Journal of Knee Surgery最新文献

{"title":"Cross Cultural Validation of the Tegner Activity Scale for a UK Paediatric Population.","authors":"Robert Alexander Fawdry, Kai Sampson, Dominic O'Dowd","doi":"10.1055/a-2982-7108","DOIUrl":"https://doi.org/10.1055/a-2982-7108","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-reported outcome measures (PROMs) commonly incorporate activity scales to assess functional status before and after treatment. The Tegner Activity Scale (TAS) is widely used in adult knee pathology but has a reading age of 18-19 years and includes predominantly adult-focused activities, limiting its applicability in children. This pilot study evaluated the understanding and performance of the TAS in a UK paediatric population and compared it with a newly developed UK paediatric activity scale.</p><p><strong>Methods: </strong>A UK-specific paediatric activity scale was developed by a panel of paediatric orthopaedic and sports surgeons with a target reading age of 8 years. Children aged ≥8 years attending a tertiary paediatric orthopaedic clinic and one parent independently completed the TAS and the new activity scale, alongside demographic and sporting participation data. Activity scores were correlated with reported sporting level, and agreement between child and parent responses was assessed. Subgroup analyses examined the effects of sporting discipline, level of competition and single- versus multisport participation.</p><p><strong>Results: </strong>Seventy child-parent pairs were recruited (mean age 12.8 years; 38.5% female). Only 53% of children reported understanding the TAS. No significant differences were found between child- and parent-reported TAS scores (6.75 vs 6.37; p=0.13), although agreement occurred in only 43.5% of pairs. Correlation between TAS score and reported sporting level was 58.6%. The new UK activity scale also demonstrated no significant difference between child- and parent-reported scores (4.84 vs 4.74; p=0.61) but improved agreement between respondents and showed significantly stronger correlation with sporting level (80.6% vs 58.6%; p<0.05). Unlike the TAS, the new scale demonstrated consistent performance across sporting disciplines and competition levels.</p><p><strong>Conclusions: </strong>The Tegner Activity Scale demonstrates limited suitability for UK paediatric patients owing to poor comprehension and weaker correlation with sporting participation. A UK-specific paediatric activity scale with a lower reading age showed significantly improved agreement and criterion validity. These findings support further development and formal validation of a UK paediatric activity PROM in accordance with COSMIN recommendations.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197433","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":"GLP-1 Receptor Agonist Use Before Total Knee Arthroplasty is Associated With Lower Postoperative MI, DVT, and VTE Rates.","authors":"Bryan Yavari, Aria Soltankhah, Nafis Eghrari, Stanna Calderon, Evan Lederman, Anup Shah","doi":"10.1055/a-2982-7440","DOIUrl":"https://doi.org/10.1055/a-2982-7440","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly prescribed for glycemic control and weight management, but their association with postoperative thrombotic events after total knee arthroplasty remains unclear. We performed a retrospective cohort study using deidentified data from the TriNetX United States Collaborative Network, including adults who underwent primary total knee arthroplasty between December 1, 2006 and June 1, 2025. Patients with prior myocardial infarction, deep vein thrombosis, venous thromboembolism, or pulmonary embolism were excluded. Exposure was defined as a prescription for a GLP-1 RA within 1 year and 1 day before surgery. A 1:1 propensity score match was performed on demographics, relevant comorbidities, and medications, yielding 11,765 patients in each cohort. Outcomes were postoperative myocardial infarction, deep vein thrombosis, venous thromboembolism, and pulmonary embolism. Compared with matched controls, patients prescribed GLP-1 receptor agonists had a significantly lower risk of myocardial infarction (25/11,246 vs 47/11,171; risk ratio [RR] 0.528; 95% confidence interval [CI], 0.325 - 0.858). GLP-1 RA use was also associated with a reduced risk of deep vein thrombosis (74/11,319 vs 103/11,308; RR 0.718; 95% CI, 0.533 - 0.966) and venous thromboembolism (133/11,040 vs 172/11,027; RR 0.772; 95% CI, 0.617 - 0.967). In contrast, no statistically significant difference was observed in the incidence of pulmonary embolism between groups (49/11,352 vs 58/11,382; RR 0.847; 95% CI, 0.580 - 1.238). Overall, preoperative GLP-1 receptor agonist use was associated with a significantly lower postoperative risk of myocardial infarction, deep vein thrombosis, and venous thromboembolism following total knee arthroplasty in this large, nationally representative cohort.