Knee Surgery, Sports Traumatology, Arthroscopy最新文献_第7页

Development of a multimodal vision transformer model for predicting traumatic versus degenerative rotator cuff tears on magnetic resonance imaging: A single-centre retrospective study 磁共振成像预测外伤性与退行性肩袖撕裂的多模态视觉转换模型的建立：一项单中心回顾性研究。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-08-13 DOI: 10.1002/ksa.70000

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.

Level of Evidence

Not applicable.

目的：区分外伤性和退行性肩袖撕裂（rct）仍然是一个诊断挑战，对治疗计划具有重要意义。虽然磁共振成像（MRI）是标准做法，但传统的放射学解释在区分这些病因方面显示出有限的可靠性。本研究评估了人工智能（AI）模型的潜力，特别是多模态视觉转换器（ViT），以区分创伤性和退行性RCT。方法：在这项回顾性的单中心研究中，分析了2016年至2019年期间在大学肩部专科医院接受手术的99例肩部mri。该队列分为训练组（n = 79）和验证组（n = 20）。创伤组需要有相关创伤记录（不包括单纯的举重损伤），之前无症状的肩部和创伤后3个月内的MRI。退行性组年龄相近，肌腱受伤，患者在影像学检查前表现为至少1年的持续肩部疼痛，无创伤史。随后将ViT与人口统计数据相结合，最终确定了多模式ViT。显著性图被用作可解释性工具。结果：多模态ViT模型的准确率为0.75±0.08，召回率为0.8±0.08，特异性为0.71±0.11，F1评分为0.76±0.1。该模型在不同的患者亚群中保持一致的性能，显示出鲁棒的泛化。显著性图显示在肩袖上没有一致的焦点。结论：人工智能在MRI上支持创伤性和退行性RCT鉴别方面具有潜力。鉴于具有挑战性的诊断场景的相似组，达到75%的准确率尤为重要。使用显著性图来确保可解释性，由于对肩袖肌腱缺乏一致的关注，提示分化中未被重视的方面。证据等级：不适用。

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引用次数: 0

Towards trustworthy artificial intelligence in musculoskeletal medicine: A narrative review on uncertainty quantification 迈向可信赖的肌肉骨骼医学人工智能：不确定性量化的叙述性回顾。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-28 DOI: 10.1002/ksa.12737

Amir M. Vahdani, Moein Shariatnia, Pranav Rajpurkar, Ayoosh Pareek

Introduction

Deep learning (DL) models have achieved remarkable performance in musculoskeletal (MSK) medical imaging research, yet their clinical integration remains hindered by their black-box nature and the absence of reliable confidence measures. Uncertainty quantification (UQ) seeks to bridge this gap by providing each DL prediction with a calibrated estimate of uncertainty, thereby fostering clinician trust and safer deployment.

Methods

We conducted a targeted narrative review, performing expert-driven searches in PubMed, Scopus, and arXiv and mining references from relevant publications in MSK imaging utilizing UQ, and a thematic synthesis was used to derive a cohesive taxonomy of UQ methodologies.

Results

UQ approaches encompass multi-pass methods (e.g., test-time augmentation, Monte Carlo dropout, and model ensembling) that infer uncertainty from variability across repeated inferences; single-pass methods (e.g., conformal prediction, and evidential deep learning) that augment each individual prediction with uncertainty metrics; and other techniques that leverage auxiliary information, such as inter-rater variability, hidden-layer activations, or generative reconstruction errors, to estimate confidence. Applications in MSK imaging, include highlighting uncertain areas in cartilage segmentation and identifying uncertain predictions in joint implant design detections; downstream applications include enhanced clinical utility and more efficient data annotation pipelines.

Conclusion

Embedding UQ into DL workflows is essential for translating high-performance models into clinical practice. Future research should prioritize robust out-of-distribution handling, computational efficiency, and standardized evaluation metrics to accelerate the adoption of trustworthy AI in MSK medicine.

Level of Evidence

Not applicable.

