Alfred Ferré-Aniorte, Ignasi Bolibar, Ramón Cugat, Eduard Alentorn-Geli
Purpose
The aim of this study was to describe the anterior cruciate ligament (ACL) injury incidence differences depending on sex and age-related categories in a large cohort of soccer players over six consecutive seasons.
Methods
This study was designed as a retrospective descriptive epidemiological study. All soccer players in a specific geographical area who sustained an ACL injury across six consecutive seasons were included in this analysis. ACL injury incidence was calculated by sex and age-related category as a percentage of all registered soccer players in the region. Additionally, soccer participation evolution, ACL injury incidence evolution, and monthly ACL injury distribution were studied. Group, seasonal, and monthly differences were analysed using chi-square tests.
Results
Between the 2016–2017 and the 2021–2022 seasons, 3381 ACL injuries were registered from a total of 782,856 player-seasons. ACL injury incidence was 0.43%. Female soccer players showed 2.79 times higher injury incidence than male players, with overall rates of 1.06% in females and 0.38% in males (p < 0.001). However, female players only showed higher ACL injury incidence than males in age groups older than 14 years. ACL injury incidence increased over the six seasons studied only in the male group. October and January were the months with the highest number of ACL injuries, with no significant differences in monthly distribution between sexes.
Conclusions
Female soccer players showed higher ACL injury incidence than males, particularly in age groups older than 14 years. October and January were identified as the months with the highest injury incidences regardless of sex. Additionally, a rising injury incidence was observed in male players, a trend not seen in females.
{"title":"Anterior cruciate ligament injury incidence in male and female soccer players: A longitudinal study over six consecutive seasons","authors":"Alfred Ferré-Aniorte, Ignasi Bolibar, Ramón Cugat, Eduard Alentorn-Geli","doi":"10.1002/ksa.70046","DOIUrl":"10.1002/ksa.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this study was to describe the anterior cruciate ligament (ACL) injury incidence differences depending on sex and age-related categories in a large cohort of soccer players over six consecutive seasons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was designed as a retrospective descriptive epidemiological study. All soccer players in a specific geographical area who sustained an ACL injury across six consecutive seasons were included in this analysis. ACL injury incidence was calculated by sex and age-related category as a percentage of all registered soccer players in the region. Additionally, soccer participation evolution, ACL injury incidence evolution, and monthly ACL injury distribution were studied. Group, seasonal, and monthly differences were analysed using chi-square tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between the 2016–2017 and the 2021–2022 seasons, 3381 ACL injuries were registered from a total of 782,856 player-seasons. ACL injury incidence was 0.43%. Female soccer players showed 2.79 times higher injury incidence than male players, with overall rates of 1.06% in females and 0.38% in males (<i>p</i> < 0.001). However, female players only showed higher ACL injury incidence than males in age groups older than 14 years. ACL injury incidence increased over the six seasons studied only in the male group. October and January were the months with the highest number of ACL injuries, with no significant differences in monthly distribution between sexes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Female soccer players showed higher ACL injury incidence than males, particularly in age groups older than 14 years. October and January were identified as the months with the highest injury incidences regardless of sex. Additionally, a rising injury incidence was observed in male players, a trend not seen in females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective comparative study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4426-4434"},"PeriodicalIF":5.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116026","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}
Katherine L. Esser, Bradley A. Lezak, Griff G. Gosnell, Heath P. Gould, Anil Ranawat, Benedict U. Nwachukwu, Michael Rizzo, Thomas Youm, Ayoosh Pareek
Purpose
To systematically review the current literature regarding the role of artificial intelligence and machine learning in predicting and optimising clinical outcomes following hip arthroscopy.
Methods
A systematic review of the PubMed, Cochrane, and EMBASE databases was completed in December 2024. Studies were included if they assessed the application of AI/ML to clinical outcomes of hip arthroscopy. Exclusion criteria were imaging-only studies, non-English publications, conference abstracts, review articles and meta-analyses. Extracted data included study characteristics, input features, algorithm types, sample sizes, and model performance. Descriptive statistical analysis was performed due to data heterogeneity.
Results
Sixteen studies met inclusion criteria, covering applications across prediction of intraoperative findings (n = 1), prediction of post-operative outcomes (n = 5), prediction of patient-reported outcomes (n = 7) and prediction of revision (n = 3). Input features commonly utilised included demographics, imaging data, preoperative patient-reported outcomes (PROs), and comorbidities. Supervised learning models were the most widely applied, including logistic regression, random forests, support vector machines (SVMs), and artificial neural networks (ANNs). Performance metrics demonstrated robust predictive ability, with AUC values ranging from 0.66 to 0.94 and accuracy rates exceeding 75% in most studies. Applications included predicting revision surgery risk, prolonged opioid use, postoperative satisfaction, and time to return to sport. Imaging-based algorithms, particularly leveraging MRI data, showed promise for surgical planning and diagnostic precision.
Conclusions
AI and ML show significant promise in enhancing outcome prediction and patient stratification in hip arthroscopy. Future research should prioritise the standardisation of datasets, external validation, and interpretability to facilitate clinical translation.
