Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose

Robot-assisted total knee arthroplasty (RATKA) aims to improve surgical precision and outcomes. This study compared clinical and radiological outcomes between RATKA and conventional total knee arthroplasty (CTKA).

Methods

A systematic review was conducted in accordance with PRISMA guidelines, including prospective studies (Level I/II evidence) from MEDLINE, Embase, Web of Science, and the Cochrane Library, up to 20 May 2025. Clinical outcomes included knee function, pain and quality-of-life scores, assessed at a minimum of one year postoperatively. Complications rates were also collected. Radiological outcomes included assessment of coronal and sagittal limb alignment, joint line restoration, and three-dimensional implant positioning. Risk of bias was assessed using validated tools.

Results

Of 11,916 screened citations, 20 studies (11 RCTs, 9 prospective cohort studies) involving 2421 patients (1268 RATKA; 1153 CTKA) were included, with follow-up ranging from 3 months to 2 years and seven different robotic systems evaluated. Meta-analysis showed that RATKA was associated with improved range of motion (mean difference 5.03°; 95%CI [1.78–8.28]; p = 0.004) and WOMAC scores (total, function and pain). No significant differences were found for OKS, KOOS, FJS or EQ-5D. Complication rates were significantly lower in the RATKA group (11.5%) compared to CTKA (16.7%; OR = 0.62; 95%CI [0.45–0.86]; p = 0.004). Radiographically, RATKA significantly improved coronal alignment, joint line restoration, and sagittal tibial positioning, with fewer outliers, compared to conventional TKA. No significant differences were observed in sagittal femoral alignment, posterior tibial slope, or femoral component rotation. Risk of bias was mostly moderate to low, though concerns remained regarding non-blinded assessments, missing data, and potential industry-related conflicts of interest.

Conclusions

RATKA demonstrated higher precision, reduced radiological outliers and complications compared to CTKA. While clinical scores slightly favoured RATKA, differences were not clinically meaningful. Long-term studies are needed to determine potential benefits in subgroups like severe deformities.

Level of Evidence

Level II.

Orthopaedic trials frequently rely on patient-reported outcomes (PROs) to measure primary end points. Thresholds for clinically meaningful score differences are then used to interpret PRO scores and support result interpretation. At the patient level, thresholds are used to determine if an individual patient has experienced a clinically meaningful improvement or deterioration, which evaluates whether or not they are a treatment responder. At the group level, thresholds are applied to interpret mean score differences between groups (e.g., trial arms) or between time points and determine if a treatment effect is meaningful. While patient-level thresholds are frequently available for commonly used PROs, interpretation of between-group-level differences is far less established. In the absence of well-defined group-level difference thresholds for PRO scores, patient-level thresholds are frequently used to interpret the difference between groups, such as trial arms. However, meaningful difference thresholds at the patient level are typically larger than relevant differences at the group level. As such, this leads to an underestimation of treatment effects reported in orthopaedic trials.

Purpose

Scapular dyskinesis (SD) is present in as many as 67%–100% of athletes with shoulder injuries but it is also highly present in many asymptomatic individuals. The aim of the present study was to identify and analyse SD among asymptomatic professional basketball players.

Methods

A total of 54 European professional basketball players of various professional levels and ages were included in this prospectively recruited cross-sectional study. Participants were assessed using subjective shoulder value (SSV), visual analogue score (VAS) and active range of motion (ROM). Visual combined palpation was used to classify scapular position and movement patterns according to Kibler's method. The clinical examination was completed by evaluating potential coexisting instability (apprehension test, Kim/Jerk and O'Brien tests) and hyperlaxity (Beighton score).

Results

The mean age of all participants (27 female, 27 male; 108 shoulders) was 23.9 ± 6.5 years. 28.7% of the included shoulders had SD (31/108; right: n = 12; left: n = 19), while none of the participants had a diagnosed SD before the present study. Shoulders with SD exhibited a significantly lower SSV (95.0 ± 10.5% vs. 99.0 ± 4.0%; p = 0.004) and reduced abduction (171.8 ± 11.7° vs. 176.6 ± 8.3°, p = 0.013) compared to shoulders without SD. Shoulders with at least one previous injury showed a significantly lower SSV compared to shoulders without previous injury (92.9 ± 12.0% vs. 98.4 ± 5.6%; p = 0.001). Shoulders with pain occurring at least once in last 12 months showed a significantly higher prevalence of SD (6/10 vs. 25/98; p = 0.022) and a lower SSV (90.5 ± 16.4% vs. 98.6 ± 4.4%; p = 0.024) compared to shoulders without pain in last 12 months.

Conclusion

SD was observed in 28.7% of the shoulders in asymptomatic European professional basketball players. SD may represent a sport-specific adaptation, but its association with reduced shoulder function and pain suggests clinical relevance, emphasising the need for early detection and intervention.

Level of Evidence

Level III, cohort study.

Purpose

To determine the long-term risk of osteoarthritis following combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP).

Methods

A comprehensive search of multiple databases (EMBASE, OVID Medline, PubMed, Cochrane, and Scopus) was independently conducted by two reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on the rates of osteoarthritis following primary, arthroscopic ACLR combined with LEAP and a minimum 5-year follow-up were eligible for inclusion. The primary outcome was the prevalence of moderate to severe radiographic arthritis defined as International Knee Documentation Committee (IKDC) grades C or D, Ahlback grades 1–5, or Kellgren–Lawrence grades 3 or 4. A comparative meta-analysis of ACLR with and without LEAP was also performed.

Results

A total of eight studies were included, comprising 849 patients who underwent ACLR with LEAP, and 164 who underwent isolated ACLR. Cumulative meta-analysis showed a 4% prevalence of moderate to severe osteoarthritis across all studies after ACLR with LEAP. Subgroup analysis demonstrated a prevalence of 3% in the 5-to-10-year follow-up group and 6% in the 10+ year follow-up group. In the three comparative cohort studies, meta-analysis revealed no statistically significant difference in moderate to severe osteoarthritis rates between ACLR with LEAP and ACLR alone.

Conclusion

This study demonstrates that long-term prevalence of moderate to severe osteoarthritis following combined ACLR with LEAP is low, and that the addition of LEAP does not increase the incidence compared to ACLR alone. These findings support the use of LEAP in selected patients, without concern for increased long-term joint degeneration.

Level of Evidence

Level III, meta-analysis and systematic review.

Purpose

Evidence on injury incidence on artificial turf for female footballers is conflicting. Some studies have found no difference in injury rates, while others have suggested increased knee injury risk. The aim of this study was to compare match injury incidences between artificial turf and natural grass in the Finnish female premier division of football.

Methods

All teams in the Finnish female premier division of football were invited to participate in a five-season prospective cohort study, and eight to ten teams took part depending on the season. Injuries were reported by players in weekly questionnaires and categorised by anatomical region, recurrence, contact, severity, and playing position. Individual match exposure was tabled, and incidences per 1000 h of match exposure and incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated for both surface types.

Results

A total of 517 league matches (401 on artificial turf and 116 on natural grass) were played during the five-season follow-up. In that time, 237 sudden-onset injuries (184 on artificial turf and 53 on natural grass) were reported. The overall injury incidence rate was 19.6/1000 match hours on artificial turf and 19.3/1000 match hours on natural grass (IRR 1.0, 95% CI 0.7–1.4). No statistical difference was observed for risk in knee injuries or other subcategories.

Conclusions

This study found no evidence of a difference in match injury risk between artificial turf and natural grass for elite level female footballers. Research with modern non-filler surfaces will be needed as pitches containing microplastic pollution are banned in the European Union.

Level of Evidence

Level II.