Hua Ying, Xianghui Li, Gai Yao, Yuning Su, Xiangjun Hu, Rongshan Cheng, Tsung-Yuan Tsai, Zimin Wang
{"title":"Artificial anterolateral ligament reconstruction provides similar knee kinematics as compared to an autologous reconstruction and a lateral extra-articular tenodesis.","authors":"Hua Ying, Xianghui Li, Gai Yao, Yuning Su, Xiangjun Hu, Rongshan Cheng, Tsung-Yuan Tsai, Zimin Wang","doi":"10.1002/ksa.12811","DOIUrl":"https://doi.org/10.1002/ksa.12811","url":null,"abstract":"<p><strong>Purpose: </strong>We biomechanically compared three anterolateral procedures (artificial-anterolateral ligament [ALL] reconstruction, autologous-ALL reconstruction and lateral extra-articular tenodesis [LET]) in knees with anterior cruciate ligament (ACL) and anterolateral complex (ALC) injuries when combined with nonanatomic artificial ACL reconstruction.</p><p><strong>Methods: </strong>Eight cadaveric knees were tested robotically at time-zero: (1) intact, (2) ACL + ALC deficient, (3) ACL reconstruction + artificial-ALL reconstruction, (4) ACL reconstruction + autologous-ALL reconstruction, (5) ACL reconstruction+LET. Each state was tested under 3 loads: (1) a 89N anterior tibial (AT) loading to test AT translation (ATT) at full extension (FE), 30°, 60° and 90°, (2) a 5N·m internal rotation (IR) tibial torque to test tibial IR at FE, 15°, 30° and 45°, (3) a simulated pivot-shift test consisting of a combined 5 N·m IR tibial torque and 7 N·m valgus load to test ATT and IR at FE, 15°, 30° and 45°.</p><p><strong>Results: </strong>ACL + ALC deficiency impaired anteroposterior and rotational knee stability across all conditions. Under 89 N AT loading, the anterior instability was fully restored by ACL reconstruction + artificial-ALL reconstruction (n.s.) and partially by ACL reconstruction + autologous-ALL reconstruction and ACL reconstruction + LET, with significant differences from the intact state at 30° (p = 0.019) and 60° (p = 0.011) in the ACL reconstruction + autologous-ALL reconstruction state and at 30° (p = 0.032) and 60° (p = 0.018) in the ACL reconstruction+LET state. Under 5 N·m IR tibial torque, the internal rotational instability was fully restored by ACL reconstruction+artificial-ALL reconstruction and ACL reconstruction + LET (n.s.) and partially by ACL reconstruction + autologous-ALL reconstruction, with significant differences from the intact state at FE (p = 0.044) and 15° (p = 0.049). During simulated pivot-shift testing, all three procedures fully restored native kinematics with no significant differences observed (n.s.).</p><p><strong>Conclusions: </strong>Artificial-ALL reconstruction, autologous-ALL reconstruction, and LET similarly restored native knee kinematics in ACL + ALC deficient knees when combined with artificial ACL reconstruction at time-zero.</p><p><strong>Level of evidence: </strong>Level V, laboratory study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736580","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}
Amir M Vahdani, Moein Shariatnia, Pranav Rajpurkar, Ayoosh Pareek
{"title":"Towards trustworthy artificial intelligence in musculoskeletal medicine: A narrative review on uncertainty quantification.","authors":"Amir M Vahdani, Moein Shariatnia, Pranav Rajpurkar, Ayoosh Pareek","doi":"10.1002/ksa.12737","DOIUrl":"https://doi.org/10.1002/ksa.12737","url":null,"abstract":"<p><strong>Introduction: </strong>Deep learning (DL) models have achieved remarkable performance in musculoskeletal (MSK) medical imaging research, yet their clinical integration remains hindered by their black-box nature and the absence of reliable confidence measures. Uncertainty quantification (UQ) seeks to bridge this gap by providing each DL prediction with a calibrated estimate of uncertainty, thereby fostering clinician trust and safer deployment.</p><p><strong>Methods: </strong>We conducted a targeted narrative review, performing expert-driven searches in PubMed, Scopus, and arXiv and mining references from relevant publications in MSK imaging utilizing UQ, and a thematic synthesis was used to derive a cohesive taxonomy of UQ methodologies.</p><p><strong>Results: </strong>UQ approaches encompass multi-pass methods (e.g., test-time augmentation, Monte Carlo dropout, and model ensembling) that infer uncertainty from variability across repeated inferences; single-pass methods (e.g., conformal prediction, and evidential deep learning) that augment each individual prediction with uncertainty metrics; and other techniques that leverage auxiliary information, such as inter-rater variability, hidden-layer activations, or generative reconstruction errors, to estimate confidence. Applications in MSK imaging, include highlighting uncertain areas in cartilage segmentation and identifying uncertain predictions in joint implant design detections; downstream applications include enhanced clinical utility and more efficient data annotation pipelines.