Onur Gültekin, Erdem Aras Sezgin, Oğuzhan Cakır, Hilmi Burak Sengul, Bekir Eray Kilinc, Barış Yılmaz, Baris Kocaoglu, Mahmut Enes Kayaalp
Purpose
To compare the accuracy, readability and patient-centeredness of responses generated by standard ChatGPT-4o and its retrieval-augmented ‘deep research’ mode for hip arthroscopy education, addressing the current uncertainty about the reliability of large language models in orthopaedic patient information.
Methods
Thirty standardised patient questions were derived through structured searches of reputable orthopaedic health information websites. Both ChatGPT configurations independently generated responses. Two fellowship-trained orthopaedic surgeons assessed each response independently, using 5-point Likert scales (1 = poor, 5 = excellent) for accuracy, clarity, comprehensiveness and readability. Intra- and interrater reliabilities were calculated, and readability metrics were also evaluated using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES).
Results
Deep Research outperformed the standard model in accuracy (4.7 ± 0.4 vs. 4.0 ± 0.5; p = 0.012) and comprehensiveness (4.8 ± 0.3 vs. 3.9 ± 0.6; p < 0.001). The standard model performed better in clarity (4.6 ± 0.4 vs. 4.4 ± 0.5; p = 0.048). Readability Likert scores were comparable (p = 0.729), but FKGL and FRES favoured the standard model (both p < 0.001). Interrater intraclass correlation coefficients (ICC) ranged from 0.57 to 0.83; intrarater ICCs from 0.63 to 0.79.
Conclusion
Deep research provides superior scientific rigour, whereas the standard model offers better readability. A hybrid approach combining model strengths may maximise educational effectiveness, though clinical oversight remains essential to mitigate misinformation risks. The observed differences were modest in magnitude, aligning with previously reported accuracy–readability trade-offs in LLMs. These results should be interpreted as exploratory and hypothesis-generating.
Level of Evidence
Level IV, cross-sectional, comparative simulation study.
目的：比较标准chatgpt - 40及其检索增强“深度研究”模式在髋关节镜教育中的准确性、可读性和患者中心性，解决目前骨科患者信息中大型语言模型可靠性的不确定性。方法：通过对知名骨科健康信息网站的结构化搜索，得到30个标准化的患者问题。两个ChatGPT配置都独立生成响应。两名接受过奖学金培训的骨科医生使用李克特5分量表（1 =差，5 =优）独立评估每个回答的准确性、清晰度、全面性和可读性。计算译者内部和译者之间的信度，并使用Flesch- kincaid Grade Level （FKGL）和Flesch Reading Ease Score （FRES）评估可读性指标。结果：深度研究在准确性（4.7±0.4 vs. 4.0±0.5;p = 0.012）和全面性（4.8±0.3 vs. 3.9±0.6）方面优于标准模型；p结论：深度研究具有更强的科学严谨性，而标准模型具有更好的可读性。结合模型优势的混合方法可以最大限度地提高教育效果，尽管临床监督对于减轻错误信息风险仍然至关重要。观察到的差异幅度不大，与之前报道的llm的准确性-可读性权衡一致。这些结果应该被解释为探索性和假设生成。证据等级：四级，横断面，比较模拟研究。
{"title":"Retrieval-augmented ChatGPT-4o improves accuracy but reduces readability in hip arthroscopy patient education","authors":"Onur Gültekin, Erdem Aras Sezgin, Oğuzhan Cakır, Hilmi Burak Sengul, Bekir Eray Kilinc, Barış Yılmaz, Baris Kocaoglu, Mahmut Enes Kayaalp","doi":"10.1002/ksa.70207","DOIUrl":"10.1002/ksa.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare the accuracy, readability and patient-centeredness of responses generated by standard ChatGPT-4o and its retrieval-augmented ‘deep research’ mode for hip arthroscopy education, addressing the current uncertainty about the reliability of large language models in orthopaedic patient information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirty standardised patient questions were derived through structured searches of reputable orthopaedic health information websites. Both ChatGPT configurations independently generated responses. Two fellowship-trained orthopaedic surgeons assessed each response independently, using 5-point Likert scales (1 = poor, 5 = excellent) for accuracy, clarity, comprehensiveness and readability. Intra- and interrater reliabilities were calculated, and readability metrics were also evaluated using Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Deep Research outperformed the standard model in accuracy (4.7 ± 0.4 vs. 4.0 ± 0.5; <i>p</i> = 0.012) and comprehensiveness (4.8 ± 0.3 vs. 3.9 ± 0.6; <i>p</i> < 0.001). The standard model performed better in clarity (4.6 ± 0.4 vs. 4.4 ± 0.5; <i>p</i> = 0.048). Readability Likert scores were comparable (<i>p</i> = 0.729), but FKGL and FRES favoured the standard model (both <i>p</i> < 0.001). Interrater intraclass correlation coefficients (ICC) ranged from 0.57 to 0.83; intrarater ICCs from 0.63 to 0.79.