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

{"title":"Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents.","authors":"Frida Hansson, Anders Stålman, Gunnar Edman, Per-Mats Janarv, Eva Bengtsson Moström, Riccardo Cristiani","doi":"10.1002/ksa.12707","DOIUrl":"https://doi.org/10.1002/ksa.12707","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether contralateral knee hyperextension (KHE) is associated with anterior knee laxity, subjective knee function or revision surgery after primary anterior cruciate ligament reconstruction (ACLR) in patients <18 years.</p><p><strong>Methods: </strong>Patients <18 years who underwent primary ACLR at Capio Artro Clinic, Stockholm, Sweden between January 2002 and March 2017 were identified. They were dichotomised into a 'hyperextension' group (≤-5°) and 'no hyperextension' group (>-5°) depending on preoperative contralateral passive knee extension degree. Anterior knee laxity (KT-1000 arthrometer) was measured preoperatively and 6 months post-operatively. The knee injury and osteoarthritis outcome score (KOOS) was collected preoperatively and after 2 years. Revision ACLR within 5 years after primary ACLR was captured in the Swedish National Knee Ligament Registry.</p><p><strong>Results: </strong>1250 patients (63.6% female [n = 795]; mean age 15.5 ± 1.5 years) were included (hyperextension group: 52.9% [n = 661]). Mean extension was -6.1 ± 2.2° in the hyperextension group and 0 ± 0.7° in the no hyperextension group. Hamstring autograft was used in 93.3% (1166 out of 1250). No significant difference between the groups was seen in anterior knee laxity or in the rate of surgical failure at 6 months post-operatively (side-to-side difference: >5 mm) (hyperextension group, 6.6% [32 out of 484 patients] vs. no hyperextension group, 6.8% [29 out of 428 patients]; p = ns). Statistically significant but non-clinically relevant intergroup differences were seen in the KOOS Sport/Recreation and Quality of Life subscales after 2 years. The rate of revision ACLR within 5 years was 11.1% (119 out of 1073 patients). The hazard for revision ACLR in the hyperextension group was not significantly different from the no hyperextension group (hazard ratio, 0.91; 95% confidence interval, 0.63-1.31; p = ns).</p><p><strong>Conclusions: </strong>There was no significant association between preoperative passive contralateral KHE and anterior knee laxity, subjective knee function or the risk of revision ACL surgery in paediatric patients. These findings suggest that KHE alone should not preclude the use of hamstring tendon grafts in children and adolescents undergoing ACL reconstruction. The study found a high rate of revision ACL surgery in this paediatric population.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145386","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":"Treatment of large chondral lesions with an autologous minced cartilage technique and synovial flap leads to superior results compared to matrix associated autologous chondrocyte transplantation technique after 24 months: A controlled clinical trial.","authors":"Johanna Mayr, Franziska Warth, Nicola Oehler, Martin Majewski, Christoph Lutter, Fabian Blanke","doi":"10.1002/ksa.12708","DOIUrl":"https://doi.org/10.1002/ksa.12708","url":null,"abstract":"<p><strong>Purpose: </strong>Treating large cartilage lesions in the knee remains a challenge. While matrix-associated autologous chondrocyte implantation (MACI) is the gold standard for medium to large lesions, the minced cartilage technique has shown promise in smaller defects. Enhancing this technique with biomaterials has been suggested for larger lesions, but its effectiveness remains unclear due to limited data. This study aimed to evaluate the outcomes of the minced cartilage technique with autologous synovial flap coverage in large knee cartilage lesions and compare the results with MACI.</p><p><strong>Methods: </strong>Twenty patients with large Grade III-IV cartilage defects (>6 cm²) at the knee were included. Ten patients underwent the autologous minced cartilage procedure (AutoCart™) with synovial flap (Group A), and ten received the MACI procedure (Group B). Clinical outcomes were assessed using the Tegner score, visual analog scale (VAS), the International Knee Documentation Committee (IKDC) forms, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). MRI evaluations were performed using the MOCART 2.0 score before surgery and 24 months postoperatively.