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

{"title":"Step-by-step insight into gait analysis: A narrative review unlocking knee biomechanics.","authors":"Giovanni Spallone, Letizia Mancini, Arianna Carnevale, Stefano Campi, Alessandro de Sire, Emiliano Schena, Pieter D'Hooghe, Michael T Hirschmann, Rocco Papalia, Umile Giuseppe Longo","doi":"10.1002/ksa.70067","DOIUrl":"https://doi.org/10.1002/ksa.70067","url":null,"abstract":"<p><p>Gait analysis offers a powerful tool for clinical and orthopaedic decision-making. By quantifying spatiotemporal, kinematic and kinetic parameters during walking, it provides a dynamic window into joint function that static imaging cannot capture. Despite its potential, gait analysis remains largely confined to specialised centres, with limited integration in clinical pathways, mainly due to its perceived complexity and lack of standardisation. This narrative review aims to bridge that gap through a step-by-step approach to guide orthopaedic surgeons, sports medicine physicians and musculoskeletal clinicians in understanding and interpreting key biomechanical markers relevant to common knee pathologies, such as osteoarthritis and anterior cruciate ligament injury. Particular attention is given to how deviations in parameters like joint angles and moments, dynamic alignment and centre of pressure trajectories can offer actionable insights into disease progression, treatment response and surgical planning. The urgent need for standardised protocols, encompassing marker placement, biomechanical modelling and data processing, is also underscored, as they are essential to ensure reproducibility and facilitate clinical translation. By clarifying the clinical meaning of gait metrics, this review empowers healthcare professionals to integrate dynamic functional data into everyday decision-making and move towards more personalised, biomechanically informed care. 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":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071637","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":"Author Reply to Letter to the Editor on \"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.70062","DOIUrl":"https://doi.org/10.1002/ksa.70062","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071631","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":"All-inside meniscal repair using polyether ether ketone versus all-suture anchors: No difference in failure rates at three-follow-up in a retrospective cohort of 2253 patients.","authors":"Christoffer von Essen, Riccardo Cristiani, Alexander Sandon, Anders Stålman","doi":"10.1002/ksa.70026","DOIUrl":"https://doi.org/10.1002/ksa.70026","url":null,"abstract":"<p><strong>Purpose: </strong>To compare mid-term failure rates of next-generation all-inside meniscal repair using polyether ether ketone (PEEK) anchors versus all-suture anchors in a large patient cohort. The null hypothesis was that there would be no difference in failure rates between PEEK and all-suture anchors.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on all consecutive patients who underwent arthroscopic all-inside meniscal repair between January 2015 and June 2022 at Capio Artro Clinic, Stockholm, Sweden. Patients were included if they had isolated or anterior cruciate ligament reconstruction (ACLR) associated medial or lateral meniscal repairs using either PEEK or all-suture devices. Revision meniscal repairs were excluded to ensure a homogeneous cohort. The primary outcome was failure of meniscal repair, defined as reoperation with partial or total meniscectomy or re-suture within 3 years. Logistic regression was used to identify predictors of failure. Between-group comparisons were performed using chi-square and t-tests.</p><p><strong>Results: </strong>Of the total cohort of 2253 patients, 271 patients received all-suture anchors and 1982 received PEEK anchors. The overall reoperation rate was 17.3% (47/271) in the all-suture group and 20.7% (410/1982) in the PEEK group, with no statistically significant difference. Subgroup analysis by laterality (medial [21.5%, 28/271] vs. lateral meniscus repair [27.1%, 324/1982]), or isolated repair versus ACLR with repair did not reveal significant differences in failure rates for the different devices. Logistic regression further revealed that isolated meniscal repair (odds ratio [OR]: 3.01; 95% confidence Interval [CI]: 2.41-3.76; p < 0.001), female gender (OR: 1.30, 95% CI: 1.05-1.61; p = 0.017), and medial meniscus repair (OR: 2.89; 95% CI: 2.27-3.69; p < 0.001) were significant predictors of meniscal repair failure.</p><p><strong>Conclusion: </strong>All-suture and PEEK-based all-inside meniscal repair devices demonstrated comparable failure rates within 3 years. Device type was not associated with increased risk of failure, whereas isolated repair, medial meniscal repair, and female gender were significant predictors. These findings support the clinical effectiveness of both anchor types, allowing device selection to be based on surgeon preference and tear characteristics rather than concerns over differential failure risk.