Knee Surgery, Sports Traumatology, Arthroscopy最新文献_第10页

Lower psychological readiness to return to sport after revision ACL surgery 前交叉韧带修复手术后重返运动的心理准备较低。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12797

Magdalena Tarchala, Matthew D. Milewski, Emma C. Gossman, Ryan P. Coene, Danielle L. Cook, Mininder S. Kocher, Dennis E. Kramer, Lyle J. Micheli, Yi-Meng Yen, Melissa A. Christino

Purpose

To investigate psychological readiness and psychological stress in young patients after revision anterior cruciate ligament reconstructions (ACLR).

Methods

Revision ACLR patients were evaluated 6-months post-operatively with patient reported outcomes (PROs): Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI), PROMIS-Psychological Stress Experience (PROMIS-PSE), International Knee Documentation Committee (IKDC/Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Patient reported outcomes (PROs) of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching between primary and revision cohorts (2:1) was performed for age, sex, and graft type.

Results

Matching resulted in 90 ACLR patients (60 primary and 30 revision). The revision cohort's mean age was 19.0 (SD ± 3.46) and 63% female. A negative correlation was detected between IKDC and PROMIS-PSE (r = −0.32; 95% confidence interval [CI] = −0.49 to −0.12; p = 0.002) and positive correlation was detected between IKDC and ACL-RSI scores (r = 0.50; 95% CI = 0.32–0.64; p < 0.001). There was a weak positive correlation between Pedi-FABS and ACL-RSI scores (r = 0.25; 95% CI = 0.05–0.43; p = 0.02). Revision ACLR patients had lower ACL-RSI/psychological readiness scores (43.4 vs. 58.7, p = 0.001) and lower Pedi-FABS scores (22 vs. 25, p = 0.02), compared to primary ACLR patients. Regression analysis showed revision patients had a 17-point decrease in ACL-RSI scores compared to primary patients (β = −17.1; 95% CI = −27.32 to −6.79; p = 0.001), controlling for age at primary surgery, meniscus repair, and propensity score. Revision patients had a 17% increase in the time to return to sports clearance compared to primary ACLR patients (95% CI = 1.02–1.34; p = 0.03). No differences were noted in Pedi-IKDC/IKDC or PROMIS-PSE scores between the cohorts.

Conclusion

Patients 6-months post revision ACLR had lower psychological readiness, inferior knee outcomes, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in revision ACLR patients is important to optimise post-operative care and outcomes.

Level of Evidence

Level II.

目的：探讨青年前交叉韧带重建术（ACLR）翻修后患者的心理准备状况和心理压力。方法：对改良ACLR患者进行术后6个月的评估，患者报告的结果（PROs）：前交叉韧带损伤后恢复运动量表（ACL-RSI），允诺-心理应激体验（允诺- pse），国际膝关节文献委员会（IKDC/ pedii -IKDC）和特殊外科医院儿童功能活动简要量表（HSS pedii - fabs）。将改良ACLR患者的患者报告结果（PROs）与原发性ACLR患者队列进行比较。根据年龄、性别和移植物类型对初级队列和修订队列进行倾向评分匹配（2:1）。结果：匹配90例ACLR患者（60例原发，30例翻修）。修订队列的平均年龄为19.0 (SD±3.46)，63%为女性。IKDC与promise - pse呈负相关(r = -0.32；95%置信区间[CI] = -0.49 ~ -0.12；p = 0.002)， IKDC与ACL-RSI评分呈正相关(r = 0.50；95% ci = 0.32-0.64；结论：ACLR翻修后6个月的患者心理准备程度较低，膝关节预后较差，运动恢复延迟。更多地关注改良ACLR患者恢复的心理方面对于优化术后护理和结果是重要的。证据等级：二级。

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引用次数: 0

Unrestricted kinematic alignment offers limited functional benefit over mechanical alignment in medial pivot total knee arthroplasty: A randomized controlled trial using conventional instrumentation 在内侧枢轴全膝关节置换术中，不受限制的运动学对齐比机械对齐提供有限的功能益处：一项使用传统器械的随机对照试验。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12751

Amir Koutp, Rene Schroedter, Lukas Leitner, Ines Vielgut, Andreas Leithner, Patrick Sadoghi

Purpose

The aim of this randomized controlled trial was to compare clinical outcomes between kinematic alignment (KA) and mechanical alignment (MA) in total knee arthroplasty (TKA) using a medial-pivot (MP) prosthesis and conventional instrumentation. The primary hypothesis was that KA would result in improved joint awareness at 2 years postoperatively.

