Knee Surgery, Sports Traumatology, Arthroscopy最新文献

{"title":"High tibial osteotomy yields sufficient clinical and radiological results in varus knee correction regardless of the site of deformity","authors":"Alessio Maione,&nbsp;Filippo Calanna,&nbsp;Alessandro Napolitano,&nbsp;Matteo Davide Parmigiani,&nbsp;Giuseppe Fedele,&nbsp;Alessandra Menon,&nbsp;Riccardo Compagnoni,&nbsp;Paolo Ferrua,&nbsp;Massimo Berruto,&nbsp;Pietro Simone Randelli","doi":"10.1002/ksa.12793","DOIUrl":"10.1002/ksa.12793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>High tibial osteotomy (HTO) can alleviate symptoms and slow osteoarthritis progression in selected patients with arthritic varus knees. However, the role of postoperative joint line obliquity (JLO) in correcting varus deformity remains unclear. The aim of this study was to evaluate clinical and radiological outcomes of HTO—lateral closing-wedge (LCW-HTO) and medial opening-wedge (MOW-HTO)—in treating varus knees with tibial- and femoral-based deformities, considering JLO boundaries (≤4°).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 99 patients (108 knees) with varus knees (preoperative hip-knee-ankle angle [HKA] ≤ 175°) undergoing HTO. Patients were classified into femoral-based (FEM-Var) or tibial-based (TIB-Var) varus groups, regardless of the surgical technique. Radiographs were analysed preoperatively and at the final follow-up (mean, 9 ± 4.2 years; range, 2–18 years). Clinical outcomes were assessed using the Hospital for Special Surgery score, International Knee Documentation Committee score, Tegner score, Numeric Rating Scale, and Crosby-Insall score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort had a mean age of 49.4 ± 10.2 years (range, 18–64 years) at the time of initial follow up. Sixty-eight knees (63%) underwent LCW-HTO, and 40 (37%) underwent MOW-HTO. The mean HKA improved from 172° ± 4.1° (range, 162°–175°) preoperatively to 178° ± 3° (range, 176°–180°) postoperatively. Most patients achieved a JLO ≤ 4° (TIB-Var: two patients &gt; 4°; FEM-Var: five patients &gt; 4°). The TIB-Var group demonstrated superior JLO correction (mean postoperative JLO: TIB-Var, 2.9° ± 1.5°; FEM-Var, 3.5° ± 1.6°; <i>p</i> &lt; 0.01) and greater changes in the joint line congruency angle (JLCA). Both groups showed significant improvements in all clinical scores (<i>p</i> &lt; 0.01), with no osteoarthritis progression at the last follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HTO is an effective procedure for treating pathological varus knees, regardless of the site of the deformity. Both FEM-Var and TIB-Var groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, the TIB-Var group showed superior correction in JLO and achieved better postoperative JLCA than the FEM-Var ones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, cohort study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3350-3360"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661765","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}

