Knee最新文献

{"title":"Physeal-sparing ACL reconstruction has equivalent survivorship and functional outcomes as transphyseal reconstruction but does not prevent growth disturbance: a systematic review of clinical and radiological outcomes","authors":"Muaaz Tahir ,&nbsp;Musab Al-Musabi ,&nbsp;Tahir Khaleeq ,&nbsp;Omar E.S. Mostafa ,&nbsp;Stephen Dalglish ,&nbsp;Amit Meena ,&nbsp;Darren de SA ,&nbsp;Peter D’Alessandro ,&nbsp;Nicolas Nicolaou ,&nbsp;Shahbaz S. Malik","doi":"10.1016/j.knee.2025.06.004","DOIUrl":"10.1016/j.knee.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>ACL reconstruction in the paediatric population presents unique challenges, owing to the ongoing skeletal growth. This systematic review aimed to compare the functional and radiological outcomes of transphyseal(TP), partial transphyseal(pTP) and physeal-sparing(PS) techniques.</div></div><div><h3>Methods</h3><div>A systematic search of the MEDLINE and EMBASE databases was performed in accordance with the PRISMA guidelines to identify studies reporting growth disturbances and/or functional outcomes. Pooled incidence of growth disturbance and graft rupture was calculated from available raw data using an inverse-variance random-effects model.</div></div><div><h3>Results</h3><div>The search identified 37 studies reporting on TP (<em>n</em> = 1389), 11 on PS (<em>n</em> = 867), 5 on pTP (<em>n</em> = 91), and 6 comparing both techniques [TP (<em>n</em> = 1668), pTP (<em>n</em> = 8), PS (<em>n</em> = 445)], with mean follow up ranging from 1.25 to 8 years. Mean age in TP studies ranged between 12–16.4, pTP; 10.7–13.6, and PS; 10.5–14.3 years. Pooled proportional incidence of leg length discrepancy was 1.3% in TP, 5.7% in pTP and 3.4% in the PS studies. Incidence of angular deformities was 1.5% in TP, 2.8% in pTP and 1.8% in the PS studies. Graft rupture rate was 6% in the TP studies, 9.8% in pTP, and 8.1% in the PS studies. Five comparative studies reported no differences in rates of graft rupture or growth disturbance.</div></div><div><h3>Conclusion</h3><div>TP, pTP and PS ACL reconstruction techniques result in similar patient reported outcomes and graft rupture rates. Patients who undergo pTP and PS reconstruction are generally younger, thus more susceptible to growth-related complications post-surgery. Larger comparative studies with age-matched cohorts are required to investigate this association further.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 510-533"},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can ChatGPT provide personalised responses for frequently asked questions regarding anterior cruciate ligament reconstruction?","authors":"Siyuan Zhang,&nbsp;Isaac Jeremiah Chua,&nbsp;Zhen Chang Liang,&nbsp;Khang Chiang Pang","doi":"10.1016/j.knee.2025.06.018","DOIUrl":"10.1016/j.knee.2025.06.018","url":null,"abstract":"<div><h3>Background</h3><div>Chat Generative Pre-trained Transformer (ChatGPT) has the potential to enhance healthcare delivery by providing accessible, high-quality medical information. However, no prior studies have evaluated its ability to provide personalised and patient-specific information. Our study aims to evaluate ChatGPT’s ability to provide personalised responses to frequently asked questions (FAQs) regarding anterior cruciate ligament (ACL) reconstruction.</div></div><div><h3>Methods</h3><div>We curated a list of 13 clinically relevant FAQs regarding ACL reconstruction and created four distinct patient profiles with varying demographics, comorbidities and activity demands. Each patient profile was entered separately as prompts into the latest version of ChatGPT (GPT-4o). ChatGPT’s responses to the FAQs were recorded and assessed independently by two orthopaedic consultants who graded the responses on a scale of 0–2 (0, 1, 2) based on their accuracy and degree that it was personalised to each patient profile.</div></div><div><h3>Results</h3><div>ChatGPT performed well in providing accurate and personalised responses, achieving a mean overall accuracy score of 1.85 and mean overall personalisation score of 1.90. It was able to provide personalised and patient-specific responses by customizing its recommendations to cater to the situation of each distinct patient – achieving mean personalisation scores of 1.96, 1.88, 1.92 and 1.81 for the four respective patient profiles.