{"title":"Artificial intelligence and machine learning is successful in predicting clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome","authors":"Katherine L. Esser, Bradley A. Lezak, Griff G. Gosnell, Heath P. Gould, Anil Ranawat, Benedict U. Nwachukwu, Michael Rizzo, Thomas Youm, Ayoosh Pareek","doi":"10.1002/ksa.70029","DOIUrl":"10.1002/ksa.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To systematically review the current literature regarding the role of artificial intelligence and machine learning in predicting and optimising clinical outcomes following hip arthroscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of the PubMed, Cochrane, and EMBASE databases was completed in December 2024. Studies were included if they assessed the application of AI/ML to clinical outcomes of hip arthroscopy. Exclusion criteria were imaging-only studies, non-English publications, conference abstracts, review articles and meta-analyses. Extracted data included study characteristics, input features, algorithm types, sample sizes, and model performance. Descriptive statistical analysis was performed due to data heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen studies met inclusion criteria, covering applications across prediction of intraoperative findings (<i>n</i> = 1), prediction of post-operative outcomes (<i>n</i> = 5), prediction of patient-reported outcomes (<i>n</i> = 7) and prediction of revision (<i>n</i> = 3). Input features commonly utilised included demographics, imaging data, preoperative patient-reported outcomes (PROs), and comorbidities. Supervised learning models were the most widely applied, including logistic regression, random forests, support vector machines (SVMs), and artificial neural networks (ANNs). Performance metrics demonstrated robust predictive ability, with AUC values ranging from 0.66 to 0.94 and accuracy rates exceeding 75% in most studies. Applications included predicting revision surgery risk, prolonged opioid use, postoperative satisfaction, and time to return to sport. Imaging-based algorithms, particularly leveraging MRI data, showed promise for surgical planning and diagnostic precision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AI and ML show significant promise in enhancing outcome prediction and patient stratification in hip arthroscopy. Future research should prioritise the standardisation of datasets, external validation, and interpretability to facilitate clinical translation.</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 11","pages":"4012-4025"},"PeriodicalIF":5.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116042","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}
Frida Hansson, Anders Stålman, Gunnar Edman, Per-Mats Janarv, Eva Bengtsson Moström, Riccardo Cristiani
<p>We would like to thank the authors for their thoughtful comments and interest in our study [<span>1, 6</span>]. We appreciate the opportunity to clarify certain aspects of our methodology. First, we would like to clarify that there are currently no universally accepted cut-off values for defining knee hyperextension in either adult or paediatric populations. The few studies that have explored the relationship between preoperative passive knee hyperextension and outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have used a threshold of ≤−5°, but this cut-off was chosen arbitrarily and lacks formal validation [<span>2-4</span>]. We fully acknowledge that passive knee hyperextension is both age- and sex-dependent and is particularly prevalent among children and adolescents [<span>11</span>]. However, the objective of our study was specifically to investigate the influence of <i>physiological</i> knee hyperextension on outcomes following ACLR. As the authors correctly noted, 52.9% of the patients in our cohort were categorised as having knee hyperextension. This should not be interpreted as <i>pathological</i> hyperextension, given that all patients included had isolated ACL injuries, with no concomitant ligamentous damage. In addition, to address the limitations related to the definition of hyperextension, we conducted a subgroup analysis of patients with knee extension ≤−10°, which similarly showed no significant association with postoperative knee laxity outcomes. We appreciate the thoughtful suggestion to incorporate age- and sex-stratified analyses or to use receiver operating characteristic curve methods to define paediatric-specific thresholds. However, as outlined above, our study was designed to assess the potential impact of <i>physiological</i> knee hyperextension, and not to redefine or establish new cut-offs for pathological hyperextension in the paediatric population.</p><p>With regard to the lack of information on rotational laxity, we agree with the authors that the pivot-shift test is an important clinical assessment and has been associated with patient-reported outcomes, return to sport, and an increased risk of graft failure [<span>5, 8</span>]. While we acknowledge the absence of rotational laxity data as a limitation, it is important to note that the primary objective of our study was not to examine the relationship between pivot-shift grading and outcomes after ACLR. Rather, our focus was on assessing the association between preoperative passive knee hyperextension and postoperative outcomes. Biomechanical studies have demonstrated increased strain and tension on the ACL during passive knee hyperextension [<span>7, 9, 10</span>], which could theoretically translate into greater postoperative laxity or a higher risk of graft failure and revision ACLR. However, in our cohort, we did not observe any significant increase in anterior knee laxity at 6 months postoperatively, nor did we find a higher rate of revi