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197386","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":"A Comprehensive Approach to Flexion-Varus Tibial Plateau Fractures: Principles of Systematic Management.","authors":"Harm Hoekstra, Teng Ye, Mattia Sisella, Nick Assink, Emma Van Zuijlen, Bernardo Innocenti, Frank F A IJpma, Cong Feng Luo","doi":"10.1055/a-2968-6315","DOIUrl":"https://doi.org/10.1055/a-2968-6315","url":null,"abstract":"<p><strong>Abstract: </strong>Tibial plateau fractures (TPFs) are complex intra-articular injuries frequently accompanied by significant soft tissue injury. Existing medical literature has shown that TPFs resulting from a flexion-varus injury mechanism, affecting the posteromedial column primarily, are associated with worse clinical outcome scores and a higher risk of conversion to total knee arthroplasty. This narrative review aims to explain why this specific subgroup has a poorer prognosis compared with other TPFs subtypes. Four key factors are examined in this review: fracture morphology, biomechanics, soft tissue involvement, and surgical management. The complex fracture morphology of flexion-varus TPFs can be most accurately assessed using three-dimensional computed tomography-based reconstructions. The mechanism of injury helps to better understand fracture morphology and potential soft tissue injury. Soft tissue injuries are frequent in these type of fractures, such as anterior cruciate ligament (ACL) avulsion fracture, lateral meniscus tears, and entrapment. These three elements are important for better understanding TPFs and adequately planning surgical strategy. The severity of the fracture and the involvement of the posterolateral depression complicate surgical treatment. Visualization of the posteromedial compartment is essential but remains challenging. Anatomical reduction and stable fixation of the posteromedial and posterolaterocentral tibial plateau, with consideration of any meniscal injury, should be performed with care. An ACL avulsion fracture should ideally be fixed. Although preoperative magnetic resonance imaging (MRI) provides valuable information about the soft tissue involved, this examination is not yet routinely performed. Given the high incidence of ACL and (lateral) meniscal injury, an MRI is highly recommended.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185418","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 of Preoperative Serum SPON1 and APOE Levels with Chronic Postsurgical Pain after Total Knee Arthroplasty.","authors":"Tao Feng, Hu Ren, Jianhui Cao, Liya Di, Zhiguang Tian","doi":"10.1055/a-2968-6034","DOIUrl":"10.1055/a-2968-6034","url":null,"abstract":"<p><strong>Abstract: </strong>To investigate the association of preoperative serum secreted phosphoprotein 1 (SPON1) and apolipoprotein E (APOE) with chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA), providing a hypothetical basis for validation studies. This retrospective study included 218 patients who underwent unilateral TKA between March 2023 and February 2025 with 6-month follow-up. CPSP was defined as a knee pain score > 3 on the visual analog scale (VAS) during movement at 6 months postoperatively. Demographic and clinical data, preoperative and postoperative pain scores, painDETECT questionnaire (PD-Q), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Hospital Anxiety and Depression Scale (HADS) scores, and preoperative serum SPON1 and APOE levels were collected. ROC curve was performed to evaluate the performance of serum SPON1 and APOE in discriminating CPSP-positive from CPSP-negative patients after TKA. Multivariable logistic regression analysis was performed to explore risk factors for CPSP following TKA. Fifty-five patients were CPSP-positive and 163 were CPSP-negative. The CPSP-positive group had fewer years of education, higher prevalence of diabetes mellitus, longer duration of preoperative pain and knee osteoarthritis (KOA), and higher preoperative