深度学习（DL）模型在肌肉骨骼（MSK）医学成像研究中取得了显著的成绩，但由于其黑箱性质和缺乏可靠的置信度措施，它们的临床整合仍然受到阻碍。不确定性量化（UQ）旨在通过为每个深度学习预测提供校准的不确定性估计来弥合这一差距，从而促进临床医生的信任和更安全的部署。方法：我们进行了有针对性的叙述性回顾，在PubMed、Scopus和arXiv中进行专家驱动的搜索，并利用UQ从MSK成像的相关出版物中挖掘参考文献，并使用主题综合来获得UQ方法的内聚分类法。结果：UQ方法包括多通道方法（例如，测试时间增强，蒙特卡罗退出和模型集成），从反复推断的可变性中推断不确定性；用不确定性度量增强每个单独预测的单次方法（例如，保形预测和证据深度学习）；以及其他利用辅助信息的技术，如评级间变异性、隐藏层激活或生成重建误差，以估计置信度。MSK成像的应用包括突出软骨分割中的不确定区域和识别关节植入物设计检测中的不确定预测；下游应用程序包括增强的临床实用程序和更高效的数据注释管道。结论：将UQ嵌入到DL工作流中对于将高性能模型转化为临床实践至关重要。未来的研究应优先考虑健壮的配送外处理、计算效率和标准化评估指标，以加速在MSK医学中采用可信赖的人工智能。证据等级：不适用。

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引用次数: 0

Do we need a robot in total knee arthroplasty? Yes! No! Not sure!—A well balanced perspective 在全膝关节置换术中我们需要机器人吗？是的!不!不确定!-平衡的视角。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-28 DOI: 10.1002/ksa.12798

Antonio Klasan, Michael T. Hirschmann

引用次数: 0

The definitions and prevalence of nutritional disorders in hip and knee arthroplasty: A systematic review 髋关节和膝关节置换术中营养失调的定义和流行：一项系统综述。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-28 DOI: 10.1002/ksa.12766

Christopher David John Little, Hariharan Subbiah Ponniah, Shvaita Ralhan, Louise Strickland, Antony Palmer, Thomas William Hamilton

Purpose

This systematic review aims to use European Society of Parenteral and Enteral Nutrition (ESPEN) terminology and diagnostic criteria to determine the prevalence of nutritional disorders in hip and knee arthroplasty.

Methods

A systematic review of Level 1–4 evidence was conducted as per the PRISMA statement and Cochrane handbook for Systematic Review (PROSPERO ID: CRD 42023360496). In March 2024, AMED, CENTRAL, EMBASE, MEDLINE, Scopus and Web of Science were searched. Articles were included if they defined and reported the prevalence of nutritional disorders in hip and knee arthroplasty populations. Exclusion criteria were subtrochanteric fracture, pathological fracture and <50 cases. The risk of bias in non-randomised studies of interventions and risk of bias 2 tools were used to assess bias. No pooled analyses were performed due to study heterogeneity.

Results

Fifty-five studies and 2,107,283 patients were included. Thirty-nine different definitions of nutritional disorder were identified. The prevalence of nutritional disorder varied depending on the chosen definition: 0.9%–71.7% in primary, 1.33%–47.5% in revision and 4.5%–60% in hip fracture arthroplasty. Thirty-four studies used albumin to diagnose malnutrition, with hypoalbuminaemia seen most frequently in hip fracture (20.3%–71.13%) and revision cohorts (2.5%–42.8%). No study reported the prevalence of sarcopenia in revision or hip fracture cohorts.

Conclusion

All forms of nutritional disorder exist within hip and knee arthroplasty populations, particularly among revision and hip fracture patients. Included studies showed poor compliance with ESPEN recommendations and heterogeneity in the chosen definition of disorder. A prospective study using ESPEN-recommended diagnostic criteria is required to better determine the prevalence of nutritional disorders, contributing towards the understanding of the financial and patient-related costs following hip and knee arthroplasty.

Level of Evidence

Systematic review of articles with Level I–IV evidence.

目的：本系统综述旨在使用欧洲肠外和肠内营养学会（ESPEN）术语和诊断标准来确定髋关节和膝关节置换术中营养失调的患病率。方法：根据PRISMA声明和Cochrane系统评价手册（PROSPERO ID: CRD 42023360496）对1-4级证据进行系统评价。2024年3月，检索了AMED、CENTRAL、EMBASE、MEDLINE、Scopus和Web of Science。定义和报道髋关节和膝关节置换术人群营养失调患病率的文章被纳入。排除标准为粗隆下骨折、病理性骨折和结果：纳入55项研究，2,107,283例患者。确定了39种不同的营养失调定义。营养失调的患病率因定义的不同而不同：原发性为0.9%-71.7%，翻修为1.33%-47.5%，髋部骨折置换术为4.5%-60%。34项研究使用白蛋白诊断营养不良，低白蛋白血症最常见于髋部骨折（20.3%-71.13%）和修订队列（2.5%-42.8%）。没有研究报道在翻修或髋部骨折队列中肌肉减少症的患病率。结论：所有形式的营养失调存在于髋关节和膝关节置换术人群中，特别是在翻修和髋部骨折患者中。纳入的研究显示对ESPEN建议的依从性较差，并且在选择的疾病定义上存在异质性。需要使用espen推荐的诊断标准进行前瞻性研究，以更好地确定营养失调的患病率，有助于了解髋关节和膝关节置换术后的经济和患者相关费用。证据水平：对具有1 - 4级证据的文章进行系统评价。