{"title":"Author Reply to ‘Letter to the Editor on “Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents”’","authors":"Frida Hansson, Anders Stålman, Gunnar Edman, Per-Mats Janarv, Eva Bengtsson Moström, Riccardo Cristiani","doi":"10.1002/ksa.70062","DOIUrl":"10.1002/ksa.70062","url":null,"abstract":"<p>We would like to thank the authors for their thoughtful comments and interest in our study [<span>1, 6</span>]. We appreciate the opportunity to clarify certain aspects of our methodology. First, we would like to clarify that there are currently no universally accepted cut-off values for defining knee hyperextension in either adult or paediatric populations. The few studies that have explored the relationship between preoperative passive knee hyperextension and outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) have used a threshold of ≤−5°, but this cut-off was chosen arbitrarily and lacks formal validation [<span>2-4</span>]. We fully acknowledge that passive knee hyperextension is both age- and sex-dependent and is particularly prevalent among children and adolescents [<span>11</span>]. However, the objective of our study was specifically to investigate the influence of <i>physiological</i> knee hyperextension on outcomes following ACLR. As the authors correctly noted, 52.9% of the patients in our cohort were categorised as having knee hyperextension. This should not be interpreted as <i>pathological</i> hyperextension, given that all patients included had isolated ACL injuries, with no concomitant ligamentous damage. In addition, to address the limitations related to the definition of hyperextension, we conducted a subgroup analysis of patients with knee extension ≤−10°, which similarly showed no significant association with postoperative knee laxity outcomes. We appreciate the thoughtful suggestion to incorporate age- and sex-stratified analyses or to use receiver operating characteristic curve methods to define paediatric-specific thresholds. However, as outlined above, our study was designed to assess the potential impact of <i>physiological</i> knee hyperextension, and not to redefine or establish new cut-offs for pathological hyperextension in the paediatric population.</p><p>With regard to the lack of information on rotational laxity, we agree with the authors that the pivot-shift test is an important clinical assessment and has been associated with patient-reported outcomes, return to sport, and an increased risk of graft failure [<span>5, 8</span>]. While we acknowledge the absence of rotational laxity data as a limitation, it is important to note that the primary objective of our study was not to examine the relationship between pivot-shift grading and outcomes after ACLR. Rather, our focus was on assessing the association between preoperative passive knee hyperextension and postoperative outcomes. Biomechanical studies have demonstrated increased strain and tension on the ACL during passive knee hyperextension [<span>7, 9, 10</span>], which could theoretically translate into greater postoperative laxity or a higher risk of graft failure and revision ACLR. However, in our cohort, we did not observe any significant increase in anterior knee laxity at 6 months postoperatively, nor did we find a higher rate of revi","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4105-4106"},"PeriodicalIF":5.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071631","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}
Lenka Stroobant, Amber Marvellie, Jani Windels, Hannes Vermue, Nele Arnout, Stefaan Van Onsem, Jan Victor
<div> <section> <h3> Purpose</h3> <p>Instability is a rising cause of revision total knee arthroplasty (rTKA), creating significant challenges for patients, surgeons and the healthcare system. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management, isolated polyethylene exchange (PE), and rTKA as treatments for post-TKA instability. The primary outcome was patient-reported outcome measures (PROMs), with secondary outcomes including reoperation rates, revision rates, and implant survival (Aim 1). Additionally, the study examined the effect of instability type on PROMs (Aim 2) and the impact of prosthesis constraint on PROMs (Aim 3).</p> </section> <section> <h3> Methods</h3> <p>A systematic search of studies published from 2000 to July 2024 was conducted. (1) Studies analysing the outcome of conservative treatment, isolated PE exchange or revision surgery for instability were included, reporting on PROMs, reoperations, revisions, and/or survival free from revision. PROMs included the Knee Society Score, both clinical (KSCS) and functional (KSFS). Revision was defined as the removal and replacing of the femoral and/or tibial component. A meta-analysis was only performed for revision surgery as treatment. (2) Instability was classified into flexion and extension instability. (3) Prosthetic constraints analysed included posterior stabilised (PS), condylar constrained knee (CCK), and rotating hinged knee (RHK).</p> </section> <section> <h3> Results</h3> <p>A total of 27 articles, involving 4269 knees, were included in the analysis: two studies on conservative management, 12 on isolated PE exchange, and 19 on revision surgeries. (1) Conservative treatment, primary physiotherapy, yielded inconsistent results. Isolated PE exchange showed poor outcomes, with recurrent instability and subsequent revision occurring in 6.5%–18.5% of cases. However, in carefully selected patients, outcomes comparable to rTKA were observed. Revision surgery showed a mean improvement of 32 points (95% confidence interval [CI], 20.5–43.5; <i>p</i> < 0.001) for KSKS and 24.3 points (95% CI, 17.2–31.4; <i>p</i> < 0.001) for KSFS. During follow-up, 5.3% (46/864) of the patients underwent a rerevision, with 41.3% attributed to instability. (2) Extension instability showed a trend toward better KSKS (<i>p</i> = 0.04) and KSFS scores (<i>p</i> = 0.03) than flexion instability, and (3) no evidence of superiority was found between different types of constraint in this study.</p> </section> <section> <h3> Conclusions</h3> <p>When guided by appropriate clinical indications, conservative management, isolated PE exchange, and
