Knee最新文献

{"title":"Difference in time-course change in muscle cross-sectional area and knee and ankle functions between Japanese male patients who meet the return-to-sport criteria and those who do not meet it after triple-bundle anterior cruciate ligament reconstruction","authors":"Masayuki Kugimoto ,&nbsp;Kensuke Oba ,&nbsp;Namiko Sugai ,&nbsp;Kazuhiro Sasaki ,&nbsp;Yoshinari Sakaki ,&nbsp;Masaki Katayose ,&nbsp;Hideji Kura","doi":"10.1016/j.knee.2025.06.023","DOIUrl":"10.1016/j.knee.2025.06.023","url":null,"abstract":"<div><h3>Background</h3><div>The lower-extremity muscles are the main target of rehabilitation post-anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate time-course changes in the cross-sectional area of lower-extremity muscles (MCSA) among<!--> <!-->ACLR patients.</div></div><div><h3>Methods</h3><div>Twenty-seven male patients who underwent ACLR<!--> <!-->were included and grouped<!--> <!-->into<!--> <!-->PASS and non-PASS. PASS could achieve a ratio of injured-to-uninjured performance surpassing 90 % in all hop-tests and Lysholm score of ≥ 90. Those who failed to achieve even one of those conditions were designated as non-PASS. About MCSA, magnetic resonance images of the lower extremity on the injured side were obtained. Quadriceps, hamstrings, gastrocnemius, and soleus were manually surrounded<!--> <!-->at<!--> <!-->the slice featured<!--> <!-->the maximal MCSA<!--> <!-->for each muscle. Range of motion (ROM) and muscle strength of the knee and ankle<!--> <!-->were measured. All parameters were measured before surgery (PRE) and at 3, 6, 9, and 12 months post-ACLR<!--> <!-->(POST3/POST6/POST9/POST12, respectively). Knee stability was measured using KT-1000 in patients who underwent second-look surgery. The significance level was set at 5 %.</div></div><div><h3>Results</h3><div>At POST12, PASS (<em>n</em> = 14) exhibited greater ankle dorsiflexion ROM, knee extension strength, and ankle plantarflexion strength than non-PASS (<em>n</em> = 13). The interaction of MCSA was not detected, thus both data were integrated into a unified group for post-hoc tests.<!--> <!-->Quadriceps MCSA at POST12 was significantly larger than that at PRE. Hamstring, gastrocnemius, and soleus<!--> <!-->MCSAs<!--> <!-->at POST12<!--> <!-->did not have significant differences than those at PRE.</div></div><div><h3>Conclusions</h3><div>Restoration of ankle function and strength may be important for returning to sports.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 592-608"},"PeriodicalIF":1.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the amount of noise generated differ between manual and robotic TJA?","authors":"John D.D. Higgins ,&nbsp;Nabil Mehta ,&nbsp;Vasili Karas ,&nbsp;Denis Nam ,&nbsp;Craig J. Della Valle","doi":"10.1016/j.knee.2025.07.003","DOIUrl":"10.1016/j.knee.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate whether noise that is generated during manual and robotic-assisted total joint arthroplasty (TJA) differs and if that noise exceeds the Occupational Safety Health Administration (OSHA) action limits.</div></div><div><h3>Methods</h3><div>Personal dosimeters were used to record the decibel (dB) level during manual and robotic-assisted total hip and knee arthroplasty (THA/TKA). The primary surgeon wore the dosimeter on their person. All robotic procedures were performed with the use of image-based robotic arm aided technique. Peak decibel levels (LCPeak) and continuous decibel levels (LAeq) were captured in each procedure. 2-tailed student T-test was calculated to evaluate a difference between LAeq and LCPeak values between groups. An exposure calculator was used to calculate the 8-h Time-Weighted-Average (TWA).</div></div><div><h3>Results</h3><div>A total of 40 procedures were recorded; 10 for each robotic and manual THA and TKA. The mean LAeq dB levels for the robotic THA and TKA were 71.4 (SD 1.9) and 69.7 (SD 2.3) dB, and for manual THA and TKA levels were 69.8 (SD 2.4) and 71.3 (SD 2.4) dB. The max LCPeak decibel in each group did not exceed the OSHA peak sound pressure limit. Average LCPeak values in manual THA were higher than robotic THA (<em>P</em> = 0.01). Manual and robotic TKA values showed no difference. No groups exceeded the 8-h TWA limit.