Felix C. Oettl, James A. Pruneski, Balint Zsidai, Yinan Yu, Ting Cong, Thomas Tischer, Michael T. Hirschmann, Kristian Samuelsson
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.
{"title":"Is orthopaedics entering the age of generative AI?—A narrative review of current applications challenges and future directions","authors":"Felix C. Oettl, James A. Pruneski, Balint Zsidai, Yinan Yu, Ting Cong, Thomas Tischer, Michael T. Hirschmann, Kristian Samuelsson","doi":"10.1002/ksa.70145","DOIUrl":"10.1002/ksa.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>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.</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":"370-377"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380477","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}
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.
{"title":"Superior functional outcomes after staged bilateral versus matched unilateral hip arthroscopy for femoroacetabular impingement syndrome at minimum 5-year follow-up","authors":"Zhuohan Cao, Guanying Gao, Yichuan Zhu, Xiang Zhou, Jianquan Wang, Yan Xu","doi":"10.1002/ksa.70139","DOIUrl":"10.1002/ksa.70139","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At a minimum 5-year follow-up, both groups showed significant improvements in all PROs (all <i>p</i> < 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 <i>p</i> < 0.001), with comparable improvements in VAS (n.s.). According to subgroup analysis by age, significantly worse postoperative HOS-ADL (<i>p</i> = 0.019) and lower rate of achieving the PASS for iHOT-12 (<i>p</i> = 0.033) were found in patients ≥ 40 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</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":"309-319"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380335","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}
Lorenz Pichler, Laura De Girolamo, Elizabeth Arendt, Berte Bøe, Mette Renate Andersen, Pim van Dijk, Guri Ranum Ekås, Elizaveta Kon, Maristella Francesca Saccomanno, Katja Tecklenburg
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.
{"title":"Sustaining momentum in gender equity: Lessons from the women in European Society of Sports Traumatology, Knee Surgery and Arthroscopy initiative","authors":"Lorenz Pichler, Laura De Girolamo, Elizabeth Arendt, Berte Bøe, Mette Renate Andersen, Pim van Dijk, Guri Ranum Ekås, Elizaveta Kon, Maristella Francesca Saccomanno, Katja Tecklenburg","doi":"10.1002/ksa.70157","DOIUrl":"10.1002/ksa.70157","url":null,"abstract":"<div>\u0000 <section>\u0000 \u0000 \u0000 <p>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.</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":"33 12","pages":"4487-4490"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70157","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380366","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}
Ahmed Mabrouk, Michael Risebury, Aadil Mumith, Sam Yasen
<div> <section> <h3> Purpose</h3> <p>Medial opening wedge high tibial osteotomy (MOWHTO) is an effective procedure for managing isolated medial compartment osteoarthritis (OA) with varus malalignment. This study investigates the effect of radiographic OA severity on the clinical outcomes and survivorship of MOWHTO.</p> </section> <section> <h3> Methods</h3> <p>A retrospective analysis of a prospectively maintained single-centre database of 1170 knee osteotomies, between 2002 and 2022, was conducted. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee OA, with varus knee malalignment, who had failed conservative management were included. Patients were stratified into four groups according to the radiographic OA severity of the medial compartment based on the Kellgren Lawrence (KL) grading system. Multiple patient-reported outcome measures (PROMs) were recorded preoperatively and at 2 and 5 years postoperatively. The delta values between preoperative and 2 and 5-year postoperative PROMs scores were calculated and compared with their reported minimal clinically important difference (MCID) scores. Deformity analysis was undertaken preoperatively and postoperatively. The rate of conversion to arthroplasty, and 5- and 10-year survivorship were recorded, as well as the hazard ratio (HR) of OA KL grade on survivorship.