Matthew Free, Christopher Hewison, James Onggo, Ryan Degen, Alan Getgood
Purpose
To determine the long-term risk of osteoarthritis following combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP).
Methods
A comprehensive search of multiple databases (EMBASE, OVID Medline, PubMed, Cochrane, and Scopus) was independently conducted by two reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on the rates of osteoarthritis following primary, arthroscopic ACLR combined with LEAP and a minimum 5-year follow-up were eligible for inclusion. The primary outcome was the prevalence of moderate to severe radiographic arthritis defined as International Knee Documentation Committee (IKDC) grades C or D, Ahlback grades 1–5, or Kellgren–Lawrence grades 3 or 4. A comparative meta-analysis of ACLR with and without LEAP was also performed.
Results
A total of eight studies were included, comprising 849 patients who underwent ACLR with LEAP, and 164 who underwent isolated ACLR. Cumulative meta-analysis showed a 4% prevalence of moderate to severe osteoarthritis across all studies after ACLR with LEAP. Subgroup analysis demonstrated a prevalence of 3% in the 5-to-10-year follow-up group and 6% in the 10+ year follow-up group. In the three comparative cohort studies, meta-analysis revealed no statistically significant difference in moderate to severe osteoarthritis rates between ACLR with LEAP and ACLR alone.
Conclusion
This study demonstrates that long-term prevalence of moderate to severe osteoarthritis following combined ACLR with LEAP is low, and that the addition of LEAP does not increase the incidence compared to ACLR alone. These findings support the use of LEAP in selected patients, without concern for increased long-term joint degeneration.
{"title":"Low prevalence of moderate to severe osteoarthritis at long-term follow-up after combined anterior cruciate ligament reconstruction and lateral extra-articular procedures: A systematic review and meta-analysis","authors":"Matthew Free, Christopher Hewison, James Onggo, Ryan Degen, Alan Getgood","doi":"10.1002/ksa.70059","DOIUrl":"10.1002/ksa.70059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To determine the long-term risk of osteoarthritis following combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of multiple databases (EMBASE, OVID Medline, PubMed, Cochrane, and Scopus) was independently conducted by two reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on the rates of osteoarthritis following primary, arthroscopic ACLR combined with LEAP and a minimum 5-year follow-up were eligible for inclusion. The primary outcome was the prevalence of moderate to severe radiographic arthritis defined as International Knee Documentation Committee (IKDC) grades C or D, Ahlback grades 1–5, or Kellgren–Lawrence grades 3 or 4. A comparative meta-analysis of ACLR with and without LEAP was also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of eight studies were included, comprising 849 patients who underwent ACLR with LEAP, and 164 who underwent isolated ACLR. Cumulative meta-analysis showed a 4% prevalence of moderate to severe osteoarthritis across all studies after ACLR with LEAP. Subgroup analysis demonstrated a prevalence of 3% in the 5-to-10-year follow-up group and 6% in the 10+ year follow-up group. In the three comparative cohort studies, meta-analysis revealed no statistically significant difference in moderate to severe osteoarthritis rates between ACLR with LEAP and ACLR alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that long-term prevalence of moderate to severe osteoarthritis following combined ACLR with LEAP is low, and that the addition of LEAP does not increase the incidence compared to ACLR alone. These findings support the use of LEAP in selected patients, without concern for increased long-term joint degeneration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, meta-analysis and systematic review.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3805-3816"},"PeriodicalIF":5.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995098","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}
Matthias Krause, Gian Salzmann, Karl-Heinz Frosch, Jannik Frings
<p>We read with great interest the recent article by Schuster et al., “presence of an aberrant anterior tibial artery does not depend on the patient's morphotype” and would like to commend the authors for their important study [<span>4</span>]. Although the aberrant anterior tibial artery (ATA) occurred in only 2.1% of their cases, the authors have highlighted its importance in the clinical setting. Intraoperative injury to the ATA during high tibial osteotomy (HTO) can lead to pseudoaneurysms or even rupture with severe bleeding, challenging current management concepts for patients with an ATA [<span>1, 5</span>]. Schuster et al. present a case of a tibial closed wedge osteotomy and intraoperative ATA injury despite the presence of a posterior soft tissue retractor supposedly to protect the neurovascular structures [<span>4</span>]. The authors conclude that ‘the presence of an ATA may be a contraindication to HTO surgery’ [<span>5</span>].</p><p>Again, while we commend the authors for their very important study, we would like to challenge ATA as a contraindication to HTO surgery and present our concept for the management of affected patients. In a 24-year-old female patient with anterior cruciate ligament (ACL) re-re-rupture, medial meniscus deficiency, concomitant 2nd degree medial femoral chondromalacia, varus knee, and increased posterior tibial slope (PTS), leg axis and PTS correction were highly indicated, but associated with an increased risk of vascular injury during surgery (Figure 1). One of the most important prerequisites for a PTS-neutral HTO is a complete transection of the dorsal cortex [<span>2</span>]. Typically, oscillating saw blades angled 4.5° in each direction are used for HTOs. A 100 mm long saw blade (measured from the centre of rotation) is deflected 4 mm to each side, placing the posterior soft tissues at particular risk during HTO. The use of chisels instead of an oscillating blade, in addition to a sufficiently placed posterior soft tissue retractor may reduce the increased risk of vascular injury. The authors highlight that the distance of the ATA to the posterior cruciate ligament footprint was 2.7 ± 1.6 and 1.0 ± 0.6 mm below the tip of the fibula [<span>3</span>]. While this is very close, the authors were nonetheless able to show that the ATA is typically not directly attached to the bone. Therefore, careful placement of the posterior soft tissue retractor, even under direct visual control with an arthroscope, may adequately protect the posterior soft tissues (Figure 2).</p><p>We believe that tibial osteotomies play an extraordinarily important role especially in young revision ligament insufficiency patients. Focusing on ATA appearance the authors have underscored its meaning in HTO and extensive preoperative planning is needed to adjust tibial osteotomy techniques in these patients. Hence, while ATA, amongst other risk factors, has been considered a potential contraindication to HTO careful placement of the pos
