IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-24 DOI: 10.1016/j.knee.2025.11.007

Matthew A. Peterman, Jane C. Brennan, Andrea H. Johnson, Benjamin M. Petre, James J. York, Justin J. Turcotte, Daniel E. Redziniak

Background

Lateral Extra-Articular Tenodesis (LET) is increasingly performed in conjunction with anterior cruciate ligament reconstruction (ACLR) to provide improved rotational knee stability. This study seeks to assess national utilization trends, revision rates, and complication profiles for primary ACLR vs ACLR with LET in a large national database.

Methods

A retrospective study of patients undergoing primary ACLR with or without LET in the PearlDiver database was performed. Multivariate analysis was performed to identify predictors of LET performance. ACLR-only and ACLR/LET patients were then propensity matched for age, sex, and comorbidity burden. 2-year postoperative outcomes including revision-ACLR, meniscus surgery, lysis of adhesion (LOA), manipulation under anesthesia (MUA), and total knee arthroplasty (TKA) were compared between groups.

Results

Of 140,866 primary ACLR analyzed, 1,814 (1.3 %) had LET, with LET utilization increasing five-fold from 0.6 % in 2015 to 3.7 % in 2023. Younger age, male sex, meniscal repair and hypermobility were associated with increased odds of LET performance, while meniscectomy use was associated with decreased odds. There were no significant differences in rates of revision ACLR (ACLR/LET: 4.8 % vs ACLR: 3.6 %; p = 0.207), meniscus surgery, LOA, MUA, or TKA between the ACLR and ACLR with LET groups at 2-year follow-up.

Conclusions

The utilization of concomitant LET with ACLR is increasing nationally; however, in this large cohort, the addition of LET was not associated with lower revision rates or increased complications at 2-year follow-up. Further prospective study with granular clinical data, patient-reported outcomes, and longer follow-up is needed to assess the potential benefits of combined ACLR/LET procedures.

背景：外侧关节外肌腱固定术（LET）越来越多地与前交叉韧带重建（ACLR）一起进行，以改善膝关节旋转稳定性。本研究旨在评估国家大型数据库中原发性ACLR与LET ACLR的使用趋势、修订率和并发症概况。方法：对PearlDiver数据库中接受原发性ACLR伴或不伴LET的患者进行回顾性研究。进行多变量分析以确定LET表现的预测因素。然后对ACLR-only和ACLR/LET患者进行年龄、性别和合并症负担的倾向匹配。比较两组术后2年的结果，包括修复- aclr、半月板手术、粘连松解（LOA）、麻醉下操作（MUA）和全膝关节置换术（TKA）。结果：在分析的140,866例原发性ACLR中，1,814例（1.3%）有LET， LET利用率从2015年的0.6%增加到2023年的3.7%，增加了5倍。年龄较小、男性、半月板修复和活动过度与LET表现的可能性增加有关，而半月板切除术与可能性降低有关。在2年的随访中，ACLR组和ACLR组在ACLR/LET翻修率（ACLR/LET: 4.8% vs ACLR: 3.6%; p = 0.207）、半月板手术、LOA、MUA或TKA方面没有显著差异。结论：在全国范围内，ACLR合并LET的使用呈上升趋势；然而，在这个大型队列中，在2年随访中，LET的加入与较低的翻修率或并发症的增加无关。需要进一步的前瞻性研究，包括详细的临床数据、患者报告的结果和更长的随访，以评估ACLR/LET联合手术的潜在益处。

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引用次数: 0

Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis – A double-blinded randomized clinical study 单次关节内注射甘露醇联合透明质酸治疗膝关节骨性关节炎的疗效和安全性——一项双盲随机临床研究

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-11 DOI: 10.1016/j.knee.2025.11.018

Chun-Yu Chen , Cheng-Chang Lu , I-Hsiu Liou , Ming-Hsuan Huang , Ruei-Sian Ding , Shu-Fen Sun

Background

Treatments for knee osteoarthritis (OA) include injections such as hyaluronic acid (HA), which stabilizes joints but degrades quickly due to reactive oxygen species. The experimental product JETKNEE combines non-crosslinked HA (20 mg/ml) with 0.5 % mannitol, that may slow HA degradation and extend its effect, but with a limited clinical evidence base.