</p><p><strong>Results: </strong>Clinical scores significantly improved in Group A after surgery, while Group B showed improvement only in the VAS, pain, and sports/recreation levels. Postoperative MRI revealed similar results between groups, with Group A showing significantly better cartilage defect volume fill and fewer subchondral changes compared to Group B (p < 0.05). The mean MOCART 2.0 score at the final follow-up was 76.0 ± 15.4 for Group A and 65.6 ± 17.6 for Group B, though without statistical significance.</p><p><strong>Conclusion: </strong>The study suggests that the all-autologous minced cartilage technique with synovial flap is an effective treatment for large chondral lesions, yielding outcomes similar to or better compared to the MACI technique.</p><p><strong>Level of evidence: </strong>This study is a retrospective comparative study and is classified as Level III evidence according to the Journal of KSSTA and JEO.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral varus deformity predominates in male Chinese osteoarthritis patients with geographic variability in functional knee phenotypes.","authors":"Songlin Li, Jiaming He, Weibo Zheng, Xuezhou Li, Jie Yang, Zhe Li, Houyi Sun, Zhuang Miao, Wenwei Qian, Peilai Liu, Qunshan Lu","doi":"10.1002/ksa.12693","DOIUrl":"https://doi.org/10.1002/ksa.12693","url":null,"abstract":"<p><strong>Purpose: </strong>The aims of this study were to generalise the distribution and sex differences in functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare the distributions of functional knee phenotypes across geographic regions.</p><p><strong>Methods: </strong>Knee phenotypes were evaluated according to Hirschmann's classification in 908 knees with OA, and the correlations among the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) and their differences between the sexes were described. Studies reporting the distributions of functional knee phenotypes for arthritic knees were included to compare the variability in geographic distribution.</p><p><strong>Results: </strong>The average values (males, females) of the HKA (173.1 ± 5.4°, 174.0 ± 6.9°), FMA (90.5 ± 2.9°, 91.6 ± 3.5°), and TMA (85.7 ± 3.1°, 85.7 ± 3.6°) demonstrated that the Chinese OA population tended towards femoral and tibial varus deformities in both males and females. A total of 145 functional knee phenotypes were identified in all 908 knees, comprising 68 types in males and 136 types in females. The most common phenotypes were VAR_HKA6° + VAR_FMA3° + NEU_TMA0° (5.7%) for all knees, VAR_HKA3° + NEU_FMA0° + NEU_TMA0° (7.4%) for males and VAR_HKA6° + VAR_FMA3° + NEU_TMA0° (5.4%) for females. The incidence of femoral varus deformity was greater than that of tibial varus deformity in 48.4% of males and 36.5% of females, and the incidence of tibial varus deformity was greater than that of femoral varus deformity in 24.7% of males and 35.2% of females. Seven studies including 16,395 knees were identified. The main femoral and tibial phenotypes in different geographic regions were VAR_FMA3° and NEU_TMA0°, but their proportional distributions differed significantly.</p><p><strong>Conclusions: </strong>Sex differences in the functional knee phenotypes of OA patients in China were identified. Femoral varus deformity was more common than tibial varus deformity in males, whereas the difference was minimal in females. Moreover, functional knee phenotypes varied significantly across geographic regions.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096815","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":"Open surgical repair as gold standard for acute Achilles tendon ruptures: Systematic review and network meta-analysis.","authors":"Alessandro Pisano, Matias Boxler, Edoardo Gambuti, Francesco Falco, Mathieu Trierweiler, Antonio Vinci, Dorian Bardhi, Gian Loreto D'Alò, Rosa Maria Malerba, Alberto Grassi, Fabio Ingravalle, Massimo Maurici","doi":"10.1002/ksa.12686","DOIUrl":"https://doi.org/10.1002/ksa.12686","url":null,"abstract":"<p><strong>Purpose: </strong>Both surgical and non-surgical treatments for acute Achilles tendon ruptures (aATRs) exist, but the optimal management strategy, especially regarding weight-bearing timing, remains unclear. This study investigates combinations of primary treatment (open surgical repair, percutaneous/minimally invasive repair and non-surgical treatment) and rehabilitation strategies (Early Weight Bearing [EWB] vs. Late Weight Bearing [LWB]) for aATRs, analysing re-rupture risk, complication rates and recovery outcomes.