{"title":"The aberrant anterior tibial artery should be respected and can be protected in high tibial osteotomy surgery","authors":"Matthias Krause, Gian Salzmann, Karl-Heinz Frosch, Jannik Frings","doi":"10.1002/ksa.12807","DOIUrl":"10.1002/ksa.12807","url":null,"abstract":"<p>We read with great interest the recent article by Schuster et al., “presence of an aberrant anterior tibial artery does not depend on the patient's morphotype” and would like to commend the authors for their important study [<span>4</span>]. Although the aberrant anterior tibial artery (ATA) occurred in only 2.1% of their cases, the authors have highlighted its importance in the clinical setting. Intraoperative injury to the ATA during high tibial osteotomy (HTO) can lead to pseudoaneurysms or even rupture with severe bleeding, challenging current management concepts for patients with an ATA [<span>1, 5</span>]. Schuster et al. present a case of a tibial closed wedge osteotomy and intraoperative ATA injury despite the presence of a posterior soft tissue retractor supposedly to protect the neurovascular structures [<span>4</span>]. The authors conclude that ‘the presence of an ATA may be a contraindication to HTO surgery’ [<span>5</span>].</p><p>Again, while we commend the authors for their very important study, we would like to challenge ATA as a contraindication to HTO surgery and present our concept for the management of affected patients. In a 24-year-old female patient with anterior cruciate ligament (ACL) re-re-rupture, medial meniscus deficiency, concomitant 2nd degree medial femoral chondromalacia, varus knee, and increased posterior tibial slope (PTS), leg axis and PTS correction were highly indicated, but associated with an increased risk of vascular injury during surgery (Figure 1). One of the most important prerequisites for a PTS-neutral HTO is a complete transection of the dorsal cortex [<span>2</span>]. Typically, oscillating saw blades angled 4.5° in each direction are used for HTOs. A 100 mm long saw blade (measured from the centre of rotation) is deflected 4 mm to each side, placing the posterior soft tissues at particular risk during HTO. The use of chisels instead of an oscillating blade, in addition to a sufficiently placed posterior soft tissue retractor may reduce the increased risk of vascular injury. The authors highlight that the distance of the ATA to the posterior cruciate ligament footprint was 2.7 ± 1.6 and 1.0 ± 0.6 mm below the tip of the fibula [<span>3</span>]. While this is very close, the authors were nonetheless able to show that the ATA is typically not directly attached to the bone. Therefore, careful placement of the posterior soft tissue retractor, even under direct visual control with an arthroscope, may adequately protect the posterior soft tissues (Figure 2).</p><p>We believe that tibial osteotomies play an extraordinarily important role especially in young revision ligament insufficiency patients. Focusing on ATA appearance the authors have underscored its meaning in HTO and extensive preoperative planning is needed to adjust tibial osteotomy techniques in these patients. Hence, while ATA, amongst other risk factors, has been considered a potential contraindication to HTO careful placement of the pos","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4096-4098"},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12807","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986515","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}
Trifon Totlis, Remigio Kort, Michael T. Hirschmann, Jon Karlsson, Nanne Kort
Total knee arthroplasty has significantly enhanced the lives of patients with end-stage knee osteoarthritis by providing pain relief, restoring physical activity, and improving overall quality of life. Historically, dissatisfaction rates have remained around 20%, but recent studies show an improvement, with a decrease of 10%. Advancements in alignment philosophies, assistive technologies, custom implants, and artificial intelligence are rising. However, there is currently only scarce evidence confirming their impact on clinical outcomes and patient satisfaction. A holistic approach that combines multiple strategies may improve outcomes, but the ideal combination is still unclear. Enhanced recovery after surgery, or fast-track surgery, has transformed knee arthroplasty, supported by substantial evidence demonstrating its benefits. This editorial highlights the evolution and future direction of fast-track knee arthroplasty principles, advantages, controversies, and safety. It advocates for a patient-centred approach, optimising care from preoperative stages to full recovery. Despite concerns in terms of the safety of rapid recovery guidelines, evidence suggests that complications might be minimised. Addressing patients' risk factors and providing education is essential during the preoperative phase. Meanwhile, criteria-based early discharge and customised post-discharge environments are vital in the post-operative stage to enhance and expedite patient recovery. Therefore, we should advance patient care by adopting fast-track arthroplasty as the new gold standard in knee arthroplasty, replacing conventional management strategies for all patients.
{"title":"Fast-track knee arthroplasty: Enhancing care quality, recovery, satisfaction and reducing complications—Time for routine use","authors":"Trifon Totlis, Remigio Kort, Michael T. Hirschmann, Jon Karlsson, Nanne Kort","doi":"10.1002/ksa.70039","DOIUrl":"10.1002/ksa.70039","url":null,"abstract":"<p>Total knee arthroplasty has significantly enhanced the lives of patients with end-stage knee osteoarthritis by providing pain relief, restoring physical activity, and improving overall quality of life. Historically, dissatisfaction rates have remained around 20%, but recent studies show an improvement, with a decrease of 10%. Advancements in alignment philosophies, assistive technologies, custom implants, and artificial intelligence are rising. However, there is currently only scarce evidence confirming their impact on clinical outcomes and patient satisfaction. A holistic approach that combines multiple strategies may improve outcomes, but the ideal combination is still unclear. Enhanced recovery after surgery, or fast-track surgery, has transformed knee arthroplasty, supported by substantial evidence demonstrating its benefits. This editorial highlights the evolution and future direction of fast-track knee arthroplasty principles, advantages, controversies, and safety. It advocates for a patient-centred approach, optimising care from preoperative stages to full recovery. Despite concerns in terms of the safety of rapid recovery guidelines, evidence suggests that complications might be minimised. Addressing patients' risk factors and providing education is essential during the preoperative phase. Meanwhile, criteria-based early discharge and customised post-discharge environments are vital in the post-operative stage to enhance and expedite patient recovery. Therefore, we should advance patient care by adopting fast-track arthroplasty as the new gold standard in knee arthroplasty, replacing conventional management strategies for all patients.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"7-13"},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986472","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}
Ville Immonen, Iida Mustakoski, Ilari Kuitunen, Tommi Vasankari, Mari Leppänen
Purpose
Evidence on injury incidence on artificial turf for female footballers is conflicting. Some studies have found no difference in injury rates, while others have suggested increased knee injury risk. The aim of this study was to compare match injury incidences between artificial turf and natural grass in the Finnish female premier division of football.
