It is not known where the anatomical axis of rotation on the tibial side will be in kinematic alignment (KA), a rapidly expanding area of total knee arthroplasty (TKA) alignment technique today. The purpose of this study was to define the tibial axis for KA-TKA.
Methods
Fifty patients who underwent computed tomography (CT) examination of the lower extremities at a single institution were included. The posterior condylar axis (PCA) and surgical epicondylar axis (SEA) were identified in the CT axial view and projected onto the tibial slice. The respective perpendicular lines that pass through was attachment of the posterior cruciate ligament (PCL) were identified as the anatomic axis of rotation of the tibia relative to the PCA and SEA, and the position of each axis of rotation. Furthermore, the relationship of these perpendicular lines with the Akagi line was evaluated.
Results
The axis of tibial rotation to the SEA was similar to that of the Akagi line; the axis of tibial rotation to the PCA was located approximately 2.9° medial to the Akagi line, and when the origin of the tibial axis was set at the PCL attachment site, the intersection point of the tibial axis was approximately 2.5 mm medial to the medial border of the tibial tuberosity. The distribution of tibial axis had a wide range.
Conclusion
Although there is a large individual variation, the average tibial axis for KA-TKA is 2.9° more internally rotated than the Akagi line.
{"title":"Anteroposterior axis of the tibia for kinematic aligned total knee arthroplasty","authors":"Seikai Toyooka, Noriaki Arai, Hironari Masuda, Hirotaka Kawano, Takumi Nakagawa","doi":"10.1002/jeo2.70087","DOIUrl":"https://doi.org/10.1002/jeo2.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>It is not known where the anatomical axis of rotation on the tibial side will be in kinematic alignment (KA), a rapidly expanding area of total knee arthroplasty (TKA) alignment technique today. The purpose of this study was to define the tibial axis for KA-TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty patients who underwent computed tomography (CT) examination of the lower extremities at a single institution were included. The posterior condylar axis (PCA) and surgical epicondylar axis (SEA) were identified in the CT axial view and projected onto the tibial slice. The respective perpendicular lines that pass through was attachment of the posterior cruciate ligament (PCL) were identified as the anatomic axis of rotation of the tibia relative to the PCA and SEA, and the position of each axis of rotation. Furthermore, the relationship of these perpendicular lines with the Akagi line was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The axis of tibial rotation to the SEA was similar to that of the Akagi line; the axis of tibial rotation to the PCA was located approximately 2.9° medial to the Akagi line, and when the origin of the tibial axis was set at the PCL attachment site, the intersection point of the tibial axis was approximately 2.5 mm medial to the medial border of the tibial tuberosity. The distribution of tibial axis had a wide range.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although there is a large individual variation, the average tibial axis for KA-TKA is 2.9° more internally rotated than the Akagi line.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study evaluated the performance of three machine learning (ML) algorithms—decision tree (DT), multilayer perceptron (MLP) and extreme gradient boosting (XGB)—in identifying regular athletes who suffered a knee injury several months to years prior. In addition, the contribution of psychological variables in addition to biomechanical ones in the classification performance of the ML algorithms was assessed, to better identify factors to get back to competitive sport with the lowest possible risk of new knee injury.
Methods
A cohort of 96 athletes, 36 with prior knee injuries, practicing an average of 5.7 ± 2.4 h per week, participated in a horizontal force-velocity test on a ballistic ergometer providing data of force, velocity and power from each lower limb. They also completed a psychological questionnaire, which included components from the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Sport Anxiety Scale (SAS). The three ML algorithms were trained on a thousand different train-test sets. Also, Shapley values were calculated for each input variable of a data set to highlight its contribution to the prediction from an ML model.
Results
Over a thousand cross-validations, higher area under the curve (AUC) values were obtained when accounted for the psychological attributes (p < 0.001). Also, higher AUC values were obtained from MLP compared to XGB or DT (p < 0.001). XGB exhibited higher AUC values than DT (p < 0.001).
Conclusions
Our results suggested that psychological factors play a more important role in recognition than biomechanical factors, with KOOS and SAS scores ranking high in the list of influential factors. Additionally, the computing stability of MLP could be recommended for classification tasks in the context of knee injuries.
Level of Evidence
Level III.
