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

{"title":"Improved function and patient satisfaction with fewer residual symptoms following kinematically versus mechanically aligned total knee arthroplasty: A retrospective study from FP-UCBM Knee Study Group.","authors":"Stefano Campi, Giancarlo Giurazza, Edoardo Franceschetti, Michael T Hirschmann, Andrea Tanzilli, Michele Paciotti, Biagio Zampogna, Matteo Pepe, Pietro Gregori, Umile Giuseppe Longo, Rocco Papalia","doi":"10.1002/ksa.70621","DOIUrl":"https://doi.org/10.1002/ksa.70621","url":null,"abstract":"<p><strong>Purpose: </strong>To compare residual symptoms, function and patient satisfaction following unrestricted kinematic alignment (KA) versus mechanical alignment (MA) in primary total knee arthroplasty (TKA). It was hypothesized that KA would reduce residual symptoms and improve function and satisfaction.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 622 patients undergoing primary TKA (315 KAs and 307 MAs) for end-stage osteoarthritis between 2022 and 2024, with a minimum 1-year follow-up. All procedures used the same implant design and standardized perioperative protocols. Outcomes included patient satisfaction, functional performance, residual symptoms and joint perception, assessed using the Forgotten Joint Score (FJS) and Joint Awareness Score (JAS). Groups were compared using t tests and χ² tests (p < 0.05).</p><p><strong>Results: </strong>KA demonstrated significantly higher overall satisfaction compared with MA (94.0% vs. 81.1%; p < 0.001), as well as greater satisfaction with activities of daily living (92.7% vs. 83.1%; p < 0.001) and pain relief (90.2% vs. 82.1%; p = 0.005). Functional outcomes favoured KA, with fewer patients reporting difficulty getting in/out of a car (8.6% vs. 18.9%; p < 0.001) or chair (9.8% vs. 18.9%; p < 0.001), higher absence of limp (86.0% vs. 73.0%; p < 0.001) and greater return to activity (91.7% vs. 80.1%; p < 0.001). Residual symptoms were less frequent in the KA group, including pain (11.7% vs. 24.1%; p < 0.001) and popping (7.3% vs. 17.9%; p < 0.001), with a higher proportion of patients reporting a 'normal' knee (89.8% vs. 79.2%; p < 0.001). FJS (91.7 vs. 82.7; p < 0.001) and JAS (92.3 vs. 83.5; p < 0.001) were both significantly higher in the KA group. No statistically significant differences were observed in stair-climbing ability, swelling or stiffness.</p><p><strong>Conclusion: </strong>Unrestricted KA in TKA is associated with fewer residual symptoms, improved function and higher patient satisfaction compared with MA at 1 year. These findings support KA as a potential strategy to reduce the prevalence of the 'unhappy knee' after TKA.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083342","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":"Detection of previous knee injuries using lower limb-worn inertial measurement units: A cross-sectional machine-learning study.","authors":"Christina Valle, Matthias Cotic, Maximilian Bartelt, Luca Seeberger, Birgit Waschulzik, Sebastian Siebenlist, Michael T Hirschmann, Georg Matziolis, Rüdiger von Eisenhart-Rothe, Daniel Rueckert, Florian Hinterwimmer, Ricardo Smits Serena","doi":"10.1002/ksa.70631","DOIUrl":"https://doi.org/10.1002/ksa.70631","url":null,"abstract":"<p><strong>Purpose: </strong>Previous knee injury increases the risk of subsequent injury, even after functional recovery, yet residual gait, running or load alterations often go undetected in routine assessment. Wearable inertial measurement units (IMUs) may enable scalable detection of such alterations outside laboratory settings. The primary aim of this study was to determine whether IMU-derived gait and running features can distinguish physically active individuals with a history of knee injury from uninjured controls using machine learning.</p><p><strong>Methods: </strong>In this cross-sectional study, 108 sports science students completed injury-history questionnaires and a walking-running-walking protocol on a 400 m track while wearing four IMUs. Of 90 participants with complete data, 23 reported prior knee injury and 67 were uninjured controls. Left- and right-side sensor data were combined into one per-participant feature vector. The model classified any prior knee injury (yes/no), not limb-specific injury. From 220 candidate features covering baseline gait, post-run changes, walk-to-run transitions, inter-limb asymmetry, variability and composite indices-a fixed pipeline (e.g., median imputation, mutual-information selection) was applied within leave-one-out cross-validation (primary) and repeated stratified five-fold cross-validation (secondary).