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}
Bruno Violante, Riccardo Compagnoni, Artur Kroell, Michael Engl, Octav Russu, George Mihai Avram, Sarper Gursu, Elvire Servien, Francesco Puglia, Pietro Simone Randelli, Reha Tandogan, Michael T. Hirschmann, European Knee Associates (EKA)
<div> <section> <h3> Purpose</h3> <p>Extensor mechanism (EM) ruptures after total knee arthroplasty (TKA) are rare but lead to substantial functional impairment and morbidity. Treatment remains challenging due to the diversity of surgical techniques and the limited number of comparative studies. The European Knee Associates (EKA) group conducted a systematic review to evaluate available treatments for EM rupture following primary TKA, assess outcomes such as extensor lag, patient-reported outcome measures (PROMs) and walking status, and to identify prevailing trends and complication rates.</p> </section> <section> <h3> Methods</h3> <p>A systematic review was registered in PROSPERO (CRD42022341591) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis and Cochrane guidelines. PubMed/Medline and Scopus databases were searched for clinical studies published between 2014 and 2024 reporting outcomes after EM repair in TKA patients. Inclusion criteria encompassed retrospective and prospective studies in English or German. Studies on EM ruptures due to infection, revision TKA, or patellectomy were excluded. Data extraction included demographics, time-to-reconstruction, repair type, extensor lag, PROMs and walking status. Due to heterogeneity, a meta-analysis was not feasible, and results were descriptively reported.</p> </section> <section> <h3> Results</h3> <p>A total of 32 studies comprising 893 EM rupture cases were included. The mean patient age was 66.8 years (standard deviation [SD] ± 7.4), with a mean body mass index of 34.5 (SD ± 6.2). Patellar tendon ruptures (39%) were the most frequent. Nine different surgical techniques were identified, including allografts, synthetic meshes, autografts and direct repairs. The overall complication rate was 16%, with autografts having the highest complication rate (38%). All repair techniques led to improvements in extensor lag and post-operative Knee Society Scores exceeding the minimal clinically important difference thresholds. However, walking status and PROMs were inconsistently reported.</p> </section> <section> <h3> Conclusions</h3> <p>EM failure after TKA remains a complex complication with variable outcomes depending on treatment strategy. Standardization of surgical techniques and outcome measures, along with multicenter collaborations, is crucial to improve future patient care as the number of TKA procedures continues to rise.</p> </section> <section> <h3> Level of Evidence</h3>
{"title":"Various surgical techniques result in different outcomes for full extensor mechanism ruptures following total knee replacement: A systematic review by the European Knee Associates (ESSKA-EKA)","authors":"Bruno Violante, Riccardo Compagnoni, Artur Kroell, Michael Engl, Octav Russu, George Mihai Avram, Sarper Gursu, Elvire Servien, Francesco Puglia, Pietro Simone Randelli, Reha Tandogan, Michael T. Hirschmann, European Knee Associates (EKA)","doi":"10.1002/ksa.70015","DOIUrl":"10.1002/ksa.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Extensor mechanism (EM) ruptures after total knee arthroplasty (TKA) are rare but lead to substantial functional impairment and morbidity. Treatment remains challenging due to the diversity of surgical techniques and the limited number of comparative studies. The European Knee Associates (EKA) group conducted a systematic review to evaluate available treatments for EM rupture following primary TKA, assess outcomes such as extensor lag, patient-reported outcome measures (PROMs) and walking status, and to identify prevailing trends and complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was registered in PROSPERO (CRD42022341591) and conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis and Cochrane guidelines. PubMed/Medline and Scopus databases were searched for clinical studies published between 2014 and 2024 reporting outcomes after EM repair in TKA patients. Inclusion criteria encompassed retrospective and prospective studies in English or German. Studies on EM ruptures due to infection, revision TKA, or patellectomy were excluded. Data extraction included demographics, time-to-reconstruction, repair type, extensor lag, PROMs and walking status. Due to heterogeneity, a meta-analysis was not feasible, and results were descriptively reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32 studies comprising 893 EM rupture cases were included. The mean patient age was 66.8 years (standard deviation [SD] ± 7.4), with a mean body mass index of 34.5 (SD ± 6.2). Patellar tendon ruptures (39%) were the most frequent. Nine different surgical techniques were identified, including allografts, synthetic meshes, autografts and direct repairs. The overall complication rate was 16%, with autografts having the highest complication rate (38%). All repair techniques led to improvements in extensor lag and post-operative Knee Society Scores exceeding the minimal clinically important difference thresholds. However, walking status and PROMs were inconsistently reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>EM failure after TKA remains a complex complication with variable outcomes depending on treatment strategy. Standardization of surgical techniques and outcome measures, along with multicenter collaborations, is crucial to improve future patient care as the number of TKA procedures continues to rise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"586-595"},"PeriodicalIF":5.0,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikolai Ramadanov, Maximilian Voss, Jonathan Lettner, Robert Hable, Robert Prill, Roland Becker, Vanessa Twardy, Ingo J. Banke
Purpose
To date, no meta-analysis has systematically compared postless and post-assisted hip arthroscopy (HAS). This underscores the need for a structured synthesis of current evidence. To address this gap, a multilevel meta-analysis was conducted to systematically compare outcomes and complication rates of HAS performed with and without a perineal post.
