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

{"title":"Psychological readiness is associated with long-term joint awareness after isolated anterior cruciate ligament reconstruction: A within-patient comparison with the contralateral healthy knee.","authors":"Mehmet Baran Uslu, Yılmaz Ergişi, Berkcan Gökalp, Osman Çömez, Ozan Altun, Uygar Daşar","doi":"10.1002/ksa.70604","DOIUrl":"https://doi.org/10.1002/ksa.70604","url":null,"abstract":"<p><strong>Purpose: </strong>To compare long-term joint awareness between reconstructed and contralateral healthy knees following isolated anterior cruciate ligament reconstruction (ACLR) and to investigate the relationships among objective knee stability, psychological readiness and joint awareness.</p><p><strong>Methods: </strong>Patients who underwent isolated hamstring tendon autograft ACLR between January 2019 and March 2021 and had a minimum follow-up of 5 years were retrospectively reviewed. Patients with concomitant meniscal, chondral, multiligament, lateral extra-articular procedures or nonhamstring grafts were excluded. Joint awareness was assessed using the forgotten joint score-12 (FJS-12) for both reconstructed and contralateral healthy knees, and the primary within-patient interlimb comparison was based on FJS-12. Secondary outcomes included ACL-return to sport after injury (ACL-RSI), International Knee Documentation Committee (IKDC), Lysholm, visual analogue scale (VAS), Tegner Activity Scale, patient satisfaction and objective stability assessed using Lachman and pivot-shift tests. Multivariable regression and mediation analyses were performed.</p><p><strong>Results: </strong>Sixty-nine patients were included in the final analysis. At a mean follow-up of 68.5 ± 3.3 months, reconstructed knees demonstrated significantly lower FJS-12 scores than contralateral healthy knees (81.2 ± 6.4 vs. 90.1 ± 5.0; p < 0.001). Patients with residual instability showed significantly lower ACL-RSI, FJS-12, IKDC and Lysholm scores (all p < 0.001). ACL-RSI was strongly correlated with reconstructed-knee FJS-12 (rho = 0.786, p < 0.001) and independently predicted both reconstructed-knee FJS-12 (β = 0.833, p < 0.001) and interlimb FJS-12 differences (β = 0.668, p < 0.001). Mediation analysis identified a statistically significant indirect association between pivot-shift status and FJS-12 through ACL-RSI (95% bootstrap CI: -11.06 to -5.29).</p><p><strong>Conclusion: </strong>Although isolated ACLR provided excellent long-term functional outcomes and restored objective stability in most patients, reconstructed knees remained perceptually inferior to contralateral healthy knees. Psychological readiness was strongly associated with long-term joint awareness. The observed associations suggest that psychological readiness may contribute to the relationship between residual rotational instability and impaired ability to achieve a 'forgotten knee'.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972984","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":"Not all previous surgeries are the same: Procedure-specific infection risk in total knee arthroplasty patients with a history of previous knee surgery.","authors":"Randa Elsheikh, Felix Amsler, Christian Brand, Bernhard Christen, Michael T Hirschmann","doi":"10.1002/ksa.70599","DOIUrl":"https://doi.org/10.1002/ksa.70599","url":null,"abstract":"<p><strong>Purpose: </strong>While patient-level factors for prosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are well-established, prior ipsilateral knee procedures are typically treated as a uniform risk factor despite likely variation in risk profile across procedure types. This study aimed to evaluate the procedure-specific risk of revision for infection in patients undergoing primary TKA with a history of one or more prior ipsilateral knee surgeries.</p><p><strong>Methods: </strong>A retrospective nationwide cohort study using data from the Swiss Implant Registry analysed all primary TKAs performed between 2015 and December 2022. The primary outcome was revision for infection, whereas secondary outcomes included all-cause revision and all-cause mortality at 2 years. Multivariable logistic regression adjusted for age, sex, body mass index and American Society of Anesthesiologists classification, with individual prior procedures entered in a second block. Cumulative surgical burden was analysed as a categorical variable.