</p> </section> <section> <h3> Results</h3> <p>A total of 605 cases were included in the study: KL1 group (<i>n </i>= 71), KL2 group (<i>n </i>= 203), KL3 group (<i>n</i> = 210) and KL4 group (<i>n</i> = 121). There was no intergroup significant difference in the demographics. The mean follow-up for the whole series was 13.2 ± 3.8 years. There was an intergroup significant difference in the mechanical tibiofemoral angle (mTFA), joint line convergence angle (JLCA), and Mikulicz point (all <i>p</i> < 0.001). A more varus TFA was noted in patients with more advanced OA grades: KL1 −4.8° ± 2.7°, KL2 −5.5° ± 2.9°, KL3 −5.7° ± 3.1° and KL4 −6.8° ± 3.1°. Similarly, there was a lower Mikulicz percentage in higher KL grades: KL1 25.5 ± 12%, KL2 25.0 ± 12.7%, KL3 21.9 ± 13.2% and KL4 17.7 ± 13.9%. Clinically, there were significant improvements across all PROMs and achievement of MCID in KOOS, OKS and VAS pain in all groups. No significant difference in survival outcomes was observed between the four OA KL grade groups (<i>p</i> = 0.8).</p> </section> <section> <h3> Conclusion</h3> <p>MOWHTO was associated with durable survivorship and excellent patient-reported outcomes across the spectrum of radiographic OA severity. However, the extent to which MOWHTO may delay the need for total knee arthroplasty re
目的：内侧开口楔形胫骨高位截骨术（MOWHTO）是治疗孤立性内侧腔室骨关节炎（OA）内翻错位的有效方法。本研究探讨骨关节炎严重程度对MOWHTO临床预后和生存率的影响。方法：回顾性分析2002年至2022年间1170例膝关节截骨手术的前瞻性单中心数据库。包括因症状性单室膝内侧骨关节炎、膝关节内翻错位、保守治疗失败而行MOWHTO的成年患者。根据基于Kellgren Lawrence （KL）分级系统的内侧室骨关节炎放射学严重程度将患者分为四组。术前、术后2年和5年记录多项患者报告的预后指标（PROMs）。计算术前、术后2年和5年PROMs评分之间的δ值，并与他们报告的最小临床重要差异（MCID）评分进行比较。术前、术后进行畸形分析。记录关节置换术转换率、5年和10年生存率，以及OA KL分级对生存率的风险比（HR）。结果：共纳入605例患者：KL1组（71例）、KL2组（203例）、KL3组（210例）、KL4组（121例）。在人口统计学上没有组间的显著差异。整个系列平均随访时间为13.2±3.8年。在机械胫股角（mTFA）、关节线会聚角（JLCA）和Mikulicz点方面，组间存在显著差异（均为p）。结论：MOWHTO与持久的生存期和出色的患者报告结果相关，跨越了放射学OA严重程度的谱。然而，MOWHTO可能延迟全膝关节置换术的程度需要通过更长期的前瞻性研究来证实。有症状的早期OA患者（Kellgren-Lawrence Grade 1）应该被告知手术后可能会有更多有限的功能改善。证据级别：回顾性队列研究（IV级）。
{"title":"Medial opening wedge high tibial osteotomy yields comparable outcome across all Kellgren–Lawrence osteoarthritis grades","authors":"Ahmed Mabrouk, Michael Risebury, Aadil Mumith, Sam Yasen","doi":"10.1002/ksa.70100","DOIUrl":"10.1002/ksa.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medial opening wedge high tibial osteotomy (MOWHTO) is an effective procedure for managing isolated medial compartment osteoarthritis (OA) with varus malalignment. This study investigates the effect of radiographic OA severity on the clinical outcomes and survivorship of MOWHTO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of a prospectively maintained single-centre database of 1170 knee osteotomies, between 2002 and 2022, was conducted. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee OA, with varus knee malalignment, who had failed conservative management were included. Patients were stratified into four groups according to the radiographic OA severity of the medial compartment based on the Kellgren Lawrence (KL) grading system. Multiple patient-reported outcome measures (PROMs) were recorded preoperatively and at 2 and 5 years postoperatively. The delta values between preoperative and 2 and 5-year postoperative PROMs scores were calculated and compared with their reported minimal clinically important difference (MCID) scores. Deformity analysis was undertaken preoperatively and postoperatively. The rate of conversion to arthroplasty, and 5- and 10-year survivorship were recorded, as well as the hazard ratio (HR) of OA KL grade on survivorship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 605 cases were included in the study: KL1 group (<i>n </i>= 71), KL2 group (<i>n </i>= 203), KL3 group (<i>n</i> = 210) and KL4 group (<i>n</i> = 121). There was no intergroup significant difference in the demographics. The mean follow-up for the whole series was 13.2 ± 3.8 years. There was an intergroup significant difference in the mechanical tibiofemoral angle (mTFA), joint line convergence angle (JLCA), and Mikulicz point (all <i>p</i> < 0.001). A more varus TFA was noted in patients with more advanced OA grades: KL1 −4.8° ± 2.7°, KL2 −5.5° ± 2.9°, KL3 −5.7° ± 3.1° and KL4 −6.8° ± 3.1°. Similarly, there was a lower Mikulicz percentage in higher KL grades: KL1 25.5 ± 12%, KL2 25.0 ± 12.7%, KL3 21.9 ± 13.2% and KL4 17.7 ± 13.9%. Clinically, there were significant improvements across all PROMs and achievement of MCID in KOOS, OKS and VAS pain in all groups. No significant difference in survival outcomes was observed between the four OA KL grade groups (<i>p</i> = 0.8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MOWHTO was associated with durable survivorship and excellent patient-reported outcomes across the spectrum of radiographic OA severity. However, the extent to which MOWHTO may delay the need for total knee arthroplasty re","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"214-228"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380678","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}
