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

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。

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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。

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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

Critical considerations in the selection between knee osteotomy and unicompartmental knee arthroplasty in younger patients with varus alignment and early-stage knee osteoarthritis 年轻内翻对准和早期膝骨关节炎患者膝关节截骨术和单室膝关节置换术选择的关键考虑因素。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12801

Matthieu Ollivier, Kristian Kley, Ayoosh Pareek, Sebastien Parratte, Michael T. Hirschmann

引用次数: 0

Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing-wedge distal femoral osteotomy in valgus knees at 8-year follow-up 在8年的随访中，术前CPAK表型不影响外翻膝关节内侧闭合楔形股骨远端截骨术后的临床和影像学结果。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-13 DOI: 10.1002/ksa.12795

Alessio Maione, Pierrenzo Pozzi, Alessandra Menon, Filippo Calanna, Riccardo Compagnoni, Paolo Ferrua, Massimo Berruto, Pietro Simone Randelli

Purpose

To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.

Methods

This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.

Results

Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [p = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [p = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [p = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [p = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.

Conclusions

MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.

Level of Evidence

Level III, case–control study.

目的：评价内侧闭合楔形股骨远端截骨术（MCW-DFO）前后膝关节冠状面排列（CPAK）表型的分布，并评估其与外翻膝关节畸形长期临床结局的相关性。方法：回顾性分析2007年至2022年间接受MCW-DFO膝关节外翻矫正的患者。术前和术后膝关节对齐采用标准长腿负重x线片进行评估，临床结果采用国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结局评分（oos）、Tegner和视觉模拟评分（VAS）进行评估。根据术前和术后CPAK分类表型对患者进行分层。比较最常见的术前和术后CPAK表型的结果。结果：纳入51例患者（54个膝关节），平均年龄48.7±13.2岁。总平均随访时间为97±57个月。所有临床评分均有统计学意义上的改善，MCW-DFO后外翻的影像学矫正也有统计学意义上的改善。根据术前CPAK表型，最流行的CPAK 6和3组的临床结果无显著差异(最终IKDC CPAK 3: 60.7±12.2,CPAK 6: 62.9±17 [p = 0.67]；最后三星CPAK 3: 76.8±6.9,77.3±14.9 CPAK 6: [p = 0.37])。同样，术后CPAK分层显示CPAK 5和CPAK 8之间无显著差异(最终IKDC CPAK 5: 63.3±15.7,CPAK 8: 71.1±10.2 [p = 0.12]；最后三星CPAK 5: 79.8±7.9,CPAK 8: 82.3±9.3 (p = 0.53)。在研究期间，1例（1.8%）患者发生假体周围骨折，1例（1.8%）患者因假关节再次干预，3例（5.5%）患者行全膝关节置换术。结论：MCW-DFO是一种安全、有效的治疗有症状的外翻膝关节畸形的方法。手术矫正获得中性机械轴（CPAK 5和8），不同JLO值无临床差异。证据等级：III级，病例对照研究。

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引用次数: 0

Postoperative changes in CPAK-classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty: A randomised controlled trial 一项随机对照试验：常规或机器人辅助全膝关节置换术后，术后cpap分级的变化对患者报告的结果测量没有显著影响。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-13 DOI: 10.1002/ksa.12740

Peter Bollars, Hans Feyen, Dinesh Nathwani, Ali Albelooshi, Max Ettinger, Ronny De Corte, Martijn G. M. Schotanus

Purpose

The purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved (“In-the-box”) or altered (“Out-of-the-box”) in both surgical techniques.

Methods

In this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.

Results

Baseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.

Conclusions

Short-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.

Level of Evidence

Level I.

目的：本研究的目的是调查术前和术后膝关节冠状面排列（CPAK）分类变化对患者报告的结果测量（PROMs）的影响，并确定接受常规排列全膝关节置换术（CTKA）或无图像机器人辅助全膝关节置换术（RATKA）的患者的CPAK分类变化率。我们假设，在两种手术技术中，无论术后CPAK分类是保留（“盒内”）还是改变（“盒外”），PROM的改善都是可比性的。方法：在这项前瞻性随机对照试验中，180名患者被分配到CTKA或RATKA组。术前、术后分别评估CPAK分型。在术后基线、3个月和12个月收集PROMs，包括膝关节社会评分、牛津膝关节评分、白天和夜间疼痛视觉模拟量表（VAS）、EuroQol-5D（指数和VAS）和患者满意度。结果：两组间基线特征相似。31%的CTKA和41%的RATKA患者保留了原生CPAK分类。术后，CPAK II型最为常见（CTKA占40%，RATKA占49%），其次是CPAK v型。两组在3个月和12个月时，无论CPAK分型改变和手术技术如何，所有prom均有显著改善。结论：TKA后的短期功能结果不受盒内或盒外CPAK分类的显著影响。CTKA和RATKA都产生了相当的PROM改进。虽然改变的CPAK通常需要更大的软组织释放，特别是在CTKA中，但这并不影响结果，这表明对齐策略应优先考虑个体解剖和软组织平衡，而不是严格的CPAK匹配。证据等级：一级。

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引用次数: 0

Lower body mass index and symptom burden in modern hip arthroscopy patients: Updated epidemiology and trends from the MASH multicenter cohort 现代髋关节镜患者的下体重指数和症状负担：来自MASH多中心队列的最新流行病学和趋势

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-13 DOI: 10.1002/ksa.12745

Robert B. Baldwin, Samarth V. Menta, Mark Kurapatti, Dominic Carreira, Shane Nho, Andrew Wolff, John Christoforetti, John Salvo, Dean Matsuda, Anil S. Ranawat

Purpose

The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.

