Journal of Experimental Orthopaedics最新文献

{"title":"Development and radiographic evaluation of a normalised guide-pin orientation abacus for anterior closing-wedge tibial osteotomy: Comparison with fixed-ratio and osteotomy-depth methods","authors":"Théo Plassard, Romir Patel, Christophe Jacquet, David Dejour, Antoine Piercecchi, Matthieu Ollivier","doi":"10.1002/jeo2.70951","DOIUrl":"https://doi.org/10.1002/jeo2.70951","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop a simplified mathematical model and abacus estimating anterior wedge resection height during slope-reducing tibial osteotomy from patient-specific guide-pin length and normalised guide-pin orientation, and to evaluate its accuracy under simulated radiographic conditions against fixed-ratio and osteotomy-depth methods. It was hypothesised that normalised guide-pin orientation would provide wedge-height estimates comparable to radiographic planning in both configurations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two hundred fifty-nine calibrated strict lateral knee radiographs from patients undergoing ACL reconstruction were retrospectively analysed in a single-centre radiographic simulation study. Supratuberosity and infratuberosity slope-reducing osteotomies were simulated with a standardised 10° correction, recording guide-pin length, orientation and corresponding anterior wedge height. Three models were compared: a trigonometric model with normalised mean angles, a fixed-ratio model and the osteotomy-depth method. Accuracy (mean absolute error, 90th percentile error) was assessed in-sample against radiographic reference measurements and confirmed by leave-one-out and five-fold cross-validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean guide-pin orientation angles were 67.4° ± 6.0° (supratuberosity) and 110.6° ± 4.7° (infratuberosity). The normalised-angle model produced mean absolute errors of 0.45 ± 0.41 mm (95% CI, 0.40–0.50) and 0.88 ± 0.79 mm (95% CI, 0.78–0.98), with 90th percentile errors of 0.91 and 1.77 mm and Bland–Altman bias of −0.17 and −0.06 mm, lower than both comparator models. Estimation error was not significantly influenced by sex or baseline posterior tibial slope, though the cohort's imbalanced sex distribution (194 men, 65 women) limited power to detect smaller effects in women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Within this model-development cohort, a patient-specific abacus based on guide-pin length and normalised guide-pin orientation produced low approximation errors under simulated radiographic conditions, without intraoperative radiographic calibration or complex calculations. These findings are exploratory and reflect in-sample performance; independent and clinical validation, including prospective intraoperative testing, are required before the method can be considered accurate, reproducible or ready for intraoperative use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146401","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 language models show distinct multidimensional performance profiles and variable reproducibility in consensus-based bone stress injury","authors":"Silvia Gandini, Jakob Lindskog, Yinan Yu, Felix Öttl, Richard Willy, Paolo Emilio Adami, Francesco Della Villa, Stefano Di Paolo, Fabio Bonsanto, Stefano Mazzoni, Francesco Feletti, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1002/jeo2.70939","DOIUrl":"10.1002/jeo2.70939","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study evaluated five publicly available large language model-based systems using a multidimensional, expert-based assessment of consensus-based clinical questions on bone stress injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten standardised questions derived from a 2025 international Delphi consensus on bone stress injuries were submitted to ChatGPT-5, Perplexity AI, Claude 4, Google Gemini 2.5 and Microsoft Copilot. Responses were independently rated by clinical experts using a multidimensional evaluation framework covering accuracy, comprehensiveness, understanding, reasoning, clarity, potential harm and trust, each rated on a 5-point Likert scale. Median scores were calculated for each question and model, and comparisons were performed using Kruskal–Wallis tests followed by Dunn's post hoc tests with Bonferroni correction. Interrater agreement was assessed using the weighted Gwet's agreement coefficient. Reproducibility was assessed by repeatedly submitting nine questions representing no, partial, and full expert consensus to each model, with response consistency scored from 1 to 3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant differences between models were observed for comprehensiveness, reasoning, clarity and trust (all <i>p</i> < 0.001), with no differences in accuracy or harm. ChatGPT-5 and Claude 4 achieved significantly