Knee最新文献 - Book学术

Revision of unicompartmental knee replacement can achieve equivalent outcomes to primary total knee replacement when revised for confirmed pathology

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-25 DOI: 10.1016/j.knee.2025.04.006

Thomas Christiner, Caitlin Chidlow, Simon Smith

Introduction

There is conflicting evidence regarding outcomes following revision of Unicompartmental Knee Replacement (UKR) to Total Knee Replacement (TKR). We hypothesise that a UKR can be successfully revised to a TKR with equivalent outcomes to primary TKR when revised for a well-defined revision diagnosis such as progression of arthritis.

Methods

From 2011 to 2023, the records of a surgeon were reviewed to identify patients who underwent revision of a UKR. Data collected included indications for revision, implant details, oxford knee scores (OKS) and survivorship. The OKS of the revision group was compared with a group of primary TKRs.

Results

A total of 21 revision UKR to TKR were included in the study. Primary Cruciate Retaining implants were used in all but 1 revision (Posterior Stabilised) with tibial sided augments or a stem required in 4. Survivorship of the revision UKRs was 95.2% at a mean of 4.37 years post-operatively. Mean OKS for the group was 37.65 with an improvement of 19.65 (p = 0.0001). Patients revised for a well-defined indication had 6-month mean OKS of 41.29, comparable to the primary TKR mean OKS of 39.5 (p = 0.535). Patients revised without confirmed pathology had mean 6-month OKS of 29.17 which was significantly worse than the remaining revision UKRs and primary TKRs (p = 0.001).

Conclusion

When a UKR is revised for a well-defined revision indication, patients can expect equivalent outcomes to primary TKR. This study also confirms that in most instances, a UKR can be successfully revised utilising primary implants with good midterm survivorship.

{"title":"Revision of unicompartmental knee replacement can achieve equivalent outcomes to primary total knee replacement when revised for confirmed pathology","authors":"Thomas Christiner, Caitlin Chidlow, Simon Smith","doi":"10.1016/j.knee.2025.04.006","DOIUrl":"10.1016/j.knee.2025.04.006","url":null,"abstract":"<div><h3>Introduction</h3><div>There is conflicting evidence regarding outcomes following revision of Unicompartmental Knee Replacement (UKR) to Total Knee Replacement (TKR). We hypothesise that a UKR can be successfully revised to a TKR with equivalent outcomes to primary TKR when revised for a well-defined revision diagnosis such as progression of arthritis.</div></div><div><h3>Methods</h3><div>From 2011 to 2023, the records of a surgeon were reviewed to identify patients who underwent revision of a UKR. Data collected included indications for revision, implant details, oxford knee scores (OKS) and survivorship. The OKS of the revision group was compared with a group of primary TKRs.</div></div><div><h3>Results</h3><div>A total of 21 revision UKR to TKR were included in the study. Primary Cruciate Retaining implants were used in all but 1 revision (Posterior Stabilised) with tibial sided augments or a stem required in 4. Survivorship of the revision UKRs was 95.2% at a mean of 4.37 years post-operatively. Mean OKS for the group was 37.65 with an improvement of 19.65 (<em>p</em> = 0.0001). Patients revised for a well-defined indication had 6-month mean OKS of 41.29, comparable to the primary TKR mean OKS of 39.5 (<em>p</em> = 0.535). Patients revised without confirmed pathology had mean 6-month OKS of 29.17 which was significantly worse than the remaining revision UKRs and primary TKRs (<em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>When a UKR is revised for a well-defined revision indication, patients can expect equivalent outcomes to primary TKR. This study also confirms that in most instances, a UKR can be successfully revised utilising primary implants with good midterm survivorship.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 118-125"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prediction of coronal alignment in robotic-assisted total knee arthroplasty with artificial intelligence

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-25 DOI: 10.1016/j.knee.2025.04.011

Joseph Bosco, Colleen M. Wixted, Catherine Di Gangi, Daniel Waren, Morteza Meftah

Introduction

Robotic-assisted technologies provide the ability to avoid soft tissue release by utilizing more accurate bony cuts during total knee arthroplasty (TKA). However, the ideal limb alignment is not yet established. The aim of this study was to predict postoperative Coronal Plane Alignment of the Knee (CPAK) using corresponding native bony measurements.

Methods

This study analyzed a retrospective cohort of 530 primary robotic-assisted TKAs. Machine learning was utilized to predict appropriate target lateral distal femoral angles (LDFA) and medial proximal tibial angles (MPTA). Normalization of LDFA and MPTA alignments was performed using the min–max scaler operation on the training set with feature range [−1, 1] and repeated separately for the input and target distributions. A neural network of hidden dimensions (16, 8, 4) was trained via supervised learning to predict planned LDFA and MPTA values from preoperative LDFA and MPTA measurements.