Methods
All teams in the Finnish female premier division of football were invited to participate in a five-season prospective cohort study, and eight to ten teams took part depending on the season. Injuries were reported by players in weekly questionnaires and categorised by anatomical region, recurrence, contact, severity, and playing position. Individual match exposure was tabled, and incidences per 1000 h of match exposure and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for both surface types.
Results
A total of 517 league matches (401 on artificial turf and 116 on natural grass) were played during the five-season follow-up. In that time, 237 sudden-onset injuries (184 on artificial turf and 53 on natural grass) were reported. The overall injury incidence rate was 19.6/1000 match hours on artificial turf and 19.3/1000 match hours on natural grass (IRR 1.0, 95% CI 0.7–1.4). No statistical difference was observed for risk in knee injuries or other subcategories.
Conclusions
This study found no evidence of a difference in match injury risk between artificial turf and natural grass for elite level female footballers. Research with modern non-filler surfaces will be needed as pitches containing microplastic pollution are banned in the European Union.
Level of Evidence
Level II.
目的：关于女子足球运动员在人造草坪上受伤发生率的证据是相互矛盾的。一些研究没有发现受伤率的差异，而另一些研究则表明膝盖受伤的风险增加。本研究的目的是比较人造草皮和天然草皮在芬兰女子足球超级联赛中的比赛伤害发生率。方法：芬兰女子足球甲级联赛的所有球队都被邀请参加一项为期五个赛季的前瞻性队列研究，根据赛季的不同，有8到10支球队参加。球员在每周的调查问卷中报告受伤情况，并根据解剖区域、复发、接触、严重程度和比赛位置进行分类。将个体火柴暴露列在表格中，计算每1000小时火柴暴露的发生率以及两种表面类型95%置信区间的发病率比（IRRs）。结果：在5个赛季的随访中，共进行了517场联赛（人工草坪401场，天然草坪116场）。其中，人造草坪损伤184例，天然草坪损伤53例。人工草坪的总损伤发生率为19.6/1000比赛小时，天然草坪为19.3/1000比赛小时（IRR 1.0, 95% CI 0.7 ~ 1.4）。在膝关节损伤或其他亚类别中，没有观察到统计学差异。结论：本研究未发现优秀女足运动员人造草皮与天然草皮在比赛损伤风险上存在差异的证据。由于含有微塑料污染的球场在欧盟被禁止，因此需要对现代非填充物表面进行研究。证据等级：二级。
{"title":"No difference in sudden-onset injury risk between artificial turf and natural grass for Finnish female elite-level footballers: A five-season study","authors":"Ville Immonen, Iida Mustakoski, Ilari Kuitunen, Tommi Vasankari, Mari Leppänen","doi":"10.1002/ksa.70018","DOIUrl":"10.1002/ksa.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Evidence on injury incidence on artificial turf for female footballers is conflicting. Some studies have found no difference in injury rates, while others have suggested increased knee injury risk. The aim of this study was to compare match injury incidences between artificial turf and natural grass in the Finnish female premier division of football.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All teams in the Finnish female premier division of football were invited to participate in a five-season prospective cohort study, and eight to ten teams took part depending on the season. Injuries were reported by players in weekly questionnaires and categorised by anatomical region, recurrence, contact, severity, and playing position. Individual match exposure was tabled, and incidences per 1000 h of match exposure and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for both surface types.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 517 league matches (401 on artificial turf and 116 on natural grass) were played during the five-season follow-up. In that time, 237 sudden-onset injuries (184 on artificial turf and 53 on natural grass) were reported. The overall injury incidence rate was 19.6/1000 match hours on artificial turf and 19.3/1000 match hours on natural grass (IRR 1.0, 95% CI 0.7–1.4). No statistical difference was observed for risk in knee injuries or other subcategories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found no evidence of a difference in match injury risk between artificial turf and natural grass for elite level female footballers. Research with modern non-filler surfaces will be needed as pitches containing microplastic pollution are banned in the European Union.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4070-4078"},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986488","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}
Philipp Schuster, Philipp Mayer, Jonathan Cornacchini, Michael Schlumberger, Janina Leiprecht, Philipp Minzlaff, Joerg Richter, Grégoire Micicoi
<p>We are pleased to note the interest in our study [<span>10</span>], the letter to the editor by Krause et al. [<span>7</span>], the case presented and the thoughts behind it. We absolutely agree that osteotomies are an indispensable part of reconstructive surgery, especially in combination with ligamentous reconstructions [<span>2, 8</span>]. However, we would like to clarify that the conclusion of our work was not that an anterior tibial artery (ATA) is an absolute contraindication for an osteotomy. But it can very well constitute a contraindication in the field of elective surgery where one must weigh up what individual benefits are achievable and what individual risks are to be taken [<span>10</span>].</p><p>In particular, the aim of our work was to raise awareness of this relevant anatomical variant among orthopedic surgeons. And the very fact that this discussion has arisen shows that this goal has actually been achieved. The supposedly ‘best’ complication is certainly the one that can be prevented.</p><p>Therefore, we would also like to put our thoughts on the letter to the editor here up for discussion, and present two exemplary cases in order to expand on this.