IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-04 DOI: 10.1016/j.knee.2026.104360

Horacio Rivarola , Camilo P. Helito , Pablo Ramos , Cristian Collazo , Marcos Palanconi , Marcos Meninato , Gonzalo Arteaga , Medardo Vargas , Francisco Endara Urresta , Carlos Peñaherrera-Carrillo , Alejandro Barros Castro

Background

The morphometric relationship between the femoral condyle and lateral meniscus has not been quantitatively characterized. Subtle alterations in femoral geometry may modify load distribution and predispose to meniscal re-tear, yet no reproducible MRI index exists to quantify this phenomenon.

Purpose

To define and validate the Femoral Condylar Consumption Index (FCCI) as a geometric MRI parameter predictive of lateral meniscal lesion and re-tear.

Methods

A retrospective case–control MRI study was conducted including 120 knees: 60 with arthroscopically confirmed lateral meniscal tears (20 re-tears) and 60 controls. The FCCI was calculated as.

FCCI = \frac{R_{0} - R_{1}}{R_{0}} x 100

where R₀ represents an internal reference radius derived from the medial femoral condyle, and R₁ the measured radius of the lateral condyle on sagittal MRI. Two blinded observers performed independent measurements. Interobserver reliability, receiver operating characteristic (ROC) analysis, and multivariate logistic regression were applied.

Results

The mean FCCI was significantly greater in the lesion group than in controls (12.8 ± 3.2% vs. 5.1 ± 2.0%, P < 0.001). An FCCI > 9% predicted meniscal tear with sensitivity 0.86 and specificity 0.82 (AUC = 0.89; 95% CI, 0.83–0.95). Recurrent tears exhibited higher values (15.6 ± 3.4%) than primary tears (11.9 ± 2.8%, P = 0.002). In multivariate analysis, FCCI > 9% remained an independent predictor (OR = 6.4; 95% CI, 2.3–10.8; P < 0.001). Reliability was excellent (ICC_inter = 0.91; ICC_intra = 0.88).

Conclusion

The FCCI is a novel, reproducible geometric parameter that quantifies posterior femoral condylar flattening and predicts both primary and recurrent lateral meniscal tears. Incorporation into preoperative MRI assessment may assist in risk stratification and surgical planning. Before FCCI can be applied prognostically, prospective validation is required to establish temporal precedence and causal relevance.

背景：股骨髁与外侧半月板之间的形态计量学关系尚未定量表征。股骨几何形状的细微改变可能会改变负荷分布，使半月板再撕裂易感，但目前还没有可重复的MRI指标来量化这一现象。目的：定义和验证股骨髁消耗指数（FCCI）作为预测外侧半月板病变和再撕裂的几何MRI参数。方法：对120个膝关节进行回顾性病例对照MRI研究，其中60个膝关节经关节镜确认为外侧半月板撕裂（20个再次撕裂），60个对照组。FCCI计算为。FCCI=R0- r1r0x100，其中R0表示股骨内侧髁的内部参考半径，R1表示矢状面MRI上测量的外侧髁半径。两名盲法观察者进行了独立的测量。采用观察者间信度、受试者工作特征（ROC）分析和多元逻辑回归。结果：病变组FCCI均值显著高于对照组（12.8±3.2% vs. 5.1±2.0%），p9%预测半月板撕裂，敏感性0.86，特异性0.82 （AUC = 0.89; 95% CI, 0.83-0.95）。复发性撕裂值（15.6±3.4%）高于原发性撕裂值（11.9±2.8%,P = 0.002）。在多变量分析中，FCCI bbbb9 %仍然是一个独立的预测因子（OR = 6.4; 95% CI, 2.3-10.8； P间= 0.91;ICCintra = 0.88）。结论：FCCI是一种新的、可重复的几何参数，可量化股骨后髁扁平程度，并预测原发性和复发性外侧半月板撕裂。纳入术前MRI评估可能有助于风险分层和手术计划。在FCCI可以用于预测之前，需要进行前瞻性验证以建立时间优先性和因果相关性。

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引用次数: 0

A 10-year clinical and radiological outcome study of posterior-stabilized total knee arthroplasty with an oxidized zirconium femoral component 氧化锆股骨假体后稳定全膝关节置换术的10年临床和影像学结果研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-06 DOI: 10.1016/j.knee.2026.104352

Martin Tripon, Gaelle Maroteau, Thibault Cottebrune, Julien Dunet, Arthur Gras, Christophe Hulet

Background

This study aimed to assess long-term survival and clinical outcomes of a posterior-stabilized total knee arthroplasty (TKA) using an Oxidized Zirconium (OxZr) femoral component after a minimum 10-year follow-up.

