Journal of Knee Surgery最新文献

{"title":"Influence of Local Anesthetic Techniques on Patient-Reported Lateral Numbness Following Total Knee Arthroplasty.","authors":"Vadim Benkovich, Artsiom Abialevich","doi":"10.1055/a-2865-2996","DOIUrl":"https://doi.org/10.1055/a-2865-2996","url":null,"abstract":"<p><strong>Abstract: </strong>Total knee arthroplasty (TKA) results in significant postoperative pain, requiring effective analgesia to enable early mobilization and reduce complications. While local infiltration analgesia (LIA) is effective, it may cause prolonged lower limb numbness if sensory nerves are affected. This study evaluated the incidence of patient-reported inferolateral knee numbness at 2 and 6 weeks and 3 months post-TKA using different LIA techniques. A retrospective cohort study of 1,142 patients undergoing TKA (2021-2024) compared two LIA techniques. Group 1 (<i>n</i> = 471) received a conventional multisite periarticular injection, while Group 2 (<i>n</i> = 671) underwent a modified protocol avoiding the inferolateral knee region to minimize sensory nerve injury. All patients received a standardized cocktail (ropivacaine 0.25%, ketorolac, dexmedetomidine, epinephrine, dexamethasone). The primary outcome was the incidence of patient-reported inferolateral knee numbness at 2, 6, and 12 weeks. Secondary outcomes included patient demographics, comorbidities, Charlson Comorbidity Index, fixation method, numbness duration, Visual Analog Scale (VAS) scores, analgesic use, anesthetic volume, and early complications, including local anesthetic systemic toxicity (LAST), allergic reactions, and hospital stay. A total of 1,142 patients were included (471 Conventional, 671 Modified). Groups were demographically comparable, except for a higher body mass index (BMI) in the Conventional group (<i>p</i>  <  0.001). Inferolateral knee numbness was significantly more common in the Conventional group at all time points: At 2 weeks, numbness was reported in 8.28% of the Conventional group versus 0.44% of the Modified group (<i>p</i>  <  0.001); the difference remained significant at 6 and 12 weeks (2.33% vs. 0.14%, <i>p</i>  <  0.001). VAS scores were slightly lower in the Conventional group postoperatively, though differences were minimal. Analgesic use and complication rates were similar. No cases of LAST, thromboembolism, or transfusion occurred. Hospital stay was slightly shorter in the Conventional group (<i>p</i>  <  0.001), with similar follow-up duration. A modified LIA technique that avoids the inferolateral knee region significantly reduced postoperative numbness without compromising pain control or safety. This targeted approach may enhance sensory outcomes following TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857447","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":"The Utilization of Internet and Social Media to Determine Rates of Return-to-Play After Patellofemoral Stabilization Surgery.","authors":"Tony Y Lee, Andrew J Burcke, Lutul D Farrow, Scott G Kaar","doi":"10.1055/a-2865-2903","DOIUrl":"10.1055/a-2865-2903","url":null,"abstract":"<p><strong>Abstract: </strong>Determination of return-to-play (RTP) following patellofemoral stabilization surgery can be challenging, as many young patients may not return for follow-up. The aim of the present study was to evaluate whether publicly accessible athletic Web sites and databases can be used to determine RTP rates and assess performance following patellofemoral stabilization surgery. All patients who underwent medial patellofemoral ligament (MPFL) reconstruction or repair between January 2017 and July 2024 at a single institution were screened. Inclusion criteria were patients under 21 years of age who underwent primary MPFL surgery. Patients were excluded if they had secondary procedures or lacked preoperative sport participation. Demographic data were confirmed via electronic medical records and used to search public sports databases (e.g., Hudl, MaxPreps, state/regional athletic sites). RTP was defined as being listed on a team roster following surgery. Pre- and postoperative performance statistics were recorded when available. Patients were each assigned a unique ID number, and data were deidentified for analysis. A total of 136 patients under 21 years of age underwent primary patellofemoral stabilization surgery within the search dates, 120 reconstructions and 16 repairs. Out of the 136 patients identified, 49 were male, 87 were female with a mean BMI of 25.7 ± 6.4 and a mean age of 15.6 ± 2.3 years. Preoperative sports participation was documented by 57 patients. RTP was confirmed in 30 patients (52.6%) through online team rosters. The majority (71.9%) of participation was identified through Hudl, MaxPreps, or regional/state athletic association databases. Furthermore, 12 (40%) of the returning athletes had available postoperative performance statistics, with most demonstrating similar or improved performance compared with preoperative levels. Social media and athletic databases represent a viable adjunct for tracking RTP following surgical treatment for patellofemoral instability in young athletes that are cost-effective and do not require patient follow-up or contact. These platforms allowed identification of over 50% of patients returning to sport, with many demonstrating competing at a similar or higher level than preoperatively.