Results

The model converged after 104 epochs and batch size 4 with mean squared error ±1.82°. The model’s regression agrees with the hypothesized change in preoperative to planned coronal alignment: valgus measurements are translated to neutral/aligned targets while varus alignments are translated to varus alignment of lesser severity. Evaluative statistics demonstrate this method for planning knee morphologies is significantly more accurate than making predictions about the mean (RMSE 1.440; R-squared 0.444; Nash Sutcliffe 0.579).

Conclusion

This study’s model provides accurate predictions for target knee alignment morphologies. Future work is warranted to evaluate this method’s usefulness for planning robotic TKA.

{"title":"Prediction of coronal alignment in robotic-assisted total knee arthroplasty with artificial intelligence","authors":"Joseph Bosco, Colleen M. Wixted, Catherine Di Gangi, Daniel Waren, Morteza Meftah","doi":"10.1016/j.knee.2025.04.011","DOIUrl":"10.1016/j.knee.2025.04.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Robotic-assisted technologies provide the ability to avoid soft tissue release by utilizing more accurate bony cuts during total knee arthroplasty (TKA). However, the ideal limb alignment is not yet established. The aim of this study was to predict postoperative Coronal Plane Alignment of the Knee (CPAK) using corresponding native bony measurements.</div></div><div><h3>Methods</h3><div>This study analyzed a retrospective cohort of 530 primary robotic-assisted TKAs. Machine learning was utilized to predict appropriate target lateral distal femoral angles (LDFA) and medial proximal tibial angles (MPTA). Normalization of LDFA and MPTA alignments was performed using the min–max scaler operation on the training set with feature range [−1, 1] and repeated separately for the input and target distributions. A neural network of hidden dimensions (16, 8, 4) was trained via supervised learning to predict planned LDFA and MPTA values from preoperative LDFA and MPTA measurements.</div></div><div><h3>Results</h3><div>The model converged after 104 epochs and batch size 4 with mean squared error ±1.82°. The model’s regression agrees with the hypothesized change in preoperative to planned coronal alignment: valgus measurements are translated to neutral/aligned targets while varus alignments are translated to varus alignment of lesser severity. Evaluative statistics demonstrate this method for planning knee morphologies is significantly more accurate than making predictions about the mean (RMSE 1.440; R-squared 0.444; Nash Sutcliffe 0.579).</div></div><div><h3>Conclusion</h3><div>This study’s model provides accurate predictions for target knee alignment morphologies. Future work is warranted to evaluate this method’s usefulness for planning robotic TKA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 126-132"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Closing the tendon defect does not affect tendon length and patellar height after bone-patellar tendon-bone ACL reconstruction. A retrospective study using radiographs

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-25 DOI: 10.1016/j.knee.2025.04.012

Tom J. Kuijs , Tim Truyers , Bas van Dun , Jasper Most , Martijn G.M. Schotanus , Edwin J.P. Jansen

Purpose

The aim of this study was to compare radiological changes in patellar height (PH) and patellar tendon length (PTL) after closure and non-closure of the patellar donor site defect during anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft.

Methods

In this retrospective study a total of 63 patients was included. All patients underwent an arthroscopically assisted ACLR using the mid-third BPTB autograft. In 30 patients the tendon donor site defect was closed. In 33 patients the tendon donor site defect was left open. The paratenon was approximated in all patients. Lateral radiographs were taken preoperatively and at 3 months after ACLR. PH was determined using the Insall-Salvati, Caton-Deschamps and Blackburne-Peel methods. PTL was measured by determining the distance between the inferior pole of the patella and the superior aspect of the tibial tubercle.

Results

Overall, no change in patellar height were observed 3 months after ACLR for the Insal-Salvati (p = 0.54), Caton-Deschamps (p = 0.75) and Blackburne-Peel methods (p = 0.83). Also, the change in pre- and postoperative patellar height did not differ between the closure- and non-closure-group for the Insall-Salvati (p = 0.77), the Caton-Deschamps (p = 0.89) and the Blackburne-Peel (p = 0.70) methods.

Overall, no significant change in PTL was observed 3 months after ACLR (p = 0.78). Between both groups, no significant difference was observed for PTL over time (p = 0.98).

Conclusion

Patellar height and patellar tendon length did not significantly change after anterior cruciate reconstruction using bone-patellar tendon-bone autografts regardless of patellar donor site closure.

Level of evidence: IIIb.

