Journal of Knee Surgery最新文献

{"title":"Risk Factors and Thresholds for Minimal Clinically Important Difference in Worsening after Unicompartmental Knee Arthroplasty.","authors":"Perry L Lim, Marcos R Gonzalez, Hany S Bedair, Christopher M Melnic","doi":"10.1055/a-2555-1941","DOIUrl":"10.1055/a-2555-1941","url":null,"abstract":"<p><p>The rising demand for unicompartmental knee arthroplasty (UKA) in the United States has led to high 1-year patient satisfaction rates. However, some patients experience substantial declines in patient-reported outcome measures (PROMs) postoperatively, which we refer to as \"minimal clinically important difference for worsening\" (MCID-W). We sought to define MCID-W values for specific PROMs and identify risk factors associated with PROMIS Physical Function Short Form 10a (PROMIS PF-10a) declines after UKA. We conducted a retrospective study of 760 patients undergoing UKA at our institution between 2016 and 2023. Preoperative and postoperative PROMIS PF-10a, PROMIS global physical, and knee injury and osteoarthritis outcome score-physical function short-form (KOOS-PS) scores were collected. Patients were stratified upon reaching minimal clinically importance difference for improvement (MCID-I), MCID-W, or \"no significant change\" (score between MCID-W and MCID-I). MCID-W and MCID-I values were determined using a distribution-based method. Logistic regression was performed to identify risk factors for scoring below MCID-W. We established the following MCID-I and MCID-W thresholds: PROMIS PF-10a (+3.00 and -1.64), KOOS-PS (+6.25 and -3.42), and PROMIS Global-Physical (+2.72 and -1.55). Bivariate analysis revealed differences in terms of revision (<i>p</i> = 0.02), reoperation (<i>p</i> = 0.03), postoperative complications (<i>p</i> = 0.002), deep venous thrombosis (DVT; <i>p</i> < 0.001), and pneumonia (<i>p</i> = 0.01) between cohorts. Body mass index >35 (odds ratio [OR] = 2.49), postoperative complications (OR = 5.09), pneumonia (OR = 22.39), DVT (OR = 9.27), and preoperative PROMIS PF-10a scores (OR = 1.07) were risk factors for scoring below the MCID-W threshold, whereas age > 80 (OR = 2.89) and preoperative PROMIS PF-10a scores (OR = 1.05) were risk factors for failing to achieve MCID-I. Our study established MCID-W values for pivotal PROMs after primary UKAs. We found that 8.8% of patients scored below MCID-W, highlighting the need to improve patient selection and perioperative care in UKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"525-532"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606834","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":"Early Improvement in Postoperative Clinical Outcomes without Patellar Resurfacing in Patella-Friendly Design of Medial Pivot TKA.","authors":"Leo Cooper, Brewer Owen, Tatsuya Soeno, Stephen Wahl, Jeffrey B Stambough, C Lowry Barnes, Simon C Mears, Benjamin M Stronach","doi":"10.1055/a-2421-5572","DOIUrl":"10.1055/a-2421-5572","url":null,"abstract":"<p><p>There is continued debate about the efficacy and indications for patellar resurfacing in total knee arthroplasty (TKA), especially with the emergence of patella-friendly designs. This study aimed to compare the postoperative outcomes in patients undergoing TKA with or without patellar resurfacing using the same implant design. This is a retrospective cohort study of patients who underwent TKA including those with patellar resurfacing (PR group) and those without (NPR group). Demographic data included age, gender, side of surgery, operative time, and body mass index (BMI). Outcomes included preoperative, 2-week, 6-week, and 1-year postoperative Knee Injury and Osteoarthritis Outcome Score and Joint Replacement (KOOS, JR) values along with knee range of motion (ROM). Postoperative complications were recorded. The power analysis with a large effect size indicated that a minimum sample size of 54 was required for Student's <i>t</i>-test and 34 for the paired <i>t</i>-test. A total of 90 medial pivot (MP) TKA were included in this study. There were 30 knees in the PR group and 60 in the NPR group. There was no significant difference between the groups for all demographic data, preoperative and postoperative ROM, and KOOS, JR values at all time points (<i>p</i> > 0.05 for all variables). The KOOS, JR significantly improved in the NPR groups at 2 weeks, 6 weeks, and 1 year postoperatively when compared with the preoperative score and at 6 weeks and 1 year postoperatively in