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deep research provides superior scientific rigour, whereas the standard model offers better readability. A hybrid approach combining model strengths may maximise educational effectiveness, though clinical oversight remains essential to mitigate misinformation risks. The observed differences were modest in magnitude, aligning with previously reported accuracy–readability trade-offs in LLMs. These results should be interpreted as exploratory and hypothesis-generating.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cross-sectional, comparative simulation study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"660-665"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650766","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}
Peter Eppinga, Wouter Welling, Rienk Dekker, Hans Zwerver
Return to performance (RTPe), the final stage of the return to sport (RTS) continuum remains poorly defined in current soccer-related musculoskeletal (MSK) research, with limited identification and application of physical and/or psychological performance-based indicators. This scoping review aimed to systematically identify and synthesise currently used RTPe criteria, with a specific focus on facilitating return to competitive soccer at the same or higher level than pre-injury and identify gaps in relation to sport-specific demands. A scoping review was conducted in accordance with the PRISMA-ScR guidelines, using comprehensive Boolean search strategies across PubMed, CINAHL, and Web of Science databases. A total of twenty-nine peer reviewed studies met the inclusion criteria. Reported RTPe criteria encompassed the following domains: clinical examination, strength assessment, functional testing, performance-based testing, time elapsed since injury, and patient-reported outcome measures (PROMs). Most studies concentrated on the second stage of the three-stage RTS continuum, that is, ‘Return to Sports’, with limited integration of on-field, sport specific, or ecologically valid performance assessments. In addition, studies frequently neglect recommendations advocating a multidimensional and standardised test battery. Moreover, psychological readiness and performance-level demands—critical components of RTPe in elite soccer—were seldom addressed or often lacked standardised definitions. Female athletes were underrepresented despite higher injury incidence (6.77 vs. 5.70/1000 h in males). Anterior cruciate ligament (ACL) injuries were overrepresented, whereas more frequently occurring injuries like posterior thigh and groin injuries received less attention. More than half of the studies focused on elite athletes, limiting generalisability to recreational level. These findings underscore the urgent need for more robust, operationalized, and sport-specific RTPe criteria to support clinical decision-making and optimise outcomes following musculoskeletal injury in soccer. Existing criteria do not reliably capture readiness to pre-injury performance levels, addressing performance metrics, sport specific demands, and sex-specific considerations.
Level of Evidence: N/A.
在目前与足球相关的肌肉骨骼（MSK）研究中，恢复运动（RTS）连续体的最后阶段（RTPe）仍然定义不明确，基于身体和/或心理表现指标的识别和应用有限。这项范围审查旨在系统地识别和综合目前使用的RTPe标准，特别关注于促进恢复与受伤前相同或更高水平的竞技足球，并确定与运动特定需求相关的差距。根据PRISMA-ScR指南进行范围审查，在PubMed， CINAHL和Web of Science数据库中使用综合布尔搜索策略。共有29项同行评议研究符合纳入标准。报道的RTPe标准包括以下几个方面：临床检查、力量评估、功能测试、基于性能的测试、受伤后的时间和患者报告的结果测量（PROMs）。大多数研究集中在三阶段RTS连续体的第二阶段，即“回归体育”，有限地整合了现场，特定运动或生态有效的绩效评估。此外，研究经常忽视提倡多维和标准化测试电池的建议。此外，心理准备和表现水平的要求——精英足球中RTPe的关键组成部分——很少得到解决，或者往往缺乏标准化的定义。尽管损伤发生率较高，但女性运动员的代表性不足（6.77比5.70/1000小时）。前交叉韧带（ACL）损伤被过度代表，而更频繁发生的损伤，如大腿后部和腹股沟损伤得到的关注较少。超过一半的研究集中在优秀运动员身上，将其推广到娱乐水平。这些发现强调了迫切需要更强大的、可操作的、运动特异性的RTPe标准，以支持临床决策和优化足球肌肉骨骼损伤后的结果。现有的标准不能可靠地捕捉受伤前的表现水平，解决表现指标、运动特定要求和性别特定考虑。证据级别：无。
