Knee最新文献

{"title":"Location of the popliteal artery during medial and lateral distal femoral osteotomy: A retrospective study using contrast-enhanced computed tomography-based three-dimensional models","authors":"Shu Takagawa ,&nbsp;Yohei Yukizawa ,&nbsp;Ayahiro Kadowaki ,&nbsp;Shota Higashihira ,&nbsp;Yutaka Inaba ,&nbsp;Naomi Kobayashi","doi":"10.1016/j.knee.2025.06.022","DOIUrl":"10.1016/j.knee.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative popliteal artery injury during distal femoral osteotomy (DFO) is a fatal complication that requires detailed anatomical examination. We evaluated the location of the popliteal artery in medial and lateral DFO using contrast-enhanced computed tomography (CT)-based three-dimensional (3D) models.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 30 knees that underwent contrast-enhanced CT primarily for cardiovascular disease. Osteotomy planes for medial and lateral DFO were created using 3D models. The popliteal artery distance was measured as the distance between two points where the bone and blood vessels were closest to each other, the location of the popliteal artery was determined by dividing the distance from the starting point to the nearest arterial point by the total osteotomy distance, and the angle closest to popliteal artery was defined as the angle formed by three points: the osteotomy starting point and the points near the bone and popliteal artery, in both models.</div></div><div><h3>Results</h3><div>The shortest distance from the artery to the osteotomy line did not differ significantly between the lateral DFO (13.5 ± 3.0 mm) and medial DFO groups (14.2 ± 3.5 mm). The ratio of popliteal artery location was significantly closer to the osteotomy starting point in the lateral DFO group (0.29 ± 0.12) than in the medial DFO group (0.45 ± 0.13) (<em>P</em> &lt; 0.001). The angle closest to the artery was significantly larger in the lateral DFO group (31.1 ± 6.9°) than in the medial DFO group (26.9 ± 7.7°) (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>In distal femoral osteotomies, the popliteal artery requires more attention during medial DFO than during lateral DFO.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 488-494"},"PeriodicalIF":1.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634086","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":"Low-dose exposure to tranexamic acid has no significant toxic effect on human cartilage","authors":"Arash Sherafatvaziri ,&nbsp;Mohammad Hossein Nabian ,&nbsp;Fardis Vosoughi ,&nbsp;Elham Madreseh ,&nbsp;Alireza Mirzamohamadi ,&nbsp;Ramin Shayan-moghadam","doi":"10.1016/j.knee.2025.06.019","DOIUrl":"10.1016/j.knee.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies have raised concerns about the potential cytotoxic effects of tranexamic acid (TXA) on cartilage. This study aimed to evaluate the safety of low-dose TXA exposure on human cartilage.</div></div><div><h3>Method</h3><div>In this ex-vivo study, 30 patients with a varus osteoarthritic knee undergoing total knee arthroplasty (TKA) were enrolled. During the surgery, a set of six osteochondral plugs was harvested from the apparently intact lateral condyle of each patient’s femur, resulting in a total of 180 plugs. Subsequently, all three plugs of each set were randomly exposed to one of the TXA treatment groups: 1 mg/ml (TI group), 5 mg/ml (TV group), or 10 mg/ml (TX group) of TXA. The remaining three plugs of each set were assigned to the control group and exposed to 0.9 % saline as a match for comparison. The effects of TXA dose and exposure time on cell viability were assessed using acridine orange/propidium iodide staining at baseline, 3, and 6 h post-exposure.</div></div><div><h3>Results</h3><div>Cell viability decreased over time in the TI, TV, TX, and control groups compared with their baselines (<em>P</em> = 0.006, <em>P</em> &lt; 0.001, <em>P</em> = 0.001, <em>P</em> &lt; 0.001, respectively). However, the differences in the trend of decline were not statistically significant between groups (<em>P</em> = 0.3), and direct comparisons among TXA concentrations and saline control at baseline, 3, and 6 h after exposure showed no statistically significant difference in cell death (<em>P</em> = 0.538, <em>P</em> = 0.256, <em>P</em> = 0.287, respectively).