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

{"title":"The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 1): Definitions, classifications, etiologies, natural history and diagnosis.","authors":"Jean Kany, Miguel Angel Ruiz Iban, Claudio Rosso, Chris Peach, Pierre Métais, Carlos Maia Dias, Emilio Calvo, Maristella Francesca Saccomanno, Berte Bøe, Emmanouil Brilakis, Kerem Bilsel, Ladislav Kovacic, Antoon Van Raebroeckx, Nuno Gomes, Frank Martetschläger, Philippe Beaufils, Felix G E Dyrna","doi":"10.1002/ksa.70587","DOIUrl":"https://doi.org/10.1002/ksa.70587","url":null,"abstract":"<p><strong>Purpose: </strong>To establish evidence-based consensus recommendations regarding the diagnosis and treatment of partial-thickness posterosuperior rotator cuff tears (PT-PS-RCTs). This part addresses the definition, classification, natural history and diagnosis of these controversial conditions in shoulder surgery.</p><p><strong>Methods: </strong>This official European Society of Sports Medicine, Knee Surgery and Arthroscopy-European Shoulder Associates (ESSKA-ESA) Formal Consensus was conducted according to the ESSKA Formal Consensus Methodology. A Steering Group developed 33 questions, followed by a standardized literature search and evidence review. For each question, a consensus statement was drafted and assigned recommendation grades (A-D) according to the level of evidence. An independent Rating Group evaluated all statements until strong agreement was achieved.</p><p><strong>Results: </strong>Twelve recommendations were generated with three Grade A, three Grade B, two Grade C, five Grade D and strong agreement. Grade A was found for the use of multiple classification systems in unison to characterize these injuries and for the distinction between acute and chronic tears. Scientific presumption level (Grade B) was found for the increased incidence of articular injuries in overhead and contact athletes and for the absence of a link between calcifying tendinitis and PT-PS-RCTs. Grade C was found to define the risk and timeframe of tear progression and the ideal imaging modality.</p><p><strong>Conclusion: </strong>This ESSKA-ESA Formal Consensus recommends that PT-PS-RCTs should be classified according to tear location, depth and tendon involvement. The aetiology of these injuries is multifactorial, and their progression is unpredictable. Current imaging modalities have limitations in characterizing these lesions. The present consensus provides clinicians with a practical evidence-based framework for the diagnosis and classification of PT-PS-RCTs while identifying key priorities for future clinical research.</p><p><strong>Level of evidence: </strong>Level I, formal consensus.</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":"148908638","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":"A novel classification system for measuring and interpreting tibial tunnel morphology for revision ACLR.","authors":"Mitchell I Kennedy, Luke V Tollefson, Nicholas I Kennedy, Christopher M LaPrade, Robert F LaPrade","doi":"10.1002/ksa.70551","DOIUrl":"https://doi.org/10.1002/ksa.70551","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to reproducibly measure computed tomography (CT) tibial tunnel features in failed anterior cruciate ligament reconstructions (ACLRs) and to propose a CT classification system for tibial tunnel morphology in the setting of evaluation for a one- versus two-stage revision ACLR surgery.</p><p><strong>Methods: </strong>A retrospective study was performed on 75 patients presenting for ACLR graft failure between July 2019 and April 2023. Inclusion criteria comprised patients who underwent a revision ACLR by a single surgeon with preoperative knee CT imaging. The centre of the anatomic tibial ACL footprint and the centre and size of the previously drilled ACLR tibial tunnel were used for axial classification. The size of the tibial tunnel on sagittal images was used to develop the sagittal classification system.