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

{"title":"Lateral meniscus injuries have more impact on pivot shift than anterolateral complex injuries in anterior cruciate ligament-injured knees.","authors":"Lukas Willinger, Armin Runer, Romed P Vieider, Andrea Achtnich, Julian Mehl, Sebastian Siebenlist, Philipp Winkler","doi":"10.1002/ksa.70027","DOIUrl":"https://doi.org/10.1002/ksa.70027","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this prospective study was to investigate the effect of Kaplan fibres (KF), anterolateral ligament (ALL) and lateral meniscus (LM) injuries on preoperative anterolateral rotational instability (ALRI) in anterior cruciate ligament (ACL)-injured knees. It was hypothesised that injuries to the ALC (i.e., KF and ALL) and to the LM would increase the preoperative anterolateral rotatory knee instability (ALRI) quantified by the pivot shift (PS) test.</p><p><strong>Methods: </strong>A prospective registry study was conducted and patients who underwent primary unilateral ACL reconstruction were included. The PS test was preoperatively performed and quantified using the PIVOT iPad application. The anterior translation of the lateral tibia plateau (ATLT) was measured and the side-to-side difference (SSD) was calculated. The PS test was additionally graded according to IKDC criteria. Injuries to the KF, ALL and LM were diagnosed on acute preoperative magnetic resonance imaging (MRI) scans. Student's t-test was used to compare means and binary regression analysis was used to calculate odds ratio (OR). Statistical significance was set to p < 0.05.</p><p><strong>Results: </strong>One hundred and twenty-four patients with a mean age of 29.9 ± 11.2 years were included in this study (61% male, 61% right knees). Patients with a LM injury showed a higher likelihood of having a high-grade PS (odds ratio [OR] = 2.5, p = 0.045). Complete radial meniscus tears of the LM significantly increased the ATLT in the quantified PS test compared to patients with an intact meniscus (p < 0.05). Injuries to the ALL, to the KF or a combination of both were not associated with high-grade PS or an increased ATLT.</p><p><strong>Conclusion: </strong>Concomitant LM tears were associated with a clinical high-grade PS. Complete radial meniscus tears of the lateral meniscus significantly increased the ATLT compared to intact meniscus. Injuries to the ALL or to the KF were not associated with high-grade PS or an increased ATLT. This study provides new clinical evidence that concomitant LM injuries contributes to increased ALRI, highlighting the importance of addressing these structures during ACL reconstruction to optimise rotational instability.</p><p><strong>Level of evidence: </strong>Level III, diagnostic studies.</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":"145025180","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 presence of spin is commonly found in the abstracts of systematic reviews and meta-analysis on robotic-assisted unicompartmental knee arthroplasty.","authors":"James Abesteh, Hassaan Abdel Khalik, Ayomide M Ade-Conde, Vickas Khanna, Etienne L Belzile, Olufemi R Ayeni","doi":"10.1002/ksa.70014","DOIUrl":"https://doi.org/10.1002/ksa.70014","url":null,"abstract":"<p><strong>Purpose: </strong>As robotic-assisted unicompartmental knee arthroplasty (RA-UKA) gains popularity, debate continues over its superiority to conventional UKA (C-UKA). Systematic reviews and meta-analyses (SRMAs) have examined this, but concerns exist about spin bias in their abstracts, which can significantly alter perceptions of a treatment's efficacy and safety. This study aims to evaluate the presence of spin bias in the abstracts of SRMAs comparing RA-UKA and C-UKA, and to assess the methodological quality of all included SRMAs using the AMSTAR-2 tool.</p><p><strong>Methods: </strong>MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched from inception to 7 February 2025 for SRMAs that assessed RA-UKA. Eligible studies assessed at least one outcome of RA-UKA. Included studies were evaluated for the presence of spin in their abstracts using the methods outlined by Yavchitz et al. All full texts were subsequently assessed for methodological quality using the AMSTAR-2 tool.