Objective

To evaluate the efficacy and safety of a single intra-articular injection of JETKNEE versus saline in patients with symptomatic knee OA.

Methods

In this double-blind randomized trial, 132 patients with Kellgren–Lawrence grade 2–3 OA received 2 ml of either JETKNEE or saline. The primary outcome was change in visual analog scale (VAS) pain score at 6 months. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, ultrasound evaluation of cartilage thickness, quadriceps muscle thickness, OA cartilage grading, and adverse events.

Results

VAS pain improved significantly in both groups without between-group difference. JETKNEE showed significantly greater improvement in WOMAC pain, function, and total scores across all time points (P < 0.05). Lequesne index improved more rapidly at early visits. No significant differences were observed in ultrasound findings or patient satisfaction. Adverse events were more frequent in the JETKNEE group but were mostly mild.

Conclusion

A single injection of JETKNEE did not show superiority to placebo in the primary outcome (VAS pain), but demonstrated improvements in secondary functional outcomes for 6 months in patients with knee OA.

膝关节骨关节炎（OA）的治疗包括注射透明质酸（HA）等，透明质酸可以稳定关节，但由于活性氧的存在，它会迅速降解。实验产品JETKNEE将非交联HA （20mg /ml）与0.5%甘露醇结合，可以减缓HA降解并延长其效果，但临床证据基础有限。目的评价单次关节内注射JETKNEE与生理盐水对症状性膝关节炎患者的疗效和安全性。方法在这项双盲随机试验中，132例Kellgren-Lawrence 2 - 3级OA患者接受了2ml的JETKNEE或生理盐水。主要观察指标为6个月时视觉模拟评分（VAS）疼痛评分的变化。次要结局包括西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、Lequesne指数、超声评估软骨厚度、股四头肌厚度、OA软骨分级和不良事件。结果两组患者vas疼痛均有明显改善，无组间差异。JETKNEE在WOMAC疼痛、功能和总分方面在各时间点均有显著性改善（P < 0.05）。Lequesne指数在早期就诊时改善更快。超声检查结果和患者满意度无显著差异。不良事件在JETKNEE组更频繁，但大多是轻微的。结论单次注射JETKNEE在主要结局（VAS疼痛）方面没有显示出安慰剂的优势，但在膝关节OA患者6个月的次要功能结局方面显示出改善。

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引用次数: 0

Improving patellofemoral pain assessment with weight-bearing computed tomography and machine learning using three-dimensional knee joint metrics 利用负重计算机断层扫描和三维膝关节指标的机器学习改进髌股疼痛评估

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-11 DOI: 10.1016/j.knee.2025.11.016

Hyo-Bin Lee , Jang-Hwan Choi

Objectives

To evaluate whether three-dimensional (3D) knee metrics derived from weight-bearing computed tomography (WBCT) with machine learning predict patellofemoral pain severity more accurately compared with two-dimensional (2D) metrics.

Methods

Diagnostic accuracy was assessed using the mean absolute error (MAE) as the primary endpoint. A five-fold cross-validation was performed for each model (random forest, gradient boosting, convolutional neural networks (CNNs), with hyperparameters tuned via grid search. The reference standard was the anterior knee pain scale (AKPS). Paired t-tests with Bonferroni correction compared with MAE differences among models. 3D knee alignment features (tilt, rotation, translations) were extracted from WBCT; 2D metrics were obtained from oblique-axial slices. Retrospective data were acquired from January to June 2022.

