Knee Surgery, Sports Traumatology, Arthroscopy最新文献

Purpose: While public databases like Transfermarkt provide valuable data for assessing the impact of anterior cruciate ligament (ACL) injuries in professional footballers, they require robust verification methods due to accuracy concerns. We hypothesised that an artificial intelligence (AI)-powered framework could cross-check ACL tear-related information from large publicly available data sets with high specificity.

Methods: The AI-powered framework uses Google Programmable Search Engine to search a curated, multilingual list of websites and OpenAI's GPT to translate search queries, appraise search results and analyse injury-related information in search result items (SRIs). Specificity was the chosen performance metric-the AI-powered framework's ability to accurately identify texts that do not mention an athlete suffering an ACL tear-with SRI as the evaluation unit. A database of ACL tears in male professional footballers from first- and second-tier leagues worldwide (1999-2024) was collected from Transfermarkt.com, and players were randomly selected for appraisal until enough SRIs were obtained to validate the framework's specificity. Player age at injury and time until return-to-play (RTP) were recorded and compared with Union of European Football Associations (UEFA) Elite Club Injury Study data.

Results: Verification of 231 athletes yielded 1546 SRIs. Human analysis of the SRIs showed that 335 mentioned an ACL tear, corresponding to 83 athletes with ACL tears. Specificity and sensitivity of GPT in identifying mentions of ACL tears in a player were 99.3% and 88.4%, respectively. Mean age at rupture was 26.6 years (standard deviation: 4.6, 95% confidence interval [CI]: 25.6-27.6). Median RTP time was 225 days (interquartile range: 96, 95% CI: 209-251), which is comparable to reports using data from the UEFA Elite Club Injury Study.

Conclusion: This study shows that an AI-powered framework can achieve high specificity in cross-checking ACL tear reports in male professional football from public databases, markedly reducing manual workload and enhancing the reliability of media-based sports medicine research.

Level of evidence: Level III.

Purpose: High-grade femoral trochlear dysplasia is associated with anterior knee pain, patellar maltracking, instability and the development of osteoarthritis. Scientific studies have signified the importance of trochlear resection on the knee extensor mechanism, and dysplasia can be addressed by a groove-deepening trochleoplasty. Alternatively, tibial tubercle anteriorisation has been proposed to reduce patellofemoral joint (PFJ) pressure and alleviate pain from osteoarthritis. However, the relative contributions of articular changes in the sagittal and axial planes remain unknown. This study aimed to better understand the effect of these different osteotomies, that alter the sagittal plane geometry, on PFJ biomechanics.

Methods: Seven cadaveric knees were used to measure the following factors: (1) PFJ contact pressure; (2) Knee extension torque (KET); and (3) Patellar kinematics at 60°, 45°, 30°, 15° and 0° of knee flexion among four different osteotomy states: native, anteriorised trochlea, combined anteriorised trochlea and anteriorised tibial tubercle, and anteriorised tibial tubercle. Analysis was made using a two-way repeated-measures analysis of variance.

Results: Anteriorising the trochlea increased mean PFJ contact pressures ×2.9 at 0° (p = 0.024) and ×2.2 (p = 0.029) at 15° flexion compared to the native state. Peak pressures increased ×4.9 at 0° and ×3.3 at 15° (n.s.). Anteriorising the trochlea reduced KET 18% (p = 0.001) at 40° flexion and 19% (p = 0.009) at 50°. The patella was anteriorised 8 mm in the extended knee (p < 0.001) and flexed 8° at 45° knee flexion (p < 0.001) compared to the native state. Elevating the tibial tubercle, alone or combined with an anteriorised trochlea, did not have a significant effect on the respective outcome measurements.

Conclusion: An anteriorised trochlea elevated PFJ contact pressure, reduced KET and altered patellar position during knee flexion/extension movement, while a tibial tubercle anteriorisation had a negligible opposite effect. These findings indicate that symptoms associated with high grade trochlear dysplasia may be addressed better at the trochlea, rather than at the tibial tubercle.

Level of evidence: Basic science.

