Annals of Joint最新文献

Background: Patients with lower leg amputations tend to develop hip osteoarthritis more frequently and at a younger age than the general population. Some amputee patients choose hip resurfacing arthroplasty (HRA) because of its bone conservation compared to total hip arthroplasty. Because of their altered gait mechanics, HRA might provide these patients with stability and functional benefits compared to total hip arthroplasty. The hypothesis is that HRA is a useful and successful alternative to total hip replacement for lower extremity amputees requiring hip implant surgery. The aim of this study was to evaluate if HRA is a successful alternative to total hip replacement in this patient population with altered gait mechanics.

Methods: This observational study reviewed the records of 39 amputee patients (45 hips) who underwent HRA using a polyethylene acetabular component. Trauma, tumor, vascular disease, infection, and congenital conditions were indications for amputation. Above knee and below knee amputations were included. Patients were evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS), Harris Hip Score (HHS), Minimal Clinically Important Difference (MCID), and Patient Acceptable Symptomatic State (PASS). Follow-up included implant survivorship, complications, and radiographic evaluation for implant osseointegration, wear, position, and leg length.

Results: Mean follow-up was 13 years (range, 3-40 years). Mean HOOS was 90, mean HHS was 92; 92% of patients achieved MCID (which required an improvement of 38 points in HOOS and 37 points in HHS), and 85% achieved PASS. There was one revision for femoral head avascular necrosis, one conventional polyethylene exchange for wear, and six temporary complications. Thirty-three (85%) patients had a leg length difference of >1 cm (range, 1-4.7 cm); the prosthetic limb was shorter in 25 (75%) and longer in 8 (25%). No patient was concerned with leg length difference and there were no differences in hip scores and implant survivorship based on limb length.

Conclusions: HRA is a demanding procedure that can be successful for patients with lower limb amputations. An unexpected finding was that leg length differences are common in these patients. Unequal leg lengths did not adversely affect implant survivorship or patient-reported outcomes.

Background: The precise location of tunnel placement significantly influences the outcome of anterior cruciate ligament (ACL) reconstruction, and an accurate understanding of tunnel placement remains paramount during postoperative assessment. Despite this, surgeons commonly estimate tunnel position and the method used to ream the tunnel based on plain radiographs alone. This study aims to determine the accuracy and reliability with which orthopaedic surgeons and musculoskeletal specialists can identify femoral tunnel (FT) reaming technique using standard postoperative radiographs alone, and to evaluate whether perceived tunnel malposition influences assumptions about reaming method.

Methods: This cross-sectional diagnostic study reviews postoperative radiographs from 40 ACL reconstructions (ACLRs) performed by the senior author. Twenty transtibially-reamed knees were matched with 20 anteromedially-reamed knees according to age, gender and body mass index (BMI). Surgical technique was identical for both groups, with the exception of FT reaming method, and postoperative radiographs were routinely obtained two weeks after surgery. Fifteen blinded orthopaedic or musculoskeletal trained reviewers evaluated radiographs for tunnel position and assumed reaming method. A kappa analysis was used to determine agreement among reviewers and assumed reaming method error rates were assessed parametrically.

Results: Reaming method was chosen correctly 64% of the time. However, the overall kappa value was low at 0.26. Transtibial error rate correlated with negative judgements of FT placement with a Pearson correlation coefficient of 0.648 (P=0.01).

Conclusions: These results suggest that the reaming method cannot be reliably determined using standard postoperative radiographs, and that evaluators who judge the tunnel placement to be poor may be biased toward assuming the tunnel was reamed transtibially. Surgeons should be careful not to associate failed ACLR with particular reaming methods without additional data.

Background and objective: High tibial osteotomy (HTO), particularly through a medial opening-wedge technique [medial opening-wedge high tibial osteotomy (MOWHTO)], is a well-established surgical intervention for correcting varus malalignment and unloading the medial compartment in younger patients with early osteoarthritis or secondary ligamentous or chondral deficiency. However, conventional methods pose high technical demands for accurate alignment, often requiring repeat intraoperative fluoroscopy. Patient-specific instrumentation (PSI), developed through three-dimensional (3D) imaging and printing technologies, offers a promising solution by enabling precise preoperative planning and intraoperative execution via customized cutting guides. This narrative review aims to explore the inception and current data surrounding PSI in HTO, specifically in regards to radiation, cost effectiveness, hinge fractures, surgical accuracy, and multiplanar osteotomies.

