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

{"title":"Patient-specific talar resurfacing improves pain and function at 24 months in osteochondral lesions of the talus.","authors":"Massimiliano Mosca, Marco Di Ponte, Edoardo Cassanelli, Margherita Bonaiuti, Giammarco Gardini, Niek Van Dijk, Stefano Zaffagnini, Silvio Caravelli","doi":"10.1002/ksa.70527","DOIUrl":"10.1002/ksa.70527","url":null,"abstract":"<p><strong>Purpose: </strong>Osteochondral lesions of the talus are a frequent cause of ankle pain and functional limitation, particularly in physically active patients. The purpose of this prospective study was to assess patient-reported outcomes, return to sport and work and safety after second-generation patient-specific focal talar resurfacing in patients with symptomatic talar osteochondral lesions.</p><p><strong>Methods: </strong>Between October 2021 and July 2023, 40 patients were screened and 20 underwent implantation of a customized focal talar resurfacing implant. Outcomes were collected preoperatively and at 3, 6, 12 and 24 months using the Foot and Ankle Outcome Score (FAOS), visual analogue scale pain at rest and during activity and the EuroQol 5-dimension 5-level questionnaire. Time to return to sport and work and adverse events (complications, reoperations and treatment failures) were recorded. Changes over time were assessed with repeated-measures analysis of variance. Best-case and worst-case sensitivity analyses explored the impact of incomplete 24-month follow-up on treatment-failure estimates.</p><p><strong>Results: </strong>Seventeen patients completed the 24-month follow-up. The mean FAOS total increased from 58.6 ± 16.6 preoperatively to 97.3 ± 4.9 at 24 months. Pain improved from 4.3 ± 2.7 to 0.0 ± 0.0 at rest and from 6.8 ± 1.7 to 0.1 ± 0.3 during activity. Seventeen of 20 patients returned to sport at a mean of 5.1 ± 3.2 months, and mean time to return to work was 4.2 ± 3.0 months. Three complications occurred, including one treatment failure requiring revision surgery. The observed treatment-failure rate was 1/20 (5%).</p><p><strong>Conclusions: </strong>Patient-specific talar resurfacing was associated with sustained improvements in pain, function and quality of life at 24 months, with high rates of return to sport and work. Larger studies with longer follow-up are needed to confirm durability and refine patient selection.</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":"3771-3782"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431929","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":"Impact of playing position on ACL injury characteristics, risk and career outcomes in football-An analysis of 742 cases of the anterior cruciate ligament registry in German football.","authors":"Shoichi Hasegawa, Werner Krutsch, Hidejuki Koga, Volker Alt, Dominik Szymski, Lorenz Huber","doi":"10.1002/ksa.70566","DOIUrl":"10.1002/ksa.70566","url":null,"abstract":"<p><strong>Purpuse: </strong>To evaluate how playing position affects anterior cruciate ligament (ACL) injury features, incidence rates and career outcomes across competition levels in male football.</p><p><strong>Methods: </strong>Using the prospectively collected 'ACL Registry in German Football', we analysed six seasons (2016-2022) across professional (first to third leagues), semi-professional (fourth to sixth) and amateur (seventh) levels. In professional players, return-to-performance over five seasons was evaluated with linear mixed-effects models, and career outcomes within three seasons after injury were assessed. Injury mechanisms were examined across all levels. Outcomes were stratified by position (goalkeeper [GK], defender [DF], midfielder [MF], forward [FW]).</p><p><strong>Results: </strong>A total of 742 ACL injuries were analysed (professional n = 172, semi-professional n = 316, amateur n = 254). Among professionals, FWs showed the highest rate of a drop in competitive level (47.5%), and GKs a numerically higher rate (54.5%); however, the GK comparison was not statistically significant after correction for multiple testing and should be regarded as exploratory. Mixed-effects models for matches and minutes played showed significant main effects for time and position (all p < 0.001) but no significant interaction (p = 0.064 matches; p = 0.105 min). Match-related incidence was highest in DFs (0.397/1000 player-hours) and MFs (0.370). Injury mechanisms varied by level; direct contact accounted for 66.7% and 46.2% in professional FWs and DFs, respectively, whereas non-contact injuries predominated across all positions in amateur players.