</p><p><strong>Results: </strong>Leave-one-out cross-validation correctly classified 76/90 participants (65/67 true negatives, 11/23 true positives), yielding an area under the receiver operating characteristic curve of 0.74, balanced accuracy of 0.72, sensitivity of 0.48, specificity of 0.97, positive predictive value (PPV) of 0.85 and negative predictive value of 0.84. Five-fold cross-validation produced more variable estimates, indicating substantial model instability across resampling partitions.</p><p><strong>Conclusions: </strong>As a proof of concept, IMU-derived features distinguished individuals with previous knee injury at high specificity but limited sensitivity. High specificity and PPV depend on the classification threshold and injury prevalence in this selected sample, not intrinsic model properties. Because predictors were not aligned to the injured side, findings cannot be interpreted biomechanically. Potential applications (e.g., targeted monitoring) require prospective external validation.</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":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083411","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":"Current concepts in isolated and combined injuries of the medial collateral ligament complex, part II: The anteromedial knee instability classification.","authors":"Armin Runer, Nicolas Bouguennec, Guido Wierer, James Robinson, Andrew Amis, Elmar Herbst, Christoph Kittl, Riccardo Cristiani, Christian Hoser, Lukas Willinger, Elisabeth Abermann, Riccardo D'Ambrosi, Eric Hamrin Senorski, Alan Getgood, Volker Musahl, Simon Ball, Andy Williams, Sebastian Siebenlist, Gilbert Moatshe, Robert Smigielski, Martin Lind, Marc Strauss, Mirco Herbort, Kristian Samuelsson, Christian Fink","doi":"10.1002/ksa.70630","DOIUrl":"10.1002/ksa.70630","url":null,"abstract":"<p><p>The medial collateral ligament (MCL) has a strong self-healing capacity; nevertheless, not every MCL injury heals adequately. Persisting medial and anteromedial knee laxity should be avoided as it may lead to increased strains and wear of the surrounding tissue, including the anterior cruciate ligament (ACL), meniscus and cartilage. Better understanding of MCL anatomy and biomechanics, especially in combined ACL-MCL injuries, has necessitated the need for updated clinical examination, classification and treatment approaches. The newly introduced anteromedial knee instability (AMKI) classification is a clinically and biomechanically based classification system designed to grade medial and anteromedial knee laxity using a structured three-letter-based system. First, an injury to the posteromedial complex and the posterior oblique ligament needs to be ruled out by testing valgus laxity in full individual knee extension. The inability to fully extend the knee might lead to a false positive result. Medial laxity is then assessed at 20°-30° of knee flexion. A Grade A injury is defined by a normal clinical valgus stress test indicating an intact superficial MCL (sMCL), but a positive external rotation test, suggesting an isolated injury to the deep MCL (dMCL). Grade B is characterised by a nearly normal or abnormal valgus laxity, combined with a nearly normal or abnormal external rotation test, indicating mild to moderate injuries to both the dMCL and sMCL with or without additional ACL injury. A Grade C injury represents a high-grade injury pattern, with both severely abnormal valgus laxity and external rotation testing, suggesting a complete injury to the medial stabilisers, often but not necessarily in combination with ACL insufficiency. Treatment of isolated MCL or combined ACL-MCL injuries is complex and multifactorial, but can be individualised based on the AMKI classification. LEVEL OF EVIDENCE: Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067124","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 re-rupture rate after primary ACL reconstruction using a modified MacIntosh iliotibial band technique with gracilis augmentation: Minimum 6-year follow-up.","authors":"Baptiste Bouyge, Antoine Gerometta, Eugénie Valentin, Mohamad Moussa, Nikolaos Lepidas, Frédéric Khiami, Alain Meyer, Olivier Grimaud, Nicolas Lefèvre, Yoann Bohu, Alexandre Hardy","doi":"10.1002/ksa.70626","DOIUrl":"https://doi.org/10.1002/ksa.70626","url":null,"abstract":"<p><strong>Purpose: </strong>Combined intra- and extra-articular anterior cruciate ligament (ACL) reconstruction has gained renewed interest to improve rotational stability and reduce graft failure. This study evaluated graft re-rupture rates, functional and return-to-sport (RTS) outcomes at a minimum 6-year follow-up after primary reconstruction using a modified MacIntosh iliotibial band (ITB) technique with gracilis augmentation.