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

{"title":"Low prevalence of moderate to severe osteoarthritis at long-term follow-up after combined anterior cruciate ligament reconstruction and lateral extra-articular procedures: A systematic review and meta-analysis.","authors":"Matthew Free, Christopher Hewison, James Onggo, Ryan Degen, Alan Getgood","doi":"10.1002/ksa.70059","DOIUrl":"https://doi.org/10.1002/ksa.70059","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the long-term risk of osteoarthritis following combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP).</p><p><strong>Methods: </strong>A comprehensive search of multiple databases (EMBASE, OVID Medline, PubMed, Cochrane, and Scopus) was independently conducted by two reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on the rates of osteoarthritis following primary, arthroscopic ACLR combined with LEAP and a minimum 5-year follow-up were eligible for inclusion. The primary outcome was the prevalence of moderate to severe radiographic arthritis defined as International Knee Documentation Committee (IKDC) grades C or D, Ahlback grades 1-5, or Kellgren-Lawrence grades 3 or 4. A comparative meta-analysis of ACLR with and without LEAP was also performed.</p><p><strong>Results: </strong>A total of eight studies were included, comprising 849 patients who underwent ACLR with LEAP, and 164 who underwent isolated ACLR. Cumulative meta-analysis showed a 4% prevalence of moderate to severe osteoarthritis across all studies after ACLR with LEAP. Subgroup analysis demonstrated a prevalence of 3% in the 5-to-10-year follow-up group and 6% in the 10+ year follow-up group. In the three comparative cohort studies, meta-analysis revealed no statistically significant difference in moderate to severe osteoarthritis rates between ACLR with LEAP and ACLR alone.</p><p><strong>Conclusion: </strong>This study demonstrates that long-term prevalence of moderate to severe osteoarthritis following combined ACLR with LEAP is low, and that the addition of LEAP does not increase the incidence compared to ACLR alone. These findings support the use of LEAP in selected patients, without concern for increased long-term joint degeneration.</p><p><strong>Level of evidence: </strong>Level III, meta-analysis and systematic review.</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":"144995098","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 deficits and significant patellofemoral chondral deterioration two years after trochleoplasty and medial patellofemoral ligament reconstruction.","authors":"Lara Pozzi, Jakob Ackermann, Peter Brem, Michel Schläppi, Samuel Blatter, Simon Rauch, Peter Philipp Koch, Jean-Romain Delaloye","doi":"10.1002/ksa.70043","DOIUrl":"https://doi.org/10.1002/ksa.70043","url":null,"abstract":"<p><strong>Purpose: </strong>Patellofemoral instability is a common knee condition and often associated with trochlear dysplasia. Sulcus-deepening trochleoplasty is a surgical option to reshape the trochlear groove and stabilise the patella. Although this procedure is considered safe and effective, the development of postoperative patellofemoral chondral lesions remains a topic of concern. The aim of this study was to evaluate the clinical and radiological outcomes following combined trochleoplasty and medial patellofemoral ligament reconstruction with a minimum follow-up of 2 years.</p><p><strong>Methods: </strong>We assessed 23 patients (24 knees) who underwent trochleoplasty with concomitant medial patellofemoral ligament reconstruction between January 2014 and July 2018 at our institution. Follow-up consisted of clinical assessment, patient related outcome measurements (Kujala, Tegner, and IKDC score), standardised strength assessment using the VALD Performance system and radiological assessment with conventional radiographs and magnetic resonance imaging.