Journal of Knee Surgery最新文献

{"title":"Contemporary Management of Knee Chondral Defects, Part I: A Framework for Treatment Selection.","authors":"Chase W Smitterberg, Giles R Scuderi, Michael A Mont","doi":"10.1055/a-2865-1757","DOIUrl":"10.1055/a-2865-1757","url":null,"abstract":"<p><strong>Abstract: </strong>Focal chondral defects of the knee present a heterogeneous clinical problem with no universally applicable solution. Lesion size, containment, subchondral bone involvement, joint alignment, meniscal integrity, patient activity demands, and system-level constraints variably influence durability, yet outcomes are often interpreted without adequate contextualization. As a result, treatment comparisons frequently reflect differences in indication rather than superiority of technique. This review proposes a constraint-based framework to guide treatment selection in focal knee chondral defects. Cartilage restoration is conceptualized as a continuum of joint-preserving strategies, each occupying a defined role determined by mechanical demands, biologic plausibility, and practical feasibility. Available interventions are organized into five categories: structural resurfacing and transfer techniques, cell-based repair, marrow stimulation-based repair, scaffold-augmented repair, and osteochondral allograft transplantation. A structured decision algorithm is presented emphasizing sequential evaluation of the joint environment, defect characteristics, and patient-specific modifiers. The framework emphasizes that malalignment, instability, meniscal deficiency, and subchondral bone pathology must be addressed to optimize durability, and that lesion geometry and depth narrow the range of biologically and mechanically plausible options. Patient expectations and system constraints refine, but do not override, lesion-driven decision-making. Rather than positioning techniques hierarchically, this model highlights appropriate application boundaries and expected trade-offs. Durable symptom relief and delay of arthroplasty remain shared endpoints across modalities. By shifting emphasis from modality comparison to constraint matching, this framework provides a unified structure for interpreting the cartilage restoration literature and establishes the foundation for the modality-specific analyses presented in subsequent parts of this series.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"671-677"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Management of Knee Chondral Defects, Part IV: Scaffold-Augmented Repair and Osteochondral Allograft Transplantation.","authors":"Chase W Smitterberg, Michael A Mont, Giles R Scuderi","doi":"10.1055/a-2865-1893","DOIUrl":"10.1055/a-2865-1893","url":null,"abstract":"<p><strong>Abstract: </strong>Scaffold-augmented repair and osteochondral allograft (OCA) transplantation represent hybrid approaches that integrate biologic stimulation with structural support. These strategies are particularly relevant when marrow stimulation alone is insufficient, but joint-preserving alternatives to arthroplasty remain viable. Scaffold-based techniques, including autologous matrix-induced chondrogenesis, enhance marrow stimulation by stabilizing the reparative clot within a three-dimensional matrix. Clinical studies demonstrate improvements in pain and function, and certain scaffolds show superior defect filling compared with microfracture alone. However, long-term comparative durability relative to cell-seeded constructs or autograft transfer remains limited, and improved structural fill does not consistently correlate with superior clinical outcomes. Traditional fresh OCA transplantation provides the most anatomically complete joint-preserving reconstruction by restoring viable hyaline cartilage and subchondral bone in a single-stage procedure. Long-term series support acceptable survivorship in large, osteochondral, and revision lesions, though graft availability, cost, and technical complexity constrain widespread use. Processed and off-the-shelf allograft cartilage products expand accessibility for smaller defects, but are generally supported by early- to mid-term data with limited high-level comparative evidence. Hybrid strategies broaden the cartilage restoration continuum by addressing defects that exceed the limitations of marrow stimulation while avoiding arthroplasty in selected patients. Durable outcomes depend on alignment between lesion size, bone involvement, joint environment, and biologic capacity. As comparative data mature, further clarification of long-term survivorship and cost-effectiveness will refine their role within joint preservation algorithms.