IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-09 DOI: 10.1016/j.knee.2026.104364

Ayla Ahmed , Jaison Patel , Kesavan Richard Sri-Ram , Anand Patel , Anusha Kumar

Background

ACL reinjury after reconstruction remains a major challenge, affecting long-term function, return to sport and healthcare costs. Although risk factors are known, accurate patient-specific prediction is limited. This scoping review synthesises evidence on supervised AI/ML models for predicting ACL reinjury or related adverse outcomes after primary ACL reconstruction, focusing on outcome definitions, validation and clinical applicability.

Methods

PubMed and Embase were searched using predefined eligibility criteria informed by PRISMA-ScR. Ten studies were included and synthesised qualitatively.

Results

Studies were heterogeneous in outcomes, data sources, modelling approaches and validation. Most used supervised ensemble methods and reported moderate-high discrimination within development datasets, but relied mainly on internal validation; external validation was uncommon. Calibration and clinical-utility reporting were inconsistent. Predictors spanned anatomical, patient-related and surgical factors, with variable availability across studies.

Conclusions

AI/ML models show potential, but the evidence base is methodologically heterogeneous and largely developmental. Limited external validation, inconsistent calibration assessment and variable outcome definitions constrain clinical applicability. Current models should therefore be considered exploratory.

背景：前交叉韧带重建后再损伤仍然是主要的挑战，影响长期功能，恢复运动和医疗费用。虽然风险因素是已知的，但准确的患者特异性预测是有限的。本综述综合了有监督的AI/ML模型的证据，用于预测初级ACL重建后ACL再损伤或相关不良后果，重点是结果定义、验证和临床适用性。方法：使用PRISMA-ScR通知的预定义资格标准对PubMed和Embase进行检索。纳入并定性综合了10项研究。结果：研究在结果、数据来源、建模方法和验证方面存在异质性。大多数使用监督集成方法，并在发展数据集中报告了中等高度的歧视，但主要依赖于内部验证；外部验证并不常见。校准和临床效用报告不一致。预测因子涉及解剖学、患者相关和外科因素，在不同的研究中可用性不同。结论：人工智能/机器学习模型显示出潜力，但证据基础在方法上是异构的，而且很大程度上是发展中的。有限的外部验证，不一致的校准评估和可变的结果定义限制了临床适用性。因此，目前的模式应被认为是探索性的。

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引用次数: 0

Artificial intelligence in knee osteoarthritis imaging and total knee arthroplasty: advances, challenges, and segmentation methods – A review 人工智能在膝关节骨关节炎成像和全膝关节置换术中的应用：进展、挑战和分割方法综述

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-21 DOI: 10.1016/j.knee.2026.104327

Ahsan Humayun , Mustafain Rehman , Muhammad Zainulabideen

Background

Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint diseases and a significant cause of disability. Total Knee Arthroplasty (TKA) is the standard treatment for advanced cases, but its success depends on accurate imaging, precise preoperative planning, and intraoperative execution. Imaging modalities such as radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are widely used in TKA workflows. Still, they are often limited by anatomical variability, image artifacts, and poor soft tissue contrast.

Methods

This review surveys automated segmentation and analysis approaches for knee imaging, covering classical methods including region-, boundary-, atlas-, and model-based techniques, as well as recent artificial intelligence (AI)-driven approaches, particularly deep learning models. Their capabilities, limitations, and clinical relevance in TKA planning and evaluation are discussed.

Results

Classical segmentation methods provide foundational tools but often exhibit limited generalization and robustness in heterogeneous clinical datasets. AI-based methods, particularly deep learning, enable automated feature extraction, improved segmentation accuracy, and enhanced classification and outcome prediction. These methods address many limitations of traditional approaches, although their dependence on large annotated datasets and variability in imaging protocols remains a significant challenge.

Conclusion

This review presents a comprehensive overview of knee anatomy, imaging modalities, and segmentation techniques relevant to TKA. Comparing classical and AI-based approaches highlights their strengths, limitations, and persistent challenges, while also identifying opportunities for integrating AI into clinical workflows to achieve more precise, reliable, and patient-specific knee arthroplasties.

膝关节骨性关节炎（KOA）是最常见的退行性关节疾病之一，也是导致残疾的重要原因。全膝关节置换术（TKA）是晚期病例的标准治疗方法，但其成功取决于准确的成像、精确的术前计划和术中执行。成像方式，如x光片、计算机断层扫描（CT）、磁共振成像（MRI）和超声在TKA工作流程中广泛使用。尽管如此，它们经常受到解剖学变异性、图像伪影和软组织对比度差的限制。本文综述了膝关节成像的自动分割和分析方法，涵盖了经典的方法，包括基于区域、边界、图谱和模型的技术，以及最近的人工智能（AI）驱动的方法，特别是深度学习模型。讨论了它们在TKA计划和评估中的能力、局限性和临床相关性。结果经典的分割方法提供了基础工具，但在异构临床数据集中往往表现出有限的泛化和鲁棒性。基于人工智能的方法，特别是深度学习，可以实现自动特征提取，提高分割精度，增强分类和结果预测。这些方法解决了传统方法的许多局限性，尽管它们对大型注释数据集的依赖和成像协议的可变性仍然是一个重大挑战。本文综述了与TKA相关的膝关节解剖、成像方式和分割技术。比较经典方法和基于人工智能的方法突出了它们的优势、局限性和持续的挑战，同时也确定了将人工智能集成到临床工作流程中的机会，以实现更精确、可靠和患者特异性的膝关节置换。