</div></div><div><h3>Conclusions</h3><div>In our study, ChatGPT demonstrated the ability to adapt to distinct patient profiles and provide highly personalised responses regarding ACL reconstruction. Despite potential ethical and regulatory challenges, the ability of AI chatbots to deliver individualized information and counselling is an exciting new frontier in personalised medicine which warrants further research.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 495-502"},"PeriodicalIF":1.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Location of the popliteal artery during medial and lateral distal femoral osteotomy: A retrospective study using contrast-enhanced computed tomography-based three-dimensional models","authors":"Shu Takagawa ,&nbsp;Yohei Yukizawa ,&nbsp;Ayahiro Kadowaki ,&nbsp;Shota Higashihira ,&nbsp;Yutaka Inaba ,&nbsp;Naomi Kobayashi","doi":"10.1016/j.knee.2025.06.022","DOIUrl":"10.1016/j.knee.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative popliteal artery injury during distal femoral osteotomy (DFO) is a fatal complication that requires detailed anatomical examination. We evaluated the location of the popliteal artery in medial and lateral DFO using contrast-enhanced computed tomography (CT)-based three-dimensional (3D) models.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 30 knees that underwent contrast-enhanced CT primarily for cardiovascular disease. Osteotomy planes for medial and lateral DFO were created using 3D models. The popliteal artery distance was measured as the distance between two points where the bone and blood vessels were closest to each other, the location of the popliteal artery was determined by dividing the distance from the starting point to the nearest arterial point by the total osteotomy distance, and the angle closest to popliteal artery was defined as the angle formed by three points: the osteotomy starting point and the points near the bone and popliteal artery, in both models.</div></div><div><h3>Results</h3><div>The shortest distance from the artery to the osteotomy line did not differ significantly between the lateral DFO (13.5 ± 3.0 mm) and medial DFO groups (14.2 ± 3.5 mm). The ratio of popliteal artery location was significantly closer to the osteotomy starting point in the lateral DFO group (0.29 ± 0.12) than in the medial DFO group (0.45 ± 0.13) (<em>P</em> &lt; 0.001). The angle closest to the artery was significantly larger in the lateral DFO group (31.1 ± 6.9°) than in the medial DFO group (26.9 ± 7.7°) (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>In distal femoral osteotomies, the popliteal artery requires more attention during medial DFO than during lateral DFO.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 488-494"},"PeriodicalIF":1.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose exposure to tranexamic acid has no significant toxic effect on human cartilage","authors":"Arash Sherafatvaziri ,&nbsp;Mohammad Hossein Nabian ,&nbsp;Fardis Vosoughi ,&nbsp;Elham Madreseh ,&nbsp;Alireza Mirzamohamadi ,&nbsp;Ramin Shayan-moghadam","doi":"10.1016/j.knee.2025.06.019","DOIUrl":"10.1016/j.knee.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies have raised concerns about the potential cytotoxic effects of tranexamic acid (TXA) on cartilage. This study aimed to evaluate the safety of low-dose TXA exposure on human cartilage.</div></div><div><h3>Method</h3><div>In this ex-vivo study, 30 patients with a varus osteoarthritic knee undergoing total knee arthroplasty (TKA) were enrolled. During the surgery, a set of six osteochondral plugs was harvested from the apparently intact lateral condyle of each patient’s femur, resulting in a total of 180 plugs. Subsequently, all three plugs of each set were randomly exposed to one of the TXA treatment groups: 1 mg/ml (TI group), 5 mg/ml (TV group), or 10 mg/ml (TX group) of TXA. The remaining three plugs of each set were assigned to the control group and exposed to 0.9 % saline as a match for comparison. The effects of TXA dose and exposure time on cell viability were assessed using acridine orange/propidium iodide staining at baseline, 3, and 6 h post-exposure.