IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-14 DOI: 10.1016/j.knee.2025.10.024

Lin Yao , Xiaoling Liang , Jin Liu , Baoxin Qian , Zhongli Xiao , Dantian Zhu , Jiaxin Feng , Shouguo Zhou , Huaqian Cui , Shaolin Li , Wei Li

Background

Accurate evaluation of the cartilage anatomy of the knee is helpful for clinical evaluation of the source of knee pain and the classification and treatment of knee osteoarthritis (OA). This study proposes a deep learning model for segmentation of knee articular cartilage in conventional proton density fat-saturated MRI sequences to assess cartilage morphology for subsequent injury grading.

Methods

This retrospective study was conducted at two radiology centers, involving 254 knees from 254 patients who had previously undergone MRI scans. The training-internal validation cohort included 219 knees from Center 1. The external validation cohort comprised 35 knees from Center 2. Two musculoskeletal radiology experts manually annotated the cartilage regions. A 3D Res U-net model was employed for segmentation, and its performance was compared with 3D U-net and 3D V-net models. Segmentation results were evaluated using the Dice coefficient and Jaccard index.

Results

The 3D Res U-net model demonstrated superior segmentation performance compared to the other deep learning methods. For cartilage in the lateral femorotibial joint, medial femorotibial joint, and patellofemoral joint, the average Dice coefficients with 3D Res U-net were 0.871, 0.860, and 0.858 in internal validation and 0.846, 0.837, and 0.819 in external validation, respectively. The Jaccard index followed a similar trend.

Conclusion

The 3D Res U-net model improves knee cartilage segmentation in conventional MR imaging, contributing to the understanding of cartilage morphology and the improvement of clinically relevant decisions.

背景：准确评估膝关节软骨解剖结构有助于临床评估膝关节疼痛的来源及膝关节骨性关节炎（OA）的分类和治疗。本研究提出了一种深度学习模型，用于在常规质子密度脂肪饱和MRI序列中分割膝关节软骨，以评估软骨形态，以便随后进行损伤分级。方法：本回顾性研究在两个放射学中心进行，涉及254例患者的254个膝关节，这些患者之前接受过MRI扫描。训练-内部验证队列包括来自中心1的219个膝关节。外部验证队列包括来自中心2的35个膝关节。两名肌肉骨骼放射学专家手工注释了软骨区域。采用三维Res U-net模型进行分割，并与三维U-net模型和三维V-net模型进行了性能比较。使用Dice系数和Jaccard指数对分割结果进行评价。结果：与其他深度学习方法相比，3D Res U-net模型表现出更好的分割性能。股胫外侧关节、股胫内侧关节和髌股关节软骨的3D Res U-net平均Dice系数在内部验证中分别为0.871、0.860和0.858，在外部验证中分别为0.846、0.837和0.819。Jaccard指数也遵循了类似的趋势。结论：3D Res U-net模型改善了常规MR成像中的膝关节软骨分割，有助于对软骨形态的理解和临床相关决策的改善。

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引用次数: 0

Association of preoperative GLP‑1 receptor agonist use with outcomes after primary total knee arthroplasty 术前GLP‑1受体激动剂使用与初次全膝关节置换术后预后的关系

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-14 DOI: 10.1016/j.knee.2025.10.026

McKenna W. Box , Troy B. Puga , Neil J. Werthmann , Andrew Jen , Yingxian Liu , John T. Riehl

Background

Evidence on whether glucagon-like peptide 1 receptor agonists (GLP-1RA) influence outcomes after total knee arthroplasty (TKA) is mixed. We evaluated the association between perioperative use of GLP-1RA and postoperative outcomes in patients with and without diabetes.

Methods

In this retrospective cohort from a single U.S. health system (2019–2023), adults undergoing primary TKA were stratified by GLP‑1RA use at the time of surgery. Primary outcomes included length-of-stay (LOS), 30-day medical complications, 90-day readmissions and surgical site infection (SSI), 1-year SSI, medical complications, and TKA implant complications, and revision TKA. Multivariable logistic regression and negative binomial regression were adjusted for age group, sex, BMI, smoking status, diabetes, and the Elixhauser Comorbidity Index. Unadjusted subgroup analyses examined outcomes by diabetes status and specific GLP-1RA agent.

Results

Among 26,154 TKA patients, 914 (3.5 %) used a GLP-1RA (73 % of these had diabetes). GLP-1RA use was associated with 45 % lower odds of 1-year implant complications (odds ratio = 0.55, 95 % CI 0.33–0.90, P = 0.02) and 10 % shorter LOS (incidence rate ratio = 0.90, 95 % CI 0.85–0.94, P < 0.001) (absolute difference of 0.17 days). No significant differences in 30-day complications, 90-day SSI, or readmissions were observed after adjustment.