Methods

A retrospective analysis was conducted on 183 TKAs in 180 patients treated with OxZr femoral component between January 2011 and December 2012. Patients had end-stage knee osteoarthritis and failed medical treatment. Exclusion criteria included the use of extension stems, bone reconstruction, or loss to follow-up. Mean follow-up was 10.39 ± 0.49 years. Primary endpoint was implant survival; secondary endpoints included functional and radiographic outcomes.

Results

Eleven revisions were performed, all due to aseptic loosening of the tibial component. The 10-year survival rate for aseptic loosening was 94% (95% CI: 90.6–97.5%), and overall survival was 89.1% (95% CI: 84.7–93.7%). Functional scores improved significantly: the IKS function score rose from 50.7 ± 11.5 to 83.2 ± 13.9, and the IKS knee score from 67.5 ± 8.3 to 88.9 ± 8.2 (both p < 0.001). Satisfaction was high, with 73.3% of patients reporting being satisfied or very satisfied. Radiolucent lines appeared in 36.6% of cases. Cement type and operative time were significant risk factors for tibial loosening.

Conclusion

The TKA with an OxZr femoral component showed good long-term survival and functional outcomes, though tibial loosening remains a concern, potentially linked to cement type.

背景：本研究旨在评估至少10年随访后使用氧化锆（OxZr）股骨组件的后稳定全膝关节置换术（TKA）的长期生存和临床结果。方法：回顾性分析2011年1月至2012年12月180例经OxZr股骨假体治疗的患者183例tka。患者患有终末期膝骨关节炎，药物治疗失败。排除标准包括使用延伸茎、骨重建或随访丢失。平均随访10.39±0.49年。主要终点是种植体存活；次要终点包括功能和影像学结果。结果：进行了11次翻修，全部是由于胫骨部件的无菌松动。无菌性松动的10年生存率为94% (95% CI: 90.6-97.5%)，总生存率为89.1% （95% CI: 84.7-93.7%）。功能评分显著改善：IKS功能评分从50.7±11.5上升到83.2±13.9，IKS膝关节评分从67.5±8.3上升到88.9±8.2（均为p）结论：OxZr股骨假体TKA具有良好的长期生存和功能结果，尽管胫骨松动仍然存在问题，可能与骨水泥类型有关。

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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

Predictors associated with failing to achieve a patient-acceptable symptom state in the Oxford Knee Score following total knee arthroplasty 全膝关节置换术后牛津膝关节评分中未能达到患者可接受症状状态的预测因素。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-02-03 DOI: 10.1016/j.knee.2026.104354

Steve Robins , Eliott Martinson , Gillian Leitch , Nick D. Clement

Aim

To define the Patient-Acceptable Symptom State (PASS) in the Oxford Knee Score (OKS) following total knee arthroplasty (TKA) and identify independent preoperative factors associated with failure to achieve this threshold.

Methods

A retrospective cohort of 3304 patients undergoing primary TKA who completed preoperative and 6-month OKS was identified from an arthroplasty registry. The PASS was defined using receiver operating curve analysis, using patient satisfaction at 6 months as the anchor. Regression analysis was used to identify independent preoperative predictors of achieving the PASS.

Results

The PASS was defined as OKS ≥31 (area under the curve [AUC] 0.865, 95% CI 0.850–0.881) with 2333 (70.6%) patients achieving this. Patients not achieving a PASS were younger, had a higher BMI, and worse baseline PROMs (all p < 0.001). Higher preoperative OKS (odds ratio [OR] 1.09 per point) and EQ-VAS (OR 1.01 per point) were independently associated with achieving a PASS (both p < 0.001). A preoperative OKS ≤19 was associated with achieving a PASS (AUC 0.707). PASS achievers were more likely to be satisfied (OR 15.3, p < 0.001), though 54.4% of non-achievers were also satisfied.

Conclusion

The PASS was defined as ≥31 points in the OKS at 6 months following TKA. Lower preoperative OKS and EQ-VAS scores were associated with failure to achieve this threshold. While PASS attainment was associated with patient satisfaction, 54% of those not achieving a PASS were still satisfied, highlighting a limitation of this PROM threshold in isolation.

Level of evidence

Retrospective study, Level III.

目的：定义全膝关节置换术（TKA）后牛津膝关节评分（OKS）中的患者可接受症状状态（PASS），并确定与未能达到该阈值相关的独立术前因素。方法：从关节置换术登记处确定3304例完成术前和6个月OKS的原发性TKA患者的回顾性队列。PASS采用受试者工作曲线分析来定义，以患者6个月时的满意度为锚点。回归分析用于确定实现PASS的独立术前预测因素。结果：通过定义为OKS≥31（曲线下面积[AUC] 0.865, 95% CI 0.850-0.881）， 2333例（70.6%）患者达到该标准。未达到PASS的患者更年轻，BMI更高，基线PROMs更差（均为p）。结论：TKA后6个月的OKS中，PASS的定义为≥31分。术前较低的OKS和EQ-VAS评分与未能达到该阈值相关。虽然达到PASS与患者满意度相关，但54%未达到PASS的患者仍然满意，这突出了孤立的PROM阈值的局限性。证据级别：回顾性研究，III级。

