Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA最新文献

{"title":"Personalized alignment in total knee arthroplasty reduces patellar tilt: A retrospective study.","authors":"Alexandre Le Guen, Simon Marmor, Vincent Le Strat, Antoine Mouton, Thomas Aubert","doi":"10.1002/ksa.70097","DOIUrl":"https://doi.org/10.1002/ksa.70097","url":null,"abstract":"<p><strong>Purpose: </strong>Patellofemoral kinematics is crucial for patient satisfaction following total knee arthroplasty (TKA). A postoperative patellar tilt greater than 5° has been associated with inferior clinical outcomes. While a femoral component external rotation beyond 3° is generally protective against patellar tilt, personalized alignment may not consistently reach this threshold. The aim of this study is to (1) assess the incidence of postoperative patellar tilt >5° following TKA with personalized alignment and (2) identify preoperative and intraoperative factors associated with this complication.</p><p><strong>Methods: </strong>This comparative retrospective study included 316 primary TKAs Attune (Johnson & Johnson®) performed between January and December 2024 using navigation or robotic assistance. All procedures were conducted at the same center by four surgeons: two using a subvastus approach and two a transquadricipital approach. Thirty-six involving residents were excluded. Patellar tilt is defined as an angle exceeding 5° between a line drawn along the anterior borders of the femoral condyles and a line connecting the posterior edges of the medial and lateral patellar facets on a patellofemoral skyline view 3 months postoperatively. No patients were lost to follow-up. To identify postoperative patellar risk factors, the following data were analyzed: Age, gender, body mass index, preoperative hip-knee-ankle angle, medial proximal tibial angle, lateral distal femoral angle, coronal plane alignment, functional knee phenotype, tibial slope, preoperative radiographic patellar tilt, range of motion, surgical approach, laterality, implant type (posterior-stabilized or cruciate-retaining), use of robotics or navigation, patellar resurfacing and patellar button size (if applicable).</p><p><strong>Results: </strong>Patellar tilt was observed in 11.8% of cases, a rate markedly lower than that reported for mechanical alignment in existing literature. Multivariate analysis identified the transquadricipital approach (odds ratio [OR]: 2.75; p = 0.02), right-sided surgery (OR: 2.63; p = 0.02) and PS implants (OR: 2.59; p = 0.04) as independent risk factors.</p><p><strong>Conclusion: </strong>Personalized alignment, the subvastus approach, and cruciate-retaining implants appear to reduce the risk of postoperative patellar tilt.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative diagnostic accuracy of next-generation sequencing in different specimen types for periprosthetic joint infection: A systematic review and meta-analysis.","authors":"Lina Wang, Shangxiang Feng, Zhongyuan Zhao, Yuchi Zhao, Shengjie Dong, Li Cao, Kun Song","doi":"10.1002/ksa.70095","DOIUrl":"https://doi.org/10.1002/ksa.70095","url":null,"abstract":"<p><strong>Purpose: </strong>Discrepancies in next-generation sequencing (NGS) results across synovial fluid, periprosthetic tissues and implant sonicate fluid pose a significant clinical challenge in diagnosing periprosthetic joint infection (PJI). We conducted a systematic review and meta-analysis to compare the diagnostic accuracy of these NGS sample types for PJI.</p><p><strong>Methods: </strong>This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in PubMed, EMBASE and the Cochrane Library databases from inception to 1 June 2025. Two independent reviewers performed data extraction and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For each specimen type, we estimated the pooled sensitivity and specificity, summary receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC).</p><p><strong>Results: </strong>Following screening, 18 studies were included. Pooled sensitivities of NGS for PJI diagnosis were as follows: synovial fluid 0.86 (95% confidence interval [CI]: 0.79-0.91), periprosthetic tissue 0.86 (95% CI: 0.69-0.95) and sonicate fluid 0.89 (95% CI: 0.77-0.95). Corresponding specificities were 0.94 (95% CI: 0.91-0.96), 0.98 (95% CI: 0.85-1.00) and 0.96 (95% CI: 0.91-0.98). AUCs were 0.93 (0.89-0.95), 0.96 (0.88-0.97) and 0.96 (0.88-0.97), respectively. Pairwise comparisons of AUCs showed no statistically significant differences (p > 0.05).</p><p><strong>Conclusions: </strong>This meta-analysis suggests that NGS of sonicate fluid demonstrates higher sensitivity compared to NGS of synovial fluid or periprosthetic tissue, while maintaining strong specificity, making it valuable for detecting infection. Periprosthetic tissue NGS demonstrated exceptional specificity and acceptable sensitivity, making it valuable for confirming infection. All specimens show clinically useful AUC values. Sonicate fluid shows promise, but specimen selection warrants careful consideration of the sensitivity-specificity trade-off in clinical practice and requires validation of clinical utility due to the absence of a perfect PJI diagnostic gold standard and the risk of false positives.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary knee arthroplasty in Sweden: A nationwide analysis of all-cause 30-day mortality and impact of age and ASA-class.","authors":"Johanna Jarstad, Johanna Albert, Olof Sköldenberg, Jon Karlsson, Jan Gustav Jakobsson","doi":"10.1002/ksa.70102","DOIUrl":"https://doi.org/10.1002/ksa.70102","url":null,"abstract":"<p><strong>Purpose: </strong>Knee arthroplasty is one of the most common orthopaedic procedures in Sweden, which is in line with many other countries in the Western world. There is no recent data on all-cause 30-day mortality associated with primary knee arthroplasty in Sweden during recent years. The purpose of the present observational quality register study was to investigate the mortality at 0, 7, 30 and 90 days after primary knee arthroplasty, and the impact of age and ASA-class.</p><p><strong>Material: </strong>Data from SPOR (Swedish PeriOperative Registry) on primary knee arthroplasty (ICD code NGB) registered between 2017 and 2021 in patients ≥18 years was analysed. Perioperative mortality rates and impact of age and ASA were analysed and are presented as numbers, proportions and 95% confidence interval.</p><p><strong>Results: </strong>The study cohort included 35,794 patients. The study found overall low 30-day mortality rate, 16 out of 35,794 patients (0.045%, 95% confidence Interval 0.027%-0.071%), no patients died on the day of surgery, six died within one week, while 50 died within 90 days, with no significant differences over the years. High age and higher ASA-class were associated with higher mortality.</p><p><strong>Conclusions: </strong>The study showed a low and stable 30-day mortality associated with primary knee arthroplasty at 0.045%. Age above 80 years and ASA-Classes III and IV were associated with increased mortality rate, the benefit versus risk in relation to knee arthroplasty procedure should be assessed individually in patients above 80 years and ASA-Classes III and IV.</p><p><strong>Level of evidence: </strong>Not applicable.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capsular management strategies in hip arthroscopy for femoroacetabular impingement syndrome: A multilevel meta-analysis.","authors":"Nikolai Ramadanov, Maximilian Voss, Maximilian Heinz, Robert Hable, Robert Prill, Roland Becker, Ingo J Banke","doi":"10.1002/ksa.70094","DOIUrl":"https://doi.org/10.1002/ksa.70094","url":null,"abstract":"<p><strong>Purpose: </strong>To compare three capsular management strategies in hip arthroscopy (capsule preservation [CP], capsule repair [CR] and capsule unrepaired [CU]) for femoroacetabular impingement syndrome (FAIS). We hypothesized that CP and CR would provide superior outcomes compared with CU.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, CENTRAL and Epistemonikos was conducted up to 31 May 2025. Outcomes of CP, CR and CU were compared using a frequentist multilevel random-effects meta-analysis with restricted maximum likelihood estimation and Hartung-Knapp adjustment.