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"693-699"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Meniscus Extrusion Volume in the Knee Flexion Position Does Not Worsen after Transtibial Pullout Repair for Medial Meniscus Posterior Root Tears: A 3-year Follow-up.","authors":"Koki Kawada, Yusuke Yokoyama, Yuki Okazaki, Masanori Tamura, Toshifumi Ozaki, Takayuki Furumatsu","doi":"10.1055/a-2824-8786","DOIUrl":"10.1055/a-2824-8786","url":null,"abstract":"<p><strong>Abstract: </strong>This study aimed to evaluate the progression of medial meniscus (MM) extrusion (MME) volume (MMEV) at knee joint extension/flexion up to 3 years after pullout repair of MM posterior root tears (MMPRT) and to assess its relationship with clinical outcomes. A retrospective analysis was conducted in 15 patients who underwent pullout repair of unilateral MMPRT and open magnetic resonance imaging (MRI) examination preoperatively and at 1 and 3 years postoperatively. An open MRI was performed at knee joint extension and flexion. MME and MMEV at knee joint extension, MM posterior extrusion (MMPE), and MMEV at knee joint flexion were evaluated. Clinical scores were recorded preoperatively and at 1 and 3 years postoperatively. The correlations between changes in MME, MMPE, and MMEV from the preoperative period to 3 years postoperatively (ΔMMEV) and clinical scores from the preoperative period to 3 years postoperatively were evaluated. MME and MMEV at knee joint extension increased significantly from preoperatively to 1 year (<i>p</i> = 0.001 and <i>p</i> = 0.016) and to 3 years (<i>p</i> < 0.001 and <i>p</i> = 0.010), with no significant change from 1 to 3 years (<i>p</i> = 0.319 and <i>p</i> = 0.840). MMPE at knee joint flexion decreased significantly from preoperatively to 1 year (<i>p</i> = 0.007) and to 3 years (<i>p</i> = 0.002), whereas no difference was observed from 1 to 3 years (<i>p</i> = 0.672). MMEV at knee joint flexion showed no significant longitudinal changes (all <i>p</i> > 0.644). After false discovery rate (FDR) adjustment, all clinical outcomes, except the pain visual analog scale, demonstrated significant time effects. No significant correlation was observed between ΔMME, ΔMMPE, and ΔMMEV at knee joint extension and clinical outcomes before/after FDR adjustment. Although moderate correlations between ΔMMEV at knee joint flexion and clinical outcomes were observed before adjustment, none remained significant after FDR correction. Three years after transtibial pullout repair for MMPRT, MMPE at knee joint flexion significantly improved, maintaining MMEV at knee joint flexion without deterioration. ΔMMEV at knee joint flexion may correlate with clinical score improvement; however, further research is required.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"711-721"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Management of Knee Chondral Defects, Part III: Cell-Based Cartilage Repair Including Autologous Chondrocyte Implantation, Orthobiologics, and Tissue-Engineered Constructs.","authors":"Chase W Smitterberg, Michael A Mont, Giles R Scuderi","doi":"10.1055/a-2865-1851","DOIUrl":"10.1055/a-2865-1851","url":null,"abstract":"<p><strong>Abstract: </strong>Cell-based cartilage repair strategies seek biologic regeneration of articular cartilage rather than mechanical resurfacing. These approaches are most appropriate for medium-to-large, contained focal defects in patients who have preserved alignment and subchondral bone who are willing to undergo staged procedures and prolonged rehabilitation. Autologous chondrocyte implantation, particularly in its matrix-induced form, represents the most established cell-based platform. Long-term follow-up studies demonstrate sustained improvements in patient-reported outcomes with acceptable reoperation and arthroplasty conversion rates beyond 10 years. Evidence remains the strongest for the technique as a class rather than for individual proprietary systems. In contrast, point-of-care orthobiologics, including bone marrow aspirate concentrate and platelet-rich plasma, are widely utilized despite heterogeneous protocols and limited high-level comparative data. Although short-term symptomatic improvements are frequently reported, structural imaging outcomes and durability remain inconsistent. Standardization challenges complicate interpretation of the existing literature. Emerging therapies, including adipose-derived regenerative cell systems, cord blood-derived