</p><p><strong>Methods: </strong>Systematic review and network meta-analysis registered in PROSPERO (CRD42023389413). Medline, Scopus, Web of Science, CINAHL, ClinicalTrials.gov, and Cochrane Library were searched for studies assessing primary treatments and rehabilitation strategies for aATR in adults (>18 years old) with at least six months of follow-up.</p><p><strong>Results: </strong>Forty-one studies (23 randomised-controlled-trials, 17 non-randomised-studies-of-intervention) comprising 5566 patients and 82 treatment arms were included. Network meta-analysis was performed for re-rupture risk and other outcomes, reporting odds ratios and treatment rankings. Open surgical repair combined with LWB has the lowest re-rupture risk (2%, 95%CI 1%-3%). EWB facilitates faster recovery but marginally increases complication risks, though not statistically significant. Non-surgical treatment shows a higher re-rupture rate than surgical options (12% vs. 2%/4%, p < 0.001). Major wound complications are rare (2.8%), with percutaneous repair having a higher risk of sural nerve injury (4% vs. 1%, p = 0.02). Deep vein thrombosis/pulmonary embolism risk is higher with non-surgical treatment (2% vs. 1%, p = 0.04). EWB leads to faster return-to-sport and higher Achilles Tendon Rupture Scores.</p><p><strong>Conclusions: </strong>Open surgical repair with LWB reduces re-rupture risk, while EWB offers faster recovery and higher patient satisfaction. Non-surgical treatment has the highest re-rupture and DVT/PE risk. Percutaneous repair increases sural nerve injury risk compared to open surgery, with no significant difference in wound complications. In patients with no contraindications, open surgical repair should be considered the gold standard, with no statistical difference in major and minor wound complications when compared to percutaneous treatment.</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":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096764","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":"Hip arthroscopy and periacetabular osteotomy generally improve sexual function in patients, but have a risk of iatrogenic pudendal nerve injury that can temporarily worsen sexual function: A systematic review.","authors":"Madeline Hubbard, Darya Pascarel, Prushoth Vivekanantha, Mahmoud Almasri, Shahbaz Malik, Amit Meena, Darren de Sa","doi":"10.1002/ksa.12700","DOIUrl":"https://doi.org/10.1002/ksa.12700","url":null,"abstract":"<p><strong>Purpose: </strong>To summarise how orthopaedic hip sports medicine procedures affect patients' sexual function so that surgeons can better counsel their patients on this topic.</p><p><strong>Methods: </strong>Three databases (MEDLINE, EMBASE and PubMed) were searched on 27 April 2024 with search terms relating to sexual activity and orthopaedic procedures. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews of Interventions.</p><p><strong>Results: </strong>Seventeen studies with a total of 5976 patients (6275 joints) were included in this study. Hip arthroscopies were performed in 5812 patients for a total of 6087 surgeries, and 164 patients received 188 osteotomies. Nine of 17 studies reported iatrogenic nerve injury (103/1854; 5.6%), mainly of the pudendal nerve (64/103, 62.1%). All of male, female, and combined male and female sexual function tended to be compromised prior to hip sports medicine surgery and improved after surgery as per International Index of Erectile Function (IIEF) (p = 0.009) and Female Sexual Function Index (FSFI) (p < 0.001) scores. Improvements after surgery were largely due to decreased hip pain and stiffness during sexual activity. Return to sexual activity was reported to be 29.2 ± 20.1 days after hip arthroscopy. Only three studies discussed preoperative counselling on sexual activity.</p><p><strong>Conclusion: </strong>Hip sports medicine surgeries can improve sexual function for patients; however, they have a risk of pudendal nerve damage that can temporarily interfere with sexual function. Surgeons should counsel their patients on the risks and benefits of hip sports orthopaedic surgeries to sexual function.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096763","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":"Early MCID achievement is associated with better long-term outcomes following arthroscopy for femoroacetabular impingement.","authors":"Karen Mullins, David Filan, Patrick Carton","doi":"10.1002/ksa.12695","DOIUrl":"https://doi.org/10.1002/ksa.12695","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether early improvement is associated with long-term outcomes following arthroscopy for femoroacetabular Impingement and establish a threshold above which would indicate sustained improvement. It was hypothesised that those who display improvements early would report better long-term outcomes than those who did not report meaningful change at 1 year, allowing further targeted intervention where necessary.