</div></div><div><h3>Conclusion</h3><div>TJA surgeons have significant noise exposure during surgery regardless of surgical technique; however, peak sound pressures and 8-h TWA dB levels discovered during mTJA and rTJA did not exceed OSHA limits.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 587-591"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and systemic safety of adding intra-articular dexmedetomidine as adjuvant therapy to bupivacaine for post-operative analgesia in knee arthroscopic procedures: a systematic review and meta-analysis","authors":"Muhammad Sohaib Khan ,&nbsp;Wania Moeen ,&nbsp;Muhammad Hamza Shuja ,&nbsp;Yasmine Adel Mohammed ,&nbsp;Wajeeh Ahmed Khan ,&nbsp;Mobeen Farooqi ,&nbsp;Mohamed Abd-ElGawad ,&nbsp;Mohammad Danish ,&nbsp;Muhammad Jansher ,&nbsp;Muhammad Umair Anjum ,&nbsp;Mohammed Mahmmoud Fadelallah Eljack ,&nbsp;Md Ariful Haque","doi":"10.1016/j.knee.2025.06.017","DOIUrl":"10.1016/j.knee.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Various analgesic methods have been evaluated for knee arthroscopy, but adequate pain control after arthroscopic procedures has been a challenge. This meta-analysis compares intra-articular bupivacaine with intra-articular bupivacaine plus dexmedetomidine, for post-op pain control after knee arthroscopy.</div></div><div><h3>Methods</h3><div>Adhering to the PRISMA guidelines we performed a thorough literature review and selected all the studies meeting our inclusion criteria (CD42024559371). Quality assessment was performed using the ROB II tool. A Random Effect (RE) model was used for analysis.</div></div><div><h3>Results</h3><div>Eight studies with 386 patients met the inclusion criteria. Combining Dexmedetomidine with Bupivacaine delays the need for first analgesic use compared to Bupivacaine alone (SMD: 4.09, 95 % CI [2.61 to 5.57], p &lt; 0.00001). Adverse events were minimal and comparable between groups in most studies. For patients who underwent knee arthroscopy under spinal anesthesia, Visual Analogue Scale scores at rest (VAS-r) and VAS scores during movement (VAS-m) showed significant differences favoring Bupivacaine and Dexmedetomidine from 4 h onward. VAS-m and VAS-r scores of patients who received general anesthesia displayed significant differences favoring Bupivacaine and Dexmedetomidine at 4 h only (SMD = −2.82 (95 % CI [−3.77 to −1.86], p &lt; 0.00001, I² = 55 %) and (SMD = −1.57 (95 % CI [−2.02 to −1.11], p &lt; 0.00001, I² = 0 %), respectively.</div></div><div><h3>Conclusion</h3><div>The combination of bupivacaine and dexmedetomidine for managing post-arthroscopic pain offers superior pain relief compared to bupivacaine alone, especially under spinal anesthesia. Further research is warranted to confirm these findings.</div></div><div><h3>Plain language summary</h3><div>Adding dexmedetomidine to bupivacaine significantly delays the need for the first analgesic dose after knee arthroscopy.</div><div>Pain relief is superior, especially under spinal anesthesia, with improved pain scores at rest and during movement from 4 h onward.</div><div>Adverse effects are minimal and comparable to bupivacaine alone, in most studies.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 534-545"},"PeriodicalIF":1.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ideal remaining meniscus width and risk factors for decrease in meniscus width after reshaping surgery in pediatric patients with discoid lateral meniscus","authors":"Kyeong Baek Kim ,&nbsp;Seong Man Jeon ,&nbsp;Joo-Hwan Kim ,&nbsp;Dong Jin Ryu ,&nbsp;Joon Ho Wang","doi":"10.1016/j.knee.2025.07.001","DOIUrl":"10.1016/j.knee.2025.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to determine the ideal remaining discoid meniscal width after reshaping surgery and to investigate the preoperative risk factors for changes in the meniscal width.