</p><p><strong>Methods: </strong>This retrospective single-centre cohort study included patients from the FAST Cohort (French Prospective Anterior Cruciate Ligament Reconstruction Cohort Study) who underwent primary reconstruction using this technique between January 2015 and October 2019. The primary outcome was graft re-rupture. Patient-reported outcome measures, RTS outcomes and complications were assessed at final follow-up. Multivariable logistic regression identified factors associated with graft re-rupture and RTS at the pre-injury level.</p><p><strong>Results: </strong>A total of 265 patients were included in graft re-rupture and complication analyses, with a mean follow-up of 84.3 ± 10.7 months. Graft re-rupture occurred in 13 patients (4.9%). Complications other than graft failure occurred in 5 patients (1.9%). Additional surgical procedures excluding ACL revision were required in 13 patients (4.9%), most commonly meniscectomy for secondary meniscal lesions (4.2%). Functional outcomes were analysed in 252 patients after excluding graft re-ruptures and improved significantly compared with preoperative values (p < 0.001), with median subjective International Knee Documentation Committee and Lysholm scores of 92.0 and 95.0, respectively. Among 249 patients who practised sport before injury, 228 (91.6%) returned to sport, including 154 (61.8%) who returned to the same sport, of whom 69 (44.8%) returned to their pre-injury level. Median time to RTS was 8.0 months. Younger age and medial meniscal tear were independently associated with graft re-rupture.</p><p><strong>Conclusion: </strong>Primary ACL reconstruction using a modified MacIntosh ITB technique with gracilis augmentation resulted in a low graft re-rupture rate, favourable patient-reported outcome scores and a high overall RTS rate at a minimum 6-year follow-up.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027474","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":"Clinical outcomes and complication rates following medial collateral ligament reconstruction using Achilles tendon allograft or hamstring tendon autograft: A systematic review.","authors":"Ross Sian, Abbas See, Tawfiq Alqeisi, Amit Meena, Stephen Dalgleish, Darren de Sa, Peter Davies, Peter D'Alessandro, Jimmy Ng, Shahbaz S Malik","doi":"10.1002/ksa.70625","DOIUrl":"https://doi.org/10.1002/ksa.70625","url":null,"abstract":"<p><strong>Purpose: </strong>The medial collateral ligament (MCL) is the most commonly injured knee ligament, yet indications for reconstruction remain debated. Although consensus statements support allograft and hamstring autograft, comparative evidence regarding graft superiority is limited. This systematic review evaluated patient-reported outcome measures (PROMs) and complication rates following MCL reconstruction using Achilles tendon (AT) allograft or hamstring autograft.</p><p><strong>Methods: </strong>A systematic review was undertaken according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. PubMed, Cochrane, Google Scholar and Scopus were searched on 11th February 2026. Studies published within the previous 20 years that included patients aged ≥16 years undergoing MCL reconstruction with hamstring autograft or AT allograft and reporting clinical, functional and patient-reported outcomes were included. Data extraction and risk of bias assessment were performed. Due to heterogeneity, findings were narratively synthesised.</p><p><strong>Results: </strong>Sixteen studies were included: six AT allograft studies (n = 107; four using a bone block) and ten hamstring autograft studies (n = 275). Mean age was 33.9 and 31.3 years, with mean follow-up of 37 and 29.1 months, respectively. Mean postoperative international knee documentation committee (IKDC) and Lysholm scores were 81.1 and 86.8 for allograft and 78.8 and 87.2, respectively, for autograft. Three allograft and six hamstring autograft studies reported preoperative and postoperative PROMs, all demonstrated significant improvement (p < 0.05). Complication rates were 11.2% for AT allograft and 4.0% for hamstring autograft. AT allograft complications included two graft failures, four cases of residual asymptomatic valgus instability, three infections and three other complications. Hamstring autograft complications included one graft failure, four cases of asymptomatic valgus instability, three manipulations, one infection and two removals of hardware.</p><p><strong>Conclusion: </strong>Both AT allograft and hamstring tendon autograft significantly improve PROMs following MCL reconstruction. AT allografts demonstrated a numerically higher complication rate; however, the evidence is indirect and insufficient to determine the superiority of either graft type.