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Kinematic alignment doesn't tell the whole story: It's time for kinetic alignment 运动学对齐并不能说明问题的全部:是时候进行动力学对齐了。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70010
Umile Giuseppe Longo, Giovanni Spallone, Arianna Carnevale, Letizia Mancini, Emiliano Schena, Rocco Papalia, Michael Tobias Hirschmann

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

在全膝关节置换术(TKA)中,越来越多地采用运动学对齐作为一种患者特有的策略来恢复原有的关节解剖。然而,它对静态放射测量的依赖可能不能充分反映现实世界的功能生物力学。这篇社论强调了用动力学原理补充静态评估的重要性。这个新兴的概念,被称为动态对齐,整合了动态参数,如动态髋关节-膝关节-踝关节角度,膝关节内收力矩,地面反作用力和肌肉力,以更好地表征体内关节负荷。这些动力学变量提供了对现实生活中关节负荷的关键洞察,并可能为植入物性能和患者满意度提供更大的预测价值。继续强调静态对齐目标可能会忽略体内膝关节功能的关键因素。将动力学数据纳入术前计划可以支持更有针对性的手术决策,有助于降低与不对准、超载和次优结果相关的风险。该社论主张将对齐概念扩展到静态几何之外,包括运动和负载,并鼓励骨科和生物力学团体在TKA规划中采用更功能和个性化的观点。
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引用次数: 0
The presence of spin is commonly found in the abstracts of systematic reviews and meta-analysis on robotic-assisted unicompartmental knee arthroplasty 在机器人辅助单室膝关节置换术的系统综述和荟萃分析摘要中,经常发现旋转的存在。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70014
James Abesteh, Hassaan Abdel Khalik, Ayomide M. Ade-Conde, Vickas Khanna, Etienne L. Belzile, Olufemi R. Ayeni

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.