Methods

One hundred patients with end-stage knee osteoarthritis were enroled between October 2020 and December 2024 and randomized to receive either KA or MA. All surgeries were performed by a single surgeon using the same MP prosthesis. Clinical scores (OKS, WOMAC, KSS, FJS-12) and radiographic measurements were collected preoperatively and at a 2-year follow-up. Subgroup analysis was performed based on coronal knee alignment (Coronal Plane Alignment of the Knee classification).

Results

At 2 years, KA demonstrated statistically significant differences in KSS Pain (p = 0.024), WOMAC total (p = 0.003) and FJS-12 (p = 0.001) compared to MA. The range of motion did not differ significantly between groups (p = 0.201). In subgroup analyses, patients with varus alignment showed a statistically significant and clinically meaningful improvement in WOMAC scores. However, most between-group differences did not exceed established minimal clinically important difference thresholds.

Conclusion

KA with an MP TKA design was associated with statistically higher functional scores and joint awareness compared to MA, particularly in patients with varus alignment. However, the observed differences were modest, and further studies are warranted to clarify the clinical relevance of KA across phenotypes-specific subgroups.

Level of Evidence

Level II, randomized controlled trial.

目的：本随机对照试验的目的是比较运动学对齐（KA）和机械对齐（MA）在全膝关节置换术（TKA）中使用内侧枢轴（MP）假体和常规器械的临床结果。主要假设是术后2年，KA可改善关节意识。方法：在2020年10月至2024年12月期间招募了100名终末期膝关节骨性关节炎患者，并随机接受KA或MA治疗。所有手术均由同一位外科医生使用相同的MP假体完成。术前和2年随访时收集临床评分（OKS、WOMAC、KSS、FJS-12）和影像学指标。基于膝关节冠状面对齐（膝关节冠状面对齐分类）进行亚组分析。结果：2年时，与MA相比，KA在KSS Pain （p = 0.024）、WOMAC total （p = 0.003）和FJS-12 （p = 0.001）方面具有统计学意义。两组患者的活动范围无显著差异（p = 0.201）。在亚组分析中，内翻对准患者的WOMAC评分有统计学意义和临床意义的改善。然而，大多数组间差异没有超过最小临床重要差异阈值。结论：与MA相比，MP TKA设计的KA与统计上更高的功能评分和关节意识相关，特别是在内翻排列患者中。然而，观察到的差异是适度的，需要进一步的研究来阐明KA在表型特异性亚组中的临床相关性。证据水平：二级（随机对照试验）。

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引用次数: 0

Elite athletes return to sport faster and more often than non-elite athletes with low complication rates following proximal hamstring repair: A systematic review 优秀运动员在近端腘绳肌修复后比非优秀运动员更快更频繁地恢复运动，并发症发生率低：一项系统回顾。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12759

Udit Dave, Trevor Poulson, Jared Rubin, Jacob T. Morgan, Nicole Chang, Myles Atkins, Luc Fortier, Johnathon R. McCormick, Andrew S. Bi, Nikhil N. Verma, Jorge Chahla

Purpose

To evaluate patient-reported outcomes, return to sport (RTS) rates and complications following proximal hamstring (PH) repair in elite and non-elite athletes. We hypothesized that PH repair leads to improved patient-reported and clinical outcomes and high RTS rates with relatively few associated complications.

Methods

In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, PubMed, Embase and Cochrane Library databases were searched in August 2024. Studies were included if they evaluated athletes at various levels of competition who underwent PH repair and reported RTS rates, complication rates or patient-reported outcomes. Due to high heterogeneity between studies, qualitative comparative analysis was conducted.

Results

The initial screen identified 1398 studies; 22 were included. Each study had non-comparative study design with low risk of bias. Overall, 168 patients across 6 studies were included in the elite athlete cohort, and 759 patients across 16 studies were included in the non-elite athlete cohort. Elite athletes had overall RTS rate of 95.6% with time to RTS from 3.0 to 7.0 months, and RTS at pre-injury level between 90.0% and 98.4%. RTS rate in non-elite athletes was 64.8%. Mean lower extremity functional scale scores were 77.9–78.0 in elite athletes and 73.8-89.0 in non-elite athletes. The overall complication rate in the elite athlete cohort was 11.6%, and in the non-elite cohort was 14.2%. Nerve-related symptoms were the most common complication in both cohorts, with rates of 2.9% and 10.9%, respectively.

