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

{"title":"Multicentric development and validation of a fully automated artificial intelligence system for planning medial open wedge high tibial osteotomy on weight-bearing anterior-posterior long leg radiographs: The ISAKOS John Joyce Award 2025.","authors":"Marco-Christopher Rupp, Claudio E von Schacky, Felix J Lindner, Matthias J Feucht, Yannick Ehmann, Lorenz Fritsch, Alexandros Doucas, Sami Haddadin, Florian Hinterwimmer, Matthias Jung, Maximilian F Russe, Rüdiger von Eisenhart-Rothe, Sebastian Siebenlist, Nikolas J Wilhelm","doi":"10.1002/ksa.70635","DOIUrl":"https://doi.org/10.1002/ksa.70635","url":null,"abstract":"<p><strong>Purpose: </strong>Preoperative planning, currently performed by orthopaedic surgeons (OS), is essential for successful osteotomy, but is labour-intensive and error-prone. As such, there is significant potential in the use of automated artificial intelligence (AI) algorithms to augment the abilities of OS in managing lower extremity pathologies in a high-volume task that demands high precision and reliability. The aim was to develop a deep learning (DL) system capable of fully autonomous planning a medial open wedge high tibial osteotomy (mow-HTO) on weight bearing anterior posterior (AP) long leg radiographs (LLR) and to validate its agreement with an expert-derived reference standard, its reliability and processing time of the DL model compared to expert OS on multicentric test data sets (two institutions).</p><p><strong>Methods: </strong>A total of 594 patients (age 41.1 ± 13.2 years, 182 female) who underwent osteotomy between 01/2014 and 01/2021 were retrospectively enrolled. Manual annotations for lower extremity alignment and high tibial landmarks were performed on AP LLR radiographs. The data set was divided into training (60%, n = 399), validation (10%, n = 59) and hold-out testing (30%, n = 136), with an additional external dataset (n = 100) for further testing. A DL system with twelve expert networks was trained to identify relevant landmarks for HTO planning. The DL model was then tested on fully automated planning of a medial open wedge HTO based on (1) the desired postoperative intersection of the mechanical axis with the tibial plateau (%-based) and (2) the desired femorotibial axis (°-based). Agreement with the expert-derived reference, reliability and processing time were compared with three expert OS using FDA-approved preoperative planning software on the test data sets.</p><p><strong>Results: </strong>For preoperative alignment parameter analysis, compared to the ground truth, human preoperative accuracy ranged from 0.13° ± 0.10° to 1.06° ± 1.4°, interrater reliability ranged from intraclass correlation (ICC) 0.84-1.0 and clinically acceptable accuracy ranged from 72% to 100%. Preoperative accuracy of the DL model ranged from 0.22° ± 0.18° to 1.04° ± 1.28°, interrater reliability ranged from ICC 0.93-1.0 and clinically acceptable accuracy ranged from 91% to 100%. For the planning of the osteotomy gap, compared to the ground truth, human accuracy ranged from 0.46 ± 0.65 mm to 0.5 ± 0.88 mm (%-based) and 0.43 ± 0.55 to 0.52 ± 0.75 mm (°-based), reliability ranged from ICC 0.9-0.96 and 0.95-0.97 and clinically acceptable accuracy was 93.6%-96.0% (%-based) and 89.8%-93.9% (°-based). For the DL model, the accuracy was 0.53 ± 0.63 mm (%-based) and 0.44 ± 0.53 mm (°-based), reliability was ICC 0.99 (both methods) and clinically acceptable accuracy was 98.1% (%-based) and 96.2% (°-based). The DL-model significantly and substantially outperformed the OS in intrarater reliability (0.88 vs. 1.0) and processing time for a fully ","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":"149225731","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":"Long-term survivorship of medial meniscus posterior horn repair during revision anterior cruciate ligament reconstruction: 10-year results from the SANTI Group.","authors":"Fabio Santamaria, Hussein Wehbe, Merwane Ayata, Charles Pioger, Victor Sonnery-Cottet, Joao Pedro Campos, Thais Dutra Vieira, Bertrand Sonnery-Cottet","doi":"10.1002/ksa.70645","DOIUrl":"https://doi.org/10.1002/ksa.70645","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the long-term rate of secondary medial meniscectomy following medial meniscus posterior horn repair performed during revision anterior cruciate ligament reconstruction (ACLR) and to compare contemporary posteromedial suture-hook repair with other repair strategies used during the study period. We hypothesized that suture-hook repair would be associated with improved long-term meniscal survivorship compared to other repair strategies performed with revision ACLR.