{"title":"Instability after total knee arthroplasty: A systematic review and meta-analysis of treatment options and outcomes","authors":"Lenka Stroobant, Amber Marvellie, Jani Windels, Hannes Vermue, Nele Arnout, Stefaan Van Onsem, Jan Victor","doi":"10.1002/ksa.70065","DOIUrl":"10.1002/ksa.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Instability is a rising cause of revision total knee arthroplasty (rTKA), creating significant challenges for patients, surgeons and the healthcare system. This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management, isolated polyethylene exchange (PE), and rTKA as treatments for post-TKA instability. The primary outcome was patient-reported outcome measures (PROMs), with secondary outcomes including reoperation rates, revision rates, and implant survival (Aim 1). Additionally, the study examined the effect of instability type on PROMs (Aim 2) and the impact of prosthesis constraint on PROMs (Aim 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of studies published from 2000 to July 2024 was conducted. (1) Studies analysing the outcome of conservative treatment, isolated PE exchange or revision surgery for instability were included, reporting on PROMs, reoperations, revisions, and/or survival free from revision. PROMs included the Knee Society Score, both clinical (KSCS) and functional (KSFS). Revision was defined as the removal and replacing of the femoral and/or tibial component. A meta-analysis was only performed for revision surgery as treatment. (2) Instability was classified into flexion and extension instability. (3) Prosthetic constraints analysed included posterior stabilised (PS), condylar constrained knee (CCK), and rotating hinged knee (RHK).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 27 articles, involving 4269 knees, were included in the analysis: two studies on conservative management, 12 on isolated PE exchange, and 19 on revision surgeries. (1) Conservative treatment, primary physiotherapy, yielded inconsistent results. Isolated PE exchange showed poor outcomes, with recurrent instability and subsequent revision occurring in 6.5%–18.5% of cases. However, in carefully selected patients, outcomes comparable to rTKA were observed. Revision surgery showed a mean improvement of 32 points (95% confidence interval [CI], 20.5–43.5; <i>p</i> < 0.001) for KSKS and 24.3 points (95% CI, 17.2–31.4; <i>p</i> < 0.001) for KSFS. During follow-up, 5.3% (46/864) of the patients underwent a rerevision, with 41.3% attributed to instability. (2) Extension instability showed a trend toward better KSKS (<i>p</i> = 0.04) and KSFS scores (<i>p</i> = 0.03) than flexion instability, and (3) no evidence of superiority was found between different types of constraint in this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When guided by appropriate clinical indications, conservative management, isolated PE exchange, and","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3817-3839"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056611","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}
Laura de Girolamo, Giuseppe Filardo, Ferran Abat, Kristoffer Weisskirchner Barfod, Ricardo Bastos, Ramon Cugat, Michael Iosifidis, Baris Kocaoglu, Elizaveta Kon, Jeremy Magalon, Rodica Marinescu, Marko Ostojic, Mikel Sanchez, Thomas Tischer, Jasmin Bagge, Konrad Slynarski, Lucienne Vonk, Philippe Beaufils, Lior Laver, ESSKA-ORBIT Group
<div> <section> <h3> Purpose</h3> <p>This European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) formal consensus aims to provide evidence- and expert opinion-based recommendations for the use of point-of-care- and expanded-cell-based therapy (CBT) in the treatment of knee osteoarthritis (OA), focusing on indications, preparation, and administration.</p> </section> <section> <h3> Methods</h3> <p>A multidisciplinary group of 77 leading experts in musculoskeletal regenerative medicine from 22 European Countries formed a steering group, a rating group, and a reader group. The steering group developed 23 questions, originating from 27 statements. The statements were graded from A (high-level scientific evidence) to D (expert opinion). The question-statement sets were scored by the rating group from 1 to 9 according to the level of agreement. The document was then assessed for geographic adaptability by the reader group composed of representatives from ESSKA-affiliated societies.</p> </section> <section> <h3> Results</h3> <p>Overall, the statements received a mean score of 8.2 (standard deviation: 0.3) points out of a possible 9 and a median score of 8 (range: 6–9). Among the 27 statements, 9 were considered appropriate with strong agreement, and 18 were considered appropriate with relative agreement. Five statements received a recommendation level of A or B, and 22 were rated as C or D. In terms of geographic adaptability, 18 affiliated ESSKA Societies expressed support, two were opposed, and two abstained. CBT has demonstrated consistent clinical benefits, particularly in pain and function improvement up to 12 months, supporting its use for patients with Kellgren–Lawrence (KL) Grades 1–3 knee OA, with some benefits, though inferior, in selected KL Grade 4. However, due to limited high-quality studies and a lack of clear superiority over other injectables, CBT should be considered as a second-line treatment option.</p> </section> <section> <h3> Conclusions</h3> <p>The consensus document acknowledges ongoing debate about CBT's full effectiveness, though evidence suggests potential clinical benefits in pain relief and functional improvement. CBT are supported as a second-line injectable treatment for KL 1–3 knee OA 1–3, with some benefits shown in Grade 4 too. However, gaps remain in high-quality studies and treatment protocols. Nevertheless, evidence suggests that CBT may be seen as an alternative to traditional injectables like corticosteroids and hyaluronic acid, given the longer-lasting benefits, and could currently be consider