{"title":"Return to performance criteria in soccer after musculoskeletal injury: A scoping review","authors":"Peter Eppinga, Wouter Welling, Rienk Dekker, Hans Zwerver","doi":"10.1002/ksa.70180","DOIUrl":"10.1002/ksa.70180","url":null,"abstract":"<p>Return to performance (RTPe), the final stage of the return to sport (RTS) continuum remains poorly defined in current soccer-related musculoskeletal (MSK) research, with limited identification and application of physical and/or psychological performance-based indicators. This scoping review aimed to systematically identify and synthesise currently used RTPe criteria, with a specific focus on facilitating return to competitive soccer at the same or higher level than pre-injury and identify gaps in relation to sport-specific demands. A scoping review was conducted in accordance with the PRISMA-ScR guidelines, using comprehensive Boolean search strategies across PubMed, CINAHL, and Web of Science databases. A total of twenty-nine peer reviewed studies met the inclusion criteria. Reported RTPe criteria encompassed the following domains: clinical examination, strength assessment, functional testing, performance-based testing, time elapsed since injury, and patient-reported outcome measures (PROMs). Most studies concentrated on the second stage of the three-stage RTS continuum, that is, ‘Return to Sports’, with limited integration of on-field, sport specific, or ecologically valid performance assessments. In addition, studies frequently neglect recommendations advocating a multidimensional and standardised test battery. Moreover, psychological readiness and performance-level demands—critical components of RTPe in elite soccer—were seldom addressed or often lacked standardised definitions. Female athletes were underrepresented despite higher injury incidence (6.77 vs. 5.70/1000 h in males). Anterior cruciate ligament (ACL) injuries were overrepresented, whereas more frequently occurring injuries like posterior thigh and groin injuries received less attention. More than half of the studies focused on elite athletes, limiting generalisability to recreational level. These findings underscore the urgent need for more robust, operationalized, and sport-specific RTPe criteria to support clinical decision-making and optimise outcomes following musculoskeletal injury in soccer. Existing criteria do not reliably capture readiness to pre-injury performance levels, addressing performance metrics, sport specific demands, and sex-specific considerations.</p><p><b>Level of Evidence:</b> N/A.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"724-751"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ingrid Trøan, Tone Bere, Inger Holm, Sverre Løken, Robert F. LaPrade, Lars Engebretsen, Gilbert Moatshe
Purpose
Multiligament knee injuries (MLKIs) are complex and often associated with significant functional impairments. Data on return to sport (RTS) and return to work (RTW) remain limited, particularly for recreational athletes and the general population. The purpose of the study was to evaluate RTS, RTW and physical activity levels after surgical treatment of MLKIs.
Methods
Patients surgically treated for MLKI at a single Level 1 Trauma centre from 2013 to 2020 were included. Patient-reported outcomes included the Tegner score and work status before and after injury. Physical activity was assessed using the activity questionnaire from the Nord-Trøndelag Health Study (HUNT 1). Health-related quality of life was measured with the EuroQol 5-Dimension Questionnaire (EQ-5D).
Results
Out of 191 eligible patients, 124 (65%) participated (mean age 37 ± 13.7 years, range 17–70). RTS: 77% (n = 84) returned to some level of sport, 37% (n = 31) returned to their pre-injury sport at any level, and only seven of 28 (25%) resumed high-level pivoting sports. The mean Tegner score declined from 5.2 to 3 (p < 0.001). RTW: 90% (n = 112) returned to work, but 15% required task modifications or became disabled. Work participation significantly declined (2.1–1.9, p < 0.04). Patients with single cruciate injuries had better outcomes, including higher Tegner (3.6 vs. 3, p = 0.043) and EQ-5D scores (0.931 vs. 0.893, p = 0.012) than those with bicruciate injuries.
Conclusion
A significant number of patients with an MLKI were unable to return to their former sports activities, with only 37% returning to the same level as before the injury. Although most patients were able to return to their pre-injury work levels, 15% had to adapt to less demanding tasks or became disabled due to the injury. Despite significant reductions in activity levels, most patients reported good health-related quality of life.