</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":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019484","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 association between passive anterior tibial subluxation and anterior cruciate ligament reconstruction failure.","authors":"Yi-Tian Gao, Wei-Li Shi, Yi-Fei Zhong, Tong Wen, Lin-Feng Qiu, Shuai-Peng Zhou, Yong Ma, Ping Liu, Hai-Jun Wang, Jian Wang, Xi Gong, Cheng Wang, Jian-Quan Wang","doi":"10.1002/ksa.70607","DOIUrl":"https://doi.org/10.1002/ksa.70607","url":null,"abstract":"<p><strong>Purpose: </strong>Increased passive anterior tibial subluxation (PATS) has been observed in patients with failed anterior cruciate ligament (ACL) reconstruction (ACLR). However, whether primary PATS is associated with future risk of graft failure and how PATS evolves over time remain unclear. This study aims to determine whether PATS measured at the time of the primary ACL injury is associated with graft failure and to characterize the longitudinal changes in PATS among patients with and without graft failure.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent primary ACLR between January 2019 and December 2023. A total of 131 patients with graft failure were propensity score-matched to 131 controls with intact grafts at a minimum 48-month follow-up (age, 28.9 ± 7.7 years; 61 females [23.3%]). Primary magnetic resonance imaging (MRI) evaluation was performed for all patients before primary ACLR. Secondary MRI evaluation was performed before revision surgery for the failure group (median [interquartile range {IQR}], 31.0 [19.1-58.0] months) and at 24 months post-operatively for the control group (median [IQR], 24.9 [23.9-27.4] months). Multivariable logistic regression and receiver operating characteristic curve analysis were performed to evaluate factors associated with graft failure. Multivariable linear regressions were performed to identify factors associated with longitudinal changes in PATS between the primary and secondary MRI evaluations. Statistical analyses were performed using R software.</p><p><strong>Results: </strong>Significantly higher lateral (L-PATS) and medial (M-PATS) PATS at both the primary and secondary MRI evaluations were observed in the failed ACLR group compared with the control group (all p < 0.05). Patients with graft failure demonstrated significant longitudinal progression of PATS compared to those with intact grafts (p < 0.05). Primary L-PATS (odds ratio [OR], 1.166; p < 0.001) and lateral tibial slope (LTS) (OR, 1.193; p < 0.001) were identified as factors independently associated with graft failure, demonstrating moderate discriminative ability (area under the curve [AUC], 0.682 and 0.668). Graft failure, female sex and medial meniscus injury were independently associated with longitudinal increases in PATS (all p < 0.05).</p><p><strong>Conclusions: </strong>Increased L-PATS measured at the time of the primary ACL injury was associated with an increased risk of graft failure. Patients who experienced graft failure demonstrated significant longitudinal increases in both L-PATS and M-PATS compared to those with intact 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":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019472","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 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 2): Treatment strategies, rehabilitation, return to sport and complications.","authors":"Jean Kany, Miguel Ruiz Iban, Emilio Calvo, Claudio Rosso, Chris Peach, Carlos Maia Dias, Pierre Métais, Maristella Francesca Saccomanno, Berte Bøe, Emmanouil Brilakis, Kerem Bilsel, Ladislav Kovacic, Antoon Van Raebroeckx, Nuno Gomes, Frank Martetschläger, Philippe Beaufils, Felix Dyrna","doi":"10.1002/ksa.70622","DOIUrl":"https://doi.org/10.1002/ksa.70622","url":null,"abstract":"<p><strong>Purpose: </strong>To establish evidence-based consensus recommendations for the management of partial-thickness posterosuperior rotator cuff tears (PT-PS-RCTs). This second part addresses treatment strategies, rehabilitation, return to sport and complications.</p><p><strong>Methods: </strong>This European Society for Sports Traumatology, Knee Surgery and Arthroscopy-European Shoulder Associates (ESSKA-ESA) Formal Consensus was conducted according to the ESSKA Formal Consensus Methodology. A Steering Group (13 shoulder surgeons) developed 33 questions and statements based on a standardized literature review and assigned recommendation grades (A-D) according to the level of evidence. Statements were evaluated by an independent Rating Group (20 shoulder surgeons) through a three-round consensus process.