IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-19 DOI: 10.1016/j.knee.2025.104298

Yoshihiro Ishida , Yasushi Takata , Rikuto Yoshimizu , Yusuke Yanatori , Naoki Takemoto , Miho Okuda , Yu Ueda , Satoru Demura , Junsuke Nakase

Background

The semitendinosus (ST) tendon is commonly used as a graft in anterior cruciate ligament (ACL) reconstruction. However, there is growing interest in the quadriceps tendon (QT). The reconstructed ACL undergoes a remodeling process, and its tissue quality is an important factor in determining when to return to sports activities. It remains unclear whether there are differences in tissue quality between QT and ST grafts at the same postoperative stage. UTE-T2* mapping has gained attention as a method for quantitatively evaluating the organization of the reconstructed ACL. This study aimed to reveal differences in tissue quality and collagen organization between QT and ST grafts at 6 months after ACL reconstruction using UTE-T2* mapping.

Methods

In this retrospective comparative study, twenty patients who had undergone ACL reconstruction using the QT and ST were included. UTE-T2* mapping was performed 6 months after surgery. T2* value was measured at intraarticular, femoral tunnel and tibial tunnel site. Each value were compared between the two groups (The Mann–Whitney U test).

Results

In the QT group, the T2* values were 11.8 ± 1.3 ms (intra-articular), 7.8 ± 1.6 ms (tibial), and 8.9 ± 1.5 ms (femoral). In the ST group, the corresponding UTE-T2* values were 11.1 ± 2.2 ms, 7.5 ± 1.9 ms, and 10.8 ± 1.6 ms, respectively. Notably, a significant difference was observed between the two groups in the femoral site (P = 0.026).

Conclusions

QT grafts were more mature than ST grafts within the femoral tunnel six months after ACL reconstruction.

背景：半腱肌（ST）肌腱是前交叉韧带（ACL）重建中常用的移植物。然而，人们对股四头肌肌腱（QT）的兴趣越来越大。重建的前交叉韧带经历了一个重塑过程，其组织质量是决定何时恢复体育活动的重要因素。目前尚不清楚QT移植和ST移植在同一术后阶段的组织质量是否存在差异。作为一种定量评价重建ACL组织的方法，UTE-T2*映射已受到关注。本研究旨在通过UTE-T2*作图揭示ACL重建后6个月QT和ST移植的组织质量和胶原组织的差异。方法回顾性比较分析20例采用QT和ST行ACL重建的患者。术后6个月进行UTE-T2*测绘。在关节内、股骨隧道和胫骨隧道处测量T2*值。比较两组间各值（Mann-Whitney U检验）。结果QT组T2*值分别为关节内（11.8±1.3 ms）、胫骨（7.8±1.6 ms）、股骨（8.9±1.5 ms）。ST组对应的UTE-T2*值分别为11.1±2.2 ms、7.5±1.9 ms和10.8±1.6 ms。值得注意的是，两组在股骨部位的差异有统计学意义（P = 0.026）。结论前交叉韧带重建6个月后，在股骨隧道内，sqt移植比ST移植更成熟。

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引用次数: 0

Thrombospondin-4 correlates with MRI measures of structural damage and pain sensitisation: a new biomarker in knee osteoarthritis 血栓反应蛋白-4与结构损伤和疼痛致敏的MRI测量相关：膝关节骨关节炎的新生物标志物

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-19 DOI: 10.1016/j.knee.2025.104305

Franklyn Arron Howe , Soraya Koushesh , Anna Blundell , Amber Law , Abiola Harrison , Vivian Ejindu , Seyi Taylor-Kuti , Andisheh Niakan , Mary Sheppard , Richard Ljuhar , Nidhi Sofat

Background

We hypothesised thrombospondin-4 (TSP-4), a molecule mediating pain sensitisation in peripheral nerve injury, is associated with pain sensitisation in OA.

Methods

A cross-sectional study of clinical, imaging and fluid biomarkers from knee OA participants was conducted. TSP-4 was assessed by immunohistochemistry (IHC) for OA tissue samples and by ELISA in serum samples. Type II collagen degradation products (CTX-II), linked to OA structural damage, was determined from urine samples. A general linear model (GLM) was used to: a) investigate how patient-reported WOMAC (Western Ontario and McMaster Universities OsteoArthritis Index) pain/stiffness subscales and pain sensitisation measured by painDETECT, related to the Hospital Anxiety and Depression Scale (HADS), structural damage quantified from MRI and X-rays, CTX-II and TSP-4; b) how TSP-4 related to structural damage. We used linear discriminant analysis (LDA) to determine a classifier for pain-sensitisation from clinical and wet-biomarkers.

