Knee最新文献

{"title":"Postoperative knee pain, satisfaction, and revision after total knee arthroplasty with and without primary patella resurfacing","authors":"Christiaan H. Righolt ,&nbsp;Colton Poitras ,&nbsp;Jhase Sniderman ,&nbsp;Thomas R. Turgeon ,&nbsp;Eric R. Bohm","doi":"10.1016/j.knee.2025.07.021","DOIUrl":"10.1016/j.knee.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Patella resurfacing during total knee arthroplasty (TKA) remains controversial. We performed a large cohort study to assess pain, function, and revision risk between patients with and without primary patella resurfacing.</div></div><div><h3>Method</h3><div>We identified 10,846 primary TKAs in 2005–2024. We ascertained patella-related pain and function from Oxford knee score questions and patient satisfaction at year one and two. We used logistic regression to estimate the association between patella status and these outcomes. We identified revision TKA and used Cox proportional hazard models to estimate its association with patella resurfacing.</div></div><div><h3>Results</h3><div>Around 78 % of patients had primary patella resurfacing during their TKA, 96 % of resurfaced patellas were done with a posterior-stabilized knee system versus 48 % of unresurfaced patellas. We observed no difference in patella-related pain and function by patella status. Patella-related pain had an adjusted odds ratio [OR] of 0.94 (95 % confidence interval [CI] 0.79–1.12) for resurfaced patellas at year one, the OR for patella-related functional issues was 0.98 (95 % CI 0.78–1.22). The hazard ratio for five years of follow up for revision was 0.75 (95 % CI 0.50–1.12).</div></div><div><h3>Conclusion</h3><div>Patients with and without primary patella resurfacing had similar patella-related pain and functional outcomes in the first two postoperative years. Unresurfaced patellas had higher revision rates, although this was not statistically significant. A small subset of patients with unresurfaced patellas may have unfavorable outcomes, but these patients may also have been revised in an attempt to reduce anterior knee pain that would have been present with primary patella resurfacing.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 28-36"},"PeriodicalIF":2.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841201","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":"Patient satisfaction following medial unicompartmental knee arthroplasty at one year: a mixed methods study","authors":"Julie Heegaard ,&nbsp;Anne Mørup-Petersen ,&nbsp;Kristian Mongelard ,&nbsp;Andreas Kappel ,&nbsp;Jacob Fyhring Mortensen ,&nbsp;Anders Odgaard","doi":"10.1016/j.knee.2025.07.011","DOIUrl":"10.1016/j.knee.2025.07.011","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to (1) determine the frequency of dissatisfaction 1-year postoperatively in medial unicompartmental knee arthroplasty (mUKA) patients, (2) determine associations between preoperative factors and dissatisfaction, (3) gain insight into causes for dissatisfaction by performing interviews and supplementary questions of dissatisfied and satisfied patients more than 3 years postoperatively.</div></div><div><h3>Method</h3><div>In the first part of the study, data concerning 336 UKA patients from a prospective cohort study (SPARK) was analyzed. Using ordinal logistic regression, associations between baseline factors and patient satisfaction was investigated. In the second part, a qualitative study was conducted 3.4-years postoperatively: Matched satisfied and dissatisfied patients participated in interviews and completed questionnaires.</div></div><div><h3>Results</h3><div>298 patients responded 1 year post surgery. Dissatisfaction was more frequent in younger patients (<em>p</em>: 0.04), patients with lower Ahlbäck score (<em>p</em>: 0.0003) and when operated on by one specific surgeon (surgeon no. 8) (<em>p</em>: 0.01). 9 dissatisfied patients participated in interviews, as did 9 matched satisfied patients. Based on interviews, we found that patient dissatisfaction was related to (1) expectations to the knee arthroplasty, (2) information and communication, (3) follow-up and rehabilitation, (4) pain and discomfort. Dissatisfied patients recalled less participation in preoperative decision-making (<em>p</em>: 0.02) and that they did not feel adequately seen or heard (<em>p</em>: 0.01).</div></div><div><h3>Conclusion</h3><div>High rates of patient satisfaction were noted 1-year postoperatively. Among interviewed dissatisfied patients, 6 of 9 expressed other reasons than knee symptoms as the reason for dissatisfaction. This study points to factors related to the surgeon, age and severity of osteoarthritis as factors that may influence short-term mUKA results.