Daniel Niederer, Matthias Keller, Wolf Petersen, Karl-Friedrich Schüttler, Turgay Efe, Tobias Engeroff, David A. Groneberg, Christine Heinrich, Michael Behringer, Natalie Mengis, Andree Ellermann, Daniel Guenther, Georg Brandl, Björn Drews, Julian Mehl, Raymond Best, Lucia Pinggera, Christian Schoepp, Matthias Krause, Thomas Stein
Purpose
Finding prognostic factors for a subsequent injury after an anterior cruciate ligament (ACL) reconstruction.
Methods
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.
Results
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).
Conclusion
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.
{"title":"Jump performance and hop function, kinesiophobia and return to sports are important prognostic factors for a subsequent injury after an anterior cruciate ligament reconstruction: A 2-year follow-up cohort study","authors":"Daniel Niederer, Matthias Keller, Wolf Petersen, Karl-Friedrich Schüttler, Turgay Efe, Tobias Engeroff, David A. Groneberg, Christine Heinrich, Michael Behringer, Natalie Mengis, Andree Ellermann, Daniel Guenther, Georg Brandl, Björn Drews, Julian Mehl, Raymond Best, Lucia Pinggera, Christian Schoepp, Matthias Krause, Thomas Stein","doi":"10.1002/ksa.70104","DOIUrl":"10.1002/ksa.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Finding prognostic factors for a subsequent injury after an anterior cruciate ligament (ACL) reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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% (<i>n</i> = 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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, a prospective cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"338-350"},"PeriodicalIF":5.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380551","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}
Yavuz Lima, Levent Özçakar, Ogün Köyağasıoğlu, Benjamin Clarsen
{"title":"Official match time underestimates injury incidence in football and beach soccer compared with futsal","authors":"Yavuz Lima, Levent Özçakar, Ogün Köyağasıoğlu, Benjamin Clarsen","doi":"10.1002/ksa.70114","DOIUrl":"10.1002/ksa.70114","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4484-4486"},"PeriodicalIF":5.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351013","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}
Felix C. Oettl, James Pruneski, Balint Zsidai, Yinan Yu, Ting Cong, Robert Feldt, Philipp W. Winkler, Michael T. Hirschmann, Kristian Samuelsson, ESSKA Artificial Intelligence Working Group
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.
{"title":"Artificial intelligence agents in orthopaedics: Concepts, capabilities and the road ahead","authors":"Felix C. Oettl, James Pruneski, Balint Zsidai, Yinan Yu, Ting Cong, Robert Feldt, Philipp W. Winkler, Michael T. Hirschmann, Kristian Samuelsson, ESSKA Artificial Intelligence Working Group","doi":"10.1002/ksa.70109","DOIUrl":"10.1002/ksa.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>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.</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":"33 12","pages":"4475-4483"},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310560","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}
Nikolai Ramadanov, Maximilian Voss, Maximilian Heinz, Robert Hable, Robert Prill, Roland Becker, Ingo J. Banke
Purpose
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.
Methods
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.
Results
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.
Conclusion
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 of Evidence
Level II, systematic review and meta-analysis of predominantly Level III studies, with additional contributions from Levels I and II studies.
