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

{"title":"Reduced spinopelvic mobility does not correlate with knee flexion deformity in patients undergoing total knee arthroplasty.","authors":"Lorenz Pichler, Rauf Alizada, Lea M S Cordes, Kerem Basarir, Asim Kayaalp, Reha Tandogan","doi":"10.1002/ksa.70047","DOIUrl":"https://doi.org/10.1002/ksa.70047","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the impact of reduced spinopelvic mobility (SM) on knee flexion deformity (KFD) in patients undergoing total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A retrospective analysis on 213 patients (271 knees) undergoing robotic-assisted primary TKA was conducted. Sagittal spinopelvic alignment (SSA) parameters-sacral slope (SS), pelvic incidence (PI), and pelvic tilt (PT)-were measured on lateral standing and sitting spinopelvic radiographs. Patients were stratified according to established SM classifications: standing-sitting difference in SS ≥ 10° versus < 10°, PT ≥ 20° versus < 20°, and Dorr's classification (DC). KFD was assessed intraoperatively using a robotic-assisted surgical platform after placement of arrays: first in the native state (KFDb), and again after osteophyte removal and maximum manual correction (KFDa). Correlations between standing-sitting changes in SSAs and KFDb/KFDa, as well as differences in mean KFDb/KFDa between SM groups, were analysed.</p><p><strong>Results: </strong>The mean differences between standing and sitting was 11.3° (SD 9.1) for SS and 6.9° (SD 9.8) for PT. Based on SM classifications, 129 knees (48%) showed a SS difference < 10°, 30 knees (11%) a PT difference ≥ 20°, and DC categorised 131 (48%) as normal, 64 (24%) as stuck standing, 74 (27%) as stuck sitting, and 1% as kyphotic. The mean KFDb and KFDa were 5° (SD 6) and 2° (SD 2), respectively. No significant correlations were found between standing-sitting changes in SSAs and KFDb or KFDa (correlation coefficients < 0.1 for all). No significant differences in mean KFDb or KFDa were observed across SM classification groups (p > 0.2 for all).</p><p><strong>Conclusion: </strong>Spinopelvic mobility does not correlate with intraoperative knee flexion deformity in patients undergoing TKA suggesting that the increased knee flexion found among these patients is a dynamic rather than a permanent compensatory mechanism.</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":"145025132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open versus arthroscopic anterior latissimus dorsi transfer for irreparable subscapularis tear: a multicentre cohort study.","authors":"Bo Taek Kim, Jean Kany, Luis Alfredo Miranda, Jung Gon Kim, Chaemoon Lim, Seung Jin Kim, Chang Hee Baek","doi":"10.1002/ksa.70021","DOIUrl":"https://doi.org/10.1002/ksa.70021","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare clinical outcomes between open and arthroscopic anterior latissimus dorsi (LD) transfer techniques for treating irreparable subscapularis (SSC) tears.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent open or arthroscopic anterior LD transfer for irreparable SSC tears between February 2014 and August 2020. Patients were included if they had irreparable SSC tears with Lafosse Grade 4 or higher and Goutallier Grade 3 or higher, but without advanced arthritis (Hamada Grade < 3). Clinical assessments involved pain scores (visual analogue scale, VAS), patient-reported scores (Constant score and subjective shoulder value [SSV]), range of motion (ROM) and internal rotation (IR) strength. Any complications, integrity of the transferred tendon and progression of glenohumeral arthritis were evaluated. Patients were excluded from the study if they lacked follow-up data or were lost to follow-up.</p><p><strong>Results: </strong>After excluding 28 patients, a total of 86 patients were included (34 arthroscopic and 52 open technique). The mean age was 63.5 ± 7.1 years, and the mean follow-up was 36.2 ± 14.9 months. Significant improvements were observed in pain (VAS from 7.2 ± 1.2 to 1.1 ± 1.5, p < 0.001), Constant score (from 29.1 ± 8.8 to 69.0 ± 12.6, p < 0.001) and SSV (from 24.3 ± 9.6 to 65.5 ± 15.7, p < 0.001). Shoulder ROM and IR strength also improved significantly. Both techniques showed comparable clinical outcomes, although the open technique group demonstrated greater gains in IR strength (p = 0.015). Complications included retear in 8.1% of patients and infection in 7%, with no significant differences between the two techniques.</p><p><strong>Conclusion: </strong>Both open and arthroscopic anterior LD transfer techniques effectively reduce pain, improve shoulder function and enhance IR strength in patients with irreparable SSC tears, with comparable clinical outcomes and minimal complications.