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Anterior cruciate ligament injury incidence in male and female soccer players: A longitudinal study over six consecutive seasons 男女足球运动员前交叉韧带损伤发生率:一项连续六个赛季的纵向研究。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-22 DOI: 10.1002/ksa.70046
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.

Level of Evidence

Level III, retrospective comparative study.

目的:本研究的目的是描述前交叉韧带(ACL)损伤发生率的差异,这取决于性别和年龄相关的类别,在一个连续六个赛季的大队列足球运动员。方法:采用回顾性描述性流行病学研究。所有在特定地理区域连续六个赛季遭受前交叉韧带损伤的足球运动员都包括在这项分析中。前交叉韧带损伤发生率按性别和年龄相关类别计算,占该地区所有注册足球运动员的百分比。此外,研究了足球参与演变、前交叉韧带损伤发生率演变和每月前交叉韧带损伤分布。使用卡方检验分析组、季节和月差异。结果:2016-2017赛季至2021-2022赛季,共有782,856名球员赛季中发生了3381例ACL损伤。前交叉韧带损伤发生率为0.43%。女性足球运动员的ACL损伤发生率是男性运动员的2.79倍,女性的总体发生率为1.06%,男性为0.38% (p)。结论:女性足球运动员的ACL损伤发生率高于男性,特别是在14岁以上年龄组。10月和1月被确定为不分性别的伤害发生率最高的月份。此外,在男性球员中观察到受伤发生率的上升,而在女性球员中没有看到这种趋势。证据等级:III级,回顾性比较研究。
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引用次数: 0
Artificial intelligence and machine learning is successful in predicting clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome 人工智能和机器学习在预测股骨髋臼撞击综合征髋关节镜术后的临床结果方面取得了成功。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-22 DOI: 10.1002/ksa.70029
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.

Level of Evidence

Level V.