</p><p><strong>Conclusions: </strong>The characteristics and outcomes of ACL injuries may vary by position. Match-related injury rates tended to be highest for DFs and MFs, while career-altering effects appeared most pronounced in FWs, with an exploratory, non-significant tendency also for GKs. Injury rate and consequence should be considered separately. Although non-contact injuries are most common overall, direct contact injuries were relatively frequent among professional FWs and DFs. Prevention and rehabilitation strategies could be tailored to each position.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3794-3806"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior opening-wedge high tibial osteotomy for restoring posterior tibial slope in PCL insufficiency and genu recurvatum: A narrative review.","authors":"Dan Cohen, Luca Ambrosini, Jörg Dickschas, Ronald van Heerwaarden, Matthieu Ollivier, Volker Musahl","doi":"10.1002/ksa.70538","DOIUrl":"10.1002/ksa.70538","url":null,"abstract":"<p><p>Sagittal plane tibial geometry is a critical and modifiable determinant of outcomes in posterior cruciate ligament (PCL) insufficiency and genu recurvatum. The posterior tibial slope normally ranges from 7° to 10°, and pathological mechanics arise when it falls below 5° or becomes reversed. In PCL insufficiency, a flattened slope substantially increases graft failure risk, with long-term data demonstrating markedly reduced 10-year survival for patients with severely flattened medial and lateral slopes. Biomechanically, tibial slope exerts a linear, independently significant effect on PCL graft force in loaded states, and flattened slopes further worsen multiplanar instability following combined ligament reconstruction. In genu recurvatum, a flat or negative slope amplifies a chronic hyperextension moment that overstresses the posterior capsule and posterolateral ligamentous complexes, producing pain, weakness, instability and functional impairment. Both conditions share a common biomechanical root and benefit from surgical correction through anterior opening-wedge high tibial osteotomy (AOW-HTO), which restores physiologic slope by shifting the tibial resting position anteriorly and reducing posterior sag. Surgical planning relies on calibrated radiographs, with each millimetre of opening corresponding to approximately 2° of correction; three-dimensional computed tomography planning with patient-specific cutting guides adds accuracy for complex or biplanar deformities. Three operative approaches are described, supratuberosity, trans-tuberosity and infratuberosity, each with distinct implications for patellar height, healing potential and concurrent ligamentous procedures. Published data report mean slope increases of 9°-24° with 70%-90% good-to-excellent functional outcomes, and modern tuberosity-sparing techniques have expanded indications while preserving patellofemoral mechanics. Principal complications include hinge fractures, patella baja, implant irritation and iatrogenic extension loss, mitigated by meticulous technique and mandatory intraoperative extension testing. Four illustrative cases, spanning recurrent PCL insufficiency, growth-arrest-related recurvatum treated with acute and gradual correction and a biplanar osteotomy combined with revision PCL reconstruction in a professional athlete, demonstrate the breadth of application. The evidence base remains predominantly Level III-IV and prospective comparative studies are needed; nevertheless, AOW-HTO is an effective, joint-preserving procedure and a valuable adjunct to ligamentous reconstruction in patients with pathological sagittal malalignment. LEVEL OF EVIDENCE: Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3719-3731"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552024","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":"Alignment boundaries and soft tissue balancing goals are inconsistently reported in robotic-assisted total knee arthroplasty studies: A narrative methodological review.","authors":"Brandon K Couch, Allyson N Pfeil, Corey F Hryc, Drake G LeBrun, Ugonna N Ihekweazu","doi":"10.1002/ksa.70331","DOIUrl":"10.1002/ksa.70331","url":null,"abstract":"<p><strong>Purpose: </strong>As robotic-assisted total knee arthroplasty (RATKA) continues to expand in clinical adoption, accurate and transparent reporting of surgical technique is critical for reproducibility and meaningful comparison of outcomes. This study aimed to assess the adequacy of reporting RATKA methods, with a focus on alignment and balancing philosophies; hypothesising that current RATKA literature may be variant and insufficient in reporting.