IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 DOI: 10.1016/j.knee.2025.104294

Carlos Peñaherrera-Carrillo , Carlos Suarez-Ahedo , Francisco Endara Urresta , Alejandro Xavier Barros Castro , Juan Pablo Alarcón Serrano

Background

Altered tibiofemoral contact mechanics contribute to cartilage degeneration in knee osteoarthritis (OA) and anterior cruciate ligament (ACL) deficiency. Predicting focal cartilage overload is challenging due to biomechanical complexity. Hertzian contact theory, though simplified, provides a physically robust framework to estimate stress distributions from geometry and material properties.

Objective

To apply Hertzian theory to model tibiofemoral contact pressures and areas in healthy, osteoarthritic, and ACL-deficient knees, and assess its capability to identify patterns linked to cartilage degeneration.

Methods

A Hertzian-based model was built for three conditions using standardized cartilage properties (E = 10 MPa, ν = 0.45) and representative sagittal radii of curvature. A 700-N vertical load simulated single-leg stance. Peak contact pressure, contact area, and stress patterns were computed. Sensitivity analyses varied modulus, curvature, and load. Outputs were compared qualitatively with anatomical degeneration regions reported in imaging studies.

Results

Compared with the healthy model (3.21 MPa; 258.3 mm²), OA showed a 26.2 % higher peak pressure and 14.2 % smaller contact area; ACL deficiency showed a 33.3 % increase in peak pressure and 19.3 % reduction in area. OA overload localized medially, ACL deficiency shifted posteriorly. Geometry changes had greater influence on contact mechanics than stiffness or load changes.

Conclusions

Hertzian theory captures key biomechanical changes in OA and ACL deficiency, identifying clinically relevant overload zones. This simplified approach underscores the dominant role of joint geometry and supports practical biomechanical risk assessment.

背景：改变的胫股接触力学有助于膝关节骨性关节炎（OA）和前交叉韧带（ACL）缺陷的软骨变性。由于生物力学的复杂性，预测局灶性软骨超载是具有挑战性的。赫兹接触理论虽然简化了，但它提供了一个物理上可靠的框架来估计几何和材料特性的应力分布。目的：应用Hertzian理论对健康、骨关节炎和acl缺陷膝关节的胫股接触压力和区域进行建模，并评估其识别软骨退变模式的能力。方法：采用标准化的软骨性质（E = 10 MPa, ν = 0.45）和具有代表性的矢状曲率半径，建立基于hertzean的模型。700牛的垂直载荷模拟单腿站立。计算了峰值接触压力、接触面积和应力模式。灵敏度分析变化的模量、曲率和载荷。输出与成像研究中报告的解剖变性区域进行定性比较。结果：与健康模型（3.21 MPa; 258.3 mm2）相比，OA的峰值压力升高26.2%，接触面积减小14.2%；前交叉韧带缺陷导致峰值压力增加33.3%，面积减少19.3%。OA过载定位于内侧，ACL缺陷向后移位。几何变化对接触力学的影响大于刚度或载荷变化。结论：赫兹理论捕捉到了OA和ACL缺陷的关键生物力学变化，确定了临床相关的过载区。这种简化的方法强调了关节几何的主导作用，并支持实际的生物力学风险评估。

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引用次数: 0

Shank motion analysis for quantifying knee gait deviations: Normative data at various walking speeds 量化膝关节步态偏差的小腿运动分析：不同步行速度下的规范数据。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 DOI: 10.1016/j.knee.2025.104293

Sophie Hameau , Karim Jamal , Charles Guignans , Isabelle Bonan , Sébastien Cordillet

Background

Knee deviations in clinical gait analysis are often measured using joint angles and could be enhanced by incorporating additional indices such as shank angular velocity in addition to knee angular velocity, particularly in the context of knee extensor thrust. The aim of this study was to establish normative data for shank and knee angular velocities at various gait speeds and to perform clinical validation of these biomarkers.

Methods

A public dataset containing three-dimensional motion capture established on 50 healthy participants was used to calculate normative data of knee and shank angular velocities at five gait speeds (means, standard deviations and confidence intervals). Eleven hemiparetic persons walking with knee extensor thrust underwent three-dimensional gait analysis, during which minimum knee and shank angular velocities during stance phase were calculated.

