Journal of Experimental Orthopaedics最新文献_第5页

Robotic total knee arthroplasty with functional positioning safely addresses major coronal deformities: Comparable complications and survivorship 机器人全膝关节置换术与功能定位安全解决主要冠状畸形：比较并发症和生存率。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-12 DOI: 10.1002/jeo2.70613

Luca Andriollo, Emanuele Diquattro, Christos Koutserimpas, Giovan Giuseppe Mazzella, Giulio Bonat, Elvire Servien, Cécile Batailler, Sébastien Lustig

Purpose

Robotic-assisted total knee arthroplasty (TKA) has emerged as a reliable strategy to improve surgical accuracy and enable functional alignment (FA), also referred to as functional knee positioning (FKP). However, its application in patients with major coronal plane deformities remains under-investigated. This study aimed to evaluate complication rates, implant survival, radiographic outcomes and patient-reported measures in patients with severe deformities undergoing robotic-assisted TKA with FA/FKP principles compared to matched controls.

Methods

A retrospective comparative study was conducted on patients who underwent robotic-assisted TKA between March 2021 and February 2023 at a single high-volume centre. Patients with ≥15° varus or ≥10° valgus deformity were included in the study group and matched 1:1 with controls presenting neutral alignment. All procedures used the Mako robotic-arm-assisted system with standardised FA/FKP principles. Clinical outcomes included knee society score (KSS), forgotten joint score (FJS-12), Kujala anterior knee pain scale (AKPS) and range of motion. Radiographic measurements and robotic data were assessed. Complications, reoperations and revision rates were analysed.

Results

Eighty-eight patients (44 per group) were analysed, with a mean follow-up of 2.8 ± 0.9 years. Complication and revision rates were comparable between groups (revision: 2.3% vs. 0%, p = 0.987). Patients with major deformities achieved higher FJS-12 scores (83.9 ± 20.2 vs. 74.9 ± 19.0, p = 0.040), although the difference did not exceed the minimal clinically important difference (MCID = 9.9). Postoperative mHKA was less neutral in the deformity group (176.8° ± 4.7 vs. 180.0° ± 3.0, p = 0.002), without adverse impact on implant survival.

Conclusions

Robotic-assisted TKA performed with FA/FKP principles appears to be a feasible option for patients with severe varus or valgus deformities. Despite residual alignment variability, complication and revision rates remained comparable to standard cases, and patient-reported outcomes suggested greater perceived functional improvement.

Level of Evidence

Level III.

目的：机器人辅助全膝关节置换术（TKA）已成为提高手术准确性和实现功能对齐（FA）的可靠策略，也称为功能性膝关节定位（FKP）。然而，其在严重冠状面畸形患者中的应用仍有待研究。本研究旨在评估与匹配对照组相比，采用FA/FKP原理进行机器人辅助TKA的严重畸形患者的并发症发生率、种植体存活率、放射学结果和患者报告的措施。方法：对2021年3月至2023年2月在单个高容量中心接受机器人辅助TKA的患者进行回顾性比较研究。≥15°内翻或≥10°外翻畸形的患者被纳入研究组，并与中性对齐的对照组1:1匹配。所有程序均使用具有标准化FA/FKP原理的Mako机械臂辅助系统。临床结果包括膝关节社会评分（KSS）、遗忘关节评分（FJS-12）、Kujala膝关节前痛量表（AKPS）和活动度。评估放射测量和机器人数据。分析并发症、再手术及翻修率。结果：共分析88例患者（每组44例），平均随访2.8±0.9年。两组间并发症和翻修率具有可比性（翻修率：2.3% vs. 0%, p = 0.987）。重度畸形患者FJS-12评分较高（83.9±20.2比74.9±19.0,p = 0.040），但差异未超过最小临床重要差异（MCID = 9.9）。畸形组术后mHKA中性度较低（176.8°±4.7比180.0°±3.0,p = 0.002），对种植体存活无不良影响。结论：采用FA/FKP原则的机器人辅助TKA似乎是严重内翻或外翻畸形患者的可行选择。尽管存在残留的对齐变异性，并发症和翻修率仍与标准病例相当，患者报告的结果显示更大的感知功能改善。证据等级：三级。

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引用次数: 0

Failed anterior cruciate ligament reconstructions have both increased posterior tibial slope and increased posterior tibial plateau offset 失败的前交叉韧带重建会增加胫骨后坡和增加胫骨后平台偏移。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-12 DOI: 10.1002/jeo2.70620

Romed P. Vieider, Robert E. Bilodeau, Mahmut E. Kayaalp, Tyler M. Hauer, Karina Dias, Ting Cong, Jonathan D. Hughes, Volker Musahl

Purpose

This study introduces the posterior tibial plateau offset (PTO). It was hypothesised that (1) the PTO is reliably quantifiable and (2) correlates with the posterior tibial slope (PTS).

Methods

The study involved lateral radiographs of patients who sustained an anterior cruciate ligament (ACL) graft failure and a control group. Exclusion criteria were skeletal immaturity, osteoarthritis (Kellgren and Lawrence grade > I), lateral radiographs with <15 cm of tibial shaft, or malrotated radiographs. The PTS was measured in both groups. The PTO was defined as the relative distance from the posterior tibial plateau to the tibial shaft axis in relation to the sagittal diameter of the tibial plateau (in%). Linear correlation assessed the PTS to PTO association.

