Journal of Knee Surgery最新文献

{"title":"Efficacy of Intra-Articular Tranexamic Acid in Reducing Early Postoperative Swelling and Pain Following Arthroscopic ACL Reconstruction: A Randomized Comparative Study.","authors":"Bushu Harna, Shivali Arya, Anil Kapoor","doi":"10.1055/a-2835-3526","DOIUrl":"10.1055/a-2835-3526","url":null,"abstract":"<p><strong>Abstract: </strong>Postoperative pain, swelling, and hemarthrosis are common early complications following arthroscopic anterior cruciate ligament (ACL) reconstruction. These complications can impede early rehabilitation and negatively affect patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing perioperative blood loss in various orthopaedic surgeries. However, evidence regarding its intra-articular use in ACL reconstruction is still evolving.</p><p><strong>Abstract: </strong>The purpose of this study was to evaluate the efficacy and safety of intra-articular TXA in reducing early postoperative swelling, pain, and wound soakage following arthroscopic ACL reconstruction.</p><p><strong>Abstract: </strong>This randomized controlled trial included 100 patients undergoing primary arthroscopic ACL reconstruction. Participants were randomized into two groups (<i>n</i> = 50 each). Group 1 received 1 g (10 mL) of intra-articular TXA at the end of surgery, while Group 2 received 10 mL of normal saline. Postoperative outcomes assessed included wound soakage, swelling (graded 0-3), and pain using the Visual Analog Scale (VAS) on postoperative day 3. Functional and pain outcomes were evaluated at 6 months using the Lysholm Knee Score and VAS.</p><p><strong>Abstract: </strong>The TXA group demonstrated significantly lower swelling scores (mean 0.9 vs. 1.8, <i>p</i> < 0.001), reduced VAS pain scores on day 3 (mean 3.2 vs. 4.8, <i>p</i> < 0.001), and no cases of wound soakage compared to eight cases in the control group (<i>p</i> < 0.05). At 6 months, both groups had comparable Lysholm scores and VAS pain scores, indicating similar short-term outcomes. No adverse events were reported in either group.</p><p><strong>Abstract: </strong>Intra-articular TXA significantly improves early postoperative outcomes in arthroscopic ACL reconstruction by reducing pain, swelling, and wound soakage. TXA is safe and may be considered a part of enhanced recovery protocols in ACL surgery.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"554-558"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522500","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":"Magnetic Resonance Imaging as a Stand-Alone Tool Fails to Accurately Assess Medial Patellofemoral Ligament Integrity: A Radiographic Analysis.","authors":"Harrison A Volaski, Joshua L Stich, Ethan S Krell, Daniel C Berman, Yungtai Lo, Lee Thompson, Mauricio Drummond, Micheal D Hossack, Benjamin J Levy","doi":"10.1055/a-2796-8709","DOIUrl":"10.1055/a-2796-8709","url":null,"abstract":"<p><p>The medial patellofemoral ligament (MPFL) is of critical importance for patellar stability and is universally incompetent in patients with patella dislocations. However, radiological (magnetic resonance imaging [MRI]) assessment of the MPFLs' integrity following dislocation is variable, adding confusion to patients and providers during treatment decision-making. We aimed to assess the reliability of MRI to evaluate MPFL integrity by measuring inter- and intraobserver agreement between a musculoskeletal radiologist and an orthopaedic surgeon, specializing in sports medicine using a novel standardized MRI-based scoring system. We anticipated higher intraobserver than interobserver reliability of MPFL integrity. We retrospectively reviewed 100 consecutive knee MRIs: 50 from patients with a clinical history of recent acute patellofemoral dislocation and 50 controls drawn from an anterior cruciate ligament (ACL) injury cohort who had no history or clinical symptoms of patellar instability. Two blinded reviewers, an orthopaedic surgeon with fellowship training in sports medicine and subspecialty expertise in patellofemoral pathology, and a fellowship-trained musculoskeletal radiologist, independently evaluated the MPFL on axial MRIs. Demographic characteristics (age, body mass index, sex) did not differ significantly between the instability and control groups. Eight percent of patellar instability patients had their MPFL graded as \"intact\" in our first review. Twenty-six percent of ACL control patients had their MPFL graded as at least attenuated. Intraobserver reliability was substantial to excellent and interobserver reliability was fair to moderate. Our findings demonstrate that MRI-based evaluation of MPFL integrity lacks the consistency and accuracy required for confident clinical decision-making and that MRI findings do not universally correlate with clinical history. These findings support a growing consensus that current imaging analyses alone are insufficient for surgical decision-making in patellofemoral instability, particularly in the assessment of the MPFL.Level