Knee最新文献

{"title":"Diagnostic accuracy of ChatGPT-4 in orthopedic oncology: a comparative study with residents","authors":"Hayden P. Baker,&nbsp;Sarthak Aggarwal,&nbsp;Senthooran Kalidoss,&nbsp;Matthew Hess,&nbsp;Rex Haydon,&nbsp;Jason A. Strelzow","doi":"10.1016/j.knee.2025.04.004","DOIUrl":"10.1016/j.knee.2025.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly being explored for its potential role in medical diagnostics. ChatGPT-4, a large language model (LLM) with image analysis capabilities, may assist in histopathological interpretation, but its accuracy in musculoskeletal oncology remains untested. This study evaluates ChatGPT-4′s diagnostic accuracy in identifying musculoskeletal tumors from histology slides compared to orthopedic surgery residents.</div></div><div><h3>Methods</h3><div>A comparative study was conducted using 24 histology slides randomly selected from an orthopedic oncology registry. Five teams of orthopedic surgery residents (PGY-1 to PGY-5) participated in a diagnostic competition, providing their best diagnosis for each slide. ChatGPT-4 was tested separately using identical histology images and clinical vignettes, with two independent attempts. Statistical analyses, including one-way ANOVA and independent t-tests were performed to compare diagnostic accuracy.</div></div><div><h3>Results</h3><div>Orthopedic residents significantly outperformed ChatGPT-4 in diagnosing musculoskeletal tumors. The mean diagnostic accuracy among resident teams was 55%, while ChatGPT-4 achieved 25% on its first attempt and 33% on its second attempt. One-way ANOVA revealed a significant difference in accuracy across groups (<em>F</em> = 8.51, <em>p</em> = 0.033). Independent t-tests confirmed that residents performed significantly better than ChatGPT-4 (<em>t</em> = 5.80, <em>p</em> = 0.0004 for first attempt; <em>t</em> = 4.25, <em>p</em> = 0.0028 for second attempt). Both residents and ChatGPT-4 struggled with specific cases, particularly soft tissue sarcomas.</div></div><div><h3>Conclusions</h3><div>ChatGPT-4 demonstrated limited accuracy in interpreting histopathological slides compared to orthopedic residents. While AI holds promise for medical diagnostics, its current capabilities in musculoskeletal oncology remain insufficient for independent clinical use. These findings should be viewed as exploratory rather than confirmatory, and further research with larger, more diverse datasets is needed to assess AI’s role in histopathology. Future studies should investigate AI-assisted workflows, refine prompt engineering, and explore AI models specifically trained for histopathological diagnosis.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 153-160"},"PeriodicalIF":1.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143891346","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":"Excellent long-term survivorship, radiologic and functional outcomes of operatively treated tibial plateau fractures","authors":"Diren Arsoy ,&nbsp;Laura J. Kleeblad ,&nbsp;Heather S. Haeberle ,&nbsp;Burak Altintas ,&nbsp;Johanna C.E. Donders ,&nbsp;Chloé L. Altchek ,&nbsp;Craig E. Klinger ,&nbsp;David S. Wellman ,&nbsp;David L. Helfet","doi":"10.1016/j.knee.2025.04.014","DOIUrl":"10.1016/j.knee.2025.04.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Long-term reports of operative tibial plateau fractures are scarce. This study aimed to define long-term knee survivorship with total knee arthroplasty (TKA) as the primary endpoint, assess radiographic and functional outcomes, and the relationship between reduction and functional outcomes.</div></div><div><h3>Methods</h3><div>Over 21 years, 170 patients were identified with operatively managed tibial plateau fractures treated by two orthopaedic trauma surgeons (109 unicondylar, 61 bicondylar). Survivorship analysis was performed to identify TKA conversion risk factors. Final follow-up radiographs were assessed for osteoarthritis severity, and clinical and functional outcomes were analyzed (KOS-ADLS, SF-12, and NRS-Pain).</div></div><div><h3>Results</h3><div>In unicondylar fractures, survivorship free of TKA was 93.6% (95% CI 88.7%–98.5%) at 10- and 15-years. Survivorship free of TKA for bicondylar fractures was 88.5% (95% CI 80.5%-96.5%) at 10-years and 84.3% (95% CI 73.1%–95.5%) at 15-years. Bicondylar involvement and non-anatomic reduction were independent risk factors for TKA (HR 2.7, HR 3.7; respectively). Bicondylar fractures demonstrated severe osteoarthritis more frequently than unicondylar (<em>p</em> = 0.043). At average 10-year follow-up (2–24 years), mean KOS-ADLS was 68.7 ± 12.5. Unicondylar patients had increased mean KOS-ADLS compared to bicondylar (71.4, 63.1, respectively; <em>p</em> = 0.005). Mean SF-12 was similar between groups.