Knee最新文献

{"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}

{"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}