</p><p><strong>Results: </strong>At least one element of abstract spin was identified in 12 of 16 included studies (75%). The most common category of spin was 'misleading reporting' in the form of selective reporting of or overemphasis on efficacy outcomes or analysis favouring the beneficial effect of the experimental intervention, observed in ten studies (63%). With the exception of one study with an overall 'low' confidence rating, all remaining studies were of 'critically low' A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) confidence. No study characteristics were significantly associated with the presence of abstract spin.</p><p><strong>Conclusion: </strong>The majority of RA-UKA SRMAs contained spin, most commonly in the form of misleading reporting and interpretation, and were rated 'critically low' in quality by AMSTAR-2. In a growing field like RA-UKA where clinical decision-making is influenced by SRMA results and conclusions, clinicians should critically review full texts to minimise the impact these biases may have on their practice.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025146","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":"Kinematic alignment doesn't tell the whole story: It's time for kinetic alignment.","authors":"Umile Giuseppe Longo, Giovanni Spallone, Arianna Carnevale, Letizia Mancini, Emiliano Schena, Rocco Papalia, Michael Tobias Hirschmann","doi":"10.1002/ksa.70010","DOIUrl":"https://doi.org/10.1002/ksa.70010","url":null,"abstract":"<p><p>Kinematic alignment is increasingly adopted in total knee arthroplasty (TKA) as a patient-specific strategy to restore native joint anatomy. However, its reliance on static radiographic measurements may not adequately reflect real-world functional biomechanics. This editorial underscores the importance of complementing static assessment with kinetic principles. This emerging concept, referred to as kinetic alignment, integrates dynamic parameters such as the dynamic hip-knee-ankle angle, knee adduction moment, ground reaction forces, and muscle forces to better characterise in vivo joint loading. These kinetic variables provide critical insight into joint loading during real-life activities and may offer greater predictive value for implant performance and patient satisfaction. Continued emphasis on static alignment targets may overlook key elements of in vivo knee function. Incorporating kinetic data into preoperative planning could support more tailored surgical decisions, helping to mitigate risks related to malalignment, overloading, and suboptimal outcomes. The editorial advocates for expanding the concept of alignment beyond static geometry, including both motion and load, and encouraging the orthopaedic and biomechanical communities to adopt a more functional and individualised perspective in TKA planning.</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":"145025213","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":"Medial parapatellar surgical approach leads to greater loss of postural sway complexity compared to mid-vastus approach in women undergoing total knee arthroplasty.","authors":"Vasileios Mylonas, Stylianos Grigoriadis, Dimitris Metaxiotis, Eleftherios Kellis, Nick Stergiou, Thomas Nikodelis","doi":"10.1002/ksa.70057","DOIUrl":"https://doi.org/10.1002/ksa.70057","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) is associated with acute postoperative effects that increase the risk of falls. These effects differ between the medial parapatellar (PP) and mid-vastus (MV) surgical techniques but have not been evaluated in terms of postural sway complexity. Loss of this complexity leads to increased randomness in the center of pressure and higher fall risk. This exploratory comparative analysis addresses this knowledge gap by examining how PP and MV techniques affect postural sway complexity in women.</p><p><strong>Methods: </strong>Twenty women with osteoarthritis (OA) were randomly assigned to TKA via the PP or MV approach. Postural sway data were collected at: 1 day before the surgery (Pre), 5 days (Post), 2 weeks, and 1 month post-surgery. We also included an age- and sex-matched healthy control group (n = 11) with a single assessment of their postural sway. The temporal structure of variability was evaluated in terms of its complexity. We quantified the complexity of postural sway using detrended fluctuation analysis (DFA) and multi-scale entropy (MSE).</p><p><strong>Results: </strong>The α exponent (DFA) and MSE values showed significant effects of time in both axes, with both surgical groups exhibiting a shift towards more random patterns following TKA. When compared to controls, the PP group exhibited a significantly lower α exponent, indicative of more random patterns, at 2 weeks and 1 month but not at Pre and Post, while no such differences were observed for the MV group. Lower α exponent and higher MSE values reflect reduced sway complexity.