Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose

The primary purpose of this study was to evaluate the prevalence of increased lateral ankle laxity (ILAL) in adolescent male soccer players. The secondary purpose was to investigate functional ankle impairments and muscle strengths related to chronic lateral ankle instability (CLAI).

Methods

The anterior talofibular ligament (ATFL) lengths of adolescent male soccer players were measured in the stress and non-stress positions using ultrasonography. The ATFL ratio, the ratio of stress ATFL length to non-stress ATFL length, was calculated as an indicator of lateral ankle laxity. The Cumberland Ankle Instability Tool (CAIT), Ankle Instability Instrument (AII) and static balance tests were used to assess functional ankle impairments related to CLAI. Isometric hip abduction and ankle eversion muscle strengths, and ankle dorsiflexion angle were also evaluated.

Results

One hundred twenty ankles from 60 male soccer players (mean age, 16.4 ± 0.7 years; mean duration of playing soccer, 9.8 ± 2.4 years) were included. ILAL was detected in 63.3% (38/60) of soccer players; 28 with ipsilateral ILAL (group I) and 10 with bilateral ILAL (group Bi). Seventeen participants (28.3%; 10 from group I, 3 from group Bi, and 4 from those without ILAL) showed a CAIT score of ≤24, and 5 (8.3%; 4 from group I and 1 from group Bi) showed an AII score of ≥5. The eversion muscle strength of the ankle with ILAL was significantly weaker than the contralateral side in group I (p = 0.006).

Conclusion

ILAL was detected in approximately two-thirds of adolescent male soccer players with relatively low CAIT and AII scores. In addition, the eversion muscle strength of the ankle with ILAL was significantly weaker than that of the contralateral side in subjects with ipsilateral ILAL. These findings suggest the possible importance of preventive interventions for soccer players with ILAL.

Level of Evidence

Level III.

Purpose

To develop a Kellgren–Lawrence (K–L) grading recognition framework for knee osteoarthritis (KOA) with enhanced capability for early-stage detection and to validate its transferability across three independent cohorts.

Methods

Weight-bearing anteroposterior knee radiographs were obtained from three datasets: the osteoarthritis initiative (OAI), Wuchuan and Shunyi. The OAI dataset included baseline, 72-month, and 96-month follow-up images, while the Wuchuan and Shunyi datasets were collected from Wuchuan (China) and Shunyi District (Beijing), respectively. Contrastive learning was incorporated into model training to construct the Augmented Dataset-Wide-ResMRnet-Contrastive Loss-Cross Entropy (AW2C) framework.

Results

The AW2C framework achieved overall classification accuracies of 83.0%, 82.0% and 80.5% on the OAI, Wuchuan and Shunyi datasets, respectively, with corresponding area under the curve (AUC) of 97.0%, 96.7% and 95.6%. Compared with the baseline model, accuracy for K–L grade 2 improved from 64% to 80%, and discrimination between K–L grades 1 and 2 was notably enhanced.

Conclusions

The proposed AW2C framework demonstrated robust and transferable performance for automated radiographic K–L grading of KOA, particularly improving recognition of early-stage and suspected disease. With further optimisation, it holds promise as a reliable tool for large-scale studies and clinical decision support.

Level of Evidence

Level III.

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.

Purpose

The aim of this systematic review was to analyze the implementation of digital rehabilitation in the rehabilitation of patients undergoing anterior cruciate ligament reconstruction (ACLR).

Methods

A systematic literature research was carried out on multiple platforms. Articles that fit our criteria were selected and analysed. We created a narrative synthesis of the extracted data, categorised by the type of digital application (sensor or no sensor), clinical characteristics and type of outcome. A formal meta-analysis was not planned as the studies were probably not homogeneous enough in terms of participants, interventions and outcomes to provide a meaningful summary.

Results

This systematic review analysed seven articles with 952 patients studying digital applications in rehabilitation⁠ after ACLR. Seven different digital applications were investigated, with three using sensors. The results showed that digital interventions were at least as effective as standard physiotherapy, with some studies showing even better outcomes in terms of Patient-Reported Outcome Measures (PROMs), muscle strength, and range of motion⁠. Patient engagement and better adherence to the rehabilitation plan was another positive finding. Importantly, no adverse events were reported in any of the studies⁠.

Conclusion

This systematic review highlights the potential of digital applications as valuable tools for rehabilitation after ACL reconstruction by enhancing patient adherence, engagement, and recovery outcomes.

Level of Evidence

N/A.

Purpose

Anterior cruciate ligament reconstruction (ACLR) is among the most performed orthopaedic procedures. Evaluating the effect of smoking on postoperative outcomes following ACLR could benefit many patients. This study investigated the impact of smoking on graft failure and functional outcomes following ACLR.

Methods

PubMed, MEDLINE, and Embase were searched up until March 9, 2025. The primary outcome was ACL graft failure after ACLR. Inclusion criteria were: age ≥18 years, ≥1-month follow-up (FU), ACL reconstruction, and articles in English. Exclusion criteria were: cadaveric studies, ACL repair, ≤5 participants, reviews, and case reports. Meta-analysis results were reported as odds ratios (ORs) and proportions with 95% confidence intervals (CIs).