目的:系统回顾人工智能和机器学习在预测和优化髋关节镜术后临床结果中的作用。方法:于2024年12月完成对PubMed、Cochrane和EMBASE数据库的系统评价。如果研究评估AI/ML在髋关节镜临床结果中的应用,则纳入研究。排除标准为影像学研究、非英文出版物、会议摘要、综述文章和荟萃分析。提取的数据包括研究特征、输入特征、算法类型、样本量和模型性能。由于数据异质性,进行描述性统计分析。结果:16项研究符合纳入标准,包括术中发现预测(n = 1)、术后结果预测(n = 5)、患者报告结果预测(n = 7)和翻修预测(n = 3)。通常使用的输入特征包括人口统计学、影像学数据、术前患者报告的结果(PROs)和合并症。监督学习模型的应用最为广泛,包括逻辑回归、随机森林、支持向量机(svm)和人工神经网络(ann)。性能指标显示出强大的预测能力,在大多数研究中,AUC值在0.66至0.94之间,准确率超过75%。应用包括预测翻修手术风险、延长阿片类药物使用、术后满意度和恢复运动的时间。基于成像的算法,特别是利用MRI数据,显示出手术计划和诊断精度的希望。结论:人工智能和机器学习在增强髋关节镜预后预测和患者分层方面具有重要的前景。未来的研究应优先考虑数据集的标准化、外部验证和可解释性,以促进临床翻译。证据等级:V级。
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引用次数: 0
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”’ 作者回复关于“儿童和青少年前交叉韧带重建后,膝关节过伸与膝关节前松弛、主观膝关节功能或翻修手术无关”的致编辑的信。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-16 DOI: 10.1002/ksa.70062
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
我们要感谢作者对我们研究的周到评论和兴趣[1,6]。我们感谢有机会澄清我们方法的某些方面。首先,我们想要澄清的是,目前在成人或儿童人群中没有普遍接受的定义膝关节过伸的临界值。少数研究探讨了术前被动膝关节过伸与前交叉韧带(ACL)重建(ACLR)后预后之间的关系,这些研究使用了≤- 5°的阈值,但这一临界值的选择是随意的,缺乏正式的验证[2-4]。我们充分认识到,被动膝关节过伸与年龄和性别有关,在儿童和青少年中尤为普遍。然而,我们研究的目的是专门研究生理性膝关节过伸对ACLR后预后的影响。正如作者正确指出的那样,我们队列中52.9%的患者被归类为膝关节过伸。考虑到所有患者都是孤立的前交叉韧带损伤,没有伴随的韧带损伤,这不应被解释为病理性过伸。此外,为了解决与超伸定义相关的局限性,我们对膝关节伸度≤- 10°的患者进行了亚组分析,同样显示与术后膝关节松弛结果无显著关联。我们很欣赏将年龄和性别分层分析或使用接受者工作特征曲线方法定义儿科特异性阈值的周到建议。然而,如上所述,我们的研究旨在评估生理性膝关节过伸的潜在影响,而不是重新定义或建立儿科人群病理性膝关节过伸的新界限。由于缺乏关于旋转松弛的信息,我们同意作者的观点,即枢轴移位试验是一项重要的临床评估,与患者报告的结果、恢复运动和移植物失败风险增加有关[5,8]。虽然我们承认缺乏旋转松弛度数据是一个局限性,但重要的是要注意,我们研究的主要目的不是检查轴心转移分级与ACLR后结果之间的关系。相反,我们的重点是评估术前被动膝关节过伸与术后结果之间的关系。生物力学研究表明,被动膝关节过伸时ACL的应变和张力增加[7,9,10],理论上这可能导致术后更大的松弛或移植物失败和翻修ACLR的风险增加。然而,在我们的队列中,我们没有观察到术后6个月前膝关节松弛的任何显著增加,也没有发现术前膝关节过伸患者术后5年的ACLR翻修率更高。我们再次感谢作者提供的宝贵意见,这些意见有助于不断完善这一重要主题。作者声明无利益冲突。本研究获得了卡罗林斯卡学院区域伦理委员会的伦理许可(日记号:2016/1613-31/2)。登记研究不要求同意参与。
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引用次数: 0
Instability after total knee arthroplasty: A systematic review and meta-analysis of treatment options and outcomes 全膝关节置换术后不稳定:治疗方案和结果的系统回顾和荟萃分析。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-12 DOI: 10.1002/ksa.70065
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
目的:不稳定性是翻修全膝关节置换术(rTKA)的一个上升原因,给患者、外科医生和医疗保健系统带来了重大挑战。本系统综述和荟萃分析旨在评估保守治疗、孤立聚乙烯交换(PE)和rTKA作为tka后不稳定治疗的结果。主要结果是患者报告的结果测量(PROMs),次要结果包括再手术率、翻修率和种植体存活率(Aim 1)。此外,本研究还研究了不稳定类型对PROMs的影响(Aim 2)和假体约束对PROMs的影响(Aim 3)。方法:系统检索2000年至2024年7月发表的相关研究。(1)研究分析了保守治疗、孤立PE置换或翻修手术治疗不稳定的结果,报告了PROMs、再手术、翻修和/或翻修后存活的情况。PROMs包括膝关节社会评分,包括临床(KSCS)和功能(KSFS)。翻修定义为股骨和/或胫骨假体的移除和置换。一项荟萃分析仅对翻修手术进行了治疗。(2)失稳分为屈曲失稳和伸展失稳。(3)假体约束分析包括后路稳定(PS)、髁约束膝关节(CCK)和旋转铰接膝关节(RHK)。结果:共纳入27篇文献,涉及4269个膝关节:2篇关于保守治疗的研究,12篇关于孤立性PE置换的研究,19篇关于翻修手术的研究。(1)保守治疗,即初级物理治疗,结果不一致。孤立PE置换的预后较差,6.5%-18.5%的病例会出现复发性不稳定和随后的翻修。然而,在精心挑选的患者中,观察到与rTKA相当的结果。翻修手术平均改善32分(95%可信区间[CI], 20.5-43.5; p)。结论:在适当的临床指征指导下,保守治疗、孤立PE置换和翻修手术可获得良好的tka后不稳定治疗结果。不稳定性仍然是矫正的主要原因,当屈伸间隙无法达到平衡时,需要更高的假体约束。证据等级:四级,系统评价。
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引用次数: 0
The use of injectable orthobiologics for knee osteoarthritis: A formal ESSKA-ORBIT consensus. Part 2—Cell-based therapy 使用可注射的骨科治疗膝骨关节炎:正式的ESSKA-ORBIT共识。第二部分:细胞疗法。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70001
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
目的:欧洲运动创伤学、膝关节外科和关节镜学会(ESSKA)正式共识旨在提供基于证据和专家意见的建议,用于治疗膝关节骨性关节炎(OA),重点关注适应症、准备和给药。方法:由来自22个欧洲国家的77位肌肉骨骼再生医学的主要专家组成的多学科小组组成了一个指导小组、一个评级小组和一个读者小组。指导小组根据27项发言提出了23个问题。这些陈述的等级从A(高级科学证据)到D(专家意见)。问题陈述集由评分组根据同意程度从1到9打分。然后,由eska附属协会代表组成的读者小组对该文件的地理适应性进行了评估。结果:总体而言,这些陈述的平均得分为8.2分(标准差:0.3),满分为9分,中位数得分为8分(范围:6-9)。在27项声明中,9项被认为是适当的,并强烈同意,18项被认为是适当的,并相对同意。推荐等级为a或B的有5个,推荐等级为C或d的有22个。在地理适应性方面,18个附属学会表示支持,2个反对,2个弃权。CBT已显示出一致的临床益处,特别是在长达12个月的疼痛和功能改善方面,支持其用于Kellgren-Lawrence (KL) 1-3级膝关节OA患者,在选定的KL 4级患者中有一些益处,尽管效果较差。然而,由于高质量的研究有限,并且与其他注射剂相比缺乏明显的优势,CBT应被视为二线治疗选择。结论:尽管有证据表明CBT在缓解疼痛和功能改善方面有潜在的临床益处,但该共识文件承认关于CBT完全有效性的持续争论。CBT被支持作为KL 1-3膝关节OA 1-3的二线注射治疗,在4级患者中也显示出一些益处。然而,在高质量的研究和治疗方案方面仍然存在差距。然而,有证据表明,CBT可能被视为皮质类固醇和透明质酸等传统注射剂的替代品,鉴于其更持久的益处,目前可以在其他非手术治疗失败后考虑CBT。证据等级:一级。
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引用次数: 0
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 较低的基线评分最好地预测髋关节镜术后最小临床重要差异的实现:来自股髋臼撞击随机对照试验和嵌入前瞻性队列的机器学习分析。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70053
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.