</div></div><div><h3>Conclusion</h3><div>Approximately 10% of operative tibial plateau fractures underwent TKA at 15-years; this rate approached 15% in bicondylar fractures. Bicondylar fractures had 2.7X higher TKA risk. In unicondylar fractures, non-anatomic reduction was associated with 3.7X higher TKA conversion risk. While both groups had similar SF-12 scores, bicondylar had significantly lower KOS-ADLS scores. Anatomic reduction is critical to prevent TKA conversion in unicondylar fractures.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 142-152"},"PeriodicalIF":1.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888043","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":"Revision of unicompartmental knee replacement can achieve equivalent outcomes to primary total knee replacement when revised for confirmed pathology","authors":"Thomas Christiner,&nbsp;Caitlin Chidlow,&nbsp;Simon Smith","doi":"10.1016/j.knee.2025.04.006","DOIUrl":"10.1016/j.knee.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>There is conflicting evidence regarding outcomes following revision of Unicompartmental Knee Replacement (UKR) to Total Knee Replacement (TKR). We hypothesise that a UKR can be successfully revised to a TKR with equivalent outcomes to primary TKR when revised for a well-defined revision diagnosis such as progression of arthritis.</div></div><div><h3>Methods</h3><div>From 2011 to 2023, the records of a surgeon were reviewed to identify patients who underwent revision of a UKR. Data collected included indications for revision, implant details, oxford knee scores (OKS) and survivorship. The OKS of the revision group was compared with a group of primary TKRs.</div></div><div><h3>Results</h3><div>A total of 21 revision UKR to TKR were included in the study. Primary Cruciate Retaining implants were used in all but 1 revision (Posterior Stabilised) with tibial sided augments or a stem required in 4. Survivorship of the revision UKRs was 95.2% at a mean of 4.37 years post-operatively. Mean OKS for the group was 37.65 with an improvement of 19.65 (<em>p</em> = 0.0001). Patients revised for a well-defined indication had 6-month mean OKS of 41.29, comparable to the primary TKR mean OKS of 39.5 (<em>p</em> = 0.535). Patients revised without confirmed pathology had mean 6-month OKS of 29.17 which was significantly worse than the remaining revision UKRs and primary TKRs (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>When a UKR is revised for a well-defined revision indication, patients can expect equivalent outcomes to primary TKR. This study also confirms that in most instances, a UKR can be successfully revised utilising primary implants with good midterm survivorship.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 118-125"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868981","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":"Prediction of coronal alignment in robotic-assisted total knee arthroplasty with artificial intelligence","authors":"Joseph Bosco,&nbsp;Colleen M. Wixted,&nbsp;Catherine Di Gangi,&nbsp;Daniel Waren,&nbsp;Morteza Meftah","doi":"10.1016/j.knee.2025.04.011","DOIUrl":"10.1016/j.knee.2025.04.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Robotic-assisted technologies provide the ability to avoid soft tissue release by utilizing more accurate bony cuts during total knee arthroplasty (TKA). However, the ideal limb alignment is not yet established. The aim of this study was to predict postoperative Coronal Plane Alignment of the Knee (CPAK) using corresponding native bony measurements.</div></div><div><h3>Methods</h3><div>This study analyzed a retrospective cohort of 530 primary robotic-assisted TKAs. Machine learning was utilized to predict appropriate target lateral distal femoral angles (LDFA) and medial proximal tibial angles (MPTA). Normalization of LDFA and MPTA alignments was performed using the min–max scaler operation on the training set with feature range [−1, 1] and repeated separately for the input and target distributions. A neural network of hidden dimensions (16, 8, 4) was trained via supervised learning to predict planned LDFA and MPTA values from preoperative LDFA and MPTA measurements.</div></div><div><h3>Results</h3><div>The model converged after 104 epochs and batch size 4 with mean squared error ±1.82°. The model’s regression agrees with the hypothesized change in preoperative to planned coronal alignment: valgus measurements are translated to neutral/aligned targets while varus alignments are translated to varus alignment of lesser severity. Evaluative statistics demonstrate this method for planning knee morphologies is significantly more accurate than making predictions about the mean (RMSE 1.440; R-squared 0.444; Nash Sutcliffe 0.579).