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

{"title":"Long-term clinical and MRI outcomes of a polyurethane meniscal scaffold implantation for the treatment of partial meniscal deficiency: A minimum 10-year follow-up study.","authors":"Vasileios S Akrivos, George A Komnos, Bela Ujvari, Artemis Hante, Eleftheria Adaktylidou, Theofilos Karachalios, Michael Hantes","doi":"10.1002/ksa.12724","DOIUrl":"https://doi.org/10.1002/ksa.12724","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the clinical and magnetic resonance imaging (MRI) results after implantation of a polyurethane scaffold for chronic segmental meniscus deficiency following partial meniscectomy in a long-term follow-up.</p><p><strong>Study design: </strong>Level IV, retrospective case series.</p><p><strong>Methods: </strong>Thirty-two knees received arthroscopic implantation of an Actifit® polyurethane meniscal implant for deficiency of the meniscus. Clinical outcomes were assessed using patient-reported outcome scores, including Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner Activity Scale and visual analogue scale (VAS) for pain and satisfaction. Preoperative MRI scans and final follow-up radiographs and MRI evaluations were performed to assess scaffold morphology, tissue integration and the status of the articular cartilage.</p><p><strong>Results: </strong>The mean follow-up was 11.4 years. Significant improvements were observed in clinical outcomes, with KOOS improving from a preoperative mean of 47.75 (standard deviation [SD]: 16.88) to a 78.62 (SD: 15.45), Lysholm scores from 46.62 (SD: 16.96) to 84.62 (SD: 13.03), Tegner Activity Scale improving from 1.8 to 4.1 at the final follow-up. The VAS for pain decreased from a preoperative mean of 5.62 (SD: 2.54) to 2.12 (SD: 2.02). MRI evaluations using the Genovese classification showed 23 knees with Type II scaffolds, 0 with Type III and 9 with Type I. Bone oedema was not present in 27 knees, with 5 knees showing Type I bone oedema. Meniscal extrusion was observed in 24 knees with partial extrusion and 8 knees with complete extrusion. The contralateral meniscus was normal in 28 knees and graded as Reicher Grade 1 in 2 knees. The Kellgren-Lawrence classification revealed 15 knees with Type I osteoarthritic changes, 10 with Type II changes and 7 with Type III changes.</p><p><strong>Conclusion: </strong>Arthroscopic treatment for patients with chronic segmental meniscal loss using a polyurethane meniscal implant can achieve sustainable long-term results regarding pain reduction and knee function. However, the MRI did not reveal normal menisci in all cases.</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":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304322","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":"Femoral cartilage variability affects the accuracy of kinematic alignment and imageless navigation in total knee arthroplasty: A prospective study from the FP-UCBM Knee Study Group.","authors":"Stefano Campi, Giancarlo Giurazza, Edoardo Franceschetti, Andrea Tanzilli, Pietro Gregori, Michael T Hirschmann, Michele Paciotti, Biagio Zampogna, Umile Giuseppe Longo, Rocco Papalia","doi":"10.1002/ksa.12725","DOIUrl":"https://doi.org/10.1002/ksa.12725","url":null,"abstract":"<p><strong>Purpose: </strong>Kinematic alignment (KA) and imageless computer-assisted surgery in total knee arthroplasty (TKA) typically compensate for cartilage wear by applying a standard 2-mm adjustment. However, recent concerns have emerged regarding the accuracy of this assumption. This study aimed to assess, for the first time in vivo, the femoral cartilage thickness on the unworn side in a consecutive series of TKA patients. The hypothesis was that significant inter-individual variability exists, thereby challenging the fundamentals of the calipered KA technique and imageless computer-assisted TKA.</p><p><strong>Methods: </strong>This prospective study analysed intraoperative femoral cartilage thickness in 182 patients (189 knees) with end-stage knee osteoarthritis undergoing TKA. Measurements were taken from the unworn distal and posterior femoral condyles. Correlations with demographic factors and coronal plane angular measurements of the lower limb were assessed, and a significance level of p < 0.05 was used for all tests.</p><p><strong>Results: </strong>The mean cartilage thickness was 2.6 ± 0.7 mm, with significant variability among individuals (range: 1.5-5 mm). Intra-individual cartilage thickness within the unworn compartment remained consistent (93% of cases differed by ≤0.5 mm). Men exhibited a thicker mean cartilage (2.8 ± 0.7 mm) compared to women (2.5 ± 0.6 mm) (p = 0.041). Weak correlations were found between cartilage thickness and height, weight, and age (p < 0.05). The posterior lateral condyle in valgus knees was more frequently worn than the posterior medial condyle in varus knees (65.8 vs. 40.3%; p = 0.043). Varus osteoarthritis patterns significantly influenced cartilage wear at the posterior medial femoral condyle, with wear being more prevalent in postero-medial osteoarthritis than in antero-medial or centro-medial osteoarthritis (p = 0.029).