Level of Evidence

Level III.

目的:本分析评估了逻辑回归和机器学习模型是否可以预测国际髋关节结果工具(iHOT-12)和髋关节结果评分(HOS)在髋关节镜检查后6个月和12个月的最小临床重要差异(MCID)的实现。方法:采用多中心股髋臼撞击随机对照试验及其嵌入前瞻性队列的数据。共纳入309例患者(平均±SD年龄34.0±8.7岁,女性37.7%)。采用基于分布的方法计算iHOT-12和HOS的MCID阈值,分别为9.0和13.0。预测模型采用人口统计学、放射学和术中变量进行训练,训练与测试数据比例为70:30。MCID成就定义为术前到术后评分的变化超过计算阈值。使用曲线下面积(AUC)评估模型判别,通过斜率、截距和Brier评分评估模型校准。结果:iHOT-12组6个月和12个月的成功率分别为83.3%和81.1%;HOS组6个月和12个月的成功率分别为64.3%和75%。对于标度较差(斜率= 2.19)的iHOT-12, Logistic回归在12个月时表现最佳(AUC = 0.724)。居屋的auc介乎6个月时的0.672-0.715及12个月时的0.665-0.699。6个月时通过最小绝对收缩和选择算子(斜率= 1.270,截距= -0.177)和12个月时通过逻辑回归(斜率= 1.093,截距= -0.079)获得最佳校准。在大多数模型中,较低的基线患者报告的结果测量(PROMs)与MCID的实现相关。结论:较低的基线评分是两种PROMs患者MCID成就的最可靠预测指标,可作为术前咨询的预后变量。HOS预测MCID的模型性能优于iHOT-12。机器学习模型通常具有与传统逻辑回归模型相当的判别和校准分数。证据等级:三级。
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引用次数: 0
Kinematic alignment doesn't tell the whole story: It's time for kinetic alignment 运动学对齐并不能说明问题的全部:是时候进行动力学对齐了。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70010
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.

