Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Kinematic alignment is increasingly adopted in total knee arthroplasty (TKA) as a patient-specific strategy to restore native joint anatomy. However, its reliance on static radiographic measurements may not adequately reflect real-world functional biomechanics. This editorial underscores the importance of complementing static assessment with kinetic principles. This emerging concept, referred to as kinetic alignment, integrates dynamic parameters such as the dynamic hip-knee-ankle angle, knee adduction moment, ground reaction forces, and muscle forces to better characterise in vivo joint loading. These kinetic variables provide critical insight into joint loading during real-life activities and may offer greater predictive value for implant performance and patient satisfaction. Continued emphasis on static alignment targets may overlook key elements of in vivo knee function. Incorporating kinetic data into preoperative planning could support more tailored surgical decisions, helping to mitigate risks related to malalignment, overloading, and suboptimal outcomes. The editorial advocates for expanding the concept of alignment beyond static geometry, including both motion and load, and encouraging the orthopaedic and biomechanical communities to adopt a more functional and individualised perspective in TKA planning.

Purpose

As robotic-assisted unicompartmental knee arthroplasty (RA-UKA) gains popularity, debate continues over its superiority to conventional UKA (C-UKA). Systematic reviews and meta-analyses (SRMAs) have examined this, but concerns exist about spin bias in their abstracts, which can significantly alter perceptions of a treatment's efficacy and safety. This study aims to evaluate the presence of spin bias in the abstracts of SRMAs comparing RA-UKA and C-UKA, and to assess the methodological quality of all included SRMAs using the AMSTAR-2 tool.

Methods

MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched from inception to 7 February 2025 for SRMAs that assessed RA-UKA. Eligible studies assessed at least one outcome of RA-UKA. Included studies were evaluated for the presence of spin in their abstracts using the methods outlined by Yavchitz et al. All full texts were subsequently assessed for methodological quality using the AMSTAR-2 tool.

Results

At least one element of abstract spin was identified in 12 of 16 included studies (75%). The most common category of spin was ‘misleading reporting’ in the form of selective reporting of or overemphasis on efficacy outcomes or analysis favouring the beneficial effect of the experimental intervention, observed in ten studies (63%). With the exception of one study with an overall ‘low’ confidence rating, all remaining studies were of ‘critically low’ A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR-2) confidence. No study characteristics were significantly associated with the presence of abstract spin.

Conclusion

The majority of RA-UKA SRMAs contained spin, most commonly in the form of misleading reporting and interpretation, and were rated ‘critically low’ in quality by AMSTAR-2. In a growing field like RA-UKA where clinical decision-making is influenced by SRMA results and conclusions, clinicians should critically review full texts to minimise the impact these biases may have on their practice.

Level of Evidence

Level IV.

Purpose

To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.

Methods

There were 166 consecutive ankle sprain injuries identified occurring during official matches in players of top European football leagues. One hundred and forty (84%) injury videos were analysed for mechanism and situational pattern, with biomechanics on 20 players. Neurocognitive errors were investigated for all noncontact injuries. Three independent reviewers evaluated each video. Ankle sprain injury epidemiology—month, timing within the match and pitch location at the time of injury and time-loss according to sprain type was also documented.

Results

More injuries occurred in offensive (n = 89, 64%) than defensive (n = 51, 36%) situations (p < 0.001). Seventy (50%) direct contact, 42 (30%) indirect contact and 28 (20%) noncontact injuries were categorised. There were 67 (48%) inversion, 30 (21%) high ankle, 25 (17%) eversion, 6 with combination of high ankle and eversion (4%) and 12 (9%) unsure injuries. Four main situational patterns were described: (i) being tackled (n = 59, 42%); (ii) tackling/pressing (n = 34, 24%); (iii) landing from a jump (n = 16, 11%) and (iv) sliding (n = 7, 5%). Inversion injuries were associated with internal rotation, while high ankle injuries typically involved toe contact with the ground, slight plantar flexion and foot eversion. A neurocognitive error was documented 59% of noncontact injuries. A similar number of injuries occurred during the 1st (n = 71, 51%) and 2nd (n = 69, 49%) half (p > 0.05).