</div></div><div><h3>Conclusion</h3><div>This study’s model provides accurate predictions for target knee alignment morphologies. Future work is warranted to evaluate this method’s usefulness for planning robotic TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 126-132"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868760","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":"Closing the tendon defect does not affect tendon length and patellar height after bone-patellar tendon-bone ACL reconstruction. A retrospective study using radiographs","authors":"Tom J. Kuijs ,&nbsp;Tim Truyers ,&nbsp;Bas van Dun ,&nbsp;Jasper Most ,&nbsp;Martijn G.M. Schotanus ,&nbsp;Edwin J.P. Jansen","doi":"10.1016/j.knee.2025.04.012","DOIUrl":"10.1016/j.knee.2025.04.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare radiological changes in patellar height (PH) and patellar tendon length (PTL) after closure and non-closure of the patellar donor site defect during anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft.</div></div><div><h3>Methods</h3><div>In this retrospective study a total of 63 patients was included. All patients underwent an arthroscopically assisted ACLR using the mid-third BPTB autograft. In 30 patients the tendon donor site defect was closed. In 33 patients the tendon donor site defect was left open. The paratenon was approximated in all patients. Lateral radiographs were taken preoperatively and at 3 months after ACLR. PH was determined using the Insall-Salvati, Caton-Deschamps and Blackburne-Peel methods. PTL was measured by determining the distance between the inferior pole of the patella and the superior aspect of the tibial tubercle.</div></div><div><h3>Results</h3><div>Overall, no change in patellar height were observed 3 months after ACLR for the Insal-Salvati (<em>p</em> = 0.54), Caton-Deschamps (<em>p</em> = 0.75) and Blackburne-Peel methods (<em>p</em> = 0.83). Also, the change in pre- and postoperative patellar height did not differ between the closure- and non-closure-group for the Insall-Salvati (<em>p</em> = 0.77), the Caton-Deschamps (<em>p</em> = 0.89) and the Blackburne-Peel (<em>p</em> = 0.70) methods.</div><div>Overall, no significant change in PTL was observed 3 months after ACLR (<em>p</em> = 0.78). Between both groups, no significant difference was observed for PTL over time (<em>p</em> = 0.98).</div></div><div><h3>Conclusion</h3><div>Patellar height and patellar tendon length did not significantly change after anterior cruciate reconstruction using bone-patellar tendon-bone autografts regardless of patellar donor site closure.</div><div><strong>Level of evidence:</strong> IIIb.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 133-141"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868857","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":"Comparable outcomes between lateral and medial unicompartmental arthroplasty at 2-year follow-up","authors":"Greg T. Minutillo,&nbsp;Alexander J. Acuña,&nbsp;Enrico M. Forlenza,&nbsp;Conor M. Jones,&nbsp;Tad L. Gerlinger","doi":"10.1016/j.knee.2025.04.013","DOIUrl":"10.1016/j.knee.2025.04.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Our study sought to evaluate (1) national rates of lateral unicompartmental knee arthroplasty (UKA) relative to medial UKA and compare, (2) 90-day medical complications and (3) 1- and 2-year surgical complications between matched lateral and medial UKA cohorts.</div></div><div><h3>Methods</h3><div>The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2016 and 2022. ICD-10 procedure codes were utilized to segregate patients into lateral and medial compartment cohorts. Patients undergoing bicompartmental-UKA were excluded. Lateral UKA patients were matched 1:4 to the medial UKA cohort based on age, sex, Elixhauser Comorbidity Index (ECI), and the following comorbidities: diabetes, tobacco use, and obesity. Medical complications at 90-days and surgical complications at 1- and 2-years post-operatively were compared utilizing multivariate logistic regression.</div></div><div><h3>Results</h3><div>Over the study period, medial UKAs were performed at a 14.17 to 1 ratio compared to lateral UKAs. Lateral UKA patients demonstrated a higher incidence of acute periprosthetic joint infection (PJI) at 90-days post-operatively (OR: 3.919, 95% CI: 1.075–14.283; <em>p</em> = 0.033). However, no differences were seen for the remaining medical outcomes. There were no differences in revision for PJI (OR: 2.071, 95% CI: 0.764–5.162; <em>p</em> = 0.192) or in all-cause revision rates (OR: 1.956, 95% CI: 0.973–3.768; <em>p</em> = 0.050) at 2-years.</div></div><div><h3>Discussion</h3><div>Although there was a higher rate of PJI in the acute post-operative setting for patients undergoing lateral UKA, the present analysis demonstrates largely comparable outcomes between our studied cohorts. These findings serve to inform adult reconstruction surgeons considering lateral unicompartmental arthroplasty in appropriately selected patients with isolated lateral compartment osteoarthritis of the knee.