</p><p>Case 1 is a complication case of a friend of the first author added as a co-author here (PM). He is also a sports-orthopedic specialist in a high volume surgical knee centre. The surgery was performed by himself, and is presented with permission. A standard medial open wedge high tibial osteotomy (HTO) was performed in a middle aged and otherwise healthy patient. Although meticulous preparation was performed and the retractor was placed correctly (Figure 1a), a strong arterial bleeding occurred while performing the osteotomy. In this case an aberrant tibial artery was present and was not seen preoperatively (Figure 1b,c). The osteotomy was finished and together with a vascular surgeon a direct posterior explorative approach was performed (Figure 1d). A destroyed aberrant tibial artery was found (accompanied by its destroyed vein) which was running in a kind of bony sulcus directly attached of the tibia, lying underneath or within the periosteum. It would not have been possible to avoid this damage because it was impossible to place the retractor between the bone and the artery. As the artery could not have been reconstructed and with the supposedly knowledge that the ATA is usually of minor relevance only a ligature was performed. Unfortunately, the patient developed exaggerating pain and increasing swelling postoperatively, ending up in a compartment syndrome on Day 3 postop (Figure 1d,e).</p><p>The prevailing view is that a lesion of this vessel is usually without consequences. This is difficult to argue against the aforementioned case. Further, the fact that we found ATAs with a considerably larger lumen than the remaining popliteal artery after the ATA branching also seriously calls this into question [<span>10</span>]. Presumably, in the majority of cases it is actual
{"title":"Response to: “The aberrant anterior tibial artery should be respected and can be protected in high tibial osteotomy (HTO) surgery”","authors":"Philipp Schuster, Philipp Mayer, Jonathan Cornacchini, Michael Schlumberger, Janina Leiprecht, Philipp Minzlaff, Joerg Richter, Grégoire Micicoi","doi":"10.1002/ksa.70005","DOIUrl":"10.1002/ksa.70005","url":null,"abstract":"<p>We are pleased to note the interest in our study [<span>10</span>], the letter to the editor by Krause et al. [<span>7</span>], the case presented and the thoughts behind it. We absolutely agree that osteotomies are an indispensable part of reconstructive surgery, especially in combination with ligamentous reconstructions [<span>2, 8</span>]. However, we would like to clarify that the conclusion of our work was not that an anterior tibial artery (ATA) is an absolute contraindication for an osteotomy. But it can very well constitute a contraindication in the field of elective surgery where one must weigh up what individual benefits are achievable and what individual risks are to be taken [<span>10</span>].</p><p>In particular, the aim of our work was to raise awareness of this relevant anatomical variant among orthopedic surgeons. And the very fact that this discussion has arisen shows that this goal has actually been achieved. The supposedly ‘best’ complication is certainly the one that can be prevented.</p><p>Therefore, we would also like to put our thoughts on the letter to the editor here up for discussion, and present two exemplary cases in order to expand on this.</p><p>Case 1 is a complication case of a friend of the first author added as a co-author here (PM). He is also a sports-orthopedic specialist in a high volume surgical knee centre. The surgery was performed by himself, and is presented with permission. A standard medial open wedge high tibial osteotomy (HTO) was performed in a middle aged and otherwise healthy patient. Although meticulous preparation was performed and the retractor was placed correctly (Figure 1a), a strong arterial bleeding occurred while performing the osteotomy. In this case an aberrant tibial artery was present and was not seen preoperatively (Figure 1b,c). The osteotomy was finished and together with a vascular surgeon a direct posterior explorative approach was performed (Figure 1d). A destroyed aberrant tibial artery was found (accompanied by its destroyed vein) which was running in a kind of bony sulcus directly attached of the tibia, lying underneath or within the periosteum. It would not have been possible to avoid this damage because it was impossible to place the retractor between the bone and the artery. As the artery could not have been reconstructed and with the supposedly knowledge that the ATA is usually of minor relevance only a ligature was performed. Unfortunately, the patient developed exaggerating pain and increasing swelling postoperatively, ending up in a compartment syndrome on Day 3 postop (Figure 1d,e).</p><p>The prevailing view is that a lesion of this vessel is usually without consequences. This is difficult to argue against the aforementioned case. Further, the fact that we found ATAs with a considerably larger lumen than the remaining popliteal artery after the ATA branching also seriously calls this into question [<span>10</span>]. Presumably, in the majority of cases it is actual","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4099-4102"},"PeriodicalIF":5.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986503","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}
Gaby V. ten Noever de Brauw, Lindsey V. Ruderman, Roderick J. M. Vossen, Inger N. Sierevelt, Jelle P. van der List, Gino M. M. J. Kerkhoffs, Hendrik A. Zuiderbaan
Purpose
To evaluate: (i) return to sport (RTS) rates following distal femoral osteotomy (DFO) and lateral unicompartmental knee arthroplasty (UKA), including the likelihood of returning to pre-arthritic or higher levels of performance; (ii) participation in low-, intermediate- and high-impact sports pre- and postoperatively; and (iii) the ability of athletes to resume sporting activities at a professional or competitive level.
Methods
A systematic literature search was conducted in PubMed, Embase and the Cochrane Library up to 17 June 2025. Studies were eligible if they focused on symptomatic lateral unicompartmental knee osteoarthritis as the primary indication and provided data on RTS outcomes. Outcomes of interest included RTS and return to performance (RTP) rates, sport participation categorized by impact level, return to play rates and sports-related patient-reported outcome measures. Random-effects models were utilized to evaluate RTS and RTP outcomes.
