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.
{"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}
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}
Blanca Julie Degener, Christoph Theil, Georg Gosheger, Patrick May, Jörg Seidel, Tim Schachtrup, Theodoros Zafeiris, Kristian Nikolaus Schneider
<div> <section> <h3> Purpose</h3> <p>Shoulder dislocations in professional football are increasing and regularly associated with substantial layoff times. However, research on players' postinjury performance remains limited. Therefore, the purpose of this study was to evaluate whether first-time shoulder dislocations negatively affect performance after return to play (RTP) and to determine whether the type of treatment (nonoperative vs. operative) influences post-injury performance outcomes.</p> </section> <section> <h3> Methods</h3> <p>Retrospective, media-based analysis of all first-time in-match shoulder dislocations in the top two German football leagues (first and second Bundesliga) from the 2012/2013 to 2021/2022 season (<i>n</i> = 30). Quantitative and qualitative performance data, as well as player-, match- and injury-related data were obtained from official databases. The Goalimpact (Goalimpact GmbH), a numerical value representing an individual player's impact on team success, served as the qualitative parameter. Data were analysed up to 2 years pre-injury and 2 years post-RTP. Statistical significance was set at <i>p</i> < 0.05.</p> </section> <section> <h3> Results</h3> <p>A total of 30 shoulder dislocations in 30 players with a median age of 25 years (Interquartile range [IQR]: 23–26) were available for analysis. Median layoff time was 65 days (IQR: 23–115), 22 days (IQR: 10–34) for those treated conservatively and 112 days (IQR: 92–133; <i>p</i> < 0.001) for players undergoing surgery. Quantitative performance parameters showed a temporary decrease, with fewer matches (<i>p</i> = 0.017) and minutes played (<i>p</i> = 0.004) in the 10 matches following RTP compared to the 10 matches pre-injury. Goalimpact values were initially comparable to pre-injury levels but improved 1 year (131 [IQR: 115–150] vs. 141 [IQR: 122–160]; <i>p</i> = 0.001) and 2 years (127 [IQR: 107–153] vs. 139 [IQR: 124–161]; <i>p</i> < 0.001) after RTP compared to pre-injury. No significant differences in performance were found regarding type of injury or type of treatment, nor were performance outcomes statistically significantly influenced by player's age, league and position played.</p> </section> <section> <h3> Conclusion</h3> <p>Shoulder dislocations in professional football led to a temporary short-term decrease in quantitative performance parameters, while qualitative performance parameters remained initially similar. Type of injury as well as type of treatment, player's age, league and position played did not significantly influence performance outco
目的：肩关节脱臼在职业足球中越来越多，并且经常与大量的裁员时间有关。然而，对运动员伤后表现的研究仍然有限。因此，本研究的目的是评估首次肩关节脱位是否会对恢复比赛（RTP）后的表现产生负面影响，并确定治疗类型（非手术与手术）是否会影响伤后的表现结果。方法：回顾性、基于媒体的分析2012/2013赛季至2021/2022赛季德国两大足球联赛（德甲和德甲）所有首次比赛中肩关节脱位的病例（n = 30）。定量和定性的表现数据，以及球员、比赛和受伤相关的数据从官方数据库中获得。Goalimpact （Goalimpact GmbH）作为定性参数，这是一个代表球员个人对球队成功影响的数值。数据分析至损伤前2年和rtp后2年。结果：30名中位年龄为25岁（四分位数间距[IQR]: 23-26）的运动员共30例肩关节脱位，可用于分析。与受伤前的10场比赛相比，RTP后10场比赛的平均休息时间为65天（IQR: 23-115），保守治疗组为22天（IQR: 10-34）， RTP后10场比赛的平均休息时间为112天（IQR: 92-133; p p = 0.017）和上场时间（p = 0.004）。目标冲击值最初与损伤前水平相当，但在1年后（131 [IQR: 115-150]对141 [IQR: 122-160]； p = 0.001）和2年后（127 [IQR: 107-153]对139 [IQR: 124-161]）有所改善；p结论：职业足球肩部脱位导致定量性能参数暂时短期下降，而定性性能参数最初保持相似。伤病类型、治疗方式、球员的年龄、联赛和位置对表现结果没有显著影响。证据等级：三级。
{"title":"Shoulder dislocations in professional male football (soccer) do not negatively affect long-term quantitative and qualitative performance parameters: A retrospective analysis of 30 in-match injuries of the German Bundesliga","authors":"Blanca Julie Degener, Christoph Theil, Georg Gosheger, Patrick May, Jörg Seidel, Tim Schachtrup, Theodoros Zafeiris, Kristian Nikolaus Schneider","doi":"10.1002/jeo2.70589","DOIUrl":"10.1002/jeo2.70589","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Shoulder dislocations in professional football are increasing and regularly associated with substantial layoff times. However, research on players' postinjury performance remains limited. Therefore, the purpose of this study was to evaluate whether first-time shoulder dislocations negatively affect performance after return to play (RTP) and to determine whether the type of treatment (nonoperative vs. operative) influences post-injury performance outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective, media-based analysis of all first-time in-match shoulder dislocations in the top two German football leagues (first and second Bundesliga) from the 2012/2013 to 2021/2022 season (<i>n</i> = 30). Quantitative and qualitative performance data, as well as player-, match- and injury-related data were obtained from official databases. The Goalimpact (Goalimpact GmbH), a numerical value representing an individual player's impact on team success, served as the qualitative parameter. Data were analysed up to 2 years pre-injury and 2 years post-RTP. Statistical significance was set at <i>p</i> < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 30 shoulder dislocations in 30 players with a median age of 25 years (Interquartile range [IQR]: 23–26) were available for analysis. Median layoff time was 65 days (IQR: 23–115), 22 days (IQR: 10–34) for those treated conservatively and 112 days (IQR: 92–133; <i>p</i> < 0.001) for players undergoing surgery. Quantitative performance parameters showed a temporary decrease, with fewer matches (<i>p</i> = 0.017) and minutes played (<i>p</i> = 0.004) in the 10 matches following RTP compared to the 10 matches pre-injury. Goalimpact values were initially comparable to pre-injury levels but improved 1 year (131 [IQR: 115–150] vs. 141 [IQR: 122–160]; <i>p</i> = 0.001) and 2 years (127 [IQR: 107–153] vs. 139 [IQR: 124–161]; <i>p</i> < 0.001) after RTP compared to pre-injury. No significant differences in performance were found regarding type of injury or type of treatment, nor were performance outcomes statistically significantly influenced by player's age, league and position played.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Shoulder dislocations in professional football led to a temporary short-term decrease in quantitative performance parameters, while qualitative performance parameters remained initially similar. Type of injury as well as type of treatment, player's age, league and position played did not significantly influence performance outco","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/PMC12682226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709832","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}