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844850","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":"Kinematic Alignment Produces Improved Flexion and Forgotten Joint Scores Compared to Mechanical Alignment in Primary Medial-Pivot Knee Arthroplasty.","authors":"David F Scott, Trisha Vuong","doi":"10.1055/a-2851-0874","DOIUrl":"10.1055/a-2851-0874","url":null,"abstract":"<p><strong>Abstract: </strong>Debates continue over which surgical approach yields better outcomes in primary total knee arthroplasty (TKA): kinematic alignment or mechanical alignment. A prospective, multicenter study was conducted comparing these strategies in patients with \"ball-in-socket\" medial-pivot implants. We hypothesized that kinematic alignment would yield superior outcomes. Participants undergoing primary TKA with medial-pivot implants were included. One site used unrestricted kinematic alignment, while three utilized mechanical alignment. Surgical techniques were standardized, including tourniquet use, medial parapatellar arthrotomy, patella resurfacing, posterior cruciate ligament sacrifice, manual instrumentation, and cement fixation. The Forgotten Joint Score (FJS) and range of motion were measured at 6 weeks, 6 months, 1 year, and 2 years postoperatively, with preoperative range of motion assessed as well. A total of 258 patients were enrolled, comprising 101 with kinematic alignment and 157 with mechanical alignment. The mean flexion and FJS were significantly better for the kinematic alignment group at 6 months, 1 year, and 2 years postoperatively. At 2 years, mean flexion was 132 ± 8.6 degrees for kinematic alignment and 122 ± 9.9 degrees for mechanical alignment (<i>p</i> < 0.0001), and the FJS was 68 ± 26.3 for kinematic and 60 ± 29 for mechanical alignment (<i>p</i> = 0.04). Furthermore, manipulation procedures for arthrofibrosis were required at a significantly lower rate in the kinematic group (2% vs. 7%; <i>p</i> = 0.05). This 2-year study demonstrated that kinematic alignment led to improved mean range of motion, FJS, and a lower manipulation rate compared with mechanical alignment in patients with medial-pivot implants. Evidence specific to medial-pivot devices implanted with different alignment philosophies remains limited, and our study addresses this gap by focusing on the medial-pivot implant in a prospective multi-center cohort. Our findings suggest that kinematic alignment offers better clinical outcomes with \"ball-in-socket\" medial-pivot implants. The study provides level II evidence.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692290","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":"Does the Anterolateral Tenodesis Really Influence the ACL Maturation Process?","authors":"Veronica Montiel, Alvaro Suárez-López Del Amo, Jesús Dámaso Aquerreta Beola, Alberto Paternain, Lara Gil-Melgosa, Carlos María Mayor de Juan, Andrés Valentí Azcárate","doi":"10.1055/a-2865-2783","DOIUrl":"https://doi.org/10.1055/a-2865-2783","url":null,"abstract":"<p><strong>Background: </strong>There is ongoing controversy regarding whether the addition of anterolateral tenodesis (ALT) affects the maturation process of anterior cruciate ligament (ACL) grafts. Some authors argue that patients undergoing ACL reconstruction with ALT demonstrate delayed graft maturation on MRI, while others report no improvement or delay in graft maturation with the addition of ALT.</p><p><strong>Purpose: </strong>The aim of this study was to analyze whether the addition of anterolateral tenodesis (ALT) affects ACL graft maturation and to evaluate interobserver agreement in MRI analysis, given the lack of consensus in the literature.</p><p><strong>Methods: </strong>This study included 168 patients: 117 underwent isolated ACL reconstruction, and 51 underwent ACL reconstruction with associated ALT between 2018 and 2021. Radiological evaluation was performed to assess graft maturation and integration. Two orthopedic surgeons and two radiologists independently assessed MRI findings to determine interobserver variability.</p><p><strong>Results: </strong>Radiological evaluation showed no significant differences between groups in the Howell ligamentization scale (p > 0.5) or signal-to-noise quotient (SNQ). Similarly, there were no differences in tendon-bone healing at the fibrous interzone (p > 0.5). Interobserver evaluation revealed only slight agreement between the four observers.</p><p><strong>Conclusion: </strong>The addition of anterolateral tenodesis to ACL reconstruction does not affect ACL graft maturation as assessed by MRI.