Pub Date : 2025-03-05DOI: 10.1016/j.knee.2025.02.005
Maria Pia Neri , Mirco Lo Presti , Davide Pellicanò , Marco Minerba , Monica Cosentino , Cosimo Vasco , Ludovica Solito , Gabrio Goracci , Stefano Zaffagnini
Purpose
The aim of this study was to assess in vitro labelled leukocyte scintigraphy (LS) diagnostic accuracy in periprosthetic knee infection diagnosis.
Methods
This is a retrospective study that includes all patients with total knee arthroplasty (TKA) who performed LS before undergoing revision surgery for septic or aseptic loosening of the implant in our department from January of 2011 to March of 2023.
The 2018 International Consensus Meeting (ICM) and 2021 European Bone and Joint Infection Society (EBJS) periprosthetic joint infection (PJI) definitions were employed to define infected and not infected patients.
Results
92 TKAs were included in this study. This was the LS diagnostic performance according to the 2018 ICM PJI definition: sensitivity 89%, specificity 80%, positive predictive value (PPV) 80%, negative predictive value (NPV) 89%, positive likelihood ratio (LR + ) 4.46, negative likelihood ratio (LR-) 0.14. According to 2021 EBJS PJI definition: sensitivity 91%, specificity 80%, PPV 76%, NPV 92%, LR + 4.43, LR- 0.12.
Conclusion
Previously published studies on LS diagnostic performance report very variable results, probably due to the different and subjective PJI diagnostic criteria employed by each article. This is one of the first studies to employ the most recent PJI definitions and to demonstrate that LS may have a higher specificity and PPV than previously estimated. Therefore it represents a valid instrument in PJI diagnosis.
{"title":"Is leukocyte scintigraphy recommended in periprosthetic knee infection diagnosis? A retrospective study of 92 total knee arthroplasties","authors":"Maria Pia Neri , Mirco Lo Presti , Davide Pellicanò , Marco Minerba , Monica Cosentino , Cosimo Vasco , Ludovica Solito , Gabrio Goracci , Stefano Zaffagnini","doi":"10.1016/j.knee.2025.02.005","DOIUrl":"10.1016/j.knee.2025.02.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to assess in vitro labelled leukocyte scintigraphy (LS) diagnostic accuracy in periprosthetic knee infection diagnosis.</div></div><div><h3>Methods</h3><div>This is a retrospective study that includes all patients with total knee arthroplasty (TKA) who performed LS before undergoing revision surgery for septic or aseptic loosening of the implant in our department from January of 2011 to March of 2023.</div><div>The 2018 International Consensus Meeting (ICM) and 2021 European Bone and Joint Infection Society (EBJS) periprosthetic joint infection (PJI) definitions were employed to define infected and not infected patients.</div></div><div><h3>Results</h3><div>92 TKAs were included in this study. This was the LS diagnostic performance according to the 2018 ICM PJI definition: sensitivity 89%, specificity 80%, positive predictive value (PPV) 80%, negative predictive value (NPV) 89%, positive likelihood ratio (LR + ) 4.46, negative likelihood ratio (LR-) 0.14. According to 2021 EBJS PJI definition: sensitivity 91%, specificity 80%, PPV 76%, NPV 92%, LR + 4.43, LR- 0.12.</div></div><div><h3>Conclusion</h3><div>Previously published studies on LS diagnostic performance report very variable results, probably due to the different and subjective PJI diagnostic criteria employed by each article. This is one of the first studies to employ the most recent PJI definitions and to demonstrate that LS may have a higher specificity and PPV than previously estimated. Therefore it represents a valid instrument in PJI diagnosis.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 154-166"},"PeriodicalIF":1.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548652","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}
Pub Date : 2025-03-04DOI: 10.1016/j.knee.2025.01.006
Ekin Barış Demir, Fatih Barça, Mert Uçak, Halis Atıl Atilla, Mutlu Akdoğan, Yalım Ateş
Background
Our aim was to compare posterior tibial slope (PTS) values, distribution, deviation from manufacturer’s recommended value and restoration of this value in total knee arthroplasty (TKA) with tibial component placement using intramedullary (IM) and extramedullary (EM) methods, and to analyze factors affecting these values.
Methods
A total of 151 knees operated with Zimmer-Biomet NexGen® LPS Fixed Bearing Knee TKA between 2022 and 2024 were retrospectively investigated. Knees were grouped by method of tibial component placement (IM or EM). Pre-operative descriptive data, postoperative PTS, scatteredness of PTS, difference between pre-operative and postoperative PTS, deviation from 7° which was claimed by the manufacturer and rate of outliers were compared between groups. Factors that might affect postoperative PTS in the EM group were analyzed.