目的:随着机器人辅助单室膝关节置换术(RA-UKA)的普及,关于其优于传统UKA (C-UKA)的争论仍在继续。系统综述和荟萃分析(srma)已经对此进行了研究,但是他们的摘要中存在自旋偏差,这可能会显著改变对治疗有效性和安全性的看法。本研究旨在比较RA-UKA和C-UKA的srma摘要中是否存在自旋偏倚,并使用AMSTAR-2工具评估所有纳入的srma的方法学质量。方法:检索MEDLINE、EMBASE和Cochrane系统评价数据库,检索自成立至2025年2月7日评估RA-UKA的srma。符合条件的研究评估了RA-UKA的至少一个结果。使用Yavchitz等人概述的方法评估纳入的研究在其摘要中是否存在自旋。随后使用AMSTAR-2工具评估所有全文的方法学质量。结果:在16项纳入的研究中,有12项(75%)确定了至少一个抽象自旋元素。在10项研究(63%)中观察到,最常见的虚假报道是“误导性报道”,其形式是选择性报道或过分强调疗效结果或有利于实验干预有益效果的分析。除了一项研究总体置信度为“低”外,其余所有研究的置信度均为“极低”(AMSTAR-2)。没有研究特征与抽象旋转的存在显著相关。结论:大多数RA-UKA srma含有自旋,最常见的形式是误导性的报告和解释,并且被AMSTAR-2评为“极低”质量。在像RA-UKA这样一个不断发展的领域,临床决策受到SRMA结果和结论的影响,临床医生应该严格审查全文,以尽量减少这些偏见对其实践的影响。证据等级:四级。
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引用次数: 0
Letter to the Editor on “Knee hyperextension is not associated with anterior knee laxity subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents” 致编辑的信“膝关节过伸与儿童和青少年前交叉韧带重建后的膝关节前松弛、主观膝关节功能或翻修手术无关”。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70063
Yaoxin Ao, Jiangfeng Lyv, Fangjun Xiao, Junxing Yang
<p>We read with great interest the article by Hansson et al., “Knee hyperextension is not associated with anterior knee laxity, subjective knee function or revision surgery after anterior cruciate ligament reconstruction in children and adolescents,” published in <i>KSSTA</i> [<span>5</span>]. This large-scale cohort study provides important evidence supporting the safe use of hamstring tendon autografts in pediatric ACL reconstruction (ACLR), suggesting that preoperative passive knee hyperextension (KHE, ≤−5°) does not negatively impact surgical outcomes.</p><p>While the findings are valuable, we would like to raise two methodological considerations that may help refine the interpretation of the results and inform future research. First, the use of the adult threshold (≤−5°) to define KHE in a pediatric cohort may not fully account for developmental norms. Passive knee hyperextension is age- and sex-dependent, with values in adolescents—particularly females—often exceeding −5° physiologically [<span>7, 9, 11, 14</span>]. In this study, 53% of patients were categorized as hyperextenders, a proportion consistent with normal variation, raising the possibility that physiological hyperextension was misclassified as pathological. This may have diluted subgroup effects, especially in those with more pronounced hyperextension (e.g., ≤−10°), for whom no outcome gradient was observed. To address this, we suggest incorporating age- and sex-stratified analyses or applying receiver operating characteristic (ROC) curves to determine pediatric-specific thresholds. Such refinements may help clarify whether the observed null association applies across all developmental stages or only within physiological ranges.</p><p>Second, although the authors acknowledge the absence of rotational stability assessment, its clinical relevance merits further discussion. KHE has been shown to increase ACL stress under rotational loads due to compounded valgus and internal rotation torques [<span>6, 10, 13</span>]. A multicenter cohort study by Ueki et al. confirmed that preoperative knee hyperextension and high-grade pivot shift were significant risk factors for residual pivot shift 1 year after surgery [<span>15</span>]. Importantly, growing evidence indicates that rotational laxity (particularly pivot shift) appears inherently higher in pediatric populations compared to adults. Kamada et al. [<span>8</span>] identified patients <20 years as having 6.1 times greater risk of residual pivot shift after ACL reconstruction, while Dejour et al. [<span>1</span>] demonstrated that high-grade pivot shift prevalence decreases significantly with age (odds ratio [OR] 0.94/year, <i>p</i> < 0.001). Rotational instability is a key contributor to functional knee deficits yet is not captured by anterior laxity measurements alone [<span>3, 16</span>]. Previous studies have demonstrated its clinical importance. High-grade pivot shifts have been associated with worse functional outcomes, re
我们饶有兴趣地阅读了汉森等人发表在KSSTA[5]上的文章“膝关节过伸与儿童和青少年前交叉韧带重建后的前膝关节松弛、主观膝关节功能或翻修手术无关”。这项大规模队列研究为支持在儿童ACL重建(ACLR)中安全使用腘绳肌腱自体移植物提供了重要证据,表明术前被动膝关节过伸(KHE,≤- 5°)不会对手术结果产生负面影响。虽然这些发现是有价值的,但我们想提出两个方法上的考虑,这可能有助于完善对结果的解释,并为未来的研究提供信息。首先,在儿童队列中使用成人阈值(≤- 5°)来定义KHE可能不能完全解释发育规范。被动膝关节过伸与年龄和性别有关,青少年(尤其是女性)的生理值通常超过- 5°[7,9,11,14]。在本研究中,53%的患者被归类为过伸症,这一比例与正常变异一致,这增加了生理性过伸症被错误归类为病理性过伸症的可能性。这可能会稀释亚组效应,特别是在那些更明显的过伸(例如≤- 10°)的患者中,他们没有观察到结果梯度。为了解决这个问题,我们建议结合年龄和性别分层分析或应用受试者工作特征(ROC)曲线来确定儿科特异性阈值。这种改进可能有助于澄清所观察到的零关联是否适用于所有发育阶段或仅在生理范围内。其次,尽管作者承认缺乏旋转稳定性评估,但其临床相关性值得进一步讨论。由于外翻和内旋扭矩的复合作用,KHE在旋转载荷下会增加ACL应力[6,10,13]。Ueki等人的一项多中心队列研究证实,术前膝关节过伸和高度枢轴移位是术后1年发生残余枢轴移位的重要危险因素。重要的是,越来越多的证据表明,与成人相比,儿科人群的旋转松弛(特别是枢轴移位)似乎固有地更高。Kamada等人([8])发现,20岁的患者在ACL重建后存在6.1倍的残余枢轴移位风险,而Dejour等人([8])表明,高度枢轴移位患病率随着年龄的增长而显著下降(优势比[OR] 0.94/年,p < 0.001)。旋转不稳定是膝关节功能性缺陷的一个关键因素,但仅靠前关节松弛度测量并不能发现[3,16]。以前的研究已经证明了它的临床重要性。高度的枢轴移位与更差的功能预后、减少运动恢复和更高的移植物失败率相关。此外,在支点转移测试中引发的恐惧与更差的oos和Tegner得分相关。值得注意的是,Diermeier等人发现,尽管定量枢轴移位(QPS)测量如胫骨加速和前路平移在解剖ACLR后正常化,但它们与患者报告的两年后的结果无关。这种脱节强调了仅仅依靠生物力学指标来评估恢复的局限性,并强调了需要更全面的评估工具来反映患者的功能感知。我们谨强调两个关键点:(1)在定义儿科KHE时使用年龄和性别特异性标准的重要性;(2)未测量的旋转不稳定性在影响功能恢复方面的潜在意义。解决这些问题可以提高风险分层的准确性,并加深我们对骨骼未成熟人群膝关节生物力学的理解。我们赞扬作者对儿科ACLR研究的宝贵贡献,并希望未来的研究将考虑这些因素,以进一步提高临床相关性和准确性。作者声明无利益冲突。
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引用次数: 0
Systematic video analysis of ankle sprain injuries in elite male football (soccer): Injury mechanisms, situational patterns, biomechanics and neurocognitive errors study: A study on 140 consecutive players 优秀男子足球运动员踝关节扭伤损伤的系统视频分析:损伤机制、情境模式、生物力学和神经认知错误研究——基于140名连续运动员的研究。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70049
Matthew Buckthorpe, Evert Verhagen, Pieter D'Hooghe, Leonardo Osti, Stefano Di Paolo, Francesco Della Villa