Results

TSP-4 was expressed in cartilage, bone marrow lesion (BML) and synovial tissue from OA samples. Upregulated TSP-4 protein was observed in cartilage, synovial tissue and BMLs in a perivascular distribution and in fibrotic tissue. Serum TSP-4 was significantly higher (p = 0.001) in those with pain sensitisation (painDETECT level ≥19) compared with non-sensitised participants. Serum TSP-4 was significantly increased with Hoffa’s synovitis (p < 0.001) and number of BMLs (p < 0.001 to p < 0.05). LDA provided classification accuracy of 80 % for pain sensitisation using TSP-4, CTX-II and HADS, supporting the biopsychosocial model of pain in OA.

Conclusion

Our data suggests TSP-4 is associated with pain sensitisation in OA and is a biomarker stratifying for pain sensitisation.

我们假设血小板反应蛋白-4 (TSP-4)，一种介导周围神经损伤疼痛致敏的分子，与OA疼痛致敏有关。方法对膝关节OA患者的临床、影像学和液体生物标志物进行横断面研究。用免疫组化法（IHC）检测OA组织样本中的TSP-4，用ELISA检测血清样本中的TSP-4。II型胶原降解产物（CTX-II）与OA结构损伤有关，从尿液样本中测定。一般线性模型（GLM）用于：A)调查患者报告的WOMAC（西安大略省和麦克马斯特大学骨关节炎指数）疼痛/僵硬亚量表和疼痛致敏性，与医院焦虑和抑郁量表（HADS）、MRI和x射线量化的结构损伤、CTX-II和TSP-4相关；b) TSP-4与结构损伤的关系。我们使用线性判别分析（LDA）从临床和湿生物标志物中确定疼痛敏感的分类器。结果stsp -4在骨性关节炎软骨、骨髓病变（BML）和滑膜组织中均有表达。在血管周围分布的软骨组织、滑膜组织和bml组织以及纤维化组织中观察到TSP-4蛋白上调。与非致敏组相比，疼痛致敏组（painDETECT水平≥19）血清TSP-4显著升高（p = 0.001）。血清TSP-4在Hoffa滑膜炎（p < 0.001）和bml数量（p < 0.001 ~ p < 0.05）中显著升高。LDA使用TSP-4、CTX-II和HADS对疼痛致敏的分类准确率为80%，支持OA疼痛的生物心理社会模型。结论：我们的数据表明，TSP-4与OA患者的疼痛致敏有关，是疼痛致敏的生物标志物。

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引用次数: 0

Validation of a short version of the Italian anterior cruciate ligament return to sport after injury (ACL-RSI) scale for psychological readiness in return to sport 意大利前十字韧带损伤后重返运动（ACL-RSI）心理准备量表的短版验证

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-19 DOI: 10.1016/j.knee.2025.104301

Emanuele Tortoli , Carlo Ramponi , Alberto Grassi , Giuseppe Giovannico , Gian Luigi Canata , Alberto Vascellari , Luca Francini , Kate E. Webster

Background

Psychological readiness is increasingly recognized as a key factor in return-to-sport (RTS) outcomes after anterior cruciate ligament reconstruction (ACLR). This study investigates the divergent and predictive validity of the Italian short version of the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale compared to the original Italian, longer form.

Methods

A total of 249 patients (174 male, 75 female) were assessed at 3, 6, and 12 months post-ACLR, using both the full and short Italian versions of the ACL-RSI to measure psychological readiness.

Results

Divergent validity was demonstrated by significantly lower scores in patients who did not RTS compared to those who did, with no significant differences between the short and full versions. Predictive validity analysis showed that scores at 3 and 6 months were excellent predictors of RTS at pre-injury or higher levels by 12 months.

Conclusion

The Italian short version of the ACL-RSI demonstrated strong divergent and predictive validity, performing similarly to the full version. Predictive values at 3 and 6 months may help clinicians identify patients at risk of not returning to sport, supporting more tailored and psychologically informed rehabilitation strategies.