{"title":"Return to sport and work after multiligament knee injury","authors":"Ingrid Trøan, Tone Bere, Inger Holm, Sverre Løken, Robert F. LaPrade, Lars Engebretsen, Gilbert Moatshe","doi":"10.1002/ksa.70175","DOIUrl":"10.1002/ksa.70175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Multiligament knee injuries (MLKIs) are complex and often associated with significant functional impairments. Data on return to sport (RTS) and return to work (RTW) remain limited, particularly for recreational athletes and the general population. The purpose of the study was to evaluate RTS, RTW and physical activity levels after surgical treatment of MLKIs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients surgically treated for MLKI at a single Level 1 Trauma centre from 2013 to 2020 were included. Patient-reported outcomes included the Tegner score and work status before and after injury. Physical activity was assessed using the activity questionnaire from the Nord-Trøndelag Health Study (HUNT 1). Health-related quality of life was measured with the EuroQol 5-Dimension Questionnaire (EQ-5D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 191 eligible patients, 124 (65%) participated (mean age 37 ± 13.7 years, range 17–70). RTS: 77% (<i>n</i> = 84) returned to some level of sport, 37% (<i>n</i> = 31) returned to their pre-injury sport at any level, and only seven of 28 (25%) resumed high-level pivoting sports. The mean Tegner score declined from 5.2 to 3 (<i>p</i> < 0.001). RTW: 90% (<i>n</i> = 112) returned to work, but 15% required task modifications or became disabled. Work participation significantly declined (2.1–1.9, <i>p</i> < 0.04). Patients with single cruciate injuries had better outcomes, including higher Tegner (3.6 vs. 3, <i>p</i> = 0.043) and EQ-5D scores (0.931 vs. 0.893, <i>p</i> = 0.012) than those with bicruciate injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A significant number of patients with an MLKI were unable to return to their former sports activities, with only 37% returning to the same level as before the injury. Although most patients were able to return to their pre-injury work levels, 15% had to adapt to less demanding tasks or became disabled due to the injury. Despite significant reductions in activity levels, most patients reported good health-related quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cross-sectional cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"329-337"},"PeriodicalIF":5.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650772","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}
Pierre-Jean Lambrey, Merwane Ayata, Hichem Abid, Pierre Chambat, Nicolas Jan, Thais Dutra Vieira, Jean-Marie Fayard
Purpose
This study aimed to evaluate the long-term functional outcomes and survivorship of medial closing wedge high tibial osteotomy (MCWHTO) in treating lateral femorotibial osteoarthritis (OA) and factors associated.
Methods
Between 1997 and 2018, 65 patients (67 knees) who underwent an MCWHTO were longitudinally assessed. Inclusion criteria were symptomatic lateral femorotibial OA in valgus knees with no signs of medial compartment OA. The primary outcome was osteotomy survivorship with a failure endpoint defined by the necessity for total knee arthroplasty (TKA). Clinical and functional outcomes, including Knee injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) activity scale and patient satisfaction, as well as radiological evaluation, including hip-knee-ankle angle (HKA), mechanical proximal tibial angle (mPTA) and mechanical lateral distal femoral angle (mLDFA), were assessed both preoperatively and at final follow-up.
Results
The mean follow-up was 11.5 ± 6.3 years [3.3–24.5]. Three patients were lost at final follow-up. Overall, 25 (39.1%) patients progressed to TKA. Median time to TKA was 12.7 years [95% CI: 10.6–17.1]. Risk of TKA conversion before 10 years was 7.4 times higher in patients with body mass index (BMI) > 30 (p = 0.004). Among the 39 remaining patients, significant postoperative improvements were observed in the KOOS from 40.8 ± 14.7 to 68.2 ± 19.2 (p < 0.0001) and the UCLA activity scale from 4.6 ± 2.1 to 7.0 ± 1.8 (p < 0.0001). Radiological evaluations showed a shift toward varus alignment (HKA: 184.5 ± 2.5 vs. 178.8 ± 2.8; p < 0.0001). There was a significant evolution of the mPTA from 89.5 ± 2.6 preoperatively to 84.0 ± 2.3 postoperatively (p < 0.0001). There was no significant difference in the measurement of mLDFA. More than 80% of patients were very satisfied or would recommend the surgery.
Conclusion
MCWHTO offers reliable long-term outcomes in valgus knees with lateral OA. Patient selection, particularly regarding BMI, is essential to achieve optimal survivorship.