Results

Hemiparetic persons walking with knee extensor thrust had significantly lower minimum knee and shank angular velocities than normative data at all gait speeds (P < 0.001). In healthy persons, the minimum values for knee and shank angular velocities during stance phase or the values at foot-off, like most knee kinematics parameters, were correlated with gait speed (r = −0.83; r = 0.67; r ≥ 0.9; P < 0.01).

Conclusion

This study provides normative data for knee and shank angular velocities at various gait speeds and demonstrates their usefulness for analysing knee deviations, notably the knee extensor thrust. This study underscores the impact of walking speed on gait patterns particularly on knee and shank angular velocities and underlines the need to compare data at the same gait speed for practice and future research.

背景：临床步态分析中的膝关节偏差通常是用关节角度来测量的，除了膝关节角速度外，还可以通过结合其他指标，如小腿角速度，特别是在膝关节伸肌推力的情况下，来增强膝关节偏差。本研究的目的是建立不同步态速度下小腿和膝关节角速度的规范数据，并对这些生物标志物进行临床验证。方法：利用一个包含50名健康参与者三维运动捕捉的公共数据集，计算五种步态速度下膝关节和小腿角速度的规范数据（均值、标准差和置信区间）。对11名偏瘫患者进行了三维步态分析，计算了站立阶段膝关节和小腿的最小角速度。结论：本研究提供了不同步态速度下膝关节和小腿角速度的规范数据，并证明了它们对分析膝关节偏差（尤其是膝关节伸肌推力）的有用性。这项研究强调了步行速度对步态模式的影响，特别是对膝关节和小腿角速度的影响，并强调了在练习和未来研究中比较相同步态速度下数据的必要性。

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引用次数: 0

Meniscal vascular contact loss ratio (MVCLR): A novel MRI index for predicting meniscal irreparability 半月板血管接触失失率（MVCLR）：一种预测半月板不可修复性的新MRI指标

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-31 DOI: 10.1016/j.knee.2025.104322

Francisco Endara Urresta , Carlos Peñaherrera-Carrillo , Alejandro Barros Castro

Background

Accurate preoperative identification of meniscal tears with limited healing potential remains challenging. Conventional magnetic resonance imaging (MRI) descriptors – tear pattern, extrusion, displacement, and signal alterations – offer limited insight into the biological viability of the vascular peripheral rim. No MRI-based parameter currently quantifies the loss of meniscocapsular contact, the anatomical region most critical for vascular-mediated healing. This gap limits the ability to anticipate reparability and contributes to intraoperative decision variability.

Purpose

To validate the meniscal vascular contact loss ratio (MVCLR), a novel geometric MRI metric, as a predictor of meniscal irreparability.

Methods

A retrospective cohort of 138 patients undergoing arthroscopic surgery for symptomatic meniscal tears was analyzed. MVCLR was calculated as the proportion of the vascularizable meniscal perimeter lacking capsular contact on proton-density fat-suppressed MRI. Intra- and interobserver reliability were assessed using intraclass correlation coefficients (ICCs). Diagnostic performance for predicting arthroscopically confirmed irreparability was evaluated using receiver operating characteristic (ROC) analysis, Youden-optimized cutoff determination, and multivariable logistic regression.

Results

Mean MVCLR was significantly higher in irreparable tears compared with repairable tears (54.8 % ± 12.6 % vs 27.9 % ± 10.3 %, P < 0.001). MVCLR demonstrated excellent discriminative ability (area under the curve 0.88; 95 % confidence interval (CI), 0.82–0.93). A cutoff of 47 % yielded 82 % sensitivity and 85 % specificity. Each 10 % increase in MVCLR independently increased the odds of irreparability by 2.3-fold (95 % CI, 1.7–3.2). Reliability was high, with ICCs of 0.87 (interobserver) and 0.92 (intraobserver).

Conclusion

MVCLR reliably predicted meniscal irreparability by quantifying peripheral contact loss and demonstrated excellent diagnostic accuracy. Its primary limitation is that intraoperative determination of irreparability remains partially subjective despite predefined criteria.

