Journal of Experimental Orthopaedics最新文献

{"title":"Creation and validation of a treatment algorithm for skeletally immature patients with acute anterior cruciate ligament injury based on MRI and patient characteristics","authors":"Alberto Grassi,&nbsp;Kyle Borque,&nbsp;Martijn Dietvorst,&nbsp;Emanuele Altovino,&nbsp;Claudio Rossi,&nbsp;Luca Ambrosini,&nbsp;Alice Bondi,&nbsp;Stefano Zaffagnini","doi":"10.1002/jeo2.70280","DOIUrl":"10.1002/jeo2.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to develop and validate a clinical decision-making algorithm, the ‘Best ACL-treatment Based on the Years of the Knee’ (BABY-Knee) Algorithm, for treating acute anterior cruciate ligament (ACL) injuries in skeletally immature patients. The algorithm integrates magnetic resonance imaging (MRI) findings and patient-specific characteristics to differentiate cases suitable for conservative management from those requiring surgical intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospective cohort of 75 skeletally immature patients (mean age: 13.9 ± 2.2 years) diagnosed with ACL rupture at a single institution between February 2022 and October 2024 was evaluated. Patients were categorized as surgical or non-surgical candidates based on the BABY-Knee Algorithm, which incorporates six weighted criteria: MRI-detected meniscal tears, lateral tibiofemoral bone bruises, skeletal age, injury mechanism and rotatory laxity. Outcomes of initial management were retrospectively analyzed for algorithm validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 75 patients, 55 (73.3%) underwent surgical reconstruction, while 20 (26.7%) were managed conservatively. Conservative treatment failed in 12 cases (60%), necessitating surgical intervention. Retrospective application of the algorithm yielded a positive predictive value of 91.7% for identifying surgical candidates and a negative predictive value of 87.5% for successful conservative treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The BABY-Knee Algorithm demonstrated high reliability in guiding treatment decisions for skeletally immature patients with acute ACL injuries, predicting outcomes of conservative treatment in nearly 90% of cases. Further studies are required to confirm its applicability in additional prospective case series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773407","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":"Anterior knee pain is a relevant cause for dissatisfaction after total knee arthroplasty without patellar resurfacing","authors":"Jörg Lützner,&nbsp;Patrick Schubert,&nbsp;Franziska Beyer,&nbsp;Cornelia Lützner","doi":"10.1002/jeo2.70382","DOIUrl":"10.1002/jeo2.70382","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of the present study was to investigate the incidence of anterior knee pain (AKP) after total knee arthroplasty (TKA) without patellar resurfacing and to determine how patient-reported outcome measures (PROMs) differ in patients with and without AKP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All primary TKAs from the local registry operated on between 2010 and 2016 were reviewed for secondary patellar resurfacing and asked about the presence of AKP (yes/no), satisfaction with the outcome of the TKA (Visual Analogue Scale [VAS] 1–10) and completion of the Oxford Knee Score (OKS) and Anterior Knee Pain Scale (AKPS). A total of 1371 primary TKAs were included, of which 201 patients had died, and 972 (70.9%) completed the additional questionnaires after a mean follow-up of 9.9 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>AKP was reported by 157 patients (16.2%), and eight patients (0.6%) had undergone secondary patellar resurfacing within two to five years after primary TKA, two of them with an additional increase of the insert due to instability. Patients who reported AKP had significantly worse OKS (mean 24.0 vs. 39.6), AKPS (mean 50.8 vs. 79.1) and satisfaction (mean 4.8 vs. 8.4/10). There were no statistically significant differences in the incidence of AKP by sex (men 15.1% vs. women 16.4%), age at surgery (&lt;60 years 19.6% vs. ≥60 years 15.2%), comorbidities (ASA 1/2 14.5% vs. ASA 3/4 18.1%) and constraint (unconstrained 15.9% vs. rotating-hinge 26.3%). The incidence of AKP in unconstrained TKA was 16.0% in CR, 12.6% in UC and 18.5% in PS implants. AKP occured significantly more frequently in patients with a BMI &gt; 40 kg/m² (26.0%, <i>p</i> = 0.03). In a multivariate regression analysis, only preoperative OKS had an independent influence on AKP (OR 0.949 per point, <i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study with long-term follow-up, a relevant proportion of patients reported AKP, which had a negative impact on PROMs and satisfaction. However, the rate of secondary patellar resurfacing was very low.