</div></div><div><h3>Conclusions</h3><div>Exposure to low-dose TXA (≤10 mg/ml) for up to 6 h did not cause significant toxic effects on human cartilage.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 479-487"},"PeriodicalIF":1.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632120","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":"Management of bone loss in revision total knee arthroplasty with tantalum cones: Primary aseptic revision versus multiple revisions","authors":"A. Zampieri ,&nbsp;S. Putman ,&nbsp;R. Erivan ,&nbsp;H. Behal ,&nbsp;H. Migaud ,&nbsp;G. Pasquier ,&nbsp;J. Dartus","doi":"10.1016/j.knee.2025.06.016","DOIUrl":"10.1016/j.knee.2025.06.016","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The increasing number of revisions following total knee arthroplasty (TKA) has led to the appearance of new challenges, including the management of bone defects. The use of porous tantalum cones is one of the options to address this bone loss.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;We carried out a retrospective study to compare the medium-term outcomes of single and multiple TKA revisions in the context of massive bone defects using tantalum cones. We analyzed: (1) the survival of the revision implants, (2) osseointegration of the cone, (3) the clinical and functional outcomes, (4) complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Between July 2011 and May 2019, 79 metaphyseal reconstructions (MRs) were performed in 58 patients (mean age 68 ± 11 (41–89)) who received tantalum cones during the procedure. Revisions for infection were excluded. The massive bone defects were classified as Anderson Orthopaedic Research Institute types 2B/3. The cone had to be removed in 12 patients (16 MRs). Implant survival free of all-cause revision and cone survival free of aseptic loosening were calculated. Osseointegration of the cones was determined on radiographs. A subset of patients (n = 46) underwent a clinical assessment including the OKS, KSS, KOOS, satisfaction level and knee flexion. All of the patients (n = 58) underwent a radiological assessment. Complications were documented during the follow up period.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean follow up was 73.1 months ± 29.8 (12–143). In all, 91 cones (48 at the femur and 43 in the tibia) had been implanted during 79 MR procedures: 40 in the primary revision group (R-primary) and 39 in the multiple revision group (R-multiple). Survivorship of the implant free of all-cause revision at 6 years was better in the R-primary group, 97.5 % (95 %CI: 93 % to 100 %) than in the R-multiple group, 70.5 % (95 %CI: 57 % to 87 %) (&lt;em&gt;P&lt;/em&gt; &lt; 0.01). Survivorship of the cone free of aseptic loosening at 6 years was comparable between the two groups: 100 % (95 %CI 100 % to 100 %) for R-primary and 96.8 % (95 %CI 91 % to 100 %) for R-multiple (&lt;em&gt;P&lt;/em&gt; = 0.26). At the final assessment, 10 of 91 cones had no bone ingrowth; all of them were in the R-multiple group (&lt;em&gt;P&lt;/em&gt; = 0.012). The functional outcomes were better in the R-primary group.&lt;!--&gt; &lt;!--&gt;The mean OKS was 31.5 ± 8.7 (16–45) vs. 25.7 ± 9.1 (9–41) in the R-multiple group (&lt;em&gt;P&lt;/em&gt; = 0.014). The mean KSS global was 146.2 ± 32.3 (69–197) vs. 136.8 ± 20.9 (98–182) in the R-multiple group (&lt;em&gt;P&lt;/em&gt; = 0.082). The KOOS global was 61.3 ± 17 (26–84) vs. 48.3 ± 15.7 (18–79) in the R-multiple group (&lt;em&gt;P&lt;/em&gt; &lt; 0.01). In the R-primary group, 78 % of patients (22/28) were satisfied or very satisfied with the outcome vs. 61 % (11/18) in the R-multiple group (&lt;em&gt;P&lt;/em&gt; = 0.25). The mean knee flexion at the final assessment was 102.7 ± 24.2 (20–125) in the R-primary group vs. 98.3 ± 16.5 (70–120) in the R-multiple group ","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 467-478"},"PeriodicalIF":1.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605327","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":"Physical measures predicting better outcomes in knee arthroplasty patients: a secondary analysis of the CORKA randomised controlled trial","authors":"Benjamin David Weedon ,&nbsp;Jon Room ,&nbsp;Karen Louise Barker","doi":"10.1016/j.knee.2025.06.014","DOIUrl":"10.1016/j.knee.