</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":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071621","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":"Excellent functional outcome and satisfactory revision rates of two-staged bicompartmental knee arthroplasty for disease progression following unicompartmental knee arthroplasty.","authors":"Conradin Schweizer, Wenzel Waldstein, Valentin Rühle, Niels Urban, Tatjana Krug, Joachim Herre, Peter R Aldinger, Christian Merle","doi":"10.1002/ksa.70040","DOIUrl":"https://doi.org/10.1002/ksa.70040","url":null,"abstract":"<p><strong>Purpose: </strong>Disease progression in the untreated compartment is the leading cause for reoperation following unicompartmental knee arthroplasty (UKA). A less-invasive alternative to total knee arthroplasty (TKA) conversion is the addition of a second UKA. The study assessed survival, functional, and radiological outcomes after two-staged bicompartmental UKA.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 102 knees (98 patients, mean age 73.7 years) who received an additional medial (n = 29) or lateral UKA (n = 73) between 2016 and 2025 with a minimum follow-up of 1 year. Primary outcomes were cumulative revision rates for (1) any reoperation and (2) implant revision. Functional outcomes included the Oxford Knee Score (OKS) and UCLA (University of California, Los Angeles) Activity Score. Radiographic assessment included measurement of the hip-knee-ankle angle (HKAA).</p><p><strong>Results: </strong>The mean follow-up was 4.0 years (SD 2.1). At 9 years, cumulative survival rate was 84.3% (95% CI: 0.763-0.923) for any reoperation and 89.3% (95% CI: 0.822-0.964) for implant revision. There were nine implant revisions (8.8%), most commonly due to medial mobile-bearing dislocation (44.4%). In 50%, implant revision to TKA was performed using primary non-modular components. Mean postoperative OKS and UCLA scores were 40.4 (SD 8.0) and 5.5 (SD 1.7), respectively. Medial osteonecrosis (ON) following primary lateral UKA accounted for 38% (11/29) of all indications for an additional medial UKA, and was associated with greater HKAA correction following prior lateral UKA.</p><p><strong>Conclusion: </strong>Two-staged bicompartmental UKA is a viable less-invasive alternative to TKA conversion for patients with disease progression or ON after primary UKA. This approach demonstrates excellent mid-term functional outcomes and satisfactory implant survivorship, providing valuable evidence to support its role as a contemporary revision option Fixed-bearing implants for additional medial UKA are advised to eliminate the risk of bearing dislocations. In the absence of major complications, conversion to non-modular TKA components is feasible.</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":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071644","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":"No difference in PROMs between kinematic and mechanical alignment in TKA: An umbrella review with secondary meta-analysis and GRADE assessment.","authors":"Johannes Stöve, Daniel Schrednitzki, Katharina Ortwig, Michael T Hirschmann, Andreas M Halder","doi":"10.1002/ksa.70034","DOIUrl":"https://doi.org/10.1002/ksa.70034","url":null,"abstract":"<p><strong>Purpose: </strong>To identify, synthesise and critically appraise the findings of meta-analyses that compare patient-reported outcome measures (PROMs) between unrestricted kinematic alignment and mechanical alignment in total knee arthroplasty (TKA). It was hypothesised that some meta-analyses inaccurately combine PROMs from unrestricted and restricted kinematic alignment techniques.</p><p><strong>Methods: </strong>Two authors independently screened articles based on inclusion and exclusion criteria and assessed the methodological quality based on the 16 domains of A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Effect sizes of difference in PROMs were tabulated for each meta-analysis. Studies included in the meta-analyses were assessed to determine if they were on true unrestricted kinematic alignment. A secondary meta-analysis excluded studies on restricted kinematic alignment techniques, to recalculate pooled estimates (mean difference (MD) with their 95% confidence interval (CI)) of the Knee Society Score (KSS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Forgotten Joint Score (FJS). The quality of evidence was assessed using the GRADE.</p><p><strong>Results: </strong>There were 15 meta-analyses pooling data from 39 clinical studies eligible for data extraction. None fulfilled all seven critical AMSTAR-2 domains. Some reported kinematic alignment yielded superior KSS (Function, n = 9; Knee, n = 6: Combined, n = 8), OKS (n = 7), WOMAC (n = 8) and FJS (n = 1). The secondary meta-analysis included only studies on unrestricted kinematic alignment and results at the latest follow-up, for which the mean and standard deviations were reported and revealed no difference in KSS, OKS, WOMAC or FJS between kinematic and mechanical alignment. GRADE analysis revealed 'very low' quality of evidence for KSS, WOMAC and FJS, while it was 'low' quality for OKS.