Knee最新文献

{"title":"High correction accuracy and low complication rate of double-level knee varization osteotomy using the free-hand technique: A single-centre retrospective analysis of 26 cases","authors":"Ahmed Mabrouk, Michael Risebury, Sam Yasen","doi":"10.1016/j.knee.2025.07.007","DOIUrl":"10.1016/j.knee.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Valgus knee malalignment with isolated lateral compartment osteoarthritis (OA) represents a challenging condition to the orthopaedic surgeon. In the young active patient, realignment osteotomy represents an appealing solution to manage the presented problem and lay a more neutral alignment for future conversion arthroplasty. Nevertheless, in substantial or bifocal (femur and tibia) deformities, double-level knee osteotomy should be considered to maintain joint line obliquity and avoid introducing secondary joint deformities.</div></div><div><h3>Methods</h3><div>A retrospective review of a prospectively maintained single-centre database of 1170 knee osteotomies was undertaken. Twenty-six patients with bifocal (femur and tibia) valgus malalignment and isolated lateral compartment osteoarthritis who had double-level osteotomy corrections (high tibial osteotomy (HTO) and distal femoral osteotomy (DFO)) were included. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee Injury and Osteoarthritis Outcome index scores, the Oxford knee score, Oxford Knee Score – Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ5D. EQ-5D stands for EuroQol 5-Dimension; it is a standardized instrument for measuring health-related quality of life (HRQoL). All lower limb alignment indices were recorded pre-and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 10-year survivorship were recorded.</div></div><div><h3>Results</h3><div>A total of 26 varization double-level osteotomy cases were followed up to a mean of 10.7 ± 3.5 years. This comprised 42.3 % males and 57.7 % females, with a mean age of 45.5 ± 10.9 years and a mean BMI of 30.9 ± 5.7 kg/m<sup>2</sup>. The mean planned correction angles for HTO and DFO were 7.4 ± 2.7° and 7.3 ± 1.9°, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from 12.5 ± 4.4° valgus to – 1.5 ± 2.6° varus, the mean MPTA improved from preoperative 93.8 ± 3.6° to postoperative 87.3 ± 2.6°, and the mean Mikulicz point improved from 105.7 ± 20.6 % to 39.9 ± 15.5 % (all P-values < 0.001). A high correction accuracy was reported for the mTFA, mLDFA and MPTA of 1.1 ± 1.3°, 1 ± 2.7°, and 0.7 ± 2.8°, respectively. The correction accuracy for the Mikulicz was 5 ± 15.6 %. All PROMs significantly improved at all time points with the most significant improvement noted at 24 months follow up (all <em>P</em>-values < 0.001). The rate of osteotomy revision was 3.8 %. The overall rate of total knee arthroplasty conversion was 15.4 % at an average of 4.9 ± 2.3 years postoperatively. The complication rate was 7.6 %. The 10-year survivorship was 86.5 %.</div></div><div><h3>Conclusion</h3><div>Varization double-level knee osteotomies for valgus knees, with severe malalignment with bifocal femoral and tibial defor","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 618-629"},"PeriodicalIF":2.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722238","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":"Clinical outcomes of quadrupled hamstring tendon use for anterior cruciate ligament reconstruction in the paediatric population: A systematic review","authors":"Omar E.S. Mostafa ,&nbsp;Muaaz Tahir ,&nbsp;Loiy Alkhatib ,&nbsp;Amit Meena ,&nbsp;Darren de SA ,&nbsp;Ejaz Mughal ,&nbsp;Peter D’Alessandro ,&nbsp;Nicolas Nicolaou ,&nbsp;Shahbaz S. Malik","doi":"10.1016/j.knee.2025.07.006","DOIUrl":"10.1016/j.knee.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to perform a systematic review to assess complication rates and clinical outcomes after use of quadrupled hamstring tendon graft for anterior cruciate ligament reconstruction (ACLR) in the paediatric population.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted following PRISMA guidelines and registered prospectively. Comparative and non-comparative studies that explicitly used quadrupled hamstring tendon for ACLR in skeletally immature patients were included. Patient-reported outcome measures, radiographic measurements and functional outcomes were reviewed. Quality assessment was performed using the Newcastle Ottawa Score.</div></div><div><h3>Results</h3><div>Thirty-four studies met the eligibility criteria with 1384 patients. The mean age was 13.5 years with 47.3 % males and mean follow up of 44.2 months. The overall complication rate was 14.2 %, graft failure was 6.5 % and revision surgery was 2.6 %. The mean postoperative Lysholm score was 93.0, the Tegner score was 7.3, and the IKDC score was 91.4. Return to activity was 88 %. The mean KT-1000 was 1.59 mm. The mean postoperative mLDFA was 91.0°, mMPTA was 87.2° and femorotibial angle was 2.59°.</div></div><div><h3>Conclusion</h3><div>Quadrupled hamstring tendon graft in ACLR offers good to excellent patient reported outcomes and low incidence of growth arrest. The graft re-rupture rate is up to 6.5%.