Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose: To evaluate what tunnel combination, with respect to anatomical transtibial pull-through root repair (ATPR) and transtibial centralisation (TTC), best restores tibiofemoral contact mechanics and meniscal extrusion following a medial meniscus posterior root tear (MMPRT).

Methods: Meniscal extrusion and contact mechanics were measured using two-dimensional imaging and pressure films in 10 porcine knee joints. The posterior root was tested under six states: (1) intact; (2) MMPRT; (3) one tunnel ATPR and one tunnel TTC (1-ATPR + 1-TTC); (4) two tunnel ATPR and one tunnel TTC (2-ATPR + 1-TTC); (5) 1-ATPR + 2-TTC; and (6) 2-ATPR + 2-TTC. The testing protocol loaded knees with 200-N axial compression at 4 flexion angles (30°, 45°, 60° and 90°). At each angle and state, meniscal extrusion was measured as the difference in its position under load to that of the unloaded condition in the intact state. Contact area and pressure were recorded for all states at all angles and were analysed using a MATLAB programme.

Results: MME was significantly reduced with both the 1-ATPR + 2-TTC and 2-ATPR + 2-TTC tunnels in comparison to the 1-ATPR + 1-TTC and 2-ATPR + 1-TTC tunnels at 60° and 90° (p < 0.05). The intact meniscus and 1-ATPR + 1-TTC technique had higher contact area at 60° (p = 0.01 and 0.04, respectively) and lower contact pressure at 90° (p = 0.01 and 0.04, respectively) compared to the 2-ATPR + 2-TTC technique. Otherwise, all tunnel combinations were similar to one another for contact mechanics and restored the loading profile to that of an intact meniscus (p > 0.05).

Conclusion: When there are concerns of extrusion following a MMPRT, a combination of one centralisation and one root repair tunnel may provide better biomechanical properties compared to the addition of extra tunnels.

Level of evidence: Not applicable (laboratory study).

Purpose: To compare donor site morbidity and patient-reported outcome measures (PROMs), knee laxity and early strength and functional outcomes, following anterior cruciate ligament reconstruction (ACLR) using a semitendinosus (ST) tendon autograft with suspensory adjustable button tibial fixation or semitendinosus-gracilis (STG) autograft with tibial screw fixation.

Methods: While 153 patients were prospectively recruited and randomized to an ST or STG autograft, 131 (62 ST and 69 STG) were retained following ACLR and followed post-surgery. Standardized surgical techniques were employed, varying only in graft selection and fixation. The primary study outcomes were early hamstring pain, donor site morbidity and strength recovery. However, several outcomes were assessed pre-surgery and at 3 and 6 months, encompassing the Donor-site-related Functional Problems following Anterior Cruciate Ligament Reconstruction (DFPACLR) score, Visual Analogue Scale (VAS) for hamstring pain and other commonly employed PROMs, anteroposterior laxity (KT-1000), isokinetic hamstring and quadriceps strength, hop testing, complications and re-operations. Intention-to-treat analysis was performed using linear mixed models for continuous data and Mann-Whitney U tests where appropriate.

Results: At 6 months, ST patients reported significantly lower hamstring pain (p < 0.001) and DFPACLR (p < 0.001) scores. A significantly higher (p < 0.001) peak knee flexor strength limb symmetry index (LSI) was observed for the ST group, though no other group differences in side-to-side laxity, hop tests or other normalized strength measures or LSIs were observed.

Conclusions: ACLR using an ST autograft resulted in less donor site pain and morbidity, and improved knee flexor strength symmetry at 6 months, while demonstrating comparable functional outcomes to the STG autograft.

Level of evidence: Level 1 prospective, double-blinded, randomized controlled trial.

Purpose: To determine the collagen composition of the semitendinosus and quadriceps tendons at different levels of physical maturity.

Methods: Tissue samples were collected from 70 patients who underwent anterior cruciate ligament or medial patellofemoral ligament reconstruction using the semitendinosus or quadriceps tendon. The samples were immunostained to identify type I and type III collagen. Confocal microscopy and image analysis software were used to determine the percentage composition of collagen types (type I + type III, 100%). Patients were categorized into three groups based on age and epiphyseal patency: immature (<20 years, >1.5 mm), young (<20 years, <1.5 mm) and adult (>20 years). The Mann-Whitney U test was used to analyze differences between the immature and other groups in the semitendinosus tendon group. The percentage of collagen content in the semitendinosus and quadriceps tendons was evaluated based on the patient's maturity level.