</div></div><div><h3>Results</h3><div>Cell viability decreased over time in the TI, TV, TX, and control groups compared with their baselines (<em>P</em> = 0.006, <em>P</em> &lt; 0.001, <em>P</em> = 0.001, <em>P</em> &lt; 0.001, respectively). However, the differences in the trend of decline were not statistically significant between groups (<em>P</em> = 0.3), and direct comparisons among TXA concentrations and saline control at baseline, 3, and 6 h after exposure showed no statistically significant difference in cell death (<em>P</em> = 0.538, <em>P</em> = 0.256, <em>P</em> = 0.287, respectively).</div></div><div><h3>Conclusions</h3><div>Exposure to low-dose TXA (≤10 mg/ml) for up to 6 h did not cause significant toxic effects on human cartilage.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 479-487"},"PeriodicalIF":1.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of bone loss in revision total knee arthroplasty with tantalum cones: Primary aseptic revision versus multiple revisions","authors":"A. Zampieri ,&nbsp;S. Putman ,&nbsp;R. Erivan ,&nbsp;H. Behal ,&nbsp;H. Migaud ,&nbsp;G. Pasquier ,&nbsp;J. Dartus","doi":"10.1016/j.knee.2025.06.016","DOIUrl":"10.1016/j.knee.2025.06.016","url":null,"abstract":"<div><h3>Background</h3><div>The increasing number of revisions following total knee arthroplasty (TKA) has led to the appearance of new challenges, including the management of bone defects. The use of porous tantalum cones is one of the options to address this bone loss.</div></div><div><h3>Purpose</h3><div>We carried out a retrospective study to compare the medium-term outcomes of single and multiple TKA revisions in the context of massive bone defects using tantalum cones. We analyzed: (1) the survival of the revision implants, (2) osseointegration of the cone, (3) the clinical and functional outcomes, (4) complications.</div></div><div><h3>Methods</h3><div>Between July 2011 and May 2019, 79 metaphyseal reconstructions (MRs) were performed in 58 patients (mean age 68 ± 11 (41–89)) who received tantalum cones during the procedure. Revisions for infection were excluded. The massive bone defects were classified as Anderson Orthopaedic Research Institute types 2B/3. The cone had to be removed in 12 patients (16 MRs). Implant survival free of all-cause revision and cone survival free of aseptic loosening were calculated. Osseointegration of the cones was determined on radiographs. A subset of patients (n = 46) underwent a clinical assessment including the OKS, KSS, KOOS, satisfaction level and knee flexion. All of the patients (n = 58) underwent a radiological assessment. Complications were documented during the follow up period.</div></div><div><h3>Results</h3><div>The mean follow up was 73.1 months ± 29.8 (12–143). In all, 91 cones (48 at the femur and 43 in the tibia) had been implanted during 79 MR procedures: 40 in the primary revision group (R-primary) and 39 in the multiple revision group (R-multiple). Survivorship of the implant free of all-cause revision at 6 years was better in the R-primary group, 97.5 % (95 %CI: 93 % to 100 %) than in the R-multiple group, 70.5 % (95 %CI: 57 % to 87 %) (<em>P</em> &lt; 0.01). Survivorship of the cone free of aseptic loosening at 6 years was comparable between the two groups: 100 % (95 %CI 100 % to 100 %) for R-primary and 96.8 % (95 %CI 91 % to 100 %) for R-multiple (<em>P</em> = 0.26). At the final assessment, 10 of 91 cones had no bone ingrowth; all of them were in the R-multiple group (<em>P</em> = 0.012). The functional outcomes were better in the R-primary group.<!--> <!