higher comprehensiveness scores, while ChatGPT-5 and Google Gemini 2.5 had significantly higher reasoning scores than Microsoft Copilot. Claude 4 demonstrated significantly lower clarity than all other models. ChatGPT-5 achieved significantly higher trust scores and showed the highest mean reproducibility score, followed by Perplexity AI and Gemini 2.5; Microsoft Copilot showed the lowest reproducibility. Interrater agreement ranged from fair to almost perfect, with substantial overall agreement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Publicly available large language model-based systems demonstrated moderate-to-high performance in addressing expert-derived, consensus-based questions on bone stress injuries, suggesting potential to support the communication of consensus-based knowledge. However, performance varied across evaluation dimensions and reproducibility, indicating that large language models may support, but should not replace, primary consensus documents or expert clinical judgement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138560","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":"CPAK classification shows limited side-to-side agreement and limited reliability as a standalone surrogate for constitutional alignment in rheumatoid arthritis knees","authors":"Toshiyuki Omori,&nbsp;Tomohiro Kayama,&nbsp;Teruyuki Miyasaka,&nbsp;Hiroteru Hayashi,&nbsp;Daisuke Kubota,&nbsp;Shoutaro Arakawa,&nbsp;Yu Yamashita,&nbsp;Taiki Neyatani,&nbsp;Mitsuru Saito","doi":"10.1002/jeo2.70942","DOIUrl":"10.1002/jeo2.70942","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Coronal Plane Alignment of the Knee classification estimates constitutional coronal alignment. In rheumatoid arthritis knees, disease-related structural changes may affect the bony parameters used for this classification. This study described its distribution and side-to-side agreement in rheumatoid arthritis knees and explored radiographic differences associated with discordance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-centre retrospective study included 57 patients and 93 knees treated with unilateral or bilateral total knee arthroplasty for rheumatoid arthritis between January 2014 and December 2024. Classification type was determined from preoperative standing full-length anteroposterior radiographs. Side-to-side agreement was assessed in 36 bilaterally evaluable patients using complete agreement and unweighted Cohen's <i>κ</i>. Side-to-side differences in the medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line convergence angle (JLCA) and Larsen score were compared between agreement and discordance groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 93 knees, Type I was most frequent at 36.6% (34 of 93), followed by Type II at 25.8% (24 of 93) and Type III at 24.7% (23 of 93). Types VII–IX were not observed. Complete side-to-side agreement was 36.1% (13 of 36), and unweighted Cohen's <i>κ</i> was 0.152 (95% confidence interval, −0.050 to 0.356; <i>p</i> = 0.093). Side-to-side differences in the MPTA, LDFA and JLCA did not differ significantly between groups. A Larsen score difference of at least 1 was more frequent in the discordance group than in the agreement group (78.3% [18 of 23] vs. 38.5% [5 of 13]; <i>p</i> = 0.030), with an odds ratio of 5.760 (95% confidence interval, 1.290–25.640).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The classification showed limited side-to-side agreement in rheumatoid arthritis knees, and discordance was associated with asymmetric radiographic structural damage, indicating limited reliability as a standalone surrogate for constitutional alignment or contralateral knee morphology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115931","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":"Oral contraceptive use and anterior cruciate ligament injury or reconstruction in women: A systematic review and meta-analysis of very low-certainty evidence","authors":"Eiki Nicholas Kobayashi,&nbsp;Natalia Zampa Silva,&nbsp;Laura Amaral Coelho de Azevedo,&nbsp;Maria Eugênia Cammarota de Abreu,&nbsp;Juliano Mangini Dias Malpaga,&nbsp;Diego Escudeiro de Oliveira,&nbsp;Pedro Baches Jorge","doi":"10.1002/jeo2.70940","DOIUrl":"10.1002/jeo2.70940","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine whether oral contraceptive use is associated with anterior cruciate ligament injury or reconstruction in women and to examine whether associations vary according to age, contraceptive formulation, duration of use and outcome definition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Scopus, Embase and Latin American and Caribbean Health Sciences Literature (LILACS) were searched through 31 July 2026 (LILACS rerun with multilingual terms on 16 September 2026). Comparative observational studies were meta-analysed. The primary analysis pooled adjusted