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

{"title":"Higher prearthritic activity is associated with higher long-term activity after medial unicompartmental knee arthroplasty.","authors":"Tosca Cerasoli, Beatrice Tabanelli, Daniele Scagnol, Laura Di Maio, Maria Pia Neri, Vito Gaetano Rinaldi, Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli","doi":"10.1002/ksa.70624","DOIUrl":"https://doi.org/10.1002/ksa.70624","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate long-term sport participation after medial unicompartmental knee arthroplasty and determine whether recalled prearthritic activity was associated with activity at final follow-up.</p><p><strong>Methods: </strong>This retrospective study included 76 knees in 70 patients evaluated at a mean follow-up of 116.3 ± 31.9 months. The Tegner Activity Scale was recorded for the retrospectively recalled prearthritic period, immediately before surgery, and final follow-up. Final Tegner score was the primary outcome. Return to sport was assessed among the 54 knees with prearthritic sport participation. Multivariable linear regression used patient-clustered standard errors, and a sensitivity analysis excluded seven revised knees. No a priori sample-size calculation was performed.</p><p><strong>Results: </strong>Of 54 previously sport-active knees, 53 returned to at least one sport (98.1%). Across all 76 knees, 61 (80.3%) participated in sport and six (7.9%) reported vigorous activity at final follow-up. Mean Tegner score decreased from 4.00 ± 1.03 prearthritically to 2.3 ± 1.5 preoperatively (p < 0.001) and increased to 3.88 ± 0.78 at final follow-up (p < 0.001 vs. preoperative; p = 0.227 vs. prearthritic). Prearthritic Tegner score was associated with final Tegner score (regression coefficient, 0.531; 95% confidence interval, 0.242-0.821; p < 0.001), and the association persisted after excluding revised knees (regression coefficient, 0.519; 95% confidence interval, 0.224-0.814; p < 0.001).</p><p><strong>Conclusion: </strong>Sport participation was high at nearly 10 years after medial unicompartmental knee arthroplasty, although vigorous activity was uncommon. Higher prearthritic activity was associated with higher final activity, but retrospective recall and substantial attrition limit causal and prognostic interpretation.</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":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009740","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":"Beyond graft integrity: Magnetic resonance imaging should define the revision roadmap in failed anterior cruciate ligament reconstruction.","authors":"Isabella Andrea Bolaños Bermúdez, Dayana Marcela Ariza Echavarría, Alejandra Duarte Vallejo, Hernán Darío Páez Rueda","doi":"10.1002/ksa.70602","DOIUrl":"https://doi.org/10.1002/ksa.70602","url":null,"abstract":"","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":"149009751","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":"Static Coronal Plane Alignment of the Knee phenotypes are associated with distinct dynamic knee kinematics in advanced knee osteoarthritis.","authors":"Dongdong Tian, Haibo Wang, Zhenxian Chen, Jing Zhang, Shuxin Yao, Weijie Zhang, Jianbing Ma","doi":"10.1002/ksa.70603","DOIUrl":"https://doi.org/10.1002/ksa.70603","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine whether Coronal Plane Alignment of the Knee (CPAK) phenotypes were associated with distinct rotational and translational knee kinematics during preoperative treadmill walking in patients with advanced knee osteoarthritis (KOA) awaiting total knee arthroplasty.</p><p><strong>Methods: </strong>Bilateral knee data were collected from 160 patients; 292 of 320 knees with Kellgren-Lawrence Grade III-IV osteoarthritis were included after radiographic screening and classified using full-length standing radiographs. During treadmill walking, flexion-extension, internal-external rotation, adduction-abduction, and anteroposterior, proximal-distal and mediolateral excursions were recorded with the Opti_Knee system. Maximum and minimum rotational angles and translational excursions, rotational range of motion (ROM), translational excursion, gait speed, step length and cadence were assessed. Common phenotypes were compared; rarer phenotypes were described.</p><p><strong>Results: </strong>Mean age was 65.0 ± 6.9 years, and 108 patients (67.5%) were women. Phenotype distribution was Type I, 110 (37.7%); Type II, 32 (11.0%); Type III, 14 (4.8%); Type IV, 77 (26.4%); Type V, 35 (12.0%); Type VI, 12 (4.1%); Type VII, 6 (2.1%); Type VIII, 4 (1.4%) and Type IX, 2 (0.7%). Type V, with neutral arithmetic hip-knee-ankle angle and neutral joint line obliquity, showed greater flexion-extension ROM than Types I and II, smaller anteroposterior and mediolateral excursions than Types I, II and IV, and greater proximal-distal excursion than Type IV. Type I had a higher minimum flexion-extension angle than Types IV and V; Type II showed greater maximum anteroposterior excursion than Types I, IV and V; Type IV had less extension restriction than Type I but greater anteroposterior and mediolateral excursions than Type V. Rare phenotypes were heterogeneous.