IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-21 DOI: 10.1016/j.knee.2026.104325

Mette J. Hansen , Mette Garval , Jeppe Lange , Charlotte Runge , Søren T. Skou , Nicolai K. Kristensen

Background

Opioids are prescribed to alleviate pain after knee arthroplasty. However, prolonged postoperative opioid use may complicate recovery and potentially increase the risk of persistent use. This study explores opioid use following fast-track knee arthroplasty.

Method

This prospective, single-center, observational study included patients scheduled for fast-track knee arthroplasty. A total of 1195 patients were included, of whom 996 underwent total knee arthroplasty (TKA) and 199 medial unicompartmental knee arthroplasty (mUKA). Participants completed a study-specific questionnaire on opioid use before surgery and at 3- and 12-month follow-up (FU).

Patient-reported data at 12-month FU were available for 797 TKA (80%) and 160 mUKA (80%).

Participants were categorized based on preoperative opioid use. The primary outcome was patient-reported opioid use at 12-month FU. Reasons for opioid use were also registered.

Results

At 12-month FU, 3% (95% confidence interval (CI) 2–4; 24 patients) of TKA patients reported daily opioid use attributed to prosthetic knee joint pain; the proportion was higher among patients with preoperative daily opioid use (17%, CI 10–26, 17 patients) compared to those without preoperative use (1%, CI 0.2–1.5, 4 patients). 1 mUKA patient (0.6%, CI 0–3) reported daily opioid use attributed to prosthetic knee joint pain at 12-month FU.

Conclusion

Persistent daily opioid use due to pain in the prosthetic knee joint was rare 12 months after fast-track TKA and mUKA. Patients with preoperative daily opioid use had a markedly higher risk of continued use compared to those without prior opioid use.

背景：阿片类药物被用于缓解膝关节置换术后的疼痛。然而，术后长时间使用阿片类药物可能会使恢复复杂化，并可能增加持续使用的风险。本研究探讨快速通道膝关节置换术后阿片类药物的使用。方法这项前瞻性、单中心、观察性研究纳入了计划行快速膝关节置换术的患者。共纳入1195例患者，其中996例行全膝关节置换术（TKA）， 199例行内侧单室膝关节置换术（mUKA）。参与者在手术前和3个月和12个月的随访（FU）中完成了一份关于阿片类药物使用的研究特定问卷。在12个月FU时，有797例TKA（80%）和160例mUKA（80%）患者报告的数据。参与者根据术前阿片类药物使用情况进行分类。主要终点是12个月FU时患者报告的阿片类药物使用情况。阿片类药物使用的原因也进行了登记。结果12个月FU， 3%(95%置信区间（CI） 2-4；24例TKA患者报告因假体膝关节疼痛而每日使用阿片类药物；术前每日使用阿片类药物的患者比例（17%,CI 10 - 26,17例）高于术前未使用阿片类药物的患者（1%,CI 0.2-1.5, 4例）。1名mUKA患者（0.6%,CI 0-3）报告在FU 12个月时因假体膝关节疼痛而每天使用阿片类药物。结论快速通道TKA和mUKA术后12个月因人工膝关节疼痛持续每日使用阿片类药物的情况较为罕见。术前每日使用阿片类药物的患者与未使用阿片类药物的患者相比，继续使用阿片类药物的风险明显更高。

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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 : 2026-01-20 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

Manipulation under anesthesia is independently associated with development of prosthetic joint infection within 1 year of total knee arthroplasty 麻醉下操作与全膝关节置换术后1年内假体关节感染的发生独立相关

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-16 DOI: 10.1016/j.knee.2026.104324

Muhammad Umar Jawad , Haroon M. Kisana , Devin W. Morrow , Thomas R. Goodine , J. Brock Walker , Andrew P. Adamczyk

Background

Prosthetic joint infection (PJI) is a devastating complication after total knee arthroplasty (TKA). Manipulation under anesthesia (MUA) is a treatment used to address post-operative stiffness following TKA. Association between MUA and development of PJI is controversial.