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 112-117"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868858","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 methods of quantifying knee laxity in the ACL injured population: A review","authors":"Natasha E.H. Allott,&nbsp;Fiyinfoluwa Timothy Oladipo,&nbsp;Katie L. Cox,&nbsp;Claire M. Finnerty,&nbsp;Matthew S. Banger,&nbsp;Alison H. McGregor","doi":"10.1016/j.knee.2025.04.009","DOIUrl":"10.1016/j.knee.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior Cruciate Ligament (ACL) injuries equate to a large proportion of Emergency Department attendances worldwide and continue to place significant burden on primary care services. Diagnosis of this injury relies on subjective physical examination tests such as the Lachman’s and Pivot Shift test; results of which can vary depending on clinician experience and individual interpretation.</div></div><div><h3>Aims</h3><div>This review seeks to identify current approaches past and present to objectively measuring knee laxity caused by ACL injury and appraise the methods of the current apparatus’ available to do this within the clinical setting.</div></div><div><h3>Methods</h3><div>A literature search across three databases (MEDLINE, EMBASE and CINAHL) was conducted, and an inclusion and exclusion criteria applied to the 780 retrieved texts to extract 19 papers fulfilling this objective. Articles published after the year 2000 were considered. The main technologies noted that quantified knee laxity were arthrometry devices, inertial motion units (IMUs), electromagnetic measurement systems (EMS), optical motion capture systems (OMC), and dynamic MRI.</div></div><div><h3>Conclusion</h3><div>Despite there being a multitude of technologies with capability to accurately measure aspects of knee laxity, there is no agreed objective measure for doing so in the clinical setting. This highlights a need for improved collaboration between the relevant stakeholders to achieve this aim.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 85-103"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868855","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":"Corticosteroids versus platelet-rich plasma injections for knee osteoarthritis: Where is there more evidence? A systematic review of 60 years of literature","authors":"Angelo Boffa ,&nbsp;Giacomo Moraca ,&nbsp;Alessandro Sangiorgio ,&nbsp;Alessandro Di Martino ,&nbsp;Alessandro Bensa ,&nbsp;Giuseppe Filardo","doi":"10.1016/j.knee.2025.03.010","DOIUrl":"10.1016/j.knee.2025.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Corticosteroid (CS) injections are often recommended by international societies for knee osteoarthritis (OA) treatment, but platelet-rich plasma (PRP) has shown higher safety and efficacy in comparative analyses. Despite this, PRP use is often not endorsed by scientific societies due to perceived insufficient body of evidence. This study aims to quantify clinical data documenting CS and PRP intra-articular injections for knee OA.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted on CS and PRP injections for knee OA. The search, performed in March 2024, used PubMed, Cochrane, and Web of Science databases, following PRISMA and Cochrane guidelines. Data collected included publication trends, number of articles, patients evaluated, and study designs documenting CS or PRP injections.</div></div><div><h3>Results</h3><div>Of 16,979 records, 356 studies were analyzed, covering 24,435 knee OA patients. Both treatments showed an increasing publication trend, with PRP surpassing CS in 2020. The analysis included 9,322 CS patients and 15,113 PRP patients. Among CS studies, there were 103 RCTs with 5,478 patients, 18 comparative studies with 1,095 patients, and 31 case series with 2,749 patients. Among PRP studies, there were 119 RCTs with 6,028 patients, 33 comparative studies with 2,011 patients, and 72 case series with 7,074 patients.</div></div><div><h3>Conclusions</h3><div>PRP injections for knee OA have been documented in more studies and in larger patient numbers compared with CS injections. The higher number of high-level trials for PRP, combined with the lower safety and efficacy documented for CS by previous meta-analyses directly comparing the two products, strongly suggests reconsidering current guidelines that favor CS, highlighting PRP’s body of evidence and the potential role in the effective and safe treatment of knee OA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 104-111"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868761","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":"Evaluating artificial intelligence performance in medical image analysis: Sensitivity, specificity, accuracy, and precision of ChatGPT-4o on Kellgren-Lawrence grading of knee X-ray radiographs","authors":"Mustafa Hüseyin Temel ,&nbsp;Yakup Erden ,&nbsp;Fatih Bağcıer","doi":"10.1016/j.knee.2025.04.008","DOIUrl":"10.1016/j.knee.