</p><p><strong>Conclusion: </strong>Static CPAK phenotypes were associated with distinct dynamic knee kinematics in patients with advanced KOA. Preoperative gait assessment may complement static CPAK classification by providing phenotype-specific dynamic kinematic information before total knee arthroplasty.</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":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009388","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":"Isolated lateral compartment cartilage changes on preoperative magnetic resonance imaging should not automatically preclude medial unicompartmental knee arthroplasty: A cohort study of 100 magnetic resonance imaging scans.","authors":"Kristine Ifigenia Bunyoz, Anders Troelsen, William Jackson, Nicholas Bottomley, Abtin Alvand, Andrew Price","doi":"10.1002/ksa.70629","DOIUrl":"https://doi.org/10.1002/ksa.70629","url":null,"abstract":"<p><strong>Purpose: </strong>Magnetic resonance imaging (MRI) frequently detects lateral compartment abnormalities in patients considered for medial unicompartmental knee replacement (UKR). The long-term prognostic significance of these findings remains unclear and may influence patient selection. The purpose of this study was to investigate whether lateral compartment cartilage changes identified on preoperative MRI are associated with an increased risk of revision following medial UKR.</p><p><strong>Methods: </strong>This retrospective cohort study included 100 knees undergoing medial UKR between 2006 and 2013 with available preoperative MRI. Lateral compartment cartilage changes on MRI were assessed using a predefined scoring system. The primary outcome was revision for any cause. Competing risk analysis using the Fine-Grey method was applied to estimate cumulative revision risk, accounting for death as a competing event.</p><p><strong>Results: </strong>Mean follow-up was 9.6 years (standard deviation [SD 4.8]). Lateral compartment cartilage changes were observed in 34 cases, including both partial- and full-thickness cartilage loss. During follow-up, six revisions occurred, with progression of lateral osteoarthritis accounting for 50% of cases. At 10 years, the cumulative incidence of revision was 9.1% (95% confidence interval [CI] 1.5-16.8) in patients without and 3.0% (95% CI 0-8.9) in patients with lateral compartment changes on preoperative MRI. No statistically significant association was detected between lateral cartilage changes on preoperative MRI and revision risk (sHR 0.40, 95% CI 0.05-3.42; p = 0.40).</p><p><strong>Conclusions: </strong>No statistically significant association was detected between lateral compartment cartilage changes on preoperative MRI and revision risk following medial UKR. When radiographic and intraoperative findings are consistent with established indications, isolated lateral MRI abnormalities should not automatically preclude consideration of medial UKR.</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":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009702","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":"Beyond clinical grading: rethinking arthrogenic muscle inhibition after anterior cruciate ligament reconstruction.","authors":"Xia Qu, Xinxiang Tang, Dujiang Yang, Bo Chen","doi":"10.1002/ksa.70612","DOIUrl":"https://doi.org/10.1002/ksa.70612","url":null,"abstract":"<p><p>Arthrogenic muscle inhibition (AMI) remains a clinically important barrier to recovery after anterior cruciate ligament reconstruction. In their recent retrospective study, Morel et al. identified early preoperative and postoperative correlates of AMI using the clinical SANTI classification. We agree that this classification is practical and reproducible for routine assessment, but we caution against conflating clinical grading with mechanistic phenotyping. In the early phase after anterior cruciate ligament reconstruction, the SANTI classification can help clinicians screen and monitor quadriceps activation failure and extension deficit, yet mechanistic inference requires complementary measures of voluntary activation, such as interpolated twitch techniques or central activation ratio assessment, and, in research settings, corticospinal evaluation with transcranial magnetic stimulation. We also believe that the reported lack of association between pain and AMI should be interpreted cautiously because isolated pain ratings may not capture task-related pain, joint irritability, or guarding during movement. Early management should therefore integrate pain and effusion control, restoration of extension, quadriceps activation, and movement quality rather than address these as separate domains. Clinical grading is valuable for early care, but it should remain distinct from mechanistic explanation. LEVEL OF EVIDENCE: N/A.