Methods

A national claims database (PearlDiver®) was used to isolate TKA and MUA within 4 months of TKA cases using the Current Procedural Terminology (CPT) codes from 2010 to 2022. PJI cases within 1 year of TKA and previously validated risk factors were identified using International Classification of Disease, 9th &10th (ICD-9&10) codes. Chi-square and logistic regression were used for univariable and multivariable analyses respectively.

Results

A total of 1,660,301 TKA cases were isolated. MUA within 16 weeks of TKA was performed in 57,113 cases. PJI within 1 year of TKA was diagnosed in 3302 cases. Rate of PJI among patients undergoing MUA (0.26%; n = 146) was significantly (p = 0.002) higher than rate of PJI among patients not undergoing MUA (0.197%; n = 3156). Multivariable analysis showed MUA within 16 weeks to be independently associated with PJI within 1 year of TKA (OR = 1.34; 95% CI: 1.13–1.58; p < 0.001). Male gender (OR = 2.36; 95%CI: 1.7–3.29; p < 0.001), deficiency anemia (OR = 1.75; 95%CI: 0.98–2.93; p = 0.044), rheumatoid arthritis (OR = 3.23; 95%CI: 1.44–6.26; p = 0.002) and blood transfusion (OR = 7.26; 95%CI: 4.28–11.67; p < 0.001) were identified as independent risk factors for development of PJI in this cohort. The ROC-AUC for the model was 0.7.

Conclusion

MUA within 16 weeks of TKA is independently associated with development of PJI within 1 year, on multivariable analysis. Further studies will help delineate whether MUA is causative of infection or if stiffness is an early symptom of an already existing, indolent infection.

假体关节感染（PJI）是全膝关节置换术（TKA）后最严重的并发症。麻醉下操作（MUA）是一种用于解决TKA术后僵硬的治疗方法。MUA与PJI发展之间的关系是有争议的。方法采用国家索赔数据库（PearlDiver®），采用现行程序术语（CPT）代码对2010 - 2022年4个月内的TKA病例进行TKA和MUA分离。使用国际疾病分类第9和第10 （ICD-9&10）代码确定TKA 1年内的PJI病例和先前验证的危险因素。单变量分析采用卡方回归，多变量分析采用logistic回归。结果共分离TKA病例1660301例。57,113例患者在TKA后16周内进行了MUA。3302例TKA术后1年内诊断为PJI。接受MUA的患者PJI发生率（0.26%,n = 146）显著高于未接受MUA的患者PJI发生率（0.197%,n = 3156）。多变量分析显示，16周内的MUA与TKA患者1年内的PJI独立相关（OR = 1.34; 95% CI: 1.13-1.58; p < 0.001）。男性（OR = 2.36; 95%CI: 1.75 - 3.29; p < 0.001）、缺乏性贫血（OR = 1.75; 95%CI: 0.98-2.93; p = 0.044）、类风湿关节炎（OR = 3.23; 95%CI: 1.44-6.26; p = 0.002）和输血（OR = 7.26; 95%CI: 4.28-11.67; p < 0.001）被确定为该队列中PJI发生的独立危险因素。模型的ROC-AUC为0.7。结论经多变量分析，TKA患者16周内mua与1年内PJI的发生独立相关。进一步的研究将有助于确定MUA是否是感染的原因，或者僵硬是否是已经存在的惰性感染的早期症状。

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引用次数: 0

Erratum to “Evaluation of Practice Patellofemoral Instability Collaborative (EPPIC)”. [The Knee 57C (2025) 325–334] “评估实践髌骨不稳定协作（EPPIC）”的勘误。[膝关节57C (2025) 325-334]

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-13 DOI: 10.1016/j.knee.2025.104320

引用次数: 0

Characterization and treatment of symptomatic bipartite patella in pediatric, adolescent, and young adult patients: a large case series 表征和治疗症状双部髌骨在儿童，青少年和年轻成人患者：一个大的病例系列

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-03 DOI: 10.1016/j.knee.2025.104315

Patrick P. Nian, Shae K. Simpson, Amith Umesh, Ariana I. Matarangas, Douglas N. Mintz, Daniel W. Green

Introduction

Bipartite patella (BPP) results from ossification center fusion failure during development. Treatment of symptomatic BPP varies and may include nonoperative management or surgical interventions. However, characteristics distinguishing symptomatic from asymptomatic and operative from nonoperative BPP remain unclear. This study presents a large case series of pediatric, adolescent, and young adult patients with symptomatic BPP and assesses the association between radiographic characteristics and symptomatology.