</div></div><div><h3>Methods</h3><div>Twenty-nine pediatric patients (39 knees) who underwent arthroscopic reshaping for symptomatic discoid lateral meniscus (DLM) were retrospectively analyzed. MRI was performed postoperatively and at 6 months or 1–2 years. Changes in meniscal width were measured, and logistic regression and receiver operating characteristic (ROC) curve analyses identified risk factors and cut-off values.</div></div><div><h3>Results</h3><div>The meniscal width gradually decreased, particularly in the midbody (25.7 % at 6 months and 38.1 % at 1–2 years, postoperatively). Risk factors for width reduction included a complete-type DLM (<em>β</em> = 26.0, <em>P</em> = 0.036) and a smaller preoperative meniscal height (<em>β</em> = −4.51, <em>P</em> = 0.048). The ROC curve analysis indicated that a preoperative meniscal height of ≤ 3.3 mm and preserving a meniscal width of ≤ 8.5 mm after surgery may result in a residual meniscal width of less than 5 mm.</div></div><div><h3>Conclusion</h3><div>The ideal remaining meniscal width after reshaping surgery should be &gt; 8.5 mm to minimize the risk of postoperative degeneration. Surgeons should consider preserving additional meniscal tissue, especially in patients with risk factors such as complete DLM or a meniscal height of less than 3.3 mm, to improve long-term joint preservation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 577-586"},"PeriodicalIF":1.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of trochlear morphology over clinical outcomes after medial patellofemoral ligament reconstruction in patients with recurrent patellar dislocation: A retrospective cohort study","authors":"Vivek Pandey ,&nbsp;Mohana Suryan ,&nbsp;Bishak S. Reddy ,&nbsp;Kiran K.V. Acharya ,&nbsp;Anika Sait ,&nbsp;Ronak Mohanty ,&nbsp;Praveen Shastry","doi":"10.1016/j.knee.2025.07.004","DOIUrl":"10.1016/j.knee.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Medial patellofemoral ligament reconstruction (MPFLR) is the standard procedure for recurrent lateral patellar dislocation. While low-grade trochlear dysplasia (TD) can be managed conservatively, trochleoplasty is recommended for high-grade TD. However, its indications and efficacy remain debatable. This study evaluates the clinical outcomes of MPFLR without trochleoplasty in patients with TD.</div></div><div><h3>Methods</h3><div>57 patients who underwent MPFLR with a minimum follow-up of two years were included. TD was classified as low-grade (Dejour Type A) or high-grade (Types B, C, D). Patient-reported outcome measures (PROMs)—Kujala, Lysholm, and International Knee Documentation Committee scores were assessed pre and postoperatively and correlated with TD grades. Pre- and postoperative PROMs were also correlated with age, gender, patella alta, patellar cartilage defect, preoperative PROMs, and type of surgery.</div></div><div><h3>Results</h3><div>The mean age at surgery was 26.9 years, and 64.9 % were female. At a mean follow-up of 72 months, no patient experienced a recurrence of dislocation. Postoperative PROMs showed a significant improvement (<em>p</em> &lt; 0.001). Patients with low-grade TD had significantly better PROMs compared to those with high-grade TD (<em>p</em> &lt; 0.05). While increasing age, cartilage lesions, and trochlear dysplasia had a significant correlation with PROMs, regression analysis revealed that preoperative Kujala score and trochlear dysplasia were major determinants of PROMs. Furthermore, there was no effect of gender, patella alta, or type of surgery on PROMs.</div></div><div><h3>Conclusion</h3><div>Isolated MPFLR significantly improves PROMs and prevents recurrence, even in patients with high-grade TD. Among all variables, Trochlear dysplasia is the most influential determinant of PROMs.</div><div><strong>Level of evidence:</strong> III, retrospective cohort study.