</p><p><strong>Results: </strong>Twenty-one Question-Statement (Q-S) pairs achieved strong agreement, generating 30 individual recommendations (1 Grade A, 6 Grade B, 10 Grade C and 13 Grade D). Grade A evidence identified an increased risk of postoperative stiffness after trans-tendon repair of articular-sided PT-PS-RCTs compared with tear completion. Grade B evidence supported conservative treatment for at least 6 months, platelet-rich plasma injections and management of stiffness before surgery; both trans-tendon/in-situ repair and tear-completion-and-repair showed similar return-to-sport rates, although tear-completion-and-repair had slightly higher retear rates. The most commonly reported patient-reported outcome measures were the American Shoulder and Elbow Surgeons, Constant-Murley and visual analogue scale scores.</p><p><strong>Conclusion: </strong>Management should be individualized according to patient characteristics (activity level, sports participation), symptoms, tear morphology and tissue quality rather than based on a single treatment algorithm. Non-surgical treatment is the preferred initial approach, whereas no surgical technique has demonstrated consistent superiority across all clinical scenarios. These recommendations provide clinicians with a practical framework to guide treatment decisions and standardize the management of PT-PS-RCTs in daily clinical practice.</p><p><strong>Level of evidence: </strong>Level I, formal consensus.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019457","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":"Fourfold higher graft failure risk with isolated BPTB versus hamstring ACL reconstruction with ALL in patients under 25 years: A prespecified subgroup analysis of a randomized controlled trial.","authors":"Fabio Santamaria, Alessandro Carrozzo, Charles Pioger, Thais Dutra Vieira, Victor Sonnery-Cottet, Jean-Marie Fayard, Mathieu Thaunat, Bertrand Sonnery-Cottet","doi":"10.1002/ksa.70617","DOIUrl":"https://doi.org/10.1002/ksa.70617","url":null,"abstract":"<p><strong>Purpose: </strong>To compare 5-year graft failure rates between isolated bone-patellar tendon-bone anterior cruciate ligament reconstruction (BPTB-ACLR) and hamstring tendon (HT)-ACLR combined with anterolateral ligament reconstruction (ALLR) in patients younger than 25 years.</p><p><strong>Methods: </strong>A prespecified subgroup analysis was performed on patients younger than 25 years enroled in a prospective comparative study. Patients underwent either isolated ACLR using a BPTB-ACLR or hamstring ACLR combined with ALLR (HT-ACLR + ALLR). The primary outcome was graft failure at 5 years. Secondary outcomes included patient-reported outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee [IKDC], Lysholm and Tegner scores). Survival analysis was performed using Kaplan-Meier estimates and log-rank testing. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors for graft failure.</p><p><strong>Results: </strong>The analysis included 281 patients younger than 25 years, with 134 undergoing isolated BPTB-ACLR and 147 undergoing HT-ACLR + ALLR. At 5 years, graft failure occurred in 22 patients (16.4%) in the isolated BPTB-ACLR group and in 7 patients (4.8%) in the HT-ACLR + ALLR group (p = 0.0013). Kaplan-Meier analysis demonstrated significantly improved graft survival in the HT-ACLR + ALLR group (log-rank p = 0.0008). On multivariate analysis, isolated BPTB-ACLR was independently associated with a higher risk of graft failure compared with HT-ACLR + ALLR (odds ratio 4.2; 95% confidence interval [CI] 1.8-11.3; p = 0.0007; hazard ratio 4.2; 95% CI 1.9-10.7; p = 0.0002). Clinical outcome scores were comparable between groups at follow-up across all patient-reported measures.</p><p><strong>Conclusion: </strong>This secondary analysis of a RCT with 5-year follow-up showed that, in patients younger than 25 years, HT-ACLR combined with ALLR was associated with a significantly lower risk of graft failure compared with isolated BPTB-ACLR, whereas patient-reported clinical outcomes were comparable between groups.</p><p><strong>Level of evidence: </strong>Level I, randomized controlled trial.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019471","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":"Anterior tibial translation in anterior cruciate ligament-deficient knees is increased regardless of tear location and independently associated with early-to-intermediate injury chronicity.","authors":"Valentin Hingsamer, Christian Arras, Maximilian M Mueller, Gioia Nash, Gregory S DiFelice","doi":"10.1002/ksa.70615","DOIUrl":"https://doi.org/10.1002/ksa.70615","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether anterior cruciate ligament (ACL) tear type and injury chronicity influence preoperative instrumented anterior tibial translation side-to-side difference (ATT-SSD) in patients undergoing primary ACL surgery, and, as a secondary aim, to evaluate the association between concomitant meniscal tears and ATT-SSD.