Finding prognostic factors for a subsequent injury after an anterior cruciate ligament (ACL) reconstruction.
We re-analysed the data of two intervention studies on adults with a hamstrings or quadriceps tendon ACL reconstruction. All participants were prospectively monitored for 24 months. At the end of the individual postsurgery rehabilitation, numerous self-reported and objective functional outcomes were quantified, all potential secondary injuries (primary outcome was the occurrence of secondary ipsi- or contralateral ACL injuries) and all rehabilitation and training measures were prospectively monitored. The association of potential factors with a secondary injury risk was determined using logistic mixed models.
We included 148 participants (mean age 25.3 years [standard deviation 5.1 years], 63 females). Eight participants had a subsequent ACL injury, among them seven ispilateral and one contralateral side ACL rupture. The final model for the likelihood of a subsequent ACL injury led to a sensitivity (correctly classified participants who had a subsequent ACL injury) of 83.3% and to a specificity (correctly identified participants without who did not have a subsequent ACL injury) of 100% (n = 93). The main contributing factors to subsequent ACL or any subsequent other injuries were: higher kinesiophobia values (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.1–3.4), higher knee loading levels during activity (Tegner activity scale, OR = 29, 95% CI: 1.1–791), lower performance levels at the Balance front hop (OR = 0.13, 95% CI: 0.03–0.52), and higher dynamic valgus (knee separation distance in the frontal plane) during the landing of a drop jump landing (OR = 0.80, 95% CI: 0.65–0.98).
Most of the predictive factors for a second subsequent injury after an ACL reconstruction are modifiable by adequate training and rehabilitation measures. The modification of these factors might decrease the secondary risk of injury risk.
Level II, a prospective cohort study.
Artificial intelligence (AI) is increasingly used in orthopaedics, yet current models are often limited to narrow, isolated tasks like analysing an X-ray or predicting a single outcome. This paper introduces AI agents—a new class of AI systems designed to overcome these limitations. Unlike traditional AI, agents can autonomously manage complex, multistep processes that mirror the complete patient journey. They can coordinate tasks from initial diagnosis and surgical scheduling to postoperative monitoring and rehabilitation, acting as intelligent assistants for clinical teams. This review explains what distinguishes AI agents from conventional AI, explores their potential applications in orthopaedic practice—including perioperative workflow optimisation, research acceleration and intelligent physician support—and discusses the significant implementation and ethical challenges that must be addressed. For the orthopaedic surgeon, understanding AI agents is becoming essential, as these systems offer a transformative potential to enhance efficiency, improve patient outcomes and shape the future of clinical leadership in a technologically advancing field.
Level V.
To compare three capsular management strategies in hip arthroscopy (capsule preservation [CP], capsule repair [CR] and capsule unrepaired [CU]) for femoroacetabular impingement syndrome (FAIS). We hypothesized that CP and CR would provide superior outcomes compared with CU.
A systematic search of PubMed, Embase, CENTRAL and Epistemonikos was conducted up to 31 May 2025. Outcomes of CP, CR and CU were compared using a frequentist multilevel random-effects meta-analysis with restricted maximum likelihood estimation and Hartung–Knapp adjustment.
Ultimately, 47 primary studies met the inclusion criteria and were included in the meta-analysis. A total of 7366 hips (7276 patients) were included across the 47 studies. These were distributed into three capsular management groups: (I) CP: 1352 hips, (II) CR: 5043 hips and (III) CU: 971 hips. CR showed the greatest improvement in modified Harris Hip Score with a mean change of 24.00 (95% confidence interval [CI]: 20.86–27.14), while CP achieved the highest MCID rate at 12 months post-operatively with a mean of 9.30 (95% CI: 7.47–11.14). No other consistent statistically significant differences were observed between groups across post-operative scores, change scores or complication rates. CP and CR both demonstrated superior outcomes compared to CU in selected functional parameters. All three strategies showed comparable results in pain reduction, revision rate, conversion to total hip arthroplasty and overall complication incidence.
CR and CP yield superior outcomes compared to leaving the CU. Surgeons should close or preserve the capsule, while future trials will clarify the optimal strategy.
Level II, systematic review and meta-analysis of predominantly Level III studies, with additional contributions from Levels I and II studies.
The clinical impact of periacetabular osteotomy (PAO) in patients with borderline hip dysplasia (BHD) remains unclear. This systematic review aims to evaluate outcomes in patients with BHD undergoing PAO.
A systematic review was conducted according to PRISMA guidelines by searching PubMed, Embase, and the Cochrane Library for English-language studies reporting clinical outcomes of PAO in BHD patients. Outcomes assessed included conversion to total hip arthroplasty (THA), return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) such as the modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), Subjective Hip Value (SHV), Hip Disability and Osteoarthritis Outcome Score (HOOS), Short-Form Health Survey (SF-12/SF-36), International Hip Outcome Tool (iHOT-12/iHOT-33) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores.
Eleven studies (2 Level III, 9 Level IV) with 657 hips met inclusion criteria. The mean patient age was 26.9 years, and follow-up was 48.1 months. The average BMI was 23.3 kg/m², and 13.0% of patients were male. mHHS improved significantly in four studies (mean: 62.6–82.9). SF-12/SF-36 physical scores improved in three studies (37.8–47.6). Two studies each showed gains in iHOT and SHV scores. The reoperation rate was 9.5%, mostly for implant irritation. THA conversion occurred in 0.2%. One study reported a 92.5% return-to-sport rate, typically within 6 months.