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, therapeutic study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70382","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773411","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 corticosteroids and hyaluronic acid injections on knee osteoarthritis trajectory","authors":"Alessandro Bensa,&nbsp;Luca Bianco Prevot,&nbsp;Giuseppe M. Peretti,&nbsp;Giuseppe Filardo","doi":"10.1002/jeo2.70333","DOIUrl":"10.1002/jeo2.70333","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;Knee osteoarthritis (OA) is one of the most prevalent orthopaedic pathologies. Intra-articular injections represent a common option to manage this condition. The aim of this study was to quantify and compare the effectiveness of corticosteroids (CS) and hyaluronic acid (HA) in affecting the knee OA trajectory over time.&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 were selected from the Osteoarthritis Initiative database, a prospective, multicentre, longitudinal, observational study, including 254 knees who received CS or HA injections. For each patient, demographic characteristics, Kellgren–Lawrence (KL) grade, joint space narrowing (JSN) of the medial and lateral compartments, knee swelling, visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and subsequent prosthesis implantation were analysed. Patients were followed from baseline to 36 months of follow-up. Clinical improvements were evaluated according to the minimal clinically important difference (MCID): VAS = 1.4, WOMAC = 6.4.&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 CS and HA groups showed no overall clinical worsening from the baseline to the 36-month evaluation. On the other hand, they both presented a worsening at short- and long-term of KL OA grade (CS: &lt;i&gt;p&lt;/i&gt; &lt; 0.001 and &lt;i&gt;p&lt;/i&gt; = 0.018; HA: &lt;i&gt;p&lt;/i&gt; = 0.042 and &lt;i&gt;p&lt;/i&gt; = 0.012) and medial JSN (CS: &lt;i&gt;p&lt;/i&gt; &lt; 0.001 and &lt;i&gt;p&lt;/i&gt; = 0.009, HA: &lt;i&gt;p&lt;/i&gt; = 0.033 and &lt;i&gt;p&lt;/i&gt; = 0.003), while lateral JSN deteriorated only in the CS group at short-term (&lt;i&gt;p&lt;/i&gt; = 0.030). The analysis of patients obtaining an improvement exceeding the MCID showed that CS outperformed HA at short-term for WOMAC (44.9% vs. 29.0%, &lt;i&gt;p&lt;/i&gt; = 0.022) with a tendency also for VAS (44.3% vs. 31.9%, &lt;i&gt;p&lt;/i&gt; = 0.086). However, only HA provided a clinically relevant long-term improvement of WOMAC (&lt;i&gt;p&lt;/i&gt; = 0.014, MD = 6.7) and VAS (&lt;i&gt;p&lt;/i&gt; = 0.024, MD = 1.2). The analysis of patients requiring total knee arthroplasty (TKA) before the end of the study did not show differences between CS and HA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The symptomatic trajectory after 36 months showed no worsening in knee OA patients undergoing intra-articular injections and different benefits based on the treatments: CS offered clinically relevant benefits compared to HA at short-term while HA provided superior functional improvement at long-term, with no differences between the two treatments of radiographic OA evolution, knee swelling, and progressio","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773986","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":"Association of spinopelvic mobility and osteosarcopenia with total hip arthroplasty outcomes","authors":"Yoshinori Okamoto,&nbsp;Hitoshi Wakama,&nbsp;Takafumi Saika,&nbsp;Kengo Tani,&nbsp;Shuhei Otsuki","doi":"10.1002/jeo2.70395","DOIUrl":"10.1002/jeo2.70395","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 assessed the association of spinopelvic mobility and osteosarcopenia with the achievement of a patient-acceptable symptom state in patient-reported outcomes after total hip arthroplasty.&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 retrospective study included 244 patients who underwent primary total hip arthroplasty with a minimum follow-up of 24 months. Spinopelvic mobility was assessed using changes in sacral slope during postural transitions, classified as stiff (&lt;10°), normal (10°–30°), or hypermobility (≥30°). Osteosarcopenia was defined by psoas muscle area on computed tomography and lumbar bone mineral density. Outcomes were assessed using the EuroQol 5-Dimension and the Hip Disability and Osteoarthritis Outcome Score–Joint Replacement. Multivariate logistic regression analysis was performed to identify predictors of a patient-acceptable symptom state achievement on the EuroQol 5-Dimension. Propensity score matching yielded 35 patients with limited mobility and 70 controls.