Ariane Lavoie-Hudon, Jean-Philippe Cloutier, Norbert Dion, Simon Laurendeau, Philippe Corbeil, Annie Arteau
Purpose
Trendelenburg gait is a common consequence of proximal femoral oncologic resection. To mitigate limping, tensor fascia latae (TFL) tenodesis is employed by suturing the muscle to the abductor mechanism, repaired to the trochanteric portion of the endoprosthesis. Objective functional evaluation of this technique has not been conducted. This study aimed to determine (1) whether the procedure induces tensor fascia latae hypertrophy, (2) its impact on functional outcomes and (3) its effect on gait patterns.
Methods
Sixteen patients who underwent proximal femoral resection and modular endoprosthesis reconstruction were assessed via computed tomography scans at least 1 year post-operatively for TFL and hip abductor hypertrophy and fatty infiltration. Patients were separated into two groups based on the presence or absence of TFL hypertrophy. Patient-related outcomes were evaluated with questionnaires, and a subset of seven patients underwent hip abductor strength measurement and gait analysis to assess objective function. Gait analysis included kinematics as well as electromyography.
Results
At 1 year, half of the cohort demonstrated TFL hypertrophy. A trend towards improved functional scores was observed in the hypertrophy group. Hip kinematics indicated a greater adduction (max of 7.2 ± 4.1° vs. 2.8 ± 2.6°, 88% difference) in the hypertrophy group, resulting in an increased pelvic drop during single-limb support (5.2 ± 3.1° in the hypertrophy group and 3.4 ± 3.7° in the no hypertrophy group, 42% difference). Gluteus medius activation tended to be slightly greater during the stance phase for the no hypertrophy group, while the TFL was most activated in the hypertrophy group in the same period.
Conclusion
The TFL tenodesis led to satisfactory functional outcomes for patients with proximal femoral reconstruction, whether they developed hypertrophy or not. TFL hypertrophy was not associated with a more favourable gait pattern, despite positive self-evaluated function.
{"title":"Does tenodesis of tensor fascia latae with hip abductors after proximal femoral resection and modular endoprosthetic reconstruction lead to functional improvements?","authors":"Ariane Lavoie-Hudon, Jean-Philippe Cloutier, Norbert Dion, Simon Laurendeau, Philippe Corbeil, Annie Arteau","doi":"10.1002/jeo2.70534","DOIUrl":"10.1002/jeo2.70534","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Trendelenburg gait is a common consequence of proximal femoral oncologic resection. To mitigate limping, tensor fascia latae (TFL) tenodesis is employed by suturing the muscle to the abductor mechanism, repaired to the trochanteric portion of the endoprosthesis. Objective functional evaluation of this technique has not been conducted. This study aimed to determine (1) whether the procedure induces tensor fascia latae hypertrophy, (2) its impact on functional outcomes and (3) its effect on gait patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sixteen patients who underwent proximal femoral resection and modular endoprosthesis reconstruction were assessed via computed tomography scans at least 1 year post-operatively for TFL and hip abductor hypertrophy and fatty infiltration. Patients were separated into two groups based on the presence or absence of TFL hypertrophy. Patient-related outcomes were evaluated with questionnaires, and a subset of seven patients underwent hip abductor strength measurement and gait analysis to assess objective function. Gait analysis included kinematics as well as electromyography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At 1 year, half of the cohort demonstrated TFL hypertrophy. A trend towards improved functional scores was observed in the hypertrophy group. Hip kinematics indicated a greater adduction (max of 7.2 ± 4.1° vs. 2.8 ± 2.6°, 88% difference) in the hypertrophy group, resulting in an increased pelvic drop during single-limb support (5.2 ± 3.1° in the hypertrophy group and 3.4 ± 3.7° in the no hypertrophy group, 42% difference). Gluteus medius activation tended to be slightly greater during the stance phase for the no hypertrophy group, while the TFL was most activated in the hypertrophy group in the same period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The TFL tenodesis led to satisfactory functional outcomes for patients with proximal femoral reconstruction, whether they developed hypertrophy or not. TFL hypertrophy was not associated with a more favourable gait pattern, despite positive self-evaluated function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"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/PMC12682228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709842","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}
To investigate age-related changes of femoral bowing and its association with bone mineral density (BMD) and bone metabolism using real-world data from the Iwaki cohort study.