</p><p><strong>Results: </strong>Five tibial tunnel sagittal CT morphologies were categorized according to uniform dilation, 'tubular' (Type A; n = 39); distal dilation, 'shovel' (Type B; n = 4); midpoint dilation, 'balloon' (Type C; n = 16); dual tunnel (Type D; n = 3) and proximal dilation, 'mushroom' (Type E; n = 13). On axial CT slices, tunnels were classified as Type I (< 2.5 mm between anatomic footprint and ACLR tunnel), Type II (2.5-12.5 mm) and Type III (>12.5 mm). The average distance between the tibial tunnel and the centre of the ACL footprint measured 4.4 ± 2.7 mm (interrater correlation coefficient [ICC] = 0.84; confidence interval [CI] = 4.0-4.8 mm). Overall, 56 (74.7%) were classified as Type I, 18 (24.0%) as Type II and 1 (1.3%) as Type III.</p><p><strong>Conclusions: </strong>This study found that there was a reproducible categorization of CT tibial tunnels by five sagittal CT morphologies and three axial CT scan categories. The study also found that relative offset of ACLR tibial tunnels to their native footprint can be reproducibly identified using CT, which may assist in the future diagnosis and identification of ACLR knees that are at greater risk of revision.</p><p><strong>Level of evidence: </strong>Level IV, retrospective cross-sectional study.</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":"148908680","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":"Association between acromial morphology, scapular control, ultrasonographic impingement and non-surgical treatment outcome in patients with isolated subacromial pain syndrome.","authors":"Adam Witten, Kristian Thorborg, Per Hölmich, Mikkel Bek Clausen, Kristoffer Weisskirchner Barfod","doi":"10.1002/ksa.70424","DOIUrl":"10.1002/ksa.70424","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to investigate whether acromial morphology, scapular control, and ultrasonographic impingement were associated with treatment outcome from three months of non-surgical treatment in patients with subacromial pain syndrome (SAPS).</p><p><strong>Methods: </strong>Patients were recruited consecutively from an orthopaedic outpatient clinic. All patients were systematically investigated for SAPS and for the presence of concomitant diagnoses by orthopaedic specialists using predefined standardised criteria. All patients diagnosed with SAPS were referred for 3 months physiotherapy. The treatment outcome was defined as the change in the Shoulder Pain and Disability Index (SPADI) from pre- to post-treatment. Acromial morphology was evaluated on standardised outlet view radiographs, scapular control was evaluated with the scapular assistance test and ultrasonographic impingement was evaluated using a reliable method. The association between each of the pathophysiological factors and treatment outcome was investigated with linear regression analyses.</p><p><strong>Results: </strong>A total of 69 patients were included in the analysis for scapular control, 62 patients for ultrasonographic impingement, and 45 patients for the radiographic analysis. Eight patients were lost to follow-up. Acromial morphology was associated with poorer treatment outcome in both the adjusted and unadjusted linear regression models. The adjusted model predicted a change in SPADI of 1.8 points per degree of increased acromial curvature (more hook-shaped acromion). There was no association between scapular control or ultrasonographic impingement and change in SPADI.</p><p><strong>Conclusion: </strong>In patients with isolated SAPS, increasing acromial curvature (more hook-shaped acromion) was associated with poorer non-surgical treatment outcome, while ultrasonographic impingement and scapular control were not. This indicates that acromial morphology may be a prognostic factor for non-surgical treatment outcome, but future research is needed to confirm the findings.</p><p><strong>Level of evidence: </strong>Level II, prognostic study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3429-3440"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147978476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic joint infection risk is comparable between unicompartmental knee arthroplasty to total knee arthroplasty conversion and primary total knee arthroplasty: A systematic review and meta-analysis.","authors":"Maximilian Budin, Matthew De Ruyter, Zachary Christopher Lum, Jürgen Slapar, Jochen Gerhard Hofstaetter, Georg Hauer, Andreas Leithner, Patrick Sadoghi","doi":"10.1002/ksa.70228","DOIUrl":"10.1002/ksa.70228","url":null,"abstract":"<p><strong>Purpose: </strong>Unicompartmental knee arthroplasty (UKA) offers benefits over total knee arthroplasty (TKA), but some studies indicated higher revision rates, often involving conversion to TKA. The infection risk associated with UKA to TKA conversion compared to primary TKA is not definitively established. This systematic review and meta-analysis aimed to determine if patients undergoing UKA to TKA conversion had a higher rate of periprosthetic joint infection (PJI) compared to primary TKA.