Conclusions

Preoperative GLP-1RA use was associated with reduced one-year implant complications and slightly shorter hospital stays following TKA. These findings, although encouraging, are exploratory. Larger, adjusted analyses are needed to confirm the benefits before recommending changes in perioperative management.

背景：关于胰高血糖素样肽1受体激动剂（GLP-1RA）是否影响全膝关节置换术（TKA）后预后的证据不一。我们评估了有或无糖尿病患者围手术期使用GLP-1RA与术后预后之间的关系。方法：在这个来自美国单一卫生系统（2019-2023）的回顾性队列中，接受原发性TKA的成年人在手术时使用GLP - 1RA进行分层。主要结局包括住院时间（LOS）、30天的医疗并发症、90天的再入院和手术部位感染（SSI）、1年的SSI、医疗并发症、TKA植入物并发症和翻修TKA。对年龄、性别、BMI、吸烟状况、糖尿病和Elixhauser合并症指数进行多变量logistic回归和负二项回归校正。未调整的亚组分析检查了糖尿病状态和特定GLP-1RA药物的结果。结果：在26154例TKA患者中，914例（3.5%）使用GLP-1RA（其中73%患有糖尿病）。GLP-1RA的使用与1年种植体并发症发生率降低45%（优势比= 0.55,95% CI 0.33-0.90, P = 0.02）和LOS缩短10%（发生率比= 0.90,95% CI 0.85-0.94， P）相关。结论：术前使用GLP-1RA与TKA后1年种植体并发症减少和住院时间略短相关。这些发现虽然令人鼓舞，但仍是探索性的。在建议改变围手术期管理之前，需要更大规模的调整分析来确认益处。

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引用次数: 0

Automatic detection of knee medial collateral ligament (MCL) tear from magnetic resonance imaging using deep neural network 基于深度神经网络的磁共振成像自动检测膝关节内侧副韧带撕裂。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-13 DOI: 10.1016/j.knee.2025.10.028

Elahe Mirzakhani , Mohammad Ayati Firoozabadi , Mohammadreza Razzaghof , Seyed Mohammad Javad Mortazavi , Toktam Khatibi

<div><h3>Background</h3><div>The medial collateral ligament (MCL) is a crucial structure supporting the stability of the knee joint. Although a clinical examination can detect an MCL tear, valgus stress radiography and magnetic resonance imaging (MRI) can confirm it. However, challenges persist in accurate MCL tear detection from MRI images, often leading to misdiagnosis and treatment delays. Therefore, proposing automatic methods for detecting MCL tears is necessary. To the best of the researcher’s knowledge, studies have yet to address this problem using deep neural networks.</div></div><div><h3>Method</h3><div>This study aims to detect medial collateral ligament (MCL) tears through knee MRI images. Our collected dataset includes coronal views of knee MRI images taken from patients in “Imam Khomeini Hospital, Tehran, Iran.” The dataset has 3575 knee MRI images from 60 patients, each with a resolution of 512 × 512 pixels. We employ the Cross-Industry Standard Process for Data Mining (CRISP-DM) methodology to structure our approach, which includes three distinct scenarios utilizing deep learning models. In Scenario One, A custom Convolutional Neural Network (CNN) architecture is designed specifically for MCL tear detection. This model undergoes a meticulous fine-tuning process and is evaluated using a comprehensive knee MRI dataset. We adapt the hyperparameters of the CNN to accurate optimize its performance, ensuring classification of MCL tears. In the second scenario, we leverage a deep neural network pre-trained on the ImageNet dataset. The pre-trained VGG19 model is utilized, where we extract features from its layers and feed them into custom output layer to classify MCL tears using fine tuning. This approach allows us to assess the effectiveness of transfer learning in improving MCL tear detection. In the third scenario, we implement transfer learning using the VGG19 architecture. We apply transfer learning by freezing the early layers of the pre-trained VGG19 model and modifying its final layers. This innovative approach aims to enhance the model’s ability to accurately identify MCL tears by utilizing learned features from a large dataset.</div></div><div><h3>Result</h3><div>The experimental results demonstrate that the first scenario achieved an accuracy of 95 %. The second scenario outperformed the others, achieving an average accuracy of 98.3 %, an average loss of 0.07, and an area under the receiver operating characteristic (ROC) curve (AUC) of 1.00. In contrast, the third scenario attained an accuracy of 80 %.</div></div><div><h3>Discussion</h3><div>This study highlights the effectiveness of deep learning, particularly the pre-trained VGG19 model, in detecting MCL tears from knee MRI images with 98.3 % accuracy. By leveraging transfer learning, our approach mitigates data limitations, demonstrating the potential of automated diagnostic tools to improve accuracy and efficiency in clinical practice.</div></div><div><h3>Conclusions</h3><d

