Journal of Knee Surgery最新文献

{"title":"Intraoperative Tibial Periprosthetic Fractures During Total Knee Arthroplasty: Incidence, Risk Factors, and Early Outcomes.","authors":"Chase W Smitterberg, Amir H Hoveidaei, Ronald E Delanois, Michael A Mont","doi":"10.1055/a-2865-1692","DOIUrl":"10.1055/a-2865-1692","url":null,"abstract":"<p><strong>Abstract: </strong>Intraoperative tibial periprosthetic fractures during total knee arthroplasty (TKA) are uncommon, but clinically relevant complications with distinct mechanisms compared with postoperative fractures. This review summarizes the incidence, intraoperative risk factors and mechanisms, recognition, and early outcomes to provide a practical, procedure-based framework. In primary TKA, intraoperative tibial fractures occur in approximately 0.1 to 0.5% of cases, with higher rates reported in keeled tibial components and revision procedures, where incidence may approach 1.5%. These fractures occur at predictable high-force steps, most commonly during keel preparation and final component impaction, with 90 to 100% occurring at these stages across multiple series. The medial tibial plateau is particularly susceptible, and excessive insertion forces, implant size and geometry, and depth of tibial resection contribute to fracture risk. Recognition relies on intraoperative awareness of timing, tactile feedback, and subtle visual and mechanical cues. Audible cracking, sudden loss of resistance, abnormal component seating, and unexpected instability should prompt suspicion. Some fractures remain occult and are identified only on postoperative imaging, emphasizing the importance of vigilance during high-risk steps. Early outcomes are generally favorable when fractures are recognized and addressed at the time of surgery, with high rates of union and implant survivorship. Large series report survivorship free from tibial component revision exceeding 95% at up to a mean 6-year follow-up, although outcomes vary by fracture pattern. Intraoperative tibial periprosthetic fractures are predictable, mechanically driven complications that occur during specific steps of TKA. Understanding their timing, mechanisms, and presentation is essential to improve recognition and optimize outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"645-648"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943352","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":"Periprosthetic Fractures Around the Knee: An Integrated Approach to Epidemiology, Risk, and Management in Total Knee Arthroplasty.","authors":"Michael A Mont, Giles R Scuderi","doi":"10.1055/a-2904-0957","DOIUrl":"https://doi.org/10.1055/a-2904-0957","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":"39 12","pages":"613"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002739","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":"Frailty Predicts Mortality While Fracture Complexity and Reduction Predict Failure After Surgery for Tibial Plateau Fractures in Elderly Patients: A Two-decade Cohort Study.","authors":"Wayne Hoskins, Vivienne Wong, Charles Gusho, Jaime Bellamy, Chloe E H Scott","doi":"10.1055/a-2968-6152","DOIUrl":"https://doi.org/10.1055/a-2968-6152","url":null,"abstract":"<p><strong>Abstract: </strong>Tibial plateau fractures in older patients are increasingly common and carry poor outcomes, yet the determinants of mortality and surgical failure are poorly defined, and frailty, central to hip fracture care, has not been examined in this group. We retrospectively reviewed all patients aged 65 years and older undergoing surgery for a tibial plateau fracture at a single center (2006-2025). Outcomes were all-cause reoperation, malunion, fracture-related infection (FRI), conversion to total knee arthroplasty (TKA), and death (treated as a competing event), analyzed with Fisher's exact test and Firth's penalized logistic regression adjusted for age, fracture complexity, and reduction. Among 47 patients (mean age 73 years; 83% female; open reduction internal fixation [ORIF] in 42, primary TKA in 5), malunion occurred in 57% of ORIF cases, all-cause reoperation in 29%, and FRI in 12%; 15% underwent conversion to TKA at a median of 9 months, accounting for 7 of 13 reoperations. Mortality over the study period was 21% (6% within 1 year). Frailty independently predicted mortality (adjusted odds ratio [aOR] 8.4, 95% confidence interval [CI]: 1.7-61.2) with a clear dose-response, but not reoperation. Fracture complexity (bicondylar/Schatzker 5-6) independently predicted malunion (aOR 7.1, CI: 1.8-37.9), while both complexity (aOR 5.0, CI: 1.2-24.8) and non-anatomical reduction (anatomical reduction protective: aOR 0.20, CI: 0.03-0.91) independently predicted reoperation. The five primary TKA patients, the only group permitted immediate