{"title":"Medial unicompartmental knee arthroplasty after knee osteotomy is safe and effective in the absence of excessive valgus overcorrection","authors":"Conradin Schweizer,&nbsp;Anil Pulatkan,&nbsp;Tatjana Krug,&nbsp;Joachim Herre,&nbsp;Peter R. Aldinger,&nbsp;Christian Merle,&nbsp;Wenzel Waldstein","doi":"10.1002/ksa.12779","DOIUrl":"10.1002/ksa.12779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Limited evidence exists regarding the safety and efficacy of medial unicompartmental knee arthroplasty (UKA) in patients with end-stage medial arthritis following knee osteotomy. This study aims to evaluate survival, functional and radiological outcomes in patients undergoing medial UKA following knee osteotomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted evaluating 63 knees (60 patients; 62% men, 38% women; mean age 61 ± 8 years; body mass index 28 ± 5 kg/m²) who underwent medial UKA (<i>n</i> = 47 mobile-bearing, <i>n</i> = 16 fixed-bearing) following knee osteotomy. Patients were considered suitable for medial UKA if they met the Oxford criteria and had a preoperative hip–knee–ankle angle (HKAA) &lt; 5° valgus and a medial proximal tibial angle (MPTA) &lt; 95°. Primary outcomes were cumulative revision rates for (1) conversion to total knee arthroplasty (TKA) and (2) any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA Activity Score. HKAA was measured to determine overall limb alignment pre- and post-operatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average time from osteotomy to UKA was 11 ± 8 years, and the mean follow-up after UKA was 5 ± 2 years. The cumulative 8-year implant survival rate was 96.3% (95% confidence interval [CI]: 0.912–1.0) for revision to TKA and 93.2% (95% CI: 0.899–0.965) for any reoperation. Two patients required revision to TKA due to overcorrection and infection. The mean OKS improved from 25.5 ± 5.9 preoperatively to 42.8 ± 6.0 post-operatively (<i>p</i> &lt; 0.001). The mean preoperative HKAA of 2.4 ± 3.0° varus was corrected to 0.0 ± 3.1°.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Medial UKA after knee osteotomy represents a viable treatment option, but it requires a strict preoperative alignment assessment. In the absence of excessive mechanical valgus alignment (HKAA &lt; 3° valgus) and severe valgus deformities (MPTA &lt; 95°) of the proximal tibia, medial UKA provides favourable midterm implant survivorship and excellent functional outcomes. In borderline cases, fixed-bearing implants should be considered to avoid valgus overcorrection.</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 12","pages":"4303-4311"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661768","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}

{"title":"Critical considerations in the selection between knee osteotomy and unicompartmental knee arthroplasty in younger patients with varus alignment and early-stage knee osteoarthritis","authors":"Matthieu Ollivier,&nbsp;Kristian Kley,&nbsp;Ayoosh Pareek,&nbsp;Sebastien Parratte,&nbsp;Michael T. Hirschmann","doi":"10.1002/ksa.12801","DOIUrl":"10.1002/ksa.12801","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3445-3453"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661761","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}

{"title":"Preoperative CPAK phenotype does not affect clinical and radiological outcomes after medial closing-wedge distal femoral osteotomy in valgus knees at 8-year follow-up","authors":"Alessio Maione,&nbsp;Pierrenzo Pozzi,&nbsp;Alessandra Menon,&nbsp;Filippo Calanna,&nbsp;Riccardo Compagnoni,&nbsp;Paolo Ferrua,&nbsp;Massimo Berruto,&nbsp;Pietro Simone Randelli","doi":"10.1002/ksa.12795","DOIUrl":"10.1002/ksa.12795","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the distribution of coronal plane alignment of the knee (CPAK) phenotypes before and after medial closing-wedge distal femoral osteotomy (MCW-DFO) and assess their correlation with long-term clinical outcomes in valgus knee deformity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective analysis included patients who underwent MCW-DFO for valgus knee correction between 2007 and 2022. Preoperative and post-operative knee alignment was assessed using standard long leg weight-bearing radiographs, and clinical outcomes were evaluated using International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner and visual analogue scale (VAS). Patients were stratified based on preoperative and post-operative CPAK classification phenotypes. Outcomes were compared between the most common preoperative and post-operative CPAK phenotypes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one patients (54 knees) were included in the study, with a mean age of 48.7 ± 13.2. The overall mean follow-up was 97 ± 57 months. Statistically significant improvements were observed in all clinical scores, and a statistically significant radiological correction of valgus was achieved following MCW-DFO. According to preoperative CPAK phenotype, the most prevalent groups, CPAK 6 and 3, showed no significant differences in clinical outcomes (final IKDC CPAK 3: 60.7 ± 12.2, CPAK 6: 62.9 ± 17 [<i>p</i> = 0.67]; final KOOS CPAK 3: 76.8 ± 6.9, CPAK 6: 77.3 ± 14.9 [<i>p</i> = 0.37]). Similarly, stratification by post-operative CPAK showed no significant differences between CPAK 5 and 8 (final IKDC CPAK 5: 63.3 ± 15.7, CPAK 8: 71.1 ± 10.2 [<i>p</i> = 0.12]; final KOOS CPAK 5: 79.8 ± 7.9, CPAK 8: 82.3 ± 9.3 [<i>p</i> = 0.53]). During the study period, one patient (1.8%) sustained a peri-implant fracture, one patient (1.8%) underwent re-intervention due to pseudoarthrosis and three patients (5.5%) underwent total knee arthroplasty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MCW-DFO is a safe, effective treatment for symptomatic valgus knee deformity. Surgical correction achieved a neutral mechanical axis (CPAK 5 and 8), with no clinical differences for different JLO values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III, case–control study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3686-3696"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621747","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}