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引用次数: 0

Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials 全膝关节置换术前外侧皮肤切口与术后1年低感觉发生率相关：一项随机试验荟萃分析

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-06-01 Epub Date: 2026-01-23 DOI: 10.1016/j.knee.2026.104345

Omar E.S. Mostafa , Eden E.S. Mostafa , Tahir Khaleeq , Osama Aweid , Loiy Alkhatib , Amit Meena , Bolarinwa Akinola , Usman Ahmed , Shahbaz S. Malik

Background

A meta-analysis of randomised trials was conducted to compare clinical and functional outcomes between the standard anteromedial or midline skin incision and unconventional anterolateral incision for total knee arthroplasty (TKA).

Methods

This study was registered prospectively on the INPLASY database. Literature search was performed on 14th December 2024 in accordance with PRISMA. Only randomised controlled trials (RCTs) comparing anterolateral incision (ALI) versus standard (midline or anteromedial) incision (SI) were included and quality-assessed. Outcomes at 1 year postoperatively were prevalence of numbness, surface area of skin numbness, degrees of knee flexion, Visual Analogue Scale (VAS), Forgotten Joint Score (FJS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).

Results

Eight RCTs totalling 609 patients (ALI 276 vs. SI 333) were included. Mean age, BMI and proportion of male patients were comparable between the two groups. There was no baseline difference between the two groups for the incision length or operative duration. Statistical difference was observed for two outcomes favouring the ALI group: prevalence of hypoesthesia (OR 0.36, CI 0.17–0.77, P = 0.008) and surface area of numbness (SMD −1.04, CI −1.80 to −0.28, P = 0.007). No significant difference was observed in KOOS (SMD 0.16, CI – 0.07 to revman 0.38, P = 0.17), FJS (SMD −0.14, CI −0.39 to 0.12, P = 0.30) and VAS (SMD −0.10, CI −0.39 to 0.20, P = 0.51).

Conclusion

An anterolateral incision to TKA results in a lower rate and smaller surface area of numbness at 1-year, with no difference in patient-reported outcome measures.

背景：一项随机试验荟萃分析比较全膝关节置换术（TKA）中标准前内侧或中线皮肤切口与非常规前外侧切口的临床和功能结果。方法本研究在INPLASY数据库中进行前瞻性注册。文献检索于2024年12月14日按照PRISMA进行。仅纳入比较前外侧切口（ALI）与标准（中线或前内侧）切口（SI）的随机对照试验（rct）并进行质量评估。术后1年的结果是麻木的发生率、皮肤麻木的表面积、膝关节屈曲程度、视觉模拟量表（VAS）、遗忘关节评分（FJS）和膝关节损伤和骨关节炎结局评分（oos）。结果共纳入8项rct，共609例患者（ALI 276 vs. SI 333）。两组患者的平均年龄、BMI和男性患者比例具有可比性。两组之间的切口长度和手术时间没有基线差异。ALI组的两项结果有统计学差异：感觉不足发生率（OR 0.36, CI 0.17-0.77, P = 0.008）和麻木表面积（SMD - 1.04, CI - 1.80 - 0.28, P = 0.007）。KOOS （SMD - 0.16, CI - 0.07 ~ revman 0.38, P = 0.17）、FJS （SMD - 0.14, CI - 0.39 ~ 0.12, P = 0.30）和VAS （SMD - 0.10, CI - 0.39 ~ 0.20, P = 0.51）均无显著差异。结论TKA前外侧切口1年的麻木率较低，麻木面积较小，患者报告的结果测量无差异。