-->The mean OKS was 31.5 ± 8.7 (16–45) vs. 25.7 ± 9.1 (9–41) in the R-multiple group (<em>P</em> = 0.014). The mean KSS global was 146.2 ± 32.3 (69–197) vs. 136.8 ± 20.9 (98–182) in the R-multiple group (<em>P</em> = 0.082). The KOOS global was 61.3 ± 17 (26–84) vs. 48.3 ± 15.7 (18–79) in the R-multiple group (<em>P</em> &lt; 0.01). In the R-primary group, 78 % of patients (22/28) were satisfied or very satisfied with the outcome vs. 61 % (11/18) in the R-multiple group (<em>P</em> = 0.25). The mean knee flexion at the final assessment was 102.7 ± 24.2 (20–125) in the R-primary group vs. 98.3 ± 16.5 (70–120) in the R-multiple group ","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 467-478"},"PeriodicalIF":1.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical measures predicting better outcomes in knee arthroplasty patients: a secondary analysis of the CORKA randomised controlled trial","authors":"Benjamin David Weedon ,&nbsp;Jon Room ,&nbsp;Karen Louise Barker","doi":"10.1016/j.knee.2025.06.014","DOIUrl":"10.1016/j.knee.2025.06.014","url":null,"abstract":"<div><h3>Background</h3><div>Evaluate functional and participation predictors of outcome following knee arthroplasty (KA) focusing on the<!--> <!-->International Classification of Functioning, Disability, and Health framework.</div></div><div><h3>Methods</h3><div>Secondary analysis of the CORKA randomised controlled trial, which included patients undergoing KA. The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) was assessed using a linear mixed-effects model. Secondary outcomes with baseline assessments of the Physical Activity Scale for the Elderly (PASE), Figure of 8 Walk Test (F8WT), 30-Second Chair Stand Test (30CST), and single-leg stance on the operated leg (SLS) were used to predict functional and participation outcomes at 6, 12, and 24-months using multiple linear regression models.</div></div><div><h3>Results</h3><div>621 participants were recruited (males 250, females 371), with a mean age of 70 ± 8 years. SLS significantly predicted LLFDI function across all time points (6-months 0.14, 0.06–0.22, <em>p</em> = 0.001, 12-months 0.18, 0.09–0.27, <em>p</em> &lt; 0.001, 24-months 0.21, 0.11–0.31, <em>p</em> &lt; 0.001), while PASE predicted it at 6-months 0.02, 0.01–0.03, <em>p</em> = 0.006 and 24-months 0.02, 0.004–0.04, <em>p</em> = 0.012. PASE also predicted disability frequency at all intervals(6-months 0.03, 0.02–0.05, <em>p</em> &lt; 0.001, 12-months 0.04, 0.02–0.05, <em>p</em> &lt; 0.001, 24-months 0.03, 0.01–0.05, <em>p</em> = 0.001), with SLS and F8WT as significant predictors at 12 and 24-months, respectively (SLS 12-months 0.13, 0.04–0.21, <em>p</em> = 0.005, F8WT 24-months −0.37, −0.73 to −0.01, <em>p</em> = 0.044). Only PASE (12-months 0.04, 0.01–0.07, <em>p</em> = 0.003, 24-months 0.04, 0.01–0.07, <em>p</em> = 0.003) and SLS (12-months 0.26, 0.10–0.42, <em>p</em> = 0.002, 24-months 0.28, 0.12–0.44, <em>p</em> = 0.001) predicted disability limitation at 12 and 24-months.</div></div><div><h3>Conclusions</h3><div>Findings suggest functional measures may be used to predict short-term outcomes, while participation measures better suit long-term outcomes after KA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 459-466"},"PeriodicalIF":1.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144595639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of early revision after trainee led primary unicompartmental and total knee replacement","authors":"Daniel J. Howgate ,&nbsp;Joseph Dixon ,&nbsp;Benjamin J.L. Kendrick ,&nbsp;Andrew J. Price ,&nbsp;Abtin Alvand","doi":"10.1016/j.knee.2025.06.010","DOIUrl":"10.1016/j.knee.2025.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Orthopaedic trainees must demonstrate competence in performing major joint replacement. This study aimed to determine the impact of lead surgeon grade and level of supervision for trainee led operations on the incidence of early revision procedures following elective primary knee replacement.</div></div><div><h3>Methods</h3><div>Data from the National Joint Registry was obtained for all primary elective total (TKR) and partial (UKR) knee replacements performed within a single NHS University Teaching Hospital from 2007 to 2021. Multivariate logistic regression was used to determine the risk of all cause revision within 1-year of the index procedure in relation to surgeon grade and level of supervision for trainee led (TL) operations.