</p><p><strong>Results: </strong>Ultimately, 47 primary studies met the inclusion criteria and were included in the meta-analysis. A total of 7366 hips (7276 patients) were included across the 47 studies. These were distributed into three capsular management groups: (I) CP: 1352 hips, (II) CR: 5043 hips and (III) CU: 971 hips. CR showed the greatest improvement in modified Harris Hip Score with a mean change of 24.00 (95% confidence interval [CI]: 20.86-27.14), while CP achieved the highest MCID rate at 12 months post-operatively with a mean of 9.30 (95% CI: 7.47-11.14). No other consistent statistically significant differences were observed between groups across post-operative scores, change scores or complication rates. CP and CR both demonstrated superior outcomes compared to CU in selected functional parameters. All three strategies showed comparable results in pain reduction, revision rate, conversion to total hip arthroplasty and overall complication incidence.</p><p><strong>Conclusion: </strong>CR and CP yield superior outcomes compared to leaving the CU. Surgeons should close or preserve the capsule, while future trials will clarify the optimal strategy.</p><p><strong>Level of evidence: </strong>Level II (systematic review and meta-analysis of predominantly Level III studies, with additional contributions from Levels I and II studies).</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence agents in orthopaedics: Concepts, capabilities and the road ahead.","authors":"Felix C Oettl, James Pruneski, Balint Zsidai, Yinan Yu, Ting Cong, Robert Feldt, Philipp W Winkler, Michael T Hirschmann, Kristian Samuelsson","doi":"10.1002/ksa.70109","DOIUrl":"https://doi.org/10.1002/ksa.70109","url":null,"abstract":"<p><p>Artificial intelligence (AI) is increasingly used in orthopaedics, yet current models are often limited to narrow, isolated tasks like analysing an X-ray or predicting a single outcome. This paper introduces AI agents-a new class of AI systems designed to overcome these limitations. Unlike traditional AI, agents can autonomously manage complex, multistep processes that mirror the complete patient journey. They can coordinate tasks from initial diagnosis and surgical scheduling to postoperative monitoring and rehabilitation, acting as intelligent assistants for clinical teams. This review explains what distinguishes AI agents from conventional AI, explores their potential applications in orthopaedic practice-including perioperative workflow optimisation, research acceleration and intelligent physician support-and discusses the significant implementation and ethical challenges that must be addressed. For the orthopaedic surgeon, understanding AI agents is becoming essential, as these systems offer a transformative potential to enhance efficiency, improve patient outcomes and shape the future of clinical leadership in a technologically advancing field. LEVEL OF EVIDENCE: Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MOCART 2.0 score of 60 or greater measured at 1 year post-operatively predicts favourable clinical outcomes after surgical repair of tibiofemoral cartilage lesions.","authors":"Hyun-Soo Moon, Sungjun Kim, Chong-Hyuk Choi, Min Jung, Kwangho Chung, Se-Han Jung, Jin-Gyu Kim, Min-Cheol Park, Sung-Hwan Kim","doi":"10.1002/ksa.70086","DOIUrl":"https://doi.org/10.1002/ksa.70086","url":null,"abstract":"<p><strong>Purpose: </strong>(1) To evaluate the relationship between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score and post-operative clinical outcomes following surgical repair of cartilage lesions in the tibiofemoral joint, and (2) to determine threshold values of the 1-year MOCART 2.0 score associated with favourable patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>Medical records of patients who underwent surgical repair for tibiofemoral joint cartilage lesions from 2010 to 2022 were retrospectively reviewed, and those who had magnetic resonance imaging and clinical assessments 1 year post-operatively were included. Outcomes were assessed using the International Knee Documentation Committee subjective score, Lysholm score and Knee Injury and Osteoarthritis Outcome Score (KOOS), with respective clinically important difference (CID) and substantial clinical benefit (SCB) values used to evaluate clinically significant improvement. Relationships between MOCART 2.0 scores and PROMs were analyzed, with cut-off values determined via receiver operating characteristic (ROC) analysis, followed by group comparisons.