Methods

We retrospectively reviewed patients ≤21 years diagnosed with BPP or multipartite patella at a single tertiary care hospital from January 2016 to September 2024. Among 73 knees (70 patients), 23 (32 %) were symptomatic. Saupe classification and fragment-to-patellar ratios were obtained from imaging. Radiographic measurements were compared using t tests or Mann-Whitney U tests.

Results

No differences in age, sex, laterality, or fragment size were found between asymptomatic and symptomatic BPP. Of 23 symptomatic knees, 15 (65 %) were treated nonoperatively and 8 (35 %) operatively. Operative patients were older than nonoperative patients (15.3 ± 2.1 vs. 11.3 ± 3.0 years, P = 0.002). All symptomatic patients played at least one sport and, on average, presented with PROMIS mobility, pain interference, physical activity, and HSS Pedi-FABS scores of 38.8 ± 5.8, 52.9 ± 7.8, 47.9 ± 14.2, and 27.0 ± 4.0. There was no significant correlation between preoperative PROMs and fragment size, and no differences in symptom duration or fragment size between nonoperative and operative patients. All 8 operative extremities ultimately underwent fragment excision.

Conclusions

Most symptomatic BPP were managed nonoperatively. Radiographic features did not distinguish symptomatic from asymptomatic or operative from nonoperative cases. Larger studies are needed to refine treatment algorithms and reduce reoperations.

双部髌骨（BPP）是在发育过程中骨化中心融合失败的结果。症状性BPP的治疗方法各不相同，可能包括非手术治疗或手术干预。然而，区分症状性与无症状性、手术性与非手术性BPP的特征尚不清楚。本研究报告了大量的儿童、青少年和年轻成人症状性BPP患者的病例系列，并评估了影像学特征与症状学之间的关系。方法回顾性分析2016年1月至2024年9月在一家三级医院诊断为BPP或多部髌骨的≤21岁的患者。73例膝关节（70例）中，23例（32%）出现症状。从影像学上获得骨瓣分类和碎片与髌骨的比值。射线测量比较采用t检验或Mann-Whitney U检验。结果无症状和有症状的BPP在年龄、性别、侧位或碎片大小上没有差异。在23例有症状的膝关节中，非手术治疗15例（65%），手术治疗8例（35%）。手术患者年龄大于非手术患者（15.3±2.1∶11.3±3.0岁，P = 0.002）。所有有症状的患者至少进行一项运动，平均表现为PROMIS活动能力、疼痛干扰、身体活动，HSS Pedi-FABS评分分别为38.8±5.8、52.9±7.8、47.9±14.2和27.0±4.0。术前PROMs与碎片大小无显著相关性，非手术患者与手术患者在症状持续时间和碎片大小上无差异。所有8个手术肢体最终都进行了碎片切除。结论有症状的BPP多数采用非手术治疗。影像学特征不能区分有症状和无症状，也不能区分手术和非手术病例。需要更大规模的研究来完善治疗算法并减少再手术。

