Articular surface lesions, which include chondral and osteochondral defects, are debilitating and favor the development of osteoarthritis. The long-term follow-up of the world's first case of implantation of an aragonite-based scaffold (Agili-C™, from CartiHeal) in a chronic post-traumatic osteochondral knee joint lesion (International Cartilage Repair Society (ICRS) grade IV, size 2 cm2) was presented. Over a decade after implantation, the treatment results remained stable, the patient was fully satisfied, and was able to resume his preinjury activities. Despite the partial meniscectomy of the medial meniscus, the degenerative process was successfully contained, with only subtle osteophytes and mild narrowing of the medial compartment. In addition, radiologic monitoring of the restored bone and cartilage tissue showed successful and durable results.
{"title":"Osteochondral knee joint lesion treated with an aragonite-based scaffold. 12-year follow-up of the world's first implantation: Case report","authors":"Matej Drobnič MD, PhD , Elizaveta Kon MD, PhD , Dror Robinson MD, PhD , Matic Kolar MD, PhD , Nir Altschuler MSc","doi":"10.1016/j.jisako.2025.101040","DOIUrl":"10.1016/j.jisako.2025.101040","url":null,"abstract":"<div><div>Articular surface lesions, which include chondral and osteochondral defects, are debilitating and favor the development of osteoarthritis. The long-term follow-up of the world's first case of implantation of an aragonite-based scaffold (Agili-C™, from CartiHeal) in a chronic post-traumatic osteochondral knee joint lesion (International Cartilage Repair Society (ICRS) grade IV, size 2 cm<sup>2</sup>) was presented. Over a decade after implantation, the treatment results remained stable, the patient was fully satisfied, and was able to resume his preinjury activities. Despite the partial meniscectomy of the medial meniscus, the degenerative process was successfully contained, with only subtle osteophytes and mild narrowing of the medial compartment. In addition, radiologic monitoring of the restored bone and cartilage tissue showed successful and durable results.</div></div><div><h3>Study design</h3><div><strong>Case-report (level of evidence: V</strong>).</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101040"},"PeriodicalIF":3.3,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patellofemoral osteoarthritis (PFOA) is unicompartmental arthritis with a hallmark of anterior knee pain, disturbing quality of life. Unlike tibiofemoral osteoarthritis, there is still a lack of evidence regarding intra-articular injection for isolated PFOA patients. This study aims to evaluate the efficacy of intra-articular hyaluronic acid (HA) in comparison to corticosteroid (CS) injections for pain reduction and improvement in knee function in isolated PFOA patients.
Methods
This was a prospective, double-blind, randomized controlled trial. Patients with isolated PFOA based on clinical and radiographic features were randomized 1:1 to receive a single-shot, 2 ml intra-articular 2% sodium hyaluronate plus 0.5% mannitol or a 2 ml solution comprising 1 ml of 40 mg triamcinolone acetonide and 1% lidocaine. The visual analog scale (VAS) for anterior knee pain, Kujala score, pain during injection, and adverse events were assessed during a 6-month follow-up.
Results
A total of 60 patients were included. Both groups demonstrated statistically significant improvements in VAS pain and Kujala scores from 48 h post-injection to 6 months compared to baseline (p < 0.05). At the 6-month follow-up, there were no significant between-group differences in VAS pain (mean difference [95% CI]: −4.46 [-11.2, 2.28]; p = 0.270) or Kujala scores (2.56 [-4.08, 9.2]; p = 0.45). However, at 48 h, 72 h, and 1 week post-injection, the CS group reported statistically significantly greater pain relief compared to the HA group (mean differences: 10.33, 9.67, and 7.67; p = 0.002, 0.003, and 0.013, respectively). No significant differences were observed in pain during injection or adverse events.
Conclusion
Intra-articular HA and CS injections provide comparable pain reduction and functional score improvement at 6-month follow-up in patients with PFOA, with better pain relief in the first week for the CS group. Intra-articular HA may be an alternative to CS, with equivalent results but without increasing the risk of chondrotoxicity and cartilage volume loss, especially in isolated PFOA patients whose tibiofemoral compartment cartilage is relatively preserved.