{"title":"Closing the tendon defect does not affect tendon length and patellar height after bone-patellar tendon-bone ACL reconstruction. A retrospective study using radiographs","authors":"Tom J. Kuijs , Tim Truyers , Bas van Dun , Jasper Most , Martijn G.M. Schotanus , Edwin J.P. Jansen","doi":"10.1016/j.knee.2025.04.012","DOIUrl":"10.1016/j.knee.2025.04.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare radiological changes in patellar height (PH) and patellar tendon length (PTL) after closure and non-closure of the patellar donor site defect during anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BPTB) autograft.</div></div><div><h3>Methods</h3><div>In this retrospective study a total of 63 patients was included. All patients underwent an arthroscopically assisted ACLR using the mid-third BPTB autograft. In 30 patients the tendon donor site defect was closed. In 33 patients the tendon donor site defect was left open. The paratenon was approximated in all patients. Lateral radiographs were taken preoperatively and at 3 months after ACLR. PH was determined using the Insall-Salvati, Caton-Deschamps and Blackburne-Peel methods. PTL was measured by determining the distance between the inferior pole of the patella and the superior aspect of the tibial tubercle.</div></div><div><h3>Results</h3><div>Overall, no change in patellar height were observed 3 months after ACLR for the Insal-Salvati (<em>p</em> = 0.54), Caton-Deschamps (<em>p</em> = 0.75) and Blackburne-Peel methods (<em>p</em> = 0.83). Also, the change in pre- and postoperative patellar height did not differ between the closure- and non-closure-group for the Insall-Salvati (<em>p</em> = 0.77), the Caton-Deschamps (<em>p</em> = 0.89) and the Blackburne-Peel (<em>p</em> = 0.70) methods.</div><div>Overall, no significant change in PTL was observed 3 months after ACLR (<em>p</em> = 0.78). Between both groups, no significant difference was observed for PTL over time (<em>p</em> = 0.98).</div></div><div><h3>Conclusion</h3><div>Patellar height and patellar tendon length did not significantly change after anterior cruciate reconstruction using bone-patellar tendon-bone autografts regardless of patellar donor site closure.</div><div><strong>Level of evidence:</strong> IIIb.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 133-141"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparable outcomes between lateral and medial unicompartmental arthroplasty at 2-year follow-up

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-25 DOI: 10.1016/j.knee.2025.04.013

Greg T. Minutillo, Alexander J. Acuña, Enrico M. Forlenza, Conor M. Jones, Tad L. Gerlinger

Introduction

Our study sought to evaluate (1) national rates of lateral unicompartmental knee arthroplasty (UKA) relative to medial UKA and compare, (2) 90-day medical complications and (3) 1- and 2-year surgical complications between matched lateral and medial UKA cohorts.

Methods

The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2016 and 2022. ICD-10 procedure codes were utilized to segregate patients into lateral and medial compartment cohorts. Patients undergoing bicompartmental-UKA were excluded. Lateral UKA patients were matched 1:4 to the medial UKA cohort based on age, sex, Elixhauser Comorbidity Index (ECI), and the following comorbidities: diabetes, tobacco use, and obesity. Medical complications at 90-days and surgical complications at 1- and 2-years post-operatively were compared utilizing multivariate logistic regression.

Results

Over the study period, medial UKAs were performed at a 14.17 to 1 ratio compared to lateral UKAs. Lateral UKA patients demonstrated a higher incidence of acute periprosthetic joint infection (PJI) at 90-days post-operatively (OR: 3.919, 95% CI: 1.075–14.283; p = 0.033). However, no differences were seen for the remaining medical outcomes. There were no differences in revision for PJI (OR: 2.071, 95% CI: 0.764–5.162; p = 0.192) or in all-cause revision rates (OR: 1.956, 95% CI: 0.973–3.768; p = 0.050) at 2-years.

Discussion

Although there was a higher rate of PJI in the acute post-operative setting for patients undergoing lateral UKA, the present analysis demonstrates largely comparable outcomes between our studied cohorts. These findings serve to inform adult reconstruction surgeons considering lateral unicompartmental arthroplasty in appropriately selected patients with isolated lateral compartment osteoarthritis of the knee.