mesenchymal stem cell constructs, and tissue-engineered osteochondral platforms, aim to enhance biologic regeneration while reducing procedural burden. Most remain investigational, with early-phase clinical trials and limited long-term outcome data. Cell-based repair occupies a distinct position within the joint-preserving continuum. Durable success depends on careful alignment between lesion characteristics and biologic plausibility. Failures often reflect application beyond appropriate constraints rather than technical inadequacy. Continued comparative studies are necessary to define durability, cost-effectiveness, and long-term joint preservation relative to structural and hybrid strategies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"688-692"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stagnant Physician Reimbursement as Hospital Reimbursement Increases for Inpatient Total Knee Arthroplasty in Commercial Payors.","authors":"Gloria Coden, John Mazzocco, David A Mattingly","doi":"10.1055/a-2824-8565","DOIUrl":"10.1055/a-2824-8565","url":null,"abstract":"<p><strong>Abstract: </strong>As inflation, new technology, and rising costs continue to strain health care in the United States, it is important to understand the trends in insurance reimbursement. We evaluated commercial insurance reimbursement for patients undergoing inpatient primary total knee arthroplasty (TKA) based on the technology utilized and over time. We retrospectively reviewed a commercial claims database for 33,157 inpatient primary TKAs performed with cemented or uncemented components between January 1, 2016 and December 31, 2021. All patients had private commercial insurance and procedure codes for both the hospital and physician were present. Records were reviewed for technology used and financial reimbursement, without adjusting for inflation. Independent-samples <i>t</i>-test and analysis of variance were performed. Hospital reimbursement increased from $25,207.65 per TKA in 2016 to $28,291.10 in 2021 (<i>p</i> < 0.001). Physician reimbursement remained similar, from $2,368.25 per TKA in 2016 to $2,279.70 in 2021 (<i>p</i> = 0.1). Cemented TKA was associated with increased hospital reimbursement compared with uncemented TKA ($26,658.98 vs. $25,854.92, <i>p</i> < 0.001), but similar physician reimbursement ($2,358.03 vs. $2,329.60, <i>p</i> = 0.6). Robotic-assisted (RA) cemented TKA had the higher hospital reimbursement ($28,910.19) than manual cemented TKA ($26,342.29), manual uncemented ($25,566.31), and RA uncemented ($26,378.05, <i>p</i> < 0.001). Physician reimbursement was similar in each of the four categories: manual cemented ($2,359.34), manual uncemented ($2,282.62), RA cemented ($2,348.66), and RA uncemented ($2,414.75, <i>p</i> = 0.5). Physician reimbursement has remained similar for primary TKA from 2016 to 2021, despite hospital reimbursement increasing. We believe that physician reimbursement should increase each year to reflect the increased cost of living caused by inflation. In addition, RA cemented primary TKA provides the highest reimbursement for both hospitals, but physicians are reimbursed similarly, independent of the technology used.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"700-710"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Management of Knee Chondral Defects, Part II: Structural Cartilage Restoration with Focal Resurfacing Implants and Osteochondral Autograft Transfer.","authors":"Chase W Smitterberg, Giles R Scuderi, Michael A Mont","doi":"10.1055/a-2865-1789","DOIUrl":"10.1055/a-2865-1789","url":null,"abstract":"<p><strong>Abstract: </strong>Structural cartilage restoration strategies provide mechanical solutions for focal knee chondral defects in which biologic repair alone is unlikely to withstand load-bearing demands. These approaches are most applicable to discrete lesions in otherwise preserved joints where restoration of articular congruity and immediate mechanical stability are required. This review evaluates focal resurfacing implants and osteochondral autograft transfer system procedures as structural joint-preserving interventions. Contemporary metal and polymer-based focal implants demonstrate meaningful short- to mid-term improvements in pain and function. However, registry data and meta-analyses reveal variable survivorship and revision risk, frequently related to progressive osteoarthritis or implant-related complications. Outcomes are highly dependent on appropriate patient selection and precise implant positioning. Osteochondral autograft transfer system