Results
Ninety-five knees (62.9%) in the EM group and 56 knees (37.1%) in the IM group were analyzed. Mean PTS decreased from 8.8 ± 3.5° to 6.7 ± 2.7° (P < 0.001) in the EM group, and from 10 ± 4.1° to 4.9 ± 2.6° (P < 0.001) in the IM group. Postoperative PTS was significantly lower in the IM group (P < 0.001). Mean deviation from 7° claimed by the manufacturer was 2.4 ± 1.4° for the EM group and 2.8 ± 1.8° for the IM group (P = 0.14). In 15 of 151 patients (9.9%), postoperative PTS was above 10°. Linear regression analysis revealed a moderate effect of pre-operative PTS and weight in the EM group.
Conclusions
Although not statistically significant, the EM method is closer to the manufacturer’s recommendation for sagittal alignment. However, both groups had a wide range of PTS and a large number of outliers. Both methods are not reliable in terms of PTS reproducibility and consistency.
{"title":"Posterior tibial slope after total knee arthroplasty is not reproducible or consistent","authors":"Ekin Barış Demir, Fatih Barça, Mert Uçak, Halis Atıl Atilla, Mutlu Akdoğan, Yalım Ateş","doi":"10.1016/j.knee.2025.01.006","DOIUrl":"10.1016/j.knee.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Our aim was to compare posterior tibial slope (PTS) values, distribution, deviation from manufacturer’s recommended value and restoration of this value in total knee arthroplasty (TKA) with tibial component placement using intramedullary (IM) and extramedullary (EM) methods, and to analyze factors affecting these values.</div></div><div><h3>Methods</h3><div>A total of 151 knees operated with Zimmer-Biomet NexGen® LPS Fixed Bearing Knee TKA between 2022 and 2024 were retrospectively investigated. Knees were grouped by method of tibial component placement (IM or EM). Pre-operative descriptive data, postoperative PTS, scatteredness of PTS, difference between pre-operative and postoperative PTS, deviation from 7° which was claimed by the manufacturer and rate of outliers were compared between groups. Factors that might affect postoperative PTS in the EM group were analyzed.</div></div><div><h3>Results</h3><div>Ninety-five knees (62.9%) in the EM group and 56 knees (37.1%) in the IM group were analyzed. Mean PTS decreased from 8.8 ± 3.5° to 6.7 ± 2.7° (<em>P</em> < 0.001) in the EM group, and from 10 ± 4.1° to 4.9 ± 2.6° (<em>P</em> < 0.001) in the IM group. Postoperative PTS was significantly lower in the IM group (<em>P</em> < 0.001<u>)</u>. Mean deviation from 7° claimed by the manufacturer was 2.4 ± 1.4° for the EM group and 2.8 ± 1.8° for the IM group (<em>P</em> = 0.14). In 15 of 151 patients (9.9%), postoperative PTS was above 10°. Linear regression analysis revealed a moderate effect of pre-operative PTS and weight in the EM group.</div></div><div><h3>Conclusions</h3><div>Although not statistically significant, the EM method is closer to the manufacturer’s recommendation for sagittal alignment. However, both groups had a wide range of PTS and a large number of outliers. Both methods are not reliable in terms of PTS reproducibility and consistency.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 136-145"},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548651","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}
Pub Date : 2025-03-04DOI: 10.1016/j.knee.2025.02.006
Jun-hee Kim
Background
Knee pain is associated with not only individual factors such as age and obesity but also physical activity factors such as occupational activities and exercise, which has a significant impact on the lives of adults and the elderly.
Objectives
The purpose of this study was to construct a model for predicting knee pain using individual and physical activity variables and to determine the relationship between knee pain and individual and physical activity variables.
Design
Observational study.
Methods
A total of 19 variables related to individual and physical activity were used to create a knee pain prediction model. Model composition variables were selected using recursive feature elimination with cross validation. The performance of the model was evaluated using test data, and the relationship between knee pain and predictor variables was analyzed using SHapley Additive exPlanations (SHAP).
Results
The CatBoost model showed the highest performance. And, activity limitation was identified as the most influential predictor, followed by weekly physical activity, body image, weight change, occupational type, age, BMI, and housing type.
Conclusion
Knee pain prediction models built with individual and physical activity variables can exhibit relatively high predictive performance, and interpretable machine learning models can provide valuable insight into the complex relationships between individual and physical activity variables and knee pain.