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 566-576"},"PeriodicalIF":1.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myostatin induces subchondral bone destruction and cartilage matrix degradation through upregulation of the Wnt/β-catenin pathway during patellofemoral osteoarthritis","authors":"Shengyang Zhang ,&nbsp;Hualiang Zhang ,&nbsp;Chengjun Zhong ,&nbsp;Quanwei Ding ,&nbsp;Chunxiao Zhang ,&nbsp;Xuesi Zhang ,&nbsp;Jianzeng Shen ,&nbsp;Songfeng Hu","doi":"10.1016/j.knee.2025.06.021","DOIUrl":"10.1016/j.knee.2025.06.021","url":null,"abstract":"<div><h3>Background</h3><div>The pathogenesis of patellofemoral osteoarthritis (PFOA) is not fully understood. The aim of this project was to investigate the role and mechanism of myostatin (MSTN) in PFOA pathogenesis.</div></div><div><h3>Methods</h3><div>Fifteen New Zealand white rabbits were divided into the following three groups: the control group, the model group and the MSTN-induced group. After 6 weeks, histopathological studies and osteoclast staining observations were carried out. The expression of genes related to osteoclast differentiation-related pathways, cartilage degradation and extracellular matrix deposition was also assessed. In addition, we investigated how macrophage transfection with a β-catenin overexpression plasmid affects osteoblast differentiation and downstream protein levels of RANKL and Smad2. MMP-13 levels were also detected to assess the extent of cartilage degradation.</div></div><div><h3>Results</h3><div>MSTN-induced subchondral bone and cartilage destruction in the patellofemoral joint was observed during histopathological examination, and osteoclast proliferation was observed via TRAP staining. The expression levels of β-catenin, MMP-13, Smad2, and RANKL were significantly increased, and the level of collagen II was significantly decreased in the samples. The expression levels of Smad2, RANKL and MMP-13 were significantly increased after the overexpression of β-catenin in macrophages.</div></div><div><h3>Conclusions</h3><div>MSTN contributes to the progression of PFOA, induces subchondral bone destruction and cartilage matrix degradation in the patellofemoral joint, and promotes osteoclast differentiation through upregulation of the Wnt/β-catenin pathway.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 546-556"},"PeriodicalIF":1.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of anterior stabilization in Bi-cruciate stabilized and posterior stabilized total knee arthroplasty during a weight-bearing extension activity","authors":"Michael T. LaCour ,&nbsp;Lauren A. Smith ,&nbsp;Harold E. Cates ,&nbsp;Michael Tim-yun Ong ,&nbsp;Patrick Shu-hang Yung ,&nbsp;Richard D. Komistek","doi":"10.1016/j.knee.2025.06.024","DOIUrl":"10.1016/j.knee.2025.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Bi-Cruciate Stabilized (BCS) and Posterior-Stabilized (PS) are two common total knee arthroplasties (TKA), where the BCS TKA offers mechanical substitution of both cruciate ligaments, while the PS TKA only offers substitution of the Posterior Cruciate ligament (PCL). The purpose of this study is to quantify whether anterior stabilization in TKA affects full extension kinematics by evaluating the weight-bearing kinematics for PS and BCS TKAs during a weight-bearing extension activity.</div></div><div><h3>Methods</h3><div>In-vivo 3D kinematics were determined for 81 subjects having a BCS (47) or PS (34) TKA implanted by two different surgeons. All subjects were asked to perform a weight-bearing step-up activity (SU) under fluoroscopic surveillance, and 3D-to-2D image registration was used to determine kinematics such as lateral anterior/posterior position, medial anterior/posterior position, axial rotation, and cam/post engagement.