背景：对愈合潜力有限的半月板撕裂进行准确的术前识别仍然具有挑战性。传统的磁共振成像（MRI）描述符-撕裂模式，挤压，位移和信号改变-对血管外周边缘的生物活力提供有限的见解。目前没有基于mri的参数量化半月板囊接触的损失，这是血管介导愈合最关键的解剖区域。这一差距限制了预测可修复性的能力，并导致术中决策的可变性。目的验证半月板血管接触损失比（MVCLR）作为半月板不可修复性的预测指标。方法对138例经关节镜手术治疗症状性半月板撕裂的患者进行回顾性分析。MVCLR计算为质子密度脂肪抑制MRI上缺乏包膜接触的可血管化半月板周长的比例。使用类内相关系数（ICCs）评估观察者内部和观察者之间的信度。通过受试者工作特征（ROC）分析、优登优化截止值测定和多变量logistic回归来评估预测关节镜下确认的不可修复性的诊断性能。结果不可修复撕裂的平均MVCLR明显高于可修复撕裂（54.8%±12.6% vs 27.9%±10.3%,P < 0.001）。MVCLR表现出良好的判别能力（曲线下面积0.88；95%可信区间（CI） 0.82 ~ 0.93）。47%的临界值产生82%的敏感性和85%的特异性。MVCLR每增加10%，不可修复的几率就增加2.3倍（95% CI, 1.7-3.2）。信度很高，ICCs为0.87（观察者间）和0.92（观察者内）。结论mvclr通过量化外周接触损失可靠地预测半月板的不可修复性，具有良好的诊断准确性。它的主要限制是术中对不可恢复性的判断尽管有预先确定的标准，但仍有部分是主观的。

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引用次数: 0

Impacts of malalignment in medial compartment knee osteoarthritis on the patellofemoral joint: A quantitative analysis during staircase motion 内侧室膝关节骨性关节炎对髌股关节的影响：楼梯运动时的定量分析

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-31 DOI: 10.1016/j.knee.2025.104319

Yanjie Mao , Tianyun Gu , Zheng Jiang , Weiming Lin , Xiaoyin Zhang , Han Guo , Axiang He , Hai Hu , Wanjun Liu , Youjia Xu

Background

The progression of medial compartment knee osteoarthritis (MCKOA) tends to be accompanied by degeneration of the patellofemoral joint (PFJ). However, the underlying biomechanical mechanisms have not been investigated. This study aims to quantitatively analyse the six-degrees-of-freedom (6-DOF) motion and contact patterns of the PFJ during staircase motion and explore the relationship between lower limb alignment and PFJ kinematics.

Methods

Thirty-two patients with unilateral MCKOA and intact contralateral extremities were enrolled. All patients performed continuous staircase motion under the surveillance of a dual fluoroscopic imaging system (DFIS) to investigate the PFJ 6-DOF, contact pattern and hip–knee–ankle angle (HKA) of their MCKOA knee and contralateral native knee.

Results

During staircase motion, MCKOA side patella presented greater flexion and varus degrees and more posterior, distal and medial translations (P < 0.05). Besides, the contact centre on the medial patellar facet shifted more medially, whereas the lateral contact centre shifted more proximally (P < 0.05). The HKA angle of the MCKOA knees was significantly greater than that of the native knees (P < 0.05). A larger HKA angle was associated with greater patellar flexion (r = 0.37, P < 0.05) and lower patellar anterior translation (r = −0.45, P < 0.05).

Conclusion

Our study revealed significant alterations in PFJ kinematics and contact patterns in MCKOA knees during motion, characterized by increased patellar flexion, varus rotation and certain altered translations. These changes were associated with the HKA angle, underscoring the importance of addressing malalignment in the MCKOA knee and providing valuable insights for restoring PFJ function and preserving joint health.

背景：内侧腔室膝骨关节炎（MCKOA）的进展往往伴随着髌骨股骨关节（PFJ）的退变。然而，潜在的生物力学机制尚未被研究。本研究旨在定量分析PFJ在楼梯运动中的六自由度运动和接触模式，探讨下肢对齐与PFJ运动学之间的关系。方法选取32例单侧MCKOA伴对侧肢体完整的患者。所有患者在双透视成像系统（DFIS）的监测下进行连续楼梯运动，以研究其MCKOA膝关节和对侧天然膝关节的PFJ 6-DOF、接触模式和髋关节-膝关节-踝关节角（HKA）。结果在楼梯运动时，MCKOA侧髌骨屈曲和内翻度较大，后侧、远端和内侧移位较多（P < 0.05）。此外，髌骨内侧关节面接触中心更向内侧移位，而外侧接触中心更向近端移位（P < 0.05）。MCKOA膝关节的HKA角明显大于天然膝关节（P < 0.05）。HKA角度越大，髌骨屈曲越大（r = 0.37, P < 0.05），髌骨前移位越低（r = - 0.45, P < 0.05）。结论：我们的研究揭示了MCKOA膝关节在运动过程中PFJ运动学和接触模式的显著改变，其特征是髌骨屈曲增加，内翻旋转和某些平移改变。这些变化与HKA角度有关，强调了解决MCKOA膝关节错位的重要性，并为恢复PFJ功能和保持关节健康提供了有价值的见解。

