Journal of Knee Surgery最新文献

{"title":"Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Augmentation: A Bibliometric Analysis of the Top 100 Cited Articles.","authors":"Osama Z Alzobi, Hamad Almannai, Ashraf Hantouly, Loay A Salman, Abdulaziz F Ahmed, Khalid A Alkhelaifi, Bashir Zikria","doi":"10.1055/a-2608-0220","DOIUrl":"10.1055/a-2608-0220","url":null,"abstract":"<p><p>There has been significant exploration into anterior cruciate ligament (ACL) reconstruction with lateral extra-articular augmentation, with a marked increase in research output over the past 10 years. This study aims to conduct a thorough bibliometric analysis of the most influential publications on ACL reconstruction combined with lateral extra-articular augmentation. This research is a cross-sectional study, classified as level 4 evidence. In July 2024, a thorough search was conducted utilizing the Web of Science Core Collection and Google Scholar databases to identify studies related to ACL reconstruction with lateral extra-articular augmentation. The 100 most cited articles that met the established inclusion criteria were carefully selected and subjected to an in-depth bibliometric analysis. The top 100 cited articles were published between 1976 and 2020, with a notable concentration during the 2010s. Citation counts for these articles ranged from 125 to 1,000, with citation density varying between 3.32 and 113.00. The United States led in both the number of publications and citations, followed by France and Italy. The majority of the studies focused on anatomical and biomechanical topics, with a growing presence of high-level evidence studies, including 15 classified as levels 1 or 2 evidence. The period from 2010 to 2020 witnessed a significant surge in the publication of the top 100 most cited articles, highlighting their scientific relevance in specialized areas. The diversity of study types, predominantly anatomical and biomechanical, reflects the substantial interest in this field, coupled with an increase in high-evidence-level research, with 15 articles classified as levels 1 or 2. The United States stands out, contributing 31% of these articles, with notable input from France and Italy. This review provides valuable insights into global research trends and outlines potential directions for future research.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"580-591"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081587","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":"Reliability of a Novel Magnetic Resonance Imaging Scoring System to Evaluate Patellofemoral Osteoarthritis.","authors":"Tyler J Uppstrom, Guilherme Palhares, Robert Cecere, Giuseppe Anzillotti, Connor F Fletcher, Emily Davidson, Alissa Burge, Sabrina M Strickland","doi":"10.1055/a-2585-4964","DOIUrl":"10.1055/a-2585-4964","url":null,"abstract":"<p><p>Knee osteoarthritis is a common degenerative or posttraumatic condition associated with significant pain and disability among patients. Isolated patellofemoral osteoarthritis (PFOA) occurs in approximately 24% of women and approximately 11% of men aged >55 years presenting with knee pain. In contrast to the tibiofemoral compartments, the current literature lacks a reliable magnetic resonance imaging (MRI) scoring system for quantitative evaluation of patellofemoral cartilage degeneration. This study aimed to describe, apply, and assess the interobserver reliability of a novel MRI scoring system for assessment of the patellofemoral cartilage. Patients who underwent patellofemoral arthroplasty for isolated PFOA between January 2012 and December 2021 were identified. Preoperative MRI scans were performed on 3.0-Tesla magnets utilizing dedicated extremity coils and standardized clinical imaging protocols consistent with International Cartilage Regeneration and Joint Preservation Society (ICRS) guidelines for the assessment of articular cartilage. A novel semiquantitative MRI patellofemoral scoring system included assessment of patellar and trochlear cartilage, bony architecture, patellofemoral alignment, and synovitis. Interobserver agreement was assessed using Cohen's Kappa coefficient for categorical variables, and the intraclass correlation coefficient (ICC) was used for the total score. A total of 72 knee MRIs were included in the final analysis. Patellar bone edema (kappa = 0.61) and patellar cysts (kappa = 0.59) demonstrated moderate interobserver agreement. All cartilage features, trochlear bone edema and cysts, osteophytes, subchondral remodeling, patellar height, and synovitis demonstrated good interobserver agreement (kappa > 0.61). Patellofemoral alignment and total score demonstrated excellent interobserver agreement (kappa > 0.81). The novel MRI scoring system for PFOA proposed in this study represents a comprehensive method to assess patellofemoral joint cartilage degeneration, including evaluation of patellar and trochlear cartilage changes, bony architecture, patellofemoral alignment, and synovitis. Importantly, all features of the scoring system demonstrated at least moderate interobserver agreement, with the majority of variables and total score demonstrating good to excellent agreement.