VAS, PD-Q, WOMAC, and HADS scores (all <i>p</i> < 0.05). Serum SPON1 and APOE levels were significantly higher in the CPSP-positive group (both <i>p</i> < 0.05), and positively correlated (<i>r</i> = 0.253, <i>p</i> < 0.05). The combination of SPON1 and APOE had an area under the curve (AUC) of 0.908 (95% CI: 0.864-0.951), indicating good discriminative ability between CPSP-positive and CPSP-negative patients, superior to SPON1 alone (<i>Z</i> = - 3.144, <i>p</i> = 0.002) and APOE alone (<i>Z</i> = - 3.078, <i>p</i> = 0.002). Multivariable analysis showed more years of education was a protective factor, whereas higher preoperative PD-Q and WOMAC scores and elevated serum SPON1 and APOE levels were risk factors for CPSP. Serum SPON1 and APOE levels were associated with CPSP after TKA, and their combination showed favorable discriminative ability. Because the model was not validated, these results represent preliminary evidence of an association; the clinical value of these markers as potential biomarkers requires confirmation in prospective studies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076288","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 Glycemic Deterioration and Outcomes after Total Knee Arthroplasty: Does It Matter?","authors":"Ezekiel Kopilak, Rajendra Singh, Jayson Stern, Jacob Feingold, Qais Naziri","doi":"10.1055/a-2968-6258","DOIUrl":"10.1055/a-2968-6258","url":null,"abstract":"<p><strong>Abstract: </strong>The prevalence of knee osteoarthritis and the annual incidence of total knee arthroplasty (TKA) continue to rise. A substantial proportion of TKA candidates have diabetes mellitus, which is associated with increased perioperative risk. Prior studies have largely focused on preoperative hemoglobin A1c (HbA1c), while the effect of postoperative glycemic control on complication rates remains less well-defined. This study evaluated the relationship between late postoperative HbA1c levels and postoperative complications following TKA. A propensity score-matched retrospective cohort study was performed using the TriNetX multi-institutional database. Adults aged 18 to 90 years who underwent primary TKA with documented HbA1c > 8% for 3 months preoperatively, who were able to decrease it to under 7.5% for < 3 months preoperatively. HbA1c values obtained 1 to 2 years postoperatively were used to define cohorts: Cohort 1 (HbA1c < 7.5%) and Cohort 2 (HbA1c ≥ 8.0%). Outcomes included early medical complications (30 and 90 days) and arthroplasty-specific complications within 5 years, including periprosthetic joint infection, revision surgery, mechanical loosening, and periprosthetic fracture. After matching, a total of 3,200 patients met the inclusion criteria, with 1,600 patients in each cohort after matching. There were no significant differences in 30- or 90-day medical complications between groups. At 5 years, rates of periprosthetic joint infection, revision surgery, mechanical loosening, and periprosthetic fracture were also similar. Elevated postoperative HbA1c at 1 to 2 years following TKA was not independently associated with increased risk of complications or implant failure when perioperative glycemic control was optimized. These findings suggest that once early healing occurs under adequate glycemic conditions, later deterioration in glycemic control may have a limited impact on arthroplasty outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076341","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":"A Uniquely Formulated Hyperosmolar Irrigation Solution is Associated with Beneficial Effects for Recovery After Arthroscopic Knee and Shoulder Surgeries: A Preclinical Canine Model.","authors":"Chantelle Bozynski, Lasun O Oladeji, Aaron Stoker, Cristi Cook, Matthew J Smith, James P Stannard, James L Cook","doi":"10.1055/a-2976-6929","DOIUrl":"https://doi.org/10.1055/a-2976-6929","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperosmolar solutions have emerged as a potential adjunct in knee and shoulder arthroscopic procedures, offering benefits such as reduced tissue edema, and enhanced operative efficiency. The purpose of this study was to compare a uniquely formulated \"hyperosmolar-plus\" solution to hyperosmolar saline and isotonic solutions in knee and shoulder arthroscopic procedures using a preclinical canine model.