Results
Nine non-comparative studies (256 patients) were included. Five on DFO (127 patients; mean age 40.1 ± 13.3 years; mean follow-up 90.4 ± 72.3 months) and four on lateral UKA (125 patients; mean age 58.0 ± 8.8 years; mean follow-up 39.1 ± 16.2 months). Most studies provided Level IV Evidence and moderate quality (Methodological Index for Non-Randomized Studies score: 8–10). Random effect models provided RTS rates of 89.7% (95% confidence interval [CI]: 76.9–95.8) for DFO and 92.4% (95% CI: 81.5–97.1) for lateral UKA. RTP rates were 62.7% (95% CI: 41.1–80.2) and 88.5% (95% CI: 75.1–95.1), respectively. High-impact sport participation decreased after lateral UKA (11.5%–3.4%), while remaining relatively stable following DFO (32.8%–28.0%). Competitive-level athletes achieved a 100% RTS rate following DFO.
Conclusions
Both DFO and lateral UKA are associated with high rates of RTS. However, lateral UKA often leads to a transition from high-impact to lower-impact activities. Clinicians can leverage these findings to optimize patient counselling and align postoperative RTS expectations with functional outcomes.
{"title":"Successful return to sport following distal femoral osteotomy and lateral unicompartmental knee arthroplasty for isolated lateral knee osteoarthritis: A systematic review and meta-analysis","authors":"Gaby V. ten Noever de Brauw, Lindsey V. Ruderman, Roderick J. M. Vossen, Inger N. Sierevelt, Jelle P. van der List, Gino M. M. J. Kerkhoffs, Hendrik A. Zuiderbaan","doi":"10.1002/ksa.70009","DOIUrl":"10.1002/ksa.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate: (i) return to sport (RTS) rates following distal femoral osteotomy (DFO) and lateral unicompartmental knee arthroplasty (UKA), including the likelihood of returning to pre-arthritic or higher levels of performance; (ii) participation in low-, intermediate- and high-impact sports pre- and postoperatively; and (iii) the ability of athletes to resume sporting activities at a professional or competitive level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search was conducted in PubMed, Embase and the Cochrane Library up to 17 June 2025. Studies were eligible if they focused on symptomatic lateral unicompartmental knee osteoarthritis as the primary indication and provided data on RTS outcomes. Outcomes of interest included RTS and return to performance (RTP) rates, sport participation categorized by impact level, return to play rates and sports-related patient-reported outcome measures. Random-effects models were utilized to evaluate RTS and RTP outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine non-comparative studies (256 patients) were included. Five on DFO (127 patients; mean age 40.1 ± 13.3 years; mean follow-up 90.4 ± 72.3 months) and four on lateral UKA (125 patients; mean age 58.0 ± 8.8 years; mean follow-up 39.1 ± 16.2 months). Most studies provided Level IV Evidence and moderate quality (Methodological Index for Non-Randomized Studies score: 8–10). Random effect models provided RTS rates of 89.7% (95% confidence interval [CI]: 76.9–95.8) for DFO and 92.4% (95% CI: 81.5–97.1) for lateral UKA. RTP rates were 62.7% (95% CI: 41.1–80.2) and 88.5% (95% CI: 75.1–95.1), respectively. High-impact sport participation decreased after lateral UKA (11.5%–3.4%), while remaining relatively stable following DFO (32.8%–28.0%). Competitive-level athletes achieved a 100% RTS rate following DFO.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both DFO and lateral UKA are associated with high rates of RTS. However, lateral UKA often leads to a transition from high-impact to lower-impact activities. Clinicians can leverage these findings to optimize patient counselling and align postoperative RTS expectations with functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, systematic review.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"192-202"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986428","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}
Common surgical techniques for managing acute acromioclavicular (AC) injuries include reconstruction of the coracoclavicular (CC) ligaments using tendon grafts or high-strength artificial looping materials, as well as fixation with a hook plate. This study presents a thorough analysis of the outcomes of anatomical reconstruction of both the CC and AC ligaments using a single-strand semitendinosus tendon graft.
Methods
All patients with acute AC joint dislocation who underwent anatomical reconstruction of the CC and AC ligaments between 2017 and 2022 were included in this retrospective analysis. Postoperative evaluation of clinical and functional outcomes was conducted using the Simple Shoulder Test, QuickDASH and Constant–Murley scores. Radiographic assessments were used to determine any loss of reduction.
Results
The study included twelve male patients with a mean age of 37.8 years (range: 23–64). According to the Rockwood classification, three patients had Type III, three had Type IV, and six had Type V dislocations. All patients underwent anatomical reconstruction of the CC and AC ligaments. The most recent follow-up, with a mean duration of 31.8 months (range: 12–64 months), demonstrated excellent postoperative functional outcomes, with scores of 87 (SD = 4.1) for the Simple Shoulder Test, 2.9 (SD = 4.5) for QuickDASH and 89.7 (SD = 3.1) for the Constant-Murley score. Radiographic assessment showed a reduction in CC distance from a preoperative mean of 16.6–8.9 mm at final follow-up. Partial loss of reduction was noted in two patients; however, neither exhibited functional impairment or activity limitations that required surgical revision. Minor complications included wound dehiscence (one patient) and persistent numbness at the incision site (two patients).
Conclusions
Reconstruction of the CC and AC ligaments using an autologous semitendinosus tendon graft for acute AC joint dislocation results in excellent clinical outcomes and satisfactory radiographic findings.