{"title":"Medial closing wedge high tibial osteotomy for lateral osteoarthritis in valgus knee offers good long-term outcomes in patients with normal body mass index","authors":"Pierre-Jean Lambrey, Merwane Ayata, Hichem Abid, Pierre Chambat, Nicolas Jan, Thais Dutra Vieira, Jean-Marie Fayard","doi":"10.1002/ksa.70176","DOIUrl":"10.1002/ksa.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the long-term functional outcomes and survivorship of medial closing wedge high tibial osteotomy (MCWHTO) in treating lateral femorotibial osteoarthritis (OA) and factors associated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 1997 and 2018, 65 patients (67 knees) who underwent an MCWHTO were longitudinally assessed. Inclusion criteria were symptomatic lateral femorotibial OA in valgus knees with no signs of medial compartment OA. The primary outcome was osteotomy survivorship with a failure endpoint defined by the necessity for total knee arthroplasty (TKA). Clinical and functional outcomes, including Knee injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) activity scale and patient satisfaction, as well as radiological evaluation, including hip-knee-ankle angle (HKA), mechanical proximal tibial angle (mPTA) and mechanical lateral distal femoral angle (mLDFA), were assessed both preoperatively and at final follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean follow-up was 11.5 ± 6.3 years [3.3–24.5]. Three patients were lost at final follow-up. Overall, 25 (39.1%) patients progressed to TKA. Median time to TKA was 12.7 years [95% CI: 10.6–17.1]. Risk of TKA conversion before 10 years was 7.4 times higher in patients with body mass index (BMI) > 30 (<i>p</i> = 0.004). Among the 39 remaining patients, significant postoperative improvements were observed in the KOOS from 40.8 ± 14.7 to 68.2 ± 19.2 (<i>p</i> < 0.0001) and the UCLA activity scale from 4.6 ± 2.1 to 7.0 ± 1.8 (<i>p</i> < 0.0001). Radiological evaluations showed a shift toward varus alignment (HKA: 184.5 ± 2.5 vs. 178.8 ± 2.8; <i>p</i> < 0.0001). There was a significant evolution of the mPTA from 89.5 ± 2.6 preoperatively to 84.0 ± 2.3 postoperatively (<i>p</i> < 0.0001). There was no significant difference in the measurement of mLDFA. More than 80% of patients were very satisfied or would recommend the surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MCWHTO offers reliable long-term outcomes in valgus knees with lateral OA. Patient selection, particularly regarding BMI, is essential to achieve optimal survivorship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"248-256"},"PeriodicalIF":5.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535021","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}
Christian Eberle, Danko Dan Milinkovic, Andrea Achtnich, Raymond Best, Philipp-Johannes Braun, Lena Eggeling, Andree Ellermann, Martin Häner, Mirco Herbort, Jürgen Höher, Andreas Imhoff, Christoph Kittl, Julian Mehl, Natalie Mengis, Peter Müller, Daniel Niederer, Daniel Günther, Wolf Petersen, Thomas Pfeiffer, Sven Scheffler, Christian Schoepp, Thomas Stein, Thomas Stoffels, Amelie Stöhr, Tobias Gensior, Tobias Jung
Purpose
The main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries.
Methods
A structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary ‘agree/disagree’ in the final third round. Levels of evidence were assigned to each statement using standardized A–E and GRADE grading systems based on the available data.
Results
High agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%–100%), whereas for 7 agreement was <80% (range 63%–74%). The highest levels of agreement were reached for imaging modalities, treatment of PCL tibial avulsions, and preservation of native PCL fibres in reconstruction techniques, whereas the greatest divergence was observed regarding the role of leg axis and slope analyses and indications for corrective osteotomies, use of augmentation in reconstruction and post-operative rehabilitation protocols. The available level of evidence across studies in the literature was predominantly low to moderate. Of the 31 statements, 17 were graded as expert opinion (E, GRADE: very low), 12 as case series (C; GRADE: low), and only 2 achieved higher levels of evidence (B2, GRADE: moderate).
Conclusion
By providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes.
{"title":"Treatment of isolated injuries of the posterior cruciate ligament—A 2025 Delphi-based structured expert statement by the ligament injury committee of the German Knee Society","authors":"Christian Eberle, Danko Dan Milinkovic, Andrea Achtnich, Raymond Best, Philipp-Johannes Braun, Lena Eggeling, Andree Ellermann, Martin Häner, Mirco Herbort, Jürgen Höher, Andreas Imhoff, Christoph Kittl, Julian Mehl, Natalie Mengis, Peter Müller, Daniel Niederer, Daniel Günther, Wolf Petersen, Thomas Pfeiffer, Sven Scheffler, Christian Schoepp, Thomas Stein, Thomas Stoffels, Amelie Stöhr, Tobias Gensior, Tobias Jung","doi":"10.1002/ksa.70187","DOIUrl":"10.1002/ksa.70187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The main goal was to perform a modified Delphi process with the Ligament Injuries Committee of the German Knee Society (DKG) to structure and optimize the management of isolated posterior cruciate ligament (PCL) injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A structured modified Delphi approach was used to develop an expert statement. Steering group formulated an initial questionnaire and distributed it to 15 experienced knee surgeons (male/female 13/2, mean age 45 ± 5 years) of the working group in Round 1. Thirty-one statements covering five thematic topics were then derived from the responses and comprehensive literature search (Medline, Scopus and Cochrane) using variations of different search terms (literature group). The statements underwent two rating cycles by the working group, using a 5-point Likert scale in Round 2 and as a binary ‘agree/disagree’ in the final third round. Levels of evidence were assigned to each statement using standardized A–E and GRADE grading systems based on the available data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>High agreement (≥80%) was achieved for 24 of the 31 statements (range, 83%–100%), whereas for 7 agreement was <80% (range 63%–74%). The highest levels of agreement were reached for imaging modalities, treatment of PCL tibial avulsions, and preservation of native PCL fibres in reconstruction techniques, whereas the greatest divergence was observed regarding the role of leg axis and slope analyses and indications for corrective osteotomies, use of augmentation in reconstruction and post-operative rehabilitation protocols. The available level of evidence across studies in the literature was predominantly low to moderate. Of the 31 statements, 17 were graded as expert opinion (E, GRADE: very low), 12 as case series (C; GRADE: low), and only 2 achieved higher levels of evidence (B2, GRADE: moderate).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By providing structured treatment protocols, this Delphi-based structured expert statement can support clinicians in day-to-day decision-making and ultimately improve patient care and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Expert survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"128-139"},"PeriodicalIF":5.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ameer A. Haider, Siddhant Bhat, Hamza Jalal, Andrew W. Kuhn
Purpose
To evaluate the overall quality and extent of viewership of primary anterior cruciate ligament (ACL) injury prevention content on TikTok.