在全膝关节置换术(TKA)中,越来越多地采用运动学对齐作为一种患者特有的策略来恢复原有的关节解剖。然而,它对静态放射测量的依赖可能不能充分反映现实世界的功能生物力学。这篇社论强调了用动力学原理补充静态评估的重要性。这个新兴的概念,被称为动态对齐,整合了动态参数,如动态髋关节-膝关节-踝关节角度,膝关节内收力矩,地面反作用力和肌肉力,以更好地表征体内关节负荷。这些动力学变量提供了对现实生活中关节负荷的关键洞察,并可能为植入物性能和患者满意度提供更大的预测价值。继续强调静态对齐目标可能会忽略体内膝关节功能的关键因素。将动力学数据纳入术前计划可以支持更有针对性的手术决策,有助于降低与不对准、超载和次优结果相关的风险。该社论主张将对齐概念扩展到静态几何之外,包括运动和负载,并鼓励骨科和生物力学团体在TKA规划中采用更功能和个性化的观点。
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引用次数: 0
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” 致编辑的信“膝关节过伸与儿童和青少年前交叉韧带重建后的膝关节前松弛、主观膝关节功能或翻修手术无关”。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70063
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
我们饶有兴趣地阅读了汉森等人发表在KSSTA[5]上的文章“膝关节过伸与儿童和青少年前交叉韧带重建后的前膝关节松弛、主观膝关节功能或翻修手术无关”。这项大规模队列研究为支持在儿童ACL重建(ACLR)中安全使用腘绳肌腱自体移植物提供了重要证据,表明术前被动膝关节过伸(KHE,≤- 5°)不会对手术结果产生负面影响。虽然这些发现是有价值的,但我们想提出两个方法上的考虑,这可能有助于完善对结果的解释,并为未来的研究提供信息。首先,在儿童队列中使用成人阈值(≤- 5°)来定义KHE可能不能完全解释发育规范。被动膝关节过伸与年龄和性别有关,青少年(尤其是女性)的生理值通常超过- 5°[7,9,11,14]。在本研究中,53%的患者被归类为过伸症,这一比例与正常变异一致,这增加了生理性过伸症被错误归类为病理性过伸症的可能性。这可能会稀释亚组效应,特别是在那些更明显的过伸(例如≤- 10°)的患者中,他们没有观察到结果梯度。为了解决这个问题,我们建议结合年龄和性别分层分析或应用受试者工作特征(ROC)曲线来确定儿科特异性阈值。这种改进可能有助于澄清所观察到的零关联是否适用于所有发育阶段或仅在生理范围内。其次,尽管作者承认缺乏旋转稳定性评估,但其临床相关性值得进一步讨论。由于外翻和内旋扭矩的复合作用,KHE在旋转载荷下会增加ACL应力[6,10,13]。Ueki等人的一项多中心队列研究证实,术前膝关节过伸和高度枢轴移位是术后1年发生残余枢轴移位的重要危险因素。重要的是,越来越多的证据表明,与成人相比,儿科人群的旋转松弛(特别是枢轴移位)似乎固有地更高。Kamada等人([8])发现,20岁的患者在ACL重建后存在6.1倍的残余枢轴移位风险,而Dejour等人([8])表明,高度枢轴移位患病率随着年龄的增长而显著下降(优势比[OR] 0.94/年,p < 0.001)。旋转不稳定是膝关节功能性缺陷的一个关键因素,但仅靠前关节松弛度测量并不能发现[3,16]。以前的研究已经证明了它的临床重要性。高度的枢轴移位与更差的功能预后、减少运动恢复和更高的移植物失败率相关。此外,在支点转移测试中引发的恐惧与更差的oos和Tegner得分相关。值得注意的是,Diermeier等人发现,尽管定量枢轴移位(QPS)测量如胫骨加速和前路平移在解剖ACLR后正常化,但它们与患者报告的两年后的结果无关。这种脱节强调了仅仅依靠生物力学指标来评估恢复的局限性,并强调了需要更全面的评估工具来反映患者的功能感知。我们谨强调两个关键点:(1)在定义儿科KHE时使用年龄和性别特异性标准的重要性;(2)未测量的旋转不稳定性在影响功能恢复方面的潜在意义。解决这些问题可以提高风险分层的准确性,并加深我们对骨骼未成熟人群膝关节生物力学的理解。我们赞扬作者对儿科ACLR研究的宝贵贡献,并希望未来的研究将考虑这些因素,以进一步提高临床相关性和准确性。作者声明无利益冲突。
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引用次数: 0
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 优秀男子足球运动员踝关节扭伤损伤的系统视频分析:损伤机制、情境模式、生物力学和神经认知错误研究——基于140名连续运动员的研究。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70049
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.