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 609-617"},"PeriodicalIF":2.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721336","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":"Difference in time-course change in muscle cross-sectional area and knee and ankle functions between Japanese male patients who meet the return-to-sport criteria and those who do not meet it after triple-bundle anterior cruciate ligament reconstruction","authors":"Masayuki Kugimoto ,&nbsp;Kensuke Oba ,&nbsp;Namiko Sugai ,&nbsp;Kazuhiro Sasaki ,&nbsp;Yoshinari Sakaki ,&nbsp;Masaki Katayose ,&nbsp;Hideji Kura","doi":"10.1016/j.knee.2025.06.023","DOIUrl":"10.1016/j.knee.2025.06.023","url":null,"abstract":"<div><h3>Background</h3><div>The lower-extremity muscles are the main target of rehabilitation post-anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate time-course changes in the cross-sectional area of lower-extremity muscles (MCSA) among<!--> <!-->ACLR patients.</div></div><div><h3>Methods</h3><div>Twenty-seven male patients who underwent ACLR<!--> <!-->were included and grouped<!--> <!-->into<!--> <!-->PASS and non-PASS. PASS could achieve a ratio of injured-to-uninjured performance surpassing 90 % in all hop-tests and Lysholm score of ≥ 90. Those who failed to achieve even one of those conditions were designated as non-PASS. About MCSA, magnetic resonance images of the lower extremity on the injured side were obtained. Quadriceps, hamstrings, gastrocnemius, and soleus were manually surrounded<!--> <!-->at<!--> <!-->the slice featured<!--> <!-->the maximal MCSA<!--> <!-->for each muscle. Range of motion (ROM) and muscle strength of the knee and ankle<!--> <!-->were measured. All parameters were measured before surgery (PRE) and at 3, 6, 9, and 12 months post-ACLR<!--> <!-->(POST3/POST6/POST9/POST12, respectively). Knee stability was measured using KT-1000 in patients who underwent second-look surgery. The significance level was set at 5 %.</div></div><div><h3>Results</h3><div>At POST12, PASS (<em>n</em> = 14) exhibited greater ankle dorsiflexion ROM, knee extension strength, and ankle plantarflexion strength than non-PASS (<em>n</em> = 13). The interaction of MCSA was not detected, thus both data were integrated into a unified group for post-hoc tests.<!--> <!-->Quadriceps MCSA at POST12 was significantly larger than that at PRE. Hamstring, gastrocnemius, and soleus<!--> <!-->MCSAs<!--> <!-->at POST12<!--> <!-->did not have significant differences than those at PRE.</div></div><div><h3>Conclusions</h3><div>Restoration of ankle function and strength may be important for returning to sports.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 592-608"},"PeriodicalIF":1.6,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696429","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":"Does the amount of noise generated differ between manual and robotic TJA?","authors":"John D.D. Higgins ,&nbsp;Nabil Mehta ,&nbsp;Vasili Karas ,&nbsp;Denis Nam ,&nbsp;Craig J. Della Valle","doi":"10.1016/j.knee.2025.07.003","DOIUrl":"10.1016/j.knee.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to evaluate whether noise that is generated during manual and robotic-assisted total joint arthroplasty (TJA) differs and if that noise exceeds the Occupational Safety Health Administration (OSHA) action limits.</div></div><div><h3>Methods</h3><div>Personal dosimeters were used to record the decibel (dB) level during manual and robotic-assisted total hip and knee arthroplasty (THA/TKA). The primary surgeon wore the dosimeter on their person. All robotic procedures were performed with the use of image-based robotic arm aided technique. Peak decibel levels (LCPeak) and continuous decibel levels (LAeq) were captured in each procedure. 2-tailed student T-test was calculated to evaluate a difference between LAeq and LCPeak values between groups. An exposure calculator was used to calculate the 8-h Time-Weighted-Average (TWA).</div></div><div><h3>Results</h3><div>A total of 40 procedures were recorded; 10 for each robotic and manual THA and TKA. The mean LAeq dB levels for the robotic THA and TKA were 71.4 (SD 1.9) and 69.7 (SD 2.3) dB, and for manual THA and TKA levels were 69.8 (SD 2.4) and 71.3 (SD 2.4) dB. The max LCPeak decibel in each group did not exceed the OSHA peak sound pressure limit. Average LCPeak values in manual THA were higher than robotic THA (<em>P</em> = 0.01). Manual and robotic TKA values showed no difference. No groups exceeded the 8-h TWA limit.</div></div><div><h3>Conclusion</h3><div>TJA surgeons have significant noise exposure during surgery regardless of surgical technique; however, peak sound pressures and 8-h TWA dB levels discovered during mTJA and rTJA did not exceed OSHA limits.