Results

A total of 146 patients (ACL graft failure, n = 103; control group, n = 43; 45% female, 60% left knees) were included. Mean overall PTO was 82% ± 7% (1%–35%), and mean PTS was 12° ± 3 (7–20). The PTS and PTO showed a moderate positive correlation in the overall collective (r = 0.5; p < 0.001), ACL graft failure group (r = 0.49; p < 0.001), and control group (r = 0.69; p < 0.001), indicating a higher slope corresponded to a greater PTO. There was no statistical difference in PTO between the ACL failure and the control group (82% vs. 83%, p < 0.05). ICC between three raters was (0.8–0.9; p < 0.05).

Conclusion

The PTO is a simple and repeatable measurement. A higher PTS is associated with a greater PTO, and the variability of the PTO across the patients with ACL graft failure and the control group was high. When planning osteotomy levels in the highly sloped proximal tibia, the PTO may be considered to optimise individualised planning for patients with failed ACL reconstruction.

Level of Evidence

Level V.

目的：本研究介绍胫骨后平台偏移（PTO）。假设：(1)PTO是可靠的可量化的，(2)与胫骨后斜率（PTS）相关。方法：研究包括前交叉韧带（ACL）移植失败患者和对照组的侧位x线片。排除标准为骨骼不成熟、骨关节炎（Kellgren和Lawrence分级> I）、侧位x线片。结果：共纳入146例患者（ACL移植物失败，n = 103；对照组，n = 43；女性45%，左膝60%）。平均总PTO为82%±7%(1%-35%)，平均PTS为12°±3（7-20）。PTS与PTO在总体上呈中度正相关（r = 0.5; p r = 0.49; p r = 0.69; p p p p p p p p p p p p p p p p p p p p p）结论：PTO是一种简单、可重复的测量方法。较高的PTS与较高的PTO相关，前交叉韧带移植失败患者和对照组的PTO差异很大。当规划胫骨近端高度倾斜的截骨水平时，PTO可以考虑为ACL重建失败的患者优化个体化计划。证据等级：V级。

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引用次数: 0

Sport participation after unicompartmental knee arthroplasty: High return rates independent of implant design or technique, a systematic review and meta-analysis 单室膝关节置换术后的运动参与：与植入物设计或技术无关的高复发率，一项系统回顾和荟萃分析。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70514

Tosca Cerasoli, Antongiulio Favero, Federico Coliva, Alberto Fogacci, Andrea Pasquini, Stefano Zaffagnini, Giulio Maria Marcheggiani Muccioli

Purpose

Unicompartmental knee arthroplasty (UKA) is a widely used treatment for isolated compartmental knee osteoarthritis, especially in younger and more active patients. Return to sport (RTS) has become a key postoperative outcome. While RTS after UKA is generally favourable, the influence of factors such as implant design, surgical technique, compartment treated and patient characteristics remains unclear. An updated and granular synthesis is needed, particularly to allow direct comparison with RTS outcomes after total knee arthroplasty (TKA).

Methods

A systematic review and meta-analysis was conducted following PRISMA guidelines and registered on PROSPERO. PubMed, Embase and Scopus were searched for studies from 2016 to April 2025 reporting RTS outcomes after UKA. Two reviewers independently screened articles, extracted data and assessed methodological quality using the modified Coleman Methodology Score. Weighted means and proportions were calculated, and correlation analyses explored associations between RTS and patient and surgical variables.

Results

Thirteen studies (n = 1675 patients) were included. The overall weighted mean RTS rate after UKA was 87.97% with a substantial proportion of patients resuming intermediate and high-impact sports. No significant differences in RTS were found between fixed-bearing and mobile-bearing implants, or between medial and lateral UKA. RTS was comparable between robotic-assisted and standard techniques. A moderate negative correlation between BMI and RTS was observed (r = −0.69, p = 0.019). Compared to TKA, UKA patients have a higher RTS rate (87.97% vs. 72%). UKA patients resumed a broader range of sports, with increased participation in intermediate- and high-impact activities.

Conclusions

UKA offers high RTS rates and supports participation in demanding physical activities. Neither implant design nor surgical technique substantially impacts RTS, whereas patient-related factors, especially BMI, are key predictors. Compared to TKA, UKA is associated with superior sport-related outcomes, underscoring its role in appropriately selected patients. These findings support shared decision-making and personalised postoperative planning.

Level of Evidence

Level III.

