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

{"title":"Treatment effects in orthopaedic trials are underestimated by applying patient-level PRO thresholds for meaningful differences at the group level.","authors":"David F Hamilton, Karlmeinrad Giesinger, Johannes M Giesinger","doi":"10.1002/ksa.12805","DOIUrl":"https://doi.org/10.1002/ksa.12805","url":null,"abstract":"<p><p>Orthopaedic trials frequently rely on patient-reported outcomes (PROs) to measure primary end points. Thresholds for clinically meaningful score differences are then used to interpret PRO scores and support result interpretation. At the patient level, thresholds are used to determine if an individual patient has experienced a clinically meaningful improvement or deterioration, which evaluates whether or not they are a treatment responder. At the group level, thresholds are applied to interpret mean score differences between groups (e.g., trial arms) or between time points and determine if a treatment effect is meaningful. While patient-level thresholds are frequently available for commonly used PROs, interpretation of between-group-level differences is far less established. In the absence of well-defined group-level difference thresholds for PRO scores, patient-level thresholds are frequently used to interpret the difference between groups, such as trial arms. However, meaningful difference thresholds at the patient level are typically larger than relevant differences at the group level. As such, this leads to an underestimation of treatment effects reported in orthopaedic trials.</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":"145014267","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":"Higher precision and preservation of frontal plane alignment in slope-reducing infra-tubercle compared to retro-tubercle high tibial osteotomy.","authors":"Romir Patel, Ahmed Mabrouk, Kristian Kley, Christophe Jacquet, Lucas Abdelkafi, Théo Plassard, Matthieu Ollivier","doi":"10.1002/ksa.70028","DOIUrl":"https://doi.org/10.1002/ksa.70028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Slope-reducing high tibial osteotomies (SR-HTOs) correct posterior tibial slope (PTS) abnormalities in patients with anterior knee instability, as in cases of anterior cruciate ligament (ACL) deficiency. The SR-HTO techniques, including infra-tubercle and retro-tubercle approaches, provide distinct benefits: retro-tubercle techniques help preserve patellofemoral joint mechanics, while infra-tubercle techniques are effective in mitigating iatrogenic varus. However, there is limited comparative literature available. This study compares the PTS correction precision, frontal plane alignment changes, patellar height (PH) alterations and complications between both SR-HTO techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective matched cohort study including 62 patients who underwent SR-HTO with ACL revision surgery between 2020 and 2023 was conducted. Of the 62 patients included, 40 (64.5%) were male and 22 (35.5%) were female. The mean follow-up period was 23.4 ± 7.7 months (range: 12-45 months). The cohort was subdivided into infra-tubercle (n = 29) and retro-tubercle (n = 33) groups. Preoperative and post-operative radiographic assessments included hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), proximal tibial slope (PTS) and PH indices. Functional outcomes were measured using the simple knee value (SKV) score. Complications such as hinge fractures, ACL re-rupture and hardware removal were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both techniques achieved similar mean slope correction with post-operative PTS in infra-tubercle: 9.2 ± 1.1° (range: 5-13.8°) versus retro-tubercle: 9.1 ± 1.3° (range: 5-14°). This has been reduced from a preoperative PTS in the infra-tubercle group of 14.2 ± 1.7° (range: 11.5-17°) versus retro-tubercle group: 14 ± 1.8° (range: 11-17.5°). Infra-tubercle osteotomy showed greater precision to pre-operative plans, with a deviation of 1.2 ± 1.1° (range: 0.0-3.6°) versus 1.8 ± 1.3° (range: 0.0-3.4°) in the retro-tubercle group (p = 0.02). Retro-tubercle SR-HTO induced greater coronal changes compared to infra-tubercle SR-HTO, ΔHKA: 1.4 ± 1.6° (range: 0-5°) versus 0.8 ± 0.8° (range: 0-2.8°) (p = 0.05); ΔMPTA: 1.6 ± 1.6° (range: 0-5.7°) versus 0.9 ± 0.7° (range: 0-2.8°) (p = 0.03). There was no intergroup difference in PH changes using either Caton-Deschamps or Schroter indices (p = 0.2). SKV improvement was greater in the infra-tubercle group compared to the retro-tubercle group, 28.7 ± 10.4 (range: 10.0-55.7) versus 20.7 ± 12.3 (range: -9.2 to 48.4) (p = 0.008). Complications were similar, with no hinge fractures and identical ACL re-rupture rates of 3.4%. Hardware removal was higher in the infra-tubercle group compared to the retro-tubercle group, 24.1% versus 9.1% (p = 0.2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Infra-tubercle SR-HTO demonstrated greater correction accuracy and better preservation of frontal plane alignment and functional outcomes compared to the retro-tubercle t","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002762","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":"Global, regional and national burden of osteoarthritis in women of childbearing age from 1990 to 2021, with projected trends up to 2045.","authors":"Jianye Tan, Yinsong Sun, Jinping Chen, Dehua Wang, Jiacheng Liu, Zhenxin Wang, Pengcheng Xiao, Lu Zhou, Yiting Lei, Wei Huang, Ke Li","doi":"10.1002/ksa.70045","DOIUrl":"https://doi.org/10.1002/ksa.70045","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to systematically quantify the global burden of osteoarthritis (OA) in women of childbearing age (WCBA) and analyze its temporal trends and regional disparities.</p><p><strong>Methods: </strong>This study utilized the Global Burden of Disease 2021 data to assess the incidence and years lived with disability (YLDs) spanning from 1990 to 2021. The Bayesian age-period-cohort (BAPC) model was adopted to forecast trends up to 2045. An analysis was conducted on the disparities across various age subgroups and regions with different socio-demographic index (SDI) levels.</p><p><strong>Results: </strong>In 2021, the global incidence of OA among WCBA stood at 8,222,896 cases. Age-standardized rates for both incidence and YLDs were most elevated in the High-income Asia Pacific, East Asia and High-income North America. That year, the global OA burden within this demographic was predominantly driven by knee and hand OA, with hand OA notably surpassing hip OA to rank second only to knee OA. In Eastern Europe and Central Asia, hand OA even overtook knee OA as the most prevalent type of OA. From 1990 to 2021, hand OA demonstrated the most rapid incidence growth with an estimated annual percentage change of 0.79 (95% confidence intervals: 0.72-0.86), with particularly marked surges in East Asia, High-income Asia Pacific and Southeast Asia. The 45-49 age bracket carried the greatest burden across all types of OA. Projections through 2045 suggest that cases of hand and hip OA will undergo substantial growth, whereas knee OA cases will increase more moderately. Despite a potential minor downturn in its age-standardized incidence and YLD rate, knee OA is poised to remain the primary culprit. Throughout the analysis, striking regional and socioeconomic disparities in the OA burden were readily apparent.</p><p><strong>Conclusion: </strong>This study reveals a growing global burden of OA among WCBA, driven primarily by knee and hand OA. These findings underscore the need to integrate WCBA into OA prevention strategies and musculoskeletal health policies tailored to age, region and joint type.</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":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002744","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":"Posterior femoral condylar morphology following mechanical vs. kinematic alignment using a medial-pivot implant designed for mechanical alignment: A CT-based comparative study.","authors":"Yohei Ohyama, Yukihide Minoda, Sho Masuda, Ryo Sugama, Hideki Ueyama, Hidetomi Terai","doi":"10.1002/ksa.70022","DOIUrl":"https://doi.org/10.1002/ksa.70022","url":null,"abstract":"<p><strong>Purpose: </strong>The kinematic alignment (KA) technique aims to restore native joint anatomy; however, the extent to which it restores posterior femoral condylar morphology after total knee arthroplasty (TKA) remains unclear. The posterior longitudinal overhang in the femoral condyle (PLOF) has been reported to affect clinical outcomes. This study aimed to compare the PLOF after medial pivot TKA performed using KA and mechanical alignment (MA) techniques.</p><p><strong>Methods: </strong>This retrospective computed tomography-based study included 50 knees (from 25 men and 25 women) with medial knee osteoarthritis who underwent unilateral TKA. Femoral component-computer-aided design (FC-CAD) models of a medial-pivot prosthesis originally engineered for MA were positioned on preoperative computed tomography images according to KA and MA protocols. The primary outcomes were medial and lateral PLOF, defined as the sagittal overhang of the FC-CAD model beyond the native bone contour. The extent of distal and posterior femoral resections and correlations among femoral morphological parameters, including femoral valgus, lateral distal femoral, and condylar twist angles, and the PLOF were analysed.