Purpose

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

Methods

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

Results

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

Discussion

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

Level of Evidence

Level IV.

目的:探讨职业男子足球运动员比赛过程中踝关节扭伤损伤的机制、情境模式、生物力学和神经认知错误。方法:对166例欧洲顶级联赛正式比赛中发生的连续踝关节扭伤进行分析。对140个(84%)受伤视频进行了机制和情境模式分析,并对20名球员进行了生物力学分析。研究了所有非接触性损伤的神经认知错误。三个独立的评论家对每个视频进行评估。踝关节扭伤的流行病学-月份,比赛时间和受伤时的球场位置以及根据扭伤类型的时间损失也被记录下来。结果:进攻损伤发生率(n = 89, 64%)高于防守损伤发生率(n = 51, 36%) (p < 0.05)。讨论:一半的踝关节扭伤发生在直接接触后,3 / 10发生在间接接触后,只有2 / 10没有接触。损伤预防实践在设计方案时应考虑机械干扰、比赛情况和神经认知因素。证据等级:四级。
{"title":"Systematic video analysis of ankle sprain injuries in elite male football (soccer): Injury mechanisms, situational patterns, biomechanics and neurocognitive errors study: A study on 140 consecutive players","authors":"Matthew Buckthorpe,&nbsp;Evert Verhagen,&nbsp;Pieter D'Hooghe,&nbsp;Leonardo Osti,&nbsp;Stefano Di Paolo,&nbsp;Francesco Della Villa","doi":"10.1002/ksa.70049","DOIUrl":"10.1002/ksa.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To describe the mechanisms, situational patterns, biomechanics and neurocognitive errors related ankle sprain injuries of professional male football players during match play.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More injuries occurred in offensive (<i>n</i> = 89, 64%) than defensive (<i>n</i> = 51, 36%) situations (<i>p</i> &lt; 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 (<i>n</i> = 59, 42%); (ii) tackling/pressing (<i>n</i> = 34, 24%); (iii) landing from a jump (<i>n</i> = 16, 11%) and (iv) sliding (<i>n</i> = 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 (<i>n</i> = 71, 51%) and 2nd (<i>n</i> = 69, 49%) half (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</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 11","pages":"4035-4049"},"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.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025207","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}
引用次数: 0
Accelerated rehabilitation after proximal hamstring avulsion repair is safe and effective: Outcomes from randomized controlled trial of two different rehabilitation regimes 近端腘绳肌腱撕脱伤修复后加速康复安全有效:两种不同康复方案的随机对照试验结果
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70030
Randeep S. Aujla, Peter Edwards, Steven Cecchi, Shahbaz Malik, Brendan Ricciardo, Peter Annear, Jay Ebert, Peter D'Alessandro

Purpose

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

Methods

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

Results

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

Conclusions

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

Level of Evidence

Level I.