</p><p><strong>Methods: </strong>An examination of patients (Tonnis 0,1) undergoing primary arthroscopy between January 2009 and March 2014, with 10-year review, was conducted. Four hundred and fifteen hip arthroscopy cases in 355 patients were included. The minimal clinically important difference (MCID) for the modified Harris Hip score (mHHS) at 1 year was calculated using the percentage of possible improvement (POPI) method. Patients were grouped as early improvers (EI) or non-improvers (NI) based on whether they achieved MCID at 1 year or not. Survival, revision rate, and the patient acceptable symptom state (PASS) were compared between groups using a Kaplan-Meier curve and chi-squared analysis.</p><p><strong>Results: </strong>One year MCID achievement required an improvement from pre-operative mHHS of at least 47%; 79% of cases achieved MCID (EI), and 21% did not (NI). At 10 years, there were six total hip replacements in the EI group compared to 16 in the NI group (survival 98% vs. 82%, p < 0.001). Revision rates were lower in the EI group (6% vs. 12%, p = 0.005), and the EI group had higher levels of PASS achievement (86% vs. 68%, p < 0.001). Regression models indicated that MCID achievement at 1 year, reduced the odds of replacement and revision surgery while increasing the odds of PASS achievement at 10 years.</p><p><strong>Conclusion: </strong>Higher survival rates, higher PASS rates and lower revision procedures were observed in EI. When accounting for other known confounding factors, improving by a minimum of 47% of what a patient could achieve in the mHHS at 1 year predicts superior outcomes long-term. For those patients failing to achieve this important improvement threshold, clinicians could consider introducing additional rehabilitation or interventions that may further improve recovery and potentially increase the likelihood of a better longer-term outcome.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096812","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":"Age and sex-specific differences of the intrafemoral and intratibial morphology using the Citak classification in patients undergoing total knee arthroplasty.","authors":"Maximilian Budin, Stephanie Huber, Sebastian Simon, Jennyfer Mitterer, Mustafa Citak, Jochen G Hofstaetter","doi":"10.1002/ksa.12691","DOIUrl":"https://doi.org/10.1002/ksa.12691","url":null,"abstract":"<p><strong>Purpose: </strong>Unlike established knee phenotype classifications, the recently introduced Citak classifications describe the intrafemoral and intratibial knee morphology. The aim of this study was to evaluate the distribution of Citak types A, B and C of the distal femur and proximal tibia in a large cohort and to examine the influence of age, body mass index (BMI) and knee phenotypes.</p><p><strong>Methods: </strong>A total of 8739 patients undergoing primary total knee arthroplasty (TKA) were included in this study. The coronal plane alignment of the knee (CPAK) and functional knee phenotypes were assessed on standardised preoperative long leg radiographs (LLR) using a validated artificial intelligence (AI) software. The Citak classification was measured manually, and BMI, sex and age were compared between the different Citak types.</p><p><strong>Results: </strong>The most common morphotypes were Citak type B of the distal femur (men: 1362 (46.5%); women 3042 (52.4%)) and Citak type C of the proximal tibia (men: 2605 (88.9%); women 5406 (93.0%)). Women with Citak type C of the distal femur (mean age 71.45a; p < 0.001) and proximal tibia (mean age 69a; p < 0.001) were significantly older, while no age differences were observed among men. Citak type A of the distal femur and proximal tibia had an overall higher BMI in both men and women.