Journal of Experimental Orthopaedics最新文献

{"title":"Ninety-three point seven percent pooled 10-year survival rate following lateral unicompartmental knee arthroplasty for isolated lateral knee osteoarthritis-A systematic review and meta-analysis.","authors":"Tsvetan Tsenkov, Yasen Nikolov, Atanas Panev, Nikolay Dimitrov, Michael T Hirschmann","doi":"10.1002/jeo2.70870","DOIUrl":"10.1002/jeo2.70870","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the available evidence on long-term outcomes following lateral unicompartmental knee arthroplasty in lateral knee osteoarthritis.</p><p><strong>Methods: </strong>An advanced search was done throughout three electronic databases (PubMed, Scopus and Embase) involving the words 'lateral unicompartmental knee arthroplasty' and 'lateral knee osteoarthritis'. Inclusion and exclusion criteria were set. The Newcastle-Ottawa scale was used in assessing the study quality. Extracted were study demographics, survival rate, follow-up period, indications and contraindications, implant type, revision rate and outcome tools. The data were systematically collected and meta-analysed.</p><p><strong>Results: </strong>After an initial screening of 1864 articles, 15 articles were selected for the review. The study quality was evaluated as 'high' in most of the selected articles. The pooled 10-year survival rate was 93.7% (95% CI: 92.5%-94.9%). The mean follow-up period ranged between 7 and 14 years (pooled mean follow-up 9.1 years). A significant negative correlation was found between patient BMI and survival rate (<i>p</i> = 0.03). Female participants were prevalent among the studies; however, no strong evidence linked the male proportion and survival rate (<i>p</i> > 0.05). The pooled revision rate was 4.6%.</p><p><strong>Conclusions: </strong>Lateral unicompartmental knee arthroplasty for isolated lateral knee osteoarthritis provided a high long-term survival rate with a low 10-year revision rate. This was provided in a non-ACL-deficient knee with a preoperative flexion of above 90 degrees and a correctable valgus by using a fixed-bearing implant. Females were more likely to undergo this procedure. A negative correlation was found between patient BMI and survival rate. There was a notable variability in the reported outcome measures among studies.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of therapeutic studies.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70870"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670738","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":"ACL rehabilitation after reconstruction: Evidence-based consensus recommendations from the German Knee Society-Part IV.","authors":"Martin Häner, Wolf Petersen, Arthur Praetorius, Natalie Mengis, Thomas Stoffels, Daniel Guenther, Thomas Pfeiffer, Julian Mehl, Andree Ellermann, Christian Eberle, Thomas Stein, Christian Schoepp, Jürgen Höher, Sven Scheffler, Amelie Stöhr, Mirko Herbort, Tobias Jung, Christoph Kittl, Philipp-Johannes Braun, Katrin Karpinski, Andrea Achtnich, Raymond Best, Ben Wagener, Jochen Bellerich, Lena Eggeling, Tobias Gensior, Christina Valle, Janina Tennler, Sebastian Stemmler, Matthias Jäger, Lars-Christopher Färber, Clemens Baier, Alexandra Schöllkopf, Max Wießmeier, Daniel Niederer","doi":"10.1002/jeo2.70875","DOIUrl":"10.1002/jeo2.70875","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this consensus was to provide evidence-based recommendations for individual rehabilitation interventions following anterior cruciate ligament reconstruction. These recommendations are intended to complement, rather than replace, comprehensive criterion-based rehabilitation protocols.</p><p><strong>Methods: </strong>A modified Delphi process conducted by the German Knee Society evaluated 29 rehabilitation topics. Evidence from systematic reviews, randomized controlled trials and prospective cohort studies (A1-C) was summarized and rated by an expert panel. Consensus was defined as ≥80% agreement between raters. Statements were graded using the Grading of Recommendations Assessment, Development and Evaluation framework, specifying the certainty of evidence.</p><p><strong>Results: </strong>Consensus was achieved for 25 topics (86%). Moderate-certainty evidence (B2) indicates that early weight bearing likely results in safe functional recovery. Supervised and unsupervised exercise (A2-B2) likely results in improved strength and function. Rehabilitation lasting ≥9 months (A1) likely results in optimal recovery guided by functional progress. Neuromuscular training (A1) and proprioceptive training (B2) likely improve sensorimotor control and functional outcomes. Plyometric (B2) and eccentric exercises (B2), as well as blood flow restriction (A1), likely result in enhanced quadriceps strength and muscle mass. Core stability exercises (C) and aquatic therapy (B1) likely improve knee function and facilitate early return to activity. Adjunctive modalities, such as cryotherapy (A2), likely reduce pain and swelling; KT (C) and digital applications (B1) may improve early-phase outcomes. Interventions such as whole-body vibration training (B2) and cross-education (C) showed inconsistent or insufficient benefits. Rehabilitation should be individualized according to patient-specific factors, concomitant injuries and functional progress.