</p><p><strong>Results: </strong>The mean medial and lateral PLOF associated with KA was significantly greater (3.8 ± 1.4 vs. 3.2 ± 2.0 mm; p = 0.002) and smaller (3.4 ± 1.6 vs. 4.1 ± 1.9 mm; p < 0.001), respectively, than those associated with MA. Compared with KA, MA decreased valgus alignment and added external rotation. The PLOF associated with KA and femoral morphological parameters was not significantly correlated.</p><p><strong>Conclusions: </strong>The KA resulted in significantly different ( > 3 mm) medial and lateral PLOF compared with the MA. The lack of correlations between the KA-associated PLOF and femoral morphological parameters suggests a native-prosthetic morphological mismatch. Surgeons should consider strategic downsizing when an MA-oriented medial-pivot FC is implanted using KA or employ KA-specific implants to optimise clinical outcomes.</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":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002770","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":"Estimation of the patient acceptable symptom state (PASS) threshold for the Banff Patellofemoral Instability Instrument 2.0.","authors":"Per Arne Skarstein Waaler, Eivind Inderhaug, Thomas Birkenes, Asle Birkeland Kjellsen, Trine Hysing-Dahl","doi":"10.1002/ksa.70061","DOIUrl":"https://doi.org/10.1002/ksa.70061","url":null,"abstract":"<p><strong>Purpose: </strong>There is a paucity of studies reporting patient acceptable symptom state (PASS) thresholds for patient reported outcome measures validated for patellar instability. The aim of this study was to determine the PASS threshold for the Banff Patellofemoral Instability Instrument 2.0 (BPII) following surgery for recurrent patellar instability.</p><p><strong>Methods: </strong>Patients who underwent patellar stabilisation surgery between 2013 and 2022 were included if they were ≥16 years of age and had ≥12 months of follow-up. The participants completed the BPII and a dichotomous PASS anchor question. The PASS threshold was then calculated using both the adjusted predictive modelling method and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Complete data were available for 218 knees of 182 patients, with a median follow-up time of 46 months. The PASS threshold was 62.4 (95% confidence interval [CI]: 58.8-65.9) using the adjusted predictive modelling method, and 66.3 (95% CI: 58.1-80.0) using ROC analysis. Overall, 173 patients (79.4%) reported satisfactory symptom states, while 72.9% and 70.6% achieved the respective PASS thresholds. The adjusted predictive modelling method yielded narrower 95% confidence intervals with minimal threshold variation across different approaches for handling bilateral cases compared to ROC analysis (1.3 vs. 8.1 points).</p><p><strong>Conclusion: </strong>The PASS threshold for BPII after patellar stabilisation surgery was 62.4 (out of 100 points). The adjusted predictive modelling method demonstrated superior precision and robustness in the PASS threshold calculation compared with the ROC analysis. This threshold provides a disease-specific reference for clinical decision making and research in patellofemoral instability.</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":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002764","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":"Scapular dyskinesis is common among asymptomatic European basketball players at the professional level.","authors":"Alp Paksoy, Doruk Akgün, Jonas Pawelke, Larissa Eckl, Arda Mavi, Selda Uzun, Berhan Bayram, Murat Canbakal, Ugur Dilicikik, Murat Erdem, Nihat D Demirkiran, Baris Kocaoglu","doi":"10.1002/ksa.70060","DOIUrl":"https://doi.org/10.1002/ksa.70060","url":null,"abstract":"<p><strong>Purpose: </strong>Scapular dyskinesis (SD) is present in as many as 67%-100% of athletes with shoulder injuries but it is also highly present in many asymptomatic individuals. The aim of the present study was to identify and analyse SD among asymptomatic professional basketball players.</p><p><strong>Methods: </strong>A total of 54 European professional basketball players of various professional levels and ages were included in this prospectively recruited cross-sectional study. Participants were assessed using subjective shoulder value (SSV), visual analogue score (VAS) and active range of motion (ROM). Visual combined palpation was used to classify scapular position and movement patterns according to Kibler's method. The clinical examination was completed by evaluating potential coexisting instability (apprehension test, Kim/Jerk and O'Brien tests) and hyperlaxity (Beighton score).