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 587-591"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680483","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":"Efficacy and systemic safety of adding intra-articular dexmedetomidine as adjuvant therapy to bupivacaine for post-operative analgesia in knee arthroscopic procedures: a systematic review and meta-analysis","authors":"Muhammad Sohaib Khan ,&nbsp;Wania Moeen ,&nbsp;Muhammad Hamza Shuja ,&nbsp;Yasmine Adel Mohammed ,&nbsp;Wajeeh Ahmed Khan ,&nbsp;Mobeen Farooqi ,&nbsp;Mohamed Abd-ElGawad ,&nbsp;Mohammad Danish ,&nbsp;Muhammad Jansher ,&nbsp;Muhammad Umair Anjum ,&nbsp;Mohammed Mahmmoud Fadelallah Eljack ,&nbsp;Md Ariful Haque","doi":"10.1016/j.knee.2025.06.017","DOIUrl":"10.1016/j.knee.2025.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Various analgesic methods have been evaluated for knee arthroscopy, but adequate pain control after arthroscopic procedures has been a challenge. This meta-analysis compares intra-articular bupivacaine with intra-articular bupivacaine plus dexmedetomidine, for post-op pain control after knee arthroscopy.</div></div><div><h3>Methods</h3><div>Adhering to the PRISMA guidelines we performed a thorough literature review and selected all the studies meeting our inclusion criteria (CD42024559371). Quality assessment was performed using the ROB II tool. A Random Effect (RE) model was used for analysis.</div></div><div><h3>Results</h3><div>Eight studies with 386 patients met the inclusion criteria. Combining Dexmedetomidine with Bupivacaine delays the need for first analgesic use compared to Bupivacaine alone (SMD: 4.09, 95 % CI [2.61 to 5.57], p &lt; 0.00001). Adverse events were minimal and comparable between groups in most studies. For patients who underwent knee arthroscopy under spinal anesthesia, Visual Analogue Scale scores at rest (VAS-r) and VAS scores during movement (VAS-m) showed significant differences favoring Bupivacaine and Dexmedetomidine from 4 h onward. VAS-m and VAS-r scores of patients who received general anesthesia displayed significant differences favoring Bupivacaine and Dexmedetomidine at 4 h only (SMD = −2.82 (95 % CI [−3.77 to −1.86], p &lt; 0.00001, I² = 55 %) and (SMD = −1.57 (95 % CI [−2.02 to −1.11], p &lt; 0.00001, I² = 0 %), respectively.</div></div><div><h3>Conclusion</h3><div>The combination of bupivacaine and dexmedetomidine for managing post-arthroscopic pain offers superior pain relief compared to bupivacaine alone, especially under spinal anesthesia. Further research is warranted to confirm these findings.</div></div><div><h3>Plain language summary</h3><div>Adding dexmedetomidine to bupivacaine significantly delays the need for the first analgesic dose after knee arthroscopy.</div><div>Pain relief is superior, especially under spinal anesthesia, with improved pain scores at rest and during movement from 4 h onward.</div><div>Adverse effects are minimal and comparable to bupivacaine alone, in most studies.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 534-545"},"PeriodicalIF":1.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670763","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":"Ideal remaining meniscus width and risk factors for decrease in meniscus width after reshaping surgery in pediatric patients with discoid lateral meniscus","authors":"Kyeong Baek Kim ,&nbsp;Seong Man Jeon ,&nbsp;Joo-Hwan Kim ,&nbsp;Dong Jin Ryu ,&nbsp;Joon Ho Wang","doi":"10.1016/j.knee.2025.07.001","DOIUrl":"10.1016/j.knee.2025.07.001","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to determine the ideal remaining discoid meniscal width after reshaping surgery and to investigate the preoperative risk factors for changes in the meniscal width.</div></div><div><h3>Methods</h3><div>Twenty-nine pediatric patients (39 knees) who underwent arthroscopic reshaping for symptomatic discoid lateral meniscus (DLM) were retrospectively analyzed. MRI was performed postoperatively and at 6 months or 1–2 years. Changes in meniscal width were measured, and logistic regression and receiver operating characteristic (ROC) curve analyses identified risk factors and cut-off values.</div></div><div><h3>Results</h3><div>The meniscal width gradually decreased, particularly in the midbody (25.7 % at 6 months and 38.1 % at 1–2 years, postoperatively). Risk factors for width reduction included a complete-type DLM (<em>β</em> = 26.0, <em>P</em> = 0.036) and a smaller preoperative meniscal height (<em>β</em> = −4.51, <em>P</em> = 0.048). The ROC curve analysis indicated that a preoperative meniscal height of ≤ 3.3 mm and preserving a meniscal width of ≤ 8.5 mm after surgery may result in a residual meniscal width of less than 5 mm.</div></div><div><h3>Conclusion</h3><div>The ideal remaining meniscal width after reshaping surgery should be &gt; 8.5 mm to minimize the risk of postoperative degeneration. Surgeons should consider preserving additional meniscal tissue, especially in patients with risk factors such as complete DLM or a meniscal height of less than 3.3 mm, to improve long-term joint preservation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 577-586"},"PeriodicalIF":1.6,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680482","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":"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}