Methods
A comprehensive search of PubMed, Embase, Epistemonikos, and CENTRAL was completed on 20 July 2025. A frequentist multilevel meta-analysis with random-effects modelling and Hartung–Knapp adjustment was conducted. Outcomes were summarised as pooled mean differences and proportions with 95% confidence intervals.
Results
Eight primary studies including 1880 hips were analysed. The pooled nerve injury rate was higher in the traditional HAS group (7%; 95% confidence interval [CI]: 0.01–0.36) compared to the postless group (3%; 95% CI: 0.00–0.20), with a significant subgroup difference (F = 10.81; p < 0.01). Mean traction time was longer in the traditional group (58.5 min) than in the postless group (52.2 min), also with a significant difference (F = 32.96; df = 1.50; p < 0.01). Other subgroup comparisons showed no significant differences.
Conclusion
While trends suggest potential advantages of postless hip arthroscopy in certain outcomes, the evidence remains limited by study heterogeneity and design. These results support its growing clinical use, though further prospective comparative studies are needed to strengthen the evidence base.
{"title":"Postless versus traditional hip arthroscopy: A multilevel meta-analysis of current evidence on efficacy and safety","authors":"Nikolai Ramadanov, Maximilian Voss, Jonathan Lettner, Robert Hable, Robert Prill, Roland Becker, Vanessa Twardy, Ingo J. Banke","doi":"10.1002/ksa.70048","DOIUrl":"10.1002/ksa.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To date, no meta-analysis has systematically compared postless and post-assisted hip arthroscopy (HAS). This underscores the need for a structured synthesis of current evidence. To address this gap, a multilevel meta-analysis was conducted to systematically compare outcomes and complication rates of HAS performed with and without a perineal post.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of PubMed, Embase, Epistemonikos, and CENTRAL was completed on 20 July 2025. A frequentist multilevel meta-analysis with random-effects modelling and Hartung–Knapp adjustment was conducted. Outcomes were summarised as pooled mean differences and proportions with 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight primary studies including 1880 hips were analysed. The pooled nerve injury rate was higher in the traditional HAS group (7%; 95% confidence interval [CI]: 0.01–0.36) compared to the postless group (3%; 95% CI: 0.00–0.20), with a significant subgroup difference (<i>F</i> = 10.81; <i>p</i> < 0.01). Mean traction time was longer in the traditional group (58.5 min) than in the postless group (52.2 min), also with a significant difference (<i>F</i> = 32.96; <i>df</i> = 1.50; <i>p</i> < 0.01). Other subgroup comparisons showed no significant differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While trends suggest potential advantages of postless hip arthroscopy in certain outcomes, the evidence remains limited by study heterogeneity and design. These results support its growing clinical use, though further prospective comparative studies are needed to strengthen the evidence base.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, systematic review and meta-analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 12","pages":"4372-4384"},"PeriodicalIF":5.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986475","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}
<div> <section> <h3> Purpose</h3> <p>Understanding the trajectory of postoperative patient-reported outcomes after hip preservation surgery is essential. This study aims to analyse patient-reported outcome trajectories up to 2 years post-surgery using the UK's national hip preservation registry and to examine the influence of potential confounders.</p> </section> <section> <h3> Methods</h3> <p>Patients who underwent hip arthroscopy or periacetabular osteotomy with preoperative International Hip Outcome Tool-12 (iHOT-12) scores and at least two follow-up measurements at 6 months, 1 year, or 2 years were included from the UK Non-Arthroplasty Hip Registry. iHOT-12 score trajectories were analysed, and Latent Growth Curve Modelling was used to identify predictors of these trajectories.</p> </section> <section> <h3> Results</h3> <p>Overall 9845 patients were included in this study. 7081 patients underwent a hip arthroscopy, and 1327 patients underwent a periacetabular osteotomy. For hip arthroscopy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year. However, there was a decrease in the minimal clinically important difference from 1 to 2 year. For periacetabular osteotomy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year, and from 1 to 2 years. Latent Growth Curve Modelling showed that body mass index (BMI) and sex had a significant impact on pre-operative iHOT-12 scores, while age and sex significantly influenced the recovery slope.