{"title":"Characterization and treatment of symptomatic bipartite patella in pediatric, adolescent, and young adult patients: a large case series","authors":"Patrick P. Nian, Shae K. Simpson, Amith Umesh, Ariana I. Matarangas, Douglas N. Mintz, Daniel W. Green","doi":"10.1016/j.knee.2025.104315","DOIUrl":"10.1016/j.knee.2025.104315","url":null,"abstract":"<div><h3>Introduction</h3><div>Bipartite patella (BPP) results from ossification center fusion failure during development. Treatment of symptomatic BPP varies and may include nonoperative management or surgical interventions. However, characteristics distinguishing symptomatic from asymptomatic and operative from nonoperative BPP remain unclear. This study presents a large case series of pediatric, adolescent, and young adult patients with symptomatic BPP and assesses the association between radiographic characteristics and symptomatology.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients ≤21 years diagnosed with BPP or multipartite patella at a single tertiary care hospital from January 2016 to September 2024. Among 73 knees (70 patients), 23 (32 %) were symptomatic. Saupe classification and fragment-to-patellar ratios were obtained from imaging. Radiographic measurements were compared using <em>t</em> tests or Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>No differences in age, sex, laterality, or fragment size were found between asymptomatic and symptomatic BPP. Of 23 symptomatic knees, 15 (65 %) were treated nonoperatively and 8 (35 %) operatively. Operative patients were older than nonoperative patients (15.3 ± 2.1 vs. 11.3 ± 3.0 years, <em>P</em> = 0.002). All symptomatic patients played at least one sport and, on average, presented with PROMIS mobility, pain interference, physical activity, and HSS Pedi-FABS scores of 38.8 ± 5.8, 52.9 ± 7.8, 47.9 ± 14.2, and 27.0 ± 4.0. There was no significant correlation between preoperative PROMs and fragment size, and no differences in symptom duration or fragment size between nonoperative and operative patients. All 8 operative extremities ultimately underwent fragment excision.</div></div><div><h3>Conclusions</h3><div>Most symptomatic BPP were managed nonoperatively. Radiographic features did not distinguish symptomatic from asymptomatic or operative from nonoperative cases. Larger studies are needed to refine treatment algorithms and reduce reoperations.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104315"},"PeriodicalIF":2.0,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885444","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

Inter-examiner and inter-day reliability of dynamic tibiofemoral movements measurement using motion capture during walking and jumping tasks 在行走和跳跃任务中使用动作捕捉的动态胫股运动测量的主考人间和日间可靠性

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-03 DOI: 10.1016/j.knee.2025.104321

Tom Vendrig, Michèle N.J. Keizer, Han Houdijk

Background

The anterior cruciate ligament (ACL) primarily restricts dynamic anterior tibia translation (ATTd) and internal tibia rotation (ITRd). Measuring these movements dynamically is essential for evaluating injury risk factors and their potential consequences. This study aimed to assess the inter-examiner and inter-day reliability of measuring ATTd and ITRd during walking and jumping tasks using optoelectronic motion capture.

Methods

Nineteen healthy participants performed walking, side hop, single-leg hop for distance, and triple hop for distance. To assess inter-examiner reliability, tasks were repeated on the same day: once after the first examiner placed markers and once after the second examiner. To assess inter-day reliability, tasks were repeated on a second day. Pointwise intraclass correlation coefficient (ICC) and standard error of measurement (SEM) values were assessed across the stance phase of walking and the jump-landing phases.

Results

For walking, ICC values over the stance phase indicated good-to-excellent reliability for ATTd and ITRd (ICC = 0.66–0.82), with SEM values below 3.2 mm and 2.8° (≤19 % of range of motion). For all jumping tasks, ICC values over the entire landing indicated excellent reliability for ATTd and ITRd (ICC = 0.75–0.86), with higher inter-examiner compared with inter-day reliability. The phase around peak ground reaction force demonstrated superior reliability compared with the entire landing, with SEM values below 2.6 mm and 2.2° (≤17 % of range of motion, except for ATTd during the side hop).

Conclusion

Results suggest adequate reliability of ATTd and ITRd for research assessing ACL injury risk factors and outcomes of various surgical and rehabilitation methods following ACL injury.

背景：前交叉韧带（ACL）主要限制动态胫骨前平移（ATTd）和胫骨内旋转（ITRd）。动态测量这些运动对于评估损伤风险因素及其潜在后果至关重要。本研究旨在评估光电动作捕捉在行走和跳跃任务中测量ATTd和ITRd的人间和日间可靠性。方法19名健康受试者分别进行步行、侧跳、单腿远跳和三腿远跳。为了评估考官之间的信度，任务在同一天重复：第一个考官打分后一次，第二个考官打分后一次。为了评估白天的可靠性，在第二天重复了这些任务。在行走的站立阶段和起跳落地阶段评估点向类内相关系数（ICC）和测量标准误差（SEM）值。结果对于行走，站位阶段的ICC值显示出良好到优异的可靠性（ICC = 0.66-0.82）， SEM值低于3.2 mm和2.8°（≤运动范围的19%）。对于所有的跳跃任务，整个着陆过程的ICC值表明，ATTd和ITRd的可靠性非常好（ICC = 0.75-0.86），与日间可靠性相比，中间可靠性更高。与整个着陆过程相比，峰值地面反力附近的相位显示出更高的可靠性，SEM值低于2.6 mm和2.2°（≤17%的运动范围，侧跳期间的ATTd除外）。结论atd和ITRd在评估ACL损伤的危险因素以及ACL损伤后各种手术和康复方法的结果方面具有足够的可靠性。