{"title":"Efficacy of single intra-articular 2% sodium hyaluronate versus corticosteroid injection in isolated patellofemoral osteoarthritis: A double-blind, randomized controlled trial","authors":"Korawish Mekariya MD , Pratchaya Manop MD , Bancha Chernchujit MD","doi":"10.1016/j.jisako.2025.101038","DOIUrl":"10.1016/j.jisako.2025.101038","url":null,"abstract":"<div><h3>Introduction/objective</h3><div>Patellofemoral osteoarthritis (PFOA) is unicompartmental arthritis with a hallmark of anterior knee pain, disturbing quality of life. Unlike tibiofemoral osteoarthritis, there is still a lack of evidence regarding intra-articular injection for isolated PFOA patients. This study aims to evaluate the efficacy of intra-articular hyaluronic acid (HA) in comparison to corticosteroid (CS) injections for pain reduction and improvement in knee function in isolated PFOA patients.</div></div><div><h3>Methods</h3><div>This was a prospective, double-blind, randomized controlled trial. Patients with isolated PFOA based on clinical and radiographic features were randomized 1:1 to receive a single-shot, 2 ml intra-articular 2% sodium hyaluronate plus 0.5% mannitol or a 2 ml solution comprising 1 ml of 40 mg triamcinolone acetonide and 1% lidocaine. The visual analog scale (VAS) for anterior knee pain, Kujala score, pain during injection, and adverse events were assessed during a 6-month follow-up.</div></div><div><h3>Results</h3><div>A total of 60 patients were included. Both groups demonstrated statistically significant improvements in VAS pain and Kujala scores from 48 h post-injection to 6 months compared to baseline (p < 0.05). At the 6-month follow-up, there were no significant between-group differences in VAS pain (mean difference [95% CI]: −4.46 [-11.2, 2.28]; p = 0.270) or Kujala scores (2.56 [-4.08, 9.2]; p = 0.45). However, at 48 h, 72 h, and 1 week post-injection, the CS group reported statistically significantly greater pain relief compared to the HA group (mean differences: 10.33, 9.67, and 7.67; p = 0.002, 0.003, and 0.013, respectively). No significant differences were observed in pain during injection or adverse events.</div></div><div><h3>Conclusion</h3><div>Intra-articular HA and CS injections provide comparable pain reduction and functional score improvement at 6-month follow-up in patients with PFOA, with better pain relief in the first week for the CS group. Intra-articular HA may be an alternative to CS, with equivalent results but without increasing the risk of chondrotoxicity and cartilage volume loss, especially in isolated PFOA patients whose tibiofemoral compartment cartilage is relatively preserved.</div></div><div><h3>Clinical Trial Registration</h3><div>TCTR20200709009.</div></div><div><h3>Level of Evidence</h3><div>Level I.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101038"},"PeriodicalIF":3.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-15DOI: 10.1016/j.jisako.2025.101037
Vella-Baldacchino Martinique, Heegaard Julie, Stephensen Snorre, Rytter Soeren, Wagner Per Kristensen, Asghar Zahid, Liddle Alex, Cobb Justin, Odgaard Anders
Introduction: The purpose of this study was to determine differences in physical activity among patients who had had a total knee replacement (TKR) or patellofemoral joint replacement (PFR), in a randomized controlled trial, 10 years after surgery.
Methods: Patients with isolated patellofemoral joint osteoarthritis (PFJ OA) were recruited to a randomized controlled trial. Patients were randomized 1:1 to PFR or TKR between 2007 and 2014. Patients were invited back to participate 10 years later. Those who accepted wore a GENEActiv wrist-worn accelerometer for 7 days. The duration of inactivity, light, moderate, and vigorous activity was compared between groups. Total physical activity, total step count, and 24-h (Euclidean norm minus 1g- ENMO) acceleration were measured and compared using t-tests or Wilcoxon tests.
Results: There were a total of 30 patients recruited as part of the study; 17 patients had a PFR, and 13 patients had a TKR. PFR patients did an average of 2% more minutes of total physical activity, 1154.2 min per week, compared to TKR patients, 1132.1 min per week; no significant difference was found (p = 0.89). PFR patients had an 8.6% higher step count compared to TKR patients per week, but did not show a statistically significant difference p > 0.05. There was no statistically significant difference between the duration of light, moderate and vigorous activity performed.
Conclusion: Although PFR had a higher step count and total physical activity per week, there was no statistically significant difference in physical activity levels between PFR and TKR participants at the 10-year follow-up.
