Journal of Knee Surgery最新文献

{"title":"Improved Posterior Slope of the Tibial Component in Unicompartmental Knee Arthroplasty Using an Offset Adjustment Method.","authors":"Yukio Akasaki, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Yasuharu Nakashima","doi":"10.1055/a-2835-3391","DOIUrl":"10.1055/a-2835-3391","url":null,"abstract":"<p><strong>Abstract: </strong>Achieving a consistent patient-specific posterior tibial slope (PTS) in unicompartmental knee arthroplasty (UKA) is critical. Current methods lack standardization, and the influence of offset adjustments on PTS reproducibility in UKA has not been studied. This study aimed to investigate the reproducibility of patient-specific PTS using a jig that adjusts the offset of the proximal and distal tibial rods in UKA. Sixty-four knees underwent UKA with the offset adjustment jig, and 64 served as controls. Preoperative and postoperative PTS were measured on lateral knee radiographs. Statistical analyses compared changes in PTS and outliers between groups. The offset adjustment group showed a moderate correlation (<i>R</i> = 0.53, <i>p</i> < 0.001) between preoperative and postoperative PTS, compared to a weak correlation (<i>R</i> = 0.32, <i>p</i> = 0.009) in the control group. The absolute PTS change was statistically significantly smaller in the offset adjustment group (1.2 degrees vs. 1.9 degrees, <i>p</i> = 0.009). Fewer outliers with PTS changes of 2 degrees or more were observed in the offset adjustment group. Using an offset adjustment jig in UKA significantly improves the reproducibility of patient-specific PTS, reducing deviations and potential biomechanical issues. This method is practical, cost-effective, and compatible with various implant models, offering a reliable solution for achieving precise PTS alignment without extending surgical time.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"608-612"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595474","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":"Fibromyalgia as a Risk Factor for Postoperative Complications Following Total Knee Arthroplasty.","authors":"Levi M Travis, Hallie B Remer, Aneesh V Samineni, Gilberto O Lobaton, Michele R D'Apuzzo","doi":"10.1055/a-2824-9079","DOIUrl":"10.1055/a-2824-9079","url":null,"abstract":"<p><strong>Abstract: </strong>Fibromyalgia is characterized by chronic, diffuse musculoskeletal pain and tenderness, associated with fatigue, sleep issues, brain fog, and depression. The effects of fibromyalgia on total knee arthroplasty (TKA) are yet to be fully understood. Previous analyses looking at patients with fibromyalgia undergoing primary TKA have shown an increased risk of developing postoperative complications; however, all have been conducted without controlling for other risk factors, including opioid use. We conducted a retrospective cohort study using the National Inpatient Sample to identify patients with fibromyalgia undergoing unilateral, primary TKA from 2016 to 2021. Patients with fibromyalgia were matched 1:1 to patients without fibromyalgia, accounting for age, sex, race, ethnicity, insurance, modified Elixhauser comorbidities, smoking, and opioid use. After matching, there were a total of 96,870 (<i>n</i> = 48,435 per group) patients who met the inclusion and exclusion criteria for this study. For those undergoing primary TKA, fibromyalgia was associated with higher rates of postoperative hypotension (3.11% vs. 2.68%, OR: 1.16, <i>p</i> < 0.01), anemia (14.51% vs. 13.60%, OR: 1.07, <i>p</i> < 0.01), atelectasis (0.71% vs. 0.59%, OR: 1.21, <i>p</i> < 0.01), urinary retention (1.28% vs. 1.09%, OR: 1.17, <i>p</i> < 0.01), fluid and electrolyte imbalance (6.46% vs. 5.82%, OR: 1.11, <i>p</i> < 0.01), intestinal obstruction (0.44% vs. 0.23%, OR: 1.95, <i>p</i> < 0.01), constipation (3.59% vs. 3.31%, OR: 1.08, <i>p</i> = 0.01), and delirium (0.58% vs. 0.44%, OR: 1.30, <i>p</i> < 0.01). A higher percentage of patients in the fibromyalgia cohort were not discharged directly home compared with the control (18.1% vs. 15.4%, <i>p</i> < 0.01). This present study showed that patients with fibromyalgia had higher rates of postoperative complications compared with a matched control cohort, even when accounting for opioid use.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"587-593"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367060","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 Artificial Intelligence Align with Evidence? Performance of ChatGPT-4o in Knee Osteoarthritis Surgical Guidelines.","authors":"Fernando García-Sanz, María Bravo-Aguilar, Lorena Canosa-Carro, María Blanco-Morales, Carlos Romero-Morales, Ángel González-de-la-Flor","doi":"10.1055/a-2802-2998","DOIUrl":"10.1055/a-2802-2998","url":null,"abstract":"<p><strong>Abstract: </strong>Artificial intelligence large language models (LLMs) such as ChatGPT are increasingly used in clinical settings, yet their reliability in reproducing evidence-based recommendations remains uncertain. This study aimed to evaluate the performance of ChatGPT-4o in addressing clinical practice guideline (CPG) recommendations for the surgical management of knee osteoarthritis and total knee arthroplasty (TKA). An observational cross-sectional design was conducted in September 2025. Twenty recommendations from the most recent American Academy of Orthopaedic Surgeons CPG on TKA were translated into structured clinical questions and submitted to ChatGPT-4o. Each query was entered three times in independent sessions to evaluate textual consistency. Two independent reviewers with expertise in musculoskeletal physiotherapy and orthopedics appraised the chatbot's answers, classifying them according to the CPG framework (\"should do,\" \"could do,\" \"do not do,\" \"uncertain\"). Agreement between reviewers and alignment with CPG recommendations were assessed using Cohen's and Fleiss' Kappa coefficients. ChatGPT-4o achieved an overall concordance of 60% with the CPG recommendations, representing fair agreement (κ = 0.392, <i>p</i> = 0.005). Internal text consistency across repeated trials was low, with several responses showing unacceptable similarity levels (<50%). Inter-rater reliability ranged from moderate to perfect (κ = 0.547-0.946). Although ChatGPT-4o provided clinically acceptable answers in several domains, discrepancies persisted, particularly in recommendations regarding functional outcomes and rehabilitation strategies. ChatGPT-4o demonstrated moderate accuracy and heterogeneous reliability when reproducing CPG recommendations for TKA. While the model may serve as a supportive tool for education and patient communication, its variability and incomplete adherence to guidelines highlight the need for cautious integration and professional oversight in clinical decision-making.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"575-580"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195884","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":"Tibial Slope Variation Across Coronal Plane Alignment of the Knee Phenotypes: A Three-Dimensional Computed Tomography-Based Analysis of Osteoarthritic Knees.","authors":"Vicente J León-Muñoz, José Hurtado-Avilés, Pablo Sanchez-Urgelles, Francisco Lajara-Marco, Mirian López-López, Fernando Santonja-Medina, Joaquín Moya-Angeler","doi":"10.1055/a-2796-8289","DOIUrl":"10.1055/a-2796-8289","url":null,"abstract":"<p><p>The Coronal Plane Alignment of the Knee (CPAK) classification system categorizes nine phenotypes based on constitutional limb alignment and joint line obliquity (JLO). Understanding relationships between CPAK phenotypes and tibial slope (TS) could streamline total knee arthroplasty planning. This study investigated the correlations between CPAK classification and medial TS in patients with osteoarthritis. A retrospective analysis of 622 cases in 535 patients with osteoarthritis undergoing primary total knee arthroplasty was conducted. Three-dimensional computed tomography imaging with MyPlanner software determined mechanical lateral distal femoral angle, mechanical medial proximal tibial angle, and medial TS. Statistical analysis included multiple linear regression, Pearson correlation, and one-way analysis of variance (ANOVA) with Tukey post hoc testing. Outliers were removed using interquartile range criteria, resulting in 581 knees for final analysis. Multiple linear regression revealed minimal correlation between coronal alignment and TS (TS = 26.35 - 0.1045 arithmetic hip-knee-ankle [aHKA] - 0.1004 JLO; <i>r</i> ² = 0.0233). aHKA angle and JLO explained only 2.33% of TS variance. Contour mapping demonstrated no discernible patterns in data distribution. Despite weak correlations, ANOVA identified statistically significant differences between CPAK groups for TS (<i>F</i> = 2.97; <i>p</i> = 0.003). Tukey post hoc analysis revealed significant differences between CPAK group I and groups V and VII, with mean differences ranging 1.39 to 2.06 degrees. No clinically meaningful relationship exists between CPAK classification and TS in osteoarthritic knees. While statistical significance differences were observed between certain CPAK groups, the extremely low correlation coefficient and small effect sizes indicate these differences fall within measurement variability and are substantially smaller than TS variations that influence total knee arthroplasty outcomes. CPAK classification cannot reliably predict sagittal plane morphology, necessitating an independent, comprehensive three-dimensional assessment of coronal and sagittal characteristics during surgical planning.Level III-Retrospective Comparative Study.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"559-566"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094725","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":"Common Peroneal Nerve Analgesia Considerations During Knee Posterolateral Corner Reconstruction.","authors":"Nicholas Newcomb, Ryan Price, Jordan A Buttner, Christopher Shultz, Christopher Arndt, Brandon Painter, Robert Schenck, Dustin Richter","doi":"10.1055/a-2824-8995","DOIUrl":"10.1055/a-2824-8995","url":null,"abstract":"<p><strong>Abstract: </strong>Peripheral nerve blockade is commonly employed as perioperative pain management for posterolateral corner (PLC) knee reconstructions. However, common peroneal nerve (CPN) analgesia limits immediate postoperative assessment (within 0.5-2 hours of surgery) for iatrogenic injury and may further cause a \"second hit\" injury in cases of preoperative CPN trauma. Meanwhile, lack of lateral knee analgesia may result in intractable pain and the need for postoperative \"rescue block.