Results: The median type I collagen content in the semitendinosus tendon was 54.2% (40.9-75.4), 98.9% (81.0-99.6) and 97.0% (40.0-100.0) in the immature (n = 6), young (n = 8) and adult (n = 18) groups, respectively. For the quadriceps tendon, the values were 98.4% (68.9-100.0), 89.1% (68.6-98.9) and 85.6% (72.3-99.6) in the immature (n = 11), young (n = 14) and adult (n = 13) groups, respectively. The semitendinosus tendon in the immature group had significantly lower type I collagen content than in the young and adult groups. Additionally, in the immature group, type I collagen content was significantly lower in the semitendinosus tendon than in the quadriceps tendon.

Conclusions: A comparison of collagen composition between the semitendinosus and quadriceps tendons, based on patient maturity level, revealed that the semitendinosus tendon in immature patients had a lower percentage of type I collagen than in mature patients and lower than the quadriceps tendon.

Level of evidence: Not applicable.

Purpose: To investigate minimal clinically important difference (MCID), substantial clinical benefit (SCB), patient acceptable symptom state (PASS) values for patient-reported outcome measures (PROMs) after patellar stabilization surgery for patellar instability. Secondary outcomes included to describe methods to calculate clinically significant outcomes (CSOs), and to report on the achievement of these metrics.

Methods: On 31 July 2024, three databases were searched. Information on whether studies calculated MCID, SCB or PASS values or used previously established values was recorded. Data on study characteristics, CSO values, and the method of MCID quantification (e.g., distribution vs. anchor) were extracted.

Results: A total of 17 articles with 1447 patients (1462 knees) were included. A total of 18 unique outcome measures were reported. Six out of 15 (40%), 2 out of 5 (40%), and zero studies used prior established values for MCID, SCB and PASS, respectively. MCID ranged widely (e.g., International Knee Documentation Committee [IKDC]: 5.6-20.5; Kujala Anterior Knee Pain Scale: 5.38-11.9 and Lysholm: 5.6-11.1). Fourteen out of 15 utilized a distribution-based method to calculate MCID, with only one study using an anchor-based method. SCB values ranged widely as well (e.g.

, ikdc: 14.5-23.6; Knee Osteoarthritis and Outcome Score [KOOS] symptoms: 4.2-14.2 and KOOS activities of daily living [ADLs]: 6.5-25.7). Large variability was found among percentages of patients that achieved MCID values (e.g.

, ikdc: 28%-98.6%, Kujala: 38%-100%, Lysholm: 44%-98.4% and Tegner: 84%-95%).

Conclusion: The significant heterogeneity in reported thresholds for MCID, SCB and PASS across studies highlights critical challenges in interpreting results after patellar stabilization surgery, specifically regarding what constitutes a clinically relevant outcome. MCID was the most commonly reported metric and calculated predominantly with distribution-based methods, with over half of the studies using previously established thresholds. PASS and SCB were widely underreported as well, suggesting a need for studies investigating patellar stabilization to prioritize the calculation of all three metrics, using anchor-based techniques.

Level of evidence: Level IV.

Purpose: This study investigates change of direction (COD) performance and biomechanics using wearable technology in athletes with a history of anterior cruciate ligament reconstruction (ACL-R) compared to healthy controls.

Methods: A within and between subjects' cross-sectional design was used. The sagittal plane kinematics of the hip, knee, and ankle during 90° side-step cutting were measured with inertial measurement units, while the vertical force was recorded with insoles in the players' boots. Twenty-six professional soccer players participated (mean age 22.7 ± 3.7 years, height 177.8 ± 5.1 cm, weight 69.4 ± 8.5 kg). Sixteen players were healthy controls, and 10 were in a full-time ACL-R rehabilitation programme, assessed 9 months post-surgery. Mixed model analysis and statistical parametric mapping were used to compare COD completion time, kinetics, and kinematics between limbs (involved vs. uninvolved) and groups (ACL-R vs. controls) during the penultimate and final foot contacts.

Results: No significant differences in COD completion time were found between limbs (p = 0.52, d = 0.22) or groups (p = 0.65, d = 0.51). However, during the penultimate foot contact, the involved limb exhibited greater ankle dorsiflexion compared to the uninvolved and controls from 48% to 100% of stance (p = 0.002, d = 0.94-1.86), with lower vertical force production (p > 0.05, d = 0.81-0.95). During the plant step, lower knee flexion angles were noted compared to the uninvolved limb and controls from 2% to 69% of stance (p = 0.011, d = 1.26-1.31).