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引用次数: 0

Technology-assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review 与标准翻修膝关节手术相比，技术辅助翻修膝关节置换术减少了影像学异常值：一项系统综述。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-24 DOI: 10.1002/ksa.12748

Matteo Innocenti, Filippo Leggieri, Simon N. van Laarhoven, Tommy de Windt, Roberto Civinini, Gijs G. van Hellemondt

Purpose

The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).

Methods

A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the I² statistic.

Results

Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip–knee–ankle angle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6% [95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15–24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.

Conclusion

Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.

目的：本系统综述的目的是评估技术辅助翻修全膝关节置换术（revTKA）的预后和并发症。方法：系统检索PubMed、EMBASE、Web of Science和Cochrane Library，检索时间为2024年10月31日。纳入标准是实验或观察性研究，≥10例患者接受机器人revTKA，评估临床和/或放射预后和/或并发症发生率。排除标准是单独的髌骨翻修、体外研究、给编辑的信、书籍章节、会议论文和无法获得全文的研究。使用非随机研究的方法学指数（minor）对每项研究进行质量评分。纳入的研究分为TKA和单室膝关节置换术（UKA）两组，进行定性和定量综合。在适当的地方进行随机效应荟萃分析。计算影像学参数的95%置信区间（ci）的平均差异。采用I2统计量评估异质性。结果：在20项研究（795例）中，10项评估revvka， 10项检查revUKA。在revTKA研究中，4项是比较队列，而在revUKA研究中，7项是比较队列。技术辅助的revTKA显示髋关节-膝关节-踝关节角度的异常值较少（13.3% [95% CI, 8.7%-19.0%]对26.1% [95% CI, 16.3%-38.1%]），股骨外侧远端角度在±3°内的良好组件定位（88.4% [95% CI, 83.2%-92.4%]对79.7% [95% CI, 68.8%-87.5%]）和胫骨内侧近端角度（91.2% [95% CI, 86.3%-94.6%]对82.6% [95% CI, 72.0%-89.8%]），更好的关节线恢复（79.5%对58.3%）在4 mm内)。手术需要额外的15-24分钟。两组间并发症发生率具有可比性。对于UKA修订，技术辅助和传统技术之间的结果大致相似，在对齐准确性和临床评分方面结果不一。结论：与常规技术相比，技术辅助的revTKA获得了最佳的对准参数，减少了异常值的发生。然而，这些影像学上的改善并不能始终转化为增强的临床结果或降低的并发症发生率。证据等级：四级。

{"title":"Technology-assisted revision knee arthroplasty reduces radiographic outliers compared with standard revision knee surgery: A systematic review","authors":"Matteo Innocenti, Filippo Leggieri, Simon N. van Laarhoven, Tommy de Windt, Roberto Civinini, Gijs G. van Hellemondt","doi":"10.1002/ksa.12748","DOIUrl":"10.1002/ksa.12748","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The aim of this systematic review was to evaluate the outcomes and complications associated with technology-assisted revision total knee arthroplasty (revTKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, EMBASE, Web of Science and the Cochrane Library was conducted from inception to 31 October 2024. The inclusion criteria were experimental or observational studies with ≥10 patients undergoing robotic revTKA, evaluating clinical and/or radiological outcomes and/or complication rates. The exclusion criteria were isolated patellar revision, in vitro studies, letters to the editor, book chapters, conference papers, and studies without accessible full text. Each study was given a quality rating using the methodological index for non-randomised studies (MINORS). The included studies were divided into those reporting revision from TKA and those from unicompartmental knee arthroplasty (UKA), for both qualitative and quantitative synthesis. Random-effects meta-analyses were performed where appropriate. Mean differences with 95% confidence intervals (CIs) were calculated for radiographic parameters. Heterogeneity was assessed using the <i>I</i><sup>2</sup> statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 20 studies (795 cases), 10 assessed revTKA and 10 examined revUKA. Of the revTKA studies, four were comparative cohorts, while among the revUKA studies, seven were comparative cohorts. Technology-assisted revTKA showed fewer outliers in hip–knee–ankle angle (13.3% [95% CI, 8.7%–19.0%] vs. 26.1% [95% CI, 16.3%–38.1%]), superior component positioning within ±3° for the lateral distal femoral angle (88.4% [95% CI, 83.2%–92.4%] vs. 79.7% [95% CI, 68.8%–87.5%]) and for the medial proximal tibial angle (91.2% [95% CI, 86.3%–94.6%] vs. 82.6% [95% CI, 72.0%–89.8%]), and better joint line restoration (79.5% vs. 58.3% within 4 mm). Procedures required an additional 15–24 min. Complication rates were comparable between groups. For UKA revisions, outcomes were generally similar between technology-assisted and conventional techniques, with mixed results on alignment accuracy and clinical scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Technology-assisted revTKA achieves optimal alignment parameters and reduces the occurrence of outliers compared with conventional techniques. However, these radiographic improvements do not consistently translate into enhanced clinical outcomes or reduced complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 ","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3606-3620"},"PeriodicalIF":5.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12748","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700954","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