Conclusions

Elite athletes are more likely to RTS following PH repair and do so faster compared to their non-elite counterparts. Minor neurologic complications account for the majority of complications in both patient cohorts, with minimal incidence of operative failure or other complications. This can guide preoperative decision-making and patient counselling based on a patient's athletic status and desire to RTS.

Level of Evidence

Level IV, systematic review of Levels III and IV studies.

目的：评估优秀和非优秀运动员近端腘绳肌（PH）修复后患者报告的结果、恢复运动（RTS）率和并发症。我们假设PH修复导致患者报告和临床结果的改善，RTS率高，相关并发症相对较少。方法：根据系统评价和meta分析指南的首选报告项目，于2024年8月检索PubMed、Embase和Cochrane图书馆数据库。如果研究评估了接受PH修复的不同水平的运动员，并报告了RTS率、并发症率或患者报告的结果，则纳入研究。由于研究间异质性较高，我们进行了定性比较分析。结果：初步筛选确定了1398项研究；22人入选。每项研究均采用低偏倚风险的非比较研究设计。总体而言，6项研究中的168例患者被纳入精英运动员队列，16项研究中的759例患者被纳入非精英运动员队列。优秀运动员在3.0至7.0个月的时间内的整体RTS率为95.6%，受伤前水平的RTS率为90.0%至98.4%。非优秀运动员的RTS率为64.8%。优秀运动员下肢功能量表平均得分为77.9 ~ 78.0分，非优秀运动员下肢功能量表平均得分为73.8 ~ 89.0分。优秀运动员队列的总并发症发生率为11.6%，而非优秀运动员队列的总并发症发生率为14.2%。神经相关症状是两个队列中最常见的并发症，发生率分别为2.9%和10.9%。结论：与非精英运动员相比，优秀运动员更有可能在PH修复后进行RTS，并且速度更快。在两组患者中，轻微的神经系统并发症占并发症的大部分，手术失败或其他并发症的发生率最低。这可以根据患者的运动状态和对RTS的渴望来指导术前决策和患者咨询。证据等级：四级，对三级和四级研究的系统评价。

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引用次数: 0

High tibial osteotomy and concurrent medial meniscus root repair provides improved objective outcomes compared to high tibial osteotomy alone for knee osteoarthritis: A systematic review 与单独高位胫骨截骨相比，高位胫骨截骨联合内侧半月板根修复术在治疗膝骨性关节炎方面提供了更好的客观结果：一项系统综述。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12796

Fardis Vosoughi, Pouya Vahedi, Mobina Taghva Nakhjiri, Sohrab Keyhani, Mehran Soleymanha, Robert F. LaPrade, Luke V. Tollefson, Iman Menbari Oskouie

Purpose

High tibial osteotomy (HTO) is a cornerstone treatment for medial compartment osteoarthritis (OA) in active patients with varus deformity. However, managing the combination of varus alignment and the medial meniscus posterior root tears (MMPRT) remains controversial. The purpose of this systematic review was to synthesise data from recent comparative studies and evaluate whether adding an MMPRT repair to an HTO enhances outcomes, particularly with respect to meniscal healing, cartilage preservation, and patient function.

Methods

We systematically searched MEDLINE, Embase, Scopus, and Web of Science through April 2025 for studies comparing isolated HTO with HTO plus MMPRT repair. Outcomes included meniscal healing, cartilage status, and patient-reported measures. Risk of bias was assessed using ROBINS-I.

Results

Six studies (506 knees) were included, with 260 undergoing HTO plus MMPRT repair. The reported mean difference in complete meniscus healing ranged from 12.5% to 40% in the HTO plus MMPRT repair group, while it ranged from 0% to 15% in the isolated HTO group. Joint space width (JSW) was reported in three studies, with one study reporting a significant improvement in the HTO plus MMPRT repair group. Cartilage outcomes were superior in three of six studies. One study reported significant functional improvement with a concomitant repair. Despite methodological heterogeneity, all studies had a moderate risk of bias.

Conclusions

While short-term subjective outcomes were similar between isolated HTO and HTO plus MMPRT repair, objective measures, namely higher meniscal healing rates and more stable cartilage scores, consistently favoured the combined approach. In the younger population, even short-term subjective outcomes showed significant improvements along with objective measures and return to sports. Long-term clinical trials are required to determine if these biological advantages translate into a delay in the progression of knee osteoarthritis, particularly in younger, active patients.