procedures and mosaicplasty restore mature hyaline cartilage and subchondral bone using autologous osteochondral plugs. Long-term series extending beyond a decade support durable outcomes in small, contained lesions. Donor-site morbidity, graft contouring limitations, and size constraints, however, restrict broader applicability. Comparative data highlight trade-offs between mechanical resurfacing and cartilage transfer. Implants avoid donor harvest, but introduce device survivorship concerns and complex revision pathways. Autograft transfer offers established durability with native tissue, but carries technical constraints and harvest-related morbidity. Structural restoration strategies occupy a defined position within the cartilage preservation continuum. Their success depends on alignment between defect characteristics, patient activity demands, and the surrounding joint environment. When applied within appropriate indications, these techniques can provide durable symptom relief, though none of them eliminates the risk of progression to arthroplasty.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"678-687"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Management of Knee Chondral Defects.","authors":"Chase W Smitterberg, Giles R Scuderi, Michael A Mont","doi":"10.1055/a-2904-0985","DOIUrl":"10.1055/a-2904-0985","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"669-670"},"PeriodicalIF":1.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiligament Knee Injuries in the Pediatric Population: A Systematic Review.","authors":"Carrie J Froemming, Daniel C Touhey, Sophia J Wang, Derrick M Knapik","doi":"10.1055/a-2982-7395","DOIUrl":"https://doi.org/10.1055/a-2982-7395","url":null,"abstract":"<p><strong>Background: </strong>Multi-ligamentous knee injuries (MLKI) in pediatric patients generally occur due to high-energy mechanisms, exhibiting unique injury patterns when compared to adults. Further understanding of the injury patterns, functional outcomes, and post-surgical complications in pediatric patients sustaining MLKI is warranted.</p><p><strong>Hypothesis/purpose: </strong>To systematically review the literature to evaluate causes and outcomes of MLKIs in pediatric patients.</p><p><strong>Study design: </strong>Level IV Methods: Studies published in PubMed, Embase, and the Cochrane Library reporting on MLKIs in the pediatric population from inception to January 2026 were identified. Inclusion criteria included studies written in English reporting on pediatric patients (≤18 years) undergoing management of MLKIs, with reported lesion etiology, surgical technique, postoperative complications, reoperations, and any patient-reported outcomes (PROs).</p><p><strong>Results: </strong>Four studies comprising 142 patients with a weighted mean follow-up of 41.2 months (range 9.5-204) were identified. The weighted mean patient age and BMI were 16.2 years (range 6-18) and 24.9 kg/m2 (range 17.9-41.6), respectively, with 69.7% (n=99/142) of patients being male. The most common injury mechanism was sports-related (70.6%, n=96/136). The posterolateral corner (PLC) was the most commonly injured structure in 71.1% (n=101/142) of patients, followed by injuries to the posterior cruciate ligament (PCL; 66.2%, n=94/142) and anterior cruciate ligament (ACL; 57.7%, n=82/142). Surgical reconstruction was performed in 96.0% (n=97/101) of PLC-involved injuries, 98.9% (n=93/94) of PCL injuries, 98.8% (n=81/82) of ACL injuries, and 48.4% (n=15/31) of MCL injuries. Repair was performed in 4.0% (n=4/101) of PLC injuries, 1.1% of PCL injuries (n=1/94), 1.2% (n=1/82) of ACL injuries, and 38.7% (n=12/31) of MCL injuries. Complications were reported in 36% (n=19/53) of patients, most commonly stiffness (11.3%, n=6/53) and reconstruction failure (5.7%, n=3/53). Revision procedures were reported in 7.5% (n=4/53) of patients.</p><p><strong>Conclusion: </strong>MLKIs in pediatric patients are most commonly reported following sport-related mechanisms, with the PLC and PCL most frequently involved. Surgical reconstruction is more frequently reported when compared to repair procedures, with complications and revision surgery reported in 36% and 7.5% patients, respectively.