This study aimed to translate and cross-culturally validate a Danish version of the BPII 2.0, and assess its construct validity, internal consistency and test-retest reliability in a Danish population of patients with patellar instability.
The BPII 2.0 was translated and cross-culturally validated according to international guidelines, including 15 think-aloud interviews in patients with patellar instability. Responses from 100 patients with patellar instability were accustomed to evaluating, construct validity, floor and ceiling effect, minimal detectable change, internal consistency and test-retest reliability. Construct validity was assessed using Spearman Rho (r) comparing the BPII 2.0-DK with the Kujala-DK, the International Knee Documentation Committee (IKDC), the Victorian Institute of Sport Assessment-Patella (VISA-P) and the Tegner activity score (TAS). Structural validity was assessed using confirmatory factor analysis (CFA). Internal consistency reliability was evaluated using Cronbach's alpha. Test-rest reliability was examined using Pearson's intraclass correlation coefficient (ICC) in 57 patients who completed the BPII 2.0 twice, with a one-week interval. The study followed the COSMIN guidelines.
Minor comprehensibility issues were corrected during translation, and patients found the BPII 2.0-DK relevant and comprehensive. High positive correlations were found with the Kujala-DK (r = 0.73), IKDC (r = 0.81) and VISA-P (r = 0.67), whereas only a low correlation was found with the TAS (r = 0.44). CFA demonstrated loadings ranging from 0.45 to 0.84. No ceiling or floor effects were observed, and a minimal detectable change of 15.3 points was found. Cronbach's alpha was 0.95, indicating excellent internal consistency, and ICC was 0.90 (95% CI: 0.86–0.94) for test-retest reliability.
The BPII 2.0-DK is a relevant, comprehensible, and comprehensive tool for patients with patellar instability. There was a high positive correlation between BPII 2.0 and Kujala-DK, IKDC and VISA-P. Furthermore, excellent internal consistency reliability and high test-retest reliability were found.
Level III.
Hip arthroscopy (HAS) evidence has expanded rapidly, but methodological quality and conclusions vary. This umbrella review of contemporary meta-analyses published January 2020–October 2025 aimed to (i) identify eligible reviews, (ii) appraise methodological quality (AMSTAR 2) and review-level risk of bias (ROBIS), (iii) quantify evidence overlap (corrected covered area, CCA) and (iv) map concordance of conclusions.
We searched PubMed/MEDLINE, Embase and Epistemonikos (2020–2025) for human HAS meta-analyses with quantitative synthesis on clinical effectiveness and safety. Two reviewers independently screened records and extracted data (consensus/third-reviewer adjudication). Quality was assessed with AMSTAR 2, risk of bias with ROBIS, and evidence overlap with CCA. No re-pooling of primary data.
From 5940 records, 44 meta-analyses were included. AMSTAR 2 confidence was predominantly weak (≈7% high, 5% moderate; most critically low); ROBIS was low risk in just over half. Overlap was slight (low redundancy). Across randomised/comparative syntheses, HAS yielded superior short-term improvements versus best-practice nonoperative care—most consistently for iHOT-33 at ~8–12 months—attenuating by ~24 months and not uniformly meeting MCIDs. Limited long-term data suggest less radiographic osteoarthritis progression versus nonoperative care. Versus open procedures, functional outcomes were similar with fewer complications after HAS. Return-to-work was ~71% at ~115 days, return-to-sport was high (elite ~94% at ~6–7 months; broader cohorts ~89%). More recent evidence increasingly favours capsular closure and labral repair. Preoperative intra-articular injection ≤3 months before HAS was associated with higher infection risk.
Evidence supports short-term benefits and a good safety profile for HAS, yet certainty remains limited. Prioritise patient selection and standardised rehab; high-quality long-term studies are needed.
Level I, systematic umbrella review of meta-analyses on hip arthroscopy.
To investigate the association between anterior cruciate ligament (ACL) remnant morphology, classified by Crain, and preoperative rotational knee instability after adjusting for preoperative and anatomical factors including time from injury to surgery and meniscal status. It was hypothesised that remnant morphology would be associated with rotational knee instability.