目的：单室膝关节置换术（UKA）是一种广泛应用于孤立性室性膝骨关节炎的治疗方法，特别是在年轻和更活跃的患者中。重返运动（RTS）已成为术后的关键结果。虽然UKA后的RTS通常是有利的，但诸如植入物设计、手术技术、治疗的隔室和患者特征等因素的影响尚不清楚。需要更新和颗粒合成，特别是允许与全膝关节置换术（TKA）后的RTS结果直接比较。方法：按照PRISMA指南进行系统评价和荟萃分析，并在PROSPERO上注册。检索了PubMed、Embase和Scopus从2016年到2025年4月报告UKA后RTS结果的研究。两位审稿人独立筛选文章，提取数据并使用改进的Coleman方法学评分评估方法学质量。计算加权平均值和比例，并进行相关分析，探讨RTS与患者和手术变量之间的关系。结果：纳入13项研究（n = 1675例患者）。UKA后的总体加权平均RTS率为87.97%，有相当比例的患者恢复中、高强度运动。固定轴承和移动轴承植入物之间，或内侧和外侧UKA之间的RTS无显著差异。RTS在机器人辅助和标准技术之间具有可比性。BMI与RTS呈中度负相关（r = -0.69, p = 0.019）。与TKA相比，UKA患者的RTS率更高（87.97% vs. 72%）。UKA患者恢复了更广泛的运动，更多地参与了中等和高强度的活动。结论：UKA提供了高RTS率，并支持参与高要求的体育活动。植入物设计和手术技术都不会对RTS产生实质性影响，而患者相关因素，尤其是BMI，是关键的预测因素。与TKA相比，UKA与更好的运动相关结果相关，强调其在适当选择的患者中的作用。这些发现支持共同决策和个性化的术后计划。证据等级：三级。

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引用次数: 0

Comparative effects of bone marrow stimulation and shockwave therapy on rotator cuff healing in chronic massive rotator cuff tears: A rat model study 骨髓刺激与冲击波治疗对慢性大块性肩袖撕裂大鼠模型愈合的影响。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70622

Utku Demirtaş, Elif Mercan Demirtaş, Mert Özcan, Fulya Öz Puyan

<div> <section> <h3> Purpose</h3> <p>Surgical intervention for massive rotator cuff tear (MRCT) has been found to result in positive outcomes; however, a high retear rate has frequently been reported. The present study employed a chronic MRCT model to assess the impact of microdrilling, a bone marrow stimulation (BMS) technique and extracorporeal shockwave therapy (ESWT) on rotator cuff healing. We hypothesized that BMS would result in superior healing than ESWT, reflected by a more normal tendon-to-bone junction histomorphology.</p> </section> <section> <h3> Methods</h3> <p>A chronic rotator cuff tear model was created in the supraspinatus and infraspinatus tendons of 30 Sprague–Dawley rats. Four weeks later, the tendons were repaired using the transosseous technique. The animals were randomly assigned to three groups. In Group I, the intervention consisted exclusively of tendon repair. In Group II, ESWT was administered at various time points in conjunction with the repair process. In Group III, microdrilling was performed prior to the initiation of repairs. The animals were euthanized at 4 and 8 weeks post-repair. Repaired tendons, specifically the tendon-to-bone junction, were evaluated histomorphologically using the Bonar score and immunohistochemically for CD34, bone morphogenetic protein-2 (BMP-2), bone morphogenetic protein-7 (BMP-7) and transforming growth factor-β1 (TGF-β1).</p> </section> <section> <h3> Results</h3> <p>A lower Bonar scale score in Group III more closely resembled normal tissue with respect to tenocyte morphology, extracellular matrix composition and vascularity, although statistical significance was limited to vascularity and extracellular matrix composition. By contrast, Group II showed a significant time-dependent deterioration in tenocyte morphology. Group III exhibited elevated BMP-2 and BMP-7 expression levels, and an increase in CD34 at the tendon-to-bone junction was observed in Group II; however, these did not reach statistical significance. TGF-β1 expression remained comparable among all groups.</p> </section> <section> <h3> Conclusions</h3> <p>Both biological augmentation with BMS and ESWT demonstrated beneficial effects on tendon-to-bone healing in a rat model of chronic MRCT; however, these effects were not statistically significant. Although increased BMP-2, BMP-7 and CD34 expressions were noted in Group III, significant improvements were noted in vascularity according to the Bonar scale score, along with early enhancements in ground substance and overall histological structure. The deterioration of tenocyte

目的：大量肩袖撕裂（MRCT）的手术治疗结果良好；然而，经常有高的复发率的报道。本研究采用慢性MRCT模型来评估微钻孔、骨髓刺激（BMS）技术和体外冲击波治疗（ESWT）对肩袖愈合的影响。我们假设BMS会比ESWT产生更好的愈合，这反映在更正常的肌腱-骨连接组织形态上。方法：以30只Sprague-Dawley大鼠的冈上、冈下肌腱为模型，建立慢性肩袖撕裂模型。四周后，采用经骨技术修复肌腱。这些动物被随机分为三组。在第一组，干预仅包括肌腱修复。在第二组中，在修复过程的不同时间点给予ESWT。在第三组中，在开始修复之前进行微钻孔。修复后4周和8周分别实施安乐死。修复后的肌腱，特别是肌腱-骨连接处，采用Bonar评分和免疫组织化学方法对CD34、骨形态发生蛋白-2 （BMP-2）、骨形态发生蛋白-7 （BMP-7）和转化生长因子-β1 （TGF-β1）进行组织形态学评估。结果：III组较低的Bonar评分与正常组织在小细胞形态、细胞外基质组成和血管性方面更接近，尽管在血管和细胞外基质组成方面有统计学意义。相比之下，II组的细胞形态出现明显的时间依赖性恶化。III组BMP-2和BMP-7表达水平升高，II组肌腱-骨交界处CD34表达增加；然而，这些没有达到统计学意义。TGF-β1的表达在各组间保持可比性。结论：在慢性MRCT大鼠模型中，BMS和ESWT生物增强对肌腱-骨愈合均有有益作用；然而，这些影响在统计学上并不显著。虽然在第三组中BMP-2、BMP-7和CD34的表达增加，但根据Bonar评分，血管功能明显改善，基质物质和整体组织学结构早期增强。ESWT组小细胞形态学的恶化突出了优化能量参数的必要性。证据级别：无。