{"title":"Comparison of predictive models for knee pain and analysis of individual and physical activity variables using interpretable machine learning","authors":"Jun-hee Kim","doi":"10.1016/j.knee.2025.02.006","DOIUrl":"10.1016/j.knee.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Knee pain is associated with not only individual factors such as age and obesity but also physical activity factors such as occupational activities and exercise, which has a significant impact on the lives of adults and the elderly.</div></div><div><h3>Objectives</h3><div>The purpose of this study was to construct a model for predicting knee pain using individual and physical activity variables and to determine the relationship between knee pain and individual and physical activity variables.</div></div><div><h3>Design</h3><div>Observational study.</div></div><div><h3>Methods</h3><div>A total of 19 variables related to individual and physical activity were used to create a knee pain prediction model. Model composition variables were selected using recursive feature elimination with cross validation. The performance of the model was evaluated using test data, and the relationship between knee pain and predictor variables was analyzed using SHapley Additive exPlanations (SHAP).</div></div><div><h3>Results</h3><div>The CatBoost model showed the highest performance. And, activity limitation was identified as the most influential predictor, followed by weekly physical activity, body image, weight change, occupational type, age, BMI, and housing type.</div></div><div><h3>Conclusion</h3><div>Knee pain prediction models built with individual and physical activity variables can exhibit relatively high predictive performance, and interpretable machine learning models can provide valuable insight into the complex relationships between individual and physical activity variables and knee pain.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 146-153"},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548653","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}
Pub Date : 2025-03-03DOI: 10.1016/j.knee.2025.02.004
Daniel J. Lombardo , Teresa Potter , Gregory Tocks , Aaron J. Johnson , Jeremy A. Ross , William A. Jiranek , Gregory J. Golladay
Introduction
Periarticular injection (PAI) is one part of total knee arthroplasty (TKA) multimodal analgesia protocols. PAI combined with neuraxial anesthesia including intrathecal morphine (ITM) has not been previously investigated. This study prospectively compares PAI to placebo injection in patients undergoing TKA under spinal anesthesia with ITM.
Methods
We performed a prospective, double-blinded randomized controlled trial comparing immediate postoperative outcomes after TKA. All patients received combined spinal-epidural (CSE) anesthesia with ITM and multimodal analgesia. The study group received a standardized PAI with 0.5% ropivacaine, clonidine, ketorolac, and epinephrine, while the control group received PAI with saline. Exclusion criteria were revision surgery, inability to receive epidural anesthesia or PAI, patients taking greater than 80 morphine milligram equivalents (MME) daily prior to surgery, and lack of patient consent to participate in the study.
Results
Sixty-four patients enrolled and completed the study from 2015 to 2021. Thirty-four were randomized to the study group and 30 to the control. There was no difference in mean total postoperative opioid consumption between PAI (125.49 MME) and control (138.80 MME); (p = 0.556). There was also no difference in opioid requirements at 0–24 and 24–48 h between PAI (58.87 and 70.57 MME), and control (70.57 and 69.72 MME); (p = 0.308 and p = 0.556).
Conclusion
This study, while underpowered, demonstrates that PAI does not significantly decrease opioid consumption after TKA compared to placebo injection when utilizing ITM spinal anesthesia. When ITM is used, PAI may be reasonably be excluded from the protocol without affecting opioid requirements.
{"title":"Periarticular injection versus placebo in total knee arthroplasty with intrathecal morphine","authors":"Daniel J. Lombardo , Teresa Potter , Gregory Tocks , Aaron J. Johnson , Jeremy A. Ross , William A. Jiranek , Gregory J. Golladay","doi":"10.1016/j.knee.2025.02.004","DOIUrl":"10.1016/j.knee.2025.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Periarticular injection (PAI) is one part of total knee arthroplasty (TKA) multimodal analgesia protocols. PAI combined with neuraxial anesthesia including intrathecal morphine (ITM) has not been previously investigated. This study prospectively compares PAI to placebo injection in patients undergoing TKA under spinal anesthesia with ITM.</div></div><div><h3>Methods</h3><div>We performed a prospective, double-blinded randomized controlled trial comparing immediate postoperative outcomes after TKA. All patients received combined spinal-epidural (CSE) anesthesia with ITM and multimodal analgesia. The study group received a standardized PAI with 0.5% ropivacaine, clonidine, ketorolac, and epinephrine, while the control group received PAI with saline. Exclusion criteria were revision surgery, inability to receive epidural anesthesia or PAI, patients taking greater than 80 morphine milligram equivalents (MME) daily prior to surgery, and lack of patient consent to participate in the study.</div></div><div><h3>Results</h3><div>Sixty-four patients enrolled and completed the study from 2015 to 2021. Thirty-four were randomized to the study group and 30 to the control. There was no difference in mean total postoperative opioid consumption between PAI (125.49 MME) and control (138.80 MME); (<em>p</em> = 0.556). There was also no difference in opioid requirements at 0–24 and 24–48 h between PAI (58.87 and 70.57 MME), and control (70.57 and 69.72 MME); (<em>p</em> = 0.308 and <em>p</em> = 0.556).</div></div><div><h3>Conclusion</h3><div>This study, while underpowered, demonstrates that PAI does not significantly decrease opioid consumption after TKA compared to placebo injection when utilizing ITM spinal anesthesia. When ITM is used, PAI may be reasonably be excluded from the protocol without affecting opioid requirements.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 122-127"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529181","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}
Pub Date : 2025-03-03DOI: 10.1016/j.knee.2025.02.003
Shelby T. Desroches , Nancy Park , David B. Frumberg , John P. Fulkerson , Johannes M. Sieberer
Purpose
This study evaluates the relationship between tibiofemoral rotation and the length of the popliteus on sagittal views to assess if there are significant length differences in the popliteus with different degrees of rotation.