This retrospective multicenter cohort study was conducted between October 2022 and June 2025. Arthroscopic assessment categorised ACL remnants according to the Crain classification. Under anaesthesia, the Lachman and pivot-shift tests were graded and dichotomised as high-grade or low-grade. Univariate comparisons were performed using the chi-square test. Multivariate logistic regression identified predictors of high-grade Lachman (L-HG) and pivot-shift (PS-HG), adjusting for age, sex, body mass index, time from injury to surgery, mechanism of injury, Tegner Activity Scale (TAS) score, and medial and lateral meniscal tears, with Crain Type 4 as the reference.
Among 304 patients, Crain types were as follows: Type 1 (16.8%), Type 2 (40.8%), Type 3 (27.6%) and Type 4 (14.8%). Overall, L-HG and PS-HG occurred in 36.8% and 39.8% of patients, respectively. L-HG did not differ among the Crain groups (p = 0.081), whereas PS-HG did (p = 0.016). In multivariate analysis, TAS score (odds ratio [OR] per unit, 0.83; 95% confidence interval [CI], 0.70–0.98; p = 0.028) and lateral meniscal tear (OR, 2.16; 95% CI, 1.31–3.58; p = 0.003) were significant predictors of L-HG. For PS-HG, Crain Type 3 had lower odds compared with Type 4 (OR, 0.43; 95% CI, 0.19–0.99; p = 0.048).
Crain remnant morphology was associated with rotational instability, with Type 3 demonstrating lower odds of high-grade pivot shift than Type 4. These findings suggest that ACL remnant morphology may play a role in rotational instability.
Level IV, cohort study.
Traumatic open book injuries of the pubic symphysis require stable fixation while minimizing surgical morbidity. Traditional symphyseal plating is associated with complications such as implant failure and infections. This study aims to evaluate the biomechanical performance of a novel minimally invasive technique using an internal fixator (IF) compared to conventional plating (symphyseal locking dynamic compression plate [SLDCP]) in human cadaveric pelvises.
Ten human cadaveric pelvises were assigned to two groups (n = 5 each). After anatomical reduction, either SLDCP or IF stabilization was applied. Intrasymphyseal compression forces, contact area and interfragmentary motion were assessed using pressure-sensitive sensor films and an optical tracking system under incrementally applied axial loads up to 600 N. Bone density and symphyseal dimensions were measured and were comparable across both groups.
At key loading stages (400 and 600 N), the IF group demonstrated significantly higher intrasymphyseal compression forces (IF 61.78 ± 31.98 N vs. SLDCP 15.98 ± 8.2 N at 400 N and IF 42.82 ± 25.2 N vs. SLDCP 9.42 ± 5.81 N at 600 N) and larger contact areas (IF 453 ± 137.6 mm2 vs. SLDCP 216 ± 135 mm2 at 400 N and IF 337.6 ± 168.45 mm2 vs. SLDCP 154 ± 59.73 mm2 at 600 N), with more homogeneous segmental force and area distributions. Higher compression forces, particularly in the caudal symphyseal region (IF 23.68 ± 18.69 N vs. SLDCP 13.78 ± 10.1 N), were achieved. Three-dimensional analysis showed reduced fragment displacement in the IF group under load.
The proposed technique using an internal fixator provided superior biomechanical stability compared to standard plating, offering a promising minimally invasive alternative for managing open book injuries. The technique facilitates uniform force transmission and improved contact conditions, which may enhance healing and reduce complications.
N/A.
