Journal of Experimental Orthopaedics最新文献

Purpose

To perform a segmental analysis of tibial torsion in females with refractory anterior knee pain (AKP) and investigate the relationship between external tibial torsion (ETT) and the position of the tibial tubercle (TT).

Methods

All disabling AKP patient refractory to adequate physical therapy, that presented to our clinic between January 2013 and December 2024 were retrospectively reviewed. Inclusion criteria: (1) females, (2) ≥18 years old, (3) torsional CT scan performed for strictly clinical reasons. Patients were classified into three groups according to ETT: normal (≤30°), moderate (31°–40°), and severe (>40°). ETT was measured proximally and distally to the TT, and the contribution of distal tibial torsion (DTT) to total tibial torsion (TTT) was calculated. TT lateralisation (TTL) relative to the tibial plateau′s maximum transverse diameter was measured. Statistical analysis for comparisons was conducted using one-way ANOVA with Bonferroni correction and Student′s t-test. Correlations were assessed with Pearson′s coefficient. To evaluate the association between TTT and the percentage of DTT, a linear regression analysis was performed. Inter-observer reproducibility was evaluated using the intraclass correlation coefficient. Statistical significance was set at p < 0.05.

Results

A total of 197 tibial CT scans from 101 AKP females were analysed. The percentage of contribution of DTT to TTT was significantly higher in the severe group (35.2%, SD 11.5) compared to the moderate (22.1%, SD 12.1) and normal (18.2%, SD 16.7) groups (p < 0.01). A moderate correlation between TTT and DTT contribution was identified (R = 0.540, p < 0.001). Linear regression analysis indicated that ETT was a significant predictor of DTT contribution (p < 0.001). No significant correlation was found between TTL and ETT severity.

Conclusion

The infratuberositary contribution to pathological ETT increases with the severity of the torsion. Moreover, the degree of ETT does not affect TTL.

Level of Evidence

Level IV.

Purpose

Micro-fragmented adipose tissue (MFAT) has been proposed as a promising option for hip osteoarthritis (OA). The aim of this prospective study was to evaluate clinical outcomes of MFAT injections in patients with hip OA.

Methods

Thirty patients (19 men and 11 women, 55.7 ± 8.2 years) with symptomatic hip OA (Tönnis Grade 1–2) were treated with a single ultrasound-guided MFAT injection. Patients were evaluated at baseline and 1–3–6–12 months of follow-up with the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Harris Hip Score (HHS). Adverse events were also documented. MFAT samples were evaluated for cell analysis and characterization.

Results

No major complications were reported, and only three patients failed. The total WOMAC score significantly improved from baseline (31.2 ± 16.4) only at 1 month (21.0 ± 14.3, p = 0.015) and 3 months (19.3 ± 15.8, p = 0.012), while VAS and HHS scores showed a significant improvement from baseline to all follow-ups. The minimal clinically important difference (MCID) for the total WOMAC score was achieved in 56.7% of patients at 6 and 12 months. Better clinical improvement and MCID achievement were observed in mild compared to moderate hip OA. A total of 300.000 cells derived from MFAT produced small colonies from Day 10 (89.9 ± 61.2), increasing by Day 20 (129.9 ± 47.9).

Conclusions

A single ultrasound-guided intra-articular MFAT injection represents a safe and promising option for hip OA treatment. However, the clinical benefit was partial, and better outcomes were observed in mild compared to moderate hip OA.

Level of Evidence

Level IV.

Purpose

To evaluate whether the use of polyetheretherketone (PEEK) or biocomposite vented anchors has any impact on bony ingrowth inside the anchor or implant-related osteolysis after implantation during remplissage for Hill-Sachs defects (HSD) in patients with shoulder instability.

Methods

Prospective cohort study with a minimum of 24 months follow-up (mean follow-up 3.11[SD = 0.67] years). Forty-nine subjects (43 males and 6 females; mean age 27.6[SD:9.22] years) with HSD undergoing remplissage were evaluated with a CT performed at a mean of 14.7[4,4] months after surgery. The procedures were performed in two cohorts: in the first, 44 anchors (4.5 mm Healicoil PEEK) were used in 26 subjects. In the second, 41 anchors (4.75 mm Healicoil Regenesorb biocomposite) were used in 21 subjects. A computed tomography evaluation of the volume of the bone defects and the degree of bony ingrowth was made.

Results

Preoperatively both cohorts were homogenous. The biocomposite anchors showed better bony ingrowth than the PEEK anchors (p = 0.0014): full bony ingrowth in 18/41(44%) in biocomposite versus 13/44(30%) in PEEK; clear ossification with a thin lucent rim in 15/41(37%) biocomposite versus 7/44(30%) PEEK; discontinuous ossification in 6/41(15%) biocomposite versus 7/44(16%) PEEK; and no ossification in 2/41(5%) biocomposite versus 17/44(39%) PEEK. The biocomposite anchors showed smaller bone defects than the PEEK anchors (p = 0.0217): no bone defect in 18/41(44%) biocomposite versus 13/44(30%) PEEK, partial bone defects in 20/41(49%) biocomposite versus 17/44(39%) PEEK; and bone defects larger than the insertion hole in 2/41(5%) biocomposite versus 13/44(30%) PEEK. One anchor in each group caused a bone defect larger than twice the size of the hole (2%). At the latest follow-up no differences in clinical outcomes between the groups were found.