背景：内侧副韧带（MCL）是支持膝关节稳定性的重要结构。虽然临床检查可以发现MCL撕裂，外翻应力摄影和磁共振成像（MRI）可以证实它。然而，从MRI图像中准确检测MCL撕裂仍然存在挑战，经常导致误诊和治疗延误。因此，提出自动检测MCL撕裂的方法是必要的。据研究人员所知，研究还没有使用深度神经网络来解决这个问题。方法：本研究旨在通过膝关节MRI图像检测内侧副韧带撕裂。我们收集的数据集包括“伊朗德黑兰伊玛目霍梅尼医院”患者膝关节MRI图像的冠状面。该数据集有来自60名患者的3575张膝关节MRI图像，每张图像的分辨率为512 × 512像素。我们采用跨行业数据挖掘标准流程（CRISP-DM）方法来构建我们的方法，其中包括利用深度学习模型的三个不同场景。在场景一中，专门为MCL撕裂检测设计了一个自定义卷积神经网络（CNN）架构。该模型经过细致的微调过程，并使用全面的膝关节MRI数据集进行评估。我们通过调整CNN的超参数来精确优化其性能，确保对MCL撕裂的分类。在第二个场景中，我们利用在ImageNet数据集上预训练的深度神经网络。利用预训练的VGG19模型，我们从其层中提取特征并将其输入自定义输出层，使用微调对MCL撕裂进行分类。这种方法允许我们评估迁移学习在改善MCL撕裂检测方面的有效性。在第三个场景中，我们使用VGG19架构实现迁移学习。我们通过冻结预训练的VGG19模型的早期层并修改其最终层来应用迁移学习。这种创新的方法旨在通过利用从大型数据集中学习到的特征来提高模型准确识别MCL撕裂的能力。结果：实验结果表明，第一种方案的准确率达到95%。第二种方案优于其他方案，平均准确率为98.3%，平均损失为0.07，受试者工作特征曲线下面积（AUC）为1.00。相比之下，第三种情况的准确率达到了80%。讨论：本研究强调了深度学习的有效性，特别是预先训练的VGG19模型，在从膝关节MRI图像中检测MCL撕裂方面的准确率为98.3%。通过利用迁移学习，我们的方法减轻了数据限制，展示了自动化诊断工具在提高临床实践准确性和效率方面的潜力。结论：我们的研究引入了一种高度准确的基于深度学习的方法来检测MCL撕裂，有可能提高及时诊断。将这种方法集成到CAD系统中可以通过支持医疗决策来改善患者的预后。未来的研究应该在不同的人群中验证这些发现，以确保稳健性。

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引用次数: 0

The use of machine learning in predicting anterior cruciate ligament injury: a systematic review and meta-analysis 使用机器学习预测前交叉韧带损伤：系统回顾和荟萃分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-12 DOI: 10.1016/j.knee.2025.10.021

Longfei Guo , Zhilei Cui , Wei Ping Loh , Shazlin Shaharudin

Background

Machine learning (ML) models are used to analyze the relationship between risk factors and anterior cruciate ligament (ACL) injury outcomes. This review assessed the practicality of ACL injury prediction models, analyzed the existing issues, and provided valuable information for future research.

Methods

A comprehensive search was conducted across PubMed, Medline, Embase, Scopus, Web of Science, and Cochrane databases for relevant studies until 30th April 2024.

Results

The search yielded 633 studies, of which eight articles (32 predictive models) were included in the final evaluation. Based on the results, the meta-analysis quantification yielded an overall area under the curve (AUC) of 0.79 (95 % CI: 0.75–0.82), a combined sensitivity of 0.57 (95 % CI: 0.45–0.68), and a combined specificity of 0.87 (95 % CI: 0.78–0.92). The included models comprised 10 ensemble algorithms and 22 non-ensemble algorithms. Ensemble methods demonstrated higher specificity (0.96 vs. 0.79) and AUC (0.79 vs. 0.68), whereas non-ensemble models showed better sensitivity (0.65 vs. 0.40).