Methods
MRIs were analyzed from two age-sex-matched cohorts: patellofemoral instability (PFI) patients and controls. Tibiofemoral rotation was measured by recording the angle between the femoral and tibial condylar lines. The popliteus length was measured by subtracting the distance from the popliteus sulcus to the femoral condyle and the sulcus to the posterior tibia on sagittal slices. Interrater reliability was calculated using intraclass correlation coefficients (ICC), a regression analysis described relationships between the metrics, and a Mann-Whitney U test compared median differences between cohorts. A significance level of 0.05 was used for all analyses.
Results
There were statistically significant positive relationships between rotation and length overall ( = 0.49, p < 0.001), for the patient group ( = 0.35, p < 0.001) and for the control group ( = 0.52, p < 0.001). There was a significant difference between the PFI and control group for the rotation (p < 0.001) and length (p = 0.002). In total, seventy knees were included, 35 patients and 35 controls. The ICC for the rotation and length measurements were 0.87 (CI: 0.77–0.93) and 0.94 (CI: 0.89–0.97) respectively.
Conclusion
This study identified increased popliteus length associated with increased external tibiofemoral rotation as seen in patella instability patients. These findings demonstrate a further need to investigate the implications of advancing the popliteus for treatment of high tibiofemoral rotations.
{"title":"The length of the popliteus on sagittal views correlates with high tibiofemoral rotations and patellar instability","authors":"Shelby T. Desroches , Nancy Park , David B. Frumberg , John P. Fulkerson , Johannes M. Sieberer","doi":"10.1016/j.knee.2025.02.003","DOIUrl":"10.1016/j.knee.2025.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the relationship between tibiofemoral rotation and the length of the popliteus on sagittal views to assess if there are significant length differences in the popliteus with different degrees of rotation.</div></div><div><h3>Methods</h3><div>MRIs were analyzed from two age-sex-matched cohorts: patellofemoral instability (PFI) patients and controls. Tibiofemoral rotation was measured by recording the angle between the femoral and tibial condylar lines. The popliteus length was measured by subtracting the distance from the popliteus sulcus to the femoral condyle and the sulcus to the posterior tibia on sagittal slices. Interrater reliability was calculated using intraclass correlation coefficients (ICC), a regression analysis described relationships between the metrics, and a Mann-Whitney <em>U</em> test compared median differences between cohorts. A significance level of 0.05 was used for all analyses.</div></div><div><h3>Results</h3><div>There were statistically significant positive relationships between rotation and length overall (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.49, <em>p</em> < 0.001), for the patient group (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.35, <em>p</em> < 0.001) and for the control group (<span><math><mrow><msup><mrow><mi>r</mi></mrow><mn>2</mn></msup></mrow></math></span> = 0.52, <em>p</em> < 0.001). There was a significant difference between the PFI and control group for the rotation (<em>p</em> < 0.001) and length (<em>p</em> = 0.002). In total, seventy knees were included, 35 patients and 35 controls. The ICC for the rotation and length measurements were 0.87 (CI: 0.77–0.93) and 0.94 (CI: 0.89–0.97) respectively.</div></div><div><h3>Conclusion</h3><div>This study identified increased popliteus length associated with increased external tibiofemoral rotation as seen in patella instability patients. These findings demonstrate a further need to investigate the implications of advancing the popliteus for treatment of high tibiofemoral rotations.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 128-135"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529183","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}
Pub Date : 2025-03-03DOI: 10.1016/j.knee.2025.02.013
Dominic Cullen , Peter Thompson , David Johnson , Claudia Lindner
Background
Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs.
Methods
We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.