weight-bearing, had fewer reoperations, no infection, no revisions or death, and earlier discharge to home. Mortality and surgical failure had distinct drivers: frailty for death, complexity and malreduction for failure. Reduction quality is the key modifiable surgical variable, and immediate-weight-bearing arthroplasty warrants prospective evaluation in select patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082468","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":"Can Valgus Deformity Influence the Evolution of a Total Knee Arthroplasty after 20 Years? A Retrospective Case-Control Study.","authors":"Xavier Paredes-Carnero, Jose Ramón Caeiro-Rey, Manuel Castro-Menendez, Jesus Escobar-Montenegro, Javier González-Babé","doi":"10.1055/a-2949-2506","DOIUrl":"https://doi.org/10.1055/a-2949-2506","url":null,"abstract":"<p><strong>Abstract: </strong>Total knee arthroplasty (TKA) is the treatment of choice for knee osteoarthritis. When it is associated with moderate and severe valgus deformities, surgical correction has proven to be more complex. However, there are scarcely any long-term studies assessing this treatment. The aim of this study was to analyze the long-term evolution of a cohort of patients with moderate or severe valgus deformities versus a control group with mild deformities. A total of 1,223 primary TKAs with a mean follow-up of 20.3 years were retrospectively reviewed. A total of 141 TKAs with moderate or severe valgus deformities (hip-knee-ankle [HKA] angle equal to or greater than 190 degrees) were compared with a control group of 1,083 TKAs with mild deformities (HKA between 170 and 190 degrees). Patients were evaluated preoperatively and postoperatively at 1, 3, 5, 8, and 13 years after surgery. The minimum follow-up done was 13 years. In addition, any complications, reinterventions, replacements, and deaths were registered until the end of the follow-up. Preoperatively, the moderate-severe valgus deformities group showed significantly worse Knee Score results than the control group (<i>p</i> < 0.001), while the range of motion was better in the moderate-severe valgus deformities group (<i>p</i> < 0.001). The postoperative outcomes were not statistically different in either group. There were no differences in the complications until the 8th year; however, from this year on and especially from 13 years after surgery, complications increased significantly (<i>p</i> < 0.001) in the moderate-severe valgus deformities group. A long-term observation of a group of TKAs with preoperative moderate or severe valgus deformities, compared with a group with mild deformities, shows that complications increase significantly 13 years after surgery.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026330","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":"Golf After Total Knee Arthroplasty: Prospective Analysis of Performance and Return to Play.","authors":"Cameron K Ledford, Jessica N Pelkowski, Nicolas M Dohse, Niall H Cochrane, Bryan D Springer, Luke S Spencer-Gardner","doi":"10.1055/a-2949-2572","DOIUrl":"10.1055/a-2949-2572","url":null,"abstract":"<p><strong>Abstract: </strong>Golf is a widely played recreational sport, but degenerative osteoarthritis in older adults can limit participation and performance. This study prospectively evaluates recreational golfers' performance metrics of play, and clinical outcomes before and after total knee arthroplasty (TKA). A prospective cohort of 10 recreational golfers undergoing primary TKA were assessed at a professional golf performance center preoperatively, and at 3 months and 1 year postoperatively. The mean age was 72 years, 90% were men, and 50% underwent TKA on the lead leg. Participants averaged 67 rounds in the year prior to surgery, and maintained a handicap index (HCP) of 18. Golf performance metrics (driver and 7-iron), force-plate biomechanics, return-to-play timing, quality of play, and Knee Injury and Osteoarthritis Outcome Score, Junior (KOOS-JR) were analyzed using descriptive statistics. The mean changes at 1 year postoperatively in driver and 7-iron swing speed (+ 1.3 and - 1.5 miles per hour [mph], respectively, 95% CI: - 5, 4.7), ball speed (+ 3.5 and - 2.6 mph, 95% CI: - 12.9, 12.3), carry distance (- 0.8 and + 6.2 yards, 95% CI: - 17.7, 17.1), maximum torque (+ 43 and + 85 pounds per foot [lbs/ft], 95% CI: - 30, 259), and vertical force (+ 93 and + 119 lbs/ft, 95% CI: - 175, 412) were obtained. All patients returned to full golf rounds playing a mean 8 (SD: ± 5.7) and 44 (SD: ± 29.7) rounds by 3 and 12 months, respectively, with no change in HCP (<i>p</i> = 0.9). The KOOS-JR significantly improved (57 to 80, <i>p</i> = 0.01). Recreational golfers safely returned to play after TKA with no significant changes in swing performance or handicap, while patient-reported outcomes improved. These findings suggest TKA enables resumption of golf without compromising performance.