</p> </section> <section> <h3> Conclusions</h3> <p>Patients who underwent hip preservation surgery exhibited significant improvement in iHOT-12 scores, surpassing the minimal clinically important difference at 6 months postoperatively. This improvement plateaued by 2 years, with a slight decline in scores between 1 and 2 years following hip arthroscopy, though the decrease remained within the clinically meaningful range. BMI, age and sex influenced score trajectories, highlighting the importance of setting patient expectations pre-operatively.</p> </section> <section> <h3> Trial Registration</h3> <p>The UK's Non-Arthroplasty Hip Registry https://www.nahr.co.uk/.</p> </section> <section> <h3> Level of Evidence</h3> <p>Level III.</p> </section>
{"title":"The trajectory of patient-reported outcomes after hip preservation surgery: A National Registry Study","authors":"Junya Yoshitani, Seper Ekhtiari, Ajay Malviya, Vikas Khanduja","doi":"10.1002/ksa.12771","DOIUrl":"10.1002/ksa.12771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Understanding the trajectory of postoperative patient-reported outcomes after hip preservation surgery is essential. This study aims to analyse patient-reported outcome trajectories up to 2 years post-surgery using the UK's national hip preservation registry and to examine the influence of potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent hip arthroscopy or periacetabular osteotomy with preoperative International Hip Outcome Tool-12 (iHOT-12) scores and at least two follow-up measurements at 6 months, 1 year, or 2 years were included from the UK Non-Arthroplasty Hip Registry. iHOT-12 score trajectories were analysed, and Latent Growth Curve Modelling was used to identify predictors of these trajectories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall 9845 patients were included in this study. 7081 patients underwent a hip arthroscopy, and 1327 patients underwent a periacetabular osteotomy. For hip arthroscopy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year. However, there was a decrease in the minimal clinically important difference from 1 to 2 year. For periacetabular osteotomy, there were significant improvements in the iHOT-12 scores from baseline to 6 months, but no significant change from 6 months to 1 year, and from 1 to 2 years. Latent Growth Curve Modelling showed that body mass index (BMI) and sex had a significant impact on pre-operative iHOT-12 scores, while age and sex significantly influenced the recovery slope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients who underwent hip preservation surgery exhibited significant improvement in iHOT-12 scores, surpassing the minimal clinically important difference at 6 months postoperatively. This improvement plateaued by 2 years, with a slight decline in scores between 1 and 2 years following hip arthroscopy, though the decrease remained within the clinically meaningful range. BMI, age and sex influenced score trajectories, highlighting the importance of setting patient expectations pre-operatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>The UK's Non-Arthroplasty Hip Registry https://www.nahr.co.uk/.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4002-4011"},"PeriodicalIF":5.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877922","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}
Werner Krutsch, Dominik Szymski, Johannes Rüther, Volker Musahl, Alberto Grassi, Thomas Tischer, Markus Gesslein
The management of anterior cruciate ligament (ACL) ruptures is carried out differently in prevention, treatment and rehabilitation for athletes than for non-athletes. However, different approaches to managing ACL ruptures are also discussed in different sports. This narrative review includes first time the current situation of ACL management in football by experiences from the practical routine as well as from scientific reports. No other sport shows such high number of literature reports and sufficient scientific evidence in the management of ACL ruptures like football and this article provides a football specific overview in prevention, treatment and return to sports strategies. These scientific reports underline the surgical treatment of ACL ruptures in football player and show a high sustainability and return to sports rate. However, reports from football show that despite good knowledge, the implementation of sustainable prevention and rehabilitation is difficult and needs improvement.
Clinical Trial Registration
Considering that this manuscript is a narrative review, no clinical trial registration is neccesary.