</div><div><strong>Level of evidence:</strong> II, prospective cohort study.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 47-59"},"PeriodicalIF":2.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841202","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":"Patients aged 80 and above face higher critical systemic complication rates after single-stage bilateral versus unilateral total knee arthroplasty: a nationwide database analysis","authors":"Manabu Kawata ,&nbsp;Shotaro Aso ,&nbsp;Ryota Yamagami ,&nbsp;Kenichi Kono ,&nbsp;Shuji Taketomi ,&nbsp;Hiroki Matsui ,&nbsp;Kiyohide Fushimi ,&nbsp;Hideo Yasunaga ,&nbsp;Sakae Tanaka","doi":"10.1016/j.knee.2025.07.018","DOIUrl":"10.1016/j.knee.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Single-stage bilateral total knee arthroplasty (SB-TKA) offers several benefits for patients with bilateral knee diseases, including reduced cumulative hospitalisation periods and costs. However, it is associated with increased mortality and postoperative complications. Patient selection criteria to minimise these risks remain unclear. This study aimed to identify age groups with increased risk of critical systemic complications after SB-TKA compared with unilateral TKA (U-TKA) using a nationwide database.</div></div><div><h3>Methods</h3><div>Data from inpatients undergoing TKA between 2010 and 2022 were obtained from the Diagnosis Procedure Combination database. The primary outcome was a composite of in-hospital death and systemic complications requiring additional procedures or interventions following TKA. To compare outcomes between the SB-TKA and U-TKA groups, stabilised inverse probability of treatment weighting (IPTW) using propensity scores was applied to balance baseline covariates. Subgroup analyses were conducted based on age categories (≤69, 70–79, and ≥80 years).</div></div><div><h3>Results</h3><div>During the study period, 25,161 SB-TKA patients and 317,037 U-TKA patients were identified. Stabilised IPTW analysis showed that the composite outcome during hospitalisation occurred more frequently after SB-TKA than after U-TKA (0.65 % vs. 0.44 %; risk ratio, 1.47; 95 % confidence interval, 1.21–1.78). Subgroup analysis revealed a significantly higher risk of the composite outcome in the SB-TKA group among patients aged ≥80 years (1.02 % vs. 0.59 %; risk ratio, 1.72; 95 % confidence interval, 1.28–2.31), while no significant differences were observed in patients aged ≤69 or 70–79 years.</div></div><div><h3>Conclusion</h3><div>SB-TKA is associated with higher risk of critical systemic complications compared with U-TKA in patients aged ≥80 years.</div><div><strong>Level of Evidence:</strong> III.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 19-27"},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826725","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":"History of knee dislocation is associated with longer operative times and higher constraint in total knee arthroplasty: a matched cohort analysis","authors":"Benjamin Albertson ,&nbsp;Christopher Kurnik ,&nbsp;William Curtis ,&nbsp;James O’Hora ,&nbsp;Todd Ludwig ,&nbsp;Christopher Shultz ,&nbsp;Robert C. Schenck ,&nbsp;Gehron Treme ,&nbsp;Dustin L. Richter ,&nbsp;Michael Decker ,&nbsp;Daniel C. Wascher","doi":"10.1016/j.knee.2025.07.015","DOIUrl":"10.1016/j.knee.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Knee dislocations (KD) are devastating injuries that are known to predispose to post-traumatic arthritis of the knee. While some patients will require total knee arthroplasty (TKA), there is limited literature on outcomes of TKA following KD. The purpose of this study is to compare surgical characteristics and outcomes between patients undergoing TKA following KD versus those undergoing TKA for osteoarthritis.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of patients who underwent TKA after KD between 2006 and 2021. The KD cohort was matched 1:2 to a cohort of primary TKA patients with a preoperative diagnosis of arthritis based on sex, age, and surgery date. Surgical variables included TKA constraint level, operative time, and tourniquet time. Postoperative complications including infection, instability, stiffness, and revision surgery were also recorded.</div></div><div><h3>Results</h3><div>Fifteen patients were identified who underwent TKA following KD with a mean follow-up of 2.8 years. The KD cohort had longer tourniquet times (117 ± 34.5 vs. 84.9 ± 23.9 min, <em>p</em> &lt; 0.01) and operative times (180.7 ± 55.9 vs 121.6 ± 25.3 min, <em>p</em> &lt; 0.001). The KD group more often required higher levels of constraint and stem usage (<em>p</em> &lt; 0.0001). KD patients trended toward higher rate of infection (20 % vs 0 %, <em>p</em> = 0.03), and revision surgery (26 % vs 3 %, <em>p</em> = 0.04). No statistically significant difference was found in postoperative range of motion at final follow-up up (118° [85–135°] vs. 116° [90–140°]; <em>p</em> = 0.8)</div></div><div><h3>Conclusion</h3><div>TKA after KD is associated with longer operative times and increased use of constrained and stemmed implants.