Journal of Experimental Orthopaedics最新文献_第7页

Strengthening exercises improve knee muscle strength and performance but not pain in ACL-reconstructed individuals: A systematic review and meta-analysis of randomised controlled trials 强化运动改善膝关节肌肉力量和表现，但不能改善acl重建个体的疼痛：随机对照试验的系统回顾和荟萃分析。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-17 DOI: 10.1002/jeo2.70576

Mostafa Jalili Bafrouei, Fateme Khorramroo, Hooman Minoonejad, Seyed Hamed Mousavi

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.

目的：前交叉韧带重建（ACLR）后，股四头肌和腘绳肌力量、功能表现和疼痛的缺陷是常见的。强化训练（SE）在解决这些结果方面的作用仍不确定。本系统综述和荟萃分析旨在评估SE对原发性ACLR后个体股四头肌和腘绳肌力量、功能表现和疼痛的影响。方法：检索自建库至2025年7月的PubMed、Web of Science、Scopus和Embase 4个数据库。入选标准包括随机对照试验（rct），对ACLR成人进行SE与常规康复的评估。数据提取遵循PRISMA 2020指南。偏倚风险采用Cochrane PEDro量表进行评估。随机效应模型用于计算标准化平均差异（SMD）， 95%置信区间（CI）。采用I²评估异质性，并进行亚组/敏感性分析和发表偏倚。结果：共纳入19项rct （n = 818）。SE显著改善股四头肌强度（SMD: 0.76; 95% CI: 0.46 ~ 1.05; p I²= 0%,p = 0.48）和腘绳肌强度（SMD: 0.70; 95% CI: 0.41 ~ 1.0; p I²= 0%,p = 0.43）。功能表现（单腿跳测试、Lysholm评分、ADL问卷、ROM扩展）也随SE的增加而改善。然而，膝关节疼痛结果显示无显著变化（SMD: -0.32; 95% CI: -0.98至0.34;p = 0.34; I²= 86%,p）结论：SE可显著增强ACLR患者的膝关节力量和功能表现，尽管其对疼痛的影响尚不清楚。临床上，建议将SE纳入康复方案，以改善康复结果，加速重返运动（RTS）并增强准备。需要进一步的研究来阐明它们对疼痛管理的影响。证据等级：一级。

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引用次数: 0

Graft remodelling of hamstring ACL graft and secondary meniscal lesions are affected by tibial slope and body mass index 小腿前交叉韧带移植物重建和继发性半月板病变受胫骨斜度和体重指数的影响。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-17 DOI: 10.1002/jeo2.70583

Nicolas Vari, Emilie Bérard, Charles Andrew Slater, Thibaut Tourcher, Kenza Limam, Régis Pailhé, Hasnae Ben-Roummane, Matthieu Ollivier, Etienne Cavaignac

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.

目的：本研究的目的是评估哪些因素与前交叉韧带移植物重塑和继发性半月板病变相关。方法：采用回顾性纵向研究方法，通过信噪比测量和继发性半月板病变的出现，探讨各种因素与移植物重构发生的关系。本研究采用前瞻性数据收集和回顾性分析。主要终点是术后1年MRI的信噪比。次要终点是仅在MRI上出现1年继发性半月板病变。研究以下参数的影响：性别、吸烟状况、年龄、体重指数、运动类型、术前半月板病变、MRI胫骨外侧斜度、MRI胫骨内侧斜度、初伤至手术时间。结果：共纳入178例患者。以下因素与信噪比显著且独立相关：体重指数> 25 kg/m2（系数= 3.33 - p p = 0.015）。术前体重指数（24.70±3.25 vs. 22.90±3.14 - p = 0.034）、胫骨内侧斜率（比值比为3.64[95%可信区间：1.17-11.3],Q3-4 vs. Q1-Q2 - p = 0.019）和胫骨外侧斜率（比值比为4.04 [1.22-13.4],Q3-4 vs. Q1-Q2 - p = 0.016）与术后1年继发性半月板病变的发生显著相关。结论：高体重指数和胫骨外侧斜度增加与较差的移植物重建显著且独立相关，并可能导致继发性半月板病变。BMI和胫骨斜度是影响前交叉韧带重建后移植物愈合和继发半月板病变的关键临床因素。证据等级：三级。

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引用次数: 0

Changes in coronal plane alignment of the knee classification do not significantly influence outcomes after restricted kinematic alignment total knee arthroplasty 膝关节分类冠状面对齐的改变对受限运动对齐全膝关节置换术后的结果没有显著影响。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-17 DOI: 10.1002/jeo2.70602

Simon Messe, Guillaume Mesnard, Hannes Vermue, Enrico Festa, Elvire Servien, Anthony Viste, Cécile Batailler, Sébastien Lustig

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.