</p><p><strong>Conclusion: </strong>Embedding UQ into DL workflows is essential for translating high-performance models into clinical practice. Future research should prioritize robust out-of-distribution handling, computational efficiency, and standardized evaluation metrics to accelerate the adoption of trustworthy AI in MSK medicine.</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":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736583","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":"Do we need a robot in total knee arthroplasty? Yes! No! Not sure!-A well balanced perspective.","authors":"Antonio Klasan, Michael T Hirschmann","doi":"10.1002/ksa.12798","DOIUrl":"https://doi.org/10.1002/ksa.12798","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736581","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}
Christopher David John Little, Hariharan Subbiah Ponniah, Shvaita Ralhan, Louise Strickland, Antony Palmer, Thomas William Hamilton
{"title":"The definitions and prevalence of nutritional disorders in hip and knee arthroplasty: A systematic review.","authors":"Christopher David John Little, Hariharan Subbiah Ponniah, Shvaita Ralhan, Louise Strickland, Antony Palmer, Thomas William Hamilton","doi":"10.1002/ksa.12766","DOIUrl":"https://doi.org/10.1002/ksa.12766","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aims to use European Society of Parenteral and Enteral Nutrition (ESPEN) terminology and diagnostic criteria to determine the prevalence of nutritional disorders in hip and knee arthroplasty.</p><p><strong>Methods: </strong>A systematic review of Level 1-4 evidence was conducted as per the PRISMA statement and Cochrane handbook for Systematic Review (PROSPERO ID: CRD 42023360496). In March 2024, AMED, CENTRAL, EMBASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the prevalence of nutritional disorders in hip and knee arthroplasty populations. Exclusion criteria were subtrochanteric fracture, pathological fracture and <50 cases. The risk of bias in non-randomised studies of interventions and risk of bias 2 tools were used to assess bias. No pooled analyses were performed due to study heterogeneity.</p><p><strong>Results: </strong>Fifty-five studies and 2,107,283 patients were included. Thirty-nine different definitions of nutritional disorder were identified. The prevalence of nutritional disorder varied depending on the chosen definition: 0.9%-71.7% in primary, 1.33%-47.5% in revision and 4.5%-60% in hip fracture arthroplasty. Thirty-four studies used albumin to diagnose malnutrition, with hypoalbuminaemia seen most frequently in hip fracture (20.3%-71.13%) and revision cohorts (2.5%-42.8%). No study reported the prevalence of sarcopenia in revision or hip fracture cohorts.</p><p><strong>Conclusion: </strong>All forms of nutritional disorder exist within hip and knee arthroplasty populations, particularly among revision and hip fracture patients. Included studies showed poor compliance with ESPEN recommendations and heterogeneity in the chosen definition of disorder. A prospective study using ESPEN-recommended diagnostic criteria is required to better determine the prevalence of nutritional disorders, contributing towards the understanding of the financial and patient-related costs following hip and knee arthroplasty.</p><p><strong>Level of evidence: </strong>Systematic review of articles with Level I-IV evidence.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736582","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}
Alexandre Le Guen, Sébastien Parratte, Vincent Marot, Régis Pailhé, Hasnae Ben-Roummane, Emilie Bérard, Etienne Cavaignac