</p><p><strong>Methods: </strong>Following preferred reporting items for systematic reviews and meta-analysis guidelines, PubMed, EMBASE and SCOPUS were searched for clinical studies comparing PJI rates in adult patients undergoing UKA to TKA conversion versus primary TKA. Data on reoperations and component use were also extracted. A random-effects model was used for the meta-analysis.</p><p><strong>Results: </strong>Six retrospective studies involving 456 UKA to TKA conversion and 719 primary TKAs were included. No significant difference in the rate of PJI was found between the UKA to TKA conversion cohort (0.66%) and the primary TKA cohort (0.70%) (odds ratio [OR] 1.21, 95% confidence interval [CI] [0.27, 4.46]; p = 0.91). However, UKA to TKA conversion was associated with a significantly higher likelihood of requiring augments (15.6% vs. 3.9%; OR 8.71, 95% CI [1.29, 58.80]; p = 0.03) and stems (36.6% vs. 1.7%; OR 45.83, 95% CI [9.53, 220.55]; p < 0.00001), indicating greater surgical complexity.</p><p><strong>Conclusion: </strong>Based on current literature, UKA to TKA conversion is associated with a similar surgical site infection/PJI rate compared to primary TKA. UKA to TKA conversion procedures necessitated significantly more revision-specific components.</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":"3314-3321"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualised total knee arthroplasty demonstrates 99.4% survival at 3 to 5 years.","authors":"Carsten Tibesku, Tarik Aït-Si-Selmi, Jacobus Hendrik Müller, Mo Saffarini, Michel Pierre Bonnin","doi":"10.1002/ksa.70265","DOIUrl":"10.1002/ksa.70265","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this multicentre observational study is to evaluate implant survival and patient-reported outcome measures (PROMs) at 3-5 years following individualised total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A consecutive series of 426 patients (434 knees) underwent CT-based, posterior-stabilised, cemented, individualised TKA between December 2018 and August 2020. After excluding 73 patients without informed consent, 353 patients (361 knees) were included for survival analysis. A further 74 were excluded (revised = 2, deceased = 11, inadequate follow-up = 61), resulting in a final cohort of 279 patients (287 knees) for PROMs assessment. Implant survival was evaluated using the Kaplan-Meier (KM) method, with revision of any component for any reason as the endpoint at 2- and 3-year follow-ups. Patients completed pre and postoperative questionnaires of the Oxford knee score (OKS) and the forgotten joint score (FJS), and also rated their level of satisfaction on a 4-level Likert scale. The proportion of patients who achieved a patient acceptable symptom state (PASS) was estimated according to the threshold of 30 for OKS and 38 for FJS.</p><p><strong>Results: </strong>Considering revision for any reason as endpoint, the survival according to the KM method was 99.4% (95% confidence interval [CI] 98.6%-100.0%) at both 2- and 3-year follow-up. The OKS improved from 22.2 ± 8.4 to 40.6 ± 7.6, and 244 knees (85%) achieved the PASS. The FJS improved from 16.7 ± 14.6 to 68.5 ± 27.7, and 233 (81%) achieved the PASS. Out of the 254 knees with their rated level of satisfaction, 250 (98.4%) were either satisfied or very satisfied.</p><p><strong>Conclusion: </strong>At 3 to 5 years' follow-up, individualised TKA demonstrated excellent implant survival (99.4%), as well as high patient satisfaction, both considering and disregarding non-respondents (87.1% and 98.4% respectively). The results are promising and warrant continued follow-up to evaluate long-term results.