{"title":"Anterolateral skin incision for total knee arthroplasty is associated with lower prevalence of postoperative hypoesthesia at 1-year: a meta-analysis of randomised trials","authors":"Omar E.S. Mostafa , Eden E.S. Mostafa , Tahir Khaleeq , Osama Aweid , Loiy Alkhatib , Amit Meena , Bolarinwa Akinola , Usman Ahmed , Shahbaz S. Malik","doi":"10.1016/j.knee.2026.104345","DOIUrl":"10.1016/j.knee.2026.104345","url":null,"abstract":"<div><h3>Background</h3><div>A meta-analysis of randomised trials was conducted to compare clinical and functional outcomes between the standard anteromedial or midline skin incision and unconventional anterolateral incision for total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>This study was registered prospectively on the INPLASY database. Literature search was performed on 14th December 2024 in accordance with PRISMA. Only randomised controlled trials (RCTs) comparing anterolateral incision (ALI) versus standard (midline or anteromedial) incision (SI) were included and quality-assessed. Outcomes at 1 year postoperatively were prevalence of numbness, surface area of skin numbness, degrees of knee flexion, Visual Analogue Scale (VAS), Forgotten Joint Score (FJS) and Knee Injury and Osteoarthritis Outcome Score (KOOS).</div></div><div><h3>Results</h3><div>Eight RCTs totalling 609 patients (ALI 276 vs. SI 333) were included. Mean age, BMI and proportion of male patients were comparable between the two groups. There was no baseline difference between the two groups for the incision length or operative duration. Statistical difference was observed for two outcomes favouring the ALI group: prevalence of hypoesthesia (OR 0.36, CI 0.17–0.77, <em>P</em> = 0.008) and surface area of numbness (SMD −1.04, CI −1.80 to −0.28, <em>P</em> = 0.007). No significant difference was observed in KOOS (SMD 0.16, CI – 0.07 to revman 0.38, <em>P</em> = 0.17), FJS (SMD −0.14, CI −0.39 to 0.12, <em>P</em> = 0.30) and VAS (SMD −0.10, CI −0.39 to 0.20, <em>P</em> = 0.51).</div></div><div><h3>Conclusion</h3><div>An anterolateral incision to TKA results in a lower rate and smaller surface area of numbness at 1-year, with no difference in patient-reported outcome measures.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"60 ","pages":"Article 104345"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039605","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

OsteoFusionFormer: dual-stage transformer fusion framework for knee osteoporosis diagnosis. osteoffusionformer：用于膝关节骨质疏松诊断的双级变压器融合框架。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-21 DOI: 10.1016/j.knee.2026.104428

Eshika Jain, Vinay Kukreja, Pratham Kaushik

Aim: The aim of the study is to introduce a new model, OsteoFusionFormer, namely a dual transformer model for automatic classification of knee osteoporosis into three groups: Normal, Osteopenia, and Osteoporosis. The objective was to overcome single-branch transformer limitations by incorporating anatomical global context and fine-grained bone features to increase diagnostic accuracy.

Method: OsteoFusionFormer combines two parallel arms, a Vision Transformer (ViT) for global anatomical representation and a Bone-Aware Transformer (BAT) for localised bone-specific features. These are combined with a hierarchical dual fusion strategy. First, cross-attention enables feature-level fusion between ViT and BAT embeddings. Next, a confidence-weighted decision-level fusion employs an auxiliary gating network to compute adaptive weights (α₁, α₂), yielding a soft-ensemble prediction. Ablation studies systematically remove modules (ViT, BAT, gating, CLAHE) to assess contributions. Interpretability is assessed via attention maps and Grad-CAM++.

Results: OsteoFusionFormer had 96.8% overall accuracy, which exceeds the accuracy of ViT-only (91.3%), BAT-only (90.1%), and late fusion averaging (93.6%). Ablation verified a drop in performance without BAT (-5.5%), ViT (-6.7%), gating (-3.2%), and CLAHE (-4.4%). Performance was verified with 15 new kinds of bone-specific indicators: Bone-Aware Accuracy: 96.8%, Trabecular Sensitivity Index: 95.2%, Cortical Degeneration Detection Rate: 97.6%, Joint Space Narrowing Recall: 96.1%, Bone Class Specificity: 97.2%, Osteopenia Detection Precision: 92.4%, Bone Focus Ratio: 91.8%, Bone Entropy Index: 0.26 bits, Visual interpretability showed good expert agreement (BIAS: 87.3%).

Conclusion: By combining global and local bone features, OsteoFusionFormer provides better accuracy, diagnosis sensitivity, and structure focus with an explainability guarantee.

目的：本研究的目的是介绍一种新的模型osteoffusionformer，即双变形模型，用于将膝关节骨质疏松症自动分为正常、骨质减少和骨质疏松三组。目的是通过结合解剖学全局背景和细粒度骨骼特征来提高诊断准确性，从而克服单分支变压器的局限性。方法：osteoffusionformer结合了两个平行臂，一个视觉变压器（ViT）用于全局解剖表征，一个骨感知变压器（BAT）用于局部骨特异性特征。这些与分层双重融合策略相结合。首先，交叉关注实现了ViT和BAT嵌入之间的特征级融合。其次，置信度加权决策级融合采用辅助门控网络计算自适应权重（α1, α2），得到软集合预测。消融研究系统地去除模块（ViT， BAT，门控，CLAHE）来评估贡献。可解释性通过注意图和grad-cam++进行评估。结果：osteoffusionformer的总体准确率为96.8%，超过了ViT-only（91.3%）、BAT-only（90.1%）和后期融合平均（93.6%）的准确率。消融证实，在没有BAT（-5.5%）、ViT（-6.7%）、门控（-3.2%）和CLAHE（-4.4%）的情况下，性能下降。15种新的骨特异性指标：骨感知准确率：96.8%，骨小梁敏感性指数：95.2%，皮质变性检出率：97.6%，关节间隙狭窄召回率：96.1%，骨类特异性：97.2%，骨质减少检测精度：92.4%，骨聚焦比：91.8%，骨熵指数：0.26位，视觉可解释性显示良好的专家一致性（BIAS: 87.3%）。结论：osteoffusionformer结合了整体和局部骨骼特征，提供了更好的准确性、诊断敏感性和结构焦点，并具有可解释性保证。