</p><p><strong>Conclusion: </strong>Current evidence suggests no difference in PROMs between kinematic and mechanical alignment in TKA. Meta-analyses that report the contrary often need more rigour as they pool studies on various kinematic alignment techniques or represent the same cohort at different times. Orthopaedic societies should promote using objective outcome measures to evaluate and compare alignment techniques.</p><p><strong>Registration: </strong>Systematic review protocol registration (Prospero: CRD42023434713).</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":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single intra-articular stromal vascular fraction with platelet-rich plasma injection yields superior clinical outcomes than a hyaluronic acid injection in patients with knee osteoarthritis: A prospective comparative study.","authors":"Trifon Totlis, Vlasios Achlatis, Panagiotis-Konstantinos Emfietzis, Theodorakys Marín Fermín, Theodoros Pettas, Aristotelis Sideridis, Ioannis Terzidis","doi":"10.1002/ksa.70068","DOIUrl":"https://doi.org/10.1002/ksa.70068","url":null,"abstract":"<p><strong>Purpose: </strong>The present study aimed to compare the efficacy and safety of a combined injection of stromal vascular fraction (SVF) and platelet rich plasma (PRP) versus a high molecular weight (HMW) hyaluronic acid (HA) injection in patients with knee osteoarthritis (KOA).</p><p><strong>Methods: </strong>A prospective comparative analysis was conducted for patients with KOA who underwent either a single intra-articular mechanical SVF combined with PRP injection (Group A) or a single intra-articular injection of HMW HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) and the EuroQol EQ-5D (EQ-5D-5L) were assessed at baseline, 3, 6 and 12 months postinjection. PRP was coded according to the DEPA classification.</p><p><strong>Results: </strong>The study included 108 knees from 67 patients (Group A: 31; Group B: 36). The VAS, KOOS total and EQ-5D-5L scores significantly improved within each group in every timepoint compared to baseline. The SVF-PRP group significantly outperformed the HMW-HA group in VAS, KOOS total and EQ-5D-5L scores at 6 months and 12 months follow-up. The proportion of patients who achieved Minimal Clinically Important Difference (MCID) at 12 months was 87.0% versus 57.4% (p = 0.0003) in KOOS, 74.1% versus 61.1% in VAS (p = 0.152) and 64.8% versus 40.7% (p = 0.005) in EQ-5D-5L, for the SVF-PRP vs HA group, respectively. No serious adverse events were reported in either group. Minor local adverse events were more common in the SVF-PRP group and spontaneously resolved within days. The implemented PRP was coded as CCA.</p><p><strong>Conclusion: </strong>Both SVF-PRP and HA injections are safe treatments, with no serious adverse events, and significantly improve pain, function and quality of life in patients with KOA. The SVF-PRP outperformed the HA group in all three PROMs at 6 months and 12 months follow-up, and in the proportion of patients who achieved MCID at 12 months postinjection.</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":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056620","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":"Instability after total knee arthroplasty: A systematic review and meta-analysis of treatment options and outcomes.","authors":"Lenka Stroobant, Amber Marvellie, Jani Windels, Hannes Vermue, Nele Arnout, Stefaan Van Onsem, Jan Victor","doi":"10.1002/ksa.70065","DOIUrl":"https://doi.org/10.1002/ksa.70065","url":null,"abstract":"<p><strong>Purpose: </strong>Instability is a rising cause of revision total knee arthroplasty (rTKA), creating significant challenges for patients, surgeons and the healthcare system. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management, isolated polyethylene exchange (PE), and rTKA as treatments for post-TKA instability. The primary outcome was patient-reported outcome measures (PROMs), with secondary outcomes including reoperation rates, revision rates, and implant survival (Aim 1). Additionally, the study examined the effect of instability type on PROMs (Aim 2) and the impact of prosthesis constraint on PROMs (Aim 3).</p><p><strong>Methods: </strong>A systematic search of studies published from 2000 to July 2024 was conducted. (1) Studies analysing the outcome of conservative treatment, isolated PE exchange or revision surgery for instability were included, reporting on PROMs, reoperations, revisions, and/or survival free from revision. PROMs included the Knee Society Score, both clinical (KSCS) and functional (KSFS). Revision was defined as the removal and replacing of the femoral and/or tibial component. A meta-analysis was only performed for revision surgery as treatment. (2) Instability was classified into flexion and extension instability. (3) Prosthetic constraints analysed included posterior stabilised (PS), condylar constrained knee (CCK), and rotating hinged knee (RHK).