</p><p><strong>Results: </strong>Among 121,692 TKAs, 40,535 (33.3%) had a history of at least one ipsilateral knee intervention. All-cause revision occurred in 4232 patients (3.5%) and revision for PJI in 803 (0.7%). Any prior surgery was independently associated with higher rates of all-cause revision (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.25-1.42; p < 0.001) and revision for PJI (OR 1.22, 95% CI 1.06-1.42; p = 0.005). On procedure-specific analysis, prior surgery for knee infection was associated with the highest risk of PJI revision (OR 3.30, 95% CI 1.56-6.96; p = 0.002), followed by tibial osteotomy (OR 2.12, 95% CI 1.60-2.82), synovectomy (OR 2.18, 95% CI 1.27-3.73), tibial osteosynthesis (OR 1.71, 95% CI 1.10-2.68) and anterior cruciate ligament reconstruction (OR 1.44, 95% CI 1.10-1.90; all p < 0.05). Infection risk was significantly elevated only in patients with more than two prior procedures (OR 2.01, 95% CI 1.51-2.68, p < 0.001).</p><p><strong>Conclusion: </strong>Prior ipsilateral knee surgery is associated with procedure-specific and cumulative risk of revision for infection after TKA, supporting the integration of prior surgical history into preoperative risk stratification protocols.</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":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148973052","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":"Outcomes after anterior cruciate ligament reconstruction with versus without lateral extra-articular tenodesis: A propensity-matched cohort study.","authors":"Ali Rteil, Koh Jason, Farid Amirouche","doi":"10.1002/ksa.70600","DOIUrl":"https://doi.org/10.1002/ksa.70600","url":null,"abstract":"<p><strong>Purpose: </strong>Lateral extra-articular tenodesis (LET) has gained increasing use as an adjunct to anterior cruciate ligament reconstruction (ACLR) to improve rotational stability and reduce graft failure. However, concerns remain regarding its potential impact on postoperative morbidity and longer-term joint outcomes. This study aimed to compare postoperative complications, healthcare utilisation and osteoarthritis risk between patients undergoing isolated ACLR and ACLR with LET.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the TriNetX research network. Patients undergoing primary ACLR with or without LET were identified using CPT. After applying the exclusion criteria, 1:1 propensity score matching was performed, yielding 5021 patients per cohort. Early outcomes at 3 and 6 months included arthrofibrosis-related procedures, wound complications, opioid use, rehabilitation utilisation, emergency room visits and hospital readmissions. Short-term outcomes at 1-2 years included subsequent ACLR and meniscal surgery. Mid-term outcomes at 5 years included knee osteoarthritis. A young high-risk subgroup aged 12-25 years was analysed for 1- and 2-year outcomes. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>ACLR/LET was associated with higher odds of arthrofibrosis-related procedures at 3, 6 and 12 months, including at 1 year (3.4% vs. 2.1%; OR 1.65, 95% CI 1.29-2.11; p < 0.001). The LET cohort also had higher odds of wound complications and hospital readmissions at 3 and 6 months, with greater early opioid and rehabilitation utilisation. At 2 years, ACLR/LET was associated with higher hazards of arthrofibrosis-related procedures (HR 2.01; p < 0.001) and subsequent meniscal surgery (HR 1.25; p < 0.05), but not subsequent ACLR. ACLR/LET was also associated with higher hazards of ICD-coded knee osteoarthritis in the primary 5-year analysis (HR 2.24, 95% CI 1.76-2.85; p < 0.001) and the 1-year landmark analysis (HR 2.57; p < 0.001). In the young subgroup, ACLR/LET was associated with lower odds of subsequent ACLR at 1 year.</p><p><strong>Conclusions: </strong>In this propensity-matched retrospective study, ACLR with LET was associated with increased early postoperative morbidity, higher hazards of subsequent meniscal surgery and ICD-coded knee osteoarthritis, and no significant reduction in subsequent ACL reconstruction in the primary 2-year time-to-event analysis. Given the retrospective design and potential residual confounding by indication, these findings should be interpreted as associations rather than definitive causal effects of LET augmentation. These results highlight the importance of careful patient selection and counselling when considering LET during ACLR.