目的：膝关节冠状面排列（CPAK）分类有助于了解膝关节排列变异性，指导个体化全膝关节置换术（TKA）策略。然而，关于术后CPAK分类改变对限制性运动学对齐（rKA） TKA后患者报告的功能结果的影响的证据仍然有限。本研究旨在探讨采用国际膝关节协会评分（IKS）测量TKA合并rKA后CPAK分类的改变是否会影响功能结局。方法：一项回顾性队列研究包括464名在2020年1月至2024年5月期间接受了后路稳定植入物（KNEO®）的原发性TKA患者。纳入标准为原发性或继发性骨关节炎，影像学检查和临床随访2年；排除资料不完整或术中并发症需要更换种植体的患者。比较术前和术后CPAK分类，并在2年随访时使用IKS膝关节和功能评分评估功能结局。由一名经验丰富的观察者对站立长腿x线片进行放射评估。结果：术后观察到CPAK分类（p p = 0.62）或IKS功能评分（78.5±13.1比76.9±12.7;p = 0.54）的显著重新分布。考虑到某些CPAK亚型转换的小样本量，亚组分析是不可行的。结论：rKA-TKA后CPAK分类的改变很常见，但对2年的功能结局没有显著影响。这些发现表明，CPAK表型转换本身可能不是临床成功的可靠预测因素，尽管需要更大规模的研究来探索亚型特异性效应。证据等级：四级。

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引用次数: 0

Comparable isokinetic quadriceps performance six months after ACL reconstruction with rectus femoris versus hamstring tendon autografts 股直肌与腘绳肌腱自体移植重建前交叉韧带6个月后四头肌的等速表现比较。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-17 DOI: 10.1002/jeo2.70601

Márcio Cabral Fagundes Rêgo, Alef Cavalcanti Matias de Barros, Jamilson Simões Brasileiro, Marcelo Cabral Fagundes Rêgo, Camilo Partezani Helito, Carlos Eduardo da Silveira Franciozi, Diego Ariel de Lima

Purpose

To compare isokinetic quadriceps performance 6 months after anterior cruciate ligament reconstruction (ACLR) using rectus femoris (RF) versus hamstring tendon (HT) autografts.

Methods

In this cross-sectional study, 75 male patients who underwent primary ACLR with RF (n = 31) or HT (n = 44) autografts were evaluated ~6 months postoperatively. Bilateral isokinetic testing at single angular velocity 60°/s (Biodex Multi-Joint System 4) measured peak torque (PT), PT normalized to body weight (PT/BW), angle at peak torque (aPT), total work (TW), and mean power (PM). Between-group comparisons used independent t-tests; paired comparisons were conducted within the RF group.

Results

No between-group differences were detected for PT, PT/BW, aPT, TW, or PM (p > 0.05 for all—primary contrast PT: mean diff. 5.3 Nm; 95% CI –20.4 to 30.9; p = 0.689). Within the RF group, the operated limb showed lower PT, PT/BW, TW, and PM than the contralateral limb (all p ≤ 0.002), with no difference in aPT.

Conclusions

At 6 months after ACLR, quadriceps performance did not differ between RF and HT autografts. These early data do not address return-to-sport timing or graft healing and should not be interpreted as evidence of equivalence (it is not powered for equivalence/non-inferiority); rather, they support RF as a potential option warranting longer-term studies incorporating functional tests and patient-reported outcomes.

Level of Evidence

Level III, cross-sectional comparative study.