{"title":"Equivocal physical activity outcomes 10 Years after patellofemoral vs total knee replacement: Follow-up of a previously reported randomized controlled trial in isolated patellofemoral joint osteoarthritis.","authors":"Vella-Baldacchino Martinique, Heegaard Julie, Stephensen Snorre, Rytter Soeren, Wagner Per Kristensen, Asghar Zahid, Liddle Alex, Cobb Justin, Odgaard Anders","doi":"10.1016/j.jisako.2025.101037","DOIUrl":"10.1016/j.jisako.2025.101037","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to determine differences in physical activity among patients who had had a total knee replacement (TKR) or patellofemoral joint replacement (PFR), in a randomized controlled trial, 10 years after surgery.</p><p><strong>Methods: </strong>Patients with isolated patellofemoral joint osteoarthritis (PFJ OA) were recruited to a randomized controlled trial. Patients were randomized 1:1 to PFR or TKR between 2007 and 2014. Patients were invited back to participate 10 years later. Those who accepted wore a GENEActiv wrist-worn accelerometer for 7 days. The duration of inactivity, light, moderate, and vigorous activity was compared between groups. Total physical activity, total step count, and 24-h (Euclidean norm minus 1g- ENMO) acceleration were measured and compared using t-tests or Wilcoxon tests.</p><p><strong>Results: </strong>There were a total of 30 patients recruited as part of the study; 17 patients had a PFR, and 13 patients had a TKR. PFR patients did an average of 2% more minutes of total physical activity, 1154.2 min per week, compared to TKR patients, 1132.1 min per week; no significant difference was found (p = 0.89). PFR patients had an 8.6% higher step count compared to TKR patients per week, but did not show a statistically significant difference p > 0.05. There was no statistically significant difference between the duration of light, moderate and vigorous activity performed.</p><p><strong>Conclusion: </strong>Although PFR had a higher step count and total physical activity per week, there was no statistically significant difference in physical activity levels between PFR and TKR participants at the 10-year follow-up.</p><p><strong>Level of evidence: </strong>Level 2.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101037"},"PeriodicalIF":3.3,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.jisako.2025.101031
{"title":"Editorial: A message of thanks to the JISAKOS community","authors":"","doi":"10.1016/j.jisako.2025.101031","DOIUrl":"10.1016/j.jisako.2025.101031","url":null,"abstract":"","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101031"},"PeriodicalIF":3.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1016/j.jisako.2025.101036
Alyssa A. Federico , Reva Y. Qiu , Golpira Elmi Assadzadeh , Nicholas G. Mohtadi
Importance
The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, with most patients undergoing surgical reconstruction. Of these patients, 6.5–27.6% require a second operation to treat loss of motion, which can cause substantial delays in patient recovery and return to sport. Currently, there is a paucity of comprehensive data regarding loss of motion following anterior cruciate ligament reconstruction (ACLR) surgery, resulting in variable measures of incidence and uncertainty about risk factors.
Objective
The primary objective of this study is to identify the incidence and risk factors for repeat surgical intervention for loss of motion following primary ACLR.
Evidence review
Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, MEDLINE, and PubMed databases were searched, along with the reference lists of included articles and related systematic reviews. Studies were included if they met the following criteria: (1) included adult patients with primary ACL ruptures treated surgically, (2) had a follow-up period of at least 3 months postoperative, (3) provided an objective definition of stiffness, arthrofibrosis, or cyclops lesions, and (4) reported the incidence and/or risk factors for loss of motion. A random-effects meta-analysis was conducted to estimate the pooled incidence of loss of motion across studies.
Findings
A total of 48 studies were included in the final analysis. Of these studies, 46 reported the incidence of loss of motion requiring surgery, with a mean pooled incidence of 4% (95% CI: 3–5 %). The incidence decreased over time from 10% (95% CI: 7–13%) in 1991–1999 to 4% (95% CI: 3–5%) in 2000–2023. There were 29 studies that reported statistically significant risk factors for loss of motion requiring surgery. The most common risk factors were female sex, acute repair, concomitant meniscus repair, delayed postoperative range of motion, and preoperative range of motion deficit.
Conclusion
The incidence of loss of motion requiring surgery after ACLR is 4%, with a variety of risk factors related to the patient, injury, surgery, and recovery. The incidence has decreased over time, but arthrofibrosis remains a devastating surgical complication that is important to discuss with patients.
Level of Evidence
III.