Methods
Data from 709 participants were collected within 10 days in June 2022. The right femoral bowing angle was measured on full-length standing radiographs of the lower limbs, with varus alignment recorded as positive. BMD was assessed using dual-energy X-ray absorptiometry and evaluated based on T-scores. Bone metabolism was assessed via serum levels of type I procollagen N-terminal propeptide, type I collagen cross-linked N-telopeptide, tartrate-resistant acid phosphatase 5b and pentosidine. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Age-related changes in femoral bowing angle were analyzed by sex and age group, and regression analysis was performed to identify factors associated with femoral bowing angle.
Results
The mean femoral bowing angle was –1.4 ± 3.8° (31.9% femoral bowing angle showed varus) in male participants and –0.9 ± 3.9° (35.3% femoral bowing angle showed varus) in female participants. In both sexes, femoral bowing angle significantly increased with age, particularly after 60 years. Regression analysis demonstrated that femoral bowing angle was positively associated with age and body mass index (BMI) and bone metabolism markers in female participants. Femoral bowing angle was negatively associated with BMD and grip strength in both sexes. Higher BMI and lower BMD were independently associated with increased femoral bowing angle in both sexes. Femoral bowing angle negatively correlated with the Knee Injury and Osteoarthritis Outcome Score subscale scores.
Conclusions
Femoral lateral bowing progressed towards varus in male and female participants >60 years of age, and was associated with aging, obesity, muscle weakness, reduced bone mineral density and high-turnover bone metabolism. Knee symptoms were negatively correlated with varus progression of femoral bowing.
{"title":"Age-related varus progression of femoral bowing and its related factors in the Iwaki cohort study","authors":"Takamasa Uehara, Eiji Sasaki, Kyota Ishibashi, Ryo Tomita, Ryoto Kura, Yukiko Sakamoto, Yuka Kimura, Sunao Tanaka, Eiichi Tsuda, Yasuyuki Ishibashi","doi":"10.1002/jeo2.70587","DOIUrl":"10.1002/jeo2.70587","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To investigate age-related changes of femoral bowing and its association with bone mineral density (BMD) and bone metabolism using real-world data from the Iwaki cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 709 participants were collected within 10 days in June 2022. The right femoral bowing angle was measured on full-length standing radiographs of the lower limbs, with varus alignment recorded as positive. BMD was assessed using dual-energy X-ray absorptiometry and evaluated based on T-scores. Bone metabolism was assessed via serum levels of type I procollagen N-terminal propeptide, type I collagen cross-linked N-telopeptide, tartrate-resistant acid phosphatase 5b and pentosidine. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Age-related changes in femoral bowing angle were analyzed by sex and age group, and regression analysis was performed to identify factors associated with femoral bowing angle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean femoral bowing angle was –1.4 ± 3.8° (31.9% femoral bowing angle showed varus) in male participants and –0.9 ± 3.9° (35.3% femoral bowing angle showed varus) in female participants. In both sexes, femoral bowing angle significantly increased with age, particularly after 60 years. Regression analysis demonstrated that femoral bowing angle was positively associated with age and body mass index (BMI) and bone metabolism markers in female participants. Femoral bowing angle was negatively associated with BMD and grip strength in both sexes. Higher BMI and lower BMD were independently associated with increased femoral bowing angle in both sexes. Femoral bowing angle negatively correlated with the Knee Injury and Osteoarthritis Outcome Score subscale scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Femoral lateral bowing progressed towards varus in male and female participants >60 years of age, and was associated with aging, obesity, muscle weakness, reduced bone mineral density and high-turnover bone metabolism. Knee symptoms were negatively correlated with varus progression of femoral bowing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level II.</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/PMC12682227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709662","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}
Medial meniscal extrusion is a key factor in accelerating knee osteoarthritis. Medial joint line obliquity causes increased contact pressure on the medial meniscus, which potentially induces medial meniscal extrusion. Our hypothesis was that medial joint line obliquity contributes to an increase in medial meniscal extrusion in both supine and upright position during early-stage knee osteoarthritis (KOA).