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引用次数: 0

Fragility of randomized controlled trials comparing cemented and cementless components in total knee arthroplasty: A systematic review. 比较全膝关节置换术中骨水泥和无骨水泥构件的随机对照试验的脆弱性：一项系统综述。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-21 DOI: 10.1016/j.knee.2026.104422

Jennifer Yu, Avanish Yendluri, Suraj A Dhanjani, John K Cordero, John J Corvi, Michael N Megafu, Calin S Moucha, Brett L Hayden, Robert L Parisien

Background: The use of cemented versus cementless components in total knee arthroplasty (TKA) remains a subject of ongoing debate, with a recent rise in cementless TKA. In this study, we assessed the robustness of outcomes reported in randomized controlled trials (RCTs) comparing cemented and cementless components in TKA.

Methods: PubMed, Embase, and Medline were queried from January 1, 2010-February 28, 2024 for RCTs with intervention arms stratified for cemented and cementless TKA components. The fragility index (FI) and reverse fragility index (rFI) were defined as the number of outcome event reversals needed to alter outcome significance. The fragility quotient (FQ) was determined by dividing the FI or rFI by the study sample size.

Results: From 176 screened RCTs, 13 studies met inclusion criteria, yielding 48 total outcomes. There were 13 statistically significant outcomes which had a median FI of 4. Thus, the significance of these outcomes may be lost by 4 patient outcome event reversals. Furthermore, an outcome event reversal in 4.1% of patients (median FQ 0.041) may be sufficient to reverse statistically significant outcomes. The median rFI across the 35 non-significant outcomes was found to be 5. In a subanalysis by outcome type, outcomes relating to component migration were found to be most fragile with a median FI of just 2. The median FI for radiolucency and complication outcomes were both equal to 5, while the median FI's for function and satisfaction were both 8. In 46% of outcomes, the number of patients lost to follow-up exceeded the outcome FI/rFI.

Conclusion: RCTs comparing cemented versus cementless TKA have considerable clinical implications in surgical decision-making, yet the outcomes in these studies are statistically fragile. Standardized reporting of FI, rFI, and FQ metrics may facilitate a more comprehensive assessment of the stability of study outcomes in TKA RCTs.

背景：在全膝关节置换术（TKA）中使用骨水泥或无骨水泥构件仍然是一个持续争论的主题，近年来无骨水泥TKA有所增加。在这项研究中，我们评估了随机对照试验（rct）中比较TKA中骨水泥和非骨水泥组件的结果的稳健性。方法：检索2010年1月1日至2024年2月28日期间PubMed、Embase和Medline的随机对照试验（rct），其中干预臂分层为骨水泥和非骨水泥TKA组件。脆弱性指数（FI）和反向脆弱性指数（rFI）定义为改变结果显著性所需的结果事件逆转次数。脆弱性商（FQ）由FI或rFI除以研究样本量确定。结果：在176项筛选的随机对照试验中，13项研究符合纳入标准，产生48个总结果。有13个具有统计学意义的结果的中位FI为4。因此，这些结果的重要性可能因4例患者结果事件逆转而丧失。此外，4.1%的患者（中位FQ为0.041）的结果事件逆转可能足以逆转具有统计学意义的结果。35个非显著结果的rFI中位数为5。在结果类型的亚分析中，与成分迁移相关的结果被发现是最脆弱的，中位FI仅为2。放射透光度和并发症结果的中位FI均为5，而功能和满意度的中位FI均为8。在46%的结果中，失去随访的患者数量超过了结果FI/rFI。结论：比较骨水泥与无骨水泥TKA的随机对照试验对手术决策具有相当大的临床意义，但这些研究的结果在统计学上是脆弱的。FI、rFI和FQ指标的标准化报告可能有助于更全面地评估TKA随机对照试验研究结果的稳定性。

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引用次数: 0

Concordance of ChatGPT, Gemini, Claude, and OpenEvidence with the 2024 AAOS guidelines on acute isolated meniscal pathology. ChatGPT、Gemini、Claude和OpenEvidence与2024年AAOS急性孤立性半月板病理指南的一致性

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-21 DOI: 10.1016/j.knee.2026.104427

Wei-Kuo Hsu, Hao-Chun Chuang, Yang-Yi Wang, Kai-Lan Hsu, Fa-Chuan Kuan, Wei-Ren Su, Chung-Hsun Chang, Chih-Kai Hong

Purpose: To evaluate the reliability and clinical applicability of the three most commonly used large language models (LLMs) (ChatGPT, Gemini, and Claude) and a domain-specific artificial intelligence (AI) platform (OpenEvidence) in providing recommendations for acute isolated meniscal pathology, to compare their accuracy, and to assess the consistency between American Academy of Orthopedic Surgeons (AAOS) Clinical Practice Guidelines (CPG) recommendations and AI-generated guidance.