</p><p><strong>Results: </strong>No recurrent patellar dislocation occurred postoperatively. The median postoperative Tegner, Kujala, and IKDC subjective scores were 4 (range 2-8), 87 (range 60-100) and 83 (range 49-98), respectively. Maximal isometric quadriceps (p < 0.001) and hamstring (p < 0.001) strength, as well as performance on the side hop test (p = 0.01), were significantly reduced on the operated side. Postoperative magnetic resonance imaging showed no evidence of chondrolysis or subchondral necrosis. However, chondropathy in the patellofemoral joint significantly worsened. While cartilage status remained stable in six knees, deterioration was observed in 18 knees and it was not significantly associated with the duration of follow-up (p = 0.96) or the preoperative status of the cartilage (p = 0.84).</p><p><strong>Conclusion: </strong>Trochleoplasty with concomitant medial patellofemoral ligament reconstruction is an effective and safe treatment option for patellofemoral instability in the setting of high-grade trochlear dysplasia. However, functional deficits and significant patellofemoral chondral deterioration were observed with a minimum 2-year follow-up.</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":"144995105","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":"Autograft anterior cruciate ligament reconstruction results in improved graft synovial coverage and stability, while remnant-preserving techniques further enhance synovialization: A systematic review and meta-analysis.","authors":"Lika Dzidzishvili, Udit Dave, Jared Rubin, David J Madden, Andrew S Bi, Etienne Cavaignac, Jorge Chahla","doi":"10.1002/ksa.70052","DOIUrl":"https://doi.org/10.1002/ksa.70052","url":null,"abstract":"<p><strong>Purpose: </strong>To compare graft synovialization and tear rates between autograft and allograft anterior cruciate ligament (ACL) reconstruction based upon second-look arthroscopy (SLA), along with joint stability, subjective and objective clinical outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase and the Cochrane Library was conducted on 7 March 2025, to identify studies reporting graft synovial coverage and tear rates on SLA following primary ACL reconstruction. Meta-analyses were conducted using a random-effects model with logit transformation. Study weights were calculated via the inverse variance method. Heterogeneity was assessed using Cochran's Q and the I² statistic. Forest plots were created to display individual and pooled estimates with 95% confidence intervals.</p><p><strong>Results: </strong>A total of 26 clinical studies comprising 2891 patients were included in this systematic review. Of these, 2164 patients underwent ACL reconstruction with autografts and 727 with allografts. SLA was performed in 2009 patients, including 1570 in the autograft group (78.1%) and 481 in the allograft group (23.9%). Good synovial coverage (>50% of the graft) was observed in 1303 autograft cases (83%) and 341 allograft cases (70.9%) (p < 0.001). Poor synovial coverage (<50%) was seen in 146 autografts (9.3%) and 93 allografts (19.3%) (p < 0.001). Torn grafts were found in 125 autografts (8%) and 25 allografts (10%) (n.s.). No significant differences in synovial coverage or graft tear rates were observed when comparing single bundle versus double bundle ACL reconstructions. Mean anterior tibial translation was significantly lower in the autograft group compared to the allograft group (1.23 ± 0.68 vs. 2.00 ± 0.38 mm; p < 0.001). No significant differences were noted in postoperative Lachman (n.s.) and pivot shift tests (n.s.), or in subjective outcomes based on Lysholm (p = 0.05) and Tegner scores (n.s.). However, significantly more patients in the autograft group achieved normal (A) or nearly normal (B) International Knee Documentation Committee (IKDC) objective scores (p = 0.02), whereas higher rates of abnormal or severely abnormal (grades C and D) IKDC scores were observed in the allograft group (p < 0.001). Remnant-preserving ACL reconstruction resulted in significantly better synovial coverage, fewer graft tears and improved knee stability compared to conventional ACL reconstruction (all p < 0.001), with no difference in cyclops lesion incidence (n.s.).