</p><p><strong>Methods: </strong>Purpose-bred research dogs (N=6) underwent bilateral shoulder (N=12) and knee (N=12) arthroscopic surgeries. Hyperosmolar-plus irrigation fluid (578 mOsm/L) was compared to lactated Ringer's solution (273 mOsm/L) and hyperosmolar saline (582 mOsm/L). Irrigation fluid was delivered to each joint at 40 mmHg for 2 hours using standard ingress and egress portals. Shoulder and knee girth measurements and ultrasonographic measurements of joint tissues were recorded before and immediately after surgery. Synovial fluid concentrations of selected biomarkers and viable chondrocyte density were evaluated. Articular cartilage, menisci and synovia were harvested for histopathologic evaluation. Differences between groups were determined, with significance set at P<0.05. Hyperosmolar solutions were associated with consistently greater knee and shoulder ROM compared to the Isotonic solution at all time points.</p><p><strong>Results: </strong>Hyperosmolar-plus was associated with significantly (p=0.02) less severe knee fat pad and synovium pathology scores compared to the Isotonic solution. Although the Isotonic solution group had the greatest mean changes in joint girth, periarticular tissue distension, and knee synovium thickness compared with both hyperosmolar solutions, differences were not statistically significant for either joint (p≥0.10). No significant differences among treatment groups were observed in cell viability or synovial fluid biomarkers.</p><p><strong>Conclusion: </strong>Hyperosmolar-plus was associated with lower histopathology severity scores for several knee and shoulder joint tissues compared to Hyperosmolar and Isotonic solutions, although differences were not statistically significant (p≥0.17). These findings suggest that a uniquely formulated hyperosmolar solution supplemented with anti-inflammatory and anti-oxidant components may have beneficial effects on joint health and recovery following common knee and shoulder arthroscopic procedures.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149110","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":"Comparison of Donor Site Morbidity in Peroneus Longus Tendon Harvest with and without Peroneal Tenodesis in ACL Reconstruction: A Randomized Controlled Study.","authors":"Bushu Harna, Shivali Arya, Dinesh Sandal, Saravpreet Ahluwalia","doi":"10.1055/a-2968-6212","DOIUrl":"10.1055/a-2968-6212","url":null,"abstract":"<p><strong>Abstract: </strong>The peroneus longus tendon (PLT) is an effective autograft for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding donor site ankle morbidity. Peroneal tenodesis is commonly performed to prevent eversion weakness, though its necessity remains controversial. This study compares donor site morbidity and functional outcomes with and without tenodesis. This randomized controlled study included 97 patients undergoing primary ACL reconstruction using PLT autografts between 2019 and 2023. Patients were randomized into two groups: Group A (<i>n</i> = 52) underwent PLT harvest with peroneal tenodesis, while Group B (<i>n</i> = 45) underwent PLT harvest without tenodesis. Donor site morbidity was assessed using the Foot and Ankle Ability Measure (FAAM), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and Visual Analog Scale (VAS) pain scores at 3, 6, and 12 months. Muscle strength was evaluated using Medical Research Council (MRC) grading for ankle eversion and first-ray plantarflexion. There were no significant differences between the two groups in FAAM, AOFAS, or VAS scores at any follow-up interval (<i>p</i> > 0.05). At 12 months, mean FAAM scores were 94.3 ± 4.8 (Group A) and 95.7 ± 3.2 (Group B); AOFAS scores were 90.1 ± 5.1 and 89.8 ± 5.3, respectively. Ankle eversion and plantarflexion strength were largely preserved in both groups, with no significant difference. Complication rates, including wound healing and sensory disturbances, were similar between groups. PLT autograft harvest for ACL reconstruction results in minimal donor site morbidity with preserved ankle function. This low morbidity supports the safety of sacrificing the PLT for graft purposes. As the tenodesis performed in this cohort was radiologically intact in only a subset of patients, this study cannot conclude that tenodesis offers no benefit compared with no tenodesis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065478","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 Figure-of-4 Maneuver: Quantitative Characterization of Lateral Compartment Behavior During Robotic Total Knee