Level of Evidence

Level III, systematic review.

目的：胫骨高位截骨术（HTO）是治疗内翻畸形患者内侧骨室骨关节炎（OA）的基础治疗方法。然而，管理内翻对齐和内侧半月板后根撕裂（MMPRT）的组合仍然存在争议。本系统综述的目的是综合最近比较研究的数据，并评估在HTO中加入MMPRT修复是否能提高预后，特别是在半月板愈合、软骨保存和患者功能方面。方法：我们系统地检索MEDLINE、Embase、Scopus和Web of Science到2025年4月，以比较分离HTO与HTO + MMPRT修复的研究。结果包括半月板愈合、软骨状态和患者报告的措施。使用ROBINS-I评估偏倚风险。结果：纳入6项研究（506个膝关节），其中260例接受HTO + MMPRT修复。据报道，在HTO + MMPRT修复组中，半月板完全愈合的平均差异为12.5%至40%，而在单独的HTO组中，平均差异为0%至15%。三项研究报告了关节间隙宽度（JSW），其中一项研究报告了HTO + MMPRT修复组的显著改善。6项研究中有3项的软骨预后较好。一项研究报告了伴随修复的显著功能改善。尽管方法学存在异质性，但所有研究均存在中等偏倚风险。结论：虽然孤立HTO和HTO + MMPRT修复的短期主观结果相似，但客观指标，即更高的半月板愈合率和更稳定的软骨评分，始终倾向于联合方法。在较年轻的人群中，即使是短期的主观结果也显示出显著的改善，随着客观测量和重返运动。需要长期的临床试验来确定这些生物学优势是否转化为延缓膝关节骨关节炎的进展，特别是在年轻、活跃的患者中。证据等级：III级，系统评价。

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引用次数: 0

Resident participation does not affect outcomes or complications after arthroscopic Bankart repair surgery 住院医师的参与不影响关节镜Bankart修复手术后的结果或并发症。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12782

Alex Quok An Teo, Hoi Pong Nicholas Wong, Sherlyn Yen Yu Tham, Fucai Han, Zavier Yongxuan Lim, Qai Ven Yap, Veerasingam Prem Kumar

Purpose

We performed a retrospective cohort study to assess the impact of resident participation on Bankart repair surgical outcomes over a 2-year mean follow-up period, by comparing clinical and patient-reported outcomes (PROs) between surgeries primarily performed by residents in training and those primarily performed by fellowship-trained attending shoulder surgeons. We hypothesised that there would be no difference in outcomes between the two groups.

Methods

All consecutive patients who underwent primary arthroscopic Bankart repair surgery for shoulder instability over a 4-year window in our institution were included. They were divided into two cohorts depending on whether they were performed primarily (>75% of the cases) by residents or attending surgeons. Standard preoperative, intraoperative and post-operative follow-up clinical (rates of recurrent instability and revision surgery) and PRO (Constant–Murley Score, American Shoulder and Elbow Surgeons, Short Form Health Survey-36 and visual analogue scale) data were collected. Data were collected manually and analysed using logistic regression and linear mixed model analysis.

Results

Three hundred twenty patients met the inclusion criteria and were enroled into the present study. The mean age was 25.08 ± 8.43, with 290 males (90.6%). One hundred fifty-three cases (47%) were performed primarily by residents. Operative times were similar with no significant difference (p = 0.08). Both cohorts demonstrated significant improvements in both shoulder-specific and global outcomes post-operatively. The stability sub-score of the ASES score was lower in the residents group by a mean of 0.31 points (p = 0.027). All the other PROs were not significantly different between the two cohorts. The rate of recurrence was also low, with no significant difference between the two cohorts (5.9% vs 4.8%, p = 0.903).

Conclusion

We found that resident involvement in arthroscopic Bankart repair as primary surgeons did not adversely affect recurrence and revision surgery rates as well as PRO measures at 2 years post-operatively, provided they were adequately supervised by attending surgeons.

Level of Evidence

Level III.