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"555-562"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188317","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":"Variable Return-to-Sport Rates with Improved Pain and Patient-Reported Outcomes Following Osteochondral Allograft Transplantation: A Systematic Review.","authors":"Justin Fengyuan Xie, Garrett R Jackson, Justin T Childers, Benjamin T Lack, Colton C Mowers, Steven F DeFroda, Clayton W Nuelle","doi":"10.1055/a-2585-4806","DOIUrl":"10.1055/a-2585-4806","url":null,"abstract":"<p><p>Osteochondral allograft transplantation (OCA) of the knee is a reliable surgical technique for managing symptomatic full-thickness chondral lesions ≥2 cm² in young and active patients. There is a need for comprehensive analysis of recent studies among a growing body of literature to better understand the outcomes of OCA among athletic patients, particularly in terms of return to sports participation and graft longevity. To systematically review existing literature reporting the return-to-sport (RTS) outcomes and patient-reported outcome measures (PROMs) following OCA of the knee among athletic patients. A systematic review was performed in PubMed, Web of Science, and Embase from database inception through December 22, 2024. Studies that reported RTS outcomes after knee OCA were included. Data were analyzed descriptively, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies. Inclusion criteria were met by 13 studies involving 699 patients. The mean patient age was 31.8 years (range 15.2-52.6), with a mean follow-up of 59.9 months (range 24-87.5). Reported RTS rates ranged from 59.4 to 90.9%. The mean time to RTS ranged from 9.0 to 14.6 months; one study documented a median RTS time of 16 months. Between 27.3 and 79.1% of athletes made RTS at the same level, 13.5 to 63.6% at higher levels, and 9.1 to 31.6% at lower levels. Significant (<i>p</i> < 0.05) improvements were noted in Tegner (delta -1.8 to 1.4), Visual Analog Scale-Pain (delta -5.7 to -3.7), and International Knee Documentation Committee scores (delta 25 to 33.0). The most common complications were deep vein thrombosis/pulmonary embolism (1.3%), symptomatic hardware (0.72%), and infections (0.72%). Graft failure ranged from 0 to 10.8%, and reoperation from 0 to 50%. OCA of the knee demonstrates variable RTS rates, with improved postoperative pain and outcomes scores. Graft failure occurred in 0 to 10.8% of patients. IV, Systematic Review of Level III and IV studies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"563-574"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005054","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":"National Football League Players Have Higher Rates of Knee Extensor Mechanism Tears During Short and Normal Rest Weeks versus Long Rest Weeks.","authors":"Warren G Haralson, Ashwin R Garlapaty, John Baumann, Garrett R Jackson, James L Cook, Steven F DeFroda","doi":"10.1055/a-2585-5099","DOIUrl":"10.1055/a-2585-5099","url":null,"abstract":"<p><p>Lower extremity injuries, particularly knee injuries, in National Football League (NFL) players are common. Extensor mechanism ruptures often require season-ending surgery. These ruptures, involving structures like the quadriceps and patellar tendons, are caused by powerful movements that overload the knee. Research on NFL injury risk factors, including time between games, is growing, but studies on rest periods and knee injuries have shown mixed results and are limited in scope. No prior research has specifically examined extensor mechanism tears in relation to short, normal, or long rest periods between games. Using publicly accessible resources (NFL injury reports, Pro-Football-Reference.com, and ESPN.com), an online search was conducted to identify NFL players who tore their quadriceps tendon or patellar tendon between the 2009 and 2023 seasons. Only regular season injuries after week 1 were included. The date of injury and prior game date were collected in order to calculate the length of rest. Next, each injury was categorized as a short (<7 days), normal (7 days), or long (>7 days) week injury. Other factors, such as age, football position, and playing surface (natural grass or artificial turf), were also collected. A total of 58 