{"title":"The use of injectable orthobiologics for knee osteoarthritis: A formal ESSKA-ORBIT consensus. Part 2—Cell-based therapy","authors":"Laura de Girolamo, Giuseppe Filardo, Ferran Abat, Kristoffer Weisskirchner Barfod, Ricardo Bastos, Ramon Cugat, Michael Iosifidis, Baris Kocaoglu, Elizaveta Kon, Jeremy Magalon, Rodica Marinescu, Marko Ostojic, Mikel Sanchez, Thomas Tischer, Jasmin Bagge, Konrad Slynarski, Lucienne Vonk, Philippe Beaufils, Lior Laver, ESSKA-ORBIT Group","doi":"10.1002/ksa.70001","DOIUrl":"10.1002/ksa.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) formal consensus aims to provide evidence- and expert opinion-based recommendations for the use of point-of-care- and expanded-cell-based therapy (CBT) in the treatment of knee osteoarthritis (OA), focusing on indications, preparation, and administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multidisciplinary group of 77 leading experts in musculoskeletal regenerative medicine from 22 European Countries formed a steering group, a rating group, and a reader group. The steering group developed 23 questions, originating from 27 statements. The statements were graded from A (high-level scientific evidence) to D (expert opinion). The question-statement sets were scored by the rating group from 1 to 9 according to the level of agreement. The document was then assessed for geographic adaptability by the reader group composed of representatives from ESSKA-affiliated societies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, the statements received a mean score of 8.2 (standard deviation: 0.3) points out of a possible 9 and a median score of 8 (range: 6–9). Among the 27 statements, 9 were considered appropriate with strong agreement, and 18 were considered appropriate with relative agreement. Five statements received a recommendation level of A or B, and 22 were rated as C or D. In terms of geographic adaptability, 18 affiliated ESSKA Societies expressed support, two were opposed, and two abstained. CBT has demonstrated consistent clinical benefits, particularly in pain and function improvement up to 12 months, supporting its use for patients with Kellgren–Lawrence (KL) Grades 1–3 knee OA, with some benefits, though inferior, in selected KL Grade 4. However, due to limited high-quality studies and a lack of clear superiority over other injectables, CBT should be considered as a second-line treatment option.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The consensus document acknowledges ongoing debate about CBT's full effectiveness, though evidence suggests potential clinical benefits in pain relief and functional improvement. CBT are supported as a second-line injectable treatment for KL 1–3 knee OA 1–3, with some benefits shown in Grade 4 too. However, gaps remain in high-quality studies and treatment protocols. Nevertheless, evidence suggests that CBT may be seen as an alternative to traditional injectables like corticosteroids and hyaluronic acid, given the longer-lasting benefits, and could currently be consider","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4079-4095"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025143","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}
Prushoth Vivekanantha, Jeffrey Kay, Nicole Simunovic, Olufemi R. Ayeni, the FIRST Investigators
Purpose
This analysis evaluated whether logistic regression and machine learning models could predict achievement of the minimal clinically important difference (MCID) for the International Hip Outcome Tool (iHOT-12) and Hip Outcome Score (HOS) at 6 and 12 months following hip arthroscopy.
Methods
Data from the multicenter Femoroacetabular Impingement RandomiSed controlled Trial and its embedded prospective cohort were used. A total of 309 patients (mean ± SD age 34.0 ± 8.7 years, 37.7% female) were included. The MCID thresholds for iHOT-12 and HOS were calculated using a distribution-based method and were 9.0 and 13.0, respectively. Predictive models were trained with demographic, radiographic, and intraoperative variables using a 70:30 training-to-test data split. MCID achievement was defined as a change from preoperative to postoperative scores that surpassed the calculated threshold. Model discrimination was assessed using the area under the curve (AUC), and calibration was evaluated via slope, intercept, and Brier scores.
Results
Achievement rates were 83.3% at 6 months and 81.1% at 12 months for iHOT-12, and 64.3% at 6 months and 75% at 12 months for HOS. Logistic regression performed best at 12 months (AUC = 0.724) for iHOT-12 with poor calibration (slope = 2.19). AUCs for HOS ranged between 0.672–0.715 at 6 months and 0.665–0.699 at 12 months. Best calibration was achieved by Least Absolute Shrinkage and Selection Operator (slope = 1.270, intercept = –0.177) at 6 months and by logistic regression at 12 months (slope = 1.093, intercept = –0.079). Lower baseline patient-reported outcome measures (PROMs) were associated with MCID achievement in most models.
Conclusion
The most robust predictor of MCID achievement for both PROMs were lower baseline scores, and can be used as a prognostic variable for preoperative counselling. Model performance for predicting MCID was superior for HOS relative to iHOT-12. Machine learning models generally had comparable discrimination and calibration scores to traditional logistic regression models.
{"title":"Lower baseline scores best predict achievement of the minimal clinically important difference after hip arthroscopy: A machine learning analysis from the Femoroacetabular Impingement RandomiSed Controlled Trial and embedded prospective cohort","authors":"Prushoth Vivekanantha, Jeffrey Kay, Nicole Simunovic, Olufemi R. Ayeni, the FIRST Investigators","doi":"10.1002/ksa.70053","DOIUrl":"10.1002/ksa.70053","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This analysis evaluated whether logistic regression and machine learning models could predict achievement of the minimal clinically important difference (MCID) for the International Hip Outcome Tool (iHOT-12) and Hip Outcome Score (HOS) at 6 and 12 months following hip arthroscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the multicenter Femoroacetabular Impingement RandomiSed controlled Trial and its embedded prospective cohort were used. A total of 309 patients (mean ± SD age 34.0 ± 8.7 years, 37.7% female) were included. The MCID thresholds for iHOT-12 and HOS were calculated using a distribution-based method and were 9.0 and 13.0, respectively. Predictive models were trained with demographic, radiographic, and intraoperative variables using a 70:30 training-to-test data split. MCID achievement was defined as a change from preoperative to postoperative scores that surpassed the calculated threshold. Model discrimination was assessed using the area under the curve (AUC), and calibration was evaluated via slope, intercept, and Brier scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Achievement rates were 83.3% at 6 months and 81.1% at 12 months for iHOT-12, and 64.3% at 6 months and 75% at 12 months for HOS. Logistic regression performed best at 12 months (AUC = 0.724) for iHOT-12 with poor calibration (slope = 2.19). AUCs for HOS ranged between 0.672–0.715 at 6 months and 0.665–0.699 at 12 months. Best calibration was achieved by Least Absolute Shrinkage and Selection Operator (slope = 1.270, intercept = –0.177) at 6 months and by logistic regression at 12 months (slope = 1.093, intercept = –0.079). Lower baseline patient-reported outcome measures (PROMs) were associated with MCID achievement in most models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The most robust predictor of MCID achievement for both PROMs were lower baseline scores, and can be used as a prognostic variable for preoperative counselling. Model performance for predicting MCID was superior for HOS relative to iHOT-12. Machine learning models generally had comparable discrimination and calibration scores to traditional logistic regression models.