</p><p><strong>Results: </strong>A total of 27 articles, involving 4269 knees, were included in the analysis: two studies on conservative management, 12 on isolated PE exchange, and 19 on revision surgeries. (1) Conservative treatment, primary physiotherapy, yielded inconsistent results. Isolated PE exchange showed poor outcomes, with recurrent instability and subsequent revision occurring in 6.5%-18.5% of cases. However, in carefully selected patients, outcomes comparable to rTKA were observed. Revision surgery showed a mean improvement of 32 points (95% confidence interval [CI], 20.5-43.5; p < 0.001) for KSKS and 24.3 points (95% CI, 17.2-31.4; p < 0.001) for KSFS. During follow-up, 5.3% (46/864) of the patients underwent a rerevision, with 41.3% attributed to instability. (2) Extension instability showed a trend toward better KSKS (p = 0.04) and KSFS scores (p = 0.03) than flexion instability, and (3) no evidence of superiority was found between different types of constraint in this study.</p><p><strong>Conclusions: </strong>When guided by appropriate clinical indications, conservative management, isolated PE exchange, and revision surgery can yield favourable outcomes in the treatment of post-TKA instability. Instability remains the leading cause of rerevision, highlighting the need for higher prosthetic constraints when flexion-extension gap balancing cannot be achieved.</p><p><strong>Level of evidence: </strong>Level IV, systematic review.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056611","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 effects of over- and under-stuffing the anterior knee compartment in primary TKA: A systematic review.","authors":"Christos Koutserimpas, Vasileios Giovanoulis, Mo Saffarini, Michel Bonnin, Michael T Hirschmann, Sébastien Lustig","doi":"10.1002/ksa.70033","DOIUrl":"https://doi.org/10.1002/ksa.70033","url":null,"abstract":"<p><strong>Purpose: </strong>Up to 20% of patients remain dissatisfied following total knee arthroplasty (TKA), often due to anterior knee pain (AKP) and other patellofemoral complications. Several studies highlighted risks of over- or under-stuffing within the patellofemoral compartment, yet there are no standardised methods for their assessment, and their effects on patient-reported outcome measures (PROMs) remain unclear. The aim of this review was to synthesise and critically appraise all published studies that investigated effects of over- and under-stuffing the anterior compartment on PROMs following primary TKA.</p><p><strong>Methods: </strong>The protocol for this systematic review followed PRISMA guidelines was registered on PROSPERO (July 2024), before electronic searches by two readers (C.K. and V.G.) using Medline and Scopus. The authors included clinical studies published in English, reporting a quantifiable method to assess the anterior compartment in TKA, with clinical and/or radiographic outcomes. The authors excluded in vitro or ex vivo studies, reviews or editorials, studies on revision TKA and studies with follow-up <1 year.</p><p><strong>Results: </strong>Searches returned 160 records, of which 14 met the eligibility criteria (10 retrospective and 4 prospective), representing 4404 knees in 3718 patients. The primary outcome was over-stuffing in five studies, which investigated its correlation with PROMs and/or AKP, while the primary outcome was under-stuffing in two studies. The PROMs reported were Western Ontario and McMaster Universities Osteoarthritis Index (eight studies), knee society score (six studies), knee injury and osteoarthritis outcome score (two studies), as well as Oxford knee score, forgotten joint score and Kujala scores (each one study). Only two studies used dynamic assessments, while 12 used static assessments. Only 3 of the 14 studies found significant effects of over-stuffing (by >5 mm) on PROMs.</p><p><strong>Conclusions: </strong>Changes in anterior offset, particularly over-stuffing, may cause patellofemoral complications. Although it would be ideal to restore the anterior compartment, small deviations do not affect clinical outcomes. A threshold of 5 mm could represent the 'safe zone' for change in anterior offset in patients undergoing TKA.</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":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035057","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 injectable orthobiologics for knee osteoarthritis: A formal ESSKA-ORBIT consensus. Part 2-Cell-based therapy.","authors":"Laura de Girolamo, Giuseppe Filardo, Ferran Abat, Kristoffer Weisskirchner Barfod, Ricardo Bastos, Ramon Cugat, Michael Iosifidis, Baris Kocaoglu, Elizaveta Kon, Jeremy Magalon, Rodica Marinescu, Marko Ostojic, Mikel Sanchez, Thomas Tischer, Jasmin Bagge, Konrad Slynarski, Lucienne Vonk, Philippe Beaufils, Lior Laver","doi":"10.1002/ksa.70001","DOIUrl":"https://doi.org/10.1002/ksa.70001","url":null,"abstract":"<p><strong>Purpose: </strong>This European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) formal consensus aims to provide evidence- and expert opinion-based recommendations for the use of point-of-care- and expanded-cell-based therapy (CBT) in the treatment of knee osteoarthritis (OA), focusing on indications, preparation, and administration.