</p><p><strong>Conclusion: </strong>These consensus recommendations provide a multimodal, evidence-based framework for anterior cruciate ligament rehabilitation. Following these recommendations likely reduces variability in clinical practice, supports safe return to sport and might lower the risk of re-injury.</p><p><strong>Level of evidence: </strong>Level V, expert consensus.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70875"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670788","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 and radiographic outcomes of revision total knee arthroplasty with a medial pivot design for aseptic failure","authors":"Giorgio Cacciola,&nbsp;Francesco Bosco,&nbsp;Federico De Meo,&nbsp;Antongiulio Bruschetta,&nbsp;Claudio Domenico Cobisi,&nbsp;Pietro Cavaliere","doi":"10.1002/jeo2.70847","DOIUrl":"10.1002/jeo2.70847","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The use of medial pivot inserts in revision total knee arthroplasty (rTKA) remains limited, with more constrained designs often preferred. This study aimed to evaluate clinical, radiographic and complication outcomes of rTKA performed with a medial pivot insert for aseptic revision indications in selected patients with preserved ligamentous stability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective analysis was conducted on a prospectively maintained institutional registry. Sixty-three consecutive patients who underwent first-time rTKA with a medial pivot revision system between 2017 and 2023 were included. Indications for revision included aseptic loosening, instability, polyethylene wear and arthrofibrosis, in the presence of mild-to-moderate bone defects (Anderson Orthopaedic Research Institute [AORI] Type I or IIa) and preserved collateral ligament integrity. Clinical outcomes were assessed using the Knee Society Score (KSS), functional KSS (fKSS) and Western Ontario and McMaster Universities Osteoarthritis Index score. Radiographic evaluation included coronal and sagittal alignment parameters and the presence of radiolucent lines (RLLs). A &lt;i&gt;p&lt;/i&gt; value &lt; 0.05 was considered statistically significant. Minimum follow-up was 2 years.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Significant improvements were observed in all clinical outcome measures and knee range of motion (ROM) from preoperative assessment to final follow-up (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). No significant differences in clinical outcomes were detected between patients with AORI Type I and Type IIa bone defects. Radiographic analysis demonstrated satisfactory restoration of coronal and sagittal alignment, with no evidence of component migration or loosening at final follow-up. RLLs were observed in three cases and were non-progressive. Two patients (3.2%) required reoperation for periprosthetic joint infection (PJI); no revisions for instability or mechanical failure were recorded.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;rTKA performed with a medial pivot insert for aseptic failure resulted in favourable clinical and radiographic outcomes with a low complication rate at short- to mid-term follow-up. These findings suggest that medial pivot designs may represent a viable option in carefully selected revision cases with mild-to-moderate bone loss and preserved ligamentous stability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670820","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 preservation versus sacrifice of the posterior cruciate ligament on clinical outcomes after medial congruent total knee arthroplasty using mechanical alignment: A systematic review and meta-analysis.","authors":"Mansour Bahardoust, Mehdi Mohammadpour, Habib Gorgani, Meisam Haghmoradi, Sajad Fakoor","doi":"10.1002/jeo2.70873","DOIUrl":"10.1002/jeo2.70873","url":null,"abstract":"<p><strong>Purpose: </strong>The debate on whether to preserve or sacrifice the posterior cruciate ligament (PCL) during medial congruent (MC) total knee arthroplasty (TKA) is still ongoing. Currently, there is no comprehensive consensus due to the limited evidence on which approach yields better outcomes. This systematic review and meta-analysis aimed to compared the functional outcomes of PCL retaining (PR) versus PCL sacrificing (PS) in MC TKA.