the PR group (<i>p</i> < 0.01). No revisions related to the patellofemoral joint were observed in patients initially undergoing patellar resurfacing. One patient in the NPR group required secondary patellar resurfacing. The patella-friendly MP TKA yielded favorable postoperative outcomes, with or without patellar resurfacing. Improvements in KOOS, JR were observed earlier in the NPR group when compared with the PR group, suggesting that patellar resurfacing may not always be necessary for modern TKA designs. LEVEL OF EVIDENCE:  Retrospective cohort study, Level III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"512-517"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142330475","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":"Patellar Overstuffing in Total Knee Arthroplasty Results in Decreased Extensor Mechanism Efficiency.","authors":"Brandon R Bukowski, Sonia K Chandi, Pravjit Bhatti, Paola Jimenez, Nathan Lenz, Fred D Cushner, Steven B Haas, Brian P Chalmers","doi":"10.1055/a-2514-9655","DOIUrl":"10.1055/a-2514-9655","url":null,"abstract":"<p><p>Patellofemoral offset is influenced by patellar thickness in total knee arthroplasty (TKA), with effects on extensor mechanism efficiency (EME), patellar contact moment arm (PCMA), and patellar contact force (PCF). This study utilized a computational model to better quantify these measures during knee range of motion (ROM). A computational model of a cruciate-sacrificing, posterior-stabilized TKA design was used to quantify moments at knee flexion angles from 0° to 135° when patella thickness was increased (\"overstuffed\") or decreased (\"understuffed\") by 2 mm and 5 mm from normal. Outcomes included changes in EME, PCMA, PCF, tibial tubercle moment arm (TTMA), and the quadriceps moment arm (QMA). Overstuffing of the patellofemoral articulation by 2 mm and 5 mm decreased EME up to 12 and 28%, respectively, with an 8% and 16% increase in EME with understuffing that peaked at 25° knee flexion. The QMA increased up to 5 and 12% with overstuffing by 2 mm and 5 mm and decreased up to 5% and 14% with understuffing, respectively. There was an increase in the PCMA/PCF, which opposed the QMA, up to 8%/17% and 16%/39% with overstuffing by 2 mm and 5 mm, respectively. The PCMA/PCF decreased up to 3%/12% and 8%/33% with understuffing by 2 mm and 5 mm, respectively. In this computational model, increased patellofemoral offset resulting in overstuffing of the patella resulted in decreased EME and increased PCMA and PCF during knee ROM. This may contribute to abnormal patellofemoral mechanics and a potential etiology for anterior knee pain and quadriceps weakness after TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"491-496"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400476","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 Cementless Patellar Implant Survivorship: A Systematic Review and Meta-Analysis of 3,005 Patellae.","authors":"Khaled A Elmenawi, Adrian E Gonzalez-Bravo, Larry J Prokop, Charles P Hannon, Matthew P Abdel, Nicholas A Bedard","doi":"10.1055/a-2509-3442","DOIUrl":"10.1055/a-2509-3442","url":null,"abstract":"<p><p>Historically, cementless patellar implants were fraught with issues of fixation and polyethylene wear. However, contemporary cementless patellar implants incorporate modern technologies for implant design and offer the potential for improved biological fixation and longevity. As such, an evaluation of the performance of modern cementless patellae is needed. The purpose of this study was to perform a systematic review and meta-analysis of contemporary cementless patellar implants used during primary total knee arthroplasty (TKA), with a particular focus on aseptic loosening of the patellar component. A systematic review of the literature was performed from January 2000 to February 22, 2024. We included all peer-reviewed studies that reported the number of revisions in patients who had cementless patellae placed in 2000 or later during primary TKA. Reviews and case reports were excluded. Out of 639 studies, 13 were included with a total of 3,005 cementless patellae analyzed. The mean patient age was 64 years and the mean body mass index (BMI) was 31 kg/m². Meta-analyses were performed to calculate the pooled revision rate per person-year of revision for aseptic loosening of the patellar component and revision for any patellar failure. Upon analysis of 13 studies involving a total of 3,005 cementless patellae, the revision rate for aseptic loosening of the patella was 0.2 per 1,000 person-years and the revision rate for any patellar failure was 1 per 1,000 person-years. Contemporary cementless patellar implants showed an overall revision rate of 1 per 1,000 person-years, demonstrating excellent longevity. The high survivorship, together with a low rate of loosening, show the utility and effectiveness of these implants. Given the nature of biologic fixation, these results are promising for long-term implant stability but additional follow-up is warranted.