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引用次数: 0

Letter to the editor regarding "ChatGPT delivers satisfactory responses to the most frequent questions on meniscus surgery". 关于“ChatGPT为半月板手术中最常见的问题提供满意的答复”的致编辑的信。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-29 DOI: 10.1016/j.knee.2025.104317

Ismail Sivri, Emre Kaygin, Serap Colak

Background: This letter addresses methodological aspects of a study that evaluated a large language model's responses to frequently asked patient questions regarding meniscus surgery. The original research collected common questions from orthopedic resources, submitted them to the model in separate sessions, and assessed the answers using an adequacy and clarification framework. The purpose of this correspondence is to highlight methodological limitations in the prompting strategy and evaluation procedures that may have influenced the study's findings.

Methods: The study used zero-shot prompting without specifying audience level, communication role, or expected response style. Each response was rated by a single orthopedic specialist using a qualitative scale. This letter reviews these methods and discusses how alternative approaches could enhance validity and reproducibility.

Results: Zero-shot prompts without audience targeting or role-based instructions can lead to general, non-specific outputs rather than patient-focused explanations. Structured prompting techniques, such as defining the audience or providing one-shot or few-shot examples, often improve clarity, consistency, and alignment with patient needs. In addition, assessment by a single rater increases subjective bias, as individual interpretation may influence scoring. Multi-rater evaluation with standardized agreement metrics would provide a more reliable and objective assessment of accuracy.

Conclusions: The study offers useful preliminary insight into the potential of artificial intelligence tools for patient education. However, limitations in prompting design and evaluator methodology restrict the strength of the conclusions. Future studies employing structured prompts and multi-rater assessments may yield more robust and clinically meaningful evidence.

背景：这封信讨论了一项研究的方法学方面，该研究评估了一个大型语言模型对半月板手术患者常见问题的反应。原始研究从骨科资源中收集常见问题，在单独的会议中将其提交给模型，并使用充分性和澄清性框架评估答案。本信函的目的是强调可能影响研究结果的提示策略和评估程序的方法学局限性。方法：研究采用零射提示，不指定受众水平、沟通角色或预期的回应方式。每个回答都由一位骨科专家使用定性量表进行评分。这封信回顾了这些方法，并讨论了如何替代方法可以提高有效性和可重复性。结果：没有针对受众或基于角色的说明的零射击提示可能导致一般的，非特定的输出，而不是以患者为中心的解释。结构化的提示技术，例如定义受众或提供一次或几次示例，通常可以提高清晰度、一致性和与患者需求的一致性。此外，单一评分者的评估增加了主观偏见，因为个人解释可能会影响评分。采用标准化协议度量的多评价者评估将提供更可靠和客观的准确性评估。结论：该研究为人工智能工具在患者教育方面的潜力提供了有用的初步见解。然而，提示设计和评估方法的局限性限制了结论的强度。未来采用结构化提示和多评分评估的研究可能会产生更有力和有临床意义的证据。

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引用次数: 0

Tibial acceleration induced by the extension maneuver referred to as the N test correlates with the International Knee Documentation Committee grade, even after anterior cruciate ligament reconstruction 即使在前交叉韧带重建后，由伸展运动引起的胫骨加速（即N试验）与国际膝关节文献委员会评分相关

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-26 DOI: 10.1016/j.knee.2025.104306

Ryota Yamagami, Shuji Taketomi, Kenichi Kono, Kohei Kawaguchi, Ryo Murakami, Takashi Kobayashi, Tomoki Murakami, Sora Koiwa, Sakae Tanaka

Background

The N test, an extension-based maneuver, reportedly elicited greater tibial acceleration than the pivot shift test in anterior cruciate ligament (ACL)-deficient (ACLD) knees. However, its utility in ACL-reconstructed (ACLR) knees, where residual instability is subtle, remains unclear. This study compared tibial acceleration between the N test and pivot shift test in ACLD and ACLR knees and assessed correlation with clinical grading.