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引用次数: 0

Reliability and validity of the Persian knee Self-Efficacy Scale in patients with knee injuries: a cross-sectional validation study 波斯膝关节自我效能量表在膝关节损伤患者中的信度和效度：一项横断面验证研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-31 DOI: 10.1016/j.knee.2026.104326

Bahram Sheikhi , Pouya Rabiei , Amir Letafatkar , Malihe Hadadnezhad , Hadi Akbari

Purpose

The Knee Self-Efficacy Scale (K-SES) is widely used to assess patients’ confidence after knee injury, but no validated Persian version exists, limiting its use in Persian-speaking populations. This study aimed to translate, adapt, and evaluate the psychometric properties of the Persian-language versions of the K-SES (K-SES-Persian).

Methods

One hundred and six Persian patients with knee injuries were recruited from orthopedic and physiotherapy centers. Construct validity was examined using confirmatory factor analysis and Pearson correlations. Reliability was assessed by Cronbach’s alpha and intraclass correlation coefficients (ICC). Convergent validity was tested with the Oxford Knee Score (OKS) and Knee outcome survey activities for daily living (KOS-ADL). Test-retest reliability was assessed in 53 patients after 7–8 days.

Results

The K-SES-Persian showed excellent internal consistency for total score (α = 0.965). An excellent internal consistency (α = 0.953) was shown for present score and good internal consistency (α = 0.898) for the future score. The factor loading for each item was greater than 0.70. The K-SES-Persian showed significant correlations with the OKS (r = 0.37, 95% CI: 0.19–0.53, p < 0.001) and the KOS-ADL (r = 0.33, 95% CI: 0.15–0.49, p = 0.001). A significant but weak correlation was found between the OKS and KOS-ADL (r = 0.219 p = 0.024), indicating limited consistency between the comparator measures used for evaluating the convergent validity of the K-SES-Persian. No floor or ceiling effects were observed.

Conclusions

The K-SES-Persian was successfully adapted and demonstrated sound psychometric properties, including construct validity, internal consistency, and test–retest reliability, with internal consistency varying across subscales, supporting its use among Persian-speaking patients with knee injuries.

目的：膝关节自我效能量表（K-SES）被广泛用于评估膝关节损伤后患者的信心，但没有有效的波斯语版本，限制了其在波斯语人群中的使用。本研究旨在翻译、改编和评估波斯语版本的K-SES （K-SES- persian）的心理测量特性。方法：从骨科和物理治疗中心招募106例波斯膝关节损伤患者。建构效度采用验证性因子分析及Pearson相关检验。信度采用Cronbach’s alpha和类内相关系数（ICC）进行评估。采用牛津膝关节评分（OKS）和日常生活膝关节结局调查活动（KOS-ADL）检验收敛效度。在7-8天后对53例患者进行重测信度评估。结果：k - ses -波斯总分具有良好的内部一致性（α = 0.965）。当前评分具有良好的内部一致性（α = 0.953），未来评分具有良好的内部一致性（α = 0.898）。各题项的因子负荷均大于0.70。k - ses -波斯量表与OKS具有显著的相关性（r = 0.37, 95% CI: 0.19-0.53, p）。结论：k - ses -波斯量表被成功地采用，并表现出良好的心理测量特性，包括结构效度、内部一致性和测试重测信度，内部一致性在各子量表中有所不同，支持其在波斯语膝损伤患者中的应用。

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引用次数: 0

Total knee arthroplasty and distal femoral replacement in young patients with bony neoplasm: complications, survival and patient-reported outcomes 年轻骨性肿瘤患者的全膝关节置换术和股骨远端置换术：并发症、生存率和患者报告的结果。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-03 DOI: 10.1016/j.knee.2026.104350

Hannah J. Szapary , Helena Franco , Alexander Farid , Vineet Desai , John E. Ready , Antonia F. Chen , Jeffrey K. Lange

Background

Total knee arthroplasty (TKA) and distal femoral replacement (DFR) can be used in limb-salvage after resection of bony tumors, but few reports have examined patient-reported outcome measurements (PROMs) with survival data in young patients. This study analyzed individuals who underwent TKA/DFR for neoplasm at a young (≤40) age, to report outcomes and survival experience.