目的：比较股直肌（RF）和腘绳肌腱（HT）自体移植前交叉韧带重建（ACLR）后6个月等速股四头肌的表现。方法：在这项横断面研究中，75例接受原发性ACLR的男性患者（n = 31）或HT （n = 44）术后6个月进行评估。单角速度为60°/s的双侧等速测试（Biodex Multi-Joint System 4）测量了峰值扭矩（PT），峰值扭矩与体重（PT/BW）、峰值扭矩角（aPT）、总功（TW）和平均功率（PM）归一化。组间比较采用独立t检验；在RF组内进行配对比较。结果：PT、PT/BW、aPT、TW或PM组间无差异（全初级对比PT：平均差5.3 Nm; 95% CI -20.4 ~ 30.9; p = 0.689）。在RF组中，手术肢体的PT、PT/BW、TW和PM均低于对侧肢体（均p≤0.002），而apt无差异。结论：ACLR后6个月，RF和HT自体移植物的股四头肌表现无差异。这些早期数据不涉及恢复运动时间或移植物愈合，不应被解释为等效的证据（不支持等效/非劣效性）；相反，他们支持射频作为一种潜在的选择，需要长期的研究，包括功能测试和患者报告的结果。证据等级：III级，横断面比较研究。

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引用次数: 0

The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival 加泰罗尼亚关节置换术登记册的第一个因果推理分析显示，抗生素负载骨水泥对膝关节假体存活有积极影响。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-17 DOI: 10.1002/jeo2.70574

Borja Velasco-Regulez, Sergi Gil-Gonzalez, Jesus Cerquides

Purpose

The survival of a knee prosthesis is one of the most important indicators of the success or failure of a knee arthroplasty. An intervention that could increase prosthetic survival is the use of antibiotic-loaded bone cement (ALBC) during primary surgery, but the evidence for this is not conclusive. The question of whether such an intervention increases prosthetic survival is a causal one, and yet it has never been addressed with causal methods in the observational studies literature. This constitutes a serious limitation, as there is growing evidence that the best-suited framework for addressing causal questions with observational data is causal inference.

Methods

In the present study, causal inference methods were employed to answer the research question of whether ALBC increases prosthetic survival. In particular, directed acyclic graphs were used for identification and causal survival forests were used to estimate the effect of interest. The rationale behind these methods is provided in the main text, and technical details are provided in Supporting Information: File S3. Data from the Catalan Arthroplasty Register were analysed.

Results

ALBC had an effect of increasing the overall prosthetic survival by 8% after 120 months of follow-up. The intervention had a positive effect across all the subgroups of the population defined by confounding variables, but the effect was greater in men, young patients, patients with rheumatoid arthritis or obesity, and patients who smoked or abused alcohol. The chosen causal assumptions had an impact on the obtained results, empirically showing the importance of using a causal framework.

Conclusions

ALBC increased knee prosthesis survival among patients in the Catalan public healthcare system. Causal inference methods are the most appropriate for answering causal questions about the effect of ALBC on prosthetic survival when the analysed data are observational.

Level of Evidence

Level III.

目的：人工膝关节成活率是衡量人工膝关节成形术成败的重要指标之一。在初次手术期间使用含抗生素骨水泥（ALBC）是一种可能增加假体存活率的干预措施，但这方面的证据尚无定论。这种干预是否会增加假体的存活率是一个因果关系，但在观察性研究文献中从未用因果方法解决过这个问题。这构成了一个严重的限制，因为越来越多的证据表明，用观测数据解决因果问题的最合适框架是因果推理。方法：本研究采用因果推理的方法来回答ALBC是否增加假体存活率的研究问题。特别是，有向无环图用于识别，因果生存森林用于估计兴趣的影响。这些方法背后的基本原理在正文中提供，技术细节在支持信息：文件S3中提供。分析来自加泰罗尼亚关节成形术登记的数据。结果：经过120个月的随访，ALBC可使假体总生存率提高8%。干预对所有由混杂变量定义的人群亚组都有积极影响，但对男性、年轻患者、类风湿关节炎或肥胖患者、吸烟或酗酒患者的影响更大。所选择的因果假设对所获得的结果有影响，从经验上显示了使用因果框架的重要性。结论：ALBC增加了加泰罗尼亚公共医疗系统患者的膝关节假体存活率。当分析的数据是观察性的时，因果推理方法最适合回答关于ALBC对假体存活影响的因果问题。证据等级：三级。

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引用次数: 0

Prevalence and longitudinal impact of kinesiophobia on outcomes following ACL reconstruction in adolescents and young adults 青少年和年轻人前交叉韧带重建后运动恐惧症的患病率和纵向影响。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-10 DOI: 10.1002/jeo2.70591

Emma van der Schoor, Robin Voskuilen, Kim Derks, Martijn Dietvorst, Rob Janssen, Marieke van der Steen