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876045","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":"Anterior Popliteus Transtibial Tuberosity Osteotomy for Moderate-to-Severe Medial Knee Osteoarthritis in a Karst Mountain Population: Factors Associated with Satisfaction and 2-Year Clinical Outcomes.","authors":"Jie Hong, Da Lei, Xin Li, Zhanyu Wu, Long Yang, Chuan Ye","doi":"10.1055/a-2949-2243","DOIUrl":"https://doi.org/10.1055/a-2949-2243","url":null,"abstract":"<p><strong>Abstract: </strong>Patients in Karst mountain regions are exposed to unusually high biomechanical demands because of frequent hill climbing, deep flexion, and long-term weight-bearing labor. This study evaluated the 2-year clinical and radiographic outcomes of anterior popliteus transtibial tuberosity osteotomy (APTTO) for moderate-to-severe medial knee osteoarthritis in this high-demand population and explored factors associated with postoperative satisfaction. We retrospectively reviewed 79 patients with moderate-to-severe medial knee osteoarthritis (Kellgren-Lawrence [K-L] grade III-IV) treated with APTTO with a minimum 2-year follow-up. Clinical outcomes, including the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and range of motion, were assessed together with radiographic parameters, including the hip-knee-ankle (HKA) angle, weight-bearing line (WBL) ratio, and medial proximal tibial angle (MPTA). Overall satisfaction was evaluated using a strict binary classification in which neutral responses were categorized as dissatisfied. Factors associated with satisfaction were analyzed using Firth-penalized logistic regression, and exploratory receiver operating characteristic (ROC) analysis was performed for postoperative MPTA. At the minimum 2-year follow-up, radiographic alignment and clinical outcomes improved significantly. The HKA angle improved from 172.25 ± 3.93 degrees preoperatively to 181.23 ± 3.14 degrees at 2 years, and the WBL ratio improved from 19.53 ± 14.35% to 57.32 ± 12.47%. Overall satisfaction was 79.7%, reaching 84.8% in the K-L grade IV subgroup. In the simplified Firth-penalized logistic regression model, postoperative MPTA remained significantly associated with satisfaction (odds ratio [OR] = 1.364; 95% confidence interval [CI], 1.055-1.763; <i>p</i> = 0.018). Exploratory ROC analysis showed an area under the curve of 0.718 (95% CI, 0.578-0.858; <i>p</i> = 0.007), and the cohort-derived postoperative MPTA threshold was 91.2 degrees. At a minimum 2-year follow-up, APTTO provided favorable clinical and radiographic outcomes and patient-reported satisfaction in this high-demand cohort. Postoperative MPTA was significantly associated with satisfaction, although the cohort-derived threshold of 91.2 degrees should be interpreted only as an exploratory reference rather than a validated correction target. Longer-term follow-up is needed to determine the durability of these short-term results. The level of evidence was III: a retrospective, prognostic study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921341","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 Impact of Patellar Resurfacing on Costs and Outcomes in Primary Total Knee Arthroplasty.","authors":"Anzar Sarfraz, Garrett Ruff, Benjamin Schaffler, Farouk Khury, Joseph Bosco, Ran Schwarzkopf, Vinay K Aggarwal","doi":"10.1055/a-2939-2342","DOIUrl":"10.1055/a-2939-2342","url":null,"abstract":"<p><strong>Abstract: </strong>Patellar resurfacing in primary total knee arthroplasty (TKA) has been debated for decades. This study aimed to evaluate cost-effectiveness and clinical outcomes of patellar resurfacing in modern TKA at a high-volume arthroplasty center. A retrospective study was conducted on 4,534 patients who underwent unilateral, elective, primary TKA from 2021 to 2024 at an urban academic institute. Patients were stratified by patellar resurfacing: resurfaced (<i>n</i> = 3,753) or not (<i>n</i> = 781). Baseline characteristics, operative costs (implants, anesthesia, operating room time), and postoperative outcomes (revision incidence) were collected. The median follow-up was 2.0 years (1.0-4.8). The individual cost of patellar component was adjusted for implant manufacturer and cementation out of total implant cost. Multivariable regression analysis determined added operating room time (ORT) due to patellar resurfacing, controlling for body mass index, usage of robotics, navigation, and cementation. Relative costs of added ORT and the patellar component were compared with total implant and procedure costs of patellar-resurfacing operations. The patellar component accounted for an average of 7.9% of the total implant