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nomogram for Poor 3-Month Functional Recovery After Total Knee Arthroplasty Using Cartilage Damage and Synovial Fluid Biomarkers: Development and Internal Evaluation.","authors":"Jiaxiang Li, Zhongyuan Hong, Zhengling Gong, Huaidong Deng, Zhongqiang Huang, Jun Wang","doi":"10.1055/a-2968-5875","DOIUrl":"10.1055/a-2968-5875","url":null,"abstract":"<p><strong>Abstract: </strong>This study aimed to develop and internally evaluate a multidimensional nomogram incorporating intraoperative cartilage damage and perioperative synovial fluid biomarkers to estimate the probability of poor functional recovery at 3 months after total knee arthroplasty (TKA). A retrospective cohort of 360 patients undergoing primary unilateral TKA was included in this study. Interleukin-6 (IL-6), tumor necrosis factor-α, cartilage oligomeric matrix protein (COMP), and total BDNF were measured in perioperative synovial fluid specimens collected after induction of anesthesia and before skin incision and were assessed together with intraoperative Outerbridge cartilage damage grade and routinely available demographic and clinical variables. The primary outcome was functional recovery at 3 months, defined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale. Least absolute shrinkage and selection operator regression was used for predictor selection, and a nomogram was developed using multivariable logistic regression. Model performance was evaluated using area under the curve (AUC), calibration, and decision curve analysis (DCA). Six predictors were retained in the final model: age, body mass index, preoperative WOMAC function score, Outerbridge grade, log(IL-6), and log(COMP). The nomogram showed promising discrimination in the held-out internal test set (AUC = 0.861, 95% CI: 0.782-0.934) and acceptable calibration (Hosmer-Lemeshow test, <i>p</i> = 0.45). Bootstrap optimism correction yielded a bias-corrected AUC of 0.842. DCA suggested potential net benefit across the evaluated threshold probabilities. The nomogram integrates clinical characteristics, intraoperative cartilage damage, and perioperative synovial fluid biomarkers to estimate the probability of poor functional recovery at 3 months after TKA. It should be regarded as a development-stage perioperative prediction model that requires prospective external validation before any clinical application.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial tibial plateau fracture-dislocations associated with posterolateral central depression exhibit radiologic ACL-type pivoting injury pattern.","authors":"Ryan Martin, Philippe Beauchamp-Chalifour, David Longino, Allan S Liew, John Kendall, Prism S Schneider","doi":"10.1055/a-2982-7510","DOIUrl":"https://doi.org/10.1055/a-2982-7510","url":null,"abstract":"<p><p>Objectives To determine whether medial tibial plateau fracture-dislocations with posterolateral central depression demonstrate radiographic features consistent with an ACL-type anterolateral rotatory injury pattern, characterized by anterior tibial translation and internal rotation. Methods Retrospective radiologic evaluation of adult patients who underwent surgery for medial plateau fracture-dislocation with associated posterolateral central depression. Only patients with both preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were included. Imaging was assessed for features associated with anterolateral tibiofemoral rotational injuries, including pivot-shift edema, anterior subluxation of the lateral compartment, tibial eminence fractures, meniscal pathology (root and intrasubstance tears), and Segond fractures. Two independent dual fellowship-trained sports traumatology orthopaedic surgeons reviewed all imaging. Categorical variables were reported as proportions and continuous variables as means with standard deviations. Institutional research ethics board approval was obtained. Results Eighteen patients met inclusion criteria. The mean age was 37 (± 11) years, and 72% were male. Pivot-shift femoral edema, anterior subluxation of the lateral compartment on MRI, tibial eminence fracture at the ACL footprint, and posterolateral central tibial depression were present in all cases (18/18, 100%). Lateral meniscal root pathology was also universal, with lateral meniscus incarceration into the posterolateral depression observed in eight patients (44%). A Segond fracture was identified in nine patients (50%). Conclusion Medial tibial plateau fracture-dislocations with posterolateral central depression demonstrate a consistent pattern of osseous and soft-tissue injury associated with anterolateral rotation. These findings suggest that transverse plane assessment may complement traditional fracture based evaluation and help identify associated soft-tissue injuries that may be important to tibiofemoral stability.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}