players met inclusion criteria. There was no difference in extensor mechanism injury rates between short weeks and normal weeks. Players were 4.7 times more likely to tear their extensor mechanism during normal weeks than long weeks (<i>p</i> = 0.0039) and 3.7 times more likely to tear their extensor mechanism during short weeks than long weeks (<i>p</i> = 0.0385). Regarding playing surface, extensor mechanism tears were more likely to occur on artificial turf than natural grass (<i>p</i> = 0.0324). During the 2009-2023 NFL seasons, players were found to have 4.7 times higher rates of knee extensor mechanism tears during short (<7 days) rest weeks and 3.7 times higher rates during normal (7 days) rest weeks between games, when compared to long (>7 days) rest weeks. There was no difference in knee extensor mechanism injury rates between the short and normal rest weeks. LEVEL OF EVIDENCE:  Level III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"549-554"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047800","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":"Comment on \"The 10-Year Outcomes of Single- versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review\".","authors":"Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1055/a-2584-4584","DOIUrl":"10.1055/a-2584-4584","url":null,"abstract":"","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"592-593"},"PeriodicalIF":1.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052792","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":"Graft Angle, Intercondylar Notch Osteophytes, and Tibial Tunnel Abnormalities Influence Graft Impingement After Anterior Cruciate Ligament Reconstruction: A Retrospective MRI-Based Study.","authors":"Miao Wu, Zebin Yang, Jieping Xu, Kangfei Shan, Chijun Ma, Fenhua Zhao, Chunlong Fu","doi":"10.1055/a-2684-8287","DOIUrl":"https://doi.org/10.1055/a-2684-8287","url":null,"abstract":"<p><p>Graft impingement is a critical cause of anterior cruciate ligament reconstruction (ACLR) failure. Identifying its contributing factors is essential for improving surgical outcomes. This retrospective study aimed to evaluate the incidence of graft impingement following ACLR using magnetic resonance imaging (MRI) and to investigate potential anatomical and surgical risk factors. The findings are intended to provide theoretical support for reducing impingement rates and enhancing functional recovery. We retrospectively reviewed clinical and MRI data of 122 patients (68 males and 54 females) who underwent ACLR at our institution from January 2015 to December 2023. MRI was used to identify graft impingement and to measure potential anatomical and surgical factors, including graft angle, posterior tibial slope, tibial intercondylar eminence angle, intercondylar notch width, notch height, and roof inclination, tibial tunnel position, preoperative and postoperative tibial displacement (measured as anterior tibial translation), and concomitant injuries. Patients were categorized based on the presence or absence of impingement. Univariate analysis was followed by multivariable logistic regression to identify independent risk factors. Graft impingement occurred in 65 patients (53.3% of cases). Multivariable logistic regression revealed that smaller graft angles (odds ratio [OR] = 0.930, 95% confidence interval [CI]: 0.873-0.991, <i>p</i> = 0.026), anterior-inferior osteophytes of the intercondylar notch roof (OR = 3.620, 95% CI: 1.408-9.311, <i>p</i> = 0.008), bony abnormalities at the tibial tunnel inlet (OR = 3.814, 95% CI: 1.509-9.632, <i>p</i> = 0.005) and postoperative tibial displacement >5 mm (OR = 6.573, 95% CI: 1.120-38.582, <i>p</i> = 0.037) were independent risk factors for graft impingement. Graft impingement after ACLR is independently associated with reduced graft angle, anterior-inferior osteophytes of the intercondylar notch, excessive postoperative tibial displacement, and bony protrusions at the tibial tunnel inlet. These findings emphasize the importance of accurate tunnel positioning and anatomical assessment during surgery to improve patient outcomes.