</p><p><strong>Conclusions: </strong>These findings suggest that TKA leads to loss of complexity in women during the postoperative stage, with the PP approach resulting in more pronounced reductions relative to healthy controls than the MV approach. Future studies should explore the long-term effects of TKA on postural sway complexity and the impact of rehabilitation protocols.</p><p><strong>Level of evidence: </strong>N/A.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025129","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":"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":"Yaoxin Ao, Jiangfeng Lyv, Fangjun Xiao, Junxing Yang","doi":"10.1002/ksa.70063","DOIUrl":"https://doi.org/10.1002/ksa.70063","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025173","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":"Unicondylar intra-articular tibial plateau osteotomies provide favourable outcomes and avoid arthroplasty in posttraumatic deformities at 4-year mean follow-up.","authors":"Rodrigo Olivieri, Tomás Pineda, José I Laso, Nicolás Franulic, Jaime Ugarte, Diego Valiente, Tania Rojas, Nicolás Gaggero, Matthieu Ollivier","doi":"10.1002/ksa.70035","DOIUrl":"https://doi.org/10.1002/ksa.70035","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the functional and radiological outcomes, complications and procedure survival in patients with posttraumatic tibial plateau deformities treated with unicondylar intra-articular tibial plateau osteotomy (UIATPO), comparing medial and lateral approaches.</p><p><strong>Methods: </strong>A retrospective study was conducted on all patients with posttraumatic intra-articular tibial plateau deformities who underwent surgical correction at a single centre between 2016 and 2022, with a minimum follow-up of 24 months. Patient characteristics, radiological correction, patient-reported outcome measures (PROMs), including the Lysholm and knee injury and osteoarthritis outcome score (KOOS), and complications were recorded. The primary outcome was functional assessment using the KOOS and Lysholm scales. Secondary outcomes included complications categorised into early (≤30 days), intermediate (31-90 days) and late (>90 days) postoperative periods, surgical reinterventions, and radiographic correction of alignment.</p><p><strong>Results: </strong>Twenty-six patients were included (46.15% male), with a mean age of 44.7 years and a mean follow-up of 48.7 months (range: 25-95). Lateral UIATPO was performed in 81% (n = 21) of cases. Statistically significant correction of the hip-knee-ankle (HKA) angle and posterior tibial slope was achieved in the lateral osteotomy group when comparing pre- and postoperative measurements, while no significant changes were observed in patellar height. Clinical outcomes were favourable, with high KOOS and Lysholm scores and no significant differences between lateral and medial groups. The main complication was infection, which occurred predominantly in medial osteotomies and was initially managed successfully with debridement, antibiotics and implant retention. No patient required conversion to knee arthroplasty at final follow-up.</p><p><strong>Conclusions: </strong>UIATPOs demonstrated good functional and radiological outcomes, with low rates of major complications and no need for conversion to knee arthroplasty at intermediate-term follow-up, supporting its role as a joint-preserving option in selected cases.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025121","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":"Image-based robotics enhance precision and efficiency in lateral UKA: A comparative study of 135 UKAs.","authors":"Clément Favroul, Cécile Batailler, Elsayed Ahmed Abdelatif, Elvire Servien, Sébastien Lustig","doi":"10.1002/ksa.70012","DOIUrl":"https://doi.org/10.1002/ksa.70012","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic-assisted lateral unicompartmental knee arthroplasty (UKA) remains technically demanding due to the complex biomechanics of the lateral compartment. Image-based (IBRA) and imageless (ILRA) robotic systems have both demonstrated superior accuracy compared to conventional mechanical instrumentation, but have not yet been directly compared in lateral UKA. This study aimed to evaluate their respective accuracy and surgical efficiency.