{"title":"Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty.","authors":"Alexandre Le Guen, Sébastien Parratte, Vincent Marot, Régis Pailhé, Hasnae Ben-Roummane, Emilie Bérard, Etienne Cavaignac","doi":"10.1002/ksa.12804","DOIUrl":"https://doi.org/10.1002/ksa.12804","url":null,"abstract":"<p><strong>Purpose: </strong>Flexion contracture is a multifactorial complication after knee osteoarthritis and knee arthroplasty. Among the causes, arthrogenic muscle inhibition (AMI) has never been studied. It is a failure to achieve proper quadriceps motor activation, which can lead to flexion contracture due to hamstring contracture. In this study, we hypothesised that AMI is present in patients with knee osteoarthritis and after knee arthroplasty. The aims were to assess: (1) the prevalence of preoperative AMI, for patients without preoperative AMI, (2) the incidence of post-operative AMI at 2 weeks, (3) its associated factors at 2 weeks and (4) the incidence 90 days after surgery.</p><p><strong>Methods: </strong>An international, prospective study enroled 341 patients undergoing knee arthroplasty across three centres. 316 patients met the inclusion criteria: symptomatic knee requiring unicompartmental, total or revision arthroplasty. Twenty-five patients undergoing simultaneous bilateral procedures were excluded. Among the included patients, 275 patients without preoperative AMI were analysed for post-operative incidence and associated factors. AMI was assessed using the SANTI classification on the day of surgery, at 15 days, and at 3 months. One patient was lost to follow-up at 3 months.</p><p><strong>Results: </strong>Preoperative AMI ≥ 1 was observed in 13% (95% confidence interval [CI] = 9-17). At 2 weeks post-operatively, AMI ≥ 1 occurred in 36% (95% CI = 30-42), with 13% showing AMI ≥ 2, characterised by quadriceps inhibition and flexion contracture. Female gender (odds ratio [OR] = 2.81; p < 0.002), early post-operative flexion contracture attitude such as keeping the knee bent, placing a pillow under the knee, or folding the hospital bed (OR = 5.89; p < 0.001), and high pain scores (OR = 13.57; p < 0.001) were significantly associated with AMI ≥ 1 at 2 weeks. At 3 months, AMI ≥ 1 occurred in 12.4% (95% CI = 8.7-16.9).</p><p><strong>Conclusion: </strong>AMI is a prevalent issue both pre- and post-operatively. Its incidence underscores the relevance of this condition; it should be considered in the management of post-operative flexion contracture in knee arthroplasty.</p><p><strong>Level of evidence: </strong>Level III, observation cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700953","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}
Matteo Innocenti, Filippo Leggieri, Simon N van Laarhoven, Tommy de Windt, Roberto Civinini, Gijs G van Hellemondt
{"title":"Technology-assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review.","authors":"Matteo Innocenti, Filippo Leggieri, Simon N van Laarhoven, Tommy de Windt, Roberto Civinini, Gijs G van Hellemondt","doi":"10.1002/ksa.12748","DOIUrl":"https://doi.org/10.1002/ksa.12748","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).</p><p><strong>Methods: </strong>A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the I<sup>2</sup> statistic.</p><p><strong>Results: </strong>Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip-knee-ankle angle (13.3% [95% CI, 8.7%-19.0%] vs. 26.1% [95% CI, 16.3%-38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%-92.4%] vs. 79.7% [95% CI, 68.8%-87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%-94.6%] vs. 82.6% [95% CI, 72.0%-89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15-24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.</p><p><strong>Conclusion: </strong>Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.</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":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700954","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}
Fredrik Boric-Persson, Aleksandra Turkiewicz, Martin Englund, Paul Neuman
{"title":"Increased reoperation rates after meniscus repair compared to arthroscopic partial meniscectomy: Data from a comprehensive clinical cohort with up to 10 years follow-up.","authors":"Fredrik Boric-Persson, Aleksandra Turkiewicz, Martin Englund, Paul Neuman","doi":"10.1002/ksa.12791","DOIUrl":"https://doi.org/10.1002/ksa.12791","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the rates of knee reoperation and medical complications after meniscal repair versus partial meniscectomy (APM) up to 10 years after surgery.</p><p><strong>Methods: </strong>All patients ≥ 15 years old operated for a meniscal tear with meniscus repair or partial meniscectomy at Scania University Hospital were included, between year 2010 and 2014. Information was retrieved from patient records until the year 2020. Rates of any reoperation, reoperation in same meniscus and medical complications were estimated. Differences were also estimated in the three outcomes in a subgroup aged 15-40 years using flexible parametric survival models adjusted for age, sex, knee laterality, tear type, medial/lateral, anterior cruciate ligament (ACL) status, osteoarthritis, body mass, height and smoking.