</p><p><strong>Methods: </strong>Two independent researchers to find relevant articles, with no time limit until 4 August 2025, searched PubMed/Medline, Scopus, Web of Science and Embase databases. Postoperative functional outcomes were compared between the PR and PS groups, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. The Cochran <i>Q</i> and <i>I</i> ² tests were employed to assess heterogeneity between studies.</p><p><strong>Results: </strong>Six cohort studies, including 903 patients, were included. The pooled estimate of the four studies demonstrated that at 3 months after surgery, the mean difference in postoperative KSS score between the PR and PS groups was 1.15, which was not statistically significant (95% CI: -1.11, 3.31). At 12 months after surgery, the mean Knee Society Score (KSS) reached statistical significance in favour of the PR group (MD: 1.97, <i>p</i> < 0.05); however, this difference did not exceed the minimal clinically important difference (MCID) of 5.3 points, indicating a lack of clinical significance There was no significant difference in the mean Oxford Knee Score (OKS) score at 3 and 12 months after surgery between the PR and PS groups.</p><p><strong>Conclusions: </strong>There appears to be no clinically meaningful difference in PR or PS during MC TKA in improving short-term clinical outcomes based on moderate-certainty evidence (Level IV). In the long term, preserving the PCL may lead to greater improvements in physical function compared to losing the PCL. However, no significant differences were noted in other clinical or functional outcomes, nor in complication rates, between the two groups.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70873"},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670780","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":"Beyond the quadriceps tendon: The rectus femoris as a distinct autograft for knee ligament reconstruction—A narrative review","authors":"Bernardo Garcia Barroso,&nbsp;Marcelo Cabral Fagundes Rêgo,&nbsp;Márcio Cabral Fagundes Rêgo,&nbsp;Felipe Silveira Martins,&nbsp;Sergio Marinho de Gusmão Canuto,&nbsp;Marcos Barbieri Mestriner,&nbsp;Carlos Eduardo Franciozi,&nbsp;Camilo Partezani Helito","doi":"10.1002/jeo2.70862","DOIUrl":"https://doi.org/10.1002/jeo2.70862","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This narrative review synthesises the anatomical, biomechanical, and clinical evidence on the rectus femoris tendon as an autograft for knee ligament reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search was conducted in PubMed and Google Scholar up to June 2026 with no language restrictions. A total of 35 articles describing the rectus femoris tendon as a graft for knee ligament reconstruction were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cadaveric studies demonstrated consistent morphometric dimensions, with a mean tendon length of approximately 30 cm and graft diameters ranging from 8 to 11 mm. Biomechanical testing across four independent cadaveric studies showed that the doubled rectus femoris provides load-to-failure within the range of established anterior cruciate ligament grafts. Multiple harvesting techniques have been described, using the identification of a fat layer between the rectus femoris and the intermediate layer as the primary landmark. The graft has been applied to isolated anterior cruciate ligament reconstruction, combined anterior cruciate ligament and anterolateral or anteromedial ligament reinforcement, posterior cruciate ligament reconstruction, and revision surgery. Early clinical series reported functional outcomes comparable to hamstring tendon autografts, with low donor-site morbidity. Isokinetic evaluation showed no difference in extensor performance between rectus femoris and hamstring tendon groups at six months. Intraoperative complications included capsular violations and premature graft amputations, concentrated in initial cases and without clinical repercussions. The current clinical evidence is limited to level III and IV studies, with a maximum mean follow-up of approximately 3.5 years in revision settings and 3 years in primary reconstruction, demonstrating improvement in patient-reported outcomes and knee stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The rectus femoris tendon is a viable autograft for knee ligament reconstruction, with consistent anatomy, adequate biomechanical properties, and early clinical results comparable to hamstring tendon autografts. It should be considered in individualised graft selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70862","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616666","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":"Distal