</p><p><strong>Conclusions: </strong>Autograft ACL reconstruction showed superior synovial coverage, lower retear and failure rates, reduced anterior tibial translation and better IKDC objective scores compared to allografts. Remnant-preserving techniques further enhanced synovial coverage, lowered graft tear rates and improved joint stability. No significant differences in synovial coverage, graft tears or failure rates were observed between single bundle an","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":"144995090","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":"Preoperative knee laxity is not associated with subjective knee function or revision surgery after primary anterior cruciate ligament reconstruction: An analysis of 5425 patients.","authors":"Riccardo Cristiani, Christoffer von Essen, Eric Hamrin Senorski, Camilo P Helito, Kristian Samuelsson, Karl Eriksson, Magnus Forssblad, Anders Stålman","doi":"10.1002/ksa.70058","DOIUrl":"https://doi.org/10.1002/ksa.70058","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To determine whether preoperative knee laxity, as measured by the KT-1000 arthrometer, was associated with subjective knee function preoperatively and at 1, 2 and 5 years, or with revision anterior cruciate ligament (ACL) reconstruction (ACLR) within 5 years of the primary surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent primary ACLR using a hamstring tendon autograft at the Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, and had no associated ligament injuries, were identified. The KT-1000 arthrometer (134-N) was used to assess knee laxity preoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained preoperatively and at 1-, 2- and 5-year follow-ups. Patients who underwent revision ACLR at any hospital or clinic nationwide within 5 years of their primary surgery were identified via the Swedish Knee Ligament Registry. KOOS subscale scores between groups were compared using analysis of covariance (ANCOVA), while differences in revision ACLR rates were evaluated using Cox regression analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 5425 patients (54.0% male) with available preoperative KT-1000 arthrometer measurements were included: side-to-side (STS) ≤ 2 mm, 1833 (33.8%); STS 3-5 mm, 2387 (44.0%); STS &gt; 5 mm, 1205 (22.2%). The only significant differences in subjective knee function among the groups were observed in the preoperative KOOS Symptoms (STS ≤ 2 mm: 75.0 ± 17.4; STS 3-5 mm: 75.1 ± 17.5; STS &gt; 5 mm: 76.4 ± 17.1; P = 0.03) and Pain (STS ≤ 2 mm: 78.9 ± 15.9; STS 3-5 mm: 79.4 ± 15.9; STS &gt; 5 mm: 80.4 ± 15.2; p = 0.02) subscale. No additional significant differences were observed between the groups in any of the KOOS subscales at the preoperative assessment or at the 1-, 2- or 5-year postoperative follow-ups. At 5 years postoperatively, the revision ACLR rates were 4.8% (89/1833) in the STS ≤ 2 mm group, 4.9% (118/2387) in the STS 3-5 mm group and 6.0% (73/1205) in the STS &gt; 5 mm group. The hazard of revision ACLR within 5 years did not differ significantly from the reference group (STS ≤ 2 mm) for either the STS 3-5 mm group (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.69-1.35; P = n.s.) or the STS &gt; 5 mm group (HR, 1.19; 95% CI, 0.89-1.60; P = n.s.). The incidence of medial meniscus injury increased progressively across the laxity groups from 20.7% in the STS ≤ 2 mm group, to 25.0% in the STS 3-5 mm group and 31.9% in the STS &gt; 5 mm group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The degree of preoperative knee laxity, as measured by the KT-1000 arthrometer, was not associated with postoperative subjective knee function or revision ACLR within 5 years of primary surgery. Medial meniscus injuries were associated with greater preoperative knee laxity. The findings of this study suggest that preoperative arthrometric knee laxity should not be considered as a prognostic factor for ACLR outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: ","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":"144995131","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":"Primary repair versus reconstruction of the anterior cruciate ligament: Functional outcomes and postural stability compared with healthy controls.","authors":"Murat Çiçeklidağ, İnci Hazal Ayas, Ethem Burak Oklaz, Furkan Aral, Muhammed Furkan Tosun, Ulunay Kanatlı","doi":"10.1002/ksa.70050","DOIUrl":"https://doi.org/10.1002/ksa.70050","url":null,"abstract":"<p><strong>Purpose: </strong>To compare functional outcomes and postural stability in patients undergoing primary anterior cruciate ligament (ACL) repair or hamstring tendon reconstruction, using healthy individuals as a reference. We hypothesized that primary ACL repair would result in superior subjective knee function and postural stability.