or matched odds ratios (ORs) for reconstruction or operatively treated injury using random-effects restricted maximum-likelihood models with Hartung–Knapp–Sidik–Jonkman confidence intervals (CIs). Risk of bias was assessed with risk of bias in nonrandomised studies of exposures and certainty with grading of recommendations assessment, development and evaluation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten studies were included; seven were meta-analysed. The primary analysis (four studies) showed no clear association (OR, 0.89; 95% CI, 0.77–1.02; <i>I</i>² = 84%; <i>τ</i>² = 0.01; 95% prediction interval, 0.66–1.19). Two crude athlete studies and the active-comparator cohort (hazard ratio, 0.95; 95% CI, 0.89–1.01) also had CIs including 1. Adding one crude database estimate yielded OR 0.85 (95% CI, 0.74–0.98; <i>I</i>² = 90%; 95% prediction interval, 0.61–1.19). Leave-one-out results were unstable. The certainty of evidence was very low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The primary adjusted or matched analysis did not establish a clear association between oral contraceptive use and anterior cruciate ligament reconstruction or operatively treated injury; substantial heterogeneity, residual confounding and very low certainty of evidence preclude causal interpretation. Current evidence does not support initiating or selecting oral contraceptives for anterior cruciate ligament injury prevention. Well-designed prospective studies with standardised exposure and outcome definitions are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, systematic review of observational studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115920","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 association between anterior cruciate ligament reconstruction using hamstring autograft and knee flexion strength deficits at 4 months on seated isokinetic testing at 180°/s in adolescents","authors":"Maika Bazebi,&nbsp;David Mazy,&nbsp;Zoe David,&nbsp;SiYu Wang,&nbsp;Alex Delisle,&nbsp;Guy Grimard,&nbsp;Marie-Lyne Nault","doi":"10.1002/jeo2.70926","DOIUrl":"10.1002/jeo2.70926","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to analyse the effect of using an ipsilateral hamstring (HS) autograft on early postoperative knee strength following anterior cruciate ligament reconstruction (ACLR) in adolescents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, single-centre study included patients aged ≤18 years who underwent primary ACLR with HS tendon autografts between January 2022 and January 2025. Demographic and operative data were collected. Isokinetic knee flexion and extension peak torque was assessed bilaterally at 180°/s using a standardized dynamometer protocol, and Limb Symmetry Index (LSI) was calculated preoperatively and at 4 months postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-three patients met the inclusion criteria (mean age, 15.6 ± 1.3 years). No significant postoperative strength deficits were detected in the operated limb for either flexion (<i>p</i> = 0.672) or extension (<i>p</i> = 0.316) compared with preoperative values. The contralateral healthy limb demonstrated significant strength gains in both flexion and extension (<i>p</i> &lt; 0.001). The LSI decreased significantly postoperatively (<i>p</i> &lt; 0.001), with a greater reduction in extension compared with flexion (12% vs. 7%). There were no differences in LSI between female and male patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACLR in adolescents using an ipsilateral HS autograft was not found to be associated with significant postoperative flexion or extension strength deficits on the operated limb at 4 months. The postoperative asymmetry seemed primarily driven by strength gains in the contralateral healthy limb. These findings highlight the importance of not overlooking quadriceps strengthening even when using an HS autograft and support the continued use of this graft choice in adolescents, especially regarding the preservation of flexion strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective case-control study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116008","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":"Single-strand superficial medial collateral ligament reconstruction with a peroneus longus split graft provides reliable control of anteromedial rotatory instability combined with anterior cruciate ligament reconstruction: A 2-year clinical cohort study","authors":"Philipp Weber,&nbsp;Simone Maxand,&nbsp;Michael Wagner","doi":"10.1002/jeo2.70941","DOIUrl":"10.1002/jeo2.70941","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;To evaluate 2-year clinical, radiological, and patient-reported outcomes after combined anterior cruciate ligament (ACL) reconstruction and single-strand superficial medial collateral ligament (sMCL) reconstruction using a peroneus longus split graft (PLSG) in patients with anteromedial rotatory instability (AMRI).