目的:本研究的目的是确定腘绳肌腱近端撕脱伤手术修复后加速(AR)与保守(CR)康复方案的安全性和有效性。方法:这项前瞻性随机对照试验(RCT)将接受近端腘绳肌腱修复的患者分配到支架,部分负重康复方案(CR = 30)或加速,非支架康复方案,允许完全负重(AR = 27)。通过患者报告的结果测量(PROMs)、患者满意度和总体变化评级(GRC)评分,在术前、术后6周、3和6个月对患者进行评估。客观测量,包括单次(SHD),三次(THD)和三次交叉(TCHD)跳跃测试,在6个月时进行评估,以及峰值等速膝关节伸肌和屈肌扭矩。结果:入选的57例患者中,4例被排除在CR组(2例感染,2例再损伤)。CR组57%为男性,平均年龄45.6岁(标准差[SD] = 13.4)。AR组44%为男性,平均年龄50.5岁(SD = 11.8)。因此,在最后6个月的随访中,对53例患者(CR = 26, AR = 27)进行了回顾。组内分析显示,两组患者的所有PROMs均有显著改善(p)。结论:该随机对照试验强调了术后康复途径的安全性和有效性,包括对近端腘绳肌腱修复后患者耐受负重,不使用支具。证据等级:一级。
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引用次数: 0
Image-based robotics enhance precision and efficiency in lateral UKA: A comparative study of 135 UKAs 基于图像的机器人技术提高横向UKA的精度和效率:135个UKA的比较研究。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70012
Clément Favroul, Cécile Batailler, Elsayed Ahmed Abdelatif, Elvire Servien, Sébastien Lustig

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.

目的:机器人辅助的外侧单腔膝关节置换术(UKA)由于外侧腔室复杂的生物力学,在技术上仍然要求很高。与传统机械仪器相比,基于图像的(IBRA)和无图像的(ILRA)机器人系统都显示出更高的精度,但尚未在横向UKA中进行直接比较。本研究旨在评估其准确性和手术效率。方法:本回顾性研究包括135例使用IBRA或ILRA系统进行侧位UKA的患者。术后x线检查结果包括髋关节-膝关节-踝关节(HKA)对齐,胫骨后坡(PTS)和关节线(JL)恢复。手术时间作为次要结果进行评估。靶区为HKA 180°~ 185°,PTS 2°~ 8°,JL±2 mm。结果:IBRA具有较高的HKA嵌套率(94.9% vs. 78.9%, p = 0.011)和JL修复率(76.2% vs. 31.6%, p)。结论:IBRA在对准精度和手术时间方面优于ILRA。这些发现支持IBRA系统在横向UKA中的附加价值。证据等级:四级,回顾性病例系列研究。
{"title":"Image-based robotics enhance precision and efficiency in lateral UKA: A comparative study of 135 UKAs","authors":"Clément Favroul,&nbsp;Cécile Batailler,&nbsp;Elsayed Ahmed Abdelatif,&nbsp;Elvire Servien,&nbsp;Sébastien Lustig","doi":"10.1002/ksa.70012","DOIUrl":"10.1002/ksa.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IBRA showed higher rates of HKA inliers (94.9% vs. 78.9%, <i>p</i> = 0.011) and JL restoration (76.2% vs. 31.6%, <i>p</i> &lt; 0.001) compared to ILRA. PTS accuracy was similar between groups (<i>p</i> = 0.30). Operative time was significantly shorter with IBRA (61.6 ± 13.5 vs. 81.9 ± 26.1 min, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>IBRA outperformed ILRA in terms of alignment accuracy and surgical duration. These findings support the added value of IBRA systems in lateral UKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 2","pages":"553-563"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025163","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}
引用次数: 0
Open versus arthroscopic anterior latissimus dorsi transfer for irreparable subscapularis tear: A multicentre cohort study 开放性与关节镜下背前阔肌转移治疗不可修复的肩胛下肌撕裂:一项多中心队列研究。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70021
Bo Taek Kim, Jean Kany, Luis Alfredo Miranda, Jung Gon Kim, Chaemoon Lim, Seung Jin Kim, Chang Hee Baek

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.