<div> <section> <h3> Purpose</h3> <p>The aim of this study was to longitudinally investigate the prevalence and impact of high-level kinesiophobia in adolescents and young adults undergoing anterior cruciate ligament (ACL) reconstruction.</p> </section> <section> <h3> Methods</h3> <p>In this retrospective cohort study conducted January 2018–January 2022, patients aged 16–21 undergoing ACL reconstruction were assessed before, and at 3 and 12 months postoperatively. Baseline characteristics were extracted from medical records. Kinesiophobia (Tampa Scale for Kinesiophobia, TSK-17), subjective knee function (International Knee Documentation Committee, IKDC), readiness to return to sport (RTS) (ACL-return to sport after injury, ACL-RSI), and activity level (Tegner activity scale) were collected via an online questionnaire. Patients were categorized into high or low level kinesiophobia using a 37-point cut-off. Change in prevalence of kinesiophobia was analysed using the <i>χ</i><sup>2</sup> test. Univariate logistic regression identified predictors of a high level of kinesiophobia at 12 months after ACL reconstruction. To explore the impact of kinesiophobia, between-group differences in patient-reported outcome measures over time were tested using repeated measures analysis of variance.</p> </section> <section> <h3> Results</h3> <p>Data of 98 patients were available. Preoperatively, the prevalence of high kinesiophobia was 63.3%, decreasing to 37.8% at 3 months and to 26.7% at 12 months. Preoperative kinesiophobia was the only significant predictor of postoperative kinesiophobia (<i>p</i> = 0.002). The high kinesiophobia group scored significantly lower on IKDC (<i>p</i> < 0.001) and ACL-RSI (<i>p</i> < 0.001). Both groups improved over time on Tegner (<i>p</i> < 0.001), IKDC (<i>p</i> < 0.001) and ACL-RSI (<i>p</i> < 0.001).</p> </section> <section> <h3> Conclusions</h3> <p>High kinesiophobia is common in adolescents and young adults undergoing ACL reconstruction. Kinesiophobia decreased the most in the first three months after reconstruction. In the group with high kinesiophobia, the knee function and readiness to RTS were significantly lower. This significant difference persists over time, despite a significant improvement in both groups. This study emphasizes the need to understand and address psychological characteristics in ACL rehabilitation.</p> </section> <section> <h3> Level of Evidence</h3> <p>Level III.</p> </se

目的：本研究的目的是纵向调查在接受前交叉韧带（ACL）重建的青少年和年轻成人中高度运动恐惧症的患病率和影响。方法：在2018年1月至2022年1月进行的这项回顾性队列研究中，对16-21岁接受ACL重建的患者进行术前、术后3个月和12个月的评估。从医疗记录中提取基线特征。运动恐惧症（坦帕运动恐惧症量表，TSK-17）、主观膝关节功能（国际膝关节文献委员会，IKDC）、重返运动准备（RTS）（acl -受伤后重返运动，ACL-RSI）和活动水平（Tegner活动量表）通过在线问卷收集。用37分的分值将患者分为高水平或低水平的运动恐惧症。使用χ 2检验分析运动恐惧症患病率的变化。单变量逻辑回归确定了前交叉韧带重建后12个月高度运动恐惧症的预测因素。为了探索运动恐惧症的影响，使用重复测量方差分析测试了患者报告的结果测量随时间的组间差异。结果：获得98例患者资料。术前，高运动恐惧症患病率为63.3%，3个月时降至37.8%，12个月时降至26.7%。术前运动恐惧症是术后运动恐惧症的唯一显著预测因子（p = 0.002）。结论：高度恐动症在前交叉韧带重建的青少年和年轻成人中很常见。运动恐惧症在重建后的前三个月减少最多。在高度运动恐惧症组中，膝关节功能和RTS准备度明显降低。尽管两组都有显著的改善，但这种显著的差异持续了一段时间。本研究强调需要了解和处理前交叉韧带康复的心理特征。证据等级：三级。

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引用次数: 0

Tibiofemoral axial rotation during the golf swing is influenced by total knee arthroplasty bearing type and foot rotation 高尔夫挥杆时胫股轴向旋转受全膝关节置换术、轴承类型和足部旋转的影响

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-10 DOI: 10.1002/jeo2.70529

Renate List, Nils Horn, Samara Monn, Danielle Hinny, Philipp Bänteli, Kevin Wunderlin, Katja Oberhofer, William R. Taylor, Stephen J. Ferguson, Tomas Drobny, Stefan Preiss, Pascal Schütz

Purpose

Golf remains a popular sport after total knee arthroplasty, although many patients report mild pain during or after play, particularly in the lead knee (knee on the target side). Lead knee kinematics during the golf swing are characterised by high tibiofemoral axial rotation at low joint flexion. However, it remains unclear whether the same range of tibiofemoral axial rotation is observed with mobile versus fixed bearing designs. This study aimed to evaluate the influence of two implant designs (mobile-bearing and fixed-bearing) and lead foot rotation (self-selected, 0° and 30° externally rotated) on implant kinematics during the golf swing.