Methods

A retrospective study on 12 TKAs/23 DFRs was conducted between January 1990–2020 in 35 patients ≤40 years old. Electronic medical records were reviewed to identify patients with neoplasm, and collect data. Patients were contacted to obtain PROMs.

Results

The median age (interquartile range) at surgery for TKAs and DFRs was 26.7 (22.7–34.0) and 24.6 years (20.9–28.4), respectively. Median follow-up was 3.95 (0.33–8.14) and 3.01 years (1.72–6.07). TKAs were more commonly due to complications after allograft reconstruction (75.0% vs. 0.00%, p < 0.0001), had lower blood loss (250 vs. 800 ml, p = 0.01) and a higher rate of tourniquet use (75.0% vs. 34.8%, p = 0.04). Revision-free survival (8-year) was 54.7% (95% confidence interval (CI): 13.7%-83.3%) for TKAs and 37.9% (95% CI: 10.4%-66.0%, p = 0.12) for DFRs. For TKAs, median KOOS Jr. was 76.3 (76.3–79.9), VR-12-Physical was 50.0 (40.5–51.7), VR-12-Mental was 40.8 (32.6–45.8), LEAS was 12.0 (12.0–13.0), and FJS was 23.0 (19.0–25.0), without statistical difference from the DFR group.

Conclusion

Patients ≤40 years old who underwent TKAs/DFRs for neoplastic disease demonstrated a similarly high postoperative complication rate and poor long-term survival. Almost all PROMs were favorable, reflecting a more promising postoperative experience than survival curves might demonstrate.

背景：全膝关节置换术（TKA）和股骨远端置换术（DFR）可用于骨肿瘤切除术后的肢体保留，但很少有报道检查年轻患者报告的预后测量（PROMs）和生存数据。本研究分析了年轻（≤40岁）接受TKA/DFR治疗肿瘤的个体，报告了结果和生存经验。方法：对1990年1月至2020年1月期间35例年龄≤40岁的患者进行12例tka /23例DFRs的回顾性研究。回顾电子病历，以确定肿瘤患者，并收集数据。联系患者获取PROMs。结果：tka和DFRs的手术年龄中位数（四分位数范围）分别为26.7岁（22.7-34.0岁）和24.6岁（20.9-28.4岁）。中位随访时间分别为3.95（0.33-8.14）和3.01年（1.72-6.07）。同种异体移植重建后并发症更常见的原因是tka （75.0% vs. 0.00%, p）。结论：≤40岁因肿瘤疾病接受tka /DFRs的患者同样具有较高的术后并发症发生率和较差的长期生存率。几乎所有的PROMs都是有利的，反映了比生存曲线可能显示的更有希望的术后体验。

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引用次数: 0

Relationship between tibio-fibular overlap ratio and lower limb torsion in an Asian population 亚洲人群胫骨-腓骨重叠率与下肢扭转的关系。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-03 DOI: 10.1016/j.knee.2026.104357

Ashton Kai Shun Tan , Xinyu Tao , Shao Jin Teo , Don Thong Siang Koh , Hee Nee Pang , Hamid Rahmatullah Bin Abd Razak , Kong Hwee Lee , Junwei Soong

Purpose

Lower limb torsion affects the accuracy of knee coronal alignment measurements, which has an impact on the planning for surgical management of knee osteoarthritis (KOA). Current computed tomography (CT) scans for evaluating torsion are costly and cannot be performed for every case. This study aimed to investigate the relationship between distal and proximal tibio-fibular overlap ratio measured on long-limb radiographs with femoral and tibial torsion quantified by CT scan in an Asian population with KOA.

Methods

A retrospective analysis was performed on patients who were planned for robotic total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) between September 2018 and April 2024 in a single tertiary institution. Proximal and distal tibio-fibular overlap was defined as the longest overlapping length between the medial cortex of the fibula and the lateral cortex of the tibia, measured on weight-bearing long-leg radiographs. Femoral and tibial torsion were assessed on CT images using the Lee and bimalleolar method, respectively. Spearman’s rank correlation coefficient was used to examine associations between the tibio-fibular overlap ratio and tibial and femoral torsion. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the overlap ratio to discriminate between increased and decreased torsion, with area under the curve (AUC), sensitivity, and specificity reported. Inter- and intra-observer reliability were assessed using intraclass correlation coefficients (ICCs) in a random sample of 30 patients.

Results

A total of 217 patients were included (74 males and 143 females; 66.3 ± 8.8 years old). The median tibio-fibular overlap ratio and femoral torsion was 0.9 (0.7–0.8) and 26.9° (−10.7° to 7°), respectively. The mean tibial torsion was 20.7° + 8.55°. Overall, a moderate positive Spearman correlation of tibio-fibular overlap ratio with tibial torsion (ρ = 0.54, P < 0.001) was observed. ROC analysis for tibio-fibular overlap ratio in predicting both decreased (AUC 0.91 ± 0.05; 95%, CI 0.81–0.99) and increased tibial torsion (AUC 0.77 ± 0.07; 95%, CI 0.64–0.90) was excellent and acceptable, respectively. For predicting low tibial torsion, the optimal cut-off was <0.5 (sensitivity 99%, specificity 82%). For predicting high tibial torsion, the optimal cutoff was >0.8 (sensitivity 76%, specificity 71%). Reliability analysis revealed excellent intra-observer and interobserver reliability.