心理准备越来越被认为是前交叉韧带重建（ACLR）后恢复运动（RTS）结果的关键因素。本研究调查了意大利短版前十字韧带-损伤后运动恢复（ACL-RSI）量表与原始意大利长版量表的差异和预测有效性。方法249例患者（男性174例，女性75例）在aclr后3、6和12个月进行评估，使用完整和简短的意大利语版ACL-RSI来测量心理准备。结果：未进行RTS治疗的患者得分明显低于进行RTS治疗的患者，短版本和完整版本之间无显著差异，证明了差异效度。预测效度分析显示，3个月和6个月的评分可以很好地预测损伤前或12个月更高水平的RTS。结论意大利短版的ACL-RSI表现出较强的发散性和预测效度，其表现与完整版相似。3个月和6个月时的预测值可以帮助临床医生确定患者有不能重返运动的风险，支持更有针对性和心理知情的康复策略。

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引用次数: 0

Paediatric Knee Surgery: A New Frontier in Orthopaedics 儿科膝关节手术：骨科的新前沿

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-19 DOI: 10.1016/j.knee.2025.104310

Adil Ajuied , Fazal Ali , Nicolas Nicolaou

引用次数: 0

Rounded-rectangular bone tunnels enhance early tendon–bone healing and limit tunnel enlargement in a rabbit anterior cruciate ligament reconstruction with quadriceps tendon graft model 圆形矩形骨隧道促进早期肌腱-骨愈合和限制隧道扩大兔前交叉韧带重建四头肌肌腱移植模型

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-18 DOI: 10.1016/j.knee.2025.104309

Naoki Takemoto, Junsuke Nakase, Yasushi Takata, Yusuke Yanatori, Manase Nishimura, Kentaro Fujita, Mikino Saito, Satoru Demura

Purpose

To determine whether rounded-rectangular bone tunnels matching the flat morphology of a quadriceps tendon (QT) graft enhance early tendon–bone healing (TBH) and suppress bone-tunnel enlargement (BTE) after anterior cruciate ligament (ACL) reconstruction in a rabbit model.

Methods

Female Japanese White rabbits underwent ACL reconstruction with a QT graft and were randomized into circular or rounded-rectangular tunnels. Knees were evaluated at 4, 8, and 12 weeks (n = 10/group/time point; total, 60). Micro–computed tomography quantified tunnel cross-sectional area and flattening ratio, with BTE (%) calculated vs. baseline. Histological TBH at the tendon–bone interface was semi-quantitatively scored (n = 4/group/time point), and biomechanical testing assessed maximum failure load and mode of failure (n = 6/group/time point). Non-parametric tests were used to compare groups, and repeated-measures analysis of variance was used to assess temporal changes.

Results

The rounded-rectangular tunnel group (Group R) showed significantly lower BTE than the circular tunnel group (Group C) at 4 and 8 weeks (both p < 0.05). Flattening ratios did not differ between groups at 4–12 weeks. In both groups, tunnel area increased from time 0 to a peak at 4 weeks and then slightly decreased and stabilized by 8–12 weeks. The histological scores favored Group R at 4 weeks (P = 0.038). The maximum failure load was higher in Group R at 4 weeks (P = 0.03).

Conclusion

Matching QT grafts with rounded-rectangular tunnels suppresses early BTE and enhances early histological integration and fixation strength after ACL reconstruction, potentially enabling safer and earlier rehabilitation.

目的探讨兔前交叉韧带（ACL）重建后圆形-矩形骨隧道是否与股四头肌肌腱（QT）的扁平形态相匹配，从而促进早期肌腱-骨愈合（TBH）并抑制骨隧道扩大（BTE）。方法用QT移植重建雌性日本大白兔前交叉韧带，随机分为圆形或圆矩形隧道。在第4周、第8周和第12周对膝关节进行评估（n = 10/组/时间点；总计60）。显微计算机断层扫描量化了隧道横截面积和平坦率，计算了BTE（%）与基线的对比。对肌腱-骨界面的组织学TBH进行半定量评分（n = 4/组/时间点），生物力学测试评估最大破坏载荷和破坏模式（n = 6/组/时间点）。非参数检验用于组间比较，重复测量方差分析用于评估时间变化。结果圆形矩形隧道组（R组）在4周和8周时BTE显著低于圆形隧道组（C组）（p < 0.05）。在4-12周时，各组间的扁平率无差异。两组患者的隧道面积均从0时开始增加，4周时达到峰值，8-12周时略有下降并趋于稳定。4周时R组组织学评分优于对照组（P = 0.038）。第4周时，R组最大失效负荷较高（P = 0.03）。结论圆矩形隧道匹配QT移植物抑制了早期BTE，增强了ACL重建后早期组织整合和固定强度，可能实现更安全和更早的康复。