重要性：前交叉韧带（ACL）是膝关节最常见的韧带损伤，大多数患者接受手术重建。在这些患者中，6.5-27.6%需要第二次手术来治疗运动能力丧失，这可能导致患者恢复和恢复运动的严重延迟。目前，缺乏关于ACL重建（ACLR）手术后运动丧失的综合数据，导致发病率的测量变化和危险因素的不确定性。目的：本研究的主要目的是确定原发性ACLR后运动丧失的重复手术干预的发生率和危险因素。证据评价：两名独立的评价者根据系统评价和荟萃分析指南的首选报告项目进行了系统评价。检索了EMBASE、MEDLINE和PubMed数据库，以及纳入的文章和相关系统综述的参考文献列表。符合以下标准的研究被纳入：(1)纳入手术治疗的原发性前交叉韧带破裂的成年患者，(2)术后随访至少3个月，(3)提供僵硬、关节纤维化或独眼病变的客观定义，(4)报告运动能力丧失的发生率和/或危险因素。进行了随机效应荟萃分析，以估计所有研究中运动能力丧失的合并发生率。结果：最终分析共纳入48项研究。在这些研究中，46项报告了需要手术的运动能力丧失的发生率，平均合并发生率为4% （95% CI为3-5%）。随着时间的推移，发病率从1991-1999年的10% （95% CI 7-13%）下降到2000-2023年的4% （95% CI 3-5%）。有29项研究报告了需要手术的运动能力丧失的统计学显著风险因素。最常见的危险因素是女性、急性修复、伴随的半月板修复、术后活动范围延迟和术前活动范围缺陷。结论及相关性：ACLR术后需要手术的运动能力丧失发生率为4%，与患者、损伤、手术和康复相关的多种危险因素。随着时间的推移，发病率已经下降，但关节纤维化仍然是一个毁灭性的手术并发症，与患者讨论是很重要的。证据水平：III。
{"title":"Incidence and risk factors of loss of motion following anterior cruciate ligament reconstruction: a systematic review and meta-analysis","authors":"Alyssa A. Federico , Reva Y. Qiu , Golpira Elmi Assadzadeh , Nicholas G. Mohtadi","doi":"10.1016/j.jisako.2025.101036","DOIUrl":"10.1016/j.jisako.2025.101036","url":null,"abstract":"<div><h3>Importance</h3><div>The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, with most patients undergoing surgical reconstruction. Of these patients, 6.5–27.6% require a second operation to treat loss of motion, which can cause substantial delays in patient recovery and return to sport. Currently, there is a paucity of comprehensive data regarding loss of motion following anterior cruciate ligament reconstruction (ACLR) surgery, resulting in variable measures of incidence and uncertainty about risk factors.</div></div><div><h3>Objective</h3><div>The primary objective of this study is to identify the incidence and risk factors for repeat surgical intervention for loss of motion following primary ACLR.</div></div><div><h3>Evidence review</h3><div>Two independent reviewers conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, MEDLINE, and PubMed databases were searched, along with the reference lists of included articles and related systematic reviews. Studies were included if they met the following criteria: (1) included adult patients with primary ACL ruptures treated surgically, (2) had a follow-up period of at least 3 months postoperative, (3) provided an objective definition of stiffness, arthrofibrosis, or cyclops lesions, and (4) reported the incidence and/or risk factors for loss of motion. A random-effects meta-analysis was conducted to estimate the pooled incidence of loss of motion across studies.</div></div><div><h3>Findings</h3><div>A total of 48 studies were included in the final analysis. Of these studies, 46 reported the incidence of loss of motion requiring surgery, with a mean pooled incidence of 4% (95% CI: 3–5 %). The incidence decreased over time from 10% (95% CI: 7–13%) in 1991–1999 to 4% (95% CI: 3–5%) in 2000–2023. There were 29 studies that reported statistically significant risk factors for loss of motion requiring surgery. The most common risk factors were female sex, acute repair, concomitant meniscus repair, delayed postoperative range of motion, and preoperative range of motion deficit.</div></div><div><h3>Conclusion</h3><div>The incidence of loss of motion requiring surgery after ACLR is 4%, with a variety of risk factors related to the patient, injury, surgery, and recovery. The incidence has decreased over time, but arthrofibrosis remains a devastating surgical complication that is important to discuss with patients.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101036"},"PeriodicalIF":3.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.jisako.2025.101034
Waldo Gonzalez , Juan Pablo Riquelme , Diego Barba , Daniela Erskine , Rodrigo Venegas , Rafael Calvo , David Figueroa
Introduction
Dynamic knee valgus has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but its role in predicting graft failure or contralateral rupture after anterior cruciate ligament reconstruction (ACLR) remains unclear. The purpose of this study was to evaluate dynamic valgus (DV) as a predictor of graft re-rupture and contralateral ACL injury following ACLR, and to explore whether graft type influences this association.
Methods
Prospective cohort study was conducted patients who underwent primary ACLR between 2020 and 2024. Patients with multiligament injuries, osteotomies, or revision surgeries were excluded. DV was measured during a standardized return-to-sport (RTS) drop jump test. Logistic regression was performed to assess associations with graft rerupture and contralateral ACL injury, adjusting for age, sex, body mass index (BMI), and graft type. Receiver operating characteristic (ROC) analysis was used to evaluated discriminative ability.