</div></div><div><h3>Results</h3><div>9,931 primary knee replacements (KR) were undertaken, of which 4850 (48.8 %) were UKR. Revision procedures were performed in 109 (1.1 %) patients within 1-year of their index operation. The risk of revision was not significantly different for consultant-led (CL) or TL operations (OR 0.84, CI 0.55–1.26, <em>p</em> = 0.4). In comparison to CL operations, no difference was observed in the risk of revision for either consultant-supervised trainee (TS, OR 0.83, CI 0.49–1.35, <em>p</em> = 0.7) or non-consultant supervised trainee (TU, OR 0.84, CI 0.46–1.43, <em>p</em> = 0.7) operations. These trends remained on sub-analysis for both UKR and TKR operations.</div></div><div><h3>Conclusions</h3><div>No differences were observed in the incidence of revision within 1-year of primary KR between consultant led and trainee led operations. These findings suggest that training surgeons in both TKR and UKR operations is not associated with an increased risk of early adverse patient outcomes requiring revision surgery.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 449-458"},"PeriodicalIF":1.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580439","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":"Neuromuscular control of the knee and hip and its relationship with function in women with patellofemoral pain","authors":"Isabela Vitória Souza Araújo ,&nbsp;Thiago André Pereira Gonçales ,&nbsp;Vera Lucia Freitas Carvalho ,&nbsp;Beatriz Signori Caetano ,&nbsp;Luisa Pereira Fernandes ,&nbsp;Deborah Hebling Spinoso","doi":"10.1016/j.knee.2025.06.009","DOIUrl":"10.1016/j.knee.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>The combined assessment of subjective and objective measures is essential to understand functional impairment in individuals with patellofemoral pain (PFP) and to guide appropriate rehabilitation strategies. The objective to was investigate the relationship between objective and subjective function and neuromuscular control of the hip and knee in women with PFP and asymptomatic women.</div></div><div><h3>Methods</h3><div>Data were collected from 30 women (22.56 ± 4.21 years) with PFP and 30 asymptomatic women (21.10 ± 1.68). Initially, anthropometric data were collected and the Anterior Knee Pain Scale (AKPS) was applied. Subsequently, objective function was assessed using four tests: step descent, single-legged chair rise, anterior hop, and lateral hop. On the second day, knee extensor, hip extensor, and hip abductor torque were assessed on an isokinetic dynamometer. The protocol consisted of 3 concentric contractions at a speed of 60°/sec for the knee joint and 30°/sec for the hip joint. For statistical analysis, the independent <em>t</em>-test was applied to compare variables between groups and the Pearson correlation test, with a significance level of <em>p</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>Women with PFP have a deficit in the ability to produce maximum hip and knee force during concentric contractions (<em>p</em> &lt; 0.05). Moderate correlations were found in strength and TDT and functional performance.</div></div><div><h3>Conclusion</h3><div>The deficit in the ability to produce muscle strength and power of the hip and knee negatively interferes with functional performance and should therefore be considered in rehabilitation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 431-438"},"PeriodicalIF":1.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572806","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":"Incidence of concomitant intra- and extra-articular lesions and procedures in patients undergoing primary and subsequent revision single-stage or 2-stage revision anterior cruciate ligament reconstruction: a matched retrospective cohort study","authors":"Anna M. Ifarraguerri ,&nbsp;Alexander B. White ,&nbsp;George D. Graham ,&nbsp;Kennedy K. Gachigi ,&nbsp;Alexander N. Berk ,&nbsp;Michael S. Collins ,&nbsp;David P. Trofa ,&nbsp;Dana P. Piasecki ,&nbsp;James E. Fleischli ,&nbsp;Patrick N. Siparsky ,&nbsp;Bryan M. Saltzman","doi":"10.1016/j.knee.2025.06.013","DOIUrl":"10.1016/j.knee.2025.06.013","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compares the concomitant intra- and extra-articular pathologies in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) to their subsequent single or 2-stage revision ACLR<strong>.