</p><p><strong>Results: </strong>Eighty-six patients were included (mean age, 51.9 ± 14.3 years; males/females, 16/70; mean lesion size, 3.1 ± 1.5 cm²). The MOCART 2.0 score showed positive correlations with most PROMs at 1 year post-operatively. Logistic regression revealed significant associations between MOCART 2.0 scores and clinical improvements beyond CID and SCB values for the Lysholm score and SCB values for KOOS symptoms, which showed similar trends even when threshold values were adjusted by ±5 points in analyses. Subsequent ROC curve analyses identified statistically significant cut-off points ranging from 56 to 61 points. Comparative analysis, classified using a threshold of 60 considering its scoring system, demonstrated that patients with scores ≥60 showed generally higher PROMs and lower osteoarthritis grades at 1 year post-operatively and final follow-ups.</p><p><strong>Conclusions: </strong>The MOCART 2.0 score, assessed one year after surgical repair for cartilage lesions in the tibiofemoral joint, positively correlates with PROMs, with scores of ≥60 expected to be associated with favourable clinical outcomes.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spheroid-based matrix-induced autologous chondrocyte implantation combined with autologous bone grafting restores physiological cartilage and subchondral bone properties in osteochondral knee defects - An MRI-based analysis.","authors":"Stephan Oehme, Benjamin Bartek, Janne Callsen, Jessica Schallock, Tobias Winkler, Thorsten Diekhoff, Tobias Jung, Danko Dan Milinkovic","doi":"10.1002/ksa.70091","DOIUrl":"https://doi.org/10.1002/ksa.70091","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the radiological and patient-reported outcome measures (PROMs) following spheroid-based matrix-induced autologous chondrocyte implantation combined with autologous bone grafting (MABCI) for the treatment of osteochondral defects of the knee.</p><p><strong>Methods: </strong>In this retrospective cohort analysis of prospectively collected data, 28 consecutive patients with 29 defects of the femoral condyle (male: 15, female: 13, mean age 27.3 ± 9.8 years, mean defect size 3.7 ± 1.6 cm²) treated with MABCI were included. Radiological assessments were performed using 3T magnetic resonance imaging (MRI) to evaluate cartilage thickness, T2 relaxation times and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scores. Clinical outcomes were assessed using validated PROMs, including the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Lysholm scale and the Patient-Reported Outcomes Measurement Information System 29-Item Profile (PROMIS-29). Correlation analyses were conducted to evaluate associations between radiological parameters and PROMs.</p><p><strong>Results: </strong>The analysis was conducted at a mean follow-up of 44.4 ± 21.6 months. Cartilage thickness in the repair tissue exceeded that of the reference cartilage (3.4 ± 0.9 mm vs. 3.0 ± 0.5 mm; p = 0.036), while T2 relaxation times in the repair tissue were within physiological range (50.5 ± 40.0 ms vs. 41.3 ± 5.4 ms; n.s.). The mean MOCART 2.0 score was 61.3 ± 13.0 (volume fill: 16.1 ± 3.7, integration with adjacent cartilage: 12.9 ± 3.3), reflecting satisfactory repair quality. All clinical scores showed significant improvement compared to the preoperative condition (IKDC: 70.6 ± 13.2 vs. 54.8 ± 17.5, p < 0.001; KOOS: pain 78.7 ± 16.9 vs. 66.1 ± 18.6, p = 0.002, symptoms 75.6 ±  16.0 vs. 65.8 ± 19.1, p = 0.006, ADL 86.8 ± 14.0 vs. 77.6 ± 16.8, p = 0.003, sport 63.0 ± 24.2 vs. 47.3 ± 26.9, p = 0.009, quality of life (QoL) 51.0 ± 22.7 vs. 39.6 ± 17.5, p = 0.014; numeric pain rating scale: 3.0 ± 2.2 vs. 5.2 ± 2.4, p < 0.001). A greater cartilage thickness was associated with reduced pain intensity (r = -0.457, p = 0.013) and improved QoL (r = 0.429, p = 0.020), indicating that better structural repair is associated with improved patient satisfaction.