III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"516-520"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127261","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":"Obesity, Anemia, and Chronic Obstructive Pulmonary Disease Identified as Key Risk Factors of Superficial Wound Washouts After Total Joint Arthroplasty.","authors":"Nicholas Stratigakis, Oscar Champigneulle, Rachel Baum, Quais Naziri","doi":"10.1055/a-2796-8070","DOIUrl":"10.1055/a-2796-8070","url":null,"abstract":"<p><strong>Abstract: </strong>Superficial surgical site infections (SSIs) limited to the skin and subcutaneous tissue following total joint arthroplasty (TJA) remain a significant source of patient morbidity, often necessitating surgical irrigation and debridement (I&D). While risk factors for deep infections such as periprosthetic joint infections are well studied, predictors of superficial SSIs managed with I&D remain underexplored. A retrospective cohort analysis was performed using the PearlDiver Mariner10 capturing over 161 million patients across inpatient and outpatient settings in the United States. Patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2010 and 2022 were identified and stratified by the occurrence of subsequent wound I&D. Patients who underwent prosthetic revision were excluded to isolate superficial infections. A total of 54,868 THA and 103,235 TKA patients were identified, with 405 (0.738%) and 568 (0.549%) requiring I&D, respectively. Among THA patients, significant predictors of superficial SSI requiring I&D included obesity (odds ratio [OR]: 1.91, <i>p</i> < 0.001), hypothyroidism (OR: 1.45, <i>p</i> = 0.005), anemia (OR: 1.64, <i>p</i> < 0.001), Type II diabetes mellitus (OR: 1.70, <i>p</i> < 0.001), and chronic obstructive pulmonary disease (COPD) (OR: 1.51, <i>p</i> = 0.004). In the TKA cohort, significant predictors included obesity (OR: 1.40, <i>p</i> = 0.002), anemia (OR: 2.21, <i>p</i> < 0.001), malnutrition (OR: 2.18, <i>p</i> < 0.001), Type II diabetes mellitus (OR: 1.43, <i>p</i> = 0.001), tobacco use (OR: 1.45, <i>p</i> = 0.005), and COPD (OR: 2.02, <i>p</i> < 0.001). The findings emphasize the importance of targeted preoperative optimization in patients with risk factors such as obesity, anemia, malnutrition, diabetes, and COPD. Differential predictors between TKA and THA highlight the need for joint-specific perioperative strategies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"540-546"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183281","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":"Clinical Outcomes of Multiligament Knee Fracture Dislocation at Minimum 2-year Follow-up.","authors":"Adam Tagliero, Jaques Williams, Sanathan Iyer, Sandeep Yanamala, Griffin Rechter, Brendan Page, Michael J Stuart, Aaron Krych, Bruce Levy","doi":"10.1055/a-2908-2434","DOIUrl":"https://doi.org/10.1055/a-2908-2434","url":null,"abstract":"<p><strong>Abstract: </strong>To report clinical and functional outcomes, including patient-reported outcome measures (PROMs), complications, reoperation rates, and arthritic progression in patients who sustained a knee dislocation (KD) type V fracture dislocation at minimum 2-year follow-up. A retrospective review from a prospectively collected database was performed to identify all patients with a KD type V fracture dislocation between 2001 and 2022 at a single institution. Patient demographics, pre- and postoperative clinical examination findings, intraoperative details, and postoperative complication rates were obtained from medical records. PROMs, including Visual Analog Scale (VAS), Tegner Activity Scale, Lysholm score, and International Knee Documentation Committee Subjective (IKDC) score were analyzed. A total of 11 patients (mean age: 33.9 ± 7.6, mean BMI: 33.5 ± 6.4 kg/m²) were included with a mean follow-up of 6.4 ± 5.4 years. Seven patients (64%) had a tibial plateau fracture involving the weight-bearing surface. Four patients (36%) had a concomitant nerve injury, one patient (9%) had a concomitant vascular injury, three patients (27%) had a concomitant cartilage injury (ICRS grade 3 + ), and seven patients (64%) had a concomitant meniscus injury. In all, 10 patients (82%) underwent fracture fixation. The mean postoperative Kellgren-Lawrence (KL) grade was 3.0 ± 1.0. Postoperative PROMs included VAS at rest of 2.0 ± 2.3, VAS with activity of 3.3 ± 3.2, IKDC of 68.3 ± 22.1, Lysholm of 79.0 ± 23.6, and Tegner of 4.3 ± 1.7. Nine patients (83%) experienced a complication, with four (36%) patients requiring a subsequent reoperation. Patients with a KD V fracture dislocation who underwent surgical management demonstrated high complication and reoperation rates with advanced radiographic evidence of osteoarthritis but ultimately satisfactory functional outcomes at mid-term follow-up. These findings underscore the complexity of KD V injuries and the importance of early recognition, multidisciplinary surgical planning, and patient counseling regarding the prolonged recovery and likelihood of residual symptoms. Level of evidence is IV-retrospective case series.