{"title":"Sport-specific differences in ACL injury, treatment and return to sports: Football","authors":"Werner Krutsch, Dominik Szymski, Johannes Rüther, Volker Musahl, Alberto Grassi, Thomas Tischer, Markus Gesslein","doi":"10.1002/ksa.12803","DOIUrl":"10.1002/ksa.12803","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 <p>The management of anterior cruciate ligament (ACL) ruptures is carried out differently in prevention, treatment and rehabilitation for athletes than for non-athletes. However, different approaches to managing ACL ruptures are also discussed in different sports. This narrative review includes first time the current situation of ACL management in football by experiences from the practical routine as well as from scientific reports. No other sport shows such high number of literature reports and sufficient scientific evidence in the management of ACL ruptures like football and this article provides a football specific overview in prevention, treatment and return to sports strategies. These scientific reports underline the surgical treatment of ACL ruptures in football player and show a high sustainability and return to sports rate. However, reports from football show that despite good knowledge, the implementation of sustainable prevention and rehabilitation is difficult and needs improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Registration</h3>\u0000 \u0000 <p>Considering that this manuscript is a narrative review, no clinical trial registration is neccesary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"4050-4058"},"PeriodicalIF":5.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857399","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}
Felix C. Oettl, Ali B. Malayeri, Pascal R. Furrer, Karl Wieser, Philipp Fürnstahl, Samy Bouaicha
Purpose
The differentiation between traumatic and degenerative rotator cuff tears (RCTs remains a diagnostic challenge with significant implications for treatment planning. While magnetic resonance imaging (MRI) is standard practice, traditional radiological interpretation has shown limited reliability in distinguishing these etiologies. This study evaluates the potential of artificial intelligence (AI) models, specifically a multimodal vision transformer (ViT), to differentiate between traumatic and degenerative RCT.
Methods
In this retrospective, single-centre study, 99 shoulder MRIs were analysed from patients who underwent surgery at a specialised university shoulder unit between 2016 and 2019. The cohort was divided into training (n = 79) and validation (n = 20) sets. The traumatic group required a documented relevant trauma (excluding simple lifting injuries), previously asymptomatic shoulder and MRI within 3 months posttrauma. The degenerative group was of similar age and injured tendon, with patients presenting with at least 1 year of constant shoulder pain prior to imaging and no trauma history. The ViT was subsequently combined with demographic data to finalise in a multimodal ViT. Saliency maps are utilised as an explainability tool.
Results
The multimodal ViT model achieved an accuracy of 0.75 ± 0.08 with a recall of 0.8 ± 0.08, specificity of 0.71 ± 0.11 and a F1 score of 0.76 ± 0.1. The model maintained consistent performance across different patient subsets, demonstrating robust generalisation. Saliency maps do not show a consistent focus on the rotator cuff.
Conclusion
AI shows potential in supporting the challenging differentiation between traumatic and degenerative RCT on MRI. The achieved accuracy of 75% is particularly significant given the similar groups which presented a challenging diagnostic scenario. Saliency maps were utilised to ensure explainability, the given lack of consistent focus on rotator cuff tendons hints towards underappreciated aspects in the differentiation.
{"title":"Development of a multimodal vision transformer model for predicting traumatic versus degenerative rotator cuff tears on magnetic resonance imaging: A single-centre retrospective study","authors":"Felix C. Oettl, Ali B. Malayeri, Pascal R. Furrer, Karl Wieser, Philipp Fürnstahl, Samy Bouaicha","doi":"10.1002/ksa.70000","DOIUrl":"10.1002/ksa.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The differentiation between traumatic and degenerative rotator cuff tears (RCTs remains a diagnostic challenge with significant implications for treatment planning. While magnetic resonance imaging (MRI) is standard practice, traditional radiological interpretation has shown limited reliability in distinguishing these etiologies. This study evaluates the potential of artificial intelligence (AI) models, specifically a multimodal vision transformer (ViT), to differentiate between traumatic and degenerative RCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective, single-centre study, 99 shoulder MRIs were analysed from patients who underwent surgery at a specialised university shoulder unit between 2016 and 2019. The cohort was divided into training (<i>n</i> = 79) and validation (<i>n</i> = 20) sets. The traumatic group required a documented relevant trauma (excluding simple lifting injuries), previously asymptomatic shoulder and MRI within 3 months posttrauma. The degenerative group was of similar age and injured tendon, with patients presenting with at least 1 year of constant shoulder pain prior to imaging and no trauma history. The ViT was subsequently combined with demographic data to finalise in a multimodal ViT. Saliency maps are utilised as an explainability tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The multimodal ViT model achieved an accuracy of 0.75 ± 0.08 with a recall of 0.8 ± 0.08, specificity of 0.71 ± 0.11 and a F1 score of 0.76 ± 0.1. The model maintained consistent performance across different patient subsets, demonstrating robust generalisation. Saliency maps do not show a consistent focus on the rotator cuff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI shows potential in supporting the challenging differentiation between traumatic and degenerative RCT on MRI. The achieved accuracy of 75% is particularly significant given the similar groups which presented a challenging diagnostic scenario. Saliency maps were utilised to ensure explainability, the given lack of consistent focus on rotator cuff tendons hints towards underappreciated aspects in the differentiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3994-4001"},"PeriodicalIF":5.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839912","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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