</p><p><strong>Methods: </strong>This retrospective cohort study included patients undergoing revision anterior cruciate ligament reconstruction (rACLR) between 2003 and 2023 at a single high-volume centre. Knees presenting with ramp lesions, meniscocapsular separations, meniscotibial disruptions and longitudinal vertical tears extending into the posterior horn of the medial meniscus treated by repair were identified and stratified according to repair strategy: contemporary posteromedial suture-hook repair versus other techniques used during the study period, including all-inside, inside-out and earlier repair techniques. The primary outcome was secondary medial meniscectomy. Time-to-event analysis was performed using Kaplan-Meier survival estimates and compared using the log-rank test. A multivariable Cox proportional hazards model was used to assess independent predictors of secondary medial meniscectomy, with administrative censoring at 10 years.</p><p><strong>Results: </strong>A total of 402 medial meniscus repairs were included, with a mean follow-up of 96.0 ± 31.4 months after administrative censoring at 10 years. At 10 years, the cumulative rate of secondary medial meniscectomy was 17.5% (95% confidence interval [CI] 13.6-22.4). Unadjusted analysis demonstrated a lower rate of secondary medial meniscectomy in the suture-hook repair group compared with other repair techniques used during the study period (15.8% [95% CI 11.3-21.9] vs. 24.1% [95% CI 16.3-34.9]; log-rank p = 0.0499). However, after multivariable adjustment, repair technique was not independently associated with secondary medial meniscectomy (hazard ratio 1.62, 95% CI 0.90-2.83; p = 0.0986).</p><p><strong>Conclusion: </strong>Long-term outcomes of medial meniscus posterior horn repair during rACLR showed a 17.5% cumulative rate of secondary medial meniscectomy at 10 years. Posteromedial suture-hook repair was associated with lower failure rates than other repair techniques on unadjusted analysis; however, repair technique was not an independent predictor of secondary medial meniscectomy after multivariable adjustment. These findings support meniscal preservation and systematic assessment of posteromedial meniscal lesions during revision ACLR while providing realistic long-term expectations regarding repair survivorship.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218022","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":"Cross-cultural adaptation and initial evaluation of selected measurement properties of the simplified chinese version of the knee injury and osteoarthritis outcome score joint replacement in patients with knee osteoarthritis.","authors":"Wanyuji Wang, Yinsong Sun, Ping Zhou, Lu Zhou, Diana Marijo Amanda Massengo Ngoyi, Fadli Sulistiawan, Régis Pailhé, Alessandro Carrozzo, Wei Huang, Etienne Cavaignac, Ke Li","doi":"10.1002/ksa.70658","DOIUrl":"https://doi.org/10.1002/ksa.70658","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to translate and culturally adapt the knee injury and osteoarthritis outcome score joint replacement (KOOS-JR) into simplified Chinese and provide an initial evaluation of selected measurement properties in patients with knee osteoarthritis (OA) scheduled for total knee replacement (TKR).</p><p><strong>Methods: </strong>Eighty-five patients completed the simplified Chinese KOOS-JR and International Knee Documentation Committee (IKDC) at baseline, and clinically stable participants repeated the KOOS-JR after 10-14 days. Selected properties included supervised data completeness, floor and ceiling effects, provisional internal consistency, test-retest reliability, measurement error and construct validity.</p><p><strong>Results: </strong>All 85 participants completed baseline and retest assessments. No floor or ceiling effects were observed. Cronbach's alpha was 0.849 at baseline and 0.816 at retest. intraclass correlation coefficient (A,1) was 0.791 (95% CI, 0.695-0.859). The mean test-retest difference was -0.39 points, with an individual-level smallest detectable change of 11.69 points. KOOS-JR and IKDC scores were strongly correlated (r_s = 0.766; 95% CI, 0.646-0.850; p < 0.001).