{"title":"Comparable outcomes between lateral and medial unicompartmental arthroplasty at 2-year follow-up","authors":"Greg T. Minutillo, Alexander J. Acuña, Enrico M. Forlenza, Conor M. Jones, Tad L. Gerlinger","doi":"10.1016/j.knee.2025.04.013","DOIUrl":"10.1016/j.knee.2025.04.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Our study sought to evaluate (1) national rates of lateral unicompartmental knee arthroplasty (UKA) relative to medial UKA and compare, (2) 90-day medical complications and (3) 1- and 2-year surgical complications between matched lateral and medial UKA cohorts.</div></div><div><h3>Methods</h3><div>The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2016 and 2022. ICD-10 procedure codes were utilized to segregate patients into lateral and medial compartment cohorts. Patients undergoing bicompartmental-UKA were excluded. Lateral UKA patients were matched 1:4 to the medial UKA cohort based on age, sex, Elixhauser Comorbidity Index (ECI), and the following comorbidities: diabetes, tobacco use, and obesity. Medical complications at 90-days and surgical complications at 1- and 2-years post-operatively were compared utilizing multivariate logistic regression.</div></div><div><h3>Results</h3><div>Over the study period, medial UKAs were performed at a 14.17 to 1 ratio compared to lateral UKAs. Lateral UKA patients demonstrated a higher incidence of acute periprosthetic joint infection (PJI) at 90-days post-operatively (OR: 3.919, 95% CI: 1.075–14.283; <em>p</em> = 0.033). However, no differences were seen for the remaining medical outcomes. There were no differences in revision for PJI (OR: 2.071, 95% CI: 0.764–5.162; <em>p</em> = 0.192) or in all-cause revision rates (OR: 1.956, 95% CI: 0.973–3.768; <em>p</em> = 0.050) at 2-years.</div></div><div><h3>Discussion</h3><div>Although there was a higher rate of PJI in the acute post-operative setting for patients undergoing lateral UKA, the present analysis demonstrates largely comparable outcomes between our studied cohorts. These findings serve to inform adult reconstruction surgeons considering lateral unicompartmental arthroplasty in appropriately selected patients with isolated lateral compartment osteoarthritis of the knee.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 112-117"},"PeriodicalIF":1.6,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The methods of quantifying knee laxity in the ACL injured population: A review

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-24 DOI: 10.1016/j.knee.2025.04.009

Natasha E.H. Allott, Fiyinfoluwa Timothy Oladipo, Katie L. Cox, Claire M. Finnerty, Matthew S. Banger, Alison H. McGregor

Introduction

Anterior Cruciate Ligament (ACL) injuries equate to a large proportion of Emergency Department attendances worldwide and continue to place significant burden on primary care services. Diagnosis of this injury relies on subjective physical examination tests such as the Lachman’s and Pivot Shift test; results of which can vary depending on clinician experience and individual interpretation.

Aims

This review seeks to identify current approaches past and present to objectively measuring knee laxity caused by ACL injury and appraise the methods of the current apparatus’ available to do this within the clinical setting.

Methods

A literature search across three databases (MEDLINE, EMBASE and CINAHL) was conducted, and an inclusion and exclusion criteria applied to the 780 retrieved texts to extract 19 papers fulfilling this objective. Articles published after the year 2000 were considered. The main technologies noted that quantified knee laxity were arthrometry devices, inertial motion units (IMUs), electromagnetic measurement systems (EMS), optical motion capture systems (OMC), and dynamic MRI.

Conclusion

Despite there being a multitude of technologies with capability to accurately measure aspects of knee laxity, there is no agreed objective measure for doing so in the clinical setting. This highlights a need for improved collaboration between the relevant stakeholders to achieve this aim.

{"title":"The methods of quantifying knee laxity in the ACL injured population: A review","authors":"Natasha E.H. Allott, Fiyinfoluwa Timothy Oladipo, Katie L. Cox, Claire M. Finnerty, Matthew S. Banger, Alison H. McGregor","doi":"10.1016/j.knee.2025.04.009","DOIUrl":"10.1016/j.knee.2025.04.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior Cruciate Ligament (ACL) injuries equate to a large proportion of Emergency Department attendances worldwide and continue to place significant burden on primary care services. Diagnosis of this injury relies on subjective physical examination tests such as the Lachman’s and Pivot Shift test; results of which can vary depending on clinician experience and individual interpretation.</div></div><div><h3>Aims</h3><div>This review seeks to identify current approaches past and present to objectively measuring knee laxity caused by ACL injury and appraise the methods of the current apparatus’ available to do this within the clinical setting.</div></div><div><h3>Methods</h3><div>A literature search across three databases (MEDLINE, EMBASE and CINAHL) was conducted, and an inclusion and exclusion criteria applied to the 780 retrieved texts to extract 19 papers fulfilling this objective. Articles published after the year 2000 were considered. The main technologies noted that quantified knee laxity were arthrometry devices, inertial motion units (IMUs), electromagnetic measurement systems (EMS), optical motion capture systems (OMC), and dynamic MRI.</div></div><div><h3>Conclusion</h3><div>Despite there being a multitude of technologies with capability to accurately measure aspects of knee laxity, there is no agreed objective measure for doing so in the clinical setting. This highlights a need for improved collaboration between the relevant stakeholders to achieve this aim.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 85-103"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Corticosteroids versus platelet-rich plasma injections for knee osteoarthritis: Where is there more evidence? A systematic review of 60 years of literature

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-24 DOI: 10.1016/j.knee.2025.03.010

Angelo Boffa , Giacomo Moraca , Alessandro Sangiorgio , Alessandro Di Martino , Alessandro Bensa , Giuseppe Filardo

Background

Corticosteroid (CS) injections are often recommended by international societies for knee osteoarthritis (OA) treatment, but platelet-rich plasma (PRP) has shown higher safety and efficacy in comparative analyses. Despite this, PRP use is often not endorsed by scientific societies due to perceived insufficient body of evidence. This study aims to quantify clinical data documenting CS and PRP intra-articular injections for knee OA.