&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;Physiological spinopelvic mobility (odds ratio 0.66, 95% confidence interval 0.56–0.78, &lt;i&gt;p&lt;/i&gt; = 0.028) and the absence of osteosarcopenia (odds ratio 0.68, 95% confidence interval 0.49–0.94, &lt;i&gt;p&lt;/i&gt; = 0.031), along with older age (odds ratio 1.12, 95% confidence interval 1.01–1.24, &lt;i&gt;p&lt;/i&gt; = 0.046), were associated with higher patient-acceptable symptom state achievement rates for EuroQol 5-Dimension. Propensity-matched analysis revealed that patients with limited mobility exhibited significantly lower nutritional indices (&lt;i&gt;p&lt;/i&gt; = 0.008), EuroQol 5-Dimension (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), Hip Disability and Osteoarthritis Outcome Score–Joint Replacement (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and satisfaction scores (&lt;i&gt;p&lt;/i&gt; = 0.005). Dynamic sacral slope changes correlated significantly with nutritional and muscle indices (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).&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;Preoperative spinopelvic stiffness and osteosarcopenia independently predict poor functional recovery following total hip arthroplasty. This indicates the need for comprehensive preoperative assessments addressing both spinopelvic biomechanics and musculoskeletal health to optimise total hip arthroplasty strategies. Future research should explore tailored surgical approaches to improve outcomes in vulnerable populations, particularly those with impaired spinopelvic mobility and osteosarcopenia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Le","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773987","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":"Interobserver reliability of the pivot shift test: A modified classification improves agreement","authors":"Juan P. Martinez-Cano,&nbsp;Sebastian Mejia-Barreto,&nbsp;Jacobo Triviño-Arias,&nbsp;Maria C. Gomez-Ayala,&nbsp;Alejandro Mejia,&nbsp;Juan F. Londoño,&nbsp;Ruben Guzman","doi":"10.1002/jeo2.70354","DOIUrl":"10.1002/jeo2.70354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The pivot shift test evaluates the anterolateral rotational instability of the knee in patients with anterior cruciate ligament (ACL) injuries. The aim of this study was to evaluate the interobserver reliability of the classic pivot shift test and a modified classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An interobserver reliability study involving 4 observers and 17 patients with high suspicion of ACL injury. Observers were blind to diagnostic images and independently evaluated each patient. Kappa–Fleiss was used to assess the pivot shift test agreement between observers. Interobserver reliability was calculated for the classic classification (grades I, II and III), as well as for a modified classification in low-grade (I) and high-grade pivot shift (II and III). Kappa agreement was categorised as poor (&lt;0.00), slight (0.00–0.20), fair (0.21–0.40), moderate (0.41–0.60), substantial (0.61–0.80) and perfect (0.81–1.00).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients had mean age of 29 years (range: 24–32) with similar sex distribution (male: 53%). The global interobserver reliability assessment favoured the modified (0.73) over the classic classification (0.39). Agreement for the classic categories (negative: 0.87, grade I: 0.61, grade II: 0.06 and grade III: 0.34), was surpassed by the modified approach (negative: 0.87, low-grade: 0.61 and high grade: 0.73).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study demonstrated that the modified pivot shift test grading improves interobserver reliability compared to the classic classification. By combining the grade II and III categories into a single high-grade category, we transformed poor and fair agreement into substantial agreement. The modified pivot shift classification can be utilised in both clinical practice and research, particularly due to its clinical implications for decision-making in patients with grade II and III pivot shifts, which may be similar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773408","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":"The assessment of ChatGPT-4's performance