Conclusion

ML models were effective in correctly identifying non-injury cases, however their ability to detect actual injury occurrences required significant improvement. Algorithm selection significantly influenced performance trade-offs: ensemble models favored specificity, whereas non-ensemble models provided superior sensitivity. These findings may guide algorithm selection to improve the accuracy and efficiency of injury prediction tools in sports medicine. Despite the challenges posed by the diversity of injury mechanisms, the study emphasizes the importance of high-quality biomechanical data, prospective study designs, and standardized methodologies in enhancing model reliability and clinical applicability, providing a basis for optimizing ACL injury prediction models.

背景：机器学习（ML）模型用于分析危险因素与前交叉韧带（ACL）损伤结局之间的关系。本文评价了ACL损伤预测模型的实用性，分析了存在的问题，为今后的研究提供了有价值的信息。方法：综合检索PubMed、Medline、Embase、Scopus、Web of Science、Cochrane等数据库的相关研究，检索截止至2024年4月30日。结果：共检索到633篇研究，其中8篇（32个预测模型）纳入最终评价。基于结果，meta分析量化得出曲线下总面积（AUC）为0.79 (95% CI: 0.75-0.82)，综合敏感性为0.57 (95% CI: 0.45-0.68)，综合特异性为0.87 （95% CI: 0.78-0.92）。纳入的模型包括10个集成算法和22个非集成算法。集合方法具有更高的特异性（0.96 vs. 0.79）和AUC (0.79 vs. 0.68)，而非集合模型具有更好的灵敏度（0.65 vs. 0.40）。结论：ML模型在正确识别非损伤病例方面是有效的，但其检测实际损伤发生的能力需要显著提高。算法选择显著影响性能权衡：集成模型倾向于特异性，而非集成模型提供更高的灵敏度。这些发现可以指导算法的选择，以提高运动医学损伤预测工具的准确性和效率。尽管损伤机制的多样性带来了挑战，但本研究强调了高质量的生物力学数据、前瞻性研究设计和标准化方法对提高模型可靠性和临床适用性的重要性，为优化ACL损伤预测模型提供了基础。

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引用次数: 0

Comparative performance of the Risk Analysis Index versus traditional frailty measures in predicting outcomes following unicompartmental knee arthroplasty: A national database analysis 风险分析指数与传统虚弱指标在预测单室膝关节置换术后预后方面的比较表现：一项国家数据库分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-10 DOI: 10.1016/j.knee.2025.10.015

Cameron J. Sabet , Bhav Jain , Jad Lawand , Stefan Prulovic , Bill Young , Dang Nguyen , Bara M. Hammadeh , Jiaqi Liu

Background

While multiple frailty assessment tools exist for perioperative risk stratification, their comparative effectiveness in unicompartmental knee arthroplasty (UKA) remains unclear. The Risk Analysis Index (RAI) represents a comprehensive frailty measure, but its performance relative to established indices requires validation. We aimed to compare the predictive accuracy of the RAI against traditional frailty measures including the modified Frailty Index-5 (mFI-5) and Geriatric Nutritional Risk Index (GNRI) for 30-day outcomes following UKA.

Methods

We analyzed 9358 patients undergoing elective UKA from the ACS-NSQIP database (2015–2021). Three frailty indices were calculated: RAI (incorporating age, sex, renal function, dyspnea, cancer, weight loss, and functional status), mFI-5 (five comorbidity domains), and GNRI (nutritional assessment). Primary outcomes were discharge disposition and 30-day readmission. Secondary outcomes included 30-day all-cause mortality, complications, reoperations, and extended length of stay.

Results

The RAI demonstrated superior discrimination for discharge disposition (area under the curve (AUC) = 0.694) and 30-day readmission (AUC = 0.615) compared with mFI-5 (AUC = 0.593 and 0.570) and GNRI (AUC = 0.521 and 0.558). Progressive increases in adverse outcomes occurred across RAI tiers, with non-home discharge rates of 1.7 % in robust patients versus 15.9 % in frail patients (P < 0.001).

Conclusions

The RAI provides superior risk stratification compared with traditional frailty measures for discharge disposition and 30-day readmission in particular following UKA, supporting its adoption as the preferred perioperative assessment tool.