</p><p><strong>Methods: </strong>A PubMed search conducted on 10 March 2025, identified studies from the top 50 orthopedic journals ranked by impact factor using the terms 'robot' and 'total knee arthroplasty'. Eligible studies included those reporting outcomes of primary RATKA procedures using patient-reported, surgical, medical, or radiographic data. A total of 134 studies met inclusion criteria and were assessed for reporting completeness across three domains: technology, technique and surgeon. The technology domain included the robotic system, software version, and implant; the technique domain included alignment philosophy, coronal and sagittal alignment boundaries, and quantitative soft tissue balancing goals; and the surgeon domain included surgeon experience and case volume.</p><p><strong>Results: </strong>Only six studies (4.5%) reported all technology domain variables, while the robotic system was identified in 97.0%, software version in 4.5%, and implant in 89.6%. For the technique domain, 32 studies (23.9%) reported all variables, with alignment philosophy reported in 79.1%, coronal boundaries in 68.7%, sagittal boundaries in 42.5%, and soft tissue balancing goals in 47.8%. Only 17 studies (12.7%) reported both surgeon-related variables, with experience and volume documented in 50.0% and 16.4% of studies, respectively.</p><p><strong>Conclusion: </strong>These findings reveal that key methodological aspects of RATKA, particularly alignment philosophy, balancing strategy, and surgeon experience, are inconsistently reported in the literature. As robotic technology becomes increasingly integrated into total knee arthroplasty, standardised and comprehensive reporting is essential to ensure reproducibility, enable accurate comparison of outcomes, and promote evidence-based adoption of RATKA techniques.</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":"3675-3690"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146230499","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":"Minimum 10-year patient-reported outcomes and survivorship after primary hip arthroscopy with interportal capsulotomy without capsular repair for stable femoroacetabular impingement syndrome: Female sex, elevated BMI and Tönnis grade predict inferior outcomes.","authors":"Griffith G Gosnell, Emily Berzolla, Bradley A Lezak, Nathaniel P Mercer, Garrett Ruff, Allison M Morgan, Ariana Lott, Thomas Youm","doi":"10.1002/ksa.70577","DOIUrl":"10.1002/ksa.70577","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to report minimum 10-year survivorship, patient-reported outcomes (PROs), clinically significant outcome achievement and predictors of outcomes and failure in patients with structurally stable femoroacetabular impingement syndrome (FAIS) who underwent primary hip arthroscopy with interportal capsulotomy without capsular repair.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients undergoing primary hip arthroscopy for FAIS from 2010 to 2013 with a minimum 10-year follow-up. Exclusion criteria included hip dysplasia, Tönnis Grade >1, prior ipsilateral hip surgery and unavailable preoperative radiographs. All patients underwent interportal capsulotomy without capsular repair. Outcomes included modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), minimal clinically important difference (MCID) achievement, survivorship and predictors of PROs and failure.</p><p><strong>Results: </strong>A total of 150 patients were included (62.7% female), with mean follow-up of 11.7 ± 1.1 years and mean age of 38.3 ± 12.1 years. Ten-year survivorship was 90.7%; 7 patients (4.7%) underwent total hip arthroplasty and 7 (4.7%) underwent revision arthroscopy. mHHS improved from 52.0 ± 11.7 to 87.9 ± 16.7 (p < 0.001), and NAHS improved from 49.5 ± 11.4 to 86.2 ± 18.0 (p < 0.001). Patient Acceptable Symptom State (PASS) was achieved by 76.0% of patients for mHHS and 65.3% for NAHS. Female sex and higher body mass index (BMI) were associated with worse 10-year PROs, whereas Tönnis Grade 1 (p = 0.003) and lower preoperative NAHS (p = 0.034) were associated with failure.</p><p><strong>Conclusion: </strong>Primary hip arthroscopy for structurally stable FAIS performed with interportal capsulotomy and without capsular repair demonstrated favourable 10-year outcomes, high PASS achievement and 90.7% survivorship. Clinically, these findings provide long-term benchmarking data for counselling appropriately selected patients with structurally stable hips. Higher BMI and female sex were associated with worse 10-year PROs, while Tönnis Grade 1 and lower preoperative NAHS were associated with increased failure risk, supporting their use in preoperative risk stratification and shared decision-making.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series (single-surgeon, without comparison group).