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引用次数: 0

Medial meniscus posterior root tear repair: An overview of surgical techniques and augmentation strategies 内侧半月板后根撕裂修复：外科技术和增强策略综述。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70578

Gabriele Cortina, Simone Perelli, Nicola Pizza, Vincenzo Condello, Vincenzo Madonna, Joan Carles Monllau

Purpose

Medial meniscus posterior root tears (MMPRTs) disrupt the hoop stress mechanism, leading to increased meniscal extrusion and early osteoarthritis. This systematic review aims to evaluate current surgical techniques for MMPRT repair, including their biomechanical principles, technical aspects and clinical outcomes, with special attention to strategies addressing meniscal extrusion.

Methods

A systematic search was conducted across PubMed, Scopus and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Inclusion criteria encompassed studies describing surgical techniques for MMPRT repair published in the last 20 years. Techniques were categorized into pull-out transtibial repair, suture anchor repair and all-inside repair. Augmentation procedures were also evaluated. Quality assessment was performed using the Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool for comparative studies.

Results

Forty-two studies were included. Thirty studies reported on pull-out transtibial techniques, eight on suture anchor repairs and four on all-inside repair. Various fixation strategies, suture configurations and devices were described. Biomechanical evidence supports the use of suture anchors for improved cyclic loading performance. Augmentation techniques such as gracilis autografts or centralization sutures were described in select cases to reduce extrusion. Comparative studies suggest that while no single technique guarantees superior healing, suture anchor repair may offer biomechanical advantages over pull-out repairs.

Conclusion

Multiple surgical options exist for MMPRT repair, each with specific advantages and limitations. The choice of technique should consider biomechanical integrity, tissue quality and the presence of extrusion. Augmentation strategies may enhance outcomes in selected cases. Further high-quality comparative studies are needed to define the optimal surgical approach.

Level of Evidence

Level III, systematic review and meta-analysis.

目的：内侧半月板后根撕裂（MMPRTs）破坏环应力机制，导致半月板挤压增加和早期骨关节炎。本系统综述旨在评估当前MMPRT修复的手术技术，包括其生物力学原理、技术方面和临床结果，并特别关注半月板挤压的策略。方法：使用PRISMA 2020指南对PubMed、Scopus和Cochrane图书馆进行系统检索。纳入标准包括在过去20年中发表的描述MMPRT修复手术技术的研究。方法分为拔除式经胫骨修复、缝合锚定修复和全内修复。还对隆胸手术进行了评估。采用比较研究的非随机干预研究的偏倚风险（ROBINS-I）工具进行质量评估。结果：纳入42项研究。30篇关于拔除胫骨技术的研究报道，8篇关于缝合锚修复，4篇关于全内修复。描述了各种固定策略，缝线配置和设备。生物力学证据支持使用缝合锚钉改善循环加载性能。增强技术，如薄股肌自体移植物或集中缝合线被描述在选择的情况下，以减少挤压。比较研究表明，虽然没有一种技术可以保证更好的愈合，但缝合锚定修复可能比拔出修复具有生物力学优势。结论：MMPRT修复有多种手术选择，每种都有其独特的优点和局限性。技术的选择应考虑生物力学完整性、组织质量和挤压的存在。增强策略可在选定病例中增强结果。需要进一步高质量的比较研究来确定最佳的手术入路。证据等级：III级，系统评价和荟萃分析。

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引用次数: 0

Chlorhexidine as the optimal disinfection method for an accidentally dropped autograft during an anterior cruciate ligament reconstruction surgery: A double-blind study 氯己定作为前交叉韧带重建手术中意外掉落自体移植物的最佳消毒方法：一项双盲研究

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70614

Soheil Pourheidar, Mehdi Moayedfar, Mahmoud Jabalameli

Purpose

No consensus exists on the optimal sterilization method for contaminated grafts during anterior cruciate ligament (ACL) reconstruction surgery. This study evaluated the efficacy of single and multiple sequential disinfectants in sterilizing the contaminated graft.

Methods

Thirty ACLs were harvested from 30 knees during total knee arthroplasty and sectioned into 10 semi-identical pieces (n = 300). All grafts were dropped simultaneously on the operating room floor and left for 60 s. Then, the grafts were assigned to the 10 study groups. (1) The control group used no sterilizing method, and in the other nine groups were used different sterilizing solutions: (2) 1% povidone-iodine (PI), (3) 4% chlorhexidine (CH), (4) antibiotics including vancomycin and colistin (AB), (5) thrice washings with PI, CH and AB, (6) twice washing with PI and CH, (7) twice washing with PI and AB, (8) twice washing with CH and AB, (9) once washing with normal saline, and (10) thrice washings with normal saline. A wet swab was also rubbed on the operating room floor. The researchers responsible for cultivation and culture analysis were blinded to the graft tags in the various groups.