Results
A total of 137 patients completed follow-up at a mean of 3.0 ± 1.2 years. Most patients were male (75.9%), with a mean age of 26.7 years. Ten patients (7.3%) sustained a graft re-rupture and nine (6.6%) a contralateral rupture. The DV was an independent predictor of graft rerupture (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.001–1.15). In sex-stratified analyses, this association was statistically significant only among men (aOR: 1.13; 95% CI: 1.02–1.24), with an area under the curve (AUC) of 0.76. A threshold between 18° and 20° yielded a balanced sensitivity and specificity of 71% and 73%, respectively. No statistically significant differences in DV were observed across graft types.
Conclusion
DV is an independent predictor of graft rerupture after ACLR, particularly among men, where valgus angles above 18–20° markedly increase the risk of failure. These findings support the integration of DV assessment into postoperative follow-up to identify high-risk patients and to inform graft selection and rehabilitation strategies.
{"title":"Dynamic knee valgus as a predictor of graft rerupture after anterior cruciate ligament reconstruction: Influence of sex and graft type","authors":"Waldo Gonzalez , Juan Pablo Riquelme , Diego Barba , Daniela Erskine , Rodrigo Venegas , Rafael Calvo , David Figueroa","doi":"10.1016/j.jisako.2025.101034","DOIUrl":"10.1016/j.jisako.2025.101034","url":null,"abstract":"<div><h3>Introduction</h3><div>Dynamic knee valgus has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but its role in predicting graft failure or contralateral rupture after anterior cruciate ligament reconstruction (ACLR) remains unclear. The purpose of this study was to evaluate dynamic valgus (DV) as a predictor of graft re-rupture and contralateral ACL injury following ACLR, and to explore whether graft type influences this association.</div></div><div><h3>Methods</h3><div>Prospective cohort study was conducted patients who underwent primary ACLR between 2020 and 2024. Patients with multiligament injuries, osteotomies, or revision surgeries were excluded. DV was measured during a standardized return-to-sport (RTS) drop jump test. Logistic regression was performed to assess associations with graft rerupture and contralateral ACL injury, adjusting for age, sex, body mass index (BMI), and graft type. Receiver operating characteristic (ROC) analysis was used to evaluated discriminative ability.</div></div><div><h3>Results</h3><div>A total of 137 patients completed follow-up at a mean of 3.0 ± 1.2 years. Most patients were male (75.9%), with a mean age of 26.7 years. Ten patients (7.3%) sustained a graft re-rupture and nine (6.6%) a contralateral rupture. The DV was an independent predictor of graft rerupture (adjusted odds ratio [aOR]: 1.07; 95% confidence interval [CI]: 1.001–1.15). In sex-stratified analyses, this association was statistically significant only among men (aOR: 1.13; 95% CI: 1.02–1.24), with an area under the curve (AUC) of 0.76. A threshold between 18° and 20° yielded a balanced sensitivity and specificity of 71% and 73%, respectively. No statistically significant differences in DV were observed across graft types.</div></div><div><h3>Conclusion</h3><div>DV is an independent predictor of graft rerupture after ACLR, particularly among men, where valgus angles above 18–20° markedly increase the risk of failure. These findings support the integration of DV assessment into postoperative follow-up to identify high-risk patients and to inform graft selection and rehabilitation strategies.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101034"},"PeriodicalIF":3.3,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1016/j.jisako.2025.101033
Victoria L'Hourre MD , Antoine Desseaux MD , Thomas Williams MD , Agathe Yvinou MD MSc
Rotating-hinge total knee arthroplasty is a valuable option in complex primary and revision procedures, Rotating-hinge total knee arthroplasty is commonly used in complex primary and revision procedures when severe ligamentous deficiency, bone loss, or instability precludes the use of less constrained implants. Although modern hinge designs aim to reduce mechanical complications, structural failure of the polyethylene insert and its metal-reinforced yoke remains a rare but serious event, often requiring further revision.
We report the case of a 62-year-old man who underwent revision total knee arthroplasty with a rotating-hinge prosthesis for a distal femoral periprosthetic fracture. Initial postoperative recovery was satisfactory. Two years later, he presented with sudden knee pain and swelling, and imaging revealed a fracture of the hinge insert keel with associated femoral component loosening. Intraoperative findings confirmed a fracture involving both the polyethylene and the metal reinforcement. Synovectomy and isolated insert exchange were performed, and cultures grew Staphylococcus aureus and Corynebacterium striatum, leading to chronic suppressive antibiotic therapy.