</p><p><strong>Conclusion: </strong>Femoral cartilage thickness varies significantly across patients, while remaining nearly uniform within the unworn compartment of the same patient. Relying on the 'one-cartilage-fits-all' paradigm may compromise the accurate restoration of individual anatomy in calipered KA total knee arthroplasty (TKA) and surgical planning in imageless computer-assisted TKA.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304319","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":"Hand-minced cartilage versus microfracture for the repair of articular cartilage defects: A propensity score matched-pair analysis with 2-year follow-up.","authors":"Jakob Hax, Louis Leuthard, Felix Öttl, Vincent A Stadelmann, Stefan Preiss, Gian M Salzmann, Armin Runer","doi":"10.1002/ksa.12728","DOIUrl":"https://doi.org/10.1002/ksa.12728","url":null,"abstract":"<p><strong>Purpose: </strong>First-time evaluation and comparison of clinical and functional short-term outcomes and revision rates between single-stage autologous hand-minced cartilage (MC) and microfracture (MFX) for knee cartilage lesions.</p><p><strong>Methods: </strong>All patients undergoing MC or MFX (2015-2021) at a single centre were retrospectively analysed from a prospectively maintained database. Propensity score matching was used for gender, age, body mass index (BMI), defect localization (patellofemoral, tibiofemoral), American Society of Anesthesiologists (ASA) classification and baseline Core Outcome Measures Index (COMI). Included were knee cartilage lesions regardless of size or concomitant procedures, with 2-year follow-up. COMI and subjective International Knee Documentation Committee (sIKDC) scores were assessed preoperatively and 6, 12 and 24 months postoperatively. Postoperative complications and revision surgeries were recorded.</p><p><strong>Results: </strong>Thirty patients each were included in the MC (female: 11, age: 32 ± 10, body mass index [BMI]: 24.4 ± 4.7) and MFX (female: 11, age: 34 ± 8, BMI: 24.2 ± 3.2) groups. Isolated cartilage surgery was performed in 11 MC (37%) versus three MFX (10%) cases. In the MC group, 12 defects (40%; MFX 17, 57%) were tibiofemoral and 18 (60%; MFX 13, 43%) patellofemoral. The average defect size was 3.63 ± 2.02 for MC and 1.58 ± 1.12 for MFX (<0.001). At 24 months, the COMI decreased similarly after MC (change score: -3.20 ± 2.05) and MFX (change score: -2.51 ± 2.52), with comparable sIKDC improvements (change score: MC: 25 ± 17; MFX: 20 ± 21). No significant difference was detected in achieving the minimal clinically important difference (MCID) at 24 months. Complications occurred in two MC (6.7%; graft hypertrophy) and three MFX (10%; method failure) cases.</p><p><strong>Conclusion: </strong>MC and MFX showed comparable short-term outcomes, despite larger defects in the MC group. Both are viable treatment options, though MFX showed limited durability in some cases.</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":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304320","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":"Incidence of meniscal tears in skeletally immature patients with anterior cruciate ligament (ACL) rupture: Medial tears are more common in patients closer to skeletal maturity while lateral tears in those with more remaining growth.","authors":"Alberto Grassi, Emre Anil Ozbek, Yuta Nakanishi, Kyle Borque, Luca Ambrosini, Stefano Zaffagnini","doi":"10.1002/ksa.12729","DOIUrl":"https://doi.org/10.1002/ksa.12729","url":null,"abstract":"<p><strong>Purpose: </strong>To report the prevalence of meniscal tears observed in patients with open physis and anterior cruciate ligament (ACL) rupture and to examine the relationship between meniscus tears and remaining growth.</p><p><strong>Methods: </strong>Skeletally immature patients who underwent ACL reconstruction between June 2022 and June 2024 in a single institute were included. Patients were considered skeletally immature if the pre-operative knee magnetic resonance imaging (MRI) revealed an open physis. MRI was used to determine the bone age of the patients, and the patients were divided into two groups as >1-year and <1-year remaining growth. Independent sample t-test was used to compare the continuous variables with normal distribution, while the Mann-Whitney U test was used in the case of non-normal distribution. Fisher exact test to compare dichotomous categorical variables.