Methods

A total of 103 knees (68 ACLD, 35 ACLR) were evaluated under general anesthesia. A triaxial inertial sensor was placed on the anterolateral tibia, and peak-to-peak anteroposterior acceleration was extracted as the sole quantitative parameter, interpreted as a surrogate for combined anterior subluxation and external rotation of the lateral tibial compartment. Each maneuver was performed five times; the mean of the central three trials was analyzed. Paired t-tests and Spearman’s rank correlation were used.

Results

In ACLD knees, the injured limb showed significantly greater acceleration than the uninjured limb in both tests (N test, 8.32 ± 4.08 vs 4.53 ± 2.49 m/s²; pivot shift, 6.11 ± 4.41 vs 3.17 ± 2.75 m/s²; both, P < 0.001). The N test induced greater acceleration than the pivot shift test in both ACLD and ACLR knees (ACLR, 4.26 ± 1.68 vs 2.68 ± 2.04 m/s²; both, P < 0.001). N test–induced acceleration correlated with IKDC grading (ACLR. r = 0.577; ACLD, r = 0.575; overall, r = 0.733; all P < 0.001).

Conclusions

The N test elicited greater tibial acceleration than the pivot shift test and correlated strongly with clinical grading, even in ACLR knees, supporting its potential as a sensitive supplementary tool for detecting subtle residual laxity after ACL reconstruction.

Level of Evidence: Level III, diagnostic study.

背景：据报道，在前交叉韧带（ACL）缺陷（ACLD）膝盖中，N试验是一种基于伸展的操作，比枢轴移位试验引起更大的胫骨加速度。然而，其在残余不稳定微妙的ACLR重建（ACLR）膝关节中的应用仍不清楚。本研究比较了ACLD和ACLR膝关节N试验和枢轴移位试验的胫骨加速度，并评估了与临床分级的相关性。方法全麻下对103例膝关节（ACLD 68例，ACLR 35例）进行评估。在胫骨前外侧放置一个三轴惯性传感器，提取峰对峰前后加速度作为唯一的定量参数，解释为胫骨外侧室联合前路半脱位和外旋的替代指标。每个动作做5次；对中心三项试验的平均值进行分析。采用配对t检验和Spearman等级相关。结果在ACLD膝关节中，两项试验中损伤肢加速度均显著大于未损伤肢（N试验，8.32±4.08 vs 4.53±2.49 m/s2；枢轴位移，6.11±4.41 vs 3.17±2.75 m/s2， P均为0.001）。在ACLD和ACLR中，N试验诱导的加速度均大于枢轴移位试验（ACLR, 4.26±1.68 vs 2.68±2.04 m/s2；均P <； 0.001）。N试验诱导加速度与IKDC分级（ACLR）相关。r = 0.577；ACLD, r = 0.575；总体而言，r = 0.733；P < 0.001)。结论N试验比枢轴移位试验引起更大的胫骨加速度，并且与临床分级密切相关，即使在ACLR膝关节中也是如此，支持其作为检测ACL重建后细微残余松弛的敏感补充工具的潜力。证据等级：III级，诊断性研究。

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引用次数: 0

A bounded functional alignment approach for total knee arthroplasty: impact on knee phenotype and patient-reported outcomes 全膝关节置换术的有限功能对齐方法：对膝关节表型的影响和患者报告的结果

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-26 DOI: 10.1016/j.knee.2025.104313

Hallie B. Remer , Chukwuemeka U. Osondu , Hannah Mosher , Yvette Hernandez , Giovanni Paraliticci , Charles M. Lawrie , Juan C. Suarez

Background

Native knee coronal alignment and joint line obliquity vary among individuals as evidenced by the Coronal Plane Alignment of the Knee (CPAK) classification. This study investigated whether a single institution’s functional alignment (FA) approach during robotic-assisted total knee arthroplasty (TKA) preserves native knee phenotypes and whether knee phenotype retention impacts patient-reported outcomes (PROs).