Methods: An exploratory cross-sectional benchmarking analysis evaluated concordance of three large language models (ChatGPT, Gemini, Claude) and one domain-specific AI (OpenEvidence) with 2024 AAOS clinical practice guidelines for acute isolated meniscal pathology. Nine guideline recommendations were converted into standardized questions and presented to each AI model on the same day. Three sports medicine orthopedic specialists independently assessed responses as concordant or discordant, with disagreements resolved by majority decision. Statistical analysis used SPSS 29, employing Cochran's Q test for concordance assessment and Fleiss' kappa for inter-rater reliability.

Results: OpenEvidence achieved perfect concordance (9/9, 100%), followed by ChatGPT (8/9, 89%), Gemini and Claude (both 7/9, 78%). Overall concordance rate was 86% (31/36). Concordance was 100% for strong and consensus recommendations, 75% for moderate and limited recommendations. Cochran's Q test showed no significant difference among models (Q = 3.00, p = 0.392). Inter-rater reliability demonstrated almost perfect agreement (κ = 0.825, 95% CI: 0.637-1.014).

Conclusions: Although ChatGPT, Gemini, and Claude demonstrated high concordance with the AAOS CPG for acute isolated meniscal pathology, their responses were not consistently guideline-concordant. OpenEvidence achieved the highest descriptive concordance rate (100%); however, statistical superiority could not be established due to the limited number of guideline items. This exploratory benchmarking analysis suggests that domain-specific AI models may represent a valuable tool for retrieving information on acute isolated meniscal injuries.

Clinical relevance: The difference between domain-specific AI model and general LLMs underscore the need to educate the general public and clinicians about the limitations of general-purpose chatbots, emphasizing that LLM outputs should be interpreted with caution in real-world practice, while tools like OpenEvidence exist for evidence-based information.

目的：评估三种最常用的大型语言模型（llm）（ChatGPT、Gemini和Claude）和一个特定领域的人工智能（AI）平台（OpenEvidence）在提供急性孤立半月板病理建议方面的可靠性和临床适用性，比较它们的准确性，并评估美国骨科医师学会（AAOS）临床实践指南（CPG）建议与人工智能生成指南之间的一致性。方法：通过探索性的横断面基准分析，评估了三个大型语言模型（ChatGPT、Gemini、Claude）和一个特定领域的AI （OpenEvidence）与2024年AAOS急性孤立半月板病理临床实践指南的一致性。9条指南建议被转换成标准化问题，并在同一天呈现给每个AI模型。三名运动医学骨科专家独立评估反应是否一致，分歧由多数决定解决。统计分析采用SPSS 29，一致性评估采用Cochran’s Q检验，信度评估采用Fleiss’kappa检验。结果：OpenEvidence达到了完美的一致性（9/ 9,100%），其次是ChatGPT (8/ 9,89%)， Gemini和Claude（均为7/ 9,78%）。总体符合率为86%（31/36）。强烈和一致建议的一致性为100%，中度和有限建议的一致性为75%。Cochran’s Q检验显示各模型间差异无统计学意义（Q = 3.00, p = 0.392）。评估间信度几乎完全一致（κ = 0.825, 95% CI: 0.637-1.014）。结论：尽管ChatGPT、Gemini和Claude在急性孤立性半月板病理上与AAOS CPG高度一致，但他们的反应并不一致。OpenEvidence达到了最高的描述一致性率（100%）；然而，由于指南项目数量有限，无法确定统计优势。这一探索性基准分析表明，特定领域的人工智能模型可能是检索急性孤立半月板损伤信息的有价值的工具。临床相关性：特定领域人工智能模型与普通法学硕士之间的差异强调了教育公众和临床医生关于通用聊天机器人局限性的必要性，强调法学硕士输出在现实世界的实践中应该谨慎解释，而像OpenEvidence这样的工具存在于循证信息中。