</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3761-3770"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805381","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":"Soleus subtendon elongation is reduced by individual suturing of Achilles subtendons after rupture.","authors":"Rasmus Kramer Mikkelsen, Lars Konradsen, Rikke Hoeffner, Michael Rindom Krogsgaard, Anne-Sofie Agergaard, Michael Kjaer, Rene Brueggebusch Svensson, Stig Peter Magnusson","doi":"10.1002/ksa.70533","DOIUrl":"10.1002/ksa.70533","url":null,"abstract":"<p><strong>Purpose: </strong>The primary aim was to evaluate if individual suturing of the gastrocnemius and soleus parts of the ruptured Achilles tendon could reestablish their length 1 week post-surgery compared to previously published results using a standard operative technique. We hypothesised that this new suturing technique would reduce the soleus subtendon length by 50% compared to the standard technique 1 week after surgery (primary endpoint). Secondary aims included soleus and gastrocnemius subtendon lengths at 26 weeks.</p><p><strong>Methods: </strong>The ambi-directional design included a retrospective part using a standard Kessler repair of the tendon as a single structure (n = 24) and a prospective part using a novel surgery that sutured the soleus and gastrocnemius subtendons separately (n = 23). One and 26 weeks after surgery, both groups underwent 3D MRI to determine the length of the soleus and gastrocnemius subtendons.</p><p><strong>Results: </strong>For the soleus subtendon, the individual suturing technique yielded a smaller side-to-side (injured-uninjured) difference (1.9 ± 14.7 mm) compared to the standard surgery (17.0 ± 11.5 mm, p < 0.0001) at week 1 and week 26 (individual 10.7 ± 14.9 mm, standard 21.5 ± 12.7 mm, p < 0.0001), although there was an increase in the individual suturing from week 1 to week 26, (p < 0.05). The side-to-side difference in gastrocnemius subtendon length was not significantly affected by suturing technique but increased with time for individual suturing from week 1 (-1.5 ± 10.6 mm) to week 26 (9.2 ± 9.4 mm, p < 0.0001), and for standard suturing from week 1 (1.8 ± 11.1 mm) to week 26 (8.4 ± 10.9 mm, p < 0.0001).</p><p><strong>Conclusion: </strong>Using an individual suturing approach, soleus and gastrocnemius subtendon lengths were nearly restored to normal values 1 week postoperatively. Subsequent elongation of the soleus subtendon over 6 months was also significantly less with individual suturing than standard surgical repair.</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":"3783-3793"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip and groin pain in physically active adults with a focus on terminology, clinical examination and imaging: A formal ESSKA-EHPA-ESMA Consensus.","authors":"Per Hölmich, Adam Weir, Theodora Papadopoulou, Athanasios Papavasiliou, Kristian Thorborg, Gian Luigi Canata, Francesco Della Villa, Lior Laver, Oliver Marin-Peña, Hannu Paajanen, Neel Badhe, Sufian S Ahmad, Üstün Aydingöz, David Hanff, Olufemi Ayeni, Patricia Thoreux, Philippe Beaufils, Vikas Khanduja","doi":"10.1002/ksa.70565","DOIUrl":"10.1002/ksa.70565","url":null,"abstract":"<p><strong>Purpose: </strong>This European Society of Sports Traumatology, Knee Surgery and Arthroscopy-European Hip Preservation Associates-European Sports Medicine Association (ESSKA-EHPA-ESMA) formal consensus aims to provide evidence- and expert opinion-based recommendations for the terminology, clinical examination and imaging concerning the assessment of athletes and physically active adults with hip and groin pain.</p><p><strong>Methods: </strong>The 'ESSKA Formal Consensus' methodology, involving a rigorous, iterative peer review process, was utilized. A multidisciplinary group of 57 experts from 22 countries formed a steering group (15 experts), rating group (20 experts) and reader group (22 experts). The steering group developed 13 questions, including four conclusive questions, across three domains: terminology, clinical examination and imaging. Statements were graded A (high-level scientific evidence) to D (expert opinion) and scored 1-9 according to the level of agreement by the rating group. The reader group assessed statements for clarity and geographic adaptability.</p><p><strong>Results: </strong>Median ratings for the 13 statements ranged from 8 to 9 out of 9. Strong agreement was recorded for five questions, relative agreement for five questions, and three questions remained uncertain. All statements were graded C. Recommended terminology includes adductor, iliopsoas, inguinal, pubic and hip joint-related groin pain. Clinical examination should include gait assessment, Trendelenburg's test, palpation and resistance testing of relevant muscle groups, hip range of motion and the flexion, adduction, internal rotation (FADIR) test. Imaging examinations are neither fully sensitive or specific and should always be used in conjunction with history and examination. Depending on the suspected pathology, plain radiographs or ultrasonography should be used as first-line investigations, with magnetic resonance imaging, computed tomography and diagnostic hip injections reserved as second-line investigations.