</p><p><strong>Conclusion: </strong>The simplified Chinese KOOS-JR showed reasonably stable test-retest performance and initial supportive construct validity in this preoperative TKR cohort. Internal-consistency evidence remains provisional because structural validity was not assessed. Further studies should evaluate structural validity, measurement invariance, responsiveness and practical burden.</p><p><strong>Level of evidence: </strong>N/A.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149218047","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 use of patellar tendon autograft and lateral meniscus repair are associated with loss of motion of the knee among female patients undergoing anterior cruciate ligament reconstruction.","authors":"Sahil Dadoo, Amalie E Nash, Zilu Yang, Nicolas Aycardi, Neel Bhardwaj, Dharmesh Vyas, Jonathan D Hughes, Volker Musahl, James J Irrgang, Bryson P Lesniak","doi":"10.1002/ksa.70652","DOIUrl":"https://doi.org/10.1002/ksa.70652","url":null,"abstract":"<p><strong>Purpose: </strong>To conduct a sex-stratified analysis of factors associated with subsequent surgery for loss of motion after anterior cruciate ligament reconstruction (ACLR), including meniscus repair and graft type.</p><p><strong>Methods: </strong>All individuals age ≥14 years who underwent primary ACLR between 2014 and 2021 were reviewed. Exclusion criteria included <6 months follow-up and concomitant meniscal root, multiligament, osteochondral or osteotomy procedures. The primary outcome was subsequent surgery for loss of motion. Demographic and surgical variables were compared between individuals who underwent subsequent surgery for loss of motion versus not, for the full cohort and among females and males separately. Significance was set to p < 0.050.</p><p><strong>Results: </strong>A total of 1226 individuals (age: 25 ± 10 years; 49% female) were included at a mean follow-up of 2.3 years. The rate of subsequent surgery for loss of motion was 9.0% for the full cohort, 12.3% for females and 5.9% for males. Among the full cohort, female sex (OR: 2.31; p < 0.001) and lateral meniscus (LM) repair (OR: 1.62; p = 0.048) were predictors of subsequent surgery for loss of motion. Among females, bone-patellar tendon-bone (BPTB) autograft use (OR: 1.91; p = 0.034) and LM repair (OR: 1.72; p = 0.046) were predictors of subsequent surgery for loss of motion, with combined BPTB autograft use and LM repair resulting in a significantly higher rate of subsequent surgery for loss of motion (32% vs. 12%; p = 0.004). Among males, graft type and meniscus repair were not associated with subsequent surgery for loss of motion (both p > 0.050).</p><p><strong>Conclusion: </strong>In this sex-stratified analysis, BPTB autograft use and LM repair were identified as factors predictive of subsequent surgery for loss of motion after primary ACLR when analysing females independently, while no predictive factors were identified when analysing males independently. Understanding factors associated with loss of motion after primary ACLR among males and females separately may guide individualised surgical decision-making and patient counselling.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217987","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":"Low graft failure after primary anterior cruciate ligament reconstruction in professional soccer players: A retrospective cohort study of 232 knees from the SANTI Study Group.","authors":"Fabio Santamaria, Pedro Mendes Santos, Merwane Ayata, Hussein Wehbe, Victor Sonnery-Cottet, Joao Pedro Campos, Jacopo Corti, Thais Dutra Vieira, Bertrand Sonnery-Cottet","doi":"10.1002/ksa.70641","DOIUrl":"https://doi.org/10.1002/ksa.70641","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine graft failure rates after primary anterior cruciate ligament reconstruction (ACLR) in professional soccer players and to evaluate factors associated with graft failure, including lateral extra-articular augmentation.</p><p><strong>Methods: </strong>A retrospective cohort study included 232 primary ACLRs in 215 professional soccer players: isolated ACLR (n = 31) and ACLR combined with a lateral extra-articular procedure (LEAP) (n = 201). The primary endpoint was graft failure, defined as symptomatic rupture confirmed clinically and by imaging or revision surgery. Time-to-event analyses accounted for variable follow-up. Contralateral ACL injury was recorded descriptively.