One year later, a second identical hinge insert fracture occurred despite infection control. Revision surgery with upsizing of the femoral component and a thicker polyethylene insert was performed. Intraoperative cultures were negative. At 12-month follow-up, the patient demonstrated stable implant positioning and satisfactory joint motion, with return to prior activity levels.
This case highlights the biomechanical vulnerability of the cone–cylinder junction of the hinge insert under cyclic loading, particularly when postoperative soft-tissue tension and flexion-extension balance are suboptimal. Isolated insert exchange alone may not sufficiently address the underlying mechanical stresses. Strategic upsizing of the femoral component can restore joint line height, improve the extensor lever arm, and reduce distraction forces transmitted through the hinge.
Early recognition of instability and consideration of mechanical contributors during revision planning may reduce recurrence risk.
{"title":"Recurrent yoke fracture in rotating-hinge total knee arthroplasty: A case report and literature review","authors":"Victoria L'Hourre MD , Antoine Desseaux MD , Thomas Williams MD , Agathe Yvinou MD MSc","doi":"10.1016/j.jisako.2025.101033","DOIUrl":"10.1016/j.jisako.2025.101033","url":null,"abstract":"<div><div>Rotating-hinge total knee arthroplasty is a valuable option in complex primary and revision procedures, Rotating-hinge total knee arthroplasty is commonly used in complex primary and revision procedures when severe ligamentous deficiency, bone loss, or instability precludes the use of less constrained implants. Although modern hinge designs aim to reduce mechanical complications, structural failure of the polyethylene insert and its metal-reinforced yoke remains a rare but serious event, often requiring further revision.</div><div>We report the case of a 62-year-old man who underwent revision total knee arthroplasty with a rotating-hinge prosthesis for a distal femoral periprosthetic fracture. Initial postoperative recovery was satisfactory. Two years later, he presented with sudden knee pain and swelling, and imaging revealed a fracture of the hinge insert keel with associated femoral component loosening. Intraoperative findings confirmed a fracture involving both the polyethylene and the metal reinforcement. Synovectomy and isolated insert exchange were performed, and cultures grew Staphylococcus aureus and Corynebacterium striatum, leading to chronic suppressive antibiotic therapy.</div><div>One year later, a second identical hinge insert fracture occurred despite infection control. Revision surgery with upsizing of the femoral component and a thicker polyethylene insert was performed. Intraoperative cultures were negative. At 12-month follow-up, the patient demonstrated stable implant positioning and satisfactory joint motion, with return to prior activity levels.</div><div>This case highlights the biomechanical vulnerability of the cone–cylinder junction of the hinge insert under cyclic loading, particularly when postoperative soft-tissue tension and flexion-extension balance are suboptimal. Isolated insert exchange alone may not sufficiently address the underlying mechanical stresses. Strategic upsizing of the femoral component can restore joint line height, improve the extensor lever arm, and reduce distraction forces transmitted through the hinge.</div><div>Early recognition of instability and consideration of mechanical contributors during revision planning may reduce recurrence risk.</div></div><div><h3>Level of Evidence</h3><div>V.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101033"},"PeriodicalIF":3.3,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.jisako.2025.101032
W.M. Nabulyato, B. Gompels, A. O'Neill, T. McMeniman, P.T. Myers
This review provides a contemporary analysis of the seminal study "Accelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction" by Shelbourne and Nitz (1990), initially published in the American Journal of Sports Medicine. This retrospective, single-surgeon cohort study compared two postoperative anterior cruciate ligament reconstruction (ACLR) patient groups, both treated using a modified Jones technique. Group I followed a traditional rehabilitation protocol involving immobilization and phased progression, while Group II underwent an accelerated rehabilitation program with early knee motion, weight-bearing, and functional recovery.
The study demonstrated superior outcomes in the accelerated group, including significantly faster knee extension recovery, quicker return of quadriceps strength by 10 weeks, greater KT-1000 stability measurements, lower complication and reoperation rates, and improved patient compliance and satisfaction. These findings led to a paradigm shift in ACL rehabilitation, challenging the necessity of prolonged immobilization and conservative progression. The study's impact continues to influence modern individualized rehabilitation protocols to optimize patient outcomes.