Results

Statistical comparisons of contamination rates between groups were performed using chi-square tests for categorical data, with Fisher's exact tests for pairwise comparisons. A p value of <0.05 was considered statistically significant for individual comparisons. Twenty-nine of the 30 control grafts were positive for bacterial culture, primarily for Staphylococcus epidermidis (n = 28) and Micrococcus luteus (n = 13). Eight samples in the PI group were positive for bacteria. No bacterium was isolated in the CH group. Grafts washed once and thrice with normal saline were positive for bacteria in 13 and 8 samples, respectively.

Conclusion

This study found the 4% CH solution to be the most effective method for sterilizing autografts accidentally dropped on the operating room floor.

Level of Evidence

NA (cadaveric, animal and basic science studies).

目的：对前交叉韧带重建手术中污染移植物的最佳消毒方法尚无共识。本研究评价了单次和多次顺序消毒对受污染移植物的消毒效果。方法：在全膝关节置换术中从30个膝关节中取出30个acl，切成10个半相同的acl片（n = 300）。所有移植物同时丢弃在手术室地板上，放置60 s。然后，将移植物分配到10个研究组。(1)对照组不采用消毒方法，其余9组采用不同的消毒溶液：(2)1%聚维酮碘（PI）、(3)4%氯己定（CH）、(4)万古霉素、粘菌素（AB）抗生素、(5)PI、CH、AB清洗3次、(6)PI、CH清洗2次、(7)PI、AB清洗2次、(8)CH、AB清洗2次、(9)生理盐水清洗1次、（10）生理盐水清洗3次。一根湿棉签也在手术室地板上擦了擦。负责培养和培养分析的研究人员对不同群体的移植物标签是盲目的。结果：组间污染率的统计比较对分类数据采用卡方检验，两两比较采用Fisher精确检验。表皮葡萄球菌（n = 28）和黄体微球菌（n = 13）的p值。PI组8份样品细菌阳性。CH组未分离出细菌。用生理盐水洗涤一次和三次的移植物分别有13个和8个样本呈细菌阳性。结论：本研究发现4% CH溶液是对意外掉在手术室地板上的自体移植物进行消毒的最有效方法。证据等级：NA（尸体、动物和基础科学研究）。

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引用次数: 0

The maximum 2D diameter column of the notch as the most important bone risk indicator compared with the posterior tibial slopes for ACL injury based on computed tomography: Analysis using machine learning approach 基于计算机断层扫描对比前交叉韧带损伤时切迹最大2D直径柱与胫骨后斜度最重要的骨风险指标：使用机器学习方法进行分析。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70630

Ke Xiao, Song Wu, Benjamin Rothrauff, Bosomtwe Kwabena Richmond, Damaris Topola Boko, Jiewen Luo, Chi Liang, Yangbo Cao, Yunheng Yao, Jinshen He

Purpose

To develop a machine learning model capable of predicting the bony risk of non-contact anterior cruciate ligament injury, thereby enabling the identification of factors that contribute to such injuries.

Methods

Data were collected from 400 cases of non-contact ACL-injured and 200 ACL-intact control subjects using Computed Tomography between March 2022 and June 2025. Thirteen features, encompassing demographic, clinical, and radiomic data, as well as six different algorithms, were utilised to develop predictive machine learning models. Shapley Additive Explanations (SHAP) analysis was subsequently performed on the optimal model.

Results

The Maximum 2D Diameter Column values for the non-contact ACL injury group and the intact ACL group were 31.12 ± 2.92 mm (95% confidence interval [CI]: 30.83–31.40, p < 0.05) and 32.37 ± 3.07 mm (95% CI: 31.94–32.80, p < 0.05). The Extreme Gradient Boosting classifier was identified as the optimal predictive model, achieving an area under the precision–recall curve of 0.94, the highest among all models evaluated. SHAP analysis revealed that the most predictive feature was the Maximum 2D Diameter Column of the notch, defined as the largest pairwise Euclidean distance between tumour surface mesh vertices in the row-slice plane, followed by the lateral and medial posterior tibial slope.

Conclusion

The machine learning model developed in this study demonstrated excellent predictive performance for non-contact ACL injuries. The Maximum 2D Diameter Column was the most important predictor, followed by the lateral and medial posterior tibial slope.

Level of Evidence

Level III.

目的：开发一种能够预测非接触性前交叉韧带损伤骨风险的机器学习模型，从而能够识别导致此类损伤的因素。方法：收集2022年3月至2025年6月期间400例非接触性acl损伤患者和200例acl完整对照者的计算机断层扫描数据。包括人口统计、临床和放射学数据在内的13个特征，以及6种不同的算法，被用于开发预测机器学习模型。随后对最优模型进行Shapley加性解释（SHAP）分析。结果：非接触性前交叉韧带损伤组和完整前交叉韧带组的最大2D Diameter Column值为31.12±2.92 mm（95%置信区间[CI]: 30.83-31.40, p）。结论：本研究建立的机器学习模型对非接触性前交叉韧带损伤具有良好的预测性能。最大2D直径柱是最重要的预测指标，其次是胫骨后外侧和内侧斜率。证据等级：三级。