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957807","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 role of generalised joint Laxity in anterior cruciate ligament reconstruction: A systematic review and meta-analysis.","authors":"Pierangelo Za, Giuseppe Francesco Papalia, Clemente Caria, Marco Minelli, Susanna Basciani, Sebastiano Vasta","doi":"10.1002/ksa.70598","DOIUrl":"https://doi.org/10.1002/ksa.70598","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review and meta-analysis aims to assess whether patients with generalised joint laxity (GJL) undergoing anterior cruciate ligament reconstruction (ACLR) have a higher risk of graft failure, worse clinical outcomes and greater residual instability compared to non-lax individuals.</p><p><strong>Methods: </strong>In accordance with the preferred reporting items for systematic reviews and meta-analyses 2020 guidelines and the PICO frameworks, studies relating to PROMs, residual laxity and re-injury rate or graft failure of patients with GJL after primary ACLR were sought for inclusion. The comparison, when available, consisted of patients without GJL undergoing primary ACLR MINORS was used for the methodological assessment.</p><p><strong>Results: </strong>A total of 13 studies were included. A total of 3905 patients were included, of whom 55% were male and 45% female. The mean age was 27.5 years (range, 23.4-29.7 years). The mean follow-up period was 41.1 months (range, 12-96 months). International Knee Documentation Committee score showed statistically significant results in favour of non-GJL group (mean value 87.7 ± 10.1) compared to GJL group (mean value 85.2 ± 11.6) (MD = -3.27, p = 0.05). Lysholm Knee Score was significantly higher in non-GJL group (mean value 93.5 ± 5.8) compared to GJL group (mean value 88.5 ± 6.3) (MD = -4.05, p = 0.005). The rates of positivity of Lachman test (OR = 2.62, p < 0.0001) and pivot shift test (OR = 2.25, p = 0.0007) were significantly higher in GJL group. The rate of ACL reconstruction failure was 9.2% in GJL group and 6.1% in non-GJL group without statistical significance (OR = 3.15, p = 0.07).</p><p><strong>Conclusions: </strong>Patients with GJL appear to have increased postoperative residual knee laxity after ACL reconstruction compared with patients without GJL. Clinical outcomes remain heterogeneous, while no statistically significant differences in graft failure rates were identified. Given the heterogeneity of clinical outcomes, future studies should clarify whether the greater residual laxity represents a clinically relevant disadvantage or whether it can be well tolerated without a meaningful impact on patient-reported and functional outcomes.</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":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946495","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":"Functional alignment robotic-assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single-surgeon randomised controlled non-inferiority trial with 2-year follow-up.","authors":"Remco Coenen, Arne Peeters, Peter Bollars, Dinesh Nathwani, Ali Albelooshi, Max Til Ettinger, Arnaud Deltour, Martijn Gerhardus Maria Schotanus","doi":"10.1002/ksa.70589","DOIUrl":"https://doi.org/10.1002/ksa.70589","url":null,"abstract":"<p><strong>Purpose: </strong>Functional alignment (FA) has emerged as an alternative to mechanical alignment (MA) in total knee arthroplasty (TKA), supported by robotic assistance to enhance precision and soft‑tissue preservation. Evidence comparing FA performed with robotic assistance to conventional MA‑TKA across mid‑term patient‑reported outcomes measures (PROMs) remains limited. This randomised controlled trial evaluated differences in recovery trajectories and 2‑year knee‑specific outcomes between FA‑RATKA and MA‑CTKA.</p><p><strong>Methods: </strong>This study reports the predefined primary 2-year outcomes of a prospective randomised controlled non-inferiority trial including 180 patients (FA-RATKA, n = 81; MA-CTKA, n = 82), of whom 163 completed follow-up. Assessments were performed preoperatively and at 3-months, 1- and 2-years using validated PROMs: Knee Society Score (KSS) subdomains, Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), VAS pain, EQ-5D-5L (index and VAS), Lower Extremity Activity Scale (LEAS), and overall satisfaction. Mixed-effects models evaluated group, time, and Group × Time interactions, adjusting for age, BMI, and soft-tissue release. Effect sizes (r) were calculated to contextualise clinical relevance.