Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose

To understand the changes in muscle force control ability and its association to gait biomechanics following anterior cruciate ligament reconstruction (ACLR).

Methods

Twenty-five participants, 9 months following ACLR, performed isometric quadriceps (20%, 40% and 100% maximum voluntary isometric contraction [MVIC]) and hamstring (20% and 40% MVIC) contractions on an isokinetic dynamometer, tracing a target line. Torque variability using coefficient of variation, and complexity using sample entropy were calculated. Knee moments and knee flexion excursion were calculated from walking gait. Two-way mixed model analyses of variance were used for between-limb comparisons and Pearson's correlations to evaluate the associations between force variables and gait biomechanics.

Results

Quadriceps and hamstring torque variability changed depending on the limb and the effort level. Quadriceps variability was higher in the ACLR limb only at maximum effort (p = 0.039, Cohen's d = 0.437). Hamstring variability showed no differences at 40% but lower torque variability (p = 0.035, Cohen's d = −0.448) at 20%. Muscle force complexity was consistently higher in the ACLR limb compared to the noninjured limb, regardless of effort level. Additionally, as effort increased, muscle force became less complex in both limbs.

Quadriceps variability was negatively associated with knee moments (r = −0.410, p = 0.042, better force control = higher knee extension moments). Hamstring complexity was positively associated with knee flexion excursion (r = 0.417, p = 0.038). Maximal strength was not associated with any gait biomechanics.

Conclusions

Quadriceps and hamstring force control ability are altered and associated with gait biomechanics at 9 months post-ACLR. Rehabilitation should include exercises focused on force control to potentially help restore gait biomechanics.

Level of Evidence

Level IV.

Women remain underrepresented in orthopedic surgery, accounting for only 13% of surgeons in Europe despite forming the majority of physicians overall. Structural barriers, including limited mentorship and work–life challenges, continue to hinder progress. To address these issues, the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) launched the Women in ESSKA initiative in 2018, fostering mentorship, leadership and visibility. Female membership and congress participation have since more than doubled, reflecting steady progress. Sustained equity efforts must extend beyond participation numbers to include transparent leadership pathways and fair representation in authorship and decision-making. True progress will depend on collaboration between women and men alike, ensuring that gender equity in orthopedics strengthens, not replaces, the core value of merit-based excellence.

Level of Evidence

Level V.

Artificial intelligence (AI) is increasingly used in orthopaedics, yet current models are often limited to narrow, isolated tasks like analysing an X-ray or predicting a single outcome. This paper introduces AI agents—a new class of AI systems designed to overcome these limitations. Unlike traditional AI, agents can autonomously manage complex, multistep processes that mirror the complete patient journey. They can coordinate tasks from initial diagnosis and surgical scheduling to postoperative monitoring and rehabilitation, acting as intelligent assistants for clinical teams. This review explains what distinguishes AI agents from conventional AI, explores their potential applications in orthopaedic practice—including perioperative workflow optimisation, research acceleration and intelligent physician support—and discusses the significant implementation and ethical challenges that must be addressed. For the orthopaedic surgeon, understanding AI agents is becoming essential, as these systems offer a transformative potential to enhance efficiency, improve patient outcomes and shape the future of clinical leadership in a technologically advancing field.

Level of Evidence

Level V.

Purpose

The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO.

Methods

A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.

Results

Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in four studies (mean: 62.6–82.9). SF-12/SF-36 physical scores improved in three studies (37.8–47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months.

Conclusion

In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA.

Level of Evidence

Level IV, systematic review of Level III–IV studies.

Purpose

Soft tissue and degenerative knee injuries, including anterior/posterior cruciate ligament (ACL/PCL) injuries, medial knee osteoarthritis (MKOA), and patellofemoral osteoarthritis (PFOA), are common causes of pain and functional decline. Knee bracing is often used as part of non-operative treatment, but its clinical effectiveness remains uncertain. This systematic review aimed to evaluate the role of bracing in improving pain, function, and preventing surgical conversion in adults with non-operatively managed knee injuries.

Methods

A systematic review was conducted following PRISMA guidelines. Embase, Ovid MEDLINE, and Ovid Emcare were searched from inception to March 2025. Studies were included if they reported clinical outcomes of knee bracing in adults with soft tissue or degenerative knee injuries treated non-operatively. Studies focused on biomechanics, prophylaxis, surgery, or paediatric populations were excluded. Data were synthesised narratively with weighted summary statistics.

Results

Seventeen studies (706 patients) were included: six on ACL injuries, three PCL, three MKOA, and five PFOA. MKOA studies showed pooled improvements of +14.6 in KOOS Pain and −1.9 in VAS (SDs 1.0 and 0.5). ACL studies reported a pooled Lysholm gain of +11.8 (SD = 4.3), while PCL outcomes showed large single-study improvements (KOOS Pain +31.0, IKDC + 30.0). WOMAC scores improved in MKOA (−13.7) but declined in PFOA (−6.4). Failure (surgical conversion) was reported in 13 studies, with the highest rates in PCL (16.4%) and ACL (10.6%), and the lowest in MKOA (0%) and PFOA (4.0%). Complications were infrequently reported; skin irritation was the most common adverse event.

