Knee最新文献

{"title":"Binomial theory applied to the creation of a treatment algorithm for patellofemoral pathology","authors":"Pablo Agustín Ramos Guarderas ,&nbsp;Gonzalo Fernando Arteaga Guerrero ,&nbsp;Medardo Javier Vargas Morante ,&nbsp;Pablo David Ramos Murillo ,&nbsp;Carlos Patricio Peñaherrera Carrillo ,&nbsp;Francisco Endara Urresta ,&nbsp;Daniel Alejandro Ramos Murillo ,&nbsp;Alejandro Xavier Barros Castro","doi":"10.1016/j.knee.2025.05.012","DOIUrl":"10.1016/j.knee.2025.05.012","url":null,"abstract":"<div><div>The annual prevalence of patellofemoral pathology in the general population is 22.7%, and in adolescents, it is 28.9%. Diagnosing this pathology is complex and requires a proper clinical examination and complementary imaging studies for adequate treatment. This study aims to clarify, simplify, and present a diagnostic and treatment algorithm based on casuistry using binomial theory.</div></div><div><h3>Materials and methods</h3><div>A retrospective study included 100 patients, 70% female, with an average age of 31, diagnosed with patellofemoral pathology, treated with different therapeutic options described in the literature, and followed up for 12 months, evaluated using the Lysholm scale.</div></div><div><h3>Results</h3><div>Among the surgically treated patients, 75% scored between 65 and 83 points on the Lysholm scale after one month; at six months, 72% scored between 84 and 100 points; after one year, 92% scored between 84 and 100 points; and the remaining 8% showed no improvement or required additional surgical procedures. The <em>Q</em> angle, TT-TG, and Fulkerson classification were correlated, obtaining <em>P</em> values of 0.65, 0.72, and 0.55 respectively, suggesting a positive correlation between these variables. Finally, the three variables were correlated for surgical decision-making, obtaining a <em>P</em> value of 0.85, with a positive and statistically significant correlation.</div></div><div><h3>Conclusion</h3><div>The algorithm proposed in this study shows good results at the one-year follow-up and should be considered as a management option for patients with patellofemoral pathology.</div><div><strong>Level of Evidence:</strong> IV. Observational retrospective case series study.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 122-131"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146955","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":"A novel arthroscopic-assisted fibular-based dual reconstruction with popliteus repair technique for posterolateral corner injury: a cadaveric and functional anatomic study","authors":"S. Ali Ghasemi ,&nbsp;Ahmad Naja ,&nbsp;Benjamin C. Murray ,&nbsp;Arthur Bartolozzi ,&nbsp;Gene Shaffer ,&nbsp;James Raphael","doi":"10.1016/j.knee.2025.05.008","DOIUrl":"10.1016/j.knee.2025.05.008","url":null,"abstract":"<div><div>The structures of the posterolateral corner (PLC) work together as a single unit to provide both static and dynamic functions to the knee. Multiple techniques have been described for PLC reconstruction, however most of these techniques re-establish the static function of the PLC without addressing dynamic components. The popliteus muscle serves an important role in providing dynamic stability to the PLC, but this function is often not restored in reconstruction techniques. We describe a novel technique for PLC reconstruction that includes popliteus repair, and review the functional anatomy and biomechanics of the PLC. We also confirm the dynamic stabilizing role of the popliteus muscle through a biomechanical analysis of four cadavers.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 103-121"},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146956","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":"Reverse fragility index comparing rates of reoperation in total knee arthroplasty with and without patellar resurfacing: a systematic review of randomized controlled trials","authors":"Stephen P Fucaloro ,&nbsp;Jack T Bragg ,&nbsp;Daniel Sun ,&nbsp;Matthew J Salzler","doi":"10.1016/j.knee.2025.05.014","DOIUrl":"10.1016/j.knee.2025.05.014","url":null,"abstract":"<div><h3>Background</h3><div>Patellar resurfacing during total knee arthroplasty (TKA) is debated. The reverse fragility index (RFI<span><span>¹</span></span>) assesses study neutrality by determining the minimum number of events needed to change non-significant results, significant. This study determined the RFI for studies showing no difference in reoperation between TKAs with and without resurfacing.