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Evaluate functional and participation predictors of outcome following knee arthroplasty (KA) focusing on the<!--> <!-->International Classification of Functioning, Disability, and Health framework.</div></div><div><h3>Methods</h3><div>Secondary analysis of the CORKA randomised controlled trial, which included patients undergoing KA. The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) was assessed using a linear mixed-effects model. Secondary outcomes with baseline assessments of the Physical Activity Scale for the Elderly (PASE), Figure of 8 Walk Test (F8WT), 30-Second Chair Stand Test (30CST), and single-leg stance on the operated leg (SLS) were used to predict functional and participation outcomes at 6, 12, and 24-months using multiple linear regression models.</div></div><div><h3>Results</h3><div>621 participants were recruited (males 250, females 371), with a mean age of 70 ± 8 years. SLS significantly predicted LLFDI function across all time points (6-months 0.14, 0.06–0.22, <em>p</em> = 0.001, 12-months 0.18, 0.09–0.27, <em>p</em> &lt; 0.001, 24-months 0.21, 0.11–0.31, <em>p</em> &lt; 0.001), while PASE predicted it at 6-months 0.02, 0.01–0.03, <em>p</em> = 0.006 and 24-months 0.02, 0.004–0.04, <em>p</em> = 0.012. PASE also predicted disability frequency at all intervals(6-months 0.03, 0.02–0.05, <em>p</em> &lt; 0.001, 12-months 0.04, 0.02–0.05, <em>p</em> &lt; 0.001, 24-months 0.03, 0.01–0.05, <em>p</em> = 0.001), with SLS and F8WT as significant predictors at 12 and 24-months, respectively (SLS 12-months 0.13, 0.04–0.21, <em>p</em> = 0.005, F8WT 24-months −0.37, −0.73 to −0.01, <em>p</em> = 0.044). Only PASE (12-months 0.04, 0.01–0.07, <em>p</em> = 0.003, 24-months 0.04, 0.01–0.07, <em>p</em> = 0.003) and SLS (12-months 0.26, 0.10–0.42, <em>p</em> = 0.002, 24-months 0.28, 0.12–0.44, <em>p</em> = 0.001) predicted disability limitation at 12 and 24-months.</div></div><div><h3>Conclusions</h3><div>Findings suggest functional measures may be used to predict short-term outcomes, while participation measures better suit long-term outcomes after KA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 459-466"},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595639","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 risk of early revision after trainee led primary unicompartmental and total knee replacement","authors":"Daniel J. Howgate ,&nbsp;Joseph Dixon ,&nbsp;Benjamin J.L. Kendrick ,&nbsp;Andrew J. Price ,&nbsp;Abtin Alvand","doi":"10.1016/j.knee.2025.06.010","DOIUrl":"10.1016/j.knee.2025.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Orthopaedic trainees must demonstrate competence in performing major joint replacement. This study aimed to determine the impact of lead surgeon grade and level of supervision for trainee led operations on the incidence of early revision procedures following elective primary knee replacement.</div></div><div><h3>Methods</h3><div>Data from the National Joint Registry was obtained for all primary elective total (TKR) and partial (UKR) knee replacements performed within a single NHS University Teaching Hospital from 2007 to 2021. Multivariate logistic regression was used to determine the risk of all cause revision within 1-year of the index procedure in relation to surgeon grade and level of supervision for trainee led (TL) operations.</div></div><div><h3>Results</h3><div>9,931 primary knee replacements (KR) were undertaken, of which 4850 (48.8 %) were UKR. Revision procedures were performed in 109 (1.1 %) patients within 1-year of their index operation. The risk of revision was not significantly different for consultant-led (CL) or TL operations (OR 0.84, CI 0.55–1.26, <em>p</em> = 0.4). In comparison to CL operations, no difference was observed in the risk of revision for either consultant-supervised trainee (TS, OR 0.83, CI 0.49–1.35, <em>p</em> = 0.7) or non-consultant supervised trainee (TU, OR 0.84, CI 0.46–1.43, <em>p</em> = 0.7) operations. These trends remained on sub-analysis for both UKR and TKR operations.