Results
The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°.
Conclusion
The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.
{"title":"An AI-based system for fully automated knee alignment assessment in standard AP knee radiographs","authors":"Dominic Cullen , Peter Thompson , David Johnson , Claudia Lindner","doi":"10.1016/j.knee.2025.02.013","DOIUrl":"10.1016/j.knee.2025.02.013","url":null,"abstract":"<div><h3>Background</h3><div>Accurate assessment of knee alignment in pre- and post-operative radiographs is crucial for knee arthroplasty planning and evaluation. Current methods rely on manual alignment assessment, which is time-consuming and error-prone. This study proposes a machine learning-based approach to fully automatically measure anatomical varus/valgus alignment in standard anteroposterior (AP) knee radiographs.</div></div><div><h3>Methods</h3><div>We collected a training dataset of 566 pre-operative and 457 one-year post-operative AP knee radiographs from total knee arthroplasty patients, along with a separate test set of 376 patients. The distal femur and proximal tibia/fibula were manually outlined using points to capture the knee joint. The outlines were used to develop an automatic system to locate the points. The anatomical femorotibial angle was calculated using the points, with varus/valgus defined as negative/positive deviations from zero. Fifty test images were clinically measured on two occasions by an orthopaedic surgeon. Agreement between points-based manual, automatic, and clinical measurements was assessed using intra-class correlation coefficient (ICC), mean absolute difference (MAD) and Bland-Altman analysis.</div></div><div><h3>Results</h3><div>The agreement between automatic and manual measurements was excellent pre-/post-operatively with ICC 0.98/0.96 and MAD 0.8°/0.7°. The agreement between automatic and clinical measurements was excellent pre-operatively (ICC: 0.97; MAD: 1.2°) but lacked performance post-operatively (ICC: 0.78; MAD: 1.5°). The clinical intra-observer agreement was excellent pre-/post-operatively with ICC 0.99/0.95 and MAD 0.9°/0.8°.</div></div><div><h3>Conclusion</h3><div>The developed system demonstrates high reliability in automatically measuring varus/valgus alignment pre- and post-operatively, and shows excellent agreement with clinical measurements pre-operatively. It provides a promising approach for automating the measurement of anatomical alignment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 99-110"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.knee.2025.02.001
N. van der Gaast , P. Bagave , N. Assink , S. Broos , R.L. Jaarsma , M.J.R. Edwards , E. Hermans , F.F.A. IJpma , A.Y. Ding , J.N. Doornberg , J.H.F. Oosterhoff , the Machine Learning Consortium
Background
Deep learning (DL) has been shown to be successful in interpreting radiographs and aiding in fracture detection and classification. However, no study has aimed to develop a computer vision model for tibia plateau fractures using the Schatzker classification. Therefore, this study aims to develop a deep learning model for (1) detection of tibial plateau fractures and (2) classification according to the Schatzker classification.
Methods
A multicenter approach was performed for the collection of radiographs of patients with tibia plateau fractures. Both anteroposterior and lateral images were uploaded into an annotation software and manually labelled and annotated. The dataset was balanced for optimizing model development and split into a training set and a test set. We trained two convolutional neural networks (GoogleNet and ResNet) for the detection and classification of tibia plateau fractures following the Schatzker classification.
Results
A total of 1506 knee radiographs from 753 patients, including 368 tibial plateau fractures and 385 healthy knees, were used to create the algorithm. The GoogleNet algorithm demonstrated high sensitivity (92.7%) but intermediate accuracy (70.4%) and positive predictive value (64.4%) in detecting tibial plateau fractures, indicating reliable detection of fractured cases. It exhibited limited success in accurately classifying fractures according to the Schatzker system, achieving an accuracy of only 34.6% and a sensitivity of 32.1%.
Conclusion
This study shows that detection of tibial plateau fractures is a task that a DL algorithm can grasp; further refinement is necessary to enhance their accuracy in fracture classification. Computer vision models might improve using different classification systems, as the current Schatzker classification suffers from a low interobserver agreement on conventional radiographs.