</p><p><strong>Methods: </strong>A multidisciplinary group of 77 leading experts in musculoskeletal regenerative medicine from 22 European Countries formed a steering group, a rating group, and a reader group. The steering group developed 23 questions, originating from 27 statements. The statements were graded from A (high-level scientific evidence) to D (expert opinion). The question-statement sets were scored by the rating group from 1 to 9 according to the level of agreement. The document was then assessed for geographic adaptability by the reader group composed of representatives from ESSKA-affiliated societies.</p><p><strong>Results: </strong>Overall, the statements received a mean score of 8.2 (standard deviation: 0.3) points out of a possible 9 and a median score of 8 (range: 6-9). Among the 27 statements, 9 were considered appropriate with strong agreement, and 18 were considered appropriate with relative agreement. Five statements received a recommendation level of A or B, and 22 were rated as C or D. In terms of geographic adaptability, 18 affiliated ESSKA Societies expressed support, two were opposed, and two abstained. CBT has demonstrated consistent clinical benefits, particularly in pain and function improvement up to 12 months, supporting its use for patients with Kellgren-Lawrence (KL) Grades 1-3 knee OA, with some benefits, though inferior, in selected KL Grade 4. However, due to limited high-quality studies and a lack of clear superiority over other injectables, CBT should be considered as a second-line treatment option.</p><p><strong>Conclusions: </strong>The consensus document acknowledges ongoing debate about CBT's full effectiveness, though evidence suggests potential clinical benefits in pain relief and functional improvement. CBT are supported as a second-line injectable treatment for KL 1-3 knee OA 1-3, with some benefits shown in Grade 4 too. However, gaps remain in high-quality studies and treatment protocols. Nevertheless, evidence suggests that CBT may be seen as an alternative to traditional injectables like corticosteroids and hyaluronic acid, given the longer-lasting benefits, and could currently be considered after other non-operative treatment fails.</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":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025143","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":"Lower baseline scores best predict achievement of the minimal clinically important difference after hip arthroscopy: A machine learning analysis from the Femoroacetabular Impingement RandomiSed Controlled Trial and embedded prospective cohort.","authors":"Prushoth Vivekanantha, Jeffrey Kay, Nicole Simunovic, Olufemi R Ayeni","doi":"10.1002/ksa.70053","DOIUrl":"https://doi.org/10.1002/ksa.70053","url":null,"abstract":"<p><strong>Purpose: </strong>This analysis evaluated whether logistic regression and machine learning models could predict achievement of the minimal clinically important difference (MCID) for the International Hip Outcome Tool (iHOT-12) and Hip Outcome Score (HOS) at 6 and 12 months following hip arthroscopy.</p><p><strong>Methods: </strong>Data from the multicenter Femoroacetabular Impingement RandomiSed controlled Trial and its embedded prospective cohort were used. A total of 309 patients (mean ± SD age 34.0 ± 8.7 years, 37.7% female) were included. The MCID thresholds for iHOT-12 and HOS were calculated using a distribution-based method and were 9.0 and 13.0, respectively. Predictive models were trained with demographic, radiographic, and intraoperative variables using a 70:30 training-to-test data split. MCID achievement was defined as a change from preoperative to postoperative scores that surpassed the calculated threshold. Model discrimination was assessed using the area under the curve (AUC), and calibration was evaluated via slope, intercept, and Brier scores.</p><p><strong>Results: </strong>Achievement rates were 83.3% at 6 months and 81.1% at 12 months for iHOT-12, and 64.3% at 6 months and 75% at 12 months for HOS. Logistic regression performed best at 12 months (AUC = 0.724) for iHOT-12 with poor calibration (slope = 2.19). AUCs for HOS ranged between 0.672-0.715 at 6 months and 0.665-0.699 at 12 months. Best calibration was achieved by Least Absolute Shrinkage and Selection Operator (slope = 1.270, intercept = -0.177) at 6 months and by logistic regression at 12 months (slope = 1.093, intercept = -0.079). Lower baseline patient-reported outcome measures (PROMs) were associated with MCID achievement in most models.</p><p><strong>Conclusion: </strong>The most robust predictor of MCID achievement for both PROMs were lower baseline scores, and can be used as a prognostic variable for preoperative counselling. Model performance for predicting MCID was superior for HOS relative to iHOT-12. Machine learning models generally had comparable discrimination and calibration scores to traditional logistic regression models.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025171","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}