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844817","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":"Association between Varus Mechanical Alignment and Medial Meniscus Tears: A Retrospective Study.","authors":"Zhiheng Lan, Yuan An, Juan Wang, Wenhua Liang, Xiaozuo Zheng, Juyuan Gu","doi":"10.1055/a-2741-1676","DOIUrl":"10.1055/a-2741-1676","url":null,"abstract":"<p><strong>Abstract: </strong>Varus mechanical alignment of the knee is a recognized contributor to medial compartment osteoarthritis (OA). Medial meniscus tears (MMT) frequently occur with knee OA. The present study aimed to analyze the association between mechanical alignment and MMT. We retrospectively analyzed 201 knee joints from patients with knee pain who underwent whole-leg weight-bearing radiographs and magnetic resonance imaging (MRI). Mechanical alignment was quantified using the hip-knee-ankle angle (HKAA), measured independently by two radiologists with excellent interrater reliability (intraclass correlation coefficient = 0.93). MMTs were assessed on MRI with high diagnostic agreement (κ = 0.87). Based on MRI findings, participants were classified into two groups: those with MMT (<i>n</i> = 104) and those without MMT (<i>n</i> = 97). Group comparisons were performed using <i>t</i>-tests and chi-square tests. Patients with MMT had greater varus alignment (HKAA: -6.2 ± 3.4 vs. -2.4 ± 1.4 degrees, <i>p</i> < 0.001), were older (53.7 ± 8.3 vs. 49.3 ± 9.0 years, <i>p</i> < 0.001), and had higher body mass index (26.6 ± 3.0 vs. 25.2 ± 2.4 kg/m², <i>p</i> = 0.001). Sex distribution did not differ between groups (<i>p</i> = 0.479). Logistic regression identified HKAA as the only independent predictor of MMT. When entered as a continuous variable, each additional degree of varus increased the odds of MMT nearly 2-fold (adjusted OR = 2.01, 95% confidence interval [CI]: 1.64-2.47, <i>p</i> < 0.001). The complementary binary analysis showed that patients with varus alignment had over a 3-fold higher risk of MMT compared with those with neutral or valgus alignment (OR = 3.25, 95% CI: 1.85-5.72, <i>p</i> < 0.001). Posterior horn tears were the most common subtype (47.1%), followed by multisite tears (33.7%). MMTs are strongly associated with varus mechanical alignment. Each incremental degree of varus increased the likelihood of MMT, and posterior horn tears were the most prevalent subtype. These findings highlight the pivotal role of mechanical alignment in the prevention, early detection, and management of MMT.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"310-316"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688563","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":"Opioid Analgesics Are Not Required After Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study.","authors":"Jonathan Salandra, Mason D Vialonga, Ian S Hong, Nicholas Thomas Andriani, Rachel Lawver, Nicole R Barakos, Richard S Yoon, Michael Sean Day","doi":"10.1055/a-2865-3107","DOIUrl":"https://doi.org/10.1055/a-2865-3107","url":null,"abstract":"<p><strong>Purpose: </strong>Opioids are associated with significant side effects and abuse potential. Surgeons aim to minimize exposure while maintaining adequate pain control. This study examines whether opioid medications are necessary for adequate analgesia following anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods: </strong>All patients undergoing ACLR were enrolled in a patient-reported outcomes database. Patients<40 years old at time of surgery were included. Prior to the initiation of opioid-free ACLR, patients underwent ACLR with a standard-opioid protocol. After the initiation of an opioid-free ACLR, the opioid was removed. All patients were counseled that a rescue opioid prescription would be issued if adequate analgesia was not obtained. All patients underwent ACLR by a single surgeon, fellowship-trained in sports medicine. Patients were assessed pre-operatively and at two weeks, six weeks, three months, six months and one year post-operatively. Pain was assessed using the Visual Analog Scale (VAS). Need for opioid medication and quantity of opioid consumption was assessed at two weeks post operatively.</p><p><strong>Results: </strong>96 patients were included; 73 patients mean age 29.1±11.9 years prior to implementation of opioid-free protocol and 23 patients mean age 20.7±7.2 years after implementation. 2-week postoperative VAS scores were significantly lower in the opioid-free group (1.2±1.2 vs. 2.5±1.9, p<0.001). VAS scores at other time points did not differ significantly between the groups. No patients required a rescue opioid prescription.</p><p><strong>Conclusion: </strong>This study serves as proof-of-concept that opioids are not required after primary ACLR in young patients. Patients with access to opioid prescription did not seek rescue opioids at any point in the study period.</p><p><strong>Level of evidence: </strong>Level III - Retrospective cohort study Keywords: Anterior Cruciate Ligament; ACL; Reconstruction; Opioid Free; Analgesia.