&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;Patients with ACL insufficiency and clinically and intraoperatively confirmed AMRI who underwent combined ACL and sMCL reconstruction using a PLSG were retrospectively identified and prospectively followed. AMRI was diagnosed in this study based on a combination of ACL insufficiency, increased anteromedial drawer in external tibial rotation, medial laxity on valgus stress testing at 20° of knee flexion, pivot-shift grading as an indicator of overall rotatory instability of the knee, and supportive arthroscopic findings such as the medial meniscus squeeze sign. At a minimum follow-up of 2 years, 59 of 63 patients (mean age 30 years, 48% female) were available for evaluation. Postoperative stability was assessed using KT-1000 instrumented side-to-side measurements for the Lachman test and anterior drawer test at 90° flexion with neutral and 15° external tibial rotation (AMRI-related). Pivot-shift grading and valgus stress radiographs obtained at 20° of knee flexion were additionally performed. Patient-reported outcome measures (PROMs) included International Knee Documentation Committee (IKDC) Subjective, Lysholm, Tegner activity scale, and return-to-any-sport rate. A non-inferiority margin of 3 mm for side-to-side differences was predefined.&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;The mean side-to-side difference for the AMRI-related anterior drawer was 0.0 ± 1.3 mm (95% CI: −0.4 to 0.3 mm), meeting the predefined non-inferiority criterion (upper one-sided 95% confidence limit 0.3 mm; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The mean Lachman side-to-side difference was 1.8 mm ± 1.3 mm and remained within clinically acceptable limits. A negative pivot-shift was observed in 93% of patients. IKDC (59 ± 20 to 85 ± 12; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and Lysholm (61 ± 25 to 89 ± 11; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) scores improved significantly, whereas the Tegner Activity Scale (5.8 ± 1.7 to 5.2 ± 1.6; &lt;i&gt;p&lt;/i&gt; = 0.007) showed a small but significant decrease. The mean side-to-side difference in medial joint opening on valgus stress radiographs was 0.6 mm ± 1.0 mm, remaining below the predefined clinical reference threshold. At 2 years, 66% of patients had returned to any sports.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115951","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":"Metaphyseal cones in septic revision total knee arthroplasty: A retrospective cohort study with minimum 2-year follow-up","authors":"Andrea Pasquini,&nbsp;Lucas Martorell de Fortuny,&nbsp;Mihail Lazar Mioc,&nbsp;Joan Gómez-Junyent,&nbsp;Gerard Solanellas Manzanares,&nbsp;Joan Felipe Soler,&nbsp;Daniel Pérez-Prieto","doi":"10.1002/jeo2.70944","DOIUrl":"10.1002/jeo2.70944","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;Metaphyseal cones improve fixation and address bone loss in revision total knee arthroplasty (rTKA), but their use in septic revision remains controversial because of theoretical concerns about biofilm formation on porous surfaces, and evidence confined to the septic setting is scarce. We aimed to describe infection eradication, implant survival and functional outcomes and the metaphyseal microbiological environment after cone implantation in septic rTKA.&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;This multicentre retrospective single-arm cohort study included consecutive patients undergoing septic rTKA with at least one porous tritanium metaphyseal cone at two centres between January 2016 and December 2023. Periprosthetic joint infection was diagnosed by the European Bone and Joint Infection Society (EBJIS) 2021 criteria. In one-stage revisions, an additional metaphyseal bone sample was obtained during reaming for cone implantation. The primary outcome was infection eradication at a minimum 24-month follow-up; infection-free implant survival was estimated by Kaplan–Meier. Secondary outcomes were metaphyseal culture positivity in one-stage patients and functional scores (Knee Society Score [KSS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], EuroQol five-dimension five-level questionnaire [EQ-5D-5L], EuroQol Visual Analogue Scale [EQ-VAS]) at last follow-up.&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;Thirty-four patients (mean age 70.3 ± 8.3 years; 55.9% female) were included: 18 (52.9%) one-stage and 16 (47.1%) two-stage revisions. Median follow-up was 44 months (interquartile range [IQR]: 35–50). Infection was eradicated in 31 patients (91.2%, 95% confidence interval [CI]: 75.1%–97.1%); all three failures occurred by 14 months. Metaphyseal cultures were positive in 12 of 18 one-stage patients (66.7%, 95% CI: 43.7–83.7). Cones were removed in three patients. Median functional scores were KSS Knee 80, KSS Functional 60, WOMAC Physical Function 17 and EQ-VAS 70.