</div></div><div><h3>Conclusions</h3><div>No differences were observed in the incidence of revision within 1-year of primary KR between consultant led and trainee led operations. These findings suggest that training surgeons in both TKR and UKR operations is not associated with an increased risk of early adverse patient outcomes requiring revision surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 449-458"},"PeriodicalIF":1.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580439","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":"Neuromuscular control of the knee and hip and its relationship with function in women with patellofemoral pain","authors":"Isabela Vitória Souza Araújo ,&nbsp;Thiago André Pereira Gonçales ,&nbsp;Vera Lucia Freitas Carvalho ,&nbsp;Beatriz Signori Caetano ,&nbsp;Luisa Pereira Fernandes ,&nbsp;Deborah Hebling Spinoso","doi":"10.1016/j.knee.2025.06.009","DOIUrl":"10.1016/j.knee.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>The combined assessment of subjective and objective measures is essential to understand functional impairment in individuals with patellofemoral pain (PFP) and to guide appropriate rehabilitation strategies. The objective to was investigate the relationship between objective and subjective function and neuromuscular control of the hip and knee in women with PFP and asymptomatic women.</div></div><div><h3>Methods</h3><div>Data were collected from 30 women (22.56 ± 4.21 years) with PFP and 30 asymptomatic women (21.10 ± 1.68). Initially, anthropometric data were collected and the Anterior Knee Pain Scale (AKPS) was applied. Subsequently, objective function was assessed using four tests: step descent, single-legged chair rise, anterior hop, and lateral hop. On the second day, knee extensor, hip extensor, and hip abductor torque were assessed on an isokinetic dynamometer. The protocol consisted of 3 concentric contractions at a speed of 60°/sec for the knee joint and 30°/sec for the hip joint. For statistical analysis, the independent <em>t</em>-test was applied to compare variables between groups and the Pearson correlation test, with a significance level of <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Women with PFP have a deficit in the ability to produce maximum hip and knee force during concentric contractions (<em>p</em> &lt; 0.05). Moderate correlations were found in strength and TDT and functional performance.</div></div><div><h3>Conclusion</h3><div>The deficit in the ability to produce muscle strength and power of the hip and knee negatively interferes with functional performance and should therefore be considered in rehabilitation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 431-438"},"PeriodicalIF":1.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572806","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":"Incidence of concomitant intra- and extra-articular lesions and procedures in patients undergoing primary and subsequent revision single-stage or 2-stage revision anterior cruciate ligament reconstruction: a matched retrospective cohort study","authors":"Anna M. Ifarraguerri ,&nbsp;Alexander B. White ,&nbsp;George D. Graham ,&nbsp;Kennedy K. Gachigi ,&nbsp;Alexander N. Berk ,&nbsp;Michael S. Collins ,&nbsp;David P. Trofa ,&nbsp;Dana P. Piasecki ,&nbsp;James E. Fleischli ,&nbsp;Patrick N. Siparsky ,&nbsp;Bryan M. Saltzman","doi":"10.1016/j.knee.2025.06.013","DOIUrl":"10.1016/j.knee.2025.06.013","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compares the concomitant intra- and extra-articular pathologies in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) to their subsequent single or 2-stage revision ACLR<strong>.</strong></div></div><div><h3>Methods</h3><div>Patients from 2012 to 2021 with minimum two-year follow-up after single-stage revision ACLR were matched with patients who underwent 2-stage revision ACLR by age, sex, and body mass index. Concomitant pathologies and procedures were compared from primary to single or 2-stage revision ACLR. The incidence of concomitant knee pathologies and procedures at the time of primary and revision ACLR was compared between the two groups.