</div></div><div><h3>Methods</h3><div>A systematic review of PubMed, Embase, and Web of Science databases was conducted to identify randomized controlled trials (RCT) showing no difference in reoperation rates between TKAs with and without patellar resurfacing. The number of reoperations and the number of patients lost to follow-up were included. The RFI was calculated for reoperation rate of each study with a threshold of <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Nineteen RCTs with 3,804 TKAs were included, 1,813 of which resurfaced the patella. The median (interquartile range [IQR<span><span>²</span></span>]) reoperation rate was 4.4% (0–9.1%) in resurfaced patellae, and 4.5% (0–8.3%) in retained patellae. The median RFI was five, indicating that only five patients would need the opposite outcome for the difference in reoperation rate to become significant. The median (IQR) loss to follow-up was eight (3–20) patients, and 63.2% (12 of 19) of studies had loss that exceeded their RFI.</div></div><div><h3>Conclusion</h3><div>Most RCTs showing no difference in reoperation rate between TKAs with or without patellar resurfacing are statistically fragile. Difference in rates can become significant with the reversal of only a few outcomes, and this number was less than a study’s loss to follow-up in most studies.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 94-102"},"PeriodicalIF":1.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134485","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":"Functional and radiological outcomes of computer-assisted and handheld robotic total knee arthroplasty: A prospective randomised study","authors":"Anoop Jhurani,&nbsp;Piyush Agarwal,&nbsp;Gaurav Ardawatia,&nbsp;Hardik Sahni,&nbsp;Mudit Srivastava","doi":"10.1016/j.knee.2025.05.003","DOIUrl":"10.1016/j.knee.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Computer navigation (CAS) and robotic assisted surgery (RAS) have been shown to improve component alignment and decrease mechanical alignment outliers. However, the difference between soft tissue releases in both imageless technologies is not well known. The objective of this prospective randomised study was to compare the soft tissue releases, functional and radiological outcomes in TKA operated with CAS or RAS and find out the mean error between planned and achieved cuts with both technologies.</div></div><div><h3>Methods</h3><div>One-hundred patients were enrolled in each group after randomisation by computer-generated sequence: Group R, robotic assisted TKA; and Group C, CAS TKA. Functional and radiological outcomes were recorded preoperatively at 6 weeks, 3, 6, 12 and 24 months.</div></div><div><h3>Results</h3><div>Group R had significantly less soft tissue releases compared with Group C (<em>P</em> = 0.04). The robotic-assisted procedures achieved statistically higher accuracy for femoral distal femur cut thickness, femoral rotation, femoral flexion and femoral coronal angle (51%, 46%, 44%, 56%, respectively) in comparison with CAS TKA (44%, 25%, 29%, 46%, respectively). RAS achieved higher accuracy for tibial cut thickness, tibial slope, tibial cut coronal plane in comparison with CAS. Group R had significantly higher KOOS, HFKS and FJS-12 than Group C (<em>P</em> &lt; 0.05) at the end of 2 years of follow up which, however, did not reach the minimal important clinical difference levels for each score.</div></div><div><h3>Conclusion</h3><div>The use of the handheld robotic system led to decreased soft tissue releases and mean cutting errors as compared with CAS, potentially leading to better pain scores and patient-reported outcomes.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 84-93"},"PeriodicalIF":1.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124682","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":"Medial closing wedge distal femoral osteotomy in ’Rescue Realignment’ post primary total knee arthroplasty: A mini-case-series of three cases","authors":"Ahmed Mabrouk ,&nbsp;Lucy Bell ,&nbsp;Matthew Dawson","doi":"10.1016/j.knee.2025.05.002","DOIUrl":"10.1016/j.knee.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>Medial closing wedge distal femoral osteotomy (MCWDFO) is an effective procedure mainly indicated for correction of the valgus malaligned native knee. Nevertheless, valgus malalignment has been reported following total knee arthroplasty (TKA). Therefore, employing a realignment osteotomy for a symptomatic valgus malaligned TKA could be a potential rescue from an unnecessary revision surgery with high morbidity and mortality and uncertain outcome.</div></div><div><h3>Methods</h3><div>The following report describes 3 consecutive cases presented with symptomatic valgus malalignment following primary TKA. The 3 cases were treated with MCWDFO to improve the overall limb alignment and biomechanics. Preoperative and postoperative alignment indices were recorded from long leg standing radiographs (LSRs). Patient reported outcome measures, assessed by simple knee value (SKV) scores, visual analogue scale (VAS) for pain and patient satisfaction were reported preoperatively and postoperatively at the latest follow up.