Results

In cross-validation, random forest using 3D metrics yielded an MAE of 7.8 (95 % confidence interval (CI): 7.3–8.2), significantly lower than 8.6 (95 % CI: 8.1–9.1) in 2D-based regression (P = 0.02). CNN predictions from distal slices had an MAE of 7.5 (95 % CI: 7.0–8.0), outperforming proximal slices (8.3 (95 % CI: 7.7–8.9), P = 0.03). AKPS improved from 72 ± 10 (pretreatment) to 82 ± 6 (post-treatment) (P < 0.001).

Conclusion

3D WBCT metrics combined with machine learning significantly improved diagnostic accuracy for patellofemoral pain severity compared with conventional 2D imaging. This approach provides an objective, reproducible framework for clinical assessment and treatment planning in orthopedic practice.

目的评价基于负重计算机断层扫描（WBCT）和机器学习的三维（3D）膝关节指标是否比二维（2D）指标更准确地预测髌骨痛的严重程度。方法以平均绝对误差（MAE）为主要终点评估诊断准确性。对每个模型（随机森林、梯度增强、卷积神经网络（cnn））进行五倍交叉验证，并通过网格搜索调整超参数。参照标准为膝关节前痛量表（AKPS）。配对t检验与Bonferroni校正比较模型间MAE差异。从WBCT中提取三维膝关节对齐特征（倾斜、旋转、平移）；从斜轴切片获得二维指标。回顾性数据采集时间为2022年1月至6月。结果在交叉验证中，使用3D指标的随机森林的MAE为7.8(95%可信区间（CI）： 7.3-8.2)，显著低于基于2d回归的8.6 (95% CI: 8.1-9.1) （P = 0.02）。CNN对远端切片的预测MAE为7.5 (95% CI: 7.0-8.0)，优于近端切片（8.3 (95% CI: 7.7-8.9), P = 0.03）。AKPS从72±10（预处理）改善到82±6（处理后）（P < 0.001）。结论与传统二维成像相比，三维WBCT指标联合机器学习显著提高了髌股疼痛严重程度的诊断准确性。这种方法为骨科实践中的临床评估和治疗计划提供了一个客观的、可重复的框架。

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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 : 2026-01-01 Epub 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

Micro-computed tomographic analysis of trabecular bone pattern in the juvenile distal femoral metaphysis 幼年股骨远端干骺端骨小梁形态的显微计算机断层分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-29 DOI: 10.1016/j.knee.2025.10.025

Sunpatch Benjavongkulchai , Catriona Davies , Craig A. Cunningham

Background

Throughout the juvenile period, the knee joint must accommodate several developmental milestones including weaning, crawling, sitting and the attainment of bipedal gait. These activities are related to the magnitude, direction and distribution of mechanical forces passing through the joint and are thought to contribute to the formation of specific trabecular bone signatures. This study aimed to investigate this trabecular bone architecture in the developing distal femur and relate this to the forces acting at key developmental milestones.

Methods

Micro-computed tomography was performed on 63 specimens within the prenatal to 7-year-old age range. Trabecular bone quantification was conducted in twenty-two volumes of interest (VOI) in the distal metaphysis. Four trabecular bone parameters were analysed within each VOI including; bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N). Statistical analysis was performed to identify significant differences between different VOIs, and between different age groups.

Results

Bone parameter values were similar between VOIs in subjects under 1 year old. A reduction of BV/TV during the first two years after birth was highlighted, with the lowest value found between 1 and 2 years old. The decreased BV/TV may be related to reduced mechanical stimulation, compared to the intra-uterine environment, and reduced nutritional supply after birth. Increased BV/TV was observed after 2 years. Significantly higher BV/TV, Tb.Th, Tb.N and lower Tb.Sp were found in sub-cortical VOIs compared to central VOIs.

Conclusion

Trabecular bone patterns were shown to reflect the forces associated with key developmental milestones.