Conclusion

Knee bracing demonstrated the most consistent pain and functional improvements in degenerative and PCL injuries. In contrast, outcomes in ACL injuries were more variable and associated with higher failure rates, underscoring the need for injury-specific bracing strategies. These findings emphasise the importance of patient selection, brace design, and early intervention, and support the need for higher-quality studies to guide non-operative management strategies.

Level of Evidence

Level IV.

Purpose

Medial open wedge high tibial osteotomy (HTO) can delay knee arthroplasty (KA) in patients with medial compartment varus knee osteoarthritis (OA). However, prospectively collected long-term outcomes and survival rates are limited. The purpose of this study was to assess the survival rate and the outcome following HTO.

Methods

In this prospective cohort study with initially 120 knees from 112 patients treated from 2008 to 2011 with an HTO, 95 knees from 88 patients (age: 47.0 ± 7.6 years; female: n = 28) were followed-up. The minimum follow-up was 12 years or an earlier conversion to KA. The 5-, 10- and 12-year survival rates were calculated. The Lysholm and IKDC scores were assessed preoperatively and 1.5, 6 and 12 years postoperatively.

Results

At the last follow-up (12.9 ± 0.8,12.0–15.1 years), 67.4% (n = 64) had no conversion to KA. 31 knees (32.6%; 2 unicompartmental KA, 29 total KA) were converted to a KA on average 7.3 ± 3.3 (1.5–13.0) years after the HTO. The 5-, 10- and 12-year survival rates were 88.2%, 76.3% and 69.7%. Knees without conversion to KA had significantly higher scores at the last follow-up compared to preoperatively: The Lysholm score increased from 60.4 ± 21.1 (14.0–91.0) preoperatively to 89.1 ± 12.5 (39.0–100.0), 86.5 ± 13.8 (39.0–100.0) and 82.6 ± 18.3 (30.0–100.0). The IKDC score also increased from 51.8 ± 16.6 (15.0–93.0) preoperatively to 77.7 ± 14.8 (21.0–100.0), 70.9 ± 15.3 (26.0–98.0) and 72.5 ± 18.1 (14.0–95.0) at the corresponding postoperative time points 1.5, 6 and 12-years.

Conclusion

HTO to treat varus medial OA showed good long-term outcomes. Most patients can expect no conversion to KA for more than twelve years and a higher subjective knee function than preoperatively.

Level of Evidence

Level IV.

Purpose

The aim of this study was to describe the anterior cruciate ligament (ACL) injury incidence differences depending on sex and age-related categories in a large cohort of soccer players over six consecutive seasons.

Methods

This study was designed as a retrospective descriptive epidemiological study. All soccer players in a specific geographical area who sustained an ACL injury across six consecutive seasons were included in this analysis. ACL injury incidence was calculated by sex and age-related category as a percentage of all registered soccer players in the region. Additionally, soccer participation evolution, ACL injury incidence evolution, and monthly ACL injury distribution were studied. Group, seasonal, and monthly differences were analysed using chi-square tests.

Results

Between the 2016–2017 and the 2021–2022 seasons, 3381 ACL injuries were registered from a total of 782,856 player-seasons. ACL injury incidence was 0.43%. Female soccer players showed 2.79 times higher injury incidence than male players, with overall rates of 1.06% in females and 0.38% in males (p < 0.001). However, female players only showed higher ACL injury incidence than males in age groups older than 14 years. ACL injury incidence increased over the six seasons studied only in the male group. October and January were the months with the highest number of ACL injuries, with no significant differences in monthly distribution between sexes.

Conclusions

Female soccer players showed higher ACL injury incidence than males, particularly in age groups older than 14 years. October and January were identified as the months with the highest injury incidences regardless of sex. Additionally, a rising injury incidence was observed in male players, a trend not seen in females.

Level of Evidence

Level III, retrospective comparative study.

Purpose

To systematically review the current literature regarding the role of artificial intelligence and machine learning in predicting and optimising clinical outcomes following hip arthroscopy.

Methods

A systematic review of the PubMed, Cochrane, and EMBASE databases was completed in December 2024. Studies were included if they assessed the application of AI/ML to clinical outcomes of hip arthroscopy. Exclusion criteria were imaging-only studies, non-English publications, conference abstracts, review articles and meta-analyses. Extracted data included study characteristics, input features, algorithm types, sample sizes, and model performance. Descriptive statistical analysis was performed due to data heterogeneity.

Results

Sixteen studies met inclusion criteria, covering applications across prediction of intraoperative findings (n = 1), prediction of post-operative outcomes (n = 5), prediction of patient-reported outcomes (n = 7) and prediction of revision (n = 3). Input features commonly utilised included demographics, imaging data, preoperative patient-reported outcomes (PROs), and comorbidities. Supervised learning models were the most widely applied, including logistic regression, random forests, support vector machines (SVMs), and artificial neural networks (ANNs). Performance metrics demonstrated robust predictive ability, with AUC values ranging from 0.66 to 0.94 and accuracy rates exceeding 75% in most studies. Applications included predicting revision surgery risk, prolonged opioid use, postoperative satisfaction, and time to return to sport. Imaging-based algorithms, particularly leveraging MRI data, showed promise for surgical planning and diagnostic precision.

Conclusions

AI and ML show significant promise in enhancing outcome prediction and patient stratification in hip arthroscopy. Future research should prioritise the standardisation of datasets, external validation, and interpretability to facilitate clinical translation.

Level of Evidence

Level V.