</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":"33 12","pages":"4385-4397"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025171","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}
Umile Giuseppe Longo, Giovanni Spallone, Arianna Carnevale, Letizia Mancini, Emiliano Schena, Rocco Papalia, Michael Tobias Hirschmann
Kinematic alignment is increasingly adopted in total knee arthroplasty (TKA) as a patient-specific strategy to restore native joint anatomy. However, its reliance on static radiographic measurements may not adequately reflect real-world functional biomechanics. This editorial underscores the importance of complementing static assessment with kinetic principles. This emerging concept, referred to as kinetic alignment, integrates dynamic parameters such as the dynamic hip-knee-ankle angle, knee adduction moment, ground reaction forces, and muscle forces to better characterise in vivo joint loading. These kinetic variables provide critical insight into joint loading during real-life activities and may offer greater predictive value for implant performance and patient satisfaction. Continued emphasis on static alignment targets may overlook key elements of in vivo knee function. Incorporating kinetic data into preoperative planning could support more tailored surgical decisions, helping to mitigate risks related to malalignment, overloading, and suboptimal outcomes. The editorial advocates for expanding the concept of alignment beyond static geometry, including both motion and load, and encouraging the orthopaedic and biomechanical communities to adopt a more functional and individualised perspective in TKA planning.
{"title":"Kinematic alignment doesn't tell the whole story: It's time for kinetic alignment","authors":"Umile Giuseppe Longo, Giovanni Spallone, Arianna Carnevale, Letizia Mancini, Emiliano Schena, Rocco Papalia, Michael Tobias Hirschmann","doi":"10.1002/ksa.70010","DOIUrl":"10.1002/ksa.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Kinematic alignment is increasingly adopted in total knee arthroplasty (TKA) as a patient-specific strategy to restore native joint anatomy. However, its reliance on static radiographic measurements may not adequately reflect real-world functional biomechanics. This editorial underscores the importance of complementing static assessment with kinetic principles. This emerging concept, referred to as kinetic alignment, integrates dynamic parameters such as the dynamic hip-knee-ankle angle, knee adduction moment, ground reaction forces, and muscle forces to better characterise in vivo joint loading. These kinetic variables provide critical insight into joint loading during real-life activities and may offer greater predictive value for implant performance and patient satisfaction. Continued emphasis on static alignment targets may overlook key elements of in vivo knee function. Incorporating kinetic data into preoperative planning could support more tailored surgical decisions, helping to mitigate risks related to malalignment, overloading, and suboptimal outcomes. The editorial advocates for expanding the concept of alignment beyond static geometry, including both motion and load, and encouraging the orthopaedic and biomechanical communities to adopt a more functional and individualised perspective in TKA planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3735-3738"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025213","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}
Yaoxin Ao, Jiangfeng Lyv, Fangjun Xiao, Junxing Yang
<p>We read with great interest the article by Hansson et al., “Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents,” published in <i>KSSTA</i> [<span>5</span>]. This large-scale cohort study provides important evidence supporting the safe use of hamstring tendon autografts in pediatric ACL reconstruction (ACLR), suggesting that preoperative passive knee hyperextension (KHE, ≤−5°) does not negatively impact surgical outcomes.</p><p>While the findings are valuable, we would like to raise two methodological considerations that may help refine the interpretation of the results and inform future research. First, the use of the adult threshold (≤−5°) to define KHE in a pediatric cohort may not fully account for developmental norms. Passive knee hyperextension is age- and sex-dependent, with values in adolescents—particularly females—often exceeding −5° physiologically [<span>7, 9, 11, 14</span>]. In this study, 53% of patients were categorized as hyperextenders, a proportion consistent with normal variation, raising the possibility that physiological hyperextension was misclassified as pathological. This may have diluted subgroup effects, especially in those with more pronounced hyperextension (e.g., ≤−10°), for whom no outcome gradient was observed. To address this, we suggest incorporating age- and sex-stratified analyses or applying receiver operating characteristic (ROC) curves to determine pediatric-specific thresholds. Such refinements may help clarify whether the observed null association applies across all developmental stages or only within physiological ranges.