目的 本研究评估了三种机器学习（ML）算法--决策树（DT）、多层感知器（MLP）和极梯度提升（XGB）--在识别数月至数年前受过膝伤的普通运动员方面的性能。此外，还评估了心理变量和生物力学变量对 ML 算法分类性能的贡献，以便更好地确定恢复竞技运动的因素，尽可能降低新的膝关节损伤风险。 方法 96 名运动员（36 人曾受过膝伤，平均每周练习 5.7±2.4 小时）参加了弹道测力计上的水平力-速度测试，该测试提供了每个下肢的力、速度和功率数据。他们还填写了一份心理问卷，其中包括膝关节损伤和骨关节炎结果评分（KOOS）和运动焦虑量表（SAS）的部分内容。三种 ML 算法在一千个不同的训练-测试集上进行了训练。此外，还计算了数据集中每个输入变量的 Shapley 值，以突出其对 ML 模型预测的贡献。 结果 在一千次交叉验证中，当考虑到心理属性时，曲线下面积（AUC）值较高（p < 0.001）。此外，与 XGB 或 DT 相比，MLP 的 AUC 值更高（p < 0.001）。XGB 的 AUC 值高于 DT（p < 0.001）。 结论 我们的结果表明，与生物力学因素相比，心理因素在识别中起着更重要的作用，KOOS 和 SAS 分数在影响因素列表中名列前茅。此外，在膝关节损伤的分类任务中，MLP 的计算稳定性值得推荐。 证据等级 III 级。
{"title":"Machine learning in knee injury sequelae detection: Unravelling the role of psychological factors and preventing long-term sequelae","authors":"Clément LIPPS LENE, Julien Frere, Thierry Weissland","doi":"10.1002/jeo2.70081","DOIUrl":"https://doi.org/10.1002/jeo2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study evaluated the performance of three machine learning (ML) algorithms—decision tree (DT), multilayer perceptron (MLP) and extreme gradient boosting (XGB)—in identifying regular athletes who suffered a knee injury several months to years prior. In addition, the contribution of psychological variables in addition to biomechanical ones in the classification performance of the ML algorithms was assessed, to better identify factors to get back to competitive sport with the lowest possible risk of new knee injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of 96 athletes, 36 with prior knee injuries, practicing an average of 5.7 ± 2.4 h per week, participated in a horizontal force-velocity test on a ballistic ergometer providing data of force, velocity and power from each lower limb. They also completed a psychological questionnaire, which included components from the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Sport Anxiety Scale (SAS). The three ML algorithms were trained on a thousand different train-test sets. Also, Shapley values were calculated for each input variable of a data set to highlight its contribution to the prediction from an ML model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a thousand cross-validations, higher area under the curve (AUC) values were obtained when accounted for the psychological attributes (<i>p</i> < 0.001). Also, higher AUC values were obtained from MLP compared to XGB or DT (<i>p</i> < 0.001). XGB exhibited higher AUC values than DT (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggested that psychological factors play a more important role in recognition than biomechanical factors, with KOOS and SAS scores ranking high in the list of influential factors. Additionally, the computing stability of MLP could be recommended for classification tasks in the context of knee injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values.
Methods
Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards.
Results
Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X-ray, while body mass index had a significant relation with D3 (p < 0.05).
Conclusion
In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.
{"title":"Radiographic acceptable zone of endobutton placement in ACL reconstruction: A prospective study","authors":"Arash Sharafatvaziri, Mohammad Tahami, Maryam Salimi, Hamid Rabie, Fardis Vosoughi, Morad Karimpour, Ghazaleh Moradkhani, Mosayeb Soleymani","doi":"10.1002/jeo2.70082","DOIUrl":"https://doi.org/10.1002/jeo2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X-ray, while body mass index had a significant relation with D3 (<i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level III.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre- and postoperative knee kinematics in total knee arthroplasty (TKA).
Methods
The intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.
Results
The mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (p = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP > 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP < 0.54).
Conclusion
Preoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.