{"title":"The maximum 2D diameter column of the notch as the most important bone risk indicator compared with the posterior tibial slopes for ACL injury based on computed tomography: Analysis using machine learning approach","authors":"Ke Xiao, Song Wu, Benjamin Rothrauff, Bosomtwe Kwabena Richmond, Damaris Topola Boko, Jiewen Luo, Chi Liang, Yangbo Cao, Yunheng Yao, Jinshen He","doi":"10.1002/jeo2.70630","DOIUrl":"10.1002/jeo2.70630","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop a machine learning model capable of predicting the bony risk of non-contact anterior cruciate ligament injury, thereby enabling the identification of factors that contribute to such injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were collected from 400 cases of non-contact ACL-injured and 200 ACL-intact control subjects using Computed Tomography between March 2022 and June 2025. Thirteen features, encompassing demographic, clinical, and radiomic data, as well as six different algorithms, were utilised to develop predictive machine learning models. Shapley Additive Explanations (SHAP) analysis was subsequently performed on the optimal model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Maximum 2D Diameter Column values for the non-contact ACL injury group and the intact ACL group were 31.12 ± 2.92 mm (95% confidence interval [CI]: 30.83–31.40, <i>p</i> < 0.05) and 32.37 ± 3.07 mm (95% CI: 31.94–32.80, <i>p</i> < 0.05). The Extreme Gradient Boosting classifier was identified as the optimal predictive model, achieving an area under the precision–recall curve of 0.94, the highest among all models evaluated. SHAP analysis revealed that the most predictive feature was the Maximum 2D Diameter Column of the notch, defined as the largest pairwise Euclidean distance between tumour surface mesh vertices in the row-slice plane, followed by the lateral and medial posterior tibial slope.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The machine learning model developed in this study demonstrated excellent predictive performance for non-contact ACL injuries. The Maximum 2D Diameter Column was the most important predictor, followed by the lateral and medial posterior tibial slope.</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":"13 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12793037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967237","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}

引用次数: 0

Comparative analysis of anatomical and dynamic techniques for medial patellofemoral ligament reconstruction: A systematic review 髌股内侧韧带重建的解剖学和动力学技术的比较分析：系统回顾

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-11 DOI: 10.1002/jeo2.70607

Juan Manuel Rodríguez-Sánchez, Nicola Pizza, Francisco S. Sánchez, Simone Perelli, Joan Carles Monllau

Purpose

To provide a comprehensive overview of the surgical techniques for medial patellofemoral ligament (MPFL) reconstruction, with a focus on their technical aspects, indications and the advantages and disadvantages of each approach. These techniques vary significantly based on patient-specific factors, such as skeletal maturity and anatomical complexity.

Methods

A systematic review of PubMed, Scopus and Embase databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies on MPFL reconstruction techniques published within the last 20 years. Studies focusing on technical descriptions of surgical methods were included, while those lacking sufficient detail or reporting only clinical outcomes were excluded. A total of 45 studies met the inclusion criteria and were analysed.

Results

Autografts, particularly semitendinosus and gracilis tendons, were the most commonly utilized, while allografts and synthetic grafts were less frequently reported. Femoral fixation methods predominantly included interference screws, whereas patellar fixation methods were evenly distributed between bony tunnels and anchors. Dynamic and quasi-anatomic techniques were commonly employed in patients with open physes to prevent damage to growth plates. Intraoperative fluoroscopy was frequently used to ensure accurate graft placement in anatomical techniques. Open surgical approaches were the most commonly reported, with minimally invasive and arthroscopic methods being less prevalent.

Conclusions

MPFL reconstruction techniques exhibit considerable variability in graft selection, fixation methods and surgical approaches. Anatomical-static techniques provide excellent biomechanical stability but may not be suitable for skeletally immature patients. In contrast, quasi-anatomical and dynamic techniques offer greater flexibility and are particularly advantageous for paediatric populations, though they may compromise long-term stability. Standardized protocols and further research are needed to optimize outcomes, particularly in complex patient scenarios.

Level of Evidence

Level III, systematic review.

目的全面介绍髌股内侧韧带（MPFL）重建的手术技术，重点介绍每种入路的技术特点、适应证和优缺点。这些技术根据患者的具体因素，如骨骼成熟度和解剖复杂性，有很大的不同。方法根据PRISMA （Preferred Reporting Items for systematic Reviews and meta - analysis）指南，对PubMed、Scopus和Embase数据库进行系统综述，以确定近20年来发表的关于MPFL重建技术的研究。关注手术方法技术描述的研究被纳入，而缺乏足够细节或仅报告临床结果的研究被排除。共有45项研究符合纳入标准并进行了分析。结果自体肌腱移植以半腱肌和股薄肌肌腱最为常见，同种异体和人工肌腱移植报道较少。股骨固定方法主要包括干涉螺钉，而髌骨固定方法均匀分布于骨隧道和锚钉之间。动态和准解剖技术通常用于开放性骨折患者，以防止生长板损伤。在解剖技术中，术中透视经常用于确保准确的移植物放置。开放手术入路是最常见的报道，微创和关节镜方法较少流行。结论MPFL重建技术在移植物选择、固定方法和手术入路方面具有相当大的可变性。解剖静态技术提供了良好的生物力学稳定性，但可能不适合骨骼不成熟的患者。相比之下，准解剖和动态技术提供了更大的灵活性，特别有利于儿科人群，尽管它们可能会损害长期稳定性。需要标准化的方案和进一步的研究来优化结果，特别是在复杂的患者情况下。证据等级III级，系统评价。