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632290","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":"Outcomes of Restorative Treatments for Isolated Trochlear Cartilage Lesions: A Systematic Review and Meta-Analysis.","authors":"Jelle P van der List, Tarik Taoufik, Emma L Flanigan, David C Flanigan, Robert A Magnussen, Nicholas A Apseloff","doi":"10.1055/a-2908-2370","DOIUrl":"10.1055/a-2908-2370","url":null,"abstract":"<p><strong>Abstract: </strong>Knee cartilage lesions can lead to debilitating symptoms, and between 6 and 15% of full-thickness cartilage lesions are found in the trochlea. Reviews summarizing the outcomes for isolated trochlear lesions are lacking. Therefore, the goal is to assess outcomes of various treatments for trochlear cartilage lesions. In April 2025, databases of PubMed, Embase, and Cochrane Library were searched for clinical studies reporting outcomes of advanced treatments of trochlear lesions (no patellar/bipolar lesions), a minimum of 1-year follow-up, and a minimum of five patients. Random-effect models for various outcomes were used, and outcomes were reported with 95% confidence intervals. Nineteen studies (328 patients, mean age: 34 years, mean follow-up: 6.2 years, mean lesion size: 4.2 cm²) were included. Most patients underwent (matrix-induced) autologous chondrocyte implantation (ACI/MACI; 228 patients) followed by osteochondral allograft (OCA; 48 patients). Most studies were level IV evidence without comparison. ACI/MACI had an estimated failure rate of 4.4% (1.6-9.2), reoperation rate: 21.7% (2.3-76.7), postoperative IKDC: 84.0 (79.0-89.0), Lysholm: 91.8 (89-94.6), Tegner activity level: 5.3 (4.6-6.1), and visual analog scale (VAS) pain: 0.9 (0.3-1.5). For OCA, the estimated failure rate was 2.1% (0.3-13.4), and one study reported a reoperation rate of 21%. Estimated postoperative IKDC was 66.3 (54.6-78.1), and VAS pain was 3.7 (0.8-6.6). Other treatments only had one study per treatment. In this study, ACI/MACI and OCA were the two most performed procedures with overall failure rates of less than 5% and satisfying patient-reported outcomes, although reoperation rates ranged widely. Patients reported clinically relevantly less pain and higher IKDC following ACI/MACI compared with OCA. (PROSPERO registration CRD420251052812).</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413375","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":"Revision Tibial Tubercle Osteotomy for Nonhealing: A Single-center Case Series.","authors":"William ElNemer, Julia S Retzky, Kathryn Barth, Craig Klinger, Robert Bilodeau, William Ricci, Peter Fabricant, David Helfet, Austin T Fragomen, Sabrina M Strickland","doi":"10.1055/a-2908-2504","DOIUrl":"https://doi.org/10.1055/a-2908-2504","url":null,"abstract":"<p><strong>Abstract: </strong>The tibial tubercle osteotomy (TTO) is a versatile surgical approach for patellofemoral joint conditions, with nonunion, fracture, and recurrent instability as common indications for revision. This case series describes the management and outcomes of revision TTOs performed for these complications. A retrospective review of 20 patients undergoing revision TTO was conducted. Patients were included if they underwent revision for nonunion, delayed union, or fracture after primary TTO. Data collected included patient demographics, primary and revision TTO details, concurrent procedures, biological adjuncts, fixation methods, and clinical outcomes. Outcomes measured were union rates, time to healing, and subsequent revision. The mean age of the cohort was 26.8 ± 11.7 years, with a mean follow-up of 2.6 ± 2.7 years. Indications for revision were nonunion (70%), fracture (15%), and recurrent instability (15%). Biological augmentation, including bone marrow aspirate concentrate (BMAC), was used in 80% of revisions. Following revision TTO, 65% achieved union at a mean time of 14.6 ± 5.0 weeks, 15% had delayed union (mean time to union 11.9 ± 6.7 weeks), and 15% required a second revision for nonunion, achieving union at a mean time of 15.2 ± 12.7 weeks. Patients with delayed union were older (38 ± 12 years, <i>p</i> = 0.049) and had higher rates of vitamin D deficiency. Revision TTO is effective in addressing nonunion, delayed union, and fractures, with a majority achieving union after revision or re-revision. Strategies such as robust fixation, biological augmentation (e.g., BMAC), and management of comorbidities, including vitamin D deficiency, play a critical role in optimizing outcomes. Further research is needed to standardize protocols and improve union rates in high-risk populations. What are the new findings: This 20-patient case series focuses specifically on revision TTO, reporting granular management and outcomes-65% union after revision, union after all re-revisions, 80% use of biologic augmentation, and an observed association of delayed union with older age and vitamin D deficiency. This adds actionable details on biologic use and fixation escalation and spotlights potentially modifiable risk factors in the revision setting.