{"title":"Preoperative tibiofemoral contact point on standing lateral radiograph predicts anteroposterior knee kinematics in total knee arthroplasty","authors":"Yusuke Tominaga, Tomofumi Kinoshita, Kazunori Hino, Tatsuhiko Kutsuna, Kunihiko Watamori, Takashi Tsuda, Yusuke Horita, Masaki Takao","doi":"10.1002/jeo2.70093","DOIUrl":"https://doi.org/10.1002/jeo2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study investigated the tibiofemoral contact point (CP) on standing lateral radiographs in knee osteoarthritis and assessed the relationship between CP and pre- and postoperative knee kinematics in total knee arthroplasty (TKA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The intraoperative knee status of 46 knees with varus deformity that underwent bicruciate stabilized TKA using a navigation system was investigated. The intraoperative anteroposterior (AP) position of the femur relative to the tibia at maximum extension, 15°, 30°, 45°, 60° and 90° was evaluated by the navigation system before and after TKA. The CP, defined as the CP between the femur and tibia, was assessed on standing lateral radiographs at the maximum extension of the knee before and 1 year after TKA. CP was expressed as the ratio of tibial plateau distance on a scale of 0–1, with 0 indicating the most anterior position of the femur relative to the tibia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean CP on standing lateral radiographs was 0.54 ± 0.12 and 0.46 ± 0.08 before and after TKA, respectively. The postoperative CP was significantly more anterior than the preoperative CP (<i>p</i> = 0.0002). The mean AP position of the femur relative to the tibia moved anteriorly during early knee flexion both before and after TKA, representing nonanatomical AP movement. The preoperative posterior CP group (CP > 0.54) showed more nonanatomical AP movement from 15° to 60° before and after TKA compared with the preoperative anterior CP group (CP < 0.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative posterior deviation of the femur relative to the tibia in the standing position was a predictive factor for nonanatomical AP knee kinematics. Biomechanical analysis of postoperative knees will be necessary; however, surgeons should focus on preoperative tibiofemoral CP on standing lateral radiographs to predict knee kinematics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level Ⅲ.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin A. Wu, Eric S. Dilbone, David N. Kugelman, Rahul K. Goel, Sean P. Ryan, Samuel S. Wellman, Michael P. Bolognesi, Thorsten M. Seyler
Purpose
The purpose of this study was to understand how objective measures of daily activity change following unicompartmental knee arthroplasty (UKA). Objective data on post-operative changes in daily physical activity following UKA are limited, highlighting the need for studies using wearable technologies to provide real-time assessments of recovery.
Methods
This pilot study included a secondary analysis of a prospective study of 33 consecutive UKA patients, with data collected using an Apple Watch and a digital care management application. Objective metrics, including step count, steadiness, standing duration and performance on the six-minute walk test, were analyzed at different post-operative time points. Descriptive statistics and the Wilcoxon signed-rank test were used for analysis.
Results
Post-operatively, there was a significant increase in daily step count at 6 weeks (p = 0.017), 6 months (p < 0.001) and 12 months (p = 0.0018). Steadiness improved significantly at 6 months (p = 0.049) and 12 months (p = 0.039) post-operatively. Standing duration increased significantly at all the post-operative time points (p < 0.001). Gait speed did not show significant changes post-operatively. The estimated six-minute walk test distance improved significantly at 6 months (p = 0.027) and 12 months (p = 0.031) post-operatively.
Conclusion
The study findings suggest that UKA improves daily physical activity levels, reflected by enhanced mobility and function. While gait speed did not significantly change, improvements in step count, steadiness, standing duration and the six-minute walk test distance indicate enhanced functional capacity and endurance post-operatively. The study highlights the benefits of UKA in improving functional outcomes in patients with knee osteoarthritis. Further research with larger sample sizes and longer follow-ups is warranted to confirm these findings.