背景：虽然存在多种衰弱评估工具用于围手术期风险分层，但它们在单室膝关节置换术（UKA）中的相对有效性尚不清楚。风险分析指数（RAI）代表了一个综合的脆弱性度量，但其相对于既定指标的表现需要验证。我们的目的是比较RAI与传统虚弱指标（包括修改后的虚弱指数-5 （mFI-5）和老年营养风险指数（GNRI））对UKA后30天预后的预测准确性。方法：我们分析了ACS-NSQIP数据库（2015-2021）中9358例选择性UKA患者。计算三个衰弱指数：RAI（包括年龄、性别、肾功能、呼吸困难、癌症、体重减轻和功能状态）、mFI-5（五个共病域）和GNRI（营养评估）。主要结局为出院处置和30天再入院。次要结局包括30天全因死亡率、并发症、再手术和延长住院时间。结果：与mFI-5 （AUC = 0.593和0.570）和GNRI （AUC = 0.521和0.558）相比，RAI对出院处置（曲线下面积(AUC) = 0.694）和30天再入院（AUC = 0.615）具有更强的区分能力。不良结局在RAI各等级中均有逐渐增加，身体健康的患者非家庭出院率为1.7%，体弱的患者为15.9% (P结论：与传统的出院处理和30天再入院措施相比，RAI提供了更好的风险分层，特别是在UKA后，支持其作为首选的围手术期评估工具。

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引用次数: 0

Knee joint biomechanics under external focus instructions promoting a quiet, safe and soft landing 膝关节生物力学在外部聚焦指导下促进安静，安全和软着陆。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-10 DOI: 10.1016/j.knee.2025.10.013

Lukáš Slovák , David Zahradník , William M. Land , Javad Sarvestan , Takehiro Iwatsuki , Kevin A. Becker , Reza Abdollahipour

Background

Anterior cruciate ligament injuries are common in young female athletes, often occurring during landing tasks. Attentional focus instructions may influence landing biomechanics and reduce injury risk, but comparative effects of different external focus (EF) cues remain unclear.

Methods

Twelve novice female volleyball players (age: 13.6 ± 0.6 years) performed double-leg drop landings from a height of 50 cm under four attentional focus conditions: (1) as quietly as possible, (2) as safely as possible, (3) as softly as possible, and (4) a no-focus control. A Qualisys 3D motion capture system and a Kistler force platform were used to analyze knee joint kinematics and kinetics during initial contact and the first two VGRF peaks, and time-series analysis was conducted to characterize the biomechanical landing pattern across conditions.

Results

All EF conditions significantly reduced biomechanical knee joint loading compared with the no-focus condition. Although no significant differences were found among the three EF instructions, the ’soft’ landing instruction produced the most pronounced changes, showing the lowest maximal VGRF, increased knee flexion angles, and reduced internal rotation angles, relative to the no-focus condition.

Conclusion

EF instructions, particularly those emphasizing a soft landing, can effectively reduce knee joint loading and potentially lower anterior cruciate ligament injury risk in young female athletes. These findings highlight the value of incorporating specific attentional focus cues into injury prevention and training programs.

背景：前交叉韧带损伤在年轻女运动员中很常见，通常发生在着陆任务中。注意焦点指示可能影响着陆生物力学并降低损伤风险，但不同外部焦点（EF）提示的比较效果尚不清楚。方法：12名年龄为13.6±0.6岁的女子排球新手在4种注意力集中条件下(1)尽可能安静，(2)尽可能安全，(3)尽可能轻柔，(4)无焦点控制下，从50 cm高处进行双腿落体。采用Qualisys 3D运动捕捉系统和Kistler力平台分析膝关节初始接触和前两个VGRF峰值时的运动学和动力学，并进行时间序列分析，表征不同条件下的生物力学着陆模式。结果：与无焦点情况相比，所有EF情况均显著降低了膝关节的生物力学负荷。虽然在三种EF指令之间没有发现显著差异，但“软”着陆指令产生了最明显的变化，相对于无焦点条件，显示出最低的最大VGRF，增加的膝关节屈曲角度和减少的内旋角度。结论：EF指令，特别是那些强调软着陆的指令，可以有效地减少年轻女运动员的膝关节负荷，并有可能降低前交叉韧带损伤的风险。这些发现强调了将特定的注意力集中线索纳入伤害预防和训练计划的价值。

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引用次数: 0

Patellotrochlear index: A systematic review of the first 20 years of application 髌滑车指数：前20年应用的系统回顾。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-10 DOI: 10.1016/j.knee.2025.10.017

Roland Manfred Biedert

Objective

To provide an update on the reliability and application of the patellotrochlear index (PTI) used to assess patellar height (PH) measurement.

Methods

A systematic literature search was conducted through PubMed registries in 2024 using the terms PTI, PH, and MRI. Inclusion criteria were original studies or review articles from 2006 onwards. All evidence levels were included. Reliability, cut-off values, statistics, and influence of muscle contraction, flexion, and weight bearing on the PTI were assessed. Comparisons with conventional radiographic measurement methods on MRI were evaluated.