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822569","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":"Inpatient Medicare TKA Patients Have Distinct Characteristics and Worse Outcomes: Implications for the New CMS PROMs Policy.","authors":"Khaled A Elmenawi, Ignacio Pasqualini, Benjamin E Jevnikar, Ahmed K Emara, Chao Zhang, Nicolas S Piuzzi","doi":"10.1055/a-2741-1586","DOIUrl":"10.1055/a-2741-1586","url":null,"abstract":"<p><strong>Abstract: </strong>The Centers for Medicare and Medicaid Services (CMS) recently mandated the collection of Patient-Reported Outcome-Based Performance Measures (PRO-PMs) for Medicare patients undergoing inpatient total knee arthroplasty (TKA). The policy's generalizability remains a concern. Therefore, we aimed to compare PROMs capture rates, patients' characteristics, and achieving the substantial clinical benefit (SCB) threshold between inpatient and outpatient Medicare TKA. A prospective cohort of Medicare patients aged ≥ 65 who underwent primary TKA between 2016 and 2022 at a single health system was analyzed (<i>n</i> = 7,926). Patients were categorized as inpatient (length of stay [LOS] > 24 hours, <i>n</i> = 2,812) or outpatient (LOS ≤ 24 hours, <i>n</i> = 5,114). Capture rates of CMS-mandated variables, baseline characteristics, and 1-year outcomes were compared. SCB was defined as a 20-point improvement in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) per CMS criteria. Baseline capture rates were similar between groups (approximately 82.8%), but 1-year KOOS-JR completion was lower for inpatients (53.3% vs. 62.4%). Inpatients had higher comorbidity burden (CCI ≥ 2: 40% vs. 33%, <i>p</i> < 0.001), worse KOOS-JR (median 44.9 vs. 47.5, <i>p</i> < 0.001), lower VR-12 MCS scores (50.2 vs. 54.1, <i>p</i> < 0.001), and more frequent nonoperative joint pain (75.1% vs. 68.6%, <i>p</i> < 0.001) and back pain (67.4% vs. 63.8%, <i>p</i> < 0.001). Outpatients trended toward better SCB achievement (OR: 0.89, 95% CI: 0.78-1.00, <i>p</i> = 0.054). Compared to outpatients, inpatient Medicare TKA patients had lower 1-year PROM capture rates, more comorbidities, and worse baseline PROMs, with a trend toward not meeting CMS SCB thresholds. These differences highlight limitations in using inpatient-only data to assess national TKA outcomes, especially as outpatient procedures grow. Nonetheless, future studies with higher power should validate these findings. The level of evidence is III (retrospective).</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"303-309"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597914","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":"Postoperative HbA1c within the non-diabetic range is not associated with systemic inflammation indices following anterior cruciate ligament reconstruction.","authors":"Jacob Wells, Sonu Bae, Ayotomi Owoeye, David C Flanigan, Tyler Barker","doi":"10.1055/a-2865-3185","DOIUrl":"https://doi.org/10.1055/a-2865-3185","url":null,"abstract":"<p><strong>Background: </strong>Glycated hemoglobin (HbA1c), a marker of long-term glycemic control, has been linked to adverse outcomes following anterior cruciate ligament reconstruction (ACLR). Systemic indices of the immune system and inflammation derived from routine blood counts serve as prognostic tools in various clinical contexts. While HbA1c and systemic indices of inflammation have been independently associated with post-surgery complications, their relationship following ACLR remains unclear. The purpose of this study was to evaluate whether elevated HbA1c levels are associated with increased systemic inflammation and complications following ACLR.</p><p><strong>Methods: </strong>This retrospective case-control study consisted of patients who underwent ACLR with HbA1c and complete blood counts (CBCs) with differentials obtained ≥90 days after surgery. Patients were separated into two groups: controls (HbA1c <5.7%; n = 59) and cases (HbA1c ≥5.7%; n = 14). Controls were matched to cases (≥2:1) based on age and BMI. Systemic indices of the immune system and inflammation (i.e., systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), pan-immune-inflammation value (PIV), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI)) were derived from CBCs.</p><p><strong>Results: </strong>No cases displayed an HbA1c >6.4% (range 5.7-6.4%). Systemic indices of the immune system and inflammation were not significantly different between controls and cases (p = 0.117-0.933). HbA1c was not significantly correlated with NLR, MLR, PLR, SII, SIRI, and PIV (all p > 0.05), and regression models confirmed no associations. Five complications occurred, with no significant difference in complication frequency between groups (p = 1.000). HbA1c did not differ significantly between patients with and without complications (p = 0.511).</p><p><strong>Conclusion: </strong>Following ACLR, elevated HbA1c was not associated with systemic inflammation or postoperative complications. These preliminary findings suggest limited utility of HbA1c values below the diabetic threshold for risk stratification in patients that underwent ACLR. Further study in patients with higher HbA1c values is warranted.