{"title":"Postoperative changes in CPAK-classification do not significantly influence patient-reported outcome measures following conventional or robotic-assisted total knee arthroplasty: A randomised controlled trial","authors":"Peter Bollars,&nbsp;Hans Feyen,&nbsp;Dinesh Nathwani,&nbsp;Ali Albelooshi,&nbsp;Max Ettinger,&nbsp;Ronny De Corte,&nbsp;Martijn G. M. Schotanus","doi":"10.1002/ksa.12740","DOIUrl":"10.1002/ksa.12740","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to investigate the impact of pre- and postoperative changes in Coronal Plane Alignment of the Knee (CPAK) classification on patient-reported outcome measures (PROMs) and to determine the rate of CPAK classification change in patients undergoing either conventionally aligned total knee arthroplasty (CTKA) or imageless robotic-assisted total knee arthroplasty (RATKA). We hypothesised that PROM improvements would be comparable regardless of whether postoperative CPAK classification was preserved (“In-the-box”) or altered (“Out-of-the-box”) in both surgical techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective randomised controlled trial, 180 patients were assigned to either CTKA or RATKA. CPAK classification was assessed pre- and postoperatively. PROMs were collected at baseline, 3, and 12 months postoperatively, including the Knee Society Score, Oxford Knee Score, visual analog scale (VAS) for daytime and night time pain, EuroQol-5D (index and VAS), and patient satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were similar between groups. Native CPAK classification was preserved in 31% of CTKA and 41% of RATKA patients. Postoperatively, CPAK II was most common (40% CTKA and 49% RATKA), followed by CPAK V. Both groups showed significant improvements in all PROMs at 3- and 12-months, regardless of CPAK classification change, and operative technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Short-term functional outcomes following TKA were not significantly influenced by In-the-box or Out-of-the box CPAK classification. Both CTKA and RATKA yielded comparable PROM improvements. Although altered CPAK often required greater soft-tissue release, especially in CTKA, this did not affect outcomes, suggesting alignment strategy should prioritise individual anatomy and soft-tissue balance over strict CPAK matching.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3333-3340"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621692","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}

{"title":"Lower body mass index and symptom burden in modern hip arthroscopy patients: Updated epidemiology and trends from the MASH multicenter cohort","authors":"Robert B. Baldwin,&nbsp;Samarth V. Menta,&nbsp;Mark Kurapatti,&nbsp;Dominic Carreira,&nbsp;Shane Nho,&nbsp;Andrew Wolff,&nbsp;John Christoforetti,&nbsp;John Salvo,&nbsp;Dean Matsuda,&nbsp;Anil S. Ranawat","doi":"10.1002/ksa.12745","DOIUrl":"10.1002/ksa.12745","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient-reported outcome measures (International Hip Outcome Tool 12-item [iHOT-12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12-item Short Form Health Survey, Patient-Reported Outcomes Measurement Information System).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US-based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well-being, with a mean iHOT-12 score of 38.7 and a mHHS of 56.0. At 2-year follow-up, 85.9% and 76.4% of patients reached our distribution-based minimal clinically important difference value for mHHS and iHOT-12, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This multicenter data set has demonstrated improved patient-reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.</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 9","pages":"3405-3417"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621728","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}

