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

{"title":"Lateral prosthetic trochlear angle deviation is common and clinically safe after robotic functionally aligned total knee arthroplasty.","authors":"Enejd Veizi, Clemente Caria, Christos Koutserimpas, Luca Andriollo, Pietro Gregori, Elvire Servien, Cécile Batailler, Sébastien Lustig","doi":"10.1002/ksa.70087","DOIUrl":"https://doi.org/10.1002/ksa.70087","url":null,"abstract":"<p><strong>Purpose: </strong>The alignment between the prosthetic trochlear angle (PTA) and the quadriceps vector (QV) is thought to influence patellofemoral kinematics and clinical outcomes following total knee arthroplasty (TKA). The aim of this study was to evaluate whether the deviation of the PTA from the QV correlates with patient-reported outcomes in image-based, robotic-assisted, functionally aligned TKAs (FA-TKAs).</p><p><strong>Methods: </strong>In this retrospective study, 237 patients undergoing image-based robotic-assisted FA-TKA between March 2021 and April 2023 were evaluated. Inclusion criteria required complete radiological and clinical data with at least 2 years of follow-up. The PTA-QV deviation was measured on post-operative long-leg radiographs. Clinical outcomes were assessed using the Knee Society Score (KSS), Knee Society Score-Functional (KSS-F) and Forgotten Joint Score (FJS).</p><p><strong>Results: </strong>The mean PTA deviation from the QV was 3.8 ± 2.4°, predominantly laterally. Only 2.9% of knees exhibited medial deviation. At a mean follow-up of 34.3 ± 6.7 months, patients demonstrated excellent clinical outcomes. PTA deviation was correlated only with the final hip-knee-ankle (HKA) angle (p < 0.001) but showed no significant correlation with clinical scores.</p><p><strong>Conclusion: </strong>In robotic-assisted, FA-TKAs, the PTA typically deviates laterally from the QV without correlating with patient outcomes. This mild lateral deviation primarily reflects overall coronal alignment and appears biomechanically safe, maintaining optimal post-operative knee function and patient satisfaction.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282562","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":"Postural coronal alignment shift after total knee arthroplasty diminishes with age and becomes negligible in elderly patients.","authors":"Komson Plangsiri, Bhumin Chotiwatanadilok, Pruk Chaiyakit, Pinkawas Kongmalai","doi":"10.1002/ksa.70085","DOIUrl":"https://doi.org/10.1002/ksa.70085","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether patient age moderates the change in coronal hip-knee-ankle (HKA) alignment between supine and standing positions following total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>In this cross-sectional study, 113 consecutive patients after primary TKA for osteoarthritis underwent standardized full-length radiographs in both supine and standing positions. The postural shift (ΔHKA) was defined as standing minus supine alignment. Associations between age and ΔHKA were examined using a linear mixed-effects model with restricted cubic splines, adjusting for body mass index (BMI), sex, preoperative alignment and time since surgery. Equivalence testing (±1° margin) was performed in patients aged ≥60 years.</p><p><strong>Results: </strong>Younger patients demonstrated a standing varus drift of approximately 2-3°, whereas the effect progressively diminished with advancing age. The age-position interaction was significant (p = 0.011), while BMI, sex, preoperative alignment and time since surgery were not. In patients ≥60 years, the mean ΔHKA was -0.01° (90% confidence interval = -0.55° to +0.53°), meeting statistical equivalence to 0 (p = 0.008). Collateral ligament laxity on stress radiography showed no association with ΔHKA.</p><p><strong>Conclusion: </strong>Postural coronal alignment change after TKA is strongly age dependent. Younger patients show a measurable varus drift, whereas older patients demonstrate negligible change within radiographic error. Age should be considered when tailoring intraoperative alignment strategies to ensure durable functional outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254236","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":"Periacetabular osteotomy with or without hip arthroscopy in patients with borderline hip dysplasia: A systematic review.","authors":"Jaydeep Dhillon, Mustafa Ansari, Carson Keeter, Matthew J Kraeutler, Michael T Hirschmann, Kristian Samuelsson","doi":"10.1002/ksa.70088","DOIUrl":"https://doi.org/10.1002/ksa.70088","url":null,"abstract":"<p><strong>Purpose: </strong>The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.</p><p><strong>Results: </strong>Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in 4 studies (mean: 62.6-82.9). SF-12/SF-36 physical scores improved in 3 studies (37.8-47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months.