Methods
The social media platform TikTok was queried using ACL injury prevention terms, and the 89 most-viewed English-language videos demonstrating primary preventative ACL injury exercises were included. This sample size was determined a priori via power analysis to detect a moderate effect. Two authors independently extracted video characteristics and engagement metrics and scored content quality using DISCERN, Principles for Health-related Information on Social Media (PRHISM) and ACL Exercise Education Score (ACLEES) scoring systems. Disputes were resolved via author consensus. Interrater reliability was assessed using Cohen's κ. Statistical analyses included linear regression, t-tests and Fisher's exact tests.
Results
Collectively, the included posts garnered 5,988,018 views, 569,486 likes and 28,385 shares. Median scores were 30 (interquartile range [IQR] 24–38) for DISCERN, 13 (IQR 10–16) for PRHISM and 10 (IQR 6–15) for ACLEES, all indicating poor overall quality. Domain analysis revealed that content was generally accessible and relevant yet lacked citation of evidence and follow-up information. Post length significantly correlated with all three scoring systems. Self-identified healthcare professionals achieved significantly higher PRHISM scores than general users in authorship, authority and financial disclosure domains. No differences were found in engagement metrics or in DISCERN and ACLEES scores between the two groups.
Conclusion
Primary ACL injury prevention content on TikTok is widely viewed, accessible and relevant, but generally of poor quality among both healthcare professionals and general users. Both post author groups inadequately provided condition-specific guidance, treatment rationale and references. TikTok may represent an important avenue for orthopaedic professionals to establish a presence and disseminate high-quality, evidence-based information regarding ACL injury prevention to youth and adolescent athletes in hopes of decreasing injury rates.
{"title":"ACL injury prevention content on TikTok: Untapped outreach potential for youth athletes","authors":"Ameer A. Haider, Siddhant Bhat, Hamza Jalal, Andrew W. Kuhn","doi":"10.1002/ksa.70128","DOIUrl":"10.1002/ksa.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the overall quality and extent of viewership of primary anterior cruciate ligament (ACL) injury prevention content on <i>TikTok</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The social media platform <i>TikTok</i> was queried using ACL injury prevention terms, and the 89 most-viewed English-language videos demonstrating primary preventative ACL injury exercises were included. This sample size was determined a priori via power analysis to detect a moderate effect. Two authors independently extracted video characteristics and engagement metrics and scored content quality using DISCERN, Principles for Health-related Information on Social Media (PRHISM) and ACL Exercise Education Score (ACLEES) scoring systems. Disputes were resolved via author consensus. Interrater reliability was assessed using Cohen's <i>κ</i>. Statistical analyses included linear regression, <i>t</i>-tests and Fisher's exact tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Collectively, the included posts garnered 5,988,018 views, 569,486 likes and 28,385 shares. Median scores were 30 (interquartile range [IQR] 24–38) for DISCERN, 13 (IQR 10–16) for PRHISM and 10 (IQR 6–15) for ACLEES, all indicating poor overall quality. Domain analysis revealed that content was generally accessible and relevant yet lacked citation of evidence and follow-up information. Post length significantly correlated with all three scoring systems. Self-identified healthcare professionals achieved significantly higher PRHISM scores than general users in authorship, authority and financial disclosure domains. No differences were found in engagement metrics or in DISCERN and ACLEES scores between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Primary ACL injury prevention content on <i>TikTok</i> is widely viewed, accessible and relevant, but generally of poor quality among both healthcare professionals and general users. Both post author groups inadequately provided condition-specific guidance, treatment rationale and references. <i>TikTok</i> may represent an important avenue for orthopaedic professionals to establish a presence and disseminate high-quality, evidence-based information regarding ACL injury prevention to youth and adolescent athletes in hopes of decreasing injury rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"698-708"},"PeriodicalIF":5.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534987","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}
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.