</p><p><strong>Results: </strong>A total of 57 skeletally immature patients (77% male), with a mean age of 14.8 ± 1.4 years, underwent ACL reconstruction during the study period. A total of 61 meniscal tears were found in 58 patients, resulting in 84% of patients having at least one meniscus tear. Lateral meniscus (65%) tears were observed most frequently during arthroscopy. Moreover, longitudinal tears (23%) were found to be the most common lateral meniscus pathology and Ramp lesion (35%) was found to be the most common medial meniscus pathology. A significantly higher prevalence of meniscal tears was reported in patients with >1-year of remaining growth (p = 0.0162). While medial meniscus tears are more common (52% vs. 18%; p = 0.0195) in patients with ≤1-year remaining growth, lateral meniscus tears are more common in patients with >1-year remaining growth (88% vs. 55%; p = 0.0179).</p><p><strong>Conclusion: </strong>Medial meniscus tears were more present in patients close to skeletal maturity while lateral tears were more common in patients with higher remaining growth. Considering the high number of false negatives of meniscal tears in preoperative MRI, high suspicion for specific tears should be used taking into account also the patient's remaining growth.</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":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304321","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":"Establishing 'normal' career longevity in professional footballers allows comparison to that of players with injuries and surgery.","authors":"Mary Jones, Arman Motesharei, Simon V Ball, J Samuel Church, James D F Calder, Andy Williams","doi":"10.1002/ksa.12722","DOIUrl":"https://doi.org/10.1002/ksa.12722","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the 'normal' career longevity of male professional footballers and the factors that affect this in order to provide a baseline against which career longevity after injury can be measured. To demonstrate how these results can be used by comparing them with published career longevity rates after anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods: </strong>Match play data for the entire careers of 4117 male footballers playing in the top four English football leagues between 1992 and 2023 was utilised. Players were grouped into ability levels and their \"still playing\" rates, and career trajectory tracked according to age. Univariate and multivariate analyses were used to determine differences by playing position and ability and Kaplan-Meier survival curves were generated. The findings were compared with published results after ACLR according to the comparable age and league level.</p><p><strong>Results: </strong>Goalkeepers had a longer overall career length than outfield players (12.4 ± 4.9 vs. 11.6 ± 4.7 years, p = <0.01).Outfield players in the English Premier League (EPL) and those also playing internationally (EPL + I) play for longer overall and longer at their highest level (14.8 ± 3.3 and 7.5 ± 5.0 years) than lower league players (League 2: 6.2 ± 4.1 and 2.9 + 2.2 years). At 5 years, EPL + I and EPL outfield players have a 60% and 40% probability of continuing to play at their highest level respectively compared to less than 20% in The Championship and below. At 10 years this is 40% and 18% respectively compared to <2% in the lower leagues. 'Still playing' rates after ACLR are up to 12.9% lower than average for 30 year old footballers.</p><p><strong>Conclusion: </strong>Career duration in footballers is affected by the position played and ability level. Career longevity and performance data is provided in a usable format for easy comparisons with studies reporting career longevity outcomes in professional footballers.</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":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278119","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 formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part II-Prevention, non-operative treatment and return to sport.","authors":"Robert Prill, C Benjamin Ma, Stephanie E Wong, Philippe Beaufils, Joan C Monllau, Elanna K Arhos, Roland Becker, Francesco Della Villa, J Brett Goodloe, James J Irrgang, Jitka Klugarova, Emma L Klosterman, Aleksandra Królikowska, Aaron J Krych, Robert F LaPrade, Robert Manske, Nicky van Melick, Jill K Monson, Marko Ostojic, Mark V Paterno, Tomasz Piontek, Simone Perelli, Alexandre Rambaud, James Robinson, Laura C Schmitt, Eric Hamrin Senorski, Thorkell Snaebjornsson, Adam J Tagliero, Airelle O Giordano, Nicolas Pujol","doi":"10.1002/ksa.12689","DOIUrl":"https://doi.org/10.1002/ksa.12689","url":null,"abstract":"<p><strong>Purpose: </strong>Part two of this consensus aimed to provide recommendations for the prevention of meniscus injuries, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures.</p><p><strong>Methods: </strong>This consensus followed the European Society of Knee Surgery, Sports Traumatology and Arthroscopy (ESSKA) formal consensus methodology. For this combined ESSKA-American Orthopedic Society for Sports Medicine (AOSSM)-American Academy of Sports Physical Therapy (AASPT) initiative, 67 experts from 14 countries, including orthopedic surgeons and physiotherapists, were involved. The 26 Steering Group members established guiding questions, screened the existing evidence, and proposed statements, and provided Grades of recommendations. The 41 Rating Group members assessed the statements according to a Likert scale (1-9). Final documents were assessed by an international peer review group for geographical adaptability.</p><p><strong>Results: </strong>Low to moderate scientific level of evidence was available, so that grades of recommendations were low (three Grade A ratings, four Grade B, three Grade C and 13 Grade D), underlining the relevance of this consensus. One strong and 17 relative agreements with overall median of 8 (8-9) and a mean of 7.92 ± 0.37 were achieved for 23 statements on 18 questions. Prevention of meniscus injuries is possible with general knee injury reduction programmes and through avoidance of certain activities. Non-operative treatment including physical therapy is the first line approach for degenerative meniscus lesions and may be an option for some acute tears. Return to sports after meniscus tear surgery should be both criterion-based and time-based. Patient reported outcomes in combination with performance-based measures are recommended to evaluate the rehabilitation process.</p><p><strong>Conclusion: </strong>This international EU-US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. These updated and structured recommendations may be applied by surgeons and physiotherapists.</p><p><strong>Level of evidence: </strong>Level I, consensus.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278121","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":"Performance and return to sport outcomes following hip arthroscopy in National Hockey League players.","authors":"David Slawaska-Eng, Marc Daniel Bouchard, Luigi Del Sordo, Alexander E Weber, Olufemi Ayeni","doi":"10.1002/ksa.12720","DOIUrl":"https://doi.org/10.1002/ksa.12720","url":null,"abstract":"<p><strong>Purpose: </strong>Intra-articular hip disorders, such as femoroacetabular impingement syndrome (FAIS), labral tears and chondral damage are common in ice hockey players, particularly in the National Hockey League (NHL). However, evidence on return-to-sport (RTS) rates and performance outcomes post-hip arthroscopy remains limited. This study evaluates RTS rates, career longevity, and performance metrics, including games played, points per game (PPG), save percentage, and performance scores (PS), following hip arthroscopy.</p><p><strong>Methods: </strong>NHL players who underwent hip arthroscopy for intra-articular pathology between 2000 and 2024 were identified using public records. RTS rates, career duration, and performance metrics were analysed pre- and post-surgery. Paired t-tests and analyses of variance (ANOVA) were performed across positions (forwards, defensemen and goaltenders).</p><p><strong>Results: </strong>A total of 92 NHL players (103 hips) met inclusion criteria. The overall RTS rate was 79.3%, increasing to 84.9% when excluding players still recovering. RTS was significantly higher in players <30 years (90.0% vs. 64.3%, p = 0.003). The average number of post-operative seasons played was 2.7, with no positional differences. Forwards showed significant declines in PPG (pre: 0.63 ± 0.38; post: 0.51 ± 0.37; p = 0.013) and PS (pre: 0.60 ± 0.74; post: 0.37 ± 0.69; ∆PS = -0.23; p = 0.026). Defensemen showed no significant change in PPG (p = 0.648) or PS (p = 0.509). Goaltenders had a decline in save percentage (pre: 0.91 ± 0.01; post: 0.89 ± 0.03; p = 0.038), while wins per season were unchanged (p = 0.205). RTS did not significantly differ by position.</p><p><strong>Conclusion: </strong>NHL players undergoing hip arthroscopy have high RTS rates and often resume multi-season careers. However, forwards experience greater declines in performance, while defensemen and goaltenders are less affected. These results underscore position-specific recovery trends and may inform rehabilitation strategies in elite hockey athletes.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278120","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 outcomes of anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis: A meta-analysis.","authors":"Yi Zhang, Sharon Si Heng Tan, Andrew Kean Seng Lim, James Hoi Po Hui","doi":"10.1002/ksa.12726","DOIUrl":"https://doi.org/10.1002/ksa.12726","url":null,"abstract":"<p><strong>Purpose: </strong>Rotational instability, post-operative high-grade pivot shifts and graft re-rupture are areas of debate in anterior cruciate ligament reconstruction (ACLR). Lateral extra-articular tenodesis (LET) techniques can control rotational laxity and reduce re-rupture by strengthening the anterolateral knee. Over-constraint and early-onset osteoarthritis are documented sequelae. This review compares the clinical, functional and patient-reported outcomes of ACLR with and without LET.