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"505-511"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056133","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":"Effect of Resurfaced Patellar Thickness on Outcomes after Total Knee Arthroplasty.","authors":"Siddhartha Dandamudi, Viktor Tollemar, Jonathan Spaan, Ashwinee Manivannan, Brett R Levine","doi":"10.1055/a-2530-7953","DOIUrl":"10.1055/a-2530-7953","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) is the gold standard for the treatment of end-stage knee osteoarthritis. Patellar resurfacing is an optional step in the procedure and remains a controversial topic of discussion. This retrospective study aims to assess the impact of over-resecting and under-resecting the patella during resurfacing on patient-reported outcomes and range of motion (ROM) after surgery. Out of 475 patients who underwent TKA between August 2017 and November 2019 at a single center by a single surgeon, 438 (92.2%) were included in the analysis. Patients were split into three study groups based on reconstructed patellar thickness; normal resection (NR) was defined as within 2 mm native thickness, over-resected was defined as ≤ -2 mm, and under-resected (UR) was defined as ≥ 2 mm. Statistical analyses included chi-squared tests, mixed effect models, and Cox proportional hazards models. There were 364, 41, and 33 patients in the NR, OR, and UR groups, respectively. The cohort's mean age at the time of surgery was 67.1 ± 9.1 and had a mean length of follow-up of 2.1 ± 1.7 years with no difference among cohorts. Significant differences were found in gender (<i>p</i> < 0.001) and BMI (<i>p</i> = 0.0134) with UR having fewer males, OR having more males, and OR having lower BMI. At 6 months, the complete cohort ROM improved from 108.7 ± 14.4 to 111 ± 11 degrees, objective knee society score (KSS) increased from 15.4 ± 11.2 to 36.2 ± 12, functional KSS increase from 47.3 ± 18.9 to 65.6 ± 22.2, and knee injury and osteoarthritis outcome score increase from 46.1 ± 15 to 70.7 ± 15 with no significant differences among cohorts. There were no patellofemoral-related complications. This study supports that while it is important to restore the anatomy in the anterior compartment of the knee, minor changes in patellar thickness from patellar resurfacing likely have minimal impact on outcomes for patients. Further studies with a larger sample size are necessary to further validate these findings.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"497-504"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123923","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":"Correlation between Anthropometric Parameters and Anterior Cruciate Ligament, Hamstring Tendon, and Posterior Horn of Medial and Lateral Meniscus Sizes.","authors":"Waleed Albishi, Sarah Aljasser, Mamdouh Almalki, Faten Almohideb, Faisal Alwahabi","doi":"10.1055/a-2555-1879","DOIUrl":"10.1055/a-2555-1879","url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) reconstruction is commonly performed in orthopedic surgery. Hamstring autografts are frequently used as a graft option for the ACL; however, a clear consensus on optimal graft size is lacking. Here, we aimed to determine the mean ACL, hamstring tendon, and posterior horn meniscal sizes in a Saudi population to determine whether correlations exist between anthropometric data and the widths of the ACL, hamstring tendons (specifically the gracilis and semitendinosus tendons), and medial and lateral meniscal posterior horns. Cross-sectional study is the study design. This study examined 705 knee magnetic resonance images to obtain the following data: ACL proximal origin width, mid-fiber width, distal insertion widths and lengths (in millimeters), semitendinosus and gracilis widths (mm), and posterior horn widths of the bilateral menisci (mm). Anthropometric data included age, sex, weight, height, and body mass index. The