tibial tubercle osteotomy: A descriptive analysis of factors that influence bone healing at the distal bony interface.","authors":"Arthur Only, Marta Engelking, Julie Agel, Elizabeth Arendt","doi":"10.1002/jeo2.70872","DOIUrl":"10.1002/jeo2.70872","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate factors that could impact bone healing following a tibial tubercle osteotomy distalization (dTTO) and the healing of the osteotomized tibial bone (OTB), focusing on its distal extent, where it contacts the anterior tibial shaft (ATS). Secondary aims: to document the average healing time at the dTTO interface, to evaluate frequency of postoperative bone absorption at the distal osteotomy interface, and whether the gap is related to complications of tibia fractures/delayed unions.</p><p><strong>Methods: </strong>Consecutive distal TTO patients were retrospectively reviewed including demographic data and distal gap measurements on intraoperative/postoperative sagittal knee radiographs. 'Gap resorption' was defined as >2 mm increase in the gap between intraoperative and follow-up radiographs.</p><p><strong>Results: </strong>A total of 101 knees underwent dTTO (2009-2015), 73 females/28 males; mean age(range): age 21 years old (13-45). 88% had x-rays that allowed assessment within 4 months. 62% had radiographic healing at the distal OTB-ATS. The initial gap was (mean [range]): 1.48 mm (0-8.4). All but two patients had initial gaps <3.3 mm. Eleven per cent had an increase in their distal bony gap >2 mm (range 2-7.8 mm) without radiographic evidence of motion at point of screw fixation. The mean thickness of the OTB as a % of total tibial width was 31% (range 22%-37%). There were 4 tibial fractures, none statistically related to initial gap distance, mm of distalization or %thickness of the osteotomy segment. Seven patients had gap resorption >2 mm, 2 with tibia fracture. Fracture time from surgery was 18-201 days.</p><p><strong>Conclusion: </strong>Of the factors reviewed in this cohort, no factors were identified directly relating to risk of tibia fracture or bone healing except gap resorption >2 mm at OTB-ATS interface. At 4 months complete radiographic healing was present in 62%. Bone resorption at the distal OTB-ATS interface is recognised postoperatively (11%). Though not statistically correlated with timely healing, it may be a risk factor for tibial shaft fracture.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70872"},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632277","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":"Early recovery patterns differ between medially congruent and posterior-stabilized total knee arthroplasty, with comparable 2-year outcomes: A triple-blinded randomized clinical trial","authors":"Fardis Vosoughi,&nbsp;Arash Sharafat Vaziri,&nbsp;Farzad Khashami,&nbsp;Zahra Vahdati,&nbsp;Iman Menbari Oskouie,&nbsp;Hossein Nematian","doi":"10.1002/jeo2.70861","DOIUrl":"10.1002/jeo2.70861","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Whether medially congruent (MC) total knee arthroplasty (TKA) provides clinically meaningful advantages over posterior-stabilized (PS) designs remains controversial. In this randomized trial, early recovery profiles and 2-year outcomes were compared between Persona® MC and PS TKA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In this triple-blinded randomized controlled trial, 82 patients undergoing primary TKA for Kellgren–Lawrence Grade IV osteoarthritis were allocated to receive a Persona® MC or PS system. The primary endpoint was Knee injury and Osteoarthritis Outcome Score–Activities of Daily Living (KOOS-ADL). Secondary outcomes included range of motion, visual analogue scale (VAS) pain, Forgotten Joint Score-12 (FJS-12), satisfaction and complications. Follow-up was 2 years. Group, time and group × time interaction were assessed using repeated-measures models.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Both groups improved over time. Significant group × time interactions were observed for ROM, VAS pain, KOOS-ADL and FJS-12, indicating different recovery profiles. MC knees had greater flexion at 2 weeks (95.3° vs. 83.9°, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and flexion contracture at 2 weeks was observed only in the PS group (0/41 vs. 4/41). Conversely, PS patients reported lower pain scores at 2 weeks (4.75 vs. 6.17, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 6 weeks (1.92 vs. 2.97, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Later flexion favoured PS, including at 2 years (118.8° vs. 113.9°, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). MC patients reported statistically higher KOOS-ADL and FJS-12 scores at 1 and 2 years; however, between-group differences did not exceed established minimum clinically important difference thresholds. Satisfaction was high in both groups and complications were infrequent.