Arthrogenic muscle inhibition: A prevalent issue in knee arthroplasty 关节源性肌肉抑制：膝关节置换术中普遍存在的问题。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-24 DOI: 10.1002/ksa.12804

Alexandre Le Guen, Sébastien Parratte, Vincent Marot, Régis Pailhé, Hasnae Ben-Roummane, Emilie Bérard, Etienne Cavaignac

Purpose

Flexion contracture is a multifactorial complication after knee osteoarthritis and knee arthroplasty. Among the causes, arthrogenic muscle inhibition (AMI) has never been studied. It is a failure to achieve proper quadriceps motor activation, which can lead to flexion contracture due to hamstring contracture. In this study, we hypothesised that AMI is present in patients with knee osteoarthritis and after knee arthroplasty. The aims were to assess: (1) the prevalence of preoperative AMI, for patients without preoperative AMI, (2) the incidence of post-operative AMI at 2 weeks, (3) its associated factors at 2 weeks and (4) the incidence 90 days after surgery.

Methods

An international, prospective study enroled 341 patients undergoing knee arthroplasty across three centres. 316 patients met the inclusion criteria: symptomatic knee requiring unicompartmental, total or revision arthroplasty. Twenty-five patients undergoing simultaneous bilateral procedures were excluded. Among the included patients, 275 patients without preoperative AMI were analysed for post-operative incidence and associated factors. AMI was assessed using the SANTI classification on the day of surgery, at 15 days, and at 3 months. One patient was lost to follow-up at 3 months.

Results

Preoperative AMI ≥  1 was observed in 13% (95% confidence interval [CI] = 9–17). At 2 weeks post-operatively, AMI ≥  1 occurred in 36% (95% CI = 30–42), with 13% showing AMI ≥  2, characterised by quadriceps inhibition and flexion contracture. Female gender (odds ratio [OR] =  2.81; p < 0.002), early post-operative flexion contracture attitude such as keeping the knee bent, placing a pillow under the knee, or folding the hospital bed (OR =  5.89; p < 0.001), and high pain scores (OR = 13.57; p < 0.001) were significantly associated with AMI ≥  1 at 2 weeks. At 3 months, AMI ≥ 1 occurred in 12.4% (95% CI = 8.7–16.9).

Conclusion

AMI is a prevalent issue both pre- and post-operatively. Its incidence underscores the relevance of this condition; it should be considered in the management of post-operative flexion contracture in knee arthroplasty.

Level of Evidence

Level III, observation cohort study.

目的：屈曲挛缩是膝关节骨性关节炎和膝关节置换术后的多因素并发症。其中，关节源性肌肉抑制（AMI）从未被研究过。这是一个未能达到适当的四头肌运动激活，这可能导致由于腘绳肌挛缩屈曲挛缩。在这项研究中，我们假设AMI存在于膝关节骨关节炎患者和膝关节置换术后。目的是评估：(1)术前无AMI患者的AMI患病率；(2)术后2周AMI发生率；(3)术后2周AMI相关因素；(4)术后90天AMI发生率。方法：一项国际前瞻性研究纳入了341名在三个中心接受膝关节置换术的患者。316例患者符合纳入标准：需要单腔、全腔或翻修性膝关节置换术的症状性膝关节。25例同时接受双侧手术的患者被排除在外。在纳入的患者中，分析275例术前无AMI的患者术后发病率及相关因素。在手术当天、15天和3个月时使用SANTI分级评估AMI。1例患者3个月后失去随访。结果：13%的患者术前AMI≥ 1（95%可信区间[CI] = 9-17）。术后2周，36%的患者AMI≥ 1 (95% CI = 30-42)， 13%的患者AMI≥ 2，表现为股四头肌抑制和屈曲挛缩。女性(优势比[OR] = 2.81；结论：AMI在术前和术后都是一个普遍的问题。它的发生强调了这种情况的相关性；在膝关节置换术后屈曲挛缩的处理中应予以考虑。证据等级：III级，观察队列研究。