Methods

We performed a retrospective cohort study of 188 patients who underwent robotic TKA with a bounded FA strategy at a single institution. Surgeons were blinded to preoperative knee phenotypes and employed an FA technique with minimized soft tissue releases. Knees were grouped as retention or reclassification of preoperative CPAK phenotype. PROs were analyzed at 1-year follow up, including minimal clinically important difference (MCID) achievement.

Results

The most common preoperative CPAK knee phenotypes were classes I (30.3 %), II (36.2 %), and III (23.9 %). Postoperatively, 74.5 % of knees retained their native phenotype, including 100 % of class I and 89 % of class III knees. Most common postoperative CPAK knee phenotypes were classes I (48.4 %) and III (23.4 %) followed by class II (20.7 %). No significant differences were identified in any PROs at 1-year follow up between retention groups (Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR): 26.4 vs. 29.4, P = 0.36). Similar proportions of both groups achieved MCID thresholds for KOOS JR and PROMIS-10 scores.

Conclusion

A bounded FA approach to robotic assisted TKA retained native CPAK phenotype in most cases, though phenotype retention did not significantly affect 1-year PROs. Within bounded FA parameters, soft tissue balance may be as important as precise phenotype restoration for short-term functional outcomes.

膝关节的冠状面对齐（CPAK）分类证明了个体间膝关节的冠状面对齐和关节线倾角的差异。本研究调查了在机器人辅助全膝关节置换术（TKA）中单一机构的功能对齐（FA）方法是否保留了原始膝关节表型，以及膝关节表型保留是否影响患者报告的结果（PROs）。方法：我们进行了一项回顾性队列研究，188名患者在同一机构接受了有界FA策略的机器人TKA。外科医生对术前膝关节表型不知情，并采用最小化软组织释放的FA技术。膝关节按术前CPAK表型保留或再分类进行分组。在1年的随访中分析PROs，包括最小临床重要差异（MCID）成就。结果术前最常见的CPAK膝关节表型为I型（30.3%）、II型（36.2%）和III型（23.9%）。术后，74.5%的膝关节保持原有表型，包括100%的I级膝关节和89%的III级膝关节。最常见的术后CPAK膝关节表型为I类（48.4%）和III类（23.4%），其次是II类（20.7%）。在1年随访中，保留组之间的任何pro均无显著差异（膝关节损伤和骨关节炎关节置换术结局评分（oos JR）： 26.4比29.4,P = 0.36）。在KOOS JR和promise -10评分中，两组达到MCID阈值的比例相似。结论机器人辅助TKA的有限FA方法在大多数情况下保留了原生CPAK表型，尽管表型保留对1年PROs没有显著影响。在限定FA参数内，对于短期功能结果，软组织平衡可能与精确的表型恢复一样重要。

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引用次数: 0

The modified Bereiter trochleoplasty for severe trochlear dysplasia demonstrates significant clinical improvement in knee function and quality of life at mid-term follow-up 经中期随访，改良的Bereiter滑车成形术治疗严重滑车发育不良患者的膝关节功能和生活质量均有显著改善

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-26 DOI: 10.1016/j.knee.2025.104308

Andrew George, Nikhil Sharma, Rakan Kabariti, Andrew Barnett

Background

Trochleoplasty is effective for patients with patellofemoral instability attributed to severe trochlear dysplasia. Previously published data on short-term outcomes demonstrate excellent results in knee function and quality of life with an acceptable complication profile. This study reports on mid-term function and quality of life outcomes following trochleoplasty for severe trochlear dysplasia, including post-operative sequelae.

Methods

A longitudinal database was investigated, identifying all trochleoplasty procedures. Patients with <3 years follow-up data were excluded. All operations were performed by a fellowship-trained sports knee surgeon utilising a modified Bereiter technique. Post-operative mid-term IKDC, Kujala and EQ-5D results were compared to baseline. Non-parametric statistical methods were used. Statistically significant differences were assessed using a paired Wilcoxon-signed rank test (p < 0.05).

Results

Fifty-two trochleoplasties were performed between 2013–2019; 28 with >3 years follow-up data were available for analysis. Mean age at surgery was 22y (SD 4.7, 14–37y); median follow-up of 5.3y (IQR 3.9–7.0y). Median Kujala score improved from 57.0 (IQR 45–66) to 96.3 (IQR 83–100). Median IKDC score improved from 42.6 (IQR 35.9–51.3) to 92.6 (IQR 71.6–98.7). Median EQ-5D scores improved from 0.691 (IQR 0.414–0.727) to 1.000 (IQR 0.818–1.000). Improvement in all scores were statistically significant (p < 0.001). There were no further symptoms of patella instability, complications of chondral necrosis or patellofemoral osteoarthritis.