Conclusion

Biocomposite vented anchors for remplissage favours bony ingrowth and lower the incidence of osteolysis and defect formation when compared to PEEK anchors with similar clinical outcomes.

Level of Evidence

Level II, prospective cohort study.

Purpose

The purpose was to compare intraoperative versus postoperative coronal, sagittal and axial alignment in total knee arthroplasty (TKA) performed using augmented reality (AR) navigation, and determine whether imperfect implant positioning affects postoperative alignment.

Methods

A retrospective assessment was conducted on a study cohort of 70 patients (70 knees), who received unrestricted kinematic aligned TKA using AR navigation between February 2022 and April 2023. Implant positioning was assessed on postoperative frontal (divergence between the proximal tibial resection and baseplate) and sagittal radiographs (gaps between the distal femoral resection and implant) to distinguish between knees with adequate and imperfect implant positioning. The deviation between intraoperative and postoperative alignment measurements (lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip knee ankle angle (HKA), posterior tibial slope (PTS) and femoral rotation) was assessed, and the number of outliers calculated using thresholds of 1° and 3°.

Results

There were considerable proportions of knees with deviations between intraoperative and postoperative LDFA (>1°, 43 [61%]; >3°,14 [20%]), MPTA (>1°, 42 [60%]; >3°, 5 [7%]), HKA angle (>1°, 42 [60%]; >3°, 17 [24%]), and PTS (>1°, 47 [67%]; >3°, 15 [21%]). It is worth noting, however, that most of the relevant deviations were observed in knees that had imperfectly positioned implants (19 of 70, 27%), where the femoral component was inadequately impacted during surgery (15 of 19, 79%) and/or the tibial baseplate had an uneven cement distribution (8 of 19, 42%).

Conclusion

The use of AR facilitates precise bone resections during TKA, yet it may not reduce deviations between intraoperative and postoperative LDFA, MPTA, HKA angle or PTS. As with any assistive technology, accurate bone resections alone are not sufficient to grant adequate implant positioning during TKA, which requires meticulous attention from surgeons to ensure sufficient component impaction and uniform cement distributions.

Level of Evidence

IV.

Purpose

The aim of this study was to quantify the difference in posterior tibial slope (PTS) in patients with anterior cruciate ligament (ACL) deficiency compared to those with a degenerative medial meniscus posterior horn tear (dMMPHT). We hypothesised that patients with ACL deficiency would have a greater PTS compared to patients with dMMPHT.

Methods

All consecutive patients diagnosed with ACL deficiency (ACL group) or a dMMPHT with an intact ACL (MM group) from 2016 to 2022 at a single centre were reviewed. PTS was measured using the medial tibial plateau and tibial mechanical axis on standard lateral knee radiographs. Linear regression analysis was completed to assess the correlation between PTS and age in both groups. Further sub-group analysis was undertaken according to age and sex of the study population.

Results

In total, 294 patients in the ACL group and 250 patients in the MM group were analysed. Age differed between the groups (ACL group: 29.5 ± 10.4 years vs. MM group: 38.7 ± 8.5 years, p < 0.001). Radiological evaluation demonstrated increased mean PTS in the ACL group compared to the MM group (10.1° ± 3.0 vs. 6.7° ± 2.6, p < 0.001). Regression analysis showed no significant correlation between the PTS and age in each group. When patients were subdivided into those younger than 30 years of age and those 30 years or older, there was no significant difference in the PTS in the ACL group. In contrast, younger patients had a steeper PTS compared to those 30 years or older in the MM group (7.5° ± 1.9 vs. 6.5° ± 2.7, p = 0.005).

Conclusions

Patients with an ACL tear had a significantly higher PTS on standard lateral knee radiographs compared to those with dMMPHTs and a normal ACL. Elevated PTS may be a risk factor for ACL rupture.

Level of Evidence

Level III, retrospective cohort study.

While the magnitude and types of data available to orthopaedic researchers are steadily growing, standardized and efficient data management workflows for orthopaedic research using artificial intelligence (AI) are currently lacking. This work introduces essential principles and best practices for planning, collecting, storing, processing, labelling and governing data in AI-based orthopaedic research. The various domains of available data quality guidelines for medical AI research are reviewed and discussed in terms of their adaptability to orthopaedic research datasets. In addition, future areas of improvement, such as registry development, the potential of synthetic data and gradual transition to continuous data streams for AI applications, are outlined.

Level of Evidence

Level V.

Purpose

Deficits in quadriceps and hamstring strength, functional performance and pain are common after anterior cruciate ligament reconstruction (ACLR). The role of strengthening exercises (SE) in addressing these outcomes remains uncertain. This systematic review and meta-analysis aimed to evaluate the effects of SE on quadriceps and hamstring strength, functional performance and pain in individuals after primary ACLR.