Methods
We analysed 124 knees with early-stage KOA. Medial joint line obliquity (knee joint line obliquity ≤ − 3°) and posterior tibial slope ( ≥ 6°) were assessed using standing full-length lower extremity radiography and magnetic resonance imaging, respectively. Medial meniscal extrusion was measured using ultrasonography in the supine and upright positions. Cases with excessive posterior tibial slope were excluded to minimise the influence of the posterior tibial slope, and the remaining 89 knees were divided into medial joint line obliquity (n = 45; age = 58.3 ± 10.5 years) and control groups (n = 44; age = 59.8 ± 11.9 years). Each measurement was compared between the two groups using t-test or chi-square test. Multiple regression analysis was performed to determine the independent factor for medial meniscal extrusion.
Results
The medial joint line obliquity group showed significantly higher medial meniscal extrusion than the control group (supine, 3.0 ± 1.0 vs. 2.4 ± 0.9 mm, p = 0.004; upright, 3.7 ± 1.0 vs. 3.2 ± 1.1 mm, p = 0.023). Meniscal tear was present in 75.6% and 75% of the medial joint line obliquity and control groups, respectively, with no significant difference in tear type distribution (p = 0.999). Medial joint line obliquity and medial meniscus tear were independent factors for increased medial meniscal extrusion in both the supine (p = 0.002 and p = 0.003, respectively) and upright positions (p = 0.017 and p = 0.001, respectively).
Conclusion
Medial joint line obliquity and medial meniscus tear may be risk factors for medial meniscal extrusion in both the supine and upright positions in early-stage KOA.
Level of Evidence
Level IV.
目的：内侧半月板挤压是加速膝关节骨性关节炎的关键因素。内侧关节线倾斜导致内侧半月板接触压力增加，这可能导致内侧半月板挤压。我们的假设是，在早期膝关节骨关节炎（KOA）中，无论是仰卧位还是直立位，内侧关节线的倾斜度都会导致内侧半月板挤压的增加。方法对124例早期KOA膝关节进行分析。分别采用站立式下肢全长x线摄影和磁共振成像评估内侧关节线倾斜度（膝关节线倾斜度≤- 3°）和胫骨后斜度（≥6°）。采用仰卧位和直立位超声测量内侧半月板挤压。排除胫骨后斜度过大的病例，尽量减少胫骨后斜度的影响，剩余89例膝关节分为内侧关节线斜度组（n = 45，年龄= 58.3±10.5岁）和对照组（n = 44，年龄= 59.8±11.9岁）。两组间各测量值比较采用t检验或卡方检验。采用多元回归分析确定内侧半月板挤压的独立因素。结果：内侧关节线倾斜组内侧半月板挤压明显高于对照组（仰卧位，3.0±1.0比2.4±0.9 mm, p = 0.004；直立位，3.7±1.0比3.2±1.1 mm, p = 0.023）。内侧关节线倾斜组和对照组的半月板撕裂率分别为75.6%和75%，撕裂类型分布差异无统计学意义（p = 0.999）。内侧关节线斜度和内侧半月板撕裂是仰卧位（p = 0.002和p = 0.003）和直立位（p = 0.017和p = 0.001）内侧半月板挤压增加的独立因素。结论：内侧关节线倾斜和内侧半月板撕裂可能是早期KOA患者仰卧位和直立位内侧半月板挤压的危险因素。证据等级：四级。
{"title":"Medial joint line obliquity and medial meniscus tear were associated with medial meniscal extrusion: A case–control study","authors":"Kazuki Asai, Yosuke Shima, Kenichi Goshima, Kazunari Kuroda, Takeshi Oshima, Yasushi Takata, Mitsuhiro Kimura, Kengo Shimozaki, Tomoyuki Kanayama, Naoki Takemoto, Manase Nishimura, Kentaro Fujita, Satoru Demura, Junsuke Nakase","doi":"10.1002/jeo2.70584","DOIUrl":"10.1002/jeo2.70584","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medial meniscal extrusion is a key factor in accelerating knee osteoarthritis. Medial joint line obliquity causes increased contact pressure on the medial meniscus, which potentially induces medial meniscal extrusion. Our hypothesis was that medial joint line obliquity contributes to an increase in medial meniscal extrusion in both supine and upright position during early-stage knee osteoarthritis (KOA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 124 knees with early-stage KOA. Medial joint line obliquity (knee joint line obliquity ≤ − 3°) and posterior tibial slope ( ≥ 6°) were assessed using standing full-length lower extremity radiography and magnetic resonance imaging, respectively. Medial meniscal extrusion was measured using ultrasonography in the supine and upright positions. Cases with excessive posterior tibial slope were excluded to minimise the influence of the posterior tibial slope, and the remaining 89 knees were divided into medial joint line obliquity (<i>n</i> = 45; age = 58.3 ± 10.5 years) and control groups (<i>n</i> = 44; age = 59.8 ± 11.9 years). Each measurement was compared between the two groups using t-test or chi-square test. Multiple regression analysis was performed to determine the independent factor for medial meniscal extrusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The medial joint line obliquity group showed significantly higher medial meniscal extrusion than the control group (supine, 3.0 ± 1.0 vs. 2.4 ± 0.9 mm, <i>p</i> = 0.004; upright, 3.7 ± 1.0 vs. 3.2 ± 1.1 mm, <i>p</i> = 0.023). Meniscal tear was present in 75.6% and 75% of the medial joint line obliquity and control groups, respectively, with no significant difference in tear type distribution (<i>p</i> = 0.999). Medial joint line obliquity and medial meniscus tear were independent factors for increased medial meniscal extrusion in both the supine (<i>p</i> = 0.002 and <i>p</i> = 0.003, respectively) and upright positions (<i>p</i> = 0.017 and <i>p</i> = 0.001, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Medial joint line obliquity and medial meniscus tear may be risk factors for medial meniscal extrusion in both the supine and upright positions in early-stage KOA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level IV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"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/PMC12682229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709797","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}
Alan Price, Rajkumar Gangadharan, Damon Simmons, William Boswell, Thomas W. Maddox, Rachel A. Oldershaw, Richard Norris
Purpose
The primary objective of this study was to investigate the association between patient-reported history elements and anterior cruciate ligament (ACL) tears. The secondary objectives were to evaluate the predictive validity of history elements and develop clinically interpretable decision rules to aid diagnostic reasoning.