背景：在整个青少年时期，膝关节必须适应几个发展里程碑，包括断奶，爬行，坐着和两足步态的实现。这些活动与通过关节的机械力的大小、方向和分布有关，并被认为有助于形成特定的骨小梁特征。本研究旨在研究发育中的股骨远端骨小梁结构，并将其与关键发育里程碑的作用力联系起来。方法：对63例产前至7岁标本进行显微计算机断层扫描。在远端干骺端22体积感兴趣区（VOI）进行骨小梁定量。在每个VOI中分析四个骨小梁参数，包括；骨体积分数（BV/TV）、骨小梁厚度(Tb；Th)、小梁间距（Tb.Sp）和小梁数（Tb.N）。对不同voi之间、不同年龄组之间的差异进行统计学分析。结果：1岁以下voi患者骨参数值相近。BV/TV在出生后的头两年减少，在1至2岁之间发现最低值。BV/TV的下降可能与机械刺激减少有关，与子宫内环境相比，出生后营养供应减少。2年后观察到BV/TV升高。显著提高BV/TV， Tb。Th,结核病。N和更低的Tb。与中央VOIs相比，皮质下VOIs中发现了Sp。结论：小梁骨模式被证明反映了与关键发育里程碑相关的力量。

{"title":"Micro-computed tomographic analysis of trabecular bone pattern in the juvenile distal femoral metaphysis","authors":"Sunpatch Benjavongkulchai , Catriona Davies , Craig A. Cunningham","doi":"10.1016/j.knee.2025.10.025","DOIUrl":"10.1016/j.knee.2025.10.025","url":null,"abstract":"<div><h3>Background</h3><div>Throughout the juvenile period, the knee joint must accommodate several developmental milestones including weaning, crawling, sitting and the attainment of bipedal gait. These activities are related to the magnitude, direction and distribution of mechanical forces passing through the joint and are thought to contribute to the formation of specific trabecular bone signatures. This study aimed to investigate this trabecular bone architecture in the developing distal femur and relate this to the forces acting at key developmental milestones.</div></div><div><h3>Methods</h3><div>Micro-computed tomography was performed on 63 specimens within the prenatal to 7-year-old age range. Trabecular bone quantification was conducted in twenty-two volumes of interest (VOI) in the distal metaphysis. Four trabecular bone parameters were analysed within each VOI including; bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N). Statistical analysis was performed to identify significant differences between different VOIs, and between different age groups.</div></div><div><h3>Results</h3><div>Bone parameter values were similar between VOIs in subjects under 1 year old. A reduction of BV/TV during the first two years after birth was highlighted, with the lowest value found between 1 and 2 years old. The decreased BV/TV may be related to reduced mechanical stimulation, compared to the intra-uterine environment, and reduced nutritional supply after birth. Increased BV/TV was observed after 2 years. Significantly higher BV/TV, Tb.Th, Tb.N and lower Tb.Sp were found in sub-cortical VOIs compared to central VOIs.</div></div><div><h3>Conclusion</h3><div>Trabecular bone patterns were shown to reflect the forces associated with key developmental milestones.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104271"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649986","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

Morphological changes of the preserved discoid lateral meniscus on serial magnetic resonance imaging following partial meniscectomy and repair: A comparison between immediate and 2-year postoperative findings 保留盘状外侧半月板部分切除和修复后的系列磁共振成像形态学变化：即时和术后2年的比较

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-18 DOI: 10.1016/j.knee.2025.11.017

Gwang-Eun Lee , Sung-Sahn Lee , Dae-Hee Lee

Background

The purpose of this study was to analyze serial magnetic resonance imaging (MRI) changes in discoid lateral meniscus (DLM) from the immediate postoperative period to 2 years after partial meniscectomy and meniscus repair.

Methods

From November 2015 to November 2023, 32 patients with MRI-confirmed torn DLM who underwent arthroscopic partial meniscectomy and meniscus repair were analyzed. MRI scans were performed immediately postoperatively and 2 years after surgery. Meniscal dimensions, including width, height, and mid-height, were measured on coronal and sagittal MRI to observe morphological changes.