Methods

In a total of 11 healthy subjects (five mobile-bearing and six fixed-bearing), kinematic and kinetic data during the golf swing were assessed using videofluoroscopy, an opto-electronic three-dimensional (3D) motion capture system and two force plates.

Results

Significantly greater ranges of tibiofemoral axial rotation in the lead knee during the golf swing were observed for the mobile-bearing compared with the fixed-bearing design, independent of foot rotation at the start. Furthermore, the present data showed that a change in foot rotation from a 0° to a 30° externally rotated lead foot increased tibiofemoral axial rotation of the mobile-bearing design but not the fixed-bearing design.

Conclusion

The present results suggest that the mobile-bearing design allows a greater range of tibiofemoral axial rotation in the lead knee than the fixed-bearing design during the golf swing, likely due to the differences in internal transverse plane constraints between the two implant designs. However, it remains unclear whether the greater rotation is preferable in terms of longevity and soft tissue loading in total knee arthroplasty patients playing golf. The present data serve as input for musculoskeletal and finite element modelling with the future goal of guiding implant selection and foot positioning recommendations for golf after total knee arthroplasty.

Level of Evidence

N/A.

目的：在全膝关节置换术后，高尔夫仍然是一项受欢迎的运动，尽管许多患者报告在比赛期间或之后有轻微的疼痛，特别是在前膝（目标侧的膝盖）。在高尔夫挥杆期间，膝关节运动学的特点是高胫骨股骨轴向旋转，低关节屈曲。然而，目前尚不清楚移动与固定轴承设计是否观察到相同的胫骨股骨轴向旋转范围。本研究旨在评估两种种植体设计（移动轴承和固定轴承）和导足旋转（自选，0°和30°外旋）对高尔夫挥杆时种植体运动学的影响。方法采用影像透视、光电三维运动捕捉系统和两个测力板对11名健康受试者（5名活动轴承和6名固定轴承）高尔夫挥杆时的运动学和动力学数据进行评估。结果在高尔夫挥杆过程中，与固定轴承设计相比，移动轴承设计观察到的前膝胫股轴向旋转范围更大，与开始时的足部旋转无关。此外，目前的数据显示，脚旋转从0°到30°的变化增加了移动轴承设计的胫股轴向旋转，而不是固定轴承设计。结论本研究结果表明，在高尔夫挥杆时，与固定轴承设计相比，移动轴承设计允许前膝关节胫骨股骨轴向旋转的范围更大，这可能是由于两种植入物设计在内部横向平面约束方面的差异。然而，就全膝关节置换术患者打高尔夫球的寿命和软组织负荷而言，更大的旋转是否更可取尚不清楚。目前的数据可作为肌肉骨骼和有限元建模的输入，未来的目标是指导全膝关节置换术后高尔夫球植入物的选择和足部定位建议。证据水平：无。

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引用次数: 0

High tibial osteotomy with individualised alignment and meniscal centralisation improves KOOS sports and recreation and cartilage status compared to conventional Fujisawa-point alignment without centralisation: A propensity score matching study 一项倾向评分匹配研究表明，与传统的不集中的fujawa点对齐相比，个性化对齐和半月板集中的高位胫骨截骨术改善了kos运动、娱乐和软骨状态。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-09 DOI: 10.1002/jeo2.70594

Kazushi Horita, Yasutoshi Ikeda, Tomoaki Kamiya, Kodai Hamaoka, Katsunori Takahashi, Yohei Okada, Makoto Emori, Atsushi Teramoto

Purpose

This study was performed to compare clinical outcomes of medial opening-wedge high tibial osteotomy (MOWHTO) with individualised alignment and medial meniscus centralisation versus conventional alignment targeting the Fujisawa point without centralisation using propensity score matching. It was hypothesised that the individualised approach with centralisation would not be inferior to conventional HTO targeting the Fujisawa point.

