Knee最新文献

{"title":"An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs","authors":"Dominic Cullen ,&nbsp;Peter Thompson ,&nbsp;David Johnson ,&nbsp;Claudia Lindner","doi":"10.1016/j.knee.2025.02.013","DOIUrl":"10.1016/j.knee.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs.</div></div><div><h3>Methods</h3><div>We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.</div></div><div><h3>Results</h3><div>The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°.</div></div><div><h3>Conclusion</h3><div>The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 99-110"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for anterior cruciate ligament reconstruction","authors":"Oday Al-Dadah (Editors-in-Chief),&nbsp;Caroline Hing","doi":"10.1016/j.knee.2025.02.026","DOIUrl":"10.1016/j.knee.2025.02.026","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages A1-A2"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601357","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":"Deep learning for tibial plateau fracture detection and classification","authors":"N. van der Gaast ,&nbsp;P. Bagave ,&nbsp;N. Assink ,&nbsp;S. Broos ,&nbsp;R.L. Jaarsma ,&nbsp;M.J.R. Edwards ,&nbsp;E. Hermans ,&nbsp;F.F.A. IJpma ,&nbsp;A.Y. Ding ,&nbsp;J.N. Doornberg ,&nbsp;J.H.F. Oosterhoff ,&nbsp;the Machine Learning Consortium","doi":"10.1016/j.knee.2025.02.001","DOIUrl":"10.1016/j.knee.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Deep learning (DL) has been shown to be successful in interpreting radiographs and aiding in fracture detection and classification. However, no study has aimed to develop a computer vision model for tibia plateau fractures using the Schatzker classification. Therefore, this study aims to develop a deep learning model for (1) detection of tibial plateau fractures and (2) classification according to the Schatzker classification.</div></div><div><h3>Methods</h3><div>A multicenter approach was performed for the collection of radiographs of patients with tibia plateau fractures. Both anteroposterior and lateral images were uploaded into an annotation software and manually labelled and annotated. The dataset was balanced for optimizing model development and split into a training set and a test set. We trained two convolutional neural networks (GoogleNet and ResNet) for the detection and classification of tibia plateau fractures following the Schatzker classification.</div></div><div><h3>Results</h3><div>A total of 1506 knee radiographs from 753 patients, including 368 tibial plateau fractures and 385 healthy knees, were used to create the algorithm. The GoogleNet algorithm demonstrated high sensitivity (92.7%) but intermediate accuracy (70.4%) and positive predictive value (64.4%) in detecting tibial plateau fractures, indicating reliable detection of fractured cases. It exhibited limited success in accurately classifying fractures according to the Schatzker system, achieving an accuracy of only 34.6% and a sensitivity of 32.1%.</div></div><div><h3>Conclusion</h3><div>This study shows that detection of tibial plateau fractures is a task that a DL algorithm can grasp; further refinement is necessary to enhance their accuracy in fracture classification. Computer vision models might improve using different classification systems, as the current Schatzker classification suffers from a low interobserver agreement on conventional radiographs.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 81-89"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resection of pathologically altered infrapatellar fat pads during total knee arthroplasty has a positive impact on postoperative knee function","authors":"Xun Xu ,&nbsp;Shijie Wang ,&nbsp;Zheng Zhu,&nbsp;Shuo Yang,&nbsp;Zhengming Zhu,&nbsp;Lingchao Kong,&nbsp;Rende Ning","doi":"10.1016/j.knee.2025.02.012","DOIUrl":"10.1016/j.knee.2025.02.012","url":null,"abstract":"<div><h3>Background</h3><div>The ongoing debate regarding the excision of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains a contentious issue, with established parameters for IPFP management still lacking. Excessive resection of IPFP tissue may lead to patellar tendon (PT) shortening and reduced mobility of the knee joint. This study aims to evaluate whether the resection of pathologically altered IPFP tissue during TKA affects knee joint function and PT dimensions.</div></div><div><h3>Methods</h3><div>A total of 100 patients with end-stage knee osteoarthritis (KOA) who successfully underwent their first TKA were randomly assigned to two groups: one group received resection of the pathologically altered IPFP tissue, while the other group underwent complete resection of all IPFP tissue. The excised IPFP specimens were subjected to pathological and immunohistochemical analysis. Patients underwent X-ray and MRI assessments prior to surgery, as well as at 6 weeks and 6 months postoperatively; additionally, the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Scale (KOOS), and Oxford Knee Score (OKS) were utilized for evaluation. Furthermore, patellar tendon length and thickness were assessed.</div></div><div><h3>Results</h3><div>Histological examination of the IPFP tissue from patients with KOA revealed that not all IPFP specimens exhibited lesions under hematoxylin and eosin (HE) staining and immunohistochemical analysis, with lesion areas predominantly localized near the synovium. There was no significant difference in the NRS scores between the two patient groups at 6 weeks or 6 months postoperatively (Mann–Whitney test, <em>P</em> = 0.391; <em>P</em> = 0.055). However, a significant difference was observed in both KOOS and OKS between the two groups at 6 months after surgery (Mann–Whitney test, <em>P</em> &lt; 0.05). Sonographic evaluation of patellar tendon parameters indicated a significant difference in PT thickness between the two groups only at 6 weeks postoperatively (Mann–Whitney test, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the resection of pathologically altered IPFP tissue during TKA in patients with end-stage KOA can significantly enhance early postoperative knee joint mobility, improve life satisfaction, and mitigate the impact on PT structure.