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引用次数: 0

Increased tibiofemoral rotation is associated with anatomical risk factors for lateral patella instability 胫股旋转增加与外侧髌骨不稳定的解剖学危险因素有关。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-09 DOI: 10.1002/jeo2.70626

Julius Watrinet, Lennart Gerdesmeyer, Felix Meurer, Romed P. Vieider, Armin Runer, Sebastian Siebenlist, Lukas Willinger

Purpose

Chronic patellofemoral instability (PFI) and pain are influenced by axial malalignment of the patellofemoral joint. Tibiofemoral rotation, defined as the rotation between femur and tibia knee, has shown to be correlated to PFI. This study aimed to determine whether tibiofemoral rotation is associated with anatomical risk factors for patellofemoral maltracking in patients with PFI. It was hypothesised that greater tibiofemoral rotation correlates with other predisposing factors for PFI.

Methods

Eighty-five consecutive patients (mean age 22.6 ± 8.9 years; 58 female) with PFI underwent standardised bilateral knee MRI in 0° extension for rotational analysis. Tibiofemoral rotation was measured as the angle between the posterior femoral condylar tangent and posterior tibial plateau tangent on axial images. Ipsilateral and contralateral values along other anatomical patellofemoral risk factors were recorded. One-sample t-tests compared to the healthy contralateral side. Pearson correlations assessed associations between tibiofemoral rotation and anatomic risk factors for patellofemoral maltracking.

Results

Mean ipsilateral tibiofemoral rotation was 6.9° ± 6.0° (range: −6.5° to 21.6°). Contralateral version averaged 6.4° ± 6.2° with no significant side difference. Absolute side-to-side difference was 3.7° ± 2.7°. Ipsilateral tibiofemoral rotation correlated with the tuberositas tibiae–trochlea groove (TT–TG) and medial posterior cruciate ligament distance (TT–PCL) (r = 0.37, p < 0.001, r = 0.43, p < 0.001), femoral torsion (r = −0.32, p = 0.003) and lateral trochlea inclination (r = −0.344, p = 0.001) whereas other patellofemoral risk factors showed no correlation.

Conclusion

Tibiofemoral rotation showed a significant correlation with anatomical risk factors associated with lateral patellar maltracking in patients with PFI. Moreover, patients with PFI demonstrated a wide variability in tibiofemoral rotation. Consideration of tibiofemoral rotation may enhance anatomical assessment and aid clinical decision-making in patients with PFI.

Level of Evidence

Level III.

目的：慢性髌股不稳（PFI）和疼痛是由髌股关节轴向错位影响的。胫骨股骨旋转，定义为股骨和胫骨膝关节之间的旋转，已被证明与PFI相关。本研究旨在确定PFI患者髌股畸形的解剖危险因素与胫股旋转是否相关。据推测，较大的胫股旋转与PFI的其他易感因素相关。方法：85例连续的PFI患者（平均年龄22.6±8.9岁；58例女性），在0°延伸处进行标准化双侧膝关节MRI旋转分析。胫骨股骨旋转测量为轴向图像上股骨后髁切线与胫骨后平台切线之间的夹角。记录沿其他解剖髌骨危险因素的同侧和对侧值。单样本t检验与健康对侧比较。Pearson相关性评估胫骨股骨旋转与髌股畸形的解剖危险因素之间的关系。结果：同侧胫股平均旋转为6.9°±6.0°（范围：-6.5°至21.6°）。对侧平均6.4°±6.2°，两侧无明显差异。绝对侧差为3.7°±2.7°。同侧胫股旋转与胫骨结节-滑车沟（TT-TG）、内侧后交叉韧带距离（TT-PCL）（r = 0.37, p r = 0.43, p r = -0.32, p = 0.003）和外侧滑车倾斜度（r = -0.344, p = 0.001）相关，而其他髌股危险因素无相关性。结论：胫骨股骨旋转与PFI患者外侧髌骨偏离相关的解剖学危险因素有显著相关性。此外，PFI患者在胫股旋转方面表现出广泛的变异性。考虑胫股旋转可以增强PFI患者的解剖学评估和帮助临床决策。证据等级：三级。

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引用次数: 0

Effect of tibial tray backside design on stress transfer and micromotion in uncemented posterior-stabilized TKA: A finite element study 胫骨托盘后部设计对非骨水泥后稳定TKA中应力传递和微运动的影响：有限元研究。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2026-01-09 DOI: 10.1002/jeo2.70608

Zhenxian Chen, Zhangwen Ma, Bo Liang, Jianian Han, Jing Zhang, Yinghu Peng, Zhongmin Jin

Purpose

The uncemented posterior-stabilized total knee arthroplasty (PS-TKA) gained increasing acceptance as younger and active patients have higher requirements for the lifespan and functionality of prostheses, because their frequent gait and deep-flexion activities may amplify tibial implant–bone interface micromotion and increase the risk of early tibial loosening. The purpose of this study is to evaluate the biomechanical fixation effects of three different tibial tray backside designs, with the aim of informing surgeons in selecting the most appropriate fixation strategy for uncemented PS-TKA.