</p><p><strong>Methods: </strong>This comparative case-control study assessed pain, function, single-leg hop performance and postural stability were assessed using the Visual Analogue Scale (VAS), Lysholm Knee Score, International Knee Documentation Committee (IKDC) Score and Biodex Biosway indices (OSI: overall stability index, API: anteroposterior index, MLI: mediolateral index) in bipedal and single-leg stance. Statistical analyses included one-way analysis of variance (ANOVA) or Kruskal-Wallis tests for group comparisons, with paired t-tests or Wilcoxon signed-rank tests for within-group comparisons, depending on data distribution.</p><p><strong>Results: </strong>A total of 113 participants were analyzed: primary repair (primary repair group [PRG], n = 40), reconstruction (reconstruction group [RG], n = 38), and control (control group [CG], n = 35) groups. Mean follow-up was 43.2 ± 10.1 months in PRG and 43.9 ± 11.7 months in RG. VAS scores were 1.37 ± 1.56 in PRG and 1.89 ± 1.62 in RG (mean difference [MD] = 0.51, 95% confidence interval [CI]: -0.19 to 1.23, p = 0.15). Lysholm scores were 92.6 ± 6.95 in PRG and 89.5 ± 9.09 in RG (MD = -3.02, 95% CI: -6.66 to 0.61, p = 0.10). IKDC scores were significantly higher in PRG (88.2 ± 9.01) than RG (82.6 ± 12.1) (MD = 5.63, 95% CI: 0.84 to 10.42, p = 0.02). On the operated side, MLI was lower in PRG (0.2 ± 0.3) than RG (0.3 ± 0.2) (MD = -0.05, 95% CI: 0.008 to 0.11, p = 0.02), indicating better mediolateral stability. Single-leg hop distance was shorter in RG (1.40 ± 0.28 m) and PRG (1.43 ± 0.27 m) compared with CG (1.62 ± 0.18 m) (CG vs. RG: MD = 0.22, 95% CI: 0.07 to 0.36; CG vs. PRG: MD = 0.18, 95% CI: 0.03 to 0.33; p = 0.001), despite LSI values exceeding 90% (RG: 93.1 ± 8.5%; PRG: 95.1 ± 6.3%).</p><p><strong>Conclusions: </strong>Primary anterior cruciate ligament repair provides comparable functional and postural outcomes to reconstruction and may offer superior subjective knee function and mediolateral balance in selected patients.</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":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986508","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":"Longitudinal correlation between X-ray and MRI findings in medial compartment knee osteoarthritis: Insights into early cartilage loss and structural changes.","authors":"Do Weon Lee, Ji-Sahn Kim, Hyuk-Soo Han, Du Hyun Ro","doi":"10.1002/ksa.70016","DOIUrl":"https://doi.org/10.1002/ksa.70016","url":null,"abstract":"<p><strong>Purpose: </strong>Knee osteoarthritis (OA) is a common joint disorder assessed using radiographic (X-ray) and magnetic resonance imaging (MRI). While X-rays are accessible, MRI provides detailed insights into meniscus and cartilage. Few studies have evaluated the correlation between X-ray and MRI findings in knee OA longitudinally. This study addresses this gap by investigating their relationship over time.</p><p><strong>Methods: </strong>The Multicenter Osteoarthritis Study (MOST) dataset, a public, longitudinal cohort study focusing on knee OA in older adults, was used. The analysis included 3710 knees with medial compartment OA from different follow-ups over the course of 7 years. X-ray findings were compared with MRI findings, encompassing cartilage, meniscal and bone pathologies.</p><p><strong>Results: </strong>In the central compartment, knee OA progression began with cartilage loss, followed by meniscal and bone pathology, while in the posterior compartment, meniscal changes preceded cartilage and bone lesions. Cartilage loss in the central femur was the earliest event, even in Kellgren-Lawrence grade 0 knees, preceding X-ray changes. Tibial osteophytes developed first on X-ray, followed by joint space narrowing and femoral osteophytes. Longitudinal regression identified meniscal extrusion, cartilage loss and meniscal tear as significant predictors of OA progression (p < 0.001), with meniscal extrusion being the strongest.