</strong></div></div><div><h3>Methods</h3><div>Patients from 2012 to 2021 with minimum two-year follow-up after single-stage revision ACLR were matched with patients who underwent 2-stage revision ACLR by age, sex, and body mass index. Concomitant pathologies and procedures were compared from primary to single or 2-stage revision ACLR. The incidence of concomitant knee pathologies and procedures at the time of primary and revision ACLR was compared between the two groups.</div></div><div><h3>Results</h3><div>Following primary ACLR<strong>,</strong> 27 patients had single-stage revision ACLR and 27 had 2-stage revision ACLR. At the time of revision surgery, 2-stage revision ACLR had increased incidence of multi-ligamentous injury and meniscus repair. Rates of chondral injury alone and chondral injury plus concomitant meniscal injury increased significantly from primary to 2-stage revision ACLR. No significant change in the incidence of concomitant pathologies or procedures was found at primary ACLR to single-stage revision ACLR.</div></div><div><h3>Conclusion</h3><div>Patients with 2-stage revision ACLR are more likely to have concomitant multi-ligamentous pathologies and meniscal repair at the time of revision. Additionally, 25.9% of patients developed chondral pathologies and 18.55% developed both chondral and meniscal lesions from primary ACLR to 2-stage revision ACLR, raising concern about the long-term outcomes of these patients.</div></div><div><h3>Level of evidence</h3><div>Retrospective Cohort; 3.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 439-448"},"PeriodicalIF":1.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572807","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":"ChatGPT-4.0 and DeepSeek-R1 does not yet provide clinically supported answers for knee osteoarthritis","authors":"Haodong Wu ,&nbsp;Shuxin Yao ,&nbsp;Huanli Bao ,&nbsp;Yishun Guo ,&nbsp;Chao Xu ,&nbsp;Jianbing Ma","doi":"10.1016/j.knee.2025.06.007","DOIUrl":"10.1016/j.knee.2025.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Large Language Models (LLMs) such as ChatGPT-4.0 and DeepSeek-R1 provide advanced natural language capabilities, but they also raise concerns regarding accuracy in medical applications. There is a lack of systematic evaluation of their performance against orthopedic guidelines, particularly for knee osteoarthritis (KOA). This study assessed the accuracy and consistency of these LLMs in relation to the most recent Chinese clinical practice guidelines for KOA.</div></div><div><h3>Methods</h3><div>Queries regarding 17 guideline-recommended KOA therapeutic strategies were posed to ChatGPT-4.0 and DeepSeek-R1. Two independent reviewers evaluated response concordance (Concordance, Discordance, or No Concordance) with guidelines. Inter-rater reliability was assessed using Cohen’s kappa coefficient. A chi-square test was employed to compare the response patterns between the two models.</div></div><div><h3>Results</h3><div>ChatGPT-4.0 showed 59 % concordance; DeepSeek-R1 achieved 71 %. Both models gave inconsistent recommendations for ozone therapy and arthroscopy. ChatGPT-4.0 had five inconsistent responses; DeepSeek-R1 had three. Inter-rater agreement was high (κ = 0.90 and 0.86). No significant difference was found in concordance rates (P = 0.7; P = 1). Only DeepSeek-R1 provided references (38 in total), but just 8 were fully verifiable.</div></div><div><h3>Conclusion</h3><div>Neither ChatGPT-4.0 nor DeepSeek-R1 consistently produced responses aligned with evidence-based clinical guidelines. These findings highlight the need for cautious interpretation of medical advice generated by current AI platforms, both by clinicians and patients.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"56 ","pages":"Pages 386-396"},"PeriodicalIF":1.6,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556805","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}