{"title":"Concordance of ChatGPT, Gemini, Claude, and OpenEvidence with the 2024 AAOS guidelines on acute isolated meniscal pathology.","authors":"Wei-Kuo Hsu, Hao-Chun Chuang, Yang-Yi Wang, Kai-Lan Hsu, Fa-Chuan Kuan, Wei-Ren Su, Chung-Hsun Chang, Chih-Kai Hong","doi":"10.1016/j.knee.2026.104427","DOIUrl":"https://doi.org/10.1016/j.knee.2026.104427","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the reliability and clinical applicability of the three most commonly used large language models (LLMs) (ChatGPT, Gemini, and Claude) and a domain-specific artificial intelligence (AI) platform (OpenEvidence) in providing recommendations for acute isolated meniscal pathology, to compare their accuracy, and to assess the consistency between American Academy of Orthopedic Surgeons (AAOS) Clinical Practice Guidelines (CPG) recommendations and AI-generated guidance.</p><p><strong>Methods: </strong>An exploratory cross-sectional benchmarking analysis evaluated concordance of three large language models (ChatGPT, Gemini, Claude) and one domain-specific AI (OpenEvidence) with 2024 AAOS clinical practice guidelines for acute isolated meniscal pathology. Nine guideline recommendations were converted into standardized questions and presented to each AI model on the same day. Three sports medicine orthopedic specialists independently assessed responses as concordant or discordant, with disagreements resolved by majority decision. Statistical analysis used SPSS 29, employing Cochran's Q test for concordance assessment and Fleiss' kappa for inter-rater reliability.</p><p><strong>Results: </strong>OpenEvidence achieved perfect concordance (9/9, 100%), followed by ChatGPT (8/9, 89%), Gemini and Claude (both 7/9, 78%). Overall concordance rate was 86% (31/36). Concordance was 100% for strong and consensus recommendations, 75% for moderate and limited recommendations. Cochran's Q test showed no significant difference among models (Q = 3.00, p = 0.392). Inter-rater reliability demonstrated almost perfect agreement (κ = 0.825, 95% CI: 0.637-1.014).</p><p><strong>Conclusions: </strong>Although ChatGPT, Gemini, and Claude demonstrated high concordance with the AAOS CPG for acute isolated meniscal pathology, their responses were not consistently guideline-concordant. OpenEvidence achieved the highest descriptive concordance rate (100%); however, statistical superiority could not be established due to the limited number of guideline items. This exploratory benchmarking analysis suggests that domain-specific AI models may represent a valuable tool for retrieving information on acute isolated meniscal injuries.</p><p><strong>Clinical relevance: </strong>The difference between domain-specific AI model and general LLMs underscore the need to educate the general public and clinicians about the limitations of general-purpose chatbots, emphasizing that LLM outputs should be interpreted with caution in real-world practice, while tools like OpenEvidence exist for evidence-based information.</p>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"61 ","pages":"104427"},"PeriodicalIF":2.0,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500583","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

Comment on "Inter-examiner and inter-day reliability of dynamic tibiofemoral movements measurement using motion capture during walking and jumping tasks". 评论“在行走和跳跃任务中使用动作捕捉测量动态胫股运动的考官间和日间可靠性”。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-19 DOI: 10.1016/j.knee.2026.104421

Palavardhan Peddapalegani, Raghav Gupta, Priyanka Bansal, Pankaj Nainwal, Hariharan Srinivasan

Background (including aims of the study): Reliable quantification of dynamic anterior tibia translation and internal tibia rotation is essential for advancing anterior cruciate ligament research beyond static clinical assessments. While optoelectronic motion capture combined with functional calibration techniques has been proposed as an accessible approach, evidence regarding its robustness across examiners, days, and task demands remains limited. This commentary aims to critically appraise the methodological and translational implications of recently reported reliability estimates for dynamic tibiofemoral measurements during walking and jump-landing tasks.

Method: A focused methodological evaluation was undertaken, examining the analytical framework used to assess inter-examiner and inter-day reliability, the interpretation of time-series intraclass correlation coefficients and standard error of measurement, and the alignment of these metrics with clinically meaningful inference. Particular attention was paid to task dependency, biological versus methodological variability, and the relevance of reliability estimates across different phases of movement.

Results: The reported findings indicate generally good-to-excellent reliability for dynamic tibiofemoral measures, with superior consistency during high-load phases of jump landings. However, reliance on pointwise time-normalized metrics may obscure phase-specific variability, and relative error estimates expressed as percentages of range of motion lack direct clinical anchoring. Differences between inter-examiner and inter-day reliability further suggest sensitivity to behavioral and task-execution factors that were not formally quantified.

Conclusion: The evaluated approach represents an important step toward accessible assessment of dynamic knee stability. Future studies may benefit from integrating event-based reliability metrics, contextualizing measurement error against clinically relevant thresholds, and accounting for variability in movement strategy to enhance translational applicability in anterior cruciate ligament research.