Conclusion

This study suggests the utility of the tibio-fibular overlap ratio as a potential screening tool for underlying tibia torsional deformity. Further evaluation of tibial torsion is recommended for knees with tibio-fibular overlap ratio of <0.5 or >0.8.

目的：下肢扭转影响膝关节冠状位测量的准确性，影响膝关节骨关节炎（KOA）的手术治疗计划。目前的计算机断层扫描（CT）评估扭转是昂贵的，并不能执行每一个病例。本研究旨在探讨亚洲KOA患者的远端和近端胫骨-腓骨重叠比在长肢x线片上测量，并通过CT扫描量化股骨和胫骨扭转。方法：回顾性分析2018年9月至2024年4月在某高等院校计划行机器人全膝关节置换术（TKA）或单室膝关节置换术（UKA）的患者。胫骨-腓骨近端和远端重叠被定义为腓骨内侧皮质和胫骨外侧皮质之间最长的重叠长度，在负重长腿x线片上测量。分别采用Lee和双踝法在CT图像上评估股骨和胫骨扭转。Spearman等级相关系数用于检查胫骨-腓骨重叠比与胫骨和股扭转之间的关系。使用受试者工作特征（ROC）曲线分析来评估重叠比区分扭转增加和减少的能力，并报告曲线下面积（AUC）、敏感性和特异性。在随机抽样的30例患者中，使用类内相关系数（ICCs）评估观察者间和观察者内的可靠性。结果：共纳入217例患者，其中男性74例，女性143例，年龄66.3±8.8岁。胫骨-腓骨中位重叠比和股扭转分别为0.9（0.7-0.8）和26.9°（-10.7°至7°）。平均胫骨扭转为20.7°+ 8.55°。总的来说，胫骨-腓骨重叠率与胫骨扭转有中度正Spearman相关性（ρ = 0.54, P = 0.8）（敏感性76%，特异性71%）。信度分析显示了出色的观察者内部和观察者之间的信度。结论：本研究提示胫骨-腓骨重叠比作为潜在的胫骨扭转畸形筛查工具的效用。对于胫骨-腓骨重叠比为0.8的膝关节，建议进一步评估胫骨扭转。

{"title":"Relationship between tibio-fibular overlap ratio and lower limb torsion in an Asian population","authors":"Ashton Kai Shun Tan , Xinyu Tao , Shao Jin Teo , Don Thong Siang Koh , Hee Nee Pang , Hamid Rahmatullah Bin Abd Razak , Kong Hwee Lee , Junwei Soong","doi":"10.1016/j.knee.2026.104357","DOIUrl":"10.1016/j.knee.2026.104357","url":null,"abstract":"<div><h3>Purpose</h3><div>Lower limb torsion affects the accuracy of knee coronal alignment measurements, which has an impact on the planning for surgical management of knee osteoarthritis (KOA). Current computed tomography (CT) scans for evaluating torsion are costly and cannot be performed for every case. This study aimed to investigate the relationship between distal and proximal tibio-fibular overlap ratio measured on long-limb radiographs with femoral and tibial torsion quantified by CT scan in an Asian population with KOA.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on patients who were planned for robotic total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) between September 2018 and April 2024 in a single tertiary institution. Proximal and distal tibio-fibular overlap was defined as the longest overlapping length between the medial cortex of the fibula and the lateral cortex of the tibia, measured on weight-bearing long-leg radiographs. Femoral and tibial torsion were assessed on CT images using the Lee and bimalleolar method, respectively. Spearman’s rank correlation coefficient was used to examine associations between the tibio-fibular overlap ratio and tibial and femoral torsion. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the overlap ratio to discriminate between increased and decreased torsion, with area under the curve (AUC), sensitivity, and specificity reported. Inter- and intra-observer reliability were assessed using intraclass correlation coefficients (ICCs) in a random sample of 30 patients.</div></div><div><h3>Results</h3><div>A total of 217 patients were included (74 males and 143 females; 66.3 ± 8.8 years old). The median tibio-fibular overlap ratio and femoral torsion was 0.9 (0.7–0.8) and 26.9° (−10.7° to 7°), respectively. The mean tibial torsion was 20.7° + 8.55°. Overall, a moderate positive Spearman correlation of tibio-fibular overlap ratio with tibial torsion (ρ = 0.54, <em>P</em> < 0.001) was observed. ROC analysis for tibio-fibular overlap ratio in predicting both decreased (AUC 0.91 ± 0.05; 95%, CI 0.81–0.99) and increased tibial torsion (AUC 0.77 ± 0.07; 95%, CI 0.64–0.90) was excellent and acceptable, respectively. For predicting low tibial torsion, the optimal cut-off was <0.5 (sensitivity 99%, specificity 82%). For predicting high tibial torsion, the optimal cutoff was >0.8 (sensitivity 76%, specificity 71%). Reliability analysis revealed excellent intra-observer and interobserver reliability.</div></div><div><h3>Conclusion</h3><div>This study suggests the utility of the tibio-fibular overlap ratio as a potential screening tool for underlying tibia torsional deformity. Further evaluation of tibial torsion is recommended for knees with tibio-fibular overlap ratio of <0.5 or >0.8.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104357"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120738","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