</p><p><strong>Conclusions: </strong>MABCI results in satisfactory cartilage regeneration and subchondral remodelling in addition to significant improvements in patient satisfaction and overall QoL.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACL injuries in elite alpine skiing reliably allow athletes to return to competition and perform at or above their pre-injury level.","authors":"Jakub Oronowicz, Viacheslav Malinovskiy, Alexander Bumberger, Andrzej Jasina, Christoph Lutter, Romain Seil, Thomas Tischer","doi":"10.1002/ksa.70090","DOIUrl":"https://doi.org/10.1002/ksa.70090","url":null,"abstract":"<p><strong>Purpose: </strong>Anterior cruciate ligament (ACL) injuries are frequently observed in alpine skiing. However, available data regarding post-injury performance levels remain scarce. This study aimed to investigate whether ACL injuries in elite-level alpine skiers limit performance levels after ACL reconstruction (ACLR).</p><p><strong>Methods: </strong>Male and female elite-level alpine skiers from national A-teams who sustained an ACL injury were retrospectively identified through media reports and the Fédération Internationale de Ski database, across all disciplines (downhill, super G, giant slalom and slalom [SL]). World Cup (WC) results and time out of competition before injury and after ACLR were analyzed. Inclusion criteria were injury during or after the 2003/2004 season and participation in at least one WC event pre-injury. Performance levels from two seasons before the injury through the 2022/2023 season were assessed.</p><p><strong>Results: </strong>Forty-eight elite alpine skiers (28 males and 20 females) met the inclusion criteria. Of these, 97.9% returned to professional competition after ACLR. One female athlete had not yet returned due to a recent injury. The mean return-to-competition (RTC) time was 11.9 ± 4.5 (range: 7-25) months for males and 11.3 ± 1.8 (8-16) months for females. Post-ACLR, athletes demonstrated similar or improved mean WC placements, regardless of discipline. A decline in performance was observed only in SL. A corresponding trend was observed in the top three placements following ACLR. Among skiers returning to competition, 80.8% of males and 63.1% of females reached their pre-injury performance levels. Athletes with multiple injuries or nonoperative treatment showed variable outcomes.</p><p><strong>Conclusion: </strong>Elite alpine skiers can successfully return to WC competition following ACL injury, with many reaching or surpassing pre-injury performance. Performance variability underscores the need for individualized therapy and rehabilitation to optimize recovery in this specific population.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional alignment improves femoral joint line obliquity preservation in comparison with the classical measured resection technique.","authors":"Oriol Pujol, Pedro Hinarejos, Albert Pons, Ernest Famada, Angela Zumel, Matías Novillo, Juan Erquicia, Joan Leal-Blanquet","doi":"10.1002/ksa.70092","DOIUrl":"https://doi.org/10.1002/ksa.70092","url":null,"abstract":"<p><strong>Purpose: </strong>(1) To analyse the femoral anatomical-mechanical axis (AA-MA) and posterior condylar-transepicondylar axis (PCA-TEA) relationships using computed tomography (CT)-based measurements. (2) To quantify the coronal and axial errors that would occur when positioning the femoral component using mechanically aligned TKA modelled as 5° of valgus from the AA and 3° of external rotation from the PCA. (3) To compare coronal and rotational femoral positioning between this systematic approach and robotic-assisted functionally aligned TKA.</p><p><strong>Methods: </strong>It is a multicentric cross-sectional observational study. Preoperative CT scans of 318 patients were analysed to determine AA-MA and PCA-TEA relationships. Then, femoral positioning was simulated, intending a measured-resection mechanical aligned TKA defined as 5° of valgus from the AA and 3° of external rotation from the PCA. It was compared with the real femoral component placement performed in each patient using robotic-assisted functionally aligned TKA.