</p><p><strong>Results: </strong>FA-RATKA demonstrated more favourable knee-specific outcomes across follow-up, with significant Group × Time interactions for KSS Function (F(3,679) = 6.970, p < 0.001; r = 0.173), KSS Satisfaction (F(3,679) = 10.892, p < 0.001; r = 0.214) and KSS Symptoms (F(3,679) = 4.425, p = 0.004; r = 0.138). FA-RATKA also showed more favourable OKS trajectories (F(3,679) = 8.053, p < 0.001; r = 0.185), lower VAS pain (F(3,679) = 8.339, p < 0.001; r = 0.188), and higher EQ-5D index scores (F(2,515) = 5.227, p = 0.006; r = 0.141). Categorical satisfaction favoured FA-RATKA at early follow-up (F(2,503) = 3.491, p = 0.031; r = 0.117). Effect sizes ranged from r = 0.117 to 0.214, corresponding to small to small-medium magnitudes.</p><p><strong>Conclusions: </strong>In this prospective, randomised, single-surgeon study, several knee-specific patient-reported outcomes demonstrated modest but statistically supported differences at 2-year follow-up, with consistently higher values in the FA-RATKA group.</p><p><strong>Level of evidence: </strong>Level I, randomised controlled trials with adequate statistical power to detect differences (narrow confidence intervals) and follow up >80%, as per the KSSTA guidelines.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946477","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":"Specific functional knee phenotypes are associated with increased osteoarthritis progression: A ≥10-year longitudinal study.","authors":"Sang Jun Song, Hyo Beom Lee, Cheol Hee Park","doi":"10.1002/ksa.70591","DOIUrl":"10.1002/ksa.70591","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate osteoarthritis (OA) progression across functional knee phenotypes (FKPs) over a follow-up period of ≥10 years.</p><p><strong>Methods: </strong>This retrospective longitudinal study included 388 patients (764 knees) with healthy knees or early OA (Kellgren-Lawrence grade ≤1) at baseline and a minimum follow-up of 10 years. FKPs were classified based on the hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) obtained from orthoradiographs. A total of 72 FKP groups were identified, of which 15 groups with a sample size ≥20 (511 knees) were finally selected for analysis. OA progression was defined as an increase in at least one Kellgren-Lawrence grade during follow-up. The OA progression rates for each FKP group were compared with those of the neutral reference group (NEU_HKA0° NEU_FMA0° NEU_TMA0°) as exploratory analyses. Finally, multivariate generalized estimating equation logistic regression analysis was performed to identify factors associated with OA progression.</p><p><strong>Results: </strong>Over a follow-up period of ≥10 years, the neutral reference group showed an OA progression rate of 52.4% (44/84). Three phenotypes showed significantly higher OA progression rates compared with the reference phenotype: VAR_HKA3°VAR_FMA3° NEU_TMA0° (88.9% [32/36]; odds ratio [OR], 7.27; 95% confidence interval [CI], 2.36-22.38; p < 0.001), VAL_HKA3° NEU_FMA0°VAL_TMA3° (84.6% [22/26]; OR, 5.00; 95% CI, 1.59-15.76; p = 0.005) and NEU_HKA0°VAR_FMA3°VAL_TMA3° (75.0% [24/32]; OR, 2.73; 95% CI, 1.10-6.76; p = 0.035). In the multivariate analysis, the three FKP categories were also significantly associated with increased risk of OA progression (VAR_HKA3°VAR_FMA3° NEU_TMA0° (adjusted odds ratio [aOR], 6.54; 95% CI, 2.20-19.41; p < 0.001), VAL_HKA3° NEU_FMA0°VAL_TMA3° (aOR, 7.50; 95% CI, 1.82-30.95; p = 0.005) and NEU_HKA0°VAR_FMA3°VAL_TMA3° (aOR, 3.10; 95% CI, 1.17-8.20; p = 0.023).</p><p><strong>Conclusions: </strong>Specific FKPs are associated with a significantly increased risk of OA progression compared with the neutral phenotype. OA progression appears to be influenced not only by overall limb alignment but also by combined femoral and tibial alignment patterns.