</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":"3406-3414"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smaller medial component gaps at deep flexion are associated with better patient-reported outcomes after robotic-assisted cruciate-retaining total knee arthroplasty using an anatomically designed implant.","authors":"Yutaka Nakamura, Hiroyasu Ogawa, Yusuke Ota, Kaito Takagi, Masaya Sengoku, Kazuichiro Onishi, Haruhiko Akiyama","doi":"10.1002/ksa.70214","DOIUrl":"10.1002/ksa.70214","url":null,"abstract":"<p><strong>Purpose: </strong>Soft tissue balance is essential for optimal function and satisfaction after total knee arthroplasty (TKA). However, the clinical significance of medial gap patterns across the entire range of motion (ROM) remains unclear. This study aimed to examine the association between intraoperative medial gap patterns and post-operative patient-reported outcome measures (PROMs) in robotic-assisted cruciate-retaining (CR) TKA. It was hypothesized that medial gap patterns with smaller deep-flexion gaps relative to mid-flexion or 90° flexion would be associated with superior PROMs.</p><p><strong>Methods: </strong>This retrospective study included 102 patients (120 knees) who underwent primary robotic-assisted CR TKA. Bone and cartilage resection thickness and simulated gaps were assessed at the planning stage, and the final component gaps were recorded at the trial stage. Medial gap patterns were classified as: 1 (constant), 2 (gradually increasing), 3 (increasing/decreasing) and 4 (gradually decreasing). Objective outcomes were assessed using the Knee Society Score (KSS), and subjective outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Forgotten Joint Score-12 and the satisfaction score of the 2011 KSS.</p><p><strong>Results: </strong>Ten, 47, 51 and 12 knees were classified into Patterns 1-4, respectively. The resection gaps at flexion and the flexion-extension gap difference were relatively larger in Pattern 2. Objective outcomes were comparable among patterns; however, the PROMs differed significantly. Pattern 3 demonstrated better WOMAC stiffness and KSS satisfaction scores than Patterns 1 and 2.</p><p><strong>Conclusion: </strong>Medial gap patterns in which deep-flexion gaps did not exceed those at mid-flexion or 90° flexion were associated with better PROMs in robotic-assisted CR TKA. These findings support the hypothesis that avoiding underestimation of native joint gaps at deep flexion is important for optimizing patient-reported 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":"3348-3361"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced postoperative inflammation and blood loss after robotic arm-assisted unicompartmental compared with total knee arthroplasty: A propensity score-matched analysis.","authors":"Dirk Müller, Florian Pohlig, Benjamin Schloßmacher, Vincent Lallinger, Michael T Hirschmann, Rüdiger von Eisenhart-Rothe, Igor Lazic","doi":"10.1002/ksa.70212","DOIUrl":"10.1002/ksa.70212","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic arm-assisted unicompartmental knee arthroplasty (raUKA) offers potential advantages over robotic arm-assisted total knee arthroplasty (raTKA), but its biological benefits remain unclear. Superior early recovery after raUKA may be related to reduced systemic inflammation and blood loss. It was hypothesised that raUKA would elicit a lower systemic inflammatory response and result in reduced perioperative blood loss compared with raTKA.</p><p><strong>Methods: </strong>Patients undergoing raUKA with the Mako® system were 1:1 propensity score-matched to raTKA patients based on age, gender, body mass index, and ASA score, yielding two balanced cohorts (n = 162 each). Blood samples were collected preoperatively, 6 h postoperatively, and on postoperative Days 3 and 5. Primary outcomes were C-reactive protein (CRP) and white blood cell (WBC) levels; secondary outcomes included operative time and calculated blood loss.</p><p><strong>Results: </strong>CRP increases were significantly lower after raUKA on Day 3 (1.6 vs. 4.6 mg/dL, p < 0.001) and Day 5 (0.8 vs. 3.7 mg/dL, p = 0.031). WBC counts were lower at 6 h in raUKA (3.8 vs. 4.5 G/L, p = 0.041) but not significantly different on Days 3 or 5. Median operative time was shorter with raUKA (81 vs. 95 minutes, p < 0.001). Haemoglobin decrease and estimated blood loss were reduced in raUKA compared with raTKA (532 vs. 669 mL, p < 0.001).