Results

Twenty-four studies met the selection criteria. These studies used a direct measure of the patellotrochlear relationship for PH on sagittal MRI, 12 used the original PTI. Five studies evaluated the effect of quadriceps contraction, weight bearing, or flexion on the PTI values. For healthy subjects, the normal PTI values varied between 31.7 % and 36.8 %, for patella alta they were <12.5 % and varied for patella infera between >50 % and 80 %. In symptomatic subjects, the normal PTI values varied between <11.9 % and 49 %, for patella alta <11.9 % and 18 %, and for patella infera >50 % and 80 % depending on the pathology. Only weak or no correlation between the PTI and measurements on conventional radiography was revealed. The statistical method influenced the PTI values.

Conclusion

The PTI is a reliable diagnostic tool for PH measurement on MRI. PTI values described in the studies are different for the various pathologies. Advantages and limitations exist. Radiographic measurement methods applied on MRI are not suitable.

目的：提供用于评估髌骨高度（PH）测量的髌骨滑车指数（PTI）的可靠性和应用的最新进展。方法：通过2024年的PubMed注册库进行系统的文献检索，检索词为PTI、PH和MRI。纳入标准为2006年以后的原始研究或综述文章。纳入了所有证据水平。评估可靠性、临界值、统计数据以及肌肉收缩、屈曲和负重对PTI的影响。并与常规MRI放射测量方法进行比较。结果：24项研究符合入选标准。这些研究在矢状面MRI上直接测量髌骨滑车与PH的关系，12使用原始的PTI。五项研究评估了股四头肌收缩、负重或屈曲对PTI值的影响。健康人的PTI值在31.7% ~ 36.8%之间，髌骨的PTI值在50% ~ 80%之间。在有症状的受试者中，正常的PTI值根据病理在50%到80%之间变化。PTI与常规x线摄影测量值之间的相关性很弱或没有相关性。统计方法对PTI值有影响。结论：PTI是一种可靠的MRI PH测量诊断工具。研究中描述的PTI值对于不同的病理是不同的。优势和局限性并存。应用于MRI的放射测量方法并不合适。

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引用次数: 0

Impact of meniscal root tears on knee osteoarthritis development: A systematic review of the literature 半月板根部撕裂对膝关节骨性关节炎发展的影响：文献系统综述。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-07 DOI: 10.1016/j.knee.2025.10.012

Gianluca Canton , Andrea Marchetti , Belinda Trobec , Michelangelo Scordo , Alessandra Mazzon , Chiara Ratti , Manuela Deodato , Alex Buoite Stella , Luigi Murena

Background

Meniscal root tears (MRTs) are a significant cause of knee pain and dysfunction. An MRT can alter the biomechanics of the knee joint, leading to cartilage damage and osteoarthritis. This systematic review aims to evaluate the impact of MRTs on the progression of knee osteoarthritis in patients undergoing non-operative treatment.

Methods

A systematic review was performed based on the PRISMA guidelines in PubMed, Scopus, and ScienceDirect databases (“meniscal root injuries” OR “meniscal root tears”) AND (“osteoarthritis” OR “joint degeneration”).

Results

Eight studies, including 1160 patients with MRTs, met the inclusion criteria. MRTs were associated with more severe cartilage damage on the medial femoral condyle (Noyes score, 4.95; P < 0.001) and on the medial tibial plateau (Noyes score, 3.9; P < 0.005) compared with other meniscus tear patterns. Eighty per cent of medial meniscus posterior root tears had an ICRS grade ≥2 chondral lesions at the medial femoral condyle, and those chondral lesions had a more progressive and faster nature compared with medial meniscus posterior horn tears. MRTs and meniscal extrusion were predominant factors associated with accelerated osteoarthritis progression (odds ratio 4.64; 95 % confidence interval, 1.61–13.34; P = 0.004).

Conclusions

MRTs have a crucial role both in the initiation and the progression of knee osteoarthritis, leading to severe cartilage damage and dramatic consequences on quality of life. Early diagnosis and appropriate management could preserve knee function and delay osteoarthritic changes.