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550700","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":"Preoperative Anxiety and Need for Information Prior to Anterior Cruciate Ligament Surgery: Epidemiological Study with Clustering Analysis.","authors":"Thibaut Noailles, Vincent Fontanier, David Laplaud, Vincent Morin, Mohamad Moussa, Alexandre Hardy","doi":"10.1055/a-2908-2036","DOIUrl":"10.1055/a-2908-2036","url":null,"abstract":"<p><strong>Abstract: </strong>Preoperative anxiety can negatively influence postoperative recovery in orthopedic surgery and may be modulated by patients' need for information. Despite the recognized role of psychosocial factors in anterior cruciate ligament reconstruction (ACLR), preoperative anxiety has been insufficiently described in this population. This study aimed to assess preoperative anxiety and information needs in ACLR patients, and to identify patient profiles using an unsupervised clustering approach. A single-center cross-sectional study was conducted in adults scheduled for outpatient ACLR between February 2022 and March 2023. Patients completed the French version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) after the anesthesia consultation. Descriptive analyses and between-group comparisons were performed. An exploratory k-prototypes clustering analysis was used to identify patient profiles based on demographic variables, APAIS scores, and satisfaction with preoperative information. Of the 381 eligible patients, 319 completed the APAIS (46.7% women; mean age 31.2 ± 10.9 years). Clinically relevant preoperative anxiety (score >11) was present in 16.3% of participants and was significantly more frequent in women. Information needs were low in 50.8%, moderate in 35.4%, and high in 13.8%. Clustering analysis revealed three profiles: (1) predominantly female, anxious patients with high anxiety scores; (2) patients with low anxiety and minimal information needs; and (3) patients with moderate anxiety but high information needs, who reported the greatest benefit from the surgeon's preoperative consultation. Preoperative anxiety and information needs were low and sex-related in patients undergoing ACLR. Distinct patient profiles highlighted the value of preoperative anxiety assessment. Systematic preoperative anxiety assessment could allow to enhance preoperative communication and optimize care management in ACLR patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413372","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":"Trends in Return to Play After ACL Reconstruction in Professional American Football Players: A Systematic Review and Meta-Analysis.","authors":"Riccardo D'Ambrosi, Derya Akbaba, Thomas Patt, Chiara Ursino, Amit Meena, Luca Sconfienza, Elmar Herbst, Elisabeth Abermann, Christian Fink","doi":"10.1055/a-2908-2656","DOIUrl":"10.1055/a-2908-2656","url":null,"abstract":"<p><strong>Abstract: </strong>Anterior cruciate ligament (ACL) injuries are frequent among professional American football players and often require surgical reconstruction followed by prolonged rehabilitation. Return to play (RTP) is a key outcome, yet substantial variability persists in reported RTP rates, timelines, level of return, and re-injury risk. This systematic review and meta-analysis aimed to compare RTP rates, time to RTP, return to preinjury performance, and ACL re-rupture rates in professional American football players across three time periods. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed, Embase, and the Cochrane Library identified studies reporting RTP outcomes following ACL reconstruction (ACLR) in professional American football players, including selected high-level collegiate cohorts. Methodological quality was assessed using the Methodological Index for Nonrandomized Studies. Four outcomes-overall RTP rate, time to RTP, return to preinjury level, and ACL re-rupture rate-were extracted and meta-analyzed across three publication periods (before 2016, 2016-2020, and after 2021) to explore temporal trends. Twelve studies met the inclusion criteria, including 1,166 professional American football players. The pooled RTP rate was 73.1% (95% confidence interval [CI], 62.5-80.5). No significant differences were found across periods (<i>p</i> > 0.05), although RTP rates numerically decreased from 78.9 to 69.8%. Among players returning to sport, 93.6% (95% CI, 77.7-100) regained their preinjury performance level, with no significant temporal differences (<i>p</i> > 0.05). The pooled ACL re-rupture rate was 4.4% (95% CI, 2.0-7.3), with comparable rates across periods. Mean time to RTP was 340.1 days (95% CI, 313.1-367.1), with no temporal differences. More than 70% of professional American football players RTP after ACLR, and most returning athletes regain their preinjury performance level, with low re-rupture rates. Although more recent studies reported numerically lower return-to-play rates, these differences were not statistically significant. This systematic review and meta-analysis included levels III and IV evidence studies and was registered with PROSPERO (registration no. CRD420251022080).