目的：我们进行了一项回顾性队列研究，通过比较主要由住院医师培训和主要由奖学金培训的主治肩部外科医生进行的手术的临床和患者报告结果（PROs），评估住院医师参与对Bankart修复手术结果的影响，平均随访2年。我们假设两组之间的结果没有差异。方法：所有在我院连续4年接受原发性关节镜Bankart肩关节不稳修复手术的患者均被纳入研究。根据主要是由住院医生还是主治医生（约75%的病例）进行手术，他们被分为两组。收集标准的术前、术中和术后随访临床（复发不稳定性和翻修手术的发生率）和PRO （Constant-Murley评分、美国肩关节外科医生、简短健康调查-36和视觉模拟量表）数据。人工收集数据，并使用逻辑回归和线性混合模型分析进行分析。结果：320例患者符合纳入标准，纳入本研究。平均年龄25.08±8.43岁，男性290例（90.6%）。153例（47%）主要由住院医师完成。手术时间相似，差异无统计学意义（p = 0.08）。两组患者术后肩部特异性和整体预后均有显著改善。as评分的稳定性分值在居民组平均低0.31分（p = 0.027）。其他所有的PROs在两组间无显著差异。复发率也较低，两组间无显著差异（5.9% vs 4.8%, p = 0.903）。结论：我们发现住院医生作为主要外科医生参与关节镜Bankart修复不会对术后2年的复发率和翻修手术率以及PRO测量产生不利影响，只要他们得到主治外科医生的充分监督。证据等级：三级。

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引用次数: 0

Effect of the patient-specific instrumentation guidance on the accurate positioning of the baseplate and screws in reverse total shoulder arthroplasty: Multicenter comparative study 患者特异性内固定指导对反向全肩关节置换术中底板和螺钉准确定位的影响：多中心比较研究

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12781

Jong Pil Yoon, Myung Sun Kim, Hyun Tae Kim, Dong Hwan Lee, Sung Wook Hong, Jong Ho Kim, Seok Won Chung

Purpose

To evaluate the accuracy of implant placement using patient-specific instrumentation (PSI) in reverse total shoulder arthroplasty (RTSA) compared to conventional techniques, and to determine whether PSI enhances the precision of glenoid component and screw positioning.

Methods

This retrospective, multi-centre comparative study included 135 patients who underwent primary RTSA across four tertiary medical centres. Patients were divided into two groups: 65 received RTSA with PSI, and 70 underwent conventional RTSA. PSI employed 3D-printed guides, based on preoperative CT scans, to precisely guide the placement of the glenoid component and peripheral screws. Postoperative imaging was used to assess screw trajectory and length, as well as baseplate version, inclination, and entry point trajectory.

Results

PSI demonstrated significantly greater accuracy in baseplate positioning compared to conventional methods, with improved outcomes in version (mean deviation: 1.5 ± 1.1° vs. 6.7 ± 5.4°, p < 0.001), inclination (2.8 ± 1.5° vs. 5.3 ± 3.7°, p = 0.012), and entry point location (1.9 ± 1.2 mm vs. 3.2 ± 1.5 mm, p = 0.037). Although mean postoperative screw lengths were greater in all directions in the PSI group, the differences were not statistically significant (all p > 0.05). Similarly, deviations from planned screw lengths were lower in the PSI group but did not reach statistical significance (all p > 0.05). Notably, PSI significantly improved the precision of peripheral screw trajectories, particularly in the superior and inferior screws across superior–inferior (S/I: p = 0.037 and p = 0.012) and anterior–posterior directions (A/P: p = 0.043 and p = 0.015), as well as in anterior (p = 0.004) and posterior screws (p = 0.008) in the A/P direction. The PSI group also had significantly fewer cases of screw prominence (9 vs. 23), and no cases of screw insertion failure or notch involvement were observed. No major complications occurred in either group.

Conclusion

PSI significantly improves the accuracy of implant placement in RTSA compared to conventional techniques, potentially reducing postoperative complications.

Level of Evidence

Level III.

目的：评价在逆行全肩关节置换术（RTSA）中使用患者特异性内固定（PSI）植入假体与传统技术相比的准确性，并确定PSI是否能提高肩关节假体和螺钉定位的精度。方法：这项回顾性的、多中心的比较研究包括135名在4个三级医疗中心接受原发性RTSA治疗的患者。患者分为两组：65例接受PSI联合RTSA， 70例接受常规RTSA。根据术前CT扫描，PSI采用3d打印导向，精确引导关节盂组件和周围螺钉的放置。术后影像学用于评估螺钉轨迹和长度、底板版本、倾角和入钉点轨迹。结果：与传统方法相比，PSI在底板定位方面显示出更高的准确性，并且版本的结果有所改善（平均偏差：1.5±1.1°vs. 6.7±5.4°，p 0.05）。同样，PSI组与计划螺钉长度的偏差较低，但没有达到统计学意义（均p < 0.05）。值得注意的是，PSI显著提高了周围螺钉轨迹的精度，特别是在上下方向（S/I: p = 0.037和p = 0.012）和前后方向（A/ p: p = 0.043和p = 0.015）的上下螺钉，以及A/ p方向的前路（p = 0.004）和后路螺钉（p = 0.008）。PSI组螺钉突出的病例也明显减少（9例对23例），没有观察到螺钉插入失败或切口受累者。两组均无重大并发症发生。结论：与传统技术相比，PSI显著提高了RTSA种植体放置的准确性，潜在地减少了术后并发症。证据等级：三级。