{"title":"Deep learning for tibial plateau fracture detection and classification","authors":"N. van der Gaast , P. Bagave , N. Assink , S. Broos , R.L. Jaarsma , M.J.R. Edwards , E. Hermans , F.F.A. IJpma , A.Y. Ding , J.N. Doornberg , J.H.F. Oosterhoff , the Machine Learning Consortium","doi":"10.1016/j.knee.2025.02.001","DOIUrl":"10.1016/j.knee.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Deep learning (DL) has been shown to be successful in interpreting radiographs and aiding in fracture detection and classification. However, no study has aimed to develop a computer vision model for tibia plateau fractures using the Schatzker classification. Therefore, this study aims to develop a deep learning model for (1) detection of tibial plateau fractures and (2) classification according to the Schatzker classification.</div></div><div><h3>Methods</h3><div>A multicenter approach was performed for the collection of radiographs of patients with tibia plateau fractures. Both anteroposterior and lateral images were uploaded into an annotation software and manually labelled and annotated. The dataset was balanced for optimizing model development and split into a training set and a test set. We trained two convolutional neural networks (GoogleNet and ResNet) for the detection and classification of tibia plateau fractures following the Schatzker classification.</div></div><div><h3>Results</h3><div>A total of 1506 knee radiographs from 753 patients, including 368 tibial plateau fractures and 385 healthy knees, were used to create the algorithm. The GoogleNet algorithm demonstrated high sensitivity (92.7%) but intermediate accuracy (70.4%) and positive predictive value (64.4%) in detecting tibial plateau fractures, indicating reliable detection of fractured cases. It exhibited limited success in accurately classifying fractures according to the Schatzker system, achieving an accuracy of only 34.6% and a sensitivity of 32.1%.</div></div><div><h3>Conclusion</h3><div>This study shows that detection of tibial plateau fractures is a task that a DL algorithm can grasp; further refinement is necessary to enhance their accuracy in fracture classification. Computer vision models might improve using different classification systems, as the current Schatzker classification suffers from a low interobserver agreement on conventional radiographs.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 81-89"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.knee.2025.02.012
Xun Xu , Shijie Wang , Zheng Zhu, Shuo Yang, Zhengming Zhu, Lingchao Kong, Rende Ning
Background
The ongoing debate regarding the excision of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains a contentious issue, with established parameters for IPFP management still lacking. Excessive resection of IPFP tissue may lead to patellar tendon (PT) shortening and reduced mobility of the knee joint. This study aims to evaluate whether the resection of pathologically altered IPFP tissue during TKA affects knee joint function and PT dimensions.
Methods
A total of 100 patients with end-stage knee osteoarthritis (KOA) who successfully underwent their first TKA were randomly assigned to two groups: one group received resection of the pathologically altered IPFP tissue, while the other group underwent complete resection of all IPFP tissue. The excised IPFP specimens were subjected to pathological and immunohistochemical analysis. Patients underwent X-ray and MRI assessments prior to surgery, as well as at 6 weeks and 6 months postoperatively; additionally, the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Scale (KOOS), and Oxford Knee Score (OKS) were utilized for evaluation. Furthermore, patellar tendon length and thickness were assessed.
Results
Histological examination of the IPFP tissue from patients with KOA revealed that not all IPFP specimens exhibited lesions under hematoxylin and eosin (HE) staining and immunohistochemical analysis, with lesion areas predominantly localized near the synovium. There was no significant difference in the NRS scores between the two patient groups at 6 weeks or 6 months postoperatively (Mann–Whitney test, P = 0.391; P = 0.055). However, a significant difference was observed in both KOOS and OKS between the two groups at 6 months after surgery (Mann–Whitney test, P < 0.05). Sonographic evaluation of patellar tendon parameters indicated a significant difference in PT thickness between the two groups only at 6 weeks postoperatively (Mann–Whitney test, P < 0.05).
Conclusions
This study demonstrated that the resection of pathologically altered IPFP tissue during TKA in patients with end-stage KOA can significantly enhance early postoperative knee joint mobility, improve life satisfaction, and mitigate the impact on PT structure.