背景（包括研究目的）：可靠的动态胫骨前移位和胫骨内旋量化是推进前交叉韧带研究超越静态临床评估的必要条件。虽然光电运动捕捉与功能校准技术相结合已被提出作为一种可访问的方法，但关于其在审查员，天数和任务需求方面的稳健性的证据仍然有限。这篇评论的目的是批判性地评估最近报道的在行走和跳跃着陆任务中动态胫股测量的可靠性估计的方法学和翻译意义。方法：进行了重点方法学评价，检查了用于评估审查员之间和日间可靠性的分析框架，时间序列类内相关系数和测量标准误差的解释，以及这些指标与临床有意义的推断的一致性。特别注意的是任务依赖性，生物与方法的可变性，以及在不同运动阶段的可靠性估计的相关性。结果：所报道的研究结果表明，动态胫股测量总体上具有良好到卓越的可靠性，在跳跃着陆的高负荷阶段具有卓越的一致性。然而，依赖于逐点时间归一化的指标可能会模糊特定阶段的可变性，并且以活动范围百分比表示的相对误差估计缺乏直接的临床锚定。内部考官和日间可靠性之间的差异进一步表明对行为和任务执行因素的敏感性没有正式量化。结论：经评估的入路是实现动态膝关节稳定性评估的重要一步。未来的研究可能会受益于整合基于事件的可靠性指标，将测量误差与临床相关阈值相结合，并考虑运动策略的可变性，以增强前交叉韧带研究的翻译适用性。

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引用次数: 0

Sex matters: central sensitization and opioid use after total knee arthroplasty. 性别因素：全膝关节置换术后中枢致敏和阿片类药物的使用。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-19 DOI: 10.1016/j.knee.2026.104426

J Ryan Martin, Reece I Vesperman, Mary S Dietrich, Courtney E Baker, Nonye Nwokedi, Madonna Agaiby, Makary Girgis, Gregory Polkowski, Lori Schirle

Background: Total knee arthroplasty (TKA) is a prevalent orthopaedic procedure often accompanied by significant postoperative pain. Central sensitization, marked by increased nervous system reactivity, may influence opioid consumption variability after TKA. Investigating central sensitization, particularly regarding sex differences, could enhance postoperative care and opioid prescribing practices for TKA patients.

Methods: Patients scheduled for TKA were assessed preoperatively and at 2 and 6 weeks postoperatively. Data collected included demographics, PROMIS-29, Brief Pain Inventory (BPI), Pain Catastrophizing Scale, Central Sensitization Inventory (CSI), and quantitative sensory testing. Participants recorded opioid use in home diaries over 6 weeks, measured in morphine milligram equivalents (MME) and days of use. Analyses involved descriptive statistics, sex differences, correlations, and regression models.

Results: Thirty-nine participants (59% females) were enrolled. CSI scores indicated sub-clinical central sensitization in a majority of patients. No sex differences were observed in patient-reported outcomes, but males consumed significantly more opioids than females (median MME: 248 vs 519, p = 0.023), with similar durations of use (median days: 18 vs 16, p = 0.50). Pain levels correlated with opioid use duration (rs = 0.50, p = 0.001), stronger in males (rs = 0.69) than females (rs = 0.33). Central sensitization correlated with opioid use duration in males (rs = 0.81, p < 0.001), unlike females (rs = -0.11, p = 0.64).

Conclusion: Central sensitization significantly impacts opioid use in males post-TKA, challenging existing beliefs. Males with preoperative CSI scores indicating central sensitization showed sustained opioid use above norms, suggesting CSI as a predictive tool for postoperative opioid consumption. Recognizing sex-specific differences in central sensitization could improve pain management and opioid prescribing in TKA.

背景：全膝关节置换术（TKA）是一种常见的骨科手术，通常伴有明显的术后疼痛。中枢致敏，以神经系统反应性增加为标志，可能影响TKA后阿片类药物消耗的变异性。研究中枢致敏，特别是关于性别差异，可以加强TKA患者的术后护理和阿片类药物处方实践。方法：术前、术后2周和6周对计划行TKA的患者进行评估。收集的数据包括人口统计学、promises -29、简短疼痛量表（BPI）、疼痛灾变量表、中枢致敏性量表（CSI）和定量感觉测试。参与者在6周的家庭日记中记录了阿片类药物的使用情况，以吗啡毫克当量（MME）和使用天数来衡量。分析包括描述性统计、性别差异、相关性和回归模型。结果：39名参与者（59%为女性）入组。CSI评分显示大多数患者有亚临床中枢致敏。在患者报告的结果中没有观察到性别差异，但男性消耗的阿片类药物明显多于女性（中位MME: 248 vs 519， p = 0.023），使用时间相似（中位天数：18 vs 16， p = 0.50）。疼痛水平与阿片类药物使用时间相关（rs = 0.50, p = 0.001），男性（rs = 0.69）强于女性（rs = 0.33）。结论：中枢致敏显著影响tka后男性阿片类药物的使用，挑战了现有的观点。术前CSI评分表明中枢致敏的男性持续使用阿片类药物高于正常值，表明CSI可作为术后阿片类药物使用的预测工具。认识到中枢致敏的性别特异性差异可以改善TKA患者的疼痛管理和阿片类药物处方。

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引用次数: 0