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引用次数: 0

Response to letter to the editor to: "ChatGPT delivers satisfactory responses to the most frequent questions on meniscus surgery". 回复致编辑的信：“ChatGPT对半月板手术中最常见的问题提供了令人满意的答复”。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-03 DOI: 10.1016/j.knee.2025.104316

Felix Winden, Markus Bormann, Fabian Gilbert, Boris Michael Holzapfel, Daniel Patrick Berthold

引用次数: 0

Evaluation of spin in abstracts of systematic reviews and meta-analyses of mesenchymal stem cell injections for treatment of knee osteoarthritis. 间充质干细胞注射治疗膝关节骨关节炎的系统综述和荟萃分析摘要中自旋的评价。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-02 DOI: 10.1016/j.knee.2025.104314

Pranit Kumaran, Jacob L Kotlier, Amir Fathi, Cailan L Feingold, Anthony C Mouchawar, Eric H Lin, Andrew B Barcenas, Frank A Petrigliano, Joseph N Liu

Purpose: Spin is the practice of distorting results interpretation in studies to view interventions more favorably. This study aims to identify and characterize the incidence of spin in the abstracts of systematic reviews and meta-analyses investigating mesenchymal stem cell therapy for knee osteoarthritis (OA).

Methods: PubMed, Web of Science, and Scopus were searched. Study title, author, journal of publication, year of publication, level of evidence, study design, funding, and adherence to PRISMA were recorded for included texts. Abstracts were analyzed for the 15 most common types of spin.

Results: Fifty-two studies met inclusion criteria. At least one type of spin was found in 50 (96 %) abstracts with a maximum of nine types exhibited in four (6.7 %) studies. The most common types of spin were spin 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies"), spin 8 ("Conclusion extrapolates the review's findings from a surrogate marker or a specific outcome to the global improvement of the disease"), and spin 9 ("Conclusion claims the beneficial effect of the experimental treatment despite reporting bias"), with 36 studies reporting them each. There was a significant correlation between year of publication with type 3 ("Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") (P = 0.034).

Conclusions: Spin is highly prevalent in systematic reviews and meta-analyses investigating mesenchymal stem cells for knee OA. Year of publication is also associated with overemphasis on outcomes favoring the intervention.

目的：旋转是在研究中歪曲结果解释以更有利地看待干预措施的做法。本研究的目的是在研究间充质干细胞治疗膝关节骨关节炎（OA）的系统综述和荟萃分析摘要中确定和描述旋转的发生率。方法：检索PubMed、Web of Science、Scopus。纳入的文献记录了研究标题、作者、发表期刊、发表年份、证据水平、研究设计、资助和对PRISMA的依从性。摘要分析了15种最常见的自旋类型。结果：52项研究符合纳入标准。在50篇（96%）摘要中发现了至少一种自旋，在4篇（6.7%）研究中发现了最多9种自旋。最常见的自旋类型是自旋5（“结论声称实验性治疗的有益效果，尽管在初步研究中存在较高的偏倚风险”）、自旋8（“结论从替代标记物或特定结果推断综述的发现，以促进疾病的整体改善”）和自旋9（“结论声称实验性治疗的有益效果，尽管报告存在偏倚”），各有36项研究报告了它们。发表年份与类型3（“选择性报告或过分强调疗效结果或有利于实验干预有益效果的分析”）之间存在显著相关性（P = 0.034）。结论：Spin在研究膝关节OA间充质干细胞的系统综述和荟萃分析中非常普遍。出版年份也与过度强调有利于干预的结果有关。

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引用次数: 0

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01

引用次数: 0

Application of Hertzian contact theory to predict cartilage overload in the osteoarthritic and anterior-cruciate-ligament-deficient knee: A biomechanical analysis 应用赫兹接触理论预测骨关节炎和前交叉韧带缺陷膝关节的软骨负荷：生物力学分析。

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