{"title":"Daily physical activity following unicompartmental knee arthroplasty: A pilot study","authors":"Kevin A. Wu, Eric S. Dilbone, David N. Kugelman, Rahul K. Goel, Sean P. Ryan, Samuel S. Wellman, Michael P. Bolognesi, Thorsten M. Seyler","doi":"10.1002/jeo2.70048","DOIUrl":"https://doi.org/10.1002/jeo2.70048","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this study was to understand how objective measures of daily activity change following unicompartmental knee arthroplasty (UKA). Objective data on post-operative changes in daily physical activity following UKA are limited, highlighting the need for studies using wearable technologies to provide real-time assessments of recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This pilot study included a secondary analysis of a prospective study of 33 consecutive UKA patients, with data collected using an Apple Watch and a digital care management application. Objective metrics, including step count, steadiness, standing duration and performance on the six-minute walk test, were analyzed at different post-operative time points. Descriptive statistics and the Wilcoxon signed-rank test were used for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Post-operatively, there was a significant increase in daily step count at 6 weeks (<i>p</i> = 0.017), 6 months (<i>p</i> < 0.001) and 12 months (<i>p</i> = 0.0018). Steadiness improved significantly at 6 months (<i>p</i> = 0.049) and 12 months (<i>p</i> = 0.039) post-operatively. Standing duration increased significantly at all the post-operative time points (<i>p</i> < 0.001). Gait speed did not show significant changes post-operatively. The estimated six-minute walk test distance improved significantly at 6 months (<i>p</i> = 0.027) and 12 months (<i>p</i> = 0.031) post-operatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study findings suggest that UKA improves daily physical activity levels, reflected by enhanced mobility and function. While gait speed did not significantly change, improvements in step count, steadiness, standing duration and the six-minute walk test distance indicate enhanced functional capacity and endurance post-operatively. The study highlights the benefits of UKA in improving functional outcomes in patients with knee osteoarthritis. Further research with larger sample sizes and longer follow-ups is warranted to confirm these findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Levels of Evidence</h3>\u0000 \u0000 <p>II.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pedro Diniz, Carlos Quental, Hélder Pereira, André Soares Ferreira, Gino M. M. J. Kerkhoffs, Frederico Castelo Ferreira, João Folgado
Purpose
The Achilles tendon is a common injury site, but anatomical risk factors for injury are relatively unexplored in the literature. This study aimed to evaluate whether changes in free tendon length would influence the results of a simulated rupture of the Achilles tendon.
Methods
Using a previously validated 3D finite element model of the free and aponeurotic Achilles tendon as a basis, two additional finite element models with 25% decreased and increased free tendon lengths were created. The finite element models were sequentially loaded from 2500 to 3500N in 100N increments, and the total volume of elements exhibiting a maximal principal strain above 10% was recorded. An Achilles tendon rupture was considered to have occurred when a continuous group of elements with a volume of at least 3 mm3 exhibited a maximum principal strain above 10%. Models were compared regarding the smallest load that met the rupture criterion and plots of the percentage of elements exhibiting maximum principal strains above 10% across the loading range. Sensitivity analyses assessed the influence of subtendon division variations and subtendon sliding restriction on the results.
Results
Rupture loads and plots of the percentage of elements with maximum principal strains above 10% were similar between models, regardless of the free tendon length. No models met the rupture criterion when simulations were run without subtendon sliding. Rupture loads in the subtendon division variation models were correlated with the subtendon cross-sectional areas.
Conclusions
The simulated rupture results of the Achilles tendon were sensitive to variations in subtendon cross-sectional areas but not in free tendon length.
{"title":"Does free tendon length influence the injury risk of the Achilles tendon? A finite element study","authors":"Pedro Diniz, Carlos Quental, Hélder Pereira, André Soares Ferreira, Gino M. M. J. Kerkhoffs, Frederico Castelo Ferreira, João Folgado","doi":"10.1002/jeo2.70036","DOIUrl":"10.1002/jeo2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The Achilles tendon is a common injury site, but anatomical risk factors for injury are relatively unexplored in the literature. This study aimed to evaluate whether changes in free tendon length would influence the results of a simulated rupture of the Achilles tendon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a previously validated 3D finite element model of the free and aponeurotic Achilles tendon as a basis, two additional finite element models with 25% decreased and increased free tendon lengths were created. The finite element models were sequentially loaded from 2500 to 3500N in 100N increments, and the total volume of elements exhibiting a maximal principal strain above 10% was recorded. An Achilles tendon rupture was considered to have occurred when a continuous group of elements with a volume of at least 3 mm<sup>3</sup> exhibited a maximum principal strain above 10%. Models were compared regarding the smallest load that met the rupture criterion and plots of the percentage of elements exhibiting maximum principal strains above 10% across the loading range. Sensitivity analyses assessed the influence of subtendon division variations and subtendon sliding restriction on the results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rupture loads and plots of the percentage of elements with maximum principal strains above 10% were similar between models, regardless of the free tendon length. No models met the rupture criterion when simulations were run without subtendon sliding. Rupture loads in the subtendon division variation models were correlated with the subtendon cross-sectional areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The simulated rupture results of the Achilles tendon were sensitive to variations in subtendon cross-sectional areas but not in free tendon length.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11561656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Craig E. Klinger, Burak Altintas, Kathryn A. Barth, Kenneth M. Lin, David C. Dewar, Lionel E. Lazaro, Jonathan P. Dyke, David S. Wellman, David L. Helfet
Purpose
Few studies have assessed trochanteric vascularity despite its implications for bone healing and surgical approaches. This study aimed to assess the regional arterial contributions of the medial femoral circumflex artery (MFCA) versus the lateral femoral circumflex artery (LFCA) to trochanteric vascularity.