Conclusion

The Modified Bereiter trochleoplasty remains safe and effective in addressing recurrent patellofemoral instability associated with severe trochlear dysplasia. There is sustained improvement in knee function and quality of life at median follow-up of 5.3 years.

背景：滑车成形术对严重滑车发育不良导致的髌股不稳患者有效。先前发表的短期结果数据表明，在膝关节功能和生活质量方面取得了良好的效果，并发症可接受。本研究报告了严重滑车发育不良患者行滑车成形术后的中期功能和生活质量，包括术后后遗症。方法对所有滑车成形术进行纵向数据库调查。排除随访3年的患者。所有手术均由一名训练有素的运动膝关节外科医生使用改良的Bereiter技术进行。术后中期IKDC、Kujala和EQ-5D结果与基线比较。采用非参数统计方法。采用配对wilcoxon符号秩检验评估差异有统计学意义（p < 0.05）。结果2013-2019年共行滑骨成形术52例；28例随访3年，可获得数据进行分析。手术平均年龄22岁（SD 4.7, 14 - 37岁）；中位随访时间为5.3年（IQR为3.9 - 7.0年）。Kujala评分中位数由57.0 （IQR 45-66）提高至96.3 （IQR 83-100）。中位IKDC评分从42.6 （IQR 35.9-51.3）提高到92.6 （IQR 71.6-98.7）。中位EQ-5D评分从0.691 （IQR 0.414-0.727）提高到1.000 （IQR 0.818-1.000）。所有评分的改善均有统计学意义（p < 0.001）。没有进一步的髌骨不稳、软骨坏死并发症或髌骨股骨骨关节炎的症状。结论改良的Bereiter滑车成形术治疗复发性髌股不稳伴严重滑车发育不良安全有效。中位随访5.3年，膝关节功能和生活质量持续改善。

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引用次数: 0

Influence of external load during back squats on knee joint arthrokinematics analyzed by vibroarthrography 用关节振动成像技术分析后蹲时外负荷对膝关节运动学的影响

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-26 DOI: 10.1016/j.knee.2025.104318

Dorota Borzucka , Krzysztof Kręcisz , Dawid Bączkowicz

Background

The specific influence of heavy external loads during back squats on patellofemoral joint arthrokinematics remains unclear. Therefore, this study aimed to evaluate these effects in vivo using vibroarthrography across a wide range of loads (0–70 kg).

Methods

An eight-load, randomized-order, within-subject design was used. Thirty-eight male team sport athletes (age: 22.0 ± 1.1 years, body mass: 82.8 ± 10.1 kg) performed back squats under eight external load conditions (0–70 kg) with 1-min rests between tests. The arthrokinematic quality of the patellofemoral joint was assessed using an accelerometer sensor placed 1 cm above the apex of the patella.

Results

The results revealed that the vibroarthrographic signal increased in an almost linear manner with an increasing knee load during the squat. This increase was statistically significant for loads equal to or greater than 40 kg (P < 0.001) for the signal variability parameters (VMS and R4) and for loads equal to or greater than 20 kg (P ≤ 0.007) for the frequency parameters (P1 and P2). Analyzing the median values, the VMS parameter increased by 150 %, R4 by 23 %, P1 by 135 %, and P2 by 140 % at the maximum load of 70 kg compared with the squat without a load.

Conclusion

The vibroarthrographic signal level steadily increases with increasing knee load during squats, seemingly associated with higher contact stress and kinetic friction of articular surfaces. This linear phenomenon is visible across the entire range of applied loads. Consequently, athletes and coaches should consider that progressively increasing loads may contribute to joint wear over time.