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引用次数: 0

Preoperative flexion contracture does not impair outcomes or early revision rates following robotic total knee arthroplasty with functional alignment 术前屈曲挛缩不影响机器人全膝关节置换术后的结果或早期翻修率。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-21 DOI: 10.1002/ksa.12799

Christos Koutserimpas, Giovan Giuseppe Mazzella, Luca Andriollo, Emanuele Diquattro, Pietro Gregori, Elvire Servien, Cécile Batailler, Sébastien Lustig

Purpose

Preoperative flexion contracture remains a challenging deformity in total knee arthroplasty (TKA). This study aimed to evaluate whether the presence of preoperative flexion contracture influences outcomes and early revision rates following robotic-assisted TKA performed with functional alignment (FA) principles.

Methods

This retrospective comparative study analysed 190 patients who underwent robotic-assisted TKA using a computed tomography-based FA strategy. Patients were grouped based on intraoperative measurement of flexion contracture: ≥10° (study group; 43 patients) and <10° (control group; 147 patients). Clinical outcomes, intraoperative data, and early revision rates were assessed at a minimum 24-month follow-up.

Results

The study group exhibited significantly more varus alignment intraoperatively and required greater lateral tibial and posterior medial femoral resections. Preoperative knee flexion was lower in the contracture group (110° vs. 120°, p = 0.0018), and postoperative flexion remained slightly reduced (120° vs. 130°, p = 0.05). Flexion contracture at follow-up was 1° in the study group versus 0° in controls (p = 0.04). However, no significant differences were observed in Knee Society Scores, Forgotten Joint Score, Kujala score, or early revision rates. All-cause revision rates were similar (97.67% vs. 98.64%, p = 0.66), with a hazard ratio of 1.85 (95% CI: 0.12–27.72). Aseptic survivorship was 100% in the contracture group versus 99.32% in controls (p = 0.59).

Conclusion

Patients with preoperative flexion contracture ≥ 10° achieved comparable mid-term outcomes and early survivorship to those without contracture following robotic-assisted TKA using FA. These findings support FA as a reliable strategy to manage complex deformities without the need for soft tissue releases.

Level of Evidence

Level III.

目的：术前屈曲挛缩是全膝关节置换术（TKA）中一个具有挑战性的畸形。本研究旨在评估术前屈曲挛缩的存在是否会影响功能对齐（FA）原则下机器人辅助TKA的结果和早期翻修率。方法：本回顾性比较研究分析了190例使用基于计算机断层扫描的FA策略进行机器人辅助TKA的患者。根据术中屈曲挛缩程度进行分组：≥10°(研究组；结果：研究组在术中表现出更多的内翻对准，需要更大的胫骨外侧和股骨后内侧切除术。挛缩组术前膝关节屈曲较低（110°vs. 120°，p = 0.0018），术后屈曲仍略有降低（120°vs. 130°，p = 0.05）。随访时，研究组屈曲挛缩为1°，对照组为0°（p = 0.04）。然而，在膝关节学会评分、遗忘关节评分、Kujala评分或早期翻修率方面没有观察到显著差异。全因修正率相似（97.67% vs. 98.64%, p = 0.66），风险比为1.85 （95% CI: 0.12-27.72）。挛缩组无菌存活率为100%，对照组为99.32% （p = 0.59）。结论：术前屈曲挛缩≥10°的患者与使用FA的机器人辅助TKA患者相比，获得了相当的中期预后和早期生存期。这些发现支持FA作为一种可靠的策略来处理复杂的畸形，而不需要软组织释放。证据等级：三级。

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引用次数: 0

Lower psychological readiness to return to sport after revision ACL surgery 前交叉韧带修复手术后重返运动的心理准备较低。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12797

Magdalena Tarchala, Matthew D. Milewski, Emma C. Gossman, Ryan P. Coene, Danielle L. Cook, Mininder S. Kocher, Dennis E. Kramer, Lyle J. Micheli, Yi-Meng Yen, Melissa A. Christino

Purpose

To investigate psychological readiness and psychological stress in young patients after revision anterior cruciate ligament reconstructions (ACLR).

Methods

Revision ACLR patients were evaluated 6-months post-operatively with patient reported outcomes (PROs): Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI), PROMIS-Psychological Stress Experience (PROMIS-PSE), International Knee Documentation Committee (IKDC/Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Patient reported outcomes (PROs) of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching between primary and revision cohorts (2:1) was performed for age, sex, and graft type.