{"title":"Approximately two-thirds of adolescent male soccer players had increased lateral ankle laxity with functional ankle impairments","authors":"Takuji Yokoe, Tsubasa Kawaguchi, Aya Kubo, Naosuke Kamei, Atsushi Teramoto, Masato Takao, Hélder Pereira","doi":"10.1002/ksa.70184","DOIUrl":"10.1002/ksa.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"320-328"},"PeriodicalIF":5.0,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524989","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}
Takaaki Hiranaka, Adam Garry Redgrift, Adia Shadd, Jason Bednarek, Ryan Willing, Alan Getgood
Purpose
To compare tensile strain changes on the lateral tibial cortex during the opening procedure of medial opening wedge high tibial osteotomy (MOWHTO) with and without hinge wire, and to evaluate strain changes after hinge wire removal.
Methods
MOWHTO was performed on five pairs of fresh-frozen human cadaveric knees (10 knees in total), which were allocated into two groups: with a hinge wire (n = 5) and without a hinge wire (n = 5). A uniaxial strain gauge was attached to the lateral tibial cortex to measure tensile strain, with negative values indicating compression and positive values indicating tension. All procedures were guided by a 3D-printed patient-specific cutting guide with a target opening gap of 9 mm, and fixation was completed using a locking plate. Tensile strain during the opening procedure was compared between groups, and strain before and after wire removal was assessed in the hinge wire group.
Results
In four out of five matched pairs, the hinge wire group exhibited smaller tensile strain changes during opening than the contralateral group without a hinge wire. During the opening procedure, the median tensile strain change was −267 με (range: −2390 to −213 με) in the hinge wire group and −753 με (range: −1889 to −383 με) in the without hinge wire group (p = 0.345). Following hinge wire removal, the median strain change was minimal (44 με; range: 21–72 με).
Conclusions
The hinge wire group showed smaller tensile strain changes during the opening procedure in most specimens, though the difference was not statistically significant. These findings provide preliminary biomechanical evidence suggesting that the hinge wire may serve as a protective method against fracture of the lateral hinge during MOWHTO, and that its removal after the plate fixation does not compromise lateral cortex stability.
{"title":"Biomechanical influence of hinge wire application and removal in medial opening wedge high tibial osteotomy: A cadaveric study","authors":"Takaaki Hiranaka, Adam Garry Redgrift, Adia Shadd, Jason Bednarek, Ryan Willing, Alan Getgood","doi":"10.1002/ksa.70150","DOIUrl":"10.1002/ksa.70150","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare tensile strain changes on the lateral tibial cortex during the opening procedure of medial opening wedge high tibial osteotomy (MOWHTO) with and without hinge wire, and to evaluate strain changes after hinge wire removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MOWHTO was performed on five pairs of fresh-frozen human cadaveric knees (10 knees in total), which were allocated into two groups: with a hinge wire (<i>n</i> = 5) and without a hinge wire (<i>n</i> = 5). A uniaxial strain gauge was attached to the lateral tibial cortex to measure tensile strain, with negative values indicating compression and positive values indicating tension. All procedures were guided by a 3D-printed patient-specific cutting guide with a target opening gap of 9 mm, and fixation was completed using a locking plate. Tensile strain during the opening procedure was compared between groups, and strain before and after wire removal was assessed in the hinge wire group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In four out of five matched pairs, the hinge wire group exhibited smaller tensile strain changes during opening than the contralateral group without a hinge wire. During the opening procedure, the median tensile strain change was −267 με (range: −2390 to −213 με) in the hinge wire group and −753 με (range: −1889 to −383 με) in the without hinge wire group (<i>p</i> = 0.345). Following hinge wire removal, the median strain change was minimal (44 με; range: 21–72 με).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The hinge wire group showed smaller tensile strain changes during the opening procedure in most specimens, though the difference was not statistically significant. These findings provide preliminary biomechanical evidence suggesting that the hinge wire may serve as a protective method against fracture of the lateral hinge during MOWHTO, and that its removal after the plate fixation does not compromise lateral cortex stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"640-646"},"PeriodicalIF":5.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515465","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}
Mahmod Hasan, Yaron Berkovich, Muhammad Khatib, Yaniv Yonai, Lior Ben Zvi, Amir Abu Alhija, Arsen Shpigelman, Eyal Ginesin
Purpose
This systematic review aimed to evaluate the clinical and functional outcomes of anterior cruciate ligament reconstruction (ACLR) using various graft types, based exclusively on studies with Level I–II evidence published in Q1–Q2 journals. The goal was to synthesise high-confidence data that can guide graft selection in orthopedic practice.