Conclusion: The findings suggest that soccer players with ACL-R can restore COD completion time at the time to return to sport. However, they used compensatory movement strategies on the involved side to achieve similar performance, and this must be considered from a rehabilitation standpoint.

Level of evidence: Level III.

Purpose: Synthetic augmentation (SA) in anterior cruciate ligament reconstruction (ACLR) aims to enhance graft durability, but its benefits remain unclear. To evaluate whether SA in ACLR improves return-to-sport (RTS) rates, reduces graft failure, enhances patient-reported outcomes (PROs) and varies in effectiveness across materials and techniques.

Methods: A systematic search of five databases was conducted until February 2025. Comparative studies were pooled using Hedges' random-effects meta-analysis with subgroup analysis based on materials and publication year. Non-comparative studies were analysed narratively. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk-of-bias tools for randomised studies. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence.

Results: Forty-seven studies were included (n = 4289): 7 randomised and 40 non-randomised studies (21 comparative; 19 non-comparative). SA systems included InternalBrace (FiberTape, 16 studies), Ligament Augmentation and Reconstruction System (polyester, 5), Ligament Augmentation Device (polyethylene, 18) and other materials (8). GRADE assessment showed moderate-certainty evidence for improved mid-term RTS rate from eight studies (odds ratio [OR]: 1.58; 95% confidence interval (CI): 1.12-2.22; N = 716; I² = 0%; p = 0.01). Internal brace showed a reduction in re-rupture rates in the long-term (OR: 0.17, 95% CI: 0.04-0.64; N = 218; I² = 0%; p = 0.01); however, pooled analysis of all techniques showed no statistically significant difference. Contemporary studies showed a better return to sport rates with SA. PROs showed no clinically meaningful differences. Non-comparative studies showed low graft failure rates (<8.7% for InternalBrace; <16.4% for other SA), high RTS rates (>90% for InternalBrace; >56.7% for other SA) and satisfactory PROs.

Conclusions: SA, particularly InternalBrace, may improve RTS rates and reduce re-rupture risk, though PROs remain inconclusive. Findings are limited by a moderate-to-serious risk of bias, emphasising the need for high-quality research.

Level of evidence: Level III.

Purpose: To evaluate practices and preferences among expert sports knee surgeons regarding biologic augmentation techniques in meniscal repair.

Methods: A 12-question multiple-choice survey was distributed to the Meniscus International Network (MenIN) Study Group. It covered biologic augmentation techniques for various meniscal tear types, both in isolation and with anterior cruciate ligament reconstruction (ACLR). Eight options were assessed: no augmentation, trephination, rasping, marrow venting, fibrin clot, platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and meniscal wrapping. Surgeons could select multiple techniques per scenario.

Results: Forty-two surgeons participated: 42% from Europe, 18% from North America, 10% from Latin America, 21% from Asia and 9% from Africa/Oceania. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons used at least one biologic augmentation technique. For meniscal tears associated with ACLR, 66% of surgeons used at least one biologic augmentation technique. The most utilized techniques were rasping (19%-69%), trephination (7%-43%), and marrow venting (0%-74%). PRP (2%-19%), BMAC (0%-14%) and meniscal wrapping (0%-10%) were least used. Biologic augmentation was most frequent for isolated radial (93%), isolated bucket-handle (86%), isolated vertical (86%) and isolated horizontal tears (98% for younger patients, 86% for degenerative tears). ACLR-associated repairs had lower augmentation rates, and meniscal root tears showed the highest percentage of non-augmented repairs. Over 50% of surgeons use a single augmentation technique, while 20% use two techniques depending on tear type. Overall, 33.3% (n = 14) of surgeons reported utilizing PRP and/or BMAC for meniscal repair augmentation, with the highest use observed in South America (12%) based on geographic usage.

Conclusions: This survey provides insights into current meniscal repair practices among expert orthopaedic sports medicine surgeons. The findings reveal variability in approaches based on tear patterns and associated procedures, with a general preference for simpler mechanical augmentation techniques over more advanced biologics. For isolated meniscal tears (excluding meniscal root tears), 90% of surgeons in this cohort report using one or more biological augmentation techniques.

Level of evidence: Level V, expert opinion.