Discussion

Half of ankle sprain injuries occurred after direct contact, 3 in 10 after indirect contact and only 2 in 10 without contact. Injury prevention practices should consider mechanical perturbation, playing situation and neurocognitive factors when designing programmes.

Level of Evidence

Level IV.

Purpose

The purpose of the study was to identify the safety and effectiveness of an accelerated (AR) versus conservative (CR) rehabilitation regimen following surgical repair of proximal hamstring tendon avulsions.

Methods

This prospective randomized controlled trial (RCT) allocated patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR = 30) or an accelerated, unbraced regime, which permitted full weight-bearing as tolerated (AR = 27). Patients were evaluated pre-operatively and at 6 weeks, 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs), patient satisfaction and global rating of change (GRC) scores. Objective measures, including the single (SHD), triple (THD) and triple crossover (TCHD) hop tests, were assessed at 6 months, as was peak isokinetic knee extensor and flexor torque.

Results

Of the 57 patients recruited, 4 were excluded from the CR group (2 infections; 2 re-injuries). The CR group contained 57% males with a mean age of 45.6 (standard deviation [SD] = 13.4). The AR group contained 44% males with a mean age of 50.5 (SD = 11.8). Therefore, 53 patients (CR = 26, AR = 27) were reviewed at the final 6-month follow-up. Within-group analyses showed that both groups significantly improved in all PROMs (p < 0.05). No significant differences were observed between groups for satisfaction, GRC scores, knee extensor torque, knee flexor torque, limb symmetry indices, re-injuries or complications at 6 months.

Conclusions

This RCT has highlighted the safety and efficacy of a post-operative rehabilitation pathway that includes weight-bearing as tolerated, without bracing, in patients after proximal hamstring tendon repair.

Level of Evidence

Level I.

Purpose

Robotic-assisted lateral unicompartmental knee arthroplasty (UKA) remains technically demanding due to the complex biomechanics of the lateral compartment. Image-based (IBRA) and imageless (ILRA) robotic systems have both demonstrated superior accuracy compared to conventional mechanical instrumentation, but have not yet been directly compared in lateral UKA. This study aimed to evaluate their respective accuracy and surgical efficiency.

Methods

This retrospective study included 135 patients who underwent lateral UKA using either IBRA or ILRA systems. Post-operative radiographic outcomes included hip–knee–ankle (HKA) alignment, posterior tibial slope (PTS) and joint line (JL) restoration. Surgical time was assessed as a secondary outcome. Target zones were HKA 180°–185°, PTS 2°–8° and JL ± 2 mm.

Results

IBRA showed higher rates of HKA inliers (94.9% vs. 78.9%, p = 0.011) and JL restoration (76.2% vs. 31.6%, p < 0.001) compared to ILRA. PTS accuracy was similar between groups (p = 0.30). Operative time was significantly shorter with IBRA (61.6 ± 13.5 vs. 81.9 ± 26.1 min, p < 0.001).

Conclusion

IBRA outperformed ILRA in terms of alignment accuracy and surgical duration. These findings support the added value of IBRA systems in lateral UKA.

Level of Evidence

Level IV, retrospective case series study.

Purpose

This study aimed to compare clinical outcomes between open and arthroscopic anterior latissimus dorsi (LD) transfer techniques for treating irreparable subscapularis (SSC) tears.

Methods

We retrospectively reviewed patients who underwent open or arthroscopic anterior LD transfer for irreparable SSC tears between February 2014 and August 2020. Patients were included if they had irreparable SSC tears with Lafosse Grade 4 or higher and Goutallier Grade 3 or higher, but without advanced arthritis (Hamada Grade < 3). Clinical assessments involved pain scores (visual analogue scale, VAS), patient-reported scores (Constant score and subjective shoulder value [SSV]), range of motion (ROM) and internal rotation (IR) strength. Any complications, integrity of the transferred tendon and progression of glenohumeral arthritis were evaluated. Patients were excluded from the study if they lacked follow-up data or were lost to follow-up.