</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":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946470","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":"Orthopaedic surgery beyond working hours: Passion, purpose and the pursuit of excellence-Do you want to become somebody, or just anybody?","authors":"Michael T Hirschmann, Elmar Herbst, Giuseppe Milano, Sebastien Lustig, Berte Boe, Roland Becker, Daniel Haverkamp, Stefano Zaffagnini, Etienne Cavaignac, Robert Prill, M Enes Kayaalp, Michael Hantes, Romain Seil, Andrej Nowakowski, Johannes Beckmann, Andreas M Müller, Karl Eriksson","doi":"10.1002/ksa.70596","DOIUrl":"https://doi.org/10.1002/ksa.70596","url":null,"abstract":"<p><p>Orthopaedic surgical education is changing as robotics, artificial intelligence, digital planning, advanced imaging and data-driven decision-making reshape clinical practice. At the same time, residency training is increasingly influenced by duty-hour regulations, well-being initiatives, burnout prevention and evolving expectations regarding work-life balance. This editorial reflects on the challenge of protecting trainees from fatigue and exploitation without protecting them from the clinical experience required to develop surgical excellence. Exceptional orthopaedic surgeons are not formed by technology or minimum exposure alone, but through deliberate practice, curiosity, reflection, responsibility, mentorship and sustained professional commitment. As digital technologies increasingly support routine tasks, human qualities such as judgement, empathy, leadership, communication and the ability to manage uncertainty will become even more important. The future of orthopaedics will therefore depend not only on innovation, but also on how surgical training cultivates professional identity, passion, purpose and excellence.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946517","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":"Select large language models outperform hip preservation experts on consensus-based hip preservation questionnaire.","authors":"Karter Morris, Felix Öttl, James A Pruneski, Bálint Zsidai, Michael T Hirschmann, Kristian Samuelsson, Matthew J Kraeutler","doi":"10.1002/ksa.70581","DOIUrl":"https://doi.org/10.1002/ksa.70581","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI) is increasingly utilized in medical education and clinical contexts, yet few studies compare the performance of large language models (LLMs) to subspecialized experts in providing guideline-based medical information on hip preservation. The purpose of this study was to evaluate the performance of three LLMs compared to a panel of international hip preservation experts in answering guideline-based questions related to femoroacetabular impingement syndrome, hip dysplasia and microinstability of the hip.</p><p><strong>Methods: </strong>A 21-item questionnaire was developed based on published consensus guidelines. The survey was distributed to a panel of hip preservation specialists identified through the professional network of the senior author. Ten experts responded and were included in the analysis. Three LLMs (ChatGPT 5.2, Gemini 3 and Claude 4.5 Sonnet) were prompted using the same questionnaire, with each LLM performing three runs per item. Outcomes included overall accuracy, percent agreement, Fleiss' κ, generalized linear mixed-effects modelling and qualitative assessment of AI answer justifications.</p><p><strong>Results: </strong>Expert accuracy was 90.5% (95% confidence interval [CI] 87.1-93.9), compared to 100% (p = 0.004) for Gemini, 98.4% (p = 0.016) for ChatGPT and 96.8% (p = 0.053) for Claude. Expert percent agreement was 42.9% and Fleiss' κ was 0.769; alternatively, AI intra-item percent agreement was 100% (Gemini) and 95.2% (ChatGPT and Claude). ChatGPT and Claude provided thorough justifications for even incorrect responses, and Gemini demonstrated formatting deviations despite 100% accuracy.</p><p><strong>Conclusion: </strong>The three LLMs demonstrated high accuracy and consistency when answering the hip preservation questionnaire, with two of the LLMs statistically outperforming the expert panel. In structured, verifiable question sets, the ability of newer LLMs to accurately and consistently respond to consensus-based questions is improving compared to prior reports. LLMs are likely to serve as an adjunct in orthopaedic education and practice, and limitations to AI's implementation into practice should be continuously and rigorously explored.