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975326","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":"Extra Attention Should Be Paid to Patellar Resurfacing to Obtain Good Postoperative Patellar Tracking in Bicruciate Substituting Total Knee Arthroplasty.","authors":"Shigeshi Mori, Kotaro Yamagishi, Naohiro Oka, Akihiro Moritake, Tomohiko Ito, Nobuhisa Shokaku, Kenji Yamazaki, Masaaki Miyazato, Koji Goto, Daisuke Togawa","doi":"10.1055/a-2684-8426","DOIUrl":"10.1055/a-2684-8426","url":null,"abstract":"<p><p>Bicruciate-substituting total knee arthroplasty (BCS-TKA) mimicking normal knee anatomy contributes to the physiological knee kinematics of the tibiofemoral joint; however, potential disadvantages have been predicted regarding the patellofemoral joint environment. This study aimed to compare the postoperative patellar tracking of BCS-TKA with that of posterior stabilized (PS)-TKA and explore the surgical factors necessary for achieving good postoperative patellar tracking. The patellar tilt angle (PTA) of the resurfaced patella 1 month and 1 year after surgery was retrospectively compared in 160 knees (80 BCS-TKA and 80 PS-TKA). The factors influencing patellar tracking, postoperative coronal limb alignment, femoral and tibial component position and axial rotation, patellar resection angle, patellar component position, and change in patellar thickness after resurfacing were evaluated. Then, the correlation between the postoperative PTA and each surgical factor was analyzed. The mean postoperative PTA significantly increased from 1 month to 1 year after surgery in BCS-TKA (6.3 ± 4.9 degrees [standard deviation] to 7.9 ± 5.8 degrees, <i>p</i> < 0.001) but not in PS-TKA. The 1-year postoperative lateral patellar tilt was significantly greater in BCS-TKA than in PS-TKA (7.9 ± 5.8 degrees vs. 4.4 ± 5.0 degrees, <i>p</i> < 0.001). The patellar resection angle positively correlated with the 1-year postoperative PTA in both groups (<i>r</i> = 0.46 and 0.40). Medial patellar component positioning showed a strong negative correlation with the 1-year postoperative PTA in BCS-TKA and a moderate correlation with PS-TKA (<i>r</i> = -0.63 and -0.38). Multivariate regression analysis showed that the patellar resection angle and patellar component position influenced 1-year postoperative patellar tilt in BCS-TKA and PS-TKA. Postoperative patellar tracking in BCS-TKA, in which the femur is positioned more anteriorly relative to the tibia, tended to be more prone to lateral inclination than in PS-TKA. For better patellar tracking, extra attention should be paid to parallel patellar resection and central patellar component positioning during patellar resurfacing in BCS-TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876308","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":"Simulated Wear and Fatigue Performance of Cobalt-Chrome-Molybdenum and Co-Cr-Free Nitrided Titanium Femoral Components in Primary Total Knee Arthroplasty.","authors":"Michael S Ramos, Kimberly D Mimnaugh, Shujaa T Khan, Diego A Orozco-Villasenor, Mackenzie Schultz, Nicolas S Piuzzi","doi":"10.1055/a-2684-8621","DOIUrl":"10.1055/a-2684-8621","url":null,"abstract":"<p><p>Cobalt-chromium-molybdenum (Co-Cr-Mo) femoral components are widely used in total knee arthroplasty (TKA) due to their mechanical strength and wear performance. However, concerns regarding corrosion, metal ion release, and hypersensitivity have prompted the development of alternative materials, including nitrided titanium-aluminum-vanadium (nTi-6Al-4V). This study aimed to compare the simulated wear performance of Co-Cr-Mo and nTi-6Al-4V femoral components when articulated against conventional polyethylene articular surface bearings and evaluate the fatigue performance of nTi-6Al-4V components. In vitro wear testing, per ISO 14243-3, was conducted for 5 million cycles (Mc) using posterior-stabilized Persona Primary knee system femoral components manufactured from Co-Cr-Mo and nTi-6Al-4V coupled with conventional ultra-high-molecular-weight polyethylene articular surfaces. Mean steady-state wear rates (mg/Mc) of the articular surface bearings were gravimetrically determined. Surface roughness (Ra) measurements of the femoral components and the articulating surfaces were captured using a contacting stylus profilometer. Polyethylene wear debris morphology was also analyzed. Two fatigue loading scenarios (cantilever loading and three-point bend) of the posterior condyles of femoral components were completed for 10 Mc. The mean steady-state wear rate of the nTi-6Al-4V bearing couple (17.0 ± 1.8 mg/Mc) was noninferior to the Co-Cr-Mo bearing couple (22.8 ± 6.7 mg/Mc). No statistically significant differences were found in the Ra measurements of femoral components or articular surfaces before and after 5.0 Mc (<i>p</i> = 0.21). No statistical difference in polyethylene debris morphology was observed between components (<i>p</i> = 0.07). In both fatigue loading scenarios, no fracture or cracking of the nTi-6Al-4V femoral components occurred. The Co-Cr-Mo and nTi-6Al-4V bearing couples performed similarly regarding mean steady-state wear rates, Ra measurements, and debris morphology in simulated wear conditions. These results provide insights into the wear properties of Co-Cr free femoral TKA components. Additionally, the nTi-6Al-4V components met the performance requirements related to posterior condyle fatigue strength. Further clinical studies are needed to confirm these in vitro findings.