Methods
This was a retrospective analysis of data collected during two prospective studies. Patient history elements including demographics, mechanism of injury, signs/symptoms at the time of injury, and subsequent symptoms since the injury were collected using a pre-existing departmental questionnaire and cross referenced with magnetic resonance imaging results. Association and predictive validity were investigated through penalised and unpenalised logistic regressions, and classification and regression tree analyses.
Results
Of the 173 included participants, 87 participants (56 males) had an ACL tear with the remainder reported as having posterior cruciate ligament, meniscal, patellofemoral joint, medial and/or lateral knee injuries. There was a significant negative association between seeing deformity (p = 0.028, odds ratio [OR]: 0.091, 95% confidence interval [CI]: 0.011–0.766) or isolated anterior knee pain (p = 0.038, OR: 0.068, 95% CI: 0.005–0.864) at the time of injury, and an ACL tear. Other patient-reported history elements, used individually or in combination, demonstrated limited clinical utility for differentiating ACL tears from other traumatic knee injuries.
Conclusion
Patient-reported deformity and isolated anterior or medial knee pain at the time of injury were significantly associated with the absence of an ACL tear. Other history elements were not significantly associated with an ACL tear, highlighting the limited clinical utility of history taking and the importance of physical examination after knee injury.
{"title":"Don't take their word for it: Investigating the diagnostic accuracy of history elements for anterior cruciate ligament tears","authors":"Alan Price, Rajkumar Gangadharan, Damon Simmons, William Boswell, Thomas W. Maddox, Rachel A. Oldershaw, Richard Norris","doi":"10.1002/jeo2.70586","DOIUrl":"10.1002/jeo2.70586","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The primary objective of this study was to investigate the association between patient-reported history elements and anterior cruciate ligament (ACL) tears. The secondary objectives were to evaluate the predictive validity of history elements and develop clinically interpretable decision rules to aid diagnostic reasoning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective analysis of data collected during two prospective studies. Patient history elements including demographics, mechanism of injury, signs/symptoms at the time of injury, and subsequent symptoms since the injury were collected using a pre-existing departmental questionnaire and cross referenced with magnetic resonance imaging results. Association and predictive validity were investigated through penalised and unpenalised logistic regressions, and classification and regression tree analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 173 included participants, 87 participants (56 males) had an ACL tear with the remainder reported as having posterior cruciate ligament, meniscal, patellofemoral joint, medial and/or lateral knee injuries. There was a significant negative association between seeing deformity (<i>p</i> = 0.028, odds ratio [OR]: 0.091, 95% confidence interval [CI]: 0.011–0.766) or isolated anterior knee pain (<i>p</i> = 0.038, OR: 0.068, 95% CI: 0.005–0.864) at the time of injury, and an ACL tear. Other patient-reported history elements, used individually or in combination, demonstrated limited clinical utility for differentiating ACL tears from other traumatic knee injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patient-reported deformity and isolated anterior or medial knee pain at the time of injury were significantly associated with the absence of an ACL tear. Other history elements were not significantly associated with an ACL tear, highlighting the limited clinical utility of history taking and the importance of physical examination after knee injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level I.</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/PMC12682225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709857","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}
Antoine Hamon, Harold Common, Théo Cojean, Henri Robert
Purpose
Conventional techniques (medial collateral ligament + posterior oblique ligament reconstructions), such as those by Lind and LaPrade, do not fully restore native knee stability in severe medial injuries. This study aimed to determine the optimal tibial insertion site for an anteromedial (AM) reconstruction strand mimicking the deep medial collateral ligament (dMCL), to better control anteromedial rotatory instability (AMRI) in knees with complete medial injury (sMCL + dMCL + POL).