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908614","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 orthopaedic surgeon's responsibility: Creating and protecting scientific evidence as its custodian.","authors":"Lika Dzidzishvili, Luca Macchiarola, Theodorakys Marin Fermin, George Mihai Avram, Michael T Hirschmann, Stefano Zaffagnini","doi":"10.1002/ksa.70592","DOIUrl":"https://doi.org/10.1002/ksa.70592","url":null,"abstract":"<p><p>Progress in surgery has never been driven by technical innovation alone. Advancing patient care extends far beyond the operating room, relying on the research and academic engagement of orthopaedic surgeons. Every improvement in surgical practice, from refined indications to optimised rehabilitation protocols, has been built on rigorous research and critical evaluation of evidence. Among academic activities, peer review is perhaps one of the most undervalued. It is time-consuming, often performed after long clinical hours, and offers little personal recognition. Yet, it remains the cornerstone of scientific integrity, strengthening manuscripts by challenging unsupported conclusions, refining methodology, and improving the quality of evidence that informs clinical decision-making. The benefits of peer review extend beyond the published article. Critically evaluating the work of others enhances reviewers' analytical skills, keeps them current with emerging evidence, and fosters more critical interpretation of the literature. The future of orthopaedic surgery is shaped not only by those who operate, but by those who question, investigate, review, and train future generations. Our patients deserve surgeons who are not merely skilled technicians but thoughtful towards scientific progress.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908630","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":"Revision anterior cruciate ligament reconstruction following failure of combined anterior cruciate ligament reconstruction with lateral extra-articular procedures: A scoping review.","authors":"Dave Osinachukwu Duru, Ciara-Clare O'Brien, Marc Daniel Bouchard, Prushoth Vivekanantha, Ashraf Hantouly, Darren de Sa, Olufemi R Ayeni, Jeffrey Kay","doi":"10.1002/ksa.70593","DOIUrl":"https://doi.org/10.1002/ksa.70593","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this scoping review was to map the existing literature describing revision anterior cruciate ligament reconstruction (ACLR) following failure of combined ACLR with lateral extra-articular procedures (LEAPs), characterize reported surgical strategies, summarize available clinical outcomes and identify gaps in the current evidence base.</p><p><strong>Methods: </strong>A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Ovid MEDLINE, Embase and PubMed were searched from inception to February 2026. Eligible studies included technical notes and clinical studies describing revision of failed combined ACLR with LEAPs, including lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALLR). Studies were included irrespective of outcome reporting, provided revision strategies were described. Single-revision or re-revision cases and adult and paediatric populations were included. Review articles, editorials and letters were excluded. Data were extracted and synthesized descriptively.</p><p><strong>Results: </strong>Nine studies were included. Three studies described detailed revision strategies, including single-stage revision ACLR with ALLR, double-bundle revision ACLR with LET preservation and all-epiphyseal revision ACLR following failed LET. Six clinical studies included 594 patients within broader primary or revision ACLR cohorts, of whom 23 were explicitly identified as undergoing revision or re-revision following failure of a combined ACLR with LEAP. Revision strategies were heterogeneous in graft selection and management of the LEAP, including LET preservation, LET revision or conversion to ALLR. Clinical outcomes were reported in two case reports, both demonstrating satisfactory short-term stability and functional outcomes following revision ACLR with LET preservation.</p><p><strong>Conclusions: </strong>The current literature on the revision of failed combined ACLR with LEAPs is limited and heterogeneous. Revision strategies vary widely, and reporting of both technique and clinical outcomes is inconsistent. Based on the limited evidence and expert opinion, revision ACLR in this context should be individualized according to surgeon experience and patient-specific factors, such as prior ACL graft harvest, tunnel interactions and the status of the prior LEAP.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908642","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}