背景：半月板根撕裂（MRTs）是膝关节疼痛和功能障碍的重要原因。核磁共振成像可以改变膝关节的生物力学，导致软骨损伤和骨关节炎。本系统综述旨在评估MRTs对接受非手术治疗的膝关节骨性关节炎患者进展的影响。方法：基于PubMed、Scopus和ScienceDirect数据库中的PRISMA指南（“半月板根损伤”或“半月板根撕裂”）和（“骨关节炎”或“关节变性”）进行系统评价。结果：8项研究，包括1160例mri患者，符合纳入标准。MRTs与股骨内侧髁更严重的软骨损伤相关（Noyes评分，4.95；P）结论：MRTs在膝骨关节炎的发生和发展中都起着至关重要的作用，导致严重的软骨损伤和对生活质量的严重影响。早期诊断和适当的治疗可以保护膝关节功能，延缓骨关节炎的改变。

{"title":"Impact of meniscal root tears on knee osteoarthritis development: A systematic review of the literature","authors":"Gianluca Canton , Andrea Marchetti , Belinda Trobec , Michelangelo Scordo , Alessandra Mazzon , Chiara Ratti , Manuela Deodato , Alex Buoite Stella , Luigi Murena","doi":"10.1016/j.knee.2025.10.012","DOIUrl":"10.1016/j.knee.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Meniscal root tears (MRTs) are a significant cause of knee pain and dysfunction. An MRT can alter the biomechanics of the knee joint, leading to cartilage damage and osteoarthritis. This systematic review aims to evaluate the impact of MRTs on the progression of knee osteoarthritis in patients undergoing non-operative treatment.</div></div><div><h3>Methods</h3><div>A systematic review was performed based on the PRISMA guidelines in PubMed, Scopus, and ScienceDirect databases (“meniscal root injuries” OR “meniscal root tears”) AND (“osteoarthritis” OR “joint degeneration”).</div></div><div><h3>Results</h3><div>Eight studies, including 1160 patients with MRTs, met the inclusion criteria. MRTs were associated with more severe cartilage damage on the medial femoral condyle (Noyes score, 4.95; <em>P</em> < 0.001) and on the medial tibial plateau (Noyes score, 3.9; <em>P</em> < 0.005) compared with other meniscus tear patterns. Eighty per cent of medial meniscus posterior root tears had an ICRS grade ≥2 chondral lesions at the medial femoral condyle, and those chondral lesions had a more progressive and faster nature compared with medial meniscus posterior horn tears. MRTs and meniscal extrusion were predominant factors associated with accelerated osteoarthritis progression (odds ratio 4.64; 95 % confidence interval, 1.61–13.34; <em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>MRTs have a crucial role both in the initiation and the progression of knee osteoarthritis, leading to severe cartilage damage and dramatic consequences on quality of life. Early diagnosis and appropriate management could preserve knee function and delay osteoarthritic changes.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104258"},"PeriodicalIF":2.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477224","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

Uniform and reliable assessment of bone union on radiographs in osteotomies around the knee: a novel classification system 膝关节周围截骨术中统一可靠的x线片骨愈合评估：一种新的分类系统。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-04 DOI: 10.1016/j.knee.2025.10.016

E.A. Bax , N. van Egmond , R.J.H. Custers , K.L. Vincken , M.C. Kruyt , W. Foppen

Background

To evaluate the inter- and intra-rater reliability of the Unified Bone Union (UBU) classification for assessing time-dependent bone healing on radiographs in osteotomies around the knee, including negative union signs. Secondary aims included assessing union progression over time, applicability across osteotomy types, and correlation between radiographic and CT-based UBU scores.

Methods

The UBU classification assesses bone healing on anteroposterior radiographs in three anatomical zones, graded from phase 0 (no callus) to phase 3 (bridging callus), including radiological negative union signs. Radiographs (n = 110) from 38 medial opening-wedge high tibial osteotomy patients were retrospectively reviewed twice by three independent raters. Inter- and intra-rater reliability were assessed using quadratic-weighted kappa (κ). Percent agreement was calculated for classification modifiers. Time-dependent changes in union were analyzed. Reliability was also tested across osteotomy types. Correlation between 6-month radiographic and CT-based UBU scores was determined using Spearman’s rho.

Results

Interrater reliability was substantial (κ 0.74–0.79), while intra-rater reliability showed almost perfect agreement (κ 0.78–0.98). Modifier agreement was good (inter-rater: 91–98 %; intra-rater: 89–95 %). The UBU score increased over time. The UBU showed substantial interrater reliability (κ = 0.75) across various osteotomy types. A strong correlation was found between radiographic and CT-based UBU scores (r = 0.82, p < 0.01).

Conclusion

The UBU classification provides a reliable and standardized method for evaluating bone union after osteotomies around the knee. It incorporates negative union signs and demonstrates strong inter- and intra-rater agreement, as well as strong correlation with CT imaging. Further research should validate its diagnostic accuracy and clinical utility.