{"title":"A validated method accounting for joint line convergence angle reduces planning errors in medial opening wedge high tibial osteotomy","authors":"Takaaki Hiranaka,&nbsp;Christopher Davey,&nbsp;Samuel Grasso,&nbsp;Giacomo Dal Fabbro,&nbsp;Harbeer Ahedi,&nbsp;Brett Fritsch,&nbsp;David Parker","doi":"10.1002/ksa.12713","DOIUrl":"10.1002/ksa.12713","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medial opening-wedge high tibial osteotomy (MOWHTO) correction error can result from either planning or execution, or both. This study aimed to (1) identify factors contributing to planning error, and (2) propose and evaluate a new planning method for reducing planning error.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 58 patients (mean age: 46.7 ± 7.2 years) with varus alignment who underwent MOWHTO using patient-specific implants. Radiographic measurements, including hip–knee–ankle angle (HKA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA) and knee joint line obliquity (KJLO), were made preoperatively and 6 months post-operatively. Overall error in HKA and surgical error in MPTA were used to calculate planning error (planning error = overall error − surgical error). A multivariable logistic regression analysis identified risk factors for suboptimal planning error (absolute error &gt;1°), and this information was used to create a method to minimize it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Suboptimal planning error was associated with increased standing JLCA (3.9 ± 1.0° vs. 2.0 ± 1.4°; <i>p</i> &lt; 0.001) and valgus KJLO (−0.6 ± 0.9° vs. 1.1 ± 2.5°; <i>p</i> = 0.005); however, multivariable logistic regression analysis identified increased standing JLCA as the only significant risk factor for suboptimal planning error (odds ratio: 3.27; <i>p</i> &lt; 0.001). A preoperative JLCA cut-off of 2.8° yielded 94% sensitivity and 78% specificity for suboptimal planning error. Retrospective ΔJLCA adjustment, performed by subtracting ΔJLCA from post-operative HKA and recalculating planning error, reduced the mean planning error from 0.6 ± 1.0° to 0.2 ± 0.7° (<i>p</i> = 0.010).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative standing JLCA ≥ 2.8° is a significant risk factor for suboptimal planning in MOWHTO, with an increased risk of over-correction in these patients. The ΔJLCA method, which adjusts patient-specific planning by detecting joint laxity preoperatively using standing and supine images, may minimize planning error and improve post-operative alignment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV, retrospective case series.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3341-3349"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621724","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}

{"title":"Total knee arthroplasty revision with primary implants: Could the kinematic alignment technique be a game changer?","authors":"Charles Riviere,&nbsp;Loïc Villet","doi":"10.1002/ksa.12794","DOIUrl":"10.1002/ksa.12794","url":null,"abstract":"","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 10","pages":"3454-3456"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621750","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}