cost in patellar-resurfacing operations. Patellar-resurfacing operations had longer operative times (112.2 vs. 105.4 minutes, <i>p <</i> 0.001), and multivariable regression determined patellar resurfacing is associated with an added 6.3 minutes of total ORT (<i>p</i> < 0.001). The patellar component implant cost and the cost of added ORT due to resurfacing accounted for 4.5% of the total procedure cost in resurfaced group. Resurfaced group had an overall 5% higher total operative cost than the non-resurfaced group. No differences existed in length of stay (LOS), discharge disposition, or all-cause and patella-specific revision incidence. We found that patellar resurfacing was associated with longer operative times and greater implant and procedure costs, although there was no effect on LOS, discharge disposition, or all-cause and patella-specific revision incidence. Ultimately, the decision to resurface the patella in primary TKA should be based on patient-specific indications and clinical judgment. However, it is important to consider the additional cost associated with this procedure. Level of evidence is III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800325","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":"Pulsed Electrical Stimulation for Knee Osteoarthritis: Reappraisal of a 21-Year Clinical Development Program.","authors":"Michael A Mont, Chase W Smitterberg, Javad Parvizi, Thomas Zizic","doi":"10.1055/a-2939-2499","DOIUrl":"https://doi.org/10.1055/a-2939-2499","url":null,"abstract":"<p><strong>Abstract: </strong>Knee osteoarthritis (OA) remains a leading cause of pain and disability, yet few nonoperative therapies have demonstrated durable clinical benefit or potential effects on structural disease progression. Pulsed electrical stimulation (PES) was investigated extensively over two decades, but this evidence has received little attention in the contemporary era of disease-modifying OA research. A structured evidence synthesis was performed of five principal prospective clinical investigations evaluating capacitively coupled PES for symptomatic knee OA. These included two randomized double-blind placebo-controlled trials, one multicenter phase IV investigation, one long-term observational study of arthroplasty deferral, and one histologic and radiographic study assessing structural cartilage changes. Collectively, the studies included 587 patients treated over more than 20 years. Clinical outcomes, functional improvement, medication utilization, safety, arthroplasty deferral, and structural findings were systematically reviewed and synthesized. Across investigations, PES consistently improved pain, physical function, physician and patient global assessments, and overall clinical status. Randomized controlled trials demonstrated significant improvements compared with placebo, while the multicenter phase IV study confirmed effectiveness in routine practice and identified a dose-response relationship, with superior outcomes following greater cumulative treatment exposure. Approximately 45% of patients reduced nonsteroidal anti-inflammatory drug use by at least 50%, and nearly 60% of compliant patients previously advised to undergo total knee arthroplasty deferred surgery for 4 years or longer. Tissue characterization in one patient, supported by radiographic observations in five additional patients, suggested hyaline-like cartilage formation and increased compartmental joint-space width. There were no serious device-related adverse events reported. More than two decades of prospective evidence suggest that PES improves pain, function, patient-reported outcomes, and clinical status while maintaining an excellent safety profile. These findings support a contemporary reappraisal of this technology as a nonoperative joint-preservation strategy for symptomatic knee OA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882540","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":"Declining Allograft Use in Young Females, Increasing Quadriceps Tendon Use, and Female-specific Adoption of Suspensory Fixation and Suture Augmentation During Anterior Cruciate Ligament Reconstruction.","authors":"Tracy M Tauro, Benjamin Hershfeld, Shebin Tharakan, Brandon Klein, Randy M Cohn, Nicholas A Sgaglione","doi":"10.1055/a-2939-2425","DOIUrl":"10.1055/a-2939-2425","url":null,"abstract":"<p><strong>Abstract: </strong>Contemporary anterior cruciate ligament reconstruction (ACLR) techniques have evolved, but whether these changes differ by sex remains unclear. This study evaluated sex-based temporal trends in graft selection, fixation strategy, and suture augmentation after primary ACLR. Following Institutional Review Board approval, a retrospective cohort study was performed within a large multicenter health system, which