</p><p><strong>Conclusion: </strong>In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level III-IV studies.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254223","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":"Kaplan fibres of the knee revisited: Anatomical variants, MRI identification and surgical implications for ACL reconstruction and rotational instability.","authors":"Ingrid C Landfald, Robert F LaPrade, Łukasz Olewnik","doi":"10.1002/ksa.70078","DOIUrl":"https://doi.org/10.1002/ksa.70078","url":null,"abstract":"<p><p>Kaplan fibres (KFs) are distinct capsulo-osseous connections between the iliotibial band and the distal femur that have re-emerged as critical contributors to anterolateral knee stability and the pivot shift phenomenon. This narrative review synthesises contemporary anatomical, radiological, biomechanical, and surgical data to clarify KF morphology, variants, and their implications in the setting of anterior cruciate ligament (ACL) injury. Anatomical studies consistently demonstrate a bipartite architecture composed of superficial and deep fibres, with variable femoral insertions and occasional accessory slips that help resist tibial internal rotation. These features may explain why some patients experience residual rotatory laxity even after anatomically positioned ACL reconstructions. On magnetic resonance imaging, KFs are best assessed with high-resolution 3 T protocols, fat-suppressed proton density or T2 sequences, and oblique planes aligned to the lateral femoral cortex. However, deep fibres are inconsistently visualised and interobserver agreement remains moderate. Clinically, KF disruption occurs in up to 60% of acute ACL tears and is strongly correlated with high-grade pivot shift. Biomechanical models confirm that KFs function as secondary stabilisers, particularly between 30° and 90° of flexion, complementing but not duplicating the roles of the ACL and anterolateral ligament. While no direct KF reconstruction technique exists, lateral extra-articular tenodesis (LET), notably the modified Lemaire procedure, replicates their tension vectors and reduces failure rates when combined with ACL reconstruction in young athletes, revision cases, or patients with generalised ligamentous laxity. Based on available evidence, we propose a preliminary Kaplan Fibre Injury Classification (KFIC) that integrates MRI and intraoperative features, and we outline a pragmatic decision-making algorithm linking KF injury patterns to augmentation strategies. Key gaps include a lack of standardised terminology, validated MRI grading, and prospective outcome studies stratified by KF status. By integrating anatomy, radiology, biomechanics, and operative perspectives, this review emphasises the critical role of KFs in rotational knee stability and provides a framework to improve preoperative planning, guide selective use of extra-articular augmentation, and optimise long-term outcomes after ACL reconstruction. LEVEL OF EVIDENCE: Basic.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234781","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":"Unrestricted kinematic alignment in varus total knee arthroplasty outperforms mechanical alignment in CPAK I phenotype, but yields comparable outcomes in CPAK IV: A retrospective analysis from the FP-UCBM Knee Study Group.","authors":"Edoardo Franceschetti, Giancarlo Giurazza, Stefano Campi, Michael T Hirschmann, Kristian Samuelsson, Andrea Tanzilli, Pietro Gregori, Michele Paciotti, Biagio Zampogna, Rocco Papalia","doi":"10.1002/ksa.70084","DOIUrl":"https://doi.org/10.1002/ksa.70084","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes in varus-aligned patients undergoing cruciate-retaining total knee arthroplasty (TKA) with mechanical alignment (MA) versus unrestricted kinematic alignment (KA). The hypothesis was that KA would yield superior outcomes, and that preserving joint line obliquity-regardless of alignment technique-would be associated with better results.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data from 140 KA and 209 MA TKA cases was performed. Inclusion criteria were: end-stage varus osteoarthritis (aHKA < 178°), MA or unrestricted KA TKA and ≥ 1-year follow-up. Exclusion criteria included prior major surgery (osteotomies, fractures) on the affected limb, inadequate preoperative full-length radiographs, or post-operative complications unrelated to alignment strategy. Patients were categorised by CPAK phenotype (I, IV and VII) based on the joint line obliquity. Clinical outcomes at 1-year follow-up were assessed using the Knee Society Score (KSS) pt.1 and 2, Oxford Knee Score (OKS), SF-12, and Forgotten Joint Score (FJS). ANOVA was used to compare results of MA and KA in the overall varus population, and in CPAK subgroups. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>KA led to significantly higher KSS pt.1 (84.6 ± 15.3 vs. 73.9 ± 18.9; p < 0.001) and FJS (90.5 ± 15.3 vs. 80.4 ± 15.8; p < 0.001) than MA. In CPAK I patients, KA outperformed MA in KSS pt.1 (83.5 ± 16.2 vs. 74.9 ± 19.1; p < 0.001) and FJS (89.8 ± 15.5 vs. 80.7 ± 17.8; p < 0.001). No differences were found between KA and MA in CPAK IV patients (p > 0.05). KSS pt.1 (80.1 ± 13.8) and FJS (86.5 ± 18.1) achieved with MA in CPAK IV were significantly higher than in both the overall varus aHKA group and CPAK I patients treated with MA (p < 0.05).</p><p><strong>Conclusions: </strong>Cruciate-retaining unrestricted KA yields better clinical outcomes compared to MA in varus aHKA patients, and in the CPAK I subgroup. In CPAK IV, preserving joint line obliquity leads to similar outcomes with both MA and KA.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234862","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":"Peroneus longus tendon harvest for ACL reconstruction yields good functional outcome of the ankle: A systematic review and meta-Analysis.","authors":"Mehran Soleymanha, Amirali Soleymani Nejad, Sohrab Keyhani, Fardis Vosoughi, Robert F LaPrade, Luke V Tollefson","doi":"10.1002/ksa.70079","DOIUrl":"https://doi.org/10.1002/ksa.70079","url":null,"abstract":"<p><strong>Purpose: </strong>The peroneus longus tendon (PLT) has emerged as a promising autograft option for anterior cruciate ligament (ACL) reconstruction, but concerns persist regarding donor-site morbidity and ankle functional outcomes. This systematic review and meta-analysis aimed to evaluate ankle performance following PLT harvest for ACL reconstruction.</p><p><strong>Methods: </strong>This systematic review and meta-analysis performed by searching five databases (PubMed, Embase, Web of Science, Scopus, and the Cochrane Library) up to March 2025. Inclusion criteria included: ACL reconstruction using PLT autograft, ≥6-month follow-up, and validated ankle outcomes (American Orthopaedic Foot And Ankle Society [AOFAS]/Foot and Ankle Disability Index [FADI] scores). Pooled effect sizes were calculated using random-effects models using R software (version 4.4.3). Heterogeneity was assessed via I² statistics, and risk of bias was evaluated using JBI checklists.</p><p><strong>Results: </strong>Twenty articles (1024 patients) were identified, comprising eleven prospective cohort studies and nine randomised clinical trials (RCT), based on title, abstract, and quality assessments. Meta-analysis demonstrated excellent postoperative ankle function, with pooled AOFAS scores of 96.0 (95% confidence interval [CI]: 92.6-99.3) at 6 months, 96.1 (93.9-98.2) at 12 months, and 97.2 (93.9-100.6) at 24 months. FADI scores similarly improved to 97.4 (96.0-98.9) by 6 months and 99.4 (98.7-100.1) at 24 months. Meta-regression revealed no significant association between age and AOFAS outcomes (β = -0.23, p = 0.36). Minor complications (e.g., transient hypaesthesia) occurred in 13%-23% of patients but resolved within months. No studies reported major nerve injuries or ankle instability.</p><p><strong>Conclusion: </strong>Peroneus longus tendon harvest for ACL reconstruction yields minimal donor-site morbidity, with consistently high AOFAS/FADI scores across all age groups. These findings support the safety of PLT autografts, though heterogeneity is evident, and the predominance of male participants and the regional focus of studies, mainly Asian populations, may affect generalisability.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194190","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 postoperative circles measurement considers recurrent instability and correlates with lower outcome scores after acute, bidirectional arthroscopically assisted acromioclavicular joint stabilization.","authors":"Philipp Vetter, Frederik Bellmann, Larissa Eckl, Alp Paksoy, Doruk Akgün, Asimina Lazaridou, Markus Scheibel","doi":"10.1002/ksa.70074","DOIUrl":"https://doi.org/10.1002/ksa.70074","url":null,"abstract":"<p><strong>Purpose: </strong>The circles measurement is a newly validated in vivo method to evaluate acromioclavicular joint (ACJ) dislocations, but its postoperative and clinical relevance has not been evaluated. We hypothesised that the postoperative circles measurement would capture recurrent vertical as well as horizontal instability and that it would be associated with outcome scores in patients undergoing acute, bidirectional arthroscopically assisted ACJ stabilisation.