</div></div><div><h3>Results</h3><div>Postoperatively, the overall limb alignment has been corrected as represented by the mechanical tibiofemoral angle and Mikulicz line. No intraoperative or postoperative complications were reported. At the final follow up (8 years for two cases and 2 years for one case), significant improvements in patient reported outcome measures, as assessed by the simple knee value and VAS pain scores and 100% satisfaction, were observed.</div></div><div><h3>Conclusion</h3><div>Medial closing wedge distal femoral osteotomy can be employed in rescue realignment of valgus malalignment post primary TKA with resultant significant improvement in patient reported outcome measures, and 100% satisfaction with no complications in a small series.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 77-83"},"PeriodicalIF":1.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124683","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":"Cephalic laxity of the posterior root of lateral meniscus: Arthroscopic sign of meniscal hypermobility. Proposal for a new arthroscopic classification","authors":"Pablo Agustín Ramos Guarderas ,&nbsp;Pablo David Ramos Murillo ,&nbsp;Gonzalo Fernando Arteaga Guerrero ,&nbsp;Medardo Javier Vargas Morante ,&nbsp;Carlos Patricio Peñaherrera Carrillo ,&nbsp;Francisco Endara Urresta ,&nbsp;Daniel Alejandro Ramos Murillo ,&nbsp;Alejandro Xavier Barros Castro","doi":"10.1016/j.knee.2025.05.010","DOIUrl":"10.1016/j.knee.2025.05.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The lateral meniscus (LM) has greater mobility than the medial meniscus (MM) due to the lack of meniscocapsular insertions at the popliteal hiatus. Hypermobile lateral meniscus (HLM) refers to excessive anterior translation of the posterior horn of the lateral meniscus (PHLM), often causing knee pain and locking, particularly during kneeling. This study investigates cephalic laxity of the posterior root of the lateral meniscus as an arthroscopic sign of meniscal hypermobility.</div></div><div><h3>Objectives</h3><div>To assess whether the degree of cephalic laxity correlates with lateral meniscus hypermobility and determine its potential as an arthroscopic diagnostic sign for HLM to establish a classification.</div></div><div><h3>Methods</h3><div>This observational descriptive case series study was conducted at a sports medicine center in Ecuador from November 2023 to May 2024. Inclusion criteria comprised patients undergoing knee arthroscopy within the study period, excluding those with posterior root injury, unstable meniscal tears, diffuse grade IV Outerbridge chondropathy, and posterolateral corner injuries. Data were analyzed using statistical software, focusing on arthroscopic findings and patient symptoms.</div></div><div><h3>Results</h3><div>Among 106 patients (57% male, 43% female; average age 38.9), a significant correlation was found between posterolateral knee pain and meniscal hypermobility. There was a 76% probability of increased pain during hyperflexion in patients with posterolateral knee pain. Pearson correlation coefficients confirmed the relationship between cephalic laxity and meniscal hypermobility.</div></div><div><h3>Conclusion</h3><div>Cephalic laxity of the posterior root of the lateral meniscus may serve as a valid arthroscopic diagnostic sign for HLM. The classification of lateral meniscus posterior root laxity (LMPRL) is reliable for surgical management.</div><div><strong>Level of evidence:</strong> IV.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 66-76"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116651","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":"Initial learning curve of lateral unicompartmental knee arthroplasty","authors":"Weibo Zheng ,&nbsp;Houyi Sun ,&nbsp;Binglong Li ,&nbsp;Ziyue Chu ,&nbsp;Dehua Liu ,&nbsp;Shihao Li ,&nbsp;Yange Luo ,&nbsp;Songlin Li ,&nbsp;Baoqing Zhang ,&nbsp;Qunshan Lu ,&nbsp;Peilai Liu","doi":"10.1016/j.knee.2025.05.013","DOIUrl":"10.1016/j.knee.2025.05.013","url":null,"abstract":"<div><div>This study obtained the learning curve of a chief surgeon’s lateral unicompartmental knee arthroplasty surgery using the cumulative summation analysis (CUSUM) method and divided the curve into two stages: the learning stage and the proficient stage. The inflection point of the learning curve is around the 11th case. The surgical time and team anxiety were relieved in the proficient stage. The study also summarized some possible methods for shortening the learning curve.</div></div><div><h3>Purpose</h3><div>To describe the initial learning curve of lateral unicompartmental knee arthroplasty (LUKA), compare its effectiveness at different stages, optimize its learning curve, reduce surgical risks, and provide experience and theoretical guidance for clinical practice.