Despite undisputed success of orthopaedic procedures, surgical site infections (SSI) such as periprosthetic joint infection (PJI) continues to compromise the outcome and result in major clinical and economic burden. The overall rate of infection is expected to rise in the future resulting in significant associated mortality and morbidity. Traditional concepts have largely attributed the source of PJI to exogenous pathogens. However, recent studies indicate that pathogens from the patient's own microbiome, colonizing the skin, nasal passages, gut microbiota, and even the surgical site play a major role in causing SSIs. Immune cell-mediated ‘Trojan Horse’ pathways have been posited as the mechanism of how bacteria reach and persist at the surgical site. In light of these developing insights, novel therapeutic strategies are under investigation. Some exciting developments include the use of membrane-permeable antibiotics, bacteriophage therapy targeting intracellular pathogens as well as probiotics, prebiotics or faecal microbiota transplantation. Overall, targeting the endogenous microbiome represents a promising frontier for improving the prevention and management of PJI in the era of rapidly increasing total joint arthroplasty procedures.
{"title":"Periprosthetic joint infection: Time to think outside the box","authors":"Min-Cong He, Augusto Ferrini, Javad Parvizi","doi":"10.1002/ksa.70056","DOIUrl":"10.1002/ksa.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Despite undisputed success of orthopaedic procedures, surgical site infections (SSI) such as periprosthetic joint infection (PJI) continues to compromise the outcome and result in major clinical and economic burden. The overall rate of infection is expected to rise in the future resulting in significant associated mortality and morbidity. Traditional concepts have largely attributed the source of PJI to exogenous pathogens. However, recent studies indicate that pathogens from the patient's own microbiome, colonizing the skin, nasal passages, gut microbiota, and even the surgical site play a major role in causing SSIs. Immune cell-mediated ‘Trojan Horse’ pathways have been posited as the mechanism of how bacteria reach and persist at the surgical site. In light of these developing insights, novel therapeutic strategies are under investigation. Some exciting developments include the use of membrane-permeable antibiotics, bacteriophage therapy targeting intracellular pathogens as well as probiotics, prebiotics or faecal microbiota transplantation. Overall, targeting the endogenous microbiome represents a promising frontier for improving the prevention and management of PJI in the era of rapidly increasing total joint arthroplasty procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"14-16"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025204","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}
David F. Hamilton, Karlmeinrad Giesinger, Johannes M. Giesinger
Orthopaedic trials frequently rely on patient-reported outcomes (PROs) to measure primary end points. Thresholds for clinically meaningful score differences are then used to interpret PRO scores and support result interpretation. At the patient level, thresholds are used to determine if an individual patient has experienced a clinically meaningful improvement or deterioration, which evaluates whether or not they are a treatment responder. At the group level, thresholds are applied to interpret mean score differences between groups (e.g., trial arms) or between time points and determine if a treatment effect is meaningful. While patient-level thresholds are frequently available for commonly used PROs, interpretation of between-group-level differences is far less established. In the absence of well-defined group-level difference thresholds for PRO scores, patient-level thresholds are frequently used to interpret the difference between groups, such as trial arms. However, meaningful difference thresholds at the patient level are typically larger than relevant differences at the group level. As such, this leads to an underestimation of treatment effects reported in orthopaedic trials.