</p><p><strong>Methods: </strong>Male patients (18-55 years) with an acute ACJ dislocation (Rockwood type V) were included retrospectively. Radiographs included a single, bilateral anteroposterior stress view and bilateral Alexander views preoperatively and postoperatively (final follow-up of minimum 2 years). Excluded were patients with previous injuries/minors/polytrauma or insufficient radiographs. The side-to-side difference (SSD) coracoclavicular distance (CCD), the degree of dynamic horizontal translation (DHT) and the SSD circles measurement as well as the ACJ instability (ACJI) and Taft (TF) score, subjective shoulder value (SSV) and Constant score were recorded at the final follow-up (minimum 2 years). The postoperative SSD circles measurement was analysed in relation to these. Statistical analysis comprised correlations and group comparisons.</p><p><strong>Results: </strong>Fifty-six patients (mean age, 38.9 ± 10.7 years) with a follow-up of 33.0 months (range, 24-55 months) were included. The postoperative SSD circles measurement demonstrated a correlation with recurrent vertical instability (SSD CCD: r = 0.37; p = 0.006), and with recurrent horizontal instability (DHT: r = 0.46; p < 0.001). A higher postoperative SSD circles measurement was associated with lower outcome scores (SSV: r = -0.31; p = 0.021; TF score: r = -0.29; p = 0.031; ACJI score: r = -0.35; p = 0.01). The cut-off values for lower scores (p < 0.05 by stepwise group comparison) were 0 mm for the SSV (p = 0.022); 2.2 mm for the TF score (p = 0.022) and 2.7 mm for the ACJI score (p = 0.024).</p><p><strong>Conclusions: </strong>The postoperative circles measurement reflects both recurrent vertical and horizontal instability and correlates with lower outcome scores following arthroscopically assisted ACJ stabilisation, supporting its use as a radiographic adjunct.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194240","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":"Five-year implant survival does not differ between hybrid and cementless total knee arthroplasty in a cohort of 5361 patients using a deep-dish mobile bearing design.","authors":"Ophélie Manchec, Emilie Bérard, Alessandro Carrozzo, Regis Pailhé, Etienne Cavaignac","doi":"10.1002/ksa.70075","DOIUrl":"https://doi.org/10.1002/ksa.70075","url":null,"abstract":"<p><strong>Purpose: </strong>This study compared total knee arthroplasty (TKA) outcomes between cementless and hybrid fixation, with separate analysis of tibial and femoral cementation. The primary hypothesis was that equivalence would exist in implant survivorship between cementless and hybrid fixation techniques. The secondary hypothesis was that cementless and hybrid TKAs would demonstrate comparable mid-term surgery-free survival rates, rates of aseptic reoperation and functional outcomes.</p><p><strong>Methods: </strong>A multicentre retrospective study was conducted using prospectively collected data from a large cohort, all implanted with the same deep-dish mobile bearing. Patients were divided according to the fixation method: fully cementless, femoral cemented/tibial uncemented and tibial cemented/femoral uncemented. The survival rates of cementless and hybrid TKA were compared with a median follow-up of 27 months. Evolution of functional outcomes (International Knee Society [IKS] score, range of motion [ROM]) from preoperative to 5-year follow-up were also compared. Propensity score matching (PSM) was performed to balance covariates (age, sex, body mass index and patellar procedure) between groups.</p><p><strong>Results: </strong>Among the 5361 primary TKA included (4549 cementless, 435 tibial hybrid and 377 femoral hybrid), 1505 reached the 5-year follow-up. Five-year revision-free survival rate was 98.7% (95% confidence interval: 98.2; 99.1) for cementless, 97.8% (94.6; 99.1) for tibial hybrid (p = 0.537) and 98.4% (94.9; 99.5) for femoral hybrid (p = 0.669). Cumulative surgery-free survival rates and functional outcomes at 5 years showed no significant differences between groups with clinically comparable results.</p><p><strong>Conclusion: </strong>No difference in survivorship was observed between cementless and hybrid TKA at 5 years in this cohort of 5361 patients, whether the tibia or femur was cemented. Rates of reoperation and aseptic reoperation were also comparable, as were clinical outcomes. These results suggest that the choice between hybrid and cementless fixation does not impact mid-term TKA survival.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194252","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":"Dynamic computed tomography assessment of patellofemoral and tibiofemoral kinematics before and after total knee arthroplasty: A pilot study.","authors":"Miriam R Boot, Sebastiaan A W van de Groes, Esther Tanck, Dennis Janssen","doi":"10.1002/ksa.70076","DOIUrl":"https://doi.org/10.1002/ksa.70076","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and evaluate the clinical feasibility of a dynamic computed tomography (CT) protocol for assessing patellofemoral (PF) and tibiofemoral (TF) kinematics before and after total knee arthroplasty (TKA), and to quantify postoperative kinematic changes in a pilot study.