\" The incidence of iatrogenic peroneal nerve injury (from nerve block and/or surgical exploration) and frequency of \"rescue blockade\" remains unknown after PLC reconstruction. This study aims to identify the incidence of these events to inform the ideal perioperative anesthesia protocol. Patients who underwent PLC reconstruction at a single Level 1 academic institution were identified over a 4-year period. Medical records were queried for demographics, injury patterns, nerve blockade, surgical interventions, and perioperative nerve injury. Fifty knees were identified: 30 (60%) underwent preoperative CPN block, and 20 (40%) underwent CPN-sparing analgesia. Preoperative CPN injury was present in 20% of the cohort. Forty percent of these neurological injuries experienced improvement of symptoms shortly after neurolysis, while another 40% required further intervention. Factors determining avoidance of CPN analgesia were preoperative CPN injury (<i>p</i> = 0.030) and low-energy injury mechanism (<i>p</i> = 0.038). Of the CPN-sparing cohort, nine (45%) underwent a postoperative rescue block. Risk factors for rescue block were younger age (25.3 years vs. 39.8 years; <i>p</i> = 0.007) and lower BMI (26.5 kg/m² vs. 33.0 kg/m²; <i>p</i> = 0.035). Incidence of iatrogenic CPN palsy following PLC reconstruction was 6%, all of which were incomplete and did not require operative intervention. Incidence of iatrogenic CPN injury was low, with only incomplete nerve palsies that did not necessitate operative intervention. Avoidance of preoperative CPN blockade allowed for immediate postoperative neurologic evaluation. However, nearly half of the CPN-sparing cohort did require a postoperative \"rescue block.\" This risk was higher among younger patients with lower BMIs.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"594-601"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487736","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":"Is the Mini-Midvastus Approach for Total Knee Arthroplasty Any Better in Reducing Blood Loss and Hospital Stay?","authors":"Ahmet Can Erdem, Mehmet Erdem, Necmettin Turgut, Levent Bayam, Fevzi Sağlam, Muhammed Fatih Serttaş","doi":"10.1055/a-2796-8160","DOIUrl":"10.1055/a-2796-8160","url":null,"abstract":"<p><strong>Abstract: </strong>Total knee arthroplasty (TKA) is a widely used surgical intervention for advanced osteoarthritis, with evolving surgical techniques aiming to reduce blood loss and hospital stay. The minimally invasive midvastus (MMV) approach is hypothesized to minimize soft tissue damage and promote faster recovery compared to the classic medial parapatellar (MPP) approach. This study aimed to compare clinical and radiological outcomes, including perioperative blood loss and hospital discharge timing, between the MMV and MPP approaches. A total of 99 patients with advanced osteoarthritis who underwent primary TKA between 2013 and 2019 were prospectively analyzed. Patients were divided into MMV (<i>n</i> = 50) and MPP (<i>n</i> = 49) groups. All surgeries were performed by the same experienced surgeon using the same prosthetic system and perioperative protocols. Clinical outcomes included hemoglobin (Hb), hematocrit (Hct), discharge timing, range of motion (ROM), Visual Analog Scale (VAS), and Oxford Knee Score (OKS). Radiological outcomes included alignment and component positioning. Statistical analysis was conducted with significance set at <i>p</i> < 0.05. There were no significant differences between groups in demographic characteristics, surgical duration, alignment parameters (mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, component tibial angle, component femoral angle), VAS, OKS, or final ROM. Postoperative (day 0 and day 3) Hb and Hct values did not differ significantly, and no blood transfusions were required in either group. However, same-day discharge was significantly more common in the MMV group (<i>p</i> = 0.02). One wound complication occurred in the MPP group; one patient from each group required postoperative manipulation under anesthesia. While both surgical approaches provided comparable clinical and radiological outcomes with no differences in blood loss, the MMV approach was associated with a higher rate of same-day discharge, suggesting an advantage in early recovery and reduced hospital stay.