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引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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

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

Background

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

Methods

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

Results

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

Conclusion

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

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

{"title":"Morphological changes of the preserved discoid lateral meniscus on serial magnetic resonance imaging following partial meniscectomy and repair: A comparison between immediate and 2-year postoperative findings","authors":"Gwang-Eun Lee , Sung-Sahn Lee , Dae-Hee Lee","doi":"10.1016/j.knee.2025.11.017","DOIUrl":"10.1016/j.knee.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to analyze serial magnetic resonance imaging (MRI) changes in discoid lateral meniscus (DLM) from the immediate postoperative period to 2 years after partial meniscectomy and meniscus repair.</div></div><div><h3>Methods</h3><div>From November 2015 to November 2023, 32 patients with MRI-confirmed torn DLM who underwent arthroscopic partial meniscectomy and meniscus repair were analyzed. MRI scans were performed immediately postoperatively and 2 years after surgery. Meniscal dimensions, including width, height, and mid-height, were measured on coronal and sagittal MRI to observe morphological changes.</div></div><div><h3>Results</h3><div>The width of the anterior and posterior horns significantly increased in the follow up MRI (anterior: from 9.0 mm to 11.55 mm (<em>P</em> < 0.001); posterior: from 8.29 mm to 9.81 mm (<em>P</em> < 0.001)) compared with the immediate postoperative MRI. While there were no significant differences in the heights of the anterior horn, midbody, and posterior horn, mid-heights were reduced in all three parts (anterior horn: from 3.47 mm to 2.84 mm (<em>P</em> < 0.001), midbody: from 2.73 mm to 2.31 mm (<em>P</em> = 0.003), and posterior horn: from 3.09 mm to 2.74 mm (<em>P</em> = 0.008)).</div></div><div><h3>Conclusion</h3><div>The meniscal width of the anterior and posterior horns of DLM in the sagittal plane increased from the immediate postoperative state through to 2 years following partial meniscectomy and meniscus repair. Although the height of the anterior horn, midbody, and posterior horns remained consistent, the mid-height of these structures decreased at the 2-year follow up compared with the immediate postoperative status.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104291"},"PeriodicalIF":2.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791518","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

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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

Hyo-Bin Lee , Jang-Hwan Choi

Objectives

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

Meniscus repair: a review of techniques and long-term outcomes 半月板修复：技术回顾和长期结果

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-06 DOI: 10.1016/j.knee.2025.11.015

Logan M. Good , Emily L. Lu , Eric M. Milliron , Parker A. Cavendish , Robert A. Duerr , Christopher C. Kaeding , David C. Flanigan , Robert A. Magnussen

Background

Advancements in technology and techniques have shaped meniscus repair outcomes, but long term results remain unclear. This review aims to comprehensively evaluate studies with a mean follow-up of greater than 10 years following inside-out, outside-in, all-inside, open, or pull-out repair techniques. In addition, this article will review the impact of concomitant anterior cruciate ligament (ACL) reconstruction on long-term meniscus repair outcomes and compare osteoarthritis risk of patients treated partial meniscectomy compared with meniscus repair. We hypothesize there is increased evidence of osteoarthritis following partial meniscectomy compared to all types of meniscal repair.

Methods

PubMed and EMBASE databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included full-text English language, human patients with at least one outcome reported after meniscus repair, and publication before June 22, 2021. Exclusion criteria included mean follow up of less than 10 years, published before the year 2000, or significant concomitant procedures within the knee during meniscus repair.

Results

Inside-out, all-inside, trans-tibial pull-out, and open repair techniques of meniscal tears demonstrate clinical success and good long-term outcomes. Data regarding the impact of concomitant anterior cruciate ligament reconstruction on meniscus repair outcomes are conflicting. The risk of osteoarthritis is reduced in meniscal repair when compared with partial meniscectomy.