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>Recent advancements in artificial intelligence, including ChatGPT, have enabled its application in medical image analysis.This study aimed to evaluate the sensitivity and specificity of ChatGPT in assessing knee osteoarthritis (KOA) radiographs using the Kellgren-Lawrence (KL) grading system.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at Izzet Baysal Physical Therapy and Rehabilitation Training and Research Hospital. Anteroposterior weight-bearing knee X-rays from 226 patients (excluding 26 due to prostheses or foreign bodies) were evaluated. Two specialists assessed the radiographs using the KL grading system, with a third specialist resolving discrepancies. ChatGPT-4o evaluated the images using the prompt, “Please evaluate this knee anteroposterior radiographic image according to the Kellgren-Lawrence grading system.” Diagnostic accuracy metrics, receiver operating characteristic (ROC) curves, and area under the curve (AUC) values were calculated.</div></div><div><h3>Results</h3><div>ChatGPT showed low sensitivity across all grades. The accuracy of the model was calculated to be 0.230. ROC AUC values were low for all grades, for KL grade 0 at 0.53, KL grade 1 at 0.56, KL grade 2 at 0.43, KL grade 3 at 0.54, KL grade 4 at 0.49, micro-average at 0.52, macro-average at 0.51, and weighted average at 0.52.</div></div><div><h3>Conclusions</h3><div>The findings of this study highlight the model’s inability to reliably distinguish between KL grades, suggesting that its utility in this specific classification task is limited and requires further optimization to improve its predictive accuracy and reliability. The model’s current limitations preclude its use as a reliable diagnostic tool. Further refinement is necessary to improve its clinical applicability.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 79-84"},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859874","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":"Fractures in Oxford unicompartmental knee arthroplasty are associated with medial positioning of the femoral component – A retrospective cohort study","authors":"Julius Watrinet ,&nbsp;Daniel Berger ,&nbsp;Philipp Blum ,&nbsp;Paul Reidler ,&nbsp;Joerg Arnholdt ,&nbsp;Sebastian Siebenlist ,&nbsp;Rolf Schipp ,&nbsp;Wolfgang Reng ,&nbsp;Matthias P. Fabritius","doi":"10.1016/j.knee.2025.04.007","DOIUrl":"10.1016/j.knee.2025.04.007","url":null,"abstract":"<div><h3>a. Purpose</h3><div>This study aimed to evaluate the relationship between femoral component positioning and the incidence of periprosthetic fractures in Oxford unicompartmental knee arthroplasty (UKA), as well as the effects of component size and preoperative coronal lower limb alignment on fracture risk.</div></div><div><h3>b. Methods</h3><div>A retrospective single-center study was conducted, including 1,642 cases of medial UKA performed between July 2015 and December 2022. Patients with symptomatic isolated medial knee osteoarthritis meeting specific selection criteria underwent surgery using either press-fit or cemented fixation based on individual bone quality. Radiographic evaluations were performed preoperatively and postoperatively to assess component positioning and alignment. Statistical analyses included the Mann-Whitney <em>U</em> test, Wilcoxon test, and Pearson’s chi-squared test to compare fracture and non-fracture groups.</div></div><div><h3>c. Results</h3><div>Out of 1,642 cases, 15 (0.9%) experienced a tibial periprosthetic fracture. These fractures were significantly associated with medial positioning of the femoral component and smaller component sizes. The fracture group had a higher mean age (74.3 ± 6.2 years) and a higher percentage of females (80%) compared to the non-fracture group. No significant differences were observed in Body Mass Index (BMI) or preoperative coronal alignment between the groups.</div></div><div><h3>d. Conclusion</h3><div>Medial positioning of the femoral component and smaller component sizes in Oxford UKA are associated with an increased risk of tibial periprosthetic fractures. Accurate implant positioning is crucial to minimize fracture risk and improve clinical outcomes. These findings underscore the importance of precise surgical techniques and may inform future guidelines for UKA procedures.</div><div>Trial registration: This study was retrospectively registered and ethical approval was waived by the local ethical committee (No. 22-0990KB).</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 70-78"},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859873","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}