背景：大负荷外负荷下蹲对髌股关节运动学的具体影响尚不清楚。因此，本研究旨在通过大范围负荷（0-70 kg）的关节振动成像技术来评估这些在体内的影响。方法采用8负荷、随机顺序、受试者内设计。38名男性团体运动员（年龄：22.0±1.1岁，体重：82.8±10.1 kg）在8种外部负荷条件下（0-70 kg）进行了后蹲训练，试验之间休息1分钟。髌股关节的关节运动质量通过放置在髌骨顶端上方1cm处的加速度传感器进行评估。结果结果显示，关节振动信号随着深蹲时膝关节负荷的增加几乎呈线性增加。对于信号变异性参数（VMS和R4），负载等于或大于40 kg (P < 0.001)，对于频率参数（P1和P2），负载等于或大于20 kg (P≤0.007)，这种增加具有统计学意义。分析中位数，在最大负荷为70 kg时，与无负荷深蹲相比，VMS参数增加了150%，R4增加了23%，P1增加了135%，P2增加了140%。结论深蹲时关节振动成像信号水平随膝关节负荷的增加而增加，似乎与关节表面接触应力和动摩擦的增加有关。这种线性现象在整个施加载荷的范围内都是可见的。因此，运动员和教练员应该考虑逐渐增加的负荷可能会随着时间的推移导致关节磨损。

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引用次数: 0

Can Knee Joint Distraction postpone knee arthroplasty? A single centre retrospective cohort analysis from a non-designer institute; 3–6-year follow-up 膝关节牵拉能推迟膝关节置换术吗？来自非设计师机构的单中心回顾性队列分析；3-6-year随访。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-24 DOI: 10.1016/j.knee.2025.104297

G.M. van Buul, S. Verhagen, R.J. de Jong, G.G. van Hellemondt, P.J.C. Heesterbeek

Background

Knee Joint Distraction (KJD) could be a joint preserving option in young osteoarthritis (OA) patients to postpone arthroplasty. We evaluated how long joint arthroplasty could be delayed following KJD, assessed complications, patient satisfaction and change in Kellgren-Lawrence (KL) OA grade.

Methods

A retrospective cohort analysis was performed 3–6 years after KJD for 34 patients treated between 2017–2019. (Total) Knee Arthroplasty ((T)KA) free interval, complications and patient satisfaction were retrieved from medical records and verified at latest patient contact. Standard weightbearing AP radiographs were used to analyze KL grade.

Results

16 of 32 included patients underwent conversion to arthroplasty. Kaplan-Meier analysis for (T)KA-free interval after KJD showed a survival rate of 46.6 % (95 % CI 23.9–66.6) after median 5.1 years (range 3–6 years). No patients lost after final event time. Patient weight was higher in the conversion group, no other associations were found between demographic data, previous surgery, and length of (T)KA-free interval. In 53 % of cases complications occurred, of which pin tract infections were the most common. No overall effect of KJD treatment on KL OA grade was seen. KL score improvement was more frequent among non-converted compared to (T)KA converted patients (p = 0.023).

Conclusion

53 % of our KJD patients experienced complications and 50 % were converted to (T)KA within 5 years after KJD treatment. This emphasizes the importance of strict patient selection and establishing realistic patient expectations, when considering this joint preserving approach. Based on these results, KJD treatment currently is not a used treatment option within our institute.

背景：膝关节牵张术（KJD）可能是年轻骨关节炎（OA）患者推迟关节置换术的一种关节保护选择。我们评估了KJD后关节置换术可以延迟多长时间，评估了并发症、患者满意度和Kellgren-Lawrence (KL) OA分级的变化。方法：对2017-2019年间接受KJD治疗的34例患者进行3-6年回顾性队列分析。从医疗记录中检索（全）膝关节置换术（(T)KA）自由间隔、并发症和患者满意度，并在最近一次患者接触时进行验证。采用标准负重AP片分析KL分级。结果：32例患者中有16例行关节置换术。Kaplan-Meier分析显示，中位5.1年（范围3-6年）后，KJD后无ka间期的生存率为46.6% （95% CI 23.9-66.6）。最后事件时间后无患者丢失。转换组患者体重较高，人口学数据、既往手术和(T)无ka间隔长度之间未发现其他关联。53%的病例发生并发症，其中针道感染最为常见。未观察到KJD治疗对KL OA分级的总体影响。与(T)KA转换患者相比，未转换患者的KL评分改善更为频繁（p = 0.023）。结论：53%的KJD患者出现并发症，50%的患者在KJD治疗后5年内转为(T)KA。这强调了严格的患者选择和建立现实的患者期望的重要性，当考虑这种关节保留方法。基于这些结果，KJD治疗目前不是我们研究所使用的治疗方案。

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引用次数: 0

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