Relatıonshıp between meniscal tears and NLR, MPV, NPR, systemic immune-inflammatıon index Relatıonshıp半月板撕裂与NLR， MPV， NPR，系统性immune-inflammatıon指数之间的关系。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-03 DOI: 10.1016/j.knee.2026.104348

Serhat Yildirim , Vatan Barisik , Dincer Atila , Muhammet Bozoglan , Murat Aksit

Background

Meniscal tears are common intra-articular knee injuries that cause pain, swelling, and impaired mobility. Although magnetic resonance imaging (MRI) remains the diagnostic gold standard, interest is increasing in hematological and inflammatory indices as potential adjunctive biomarkers reflecting inflammatory activity.

Purpose

To examine the relationship between meniscal tears and systemic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), neutrophil-to-platelet ratio (NPR), and systemic immune-inflammation index (SII), and to assess their diagnostic performance.

Methods

A retrospective case–control study was conducted at Tepecik Training and Research Hospital, comprising 286 participants 143 patients with MRI-confirmed meniscal tears and 143 age- and sex-matched healthy controls. Hematological indices were derived from complete blood counts. Between-group comparisons were performed using the Mann–Whitney U and chi-square tests, correlations were evaluated by Spearman’s analysis, and receiver operating characteristic (ROC) curves assessed discriminative ability.

Results

Meniscal tear patients showed significantly lower MPV (p < 0.001) and NLR (p < 0.001), but higher NPR (p = 0.023) compared to controls. No significant difference was observed for SII (p = 0.740). Smoking was associated with higher MPV-to-lymphocyte ratio (p = 0.007). ROC analysis indicated weak discrimination for NPR (AUC = 0.578, p = 0.023) and poor performance for SII (AUC = 0.511).

Conclusion

Inflammatory indices, particularly NPR, may reflect systemic inflammatory changes related to meniscal tears. While their diagnostic utility alone is limited, they may serve as supportive tools alongside imaging in evaluating meniscal pathology.

背景：半月板撕裂是膝关节内常见的损伤，可引起疼痛、肿胀和活动能力受损。尽管磁共振成像（MRI）仍然是诊断的金标准，但人们对血液学和炎症指标作为反映炎症活性的潜在辅助生物标志物的兴趣正在增加。目的：探讨半月板撕裂与全身炎症指标的关系，包括中性粒细胞与淋巴细胞比值（NLR）、平均血小板体积（MPV）、中性粒细胞与血小板比值（NPR）和全身免疫炎症指数（SII），并评价其诊断价值。方法：在Tepecik培训和研究医院进行了一项回顾性病例对照研究，包括286名参与者，143名mri证实的半月板撕裂患者和143名年龄和性别匹配的健康对照组。血液学指标来源于全血细胞计数。组间比较采用Mann-Whitney U检验和卡方检验，相关性采用Spearman分析，受试者工作特征（ROC）曲线评估判别能力。结果：半月板撕裂患者MPV明显降低(p)。结论：炎症指数，尤其是NPR，可能反映了半月板撕裂相关的全身性炎症变化。虽然它们单独的诊断效用有限，但它们可以作为辅助工具与影像学一起评估半月板病理。