Level of Evidence

Level IV.

目的:探讨职业男子足球运动员比赛过程中踝关节扭伤损伤的机制、情境模式、生物力学和神经认知错误。方法:对166例欧洲顶级联赛正式比赛中发生的连续踝关节扭伤进行分析。对140个(84%)受伤视频进行了机制和情境模式分析,并对20名球员进行了生物力学分析。研究了所有非接触性损伤的神经认知错误。三个独立的评论家对每个视频进行评估。踝关节扭伤的流行病学-月份,比赛时间和受伤时的球场位置以及根据扭伤类型的时间损失也被记录下来。结果:进攻损伤发生率(n = 89, 64%)高于防守损伤发生率(n = 51, 36%) (p < 0.05)。讨论:一半的踝关节扭伤发生在直接接触后,3 / 10发生在间接接触后,只有2 / 10没有接触。损伤预防实践在设计方案时应考虑机械干扰、比赛情况和神经认知因素。证据等级:四级。
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引用次数: 0
Accelerated rehabilitation after proximal hamstring avulsion repair is safe and effective: Outcomes from randomized controlled trial of two different rehabilitation regimes 近端腘绳肌腱撕脱伤修复后加速康复安全有效:两种不同康复方案的随机对照试验结果
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70030
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.

Level of Evidence

Level I.

目的:本研究的目的是确定腘绳肌腱近端撕脱伤手术修复后加速(AR)与保守(CR)康复方案的安全性和有效性。方法:这项前瞻性随机对照试验(RCT)将接受近端腘绳肌腱修复的患者分配到支架,部分负重康复方案(CR = 30)或加速,非支架康复方案,允许完全负重(AR = 27)。通过患者报告的结果测量(PROMs)、患者满意度和总体变化评级(GRC)评分,在术前、术后6周、3和6个月对患者进行评估。客观测量,包括单次(SHD),三次(THD)和三次交叉(TCHD)跳跃测试,在6个月时进行评估,以及峰值等速膝关节伸肌和屈肌扭矩。结果:入选的57例患者中,4例被排除在CR组(2例感染,2例再损伤)。CR组57%为男性,平均年龄45.6岁(标准差[SD] = 13.4)。AR组44%为男性,平均年龄50.5岁(SD = 11.8)。因此,在最后6个月的随访中,对53例患者(CR = 26, AR = 27)进行了回顾。组内分析显示,两组患者的所有PROMs均有显著改善(p)。结论:该随机对照试验强调了术后康复途径的安全性和有效性,包括对近端腘绳肌腱修复后患者耐受负重,不使用支具。证据等级:一级。
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引用次数: 0
期刊
Knee Surgery, Sports Traumatology, Arthroscopy
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