Methods

A systematic review of the literature was conducted on CS and PRP injections for knee OA. The search, performed in March 2024, used PubMed, Cochrane, and Web of Science databases, following PRISMA and Cochrane guidelines. Data collected included publication trends, number of articles, patients evaluated, and study designs documenting CS or PRP injections.

Results

Of 16,979 records, 356 studies were analyzed, covering 24,435 knee OA patients. Both treatments showed an increasing publication trend, with PRP surpassing CS in 2020. The analysis included 9,322 CS patients and 15,113 PRP patients. Among CS studies, there were 103 RCTs with 5,478 patients, 18 comparative studies with 1,095 patients, and 31 case series with 2,749 patients. Among PRP studies, there were 119 RCTs with 6,028 patients, 33 comparative studies with 2,011 patients, and 72 case series with 7,074 patients.

Conclusions

PRP injections for knee OA have been documented in more studies and in larger patient numbers compared with CS injections. The higher number of high-level trials for PRP, combined with the lower safety and efficacy documented for CS by previous meta-analyses directly comparing the two products, strongly suggests reconsidering current guidelines that favor CS, highlighting PRP’s body of evidence and the potential role in the effective and safe treatment of knee OA.

{"title":"Corticosteroids versus platelet-rich plasma injections for knee osteoarthritis: Where is there more evidence? A systematic review of 60 years of literature","authors":"Angelo Boffa , Giacomo Moraca , Alessandro Sangiorgio , Alessandro Di Martino , Alessandro Bensa , Giuseppe Filardo","doi":"10.1016/j.knee.2025.03.010","DOIUrl":"10.1016/j.knee.2025.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Corticosteroid (CS) injections are often recommended by international societies for knee osteoarthritis (OA) treatment, but platelet-rich plasma (PRP) has shown higher safety and efficacy in comparative analyses. Despite this, PRP use is often not endorsed by scientific societies due to perceived insufficient body of evidence. This study aims to quantify clinical data documenting CS and PRP intra-articular injections for knee OA.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted on CS and PRP injections for knee OA. The search, performed in March 2024, used PubMed, Cochrane, and Web of Science databases, following PRISMA and Cochrane guidelines. Data collected included publication trends, number of articles, patients evaluated, and study designs documenting CS or PRP injections.</div></div><div><h3>Results</h3><div>Of 16,979 records, 356 studies were analyzed, covering 24,435 knee OA patients. Both treatments showed an increasing publication trend, with PRP surpassing CS in 2020. The analysis included 9,322 CS patients and 15,113 PRP patients. Among CS studies, there were 103 RCTs with 5,478 patients, 18 comparative studies with 1,095 patients, and 31 case series with 2,749 patients. Among PRP studies, there were 119 RCTs with 6,028 patients, 33 comparative studies with 2,011 patients, and 72 case series with 7,074 patients.</div></div><div><h3>Conclusions</h3><div>PRP injections for knee OA have been documented in more studies and in larger patient numbers compared with CS injections. The higher number of high-level trials for PRP, combined with the lower safety and efficacy documented for CS by previous meta-analyses directly comparing the two products, strongly suggests reconsidering current guidelines that favor CS, highlighting PRP’s body of evidence and the potential role in the effective and safe treatment of knee OA.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 104-111"},"PeriodicalIF":1.6,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating artificial intelligence performance in medical image analysis: Sensitivity, specificity, accuracy, and precision of ChatGPT-4o on Kellgren-Lawrence grading of knee X-ray radiographs

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-23 DOI: 10.1016/j.knee.2025.04.008

Mustafa Hüseyin Temel , Yakup Erden , Fatih Bağcıer

Background

Recent advancements in artificial intelligence, including ChatGPT, have enabled its application in medical image analysis.This study aimed to evaluate the sensitivity and specificity of ChatGPT in assessing knee osteoarthritis (KOA) radiographs using the Kellgren-Lawrence (KL) grading system.

Methods

A retrospective study was conducted at Izzet Baysal Physical Therapy and Rehabilitation Training and Research Hospital. Anteroposterior weight-bearing knee X-rays from 226 patients (excluding 26 due to prostheses or foreign bodies) were evaluated. Two specialists assessed the radiographs using the KL grading system, with a third specialist resolving discrepancies. ChatGPT-4o evaluated the images using the prompt, “Please evaluate this knee anteroposterior radiographic image according to the Kellgren-Lawrence grading system.” Diagnostic accuracy metrics, receiver operating characteristic (ROC) curves, and area under the curve (AUC) values were calculated.

Results

ChatGPT showed low sensitivity across all grades. The accuracy of the model was calculated to be 0.230. ROC AUC values were low for all grades, for KL grade 0 at 0.53, KL grade 1 at 0.56, KL grade 2 at 0.43, KL grade 3 at 0.54, KL grade 4 at 0.49, micro-average at 0.52, macro-average at 0.51, and weighted average at 0.52.