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Persona® MC and PS TKA showed different recovery profiles rather than clear superiority of either design. MC-TKA was associated with better early flexion and fewer observed early flexion contractures, whereas PS TKA was associated with lower early postoperative pain and greater flexion at later follow-up. MC showed statistically higher KOOS-ADL and FJS-12 scores, but these differences remained below minimum clinically important difference thresholds. Both designs provided substantial 2-year improvement without clinically meaningful between-group differences in patient-reported outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Level of Evidence&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632224","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":"Needle arthroscopy as an emerging office-based tool: Promising diagnostic value but limited evidence for therapeutic equivalence-A systematic review and frequentist meta-analysis.","authors":"Ingo J Banke, Roland Becker, Maximilian Voss, Nikolai Ramadanov","doi":"10.1002/jeo2.70857","DOIUrl":"10.1002/jeo2.70857","url":null,"abstract":"<p><strong>Purpose: </strong>Needle (Nano) arthroscopy is an emerging minimally invasive technique primarily used for diagnostic assessment and selected therapeutic procedures that may facilitate office-based joint evaluation. However, comparative evidence regarding functional outcomes, procedural performance and safety remains limited. This systematic review and meta-analysis compared needle arthroscopy with conventional arthroscopy regarding functional outcomes, diagnostic performance and complication rates.</p><p><strong>Methods: </strong>Comparative studies of needle arthroscopy versus conventional arthroscopy were pooled using random-effects meta-analysis with Hartung-Knapp adjustment. Dichotomous outcomes were analysed as odds ratios (ORs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). Functional outcomes, procedural success, complications and diagnostic performance were quantitatively synthesized. Between-study heterogeneity was assessed using <i>I</i> ² and <i>τ</i> ², and diagnostic parameters were analysed exploratorily when required data were reconstructed from reported percentages.</p><p><strong>Results: </strong>Nine studies including 503 patients were analysed. Needle arthroscopy and conventional arthroscopy demonstrated comparable procedure completion (OR 1.00, 95% CI 0.17-5.93) and diagnostic success (OR 1.01, 95% CI 0.10-10.07). Complication rates were low and similar between groups (OR 1.00, 95% CI 0.20-5.06), with no differences in infection or reoperation. Needle arthroscopy showed improved functional outcomes at 0.5 months (KOOS4 [KOOS composite score (mean of four subscales)]: MD +15.25, 95% CI 7.82-22.67) and maintained a significant advantage at 1.5 months (MD +7.25, 95% CI 0.27-14.22). Exploratory diagnostic analyses revealed no significant differences in sensitivity or specificity. Certainty of evidence ranged from moderate to very low.</p><p><strong>Conclusion: </strong>Needle arthroscopy provides comparable diagnostic and procedural performance to conventional arthroscopy and offers an early functional advantage. However, while current evidence is insufficient to replace conventional arthroscopy as the reference standard, needle arthroscopy may represent a valuable adjunct or emerging alternative in selected clinical settings.</p><p><strong>Level of evidence: </strong>Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70857"},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632230","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":"Mechanically aligned total knee arthroplasty demonstrates acceptable outcomes in obese patients, with insufficient evidence for alternative alignment strategies: A systematic review.","authors":"Helena Son, Andjela Dragovic, Marc Daniel Bouchard, Maaya Chander, Prushoth Vivekanantha, Hassaan Abdel Khalik, Naser Ali Alenezi, Luca Farinelli, Darren de Sa, Amit Meena","doi":"10.1002/jeo2.70860","DOIUrl":"10.1002/jeo2.70860","url":null,"abstract":"<p><strong>Purpose: </strong>Obesity (body mass index [BMI] ≥ 30 kg/m²) is increasingly prevalent among total knee arthroplasty (TKA) patients and is associated with unique challenges. The role of various TKA alignment strategies in obese patients remains unclear. To evaluate the clinical, functional, radiographic, survivorship and complication outcomes of primary TKA in obese patients across alignment philosophies.