Results

Matching resulted in 90 ACLR patients (60 primary and 30 revision). The revision cohort's mean age was 19.0 (SD ± 3.46) and 63% female. A negative correlation was detected between IKDC and PROMIS-PSE (r = −0.32; 95% confidence interval [CI] = −0.49 to −0.12; p = 0.002) and positive correlation was detected between IKDC and ACL-RSI scores (r = 0.50; 95% CI = 0.32–0.64; p < 0.001). There was a weak positive correlation between Pedi-FABS and ACL-RSI scores (r = 0.25; 95% CI = 0.05–0.43; p = 0.02). Revision ACLR patients had lower ACL-RSI/psychological readiness scores (43.4 vs. 58.7, p = 0.001) and lower Pedi-FABS scores (22 vs. 25, p = 0.02), compared to primary ACLR patients. Regression analysis showed revision patients had a 17-point decrease in ACL-RSI scores compared to primary patients (β = −17.1; 95% CI = −27.32 to −6.79; p = 0.001), controlling for age at primary surgery, meniscus repair, and propensity score. Revision patients had a 17% increase in the time to return to sports clearance compared to primary ACLR patients (95% CI = 1.02–1.34; p = 0.03). No differences were noted in Pedi-IKDC/IKDC or PROMIS-PSE scores between the cohorts.

Conclusion

Patients 6-months post revision ACLR had lower psychological readiness, inferior knee outcomes, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in revision ACLR patients is important to optimise post-operative care and outcomes.

Level of Evidence

Level II.

目的：探讨青年前交叉韧带重建术（ACLR）翻修后患者的心理准备状况和心理压力。方法：对改良ACLR患者进行术后6个月的评估，患者报告的结果（PROs）：前交叉韧带损伤后恢复运动量表（ACL-RSI），允诺-心理应激体验（允诺- pse），国际膝关节文献委员会（IKDC/ pedii -IKDC）和特殊外科医院儿童功能活动简要量表（HSS pedii - fabs）。将改良ACLR患者的患者报告结果（PROs）与原发性ACLR患者队列进行比较。根据年龄、性别和移植物类型对初级队列和修订队列进行倾向评分匹配（2:1）。结果：匹配90例ACLR患者（60例原发，30例翻修）。修订队列的平均年龄为19.0 (SD±3.46)，63%为女性。IKDC与promise - pse呈负相关(r = -0.32；95%置信区间[CI] = -0.49 ~ -0.12；p = 0.002)， IKDC与ACL-RSI评分呈正相关(r = 0.50；95% ci = 0.32-0.64；结论：ACLR翻修后6个月的患者心理准备程度较低，膝关节预后较差，运动恢复延迟。更多地关注改良ACLR患者恢复的心理方面对于优化术后护理和结果是重要的。证据等级：二级。

{"title":"Lower psychological readiness to return to sport after revision ACL surgery","authors":"Magdalena Tarchala, Matthew D. Milewski, Emma C. Gossman, Ryan P. Coene, Danielle L. Cook, Mininder S. Kocher, Dennis E. Kramer, Lyle J. Micheli, Yi-Meng Yen, Melissa A. Christino","doi":"10.1002/ksa.12797","DOIUrl":"10.1002/ksa.12797","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate psychological readiness and psychological stress in young patients after revision anterior cruciate ligament reconstructions (ACLR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Revision ACLR patients were evaluated 6-months post-operatively with patient reported outcomes (PROs): Anterior Cruciate Ligament Return to Sport After Injury Scale (ACL-RSI), PROMIS-Psychological Stress Experience (PROMIS-PSE), International Knee Documentation Committee (IKDC/Pedi-IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS). Patient reported outcomes (PROs) of revision ACLR patients were compared to a cohort of primary ACLR patients. Propensity score matching between primary and revision cohorts (2:1) was performed for age, sex, and graft type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Matching resulted in 90 ACLR patients (60 primary and 30 revision). The revision cohort's mean age was 19.0 (SD ± 3.46) and 63% female. A negative correlation was detected between IKDC and PROMIS-PSE (<i>r</i> = −0.32; 95% confidence interval [CI] = −0.49 to −0.12; <i>p</i> = 0.002) and positive correlation was detected between IKDC and ACL-RSI scores (<i>r</i> = 0.50; 95% CI = 0.32–0.64; <i>p</i> < 0.001). There was a weak positive correlation between Pedi-FABS and ACL-RSI scores (<i>r</i> = 0.25; 95% CI = 0.05–0.43; <i>p</i> = 0.02). Revision ACLR patients had lower ACL-RSI/psychological readiness scores (43.4 vs. 58.7, <i>p</i> = 0.001) and lower Pedi-FABS scores (22 vs. 25, <i>p</i> = 0.02), compared to primary ACLR patients. Regression analysis showed revision patients had a 17-point decrease in ACL-RSI scores compared to primary patients (<i>β</i> = −17.1; 95% CI = −27.32 to −6.79; <i>p</i> = 0.001), controlling for age at primary surgery, meniscus repair, and propensity score. Revision patients had a 17% increase in the time to return to sports clearance compared to primary ACLR patients (95% CI = 1.02–1.34; <i>p</i> = 0.03). No differences were noted in Pedi-IKDC/IKDC or PROMIS-PSE scores between the cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients 6-months post revision ACLR had lower psychological readiness, inferior knee outcomes, and delayed return to sport clearance. Greater attention to the psychological aspects of recovery in revision ACLR patients is important to optimise post-operative care and outcomes.</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 10","pages":"3697-3706"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661767","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