{"title":"The classic from Shelbourne and Nitz (1990) on accelerated rehabilitation after anterior cruciate ligament reconstruction","authors":"W.M. Nabulyato, B. Gompels, A. O'Neill, T. McMeniman, P.T. Myers","doi":"10.1016/j.jisako.2025.101032","DOIUrl":"10.1016/j.jisako.2025.101032","url":null,"abstract":"<div><div>This review provides a contemporary analysis of the seminal study \"Accelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction\" by Shelbourne and Nitz (1990), initially published in the <em>American Journal of Sports Medicine</em>. This retrospective, single-surgeon cohort study compared two postoperative anterior cruciate ligament reconstruction (ACLR) patient groups, both treated using a modified Jones technique. Group I followed a traditional rehabilitation protocol involving immobilization and phased progression, while Group II underwent an accelerated rehabilitation program with early knee motion, weight-bearing, and functional recovery.</div><div>The study demonstrated superior outcomes in the accelerated group, including significantly faster knee extension recovery, quicker return of quadriceps strength by 10 weeks, greater KT-1000 stability measurements, lower complication and reoperation rates, and improved patient compliance and satisfaction. These findings led to a paradigm shift in ACL rehabilitation, challenging the necessity of prolonged immobilization and conservative progression. The study's impact continues to influence modern individualized rehabilitation protocols to optimize patient outcomes.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101032"},"PeriodicalIF":3.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jisako.2025.101030
Horacio Rivarola, Cristian Collazo, Marcos Palanconi, Marcos Meninato, Francisco Endara Urresta, Bautista Rivarola, Mateo Lazzari, Maria Jesús Tuca
Introduction/objectives: Juvenile osteochondritis dissecans (JOCD) of the knee is increasingly observed in skeletally immature athletes due to higher participation in competitive sports. Conservative treatment achieves healing in only 50% of cases, often delaying return to play. The purpose of this study was to evaluate the clinical and radiologic outcomes of early arthroscopic fixation of low-grade JOCD with bioabsorbable pins in high-demand juvenile athletes. We hypothesized that early fixation would result in complete consolidation, excellent functional recovery, and safe return to sport.
Methods: A retrospective analysis was conducted on 32 consecutive patients (16 males, 10 females; mean age, 13.5 ± 2.1 years) with low-grade stable JOCD lesions treated with arthroscopic fixation using SmartNail® bioabsorbable pins between 2004 and 2022. Lesions were staged according to the Di Paola magnetic resonance imaging (MRI) and Guhl arthroscopic classifications, with instability evaluated using De Smet criteria. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Visual analogue score (VAS) pain score. The MRI follow-up at 3, 6, and 12 months confirmed consolidation. Statistical analysis was performed using paired t-tests with significance set at p < 0.05.
Results: The mean follow-up was 6.8 ± 3.2 years. The IKDC score improved from 72.1 ± 8.3 to 94.7 ± 4.5 (Δ +22.6; 95% CI, 18.9-26.2; p < 0.001), and the Lysholm score improved from 68.2 ± 7.6 to 93.5 ± 4.2 (Δ +25.3; 95% CI, 21.4-29.1; p < 0.001). Both exceeded minimal clinically important difference (MCID) thresholds with large effect sizes (Cohen's d > 2.8). The Tegner activity scale was restored to pre-injury levels (6.9 ± 0.5 vs 6.8 ± 0.4; p = 0.41). MRI confirmed 100% consolidation at 6 months, with no implant migration, synovitis, or degenerative changes. All patients returned to sport at their pre-injury level at a mean of 6.2 ± 1.1 months, and no reoperations were required.
Conclusion: Early arthroscopic fixation with bioabsorbable pins in skeletally immature athletes with low-grade JOCD ensures complete consolidation, excellent functional outcomes, and reliable return to sport, demonstrating favorable outcomes compared with those reported in the literature for conservative treatment. This technique may represent a safe and effective surgical option for high-demand juvenile patients.
Level of evidence: Level IV, retrospective case series.