{"title":"Relatıonshıp between meniscal tears and NLR, MPV, NPR, systemic immune-inflammatıon index","authors":"Serhat Yildirim , Vatan Barisik , Dincer Atila , Muhammet Bozoglan , Murat Aksit","doi":"10.1016/j.knee.2026.104348","DOIUrl":"10.1016/j.knee.2026.104348","url":null,"abstract":"<div><h3>Background</h3><div>Meniscal tears are common intra-articular knee injuries that cause pain, swelling, and impaired mobility. Although magnetic resonance imaging (MRI) remains the diagnostic gold standard, interest is increasing in hematological and inflammatory indices as potential adjunctive biomarkers reflecting inflammatory activity.</div></div><div><h3>Purpose</h3><div>To examine the relationship between meniscal tears and systemic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), neutrophil-to-platelet ratio (NPR), and systemic immune-inflammation index (SII), and to assess their diagnostic performance.</div></div><div><h3>Methods</h3><div>A retrospective case–control study was conducted at Tepecik Training and Research Hospital, comprising 286 participants 143 patients with MRI-confirmed meniscal tears and 143 age- and sex-matched healthy controls. Hematological indices were derived from complete blood counts. Between-group comparisons were performed using the Mann–Whitney U and chi-square tests, correlations were evaluated by Spearman’s analysis, and receiver operating characteristic (ROC) curves assessed discriminative ability.</div></div><div><h3>Results</h3><div>Meniscal tear patients showed significantly lower MPV (<em>p</em> < 0.001) and NLR (<em>p</em> < 0.001), but higher NPR (<em>p</em> = 0.023) compared to controls. No significant difference was observed for SII (<em>p</em> = 0.740). Smoking was associated with higher MPV-to-lymphocyte ratio (<em>p</em> = 0.007). ROC analysis indicated weak discrimination for NPR (AUC = 0.578, <em>p</em> = 0.023) and poor performance for SII (AUC = 0.511).</div></div><div><h3>Conclusion</h3><div>Inflammatory indices, particularly NPR, may reflect systemic inflammatory changes related to meniscal tears. While their diagnostic utility alone is limited, they may serve as supportive tools alongside imaging in evaluating meniscal pathology.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104348"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120728","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

Finite element analysis of the impact of running foot strike pattern on patellar cartilage stress 跑脚冲击方式对髌骨软骨应力影响的有限元分析

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-12 DOI: 10.1016/j.knee.2026.104362

Shiqi Yu , Yuwen Shangguan , Peng Yuan , Yilin Xu , Xianfeng Yang , Lijun Qin , Yawei Song

Objective

This study aimed to compare the effects of forefoot strike (FFS) and rearfoot strike (RFS) running on patellar cartilage stress, strain, contact area, and patellar movement using finite element analysis.

Methods

Twenty-four healthy runners were assigned to RFS (n = 12) or FFS (n = 12) groups based on their habitual foot strike pattern. Biomechanical data were collected during running at 3 m/s. A 3D finite element model of the patellofemoral joint was developed from MRI data. All finite element simulations were performed on a single subject-specific knee model, with loading conditions representing the group-averaged biomechanics of RFS and FFS patterns. Knee angle and quadriceps muscle forces derived from OpenSim were applied as boundary conditions to simulate cartilage mechanical behavior.

Results

No significant differences were observed between the FFS and RFS in peak knee angles or in the peak forces of the quadriceps muscle forces. The FFS exhibited lower peak values in patellar cartilage stress, strain, and contact area compared with the RFS. In both foot strike patterns, stress concentration initially shifted from the central ridge to the lateral cartilage and then back to the central ridge, with peak stress localized in the lateral cartilage. Patellar movement was similar between groups, characterized by lateral, posterior, and inferior translation, as well as flexion, medial tilt, and internal rotation during mid-stance phase.

Conclusion

While FFS running reduces peak stress and strain in the patellar cartilage, it does not alter the fundamental stress distribution pattern or patellar movement. This suggests inherent spatiotemporal loading characteristics independent of foot strike pattern. Future prevention strategies should consider both the magnitude and spatiotemporal distribution of stress for more targeted interventions.

目的通过有限元分析比较前脚着地（FFS）和后脚着地（RFS）跑步对髌骨软骨应力、应变、接触面积和髌骨运动的影响。方法选取24名健康跑步者，根据其惯常的足部击打方式分为RFS组（n = 12）和FFS组（n = 12）。在以3m /s速度奔跑时采集生物力学数据。根据MRI数据建立了髌股关节的三维有限元模型。所有有限元模拟均在单个受试者特定的膝关节模型上进行，加载条件代表RFS和FFS模式的组平均生物力学。采用OpenSim软件导出的膝关节角度和股四头肌力作为边界条件，模拟软骨力学行为。结果两组在膝关节峰值角度和股四头肌力量峰值上均无显著差异。与RFS相比，FFS在髌骨软骨应力、应变和接触面积上的峰值较低。在两种足击模式中，应力集中最初从中央脊向外侧软骨转移，然后又回到中央脊，应力峰值位于外侧软骨。两组之间的髌骨运动相似，其特征是外侧、后方和下方平移，以及站立中期的屈曲、内侧倾斜和内旋。结论FFS运动虽然降低了髌骨软骨的峰值应力和应变，但没有改变基本应力分布模式和髌骨运动。这表明固有的时空载荷特征独立于足击模式。未来的预防策略应考虑压力的大小和时空分布，以便采取更有针对性的干预措施。

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引用次数: 0

Cemented metal-on-polyethylene spacers have similar cost profiles with lower complications rates compared to molded all-cement articulating spacers for treatment of knee periprosthetic joint infection 在治疗膝关节假体周围关节感染方面，与模塑全水泥关节垫片相比，金属-聚乙烯粘合垫片成本相似，并发症发生率更低

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-28 DOI: 10.1016/j.knee.2026.104347

Angel X Xiao , Ramesh B Ghanta , Alejandro S. Cazzulino , Kelechi Nwachuku , Erdan Kayupov , Erik N. Hansen

Background

All-cement spacers or metal-on-polyethylene (MoP) spacers are types of articulating spacers used in two-stage treatment of total knee arthroplasty (TKA) periprosthetic joint infection (PJI). While MoP spacers have improved durability and versatility, there is concern that use of primary arthroplasty components as a temporary spacer is not cost-effective. We investigated the cost of MoP versus molded all-cement articulating spacers for the treatment of TKA PJI.