Methods

This retrospective matched case–control study analysed 161 consecutive knees treated with MOWHTO. After applying uniform exclusion criteria and 1:1 propensity score matching for demographic, radiographic, and meniscal factors, 24 knees with HTO and centralisation and 24 control knees were compared. The centralisation group received individualised alignment based on patient characteristics, targeting a weight-bearing line (WBL) ratio of 57.0%–62.5%, whereas the control group followed the standard 62.5% WBL target. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were radiographic alignment and International Cartilage Repair Society (ICRS) cartilage grade on second-look arthroscopy.

Results

The mean follow-up duration was 2.5 ± 0.4 years in the centralisation group and 2.5 ± 0.5 years in the control group. Both groups showed significant improvements in all KOOS subscales from preoperative to final follow-up (all p < 0.01). Final KOOS values were comparable, except for a higher Sports and Recreation score in the centralisation group (72.8 ± 21.1 vs. 56.1 ± 27.5; p = 0.039). Postoperative alignment was more neutral in the centralisation group (WBL ratio 51.9% ± 8.7% vs. 61.4% ± 7.6%; p < 0.001). Improvement in the ICRS grade of the medial femoral condyle was observed in 54.2% of knees in the centralisation group compared with 12.5% in the control group (p = 0.001).

Conclusion

MOWHTO with individualised alignment and medial meniscus centralisation achieved clinical outcomes not inferior to conventional alignment targeting the Fujisawa point without centralisation.

Level of Evidence

Level III, retrospective cohort study.

目的：本研究采用倾向性评分匹配比较个体化对齐和内侧半月板中心化的内侧开口楔形高位胫骨截骨术（MOWHTO）与不中心化的针对Fujisawa点的常规对齐的临床结果。据推测，集中的个性化方法不会逊于针对藤泽点的传统HTO。方法：本回顾性匹配病例对照研究分析了161例经MOWHTO治疗的连续膝关节。采用统一的排除标准和人口统计学、放射学和半月板因素的1:1倾向评分匹配后，比较24个HTO和集中化膝关节和24个对照膝关节。中心化组根据患者特征进行个体化调整，目标是体重线（WBL）比率为57.0%-62.5%，而对照组则遵循标准的62.5% WBL目标。主要终点是膝关节损伤和骨关节炎结局评分（kos）。次要结果是放射学对齐和国际软骨修复协会（ICRS）关节镜下的软骨分级。结果：集中治疗组平均随访时间2.5±0.4年，对照组平均随访时间2.5±0.5年。从术前到最终随访，两组的所有oos量表均有显著改善（均p p = 0.039）。中心化组术后对齐更加中性（WBL比51.9%±8.7% vs. 61.4%±7.6%;p p = 0.001）。结论：MOWHTO与个体化对准和内侧半月板中心化取得的临床效果不低于传统对准Fujisawa点而不中心化。证据等级：III级，回顾性队列研究。

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引用次数: 0

Severe knee osteoarthritis is associated with histological and ultrastructural changes in the semitendinosus tendon 严重膝骨关节炎与半腱肌腱的组织学和超微结构改变有关。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-08 DOI: 10.1002/jeo2.70565

Dlshad Qadir, Khaled Meknas, Sonja Eriksson Steigen, Randi Olsen, Ninni Sernert, Jüri-Toomas Kartus, Ioannis Karikis

Purpose

This study aimed to assess degenerative changes in the semitendinosus tendon in patients with knee osteoarthritis (OA). The hypothesis was that individuals with severe OA would demonstrate more pronounced histological and ultrastructural tendon degeneration than those with mild-to-moderate OA.

Methods

Tendon samples were obtained from 45 patients with knee OA. Twenty patients (median age: 53 [30–63] years) with mild-to-moderate OA underwent high tibial osteotomy (HTO), while 25 patients (median age: 71 [51–88] years) with severe OA underwent total knee arthroplasty (TKA). Semitendinosus tendon biopsies were collected at the time of surgery and examined histologically and ultrastructurally using light and electron microscopy.

Results

The severe OA group exhibited a significantly larger mean fibril diameter than did the mild-to-moderate OA group. Histological analysis revealed significant differences across all components of the semiquantitative scoring system, except in cellularity, which remained similar between groups. The overall degenerative score was significantly higher in the severe OA group.

Conclusions

Advanced knee OA is associated with significant histological and ultrastructural degeneration of the semitendinosus tendon, which could be interpreted as an adaptive response to chronic joint degeneration and biomechanical stress.

Level of Evidence

Level III.