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</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":"145025215","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":"Generalised joint hypermobility and excess knee hyperextension are associated with an increased risk for second ACL injury, but not primary ACL injury, in female football players: A 5-year follow-up.","authors":"Anne Fältström, Joanna Kvist, Martin Hägglund","doi":"10.1002/ksa.70011","DOIUrl":"https://doi.org/10.1002/ksa.70011","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the association between generalised joint hypermobility, knee hyperextension, knee laxity, and static standing alignment with the risk of anterior cruciate ligament (ACL) injury in a cohort of female football players with an ACL-reconstructed (ACLR) knee and in knee-healthy controls.</p><p><strong>Methods: </strong>We prospectively followed 117 female football players with ACLR (age, mean ± standard deviation, 20 ± 2 years; average 19 ± 9 months after ACLR) and 119 knee-healthy players (age, 19 ± 3 years) for 5 years. At baseline, all players were assessed for generalised joint hypermobility (Beighton score), knee extension range of motion, knee laxity (KT-1000, Lachman and pivot shift tests), and static standing alignment (visual assessment graded as varus, valgus or neutral). Log-binomial regression with risk ratios (RRs) and 95% confidence intervals (CIs) for new ACL injury were calculated. Point biserial and Spearman's rank correlations were used for correlation analysis of baseline anatomical variables.</p><p><strong>Results: </strong>During the 5-year follow-up, 43 ACLR players sustained a second ACL injury (30 re-ruptures and 13 contralateral ruptures) and 11 knee-healthy players had an index ACL injury. ACLR players with Beighton score ≥5 (RR, 1.67; 95% CI, 1.04-2.70; p = 0.035) and knee hyperextension >5° in the non-ACL-reconstructed knee (RR, 1.67; 95% CI, 1.02-2.73; p = 0.042) had higher risk of a second ACL injury; knee laxity and static standing alignment were not associated with a second ACL injury (n.s.). No significant associations were seen between baseline variables and index ACL injury in knee-healthy players (n.s.). There was moderate correlation between KT-1000 and the Lachman test (r = 0.594-0.673), and negligible to moderate correlations between other baseline variables.</p><p><strong>Conclusions: </strong>Generalised joint hypermobility and knee hyperextension were associated with an increased risk of second ACL injury in female football players with ACLR. Screening for generalised joint hypermobility and knee hyperextension may inform prevention strategies for female football players after ACL injury.</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":"145025148","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 survival, higher surgical complexity, but no difference in physical functioning and pain in total knee arthroplasty following osteotomy versus primary total knee arthroplasty without osteotomy: Analysis of 189,932 procedures of the Dutch Arthroplasty Register.","authors":"Maarten R Huizinga, Astrid J de Vries, Liza N van Steenbergen, Reinoud W Brouwer","doi":"10.1002/ksa.70013","DOIUrl":"https://doi.org/10.1002/ksa.70013","url":null,"abstract":"<p><strong>Purpose: </strong>Total knee arthroplasty (TKA) following an osteotomy around the knee might be technically more challenging and yield inferior outcome compared with primary TKA. The aim of this study was to investigate the survival, use of revision components and clinical outcome of TKAs postosteotomy compared with primary TKAs.</p><p><strong>Methods: </strong>Patients from the Dutch Arthroplasty Register who underwent TKA after osteotomy or primary TKA with osteoarthritis as primary diagnosis from 2007 to 2022 and aged ≥18 years at the time of the procedure were selected. Kaplan-Meier and multivariable Cox proportional hazards regression analyses were used to estimate the survival and hazard ratio (HR) for revision. The use of TKA revision components was analysed and used as stratification factor. Patient-reported outcome measures (PROMs) (Numeric Rating Scale for pain at rest and during activity, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form and Oxford knee score) were assessed preoperatively and 6 and 12 months postoperatively.</p><p><strong>Results: </strong>A significantly higher survival of the TKA until 15-year follow-up was found in primary TKAs, with a median survival of 4.1 years (interquartile range 5.0) compared to TKAs following osteotomy. The proportion of TKA revision components was higher after a previous osteotomy (2.5 vs. 0.5%; p < 0.001). A higher TKA revision risk was found in the primary component group after a previous osteotomy compared to primary TKAs (HR: 1.2, 95% confidence interval: 1.14-1.35). The use of revision components increased the risk for a TKA revision in both groups. No differences in PROMs between groups were found.</p><p><strong>Conclusion: </strong>This study showed that a previous osteotomy is associated with decreased implant survival in subsequent TKAs, especially if a TKA component with stems and/or augmentations was used.