</p><p><strong>Methods: </strong>This retrospective study included 135 patients who underwent lateral UKA using either IBRA or ILRA systems. Post-operative radiographic outcomes included hip-knee-ankle (HKA) alignment, posterior tibial slope (PTS) and joint line (JL) restoration. Surgical time was assessed as a secondary outcome. Target zones were HKA 180°-185°, PTS 2°-8° and JL ± 2 mm.</p><p><strong>Results: </strong>IBRA showed higher rates of HKA inliers (94.9% vs. 78.9%, p = 0.011) and JL restoration (76.2% vs. 31.6%, p < 0.001) compared to ILRA. PTS accuracy was similar between groups (p = 0.30). Operative time was significantly shorter with IBRA (61.6 ± 13.5 vs. 81.9 ± 26.1 min, p < 0.001).</p><p><strong>Conclusion: </strong>IBRA outperformed ILRA in terms of alignment accuracy and surgical duration. These findings support the added value of IBRA systems in lateral UKA.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series study.</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":"145025163","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":"Accelerated rehabilitation after proximal hamstring avulsion repair is safe and effective: Outcomes from randomized controlled trial of two different rehabilitation regimes.","authors":"Randeep S Aujla, Peter Edwards, Steven Cecchi, Shahbaz Malik, Brendan Ricciardo, Peter Annear, Jay Ebert, Peter D'Alessandro","doi":"10.1002/ksa.70030","DOIUrl":"https://doi.org/10.1002/ksa.70030","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study was to identify the safety and effectiveness of an accelerated (AR) versus conservative (CR) rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions.</p><p><strong>Methods: </strong>This prospective randomized controlled trial (RCT) allocated patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR = 30) or an accelerated, unbraced regime, which permitted full weight-bearing as tolerated (AR = 27). Patients were evaluated pre-operatively and at 6 weeks, 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs), patient satisfaction and global rating of change (GRC) scores. Objective measures, including the single (SHD), triple (THD) and triple crossover (TCHD) hop tests, were assessed at 6 months, as was peak isokinetic knee extensor and flexor torque.</p><p><strong>Results: </strong>Of the 57 patients recruited, 4 were excluded from the CR group (2 infections; 2 re-injuries). The CR group contained 57% males with a mean age of 45.6 (standard deviation [SD] = 13.4). The AR group contained 44% males with a mean age of 50.5 (SD = 11.8). Therefore, 53 patients (CR = 26, AR = 27) were reviewed at the final 6-month follow-up. Within-group analyses showed that both groups significantly improved in all PROMs (p < 0.05). No significant differences were observed between groups for satisfaction, GRC scores, knee extensor torque, knee flexor torque, limb symmetry indices, re-injuries or complications at 6 months.</p><p><strong>Conclusions: </strong>This RCT has highlighted the safety and efficacy of a post-operative rehabilitation pathway that includes weight-bearing as tolerated, without bracing, in patients after proximal hamstring tendon repair.</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":"145025185","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":"Systematic video analysis of ankle sprain injuries in elite male football (soccer): Injury mechanisms, situational patterns, biomechanics and neurocognitive errors study: A study on 140 consecutive players.","authors":"Matthew Buckthorpe, Evert Verhagen, Pieter D'Hooghe, Leonardo Osti, Stefano Di Paolo, Francesco Della Villa","doi":"10.1002/ksa.70049","DOIUrl":"https://doi.org/10.1002/ksa.70049","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.</p><p><strong>Methods: </strong>There were 166 consecutive ankle sprain injuries identified occurring during official matches in players of top European football leagues. One hundred and forty (84%) injury videos were analysed for mechanism and situational pattern, with biomechanics on 20 players. Neurocognitive errors were investigated for all noncontact injuries. Three independent reviewers evaluated each video. Ankle sprain injury epidemiology-month, timing within the match and pitch location at the time of injury and time-loss according to sprain type was also documented.