Patellofemoral alignment safe zones in robotic-assisted total knee arthroplasty do not affect outcomes but do influence patellar resurfacing rates 机器人辅助全膝关节置换术中髌骨-股骨对齐安全区不影响手术结果，但会影响髌骨表面置换率。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12786

Emanuele Diquattro, Luca Andriollo, Christos Koutserimpas, Jean Baltzer, Elvire Servien, Cécile Batailler, Sébastien Lustig

Purpose

Anterior compartment management remains a challenging aspect of total knee arthroplasty (TKA), particularly in personalised alignment strategies. This study aimed to assess whether restoring patellofemoral alignment parameters within predefined safe zones—specifically patellar tilt (PTi), patellar translation (PTr) and patellar offset (PO)—is associated with improved clinical outcomes following robotic-assisted TKA (rTKA).

Methods

This retrospective study included 283 patients who underwent primary rTKA between March 2021 and January 2023 using functional alignment (FA) or functional knee positioning (FKP) principles. All surgeries were performed using a CT-based robotic system (Mako, Stryker). Patients were stratified into groups based on radiographic values of PTi, PTr and ΔPO, using thresholds derived from prior robotic studies to define safe zones. Clinical outcomes at a mean follow-up of 2.8 ± 0.8 years included Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12) and Kujala Anterior Knee Pain Scale (AKPS).

Results

There were no statistically significant differences in final KSS, FJS-12 or AKPS between groups within or outside the safe zones for PTi, PTr or ΔPO. However, patients with PTi < 0°, ΔPO > 0 mm (overstuffing) or PTr within ±2 mm showed significantly higher rates of patellar resurfacing (p < 0.001). No group demonstrated superior clinical outcomes across the three parameters studied.

Conclusion

Restoring patellofemoral alignment parameters within predefined safe zones was not associated with improved short-term clinical outcomes in rTKA. Robotic-assisted FA provides accurate restoration of the anterior compartment, reducing reliance on patellar resurfacing in eligible patients. Our data suggest that target biomechanical parameters can potentially be achieved without resurfacing in cases where it is not indicated. Our hypothesis that patients within the proposed safe zones would demonstrate improved clinical outcomes was not supported by the current results. Further prospective studies are needed to determine whether femoral safe zones can predict long-term benefit.

Level of Evidence

Level II.

目的：前腔室管理仍然是全膝关节置换术（TKA）的一个具有挑战性的方面，特别是在个性化对齐策略。本研究旨在评估在预定义的安全区域内恢复髌骨-股骨对齐参数-特别是髌骨倾斜（PTi），髌骨平移（PTr）和髌骨偏移(PO)-是否与机器人辅助TKA （rTKA）后临床结果的改善有关。方法：本回顾性研究纳入了283例在2021年3月至2023年1月期间采用功能对齐（FA）或功能膝关节定位（FKP）原则进行原发性rTKA的患者。所有手术均使用基于ct的机器人系统（Mako, Stryker）进行。根据PTi、PTr和ΔPO的放射学值将患者分层，使用先前机器人研究得出的阈值来定义安全区。平均随访2.8±0.8年的临床结果包括膝关节社会评分（KSS）、遗忘关节评分-12 （FJS-12）和Kujala前膝关节疼痛量表（AKPS）。结果：PTi、PTr、ΔPO安全区内外两组患者最终KSS、FJS-12、AKPS差异无统计学意义。然而，PTi为0 mm（过度填充）或PTr为±2 mm的患者髌骨表面置换率明显更高(p结论：在预先确定的安全区域内恢复髌骨股骨对齐参数与改善rTKA的短期临床结果无关。机器人辅助FA提供准确的前腔室修复，减少对符合条件的患者髌骨表面置换术的依赖。我们的数据表明，在没有指征的情况下，目标生物力学参数可以在没有表面修复的情况下实现。我们的假设是，在建议的安全区域内的患者会表现出更好的临床结果，但目前的结果并不支持这一假设。需要进一步的前瞻性研究来确定股骨安全区是否可以预测长期获益。证据等级：二级。