Methods: A comprehensive literature review was conducted using PubMed, incorporating studies related to "high tibial osteotomy", "virtual planning", "patient-specific instrumentation", and "3D planning" published up to March 1st, 2025. Relevant English-language studies were included to summarize the use and outcomes associated with PSI in HTO.

Key content and findings: The literature consistently demonstrates that PSI significantly enhances the precision and reproducibility of HTO. PSI is associated with a marked reduction in intraoperative fluoroscopy use and operative time, supporting its role in improving surgical efficiency and radiation safety. The costs of PSI vs. traditional osteotomy are nearly identical, with potential for even further monetary savings in revision rates, survivorship, and downstream healthcare utilization. Current evidence on hinge fracture prevention remains inconclusive, but PSI offers theoretical benefits through controlled cutting depths, hinge-pin technology, and anatomically tailored guides. Studies report alignment deviations typically within 2° of the preoperative plan in both coronal and sagittal planes, surpassing traditional and navigation-assisted techniques.

Conclusions: PSI represents a significant advancement in the execution of high tibial osteotomies, offering increased surgical accuracy, reduced radiation exposure, and enhanced procedural efficiency. It holds particular value in complex or multiplanar deformities where traditional techniques are limited. Although cost and hinge fracture data remain areas for further investigation, the growing body of evidence supports PSI's clinical utility and reproducibility. As 3D planning technologies and guided manufacturing become more accessible, PSI is well-positioned to become a standard adjunct in knee realignment procedures.

Background and objective: Injuries of the anterior cruciate ligament (ACL) are common among high-level athletes. Treatment is not always successful and elite athletes often have difficulties returning to a preinjury level of performance. Treatment of athletes is very demanding due to the high loads and strong forces on the ACL during competitive sports. Multiple risk factors associated with ACL reconstruction failure have been identified over the past decades. To provide the best possible treatment, knowledge about the diagnostic tools at the physician's disposal and their interpretation are of utmost importance. The objective of this review is to provide a structured summary of the literature on the evaluation of ACL-injured high-level athletes.

Methods: A manual PubMed review about evaluation of ACL injured high-level athletes has been conducted on January 30^th, 2025.

Key content and findings: The Lachman test yields high sensitivity, and the pivot-shift test high specificity. Knee hyperextension and general joint laxity (GJL) are risk factors for ACL reconstruction failure. Radiographs are necessary to rule out fractures or dislocations and are needed for alignment analysis, especially of the posterior tibial slope (PTS). Magnetic resonance imaging (MRI) is recommended to confirm diagnosis, rule out concomitant injuries and plan anatomic reconstruction. Instrumented laxity measurement tools aim to measure anterior or rotational laxity. A variety of arthrometers can be used to quantitatively measure anterior laxity. Preoperative and postoperative pivot-shift correlates with clinical outcome of ACL reconstruction. Many attempts have been made to establish simple and reliable quantification methods. It remains a challenging task especially due to the dynamic nature of the pivot-shift test. Randomised controlled trials with large cohorts and multi-centre studies might provide more information about the reliability, accuracy and validity of these tools in the future and help determine a gold standard.

Conclusions: This narrative review provides a structured summary of the literature and evidence-based recommendations regarding the assessment of ACL injured high-level athletes.

Background and objective: The integration of artificial intelligence (AI) into medical education is reshaping traditional learning paradigms. In orthopaedic surgery, AI applications such as virtual reality (VR) and augmented reality (AR) simulations and intelligent tutoring systems are being utilized to enhance training. This review aims to explore the current applications, benefits, challenges, and future directions of AI in orthopaedic education, while also addressing relevant ethical and logistical considerations.