目的:本研究旨在比较开放和关节镜下背前阔肌(LD)转移技术治疗不可修复的肩胛下肌(SSC)撕裂的临床效果。方法:我们回顾性分析了2014年2月至2020年8月期间因不可修复的SSC撕裂而接受开放或关节镜前路LD转移的患者。如果患者有不可修复的SSC撕裂,Lafosse分级为4级或更高,Goutallier分级为3级或更高,但没有晚期关节炎,则纳入患者(Hamada分级结果:在排除28例患者后,共纳入86例患者(34例关节镜和52例开放技术)。平均年龄63.5±7.1岁,平均随访36.2±14.9个月。疼痛(VAS)评分从7.2±1.2降至1.1±1.5,p显著改善。结论:开放和关节镜下前路LD转移技术均可有效减轻SSC不可修复撕裂患者的疼痛,改善肩功能,增强IR强度,临床结果相当,并发症最少。证据级别:III级,回顾性比较病例系列。
{"title":"Open versus arthroscopic anterior latissimus dorsi transfer for irreparable subscapularis tear: A multicentre cohort study","authors":"Bo Taek Kim,&nbsp;Jean Kany,&nbsp;Luis Alfredo Miranda,&nbsp;Jung Gon Kim,&nbsp;Chaemoon Lim,&nbsp;Seung Jin Kim,&nbsp;Chang Hee Baek","doi":"10.1002/ksa.70021","DOIUrl":"10.1002/ksa.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to compare clinical outcomes between open and arthroscopic anterior latissimus dorsi (LD) transfer techniques for treating irreparable subscapularis (SSC) tears.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 &lt; 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>p</i> &lt; 0.001), Constant score (from 29.1 ± 8.8 to 69.0 ± 12.6, <i>p</i> &lt; 0.001) and SSV (from 24.3 ± 9.6 to 65.5 ± 15.7, <i>p</i> &lt; 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 (<i>p</i> = 0.015). Complications included retear in 8.1% of patients and infection in 7%, with no significant differences between the two techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, retrospective comparative case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 11","pages":"3985-3993"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025215","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}
引用次数: 0
Lower survival, higher surgical complexity, but no difference in physical functioning and pain in total knee arthroplasty following osteotomy versus primary total knee arthroplasty without osteotomy: Analysis of 189,932 procedures of the Dutch Arthroplasty Register 截骨后全膝关节置换术与不截骨的首次全膝关节置换术相比,生存率较低,手术复杂性较高,但在身体功能和疼痛方面没有差异:荷兰关节置换术登记的189,932例手术分析。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70013
Maarten R. Huizinga, Astrid J. de Vries, Liza N. van Steenbergen, Reinoud W. Brouwer

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.