Methods

The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient-reported outcome measures (International Hip Outcome Tool 12-item [iHOT-12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12-item Short Form Health Survey, Patient-Reported Outcomes Measurement Information System).

Results

Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US-based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well-being, with a mean iHOT-12 score of 38.7 and a mHHS of 56.0. At 2-year follow-up, 85.9% and 76.4% of patients reached our distribution-based minimal clinically important difference value for mHHS and iHOT-12, respectively.

Conclusion

This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.

Level of Evidence

Level IV.

目的：本研究旨在描述2018年至2023年期间接受髋关节镜检查的一大组患者的流行病学、诊断和手术数据。我们还探讨了这些趋势与以前的队列，特别是2014-2017年髋关节多中心关节镜研究（MASH）研究的比较。鉴于髋关节镜文献的快速增长，我们假设外科医生正在对平均体重指数（BMI）较低、年龄较年轻、手术时报告症状较轻、术前症状持续时间较短的患者进行手术。方法：在MASH数据库中检索2018年至2023年间接受髋关节镜治疗FAI的患者，并在注册表中提供人口统计数据。标准化数据包括人口统计学、症状、影像学、术中诊断（唇裂、软骨病变）和患者报告的结果测量（国际髋关节结果工具12项[iHOT-12]、改良Harris髋关节评分[mHHS]、HOS、视觉模拟量表、12项简明健康调查、患者报告的结果测量信息系统）。结果：我们的研究发现，2018年至2023年期间在美国8个不同地点选择接受髋关节镜检查的患者平均年龄为34.3岁，体重指数为25.0 kg/m²。大多数患者症状至少持续4个月（91.4%），其中33.4%报告症状持续2年以上。运动（86.6%）和久坐（63.8%）常使症状加重。手术前，患者报告了严重的功能限制和健康受损，iHOT-12平均评分为38.7，mHHS为56.0。在2年的随访中，85.9%和76.4%的患者分别达到了我们基于分布的mHHS和iHOT-12最小临床重要差异值。结论：该多中心数据集显示，手术时患者报告的症状得到改善，患者平均BMI下降，手术前报告的症状持续时间增加。该数据提供了髋关节镜患者特征的当代基准，重申了髋关节镜检查的有效性，并提示更早、更有效地诊断髋关节形态异常。证据等级：四级。

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引用次数: 0

A validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy 一种考虑关节线收敛角的有效方法减少了内侧开口楔形胫骨高位截骨术的规划误差。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-13 DOI: 10.1002/ksa.12713

Takaaki Hiranaka, Christopher Davey, Samuel Grasso, Giacomo Dal Fabbro, Harbeer Ahedi, Brett Fritsch, David Parker

Purpose

Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.

Methods

A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error >1°), and this information was used to create a method to minimize it.

Results

Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; p < 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; p = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; p < 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (p = 0.010).

Conclusion

Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.

Level of Evidence

Level IV, retrospective case series.

目的：内侧开楔形高位胫骨截骨术（MOWHTO）矫正错误可能由计划或执行引起，或两者兼而有之。本研究旨在(1)识别导致规划误差的因素；(2)提出并评价一种新的规划方法以减少规划误差。方法：回顾性分析58例（平均年龄：46.7±7.2岁）内翻对准患者使用患者特异性植入物进行MOWHTO。术前和术后6个月影像学测量包括髋关节-膝关节-踝关节角（HKA）、胫骨内侧近端角（MPTA）、关节线收敛角（JLCA）和膝关节线倾角（KJLO）。HKA的总体误差和MPTA的手术误差计算计划误差（计划误差=总体误差-手术误差）。多变量逻辑回归分析确定了次优规划误差（绝对误差>.1°）的风险因素，并利用这些信息创建最小化规划误差的方法。结果：次优规划误差与站立JLCA增加相关(3.9±1.0°vs 2.0±1.4°；结论：术前站立JLCA≥2.8°是MOWHTO患者计划不理想的重要危险因素，这些患者过度矫正的风险增加。ΔJLCA方法通过术前使用站立和仰卧图像检测关节松弛来调整患者特定的计划，可以最大限度地减少计划错误并改善术后对齐。证据级别：四级，回顾性病例系列。

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引用次数: 0

Total knee arthroplasty revision with primary implants: Could the kinematic alignment technique be a game changer? 全膝关节置换术翻修与初级植入物：运动学对齐技术能改变游戏规则吗？

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-13 DOI: 10.1002/ksa.12794

Charles Riviere, Loïc Villet

引用次数: 0