Methods

A retrospective review of primary TKA PJIs treated with articulating spacers between 2013 and 2020 was performed. Primary TKA implants were used for MoP spacers and molds were used to create all-cement spacers. Supply, implant, and surgical encounter costs were reviewed. Total cost and complications were reviewed.

Results

Thirty-two molded all-cement and 17 MoP spacers were included. There was no difference between all-cement and MoP spacer Stage 1 cost ($4184 vs $4365), Stage 2 cost ($20,026 vs $20,441) or total cost ($24,210 vs $24,614). Moreover, spacer cost accounted for 17% of total cost. 3 patients in the all-cement group had mechanical complications requiring additional surgery. The MoP group had a shorter length of stay (LOS) after stage 2 (2.06 vs 4.16 days). Spacer choice did not affect stage 1 LOS, discharge disposition, operating room time, or reinfection rate.

Conclusion

MoP spacers have similar cost profiles, but lower incidence of complications compared to molded all-cement articulating spacers for two-stage exchange in treatment of TKA PJI. More than 80% of the surgical implant and supply cost is incurred during Stage 2 regardless of the spacer construct utilized.

背景全水泥垫片或金属对聚乙烯（MoP）垫片是用于全膝关节置换术（TKA）假体周围关节感染（PJI）两阶段治疗的关节垫片类型。虽然MoP垫片提高了耐用性和多功能性，但人们担心使用初级关节置换术部件作为临时垫片的成本效益不高。我们研究了MoP与模塑全水泥关节垫片治疗TKA PJI的成本。方法回顾性分析2013年至2020年使用关节间隔器治疗原发性TKA PJIs的病例。初次TKA植入物用于MoP垫片，并用模具制作全水泥垫片。我们回顾了供应、植入和手术费用。回顾了总费用和并发症。结果32例全水泥模塑，17例MoP垫片。全水泥和MoP隔离器第一阶段的成本（4184美元对4365美元）、第二阶段的成本（20,026美元对20,441美元）或总成本（24,210美元对24,614美元）没有差异。此外，封隔器成本占总成本的17%。全水泥组3例患者出现机械并发症，需进行额外手术。MoP组在2期后的停留时间（LOS）较短（2.06天vs 4.16天）。隔离剂的选择不影响1期LOS、出院处置、手术室时间或再感染率。结论与模塑全水泥关节垫片相比，mop垫片两段置换治疗TKA PJI的成本相似，但并发症发生率较低。超过80%的手术植入和供应成本发生在第二阶段，无论使用的是哪种间隔结构。

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引用次数: 0

Midterm clinical outcomes and survivorship of a next generation revision knee system in complex primary and revision total knee arthroplasty 新一代膝关节翻修系统在复杂的初次和翻修全膝关节置换术中的中期临床结果和生存期

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-20 DOI: 10.1016/j.knee.2026.104328

Nicholas B. Frisch , Paul Edwards , Michael Bloomfield , Roberta E. Redfern , Nicholas Brown , John Dundon

Background

The burden of revision total knee arthroplasty (TKA) is expected to continue to grow with the increase in the number of primary procedures performed each year. The purpose of this study was to evaluate the early clinical outcomes of a novel revision knee system for use in revision and complex primary TKA.

Methods

Multicenter prospective observational cohort study of 185 patients undergoing revision TKA (rTKA) or complex primary TKA with a next generation revision knee system. Patients were separated into cohorts based on indication and combination of components. 2-year implant survivorship was examined. Clinical outcomes including Knee Society Knee Scores (KS-KS), Knee Injury and Osteoarthritis Outcomes – Joint Replacement (KOOS JR) and pain scores were compared by indication and component combinations.

Results

Most patients underwent TKA for aseptic revision (89.7%); implant survivorship at 2 years was 97.2% (95%CI 93.5–98.8) considering all indications; 97.0% (95%CI 93.0–98.7) in revision cases only. KS-KS scores improved significantly in all cohorts, with overall mean increase of 40.8 ± 22.9 points (p < 0.001). KOOS JR scores improved by 27.0 ± 20.3 (p < 0.001); pain reduction demonstrated overall mean of 3.5 ± 3.4 points (p < 0.001). Subgroup analysis of fixation method revealed no difference in KS-KS scores in uncemented approach (80.5 ± 16.4 vs 84.7 ± 14.0, p = 0.06)

Conclusion

This revision implant system demonstrated high survival and improvement in functional outcomes after 2 years, in both the complex primary and revision TKA setting. Further study is warranted to monitor long-term results.