</p><p><strong>Methods: </strong>In this prospective single-centre study, patients with primary osteoarthritis scheduled for cemented TKA underwent dynamic CT scans preoperatively and at 1-year follow-up during active flexion-extension-flexion. Preoperatively, the femur, tibia and patella were segmented using a neural network. Postoperatively, computer-aided design (CAD) implant models were aligned to CT data to determine relative implant-bone orientation. Due to metal artefacts, preoperative patella meshes were manually aligned to postoperative scans by four raters, and averaged for analysis. Anatomical coordinate systems were applied to quantify patellar flexion, tilt, proximal tip rotation, mediolateral translation and femoral condyle anterior-posterior translation. Descriptive statistics were reported, and interoperator agreement for patellar registration was assessed using intraclass correlation coefficients (ICCs).</p><p><strong>Results: </strong>Ten patients (mean age, 65 ± 8 years; 6 men) were analysed across a shared flexion range of 14°-55°. Postoperatively, the patella showed increased flexion (median difference: 0.9°-3.9°), medial proximal tip rotation (median difference: 1.5°-6.0°), lateral tilt (median difference: 2.7°-5.5°), and lateral shift (median difference: -1.5 to -2.8 mm). The medial and lateral femoral condyles translated 2-4 mm anterior-posteriorly during knee flexion. Interoperator agreement for patellar registration ranged from good to excellent across all parameters (ICC = 0.85-1.00).</p><p><strong>Conclusion: </strong>This pilot study demonstrates that dynamic CT enables in vivo assessment of PF and TF kinematics before and after TKA. The protocol quantified postoperative kinematic changes and demonstrated potential as research tool. Further automation is needed to investigate relationships between these kinematic patterns and patient outcomes in larger-scale studies.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188249","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":"Time-dependent wound management protocol prevents periprosthetic joint infection in total knee arthroplasty with persistent drainage.","authors":"Filippo Leggieri, Francesco Ferriani, Enrico Di Benedetto, Enrick Miani, Enrico Festa, Giovanni Balato, Stefano M P Rossi, Francesco Benazzo, Andrea Baldini","doi":"10.1002/ksa.70077","DOIUrl":"https://doi.org/10.1002/ksa.70077","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the success rate of a standardised protocol for managing persistent wound drainage following total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A prospective observational study was conducted at four institutions between January and June 2022 across primary and revision TKAs. Sixty-two patients (mean age 71.5 ± 9.3 years; 45.2% male) who experienced postoperative wound drainage after primary (58.1%) or revision (41.9%) TKA were enrolled. The protocol included staged interventions: anticoagulation adjustments and dressing changes during Days 1-3, incisional negative pressure wound therapy during Days 3-5, and wound debridement above the joint capsule if drainage persisted beyond Day 7. Outcomes were evaluated using the ASEPSIS score. The primary outcome was defined as complete wound healing without progression to debridement, antibiotics and implant retention (DAIR) procedure or periprosthetic joint infection (PJI).</p><p><strong>Results: </strong>The mean follow-up was 13.2 months (range, 11.7-15.1 months). The protocol achieved a 91.9% success rate in preventing progression to DAIR. The median number of visits required to achieve wound healing was 3.5 for the cohort. DAIR rate was 8.1% (n = 5), while PJI rate was 1.6% (n = 1). Primary TKA procedures demonstrated more efficient healing trajectories compared to revision cases, requiring fewer clinical visits (median 3 vs. 5, p < 0.001) and shorter hospital stays (mean 4.5 vs. 7.5 days, p = 0.017). Cox proportional hazards model identified intervention type (revision vs. primary, hazard ratio [HR] 0.24, p < 0.001), advanced age (HR: 0.95 per year, p = 0.006), and male gender (HR: 0.45, p = 0.020) as significant independent predictors of increased time required to achieve wound healing.</p><p><strong>Conclusion: </strong>Our standardised wound management protocol achieved a high success rate in preventing progression to PJI following TKA. The time-dependent approach to intervention escalation provides clear clinical decision-making criteria and suggests that early identification and systematic management of wound complications are critical determinants of successful outcomes, particularly for primary TKA procedures.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188307","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}