Methods

Four databases (PubMed, Web of Science, Scopus and Embase) were searched from inception to July 2025. Eligibility criteria included randomised controlled trials (RCTs) on adults with ACLR evaluating SE versus conventional rehabilitation. Data extraction followed PRISMA 2020 guidelines. The risk of bias was assessed using the Cochrane PEDro scale. Random-effects models were used to calculate standardised mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed with I², and subgroup/sensitivity analyses and publication bias were performed.

Results

Nineteen RCTs (n = 818) were included. SE significantly improved quadriceps strength (SMD: 0.76; 95% CI: 0.46 to 1.05; p < 0.01; I² = 0%, p = 0.48) and hamstring strength (SMD: 0.70; 95% CI: 0.41 to 1.0; p < 0.01; I² = 0%, p = 0.43). Functional performance (single-leg hop test, Lysholm score, ADL questionnaire, ROM extension) also improved with SE. However, knee pain outcomes showed no significant changes (SMD: −0.32; 95% CI: −0.98 to 0.34; p = 0.34; I² = 86%, p < 0.01).

Conclusions

SE significantly enhances knee strength and functional performance in individuals with ACLR, although their effects on pain remain unclear. Clinically, incorporating SE into rehabilitation protocols is recommended to improve recovery outcomes, accelerate return to sport (RTS) and enhance readiness. Further studies are warranted to clarify their impact on pain management.

Level of Evidence

Level I.

Purpose

The purpose of this study was to evaluate which factors are associated with the remodelling of an anterior cruciate ligament graft and secondary meniscal lesions.

Methods

A retrospective longitudinal study was conducted to investigate the relationship between various factors and the occurrence of graft remodelling measured with the signal to noise quotient or the appearance of secondary meniscal lesion. Data were collected prospectively and analysed retrospectively for this study. The principal endpoint was the signal-to-noise quotient on MRI at 1 year postoperatively. The secondary endpoint was the appearance of 1-year secondary meniscal lesion on MRI only. The effect of the following parameters was investigated: gender, smoking status, age, body mass index, type of sport, preoperative meniscal lesion, lateral tibial slope measured on MRI, medial tibial slope measured on MRI and time from initial injury to surgery.

Results

A total of 178 patients were enroled. The following factors were significantly and independently associated with the signal to noise quotient: body mass index > 25 kg/m² (coefficient = 3.33 - p < 0.001) and lateral tibial slope ≥ 1.5° (Q2-3-4 vs. Q1 - coefficient = 2.24 - p = 0.015). Higher preoperative body mass index (24.70 ± 3.25 vs. 22.90 ± 3.14 - p = 0.034), medial tibial slope (odds ratio = 3.64 [95% confidence interval: 1.17–11.3] for Q3-4 vs. Q1-Q2 - p = 0.019) and lateral tibial slope (odds ratio = 4.04 [1.22–13.4] for Q3-4 vs. Q1-Q2 – p = 0.016) were significantly associated with the occurrence of secondary meniscal lesions on magnetic resonance imaging 1 year after surgery.

Conclusion

Having a high body mass index and an increased lateral tibial slope were significantly and independently associated with poorer graft remodelling and may lead to secondary meniscal lesions. BMI and tibial slope are key clinical factors influencing graft healing and secondary meniscal lesions after ACL reconstruction.

Level of Evidence

Level III.

Purpose

The coronal plane alignment of the knee (CPAK) classification helps understand knee alignment variability, guiding personalised total knee arthroplasty (TKA) strategies. However, evidence regarding the impact of postoperative CPAK classification changes on patient-reported functional outcomes after restricted kinematic alignment (rKA) TKA remains limited. This study aimed to investigate whether CPAK classification changes after TKA with rKA influence functional outcomes, measured by the International Knee Society score (IKS).

Methods

A retrospective cohort study included 464 patients who underwent primary TKA with a posterior stabilised implant (KNEO^®) between January 2020 and May 2024. The inclusion criteria were primary or secondary osteoarthritis with complete radiographic and clinical follow-up at 2 years; patients with incomplete data or intraoperative complications requiring implant change were excluded. Pre- and postoperative CPAK classifications were compared, and functional outcomes were assessed using IKS knee and function scores at 2 years of follow-up. Radiographic assessment was performed on standing long-leg radiographs by a single experienced observer.

Results

A significant redistribution of CPAK classifications was observed postoperatively (p < 0.001), with 22.2% of CPAK I changing to CPAK II and 19.1% changing to CPAK V. In total, 33.3% of all knees retained their initial CPAK classification. No significant differences were observed in the postoperative IKS Knee (85.2 ± 12.3 vs. 83.9 ± 11.8; p = 0.62) or IKS Function scores (78.5 ± 13.1 vs. 76.9 ± 12.7; p = 0.54). Given the small sample sizes within certain CPAK subtype transitions, subgroup analyses were not feasible.

Conclusions

Changes in CPAK classification following rKA-TKA were common but did not significantly influence functional outcomes at 2 years. These findings suggest that CPAK phenotype transition alone may not be a reliable predictor of clinical success, although larger studies are needed to explore subtype-specific effects.

Level of Evidence

Level IV.