compared to expert's consensus on chronic lateral ankle instability","authors":"Takuji Yokoe,&nbsp;Giulia Roversi,&nbsp;Nuno Sevivas,&nbsp;Naosuke Kamei,&nbsp;Pedro Diniz,&nbsp;Hélder Pereira","doi":"10.1002/jeo2.70393","DOIUrl":"10.1002/jeo2.70393","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the accuracy of answers to clinical questions on the surgical treatment of chronic lateral ankle instability (CLAI) using ChatGPT-4 as a reference for consensus statements developed by the ESSKA-AFAS Ankle Instability Group (AIG). This study simulated the clinical settings where non-expert clinicians treat patients with CLAI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The large language model (LLM) ChatGPT-4 was used on 10 February 2025 to answer a total of 17 questions regarding the surgical management of CLAI that were developed by the ESSKA-AFAS AIG. The ChatGPT responses were compared with the consensus statements developed by ESSKA-AFAS AIG. The consistency and accuracy of the answers by ChatGPT as a reference for the experts' answers were evaluated. The consistency of ChatGPT's answers to the consensus statements was assessed by the question, 'Is the answer by ChatGPT agreement with those by the experts? (Yes or No)'. Four scoring categories: Accuracy, Overconclusiveness (proposed recommendation despite the lack of consensus), Supplementary (additional information not covered by the consensus statement), and Incompleteness, were used to evaluate the quality of ChatGPT's answers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 17 questions on the surgical management of CLAI, 11 answers (64.7%) were agreement with the consensus statements by the experts. The percentages of ChatGPT's answers that were considered ‘Yes’ in the Accuracy and Supplementary were 64.7% (11/17) and 70.6% (12/17), respectively. The percentages of ChatGPT's answers that were considered “No” in the Overconclusiveness and Incompleteness were 76.5% (13/17) and 88.2% (15/17), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The present study showed that ChatGPT-4 could not provide answers to queries on the surgical management of CLAI, such as foot and ankle experts. However, ChatGPT also showed its promising potential for its application when managing patients with CLAI.</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":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773510","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-stage autograft revision for failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction: Improved clinical outcomes at a minimum 5-year follow-up","authors":"Vasileios S. Akrivos,&nbsp;Antonios Koutalos,&nbsp;Ioannis Nastas,&nbsp;Nifon Gkekas,&nbsp;Pavlos Akritidis,&nbsp;Evangelos Gatos,&nbsp;Michael Hantes","doi":"10.1002/jeo2.70381","DOIUrl":"10.1002/jeo2.70381","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate mid-term clinical outcomes and intraoperative findings in patients undergoing single-stage revision after failed ligament advanced reinforcement system (LARS) anterior cruciate ligament reconstruction (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study evaluated patients who underwent ACL revision surgery following initial reconstruction using the LARS device. Clinical assessments included the Tegner activity scale, Lysholm Knee score, and International Knee Documentation Committee (IKDC) scores, recorded preoperatively and at a minimum follow-up of 5 years. Preoperative imaging was conducted to assess tunnel widening, alignment, and the presence of arthritic changes. Intraoperative evaluations included arthroscopic inspection of the synovium, menisci, and cartilage. Synovial biopsies were obtained for histological analysis of inflammation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five patients were included in the study. Clinical scores demonstrated significant improvement in Tegner activity scale (<i>p</i> = 0.0006), Lysholm Knee score (<i>p</i> = 0.0001) and IKDC score (<i>p</i> = 0.0001) following revision surgery, with a mean follow-up duration of 7.8 years (SD = 2.13). Preoperative imaging revealed early arthritic changes in 52% of patients. Intraoperative findings showed that all patients exhibited synovial membrane inflammation, with a 100% incidence of synovitis. Additionally, 68% of patients presented with Stage III or IV chondral lesions according to the ICRS classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Single-stage revision ACLR using autografts led to significant clinical improvement after LARS ACLR failure, with a mean follow-up of 7.8 years. All cases during revision demonstrated synovial inflammation, with a high prevalence of chondral lesions and early arthritis. While these findings may point to a potential association between synthetic grafts and degenerative joint pathology, causality cannot be established, as degenerative changes are known to occur following failed ACL reconstructions regardless of graft type.