The evolution of orthopaedics has witnessed a pronounced shift from generalist practice to subspecialisation, a trend that has fundamentally reshaped the field over the past century. Originally, orthopaedic surgeons were trained to address a broad spectrum of musculoskeletal conditions. However, increasing complexity and specialization in knowledge have driven a progressive narrowing of focus within orthopaedics. This editorial explores the rise of subspecialty training and fellowship programs in orthopaedics, particularly in North America, where over 90% of orthopaedic surgeons now pursue subspecialty fellowships. While subspecialisation has improved surgical outcomes and created experts in specific anatomical regions and techniques, it has also led to challenges. Surgeons with highly focused expertise may face difficulties in managing conditions outside their niche, and subspecialisation may inadvertently limit comprehensive patient care, especially for those with complex, multi-faceted needs. The career paths of orthopaedic trainees are increasingly shaped by both personal interests and market demands, with subspecialists seeking greater professional and economic benefits. Additionally, orthopaedic training models in Europe vary, further complicating a unified approach to subspecialisation. This editorial calls for a balanced perspective that values both subspecialty excellence and the broad-based skills of orthopaedic generalists, particularly as the future of generalist orthopaedic practice faces uncertainty amidst ongoing subspecialisation trends.

Purpose: Sulcus-deepening trochleoplasty (TP) effectively treats patellofemoral (PF) instability (PFI) caused by high-grade trochlear dysplasia (TD), but current evidence is based on small case series. We hypothesised, that TP would result in significant functional improvements and a low re-dislocation rate but would not accelerate the progression of PF cartilage deterioration.

Methods: We retrospectively reviewed all TP cases performed by a single surgeon between 2015 and 2021. Inclusion criteria were postoperative Magnetic resonance imaging (MRI) >6 and >12 months and a clinical follow-up >12 months. Patients with simultaneous cartilage repair, open physes or incomplete records were excluded. Clinical outcomes were assessed using pre- and postoperative scores, postoperative Banff Patellofemoral Instability Instrument (BPII) 2.0 and Knee Injury and Osteoarthritis Outcome Score (KOOS), re-dislocation rate and patient satisfaction. PF cartilage was evaluated via Area Measurement and Depth & Underlying Structures (AMADEUS) scores preoperatively, at 6 months and at the final follow-up.

Results: We included 113 patients (25.8 ± 8.3 years) with high-grade TD (Dejour B-D; mean lateral inclination angle: -2.9 ± 9.1°), 85% of whom had advanced cartilage lesions. All underwent TP, lateral retinacular lengthening (LRL) and medial patellofemoral ligament reconstruction (MPFL-R). After 34.8 ± 20.9 months, function, pain levels and Tegner scores improved significantly (p < 0.001). KOOS dimensions were: symptoms 79.9 ± 13.5, pain 86.4 ± 12.1, activity 91.9 ± 8.3, sports 71.7 ± 22.2 and quality-of-life 58.1 ± 23.8. BPII 2.0 was 64.3 ± 31.4. Preoperative AMADEUS scores (55.2 ± 17.4) remained stable at 6 months (p = 0.343) but improved to 58.4 ± 16.0 at 28.6 (12-89) months (p = 0.004). Complication and re-dislocation rates were 5.3% and 1.8%, with 93% patient satisfaction.

Conclusion: Sulcus-deepening TP with MPFL-R and LRL yields good to excellent short-term results without progressive chondral deterioration, enabling patients to return to their prior or higher activity levels despite advanced preoperative chondral lesions. TP can be considered a safe, joint-preserving technique for PF stabilisation.

Level of evidence: Level III, retrospective cohort study.

Purpose: To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.

Methods: Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference.

Results: 376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile.

Conclusions: Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended.

Level of evidence: Level II.

Purpose: To explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).

Methods: Nine fresh-frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four 'recenter' interventions were then sequentially applied: subacromial interposition (SI) using 4- and 8-mm spacers and superior capsule reconstruction (SCR) using two- and four-layer fascia lata grafts. Dynamic biomechanical experiments were performed for each condition. The primary outcomes were glenohumeral abduction angle (GAA). The secondary outcomes were acromiohumeral distance (AHD) and subacromial contact pressure.