mean ± standard deviation of proximal, mid-fiber, and distal ACL attachment widths were 8.4 ± 2.4, 9.9 ± 2.4, and 13.5 ± 2.7 mm, respectively. The mean ACL length was 30.8 ± 4.5 mm, while the mean semitendinosus and gracilis widths were 4.5 ± 1 and 3.3 mm, respectively. The mean medial and lateral meniscus posterior horn widths were 14.1 ± 2.7 and 9.3 ± 1.3 mm, respectively. Height and weight were significantly positively correlated with ACL width and length (<i>p</i> < 0.010) semitendinosus and gracilis tendon (<i>p</i> < 0.010) and posterior horn menisci (<i>p</i> < 0.010) widths. The mean ACL width and length, hamstring tendon (gracilis and semitendinosus) width, and posterior horn width of both menisci were positively correlated with an individual's height and weight. The level of evidence is IV.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"518-524"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606860","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":"Dalí Sign: Characterization and Case Series of Patellar Bony Shell Morphological Changes after Two-Stage Revision for Periprosthetic Joint Infection.","authors":"Alexandra L Hohmann, Cristian A DeSimone, Jessica H Leipman, Yale A Fillingham, Jess H Lonner","doi":"10.1055/a-2559-5268","DOIUrl":"10.1055/a-2559-5268","url":null,"abstract":"<p><p>The fate of the patella in two-stage revision total knee arthroplasty (TKA) for periprosthetic joint infection (PJI) in which the patella is left as a bony shell is poorly described. The purpose of this case series is to describe a phenomenon we name the Dalí Sign, which is characterized by elongation and curvature of the patella around the lateral edge of the femoral component occasionally observed in patients undergoing two-stage revision without reimplantation of the patellar component. Our institutional surgical database was queried for patients who were treated with two-stage revision arthroplasty for PJI by the two senior authors. All available sequential skyline patellar radiographs were viewed from immediately prior to first-stage explantation to latest image at final outpatient follow-up at our institution and assessed for the abovementioned morphological changes. Included patients underwent a two-stage revision surgery for PJI at our institution, had a patellar component removed during the first stage of their treatment which included implant explantation and insertion of temporary antibiotic spacers, did not have the patellar component reimplanted during their second-stage revision surgery, and demonstrated radiographic patellar morphological changes at final follow-up. Patients' demographic, surgical, and outcome data were recorded. Our review identified six patients meeting these criteria. Mean follow-up after second-stage surgery was 12 months (range 2 to 21 months). At final follow-up, three patients were walking without pain, one patient was exercising to tolerance, one patient was walking with pain, and one was using a wheelchair or a walker for mobility. In this case series, we characterize the Dalí Sign, the elongation and curvature of the patellar bony shell over the femoral component after two-stage revision for PJI. Further comparative cohort studies are necessary to identify the incidence and risk factors for the development of this morphological change and to compare outcomes of patients with and without the Dalí Sign when left with a bony shell after staged revision TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"486-490"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651541","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":"Patellofemoral Joint Management in Total Knee Arthroplasty.","authors":"Benjamin Mckee Stronach","doi":"10.1055/a-2564-3353","DOIUrl":"10.1055/a-2564-3353","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"485"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042244","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":"Combined Treatment of Articular Cartilage Defects and Patellar Instability with Autologous Chondrocyte Implantation and Patellar Stabilization.","authors":"Connor C Jacob, Ryan H Barnes, Jordan Haber, Parker A Cavendish, Eric Milliron, Robert A Magnussen, David C Flanigan","doi":"10.1055/a-2585-4916","DOIUrl":"10.1055/a-2585-4916","url":null,"abstract":"<p><p>High-grade chondral injuries in the setting of patellar instability are a challenging problem for patients and surgeons. In patients undergoing autologous