</p><p><strong>Conclusion: </strong>The Citak types of the distal femur and the proximal tibia are age, sex and BMI dependent in patients undergoing primary TKA. Recognising these morphological variations might improve preoperative planning and implant selection in TKA, potentially improving patient outcomes. The Citak classification is useful to further characterise various knee morphotypes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096803","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":"High continuous fragility index values for randomised controlled trials investigating medial patellofemoral ligament reconstruction for patellar instability: A systematic review.","authors":"Dalraj Dhillon, Paary Balakumar, Prushoth Vivekanantha, Amit Meena, Shahbaz Malik, Darren de Sa","doi":"10.1002/ksa.12701","DOIUrl":"https://doi.org/10.1002/ksa.12701","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the statistical fragility of randomised controlled trials (RCTs) investigating medial patellofemoral ligament reconstruction (MPFLR) of patients with patellar instability.</p><p><strong>Methods: </strong>A search of PubMed, MEDLINE, and EMBASE databases for RCTs investigating surgical management of patients with patellar instability from inception to 25 April 2024. Studies that reported over one significant dichotomous outcome, significant continuous outcome, and/or nonsignificant dichotomous outcome were included for analysis. The fragility index (FI), continuous fragility index (CFI) and reverse fragility index (RFI) were calculated for significant dichotomous outcomes, significant continuous outcomes, and non-significant dichotomous outcomes, respectively.</p><p><strong>Results: </strong>Thirteen RCTs were included which reported on a total of 929 patients (64.1% female, mean age of 24.4 years [range: 10-47 years] before any patients were lost to follow-up. The median FI was 1.0 (interquartile range [IQR], 1; 95% confidence interval [CI], 0.725-2.275; range, 0-4). The number of patients lost to follow-up at the final time point was greater than the study-specific FI in 7 out of 8 outcomes from four studies (87.5%). The overall median CFI for included RCTs amongst 31 outcomes from nine studies was 11.7 (IQR, 12.9-95% CI, 8.9-13.9; range 0-30.3). The number of patients lost to follow-up at the final time point was greater than the study-specific CFI in thirteen outcomes from six studies (41.9%). The median RFI was 7.0 (IQR, 1.0; 95% CI, 6.5-7.5). The number of participants lost to follow-up was greater than the study-specific RFI in a single outcome from one study (16.7%).</p><p><strong>Conclusion: </strong>This systematic review shows that while FI was low at a median of 1.0, consistent with RCTs in sports medicine, the other indicators of statistical fragility were relatively high, especially CFI (11.7). The level of fragility should be taken into account when assessing practical applicability of RCTs on patellar instability, in combination with other indicators of study rigour.</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":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096817","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":"Coronal plane alignment of the knee phenotypes distribution varies significantly as a function of geographic, osteoarthritic and sex-related factors: A systematic review and meta-analysis.","authors":"Giancarlo Giurazza, Andrea Tanzilli, Edoardo Franceschetti, Stefano Campi, Pietro Gregori, Francesco Rosario Parisi, Michele Paciotti, Giovanni Perricone, Biagio Zampogna, Rocco Papalia","doi":"10.1002/ksa.12704","DOIUrl":"https://doi.org/10.1002/ksa.12704","url":null,"abstract":"<p><strong>Purpose: </strong>The coronal plane alignment of the knee (CPAK) classification is a nine-phenotype matrix based on limb alignment and joint line obliquity. This study aimed to provide a global overview of CPAK distribution, hypothesising significant geographic, osteoarthritic and sex-related variations.</p><p><strong>Methods: </strong>A systematic literature search (Embase, Medline/PubMed and Cochrane Library) following PRISMA guidelines was conducted, utilising the search terms \"Coronal Plane Alignment of the Knee\" OR \"CPAK\". Studies considering image modalities other than long-leg radiographs were excluded. A random-effects meta-analysis of proportions was performed, and statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>A total of 38 studies comprising 46,966 knees were analysed. The most common phenotypes worldwide were CPAK I (33.1%), II (25.9%) and III (14.4%) in the osteoarthritic population and CPAK II (34.9%), I (21.5%) and III (19.3%) in the healthy population. Among osteoarthritic populations, CPAK type I was predominant in Europe (29.2%), Asia (41.9%) and America (33.6%), type II in Australia (32.6%) and type III in Africa (28.6%). In healthy populations, type II was predominant in Europe (42.8%) and Asia (35.3%), whereas type I was most common in South America (44.8%). Significant regional differences were observed among both osteoarthritic and healthy knees, and between osteoarthritic and healthy knees in individual countries. In Europe, significant sex differences were observed in the distribution of types I (39.1% M; 23.5% F) and III (11.4% M; 24.6% F) in the osteoarthritic population, and in the distribution of types I (26.7% M; 9.4% F), II (43.9% M; 34.4% F) and III (11.3% M; 20.6% F) in the healthy population. In Asia, significant sex differences were found for type III in osteoarthritic knees (6.3% M; 11.4% F).