{"title":"Anatomical reconstruction of coracoclavicular and acromioclavicular ligaments using an autologous tendon graft provides excellent outcomes in acute acromioclavicular joint dislocation","authors":"Efstathios Konstantinou, Alexandros Koskiniotis, Nikolaos Stefanou, Antonios Koutalos, Efstratios Athanaselis, Michael Hantes, Socratis Varitimidis","doi":"10.1002/ksa.70051","DOIUrl":"10.1002/ksa.70051","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Common surgical techniques for managing acute acromioclavicular (AC) injuries include reconstruction of the coracoclavicular (CC) ligaments using tendon grafts or high-strength artificial looping materials, as well as fixation with a hook plate. This study presents a thorough analysis of the outcomes of anatomical reconstruction of both the CC and AC ligaments using a single-strand semitendinosus tendon graft.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients with acute AC joint dislocation who underwent anatomical reconstruction of the CC and AC ligaments between 2017 and 2022 were included in this retrospective analysis. Postoperative evaluation of clinical and functional outcomes was conducted using the Simple Shoulder Test, QuickDASH and Constant–Murley scores. Radiographic assessments were used to determine any loss of reduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included twelve male patients with a mean age of 37.8 years (range: 23–64). According to the Rockwood classification, three patients had Type III, three had Type IV, and six had Type V dislocations. All patients underwent anatomical reconstruction of the CC and AC ligaments. The most recent follow-up, with a mean duration of 31.8 months (range: 12–64 months), demonstrated excellent postoperative functional outcomes, with scores of 87 (SD = 4.1) for the Simple Shoulder Test, 2.9 (SD = 4.5) for QuickDASH and 89.7 (SD = 3.1) for the Constant-Murley score. Radiographic assessment showed a reduction in CC distance from a preoperative mean of 16.6–8.9 mm at final follow-up. Partial loss of reduction was noted in two patients; however, neither exhibited functional impairment or activity limitations that required surgical revision. Minor complications included wound dehiscence (one patient) and persistent numbness at the incision site (two patients).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Reconstruction of the CC and AC ligaments using an autologous semitendinosus tendon graft for acute AC joint dislocation results in excellent clinical outcomes and satisfactory radiographic findings.</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 12","pages":"4364-4371"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70051","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986259","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}
Rebecca Hamrin Senorski, Ramana Piussi, Johan Högberg, Roland Thomeé, Kristian Samuelsson, Eric Hamrin Senorski
Purpose
To compare patients treated with rehabilitation alone to those undergoing anterior cruciate ligament (ACL) reconstruction and rehabilitation with regard to recovery of muscle strength, return to knee-strenuous sport and patient-reported outcomes during the first 12 months of treatment.
Methods
This study is a prospective cohort study, based on data from a rehabilitation registry, Project ACL, Gothenburg, Sweden. Included patients were ≥15 years with a primary ACL injury and had completed four follow-ups under first year of treatment. Patients were divided into two groups, depending on treatment choice (1) rehabilitation alone (rehabilitation group), or (2) rehabilitation with ACL reconstruction (ACLR group). Absolute and symmetrical isokinetic muscle strength and patient reported outcomes were assessed using a predefined schedule. Analyses were adjusted for age at time of injury. Subanalyses were performed separately on muscle strength for female and male patients. Clinical relevance was assessed with Cohen's d.
Results
In total, 31 patients in the rehabilitation group and 359 patients in the ACLR group were included. The rehabilitation group reported significantly greater symmetrical strength at every follow-up, except 12-month follow-up for knee flexion, and better quality of life at 8 months. Female patients in the rehabilitation group were stronger in their injured limbs knee extension at 10-week, 4-month and 8-month follow-up as well as for the knee flexion at 10 weeks although no clinically relevant results. The ACLR group demonstrated significantly larger changes in limb symmetry from the 2- to 12-month follow-up, greater future knee self-efficacy at 10 weeks, 4- and 8-month follow-up, and higher level of physical activity compared with the rehabilitation group, both preinjury, and at the 8- and 12-month follow-ups.
Conclusion
Patients treated with rehabilitation alone recovered greater limb symmetry, while patients treated with ACLR had greater change in limb symmetry between 2 and 12 months after treatment. Patients in the ACLR group had higher future knee-related self-efficacy and were active at a higher level of physical activity at 8 and 12 months after treatment.
{"title":"Rehabilitation alone after anterior cruciate ligament injury yields greater limb symmetry but lower knee related self-efficacy without limiting return to preinjury activity level","authors":"Rebecca Hamrin Senorski, Ramana Piussi, Johan Högberg, Roland Thomeé, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1002/ksa.70042","DOIUrl":"10.1002/ksa.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare patients treated with rehabilitation alone to those undergoing anterior cruciate ligament (ACL) reconstruction and rehabilitation with regard to recovery of muscle strength, return to knee-strenuous sport and patient-reported outcomes during the first 12 months of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is a prospective cohort study, based on data from a rehabilitation registry, Project ACL, Gothenburg, Sweden. Included patients were ≥15 years with a primary ACL injury and had completed four follow-ups under first year of treatment. Patients were divided into two groups, depending on treatment choice (1) rehabilitation alone (rehabilitation group), or (2) rehabilitation with ACL reconstruction (ACLR group). Absolute and symmetrical isokinetic muscle strength and patient reported outcomes were assessed using a predefined schedule. Analyses were adjusted for age at time of injury. Subanalyses were performed separately on muscle strength for female and male patients. Clinical relevance was assessed with Cohen's <i>d</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 31 patients in the rehabilitation group and 359 patients in the ACLR group were included. The rehabilitation group reported significantly greater symmetrical strength at every follow-up, except 12-month follow-up for knee flexion, and better quality of life at 8 months. Female patients in the rehabilitation group were stronger in their injured limbs knee extension at 10-week, 4-month and 8-month follow-up as well as for the knee flexion at 10 weeks although no clinically relevant results. The ACLR group demonstrated significantly larger changes in limb symmetry from the 2- to 12-month follow-up, greater future knee self-efficacy at 10 weeks, 4- and 8-month follow-up, and higher level of physical activity compared with the rehabilitation group, both preinjury, and at the 8- and 12-month follow-ups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients treated with rehabilitation alone recovered greater limb symmetry, while patients treated with ACLR had greater change in limb symmetry between 2 and 12 months after treatment. Patients in the ACLR group had higher future knee-related self-efficacy and were active at a higher level of physical activity at 8 and 12 months after treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4435-4445"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986510","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}
Yuta Koshino, Mina Samukawa, Tomoya Ishida, Harukazu Tohyama
Purpose
Managing Achilles tendon (AT) load during dynamic activities is essential for preventing and rehabilitating Achilles tendinopathy. While various exercises have been studied, the impact of verbal instructions on landing mechanics remains unclear. This study aimed to identify instructional methods that effectively reduce AT load during drop vertical jumps (DVJs).