Arthroplasty.","authors":"Ravi C Vattipalli, Varoon C Palakodety","doi":"10.1055/a-2968-6106","DOIUrl":"10.1055/a-2968-6106","url":null,"abstract":"<p><strong>Abstract: </strong>Conventional intraoperative gap assessment is performed in standardized reference positions that do not replicate many functional postures patients assume during daily activities. Physiologic lateral compartment opening becomes most apparent in postures combining flexion, hip external rotation, and relative varus alignment, such as sitting cross-legged, and shoe or sock application. The figure-of-4 position reproduces this combination intraoperatively. The purpose of this study was to describe the figure-of-4 maneuver as an intraoperative positional assessment during robotic total knee arthroplasty (rTKA) and quantitatively characterize compartment behavior during its execution using standardized robotic measurements. Eighty-three consecutive primary rTKAs performed by a single surgeon were retrospectively analyzed. After bone preparation and balancing, with trial components in situ, each knee underwent conventional and figure-of-4 assessment. The VELYS standardized robotic measurement framework was used for both conditions; only limb posture differed. Compartment behavior was expressed as the medial-to-lateral gap difference (ΔML; medial minus lateral) in flexion and extension. Conventional and figure-of-4 ΔML were compared within each knee using paired <i>t</i>-tests and Wilcoxon signed-rank tests. Preoperative hip-knee-ankle (HKA) angle was correlated with the change in ΔML using Pearson and Spearman coefficients. Figure-of-4 assessment produced consistently more negative flexion ΔML than conventional assessment (mean difference - 2.181 mm; 95% CI: - 2.414 to - 1.947; <i>p</i> < 0.001; Cohen's <i>d</i> = 2.039). Extension ΔML did not differ significantly (mean difference 0.080 mm; 95% CI: - 0.019 to 0.178; <i>p</i> = 0.113). Preoperative HKA angle did not correlate with the change in flexion ΔML (<i>r</i> = 0.091, <i>p</i> = 0.416) or extension ΔML (<i>r</i> = - 0.111, <i>p</i> = 0.318). Figure-of-4 assessment consistently demonstrated greater lateral compartment opening in flexion than conventional assessment, while extension measurements remained essentially unchanged. The standardized robotic measurement framework enabled objective quantification of compartment behavior in a positional condition not evaluated during routine assessment. The maneuver characterizes behavior of the prepared knee in a posture associated with common activities of daily living and provides information complementary to conventional assessment.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065566","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":"Pre-existing Atrial Fibrillation and Long-term Outcomes Following Total Knee Arthroplasty.","authors":"Elisabeth S Merten, Jackson W Durbin, Diego Garcia, Amy Y Zhao, Aribah Shah, Sean Williams, Nicholas Siegel, Gregory Y Golladay, Savyasachi C Thakkar","doi":"10.1055/a-2968-5946","DOIUrl":"https://doi.org/10.1055/a-2968-5946","url":null,"abstract":"<p><strong>Abstract: </strong>A significant population of patients undergoing total knee arthroplasty (TKA) concomitantly have atrial fibrillation (AF). Previous studies have examined acute postoperative complications; however, the long-term impact of pre-existing AF on surgical outcomes after TKA remains underexplored. This study aimed to evaluate 2-, 5-, and 10-year risk and indications for revision among patients with AF undergoing TKA. The TriNetX database was utilized for this retrospective cohort study. The primary outcome was 2-, 5-, and 10-year risk of revision following primary TKA among patients with and without pre-existing AF. The AF and control cohorts were 1:1 propensity matched by age, sex, race, clinical comorbidities, and anticoagulant and aspirin use. Covariate balance after matching was assessed using standardized mean differences (SMDs). Cox proportional hazards models and Kaplan-Meier survival estimates were used to evaluate all-cause revision and specific complications. Results were reported as hazard ratios (HRs) with 95% confidence intervals (CIs), survival probabilities, and <i>p</i>-values. A <i>p</i>-value of < 0.05 was considered statistically significant. Patients with pre-existing AF (<i>n</i> = 24,671) had a significantly higher risk of all-cause revision at 2 years (HR 1.27, 95% CI: 1.13-1.43, <i>p</i> < 0.0001), 5 