目的：本研究旨在评估膝关节骨性关节炎（OA）患者半腱肌腱的退行性改变。假设患有严重OA的个体比轻度至中度OA的个体表现出更明显的组织学和超微结构肌腱变性。方法：对45例膝关节OA患者进行肌腱标本采集。20例轻中度OA患者（中位年龄：53[30-63]岁）行高位胫骨截骨术（HTO）， 25例重度OA患者（中位年龄：71[51-88]岁）行全膝关节置换术（TKA）。手术时收集半腱肌腱活检，使用光镜和电子显微镜进行组织学和超微结构检查。结果：重度OA组的平均纤维直径明显大于轻度至中度OA组。组织学分析显示，除了细胞结构外，半定量评分系统的所有组成部分都存在显著差异，各组之间保持相似。严重OA组总体退行性评分明显较高。结论：晚期膝关节骨性关节炎与半腱肌腱明显的组织学和超微结构变性有关，这可能被解释为对慢性关节变性和生物力学应力的适应性反应。证据等级：三级。

{"title":"Severe knee osteoarthritis is associated with histological and ultrastructural changes in the semitendinosus tendon","authors":"Dlshad Qadir, Khaled Meknas, Sonja Eriksson Steigen, Randi Olsen, Ninni Sernert, Jüri-Toomas Kartus, Ioannis Karikis","doi":"10.1002/jeo2.70565","DOIUrl":"10.1002/jeo2.70565","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to assess degenerative changes in the semitendinosus tendon in patients with knee osteoarthritis (OA). The hypothesis was that individuals with severe OA would demonstrate more pronounced histological and ultrastructural tendon degeneration than those with mild-to-moderate OA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Tendon samples were obtained from 45 patients with knee OA. Twenty patients (median age: 53 [30–63] years) with mild-to-moderate OA underwent high tibial osteotomy (HTO), while 25 patients (median age: 71 [51–88] years) with severe OA underwent total knee arthroplasty (TKA). Semitendinosus tendon biopsies were collected at the time of surgery and examined histologically and ultrastructurally using light and electron microscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The severe OA group exhibited a significantly larger mean fibril diameter than did the mild-to-moderate OA group. Histological analysis revealed significant differences across all components of the semiquantitative scoring system, except in cellularity, which remained similar between groups. The overall degenerative score was significantly higher in the severe OA group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Advanced knee OA is associated with significant histological and ultrastructural degeneration of the semitendinosus tendon, which could be interpreted as an adaptive response to chronic joint degeneration and biomechanical stress.</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":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12683678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716109","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

The Rosenberg view outperforms conventional AP radiographs in detecting medial knee osteoarthritis: A matched-pair analysis using intraoperative cartilage status 在检测膝关节内侧骨关节炎方面，Rosenberg透视优于传统的AP x线片：术中软骨状态的配对分析。

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics

Pub Date : 2025-12-07 DOI: 10.1002/jeo2.70582

Clemens Clar, Amir Koutp, Lukas Leitner, Jakob Tettmann, Andreas Leithner, Patrick Sadoghi

Purpose

This study aimed to compare the diagnostic performance of the Rosenberg view against conventional anteroposterior (AP) radiographs for detecting knee osteoarthritis (OA). Using intraoperative cartilage status as the gold standard, the diagnostic accuracy of both views was evaluated in a matched-pair analysis. It was hypothesised that the Rosenberg view would demonstrate superior sensitivity in detecting cartilage wear, particularly in the medial compartment.

Methods

This retrospective matched-pair analysis evaluated 150 knee OA patients undergoing arthroplasty with same-day preoperative AP and Rosenberg radiographs (≤1 week before surgery). Two blinded observers independently graded medial and lateral compartments using the KL scale (1–4), with interobserver reliability assessed via weighted kappa coefficients. Intraoperative cartilage status (‘worn’/‘unworn’) served as the reference standard. Statistical analysis included Firth's penalised logistic regression (to address complete separation), ROC curve analysis with DeLong's test for AUC comparisons and performance metrics at optimal probability thresholds determined by Youden's index.

Results

The cohort (93 females, 57 males; mean age 65.6 ± 8.8 years; mean BMI 30.2 ± 5.44 kg/m²) demonstrated superior diagnostic performance for Rosenberg views in medial compartment assessment (AUC 0.976, 95% CI 0.96–0.99 vs AP 0.899, p = 0.017), with excellent interobserver agreement (weighted κ = 0.99). At the optimal threshold (0.41), sensitivity was 62.0% and specificity was 81.0%. Lateral compartment analysis revealed comparable performance between views (Rosenberg AUC 0.756 vs. AP 0.706, p = 0.11), though study power was limited (44.4%) for this comparison.