</p><p><strong>Results: </strong>At a mean follow-up of 100 months, 13 graft failures occurred (5.6%). Unadjusted failure rates were lower in ACLR + LEAP versus isolated ACLR (4.5% vs. 12.9%), but survival analysis showed no significant difference (hazard ratio [HR] 2.48; 95% confidence interval [CI] 0.49-9.87; p = 0.246). Multivariable Cox regression identified no independent predictors of graft failure. Mean time to graft failure was longer in the ACLR + LEAP group than in the isolated ACLR group (54.8 ± 52.0 vs. 36.6 ± 38.2 months). Reoperations occurred in 32 knees (17.7%), with rates of 15.2% in the ACLR + LEAP group and 30.0% in the isolated ACLR group (p = 0.0528). Increased preoperative laxity (≥7 mm; HR 2.72; 95% CI 1.23-6.17; p = 0.014) and bone-patellar tendon-bone graft use (HR 3.14; 95% CI 1.26-7.20; p = 0.037) were independent risk factors for reoperation. Contralateral ACL injury occurred in 27.1% of knees, more frequently in female athletes (48.7% vs. 22.8%). Among patients who experienced graft failure, 53.8% also had a contralateral ACL injury.</p><p><strong>Conclusion: </strong>Primary ACL reconstruction in professional soccer players was associated with durable long-term graft survival. Although ACLR combined with an LEAP was associated with fewer graft failures than isolated ACLR, an independent protective effect was not confirmed. The high rate of contralateral ACL injury highlights the multifactorial nature of reinjury risk in this elite population.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198832","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":"Visual presentation, statistical reporting and methodological considerations in a meta-analysis of remnant-preserving anterior cruciate ligament reconstruction.","authors":"Qianjiang Xiong, Xin Wang, Weili Fu","doi":"10.1002/ksa.70639","DOIUrl":"https://doi.org/10.1002/ksa.70639","url":null,"abstract":"<p><p>This Letter addresses critical methodological inconsistencies in a recent meta-analysis on remnant-preserving anterior cruciate ligament reconstruction. We identify specific errors in statistical reporting and forest-plot visualization. A reconstructed analysis is provided to ensure accurate interpretation of clinical stability outcomes.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence across the continuum of care for the aging musculoskeletal patient: From longitudinal phenotyping to personalized surgery and recovery monitoring.","authors":"Felix C Oettl, Balint Zsidai, James A Pruneski, Jacob F Oeding, Umile Giuseppe Longo, Michael T Hirschmann, Ro Du Hyun, Kristian Samuelsson","doi":"10.1002/ksa.70647","DOIUrl":"https://doi.org/10.1002/ksa.70647","url":null,"abstract":"<p><p>Musculoskeletal care is being reshaped by population aging, multimorbidity, frailty, osteoporosis, sarcopenia, polypharmacy and increasing vulnerability to postoperative loss of independence. Artificial intelligence (AI) has entered orthopaedic research, but its clinical translation remains constrained. Many models address isolated diagnostic, imaging or short-term prediction tasks rather than the longitudinal care trajectories that determine outcomes in older musculoskeletal patients. The central limitation is therefore not simply whether older adults are represented in datasets, but whether AI systems are valid across the continuum of geriatric orthopaedic care. This review argues for a transition from task-specific orthopaedic AI toward continuum-of-care AI for the aging musculoskeletal patient. Upstream, radiomics, longitudinal osteoarthritis phenotyping, opportunistic computed tomography (CT)-based skeletal assessment and AI-augmented dual-energy X-ray absorptiometry (DXA) modelling may improve prediction of disease progression, fracture risk, treatment failure and surgical timing. At the point of intervention, AI-assisted arthroplasty planning may help move total knee arthroplasty from generic alignment targets toward phenotype-specific reconstruction strategies that account for constitutional alignment, bone morphology, ligament envelope, neuromuscular control, frailty and functional reserve. Perioperatively, automated