years (HR 1.23, 95% CI: 1.11-1.37, <i>p</i> < 0.0001), and 10 years (HR 1.23, 95% CI: 1.12-1.35, <i>p</i> < 0.0001) post-TKA compared to matched controls (<i>n</i> = 24,671). The AF cohort demonstrated increased risk of periprosthetic joint infection (PJI) (HR 1.33, 95% CI: 1.22-1.44, <i>p</i> < 0.0001) while showing decreased incidence of arthrofibrosis (HR 0.85, 95% CI: 0.80-0.91, <i>p</i> < 0.0001). No significant difference in periprosthetic fracture, mechanical loosening, osteolysis, or articular wear was observed. Pre-existing AF is associated with increased long-term risk of revision following TKA up to 10 years postoperatively compared to matched controls, even after matching for comorbidity burden and anticoagulant use. These findings should be interpreted cautiously in the context of modest effect sizes and limitations inherent within the TriNetX database. Future studies should examine whether perioperative anticoagulation management strategies influence long-term postoperative complications in patients with AF undergoing TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117091","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":"Practice Variations Among Alternative Alignment Strategies in Total Knee Arthroplasty: A Systematic Review.","authors":"Matthew T Geiselmann, Lohith Vatti, Benjamin Hershfeld, Giles R Scuderi","doi":"10.1055/a-2968-5826","DOIUrl":"10.1055/a-2968-5826","url":null,"abstract":"<p><strong>Abstract: </strong>Restoration of limb alignment and joint stability across the functional range of motion is a primary goal of total knee arthroplasty (TKA). Multiple alignment strategies have evolved to achieve these objectives, yet a single optimal strategy remains controversial. This study evaluates practice variation among kinematic (KA), functional (FA), and mechanical alignment (MA) strategies in TKA with respect to tibial insert selection, posterior cruciate ligament (PCL) preservation, and deformity tolerance. A systematic PubMed review identified English-language studies of primary TKA published between 2006 and 2025 that reported alignment strategy, tibial insert type, PCL status, and mean deformity. Unicompartmental, revision/complex arthroplasty, and review or editorial studies were excluded. Of 1,099 identified articles, 152 met inclusion criteria for final analysis. Fifty studies (4,672 cases) evaluated KA, 10 studies (2,021 cases) evaluated FA, and 103 studies (11,446 cases) evaluated MA, contributing 242 analytic cohorts. In KA, tibial inserts included 54.5% cruciate-retaining (CR), 0.3% bicruciate retaining (BCR), 7.5% bicruciate stabilized (BCS), 4.3% condylar-stabilized (CS), 11.9% posterior stabilized (PS), 13.2% medial congruent/medial stabilized (MC/MS), 0.7% medial pivot (MP), 2.5% ball-in-socket medial conforming (B-in-S MC), 0.5% ball-in-socket condylar-stabilized (B-in-S CS), 3.9% ultra-congruent (UC), 0.2% constrained posterior-stabilized (CPS), and 0.4% constrained condylar knee (CCK). FA utilized 47.9% CR, 1.0% BCR, 6.0% CS, 36.9% PS, and 8.2% MC/MS, with no BCS, MP, B-in-S MC, B-in-S CS, UC, CPS, or CCK reported. MA demonstrated 34.6% CR, 1.3% BCR, 4.6% BCS, 3.0% CS, 45.4% PS, 0.7% MC/MS, 2.4% MP, 2.3% UC, 3.6% CPS, and 2.1% CCK. The PCL was preserved in 63.1% of KA, 58.9% of FA, and 38.4% of MA cases. Tibial insert distribution, PCL preservation, and instrumentation technique differed significantly across alignment strategies (all <i>p</i> < 0.001). Using a signed coronal deformity convention in which negative values indicate varus and positive values indicate valgus, mean preoperative coronal deformity was - 2.9, - 4.1, and - 4.7 degrees for KA, FA, and MA, respectively, with the most varus reported cohort-level mean deformities of - 13.4, - 17.6, and - 21.0 degrees; mean deformity did not significantly differ across alignment strategies (<i>p</i> = 0.124). Manual instrumentation predominated in KA (62.6%) and MA (74.5%), whereas FA was primarily robotic (90.8%). Significant heterogeneity exists in implant selection, PCL management, and instrumentation technique across alignment strategies, while mean preoperative coronal deformity did not significantly differ. Within the included literature, alignment philosophy alone does not dictate surgical practice and highlights the need for standardized definitions and reporting.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065569","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}