</div></div><div><h3>Results</h3><div>Following primary ACLR<strong>,</strong> 27 patients had single-stage revision ACLR and 27 had 2-stage revision ACLR. At the time of revision surgery, 2-stage revision ACLR had increased incidence of multi-ligamentous injury and meniscus repair. Rates of chondral injury alone and chondral injury plus concomitant meniscal injury increased significantly from primary to 2-stage revision ACLR. No significant change in the incidence of concomitant pathologies or procedures was found at primary ACLR to single-stage revision ACLR.</div></div><div><h3>Conclusion</h3><div>Patients with 2-stage revision ACLR are more likely to have concomitant multi-ligamentous pathologies and meniscal repair at the time of revision. Additionally, 25.9% of patients developed chondral pathologies and 18.55% developed both chondral and meniscal lesions from primary ACLR to 2-stage revision ACLR, raising concern about the long-term outcomes of these patients.</div></div><div><h3>Level of evidence</h3><div>Retrospective Cohort; 3.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 439-448"},"PeriodicalIF":1.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572807","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":"ChatGPT-4.0 and DeepSeek-R1 does not yet provide clinically supported answers for knee osteoarthritis","authors":"Haodong Wu ,&nbsp;Shuxin Yao ,&nbsp;Huanli Bao ,&nbsp;Yishun Guo ,&nbsp;Chao Xu ,&nbsp;Jianbing Ma","doi":"10.1016/j.knee.2025.06.007","DOIUrl":"10.1016/j.knee.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Large Language Models (LLMs) such as ChatGPT-4.0 and DeepSeek-R1 provide advanced natural language capabilities, but they also raise concerns regarding accuracy in medical applications. There is a lack of systematic evaluation of their performance against orthopedic guidelines, particularly for knee osteoarthritis (KOA). This study assessed the accuracy and consistency of these LLMs in relation to the most recent Chinese clinical practice guidelines for KOA.</div></div><div><h3>Methods</h3><div>Queries regarding 17 guideline-recommended KOA therapeutic strategies were posed to ChatGPT-4.0 and DeepSeek-R1. Two independent reviewers evaluated response concordance (Concordance, Discordance, or No Concordance) with guidelines. Inter-rater reliability was assessed using Cohen’s kappa coefficient. A chi-square test was employed to compare the response patterns between the two models.</div></div><div><h3>Results</h3><div>ChatGPT-4.0 showed 59 % concordance; DeepSeek-R1 achieved 71 %. Both models gave inconsistent recommendations for ozone therapy and arthroscopy. ChatGPT-4.0 had five inconsistent responses; DeepSeek-R1 had three. Inter-rater agreement was high (κ = 0.90 and 0.86). No significant difference was found in concordance rates (P = 0.7; P = 1). Only DeepSeek-R1 provided references (38 in total), but just 8 were fully verifiable.</div></div><div><h3>Conclusion</h3><div>Neither ChatGPT-4.0 nor DeepSeek-R1 consistently produced responses aligned with evidence-based clinical guidelines. These findings highlight the need for cautious interpretation of medical advice generated by current AI platforms, both by clinicians and patients.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 386-396"},"PeriodicalIF":1.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556805","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":"Unveiling knee morphology with SHAP: shaping personalized medicine through explainable AI","authors":"Berke Cansiz ,&nbsp;Serdar Arslan ,&nbsp;Muhammet Zeki Gültekin ,&nbsp;Gorkem Serbes","doi":"10.1016/j.knee.2025.06.012","DOIUrl":"10.1016/j.knee.2025.06.012","url":null,"abstract":"<div><h3>Purpose:</h3><div>This study aims to enhance personalized medical assessments and the early detection of knee-related pathologies by examining the relationship between knee morphology and demographic factors such as age, gender, and body mass index. Additionally, gender-specific reference values for knee morphological features will be determined using explainable artificial intelligence (XAI).