Results

The width of the anterior and posterior horns significantly increased in the follow up MRI (anterior: from 9.0 mm to 11.55 mm (P < 0.001); posterior: from 8.29 mm to 9.81 mm (P < 0.001)) compared with the immediate postoperative MRI. While there were no significant differences in the heights of the anterior horn, midbody, and posterior horn, mid-heights were reduced in all three parts (anterior horn: from 3.47 mm to 2.84 mm (P < 0.001), midbody: from 2.73 mm to 2.31 mm (P = 0.003), and posterior horn: from 3.09 mm to 2.74 mm (P = 0.008)).

Conclusion

The meniscal width of the anterior and posterior horns of DLM in the sagittal plane increased from the immediate postoperative state through to 2 years following partial meniscectomy and meniscus repair. Although the height of the anterior horn, midbody, and posterior horns remained consistent, the mid-height of these structures decreased at the 2-year follow up compared with the immediate postoperative status.

本研究的目的是分析盘状外侧半月板（DLM）在半月板部分切除术和半月板修复术后的连续磁共振成像（MRI）变化。方法分析2015年11月至2023年11月，32例mri证实的DLM撕裂患者行关节镜半月板部分切除术和半月板修复术。术后立即和术后2年分别进行MRI扫描。在冠状面和矢状面MRI上测量半月板尺寸，包括宽度、高度和中高，观察形态学变化。结果在随访MRI中，前后角的宽度明显增加(前角从9.0 mm增加到11.55 mm (P < 0.001)；与术后即刻MRI相比，后侧：从8.29 mm增加到9.81 mm （P < 0.001）。虽然前角、中体和后角的高度没有显著差异，但三个部分的中间高度都降低了(前角从3.47 mm降至2.84 mm (P < 0.001)，中体从2.73 mm降至2.31 mm （P = 0.003)，后角从3.09 mm降至2.74 mm (P = 0.008)）。结论经部分半月板切除及半月板修复后，DLM前后角矢状面半月板宽度从术后即刻至术后2年内均有所增加。虽然前角、中体和后角的高度保持一致，但与术后立即状态相比，这些结构的中高度在2年随访中有所下降。

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引用次数: 0

Long term outcomes of residual valgus alignment after total knee arthroplasty for valgus knee deformity: a minimum 10-year follow up 外翻膝畸形全膝关节置换术后残留外翻对准的长期结果：至少10年随访。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 Epub Date: 2025-10-07 DOI: 10.1016/j.knee.2025.09.002

Sung-Sahn Lee , Tae Woo Kim , Motaz Doubi , Young-Wan Moon

Background

This study aimed to evaluate the impact of postoperative hip-knee-ankle (HKA) angle on clinical outcomes and survivorship in total knee arthroplasty (TKA) patients with valgus knee.

Methods

We retrospectively reviewed TKAs performed for valgus knee deformity between January 2005 and February 2015. Patients were categorized into two groups based on postoperative HKA angle: neutrally aligned (0° ± 3°) and residual valgus groups (>3°). Preoperative and postoperative clinical outcomes, including the Western Ontario and McMaster University Osteoarthritis (WOMAC) Index and Knee Society Scores (KSSs), as well as radiographic parameters such as HKA angle and lateral distal femoral angle (LDFA), were compared between the groups. Survivorship analysis was also conducted.

Results

A total of 73 knees (64 patients) were included, with a mean follow-up period of 140.1 ± 14.4 months. Of these, 55 and 18 knees were classified as neutrally aligned and residual valgus group, respectively. The preoperative HKA angle and LDFA were significantly different between the two groups. Postoperative LDFA (88.6° ± 1.8° vs. 86.7° ± 1.7°, P < 0.001) differed significantly. However, long-term WOMAC Index and KSSs were comparable. The cumulative survival rates were 96.4 % in the neutrally aligned group and 100 % in the residual valgus group, with no significant difference (P = 0.322).