背景：评估统一骨愈合（UBU）分类在评估膝关节周围截骨术中随时间变化的骨愈合时的可靠性，包括阴性愈合迹象。次要目的包括评估骨愈合随时间的进展，不同截骨类型的适用性，以及x线摄影和基于ct的UBU评分之间的相关性。方法：UBU分级评估骨愈合在三个解剖区域的正位x线片上，从0期（无骨痂）到3期（桥接骨痂），包括放射学阴性愈合征象。本文回顾性分析了38例内侧楔形高位胫骨截骨术患者的x线片（n = 110），由三位独立评分者进行了两次评估。使用二次加权kappa （κ）评估评分间和评分内的信度。计算了分类修饰符的一致性百分比。分析了结合度随时间的变化。也测试了不同截骨类型的可靠性。使用Spearman’s rho确定6个月x线摄影和基于ct的UBU评分之间的相关性。结果：评分间信度显著（κ 0.74-0.79），评分内信度几乎完全一致（κ 0.78-0.98）。修饰语一致性较好（内部修饰语一致性：91- 98%；内部修饰语一致性：89- 95%）。UBU评分随着时间的推移而增加。UBU在各种截骨类型中显示出显著的互信度（κ = 0.75）。x线片评分与ct评分之间存在很强的相关性（r = 0.82, p）。结论：UBU分级为评估膝关节周围截骨术后骨愈合提供了一种可靠、标准化的方法。它包含负结合征象，表现出很强的骨间和骨内一致性，并与CT成像有很强的相关性。进一步的研究应验证其诊断准确性和临床应用价值。

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引用次数: 0

Changes in MRI T2 mapping value in quadriceps tendon harvest donor site after anterior cruciate ligament reconstruction reflects tendon maturation and correlates with clinical scores 前交叉韧带重建后股四头肌肌腱采集供区MRI T2定位值的变化反映了肌腱的成熟程度，并与临床评分相关

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-10-31 DOI: 10.1016/j.knee.2025.10.010

Shuko Tsumoto , Yusuke Hashimoto , Kazuya Nishino , Ken Iida , Hidetomi Terai

Background

Quantitative studies analyzing harvest donor site healing are limited. Therefore, this study aimed to assess the healing of the harvest donor site over 2 years after anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon bone (QTB) by using magnetic resonance imaging (MRI) T2 mapping technique.

Methods

Patients who underwent ACLR with QTB and were followed up for a minimum of 24 months were enrolled in this study. T2 value was evaluated using MRI, which was routinely performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Clinical assessments, including Lysholm, donor site morbidity, anterior knee pain (AKP) score, and Tegner activity scores, and KT-2000 arthrometric analysis were also performed at these time points. The change in T2 value and the relationship with the clinical scores were evaluated.

Results

In total, 28 patients (29 knees) were included in this study. Functional score and ligament laxity improved from preoperative to 24 months postoperatively. The T2 value of the harvest donor site gradually decreased over time after surgery. At 24 months post-surgery, T2 value, both Lyshlom score, and AKP showed a negative correlation (r = −0.6, P = 0.01; r = −0.5, P = 0.03, respectively).

Conclusion

After ACLR, the quadriceps tendon harvest donor site T2 value decreased over time and correlated with Lyshlom and AKP scores. This suggests that T2 value can be used as a tool for evaluating harvest donor site healing after ACLR.

背景：定量分析供体部位愈合的研究是有限的。因此，本研究旨在通过磁共振成像（MRI） T2定位技术评估股四头肌腱骨（QTB）前交叉韧带重建（ACLR）后2年内收获供体部位的愈合情况。方法接受ACLR合并QTB并随访至少24个月的患者纳入本研究。术前及术后3、6、12、24个月常规行MRI评估T2值。临床评估，包括Lysholm，供体部位发病率，前膝关节疼痛（AKP）评分和Tegner活动评分，以及KT-2000关节测量分析也在这些时间点进行。观察T2值变化及与临床评分的关系。结果本研究共纳入28例患者（29个膝关节）。术前至术后24个月，功能评分和韧带松弛度均有所改善。手术后收获供体部位T2值随时间逐渐降低。术后24个月，T2值、Lyshlom评分与AKP呈负相关（r = - 0.6, P = 0.01; r = - 0.5, P = 0.03）。结论ACLR术后，股四头肌腱供体T2值随时间推移而降低，并与Lyshlom和AKP评分相关。这表明T2值可以作为评估ACLR后收获供体愈合的工具。

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引用次数: 0

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