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引用次数: 0

The preoperative education on realistic expectations does not continually improve patients' satisfaction after total knee arthroplasty? A randomized controlled trial with serial assessment 全膝关节置换术前现实期望教育不能持续提高患者满意度？一项随机对照试验，进行系列评估。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12789

Seung Hoon Lee, Hyun Jin Yoo, Hee Seung Nam, Jade P. Y. Ho, Yong Seuk Lee

Purpose

This study aimed to determine whether preoperative education using an additional module based on realistic expectations continuously improves patient satisfaction after total knee arthroplasty (TKA), particularly in highly centrally sensitized patients.

Methods

This was a single-center, randomized controlled trial. Initially, 172 patients who underwent TKA were enroled. The patients were randomly assigned to the intervention (additional module on realistic expectations) or control (standard preoperative education) groups. Prospective serial assessments were conducted at postoperative 3-months, 6-months, 1-year and 2-years. The primary outcome was patient satisfaction, and the secondary outcomes were Short Form (SF)-36 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Subgroup analysis was performed using central sensitization inventory (CSI) scores.

Results

At 1-year, the mean satisfaction score was higher in the intervention group than in the control group (4.2 ± 0.9 vs. 3.9 ± 0.9, p = 0.01); however, it was not different at 2-years. Significant differences were noted in the SF-36 physical and mental (p = 0.02 and p = 0.02, respectively) and WOMAC pain and stiffness at 6-months (p = 0.04 and p = 0.04, respectively). At 1-year, a significant difference was noted in WOMAC pain (p = 0.05); however, no difference was noted at 2-years. The satisfaction score in the top 25% CSI group at 1-year was 4.6 ± 0.6 in the intervention group and 3.8 ± 0.8 in the control group (p = 0.01). However, preoperative CSI did not affect satisfaction and clinical scores at 2 years.

Conclusions

Preoperative education on realistic expectations after TKA showed effects on secondary outcomes at postoperative 6-months, with the effect on WOMAC pain persisting at postoperative 1-year. However, the effect on patient satisfaction only appeared at 1-year postoperatively. Differences between the preoperative CSI groups were observed up to postoperative 1-year but not at postoperative 2-years.

Level of Evidence

Level I.

目的：本研究旨在确定在全膝关节置换术（TKA）后，使用基于现实期望的额外模块进行术前教育是否能持续提高患者满意度，特别是在高度中枢敏感的患者中。方法：采用单中心随机对照试验。最初，172名接受TKA的患者入组。患者被随机分配到干预组（额外的现实期望模块）或对照组（标准术前教育）组。术后3个月、6个月、1年和2年进行前瞻性系列评估。主要终点是患者满意度，次要终点是SF -36和Western Ontario and McMaster university Osteoarthritis Index （WOMAC）。采用中心致敏量表（CSI）评分进行亚组分析。结果：干预组1年平均满意度评分高于对照组（4.2±0.9比3.9±0.9,p = 0.01）；然而，在2岁时没有什么不同。在6个月时，SF-36生理和心理评分（p = 0.02和p = 0.02）和WOMAC疼痛和僵硬度（p = 0.04和p = 0.04）均有显著差异。1年时，WOMAC疼痛有显著差异（p = 0.05）；然而，在2年没有发现差异。干预组满意度为4.6±0.6分，对照组满意度为3.8±0.8分（p = 0.01）。然而，术前CSI不影响满意度和2年时的临床评分。结论：TKA术后现实期望的术前教育对术后6个月的次要结局有影响，对术后1年WOMAC疼痛的影响持续存在。然而，对患者满意度的影响仅出现在术后1年。术前CSI组之间的差异观察到术后1年，但术后2年没有。证据等级：一级。