Conclusions

The findings of this study highlight the model’s inability to reliably distinguish between KL grades, suggesting that its utility in this specific classification task is limited and requires further optimization to improve its predictive accuracy and reliability. The model’s current limitations preclude its use as a reliable diagnostic tool. Further refinement is necessary to improve its clinical applicability.

{"title":"Evaluating artificial intelligence performance in medical image analysis: Sensitivity, specificity, accuracy, and precision of ChatGPT-4o on Kellgren-Lawrence grading of knee X-ray radiographs","authors":"Mustafa Hüseyin Temel , Yakup Erden , Fatih Bağcıer","doi":"10.1016/j.knee.2025.04.008","DOIUrl":"10.1016/j.knee.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>Recent advancements in artificial intelligence, including ChatGPT, have enabled its application in medical image analysis.This study aimed to evaluate the sensitivity and specificity of ChatGPT in assessing knee osteoarthritis (KOA) radiographs using the Kellgren-Lawrence (KL) grading system.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at Izzet Baysal Physical Therapy and Rehabilitation Training and Research Hospital. Anteroposterior weight-bearing knee X-rays from 226 patients (excluding 26 due to prostheses or foreign bodies) were evaluated. Two specialists assessed the radiographs using the KL grading system, with a third specialist resolving discrepancies. ChatGPT-4o evaluated the images using the prompt, “Please evaluate this knee anteroposterior radiographic image according to the Kellgren-Lawrence grading system.” Diagnostic accuracy metrics, receiver operating characteristic (ROC) curves, and area under the curve (AUC) values were calculated.</div></div><div><h3>Results</h3><div>ChatGPT showed low sensitivity across all grades. The accuracy of the model was calculated to be 0.230. ROC AUC values were low for all grades, for KL grade 0 at 0.53, KL grade 1 at 0.56, KL grade 2 at 0.43, KL grade 3 at 0.54, KL grade 4 at 0.49, micro-average at 0.52, macro-average at 0.51, and weighted average at 0.52.</div></div><div><h3>Conclusions</h3><div>The findings of this study highlight the model’s inability to reliably distinguish between KL grades, suggesting that its utility in this specific classification task is limited and requires further optimization to improve its predictive accuracy and reliability. The model’s current limitations preclude its use as a reliable diagnostic tool. Further refinement is necessary to improve its clinical applicability.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 79-84"},"PeriodicalIF":1.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Fractures in Oxford unicompartmental knee arthroplasty are associated with medial positioning of the femoral component – A retrospective cohort study

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-22 DOI: 10.1016/j.knee.2025.04.007

Julius Watrinet , Daniel Berger , Philipp Blum , Paul Reidler , Joerg Arnholdt , Sebastian Siebenlist , Rolf Schipp , Wolfgang Reng , Matthias P. Fabritius

a. Purpose

This study aimed to evaluate the relationship between femoral component positioning and the incidence of periprosthetic fractures in Oxford unicompartmental knee arthroplasty (UKA), as well as the effects of component size and preoperative coronal lower limb alignment on fracture risk.

b. Methods

A retrospective single-center study was conducted, including 1,642 cases of medial UKA performed between July 2015 and December 2022. Patients with symptomatic isolated medial knee osteoarthritis meeting specific selection criteria underwent surgery using either press-fit or cemented fixation based on individual bone quality. Radiographic evaluations were performed preoperatively and postoperatively to assess component positioning and alignment. Statistical analyses included the Mann-Whitney U test, Wilcoxon test, and Pearson’s chi-squared test to compare fracture and non-fracture groups.

c. Results

Out of 1,642 cases, 15 (0.9%) experienced a tibial periprosthetic fracture. These fractures were significantly associated with medial positioning of the femoral component and smaller component sizes. The fracture group had a higher mean age (74.3 ± 6.2 years) and a higher percentage of females (80%) compared to the non-fracture group. No significant differences were observed in Body Mass Index (BMI) or preoperative coronal alignment between the groups.

d. Conclusion

Medial positioning of the femoral component and smaller component sizes in Oxford UKA are associated with an increased risk of tibial periprosthetic fractures. Accurate implant positioning is crucial to minimize fracture risk and improve clinical outcomes. These findings underscore the importance of precise surgical techniques and may inform future guidelines for UKA procedures.

Trial registration: This study was retrospectively registered and ethical approval was waived by the local ethical committee (No. 22-0990KB).