Methods

The finite element and micromotion models were developed to quantify the tibial von Mises stress and interface micromotion under the knee loading conditions. The effects of three common tibial tray backside designs, including a cylindrical stem with a triple flat keel (CS-TFK), a tapered stem with a double flat keel (TS-DFK) and a cylindrical stem with a double serrated keel (CS-DSK), on stress transfer and interface micromotion were compared.

Results

During walking, all designs exhibited similar stress and micromotion patterns, with minimal risk for prostheses instability. During squatting, the cylindrical stem with double serrated keel design exhibited the highest proximal tibial stress (124.03 MPa) and the lowest maximum micromotion (361.91 µm), resulting in the largest area suitable for bone ingrowth (42.53%). In contrast, the tapered stem with double flat keel design had the lowest stress (90.70 MPa), and its area at risk for poor osseointegration (micromotion >150 µm) increased by 44.70% compared with the cylindrical stem with double serrates keel design.

Discussion

The tibial tray backside design influenced its primary fixation. Among the evaluated designs, the CS-DSK balanced stress transfer and interface micromotion, suggesting it may be favored for uncemented PS-TKA in younger, active patients to lower the likelihood of early tibial aseptic loosening. CS-DSK favored early ingrowth but produced higher local stresses, so overload risk should be monitored in older patients with osteoporosis.

Level of Evidence

N/A.

目的：无骨水泥后稳定全膝关节置换术（PS-TKA）越来越被接受，因为年轻和活跃的患者对假体的寿命和功能有更高的要求，因为他们频繁的步态和深度屈曲活动可能会放大胫骨植入物-骨界面的微运动，增加早期胫骨松动的风险。本研究的目的是评估三种不同胫骨托盘后部设计的生物力学固定效果，目的是为外科医生选择最合适的非骨水泥PS-TKA固定策略提供信息。方法：建立有限元模型和微运动模型，量化膝关节加载条件下胫骨von Mises应力和界面微运动。比较了三种常见的胫骨托盘后部设计，包括圆柱杆与三平龙骨（CS-TFK），锥形杆与双平龙骨（TS-DFK）和圆柱杆与双锯齿龙骨（CS-DSK），对应力传递和界面微动的影响。结果：在行走过程中，所有设计都表现出相似的应力和微运动模式，假体不稳定的风险最小。在深蹲时，双锯齿龙骨设计的柱状茎胫骨近端应力最大（124.03 MPa），微动最小（361.91µm），适合骨向内生长的面积最大（42.53%）。与双锯齿龙骨柱杆相比，双扁平龙骨柱杆的应力最低（90.70 MPa），其骨整合不良风险面积（微动>150µm）增加了44.70%。讨论：胫骨托盘后部设计影响其初次固定。在评估的设计中，CS-DSK平衡了应力传递和界面微动，表明它可能更适合于年轻、活跃的未骨水泥PS-TKA患者，以降低早期胫骨无菌性松动的可能性。CS-DSK有利于早期生长，但产生较高的局部应力，因此应监测老年骨质疏松患者的过载风险。证据级别：无。

{"title":"Effect of tibial tray backside design on stress transfer and micromotion in uncemented posterior-stabilized TKA: A finite element study","authors":"Zhenxian Chen, Zhangwen Ma, Bo Liang, Jianian Han, Jing Zhang, Yinghu Peng, Zhongmin Jin","doi":"10.1002/jeo2.70608","DOIUrl":"10.1002/jeo2.70608","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The uncemented posterior-stabilized total knee arthroplasty (PS-TKA) gained increasing acceptance as younger and active patients have higher requirements for the lifespan and functionality of prostheses, because their frequent gait and deep-flexion activities may amplify tibial implant–bone interface micromotion and increase the risk of early tibial loosening. The purpose of this study is to evaluate the biomechanical fixation effects of three different tibial tray backside designs, with the aim of informing surgeons in selecting the most appropriate fixation strategy for uncemented PS-TKA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The finite element and micromotion models were developed to quantify the tibial von Mises stress and interface micromotion under the knee loading conditions. The effects of three common tibial tray backside designs, including a cylindrical stem with a triple flat keel (CS-TFK), a tapered stem with a double flat keel (TS-DFK) and a cylindrical stem with a double serrated keel (CS-DSK), on stress transfer and interface micromotion were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During walking, all designs exhibited similar stress and micromotion patterns, with minimal risk for prostheses instability. During squatting, the cylindrical stem with double serrated keel design exhibited the highest proximal tibial stress (124.03 MPa) and the lowest maximum micromotion (361.91 µm), resulting in the largest area suitable for bone ingrowth (42.53%). In contrast, the tapered stem with double flat keel design had the lowest stress (90.70 MPa), and its area at risk for poor osseointegration (micromotion >150 µm) increased by 44.70% compared with the cylindrical stem with double serrates keel design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The tibial tray backside design influenced its primary fixation. Among the evaluated designs, the CS-DSK balanced stress transfer and interface micromotion, suggesting it may be favored for uncemented PS-TKA in younger, active patients to lower the likelihood of early tibial aseptic loosening. CS-DSK favored early ingrowth but produced higher local stresses, so overload risk should be monitored in older patients with osteoporosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>N/A.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"13 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953307","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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