{"title":"The preoperative education on realistic expectations does not continually improve patients' satisfaction after total knee arthroplasty? A randomized controlled trial with serial assessment","authors":"Seung Hoon Lee, Hyun Jin Yoo, Hee Seung Nam, Jade P. Y. Ho, Yong Seuk Lee","doi":"10.1002/ksa.12789","DOIUrl":"10.1002/ksa.12789","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to determine whether preoperative education using an additional module based on realistic expectations continuously improves patient satisfaction after total knee arthroplasty (TKA), particularly in highly centrally sensitized patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-center, randomized controlled trial. Initially, 172 patients who underwent TKA were enroled. The patients were randomly assigned to the intervention (additional module on realistic expectations) or control (standard preoperative education) groups. Prospective serial assessments were conducted at postoperative 3-months, 6-months, 1-year and 2-years. The primary outcome was patient satisfaction, and the secondary outcomes were Short Form (SF)-36 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Subgroup analysis was performed using central sensitization inventory (CSI) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 1-year, the mean satisfaction score was higher in the intervention group than in the control group (4.2 ± 0.9 vs. 3.9 ± 0.9, <i>p</i> = 0.01); however, it was not different at 2-years. Significant differences were noted in the SF-36 physical and mental (<i>p</i> = 0.02 and <i>p</i> = 0.02, respectively) and WOMAC pain and stiffness at 6-months (<i>p</i> = 0.04 and <i>p</i> = 0.04, respectively). At 1-year, a significant difference was noted in WOMAC pain (<i>p</i> = 0.05); however, no difference was noted at 2-years. The satisfaction score in the top 25% CSI group at 1-year was 4.6 ± 0.6 in the intervention group and 3.8 ± 0.8 in the control group (<i>p</i> = 0.01). However, preoperative CSI did not affect satisfaction and clinical scores at 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative education on realistic expectations after TKA showed effects on secondary outcomes at postoperative 6-months, with the effect on WOMAC pain persisting at postoperative 1-year. However, the effect on patient satisfaction only appeared at 1-year postoperatively. Differences between the preoperative CSI groups were observed up to postoperative 1-year but not at postoperative 2-years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3853-3865"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rethinking arthrogenic muscle inhibition in anterior cruciate ligament injury and surgery 前交叉韧带损伤及手术中关节源性肌肉抑制的再思考。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12790

Bertrand Sonnery-Cottet, Alexandre Le Guen, Etienne Cavaignac, the SANTI Study Group

引用次数: 0

High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity 不论畸形部位如何，高位胫骨截骨术在膝关节内翻矫正中均能获得充分的临床和影像学结果。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12793

Alessio Maione, Filippo Calanna, Alessandro Napolitano, Matteo Davide Parmigiani, Giuseppe Fedele, Alessandra Menon, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli

Purpose

High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).

Methods

A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.

Results

The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients > 4°; FEM-Var: five patients > 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; p < 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (p < 0.01), with no osteoarthritis progression at the last follow-up.

Conclusion

HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.

Level of Evidence

Level IV, cohort study.

目的：胫骨高位截骨术（HTO）可以缓解膝关节关节炎内翻患者的症状并减缓骨性关节炎的进展。然而，术后关节线倾角（JLO）在矫正内翻畸形中的作用尚不清楚。本研究的目的是评估hto -外侧闭合楔（LCW-HTO）和内侧打开楔（MOW-HTO）治疗胫骨和股骨畸形膝内翻的临床和影像学结果，考虑JLO边界（≤4°）。方法：回顾性分析99例膝内翻（术前髋关节-膝关节-踝关节角[HKA]≤175°）行HTO的患者（108个膝关节）。无论手术技术如何，患者被分为股骨（FEM-Var）或胫骨（TIB-Var）内翻组。术前和最终随访时的x线片分析(平均9±4.2年；范围：2-18年)。临床结果采用特殊外科医院评分、国际膝关节文献委员会评分、Tegner评分、数值评定量表和Crosby-Insall评分进行评估。结果：首次随访时，患者平均年龄为49.4±10.2岁（范围18-64岁）。68个膝关节（63%）接受了LCW-HTO， 40个膝关节（37%）接受了MOW-HTO。平均HKA由术前172°±4.1°（范围162°-175°）改善至术后178°±3°（范围176°-180°）。大多数患者达到JLO≤4°(TIB-Var: 2例患者达到4°；FEM-Var: 5例患者（bb0 4°）。TIB-Var组表现出更好的JLO矫正(术后平均JLO: TIB-Var， 2.9°±1.5°；FEM-Var, 3.5°±1.6°；结论：HTO是治疗病理性膝内翻的有效方法，与畸形部位无关。FEM-Var组和TIB-Var组在临床评分、骨关节炎的发展和中性机械轴的恢复方面都有相当的改善。值得注意的是，TIB-Var组在JLO矫正方面优于FEM-Var组，术后JLCA也优于FEM-Var组。证据等级：IV级，队列研究。