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025211","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":"Robotic arm-assisted total knee arthroplasty reduces postoperative inflammatory response and blood loss compared to manual total knee arthroplasty: A matched-pairs analysis of 688 patients.","authors":"Dirk Müller, Igor Lazic, Benjamin Schloßmacher, Vincent Lallinger, Michael T Hirschmann, Rüdiger von Eisenhart-Rothe, Florian Pohlig","doi":"10.1002/ksa.70054","DOIUrl":"https://doi.org/10.1002/ksa.70054","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic arm-assisted total knee arthroplasty (raTKA) has demonstrated several advantages over manual TKA (mTKA), including enhanced early recovery. Reduced soft tissue trauma and avoidance of femoral intramedullary canal opening have been hypothesised to lower the systemic inflammatory response. However, findings from previous small-cohort studies have been inconsistent. This study aimed to evaluate postoperative systemic inflammation in a large patient cohort.</p><p><strong>Methods: </strong>Patients who underwent raTKA using the Mako® system were matched with patients who received mTKA based on gender, American Society of Anesthesiologists score, age and body mass index. This matching process resulted in two comparable cohorts, each comprising 344 patients. Blood samples were collected preoperatively, 6 h postoperatively, and on postoperative Days 3 and 5. Measurements included C-reactive protein (CRP), white blood cell count (WBC) and calculated blood loss.</p><p><strong>Results: </strong>The highest CRP levels were observed on postoperative Day 3 in both groups. The median CRP increase was significantly lower in the raTKA group compared with the mTKA group on Day 3 (4.4 vs. 5.3 mg/dL; p = 0.002) and slightly lower on Day 5 (3.5 vs. 3.8 mg/dL; p = 0.349). The WBC count peaked at 6 h postoperatively in both groups before steadily declining, with no significant difference between groups. The median operation time was significantly longer in the raTKA group (92 vs. 86 min; p < 0.001). Despite a longer surgical duration, the median blood loss was significantly lower in the raTKA group (653 vs. 729 mL; p = 0.005).</p><p><strong>Conclusion: </strong>In the largest comparative analysis to date, raTKA was linked to significantly lower postoperative CRP levels than mTKA. Reduced soft tissue trauma, avoidance of femoral intramedullary canal violation and significantly lower blood loss may all contribute to a diminished systemic inflammatory response, potentially explaining the improved early functional outcomes observed with raTKA.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025140","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":"Prospective randomised controlled trial comparing PLLA and PLDLA/HA/β-TCP interference screws in anterior cruciate ligament reconstruction: CT scans, MRI and clinical outcomes.","authors":"Christian Coppola, Raul Mayr, Rene El Attal, Vinzenz Smekal, Gerald Degenhart, Christof Kranewitter, Josef Fritz, Christian Koidl","doi":"10.1002/ksa.70024","DOIUrl":"https://doi.org/10.1002/ksa.70024","url":null,"abstract":"<p><strong>Purpose: </strong>Modifying interference screw composition may ensure better osteoconductive properties in order to reduce tunnel enlargement after anterior cruciate ligament (ACL) reconstruction. The primary and secondary purposes were to evaluate tunnel and screw volume changes in poly-L-lactide acid (PLLA) and poly-D-lactic acid + hydroxyapatite + β-tricalcium phosphate (PLDLA+) screws. The tertiary purpose was to compare patient reported- and functional outcomes between PLLA and PLDLA+ group. It was hypothesised that PLLA group would show more tunnel enlargement and a lower rate of resorption than PLDLA+ group with similar clinical results.</p><p><strong>Methods: </strong>Patients were treated with ACL reconstruction using hamstring autograft with femoral and tibial interference screw fixation (PLLA or PLDLA+). Tunnel volume changes were assessed after 0, 24 and 36 months on computed tomography (CT) scans. Screw volume changes were analysed after 0, 3, 6, 12, 24 and 36 months on magnetic resonance imaging (MRI). Patient reported outcome scores (PROMS) and knee laxity were analysed after 12 and 36 months. Data were evaluated using analysis of variance (ANOVA) with Bonferroni correction. Significance was set at <0.05.</p><p><strong>Results: </strong>Femoral/tibial tunnel volume enlarged 10.7 ± 46.6%/3.8 ± 14.4% (PLLA, n = 9) and 2.6 ± 30.8%/19.0 ± 20.5% (PLDLA +, n = 13) after 36 months on CT scans (p = 0.063/p = 0.070). Using MRI scans, femoral/tibial screw volume decreased -53.8 ± 6.9%/-48.8 ± 9% (PLLA) and -88.2 ± 8.9%/-80.6 ± 3.4% (PLDLA+) (p ≤ 0.001/p ≤ 0.001). No difference was found between the two groups (PLLA, n = 17; PLDLA+, n = 19) in PROMS and knee laxity (n.s. and/or minimal clinically important difference (MCID) not reached).</p><p><strong>Conclusions: </strong>Tunnel volumes remained slightly enlarged, screw degradation was significantly higher in the PLDLA+ group while clinical outcomes led to good short-term results. Comparable tunnel enlargement for both screws can be expected in revision ACL reconstruction.