Methods
A comprehensive literature search of PubMed and Embase was conducted in accordance with PRISMA guidelines. Inclusion criteria were: (1) Level I–II study design, (2) publication in Q1–Q2 journals, (3) comparison of graft types (e.g., BPTB, HT, QT and allografts), and (4) reporting of outcomes including graft failure (GF), return to sport (RTS), anterior knee laxity, and patient-reported outcome measures (PROMs). Eighteen studies met all inclusion criteria.
Results
BPTB autografts demonstrated the lowest failure rates (2%–6%) and highest RTS (~81%) but were associated with higher anterior knee pain. Hamstring autografts showed higher failure rates (11%–17%) and lower RTS (~52%) but favourable PROMs. QT autografts had low failure rates (2%–3%), good stability, and reduced donor-site morbidity, with RTS ~ 64% based on limited data. Allograft results were variable: BPTB allografts demonstrated good function in selected populations, while hamstring and tibialis posterior allografts showed higher failure rates (6.2%–13.8%), particularly in younger patients.
Conclusions
BPTB and QT autografts appear to offer the best combination of Failure rate and functional outcomes for high-demand patients. Hamstring autografts remain a practical option but may be less suitable for younger athletes. Allografts—particularly tibialis posterior—should be used cautiously due to elevated failure risk.
{"title":"Graft selection in ACL reconstruction: Clinical and functional outcomes based on level I–II evidence","authors":"Mahmod Hasan, Yaron Berkovich, Muhammad Khatib, Yaniv Yonai, Lior Ben Zvi, Amir Abu Alhija, Arsen Shpigelman, Eyal Ginesin","doi":"10.1002/ksa.70167","DOIUrl":"10.1002/ksa.70167","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This systematic review aimed to evaluate the clinical and functional outcomes of anterior cruciate ligament reconstruction (ACLR) using various graft types, based exclusively on studies with Level I–II evidence published in Q1–Q2 journals. The goal was to synthesise high-confidence data that can guide graft selection in orthopedic practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search of PubMed and Embase was conducted in accordance with PRISMA guidelines. Inclusion criteria were: (1) Level I–II study design, (2) publication in Q1–Q2 journals, (3) comparison of graft types (e.g., BPTB, HT, QT and allografts), and (4) reporting of outcomes including graft failure (GF), return to sport (RTS), anterior knee laxity, and patient-reported outcome measures (PROMs). Eighteen studies met all inclusion criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>BPTB autografts demonstrated the lowest failure rates (2%–6%) and highest RTS (~81%) but were associated with higher anterior knee pain. Hamstring autografts showed higher failure rates (11%–17%) and lower RTS (~52%) but favourable PROMs. QT autografts had low failure rates (2%–3%), good stability, and reduced donor-site morbidity, with RTS ~ 64% based on limited data. Allograft results were variable: BPTB allografts demonstrated good function in selected populations, while hamstring and tibialis posterior allografts showed higher failure rates (6.2%–13.8%), particularly in younger patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BPTB and QT autografts appear to offer the best combination of Failure rate and functional outcomes for high-demand patients. Hamstring autografts remain a practical option but may be less suitable for younger athletes. Allografts—particularly tibialis posterior—should be used cautiously due to elevated failure risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"543-552"},"PeriodicalIF":5.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515528","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}
Ligan Jia, Guangyuan Du, Zijuan Fan, Xiaoke Li, Haifeng Liu, Jing Zhang, Dijun Li, Lei Yan, Jingwei Jiu, Ruoqi Li, Songyan Li, Yiqi Yang, Huachen Liu, Yijia Ren, Xuanbo Liu, Jiao Jiao Li, Yuqing Zhang, Jianhao Lin, Bin Wang
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.
{"title":"Deep contrastive learning improves identification of early-stage knee osteoarthritis across multicohort X-ray datasets","authors":"Ligan Jia, Guangyuan Du, Zijuan Fan, Xiaoke Li, Haifeng Liu, Jing Zhang, Dijun Li, Lei Yan, Jingwei Jiu, Ruoqi Li, Songyan Li, Yiqi Yang, Huachen Liu, Yijia Ren, Xuanbo Liu, Jiao Jiao Li, Yuqing Zhang, Jianhao Lin, Bin Wang","doi":"10.1002/ksa.70191","DOIUrl":"10.1002/ksa.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"362-369"},"PeriodicalIF":5.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515520","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}
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