</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":"149009730","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 right measure for the right question: A framework for domain-matched patient-reported outcome measure selection in knee arthroplasty research.","authors":"Lorenz Pichler, Moses K D El Kayali, Rüdiger von Eisenhart-Rothe, Sébastien Lustig, Reha Tandogan, Stefano Campi, Joan Leal-Blanquet, Markus P Arnold, Andrew J Price, Michael T Hirschmann, Joost A Burger","doi":"10.1002/ksa.70620","DOIUrl":"https://doi.org/10.1002/ksa.70620","url":null,"abstract":"<p><p>Patient-reported outcome measures (PROMs) are one of the primary tools for evaluating outcomes in knee arthroplasty research. Yet, they are frequently selected by convention rather than scientific rationale. The available instruments differ substantially in their measurement domains, spanning joint-specific symptoms and perception, physical function and activities of daily living, sport-specific and high-demand function, health-related quality of life, and patient satisfaction and expectation. When the domain of the chosen PROM does not correspond to the domain addressed by the research question, clinically meaningful differences may go undetected, producing false-negative results. This problem is further compounded by floor and ceiling effects that vary between instruments and follow-up timepoints, and by minimal clinically important difference thresholds that are PROM-specific, population-specific, and may be set unrealistically high for comparative studies between two effective surgical interventions. This editorial proposes a domain-matched approach to PROM selection in knee arthroplasty research and presents a practical framework assigning a first-choice instrument, acceptable alternatives, and supplementary measures to five clinical research domains: mechanical aspects of surgery, treatment selection and operative indication, early postoperative recovery, revision arthroplasty outcomes, and long-term outcomes in standard and high-demand patients.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993644","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":"Improving anterior cruciate ligament reconstruction outcomes using a unified return-to-sport communication framework.","authors":"Tolgahan Korkmaz, Yener Ince","doi":"10.1002/ksa.70619","DOIUrl":"https://doi.org/10.1002/ksa.70619","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993654","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":"Peroneus longus tendon autograft for anterior cruciate ligament reconstruction: Current evidence, donor-site complications and patient selection.","authors":"Ahmet Emin Okutan, Nicolaas Budhiparama, Mirco Herbort, Özkan Köse, Wolf Petersen, Guido Wierer, Tunay Erden, Elmar Herbst, Thomas Tischer, Michael T Hirschmann, Romain Seil, Ahmet Uğur Turhan, Mahmut Enes Kayaalp","doi":"10.1002/ksa.70616","DOIUrl":"https://doi.org/10.1002/ksa.70616","url":null,"abstract":"<p><p>The search for the ideal autograft for anterior cruciate ligament (ACL) reconstruction (ACLR) remains a longstanding challenge in orthopaedic surgery, as each available graft possesses distinct advantages and inherent limitations. The peroneus longus tendon (PLT) has emerged as an alternative autograft, expanding graft options without further compromising the injured knee. Initially regarded with caution because of concerns regarding its role in foot and ankle biomechanics, the PLT has evolved into an increasingly recognised alternative autograft option supported by a growing body of anatomical, biomechanical and clinical evidence. The accumulating evidence suggests that the PLT provides reliable graft characteristics, while available comparative studies report broadly similar short- to mid-term clinical outcomes to established autografts and generally favourable donor-site function. However, the predominantly retrospective and heterogeneous evidence base does not establish graft equivalence or noninferiority. Although important questions remain, particularly regarding sport-specific ankle performance in high-demand athletes, long-term donor-site consequences and optimal harvest techniques, the available evidence supports consideration of the PLT as an additional autograft option for ACLR. Rather than establishing graft superiority, this editorial synthesises the current evidence, highlights the strengths and limitations of the PLT, and provides a practical framework for individualised ACL graft selection.