</p><p><strong>Methods: </strong>This retrospective single-surgeon study included 521 patients who underwent surgery for ACL injury between October 2019 and January 2026. Preoperative ATT-SSD was measured using a Lachmeter® digital arthrometer, and ACL tears were classified arthroscopically according to the modified Sherman classification. Injuries were categorized by time to first visit as acute (<28 days), subacute (28-90 days) or chronic (>90 days). Associations between tear type, chronicity, meniscal repair and ATT-SSD were assessed using analysis of variance, subgroup comparisons, interaction analysis and multivariable linear regression.</p><p><strong>Results: </strong>ATT-SSD differed across tear-type groups (p = 0.006), with Types III-V tears demonstrating a 0.5-mm greater mean ATT-SSD than Type I tears (p = 0.004), while Type II tears did not differ significantly from either group. Acute injuries showed greater ATT-SSD than subacute and chronic injuries (4.6 ± 1.5 vs. 4.2 ± 1.5 and 4.0 ± 1.5 mm; p = 0.005). The tear type × chronicity interaction was not significant (B = 0.019, p = 0.951). ATT-SSD was higher in patients undergoing medial meniscus repair. In multivariable regression, only chronicity remained independently associated with ATT-SSD (B = -0.205, p = 0.032), whereas ACL tear location was not independently associated with ATT-SSD.</p><p><strong>Conclusions: </strong>Mean ATT-SSD remained above the clinically meaningful threshold of ≥3 mm across all ACL tear types. Although small differences in ATT-SSD were observed according to tear location and early-to-intermediate injury chronicity in unadjusted analyses, only chronicity remained independently associated with ATT-SSD after adjustment. These findings suggest that ACL tear location alone should not be seen as a clinical predictor of anterior sagittal knee stability after ACL injury.</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":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019476","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":"Limited predictive value of preseason isokinetic strength testing for noncontact lower extremity injuries in elite female football players: A 5-year prospective cohort study.","authors":"Jonas Seiler, Amelie Haas, Dominik Gnädinger, Gerrit Bode, Matthias Rosa, Robert Prill, Hagen Schmal, Lisa Bode","doi":"10.1002/ksa.70623","DOIUrl":"https://doi.org/10.1002/ksa.70623","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate associations between preseason isokinetic strength and subsequent noncontact lower extremity injuries in professional and elite youth female football players.</p><p><strong>Methods: </strong>In this prospective study, 271 players (professional, under 20 [U20], under 17 [U17]) underwent preseason isokinetic testing over five seasons. Measurements included concentric/eccentric hamstring and concentric quadriceps strength (60°/s, 240°/s). Conventional, functional hamstring-to-quadriceps (H/Q) ratios and limb symmetry indices (LSI) were calculated. Group differences were assessed using linear mixed models (Group × Limb interactions), and prospective injury risk was evaluated using multivariable generalised estimating equations (GEE), accounting for multi-season participation.</p><p><strong>Results: </strong>A total of 70 noncontact injuries were recorded (anterior cruciate ligament [ACL]: n = 11; meniscus/collateral ligament: n = 20; ankle: n = 21; muscle: n = 18). Linear Mixed Models revealed significant Group × Limb interactions for hamstring strength and H/Q-ratio parameters, most pronounced in the knee and muscle-injury subgroups. In GEE analysis, a lower conventional H/Q ratio was associated with a higher injury risk across the overall cohort (aOR: 0.78; 95% CI: 0.62-0.98; p = 0.03) and muscle injuries specifically (aOR: 0.67; 95% CI: 0.45-0.92; p = 0.04). A history of previous ACL injury was independently associated with an increased risk of subsequent ACL rupture (aOR: 1.73; 95% CI: 1.02-4.70; p = 0.05). Higher baseline quadriceps strength showed a nonsignificant trend towards increased muscle-injury risk (aOR: 1.60; 95% CI: 0.96-2.67; p = 0.08). No significant independent predictors were identified for ankle or non-ACL knee injuries.</p><p><strong>Conclusions: </strong>Preseason isokinetic testing possesses limited independent predictive utility for future noncontact lower extremity injuries and should therefore not be used as a standalone screening tool, although a higher hamstring-to-quadriceps ratio showed a modest protective association warranting further investigation. Instead, isokinetic profiles should be integrated into a broader, multifactorial assessment battery for athlete monitoring and rehabilitation management in elite female football.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009107","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}