Methods
Twenty fresh-frozen cadaveric knees (13 female, 7 male donors; mean age: 80 years) were tested using Dyneelax® static laximeter at 30° of flexion. After standardised transections of the superficial MCL (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL), each knee was reconstructed using a trifid flat graft including an AM strand. Knees were assigned to two groups based on the tibial insertion angle (α) between the AM strand and the sMCL: group α ≤ 20° (anatomical reconstruction) and group α > 20° (oblique isometric reconstruction). Anterior tibial translation (ATT), internal rotation (IR), and external rotation (ER) were measured under 200 N of force and 5 N-m torques. Residual laxities were calculated in both absolute and relative terms, compared to the intact state, and analysed using ANOVA and Student's t-tests.
Results
Both reconstruction techniques significantly reduced laxity compared to the transected state. However, group α > 20° showed significantly lower residual laxity for ATT (0.74 ± 0.58 mm vs. 1.30 ± 0.56 mm, p = 0.04) and for ER (0.35 ± 0.39° vs. 1.05 ± 0.89°, p = 0.04), with no significant difference for IR (p = 0.24).
Conclusion
There is a trend toward better stability with a more oblique AM strand, which must be confirmed by further biomechanical studies. This trifid flat graft approach more accurately replicates the biomechanical function of the dMCL and anteromedial capsule, and could provide a refined strategy for reconstructing severe medial knee instability
Level of Evidence
Level V, experimental cadaveric study.
目的：常规技术（内侧副韧带+后斜韧带重建），如Lind和LaPrade，不能完全恢复严重内侧损伤的膝关节稳定性。本研究旨在确定模拟深内侧副韧带（dMCL）的前内侧（AM）重建链的最佳胫骨插入位置，以更好地控制完全内侧损伤（sMCL + dMCL + POL）膝关节的前内侧旋转不稳定性（AMRI）。方法：采用Dyneelax®静态屈曲仪，对20例新鲜冷冻尸体膝关节（女性13例，男性7例，平均年龄80岁）进行测试。在标准横断浅表MCL （sMCL）、深MCL （dMCL）和后斜韧带（POL）后，使用包括AM链的三裂扁平移植物重建每个膝关节。根据AM股与sMCL之间的胫骨插入角（α）将膝关节分为两组：α≤20°组（解剖重建）和α > 20°组（斜等距重建）。在200 N的力和5 N-m的扭矩下测量胫骨前平移（ATT）、内旋（IR）和外旋（ER）。与完整状态相比，以绝对和相对方式计算剩余松弛度，并使用方差分析和学生t检验进行分析。结果：与横切状态相比，两种重建技术都显著降低了松弛度。然而，α bbb20°组在ATT（0.74±0.58 mm vs. 1.30±0.56 mm, p = 0.04）和ER（0.35±0.39°vs. 1.05±0.89°，p = 0.04）和IR （p = 0.24）方面的剩余松弛度均显著降低。结论：AM股斜向有更好的稳定性趋势，这需要进一步的生物力学研究来证实。这种三裂平板移植入路更准确地复制了dMCL和前内侧囊的生物力学功能，并可以为重建严重内侧膝关节不稳定提供一种精细的策略。证据等级：V级，实验性尸体研究。
{"title":"Which tibial implantation site for the deep medial collateral ligament should be chosen to control anteromedial rotatory instability of the knee?","authors":"Antoine Hamon, Harold Common, Théo Cojean, Henri Robert","doi":"10.1002/jeo2.70585","DOIUrl":"10.1002/jeo2.70585","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Conventional techniques (medial collateral ligament + posterior oblique ligament reconstructions), such as those by Lind and LaPrade, do not fully restore native knee stability in severe medial injuries. This study aimed to determine the optimal tibial insertion site for an anteromedial (AM) reconstruction strand mimicking the deep medial collateral ligament (dMCL), to better control anteromedial rotatory instability (AMRI) in knees with complete medial injury (sMCL + dMCL + POL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty fresh-frozen cadaveric knees (13 female, 7 male donors; mean age: 80 years) were tested using Dyneelax® static laximeter at 30° of flexion. After standardised transections of the superficial MCL (sMCL), deep MCL (dMCL), and posterior oblique ligament (POL), each knee was reconstructed using a trifid flat graft including an AM strand. Knees were assigned to two groups based on the tibial insertion angle (α) between the AM strand and the sMCL: group <i>α</i> ≤ 20° (anatomical reconstruction) and group <i>α</i> > 20° (oblique isometric reconstruction). Anterior tibial translation (ATT), internal rotation (IR), and external rotation (ER) were measured under 200 N of force and 5 N-m torques. Residual laxities were calculated in both absolute and relative terms, compared to the intact state, and analysed using ANOVA and Student's t-tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both reconstruction techniques significantly reduced laxity compared to the transected state. However, group <i>α</i> > 20° showed significantly lower residual laxity for ATT (0.74 ± 0.58 mm vs. 1.30 ± 0.56 mm, <i>p</i> = 0.04) and for ER (0.35 ± 0.39° vs. 1.05 ± 0.89°, <i>p</i> = 0.04), with no significant difference for IR (<i>p</i> = 0.24).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is a trend toward better stability with a more oblique AM strand, which must be confirmed by further biomechanical studies. This trifid flat graft approach more accurately replicates the biomechanical function of the dMCL and anteromedial capsule, and could provide a refined strategy for reconstructing severe medial knee instability</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>Level V, experimental cadaveric study.</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/PMC12682233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145709940","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}
Riccardo Sacco, Andrea Tecame, Matthieu Lalevée, Antoine Perrier, Edward Massa, Pascal Kouyoumdjian, Paolo Adravanti