evaluated all primary ACLR procedures performed between 2014 and 2022 and were identified using Current Procedural Terminology code 29888. Adult patients (≥18 years) were included, while those with multiligamentous injuries or revision ACLR were excluded. Demographic and operative variables were analyzed by sex, and temporal trends were assessed using correlation and categorical analyses. A two-sided <i>p</i>-value <0.05 was considered statistically significant. Of 2,695 primary ACLR procedures identified, 1,781 met inclusion criteria, including 583 female patients (32.7%) and 1,198 male patients (67.3%), with a mean age of 31.2 ± 10.6 years. Autograft was used in 1,162 cases (65.2%). Autograft utilization was lower in females than males (58.5% vs. 68.5%, <i>p</i> < 0.001). Among females ≤25 years, allograft use declined from 26.3% in 2014 to 0.0% by 2022 (<i>r</i> = - 0.722, <i>p</i> = 0.015). Overall quadriceps tendon graft utilization, including both autograft and allograft sources, increased in both sexes, reaching 20.5% in females and 16.7% in males by 2022. In temporal analyses, quadriceps tendon allograft utilization increased among females (<i>r</i> = 0.719, <i>p</i> = 0.029), while quadriceps tendon autograft utilization increased among males (<i>r</i> = 0.772, <i>p</i> = 0.015). Suspensory fixation (<i>r</i> = 0.703, <i>p</i> = 0.034) and suture augmentation (<i>r</i> = 0.765, <i>p</i> = 0.016) increased significantly among female patients over time, while pin fixation declined in both females (<i>r</i> = - 0.692, <i>p</i> = 0.039) and males (<i>r</i> = - 0.765, <i>p</i> = 0.016). These findings demonstrated that contemporary ACLR technique selection evolved in a sex-specific manner, with distinct patterns in graft adoption and fixation strategy consistent with changing operative preferences over time.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800159","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":"Objective Quantification of Soft-Tissue Balance in Total Knee Arthroplasty: Expanded Validation of the Pendulum Knee Drop Test Across Multiple Surgeons.","authors":"Kevin Abbruzzese, Michael A Mont, Michael Dunbar, Jared Weir, Chase W Smitterberg, Sally LiArno","doi":"10.1055/a-2939-2643","DOIUrl":"https://doi.org/10.1055/a-2939-2643","url":null,"abstract":"<p><strong>Abstract: </strong>Despite increasing evidence showing major diversity in subjective balancing approaches, soft-tissue balance during total knee arthroplasty (TKA) remains primarily based upon empirical surgeon assessment. A quantitative technique for describing knee stiffness and laxity after TKA was previously introduced: the modified pendulum knee drop (PKD) test. This study expands upon prior validation work by evaluating the reproducibility of surgeon-directed balancing assessments compared with the modified PKD test across a larger cohort of arthroplasty surgeons. Robotic-assisted TKAs were performed on an advanced knee simulator model previously validated for ligament balancing investigations. After completing blinded polyethylene insert identification trials using manual balance assessments, eight high-volume arthroplasty surgeons underwent additional testing with the modified PKD test. During several testing cycles, polyethylene inserts ranging from 9 to 14 mm were randomly assigned and assessed. For both manual and PKD-assisted evaluations, accuracy, delta error, and intra- and interobserver reliability were computed. Stiffness and laxity behavior were described using oscillatory excursion measurements and logarithmic decrement values. Surgeons correctly identified polyethylene insert thickness manually in 60% of trials and within 1 mm in 84.2% of trials. In contrast, PKD-assisted balancing resulted in 97% correct insert identification (<i>p</i> < 0.001). The mean delta between surgeon-estimated and actual polyethylene thickness was 0.68 mm during manual assessment versus 0.05 mm with the PKD test (<i>p</i> < 0.001). Intraobserver reliability improved from a kappa of 0.61 during manual balancing to 0.96 with PKD assessment, while interobserver reliability improved from 0.38 to 0.97, respectively. The PKD test maintained highly reproducible thickness-independent stiffness ranking patterns across nearly all trials. High-volume arthroplasty surgeons demonstrated substantial variability during subjective soft-tissue balancing assessments, whereas the modified PKD test provided highly reproducible, objective biomechanical characterization of stiffness and laxity during TKA. These expanded findings further validate the PKD methodology as a reproducible tool to quantify soft-tissue knee laxity during robotic-assisted TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882559","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}