and psychological stress. This European wide multi-centre observational evaluation assessed the impact of a handheld robotic-assisted surgical system on intra-operative workload using the NASA Task Load Index instrument to compare robotic-assisted and manual instrumentation approaches during revision knee arthroplasty.</p><p><strong>Methods: </strong>Data were collected from 212 surveys following 100 revision knee arthroplasty procedures, capturing subjective workload measures across six NASA Task Load Index domains from surgeons and peri-operative theatre staff.</p><p><strong>Results: </strong>The results demonstrated a significant reduction in the overall workload with robotic-assistance compared with manual instrumentation (median overall workload score 0.0 vs. 8.5 respectively, <i>p</i> = 0.0003). Domain-specific analyses revealed significantly lower mental demand, physical demand and effort in the robotic-assisted group without compromising perceived surgical performance, temporal demand, or frustration. A subgroup analysis of the lead surgeons showed consistent perceived workload reductions consistent with the overall findings. These results suggest that the handheld robotic-assisted surgical system may mitigate cognitive and physical strain during complex revision knee arthroplasty procedures.</p><p><strong>Conclusions: </strong>This evaluation underscores the potential of robotic-assisted technology to enhance surgical ergonomics, reduce surgeon fatigue and improve well-being, which may translate into sustained surgical performance. Future work should incorporate objective ergonomic measures, expand participant roles and explore long-term impacts on clinical outcomes and staff welfare.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 ","pages":"e70737"},"PeriodicalIF":2.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821828","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":"A higher posterior tibial slope and tunnel malposition do not predispose to non-traumatic anterior cruciate ligament failure.","authors":"Lorenz Fritsch, Lukas Willinger, Romed P Vieieder, Luca Bausch, Julian Mehl, Svenja Höger, Sebastian Siebenlist, Armin Runer","doi":"10.1002/jeo2.70699","DOIUrl":"https://doi.org/10.1002/jeo2.70699","url":null,"abstract":"<p><strong>Purpose: </strong>A higher posterior tibial slope (PTS) and malpositioning of bone tunnels are known risk factors for anterior cruciate ligament reconstruction (ACL reconstruction; ACLR) failure. However, it remains unclear whether these factors account for the mechanism of failure, whether traumatic or non-traumatic. The purpose of this study was to analyze whether the ACL failure mechanism correlates with a higher PTS or non-anatomical bone tunnels. It was hypothesized that a higher PTS and bone tunnel malposition are associated with non-traumatic ACLR failure.</p><p><strong>Methods: </strong>In this retrospective study, all ACLR failures between 2015 and 2023 treated surgically at a single institution were included. The following factors were evaluated: sex, age at the time of revision surgery, PTS, anatomical versus non-anatomical tunnel placement, concomitant pathologies and fixation techniques. PTS was measured using the Dejour technique. Tibial and femoral tunnels were analyzed according to the method described by Stäubli and Rauschning, and Bernard et al., respectively. A logistic regression analysis was performed to evaluate the effect of each factor on the mechanism of graft failure (traumatic vs. non-traumatic).</p><p><strong>Results: </strong>Data from 143 of 144 available patients (99.3%) were included. There was no statistically significant difference in patient demographics between the two groups (<i>p</i> > 0.05). There was no statistically significant association between the PTS or tunnel malposition and non-traumatic ACLR failure (<i>p</i> > 0.05). However, medial meniscus injuries were significantly more frequent in the non-traumatic group (<i>n</i> = 53 [54.1%] vs. <i>n</i> = 16 [35.6%]; <i>p</i> = 0.034). The logistic regression showed no significant impact of any studied factor (<i>p</i> > 0.05) on the mechanism of ACLR failure.</p><p><strong>Conclusion: </strong>Patients in our cohort with non-traumatic ACLR failure did not demonstrate a higher PTS or a higher incidence of non-anatomically positioned tibial or femoral tunnels compared with patients experiencing traumatic retears. However, non-traumatic cases were associated with a higher prevalence of medial meniscus tears.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 2","pages":"e70699"},"PeriodicalIF":2.7,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821858","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}