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993645","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":"Comparable functional outcomes after total hip arthroplasty in patients with and without prior ipsilateral hip arthroscopy: A comparative cohort study.","authors":"Jan Krautter, Sven Feil, Fritz Thorey","doi":"10.1002/ksa.70590","DOIUrl":"https://doi.org/10.1002/ksa.70590","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether prior ipsilateral hip arthroscopy (HA) influences the functional outcome of subsequent total hip arthroplasty (THA) in patients with a conversion time of more than 6 months, compared with primary THA.</p><p><strong>Methods: </strong>In this retrospective cohort study, patients were categorised into two groups, those with prior HA to THA (HA-THA) and those with primary THA (THA). The primary outcome measure was the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes comprised complication rate, revision rates and patient-reported outcome measures (PROMs) including Harris Hip Score (HHS), Oxford Hip Score (OHS) and Visual Analogue Scale.</p><p><strong>Results: </strong>A total of 546 patients (HA-THA: n = 89; THA: n = 457) with a mean age of 67.0 ± 13.3 years (54% male) and mean follow-up of 52.6 ± 28.1 months were included. Both groups demonstrated a significant improvement from pre- to post-operatively in all HOOS subscales with a significantly higher mean improvement in THA (p < 0.001). Postoperatively, HOOS subscales showed no significant differences between groups except quality of life (HA-THA: 75.7 ± 24.0; THA: 82.9 ± 18.2; p = 0.009). Three patients in HA-THA (3.4%) required a revision surgery. Higher BMI was associated with worse functional outcome in THA group.</p><p><strong>Conclusion: </strong>Prior ipsilateral HA was not associated with inferior PROMs after THA compared with primary THA. Patients undergoing THA after previous HA can therefore be counselled that a prior HA is unlikely to compromise the functional result of subsequent arthroplasty, but the timing of conversion may be relevant to complication and revision rates.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993663","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":"Preserved anterolateral ligament graft continuity on MRI and lower knee laxity after ACL graft failure than before index combined ACL-ALL reconstruction: A retrospective case series.","authors":"Renata Vidal Leão, Debora Mayumi Takamune, Andre Giardino Moreira da Silva, Gabriela Ribeiro Camerin, Diego Ariel de Lima, Camilo Partezani Helito","doi":"10.1002/ksa.70618","DOIUrl":"https://doi.org/10.1002/ksa.70618","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate magnetic resonance imaging (MRI)-based continuity and signal characteristics of reconstructed anterolateral ligament (ALL) grafts and compare anteroposterior and rotational knee laxity after anterior cruciate ligament (ACL) graft failure with values recorded before the index combined ACL-ALL reconstruction.</p><p><strong>Methods: </strong>This retrospective case series included 15 patients who experienced ACL graft failure after combined ACL-ALL reconstruction; the index combined procedure was primary in 12 patients and a revision in 3. MRI was reviewed to assess ALL graft continuity, intrinsic signal changes and periligamentous edema. Side-to-side anterior tibial translation (ATT) measured with the KT-1000 arthrometer and pivot-shift grade were compared between the preindex reconstruction assessment and the assessment after ACL graft failure using Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>ACL graft failure occurred at a mean of 22 ± 1.5 months (range, 18-24 months) after the index reconstruction. The ALL graft showed preserved continuity on MRI in all 15 patients (100%), and mild signal changes were observed in 9 (60%). Median ATT was lower after ACL graft failure than before the index reconstruction (5 vs. 7 mm; median paired reduction, 2 mm [IQR, 1-3]; p = 0.001). Median pivot-shift grade was also lower (1 vs. 2; median paired reduction, 1 grade [IQR, 1-1.5]; p = 0.001). ATT and pivot-shift grade improved in 12 of 15 patients (80%), and no patient demonstrated a high-grade pivot shift after ACL graft failure.</p><p><strong>Conclusion: </strong>Following ACL graft failure after combined ACL-ALL reconstruction, MRI showed preserved ALL graft continuity in all cases, and knee laxity was lower than before the index reconstruction. In this setting, physical examination findings should be interpreted cautiously because anteroposterior and rotational laxity may be lower than expected. The retrospective design and small, heterogeneous sample preclude causal attribution to the ALL graft and any conclusion that anterolateral revision can be omitted.</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":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993647","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}