</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":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773410","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":"Impact of tibial supplementary fixation in anterior cruciate ligament reconstruction for soft tissue auto and allografts: Modest enhancement in stability and increased incidence of pain: A systematic review and meta-analysis","authors":"Fuwen Zheng,&nbsp;Jiahao Gao,&nbsp;Chenyu Wang,&nbsp;Xu Zheng,&nbsp;Jinshuo Tang,&nbsp;Jinrui Zhang,&nbsp;Jianlin Zuo","doi":"10.1002/jeo2.70390","DOIUrl":"10.1002/jeo2.70390","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate whether the joint function, stability and safety of tibial supplementary fixation in anterior cruciate ligament reconstruction is superior compared with tibial screw fixation alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Cochrane Library, EMBASE and Web of Science were searched, tracking until 12 April 2025. Eligible studies included published randomized controlled trials (RCTs) and low-risk cohort studies comparing clinical outcomes and complications between tibial screw interference with supplementary fixation (Group I) and tibial screw interference alone or with a sheath (Group II). RCTs were assessed using the Cochrane Risk of Bias tool, while cohort studies were evaluated with the Newcastle–Ottawa Scale and Methodological index for non-randomized studies. Model selection (random or fixed-effects) was based on data heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This meta-analysis included eight studies with 943 patients (Group I: 386, Group II: 557). Group I showed no significant differences in side-to-side difference (SSD) in the sheath subgroup at 24 months, SSD &lt;3 mm at 9.1 kg at 12 and 24 months, or manual maximum testing at 24 months, Pivot test at 8–12 and 24 months, Lachman test at 8–12 months, International Knee Documentation Committee objective and subjective score at 24 months compared to Group II. Group I demonstrated statistically significant reductions in SSD (mean difference: −1.02; 95% CI: −1.79 to −0.25; <i>p</i> = 0.009) in the no-sheath subgroup and lower Lachman test positivity (odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.13–0.71; <i>p</i> = 0.01) at 24 months. Ligament retear rates were similar; however, Group I experienced a substantially higher incidence of kneeling pain (OR = 6.28; 95% CI: 1.86–2.25; <i>p</i> &lt; 0.01), an outcome that could adversely affect patient comfort and long-term functional recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Enhanced supplementary tibial fixation with soft tissue autografts and allografts offers similar joint function and a modest enhancement of stability compared to tibial interference screw fixation alone, but is associated with a higher incidence of pain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective cohort studies have been analysed, alongside RCTs, and thus this is the level of evidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773668","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":"Outcome after isolated medial patellofemoral ligament reconstruction is dependent on age but not on body mass index or gender","authors":"Olivia Bohe,&nbsp;Antonia Schneider,&nbsp;Armin Runer,&nbsp;Sebastian Siebenlist,&nbsp;Andrea Achtnich","doi":"10.1002/jeo2.70332","DOIUrl":"10.1002/jeo2.70332","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;Medial patellofemoral ligament (MPFL) reconstruction is the most used surgical technique in the treatment of patellofemoral instability. However, the role of patient specific factors like age, sex and body mass index (BMI) at surgery is being increasingly discussed. The aim of this study was to study the influence of these factors with regards to functional outcomes and redislocation rates.