Methods: A targeted literature review was conducted using PubMed, prioritizing studies published in 2024 and including relevant articles from 2023. Search terms included "artificial intelligence", "orthopaedic education", "surgical simulation", and related keywords. Studies were selected based on relevance to orthopaedic surgery education, with a particular focus on surgical skill acquisition, diagnostic training, and curriculum development. Both peer-reviewed and selected non-peer-reviewed sources were analyzed to synthesize current trends and emerging practices. Relevant articles were also identified using manual reference searching.

Key content and findings: The review highlights a positive shift in attitudes toward AI among educators and learners, particularly for its ability to simulate surgical environments safely and personalize learning. Current applications include AI-powered VR/AR platforms for realistic procedural training, intelligent tutoring systems that tailor feedback to individual learning gaps, and tools for enhancing diagnostic reasoning. Despite these advances, challenges remain, including concerns about overreliance on technology, institutional readiness, and the need for adjustments to the curriculum.

Conclusions: AI presents a transformative opportunity for orthopaedic education by enabling safer, more personalized, and more efficient learning. While current applications show promising results in improving both knowledge and technical skill, ongoing evaluation, thoughtful integration, and structured implementation are necessary to maximize educational value while addressing limitations and ethical concerns.

Background: A clear synthesis of anterior cruciate ligament (ACL) injuries across various sports is lacking. This review aimed to explore the ACL injury across various sports, with focus on the injury mechanism, situational patterns and the circumstances of the ACL injury in articles using video analyses on American football, Australian football, basketball, football (soccer), handball, and rugby.

Methods: A systematic literature search in four databases was conducted in October 2023. English-language articles that analyzed the injury mechanism and situational patterns of ACL injuries through video analysis in American football, Australian football, basketball, football (soccer), handball, and rugby, were considered for inclusion. Data of the injury mechanism, offensive and defensive play, when the injury occurred during the game, the player position, and the horizontal velocity of which the injury occurred were summarized using weighted averages with standard deviation for all, and for respective sports.

Results: Twenty-eight articles were included in this scoping review with 1,274 professional athletes, of whom 1,055 (83%) were men. The most common ACL injury mechanism across all sports was non-contact with 43.7%±12.0% of ACL injuries. With regard to game play, the distribution of ACL injuries during offensive versus defensive play was relatively even across all sports (47.2%±20.6% offensive vs. 49.1%±20.9% defensive). Most ACL injuries occurred during the first half across all sports (57.5%±8.9%). The most frequent horizontal velocity at the time of the ACL injury was medium (46.0%±9.9%), corresponding to running, and high to very high velocities (43.4%±18.3%) across all sports.

Conclusions: This scoping review provides an overview of the ACL injury mechanisms, situational patterns, and injury circumstances associated with ACL injuries across multiple sports. By examining the role of contact, type of game play, timing, player position, and horizontal velocity in injury occurrence, this review offers valuable insights for both injury prevention and future research. To understand these factors can inform more effective prevention strategies and help reduce the incidence of ACL injuries in athletes.

The medial meniscus posterior root (MMPR) provides biomechanical support to the medial compartment of the knee. An MMPR tear confers significantly increased peak contact pressures in the medial compartment. MMPR tears (MMPRTs), when unrecognized or when treated nonoperatively, often result in rapid progression of osteoarthritis. Once described as a silent epidemic, awareness of the clinical presentation and common imaging findings associated with MMPRTs has improved recognition of MMPRTs by orthopedic surgeons. The majority of patients with MMPRTs are candidates for repair of the MMPR whenever possible. In patients with early osteoarthritis, coronal knee malalignment, advanced age, or irreparable tear patterns, the indications for management are not well defined. Various techniques for repair for the repair of MMPR have been described, including the arthroscopic approach, suture configurations, and different implant properties. In addition to the repair of the MMPR, a novel technique aiming to centralize the meniscus can decrease meniscal extrusion, which is often not reliably addressed with MMPR repair alone. While MMPRTs remain a challenging injury for patients, increased recognition of these tears allows for improved decision-making regarding management of these injuries. Surgical management techniques continue to be refined and are aimed at restoring native anatomy of the medial meniscus to the extent possible, with the ultimate goal of prolonging the life of the native knee and facilitating a return to satisfactory function.