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on the relevant data of the initial 30 patients who underwent LUKA performed by a single primary surgeon from August 2018 to September 2022. Cumulative summation analysis (CUSUM) was utilized to analyse the surgical time of 30 consecutive surgeries and plot the learning curve. The learning curve was divided into two stages: the learning stage and the proficient stage. The perioperative parameters, including the state-trait anxiety inventory (STAI), surgical time, pre- and postoperative haemoglobin levels, length of hospital stay, and surgical incision length, were recorded. Postoperative imaging indicators, which reflect the placement position of the prosthesis, and functional follow-up results between these two stages were explored and analysed.</div></div><div><h3>Results</h3><div>The CUSUM showed that the learning curve reached a maximum at the 11th case and then decreased gradually; hence, patients 1–11 represented the learning stage, and patients 12–30 represented the proficient stage. All patients were followed up at 6-month, 1-year and 2-year after surgery. During the follow-up period, none of the patients experienced complications such as implant loosening, periprosthetic fracture, dislocation of the bearing insert, or periprosthetic infection. There were no statistically significant differences (<em>P</em> &gt; 0.05) observed between the learning stage and proficient stage for any of the observed parameters, except for surgical time.</div></div><div><h3>Conclusions</h3><div>The operation time-related learning curve for LUKA patients was 11, but surgery did not affect postoperative imaging or functional outcomes at early follow-up.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 41-51"},"PeriodicalIF":1.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099126","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":"Reliability of measuring femoral tunnel aperture location after anterior cruciate ligament reconstruction: quadrant method versus anatomical coordinate axes method","authors":"Jong-Hyub Song ,&nbsp;Sung-Sahn Lee ,&nbsp;Dae-Hee Lee","doi":"10.1016/j.knee.2025.05.007","DOIUrl":"10.1016/j.knee.2025.05.007","url":null,"abstract":"<div><h3>Background</h3><div>The purpose was to quantitatively compare the reliability of the quadrant and ACA methods in identifying the position of the femoral tunnel aperture after ACL reconstruction (ACLR) using 3D-CT.</div></div><div><h3>Methods</h3><div>This study included 90 patients (90 knees) who underwent primary single-bundle ACLR. 3D-CT was performed on each knee, and the femoral tunnels were evaluated twice each by two observers using both the quadrant and anatomical coordinate axes (ACA) methods. The data were analyzed statistically to determine the inter and intraobserver reliabilities using an intraclass correlation coefficient [ICC, excellent (&gt;0.9), good (0.75–0.9), moderate (0.5–0.75), poor (&lt;0.5)].</div></div><div><h3>Results</h3><div>Regarding intraobserver comparisons, the ICCs of quadrant method (1st observer: excellent, 2nd observer: excellent) were better than ACA method (1st observer: good, 2nd observer: good) on Y-axis. Both methods showed good ICCs on X-axis. Regarding interobserver comparisons, the ICCs of the ACA method were better than those of the quadrant method on the X-axis. (1st measurement: moderate, 2nd measurement: good vs. 1st measurement: good, 2nd measurement: good) However, ICCs of quadrant method were better on the Y-axis. (1st measurement: excellent, 2nd measurement: excellent vs. 1st measurement: excellent, 2nd measurement: good).</div></div><div><h3>Conclusion</h3><div>For measuring the femoral tunnel aperture on 3D-CT after ACLR, the quadrant method showed better intraobserver and interobserver reliability on Y-axis, whereas the ACA method showed better interobserver reliability on the X-axis.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 22-28"},"PeriodicalIF":1.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099213","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":"New-onset anxiety and depression after anterior cruciate ligament reconstruction: A national database study of incidence, risk-factors, and outcomes","authors":"Andrea H. Johnson,&nbsp;David C. Lutati,&nbsp;Jacob Z. Offer,&nbsp;Jane C. Brennan,&nbsp;Benjamin M. Petre,&nbsp;James J. York,&nbsp;Daniel E. Redziniak,&nbsp;Justin J. Turcotte","doi":"10.1016/j.knee.2025.05.005","DOIUrl":"10.1016/j.knee.2025.05.005","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies evaluating the mental-health burden of recovery from anterior cruciate ligament reconstruction (ACLR) have focused primarily on athletes. The purpose of this study is to evaluate rates of new-onset anxiety and depression (NOAD) after ACLR and identify risk factors in the broad population of ACLR patients.