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 12-18"},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826943","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":"High-grade trochlear dysplasia is associated with a more negative sagittal tibial tuberosity-trochlear groove distance: A retrospective cohort study.","authors":"Brian T Bueno, Michael R Moore, Andrew S Bi, Larry Chen, Jairo Triana, Laith M Jazrawi, Guillem Gonzalez-Lomas, Daniel J Kaplan","doi":"10.1016/j.knee.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.knee.2025.07.005","url":null,"abstract":"<p><strong>Purpose: </strong>To identify demographic or radiographic predictors of sagittal tibial tuberosity-trochlear groove (sTT-TG) distance utilizing a cohort of patellofemoral surgical patients.</p><p><strong>Methods: </strong>Patients who underwent an osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI) from 2010 to 2020 were included if they had patellofemoral high-grade lesions and preoperative magnetic resonance imaging (MRI). Patient demographics, radiographic measurements such as coronal TT-TG, Caton-Deschamps index (CDI), and trochlear dysplasia were recorded. The preoperative sTT-TG distance was measured independently on axial T2-weighted MRI sequences by two authors at least two weeks apart. An interclass correlation coefficient (ICC) was calculated to assess intra- and inter-rater reliability of sTT-TG measurements, and univariate and multivariable linear regression models were used to assess the relationship between sTT-TG and any demographic or radiographic predictors.</p><p><strong>Results: </strong>Seventy-three knees composed of 44 females and 29 males with a mean age of 31.0 ± 10.1 years, a mean BMI of 26.8 ± 6.1, and a mean follow-up of 60.4 ± 21.0 months were included. Thirty-four of these (46.6 %) underwent OCA transplantations and 39 (53.4 %) underwent ACI/MACIs. Thirty-one (42.4 %) knees were determined to have evidence of trochlear dysplasia. Twenty-four patients were found to have high grade trochlear dysplasia (grades B, C and D) and 7 patients were found to have low grade trochlear dysplasia (grade A). The mean sTT-TG of the entire cohort was -5.3 ± 4.9 mm. Interobserver reliability for sTT-TG measurements was excellent with an ICC of 0.95 (0.927-0.969, p < 0.001). There was a significant difference in sTT-TG between patients who had no trochlear dysplasia, low-grade trochlear dysplasia and high grade trochlear dysplasia (-3.51 ± 3.96 vs. -6.17 ± 4.29 vs. -9.25 ± 5.32, p < 0.001). On multivariate regression, trochlear dysplasia remained the only significant predictor of sTT-TG (β = -2.25, p = 0.005). Post-hoc analysis showed that both low- and high-grade dysplasia were associated with significantly more negative sTT-TG values compared to patients without dysplasia, though no significant difference was observed between the low- and high-grade groups.</p><p><strong>Conclusion: </strong>Trochlear dysplasia was associated with a more negative sagittal tibial tuberosity-trochlear groove (sTT-TG) distance, with increasing severity of trochlear dysplasia correlated with a relatively more posterior tibial tuberosity.</p><p><strong>Level of evidence: </strong>Level III; diagnostic cross-sectional study.</p>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812738","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":"Current concepts in tenosynovial giant cell tumour of the knee","authors":"Nicholas C. Eastley,&nbsp;Jonathan D. Stevenson,&nbsp;Robert U. Ashford","doi":"10.1016/j.knee.2025.07.010","DOIUrl":"10.1016/j.knee.2025.07.010","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages A9-A15"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801044","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":"Training the knee surgeons of tomorrow: towards a subspecialist paradigm","authors":"Chinmay M. Gupté","doi":"10.1016/j.knee.2025.07.002","DOIUrl":"10.1016/j.knee.2025.07.002","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages A3-A8"},"PeriodicalIF":2.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765840","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 regarding “Fractures in Oxford unicompartmental knee arthroplasty are associated with medial positioning of the femoral component – A retrospective cohort study”","authors":"","doi":"10.1016/j.knee.2025.07.012","DOIUrl":"10.1016/j.knee.2025.07.012","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 663-664"},"PeriodicalIF":2.