</p><p><strong>Results: </strong>The mean age of all participants (27 female, 27 male; 108 shoulders) was 23.9 ± 6.5 years. 28.7% of the included shoulders had SD (31/108; right: n = 12; left: n = 19), while none of the participants had a diagnosed SD before the present study. Shoulders with SD exhibited a significantly lower SSV (95.0 ± 10.5% vs. 99.0 ± 4.0%; p = 0.004) and reduced abduction (171.8 ± 11.7° vs. 176.6 ± 8.3°, p = 0.013) compared to shoulders without SD. Shoulders with at least one previous injury showed a significantly lower SSV compared to shoulders without previous injury (92.9 ± 12.0% vs. 98.4 ± 5.6%; p = 0.001). Shoulders with pain occurring at least once in last 12 months showed a significantly higher prevalence of SD (6/10 vs. 25/98; p = 0.022) and a lower SSV (90.5 ± 16.4% vs. 98.6 ± 4.4%; p = 0.024) compared to shoulders without pain in last 12 months.</p><p><strong>Conclusion: </strong>SD was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. SD may represent a sport-specific adaptation, but its association with reduced shoulder function and pain suggests clinical relevance, emphasising the need for early detection and intervention.</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":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002721","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":"Correction to \"Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction\".","authors":"","doi":"10.1002/ksa.70064","DOIUrl":"https://doi.org/10.1002/ksa.70064","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995084","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 synovial leucocyte count and polymorphonuclear percentage reliably differentiate periprosthetic joint infection after unicompartmental knee arthroplasty.","authors":"Stefanie Donner, Georg Matziolis, Yves Gramlich, Igor Lazic, Daniel Schrednitzki, Anne Pohrt, Nora Renz, Nils Meißner","doi":"10.1002/ksa.70036","DOIUrl":"https://doi.org/10.1002/ksa.70036","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine diagnostic thresholds for synovial fluid leucocyte count and polymorphonuclear (PMN) percentage to identify the diagnosis periprosthetic joint infection (PJI) in patients with failed unicompartmental knee arthroplasties (UKAs).</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included 239 patients who underwent revision of an UKA for either septic or aseptic indications at five university-affiliated medical centres. Among these, 30 patients (13%) underwent revision for PJI and 209 (87%) for noninfectious causes. PJI was diagnosed according to the European Bone and Joint Infection Society (EBJIS) criteria. Preoperative synovial fluid leucocyte count, synovial PMN percentage, serum C-reactive protein (CRP) and white blood cell (WBC) count were evaluated. Diagnostic performance and optimal thresholds for each parameter were assessed using receiver operating characteristic curves and Youden's index.</p><p><strong>Results: </strong>The PJI group demonstrated significantly higher median synovial leucocyte counts (11,399/μL vs. 429/μL, p < 0.001), and significantly higher synovial PMN percentage (82% vs. 28%, p < 0.001) compared to the non-PJI group. The optimal diagnostic cut-off for synovial fluid leucocyte count was 2318/μL (area under curve [AUC] 0.93; sensitivity 83%, specificity 95%) and for PMN percentage, 64% (AUC 0.90; sensitivity 76%, specificity 95%). Serum CRP (cut-off 9 mg/L; AUC 0.85) and WBC count (cut-off 8 G/L; AUC 0.71), showed lower diagnostic accuracy.</p><p><strong>Conclusions: </strong>This study establishes UKA-specific diagnostic thresholds for PJI, which are consistent with the EBJIS PJI criteria established for TKA. Synovial biomarkers, particularly synovial fluid leucocyte count and PMN percentage, demonstrated superior diagnostic performance compared to serum CRP and WBC count. These findings underscore the need for tailored diagnostic criteria to improve the accuracy of PJI diagnosis and guide clinical decision-making in UKA revision.