背景翻修全膝关节置换术（TKA）的负担预计将随着每年进行的初级手术数量的增加而继续增长。本研究的目的是评估一种新型翻修膝关节系统用于翻修和复杂的原发性全膝关节置换术的早期临床结果。方法采用多中心前瞻性观察队列研究，对185例接受改进型全膝关节置换术（rTKA）或采用下一代改进型膝关节系统的复杂原发性全膝关节置换术的患者进行研究。根据适应症和药物组合将患者分成队列。检查2年种植体存活情况。临床结果包括膝关节学会膝关节评分（KS-KS）、膝关节损伤和骨关节炎预后-关节置换术（oos JR）和疼痛评分，通过适应症和成分组合进行比较。结果绝大多数患者采用TKA进行无菌翻修（89.7%）；考虑到所有适应症，2年种植体成活率为97.2% (95%CI 93.5-98.8)；97.0% （95%CI 93.0-98.7）仅为翻修病例。所有队列的KS-KS评分均显著提高，总体平均提高40.8±22.9分（p < 0.001）。kos JR评分提高27.0±20.3分（p < 0.001）；疼痛减轻总体平均为3.5±3.4分（p < 0.001）。固定方法的亚组分析显示，未骨水泥入路的KS-KS评分无差异（80.5±16.4 vs 84.7±14.0,p = 0.06）。结论该改良种植体系统在复杂的初级和改良TKA设置中均表现出较高的生存率和2年后功能结局的改善。有必要进一步研究以监测长期结果。

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引用次数: 0

Arthroscopic findings and intra-articular anomalies in congenital cruciate ligament deficiency 先天性交叉韧带缺乏的关节镜表现及关节内异常

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-29 DOI: 10.1016/j.knee.2026.104349

Sheba Z. Basheer , Tariq A. Kwaees , Paul Haslam, Fazal M. Ali, Nicolas Nicolaou

Background

This study aims to evaluate the arthroscopic findings of patients undergoing surgery for congenital cruciate ligament deficiency. Specifically, it investigates the frequency and types of intra-articular meniscal and ligament abnormalities associated with this rare condition, which often presents with knee instability in conjunction with longitudinal limb deficiency.

Methods

This prospective case series included 53 knees from 51 patients undergoing surgery for congenital cruciate ligament deficiency over a seven year period at a single tertiary centre. Patient demographics, clinical findings, imaging and surgical outcomes were documented. Preoperative MRI scans were used to assess intra-articular anatomy and arthroscopic findings were recorded, focusing on osseous and meniscal morphology as well as ligament anomalies.

Results

Among the 53 knees, 61% were associated with congenital longitudinal limb deficiencies, primarily fibular hemimelia. The ACL was deficient in all cases, while the PCL was also absent or underdeveloped in seven knees. Meniscal abnormalities were found in 42 knees (79.25%), including atypical shape, abnormal attachments and hypertrophied meniscofemoral ligaments that seemed to have a role in constraining sagittal instability.

Conclusion

Congenital cruciate ligament deficiency presents complex intra-articular anomalies, notably in ligament and meniscal structure. Hypertrophied meniscofemoral ligaments often provide compensatory stability, which can be disrupted by trivial trauma. Arthroscopic assessment is critical in planning reconstruction, especially given the atypical anatomy in these patients.

本研究旨在评估先天性交叉韧带缺乏手术患者的关节镜表现。具体来说，它调查了与这种罕见疾病相关的关节内半月板和韧带异常的频率和类型，这种疾病通常表现为膝关节不稳定并伴有纵向肢体缺陷。方法本前瞻性病例系列包括51例先天性交叉韧带缺乏症患者的53个膝关节，在单一三级中心进行了7年的手术。记录了患者的人口统计学、临床表现、影像学和手术结果。术前MRI扫描用于评估关节内解剖，并记录关节镜检查结果，重点是骨和半月板形态以及韧带异常。结果53例膝关节中，61%伴有先天性纵肢缺陷，以腓骨偏瘫为主。所有病例均有前交叉韧带缺失，而7例膝关节前交叉韧带缺失或发育不全。42例膝关节（79.25%）发现半月板异常，包括形状不典型、附着异常和半月板股骨韧带肥大，这似乎对限制矢状面不稳定起作用。结论先天性交叉韧带缺损表现为复杂的关节内异常，尤其是韧带和半月板结构异常。肥厚的半月板股骨韧带通常提供代偿稳定性，可被轻微的创伤破坏。关节镜评估是计划重建的关键，特别是考虑到这些患者的非典型解剖结构。

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引用次数: 0

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