Methods
Twenty-three healthy participants performed DVJs under five instructional conditions: (1) natural: no instruction; (2) posterior-centre of pressure (COP): shifting the COP posteriorly; (3) hip-flexion: increasing hip flexion; (4) knee-flexion: increasing knee flexion; and (5) quiet-landing: minimising landing sound. A three-dimensional motion analysis system recorded peak AT force, loading rate, joint angles, ground reaction force (GRF) and COP position. Data were analysed using the Friedman test, the Wilcoxon signed-rank test with Holm's correction and effect size (ES).
Results
Peak AT force was significantly lower in hip-flexion and posterior-COP compared to natural (p < 0.001, ES = −0.87 and −0.82, respectively). Hip-flexion also showed lower AT force than the knee-flexion and quiet-landing (p < 0.01). Loading rates were lower in hip-flexion (ES = −0.73) and quiet-landing (ES = −0.64) than in natural (p < 0.01) but were higher in posterior-COP than hip-flexion (p = 0.042). Hip-flexion, knee-flexion and quiet-landing increased hip flexion (p < 0.001), while knee-flexion and quiet-landing increased knee flexion (p < 0.001) compared to natural. Posterior-COP resulted in decreased hip, knee and ankle flexion, increased vertical GRF and a more posterior COP position compared to the other conditions (p < 0.05). Vertical GRF was lower in hip-flexion, knee-flexion and quiet-landing than in natural (p < 0.005).
Conclusions
Increasing hip flexion is the most effective strategy for reducing AT force during landing, and may aid in the prevention and rehabilitation of Achilles tendinopathy. Although a posterior COP shift lowers AT force, it increases AT loading rate and GRF, potentially elevating injury risk.
{"title":"Effects of landing instructions on Achilles tendon load: Emphasising hip flexion as the optimal strategy","authors":"Yuta Koshino, Mina Samukawa, Tomoya Ishida, Harukazu Tohyama","doi":"10.1002/ksa.70006","DOIUrl":"10.1002/ksa.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Managing Achilles tendon (AT) load during dynamic activities is essential for preventing and rehabilitating Achilles tendinopathy. While various exercises have been studied, the impact of verbal instructions on landing mechanics remains unclear. This study aimed to identify instructional methods that effectively reduce AT load during drop vertical jumps (DVJs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-three healthy participants performed DVJs under five instructional conditions: (1) natural: no instruction; (2) posterior-centre of pressure (COP): shifting the COP posteriorly; (3) hip-flexion: increasing hip flexion; (4) knee-flexion: increasing knee flexion; and (5) quiet-landing: minimising landing sound. A three-dimensional motion analysis system recorded peak AT force, loading rate, joint angles, ground reaction force (GRF) and COP position. Data were analysed using the Friedman test, the Wilcoxon signed-rank test with Holm's correction and effect size (ES).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Peak AT force was significantly lower in hip-flexion and posterior-COP compared to natural (<i>p</i> < 0.001, ES = −0.87 and −0.82, respectively). Hip-flexion also showed lower AT force than the knee-flexion and quiet-landing (<i>p</i> < 0.01). Loading rates were lower in hip-flexion (ES = −0.73) and quiet-landing (ES = −0.64) than in natural (<i>p</i> < 0.01) but were higher in posterior-COP than hip-flexion (<i>p</i> = 0.042). Hip-flexion, knee-flexion and quiet-landing increased hip flexion (<i>p</i> < 0.001), while knee-flexion and quiet-landing increased knee flexion (<i>p</i> < 0.001) compared to natural. Posterior-COP resulted in decreased hip, knee and ankle flexion, increased vertical GRF and a more posterior COP position compared to the other conditions (<i>p</i> < 0.05). Vertical GRF was lower in hip-flexion, knee-flexion and quiet-landing than in natural (<i>p</i> < 0.005).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Increasing hip flexion is the most effective strategy for reducing AT force during landing, and may aid in the prevention and rehabilitation of Achilles tendinopathy. Although a posterior COP shift lowers AT force, it increases AT loading rate and GRF, potentially elevating injury risk.</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 11","pages":"4026-4034"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986232","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}
Stefano Di Paolo, Matthew Buckthorpe, Luca Pirli Capitani, Luca Ciampone, Alfredo Bravo-Sànchez, Margherita Mendicino, Filippo Tosarelli, Alberto Grassi, Stefano Zaffagnini, Francesco Della Villa
Purpose
Ground reaction forces (GRF) data have been introduced to enhance the understanding of anterior cruciate ligament (ACL) injury pathomechanics. However, translating GRF information into daily clinical practice remains challenging for high-demanding movements such as cutting manoeuvres. This study aims to describe GRF of the 90° change of direction (COD) task, providing robust benchmark data and force-time curve description to enhance their use in clinical practice, particularly ACL injury prevention.