{"title":"Mid-term survival and physiological joint angles after double level osteotomy of severe varus osteoarthritis","authors":"Moritz Herbst,&nbsp;Steffen Schröter,&nbsp;Atesch Ateschrang,&nbsp;Christoph Ihle,&nbsp;Felix Finger,&nbsp;Tina Histing,&nbsp;Stefan Döbele,&nbsp;Cornelius Fischer,&nbsp;Marc-Daniel Ahrend","doi":"10.1002/ksa.12754","DOIUrl":"10.1002/ksa.12754","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Double-level osteotomy (DLO) is a joint-preserving technique for the treatment of symptomatic varus knee osteoarthritis (OA) in cases of femoral and tibial combined deformity. The study aimed to investigate the mid-term survival rate (&gt;5 years) and restoration of postoperative joint angles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixty-five knees underwent DLO (medial open wedge high tibial osteotomy (MOWHT) and lateral closing wedge distal femoral osteotomy (LCWDFO) between 2011 and 2015. Minimum follow-up was 5 years. The survival rate was recorded and, in case of conversion to knee arthroplasty, the time of conversion. Radiographs were obtained preoperatively, 6 weeks postoperatively and at the last follow-up. On radiographs mechanical tibiofemoral angle (mTFA), mechanical medial proximal tibia angle (mMPTA), mechanical lateral distal femur angle (mLDFA), joint line convergence angle (JLCA) and joint line obliquity (JLO) were measured. The clinical outcome was measured using International Knee Documentation Committee (IKDC), Oxford and Lysholm score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-nine knees (75% follow-up) were included after 8.0 ± 1.4 years. At the last follow-up, six knees underwent arthroplasty (7-year survival rate: 91.8%; 5-year survival rate: 93.9%) in average after 5.1 ± 2.3 years. Preoperatively, there was a varus deformity of −10.0 ± 2.5° (mTFA). In addition, pathologic knee joint angles with an mMPTA of 84.7 ± 2.2°, an mLDFA of 91.4 ± 2.1°, an JLCA of 3.4 ± 1.8 and a JLO of 3.0 ± 1.9°. Six weeks postoperatively mTFA was 0.7 ± 2.2° with values of mMPTA 91.0 ± 2.3°, mLDFA 86.8 ± 2.0° and JLO of 2.8 ± 2.1°. In the mid-term, a preserved leg axis (mTFA: −0.9 ± 2.7°) and preserved joint angles (mMPTA: 90.3 ± 2.7°, mLDFA: 87.1 ± 2.3°, JLCA: 4.3 ± 1.9 JLO: 3.2 ± 2.1°) were observed. At the last follow-up, the IKDC, Oxford Knee Score (OKS) and Lysholm score were: 61.2%, 36.1 points and 78.3 points, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study demonstrates that DLO is an effective surgical technique to restore physiological joint angles in patients with severe preoperative deformity and symptomatic varus OA. Mid-term results indicate good clinical outcomes and a low conversion rate to TKA.</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":"3963-3974"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12754","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621729","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}

{"title":"Are current total knee arthroplasty implants tested and approved for personalised alignment?","authors":"Sabrina Böhle,&nbsp;Leandra Bauer,&nbsp;Matthias Woiczinski,&nbsp;Georg Matziolis","doi":"10.1002/ksa.12783","DOIUrl":"10.1002/ksa.12783","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Total knee arthroplasty (TKA) traditionally aims for neutral mechanical alignment (MA) to ensure implant longevity. However, this approach ignores individual knee variations, potentially leading to soft-tissue imbalances and suboptimal functional outcomes. As an alternative, personalised alignment techniques (PAT) have emerged that aim to restore bony anatomy, potentially improve soft tissue balance and thus accelerate recovery. Despite promising short-term results, long-term outcomes and regulatory approval remain unclear. This study investigates the extent to which TKA systems from various manufacturers are approved for kinematic alignment and allowable deviations from neutral MA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>TKA systems were identified using the 2020 Endoprosthesis Registry Germany (EPRD). Manufacturers were systematically contacted to determine if their implants were approved for deviations from neutral MA and the maximum permissible deviations. Follow-ups in 2021 and 2022 resulted in responses from 11 of 13 manufacturers, with an additional update in 2023 and 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven of twelve responding manufacturers either stated that their prostheses were not approved for MA deviations or did not specify details. Among the others, approval varied between implant systems. Two allowed deviations for specific implants without defined limits, while three specified allowable deviation ranges (Triathlon from Stryker with their Mako System 6° varus to 3° valgus; ATTUNE CR FB from Johnson &amp; Johnson deviation 7° varus to 3° valgus°; ATTUNE PS FB and ATTUNE RP ± 3°; Primary system from Zimmer Biomet 0 ± 5° with their ROSA system). Revision systems universally restricted axis deviation due to mechanical constraints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Only a limited number of manufacturers have conducted rigorous testing of their systems for deviations from MA, and consequently, are able to specify limits to such deviations. Additionally, practical limitations arise from the complexity of PAT, patient-specific factors and prosthesis suitability. To safeguard patient safety and ensure implant longevity, manufacturers should systematically evaluate alignment deviations through standardised tests or computational simulations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"34 1","pages":"174-182"},"PeriodicalIF":5.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621726","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}