{"title":"Fractures in Oxford unicompartmental knee arthroplasty are associated with medial positioning of the femoral component – A retrospective cohort study","authors":"Julius Watrinet , Daniel Berger , Philipp Blum , Paul Reidler , Joerg Arnholdt , Sebastian Siebenlist , Rolf Schipp , Wolfgang Reng , Matthias P. Fabritius","doi":"10.1016/j.knee.2025.04.007","DOIUrl":"10.1016/j.knee.2025.04.007","url":null,"abstract":"<div><h3>a. Purpose</h3><div>This study aimed to evaluate the relationship between femoral component positioning and the incidence of periprosthetic fractures in Oxford unicompartmental knee arthroplasty (UKA), as well as the effects of component size and preoperative coronal lower limb alignment on fracture risk.</div></div><div><h3>b. Methods</h3><div>A retrospective single-center study was conducted, including 1,642 cases of medial UKA performed between July 2015 and December 2022. Patients with symptomatic isolated medial knee osteoarthritis meeting specific selection criteria underwent surgery using either press-fit or cemented fixation based on individual bone quality. Radiographic evaluations were performed preoperatively and postoperatively to assess component positioning and alignment. Statistical analyses included the Mann-Whitney <em>U</em> test, Wilcoxon test, and Pearson’s chi-squared test to compare fracture and non-fracture groups.</div></div><div><h3>c. Results</h3><div>Out of 1,642 cases, 15 (0.9%) experienced a tibial periprosthetic fracture. These fractures were significantly associated with medial positioning of the femoral component and smaller component sizes. The fracture group had a higher mean age (74.3 ± 6.2 years) and a higher percentage of females (80%) compared to the non-fracture group. No significant differences were observed in Body Mass Index (BMI) or preoperative coronal alignment between the groups.</div></div><div><h3>d. Conclusion</h3><div>Medial positioning of the femoral component and smaller component sizes in Oxford UKA are associated with an increased risk of tibial periprosthetic fractures. Accurate implant positioning is crucial to minimize fracture risk and improve clinical outcomes. These findings underscore the importance of precise surgical techniques and may inform future guidelines for UKA procedures.</div><div>Trial registration: This study was retrospectively registered and ethical approval was waived by the local ethical committee (No. 22-0990KB).</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 70-78"},"PeriodicalIF":1.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of intraoperative kinematics between cruciate-retaining and medial-stabilized inserts in total knee arthroplasty using a CT-free navigation system

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-21 DOI: 10.1016/j.knee.2025.04.003

Hibiki Kakiage , Shogo Hashimoto , Ryota Takase , Takeshi Shimada , Takashi Ohsawa , Hirotaka Chikuda

Background

The kinematics of total knee arthroplasty (TKA) have been shown to affect postoperative function and patient satisfaction. A medial stabilized (MS) insert was designed to improve kinematics by enhancing medial stability and inducing lateral rollback in comparison to cruciate-retaining (CR) inserts. This study aimed to compare the intraoperative kinematic patterns between CR and MS inserts in TKA using a CT-free navigation system.

Methods

A total of 23 knees from 21 patients who underwent primary TKA for osteoarthritis were included. A CT-free navigation system (BrainLab KNEE3) was used to record intraoperative kinematics during the CR and MS insert trials. Kinematic parameters, including kinematic patterns, such as anteroposterior (AP) translation of the medial and lateral condyles and rotational angles, were analyzed based on range of motion.

Results

The MS insert exhibited significantly less medial AP translation compared to the CR insert (7.0 ± 5.0 vs. 10.3 ± 5.1 mm, p = 0.04). No significant differences were observed in the lateral AP translation (11.5 ± 6.2 vs. 12.8 ± 5.2 mm, p = 0.41), rotational angle (6.3 ± 4.5 vs. 4.7 ± 4.4, p = 0.20), or kinematic patterns.

Conclusion

MS inserts may enhance stability by reducing medial translation. Their effect on reproducing medial pivot kinematics is comparable to that of the CR inserts.

{"title":"Comparison of intraoperative kinematics between cruciate-retaining and medial-stabilized inserts in total knee arthroplasty using a CT-free navigation system","authors":"Hibiki Kakiage , Shogo Hashimoto , Ryota Takase , Takeshi Shimada , Takashi Ohsawa , Hirotaka Chikuda","doi":"10.1016/j.knee.2025.04.003","DOIUrl":"10.1016/j.knee.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>The kinematics of total knee arthroplasty (TKA) have been shown to affect postoperative function and patient satisfaction. A medial stabilized (MS) insert was designed to improve kinematics by enhancing medial stability and inducing lateral rollback in comparison to cruciate-retaining (CR) inserts. This study aimed to compare the intraoperative kinematic patterns between CR and MS inserts in TKA using a CT-free navigation system.</div></div><div><h3>Methods</h3><div>A total of 23 knees from 21 patients who underwent primary TKA for osteoarthritis were included. A CT-free navigation system (BrainLab KNEE3) was used to record intraoperative kinematics during the CR and MS insert trials. Kinematic parameters, including kinematic patterns, such as anteroposterior (AP) translation of the medial and lateral condyles and rotational angles, were analyzed based on range of motion.</div></div><div><h3>Results</h3><div>The MS insert exhibited significantly less medial AP translation compared to the CR insert (7.0 ± 5.0 vs. 10.3 ± 5.1 mm, <em>p</em> = 0.04). No significant differences were observed in the lateral AP translation (11.5 ± 6.2 vs. 12.8 ± 5.2 mm, <em>p</em> = 0.41), rotational angle (6.3 ± 4.5 vs. 4.7 ± 4.4, <em>p</em> = 0.20), or kinematic patterns.</div></div><div><h3>Conclusion</h3><div>MS inserts may enhance stability by reducing medial translation. Their effect on reproducing medial pivot kinematics is comparable to that of the CR inserts.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 55-61"},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143852348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is the knee joint more vulnerable to injury in unplanned cutting tasks? An EMG vector field analysis of high-level female athletes

IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-04-21 DOI: 10.1016/j.knee.2025.04.002

Kevin Bill , Patrick Mai , Uwe G. Kersting , Tron Krosshaug

Objectives

Neuromuscular activation and peak external knee abduction moments (pKAM) are risk factors for anterior cruciate ligament injuries during sidestep cutting. This study aimed to: 1) compare thigh muscle activity between preplanned and unplanned sidestep cuts, 2) assess rank correlations of mean thigh muscle pre-activity in both cuts, 3) investigate the relationship between pKAM and thigh muscle activity in 31 experienced female handball players.

Methods

Four-component (vastus medialis, vastus lateralis, semitendinosus, biceps femoris) electromyogram vector fields were compared from 100 ms before ground contact until toe-off using Statistical Parametric Mapping. Spearman’s rank correlation coefficient was used to assess rank correlations of mean pre-activity of individual muscles between cuts. Relationships between pKAM and the four-component electromyogram vector fields were assessed using Canonical Correlation Analysis.

Results

Four-component muscle activity differed before ground contact and push-off, mostly due to activity differences in muscle pairs. Individual analyses showed lower vastus medialis activity in unplanned cuts right before ground contact. High pre-activity rank correlations were found for vastus medialis and lateralis, moderate for semitendinosus, and none for biceps femoris between preplanned and unplanned cuts. Canonical correlation analyses indicated no relationship between muscle activity and pKAM.

Conclusion

The knee might be more vulnerable to injury in unplanned tasks due to lower muscular pre-activity. Muscle activity does not vary with pKAM, suggesting passive structures must absorb higher loads with increasing pKAM. Differences in vastus medialis pre-activity and inconsistencies in biceps femoris pre-activity ranking highlight areas for targeted neuromuscular training to better protect the knee against external loads.

{"title":"Is the knee joint more vulnerable to injury in unplanned cutting tasks? An EMG vector field analysis of high-level female athletes","authors":"Kevin Bill , Patrick Mai , Uwe G. Kersting , Tron Krosshaug","doi":"10.1016/j.knee.2025.04.002","DOIUrl":"10.1016/j.knee.2025.04.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Neuromuscular activation and peak external knee abduction moments (pKAM) are risk factors for anterior cruciate ligament injuries during sidestep cutting. This study aimed to: 1) compare thigh muscle activity between preplanned and unplanned sidestep cuts, 2) assess rank correlations of mean thigh muscle pre-activity in both cuts, 3) investigate the relationship between pKAM and thigh muscle activity in 31 experienced female handball players.</div></div><div><h3>Methods</h3><div>Four-component (vastus medialis, vastus lateralis, semitendinosus, biceps femoris) electromyogram vector fields were compared from 100 ms before ground contact until toe-off using Statistical Parametric Mapping. Spearman’s rank correlation coefficient was used to assess rank correlations of mean pre-activity of individual muscles between cuts. Relationships between pKAM and the four-component electromyogram vector fields were assessed using Canonical Correlation Analysis.</div></div><div><h3>Results</h3><div>Four-component muscle activity differed before ground contact and push-off, mostly due to activity differences in muscle pairs. Individual analyses showed lower vastus medialis activity in unplanned cuts right before ground contact. High pre-activity rank correlations were found for vastus medialis and lateralis, moderate for semitendinosus, and none for biceps femoris between preplanned and unplanned cuts. Canonical correlation analyses indicated no relationship between muscle activity and pKAM.</div></div><div><h3>Conclusion</h3><div>The knee might be more vulnerable to injury in unplanned tasks due to lower muscular pre-activity. Muscle activity does not vary with pKAM, suggesting passive structures must absorb higher loads with increasing pKAM. Differences in vastus medialis pre-activity and inconsistencies in biceps femoris pre-activity ranking highlight areas for targeted neuromuscular training to better protect the knee against external loads.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"55 ","pages":"Pages 62-69"},"PeriodicalIF":1.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0