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822530","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":"Iatrogenic Patella Baja Following Primary Total Knee Arthroplasty: Is the Patellar Tendon to Blame?","authors":"Elizabeth A Abe, Benjamin Miltenberg, Michael Meghpara, Harrison S Fellheimer, Elijah Hoffman, Matthew B Sherman, James J Purtill","doi":"10.1055/a-2741-1142","DOIUrl":"10.1055/a-2741-1142","url":null,"abstract":"<p><strong>Abstract: </strong>Patellar tendon shortening (PTS) following primary total knee arthroplasty (TKA) is thought to occur because of excessive soft tissue tensioning during wound closure. Few studies have examined the incidence of acute PTS in TKA patients. The purpose of this prospective study was to evaluate the incidence and clinical implications of acute PTS after primary TKA. All patients undergoing primary TKA for osteoarthritis (OA) from January 2024 through April 2024 by a single, fellowship-trained surgeon were included. Patient demographics and range of motion (ROM) were recorded preoperatively. Range of motion and physical therapy (PT) requirements were recorded at 6-week follow-up. Patellar tendon length was determined by the Insall-Salvati ratio (ISR) and measured preoperatively, on postoperative day (POD) 0, and at 6 weeks following surgery. Significant PTS was defined as a decrease in the ISR of ≥10%. In total, 89 patients were included in the analysis. Of these, 54 (60.7%) patients experienced significant PTS and 35 (39.3%) did not experience significant PTS immediately following TKA. Preoperative ISR and ROM was similar between cohorts; however, on POD 0, the ISR decreased by 21.9 ± 8.7% in the significant PTS cohort versus 0.8 ± 10.9% (<i>p</i> < 0.001) in the insignificant PTS cohort. From POD 0 to 6 weeks postoperatively, ISR increased by 25.0 ± 15.8% in the significant PTS cohort versus 7.6 ± 12.0% in the insignificant PTS cohort (<i>p</i> < 0.001). The ISR decreased by 2.9 ± 10.9% for patients in the significant PTS cohort and increased by 5.7 ± 7.9% for patients in the insignificant PTS cohort (<i>p</i> < 0.001). There was no significant difference in PT requirements or ROM between cohorts at 6-week follow-up. Patellar tendon shortening following TKA resolved by 6 weeks postoperatively; no ROM deficits or additional PT requirements were found to exist between cohorts.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"322-328"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145507624","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":"Kinematic versus Mechanically Aligned Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials.","authors":"Marc Boutros, Guy Awad, Adeline Mouawad, Elie Mansour","doi":"10.1055/a-2741-1246","DOIUrl":"10.1055/a-2741-1246","url":null,"abstract":"<p><strong>Abstract: </strong>Alignment strategy in total knee arthroplasty (TKA) remains a subject of debate. Although mechanical alignment (MA) has long been the standard, kinematic alignment (KA) has gained interest for its patient-specific approach aiming to restore native knee kinematics. Comparative evidence from randomized controlled trials (RCTs) on clinical effectiveness and safety remains variable. A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar through June 2025 identified 21 RCTs comparing KA and MA in primary TKA. Outcomes assessed included functional scores (Knee Society Score [KSS], Oxford Knee Score [OKS], KOOS, WOMAC), quality of life (EQ-5D, Forgotten Joint Score [FJS]), pain (VAS at rest and mobilization), range of motion, satisfaction, and complications rates. KA was associated with modestly better outcomes in early postoperative function and patient satisfaction. Statistically significant advantages were found for knee flexion (MD = 2.49 degrees; <i>p</i> = 0.002), KSS function (MD = 6.39; <i>p</i> < 0.00001), KSS objective score (MD = 2.24; <i>p</i> < 0.00001), KSS satisfaction (MD = 3.11; <i>p</i> = 0.001), FJS (MD = 3.79; <i>p</i> < 0.0001), WOMAC (MD = -6.44; <i>p</i> = 0.01), and VAS pain at rest (MD = -0.39; <i>p</i> < 0.0001). No significant differences were observed in extension, pain during mobilization, length of stay, or complication rates. Kinematic alignment yields clinical outcomes at least equivalent to mechanical alignment, with small but statistically significant improvements in early function, joint awareness, and patient satisfaction, without increased risk of complications or revision. Although the clinical relevance of these differences is modest, KA represents a safe and effective alternative that may enhance patient-perceived recovery. Long-term data remain essential to determine whether KA offers durable advantages in survivorship and late functional outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"283-295"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597974","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}