{"title":"Resection of pathologically altered infrapatellar fat pads during total knee arthroplasty has a positive impact on postoperative knee function","authors":"Xun Xu , Shijie Wang , Zheng Zhu, Shuo Yang, Zhengming Zhu, Lingchao Kong, Rende Ning","doi":"10.1016/j.knee.2025.02.012","DOIUrl":"10.1016/j.knee.2025.02.012","url":null,"abstract":"<div><h3>Background</h3><div>The ongoing debate regarding the excision of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains a contentious issue, with established parameters for IPFP management still lacking. Excessive resection of IPFP tissue may lead to patellar tendon (PT) shortening and reduced mobility of the knee joint. This study aims to evaluate whether the resection of pathologically altered IPFP tissue during TKA affects knee joint function and PT dimensions.</div></div><div><h3>Methods</h3><div>A total of 100 patients with end-stage knee osteoarthritis (KOA) who successfully underwent their first TKA were randomly assigned to two groups: one group received resection of the pathologically altered IPFP tissue, while the other group underwent complete resection of all IPFP tissue. The excised IPFP specimens were subjected to pathological and immunohistochemical analysis. Patients underwent X-ray and MRI assessments prior to surgery, as well as at 6 weeks and 6 months postoperatively; additionally, the Numeric Rating Scale (NRS), Knee Injury and Osteoarthritis Outcome Scale (KOOS), and Oxford Knee Score (OKS) were utilized for evaluation. Furthermore, patellar tendon length and thickness were assessed.</div></div><div><h3>Results</h3><div>Histological examination of the IPFP tissue from patients with KOA revealed that not all IPFP specimens exhibited lesions under hematoxylin and eosin (HE) staining and immunohistochemical analysis, with lesion areas predominantly localized near the synovium. There was no significant difference in the NRS scores between the two patient groups at 6 weeks or 6 months postoperatively (Mann–Whitney test, <em>P</em> = 0.391; <em>P</em> = 0.055). However, a significant difference was observed in both KOOS and OKS between the two groups at 6 months after surgery (Mann–Whitney test, <em>P</em> < 0.05). Sonographic evaluation of patellar tendon parameters indicated a significant difference in PT thickness between the two groups only at 6 weeks postoperatively (Mann–Whitney test, <em>P</em> < 0.05).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the resection of pathologically altered IPFP tissue during TKA in patients with end-stage KOA can significantly enhance early postoperative knee joint mobility, improve life satisfaction, and mitigate the impact on PT structure.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 58-70"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.knee.2025.02.011
Colin C. Neitzke, Jeffrey A. O’Donnell, Claude J. Regis, Pravjit Bhatti, Yu-Fen Chiu, Andrew D. Pearle, David J. Mayman, Brian P. Chalmers
Introduction
Lateral unicompartmental knee arthroplasty (UKA) has historically shown mixed results and there is limited contemporary literature on lateral robotic-assisted UKA (RA-UKA) outcomes. This study aimed to evaluate the short-term survivorship, clinical, and radiographic outcomes of lateral RA-UKA.
Methods
A retrospective review identified 138 lateral RA-UKAs performed from 2016 to 2022 at a single institution, with a study population of 58% women, a mean BMI of 27 kg/m2, and a mean age of 62 years. The mean follow-up was two years. Kaplan-Meier analysis assessed survivorship free from all-cause reoperation and revision. A radiographic review evaluated component positioning, aseptic loosening, and osteoarthritis progression.
Results
The one- and two-year survivorship free from all-cause revision was 100% (95% confidence interval [CI]: 100 to 100%). The one- and two-year survivorship free from all-cause reoperation was 97% (95% CI: 91 to 99%) and 96% (95% CI: 90 to 98%), respectively. There were six (4%) reoperations, most commonly for arthroscopic lysis/removal of scar tissue, synovitis, and osteophyte. The mean anatomic tibiofemoral angle decreased from 9.7° to 5.9° valgus. At the latest follow-up, 11 (8%) knees showed radiographic osteoarthritis progression. From preoperatively to two years postoperatively, the mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 56 to 82 (P < 0.0001), and the mean visual analog scale for pain decreased from 53 to 18 (P = 0.001).
Conclusions
Short-term follow-up of contemporary lateral RA-UKA demonstrated high survivorship free from all-cause reoperation (96%) and revision (100%). Patients had significant improvements in PROMs, and a minority had osteoarthritis progression.