</p><p><strong>Conclusion: </strong>This is the first study to directly compare inflammatory response and blood loss between raUKA and raTKA. raUKA was associated with lower CRP and early WBC elevations, reduced blood loss, and shorter operative times. These results provide clinically relevant biomarker reference values and highlight perioperative advantages of raUKA. Collectively, they support raUKA as a less invasive alternative to raTKA in appropriately selected patients.</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":"3339-3347"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manipulation under anaesthesia and/or lysis of adhesions prior to revision total knee arthroplasty increases the risk of subsequent revision.","authors":"Kevin D Plancher, Elias Schwartz, Carlo Mannina, Karen K Briggs, Stephanie C Petterson","doi":"10.1002/ksa.70211","DOIUrl":"10.1002/ksa.70211","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine if prior manipulation under anaesthesia (MUA) and/or lysis of adhesions (LOA) was associated with an increased risk of re-revision following index revision total knee arthroplasty (TKA) in patients that had a diagnosis of arthrofibrosis.</p><p><strong>Methods: </strong>The PearlDiver Mariner database was queried by Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes to identify patients who had a diagnosis of arthrofibrosis at the time of revision TKA. Patients were divided into two groups: those with prior MUA and/or LOA and those without prior MUA and/or LOA. The groups were 1:3 propensity score matched by age, gender, anemia, and Elixhauser Comorbidity Index (ECI). The primary outcome was incidence of re-revision TKA at 5 years. Secondary outcomes included periprosthetic joint infection (PJI) at 6 months and 5 years, 90-day hospital readmission, and the incidence of deep vein thrombosis (DVT), blood transfusion, and acute kidney injury (AKI) at 6 months. Logistic regression was used to determine predictors of re-revision TKA.</p><p><strong>Results: </strong>After propensity matching, 2622 patients with a diagnosis of arthrofibrosis underwent index revision TKA without prior MUA and/or LOA and 874 patients underwent index revision after a prior LOA and/or MUA. The incidence of re-revision TKA at 5 years in patients with prior MUA and/or LOA (20% vs. 14%; OR 1.5, 95% confidence interval [CI] [1.3-1.9], p < 0.001) was significantly higher compared to patients with no prior MUA and/or LOA. Predictors of re-revision were age, ECI, and prior MUA and/or LOA (OR: 1.5, 95% CI [1.2-1.9]) (R² = 0.21; p < 0.01). No significant differences were observed between groups for PJI at 6 months and 5 years, 90-day hospital readmission, or DVT, blood transfusion, and AKI at 6 months.</p><p><strong>Conclusion: </strong>A history of prior MUA and/or LOA, older age, and ECI are associated with a significantly higher risk of re-revision TKA in patients that have a diagnosis of arthrofibrosis at the time of index revision TKA.</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":"3333-3338"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excellent midterm functional and clinical outcomes of bi-cruciate retaining versus cruciate retaining total knee arthroplasty: A prospective cohort study.","authors":"Soufyan Kalaai, Bert Boonen, Emiel H van Haaren, Rob P A De Bie, Jasper Most, Martijn G M Schotanus","doi":"10.1002/ksa.70287","DOIUrl":"10.1002/ksa.70287","url":null,"abstract":"<p><strong>Purpose: </strong>bi-cruciate retaining total knee arthroplasty (BCR-TKA) is recognised as an alternative to a Cruciate Retaining Total Knee Arthroplasty (CR-TKA) in the pursuit of reducing joint awareness and approaching a 'forgotten artificial knee joint'. The aim of this retrospective cohort study was to provide a short-term comparison on functional and clinical outcomes between BCR-TKA and CR-TKA in osteoarthritis patients.</p><p><strong>Methods: </strong>The cohort consisted of 61 BCR-TKA patients, matched for age, BMI and sex with 61 CR-TKA patients. They were operated on between 2014 and 2016. Patient-Reported Outcome Measurements, including the Forgotten Joint Score (FJS-12), Oxford Knee Score (OKS), Western Ontario and McMaster Osteoarthritis (WOMAC) and Visual Analogue Score (VAS) pain, were collected preoperatively and at 3-, 12-, 24-months and 5-years postoperatively. Additionally, domain-specific questionnaires were included, such as the FJS. Effect size for the FJS-12 was calculated at the 3-year follow-up to quantify the difference between BCR- and CR-TKA. Functional performance was additionally evaluated using a validated balance-based exergaming system, consisting of a pressure-sensitive balance platform delivering real-time visual feedback to quantify dynamic stability.