&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;In this cohort, cone implantation in septic rTKA was associated with a high infection eradication rate and durable implant survival, with three cone removals. The 66.7% metaphyseal culture positivity in one-stage patients is an exploratory finding that may reflect occult infection or sample contamination and cannot be generalised beyond this subgroup. These findings support cones as a reconstructive option in septic rTKA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115967","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":"Popliteal artery injury associated with multiligament knee injuries and tibial plateau fractures: A 20-year retrospective cohort study","authors":"Efstathios Konstantinou,&nbsp;Nikolaos Stefanou,&nbsp;Christina Arnaoutoglou,&nbsp;Zoe Dailiana,&nbsp;Sokratis Varitimidis,&nbsp;Michael Hantes","doi":"10.1002/jeo2.70943","DOIUrl":"10.1002/jeo2.70943","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Popliteal artery injury (PAI) around the knee is a limb-threatening condition typically associated with high-energy trauma, particularly multiligament knee injuries (MLKIs) and tibial plateau fractures. This study aimed to analyse injury patterns, management, complications and functional outcomes, with the hypothesis that fracture-related PAI would be associated with better functional outcomes than MLKI-associated PAI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted of patients treated for PAI at a tertiary referral centre from 2003 to 2023. Patients were eligible if computed tomography angiography confirmed PAI associated with MLKI or a high-energy tibial plateau fracture. Demographics, injury characteristics, surgical management and complications were recorded. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS) for pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-eight patients (mean age, 44.1 years; 68.7% male) were included: 36 with MLKIs and 12 with fracture-related vascular injuries. Vascular procedures comprised popliteal bypass grafting in 30 patients (62.5%), venous patch angioplasty in 10 (20.8%) and primary arterial repair in 8 (16.7%). External fixation was applied to all patients. Peroneal nerve injury occurred in 15 patients (31.3%). Amputation was required in five patients (10.4%), all within the MLKI group and was associated with delayed presentation, advanced soft-tissue compromise and neurovascular injury severity at the time of referral. At final follow-up, the fracture group had higher IKDC scores (85.4 vs. 74.2; <i>p</i> = 0.032) and lower VAS pain scores (2.39 vs. 3.47; <i>p</i> = 0.049) than the MLKI group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this cohort, fracture-related PAI was associated with better functional outcomes than MLKI-associated PAI, whereas all amputations occurred in the MLKI group after delayed presentation and referral. These findings emphasize the importance of timely diagnosis, referral and coordinated vascular–orthopaedic management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective comparative study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115987","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":"Lower patella-patellar tendon angle is associated with increased odds of patellofemoral osteoarthritis progression in ACL revision patients: A case control study.","authors":"Domenico Franco, Chilan B G Leite, Nicole Krabb, Sebastian Schmidt, Giovanna Medina, Eric M Berkson, Peter D Asnis, Lars C Richardson, Elizabeth G Matzkin, Cale Jacobs, Christian Lattermann","doi":"10.1002/jeo2.70931","DOIUrl":"https://doi.org/10.1002/jeo2.70931","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether a lower preoperative patella-patellar tendon angle (P-PTA) is associated with progression of patellofemoral osteoarthritis (PFOA) in patients undergoing anterior cruciate ligament (ACL) revision surgery. We hypothesised that patients with lower preoperative P-PTA would have higher odds of PFOA progression.</p><p><strong>Methods: </strong>A database search (2015-2023) included patients who underwent ACL revision surgery with magnetic resonance imaging (MRI) available at both initial and revision ACL injuries. Inclusion criteria were primary arthroscopic anterior cruciate ligament reconstruction without cartilage restoration procedures and ≥2 years between ACL injuries. Demographic data, graft type, patellofemoral joint measurements (P-PTA, Sagittal tibial tubercle-trochlear groove distance, Insall-Salvati ratio) and PFOA progression were collected at both time points. PFOA progression was defined using MRI osteoarthritis knee score (MOAKS) criteria.