</div></div><div><h3>Methods:</h3><div>A retrospective analysis was conducted on the MRI data of 500 healthy knees aged 20–40 years. The study included various knee morphological features such as Distal Femoral Width (DFW), Lateral Femoral Condyler Width (LFCW), Intercondylar Femoral Width (IFW), Anterior Cruciate Ligament Width (ACLW), and Anterior Cruciate Ligament Length (ACLL). Machine learning models, including Decision Trees, Random Forests, Light Gradient Boosting, Multilayer Perceptron, and Support Vector Machines, were employed to predict gender based on these features. The SHapley Additive exPlanation was used to analyze feature importance.</div></div><div><h3>Results:</h3><div>The learning models demonstrated high classification performance, with 83.2% (±5.15) for classification of clusters based on morphological feature and 88.06% (±4.8) for gender classification. These results validated that the strong correlation between knee morphology and gender.</div></div><div><h3>Conclusion:</h3><div>The study found that DFW is the most significant feature for gender prediction, with values below 78–79 mm range indicating females and values above this range indicating males. LFCW, IFW, ACLW, and ACLL also showed significant gender-based differences. The findings establish gender-specific reference values for knee morphological features, highlighting the impact of gender on knee morphology. These reference values can improve the accuracy of diagnoses and treatment plans tailored to each gender, enhancing personalized medical care.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 415-430"},"PeriodicalIF":1.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556807","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 preventive effects of neuromuscular training on lower extremity sports injuries in adolescent and young athletes: a systematic review and meta-analysis","authors":"Yuda LI ,&nbsp;Weidong ZHU","doi":"10.1016/j.knee.2025.06.008","DOIUrl":"10.1016/j.knee.2025.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents and young athletes who frequently engage in sports face a high risk of lower extremity injuries. Neuromuscular training (NMT) has been shown to effectively reduce sports-related injury incidence in this population. However, the intervention efficacy of NMT varies under the influence of different factors. This meta-analysis aimed to determine the preventive effects of NMT on various types of lower extremity injuries and investigate the impact of five moderating factors—Age, Sex, Training Duration, Training Frequency, and Intervention Period—on NMT program quality.</div></div><div><h3>Methods</h3><div>A systematic search of Web of Science, PubMed, Scopus, Cochrane Library, and PEDro databases was conducted in November 2024 using the search strategy: <em>(Neuromuscular Training OR NMT) AND (Sport Injury OR Injury Prevention)</em>. Eligible studies met the following criteria: 1) evaluated NMT programs; 2) reported clear mean age or age range of participants; 3) employed a randomized controlled trial (RCTs) design; 4) provided detailed raw data; and 5) included comprehensive injury data. Two reviewers independently extracted data and assessed study quality. Meta-analyses were performed to pool rate ratios (RRs) for lower extremity injuries and analyze the effects of moderating factors.</div></div><div><h3>Results</h3><div>Data from 24 included studies demonstrated that NMT reduced the overall risk of lower extremity injuries by 27 % (0.73, 95 % CI 0.67–0.79). Subgroup analyses by injury type yielded the following RRs: mixed lower extremity injuries (0.72, 95 % CI 0.63–0.83), knee injuries (0.72, 95 % CI 0.62–0.84), and ankle injuries (0.73, 95 % CI 0.63–0.84). Comprehensive moderator analyses revealed that NMT programs exhibited optimal preventive effects for knee injuries, males, and adolescents aged 12–18 years. Regarding training dosage, the greatest risk reduction was observed with programs involving 20–30 min per session, 1–2 sessions per week, and an intervention period exceeding 6 months.</div></div><div><h3>Conclusion</h3><div>NMT programs involving 20–30 min per session, 1–2 weekly sessions, and an intervention period of ≥ 6 months are most effective in preventing knee injuries among male adolescents aged 12–18 years.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 373-385"},"PeriodicalIF":1.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556803","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}