</div></div><div><h3>Methods</h3><div>A retrospective review of the PearlDiver national database was performed. All patients included had no prior diagnosis of depression or anxiety prior to undergoing ACLR and had ≥1-year follow-up. The primary outcome was development of NOAD within 1-year postoperatively. Multivariate regression was used to assess predictors of NOAD; clinical outcomes were compared between patients with and without NOAD.</div></div><div><h3>Results</h3><div>Of the 20,442 ACLR patients included, 1,284 (6.3%) were diagnosed with NOAD within 1-year postoperatively. Men (OR: 0.63, <em>p</em> &lt; 0.001) and patients from the southern US (OR: 0.81, <em>p</em> = 0.007) had lower rates of NOAD. Conversely, older patients (OR: 1.02, <em>p</em> &lt; 0.001), patients with alcohol disorders (OR: 2.19, <em>p</em> &lt; 0.001), anemia (OR: 1.26, <em>p</em> = 0.008), headaches/migraines (OR: 1.60, <em>p</em> &lt; 0.001), obesity (OR: 1.38; <em>p</em> &lt; 0.001), sleep apnea (OR: 1.40, <em>p</em> &lt; 0.001), tobacco use (OR: 2.15, <em>p</em> &lt; 0.001), and preoperative opioid use (OR: 1.23, <em>p</em> = 0.001) had higher rates of NOAD. Postoperatively, patients with NOAD had higher rates of 90-day readmission (1.1% vs. 0.3%; <em>p</em> &lt; 0.001), higher rates of opioid use at 1-year (30.7% vs. 20.4%; <em>p</em> &lt; 0.001), and higher rates of additional knee surgery at 2-years (5.4% vs. 3.2%; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The current study highlights risk factors for NOAD after ACLR that may be used to identify at-risk populations. The development of targeted multidisciplinary interventions may improve outcomes for these patients.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 29-40"},"PeriodicalIF":1.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099214","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":"Developing and validating a machine learning model to predict chronic pain following total knee arthroplasty","authors":"Ziliang Cheng ,&nbsp;Jingjing Li ,&nbsp;Weishan Wu ,&nbsp;Jiguang Yin ,&nbsp;Xiangpeng Wang","doi":"10.1016/j.knee.2025.05.011","DOIUrl":"10.1016/j.knee.2025.05.011","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to compare the performance of various machine learning algorithms in predicting chronic pain after total knee arthroplasty (CPSP).</div></div><div><h3>Methods</h3><div>Patients with CPSP after total knee arthroplasty at the same medical center between January 1, 2021, and January 1, 2023, were selected for this study. A retrospective cohort design was employed to collect samples, which were then randomly divided into a training set and a test set in a 7:3 ratio. Valid high-risk factors were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) method. Subsequently, five predictive models were constructed and evaluated based on machine learning (ML) algorithms, including Decision Tree (DT), Light Gradient Boosting Machine (LGBM), Support Vector Machine (SVM), Random Forest (RF), and Extreme Gradient Boosting (XGBoost). In the test dataset, the model’s performance was evaluated using metrics including accuracy, precision, recall, specificity, F1-score, Brier score, and area under the curve (AUC). The Brier score helped identify the most suitable model, and SHAP values were explained to analyze the key factors affecting the predictions.</div></div><div><h3>Results</h3><div>This study enrolled 785 patients who underwent total knee arthroplasty, with 549 in the training − set and 236 in the test − set. The overall CPSP incidence was 39.6%. Nine high − risk factors were identified: hospital stay length, albumin levels, acute postoperative pain status (APSP), non-operative pain status, pain catastrophizing, osteoporosis, preoperative operative-area pain score, education level, and rehabilitation site. The AUC values were: DT(0.877), LGBM(0.914), SVM(0.890), RF(0.918), and XGBoost(0.898). The Brier scores were: DT (0.123), LGBM (0.119), SVM (0.126), RF (0.111), and XGBoost (0.124). These findings suggest that the RF model had the best performance.</div></div><div><h3>Conclusion</h3><div>The incidence of CPSP in TKA patients is high, which has a significant adverse effect on body function and needs to be paid attention to. Nine risk factors have been identified. RF model can effectively identify CPSP patients, which is helpful for clinical medical staff to early identify and intervene in high-risk patients.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 52-65"},"PeriodicalIF":1.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099127","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}