chondrocyte implantation (ACI) to address cartilage defects, medial patellofemoral ligament (MPFL) reconstruction with or without tibial tubercle osteotomy (TTO) is one option to both treat patellar instability and repair and offload defects. The primary aim of this case series was to describe return to activity, reoperation rates, and instances of recurrent patellar instability after medial patellofemoral ligament reconstruction with ACI with or without TTO. We also discuss reoperation rates among patients with multiple cartilage defects in comparison to those with single cartilage defects. A retrospective chart review from 2010 to 2022 identified patients with patellar instability who underwent concurrent MPFL reconstruction and cartilage restoration at a single academic institution. Data regarding patient demographics, cartilage defect location and size, concomitant procedures, return to activity data, and repeat surgery risk were collected. Review identified 14 patients who underwent cartilage restoration and MPFL reconstruction, including 11 who underwent a concomitant TTO. Clinical follow-up was 2.68 years. All patients returned to activity with a mean time of 13.7 months. There were no instances of graft delamination or persistent symptoms necessitating arthroplasty. One patient underwent a second surgery on the index knee for tibial tubercle hardware removal. Cartilage restoration with patellar stabilization surgery may be effective for addressing high-grade cartilage defects associated with patellar instability.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"533-538"},"PeriodicalIF":1.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023316","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":"Medicaid-Insured Patients Exhibit Similar Improvements in Knee Range of Motion Compared to Commercially Insured Patients Despite Inferior Access to Physical Therapy Following ACL Reconstruction.","authors":"Eric V Neufeld, John M Tarazi, Catherine Wickes, Brandon J Klein, Melissa A Colleluori, Randy M Cohn, Andrew D Goodwillie","doi":"10.1055/a-2640-3314","DOIUrl":"https://doi.org/10.1055/a-2640-3314","url":null,"abstract":"<p><p>Insurance status has been shown to impact clinical outcomes after several orthopaedic procedures. Current evidence examining the role of insurance provider on outcomes following anterior cruciate ligament (ACL) reconstruction is limited. Therefore, the purpose of this investigation was to explore the effect that insurance carrier had on physical therapy (PT) access, knee range of motion (ROM), and Knee Outcome Survey (KOS) scores. A retrospective cohort study identified patients who underwent ACL reconstruction at an academic health system from January 1, 2019 to December 31, 2021. Patients were partitioned into two cohorts based on their insurance provider: Managed care (MC) or commercial (COM). Outcomes recorded change in knee active range of motion (AROM), passive ROM (PROM), KOS score, and reason for conclusion of PT. Univariate and multivariate analyses were performed by chi-squared tests, Welch's <i>t</i>-tests, as well as multivariable logistic and linear regression with Bonferroni corrections applied to control the family-wise error rate. The study cohort included 149 patients who underwent ACL reconstruction and completed rehabilitation within affiliated PT locations. The MC cohort experienced a longer time until the first PT visit, shorter duration of PT, fewer total PT visits as well as insurance-authorized visits, and a smaller maximum number of visits per patient's benefit. However, there was no difference between cohorts in the number of visits divided over the treatment duration or the number of visits attended over the total number authorized. Both the groups displayed statistically similar improvements in AROM, PROM, and KOS in addition to comparable reasons for concluding PT. Furthermore, regression demonstrated that no insurance parameter predicted changes in AROM, PROM, KOS, or reason for concluding PT. MC-provided patients who underwent ACL reconstruction had inferior access to PT compared with those insured by COM. However, MC and COM yielded a similar percentage utilization of authorized PT visits and number of insurance denials leading to early PT termination. Both the cohorts also demonstrated similar improvements in AROM, PROM, and KOS.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643927","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}