frailty and sarcopenia phenotyping, wearable gait analysis and multimodal temporal models integrating imaging, electronic health records, laboratory data, medications, patient-reported outcomes and wearable signals may support dynamic risk prediction. After discharge, continuous monitoring of mobility, sleep, pain trajectories, wound-related symptoms and rehabilitation adherence may help close the high-risk surveillance gap during the 90-day postoperative episode. However, clinical adoption requires more than high discrimination. Explainable AI should be understood as one component of a broader trust framework that also includes calibration, uncertainty quantification, decision-curve analysis, external and prospective validation, workflow integration, post-deployment monitoring and accountability. The future of orthopaedic AI is not simply better diagnosis or more precise surgery, but longitudinal, multimodal support across the full care continuum: predicting progression, selecting treatment, personalizing surgery, optimizing perioperative care, monitoring recovery and preserving mobility and independence. LEVEL OF EVIDENCE: Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198760","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":"Sex-related differences after ACL reconstruction differ between early functional recovery and 5-year outcomes.","authors":"Thibault Marty-Diloy, Nicolas Graveleau, Nicolas Bouguennec","doi":"10.1002/ksa.70651","DOIUrl":"https://doi.org/10.1002/ksa.70651","url":null,"abstract":"<p><strong>Purpose: </strong>To compare early functional recovery and 5-year clinical, sports and psychological outcomes after anterior cruciate ligament reconstruction (ACLR) according to sex.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients who underwent primary ACLR between January 2017 and December 2019, with standardized 6-month functional and psychological assessment and available 5-year follow-up. Patients were analyzed according to sex. Baseline characteristics, 6-month quadriceps strength and hop-test performance, and 5-year patient-reported and sports outcomes were compared between groups. The primary outcome was recovery of preinjury activity level at 5 years, defined as a post-operative Tegner score greater than or equal to the preoperative Tegner score. Multivariable logistic regression was used to identify factors independently associated with the primary outcome.</p><p><strong>Results: </strong>A total of 479 patients were included, comprising 173 women (36.1%) and 306 men (63.9%). At 6 months, men demonstrated higher quadriceps limb symmetry and lower hop-test deficits than women, whereas anterior cruciate ligament return to sport after injury (ACL-RSI) did not differ significantly between groups. At 5 years, overall return-to-sport rates were similar between sexes (187 [61.2%] men vs. 103 [59.5%] women, p = 0.85), but men had higher post-operative Tegner (6 [5-7] vs. 5 [4-7], p < 0.001), IKDC (82.5 [75.7-87.3] vs. 79.5 [72.8-86.3], p = 0.02) and ACL-RSI scores (77.5 [55.8-92.5] vs. 69.2 [53.3-85.8], p = 0.02) and were more likely to recover their preinjury activity level (137 [45.1%] vs. 48 [28.1%], p < 0.001). In the baseline-adjusted multivariable model, male sex was independently associated with recovery of preinjury activity level (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.40-3.39; p < 0.001). This association persisted after inclusion of 6-month recovery variables (OR = 1.93, 95% CI = 1.20-3.15; p = 0.007), while lower single-hop deficit was also independently associated with the outcome.</p><p><strong>Conclusions: </strong>Men and women did not demonstrate the same recovery profile after ACLR. Early differences were mainly functional, whereas 5-year differences involved recovery of preinjury activity level, subjective knee function and psychological readiness, despite similar overall return-to-sport rates. These findings suggest that return to sport should not be interpreted as equivalent recovery quality after ACLR.