{"title":"Capsular management strategies in hip arthroscopy for femoroacetabular impingement syndrome: A multilevel meta-analysis","authors":"Nikolai Ramadanov, Maximilian Voss, Maximilian Heinz, Robert Hable, Robert Prill, Roland Becker, Ingo J. Banke","doi":"10.1002/ksa.70094","DOIUrl":"10.1002/ksa.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, systematic review and meta-analysis of predominantly Level III studies, with additional contributions from Levels I and II studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"284-308"},"PeriodicalIF":5.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310525","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}
Jaydeep Dhillon, Mustafa Ansari, Carson Keeter, Matthew J. Kraeutler, Michael T. Hirschmann, Kristian Samuelsson
Purpose
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.
Methods
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.
Results
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.
Conclusion
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 of Evidence
Level IV, systematic review of Level III–IV studies.
{"title":"Periacetabular osteotomy with or without hip arthroscopy in patients with borderline hip dysplasia: A systematic review","authors":"Jaydeep Dhillon, Mustafa Ansari, Carson Keeter, Matthew J. Kraeutler, Michael T. Hirschmann, Kristian Samuelsson","doi":"10.1002/ksa.70088","DOIUrl":"10.1002/ksa.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with BHD undergoing PAO, there is consistent improvement in most PROMs along with a low rate of reoperation and conversion to THA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, systematic review of Level III–IV studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4221-4233"},"PeriodicalIF":5.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254223","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}
Philipp Vetter, Frederik Bellmann, Larissa Eckl, Alp Paksoy, Doruk Akgün, Asimina Lazaridou, Markus Scheibel
<div> <section> <h3> Purpose</h3> <p>The circles measurement is a newly validated in vivo method to evaluate acromioclavicular joint (ACJ) dislocations, but its postoperative and clinical relevance has not been evaluated. We hypothesised that the postoperative circles measurement would capture recurrent vertical as well as horizontal instability and that it would be associated with outcome scores in patients undergoing acute, bidirectional arthroscopically assisted ACJ stabilisation.</p> </section> <section> <h3> Methods</h3> <p>Male patients (18–55 years) with an acute ACJ dislocation (Rockwood type V) were included retrospectively. Radiographs included a single, bilateral anteroposterior stress view and bilateral Alexander views preoperatively and postoperatively (final follow-up of minimum 2 years). Excluded were patients with previous injuries/minors/polytrauma or insufficient radiographs. The side-to-side difference (SSD) coracoclavicular distance (CCD), the degree of dynamic horizontal translation (DHT) and the SSD circles measurement as well as the ACJ instability (ACJI) and Taft (TF) score, subjective shoulder value (SSV) and Constant score were recorded at the final follow-up (minimum 2 years). The postoperative SSD circles measurement was analysed in relation to these. Statistical analysis comprised correlations and group comparisons.</p> </section> <section> <h3> Results</h3> <p>Fifty-six patients (mean age, 38.9 ± 10.7 years) with a follow-up of 33.0 months (range, 24–55 months) were included. The postoperative SSD circles measurement demonstrated a correlation with recurrent vertical instability (SSD CCD: <i>r</i> = 0.37; <i>p</i> = 0.006), and with recurrent horizontal instability (DHT: <i>r</i> = 0.46; <i>p</i> < 0.001). A higher postoperative SSD circles measurement was associated with lower outcome scores (SSV: <i>r</i> = −0.31; <i>p</i> = 0.021; TF score: <i>r</i> = −0.29; <i>p</i> = 0.031; ACJI score: <i>r</i> = −0.35; <i>p</i> = 0.01). The cut-off values for lower scores (<i>p</i> < 0.05 by stepwise group comparison) were 0 mm for the SSV (<i>p</i> = 0.022); 2.2 mm for the TF score (<i>p</i> = 0.022) and 2.7 mm for the ACJI score (<i>p</i> = 0.024).</p> </section> <section> <h3> Conclusions</h3> <p>The postoperative circles measurement reflects both recurrent vertical and horizontal instability and correlates with lower outcome scores following arthroscopically assisted ACJ stabilisation, supporting its use as a radiographic adjunct.</p> </section> <section> <h3> Level of Evidence</h3> <p>Level IV, retrospective case series.<