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"567-574"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318638","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":"Impacts of National Centralized Procurement on Willingness to Undergo Total Knee Arthroplasty in China: A Propensity Score Matching Analysis of 6,522 Patients.","authors":"Zili Lin, Yang Zhan, Ping Zheng, Shengjian Weng","doi":"10.1055/a-2824-8662","DOIUrl":"10.1055/a-2824-8662","url":null,"abstract":"<p><strong>Abstract: </strong>This study aimed to evaluate the changes in hospitalization costs of patients with advanced knee osteoarthritis under the centralized procurement policy of artificial joint prostheses in China and to determine whether these changes are related to patients' willingness to undergo surgery. A total of 7,189 patients with advanced knee osteoarthritis who visited the orthopedic outpatient department of Fuzhou Second General Hospital from May 2020 to April 2024 were included in this study. Patients were categorized into a control group according to the implementation timing of the national centralized procurement (NCP) and an NCP group. Data recorded included the patient's sex, age, date of treatment, decision to undergo surgical treatment, and for patients who did undergo surgical treatment, hospitalization costs and related composition, length of hospital stay, duration of surgery, and type of medical insurance. Of the 7,189 patients included, 3,427 were categorized into the control group and 3,762 patients into the NCP group. A total of 3,261 pairs of patients were successfully matched using the propensity score matching (PSM) method. Surgical intervention was received by 1,374 patients (42.1%) in the control group and 1,662 (51.0%) in the centralized procurement group. Pearson's chi-square test revealed a significant difference in surgical intention between the two groups (<i>p</i> < 0.001). Comparison of pre- and postcentralized procurement data for patients who underwent surgery showed a significant reduction in hospitalization and consumable costs after the introduction of centralized procurement (<i>p</i> < 0.001). The centralized procurement policy for artificial joint prostheses introduced in China has significantly reduced hospitalization costs for patients with advanced knee osteoarthritis and has increased their willingness to undergo surgery.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"602-607"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349437","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":"Metal Hypersensitivity in Total Knee Arthroplasty: Innovation Disproportionate to Clinical Necessity.","authors":"Katharine P Playter, Hannah I Travers, Zachary L McBeth, Mikhail Kuznetsov, Sophia M Ly, Ruijia Niu, Carl T Talmo, Ran Schwarzkopf, Eric L Smith","doi":"10.1055/a-2824-9142","DOIUrl":"10.1055/a-2824-9142","url":null,"abstract":"<p><strong>Abstract: </strong>Metal hypersensitivity in patients undergoing total knee arthroplasty (TKA) remains a poorly defined clinical entity. This study aimed to characterize the clinical burden of metal hypersensitivity in a national database. The primary objective was to evaluate trends in metal hypersensitivity diagnosis in the general and TKA populations, as well as the TKA revision rate in patients with and without metal hypersensitivity. Secondary objectives were to identify trends in the release of \"metal-sensitive\" joint replacement alternatives. A retrospective analysis was conducted using the Merative MarketScan Commercial and Medicare Supplemental databases from January 2018 to December 2023. Patients with a diagnosis of metal hypersensitivity were identified using International Classification of Diseases, 10th Edition (ICD-10) codes. Annual incidence was calculated for the general population and for patients undergoing TKA. TKA revision rates were calculated for patients with and without metal hypersensitivity. Secondary analyses assessed the incidence of novel TKA implants that are specifically advertised as \"metal sensitive.\" The overall incidence of metal hypersensitivity in the general database population ranged from 0.019 to 0.025%. Patients undergoing TKA demonstrated significantly higher rates of metal allergy diagnosis (<i>p</i> < 0.001, annually), with the overall incidence ranging from 0.133 to 0.165%. Nonsignificant downward trends in the incidence of metal hypersensitivity were noted in both the general and TKA populations. Patients with metal hypersensitivity had TKA revisions at a rate that was significantly higher than those who did not (14.03% vs. 3.15%; <i>p</i> < 0.001). Patients with a diagnosis of metal allergy represented 0.68% of all revision cases. Seven novel orthopedic implants with explicit \"metal sensitive\" marketing were released between 2018 and 2025. This national database study demonstrates low and stable rates of metal hypersensitivity among both the general and TKA patients. There was no change in the incidence of metal hypersensitivity in either population over time. Patients with metal hypersensitivity represented less than 1% of TKA revisions. These findings challenge the value of medical device development for niche markets.