简介/目的：由于参加竞技体育的次数增多，在骨骼发育不成熟的运动员中越来越多地观察到膝关节的幼年性骨软骨炎（JOCD）。保守治疗只在50%的病例中实现愈合，经常延迟恢复比赛。本研究的目的是评估高需求青少年运动员早期关节镜下使用生物吸收针固定低级别JOCD的临床和影像学结果。我们假设早期的固定将导致完全的巩固，良好的功能恢复和安全的运动恢复。方法：回顾性分析2004年至2022年间连续32例（男性16例，女性10例，平均年龄13.5±2.1岁）采用SmartNail®生物吸收针关节镜固定治疗低级别稳定JOCD病变的患者。根据Di Paola MRI和Guhl关节镜分类对病变进行分期，使用De Smet标准评估不稳定性。临床结果采用IKDC主观评分、Lysholm评分、Tegner活动量表和VAS疼痛评分进行评估。MRI随访3、6、12个月证实实变。采用配对t检验进行统计学分析，p < 0.05为显著性。结果：平均随访时间为6.8±3.2年。IKDC评分从72.1±8.3提高到94.7±4.5 （Δ +22.6; 95% CI, 18.9-26.2; p < 0.001）， Lysholm评分从68.2±7.6提高到93.5±4.2 （Δ +25.3; 95% CI, 21.4-29.1; p < 0.001）。两者都超过了mcd阈值，效应量很大（Cohen’s d = 2.8）。Tegner活动量表恢复到损伤前水平（6.9±0.5 vs 6.8±0.4;p = 0.41）。6个月时MRI证实100%实变，无植入物移位、滑膜炎或退行性改变。所有患者在平均6.2±1.1个月后恢复到损伤前的运动水平，无需再手术。结论：与文献报道的保守治疗相比，早期关节镜下生物吸收针固定低级别JOCD的骨骼未成熟运动员可确保完全巩固，良好的功能预后和可靠的恢复运动，显示出良好的结果。对于高需求的青少年患者，这项技术可能是一种安全有效的手术选择。证据级别：四级，回顾性病例系列。
{"title":"Early arthroscopic fixation of low-grade juvenile osteochondritis dissecans with bioabsorbable pins achieves excellent clinical and imaging outcomes in high-demand athletes.","authors":"Horacio Rivarola, Cristian Collazo, Marcos Palanconi, Marcos Meninato, Francisco Endara Urresta, Bautista Rivarola, Mateo Lazzari, Maria Jesús Tuca","doi":"10.1016/j.jisako.2025.101030","DOIUrl":"10.1016/j.jisako.2025.101030","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Juvenile osteochondritis dissecans (JOCD) of the knee is increasingly observed in skeletally immature athletes due to higher participation in competitive sports. Conservative treatment achieves healing in only 50% of cases, often delaying return to play. The purpose of this study was to evaluate the clinical and radiologic outcomes of early arthroscopic fixation of low-grade JOCD with bioabsorbable pins in high-demand juvenile athletes. We hypothesized that early fixation would result in complete consolidation, excellent functional recovery, and safe return to sport.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 32 consecutive patients (16 males, 10 females; mean age, 13.5 ± 2.1 years) with low-grade stable JOCD lesions treated with arthroscopic fixation using SmartNail® bioabsorbable pins between 2004 and 2022. Lesions were staged according to the Di Paola magnetic resonance imaging (MRI) and Guhl arthroscopic classifications, with instability evaluated using De Smet criteria. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Tegner activity scale, and Visual analogue score (VAS) pain score. The MRI follow-up at 3, 6, and 12 months confirmed consolidation. Statistical analysis was performed using paired t-tests with significance set at p < 0.05.</p><p><strong>Results: </strong>The mean follow-up was 6.8 ± 3.2 years. The IKDC score improved from 72.1 ± 8.3 to 94.7 ± 4.5 (Δ +22.6; 95% CI, 18.9-26.2; p < 0.001), and the Lysholm score improved from 68.2 ± 7.6 to 93.5 ± 4.2 (Δ +25.3; 95% CI, 21.4-29.1; p < 0.001). Both exceeded minimal clinically important difference (MCID) thresholds with large effect sizes (Cohen's d > 2.8). The Tegner activity scale was restored to pre-injury levels (6.9 ± 0.5 vs 6.8 ± 0.4; p = 0.41). MRI confirmed 100% consolidation at 6 months, with no implant migration, synovitis, or degenerative changes. All patients returned to sport at their pre-injury level at a mean of 6.2 ± 1.1 months, and no reoperations were required.</p><p><strong>Conclusion: </strong>Early arthroscopic fixation with bioabsorbable pins in skeletally immature athletes with low-grade JOCD ensures complete consolidation, excellent functional outcomes, and reliable return to sport, demonstrating favorable outcomes compared with those reported in the literature for conservative treatment. This technique may represent a safe and effective surgical option for high-demand juvenile patients.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101030"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jisako.2025.101029
Kristen I. Barton, Pascale Thibaudeau, Laurie A. Hiemstra
{"title":"Supporting pregnancy and parental leave within orthopedics","authors":"Kristen I. Barton, Pascale Thibaudeau, Laurie A. Hiemstra","doi":"10.1016/j.jisako.2025.101029","DOIUrl":"10.1016/j.jisako.2025.101029","url":null,"abstract":"","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101029"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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