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765839","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":"Joint distraction versus custom-made unloading orthosis for knee osteoarthritis – A clinical and radiological study","authors":"M.R. Huizinga ,&nbsp;A.J. de Vries ,&nbsp;M.P. Jansen ,&nbsp;S.C. Mastbergen ,&nbsp;P.C. Jutte ,&nbsp;R.W. Brouwer","doi":"10.1016/j.knee.2025.07.008","DOIUrl":"10.1016/j.knee.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>A promising treatment option to postpone knee replacement is knee joint distraction (KJD). This treatment shows clinical and radiological improvements, but is invasive, with substantial adverse effects. A custom-made orthosis was developed for unloading the knee, striving for comparable clinical outcomes with KJD with less side effects. The aim of this study is to evaluate the effectiveness of a KJD for 6 weeks compared to a knee-unloading orthosis for 8 weeks on clinical outcomes, progression of osteoarthritis and adverse events.</div></div><div><h3>Methods</h3><div>Two cohort studies investigating different treatments (KJD vs orthosis) for patient with severe knee osteoarthritis (Kellgren-Lawrence grades 2–4), age ≤ 65 were compared. During the 2 year follow-up, clinical outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis and numeric rating scale for pain. Progression of osteoarthritis was determined by the radiographic minimum joint space width (mJSW); adverse events were obtained from the charts.</div></div><div><h3>Results</h3><div>In both patient groups (KJD: <em>n</em> = 21; orthosis: <em>n</em> = 10) significant clinical improvement was found during the 2-years follow-up. For the KJD group the median mJSW increased from 0.0 at baseline to 0.9 mm at one- and two-year follow-up; in the orthosis group the mJSW remained 0.0 during all time-points. Adverse events were reported in 86 % of the KJD patients versus 30 % in the orthosis group.</div></div><div><h3>Conclusion</h3><div>Both KJD and unloading orthosis treatment improves clinical outcome for at least 2 years in patients ≤ 65 years. Only KJD influenced progression of osteoarthritis, but had more side effects compared with the orthosis treatment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 637-645"},"PeriodicalIF":2.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722239","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":"Severe bone contusion is a risk factor for poor healing of the anterolateral ligament tear following anterior cruciate ligament reconstructions","authors":"Nam-Hong Choi ,&nbsp;Bong-Seok Yang ,&nbsp;Jin-Su Kim ,&nbsp;Brian N. Victoroff","doi":"10.1016/j.knee.2025.07.009","DOIUrl":"10.1016/j.knee.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>A previous study demonstrated that incidence of residual pivot shift following anterior cruciate ligament (ACL) reconstructions was significantly higher in the poorly healed anterolateral ligament (ALL) group than the healed ALL group. However, the risk factor for unhealed ALL remains unknown in literature.</div></div><div><h3>Methods</h3><div>Inclusion criteria were patients who underwent hamstring ACL reconstructions within 6 weeks after injury from January 2008 to March 2021. Included patients had concomitant ALL injuries that were confirmed by preoperative magnetic resonance imaging (MRI). Preoperative ALL injury was graded by the Muramatsu classification, and postoperative ALL healing was graded by a modification of the Lee classification (good, partial, and non-visualized). The patients were allocated to an improved group and an unimproved group on the basis of a comparison of pre- and postoperative MRI. Severity of bone contusion was graded as none, minimal, moderate, and severe by the Song classification.</div></div><div><h3>Results</h3><div>128 patients were included. Preoperatively, 86 (67.2 %) patients had partial ALL tears and 42 (32.8 %) patients had complete tears. Postoperatively, 17 (13.3 %) patients showed “good”, 91(71.1 %) showed “partial”, and 20 (15.6 %) showed “non-visualized” healing. Thirty-eight (29.7 %) and 90 (70.3 %) patients were allocated to the improved group and unimproved group, respectively. Severity of the bone contusion was a risk factor for “unimproved” ALL (<em>P</em> = 0.015). As the severity of bone contusion increased 1 grade, risk of “unimproved” ALL increased by 1.78 times.</div></div><div><h3>Conclusion</h3><div>Severe bony contusion was associated with poor healing of the ALL following ACL reconstructions.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 630-636"},"PeriodicalIF":2.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722237","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}