</p><p><strong>Level of evidence: </strong>Level 1, RCT.</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":"145025183","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":"Periprosthetic joint infection: Time to think outside the box.","authors":"Min-Cong He, Augusto Ferrini, Javad Parvizi","doi":"10.1002/ksa.70056","DOIUrl":"https://doi.org/10.1002/ksa.70056","url":null,"abstract":"<p><p>Despite undisputed success of orthopaedic procedures, surgical site infections (SSI) such as periprosthetic joint infection (PJI) continues to compromise the outcome and result in major clinical and economic burden. The overall rate of infection is expected to rise in the future resulting in significant associated mortality and morbidity. Traditional concepts have largely attributed the source of PJI to exogenous pathogens. However, recent studies indicate that pathogens from the patient's own microbiome, colonizing the skin, nasal passages, gut microbiota, and even the surgical site play a major role in causing SSIs. Immune cell-mediated 'Trojan Horse' pathways have been posited as the mechanism of how bacteria reach and persist at the surgical site. In light of these developing insights, novel therapeutic strategies are under investigation. Some exciting developments include the use of membrane-permeable antibiotics, bacteriophage therapy targeting intracellular pathogens as well as probiotics, prebiotics, or faecal microbiota transplantation. Overall, targeting the endogenous microbiome represents a promising frontier for improving the prevention and management of PJI in the era of rapidly increasing total joint arthroplasty procedures.</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":"145025204","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":"Reducing unintended valgus deformity after supracondylar femoral derotational osteotomy: Influence of derotation amount and osteotomy method based on femoral antecurvature.","authors":"Jisu Park, Hyunkwon Kim, Seonjin Shin, Tae Woo Kim, Moon Jong Chang, Dai-Soon Kwak","doi":"10.1002/ksa.70041","DOIUrl":"https://doi.org/10.1002/ksa.70041","url":null,"abstract":"<p><strong>Purpose: </strong>The purposes of this study were threefold: (1) to evaluate the influence of femoral antecurvature on coronal alignment changes following supracondylar femoral derotational osteotomy (FDO); (2) to investigate the combined effects of derotation angle and osteotomy orientation in relation to femoral antecurvature and (3) to propose a practical strategy for minimising valgus deviation after FDO based sagittal femoral bowing.</p><p><strong>Materials and methods: </strong>Sixty-six cadaveric femoral computed tomography (CT) scans were analysed using three-dimensional (3D) simulation. Femurs were classified into three groups based on the degree of antecurvature using the distal diaphyseal angle (DDA). Virtual surgery was simulated at 7 cm above the joint line using two osteotomy methods (shaft-perpendicular and distal femur condylar line [DFC]-parallel) and two derotation angles (10° and 20°). Mechanical lateral distal femoral angle (mLDFA) was measured before and after simulation. Multivariable and stratified regression analyses were performed.</p><p><strong>Results: </strong>Greater antecurvature led to larger mLDFA decrease, with more pronounced valgus shifts at higher derotation angles. Making DFC-parallel osteotomy significantly reduced valgus change regardless of bowing (β = -0.331, p = 0.005). A significant interaction was found between DDA and derotation angle (β = 0.015, p < 0.001). The combination of DFC-parallel osteotomy with 10° derotation provided the least valgus change (R² = 0.84). The allowable derotation angle to maintain <1° valgus shift decreased as DDA increased.</p><p><strong>Conclusion: </strong>Femoral antecurvature significantly affects coronal alignment after supracondylar FDO. Although the optimal target angle for derotation remains a surgical choice, understanding the relationship between sagittal bowing and coronal alignment can help tailor patient-specific decisions. To minimise valgus shift after supracondylar FDO, aligning the osteotomy plane parallel to the distal femur condylar line can be effective. This method is simple and practical for standard surgical procedures.</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":"145025202","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":"Robot-assisted total knee arthroplasty demonstrates superior radiological but comparable clinical outcomes compared to conventional techniques: A meta-analysis of prospective studies.","authors":"Victor Klincke, Renee Huyghe, Hannes Vermue, Manuel Martens, Jan Victor","doi":"10.1002/ksa.70007","DOIUrl":"https://doi.org/10.1002/ksa.70007","url":null,"abstract":"<p><strong>Purpose: </strong>Robot-assisted total knee arthroplasty (RATKA) aims to improve surgical precision and outcomes. This study compared clinical and radiological outcomes between RATKA and conventional total knee arthroplasty (CTKA).