Background and objective: Multiligament knee injuries (MLKIs), although rare in athletes, can present distinct challenges beyond the high-energy trauma commonly seen in the general population. The combination of anterior cruciate ligament (ACL) injury with other major knee stabilizers creates substantial treatment challenges as most athletes experience pressure to return to top-level sports quickly, while maintaining joint stability over a long career. This narrative review summarizes the epidemiology and biomechanics of common injury patterns, classification systems, surgical decision-making and rehabilitation strategies for managing multiple ligament knee injuries in athletes.

Methods: A narrative literature review was conducted using PubMed and MEDLINE databases, targeting English-language studies from 2000 to 2024. Relevant studies were identified through keyword searches including "multiligament knee injury", "ACL reconstruction", "athlete", "return to play", and "concomitant ligament injury". Studies focused on biomechanics, surgical technique, rehabilitation, biologic augmentation, and performance outcomes were included.

Key content and findings: MLKIs are recognized with an increasing incidence in athletes; however, they are not well studied in the literature outside of traumatic, typically high energy settings. In athletes, management becomes more complex as surgical intervention must be considered in tandem with return-to-play (RTP) necessitating individualized planning. Underlying knee biomechanics can help identify potential risk for specific injury patterns. Surgical reconstruction with autograft in a single staged procedure is preferred due to possible lower risk for re-rupture and potentially quicker return to sport; however, graft selection based on number of ligaments involved and timing of surgery remain points of controversy. Importantly, avoiding tunnel collision during MLKI reconstruction adds a unique challenge and requires thoughtful surgical preoperative planning. Appropriate rehabilitation is critical as well to allow RTP at the same level. Generally, early range of motion with progressive weight bearing is recommended with an additive potential for standardized testing to evaluate for RTP. As MLKI research continues to progress, identifying optimal graft selection, timing of reconstruction, and rehabilitation protocols with a potential role for biologics will improve athletes' successful RTP.

Conclusions: MLKIs in athletes present unique challenges that extend beyond those seen in high-energy trauma cases. Coordinating surgical management with RTP goals requires individualized planning and thoughtful rehabilitation. Ongoing research is needed to refine graft selection, surgical timing, and recovery protocols. In this narrative review, we aim to review the literature, highlight treatment gaps and future areas of research, and provide

Background and objective: Cartilage lesions of the knee occur frequently and can cause debilitating symptoms such as pain, swelling, locking, clicking, or catching. In some lesions, both the cartilage and underlying subchondral bone are affected, which may require treatment of both the osseous and cartilaginous units. The objective of this review was to assess the available evidence of advanced treatments for osteochondral lesions in the knee.

Methods: A literature search was conducted in the electronic databases of PubMed, Embase and Cochrane Library for a narrative review on studies reporting outcomes of osteochondral knee treatments. Studies were included if they reported outcomes at minimum 1-year follow-up and had minimum 5 patients, and biomechanical, translational and basic science studies were excluded.

Key content and findings: In addition to chondroplasty and microfracture, four major advanced osteochondral restoration procedures aimed at treating injuries to the osteochondral unit were identified in the literature, which consisted of surgical internal fixation of either acute osteochondral fragments or osteochondritis dissecans (OCD) lesions, osteochondral autograft transplantation (OAT), osteochondral allograft (OCA) transplantation and biphasic scaffold implantation. Internal fixation of acute osteochondral patellofemoral fractures has been found to have superior outcomes compared to fragment removal, but does require concomitant patellar stabilization. Fixation of OCD also leads to good outcomes without superiority for fixation method. Osteochondral autograft is an excellent treatment option for smaller defects and has a high rate of return to sport. OCA outcomes are excellent with good survival rates although reoperations can frequently occur. Finally, biphasic scaffolds are relatively recent and can be used in both more acute as well as more degenerative settings and the short-term outcomes are promising.

Conclusions: Osteochondral injury in the knee requires unique treatment options as both the underlying bone and cartilage need to be treated, due to their poor healing capacity and significant cause of morbidity. Several treatment options exist and the overall outcomes of these treatments are satisfactory in improving patient-reported outcomes, and most patients can return to activities.