Conclusions

These findings support the consideration of the Rosenberg view in routine diagnostic workflows for knee OA to improve detection of medial compartment disease and better inform treatment planning.

Level of Evidence

Level II, retrospective sub-analysis of a randomised controlled trial.

目的：本研究旨在比较Rosenberg视图与常规正位（AP） x线片对膝关节骨关节炎（OA）的诊断性能。以术中软骨状态为金标准，在配对分析中评估两种视图的诊断准确性。假设Rosenberg视图在检测软骨磨损方面表现出优越的敏感性，特别是在内侧腔室。方法：本回顾性配对分析评估了150例膝关节OA患者接受关节置换术的术前同一天AP和Rosenberg x线片（术前≤1周）。两名盲法观察者使用KL量表（1-4）独立对内侧和外侧隔室进行评分，通过加权kappa系数评估观察者间的可靠性。术中软骨状态（“磨损”/“未磨损”）作为参考标准。统计分析包括Firth的惩罚逻辑回归（以解决完全分离问题），使用DeLong的AUC比较测试进行ROC曲线分析，以及由Youden指数确定的最佳概率阈值下的性能指标。结果：该队列（93名女性，57名男性，平均年龄65.6±8.8岁，平均BMI 30.2±5.44 kg/m²）在内侧室评估中表现出优异的Rosenberg视图诊断性能（AUC 0.976, 95% CI 0.96-0.99 vs AP 0.899, p = 0.017），观察者间一致性极佳（加权κ = 0.99）。在最佳阈值（0.41）下，敏感性为62.0%，特异性为81.0%。侧室分析显示不同视图之间的表现相当（Rosenberg AUC 0.756 vs. AP 0.706, p = 0.11），尽管该比较的研究能力有限（44.4%）。结论：这些发现支持在膝关节OA的常规诊断流程中考虑Rosenberg观点，以提高对内侧隔室疾病的检测，并更好地为治疗计划提供信息。证据等级：二级，随机对照试验的回顾性亚分析。

{"title":"The Rosenberg view outperforms conventional AP radiographs in detecting medial knee osteoarthritis: A matched-pair analysis using intraoperative cartilage status","authors":"Clemens Clar, Amir Koutp, Lukas Leitner, Jakob Tettmann, Andreas Leithner, Patrick Sadoghi","doi":"10.1002/jeo2.70582","DOIUrl":"10.1002/jeo2.70582","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to compare the diagnostic performance of the Rosenberg view against conventional anteroposterior (AP) radiographs for detecting knee osteoarthritis (OA). Using intraoperative cartilage status as the gold standard, the diagnostic accuracy of both views was evaluated in a matched-pair analysis. It was hypothesised that the Rosenberg view would demonstrate superior sensitivity in detecting cartilage wear, particularly in the medial compartment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective matched-pair analysis evaluated 150 knee OA patients undergoing arthroplasty with same-day preoperative AP and Rosenberg radiographs (≤1 week before surgery). Two blinded observers independently graded medial and lateral compartments using the KL scale (1–4), with interobserver reliability assessed via weighted kappa coefficients. Intraoperative cartilage status (‘worn’/‘unworn’) served as the reference standard. Statistical analysis included Firth's penalised logistic regression (to address complete separation), ROC curve analysis with DeLong's test for AUC comparisons and performance metrics at optimal probability thresholds determined by Youden's index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort (93 females, 57 males; mean age 65.6 ± 8.8 years; mean BMI 30.2 ± 5.44 kg/m²) demonstrated superior diagnostic performance for Rosenberg views in medial compartment assessment (AUC 0.976, 95% CI 0.96–0.99 vs AP 0.899, <i>p</i> = 0.017), with excellent interobserver agreement (weighted <i>κ</i> = 0.99). At the optimal threshold (0.41), sensitivity was 62.0% and specificity was 81.0%. Lateral compartment analysis revealed comparable performance between views (Rosenberg AUC 0.756 vs. AP 0.706, <i>p</i> = 0.11), though study power was limited (44.4%) for this comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings support the consideration of the Rosenberg view in routine diagnostic workflows for knee OA to improve detection of medial compartment disease and better inform treatment planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II, retrospective sub-analysis of a randomised controlled trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12682230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709878","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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