</p><p><strong>Conclusion: </strong>Knee OA progression differs by compartment, with cartilage loss initiating changes centrally and meniscal pathology leading posteriorly. Tibial osteophytes appear early on X-ray. Meniscal extrusion is the strongest predictor of OA progression, highlighting the importance of MRI in identifying early changes and guiding personalised management.</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":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986443","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 posterior cruciate ligament-posterior femoral cortex angle (PCL-PCA): A precise indicator of knee decompensation in skeletally immature ACL-injured patients.","authors":"Robin N J Voskuilen, Martijn Dietvorst, Marieke C van der Steen, Annika B Ito, Maximiliano Ibañez, Joan Carlos Monllau, Romain Seil, Caroline Mouton, Rob P A Janssen","doi":"10.1002/ksa.70032","DOIUrl":"https://doi.org/10.1002/ksa.70032","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the most reliable and precise method for measuring the buckling phenomenon of the posterior cruciate ligament (PCL) in skeletally immature patients on magnetic resonance imaging (MRI). The posterior cruciate ligament (PCL)-line sign, PCL angle (PCLA), PCL inclination angle (PCLIA) and PCL-posterior cortex angle (PCL-PCA) were considered. Secondary aims were to (1) compare PCL buckling between healthy and ACL-injured patients to establish a discrimination threshold, (2) assess its validity against other MRI parameters. The hypothesis was that the PCL-PCA is the most reliable and precise method to detect knee decompensation.</p><p><strong>Methods: </strong>Fifty-five ACL-injured patients with open physes were matched with 51 controls by gender and skeletal age. The PCL buckling phenomenon was measured on MRI using four methods, each repeated after two weeks. The presence of a lateral collateral ligament (LCL) sign, medial/lateral anterior tibial translation (ATT) and meniscal bone angle (MBA) were considered. Intra- and inter-observer reliability were assessed using Cohen's Kappa and intra-class correlation coefficients (ICCs). Standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Group comparisons used t tests and chi-square tests; receiver-operating characteristic curves identified optimal thresholds, and Pearson correlations assessed relationships between PCL measures and knee decompensation indicators.</p><p><strong>Results: </strong>PCL-line, PCLA and PCL-PCA showed excellent intra- and inter-observer reliability (ICCs > 0.90), while PCLIA was rated good (ICC = 0.75-0.90). PCL-PCA showed the highest precision (SEM = 2.0°) and best discrimination between healthy and ACL-injured patients (sensitivity: 80%, specificity 74.1%, cut-off ≤ 31.5°) It correlated with medial/lateral MBA (0.36; p < 0.001, 0.37; p < 0.001, respectively) and ATT (-0.59; p < 0.001, -0.52; p < 0.001, respectively), yet did not differ between positive and negative LCL signs (n.s.).</p><p><strong>Conclusion: </strong>PCL-PCA showed the highest reliability/precision to measure the PCL buckling phenomenon. Its correlation with other indicators of knee decompensation confirms that PCL-PCA can be used to detect knee decompensation in children.</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":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986500","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 aberrant anterior tibial artery should be respected and can be protected in high tibial osteotomy surgery.","authors":"Matthias Krause, Gian Salzmann, Karl-Heinz Frosch, Jannik Frings","doi":"10.1002/ksa.12807","DOIUrl":"https://doi.org/10.1002/ksa.12807","url":null,"abstract":"","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986515","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":"Fast-track knee arthroplasty: Enhancing care quality, recovery, satisfaction and reducing complications-Time for routine use.","authors":"Trifon Totlis, Remigio Kort, Michael T Hirschmann, Jon Karlsson, Nanne Kort","doi":"10.1002/ksa.70039","DOIUrl":"https://doi.org/10.1002/ksa.70039","url":null,"abstract":"<p><p>Total knee arthroplasty (TKA) has significantly enhanced the lives of patients with end-stage knee osteoarthritis