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876309","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":"Risk Factors for Surgical Site Infection following External Fixation and Osteosynthesis of Patients with Tibial Plateau Fracture.","authors":"José Eduardo N Forni, Caio Henrique N Rabesquine, Wahi Jalikj","doi":"10.1055/a-2664-7448","DOIUrl":"https://doi.org/10.1055/a-2664-7448","url":null,"abstract":"<p><p>Tibial plateau fractures account for approximately 1% of all fractures and normally occur as low- or high-energy injuries. This study aims to assess risk factors for site infection following external fixation and osteosynthesis of patients with tibial plateau fracture. A retrospective study was conducted involving the records of patients with Schatzker types I, II, III, IV, V, and VI tibial plateau fractures submitted to external fixation by the emergency ward staff, followed by internal fixation with definitive osteosynthesis after improvement of the soft tissues by the knee surgery team. The following data were collected: energy of fracture, presence/absence of exposed fracture, time between injury and emergency care, time between external fixation and definitive osteosynthesis, comorbidities, number of access routes, duration of surgery, number of participants in surgery, type of surgeon (resident or professor), distance from Schanz screws to focus of the fracture, type of fracture according to the Schatzker classification, and patient age. Among the 137 patients studied, mean age was 43.4 ± 13.8 years, 72.9% were male, 5.1% had diabetes; 43% had Schatzker VI tibial fracture; 82.4% of the fractures were caused by high-energy trauma; 90.5% had closed fractures; 100% used an external fixator prior to definitive osteosynthesis; and 49.6% had dual surgical access (medial and lateral). The prevalence of infection at the surgical site was 19.7%. In the comparison of patients with and without infection, a significant difference was found in the distance between the Schanz screws and focus of fracture (<i>p</i> = 0.0093), which was smaller in patients with infection at the surgical site. A longer time of external fixator use was also associated with the occurrence of infection at the surgical site (<i>p</i> = 0.0283). In conclusion, the positioning of Schanz screw that is an important factor for infection of surgical site, with risk of infection higher in individuals with screws closer to the focus of fracture. Duration of external fixator use may also increase risk of infection after definitive osteosynthesis.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856725","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":"Robotically Assisted Medial Reduction Osteotomy: A Technique Based on the Pythagorean Theorem.","authors":"Olivia J Bono, Christopher Wester, James V Bono","doi":"10.1055/a-2664-7508","DOIUrl":"10.1055/a-2664-7508","url":null,"abstract":"<p><p>Varus deformity can present a significant challenge for limb alignment correction and balancing in total knee arthroplasty (TKA). One technique to address these challenges is a medial reduction osteotomy. This article describes utilization of a robotic platform to perform a safe and accurate medial subtraction osteotomy prior to balancing and bony resections. Deformity correction can be predicted by the Pythagorean Theorem. Computed tomography-based robotic systems can be used to perform medial reduction osteotomy of the tibia in the setting of significant varus deformity in patients undergoing TKA. Prior to balancing and bony cuts, the tibial component is downsized \"virtually\" from the planned size. Through lateralization of the component, the excess medial bone can be mapped via tracking of the registration probe and removed. The amount of medial tibial bone resected determines the amount of laxity that will be created when the tibia is reduced under the femur when implants are placed. Following this, soft tissue tensioning, planning, bony resections, and trialing can progress as normal for a robotic total knee. Through the described technique, the authors have been able to predict the amount of coronal plane correction based on the size of the osteotomized fragment using the Pythagorean Theorem. Robotic guidance of a medial subtraction osteotomy provides a safe and predictable means of varus correction. This is beneficial in that it can be performed with great accuracy and prior to any further balancing maneuvers or bony cuts.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144734467","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}