{"title":"Excellent early outcomes following lateral robotic-assisted unicompartmental knee arthroplasty","authors":"Colin C. Neitzke, Jeffrey A. O’Donnell, Claude J. Regis, Pravjit Bhatti, Yu-Fen Chiu, Andrew D. Pearle, David J. Mayman, Brian P. Chalmers","doi":"10.1016/j.knee.2025.02.011","DOIUrl":"10.1016/j.knee.2025.02.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Lateral unicompartmental knee arthroplasty (UKA) has historically shown mixed results and there is limited contemporary literature on lateral robotic-assisted UKA (RA-UKA) outcomes. This study aimed to evaluate the short-term survivorship, clinical, and radiographic outcomes of lateral RA-UKA.</div></div><div><h3>Methods</h3><div>A retrospective review identified 138 lateral RA-UKAs performed from 2016 to 2022 at a single institution, with a study population of 58% women, a mean BMI of 27 kg/m<sup>2</sup>, and a mean age of 62 years. The mean follow-up was two years. Kaplan-Meier analysis assessed survivorship free from all-cause reoperation and revision. A radiographic review evaluated component positioning, aseptic loosening, and osteoarthritis progression.</div></div><div><h3>Results</h3><div>The one- and two-year survivorship free from all-cause revision was 100% (95% confidence interval [CI]: 100 to 100%). The one- and two-year survivorship free from all-cause reoperation was 97% (95% CI: 91 to 99%) and 96% (95% CI: 90 to 98%), respectively. There were six (4%) reoperations, most commonly for arthroscopic lysis/removal of scar tissue, synovitis, and osteophyte. The mean anatomic tibiofemoral angle decreased from 9.7° to 5.9° valgus. At the latest follow-up, 11 (8%) knees showed radiographic osteoarthritis progression. From preoperatively to two years postoperatively, the mean Knee Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 56 to 82 (<em>P</em> < 0.0001), and the mean visual analog scale for pain decreased from 53 to 18 (<em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>Short-term follow-up of contemporary lateral RA-UKA demonstrated high survivorship free from all-cause reoperation (96%) and revision (100%). Patients had significant improvements in PROMs, and a minority had osteoarthritis progression.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 50-57"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520917","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}
Pub Date : 2025-03-01DOI: 10.1016/j.knee.2025.02.010
Tadeu Aldrovando Brihy de Albuquerque , Cintia Lopes Ferreira , Fabiano Politti , Cintia Elord Júlio , Gabor József Barton , Paulo Roberto Garcia Lucareli
Background
Patellofemoral pain (PFP) affects many women’s movement function and quality of life. PFP is related to changes in muscle activity and movement patterns during functional tasks. This study aimed to determine whether the combined analysis of kinematics and electromyography data enhances the ability to discriminate between women with and without PFP, compared with the independent analysis of kinematics and electromyography.
Methods
Thirty-seven women with PFP and 34 unimpaired controls were evaluated for kinematics and electromyography during the lateral step-down (LSD) task. For three-dimensional kinematics, movements in the sagittal, frontal, and transverse planes of the trunk, pelvis, hip, knee, and foot were assessed. For electromyography, filtered, rectified, and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used. The artificial neural network-based movement deviation profile (MDP) was used to analyse kinematics, electromyography and kinematics combined with electromyography. A MANOVA of MDPmean Z-scores was used to compare the groups, considering P < 0.05.
Results
Multivariate analysis showed group interaction. There was a significant difference between groups in the Z-score for kinematics. However, no significant differences were observed between groups for electromyography and kinematics combined with electromyography.
Conclusion
Women with PFP exhibit altered movement patterns during the LSD task but no change in the MDP of muscular activity. Using the MDP, which can combine kinematic and electromyography variables from different segments and muscles, kinematics was the most influential in distinguishing between women with and without PFP.
{"title":"Can the combination of kinematics and electromyography enhance the identification of individuals with patellofemoral pain?","authors":"Tadeu Aldrovando Brihy de Albuquerque , Cintia Lopes Ferreira , Fabiano Politti , Cintia Elord Júlio , Gabor József Barton , Paulo Roberto Garcia Lucareli","doi":"10.1016/j.knee.2025.02.010","DOIUrl":"10.1016/j.knee.2025.02.010","url":null,"abstract":"<div><h3>Background</h3><div>Patellofemoral pain (PFP) affects many women’s movement function and quality of life. PFP is related to changes in muscle activity and movement patterns during functional tasks. This study aimed to determine whether the combined analysis of kinematics and electromyography data enhances the ability to discriminate between women with and without PFP, compared with the independent analysis of kinematics and electromyography.</div></div><div><h3>Methods</h3><div>Thirty-seven women with PFP and 34 unimpaired controls were evaluated for kinematics and electromyography during the lateral step-down (LSD) task. For three-dimensional kinematics, movements in the sagittal, frontal, and transverse planes of the trunk, pelvis, hip, knee, and foot were assessed. For electromyography, filtered, rectified, and smoothed signals from the adductor longus, gluteus medius, vastus lateralis and medialis, rectus femoris, biceps femoris, medial gastrocnemius and tibialis anterior muscles were used. The artificial neural network-based movement deviation profile (MDP) was used to analyse kinematics, electromyography and kinematics combined with electromyography. A MANOVA of MDP<sub>mean</sub> Z-scores was used to compare the groups, considering <em>P <</em> 0.05.</div></div><div><h3>Results</h3><div>Multivariate analysis showed group interaction. There was a significant difference between groups in the Z-score for kinematics. However, no significant differences were observed between groups for electromyography and kinematics combined with electromyography.</div></div><div><h3>Conclusion</h3><div>Women with PFP exhibit altered movement patterns during the LSD task but no change in the MDP of muscular activity. Using the MDP, which can combine kinematic and electromyography variables from different segments and muscles, kinematics was the most influential in distinguishing between women with and without PFP.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"54 ","pages":"Pages 90-98"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520916","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}
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