Conclusion

The residual valgus group exhibited more severe preoperative femoral valgus. Primary cause of postoperative residual valgus was residual femoral valgus. Residual valgus alignment was not related to inferior long-term clinical outcomes and survival rates compared to neutrally aligned TKA for preoperative valgus deformity.

背景：本研究旨在评估髋关节-膝关节-踝关节（HKA）术后角度对膝外翻全膝关节置换术（TKA）患者临床结局和生存率的影响。方法：回顾性分析2005年1月至2015年2月间为外翻膝关节畸形行tka的病例。根据术后HKA角度将患者分为两组：中立对准组（0°±3°）和残留外翻组（>3°）。比较两组患者的术前和术后临床结果，包括Western Ontario and McMaster University Osteoarthritis (WOMAC) Index和Knee Society Scores (KSSs)，以及HKA角和股骨外侧远端角（LDFA）等影像学参数。还进行了生存分析。结果：共纳入73个膝关节（64例），平均随访时间140.1±14.4个月。其中，55膝和18膝分别被分类为中性排列组和残留外翻组。两组术前HKA角度及LDFA差异有统计学意义。术后LDFA（88.6°±1.8°vs 86.7°±1.7°，P）结论：残余外翻组术前股骨外翻更为严重。术后残留外翻的主要原因是股外翻残留。与术前外翻畸形的中性对齐TKA相比，残余外翻对齐与较差的长期临床结果和生存率无关。

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引用次数: 0

Anatomical variability in the quadriceps tendon: structural layering and patellar insertion patterns 股四头肌肌腱的解剖变异：结构分层和髌骨止点模式。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 Epub Date: 2025-10-08 DOI: 10.1016/j.knee.2025.09.004

Hyun Jin Park , Seong-Kyu Choi , Hongtae Kim , Mi‑Sun Hur

Purpose

The quadriceps tendon is a complex anatomical structure that is crucially involved in knee stability and extension by transmitting forces from the quadriceps muscles to the patella. This study investigated anatomical variability in the quadriceps tendon of elderly Korean cadavers, focusing on the structural layering and muscle contributions at its patellar insertion.

Methods

Sixty-three quadriceps tendon specimens from 35 Korean cadavers were dissected to assess the composition and arrangement of the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), and vastus intermedius (VI).

Results

The quadriceps tendon configurations were categorized into four distinct types based on the pattern of muscle layering: Type 1, a trilaminar structure with the RF as the superficial layer, the VM and VL combined as the middle layer, and the VI as the deepest layer (8/20, 40 %); Type 2, a multilayered arrangement with RF insertions merging with the VM and VL (8/20, 40 %); Type 3, comprising the RF, VL, and VI, with no contribution from the VM (3/20, 15 %); and Type 4, consisting solely of the RF and VI (1/20, 5 %). In terms of tendon ratios, the combined vastus muscles (VM + VL) were 1–3 times larger than the RF and VI in 50 of 63 specimens, while 12 specimens displayed ratios as high as 4–6 times.

Conclusion

These data suggest that adjusted approaches that account for individual anatomical differences may improve outcomes in surgical procedures involving the knee.

目的：股四头肌肌腱是一种复杂的解剖结构，通过将力量从股四头肌传递到髌骨，对膝关节的稳定和伸展起着至关重要的作用。本研究研究了韩国老年尸体的股四头肌肌腱的解剖学变异，重点研究了其髌骨止点的结构分层和肌肉贡献。方法：解剖35具韩国尸体的63份股四头肌肌腱标本，评估股直肌（RF）、股内侧肌（VM）、股外侧肌（VL）和股中间肌（VI）的组成和排列。结果：股四头肌肌腱构型根据肌肉分层模式可分为四种不同的类型：1型，以RF为浅层，VM和VL结合为中间层，VI为最深层的三层结构（8/ 20,40 %）；类型2，射频插入与VM和VL合并的多层排列（8/ 20,40 %）；类型3，包括RF， VL和VI，没有VM的贡献（3/ 20,15 %）；类型4，仅由RF和VI组成（1/ 20,5 %）。在肌腱比值方面，63例标本中有50例合并股肌（VM + VL）比RF和VI大1-3倍，12例标本的比值高达4-6倍。结论：这些数据表明，考虑到个体解剖差异的调整入路可能会改善涉及膝关节的外科手术的结果。