Results

A total of 12 studies were included (92,208 patients) (mean FU: 42.8 ± 17.0 months; mean age: 35.9 ± 6 years; 6.8% smokers; 57.9% male). The quality of included studies was moderate, (MINORS score range: 9 to 21). In smoker's reoperation rate was 7.6% (FU 59.4 months). For non-smokers the reoperation rate was 5.2% (59.9 months FU). Three studies (2,823 patients) compared ACL graft failure rates, with similar pooled failure rates of 5.0% and 5.5% in smokers and non-smokers, respectively (OR 1.12 [95% CI: 0.38–3.29]). Four studies (1285 patients) compared postoperative IKDC scores with mean scores of 79.6 ± 10.3 in smokers and 84.0 ± 9.5 in non-smokers, respectively (OR 5.12 [95% CI: 3.59–6.65]). One study reported Tegner scores that were not different between smokers (5.0) and non-smokers (5.4).

Conclusion

This systematic review demonstrated that ACL graft failure and all-cause reoperation rates did not differ significantly between smokers and non-smokers. Nonetheless, non-smokers were significantly more likely to achieve superior functional outcomes following ACL reconstruction.

Level of Evidence

Level IV.

Purpose

This review systematically maps the existing research on objective return to sport criteria for shoulder injuries, with a focus on clinical tests that inform decision-making.

Methods

A scoping review was performed. The following databases were searched from inception up to July 2025: Cochrane Library, Embase, Medline, PEDRo, Cinahl and AMED. All studies, regardless of design, which assessed any kind of shoulder function with regard to return to sport decision-making in individuals participating in sports and presented with a shoulder injury were included. The result was qualitatively presented in free text, tables and figures.

Results

Eleven studies were identified that reported objective shoulder tests prior to return to sport in athletes after shoulder instability surgery. The tests evaluated various parameters, including range of motion, muscular strength, muscular endurance, power, plyometrics, movement quality and trunk control. The passing rates of isokinetic shoulder strength tests ranged from 40% to 70%, the isometric shoulder strength tests from 28% to 100%, for shoulder endurance tests from 70% to 81% and shoulder performance tests from 29% to 100%. These assessments were conducted within a time frame of 4–21 months following surgery. The rate of subsequent shoulder instability or re-dislocation ranged from 5% to 10% after returning to sport.

Conclusions

Passing rates for objective shoulder tests, including muscular strength and endurance, as well as performance tests, varied widely, with re-dislocation rates between 5% and 10% after returning to sport. However, the predominance of case series limits the ability to draw definitive conclusions about the effectiveness of these tests in reducing the risk of subsequent shoulder instability.

Level of Evidence

Level IV, scoping review of level III.

Artificial intelligence (AI) in medicine is undergoing a pivotal transformation, evolving from discriminative models that classify data to generative AI systems capable of creating novel content. Generative AI is a type of artificial intelligence that can learn from and mimic large amounts of data to create content such as text, images, music, videos, code, and more. The generative AI paradigm relies on advanced architectures, including large language models (LLMs), which are likely to redefine key processes in the practice of clinical medicine. The imaging- and procedure-heavy specialty of orthopaedic surgery is uniquely positioned to benefit from innovations in spatial reasoning, biomechanical analysis, and procedural planning using generative AI. Key applications are rapidly emerging, like streamlining clinical workflows through automated documentation, the mediation of patient-provider communication and enhanced interpretability of complex medical information. While an exciting field the current evidence base is quite limited. The continued integration of these technologies promises to enhance surgical precision, democratise access to advanced planning, and ultimately improve patient outcomes. However, realising this potential requires overcoming significant challenges related to the ‘black box’ nature of models, data bias, and evolving regulatory oversight. Rigorous clinical validation through prospective trials will be essential to ensure the safe, effective, and equitable implementation of generative AI in the future of orthopaedic care.

Level of Evidence

Level V.

Purpose

To evaluate the mid-term clinical outcomes of staged bilateral hip arthroscopy for patients with bilateral femoroacetabular impingement syndrome (FAIS) and to assess the influence of age on these outcomes, using unilateral hip arthroscopy as a control.

Methods

Patients with bilateral FAIS who underwent staged bilateral hip arthroscopy between 2011 and 2020 was included in the study group. They were matched 1:2 by age, sex, and body mass index to a control group of patients who underwent unilateral hip arthroscopy. A total of 59 patients (118 hips) undergoing staged bilateral arthroscopy were matched to 118 unilateral cases. Patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activity of Daily Living Scale (HOS-ADL), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were collected preoperatively and minimum 5-year postoperatively. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated and compared between groups. Subgroup analysis was performed within the study group to assess the effect of age on clinical outcomes.

Results

At a minimum 5-year follow-up, both groups showed significant improvements in all PROs (all p < 0.001). Compared to the unilateral group, the bilateral group exhibited significantly greater improvements from baseline in mHHS, iHOT-12, HOS-ADL and HOS-SSS (all p < 0.001), with comparable improvements in VAS (n.s.). According to subgroup analysis by age, significantly worse postoperative HOS-ADL (p = 0.019) and lower rate of achieving the PASS for iHOT-12 (p = 0.033) were found in patients ≥ 40 years.

Conclusion

At a minimum 5-year follow-up, staged bilateral hip arthroscopy for patients with bilateral FAIS demonstrated superior functional improvement and similar pain relief compared to unilateral procedure performed for unilateral FAIS. Patients aged ≥40 years in the bilateral group had inferior outcomes compared to those < 40 years. These findings highlight the clinical relevance of staged bilateral hip arthroscopy as a viable treatment option for patients with bilateral FAIS, especially in younger individuals.

Level of Evidence

Level III.

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.