目的:与原发性全膝关节置换术相比,膝关节周围截骨术后的全膝关节置换术在技术上更具挑战性,且预后较差。本研究的目的是研究与原发tka相比,tka在截骨后的生存率、翻修组件的使用和临床结果。方法:选择2007年至2022年在荷兰关节成形术登记册中接受截骨后TKA或原发性TKA合并骨关节炎作为主要诊断的患者,手术时年龄≥18岁。Kaplan-Meier和多变量Cox比例风险回归分析用于估计生存率和风险比(HR)。分析了TKA修正分量的使用情况,并将其作为分层因子。术前、术后6个月和12个月评估患者报告的预后指标(PROMs)(休息和活动时疼痛数值评定量表、膝关节损伤和骨关节炎预后评分、身体功能简表和牛津膝关节评分)。结果:与截骨后的TKA相比,原发性TKA的15年随访期生存率显著提高,中位生存率为4.1年(四分位数间差5.0)。结论:本研究表明,先前的截骨术与后续TKA种植体存活率降低有关,特别是如果使用了带茎和/或增强物的TKA假体。证据等级:二级。
{"title":"Lower survival, higher surgical complexity, but no difference in physical functioning and pain in total knee arthroplasty following osteotomy versus primary total knee arthroplasty without osteotomy: Analysis of 189,932 procedures of the Dutch Arthroplasty Register","authors":"Maarten R. Huizinga,&nbsp;Astrid J. de Vries,&nbsp;Liza N. van Steenbergen,&nbsp;Reinoud W. Brouwer","doi":"10.1002/ksa.70013","DOIUrl":"10.1002/ksa.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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%; <i>p</i> &lt; 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</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":"34 2","pages":"564-573"},"PeriodicalIF":5.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025211","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}
引用次数: 0
Reducing unintended valgus deformity after supracondylar femoral derotational osteotomy: Influence of derotation amount and osteotomy method based on femoral antecurvature 减少股骨髁上旋转截骨术后意外外翻畸形:基于股骨前曲率的旋转量和截骨方法的影响。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70041
Jisu Park, Hyunkwon Kim, Seonjin Shin, Tae Woo Kim, Moon Jong Chang, Dai-Soon Kwak

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.

目的:本研究的目的有三个:(1)评估股骨前孔对髁上股骨旋转截骨术(FDO)后冠状位改变的影响;(2)研究旋转角度和截骨方向对股前曲率的综合影响;(3)提出一种实用的策略,以减少FDO为基础的矢状股弓形术后外翻偏差。材料与方法:对66例尸体股骨计算机断层扫描(CT)进行三维模拟分析。根据远端骨干角(DDA)的前弯曲程度将股骨分为三组。采用两种截骨方法(轴垂直和股骨远端髁线[DFC]平行)和两个旋转角度(10°和20°)在关节线以上7cm处模拟虚拟手术。模拟前后测量股骨远端机械外侧角(mLDFA)。进行了多变量和分层回归分析。结果:前温越大,mLDFA下降幅度越大,旋转角度越大,外翻移位更明显。行dfc平行截骨术可显著降低外翻变化(β = -0.331, p = 0.005)。结论:股骨前曲率对髁上FDO术后冠状位排列有显著影响。虽然旋转的最佳目标角度仍然是外科手术的选择,但了解矢状面弯曲和冠状面对齐之间的关系可以帮助量身定制患者具体的决定。为了减少髁上FDO后外翻移位,将截骨平面平行于股骨远端髁突线对齐是有效的。该方法简单实用,适用于标准外科手术。证据等级:四级。
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引用次数: 0
Periprosthetic joint infection: Time to think outside the box 假体周围关节感染:是时候跳出思维定势了。
IF 5 2区 医学 Q1 ORTHOPEDICS Pub Date : 2025-09-09 DOI: 10.1002/ksa.70056
Min-Cong He, Augusto Ferrini, Javad Parvizi

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.

尽管骨科手术取得了无可争议的成功,但手术部位感染(SSI),如假体周围关节感染(PJI)继续损害预后,并导致重大的临床和经济负担。总体感染率预计将在未来上升,导致显著的相关死亡率和发病率。传统观念认为PJI的来源主要是外源性病原体。然而,最近的研究表明,来自患者自身微生物群的病原体,定殖于皮肤、鼻道、肠道微生物群,甚至手术部位,在引起ssi中起主要作用。免疫细胞介导的“特洛伊木马”途径被认为是细菌如何到达并持续存在于手术部位的机制。鉴于这些发展中的见解,新的治疗策略正在研究中。一些令人兴奋的发展包括膜渗透性抗生素的使用,针对细胞内病原体的噬菌体治疗以及益生菌,益生元或粪便微生物群移植。总的来说,在快速增加的全关节置换术时代,针对内源性微生物群代表了改善PJI预防和管理的一个有希望的前沿。
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引用次数: 0
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Knee Surgery, Sports Traumatology, Arthroscopy
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