Methods
One thousand and two healthy football (soccer) players (16.3 ± 2.8 years, 264 females) performed three preplanned 90° COD tasks per limb at maximum intensity, with the cutting foot contact performed on an artificial turf floor embedded force platform (AMTI), which collected GRF data (frequency: 1000 Hz). Peak GRF (impact and propulsion phases, and their ratio), ground contact time, rate of force acceptance (RFA), impulse were presented as absolute values and normalised to body weight (BW). Differences in kinetics metrics according to sex, level of play, limb dominance were determined via Student's t-test (p < 0.05). Multiple linear regression analyses determined the association between players' characteristics and kinetics.
Results
Six thousand and eight valid attempts were included. Vertical GRF was 1516 ± 526 N (2.48 ± 0.79 N/BW) and occurred 32.6 ms after initial contact (10.4% of the cut stance). Vertical RFA was 95,200 ± 48,138 N/s (155.6 ± 75.5 N/s/BW). Male players had higher absolute and normalised GRFs and vertical RFA than females (p < 0.001). Elite players had smaller impulse: propulsion ratio than subelite players (p < 0.001). The regression showed limited variance of GRF metrics (adjusted-R2 = 0.047–0.014, p < 0.001).
Conclusion
Normative data and explanation of clinically relevant GRF features were provided. GRF features could enrich the understanding of players' COD movement quality and performances. Sports medical and performance practitioners may include the analysis of GRF during COD as part of athlete screening for participation, injury risk and return to play, potentially offering insights for ACL (re)injury risk mitigation.
Level of Evidence
Level IV, cohort study.
目的：引入地面反作用力（GRF）数据，以提高对前交叉韧带（ACL）损伤病理力学的认识。然而，将GRF信息转化为日常临床实践对于高要求的运动（如切割运动）仍然具有挑战性。本研究旨在描述90°方向改变（COD）任务的GRF，提供稳健的基准数据和力-时间曲线描述，以增强其在临床实践中的应用，特别是ACL损伤预防。方法：1200名健康足球运动员（16.3±2.8岁，女性264名）在人造草坪地板嵌入式力平台（AMTI）上进行3次预先计划的每肢最大强度90°COD任务，并收集GRF数据（频率：1000 Hz）。峰值GRF（冲击和推进阶段及其比率）、与地面接触时间、力接受率（RFA）、冲量以绝对值表示，并与体重（BW）归一化。根据性别、游戏水平、肢体优势，动力学指标的差异通过学生t检验(p)确定。结果：包括六千零八次有效尝试。垂直GRF为1516±526 N(2.48±0.79 N/BW)，发生在初次接触后32.6 ms（切位的10.4%）。垂直RFA是95200±48138 N / s(155.6±75.5 N / s / BW)。男性球员的绝对、标准化GRF和垂直RFA均高于女性（p = 0.047-0.014, p）。结论：为临床相关GRF特征提供了规范数据和解释。GRF特征可以丰富对玩家COD移动质量和表现的理解。运动医学和表演从业者可能会在COD期间对GRF进行分析，作为运动员参与、受伤风险和恢复比赛筛查的一部分，潜在地为降低ACL（再）损伤风险提供见解。证据等级：IV级，队列研究。
{"title":"Boosting the clinical use of ground reaction forces in anterior cruciate ligament injury prevention: The ‘CUTtheACL’ study","authors":"Stefano Di Paolo, Matthew Buckthorpe, Luca Pirli Capitani, Luca Ciampone, Alfredo Bravo-Sànchez, Margherita Mendicino, Filippo Tosarelli, Alberto Grassi, Stefano Zaffagnini, Francesco Della Villa","doi":"10.1002/ksa.70017","DOIUrl":"10.1002/ksa.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Ground reaction forces (GRF) data have been introduced to enhance the understanding of anterior cruciate ligament (ACL) injury pathomechanics. However, translating GRF information into daily clinical practice remains challenging for high-demanding movements such as cutting manoeuvres. This study aims to describe GRF of the 90° change of direction (COD) task, providing robust benchmark data and force-time curve description to enhance their use in clinical practice, particularly ACL injury prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One thousand and two healthy football (soccer) players (16.3 ± 2.8 years, 264 females) performed three preplanned 90° COD tasks per limb at maximum intensity, with the cutting foot contact performed on an artificial turf floor embedded force platform (AMTI), which collected GRF data (frequency: 1000 Hz). Peak GRF (impact and propulsion phases, and their ratio), ground contact time, rate of force acceptance (RFA), impulse were presented as absolute values and normalised to body weight (BW). Differences in kinetics metrics according to sex, level of play, limb dominance were determined via Student's <i>t</i>-test (<i>p</i> < 0.05). Multiple linear regression analyses determined the association between players' characteristics and kinetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six thousand and eight valid attempts were included. Vertical GRF was 1516 ± 526 N (2.48 ± 0.79 N/BW) and occurred 32.6 ms after initial contact (10.4% of the cut stance). Vertical RFA was 95,200 ± 48,138 N/s (155.6 ± 75.5 N/s/BW). Male players had higher absolute and normalised GRFs and vertical RFA than females (<i>p</i> < 0.001). Elite players had smaller impulse: propulsion ratio than subelite players (<i>p</i> < 0.001). The regression showed limited variance of GRF metrics (adjusted-<i>R</i><sup>2</sup> = 0.047–0.014, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Normative data and explanation of clinically relevant GRF features were provided. GRF features could enrich the understanding of players' COD movement quality and performances. Sports medical and performance practitioners may include the analysis of GRF during COD as part of athlete screening for participation, injury risk and return to play, potentially offering insights for ACL (re)injury risk mitigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cohort study.</p>\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4059-4069"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986240","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}
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