</div></div><div><h3>Results</h3><div>The BCS TKA subjects were able to reach greater hyperextension than the PS TKA subjects at full extension (<em>p</em> &lt; 0.0001). The BCS TKA was also positioned statistically more anterior than its PS counterpart at full extension (<em>p</em> &lt; 0.0001), and it also experienced more anterior motion of both condyles from maximum flexion to full extension than the PS TKA (<em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>The results in this study suggest that the BCS TKA design differences such as anterior stabilization could be beneficial for achieving more condylar motion and axial rotation near full extension, ultimately helping to recreate the native screw-home mechanism in TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 557-565"},"PeriodicalIF":1.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspensory screw fixation does not lead to increased tunnel widening in Anterior Cruciate Ligament reconstruction: a randomized controlled trial comparing interference and suspensory screw fixation","authors":"Gerrit J. Van de Pol ,&nbsp;Mark McMullan ,&nbsp;John M. Kinyanjui ,&nbsp;Peter Jenvey ,&nbsp;James Brown","doi":"10.1016/j.knee.2025.06.011","DOIUrl":"10.1016/j.knee.2025.06.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Fixation of Anterior Cruciate Ligament (ACL) grafts inside the tunnels can broadly be achieved by interference screw fixation or suspensory fixation. The aim of this study was to compare the two fixation techniques using Magnetic Resonance Imaging (MRI).</div></div><div><h3>Methods</h3><div>This Randomized Controlled Trial allocated patients into two groups: aperture fixation (AF) with interference screw and suspensory screw (SF) fixation with a tape-locking screw construct. The primary outcome was tunnel widening at 1 year. The secondary outcomes were KT-1000 knee laxity and patient reported outcomes by IKDC, Lysholm, KOOS-QoL, VAS and Tegner activity scores. Intraclass and interclass correlation for tunnel widening measurements were obtained and the effects of fixation technique on change in tunnel size was estimated using linear regression modelling.</div></div><div><h3>Results</h3><div>Sixty patients were included and randomized, 29 to AF and 31 to SF technique. Fifty-four patients completed clinical follow-up of whom 50 underwent MRI investigation. The baseline demographics did not differ between the groups. There was no significant difference in mean tibial or femoral aperture widening between the groups. The AF tibial widening was 46 % (SD 28 %) and the SF tibial widening was 38 % (SD 25 %) (P = NS). The AF femoral tunnel widening was 21 % (SD 44 %) compared to 42 % (SD 33 %) in SF (P = NS). The mean ACL graft size for the AF group was 7.4 mm (SD 0.5 mm) and 8.3 mm (SD 0.7 mm) for the SF group. The side-to-side KT-1000 laxity was comparable between the groups. Also, there was no significant difference between in patient reported outcome scores at 1 or 2 years for any of the clinical outcome measures.</div></div><div><h3>Conclusion</h3><div>This study demonstrates no difference in tunnel widening or clinical outcomes between suspensory screw fixation and aperture screw fixation. Clinically, this suggests that neither technique is inferior for surgeon choice, but longer term follow up and repeat imaging is required.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 503-509"},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physeal-sparing ACL reconstruction has equivalent survivorship and functional outcomes as transphyseal reconstruction but does not prevent growth disturbance: a systematic review of clinical and radiological outcomes","authors":"Muaaz Tahir ,&nbsp;Musab Al-Musabi ,&nbsp;Tahir Khaleeq ,&nbsp;Omar E.S. Mostafa ,&nbsp;Stephen Dalglish ,&nbsp;Amit Meena ,&nbsp;Darren de SA ,&nbsp;Peter D’Alessandro ,&nbsp;Nicolas Nicolaou ,&nbsp;Shahbaz S. Malik","doi":"10.1016/j.knee.2025.06.004","DOIUrl":"10.1016/j.knee.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>ACL reconstruction in the paediatric population presents unique challenges, owing to the ongoing skeletal growth. This systematic review aimed to compare the functional and radiological outcomes of transphyseal(TP), partial transphyseal(pTP) and physeal-sparing(PS) techniques.