{"title":"High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity","authors":"Alessio Maione, Filippo Calanna, Alessandro Napolitano, Matteo Davide Parmigiani, Giuseppe Fedele, Alessandra Menon, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli","doi":"10.1002/ksa.12793","DOIUrl":"10.1002/ksa.12793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients > 4°; FEM-Var: five patients > 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; <i>p</i> < 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (<i>p</i> < 0.01), with no osteoarthritis progression at the last follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3350-3360"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medial unicompartmental knee arthroplasty after knee osteotomy is safe and effective in the absence of excessive valgus overcorrection 在没有过度外翻矫直的情况下，膝关节截骨后内侧单室膝关节置换术是安全有效的。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12779

Conradin Schweizer, Anil Pulatkan, Tatjana Krug, Joachim Herre, Peter R. Aldinger, Christian Merle, Wenzel Waldstein

Purpose

Limited evidence exists regarding the safety and efficacy of medial unicompartmental knee arthroplasty (UKA) in patients with end-stage medial arthritis following knee osteotomy. This study aims to evaluate survival, functional and radiological outcomes in patients undergoing medial UKA following knee osteotomy.

Methods

A retrospective analysis was conducted evaluating 63 knees (60 patients; 62% men, 38% women; mean age 61 ± 8 years; body mass index 28 ± 5 kg/m²) who underwent medial UKA (n = 47 mobile-bearing, n = 16 fixed-bearing) following knee osteotomy. Patients were considered suitable for medial UKA if they met the Oxford criteria and had a preoperative hip–knee–ankle angle (HKAA) < 5° valgus and a medial proximal tibial angle (MPTA) < 95°. Primary outcomes were cumulative revision rates for (1) conversion to total knee arthroplasty (TKA) and (2) any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA Activity Score. HKAA was measured to determine overall limb alignment pre- and post-operatively.

Results

The average time from osteotomy to UKA was 11 ± 8 years, and the mean follow-up after UKA was 5 ± 2 years. The cumulative 8-year implant survival rate was 96.3% (95% confidence interval [CI]: 0.912–1.0) for revision to TKA and 93.2% (95% CI: 0.899–0.965) for any reoperation. Two patients required revision to TKA due to overcorrection and infection. The mean OKS improved from 25.5 ± 5.9 preoperatively to 42.8 ± 6.0 post-operatively (p < 0.001). The mean preoperative HKAA of 2.4 ± 3.0° varus was corrected to 0.0 ± 3.1°.

Conclusion

Medial UKA after knee osteotomy represents a viable treatment option, but it requires a strict preoperative alignment assessment. In the absence of excessive mechanical valgus alignment (HKAA < 3° valgus) and severe valgus deformities (MPTA < 95°) of the proximal tibia, medial UKA provides favourable midterm implant survivorship and excellent functional outcomes. In borderline cases, fixed-bearing implants should be considered to avoid valgus overcorrection.

Level of Evidence

Level IV.

目的：关于内侧单室膝关节置换术（UKA）治疗膝关节截骨后终末期内侧关节炎的安全性和有效性的证据有限。本研究旨在评估膝关节截骨术后内侧UKA患者的生存、功能和放射学结果。方法：对63例膝关节(60例；男性62%，女性38%；平均年龄61±8岁；体重指数28±5 kg/m2)，在膝关节截骨术后行内侧UKA （n = 47, n = 16）。如果患者符合牛津标准，术前髋关节-膝关节-踝关节角（HKAA），则认为患者适合内侧UKA。结果：从截骨到UKA的平均时间为11±8年，UKA后平均随访时间为5±2年。改良TKA的累积8年种植体存活率为96.3%(95%可信区间[CI]: 0.912-1.0)，再手术的累积8年种植体存活率为93.2% （95% CI: 0.899-0.965）。2例患者因矫直过度和感染需要对TKA进行修正。平均OKS从术前的25.5±5.9提高到术后的42.8±6.0 (p结论：膝关节截骨后内侧UKA是一种可行的治疗选择，但需要严格的术前对齐评估。在没有过度机械外翻对准(HKAA证据水平：四级。

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引用次数: 0