目的：环形测量法是一种新的体内评估肩锁关节（ACJ）脱位的方法，但其术后和临床相关性尚未得到评价。我们假设术后圆周测量可以捕获复发的垂直和水平不稳定，并且与急性双向关节镜辅助ACJ稳定患者的结果评分相关。方法：回顾性分析男性急性ACJ脱位（Rockwood V型）患者（18-55岁）。x线片包括术前和术后单侧、双侧前后应力位和双侧亚历山大位（最终随访至少2年）。排除了既往损伤/未成年/多发创伤或x线片不充分的患者。最后随访时（至少2年）记录侧侧差（SSD）、喙锁骨距离（CCD）、动态水平平移度（DHT）、侧侧差（SSD）测量以及ACJ不稳定性（ACJI）和Taft （TF）评分、主观肩值（SSV）和Constant评分。与此相关分析术后SSD圆测量。统计分析包括相关性和组间比较。结果：56例患者（平均年龄38.9±10.7岁），随访33.0个月（范围24-55个月）。术后SSD圆测量显示与复发性垂直不稳定（SSD CCD: r = 0.37; p = 0.006）和复发性水平不稳定（DHT: r = 0.46; p）相关。结论：术后圆测量反映了复发性垂直和水平不稳定，并与关节镜辅助ACJ稳定后较低的预后评分相关，支持其作为影像学辅助手段的应用。证据级别：四级，回顾性病例系列。
{"title":"The postoperative circles measurement considers recurrent instability and correlates with lower outcome scores after acute, bidirectional arthroscopically assisted acromioclavicular joint stabilization","authors":"Philipp Vetter, Frederik Bellmann, Larissa Eckl, Alp Paksoy, Doruk Akgün, Asimina Lazaridou, Markus Scheibel","doi":"10.1002/ksa.70074","DOIUrl":"10.1002/ksa.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The circles measurement is a newly validated in vivo method to evaluate acromioclavicular joint (ACJ) dislocations, but its postoperative and clinical relevance has not been evaluated. We hypothesised that the postoperative circles measurement would capture recurrent vertical as well as horizontal instability and that it would be associated with outcome scores in patients undergoing acute, bidirectional arthroscopically assisted ACJ stabilisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Male patients (18–55 years) with an acute ACJ dislocation (Rockwood type V) were included retrospectively. Radiographs included a single, bilateral anteroposterior stress view and bilateral Alexander views preoperatively and postoperatively (final follow-up of minimum 2 years). Excluded were patients with previous injuries/minors/polytrauma or insufficient radiographs. The side-to-side difference (SSD) coracoclavicular distance (CCD), the degree of dynamic horizontal translation (DHT) and the SSD circles measurement as well as the ACJ instability (ACJI) and Taft (TF) score, subjective shoulder value (SSV) and Constant score were recorded at the final follow-up (minimum 2 years). The postoperative SSD circles measurement was analysed in relation to these. Statistical analysis comprised correlations and group comparisons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six patients (mean age, 38.9 ± 10.7 years) with a follow-up of 33.0 months (range, 24–55 months) were included. The postoperative SSD circles measurement demonstrated a correlation with recurrent vertical instability (SSD CCD: <i>r</i> = 0.37; <i>p</i> = 0.006), and with recurrent horizontal instability (DHT: <i>r</i> = 0.46; <i>p</i> < 0.001). A higher postoperative SSD circles measurement was associated with lower outcome scores (SSV: <i>r</i> = −0.31; <i>p</i> = 0.021; TF score: <i>r</i> = −0.29; <i>p</i> = 0.031; ACJI score: <i>r</i> = −0.35; <i>p</i> = 0.01). The cut-off values for lower scores (<i>p</i> < 0.05 by stepwise group comparison) were 0 mm for the SSV (<i>p</i> = 0.022); 2.2 mm for the TF score (<i>p</i> = 0.022) and 2.7 mm for the ACJI score (<i>p</i> = 0.024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The postoperative circles measurement reflects both recurrent vertical and horizontal instability and correlates with lower outcome scores following arthroscopically assisted ACJ stabilisation, supporting its use as a radiographic adjunct.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.<","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"257-267"},"PeriodicalIF":5.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194240","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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