Results: In the intact condition, the GAA was significantly greater compared to the IMRCT condition at most deltoid force levels (p < 0.05 for all except at 80 N). IMRCT significantly increased maximum contact pressure (MCP) compared to intact (Δ +0.09 MPa, p = 0.029). For recentering interventions, neither SI nor SCR improved GAA (p > 0.05). The 8-mm spacer and four-layer SCR condition significantly increased MCP compared to the intact condition (Δ +0.22 MPa, p = 0.048, Δ +0.24 MPa, p = 0.012, respectively).

Conclusion: Both SCR and SI could effectively recenter the humeral head, but neither technique improved shoulder abduction, with both even significantly increasing subacromial contact pressures. These findings suggest that surgical goals focusing solely on recentering humeral head may need re-evaluation, particularly, for patients with high functional demands on shoulder abduction.

Level of evidence: N/A.

Purpose: To evaluate factors associated with revision anterior cruciate ligament reconstruction (ACLR) within 5 years of primary ACLR in children and adolescents.

Methods: Children and adolescents (age <20 years at surgery) who underwent primary hamstring tendon ACLR at the Capio Artro Clinic, Stockholm, Sweden, between January 2005 and December 2018 were identified. Revision ACLR within 5 years of primary ACLR was captured in the Swedish National Knee Ligament Registry. Univariable and multivariable logistic regression analyses were used to evaluate the associations between revision ACLR and preoperative (age, sex, body mass index, time from injury to surgery, pre-injury Tegner activity level, medial collateral ligament injury, passive contralateral knee hyperextension [≤-5°]), intraoperative (medial meniscus and lateral meniscus [LM] resection or repair, cartilage injury and graft diameter) and post-operative (KT-1000 side-to-side anterior knee laxity, limb symmetry index for extension and flexion strength and single-leg-hop (SLH) test performance at 6 months) factors at primary ACLR.

Results: A total of 1888 patients (mean age: 16.0 ± 2.0, range: 8-19 years) who underwent primary ACLR were included. The overall incidence of revision ACLR within 5 years was 9.0% (170 out of 1888). Univariable analysis revealed that a time from injury to primary ACLR of <5 months (odds ratio [OR]: 2.27, 95% confidence interval [CI]: 1.61-2.35, p < 0.001) and LM resection (OR: 1.49, 95% CI: 1.00-2.20, p = 0.04) increased the odds of revision ACLR. Multivariable analysis showed that revision ACLR was significantly associated only with a time from injury to primary ACLR of <5 months (OR: 2.56, 95% CI: 1.72-3.70, p < 0.001).

Conclusion: There was a lack of association between revision ACLR and preoperative, intraoperative and post-operative factors at primary ACLR in children and adolescents. A time from injury to primary ACLR of <5 months was the only factor associated with revision ACLR within 5 years.

Level of evidence: Level III.

Purpose: This study aims to compare the 2-year clinical outcomes of meniscal reconstructions using allograft versus autograft tissue, with a focus on patient-reported outcomes, complication rates and surgical revision rates.

Methods: This prospective comparative cohort study included 60 patients (ages 18-60 years) undergoing meniscal reconstruction. Patients were divided into an allograft group (n = 31) and an autograft group (n = 29; Hamstring tendon = 25 and patellar tendons = 4). Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) score and EuroQol-5D (EQ-5D) score. Surgical revision rates, reoperation rates and complication rates were recorded. Time-to-reoperation was analyzed using Kaplan-Meier survival curves and a Cox hazards model was used to identify predictors of time-to-reoperation/revision (failure).

Results: At 2 years, the autograft group had higher KOOS pain scores (89.93 vs. 86.87, p = 0.002) and EQ-5D scores (0.884 vs. 0.802, p = 0.002) compared to the allograft group. There were no differences in KOOS sports, symptoms, activities of daily living or UCLA scores between the groups. The allograft group had a higher complication (relative risk [RR] = 2.34, 95% confidence interval [CI]: 0.49-11.13, p = 0.266), reoperation (RR = 1.87, 95% CI: 0.51-6.80, p = 0.329) and revision surgery rates (RR = 2.81, 95% CI: 0.31-25.48, p = 0.334), although not statistically significant. Cox modelling identified autograft as a significant predictor of reduced reoperation risk (hazards ratio = 0.057, 95% CI: 0.004-0.036, p = 0.036), with higher preoperative KOOS pain and sports scores also associated with reduced reoperation risk.