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引用次数: 0

Bisphosphonate use in patients undergoing total knee arthroplasty reduces overall and aseptic revisions and periprosthetic bone mineral density loss: A systematic review from the FP-UCBM Knee Study Group 全膝关节置换术患者使用双膦酸盐可减少整体和无菌修复以及假体周围骨矿物质密度损失：FP-UCBM膝关节研究组的一项系统综述。

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy

Pub Date : 2025-07-18 DOI: 10.1002/ksa.12802

Giancarlo Giurazza, Marco Edoardo Cardinale, Edoardo Franceschetti, Stefano Campi, Giuseppe Francesco Papalia, Pietro Gregori, Francesco Rosario Parisi, Augusto Ferrini, Michele Paciotti, Rocco Papalia

Purpose

Bisphosphonates (BPs), widely used for osteoporosis management, have garnered attention in the context of total knee arthroplasty (TKA) for their potential to preserve periprosthetic bone mineral density (BMD) and mitigate risks such as aseptic loosening, periprosthetic fractures, and implant failure. This study systematically reviewed the current literature on the topic, hypothesising that BP therapy reduces the risk of postoperative adverse outcomes in patients undergoing TKA.

Methods

A systematic literature search was conducted on 1 December 2024 using PubMed, Cochrane Library, Scopus and Google Scholar. Inclusion criteria were: English-language randomised controlled trials (RCTs), comparative prospective or retrospective studies, and studies evaluating postoperative outcomes (including all-cause and aseptic revisions, periprosthetic BMD loss, periprosthetic fractures and implant migration) in patients undergoing TKA who received BP treatment. Exclusion criteria were: computational studies; case reports; studies focusing uniquely on the surgical technique; studies reporting only cumulative data for total joint arthroplasty.

Results

A total of 14 studies (480,294 patients) were included. Six studies focused exclusively on osteoporotic patients, six on non-osteoporotic patients and two on a mixed BMD population. The rate of all-cause and aseptic revisions was 1.5% and 1.1% respectively for BP users, and 2.3% and 2.5%, for non-BP users. Mean pre-/post-operative variation in BMD was –0.04 for BP users and –0.2 for non-BP users. The risk of bias was graded as low using the ROB 2 tool for RCTs and the Newcastle–Ottawa Scale for observational studies.

Conclusion

Bisphosphonate use in patients undergoing total knee arthroplasty is associated with lower rates of overall and aseptic revisions, reduced periprosthetic BMD loss, and inconclusive effects on periprosthetic fractures and implant migration.

Level of Evidence

Level IV.

目的：双膦酸盐（bp）广泛用于骨质疏松症治疗，在全膝关节置换术（TKA）中引起了人们的关注，因为它们具有保持假体周围骨矿物质密度（BMD）和减轻无菌性松动、假体周围骨折和植入物失败等风险的潜力。本研究系统地回顾了目前关于该主题的文献，假设BP治疗降低了TKA患者术后不良后果的风险。方法：于2024年12月1日使用PubMed、Cochrane Library、Scopus和谷歌Scholar进行系统文献检索。纳入标准为：英文随机对照试验（RCTs）、比较前瞻性或回顾性研究，以及评估接受BP治疗的TKA患者术后结局（包括全因和无菌修复、假体周围骨密度损失、假体周围骨折和植入物移位）的研究。排除标准为：计算研究；病例报告;专注于手术技术的研究；研究仅报告全关节置换术的累积数据。结果：共纳入14项研究（480294例患者）。6项研究专门针对骨质疏松症患者，6项针对非骨质疏松症患者，2项针对混合骨密度人群。BP使用者的全因修正率和无菌修正率分别为1.5%和1.1%，非BP使用者的全因修正率和无菌修正率分别为2.3%和2.5%。BP使用者和非BP使用者的平均术前/术后BMD差异分别为-0.04和-0.2。使用随机对照试验的ROB 2工具和观察性研究的纽卡斯尔-渥太华量表将偏倚风险分级为低。结论：在全膝关节置换术患者中使用双膦酸盐可降低整体修复率和无菌修复率，减少假体周围骨密度损失，以及对假体周围骨折和植入物迁移的影响尚无定论。证据等级：四级。

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引用次数: 0

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