</p><p><strong>Results: </strong>Mean AA-MA relationship was 6.0 ± 0.9° and mean PCA-TEA was 3.1 ± 1.8°. In measured-resection, mechanically aligned TKA, 74.4% and 45.8% of patients would present a femoral component implanted in varus from the MA and internal rotation from the TEA, respectively. Functional alignment was significantly closer to the native LDFA than mechanical alignment (2.0° vs 3.5°). With mechanical alignment, 45.8% of femoral components would be implanted in internal rotation from the TEA, compared to only 8.8% with functional alignment.</p><p><strong>Conclusions: </strong>Measured resection based on average population data (5° of valgus from the AA and 3° of external rotation from the PCA) may result in a considerable proportion of femoral components implanted in varus and internal rotation. In contrast, robotic-assisted functionally aligned TKA provided significantly improved restoration of the native femoral joint line obliquity and effectively prevented excessive internal rotation.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The addition of a lateral extra-articular procedure to a primary anterior cruciate ligament reconstruction is associated with an increased rate of further surgery for cyclops lesions and restricted range of motion.","authors":"Timothy Voskuijl, Kate E Webster, Timothy S Whitehead, Haydn J Klemm, Lachlan M Batty, Julian A Feller","doi":"10.1002/ksa.70089","DOIUrl":"https://doi.org/10.1002/ksa.70089","url":null,"abstract":"<p><strong>Purpose: </strong>There has been a resurgence in the use of a lateral extra-articular procedure (LEAP) in association with anterior cruciate ligament (ACL) reconstruction to reduce the risk of graft failure. The aim of this study was to examine whether the use of a LEAP in the setting of a primary ACL reconstruction was associated with an increased rate of reoperation for loss of range of motion or a symptomatic cyclops lesion.</p><p><strong>Methods: </strong>A consecutive cohort of patients aged less than 30 years who received a primary hamstring or quadriceps tendon autograft ACL reconstruction between January 2016 and December 2021 was retrospectively analysed. The usage of a modified Ellison LEAP in this cohort increased from 0% in 2016 to 51% in 2021. Reoperation rates for loss of motion or a symptomatic cyclops lesion during the first year after surgery, as well as knee extension deficits at 12 months, were compared between LEAP and no-LEAP patients. Contingency analyses with risk ratio (RR) were calculated.</p><p><strong>Results: </strong>A total of 1076 patients were included in this study [59.6% male, mean age 21.6 (SD 4.4) years, 84.9% hamstring tendon autografts]. In 17.3% (186/1076) of the patients the ACL reconstruction was augmented with a modified Ellison procedure. Of this group [67.2% male, mean age 18.8 (SD 3.7) years, 79.6% hamstring tendon autografts], 8.1% (confidence interval (CI) 4.2%-12%) required further surgery for restricted motion or a cyclops lesion in the first year after surgery, compared to 3.8% (CI 2.6%-5.1%) in the no-LEAP group (risk ratio (RR) 2.1, p = 0.012). The difference in reoperation rates between those with and those without LEAP was more marked for patients who received a quadriceps tendon autograft (13.2% vs. 3.2%, RR 4.1, p = 0.019), compared to patients treated with a hamstring tendon autograft (6.8% vs. 3.9%, RR 1.8, p = 0.122). There was no significant difference in extension deficit at 12 months between patients with and those without a LEAP (mean 1.02 ± SD 2.6 degrees vs. mean 0.97 ± SD 2.4 degrees, p = 0.85).</p><p><strong>Conclusion: </strong>Surgical intervention for a loss of range of motion or symptomatic cyclops lesion in the first postoperative year after primary ACL reconstruction was more common in patients who had an additional LEAP than in those who did not. The higher intervention rate was more apparent in patients who had a quadriceps tendon autograft ACL reconstruction.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}