Methods
Ten adult human cadaveric pelvises to mid-femur specimens were obtained. One hip was randomly assigned experimental (either MFCA or LFCA MRI-contrast infusion) and contralateral as control (MFCA and LFCA magnetic resonance imaging [MRI]-contrast infusion). Vascular dissection was performed for MFCA and LFCA cannulation. Pre- and post-contrast 3T MRI was completed, and intra-osseous contributions were quantified by region: greater trochanter (GT), intertrochanteric (IT), lesser trochanter (LT) and subtrochanteric (ST). A polyurethane compound mixed with barium sulfate was injected into the LFCA cannula, and into the MFCA cannula for the contralateral hip. Computed tomography (CT) imaging was completed to assess terminal branch locations.
Results
MFCA provided the majority of arterial contributions to the full trochanteric region (68.5% MFCA, 31.5% LFCA; standard deviation [SD]: 10.7%, p < 0.001). Over 70% of arterial contributions to ST, LT and IT regions are derived from MFCA. GT contributions were more balanced (52.5% MFCA, 47.5% LFCA; SD: 33.7%; p = 0.853). Significant differences were found between MFCA and LFCA contributions in all regions except for the GT. CT revealed multiple consistent MFCA and LFCA trochanteric terminal branches.
Conclusions
MFCA provided the dominant trochanteric arterial supply, which highlights MFCA's importance to overall hip vascularity. LFCA's trochanteric contribution was smaller but still provided trochanteric contributions, especially the GT region. Knowledge of trochanteric arterial contributions can be beneficial for optimizing surgical approaches and fixation to protect terminal branches during trochanteric fracture, nonunion treatment and trochanteric osteotomies.
{"title":"Assessment of trochanteric vascularity using quantitative magnetic resonance imaging in a cadaveric model","authors":"Craig E. Klinger, Burak Altintas, Kathryn A. Barth, Kenneth M. Lin, David C. Dewar, Lionel E. Lazaro, Jonathan P. Dyke, David S. Wellman, David L. Helfet","doi":"10.1002/jeo2.70092","DOIUrl":"https://doi.org/10.1002/jeo2.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Few studies have assessed trochanteric vascularity despite its implications for bone healing and surgical approaches. This study aimed to assess the regional arterial contributions of the medial femoral circumflex artery (MFCA) versus the lateral femoral circumflex artery (LFCA) to trochanteric vascularity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ten adult human cadaveric pelvises to mid-femur specimens were obtained. One hip was randomly assigned experimental (either MFCA or LFCA MRI-contrast infusion) and contralateral as control (MFCA and LFCA magnetic resonance imaging [MRI]-contrast infusion). Vascular dissection was performed for MFCA and LFCA cannulation. Pre- and post-contrast 3T MRI was completed, and intra-osseous contributions were quantified by region: greater trochanter (GT), intertrochanteric (IT), lesser trochanter (LT) and subtrochanteric (ST). A polyurethane compound mixed with barium sulfate was injected into the LFCA cannula, and into the MFCA cannula for the contralateral hip. Computed tomography (CT) imaging was completed to assess terminal branch locations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MFCA provided the majority of arterial contributions to the full trochanteric region (68.5% MFCA, 31.5% LFCA; standard deviation [SD]: 10.7%, <i>p</i> < 0.001). Over 70% of arterial contributions to ST, LT and IT regions are derived from MFCA. GT contributions were more balanced (52.5% MFCA, 47.5% LFCA; SD: 33.7%; <i>p</i> = 0.853). Significant differences were found between MFCA and LFCA contributions in all regions except for the GT. CT revealed multiple consistent MFCA and LFCA trochanteric terminal branches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MFCA provided the dominant trochanteric arterial supply, which highlights MFCA's importance to overall hip vascularity. LFCA's trochanteric contribution was smaller but still provided trochanteric contributions, especially the GT region. Knowledge of trochanteric arterial contributions can be beneficial for optimizing surgical approaches and fixation to protect terminal branches during trochanteric fracture, nonunion treatment and trochanteric osteotomies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Not applicable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Razick, Muzammil Akhtar, Stephen M. Howell, Alexander J. Nedopil, Maury L. Hull
Purpose
A previous study on osteoarthritic knees found that the average position of the centre of the proximal quadriceps tendon (PQT) was 9 mm lateral from the native trochlear groove. In patients with lateral patellar facet osteoarthritis, which indicates patellofemoral instability, the average location was 21 mm. The researchers suggested that a position more lateral than 20 mm might lead to poor outcomes after kinematically aligned total knee arthroplasty (KA TKA)—the current study aimed to test this hypothesis.
