Yashar Khani, Amir Mehrvar, Sadra Mohebbi, Mohammadhossein Hefzosseheh, Mahya Aliakbari, Fateme Mansouri Rad, Mohammad Poursalehian
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Scopus, PubMed, Embase, and Web of Science were searched up to March 2024 without date or language restrictions. Studies comparing CR and CS implants reporting FJS outcomes were included. Data extracted included study characteristics, patient demographics, intervention details, follow-up durations, and FJS scores. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Intervention-I tool. A random-effects meta-analysis using Hedges g was performed, with sensitivity analyses and meta-regression to explore heterogeneity.</p><p><strong>Results: </strong>Seventeen cohort studies involving 4,245 patients were included. The meta-analysis demonstrated that CS implants were superior to CR implants in terms of FJS (Hedges g = -0.39; p = 0.018), indicating a small to medium effect size favoring CS designs. High heterogeneity was observed (I<sup>2</sup> = 95.69%). Sensitivity analyses yielded similar results, and meta-regression did not identify significant sources of heterogeneity.</p><p><strong>Conclusion: </strong>CS implants are associated with superior joint awareness compared with CR implants in TKA, as measured by the FJS. Despite the theoretical advantage of PCL preservation, CR implants did not demonstrate better joint awareness. The findings should be interpreted with caution due to study heterogeneity and limitations in study design. Further high-quality randomized controlled trials are necessary to confirm these results.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"10 3","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324053/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cruciate-Retaining Implants Do Not Provide a More Natural Joint Feeling Than Cruciate-Substituting Implants in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.\",\"authors\":\"Yashar Khani, Amir Mehrvar, Sadra Mohebbi, Mohammadhossein Hefzosseheh, Mahya Aliakbari, Fateme Mansouri Rad, Mohammad Poursalehian\",\"doi\":\"10.2106/JBJS.OA.25.00136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The Forgotten Joint Score (FJS) is a patient-reported outcome measure developed to assess joint awareness, potentially differentiating between \\\"good\\\" and \\\"excellent\\\" outcomes. Prosthetic designs, specifically cruciate-retaining (CR) and cruciate-substituting (cruciate sacrificing/substituting [CS]) implants, may influence joint awareness due to differences in posterior cruciate ligament (PCL) preservation. Our objective was to compare the joint awareness outcomes, measured by the FJS, between CR and CS implants in total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science were searched up to March 2024 without date or language restrictions. Studies comparing CR and CS implants reporting FJS outcomes were included. Data extracted included study characteristics, patient demographics, intervention details, follow-up durations, and FJS scores. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Intervention-I tool. A random-effects meta-analysis using Hedges g was performed, with sensitivity analyses and meta-regression to explore heterogeneity.</p><p><strong>Results: </strong>Seventeen cohort studies involving 4,245 patients were included. The meta-analysis demonstrated that CS implants were superior to CR implants in terms of FJS (Hedges g = -0.39; p = 0.018), indicating a small to medium effect size favoring CS designs. High heterogeneity was observed (I<sup>2</sup> = 95.69%). Sensitivity analyses yielded similar results, and meta-regression did not identify significant sources of heterogeneity.</p><p><strong>Conclusion: </strong>CS implants are associated with superior joint awareness compared with CR implants in TKA, as measured by the FJS. Despite the theoretical advantage of PCL preservation, CR implants did not demonstrate better joint awareness. The findings should be interpreted with caution due to study heterogeneity and limitations in study design. Further high-quality randomized controlled trials are necessary to confirm these results.</p>\",\"PeriodicalId\":36492,\"journal\":{\"name\":\"JBJS Open Access\",\"volume\":\"10 3\",\"pages\":\"\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324053/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS Open Access\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.OA.25.00136\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Open Access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.OA.25.00136","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：遗忘关节评分（FJS）是一种患者报告的结果测量方法，用于评估关节意识，潜在地区分“良好”和“优秀”的结果。假体设计，特别是交叉保留（CR）和交叉替代（交叉牺牲/替代[CS]）植入物，由于后交叉韧带（PCL）保存的差异，可能会影响关节意识。我们的目的是比较全膝关节置换术（TKA）中CR和CS植入物之间通过FJS测量的关节感知结果。方法：根据PRISMA指南进行系统评价和荟萃分析。Scopus, PubMed， Embase和Web of Science的检索截止到2024年3月，没有日期或语言限制。比较CR和CS植入物报告FJS结果的研究包括在内。提取的数据包括研究特征、患者人口统计、干预细节、随访时间和FJS评分。偏倚风险采用干预ⅰ类非随机研究的偏倚风险评估。使用Hedges进行随机效应荟萃分析，采用敏感性分析和元回归来探索异质性。结果：纳入了17项队列研究，涉及4245例患者。meta分析显示，CS植入物在FJS方面优于CR植入物(Hedges g = -0.39；p = 0.018)，表明小到中等的效应量有利于CS设计。异质性较高（I2 = 95.69%）。敏感性分析得出了类似的结果，元回归没有发现显著的异质性来源。结论：通过FJS测量，与CR种植体相比，CS种植体在TKA中具有更好的关节意识。尽管理论上PCL保存有优势，但CR植入物并没有表现出更好的关节意识。由于研究的异质性和研究设计的局限性，研究结果应谨慎解释。需要进一步的高质量随机对照试验来证实这些结果。
Cruciate-Retaining Implants Do Not Provide a More Natural Joint Feeling Than Cruciate-Substituting Implants in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Background: The Forgotten Joint Score (FJS) is a patient-reported outcome measure developed to assess joint awareness, potentially differentiating between "good" and "excellent" outcomes. Prosthetic designs, specifically cruciate-retaining (CR) and cruciate-substituting (cruciate sacrificing/substituting [CS]) implants, may influence joint awareness due to differences in posterior cruciate ligament (PCL) preservation. Our objective was to compare the joint awareness outcomes, measured by the FJS, between CR and CS implants in total knee arthroplasty (TKA).
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Scopus, PubMed, Embase, and Web of Science were searched up to March 2024 without date or language restrictions. Studies comparing CR and CS implants reporting FJS outcomes were included. Data extracted included study characteristics, patient demographics, intervention details, follow-up durations, and FJS scores. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Intervention-I tool. A random-effects meta-analysis using Hedges g was performed, with sensitivity analyses and meta-regression to explore heterogeneity.
Results: Seventeen cohort studies involving 4,245 patients were included. The meta-analysis demonstrated that CS implants were superior to CR implants in terms of FJS (Hedges g = -0.39; p = 0.018), indicating a small to medium effect size favoring CS designs. High heterogeneity was observed (I2 = 95.69%). Sensitivity analyses yielded similar results, and meta-regression did not identify significant sources of heterogeneity.
Conclusion: CS implants are associated with superior joint awareness compared with CR implants in TKA, as measured by the FJS. Despite the theoretical advantage of PCL preservation, CR implants did not demonstrate better joint awareness. The findings should be interpreted with caution due to study heterogeneity and limitations in study design. Further high-quality randomized controlled trials are necessary to confirm these results.
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