The integration of artificial intelligence (AI), the rise of mega-journals, and the manipulation of impact factors present challenges to scientific integrity. These trends threaten the core principles of objectivity, reproducibility, and transparency. This editorial highlights two categories of threats: (1) external pressures, such as AI misuse and metric-driven publishing models, and (2) internal systemic flaws, including the ‘publish or perish’ culture and methodological fragility. Mega-journals, characterized by high-volume publishing and broad interdisciplinary scopes, improve accessibility and accelerate dissemination. However, the emphasis on publication volume might weaken the rigor of peer review. To navigate these challenges, the authors propose a balanced approach that harnesses innovation without compromising scientific integrity. Proposed solutions include mandating AI transparency through frameworks like CONSORT-AI, and redefining impact metrics to emphasize reproducibility, mentorship, and societal impact alongside citations. Scientific journals should promote career opportunities less on publication quantity and more on quality. Global cooperation, via initiatives like the San Francisco Declaration on Research Assessment (DORA) and the Committee on Publication Ethics (COPE), is essential to standardize ethics and address resource disparities. This editorial proposes solutions for researchers, journals, and policymakers to realign academic incentives and uphold the ethical foundation of the science. By fostering transparency, accountability, and equity, the scientific community can preserve its ethical foundations while embracing transformative tools—ultimately advancing knowledge and serving society.
Level V.
Anterior cruciate ligament (ACL) injuries have consistently been linked to specific kinetic and kinematic patterns, including elevated vertical ground reaction forces, increased knee abduction angle and moment (dynamic valgus), reduced knee flexion during landing and excessive hip adduction/internal rotation. However, the relationship between motor competence as a factor affecting athletes' performance and kinetic and kinematic variables has not yet been investigated.
A total of 112 elite athletes (66 males and 46 females; mean age = 19.4 ± 1.1 years) from basketball, volleyball and handball were assessed. Motor competence was evaluated using the short form of the Bruininks–Oseretsky Test of Motor Proficiency. Biomechanical data were collected during a single-leg drop landing task using a three-dimensional motion analysis system (Vicon) and a force plate. Pearson correlation coefficients and multiple linear regression (Enter method) were used to analyse relationships between motor competence and kinetic/kinematic variables.
All biomechanical variables showed significant correlations with motor competence (p < 0.001). Notably, knee flexion angle (r = 0.613) and knee abduction angle (r = −0.576) demonstrated strong associations. Regression analysis identified several biomechanical variables that were statistically associated with motor competence, explaining 69.6% of its variance.
Motor competence was related to several kinetic and kinematic variables previously linked to ACL injury risk. However, due to the cross-sectional design, these associations should not be interpreted as causal, and further longitudinal or interventional studies are warranted.
Level IV, cross-sectional study.
To explore the results of a fluoroscopic-guided intra-osseous (IO) and intra-articular (IA) injection of expanded adipose-derived stromal cells (ASCs) in athletes with bone marrow lesions (BML) associated with knee osteoarthritis (OA).
A prospective study was conducted on 16 athletes (9 males, 7 females; mean age 30.5 ± 2.8 years), including two with bilateral knee involvement. All had Kellgren-Lawrence grades 2–4 and received IA and IO injections of 24.3 ± 2.1 million and 23.4 ± 1.9 million ASCs, respectively. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Numeric Pain Rating Scale (NPRS), and Tegner activity scale at baseline, 6 months, and 12 months. Radiological changes were evaluated using Magnetic Resonance Imaging Osteoarthritis Knee Scores (MOAKS) at baseline and 12 months.
Significant improvements were observed in NPRS, Tegner, and all KOOS subscales at 6 months and 12 months with respect to baseline (p < 0.05). At 12 months, NPRS decreased from 6.6 ± 0.9 to 2.4 ± 0.5, and Tegner increased from 4.4 ± 1.8 to 7.8 ± 1.1. All KOOS subscale scores improved at 12 months. Symptoms: 49.3 ± 6.4 to 74.1 ± 4.9; pain: 49.4 ± 4.3 to 75.8 ± 3.2; sport and recreation: 30.6 ± 6.2 to 67.8 ± 4.3; activities of daily living: 57.6 ± 3.6 to 79.9 ± 4.8; and quality of life: 35.4 ± 10.3 to 66.3 ± 5.3. A mild decline yet significant in the KOOS sport and recreation subscale was noted between 6 and 12 months (p = 0.02), but remained significantly improved from baseline. MOAKS analysis showed improvement in 12 of 27 evaluated regions. No major complications occurred.
Combined IA and IO ASC injections are a safe and effective treatment for OA-BMLs in athletes, offering sustained clinical and radiological benefits over 12 months.
Level III.
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