Conclusion: These preliminary results show that meniscal reconstruction using autograft tissue is associated with better clinical outcomes in terms of pain relief and quality of life, as well as lower reoperation and complication rates, compared to allograft tissue. However, these observations need to be validated by well-powered research.

Level of evidence: Level III prospective.

Purpose: Recently, blood flow restriction (BFR) and cross education (CE) trainings are the options for quadriceps strength recovery after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the effects of CE combined with BFR on quadriceps strength and thickness after ACLR.

Methods: Twenty-four male patients [(Age: 24.9 ± 6.3 years, body mass index: 24 ± 2.3 kg/m²) who had undergone ACLR with hamstring autograft were included. At 4 weeks after surgery, the patients were randomly divided into two groups (Group-1: CE + BFR, n = 13, Group-2: CE, n = 11). All patients had standardized rehabilitation for their reconstructed limb until 12 weeks postsurgery, and they all received CE training for uninjured limb at isokinetic system (quadriceps eccentric contraction, 60°/s 3-set 12-rep, 2-days in a week) during 8 weeks. Group 2 performed the same CE procedure with BFR. Quadriceps isometric strength was measured using an isokinetic dynamometer, while the thickness of quadriceps (rectus femoris, vastus lateralis, vastus medialis obliquus) and cross-sectional area of rectus femoris were evaluated using ultrasound pretraining (4th-week postsurgery) and posttraining (12th-week postsurgery). Analysis of variance was used for statistical analysis.

Results: Group-by-time interaction and the group main effect were not significant for any measured variables in both limbs (p > 0.05). There was a significant main effect of time observed for quadriceps strength and thickness in involved and uninvolved limbs (p < 0.001, p < 0.05, respectively). In Group 1, the limb symmetry index for quadriceps strength increased from 49.3% to 71.7%, while in Group 2, it increased from 50.9% to 75.2%.

Conclusion: BFR training, adapted to CE eccentric strengthening, may not be effective for quadriceps muscle strength recovery after ACLR. Further investigations with varied training protocols are needed to research the impact of BFR on CE.

Level of evidence: Level II randomized controlled trial.

Purpose: To identify values of reported quadriceps tendon (QT) autograft diameter and length in anterior cruciate ligament reconstruction (ACLR), and to identify methods to predict these parameters.

Methods: A search was conducted across three databases from inception to 30 March 2024. Data on study characteristics, demographics, anthropometric data, imaging techniques, and QT autograft or harvested QT tendon parameters were extracted. Values quantifying the statistical strength of associations between imaging or anthropometric characteristics and graft or tendon parameters as well as for associations between these parameters and postoperative outcomes were recorded.

Results: A total of 3633 patients were included. The weighted mean QT autograft diameter and length were 8.9 (standard deviation [SD]: 0.7, range: 7.8-10.4) mm and 8.1 (SD: 1.3, range: 5.6-9.3) cm, respectively. A total of 93.8% of studies that reported mean QT autograft diameter found a value of 8 mm or greater. The QT groups had similar or significantly greater mean autograft diameter compared to the hamstring tendon (HT) groups in 91.7% of studies that reported significance. Regarding MRI measurements, 71.4% of the correlation coefficients reported showed a moderate positive correlation, 28.6% showed a low positive correlation and 14.3% showed a high positive correlation. Regarding anthropometric characteristics, 33.3% and 16.7%, 16.7% and 14.3% of studies that reported on the relationship between QT autograft diameter and height, weight, body mass index or age, respectively, found a low positive statistically significant correlation. Only statistically nonsignificant associations were reported between QT autograft parameters and post-operative outcomes and complications.

Conclusions: QT autografts used in ACLR have a mean diameter of 8 mm or greater and are consistently larger than HT autografts. Preoperative MRI measurements are better than anthropometric characteristics at predicting QT autograft parameters; however, preoperative prediction may not be necessary for this graft type. QT autograft parameters were not found to be significantly associated with any post-operative complication or outcome.

Level of evidence: Level IV.