</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":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198829","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":"Previous bariatric surgery before knee arthroplasty: A cautious interpretation.","authors":"Xia Qu, Guangxiang Sun, Bo Chen","doi":"10.1002/ksa.70640","DOIUrl":"https://doi.org/10.1002/ksa.70640","url":null,"abstract":"<p><p>We read with interest the nationwide register-based study by Aljuboori et al. examining previous bariatric surgery (BAS) and reintervention after knee arthroplasty. The authors appropriately state that their findings do not establish a benefit of BAS or negate the influence of residual obesity. We highlight several interpretive constraints. Matching on body mass index (BMI) at arthroplasty conditions on a post-exposure variable, while restriction to patients who ultimately underwent arthroplasty excludes those who improved sufficiently to avoid surgery. The 95% confidence interval for 2-year reintervention supports the absence of a statistically detectable difference, not equivalence or non-inferiority. Two-year follow-up may miss later mechanical failures, and exclusion of approximately 9% of screened records, including patients with missing BMI, may introduce additional selection bias. Glucagon-like peptide-1 (GLP-1) receptor agonists remain an important future perspective. Overall, the study provides useful short-term conditional observational evidence among selected arthroplasty recipients with comparable BMI, rather than an estimate of the overall causal effect of BAS before knee arthroplasty.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187596","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":"Greater three-dimensional cam burden and superolateral location are associated with end-stage hip osteoarthritis: A retrospective comparative study.","authors":"Servet Igrek, Okan Yigit, Sebati Baser Canbaz, Husnu Yilmaz, Emrah Gokay Ozgur, Engin Eceviz, Baris Kocaoglu","doi":"10.1002/ksa.70646","DOIUrl":"https://doi.org/10.1002/ksa.70646","url":null,"abstract":"<p><strong>Purpose: </strong>Cam-type femoroacetabular impingement (FAI) is a recognised structural contributor to primary hip osteoarthritis (OA), yet many cam-positive hips do not progress to radiographic joint failure. This study aimed to compare three-dimensional cam morphology and lesion location between cam-positive hips with end-stage primary osteoarthritis and cam-positive, non-arthritic hips in an elderly fracture cohort.</p><p><strong>Methods: </strong>Hospital records and imaging archives from January 2020 to January 2026 were retrospectively reviewed at a single centre. The OA group comprised patients undergoing total hip arthroplasty for primary OA, and the fracture group comprised patients aged ≥ 65 years treated for intertrochanteric or subtrochanteric femoral fractures without radiographic OA. Cam morphology was characterised using radial CT-based alpha angle, three-dimensional cam volume, cam/head volume ratio, and clock-face-based lesion location. Group comparisons, receiver operating characteristic analyses, correlation testing, and multivariable logistic regression were performed.</p><p><strong>Results: </strong>A total of 438 cam-positive hips were included (126 OA and 312 fracture). OA hips demonstrated higher alpha angles (72.44° ± 5.94° vs. 62.45° ± 5.07°), larger cam volumes (5274.77 ± 1353.26 mm³ vs. 3215.20 ± 1524.84 mm³), higher cam/head ratios (8.61% ± 2.02% vs. 6.35% ± 1.97%), and more superolateral lesions (52.4% vs. 36.2% anterior in the fracture group) (all p < 0.001). Exploratory receiver operating characteristic analyses identified cohort-specific discriminatory values of 66° for alpha angle (AUC, 0.884), 4421 mm³ for cam volume (AUC, 0.839), and 6.4% for the cam-to-head volume ratio (AUC, 0.791). In multivariable analyses using continuous morphology measures, higher alpha angle, greater cam volume, higher cam-to-head volume ratio, and superolateral lesion location were associated with end-stage OA-group membership.</p><p><strong>Conclusions: </strong>Compared with non-arthritic cam-positive hips in an elderly fracture cohort, end-stage primary OA hips had greater three-dimensional cam burden, with lesions more often located superolaterally. These retrospective associations do not establish longitudinal progression, causality, or individual prognosis.</p><p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Level of evidence: </strong>Level III, study of a non-consecutive patients, study of diagnostic test.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149187557","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}