<div> <section> <h3> Purpose</h3> <p>Randomised controlled trials (RCTs) comparing robotic-assisted (RA-TKA) and conventional total knee arthroplasty (C-TKA) have demonstrated evolving trends in alignment strategies, surgical workflows and outcomes measurements. This review synthesises current evidence to clarify the evolving role of RA-TKA over the past two decades.</p> </section> <section> <h3> Methods</h3> <p>A PRISMA systematic review was conducted searching PubMed, Cochrane Library, and Google Scholar (2000–2024). Eligible studies were Level I RCTs comparing RA-TKA to C-TKA with well-defined alignment strategies and surgical workflows. Data included demographics, robotic and prosthetic systems, learning curves, outcome measures and complications.</p> </section> <section> <h3> Results</h3> <p>From 850 records, 9 RCTs were included (627 TKAs: 317 RA-TKA, 310 C-TKA). Patients averaged 66.9 years, BMI 28.1 kg/m², 27.9% male, 69.7 knees, follow-up 23.7 months. Coronal deformity was predominantly varus (<10°). Robotic systems included Robodoc, Mako, and Navio using cruciate-retaining or posterior-stabilised prostheses. All earlier studies followed mechanical alignment (MA); after 2021 all RA-TKAs adopted personalised alignment strategies. Patellar management varied widely, with no RA-TKA workflow addressing the patellofemoral space. Most procedures were performed by one or two experienced surgeons; learning curves were only noted in early MA studies. RA-TKA reduced alignment outliers by 10%–24% (<i>p</i> < 0.05) versus C-TKA regardless of the alignment strategy, with no significant difference in functional scores (WOMAC, HSS, KSS, OKS and FJS), range of motion or complications. Recent trials increasingly assessed inflammatory markers, periarticular tissue injury, and quality-of-life outcomes.</p> </section> <section> <h3> Conclusions</h3> <p>Over the past two decades, RA-TKA has evolved substantially, transitioning from purely bone-cutting technology to decision-making platforms enabling alignment personalisation and dynamic soft-tissue assessment, improving surgical precision regardless of alignment strategy. Clinical superiority over C-TKA remains inconclusive in relatively low-risk patients, predominantly older females with varus deformity, highlighting the need for studies with more diverse populations, prosthetic design, long-term follow-up, patient-specific outcomes, standardised workflow and learning curve reporting, and patellofemoral space optimisation.</p> </section> <section>
{"title":"Robotic vs. conventional total knee arthroplasty over two decades: Evolving trends toward personalised alignment without significant clinical superiority in predominantly mild varus deformity—A systematic review of RCTs","authors":"Riccardo Sacco, Andrea Tecame, Matthieu Lalevée, Antoine Perrier, Edward Massa, Pascal Kouyoumdjian, Paolo Adravanti","doi":"10.1002/jeo2.70452","DOIUrl":"10.1002/jeo2.70452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Randomised controlled trials (RCTs) comparing robotic-assisted (RA-TKA) and conventional total knee arthroplasty (C-TKA) have demonstrated evolving trends in alignment strategies, surgical workflows and outcomes measurements. This review synthesises current evidence to clarify the evolving role of RA-TKA over the past two decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A PRISMA systematic review was conducted searching PubMed, Cochrane Library, and Google Scholar (2000–2024). Eligible studies were Level I RCTs comparing RA-TKA to C-TKA with well-defined alignment strategies and surgical workflows. Data included demographics, robotic and prosthetic systems, learning curves, outcome measures and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 850 records, 9 RCTs were included (627 TKAs: 317 RA-TKA, 310 C-TKA). Patients averaged 66.9 years, BMI 28.1 kg/m², 27.9% male, 69.7 knees, follow-up 23.7 months. Coronal deformity was predominantly varus (<10°). Robotic systems included Robodoc, Mako, and Navio using cruciate-retaining or posterior-stabilised prostheses. All earlier studies followed mechanical alignment (MA); after 2021 all RA-TKAs adopted personalised alignment strategies. Patellar management varied widely, with no RA-TKA workflow addressing the patellofemoral space. Most procedures were performed by one or two experienced surgeons; learning curves were only noted in early MA studies. RA-TKA reduced alignment outliers by 10%–24% (<i>p</i> < 0.05) versus C-TKA regardless of the alignment strategy, with no significant difference in functional scores (WOMAC, HSS, KSS, OKS and FJS), range of motion or complications. Recent trials increasingly assessed inflammatory markers, periarticular tissue injury, and quality-of-life outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Over the past two decades, RA-TKA has evolved substantially, transitioning from purely bone-cutting technology to decision-making platforms enabling alignment personalisation and dynamic soft-tissue assessment, improving surgical precision regardless of alignment strategy. Clinical superiority over C-TKA remains inconclusive in relatively low-risk patients, predominantly older females with varus deformity, highlighting the need for studies with more diverse populations, prosthetic design, long-term follow-up, patient-specific outcomes, standardised workflow and learning curve reporting, and patellofemoral space optimisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670058","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}
To compare the anterior tibial translation (ATT) between single-bundle (SB) and double-bundle (DB) ‘supra’-over-the-top anterior cruciate ligament reconstruction (s-OTT ACLR) during the anterior drawer test in a cadaveric model.