{"title":"Treatment effects in orthopaedic trials are underestimated by applying patient-level PRO thresholds for meaningful differences at the group level","authors":"David F. Hamilton, Karlmeinrad Giesinger, Johannes M. Giesinger","doi":"10.1002/ksa.12805","DOIUrl":"10.1002/ksa.12805","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>Orthopaedic trials frequently rely on patient-reported outcomes (PROs) to measure primary end points. Thresholds for clinically meaningful score differences are then used to interpret PRO scores and support result interpretation. At the patient level, thresholds are used to determine if an individual patient has experienced a clinically meaningful improvement or deterioration, which evaluates whether or not they are a treatment responder. At the group level, thresholds are applied to interpret mean score differences between groups (e.g., trial arms) or between time points and determine if a treatment effect is meaningful. While patient-level thresholds are frequently available for commonly used PROs, interpretation of between-group-level differences is far less established. In the absence of well-defined group-level difference thresholds for PRO scores, patient-level thresholds are frequently used to interpret the difference between groups, such as trial arms. However, meaningful difference thresholds at the patient level are typically larger than relevant differences at the group level. As such, this leads to an underestimation of treatment effects reported in orthopaedic trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3739-3743"},"PeriodicalIF":5.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12805","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014267","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}
Romir Patel, Ahmed Mabrouk, Kristian Kley, Christophe Jacquet, Lucas Abdelkafi, Théo Plassard, Matthieu Ollivier
<div> <section> <h3> Purpose</h3> <p>Slope-reducing high tibial osteotomies (SR-HTOs) correct posterior tibial slope (PTS) abnormalities in patients with anterior knee instability, as in cases of anterior cruciate ligament (ACL) deficiency. The SR-HTO techniques, including infra-tubercle and retro-tubercle approaches, provide distinct benefits: retro-tubercle techniques help preserve patellofemoral joint mechanics, while infra-tubercle techniques are effective in mitigating iatrogenic varus. However, there is limited comparative literature available. This study compares the PTS correction precision, frontal plane alignment changes, patellar height (PH) alterations and complications between both SR-HTO techniques.</p> </section> <section> <h3> Methods</h3> <p>A retrospective matched cohort study including 62 patients who underwent SR-HTO with ACL revision surgery between 2020 and 2023 was conducted. Of the 62 patients included, 40 (64.5%) were male and 22 (35.5%) were female. The mean follow-up period was 23.4 ± 7.7 months (range: 12–45 months). The cohort was subdivided into infra-tubercle (<i>n</i> = 29) and retro-tubercle (<i>n</i> = 33) groups. Preoperative and post-operative radiographic assessments included hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), proximal tibial slope (PTS) and PH indices. Functional outcomes were measured using the simple knee value (SKV) score. Complications such as hinge fractures, ACL re-rupture and hardware removal were recorded.</p> </section> <section> <h3> Results</h3> <p>Both techniques achieved similar mean slope correction with post-operative PTS in infra-tubercle: 9.2 ± 1.1° (range: 5–13.8°) versus retro-tubercle: 9.1 ± 1.3° (range: 5–14°). This has been reduced from a preoperative PTS in the infra-tubercle group of 14.2 ± 1.7° (range: 11.5–17°) versus retro-tubercle group: 14 ± 1.8° (range: 11–17.5°). Infra-tubercle osteotomy showed greater precision to pre-operative plans, with a deviation of 1.2 ± 1.1° (range: 0.0–3.6°) versus 1.8 ± 1.3° (range: 0.0–3.4°) in the retro-tubercle group (<i>p</i> = 0.02). Retro-tubercle SR-HTO induced greater coronal changes compared to infra-tubercle SR-HTO, ΔHKA: 1.4 ± 1.6° (range: 0–5°) versus 0.8 ± 0.8° (range: 0–2.8°) (<i>p</i> = 0.05); ΔMPTA: 1.6 ± 1.6° (range: 0–5.7°) versus 0.9 ± 0.7° (range: 0–2.8°) (<i>p</i> = 0.03). There was no intergroup difference in PH changes using either Caton–Deschamps or Schroter indices (<i>p</i> = 0.2). SKV improvement was greater in the infra-tubercle group compared to the retro-tubercle group, 28.7 ± 10.4 (range: 10.0–55.7) versus 20.7 ± 12.3 (range: −9.2 to 48.4) (<i>p</i> = 0.008). Complications were similar, with no