</p><p>Second, although the authors acknowledge the absence of rotational stability assessment, its clinical relevance merits further discussion. KHE has been shown to increase ACL stress under rotational loads due to compounded valgus and internal rotation torques [<span>6, 10, 13</span>]. A multicenter cohort study by Ueki et al. confirmed that preoperative knee hyperextension and high-grade pivot shift were significant risk factors for residual pivot shift 1 year after surgery [<span>15</span>]. Importantly, growing evidence indicates that rotational laxity (particularly pivot shift) appears inherently higher in pediatric populations compared to adults. Kamada et al. [<span>8</span>] identified patients <20 years as having 6.1 times greater risk of residual pivot shift after ACL reconstruction, while Dejour et al. [<span>1</span>] demonstrated that high-grade pivot shift prevalence decreases significantly with age (odds ratio [OR] 0.94/year, <i>p</i> < 0.001). Rotational instability is a key contributor to functional knee deficits yet is not captured by anterior laxity measurements alone [<span>3, 16</span>]. Previous studies have demonstrated its clinical importance. High-grade pivot shifts have been associated with worse functional outcomes, re
{"title":"Letter to the Editor on “Knee hyperextension is not associated with anterior knee laxity subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents”","authors":"Yaoxin Ao, Jiangfeng Lyv, Fangjun Xiao, Junxing Yang","doi":"10.1002/ksa.70063","DOIUrl":"10.1002/ksa.70063","url":null,"abstract":"<p>We read with great interest the article by Hansson et al., “Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents,” published in <i>KSSTA</i> [<span>5</span>]. This large-scale cohort study provides important evidence supporting the safe use of hamstring tendon autografts in pediatric ACL reconstruction (ACLR), suggesting that preoperative passive knee hyperextension (KHE, ≤−5°) does not negatively impact surgical outcomes.</p><p>While the findings are valuable, we would like to raise two methodological considerations that may help refine the interpretation of the results and inform future research. First, the use of the adult threshold (≤−5°) to define KHE in a pediatric cohort may not fully account for developmental norms. Passive knee hyperextension is age- and sex-dependent, with values in adolescents—particularly females—often exceeding −5° physiologically [<span>7, 9, 11, 14</span>]. In this study, 53% of patients were categorized as hyperextenders, a proportion consistent with normal variation, raising the possibility that physiological hyperextension was misclassified as pathological. This may have diluted subgroup effects, especially in those with more pronounced hyperextension (e.g., ≤−10°), for whom no outcome gradient was observed. To address this, we suggest incorporating age- and sex-stratified analyses or applying receiver operating characteristic (ROC) curves to determine pediatric-specific thresholds. Such refinements may help clarify whether the observed null association applies across all developmental stages or only within physiological ranges.</p><p>Second, although the authors acknowledge the absence of rotational stability assessment, its clinical relevance merits further discussion. KHE has been shown to increase ACL stress under rotational loads due to compounded valgus and internal rotation torques [<span>6, 10, 13</span>]. A multicenter cohort study by Ueki et al. confirmed that preoperative knee hyperextension and high-grade pivot shift were significant risk factors for residual pivot shift 1 year after surgery [<span>15</span>]. Importantly, growing evidence indicates that rotational laxity (particularly pivot shift) appears inherently higher in pediatric populations compared to adults. Kamada et al. [<span>8</span>] identified patients <20 years as having 6.1 times greater risk of residual pivot shift after ACL reconstruction, while Dejour et al. [<span>1</span>] demonstrated that high-grade pivot shift prevalence decreases significantly with age (odds ratio [OR] 0.94/year, <i>p</i> < 0.001). Rotational instability is a key contributor to functional knee deficits yet is not captured by anterior laxity measurements alone [<span>3, 16</span>]. Previous studies have demonstrated its clinical importance. High-grade pivot shifts have been associated with worse functional outcomes, re","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4103-4104"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025173","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}
Matthew Buckthorpe, Evert Verhagen, Pieter D'Hooghe, Leonardo Osti, Stefano Di Paolo, Francesco Della Villa
Purpose
To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.
Methods
There were 166 consecutive ankle sprain injuries identified occurring during official matches in players of top European football leagues. One hundred and forty (84%) injury videos were analysed for mechanism and situational pattern, with biomechanics on 20 players. Neurocognitive errors were investigated for all noncontact injuries. Three independent reviewers evaluated each video. Ankle sprain injury epidemiology—month, timing within the match and pitch location at the time of injury and time-loss according to sprain type was also documented.
Results
More injuries occurred in offensive (n = 89, 64%) than defensive (n = 51, 36%) situations (p < 0.001). Seventy (50%) direct contact, 42 (30%) indirect contact and 28 (20%) noncontact injuries were categorised. There were 67 (48%) inversion, 30 (21%) high ankle, 25 (17%) eversion, 6 with combination of high ankle and eversion (4%) and 12 (9%) unsure injuries. Four main situational patterns were described: (i) being tackled (n = 59, 42%); (ii) tackling/pressing (n = 34, 24%); (iii) landing from a jump (n = 16, 11%) and (iv) sliding (n = 7, 5%). Inversion injuries were associated with internal rotation, while high ankle injuries typically involved toe contact with the ground, slight plantar flexion and foot eversion. A neurocognitive error was documented 59% of noncontact injuries. A similar number of injuries occurred during the 1st (n = 71, 51%) and 2nd (n = 69, 49%) half (p > 0.05).
Discussion
Half of ankle sprain injuries occurred after direct contact, 3 in 10 after indirect contact and only 2 in 10 without contact. Injury prevention practices should consider mechanical perturbation, playing situation and neurocognitive factors when designing programmes.