</p><p><strong>Methods: </strong>Eligible studies (1) included patients who underwent primary TKA with defined alignment, (2) reported BMI ≥ 30 kg/m² or provided stratified data for obese versus non-obese groups, (3) reported at least one of: patient-reported outcome measures (PROMs), range of motion (ROM), radiographic outcomes, or complications and (4) were randomized controlled trials (RCTs), cohort studies or case-control studies.</p><p><strong>Results: </strong>Thirty studies were included. 8468 obese patients (14,662 knees) underwent mechanically aligned TKA, with mean follow-up of 91.1 ± 45.3 months (range, 0.5-110.5 months). Mechanically aligned TKA in obese patients was associated with post-operative improvements in PROMs, including Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee Score. Short-term cumulative aseptic revision incidence was low, ranging from 0.5% to 1.3%, while revision-free survivorship commonly exceeded 95% at short-term and >90% at long-term follow-up. Radiographic outcomes demonstrated reliable restoration of near-neutral limb alignment across BMI strata. One study evaluated a kinematically-designed bicruciate-stabilized implant with an unspecified alignment strategy in obese patients, and another study evaluated functional alignment in obese patients, limiting comparisons.</p><p><strong>Conclusion: </strong>Evidence evaluating the influence of alignment on outcomes in obese patients undergoing TKA remains insufficient to determine whether alignment philosophy meaningfully affects clinical or radiographic outcomes. Although mechanically aligned TKA demonstrated generally acceptable post-operative outcomes in obese cohorts, the available literature was overwhelmingly dominated by mechanically aligned studies, with only limited evaluation of alternative approaches.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70860"},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632206","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":"MERItest^TM-A multidimensional model for functional evaluation at 6 months after ACL reconstruction.","authors":"Xavier Laurent, Damien Dodelin, Nicolas Graveleau, Nicolas Bouguennec","doi":"10.1002/jeo2.70836","DOIUrl":"10.1002/jeo2.70836","url":null,"abstract":"<p><p>At 6 months following anterior cruciate ligament reconstruction (ACLR), athletes transition from structured rehabilitation toward sport-specific reconditioning, a critical phase characterised by elevated re-injury risk and high variability in recovery trajectories. Yet clinical assessments at this milestone often rely on unidimensional metrics such as hop distance or limb symmetry indices (LSI), which fail to capture the complexity of functional readiness. This gap between apparent recovery and underlying neuromechanical deficits may contribute to persistently high re-injury rates, even in athletes who meet conventional return to sport criteria. The MERItest^TM is presented as a structured, multidimensional evaluation framework designed to enhance clinical reasoning at the 6-month follow-up. Rather than introducing new isolated tests, it integrates three complementary domains: monoarticular isometric strength testing, three-dimensional biomechanical analysis of functional tasks (jumping, hopping and running), and psychological readiness assessment using the anterior cruciate ligament-return to sport after injury (ACL-RSI) questionnaire, into a unified interpretive model. The isometric component quantifies contractile capacity of key muscle groups, the three-dimensional biomechanical analysis captures movement strategies and intersegmental coordination under dynamic loading, and the psychological assessment contextualises motor behaviour through confidence and risk appraisal. By examining not only how much force an athlete produces, but how movement is organised and experienced, the framework enables identification of residual deficits and compensatory strategies often overlooked by performance-based testing alone. The MERItest^TM proposes a shift from checklist-driven clearance decisions toward multidimensional profiling and individualised interpretation of recovery patterns, thereby supporting more informed clinical reasoning. Its design balances biomechanical rigour with clinical feasibility, supporting integration in both research and specialised clinical environments. Although prospective validation is required to confirm its predictive utility, this framework reframes the 6-month evaluation as a diagnostic opportunity rather than a binary clearance checkpoint.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 3","pages":"e70836"},"PeriodicalIF":3.2,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632252","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}