Methods
This was a controlled laboratory study. Seven fresh-frozen cadaveric knee specimens and a robotic testing system were used. Initially, the same testing procedure (100 N anterior drawer load applied at 0°, 15°, 30°, 60° and 90° of knee flexion) was applied to the following four different knee conditions: intact, anterior cruciate ligament (ACL)-sectioned, SB s-OTT ACLR and DB s-OTT ACLR knees. Subsequently, a combined load of 5 Nm internal tibial torque and 10 Nm valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot shift. During the tests, anterior tibial translation (ATT) was recorded. The initial tension was set at 22 N for the SB s-OTT ACLR and 11 N for each graft in the DB s-OTT ACLR at 30° of knee flexion. For the SB s-OTT ACLR with an 8-mm-diameter tibial tunnel, the drilling area was 16 Π mm² (4 × 4 × Π). Regarding the DB s-OTT ACLR with two 5-mm-diameter tibial tunnels, the total drilling area was 12.5 Π mm² (2.5 × 2.5 × Π × 2).
Results
Both SB and DB s-OTT ACL reconstructions significantly reduced ATT compared with the ACL-sectioned state under both anterior drawer and simulated pivot-shift loads, while showing no difference from the intact knee. No significant ATT difference was detected between SB and DB s-OTT ACLRs at any tested flexion angle, and DB achieved anterior knee stability comparable to SB despite its lower initial graft tension.
Conclusions
DB s-OTT ACLR demonstrated ATT and in situ graft force comparable to SB s-OTT ACLR in a cadaveric robotic study. These findings suggest that DB s-OTT ACLR can achieve anterior knee stability similar to SB s-OTT ACLR with lower initial graft tension.
{"title":"Double tibial tunnels ‘supra’ over-the-top anterior cruciate ligament reconstruction with lower initial graft tension achieves comparable anterior stability to single-tunnel: A cadaveric study using a robotic simulator","authors":"Kousuke Shiwaku, Tomoyuki Suzuki, Konsei Shino, Satoshi Yamakawa, Hidenori Otsubo, Daisuke Suzuki, Shinichiro Okimura, Katsunori Takahashi, Shogo Nabeki, Hirofumi Ohnishi, Hiromichi Fujie, Atsushi Teramoto","doi":"10.1002/jeo2.70466","DOIUrl":"10.1002/jeo2.70466","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To compare the anterior tibial translation (ATT) between single-bundle (SB) and double-bundle (DB) ‘supra’-over-the-top anterior cruciate ligament reconstruction (s-OTT ACLR) during the anterior drawer test in a cadaveric model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a controlled laboratory study. Seven fresh-frozen cadaveric knee specimens and a robotic testing system were used. Initially, the same testing procedure (100 N anterior drawer load applied at 0°, 15°, 30°, 60° and 90° of knee flexion) was applied to the following four different knee conditions: intact, anterior cruciate ligament (ACL)-sectioned, SB s-OTT ACLR and DB s-OTT ACLR knees. Subsequently, a combined load of 5 Nm internal tibial torque and 10 Nm valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot shift. During the tests, anterior tibial translation (ATT) was recorded. The initial tension was set at 22 N for the SB s-OTT ACLR and 11 N for each graft in the DB s-OTT ACLR at 30° of knee flexion. For the SB s-OTT ACLR with an 8-mm-diameter tibial tunnel, the drilling area was 16 Π mm² (4 × 4 × Π). Regarding the DB s-OTT ACLR with two 5-mm-diameter tibial tunnels, the total drilling area was 12.5 Π mm² (2.5 × 2.5 × Π × 2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both SB and DB s-OTT ACL reconstructions significantly reduced ATT compared with the ACL-sectioned state under both anterior drawer and simulated pivot-shift loads, while showing no difference from the intact knee. No significant ATT difference was detected between SB and DB s-OTT ACLRs at any tested flexion angle, and DB achieved anterior knee stability comparable to SB despite its lower initial graft tension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DB s-OTT ACLR demonstrated ATT and in situ graft force comparable to SB s-OTT ACLR in a cadaveric robotic study. These findings suggest that DB s-OTT ACLR can achieve anterior knee stability similar to SB s-OTT ACLR with lower initial graft tension.</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":"12 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12666155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662240","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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