</p><p><strong>Conclusion: </strong>CPAK distribution varies significantly as a function of geographic, osteoarthritic, and sex-related factors. A personalised approach to TKA may be desirable to better accommodate these differences.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096808","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":"Several flat tendon graft types are viable options for flat superficial medial collateral ligament reconstructions-A biomechanical analysis.","authors":"Thorben Briese, Christian Peez, Philipp Runde, Matthias Klimek, Adrian Deichsel, Michael J Raschke, Christoph Kittl, Elmar Herbst","doi":"10.1002/ksa.12705","DOIUrl":"https://doi.org/10.1002/ksa.12705","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Flat superficial medial collateral ligament (sMCL) reconstruction helps restore knee kinematics in medial instability, but recommendations on grafts that best mimic the sMCL's biomechanical properties are missing. This study aimed to compare the biomechanical properties of flat grafts to the native sMCL, hypothesizing that (1) flat grafts exhibit unique biomechanical properties and (2) graft configuration affects their biomechanical properties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Controlled laboratory study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The sMCL, semitendinosus, gracilis, quadriceps tendons and iliotibial band (ITB) were harvested from 20 fresh-frozen human cadaveric knees. Flat grafts were prepared, providing single- and double-strand grafts. The following groups (n = 10 each) were defined: (1) native sMCL, (2) single-strand semitendinosus tendon (SemiT single), (3) double-strand semitendinosus tendon (SemiT double), (4) single-strand gracilis tendon (Gracilis single), (5) double-strand gracilis tendon (Gracilis double), (6) single-strand ITB (ITB single), (7) double-strand ITB (ITB double) and (8) superficial layer of the quadriceps tendon (Quad). Using a universal uniaxial testing machine, the grafts were preconditioned (10 cycles, 10-50 N) and subsequently loaded to failure (LTF) (20 mm/min). Biomechanical properties of the grafts were compared using a one-way analysis of variance with post hoc correction (p &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Double-strand configuration of the hamstring tendons and the ITB resulted in a significant increase in stiffness, LTF and yield load (p &lt; 0.05) and a significant decrease in tensile stress and ultimate strain (p &lt; 0.05) compared to single-strand grafts. Single-strand SemiT and Quad, as well as double-strand Gracilis and ITB grafts, demonstrated comparable biomechanical properties to the native sMCL (n.s.). In contrast, double-strand SemiT tendon grafts exhibited significantly greater stiffness, LTF and yield load compared to the native sMCL (p &lt; 0.01). Conversely, single-strand graft configuration of Gracilis and ITB resulted in significantly lower stiffness, LTF and yield load (p &lt; 0.01) and higher tensile stress and ultimate strain (p &lt; 0.001) compared to the native sMCL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The graft type and configuration of the grafts significantly affects the biomechanical properties of flat sMCL grafts. Single-strand SemiT and Quad, and double-strand Gracilis and ITB grafts, mimic the biomechanical properties of the native sMCL, representing viable options for flat sMCL reconstructions. In contrast, double-strand SemiT grafts exceeded these properties, while single-strand Gracilis and ITB grafts demonstrate decreased biomechanical properties, possibly resulting in increased risk of medial overconstraint or residual laxity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;There is no level of evidence as this study was an experimental laboratory study.","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103498","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}