</div></div><div><h3>Methods</h3><div>A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting growth disturbances and/or functional outcomes. Pooled incidence of growth disturbance and graft rupture was calculated from available raw data using an inverse-variance random-effects model.</div></div><div><h3>Results</h3><div>The search identified 37 studies reporting on TP (<em>n</em> = 1389), 11 on PS (<em>n</em> = 867), 5 on pTP (<em>n</em> = 91), and 6 comparing both techniques [TP (<em>n</em> = 1668), pTP (<em>n</em> = 8), PS (<em>n</em> = 445)], with mean follow up ranging from 1.25 to 8 years. Mean age in TP studies ranged between 12–16.4, pTP; 10.7–13.6, and PS; 10.5–14.3 years. Pooled proportional incidence of leg length discrepancy was 1.3% in TP, 5.7% in pTP and 3.4% in the PS studies. Incidence of angular deformities was 1.5% in TP, 2.8% in pTP and 1.8% in the PS studies. Graft rupture rate was 6% in the TP studies, 9.8% in pTP, and 8.1% in the PS studies. Five comparative studies reported no differences in rates of graft rupture or growth disturbance.</div></div><div><h3>Conclusion</h3><div>TP, pTP and PS ACL reconstruction techniques result in similar patient reported outcomes and graft rupture rates. Patients who undergo pTP and PS reconstruction are generally younger, thus more susceptible to growth-related complications post-surgery. Larger comparative studies with age-matched cohorts are required to investigate this association further.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 510-533"},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can ChatGPT provide personalised responses for frequently asked questions regarding anterior cruciate ligament reconstruction?","authors":"Siyuan Zhang,&nbsp;Isaac Jeremiah Chua,&nbsp;Zhen Chang Liang,&nbsp;Khang Chiang Pang","doi":"10.1016/j.knee.2025.06.018","DOIUrl":"10.1016/j.knee.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Chat Generative Pre-trained Transformer (ChatGPT) has the potential to enhance healthcare delivery by providing accessible, high-quality medical information. However, no prior studies have evaluated its ability to provide personalised and patient-specific information. Our study aims to evaluate ChatGPT’s ability to provide personalised responses to frequently asked questions (FAQs) regarding anterior cruciate ligament (ACL) reconstruction.</div></div><div><h3>Methods</h3><div>We curated a list of 13 clinically relevant FAQs regarding ACL reconstruction and created four distinct patient profiles with varying demographics, comorbidities and activity demands. Each patient profile was entered separately as prompts into the latest version of ChatGPT (GPT-4o). ChatGPT’s responses to the FAQs were recorded and assessed independently by two orthopaedic consultants who graded the responses on a scale of 0–2 (0, 1, 2) based on their accuracy and degree that it was personalised to each patient profile.</div></div><div><h3>Results</h3><div>ChatGPT performed well in providing accurate and personalised responses, achieving a mean overall accuracy score of 1.85 and mean overall personalisation score of 1.90. It was able to provide personalised and patient-specific responses by customizing its recommendations to cater to the situation of each distinct patient – achieving mean personalisation scores of 1.96, 1.88, 1.92 and 1.81 for the four respective patient profiles.</div></div><div><h3>Conclusions</h3><div>In our study, ChatGPT demonstrated the ability to adapt to distinct patient profiles and provide highly personalised responses regarding ACL reconstruction. Despite potential ethical and regulatory challenges, the ability of AI chatbots to deliver individualized information and counselling is an exciting new frontier in personalised medicine which warrants further research.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 495-502"},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}