</p><p><strong>Results: </strong>Records identified 2098 patients (395 undergoing meniscal repair and 1703 partial meniscectomy) with 540 reoperations in 430 patients. The incidence rate of reoperation was 32/1000 person-years (95% confidence interval [CI] 29-35) and of reoperation in the same meniscus 19/1000 person-years (95% CI 17-21). There were 2.1% postoperative complications. In the age group 15-40 years, with only bucket-handle, longitudinal and horizontal tears, 341 patients had meniscal repair and 361 partial meniscectomy. The incidence rate of any reoperation was 105 (95% CI 90-122) per 1000 person-years in the meniscal repair group and 24 (95% CI 18-31) in the partial meniscectomy group. The adjusted hazard ratio of any reoperation comparing meniscal repair with partial meniscectomy was 4.3 (95% CI 3.1-6.0) and of reoperations in the same meniscus 17 (95% CI 9-31). 3.3% patients had postoperative complications (15 after meniscal repair and 14 after partial meniscectomy).</p><p><strong>Conclusions: </strong>The risk of any knee reoperation after meniscal repair had a four-fold increase compared with partial meniscectomy, and for same meniscus reoperations about 17-fold. The rate of medical postoperative complications was low.</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":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677132","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}
David H Dejour, Stefano Pasqualotto, Francesco Puglia, Andrea Amarossi, Jacobus H Müller, Edoardo Giovanetti de Sanctis, Paolo Ferrua
{"title":"Standardized magnetic resonance image-based assessment to define functional patella alta relative to both tibia and trochlea: A cross-sectional comparative study.","authors":"David H Dejour, Stefano Pasqualotto, Francesco Puglia, Andrea Amarossi, Jacobus H Müller, Edoardo Giovanetti de Sanctis, Paolo Ferrua","doi":"10.1002/ksa.12757","DOIUrl":"https://doi.org/10.1002/ksa.12757","url":null,"abstract":"<p><strong>Purpose: </strong>Determine whether patellar height differs significantly between knees with objective patellar instability (OPI) and controls, and to develop a magnetic resonance imaging-based (MRI-based) quantitative method for classifying 'functional patella alta' relative to both tibia and trochlea.</p><p><strong>Methods: </strong>This cross-sectional study included all records of adults who underwent an MRI of their knee between 2019 and 2022 at the senior authors' centre. The OPI group (n = 127) included patients with >2 documented episodes of lateral patellar dislocation and no previous knee surgery, and the control group (n = 97) included patients with isolated meniscal tears and no history of patellofemoral disorders or knee surgery. Four readers independently measured the MRI patellar height index (PHI), the sagittal patellar engagement (SPE) index and the patellar tendon length (PTL). The control group's interquartile ranges of PHI (75th percentile) and SPE index (25th percentile) were used to define 'patella norma' (PHI ≤ 1.16 and SPE index ≥ 0.38) and 'functional patella alta' (PHI > 1.16 and SPE index < 0.38). Multivariable logistic regression analyses assessed the associations between patellar height and trochlear dysplasia with knees exhibiting OPI.</p><p><strong>Results: </strong>Comparison between 'patella norma' and 'functional patella alta' revealed statistically significant differences for PHI (mean difference [MD], -0.23; p < 0.001), SPE index (MD, 0.28; p < 0.001) and PTL (MD, -7; p < 0.001). The prevalence of 'functional patella alta' was 24% in OPI knees (30 of 127) and 6% in control knees (6 of 97). Multivariable logistic regression revealed that 'functional patella alta' and trochlear dysplasia were independently associated with OPI.</p><p><strong>Conclusion: </strong>Standardized MRI-based assessment of patella alta relative to both tibia and trochlea is reliable using thresholds of PHI (>1.16) and SPE index (<0.38). These thresholds, specifically developed for MRI, should improve the conventional assessment using the Caton-Deschamps index, originally developed for true lateral radiographs.</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":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677134","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}
Frank Wein, Clément Ferri, Lisa Peduzzi, Arthur Barbaret, Paul Walbron