Methods
The study involved all patients (n = 302) who underwent KA TKA (n = 313) in 2019, had a post-operative long-leg scanogram and knee computed tomography scan, and completed a 2-year questionnaire. An evaluator measured the location of the PQT relative to the centre of the distal prosthetic trochlear groove. A Spearman's rank correlation coefficient analysis determined whether there was an association between the location of the PQT and the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) at 2 years.
Results
The mean location of the PQT was 11 ± 8 mm (range, −2 medial to 36 mm lateral), with 16% (N = 46) of the KA TKAs having a more lateral location than 20 mm. The location of the PQT was not associated with the FJS (r = −0.0349, p = 0.7281) and OKS (r = −0.0641, p = 0.9009)—no patient response indicated symptoms or operative treatment for patellofemoral instability.
Conclusion
Even though 16% of patients with a KA TKA had a more lateral location than 20 mm, there is no reason to measure the centre of the PQT relative to the distal prosthetic groove. This is because the location did not show any association with the 2-year FJS and OKS nor had any patient experienced patellofemoral instability.
{"title":"The location of the centre of the proximal quadriceps tendon in kinematically aligned total knee arthroplasty is not associated with poor outcome scores or symptomatic patellar instability","authors":"Daniel Razick, Muzammil Akhtar, Stephen M. Howell, Alexander J. Nedopil, Maury L. Hull","doi":"10.1002/jeo2.70075","DOIUrl":"10.1002/jeo2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>A previous study on osteoarthritic knees found that the average position of the centre of the proximal quadriceps tendon (PQT) was 9 mm lateral from the native trochlear groove. In patients with lateral patellar facet osteoarthritis, which indicates patellofemoral instability, the average location was 21 mm. The researchers suggested that a position more lateral than 20 mm might lead to poor outcomes after kinematically aligned total knee arthroplasty (KA TKA)—the current study aimed to test this hypothesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study involved all patients (<i>n</i> = 302) who underwent KA TKA (<i>n</i> = 313) in 2019, had a post-operative long-leg scanogram and knee computed tomography scan, and completed a 2-year questionnaire. An evaluator measured the location of the PQT relative to the centre of the distal prosthetic trochlear groove. A Spearman's rank correlation coefficient analysis determined whether there was an association between the location of the PQT and the Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) at 2 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean location of the PQT was 11 ± 8 mm (range, −2 medial to 36 mm lateral), with 16% (<i>N</i> = 46) of the KA TKAs having a more lateral location than 20 mm. The location of the PQT was not associated with the FJS (<i>r</i> = −0.0349, <i>p</i> = 0.7281) and OKS (<i>r</i> = −0.0641, <i>p</i> = 0.9009)—no patient response indicated symptoms or operative treatment for patellofemoral instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Even though 16% of patients with a KA TKA had a more lateral location than 20 mm, there is no reason to measure the centre of the PQT relative to the distal prosthetic groove. This is because the location did not show any association with the 2-year FJS and OKS nor had any patient experienced patellofemoral instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael C. Dean, Jacob F. Oeding, Pedro Diniz, Romain Seil, Kristian Samuelsson, ESSKA Artificial Intelligence Working Group
Purpose
The purpose of this article is to explore the potential of digital twin technologies in orthopaedics and to evaluate how their integration with artificial intelligence (AI) and deep learning (DL) can improve orthopaedic evaluation and treatment. This review addresses key applications of digital twins, including surgical planning, patient-specific outcome prediction, augmented reality-assisted surgery and simulation-based surgical training.