</p><p><strong>Results: </strong>More injuries occurred in offensive (n = 89, 64%) than defensive (n = 51, 36%) situations (p < 0.001). Seventy (50%) direct contact, 42 (30%) indirect contact and 28 (20%) noncontact injuries were categorised. There were 67 (48%) inversion, 30 (21%) high ankle, 25 (17%) eversion, 6 with combination of high ankle and eversion (4%) and 12 (9%) unsure injuries. Four main situational patterns were described: (i) being tackled (n = 59, 42%); (ii) tackling/pressing (n = 34, 24%); (iii) landing from a jump (n = 16, 11%) and (iv) sliding (n = 7, 5%). Inversion injuries were associated with internal rotation, while high ankle injuries typically involved toe contact with the ground, slight plantar flexion and foot eversion. A neurocognitive error was documented 59% of noncontact injuries. A similar number of injuries occurred during the 1st (n = 71, 51%) and 2nd (n = 69, 49%) half (p > 0.05).</p><p><strong>Discussion: </strong>Half of ankle sprain injuries occurred after direct contact, 3 in 10 after indirect contact and only 2 in 10 without contact. Injury prevention practices should consider mechanical perturbation, playing situation and neurocognitive factors when designing programmes.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025207","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":"Similar graft failure rates in low-activity patients (Tegner activity scale ≤ 4) undergoing anterior cruciate ligament reconstruction with or without lateral extra-articular augmentation.","authors":"Ali Alayane, Mohamad K Moussa, Maher Ghandour, Mohamad Ayari, Alain Meyer, Olivier Grimaud, Frédéric Khiami, Nicolas Lefèvre, Yoann Bohu, Alexandre Hardy","doi":"10.1002/ksa.70031","DOIUrl":"https://doi.org/10.1002/ksa.70031","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the outcomes of isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR + lateral extra-articular procedures (LEAPs) at mid-term follow-up in a low activity population based on the Tegner activity scale (TAS ≤ 4).</p><p><strong>Methods: </strong>This was a retrospective analysis comparing patients with a pre-injury TAS ≤ 4 who underwent primary isolated ACLR versus ACLR + LEAPs between 2012 and 2022. Propensity score matching based on age, sex, and presence of meniscal injury was used to establish two groups: ACLR alone and ACLR with LEAP. The primary outcome was the graft failure rate, compared between both groups as diagnosed by clinical instability and radiological rupture of the graft. No formal a priori sample size calculation was performed. Secondary outcomes included return to sport (RTS) metrics and Lysholm score, TAS, International Knee Documentation Committee (IKDC) score, ACL return to sport after injury scale (ACL-RSI) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at the final follow-up for each patient.</p><p><strong>Results: </strong>In the ACLR group, 170 patients were included, while in the ACLR + LEAPs group, 112 patients met the inclusion criteria. The mean age of patients was 30.9 years (standard deviation [SD] = 10.8) for ACLR and 27.8 years (SD = 10.5) for ACLR + LEAP, with similar demographics and injury characteristics across both groups (p > 0.05). The mean follow-up period was 42.74 (34.28) months for the ACLR group and 34.98 (29.32) months for the ACLR + LEAP group. Graft failure rates were similar between groups: 4.2% (6/140) in ACLR versus 5.3% (5/93) in ACLR + LEAP (p > 0.05). No significant differences were observed in post-operative IKDC scores (ACLR: 73.9 ± 24.5 vs. LEAP: 75.4 ± 22.7), Lysholm scores (86.5 ± 15.1 vs. 88.6 ± 11.0), ACL-RSI scores (55.0 ± 33.4 vs. 58.3 ± 32.9) or KOOS subscales: Pain (88.5 ± 15.2 vs. 90.3 ± 9.1), Symptoms (83.1 ± 17.4 vs. 80.8 ± 15.2), ADL (92.7 ± 13.9 vs. 94.5 ± 8.2), Sport (76.4 ± 25.5 vs. 75.0 ± 22.8) and QoL (72.2 ± 27.4 vs. 72.1 ± 24.6). However, the ACLR + LEAP group showed a greater improvement in activity level, with TAS increasing from 2.8 ± 1.3 to 5.2 ± 2.0, compared to 3.0 ± 1.2 to 4.4 ± 1.9 in the ACLR group (p = 0.004). RTS was achieved by 74.2% of ACLR patients and 77.4% of ACLR + LEAP patients (p > 0.05), with 5.8% vs. 12.6% returning to a higher level than preinjury, respectively.</p><p><strong>Conclusion: </strong>Patients with a low TAS ≤ 4 who underwent isolated ACLR have a similar graft failure rate compared to those who underwent ACLR + LEAPs. This finding should be interpreted with caution, as the study was underpowered. Furthermore, the ACLR + LEAP group achieved a statistically significant, though modest, improvement in post-operative activity level.</p><p><strong>Level of evidence: </strong>Level III, cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025161","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}