{"title":"Arthroscopic minced cartilage implantation provides superior clinical and magnetic resonance imaging outcomes compared to microfracture in patellar cartilage defects.","authors":"Frank Wein, Clément Ferri, Lisa Peduzzi, Arthur Barbaret, Paul Walbron","doi":"10.1002/ksa.12800","DOIUrl":"https://doi.org/10.1002/ksa.12800","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical and radiological outcomes of arthroscopic minced cartilage implantation (MCI) versus microfracture (MFx) in patients with patellar cartilage defects.</p><p><strong>Methods: </strong>A retrospective, single-centre cohort study was conducted on 46 patients treated between January 2021 and December 2022. Patients underwent either MCI (n = 26) or MFx (n = 20) with a minimum follow-up of 24 months (mean 35.7 ± 6.2). Magnetic resonance imaging (MRI) outcomes were assessed using the MOCART 2.0 Knee score by an independent blinded radiologist. Clinical outcomes included pain (visual analogue scale), function (self knee value), International Knee Documentation Committee, knee injury and osteoarthritis outcome score (KOOS) and patient acceptable symptom state (PASS)/minimal clinically important difference scores.</p><p><strong>Results: </strong>The MOCART 2.0 score was significantly higher in the MCI group (mean 86; 95% confidence interval [CI]: 83-92) compared to the MFx group (mean 66; 95% CI: 55-73) (p < 0.001). MCI patients achieved significantly greater improvements across all clinical measures, notably in the KOOS sport subscore (+33.2 vs. +5.3 points). PASS was achieved in 100% of MCI patients versus 35% of MFx patients (p < 0.001). No major complications or reoperations were reported.</p><p><strong>Conclusion: </strong>Both MCI and MFx improved clinical and MRI outcomes in patellar cartilage defects after 2 years, but MCI demonstrated significantly superior results across all parameters. Arthroscopic MCI appears to be an effective, safe, single-stage alternative to MFx for treating focal patellar cartilage lesions.</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":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677131","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}
Christos Koutserimpas, Giovan Giuseppe Mazzella, Luca Andriollo, Emanuele Diquattro, Pietro Gregori, Elvire Servien, Cécile Batailler, Sébastien Lustig
{"title":"Preoperative flexion contracture does not impair outcomes or early revision rates following robotic total knee arthroplasty with functional alignment.","authors":"Christos Koutserimpas, Giovan Giuseppe Mazzella, Luca Andriollo, Emanuele Diquattro, Pietro Gregori, Elvire Servien, Cécile Batailler, Sébastien Lustig","doi":"10.1002/ksa.12799","DOIUrl":"https://doi.org/10.1002/ksa.12799","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative flexion contracture remains a challenging deformity in total knee arthroplasty (TKA). This study aimed to evaluate whether the presence of preoperative flexion contracture influences outcomes and early revision rates following robotic-assisted TKA performed with functional alignment (FA) principles.</p><p><strong>Methods: </strong>This retrospective comparative study analysed 190 patients who underwent robotic-assisted TKA using a computed tomography-based FA strategy. Patients were grouped based on intraoperative measurement of flexion contracture: ≥10° (study group; 43 patients) and <10° (control group; 147 patients). Clinical outcomes, intraoperative data, and early revision rates were assessed at a minimum 24-month follow-up.</p><p><strong>Results: </strong>The study group exhibited significantly more varus alignment intraoperatively and required greater lateral tibial and posterior medial femoral resections. Preoperative knee flexion was lower in the contracture group (110° vs. 120°, p = 0.0018), and postoperative flexion remained slightly reduced (120° vs. 130°, p = 0.05). Flexion contracture at follow-up was 1° in the study group versus 0° in controls (p = 0.04). However, no significant differences were observed in Knee Society Scores, Forgotten Joint Score, Kujala score, or early revision rates. All-cause revision rates were similar (97.67% vs. 98.64%, p = 0.66), with a hazard ratio of 1.85 (95% CI: 0.12-27.72). Aseptic survivorship was 100% in the contracture group versus 99.32% in controls (p = 0.59).</p><p><strong>Conclusion: </strong>Patients with preoperative flexion contracture ≥ 10° achieved comparable mid-term outcomes and early survivorship to those without contracture following robotic-assisted TKA using FA. These findings support FA as a reliable strategy to manage complex deformities without the need for soft tissue releases.</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":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677133","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}