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 58-70"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: “Prognostic factors of knee pain and function 12 months after total knee arthroplasty: A prospective cohort study of 798 patients”","authors":"Elena Tchetina","doi":"10.1016/j.knee.2024.08.004","DOIUrl":"10.1016/j.knee.2024.08.004","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 302-303"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147001","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":"Letter to the editor: Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system. Knee. 2024 Mar;47:1–12","authors":"","doi":"10.1016/j.knee.2024.10.004","DOIUrl":"10.1016/j.knee.2024.10.004","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 304-305"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513601","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":"Response to : Letter to the editor on “Aseptic loosening of the option stemmed tibial tray in the Zimmer NexGen LPS total knee arthroplasty system”","authors":"","doi":"10.1016/j.knee.2024.10.005","DOIUrl":"10.1016/j.knee.2024.10.005","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 306-307"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513602","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 early outcomes following lateral robotic-assisted unicompartmental knee arthroplasty","authors":"Colin C. Neitzke,&nbsp;Jeffrey A. O’Donnell,&nbsp;Claude J. Regis,&nbsp;Pravjit Bhatti,&nbsp;Yu-Fen Chiu,&nbsp;Andrew D. Pearle,&nbsp;David J. Mayman,&nbsp;Brian P. Chalmers","doi":"10.1016/j.knee.2025.02.011","DOIUrl":"10.1016/j.knee.2025.02.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Lateral unicompartmental knee arthroplasty (UKA) has historically shown mixed results and there is limited contemporary literature on lateral robotic-assisted UKA (RA-UKA) outcomes. This study aimed to evaluate the short-term survivorship, clinical, and radiographic outcomes of lateral RA-UKA.</div></div><div><h3>Methods</h3><div>A retrospective review identified 138 lateral RA-UKAs performed from 2016 to 2022 at a single institution, with a study population of 58% women, a mean BMI of 27 kg/m², and a mean age of 62 years. The mean follow-up was two years. Kaplan-Meier analysis assessed survivorship free from all-cause reoperation and revision. A radiographic review evaluated component positioning, aseptic loosening, and osteoarthritis progression.</div></div><div><h3>Results</h3><div>The one- and two-year survivorship free from all-cause revision was 100% (95% confidence interval [CI]: 100 to 100%). The one- and two-year survivorship free from all-cause reoperation was 97% (95% CI: 91 to 99%) and 96% (95% CI: 90 to 98%), respectively. There were six (4%) reoperations, most commonly for arthroscopic lysis/removal of scar tissue, synovitis, and osteophyte. The mean anatomic tibiofemoral angle decreased from 9.7° to 5.9° valgus. At the latest follow-up, 11 (8%) knees showed radiographic osteoarthritis progression. From preoperatively to two years postoperatively, the mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 56 to 82 (<em>P</em> &lt; 0.0001), and the mean visual analog scale for pain decreased from 53 to 18 (<em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Short-term follow-up of contemporary lateral RA-UKA demonstrated high survivorship free from all-cause reoperation (96%) and revision (100%). Patients had significant improvements in PROMs, and a minority had osteoarthritis progression.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 50-57"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520917","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 the combination of kinematics and electromyography enhance the identification of individuals with patellofemoral pain?","authors":"Tadeu Aldrovando Brihy de Albuquerque ,&nbsp;Cintia Lopes Ferreira ,&nbsp;Fabiano Politti ,&nbsp;Cintia Elord Júlio ,&nbsp;Gabor József Barton ,&nbsp;Paulo Roberto Garcia Lucareli","doi":"10.1016/j.knee.2025.02.010","DOIUrl":"10.1016/j.knee.2025.02.010","url":null,"abstract":"<div><h3>Background</h3><div>Patellofemoral pain (PFP) affects many women’s movement function and quality of life. PFP is related to changes in muscle activity and movement patterns during functional tasks. This study aimed to determine whether the combined analysis of kinematics and electromyography data enhances the ability to discriminate between women with and without PFP, compared with the independent analysis of kinematics and electromyography.</div></div><div><h3>Methods</h3><div>Thirty-seven women with PFP and 34 unimpaired controls were evaluated for kinematics and electromyography during the lateral step-down (LSD) task. For three-dimensional kinematics, movements in the sagittal, frontal, and transverse planes of the trunk, pelvis, hip, knee, and foot were assessed. For electromyography, filtered, rectified, and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used. The artificial neural network-based movement deviation profile (MDP) was used to analyse kinematics, electromyography and kinematics combined with electromyography. A MANOVA of MDP_mean Z-scores was used to compare the groups, considering <em>P &lt;</em> 0.05.</div></div><div><h3>Results</h3><div>Multivariate analysis showed group interaction. There was a significant difference between groups in the Z-score for kinematics. However, no significant differences were observed between groups for electromyography and kinematics combined with electromyography.</div></div><div><h3>Conclusion</h3><div>Women with PFP exhibit altered movement patterns during the LSD task but no change in the MDP of muscular activity. Using the MDP, which can combine kinematic and electromyography variables from different segments and muscles, kinematics was the most influential in distinguishing between women with and without PFP.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 90-98"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520916","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":"Response to letter to the editor by Dr. Liu Aifeng et al.","authors":"","doi":"10.1016/j.knee.2024.12.018","DOIUrl":"10.1016/j.knee.2024.12.018","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"53 ","pages":"Pages 310-311"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973461","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}