</p><p><strong>Results: </strong>At 5-year follow-up, BCR-TKA showed significantly better patient-reported outcome measures (PROMs) than CR-TKA, including joint awareness, stiffness, function, pain and daily activity-related disabilities (FJS-12, OKS, WOMAC, VAS pain). In the subgroup completing exergaming assessment, BCR-TKA demonstrated superior dynamic stability (71.91% vs. 66.90%, p = 0.021). The 5-year survival rate was 98.4% for BCR-TKA and 95.1% for CR-TKA, with no significant difference in revision rates.</p><p><strong>Conclusion: </strong>BCR-TKA resulted in superior midterm joint awareness and functional outcomes compared to the CR-TKA. Additionally, objective data collected through exergaming demonstrated a positive trend in favour of BCR-TKA, further supporting its functional benefits. This study illustrates that the bi-cruciate retaining surgical technique for TKA is a promising step toward reducing joint awareness and achieving the 'forgotten' artificial knee. As ACL preservation may enhance rotational stability and proprioception, future research should incorporate high-resolution kinematic analyses such as 3D gait analysis.</p><p><strong>Level of evidence: </strong>Level III, therapeutic, retrospective cohort study.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"3399-3405"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with previous anterior cruciate ligament reconstruction achieve equally good outcomes after total knee arthroplasty: A Swedish registry-based study of 7755 patients.","authors":"Ioannis Syrikas, Ioannis Karikis, Neel Desai, Georgios Tsikandylakis","doi":"10.1002/ksa.70240","DOIUrl":"10.1002/ksa.70240","url":null,"abstract":"<p><strong>Purpose: </strong>Patients who have undergone anterior cruciate ligament reconstruction (ACLR) may later require total knee arthroplasty (TKA) due to osteoarthritis (OA). The impact of previous ACLR on patient-reported outcomes (PROs) after TKA remains uncertain. This study compared PROs 1 year after TKA between patients with knee OA with a history of ACLR (group of patients who underwent total knee arthroplasty after anterior cruciate ligament reconstruction [ACLROA]) and those without prior major surgery on the operated knee (controls).</p><p><strong>Methods: </strong>The Swedish Arthroplasty and Knee Ligament Registers were linked. ACLROA cases were matched 1:2 to controls by age, sex, BMI, ASA score, implant type and surgery time period. Preoperative and 1-year postoperative patient-reported outcome measures (PROMs) included five-point Likert scales for satisfaction and pain, knee injury and Osteoarthritis Outcome Score, 12-item short form (KOOS-12), and EuroQol 5-dimensions, 3-level version (EQ-5D-3L).</p><p><strong>Results: </strong>Cohort sizes varied for the analysis of PROMs: satisfaction was compared between 998 ACLROA patients and 1996 controls, pain between 441 and 882, KOOS-12 between 595 and 1190, and EQ-5D-3L between 551 and 1102, respectively. At 1 year postoperatively, satisfaction scores differed significantly (p = 0.016), with a higher proportion of ACLROA patients reporting being 'very satisfied' (53% vs. 49%), although pain scores did not differ (p = 0.263). The mean KOOS-12 total score was 59 ± 16 points for ACLROA patients and 58 ± 16 for the controls (p = 0.22). The mean EQ-5D-3L index was 0.89 ± 0.11 for ACLROA patients and 0.88 ± 0.11 for the controls (p = 0.019).</p><p><strong>Conclusions: </strong>Prior ACLR did not compromise early PROs after subsequent TKA. Satisfaction, pain relief, knee function and HRQoL were comparable between groups. Although some differences reached statistical significance, they did not exceed established thresholds for clinical relevance. Prior ACLR should therefore not be considered a negative prognostic factor regarding PROs during preoperative counselling for TKA.</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":"3377-3386"},"PeriodicalIF":5.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13502416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}