Results

After excluding 28 patients, a total of 86 patients were included (34 arthroscopic and 52 open technique). The mean age was 63.5 ± 7.1 years, and the mean follow-up was 36.2 ± 14.9 months. Significant improvements were observed in pain (VAS from 7.2 ± 1.2 to 1.1 ± 1.5, p < 0.001), Constant score (from 29.1 ± 8.8 to 69.0 ± 12.6, p < 0.001) and SSV (from 24.3 ± 9.6 to 65.5 ± 15.7, p < 0.001). Shoulder ROM and IR strength also improved significantly. Both techniques showed comparable clinical outcomes, although the open technique group demonstrated greater gains in IR strength (p = 0.015). Complications included retear in 8.1% of patients and infection in 7%, with no significant differences between the two techniques.

Conclusion

Both open and arthroscopic anterior LD transfer techniques effectively reduce pain, improve shoulder function and enhance IR strength in patients with irreparable SSC tears, with comparable clinical outcomes and minimal complications.

Level of Evidence

Level III, retrospective comparative case series.

Purpose

Total knee arthroplasty (TKA) following an osteotomy around the knee might be technically more challenging and yield inferior outcome compared with primary TKA. The aim of this study was to investigate the survival, use of revision components and clinical outcome of TKAs postosteotomy compared with primary TKAs.

Methods

Patients from the Dutch Arthroplasty Register who underwent TKA after osteotomy or primary TKA with osteoarthritis as primary diagnosis from 2007 to 2022 and aged ≥18 years at the time of the procedure were selected. Kaplan–Meier and multivariable Cox proportional hazards regression analyses were used to estimate the survival and hazard ratio (HR) for revision. The use of TKA revision components was analysed and used as stratification factor. Patient-reported outcome measures (PROMs) (Numeric Rating Scale for pain at rest and during activity, Knee injury and Osteoarthritis Outcome Score Physical Function Short Form and Oxford knee score) were assessed preoperatively and 6 and 12 months postoperatively.

Results

A significantly higher survival of the TKA until 15-year follow-up was found in primary TKAs, with a median survival of 4.1 years (interquartile range 5.0) compared to TKAs following osteotomy. The proportion of TKA revision components was higher after a previous osteotomy (2.5 vs. 0.5%; p < 0.001). A higher TKA revision risk was found in the primary component group after a previous osteotomy compared to primary TKAs (HR: 1.2, 95% confidence interval: 1.14–1.35). The use of revision components increased the risk for a TKA revision in both groups. No differences in PROMs between groups were found.

Conclusion

This study showed that a previous osteotomy is associated with decreased implant survival in subsequent TKAs, especially if a TKA component with stems and/or augmentations was used.

Level of Evidence

Level II.

Purpose

The purposes of this study were threefold: (1) to evaluate the influence of femoral antecurvature on coronal alignment changes following supracondylar femoral derotational osteotomy (FDO); (2) to investigate the combined effects of derotation angle and osteotomy orientation in relation to femoral antecurvature and (3) to propose a practical strategy for minimising valgus deviation after FDO based sagittal femoral bowing.

Materials and Methods

Sixty-six cadaveric femoral computed tomography (CT) scans were analysed using three-dimensional (3D) simulation. Femurs were classified into three groups based on the degree of antecurvature using the distal diaphyseal angle (DDA). Virtual surgery was simulated at 7 cm above the joint line using two osteotomy methods (shaft-perpendicular and distal femur condylar line [DFC]-parallel) and two derotation angles (10° and 20°). Mechanical lateral distal femoral angle (mLDFA) was measured before and after simulation. Multivariable and stratified regression analyses were performed.

Results

Greater antecurvature led to larger mLDFA decrease, with more pronounced valgus shifts at higher derotation angles. Making DFC-parallel osteotomy significantly reduced valgus change regardless of bowing (β = −0.331, p = 0.005). A significant interaction was found between DDA and derotation angle (β = 0.015, p < 0.001). The combination of DFC-parallel osteotomy with 10° derotation provided the least valgus change (R² = 0.84). The allowable derotation angle to maintain <1° valgus shift decreased as DDA increased.

Conclusion

Femoral antecurvature significantly affects coronal alignment after supracondylar FDO. Although the optimal target angle for derotation remains a surgical choice, understanding the relationship between sagittal bowing and coronal alignment can help tailor patient-specific decisions. To minimise valgus shift after supracondylar FDO, aligning the osteotomy plane parallel to the distal femur condylar line can be effective. This method is simple and practical for standard surgical procedures.

Level of Evidence

Level IV.

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.