</p><p><strong>Methods: </strong>Studies on the comparative outcomes of ACLR with and without LET were identified. All clinical, functional and patient-reported outcomes were extracted. The quality of each study was assessed. Random-effects model was then used to obtain pooled estimates of procedural differences for each outcome if they were reported by three or more studies.</p><p><strong>Results: </strong>Twenty-seven studies and 3225 patients were included. ACR with LET conferred statistically significant better laxity reduction through KT1000 testing with pooled RR estimate of 0.83 (95% confidence interval [CI], 0.73-0.95) and a better side-side comparison of anterior tibial translation with pooled WMD estimate of 0.61 (95% CI, 0.22-0.99). LET further lowered rates of graft failure/re-rupture with a pooled RR estimate of 0.93 (95% CI, 0.90-0.95). There was no significant difference in time taken for return to sports with a pooled WMD estimate of 0.00 (95% CI, -1.80 -1.80) or in subjective patient-reported outcome measures such as IKDC subjective score with a pooled WMD estimate of -0.75 (95% CI, -2.18 to 0.68), Lysholm score with a pooled WMD estimate of -1.73 (95% CI, -4.12 to 0.67), or Tegner activity index with a pooled WMD estimate of -0.55 (95% CI, -1.11 to 0.02). Osteoarthritic data was not assessed in this review due to the lack of data.</p><p><strong>Conclusion: </strong>LET addition confers better clinical outcomes over isolated ACLR. However, there is no significant difference between functional outcomes regarding returning to sports or subjective patient-reported outcome measures.</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":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278118","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":"Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions!","authors":"Umile Giuseppe Longo, Giovanni Intermesoli, Raffaele Di Tommaso, Alberto Lalli, Bruno Violante, Michael T Hirschmann","doi":"10.1002/ksa.12706","DOIUrl":"https://doi.org/10.1002/ksa.12706","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review was conducted to evaluate the current literature on metal hypersensitivity in patients undergoing joint arthroplasty. The aims of the study were to report diagnostic tools used to assess metal hypersensitivity and to report complications arising in patients who are hypersensitive to nickel or other metals performing joint arthroplasty. Given the potential impact on implant longevity and patient outcomes, understanding the clinical relevance of metal hypersensitivity is crucial for optimising surgical decision-making.</p><p><strong>Methods: </strong>This systematic review adheres to PRISMA guidelines and evaluates the variability in diagnostic approaches and the challenges in clinical management. Included in this review were studies involving patients sensitive to nickel or other metals undergoing joint arthroplasty. Eligibility criteria focused on commonly employed diagnostic tools and associated complications. A comprehensive literature search was conducted across Medline, EMBASE, Scopus, CINAHL, and CENTRAL databases. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool for case series and the ROBINS-I tool for case-control studies.</p><p><strong>Results: </strong>Twenty-four articles met the inclusion criteria and were included in this systematic review. A total of 4865 patients undergoing joint arthroplasty were selected. Diagnostic tools included patch testing, lymphocyte transformation test (LTT), and medical history assessment. Variability in time point of testing and diagnostic protocols was noted. Complications including joint pain, swelling, reduced range of motion, and implant failure were reported in 12 studies. Clinical outcomes varied widely: some studies showing no significant differences between hypersensitive and non-hypersensitive patients, while others reported increased pain and reduced joint function.</p><p><strong>Conclusion: </strong>There is a lack of a standardised protocol for diagnosing metal hypersensitivity, leading to uncertainty regarding test selection and timing. This inconsistency leads to variability in reported outcomes, with limited studies focusing on post-surgical hypersensitivity in patients.</p><p><strong>Level of evidence: </strong>Level III, systematic review.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251954","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":"Beyond the curve: The influence of cut-off selection methods on synovial biomarker interpretation for periprosthetic joint infection.","authors":"Sujeesh Sebastian, Jochen G Hofstaetter","doi":"10.1002/ksa.12716","DOIUrl":"https://doi.org/10.1002/ksa.12716","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251953","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}