In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA.
Level IV, systematic review of Level III–IV studies.
While traditional high tibial osteotomy (HTO) techniques primarily address malalignment in the coronal plane, the significance of sagittal plane alignment, particularly the posterior tibial slope (PTS), is not to be overlooked in the setting of cruciate ligament insufficiency. Combined deformities involving both the coronal plane and the sagittal plane are less common and present unique surgical challenges. This narrative review summarizes the literature and introduces tips and tricks for managing complex biplanar deformities through a case-based discussion of different techniques.
This narrative review includes preoperative planning, surgical techniques, clinical outcomes and illustrative clinical cases detailing surgical rationale and technical nuances in the correction of biplanar proximal tibial deformities. Emphasis is placed on the importance of accurate assessment and correction of biplanar deformities to optimize patient outcomes. Four representative technique presentations are included: (1) Hybrid HTO with a posterior opening wedge (POW) and anterior closing wedge (ACW), (2) asymmetrical medial closing wedge (MCW) HTO, (3) medial opening wedge (MOW) HTO with an anterolateral hinge and (4) a double HTO with both an infratuberosity ACW and high MOW.
Biplanar HTO is a knee-preserving surgical option for a small cohort of patients with complex knee deformities involving both the coronal and sagittal planes. Precise preoperative planning and meticulous surgical execution are essential to address these biplanar malalignments effectively. This narrative review serves as a guide for orthopaedic surgeons, highlighting key considerations when planning biplanar HTO and serves as a practical guide for complex cases.
Level V.
Soft tissue and degenerative knee injuries, including anterior/posterior cruciate ligament (ACL/PCL) injuries, medial knee osteoarthritis (MKOA), and patellofemoral osteoarthritis (PFOA), are common causes of pain and functional decline. Knee bracing is often used as part of non-operative treatment, but its clinical effectiveness remains uncertain. This systematic review aimed to evaluate the role of bracing in improving pain, function, and preventing surgical conversion in adults with non-operatively managed knee injuries.
A systematic review was conducted following PRISMA guidelines. Embase, Ovid MEDLINE, and Ovid Emcare were searched from inception to March 2025. Studies were included if they reported clinical outcomes of knee bracing in adults with soft tissue or degenerative knee injuries treated non-operatively. Studies focused on biomechanics, prophylaxis, surgery, or paediatric populations were excluded. Data were synthesised narratively with weighted summary statistics.
Seventeen studies (706 patients) were included: six on ACL injuries, three PCL, three MKOA, and five PFOA. MKOA studies showed pooled improvements of +14.6 in KOOS Pain and −1.9 in VAS (SDs 1.0 and 0.5). ACL studies reported a pooled Lysholm gain of +11.8 (SD = 4.3), while PCL outcomes showed large single-study improvements (KOOS Pain +31.0, IKDC + 30.0). WOMAC scores improved in MKOA (−13.7) but declined in PFOA (−6.4). Failure (surgical conversion) was reported in 13 studies, with the highest rates in PCL (16.4%) and ACL (10.6%), and the lowest in MKOA (0%) and PFOA (4.0%). Complications were infrequently reported; skin irritation was the most common adverse event.
Knee bracing demonstrated the most consistent pain and functional improvements in degenerative and PCL injuries. In contrast, outcomes in ACL injuries were more variable and associated with higher failure rates, underscoring the need for injury-specific bracing strategies. These findings emphasise the importance of patient selection, brace design, and early intervention, and support the need for higher-quality studies to guide non-operative management strategies.
Level IV.
Medial open wedge high tibial osteotomy (HTO) can delay knee arthroplasty (KA) in patients with medial compartment varus knee osteoarthritis (OA). However, prospectively collected long-term outcomes and survival rates are limited. The purpose of this study was to assess the survival rate and the outcome following HTO.
In this prospective cohort study with initially 120 knees from 112 patients treated from 2008 to 2011 with an HTO, 95 knees from 88 patients (age: 47.0 ± 7.6 years; female: n = 28) were followed-up. The minimum follow-up was 12 years or an earlier conversion to KA. The 5-, 10- and 12-year survival rates were calculated. The Lysholm and IKDC scores were assessed preoperatively and 1.5, 6 and 12 years postoperatively.
At the last follow-up (12.9 ± 0.8,12.0–15.1 years), 67.4% (n = 64) had no conversion to KA. 31 knees (32.6%; 2 unicompartmental KA, 29 total KA) were converted to a KA on average 7.3 ± 3.3 (1.5–13.0) years after the HTO. The 5-, 10- and 12-year survival rates were 88.2%, 76.3% and 69.7%. Knees without conversion to KA had significantly higher scores at the last follow-up compared to preoperatively: The Lysholm score increased from 60.4 ± 21.1 (14.0–91.0) preoperatively to 89.1 ± 12.5 (39.0–100.0), 86.5 ± 13.8 (39.0–100.0) and 82.6 ± 18.3 (30.0–100.0). The IKDC score also increased from 51.8 ± 16.6 (15.0–93.0) preoperatively to 77.7 ± 14.8 (21.0–100.0), 70.9 ± 15.3 (26.0–98.0) and 72.5 ± 18.1 (14.0–95.0) at the corresponding postoperative time points 1.5, 6 and 12-years.
HTO to treat varus medial OA showed good long-term outcomes. Most patients can expect no conversion to KA for more than twelve years and a higher subjective knee function than preoperatively.
Level IV.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：