</p><p><strong>Results: </strong>Sixty-two knees in 61 patients met the inclusion criteria (mean age at primary injury 30.60 ± 12.30 years; body mass index 26.70 ± 4.40 kg/m²; mean interval between injuries 4.77 ± 3.04 years). Twenty-two knees (35.50%) had no PFOA progression, and 40 (64.50%) had progression. Preoperative P-PTA was significantly lower in the progression group (141.90 ± 4.60°) than in the no-progression group (144.80 ± 5.70°; <i>p</i> = 0.044); this difference persisted at the second injury (142.30 ± 4.90° vs. 145.60 ± 6.60°; <i>p</i> = 0.043). Age (<i>p</i> = 0.02) and graft type (<i>p</i> = 0.015) also differed between groups. Insall-Salvati and sTT-TG at the first injury did not differ between groups. Multivariable logistic regression identified lower preoperative P-PTA as an independent predictor of progression (OR: 1.15 per 1° decrease; 95% CI: 1.02-1.30; <i>p</i> = 0.022). P-PTA alone showed limited discrimination (AUC: 0.66, 95% CI: 0.50-0.80), whereas the multivariable model showed higher apparent discrimination (AUC: 0.79, 95% CI: 0.68-0.90). Both receiver operating characteristic analyses were derived and evaluated in the same cohort, and no independent validation was performed.</p><p><strong>Conclusion: </strong>In this ACL revision cohort, a lower preoperative P-PTA was independently associated with MOAKS-defined PFOA progression. Each 1° decrease in P-PTA was associated with 15% higher odds of progression. However, the mean between-group difference was smaller than the MDC95, limiting individual-level interpretation of P-PTA measurements.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":"e70931"},"PeriodicalIF":3.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115922","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":"Magnetic resonance imaging-based meniscal coverage and cartilage thickness are associated with mechanical axis alignment in knee osteoarthritis","authors":"Atsushi Sasabe,&nbsp;Nobutake Ozeki,&nbsp;Hisako Katano,&nbsp;Yusuke Nakagawa,&nbsp;Tomomasa Nakamura,&nbsp;Hideyuki Koga,&nbsp;Ichiro Sekiya","doi":"10.1002/jeo2.70927","DOIUrl":"10.1002/jeo2.70927","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;This study examined whether magnetic resonance imaging (MRI)-based meniscal and cartilage measurements explain the percentage of mechanical axis (%MA) to a degree comparable with the joint line convergence angle (JLCA) when added to the arithmetic hip–knee–ankle (aHKA) angle. The association between tibial bony alignment and medial meniscal coverage across osteoarthritis (OA) severity was also assessed.&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;This cross-sectional study included 94 knees from 89 female patients (mean age, 54.6 years; Kellgren–Lawrence [KL] Grade 0–4). Weight-bearing full-leg radiographs were used to assess %MA, aHKA, the medial proximal tibial angle (MPTA) and JLCA. Three-dimensional MRI measured medial meniscus coverage and cartilage thickness. Multiple regression compared the contributions of JLCA and MRI-based measurements when each was added to aHKA. The MPTA-by-OA-severity interaction was analyzed.&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;MPTA was significantly correlated with the medial meniscus coverage ratio (MMCR) in knees with advanced OA (KL Grade 3–4; &lt;i&gt;r&lt;/i&gt; = 0.404) but not with mild or no OA (KL Grade 0–2; &lt;i&gt;r&lt;/i&gt; = 0.064), whereas the MPTA-by-severity interaction was not significant (&lt;i&gt;p&lt;/i&gt; = 0.116). Model A explained 67% of the %MA variance (adjusted &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.668). Adding JLCA improved model fit (Model B: adjusted &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.840). Adding MMCR and the height-normalized medial-to-lateral cartilage thickness difference to aHKA achieved a comparable model fit (Model C: adjusted &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.841), with all predictors significant (&lt;i&gt;p&lt;/i&gt; &lt; 0.01) and no multicollinearity. In a combined model including aHKA, JLCA, MMCR and cartilage thickness difference, all four variables remained significantly associated with %MA (adjusted &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.864).&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;Bony alignment and MRI-based intra-articular structural measurements were associated with weight-bearing mechanical axis alignment in knee OA. When added to aHKA, MRI-based meniscal coverage and cartilage thickness explained %MA with a model fit comparable to that obtained by adding JLCA. Thus, MRI-based measurements may add complementary structural information to conventional radiographic evaluation.&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 &lt;p&gt;Level III, cross-sectional study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115940","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}