{"title":"Systematic video analysis of ankle sprain injuries in elite male football (soccer): Injury mechanisms, situational patterns, biomechanics and neurocognitive errors study: A study on 140 consecutive players","authors":"Matthew Buckthorpe, Evert Verhagen, Pieter D'Hooghe, Leonardo Osti, Stefano Di Paolo, Francesco Della Villa","doi":"10.1002/ksa.70049","DOIUrl":"10.1002/ksa.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>There were 166 consecutive ankle sprain injuries identified occurring during official matches in players of top European football leagues. One hundred and forty (84%) injury videos were analysed for mechanism and situational pattern, with biomechanics on 20 players. Neurocognitive errors were investigated for all noncontact injuries. Three independent reviewers evaluated each video. Ankle sprain injury epidemiology—month, timing within the match and pitch location at the time of injury and time-loss according to sprain type was also documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More injuries occurred in offensive (<i>n</i> = 89, 64%) than defensive (<i>n</i> = 51, 36%) situations (<i>p</i> < 0.001). Seventy (50%) direct contact, 42 (30%) indirect contact and 28 (20%) noncontact injuries were categorised. There were 67 (48%) inversion, 30 (21%) high ankle, 25 (17%) eversion, 6 with combination of high ankle and eversion (4%) and 12 (9%) unsure injuries. Four main situational patterns were described: (i) being tackled (<i>n</i> = 59, 42%); (ii) tackling/pressing (<i>n</i> = 34, 24%); (iii) landing from a jump (<i>n</i> = 16, 11%) and (iv) sliding (<i>n</i> = 7, 5%). Inversion injuries were associated with internal rotation, while high ankle injuries typically involved toe contact with the ground, slight plantar flexion and foot eversion. A neurocognitive error was documented 59% of noncontact injuries. A similar number of injuries occurred during the 1st (<i>n</i> = 71, 51%) and 2nd (<i>n</i> = 69, 49%) half (<i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Half of ankle sprain injuries occurred after direct contact, 3 in 10 after indirect contact and only 2 in 10 without contact. Injury prevention practices should consider mechanical perturbation, playing situation and neurocognitive factors when designing programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4035-4049"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025207","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}
Randeep S. Aujla, Peter Edwards, Steven Cecchi, Shahbaz Malik, Brendan Ricciardo, Peter Annear, Jay Ebert, Peter D'Alessandro
Purpose
The purpose of the study was to identify the safety and effectiveness of an accelerated (AR) versus conservative (CR) rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions.
Methods
This prospective randomized controlled trial (RCT) allocated patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR = 30) or an accelerated, unbraced regime, which permitted full weight-bearing as tolerated (AR = 27). Patients were evaluated pre-operatively and at 6 weeks, 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs), patient satisfaction and global rating of change (GRC) scores. Objective measures, including the single (SHD), triple (THD) and triple crossover (TCHD) hop tests, were assessed at 6 months, as was peak isokinetic knee extensor and flexor torque.
Results
Of the 57 patients recruited, 4 were excluded from the CR group (2 infections; 2 re-injuries). The CR group contained 57% males with a mean age of 45.6 (standard deviation [SD] = 13.4). The AR group contained 44% males with a mean age of 50.5 (SD = 11.8). Therefore, 53 patients (CR = 26, AR = 27) were reviewed at the final 6-month follow-up. Within-group analyses showed that both groups significantly improved in all PROMs (p < 0.05). No significant differences were observed between groups for satisfaction, GRC scores, knee extensor torque, knee flexor torque, limb symmetry indices, re-injuries or complications at 6 months.
Conclusions
This RCT has highlighted the safety and efficacy of a post-operative rehabilitation pathway that includes weight-bearing as tolerated, without bracing, in patients after proximal hamstring tendon repair.
{"title":"Accelerated rehabilitation after proximal hamstring avulsion repair is safe and effective: Outcomes from randomized controlled trial of two different rehabilitation regimes","authors":"Randeep S. Aujla, Peter Edwards, Steven Cecchi, Shahbaz Malik, Brendan Ricciardo, Peter Annear, Jay Ebert, Peter D'Alessandro","doi":"10.1002/ksa.70030","DOIUrl":"10.1002/ksa.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of the study was to identify the safety and effectiveness of an accelerated (AR) versus conservative (CR) rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective randomized controlled trial (RCT) allocated patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR = 30) or an accelerated, unbraced regime, which permitted full weight-bearing as tolerated (AR = 27). Patients were evaluated pre-operatively and at 6 weeks, 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs), patient satisfaction and global rating of change (GRC) scores. Objective measures, including the single (SHD), triple (THD) and triple crossover (TCHD) hop tests, were assessed at 6 months, as was peak isokinetic knee extensor and flexor torque.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 57 patients recruited, 4 were excluded from the CR group (2 infections; 2 re-injuries). The CR group contained 57% males with a mean age of 45.6 (standard deviation [SD] = 13.4). The AR group contained 44% males with a mean age of 50.5 (SD = 11.8). Therefore, 53 patients (CR = 26, AR = 27) were reviewed at the final 6-month follow-up. Within-group analyses showed that both groups significantly improved in all PROMs (<i>p</i> < 0.05). No significant differences were observed between groups for satisfaction, GRC scores, knee extensor torque, knee flexor torque, limb symmetry indices, re-injuries or complications at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This RCT has highlighted the safety and efficacy of a post-operative rehabilitation pathway that includes weight-bearing as tolerated, without bracing, in patients after proximal hamstring tendon repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4412-4425"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025185","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号