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"581-586"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147367034","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 Functional Outcomes and Implant Positioning between a CT-based, Semi-active Robotic System and a CT-free Passive Robotic System in Total Knee Arthroplasty.","authors":"Zachary Jieyi Cheong, Abel Kai Yi Chen, Zian Cheng, Denzel Ming Wei Lim, Tan Tong Leng, Lynn Thwin","doi":"10.1055/a-2939-2755","DOIUrl":"https://doi.org/10.1055/a-2939-2755","url":null,"abstract":"<p><strong>Abstract: </strong>Robotic Total Knee Arthroplasties (TKAs) have gained popularity over recent years, having been shown to achieve better component alignment than conventional TKAs. However, few studies have compared the different robotic systems. This study was conducted to compare the functional outcomes and implant positioning between a computed tomography (CT) based, semi-active robotic system and a CT-free, passive robotic system. A single-centre propensity score matched retrospective study was conducted comparing 181 CT-based and 113 CT-free cases. Patient reported outcome measures including Oxford Knee Score (OKS), Knee Society Score - Function (KSS-F), Visual Analogue Scale (VAS) pain score and Passive Range of Motion (ROM) were evaluated preoperatively and at 3 months, 1 year and 2 years postoperatively. Postoperative radiographs including lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip knee angle (HKA), femoral flexion and posterior tibial slope (PTS) were also measured. Postoperatively, the CT-based group had better KSS-F scores at 1 year (78.2 vs. 65.9) and 2 years (78 vs. 72), exceeding previously documented MCIDs. Better OKS scores were also demonstrated at 2 years (41.7 vs. 39.8) in the CT-based group. However this does not exceed previously documented MCIDs and is likely clinically insignificant. There was no significant observable difference in VAS pain score and passive ROM. The CT-based group also demonstrate better surgical accuracy, with MPTA (90.0° vs. 87.8°) and HKA (_0.22° vs. _2.52°) closer to planned targets of mechanical alignment. Femoral flexion (3.22° ± 0.37° vs 0.15° ± 0.47°, <i>p</i> = 0.001) was also closer to the target of 3° of flexion. There was no significant difference in posterior tibial slope. We conclude that a CT-based, semi-active robotic system resulted in better functional outcomes and implant positioning than a CT-free passive robotic system.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867453","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 Adductor Canal Block After Knee Manipulation Reduce Postmanipulation Opioid Prescribing or Improve Range of Motion?","authors":"Matthew T Geiselmann, Kevin Chang, Fernando A Huyke-Hernández, David M Glatt, James A Germano, Bradley Gerber","doi":"10.1055/a-2939-2815","DOIUrl":"10.1055/a-2939-2815","url":null,"abstract":"<p><strong>Abstract: </strong>Manipulation under anesthesia (MUA) is a noninvasive intervention commonly performed after total knee arthroplasty (TKA) for persistent knee stiffness unresponsive to conservative measures. Adjunctive strategies, including periarticular injections and regional anesthesia, have been proposed to improve pain control and outcomes following MUA. This study evaluated whether adductor canal block (ACB) at the time of MUA reduces postoperative opioid use and improves range of motion (ROM). We performed a retrospective review of 83 consecutive patients undergoing MUA after TKA between October 2021 and April 2024 at a single institution. All patients after June 28, 2023, were offered ACB per an initiative set by the institution's Department of Anesthesia. Patients receiving ACB after the initiative were compared with controls prior to the initiative. Five patients were excluded (four lost to follow-up, one due to concomitant open lysis of adhesion), leaving 78 patients: 39 received ACB and 39 served as controls. Demographic variables collected included age, sex, and relevant medical comorbidities. Clinical variables comprised time to manipulation, pre- and postmanipulation ROM, and postoperative opioid prescription data. Mean time to MUA was 76.6 days after TKA; controls underwent earlier manipulation (64.2 days vs. 88.9 days). Premanipulation ROM ranged from 4.3 to 84.1 degrees in controls and 2.8 to 85.5 degrees in the ACB group. At 2 weeks, ROM improved to 2.5 to 102.7 degrees and 1.2 to 101.8 degrees, respectively (<i>p</i> = 0.821). Eighteen patients (23.1%) received opioid prescriptions within 30 days, most commonly oxycodone 5 mg. Opioids were prescribed to seven (17.9%) of controls and eleven (28.2%) of ACB patients (<i>p</i> = 0.345). Mean morphine milligram equivalents were 43.7 (SD: 115.9) and 70.6 (122.3), respectively (<i>p</i> = 0.225). The remaining patients did not require opioid prescriptions during the postmanipulation period. MUA resulted in short-term ROM improvement regardless of ACB use. Although the ACB group underwent later manipulation, both groups achieved comparable gains at 2 weeks. ACB was not associated with reduced opioid prescribing or improved ROM, suggesting no measurable benefit in this setting.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800233","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}