</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines, including prospective studies (Level I/II evidence) from MEDLINE, Embase, Web of Science, and the Cochrane Library, up to 20 May 2025. Clinical outcomes included knee function, pain and quality-of-life scores, assessed at a minimum of one year postoperatively. Complications rates were also collected. Radiological outcomes included assessment of coronal and sagittal limb alignment, joint line restoration, and three-dimensional implant positioning. Risk of bias was assessed using validated tools.</p><p><strong>Results: </strong>Of 11,916 screened citations, 20 studies (11 RCTs, 9 prospective cohort studies) involving 2421 patients (1268 RATKA; 1153 CTKA) were included, with follow-up ranging from 3 months to 2 years and seven different robotic systems evaluated. Meta-analysis showed that RATKA was associated with improved range of motion (mean difference 5.03°; 95%CI [1.78-8.28]; p = 0.004) and WOMAC scores (total, function and pain). No significant differences were found for OKS, KOOS, FJS or EQ-5D. Complication rates were significantly lower in the RATKA group (11.5%) compared to CTKA (16.7%; OR = 0.62; 95%CI [0.45-0.86]; p = 0.004). Radiographically, RATKA significantly improved coronal alignment, joint line restoration, and sagittal tibial positioning, with fewer outliers, compared to conventional TKA. No significant differences were observed in sagittal femoral alignment, posterior tibial slope, or femoral component rotation. Risk of bias was mostly moderate to low, though concerns remained regarding non-blinded assessments, missing data, and potential industry-related conflicts of interest.</p><p><strong>Conclusions: </strong>RATKA demonstrated higher precision, reduced radiological outliers and complications compared to CTKA. While clinical scores slightly favoured RATKA, differences were not clinically meaningful. Long-term studies are needed to determine potential benefits in subgroups like severe deformities.</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":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025127","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":"Knee pain associated with bone-patellar tendon-bone autografts does not limit activity levels, sports participation or quality of life after ACL reconstruction.","authors":"Timothy McAleese, Niamh Keane, Kate Sheridan, Enda King, Kieran A Moran, Mark Jackson, Daniel Withers, Ray Moran, Brian M Devitt","doi":"10.1002/ksa.70008","DOIUrl":"https://doi.org/10.1002/ksa.70008","url":null,"abstract":"<p><strong>Purpose: </strong>Bone-patellar tendon-bone (BPTB) and Hamstring (HT) autografts are commonly used for anterior cruciate ligament reconstruction (ACLR). Concerns exist regarding postoperative anterior knee pain (AKP) and kneeling discomfort with BPTB grafts. However, many studies solely report the presence/absence of anterior knee pain, without assessing its clinical significance in terms of functional limitation or impact on quality of life.</p><p><strong>Methods: </strong>This study prospectively analysed 1407 patients undergoing primary ACLR with BPTB or HT autografts. Knee pain prevalence, severity, and location were measured at 6 months, 1 year, 2 years, and 5 years postoperatively using a pain questionnaire. Patient-reported measures (Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], International Knee Documentation Committee [IKDC] and Marx) and return to play (RTP) rates were also collected to evaluate knee symptoms, function and activity levels. Multivariable regression identified factors associated with knee pain at each time point.</p><p><strong>Results: </strong>The mean age was 24.5  ±  7.1 years, with 74.3% male. BPTB grafts were used in 81% (n = 1145) and HT in 19% (n = 262). At 6 months, the BPTB group reported a higher prevalence of AKP (26% vs. 6%, p < 0.001). There was no difference between graft types at 1 year and 2 years postoperatively. At 5 years, the BPTB group were 1.59 times more likely to report pain, although most pain was mild and there was no significant differences in KOOS, WOMAC, IKDC, Marx scores or RTP rates. Female patients (OR 1.41, p < 0.035) and BPTB grafts (OR 1.78, p < 0.004) were associated with knee pain at 6 months. At 5 years, older age (OR 1.06, p < 0.001), BPTB grafts (OR 1.59, p < 0.027), and medial femoral condyle chondral pathology (OR 1.7, p < 0.020) increased the odds of having pain.</p><p><strong>Conclusion: </strong>BPTB grafts are associated with early AKP, which improves over time. AKP related to BPTB is mild and does not affect activity levels, sports participation or quality of life. Mild AKP should not deter surgeons from using BPTB autografts for ACLR, given the other advantages of this graft choice.</p><p><strong>Level of evidence: </strong>Level II, prospective study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014269","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}