</p><p><strong>Conclusion: </strong>This consensus provides a structured reference frame for the terminology, examination and imaging for athletes and physically active adults with hip and groin pain. Different and combined aetiologies for hip and groin pain exist, and therefore consistent terminology and systematic clinical examination are essential. Red flags must not be ignored, and imaging must be interpreted alongside history and examination findings.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3844-3855"},"PeriodicalIF":5.0,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterolateral corner deficiency amplifies varus-related anterior cruciate ligament forces under dynamic loading: A biomechanical study.","authors":"Florian Gellhaus, Adrian Deichsel, Joelle Stening, Alina Albert, Christian Peez, Peter Behrendt, Andreas Seekamp, Michael J Raschke, Klemens Horst, Christoph Kittl","doi":"10.1002/ksa.70654","DOIUrl":"https://doi.org/10.1002/ksa.70654","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the influence of varus alignment, posterolateral corner (PLC) insufficiency, and PLC reconstruction on forces acting on the anterior cruciate ligament (ACL). It was hypothesized that increasing varus would increase ACL force, PLC transection would amplify this increase, and reconstruction would restore force toward PLC-intact values.</p><p><strong>Methods: </strong>Eight cadaveric knees (mean age 62 ± 12 years) underwent dynamic testing at 0°, 10°, 20°, 30° and 40° flexion under 200 N axial load in a materials testing machine with a custom five-degree-of-freedom setup. The ACL was tibially detached and refixated with 80 N using a custom tensioner. Lateral opening-wedge distal femoral osteotomy with external fixation and three-dimensionally printed wedges established 0°, 3°, 5° and 8° varus. Three conditions were tested: (1) native, (2) PLC transection (lateral collateral ligament and popliteus tendon) and (3) PLC reconstruction in Arciero technique.</p><p><strong>Results: </strong>Axial loading caused ACL forces in PLC-intact knees ranging from 77.1 ± 7.3 N (neutral alignment in 20° flexion) to 109.9 ± 46.8 N (8° varus at 40° flexion). Significant increases in ACL forces were observed at 30° (p = 0.006) and 40° (p = 0.001) of flexion with 8° varus. Following PLC transection, significant increases in ACL forces occurred at 5° varus and higher from 10° of flexion onwards, with a notable increase from 80.0 ± 12.3 (neutral) to 153.2 ± 58.4 N (8° varus, 40° flexion, p < 0.001). After PLC reconstruction, no significant effects of varus alignment or flexion on ACL forces were observed (p > 0.05).</p><p><strong>Conclusion: </strong>Under axial compression and simulated varus-thrust loading conditions, varus alignment of 5° or less did not significantly increase ACL forces in PLC-intact knees, whereas 8° varus resulted in significantly increased ACL loading at selected flexion angles. PLC deficiency was associated with greater increases in ACL force with increasing varus alignment.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225754","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":"A mathematical model of knee joint line orientation: Independent effects of femoral and tibial coronal anatomy and limits on achieving a horizontal joint line.","authors":"Gautier Beckers, Mathias Hengartner, Marin Lavigne, Marc-Olivier Kiss, Vincent Massé, Pascal-André Vendittoli","doi":"10.1002/ksa.70653","DOIUrl":"https://doi.org/10.1002/ksa.70653","url":null,"abstract":"<p><strong>Purpose: </strong>Natural knee joint line orientation (JLO) relative to the ground remains poorly understood. A JLO parallel to the floor is commonly assumed to favour balanced medial-lateral compartment loading, but the independent influence of femoral and tibial coronal anatomy on JLO during bipodal and single-limb stance has not been quantified. This study aimed to quantify the independent effects of the medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA) on knee JLO relative to the ground during bipodal and single-limb stance using a mathematical model.