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引用次数: 0

Re-evaluation of the cartilage safety of low-dose tranexamic acid 小剂量氨甲环酸对软骨安全性的再评价。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 Epub Date: 2025-08-23 DOI: 10.1016/j.knee.2025.08.003

Murat Yüncü

引用次数: 0

Clinical comparative evaluation of anterior cruciate ligament reconstruction supported by an orthopedic surgical simulation system 骨科手术模拟系统支持下前交叉韧带重建的临床比较评价

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 Epub Date: 2025-09-10 DOI: 10.1016/j.knee.2025.08.017

Song Li , Xuewei Wen , ZhiYue Zhang , Yanlin Li , Xiao Yang , LiChao Zhang , Shuo Li , Tian Fu Jin , GuangChao Chen , ZiMing Gu , YaTong Liao , Fan Wang , RunZe Li , MinYuan Zhang , FengYuan Guo , Chuan He

Objective

This study utilizes self-developed BioMxsf software to establish a virtual surgical system that assists in the surgical process of anterior cruciate ligament (ACL) reconstruction through a three-dimensional imaging model of the knee joint. Introducing these technical methods can provide insights and references to improve ACL reconstruction in clinical practice.

Methods

After scanning the knee joint data of patients and importing it into the BioMxsf software, a three-dimensional image model of the knee joint was created. A virtual surgical system was established to support the operational process of ACL reconstruction surgery. The ACL reconstruction surgery was performed on patients with the assistance of the virtual surgical system.

Results

The average surgical time for the BioMxsf simulation group (BSG) was 97.7 ± 8.5 min. In contrast, the surgical time for the conventional surgery group (CSG) was 107.4 ± 7.8 min, indicating a significant reduction in surgery duration (P ≤ 0.014, Chi-square test). In terms of functional scores, the CSG had a score of 81.4 ± 3.14. In contrast, the BSG scored 84.97 ± 3.97, demonstrating that patients in the BSG had better postoperative knee function than those in the CSG, with a statistically significant difference (P = 0.016). Although the functional scores reached statistical significance, they were below the reported minimal clinically important difference and are unlikely to be clinically meaningful.

Conclusion

This study demonstrated the clinical feasibility of a virtual surgical system to assist ACL reconstruction. The virtual surgical system significantly reduced operative time and enhanced ACL reconstruction’s safety.

目的本研究利用自主开发的BioMxsf软件，通过膝关节三维成像模型，建立一个辅助前交叉韧带（ACL）重建手术过程的虚拟手术系统。介绍这些技术方法可以为临床改进ACL重建提供参考。方法对患者膝关节数据进行扫描，导入BioMxsf软件，建立膝关节三维图像模型。建立虚拟手术系统，支持ACL重建手术的操作过程。在虚拟手术系统的辅助下对患者进行ACL重建手术。结果BioMxsf模拟组（BSG）平均手术时间为97.7±8.5 min。常规手术组（CSG）手术时间为107.4±7.8 min，手术时间明显缩短（P≤0.014，卡方检验）。功能评分方面，CSG评分为81.4±3.14分。BSG评分为84.97±3.97，BSG组患者术后膝关节功能优于CSG组，差异有统计学意义（P = 0.016）。虽然功能评分达到了统计学意义，但它们低于报道的最小临床重要差异，不太可能具有临床意义。结论本研究证明虚拟手术系统辅助ACL重建的临床可行性。虚拟手术系统大大缩短了手术时间，提高了ACL重建的安全性。

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