{"title":"Higher precision and preservation of frontal plane alignment in slope-reducing infra-tubercle compared to retro-tubercle high tibial osteotomy","authors":"Romir Patel, Ahmed Mabrouk, Kristian Kley, Christophe Jacquet, Lucas Abdelkafi, Théo Plassard, Matthieu Ollivier","doi":"10.1002/ksa.70028","DOIUrl":"10.1002/ksa.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Slope-reducing high tibial osteotomies (SR-HTOs) correct posterior tibial slope (PTS) abnormalities in patients with anterior knee instability, as in cases of anterior cruciate ligament (ACL) deficiency. The SR-HTO techniques, including infra-tubercle and retro-tubercle approaches, provide distinct benefits: retro-tubercle techniques help preserve patellofemoral joint mechanics, while infra-tubercle techniques are effective in mitigating iatrogenic varus. However, there is limited comparative literature available. This study compares the PTS correction precision, frontal plane alignment changes, patellar height (PH) alterations and complications between both SR-HTO techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective matched cohort study including 62 patients who underwent SR-HTO with ACL revision surgery between 2020 and 2023 was conducted. Of the 62 patients included, 40 (64.5%) were male and 22 (35.5%) were female. The mean follow-up period was 23.4 ± 7.7 months (range: 12–45 months). The cohort was subdivided into infra-tubercle (<i>n</i> = 29) and retro-tubercle (<i>n</i> = 33) groups. Preoperative and post-operative radiographic assessments included hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), proximal tibial slope (PTS) and PH indices. Functional outcomes were measured using the simple knee value (SKV) score. Complications such as hinge fractures, ACL re-rupture and hardware removal were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both techniques achieved similar mean slope correction with post-operative PTS in infra-tubercle: 9.2 ± 1.1° (range: 5–13.8°) versus retro-tubercle: 9.1 ± 1.3° (range: 5–14°). This has been reduced from a preoperative PTS in the infra-tubercle group of 14.2 ± 1.7° (range: 11.5–17°) versus retro-tubercle group: 14 ± 1.8° (range: 11–17.5°). Infra-tubercle osteotomy showed greater precision to pre-operative plans, with a deviation of 1.2 ± 1.1° (range: 0.0–3.6°) versus 1.8 ± 1.3° (range: 0.0–3.4°) in the retro-tubercle group (<i>p</i> = 0.02). Retro-tubercle SR-HTO induced greater coronal changes compared to infra-tubercle SR-HTO, ΔHKA: 1.4 ± 1.6° (range: 0–5°) versus 0.8 ± 0.8° (range: 0–2.8°) (<i>p</i> = 0.05); ΔMPTA: 1.6 ± 1.6° (range: 0–5.7°) versus 0.9 ± 0.7° (range: 0–2.8°) (<i>p</i> = 0.03). There was no intergroup difference in PH changes using either Caton–Deschamps or Schroter indices (<i>p</i> = 0.2). SKV improvement was greater in the infra-tubercle group compared to the retro-tubercle group, 28.7 ± 10.4 (range: 10.0–55.7) versus 20.7 ± 12.3 (range: −9.2 to 48.4) (<i>p</i> = 0.008). Complications were similar, with no","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3975-3984"},"PeriodicalIF":5.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002762","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}
Alp Paksoy, Doruk Akgün, Jonas Pawelke, Larissa Eckl, Arda Mavi, Selda Uzun, Berhan Bayram, Murat Canbakal, Ugur Dilicikik, Murat Erdem, Nihat D. Demirkiran, Baris Kocaoglu
Purpose
Scapular dyskinesis (SD) is present in as many as 67%–100% of athletes with shoulder injuries but it is also highly present in many asymptomatic individuals. The aim of the present study was to identify and analyse SD among asymptomatic professional basketball players.
Methods
A total of 54 European professional basketball players of various professional levels and ages were included in this prospectively recruited cross-sectional study. Participants were assessed using subjective shoulder value (SSV), visual analogue score (VAS) and active range of motion (ROM). Visual combined palpation was used to classify scapular position and movement patterns according to Kibler's method. The clinical examination was completed by evaluating potential coexisting instability (apprehension test, Kim/Jerk and O'Brien tests) and hyperlaxity (Beighton score).
Results
The mean age of all participants (27 female, 27 male; 108 shoulders) was 23.9 ± 6.5 years. 28.7% of the included shoulders had SD (31/108; right: n = 12; left: n = 19), while none of the participants had a diagnosed SD before the present study. Shoulders with SD exhibited a significantly lower SSV (95.0 ± 10.5% vs. 99.0 ± 4.0%; p = 0.004) and reduced abduction (171.8 ± 11.7° vs. 176.6 ± 8.3°, p = 0.013) compared to shoulders without SD. Shoulders with at least one previous injury showed a significantly lower SSV compared to shoulders without previous injury (92.9 ± 12.0% vs. 98.4 ± 5.6%; p = 0.001). Shoulders with pain occurring at least once in last 12 months showed a significantly higher prevalence of SD (6/10 vs. 25/98; p = 0.022) and a lower SSV (90.5 ± 16.4% vs. 98.6 ± 4.4%; p = 0.024) compared to shoulders without pain in last 12 months.
Conclusion
SD was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. SD may represent a sport-specific adaptation, but its association with reduced shoulder function and pain suggests clinical relevance, emphasising the need for early detection and intervention.
Level of Evidence
Level III, cohort study.