</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":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995100","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 injury mechanism varies by injury category: Video analysis of multi-ligament knee injuries in the National Football League.","authors":"Ethan Ruh, Tyler Kallman, Elizabeth Lyden, Justin Greiner","doi":"10.1002/ksa.70025","DOIUrl":"https://doi.org/10.1002/ksa.70025","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to characterize the mechanism of multi-ligament knee injury (MLKI) sustained during a National Football League (NFL) game through video analysis.</p><p><strong>Methods: </strong>A retrospective video analysis of official NFL game footage spanning 1997-2022 was performed. Players with MLKIs were identified from publicly available injury surveillance data. Player and game demographic information was collected. Athletes were categorized based on ligament injury patterns. Videos including MLKI were analyzed to categorize injuries based on non-contact, indirect or direct contact mechanisms and determine the hip, knee and ankle position at the time of injury. Differences across MLKI groups were identified by Fisher's exact test.</p><p><strong>Results: </strong>Thirty-five MLKIs were identified. MLKIs most commonly occurred from direct contact to the limb (80%), with the second most common injury mechanism being indirect contact (14.3%). The most common MLKI was injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) (65%), while the second most common was the ACL and lateral collateral ligament (LCL) (15%). Direct contact MLKI most often resulted in a valgus and external rotational force about a flexed knee (58%). There were statistically significant differences when comparing the direction of contact, hip and knee position between injury MLKI groups. Combined ACL and MCL injury commonly occurs with knee flexion, valgus and external rotation. Combined ACL/posterior cruciate ligament (PCL) or ACL/LCL injuries occurred most commonly with varus and internal rotational forces on an extended knee. Multiligament injuries involving three ligaments occurred only from direct contact mechanisms.</p><p><strong>Conclusion: </strong>Various injury mechanisms and characteristics result in different types of MLKI in NFL athletes, though the vast majority of MLKIs occur from direct contact forces to the knee. Combined ACL and MCL injury occurred most frequently, resembling the mechanism and lower extremity position for isolated ACL injury, though it frequently occurs due to direct contact with the knee.</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":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995124","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":"Thresholds for minimum clinically important difference, minimal important change and patient acceptable symptom state for the ACL-RSI and the K-SES in patients after anterior cruciate ligament reconstruction.","authors":"Ramana Piussi, Jakob Lindskog, Rebecca Hamrin Senorski, Roland Thomeé, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1002/ksa.70044","DOIUrl":"https://doi.org/10.1002/ksa.70044","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to calculate and provide Patient Acceptable Symptom State (PASS) thresholds, Minimum Clinically Important Difference (MCID), and Minimal Important Change (MIC) values for the ACL-Return to Sport after Injury (ACL-RSI) scale and the Knee Self-Efficacy Scale (K-SES) in patients treated with ACL reconstruction.</p><p><strong>Method: </strong>Data were extracted from a rehabilitation specific registry, Project ACL. The registry prospectively collects patient-reported outcomes (PROs). PASS, MCID and MIC were calculated using receiver operating characteristic (ROC) curve analysis and anchor-based methods. Calculations were made for patients who completed the ACL-RSI and K-SES₁₈ at follow-up points 4 (K-SES₁₈ only), 8, 12 and 18 months post-surgery.</p><p><strong>Results: </strong>A total of 704 patients aged 15-50 year, who underwent ACL reconstruction were included. The PASS thresholds increased over time, with AUC values indicating acceptable discrimination at all follow-ups, especially at 18 months. The MCID values ranged from 1.6-4.1 for the K-SES₁₈ and 13.6-30.4 for the ACL-RSI. The MIC values varied between follow-ups, with negative or near-zero values observed at certain intervals, particularly for K-SES₁₈ future.</p><p><strong>Conclusion: </strong>The PASS, MCID and MIC values for the K-SES₁₈ and the ACL-RSI vary over time. Practical thresholds are provided for clinicians to better interpret scores and to determine if meaningful improvements have been achieved.</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":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995109","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}