</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406435","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":"Interobserver Variability of Intraoperative Soft Tissue Laxity Assessment in Robotic-Assisted Total Knee Arthroplasty Using the ROSA System.","authors":"Hiroki Kishi, Daisuke Nishiyama, Daisuke Fukui, Manabu Yamanaka, Hiroshi Yamada","doi":"10.1055/a-2908-1899","DOIUrl":"10.1055/a-2908-1899","url":null,"abstract":"<p><strong>Abstract: </strong>This study evaluated the interobserver reliability of intraoperative soft tissue laxity assessment during robotic-arm-assisted total knee arthroplasty (TKA) using the Robotic Surgical Assistant (ROSA) system. Although robotic systems have improved the precision of bone alignment, the reproducibility of soft tissue evaluations-critical for achieving joint balance-remains uncertain. We retrospectively analyzed 37 knees from 30 patients who underwent ROSA-assisted TKA. Soft tissue laxity was manually assessed under varus and valgus stress at extension and 90 degrees of knee flexion. Two parameters were recorded: joint gap widening and hip-knee angle (HKA). Interobserver agreement was evaluated using intraclass correlation coefficients (ICC), Pearson's correlation coefficients, and Bland-Altman analysis. Angular measurements, particularly HKA at extension, demonstrated excellent interobserver reliability (ICC = 0.94). In contrast, gap-based measurements showed greater variability, with lateral laxity under varus stress at extension demonstrating poor reliability (ICC = 0.31). Agreement between observers was generally stronger at extension than at 90 degrees of flexion. Contralateral assessments showed better consistency. While robotic systems improve alignment accuracy in TKA, intraoperative soft tissue laxity evaluation remains prone to interobserver variability. Gap-based measurements are less reliable than angular assessments, underscoring the need for standardized evaluation methods to improve consistency in soft tissue evaluation during robotic TKA.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406459","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":"Early Quadriceps Recovery and Edema Reduction Predict Functional Performance After Total Knee Arthroplasty.","authors":"Sibel Bozgeyik-Bagdatli, Ezgi Ünüvar Yuksel, Hande Güney-Deniz, Ömür Çaglar","doi":"10.1055/a-2908-2174","DOIUrl":"10.1055/a-2908-2174","url":null,"abstract":"<p><strong>Abstract: </strong>Total knee arthroplasty (TKA) is an effective intervention that alleviates pain and restores joint function in patients with advanced knee osteoarthritis. However, persistent quadriceps muscle weakness often limits early functional recovery, and the contribution of early postoperative changes in muscle strength, edema, and pain to short-term function remains unclear. The aim of the study was to investigate early postoperative changes in quadriceps strength, edema, and pain, and their relationships with functional performance at 6 weeks after unilateral TKA. A total of 24 patients (mean age: 68.67 years; body mass index: 33.18 kg/m²; 20 females, 4 males) undergoing primary unilateral TKA were assessed on postoperative day 1, week 2, and week 6. Outcome measures included isometric quadriceps strength, knee edema, pain intensity (VAS), and functional performance (5 times sit-to-stand test [5T-Stst], 2-minute walk test [2MWt], WOMAC). Correlations and forward stepwise multiple regression analyses evaluated the predictive value of early recovery indicators on functional outcomes. Significant improvements in quadriceps strength and reductions in edema and pain were observed within 6 weeks. Early quadriceps strength gains (day 1 to week 2) were strongly associated with faster 5T-Stst performance at week 6 (r = -0.644, <i>p</i> = 0.001), accounting for 27% of its variance (R² = 0.27, <i>p</i> = 0.005). Edema reduction also correlated with improved sit-to-stand performance (r = 0.528, <i>p</i> = 0.008), whereas early pain reduction showed no significant correlation with functional outcomes. Early postoperative improvements in quadriceps muscle strength and edema resolution are critical predictors of short-term functional recovery after TKA, whereas pain relief alone is insufficient. These findings emphasize the first 2 postoperative weeks as a pivotal window for rehabilitation interventions focusing on neuromuscular activation and swelling control. Objective assessment of quadriceps strength from the first postoperative day may guide personalized rehabilitation strategies and optimize recovery strategies.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148399674","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}