目的：肩胛骨运动障碍（SD）存在于多达67%-100%的肩部损伤运动员中，但也高度存在于许多无症状个体中。本研究的目的是识别和分析无症状职业篮球运动员的障碍。方法：对54名不同职业水平和年龄的欧洲职业篮球运动员进行前瞻性横断面研究。参与者使用主观肩值（SSV）、视觉模拟评分（VAS）和活动范围（ROM）进行评估。采用视觉联合触诊法对肩胛骨位置和运动模式进行分类。临床检查通过评估潜在的共存不稳定（理解测试，Kim/Jerk和O'Brien测试）和过度松弛（Beighton评分）来完成。结果：所有参与者的平均年龄（女性27人，男性27人，108肩）为23.9±6.5岁。28.7%的受试者患有SD(31/108；右：n = 12；左：n = 19)，而在本研究之前，没有受试者被诊断患有SD。与没有SD的肩部相比，有SD的肩部SSV明显降低（95.0±10.5% vs. 99.0±4.0%,p = 0.004），外展减少（171.8±11.7°vs. 176.6±8.3°，p = 0.013）。至少有一次既往损伤的肩部与无既往损伤的肩部相比，SSV显著降低（92.9±12.0% vs 98.4±5.6%;p = 0.001）。与过去12个月内无疼痛的肩部相比，在过去12个月内至少发生一次疼痛的肩部显示出更高的SD患病率（6/10比25/98，p = 0.022）和更低的SSV患病率（90.5±16.4%比98.6±4.4%,p = 0.024）。结论：无症状欧洲职业篮球运动员肩关节部位存在28.7%的SD。SD可能代表一种运动特异性适应，但其与肩部功能减退和疼痛的关联提示临床相关性，强调早期发现和干预的必要性。证据等级：III级，队列研究。
{"title":"Scapular dyskinesis is common among asymptomatic European basketball players at the professional level","authors":"Alp Paksoy, Doruk Akgün, Jonas Pawelke, Larissa Eckl, Arda Mavi, Selda Uzun, Berhan Bayram, Murat Canbakal, Ugur Dilicikik, Murat Erdem, Nihat D. Demirkiran, Baris Kocaoglu","doi":"10.1002/ksa.70060","DOIUrl":"10.1002/ksa.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Scapular dyskinesis (SD) is present in as many as 67%–100% of athletes with shoulder injuries but it is also highly present in many asymptomatic individuals. The aim of the present study was to identify and analyse SD among asymptomatic professional basketball players.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 54 European professional basketball players of various professional levels and ages were included in this prospectively recruited cross-sectional study. Participants were assessed using subjective shoulder value (SSV), visual analogue score (VAS) and active range of motion (ROM). Visual combined palpation was used to classify scapular position and movement patterns according to Kibler's method. The clinical examination was completed by evaluating potential coexisting instability (apprehension test, Kim/Jerk and O'Brien tests) and hyperlaxity (Beighton score).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of all participants (27 female, 27 male; 108 shoulders) was 23.9 ± 6.5 years. 28.7% of the included shoulders had SD (31/108; right: <i>n</i> = 12; left: <i>n </i>= 19), while none of the participants had a diagnosed SD before the present study. Shoulders with SD exhibited a significantly lower SSV (95.0 ± 10.5% vs. 99.0 ± 4.0%; <i>p</i> = 0.004) and reduced abduction (171.8 ± 11.7° vs. 176.6 ± 8.3°, <i>p</i> = 0.013) compared to shoulders without SD. Shoulders with at least one previous injury showed a significantly lower SSV compared to shoulders without previous injury (92.9 ± 12.0% vs. 98.4 ± 5.6%; <i>p</i> = 0.001). Shoulders with pain occurring at least once in last 12 months showed a significantly higher prevalence of SD (6/10 vs. 25/98; <i>p</i> = 0.022) and a lower SSV (90.5 ± 16.4% vs. 98.6 ± 4.4%; <i>p</i> = 0.024) compared to shoulders without pain in last 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SD was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. SD may represent a sport-specific adaptation, but its association with reduced shoulder function and pain suggests clinical relevance, emphasising the need for early detection and intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4353-4363"},"PeriodicalIF":5.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002721","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}
Dutaillis B, Collings T, Bellinger P, Timmins RG, Williams MD, Bourne MN. Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2025;33(7):2684–2699. https://doi.org/10.1002/ksa.12694
The conflict-of-interest statement has been updated to declare potential perceived conflicts of interest for authors Matthew Bourne and Morgan Williams:
“Associate Professor Matthew Bourne is supported by an Advance Queensland Industry Research Fellowship in partnership with VALD. Dr. Morgan Williams is an employee of VALD.”
{"title":"Correction to “Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction”","authors":"","doi":"10.1002/ksa.70064","DOIUrl":"10.1002/ksa.70064","url":null,"abstract":"<p>Dutaillis B, Collings T, Bellinger P, Timmins RG, Williams MD, Bourne MN. Time-course changes in lower limb strength, vertical jump metrics and their relationship with patient reported outcomes following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2025;33(7):2684–2699. https://doi.org/10.1002/ksa.12694</p><p>The conflict-of-interest statement has been updated to declare potential perceived conflicts of interest for authors Matthew Bourne and Morgan Williams:</p><p>“Associate Professor Matthew Bourne is supported by an Advance Queensland Industry Research Fellowship in partnership with VALD. Dr. Morgan Williams is an employee of VALD.”</p><p>We apologise for this omission.</p>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":""},"PeriodicalIF":5.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew 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}
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