&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;All patients with patellofemoral instability, who were treated with isolated MPFL reconstruction surgery between 01/2017 to 01/2022, were included. Patients with pathologic risk factors, high-grade cartilage damage, prior surgeries and age &lt;14 years were excluded. Demographic information and information concerning surgery, complications and history were collected. Patient reported outcome measures (PROMs) were collected preoperatively, after 6 and 12 months postoperatively and at final follow-up using multiple standardised scores (knee injury and osteoarthritis outcome score, International Knee Documentation Committee [IKDC], Tegner activity scale, Kujala, BANFF).&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;Of the 62 patients included in this study 42 (67.7%) were female with a mean age of 24.8 ± 7.6 years and a mean BMI of 24.5 ± 4.7 kg/m&lt;sup&gt;2&lt;/sup&gt; at the time of surgery. Final follow-up was 42.3 ± 23.4 months. Fifty-four (90.3%) patients were satisfied with the functional outcome, four (6.5%) patients suffered recurrent dislocation.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Overall, the functional outcome was very good in our study population (e.g., Kujala 87.0 ± 10.5, IKDC 76.4 ± 13.7). In the subgroup analysis, there were no significant differences in the functional outcome between women and men (e.g., Kujala score: 87.2 ± 11.4 vs. 86.4 ± 7.8, &lt;i&gt;p&lt;/i&gt; = 0.81) and there was no correlation with BMI at time of surgery (e.g., Kujala, &lt;i&gt;r&lt;/i&gt; = 0.11, &lt;i&gt;p&lt;/i&gt; = 0.53). However, statistically significant correlations were detected in functional outcome with the age at surgery.&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;Older age at the time of surgery has a highly significant negative correlation with the functional outcome after isolated MPFL reconstruction. Therefore, surgeons must be highly vigilant and identify high-risk patients even before surgery and necessary MPFL reconstruction should not be delayed.&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 II","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717032","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":"New algorithm for management of multiligament knee injuries: A tertiary level trauma center experience","authors":"Ayman AbdelKawi,&nbsp;Mohammed Fargaly,&nbsp;Gaber Eid,&nbsp;Maher El Assal,&nbsp;Hesham Elkady,&nbsp;Tarek N. Fetih","doi":"10.1002/jeo2.70387","DOIUrl":"10.1002/jeo2.70387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Multiligament knee injuries (MLKIs) are severe orthopedic traumas frequently associated with concomitant structural damage, often leading to significant long-term morbidity. This study aimed to evaluate the rate of return to work (RTW) following the management of MLKIs using a standardized treatment algorithm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective interventional study included patients with MLKIs who presented to a tertiary trauma center between 2019 and 2022. A total of 32 patients (30 males and 2 females) were enrolled and classified according to the Schenck classification system. The median age at the time of injury was 31 years (range: 17–60 years). The mechanism of injury was high-energy trauma in 21 patients, sports-related trauma in eight patients, and low-energy trauma in three patients. Clinical outcomes were assessed at final follow-up using the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee evaluation form, University of California Los Angeles (UCLA) activity score, and return to work status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At a mean 2-year postoperative follow-up, the average range of motion across all patients was 134.2° ± 16.6°. The mean postoperative Lysholm, IKDC, and UCLA scores were 86.4 ± 12.6, 65.9 ± 9.7, and 6.9 ± 2.2, respectively. Notably, 90.6% of the patients achieved a successful return to their previous work. The proportion of patients returning to work was significantly higher in the Knee Dislocation Injury (KDI) group compared to the other three Schenck classification groups, which showed no significant difference among themselves. Radiographic evidence of osteoarthritis (OA) was observed in four cases (12.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that satisfactory to excellent short-term clinical outcomes, including a high rate of return to work, can be achieved following ligament reconstruction for multiligament knee injuries when utilizing a standardized treatment algorithm. However, the potential for long-term complications, such as the development of knee osteoarthritis, warrants careful consideration and continued monitoring.</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":"12 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712063","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}