Methods
Existing studies on digital twins in various domains, including engineering, biomedical and orthopaedics are reviewed. We also reviewed advancements in AI and DL relevant to digital twins. We focused on identifying key benefits, challenges and future directions for the implementation of digital twins in orthopaedic practice.
Results
The review highlights that digital twins offer significant potential to revolutionise orthopaedic care by enabling precise surgical planning, real-time outcome prediction and enhanced training. Digital twins can model patient-specific anatomy using advanced imaging techniques and dynamically update with real-time data, providing valuable insights during surgery and postoperative care. However, challenges such as the need for large-scale data sets, technological limitations and integration issues must be addressed to fully realise these benefits.
Conclusion
Digital twins represent a promising frontier in orthopaedic research and practice, with the potential to improve patient outcomes and enhance surgical precision. To enable widespread adoption, future research must focus on overcoming current challenges and further refining the integration of digital twins with AI and DL technologies.
{"title":"Leveraging digital twins for improved orthopaedic evaluation and treatment","authors":"Michael C. Dean, Jacob F. Oeding, Pedro Diniz, Romain Seil, Kristian Samuelsson, ESSKA Artificial Intelligence Working Group","doi":"10.1002/jeo2.70084","DOIUrl":"10.1002/jeo2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of this article is to explore the potential of digital twin technologies in orthopaedics and to evaluate how their integration with artificial intelligence (AI) and deep learning (DL) can improve orthopaedic evaluation and treatment. This review addresses key applications of digital twins, including surgical planning, patient-specific outcome prediction, augmented reality-assisted surgery and simulation-based surgical training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Existing studies on digital twins in various domains, including engineering, biomedical and orthopaedics are reviewed. We also reviewed advancements in AI and DL relevant to digital twins. We focused on identifying key benefits, challenges and future directions for the implementation of digital twins in orthopaedic practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review highlights that digital twins offer significant potential to revolutionise orthopaedic care by enabling precise surgical planning, real-time outcome prediction and enhanced training. Digital twins can model patient-specific anatomy using advanced imaging techniques and dynamically update with real-time data, providing valuable insights during surgery and postoperative care. However, challenges such as the need for large-scale data sets, technological limitations and integration issues must be addressed to fully realise these benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Digital twins represent a promising frontier in orthopaedic research and practice, with the potential to improve patient outcomes and enhance surgical precision. To enable widespread adoption, future research must focus on overcoming current challenges and further refining the integration of digital twins with AI and DL technologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
João Pedro Oliveira, Otília C. d'Almeida, Ricardo Sampaio, José Carlos Noronha
Purpose
To longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the inside-out tibial tunnel drilling technique for all-inside Anterior Cruciate Ligament Reconstruction (ACLR). We hypothesized that due the necessary angle for the inside-out reaming procedure, the described technique could input changes in the tibial socket.
Methods
Fourteen knees treated with the same all-inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow-up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.
Results
Both femoral and tibial tunnels had an expected increase at 6 months follow-up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.
Conclusions
Overall, our results show that within a 4-year follow-up period, the inside-out tibial tunnel drilling technique for all-inside ACLR represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.
{"title":"Inside-out tibial tunnel drilling technique is a reliable approach for all-inside ACL reconstruction: A longitudinal MRI assessment","authors":"João Pedro Oliveira, Otília C. d'Almeida, Ricardo Sampaio, José Carlos Noronha","doi":"10.1002/jeo2.70068","DOIUrl":"10.1002/jeo2.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the <i>inside-out tibial tunnel drilling technique for all-inside Anterior Cruciate Ligament Reconstruction (ACLR)</i>. We hypothesized that due the necessary angle for the inside-out reaming procedure, the described technique could input changes in the tibial socket.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fourteen knees treated with the same all-inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow-up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both femoral and tibial tunnels had an expected increase at 6 months follow-up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Overall, our results show that within a 4-year follow-up period, the <i>inside-out tibial tunnel drilling technique for all-inside ACLR</i> represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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