by providing pain relief, restoring physical activity, and improving overall quality of life. Historically, dissatisfaction rates have remained around 20%, but recent studies show an improvement, with a decrease of 10%. Advancements in alignment philosophies, assistive technologies, custom implants, and artificial intelligence are rising. However, there is currently only scarce evidence confirming their impact on clinical outcomes and patient satisfaction. A holistic approach that combines multiple strategies may improve outcomes, but the ideal combination is still unclear. Enhanced recovery after surgery (ERAS), or fast-track surgery, has transformed knee arthroplasty, supported by substantial evidence demonstrating its benefits. This editorial highlights the evolution and future direction of fast-track knee arthroplasty principles, advantages, controversies, and safety. It advocates for a patient-centred approach, optimising care from preoperative stages to full recovery. Despite concerns in terms of the safety of rapid recovery guidelines, evidence suggests that complications might be minimised. Addressing patients' risk factors and providing education is essential during the preoperative phase. Meanwhile, criteria-based early discharge and customised post-discharge environments are vital in the post-operative stage to enhance and expedite patient recovery. Therefore, we should advance patient care by adopting fast-track arthroplasty as the new gold standard in knee arthroplasty, replacing conventional management strategies for all patients.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable outcomes and early revision rates between restricted and unrestricted functional knee positioning in robotic-assisted total knee arthroplasty for varus deformities ≥10°.","authors":"Christos Koutserimpas, Konstantinos Dretakis, Enejd Veizi, Nevzat Arıcan, Elvire Servien, Cécile Batailler, Sébastien Lustig","doi":"10.1002/ksa.70055","DOIUrl":"https://doi.org/10.1002/ksa.70055","url":null,"abstract":"<p><strong>Purpose: </strong>Functional knee positioning (FKPos) in total knee arthroplasty (TKA) optimises outcomes by balancing individual anatomical and soft tissue characteristics. Managing marked varus deformity presents challenges in achieving balance when tibial alignment is restricted to 3° of varus, necessitating either medial soft tissue release or unrestricted tibial positioning. This study aims to compare restricted FKPos with medial soft tissue release to unrestricted FKPos without soft tissue release in patients with varus deformity ≥10°.</p><p><strong>Methods: </strong>This retrospective, two-center study analysed robotic-assisted TKAs. Patients were categorised into two groups: restricted FKPos with medial soft tissue release (Group A) and unrestricted FKPos without soft tissue release (Group B). Inclusion criteria required a preoperative coronal alignment of ≥10° varus. Outcomes included Knee Society Scores (KSS), Forgotten Joint Scores (FJS), complications, and implant survivorship over a median follow-up of 38 months (interquartile range [IQR] 30-45).</p><p><strong>Results: </strong>A total of 205 patients (Group A: 71 and Group B: 134) were included. No significant differences were observed in functional outcomes (KSS and FJS) or complication rates between the groups. Median tibial varus alignment was 1° in Group A and 4.5° in Group B (p < 0.0001). Implant survivorship was comparable between groups (1.4% in Group A and 0.75% in Group B; p = 0.65; hazard ratio = 1.94; 95% confidence interval: 0.11-35.62).</p><p><strong>Conclusion: </strong>This study demonstrated that restricted FKPos with medial soft tissue release and unrestricted FKPos without soft tissue release result in comparable short-term outcomes, complication rates, and implant survivorship in ≥10° varus deformities. While these findings suggest that unrestricted tibial positioning may be a promising alternative to traditional approaches, further studies with long-term follow-up are needed to confirm its safety and durability.</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":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986264","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}