</p><p><strong>Methods: </strong>A two-dimensional geometric model of the lower limb was developed using representative anthropometric parameters. MPTA and LDFA were varied independently across the native varus-valgus range, from neutral to 7°, in 1° increments, yielding 36 discrete anatomical configurations. For each configuration, knee JLO relative to the ground was calculated for bipodal and single-limb stance, along with the theoretical mediolateral centre of mass (COM) displacement required to achieve a horizontal JLO. The model is deterministic and closed-form; results are reported to 0.1° and 0.1 mm.</p><p><strong>Results: </strong>Transition from bipodal to single-limb stance reduced JLO by 2.6° regardless of coronal anatomy. Each 1° change in MPTA or LDFA altered JLO by approximately 0.5° (0.54° and 0.46° per degree, respectively), indicating comparable effect magnitudes for tibial and femoral anatomy. However, MPTA and LDFA produced distinct geometric relationships, yielding different JLOs despite identical hip-knee-ankle alignment. Only a limited subset of configurations produced a horizontal JLO without theoretical COM displacement.</p><p><strong>Conclusion: </strong>Femoral and tibial coronal anatomy independently and predictably influence knee JLO during bipodal and single-limb stance, and overall alignment alone does not predict JLO. Achieving a horizontal JLO would require substantial COM adaptation in most configurations. Whether a horizontal JLO is physiologically achievable, or the primary biomechanical objective in all individuals, remains unknown.</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":5.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225720","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":"Digital tensioning demonstrates smaller medial and larger lateral gap measurements than manual assessment in robotic-assisted total knee arthroplasty.","authors":"Felipe Moreira Borim, Cindy Zeng, Timothy Lording","doi":"10.1002/ksa.70650","DOIUrl":"https://doi.org/10.1002/ksa.70650","url":null,"abstract":"<p><strong>Purpose: </strong>With the increasing use of robotic systems in total knee arthroplasty (TKA), contemporary alignment strategies have increasingly relied on accurate intraoperative gap measurements to achieve optimal soft tissue balance. Digital tensioning devices offer a potentially more objective and reproducible method of gap measurement; however, the relationship between digital and manual gap measurement techniques remains unclear. This study aims to compare gap measurements obtained using a digital tensioning device versus manual tensioning with a Z-retractor, and to explore whether gap discrepancies vary in the medial versus lateral compartment.</p><p><strong>Methods: </strong>A total of 170 primary TKA cases performed using the CORI robotic system (serial number SN000618, software versions v2.0.1.1 or v2.0.2.0) were prospectively collected from April 2024 to March 2025. Primary TKA cases with complete digital and manual gap measurements obtained according to the study protocol were included; cases with incomplete data or protocol deviation were excluded. All procedures followed a standardised workflow in which the default initial implant position was planned in neutral mechanical alignment. Intraoperative gap measurements were first obtained using the CORI Digital Tensioner (using 100 N medially and 50 N laterally), followed by manual gap assessments using a Z-retractor technique. Gap measurements were compared across the analysed flexion arc.</p><p><strong>Results: </strong>A total of 152 knees were ultimately included, comprising 78 right (51.3%) and 74 left (48.7%) knees. Mean preoperative alignment was 3.72 ± 4.43°, with a mean preoperative range of motion from 6.44 ± 6.06° to 143.34 ± 7.79°. The digital tensioner consistently demonstrated significantly larger lateral gaps compared with manual tensioning, particularly in extension (0°: 2.38 mm vs. 1.63 mm, p < 0.001). Conversely, the digital tensioner produced smaller medial gaps compared to manual tensioning both in extension (-0.92 mm vs. -0.00 mm) and at 100° of flexion (0.79 mm vs. 1.19 mm, p < 0.001). These directional differences were maintained across preoperative alignment and range-of-motion subgroups.</p><p><strong>Conclusion: </strong>Gap measurements obtained using a digital tensioner consistently demonstrated greater lateral opening in extension and reduced medial gaps compared to manual assessment. The direction of these differences was maintained across preoperative alignment and preoperative flexion range. While digital tensioning may provide a more standardised approach to intraoperative gap assessment, surgeons should recognise technique-specific measurement differences when interpreting gap data for robotic-assisted TKA planning and soft-tissue balancing.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225752","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}