Conclusion

Outcomes of meniscus repair are favorable at 10 years post-operative regardless of technique. While the impact of concomitant ACL reconstruction on meniscus repair outcomes is unclear, meniscus repair is associated with decreased osteoarthritis risk compared to partial meniscectomy.

Level of evidence

IV; systematic review of level III-IV studies.

技术和技术的进步影响了半月板修复的结果，但长期结果仍不清楚。本综述旨在综合评价平均随访时间超过10年的研究，这些研究采用了由内而外、由外而内、全内、开放式或拔出式修复技术。此外，本文将回顾联合前交叉韧带（ACL）重建对半月板长期修复结果的影响，并比较半月板部分切除术与半月板修复患者骨关节炎的风险。我们假设与所有类型的半月板修复相比，部分半月板切除术后骨关节炎的证据增加。方法按照PRISMA （Preferred Reporting Items for Systematic Reviews and meta - analysis）指南对spubmed和EMBASE数据库进行检索。纳入标准包括英文全文，半月板修复后报告至少一项结果的人类患者，并在2021年6月22日之前发表。排除标准包括平均随访少于10年，发表于2000年之前，或在半月板修复过程中膝关节内有重要的伴随手术。结果由内而外、全内、经胫骨拔出和开放修复半月板撕裂技术均取得了临床成功和良好的远期疗效。关于联合前交叉韧带重建对半月板修复结果的影响的数据是相互矛盾的。与半月板部分切除术相比，半月板修复术降低了骨关节炎的风险。结论不论采用何种技术，术后10年半月板修复效果良好。虽然合并前交叉韧带重建对半月板修复结果的影响尚不清楚，但与半月板部分切除术相比，半月板修复与降低骨关节炎风险相关。证据水平eiv；III-IV级研究的系统评价。

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引用次数: 0

Comparison of methods for evaluating soft tissue balance in robotic-assisted total knee arthroplasty: A cadaveric study 机器人辅助全膝关节置换术中软组织平衡评估方法的比较：一项尸体研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-03 DOI: 10.1016/j.knee.2025.11.012

Yasuaki Tamaki , Daisuke Hamada , Keizo Wada , Shota Shigekiyo , Yuto Sugimine , Yutaka Kinoshita , Koichi Tomita , Koichi Sairyo

Background

Robotic-assisted total knee arthroplasty (TKA) can simulate postoperative soft tissue balance based on three-dimensional positional information for the prosthesis and preoperative soft tissue balance data. However, the accuracy of soft tissue balance data obtained during robotic-assisted TKA is unclear. This study aimed to compare the reproducibility of three different assessment methods for soft tissue balance in robotic-assisted TKA and to examine the influence of examiner experience.

Methods

Seven fresh-frozen cadavers were used. Three examiners assessed the medial and lateral gaps by applying a continuous varus/valgus load to the knee throughout the full range of motion using an image-free system (Navio). Soft tissue balance was evaluated by applying mild manual stress (mild group), maximum manual stress (max group), and a Z-retractor (Z group). Each examiner performed the procedure twice, and intra-rater and inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC).

Results

In medial gap assessment, the ICCs for intra-rater reliability ranged from 0.88 to 0.95 in the mild group, 0.89 to 0.94 in the max group, and 0.89 to 0.95 in the Z group, with respective ICCs of 0.88, 0.88, and 0.92 for inter-rater reliability. In lateral gap assessment, the ICCs for intra-rater reliability ranged from 0.37 to 0.66 in the mild group, 0.33 to 0.86 in the max group, and 0.62 to 0.96 in the Z group, with respective ICCs of 0.41, 0.24, and 0.57 for inter-rater reliability.

Conclusion

Intra-rater and inter-rater reliability was high for the medial gap assessment but lower for the lateral gap assessment.

背景：机器人辅助全膝关节置换术（robot -assisted total knee arthroplasty， TKA）可以基于假体的三维位置信息和术前软组织平衡数据模拟术后软组织平衡。然而，在机器人辅助TKA中获得的软组织平衡数据的准确性尚不清楚。本研究旨在比较机器人辅助TKA中软组织平衡的三种不同评估方法的可重复性，并检查检查者经验的影响。方法：采用新鲜冷冻尸体7具。三名检查人员通过使用无图像系统（Navio）在整个活动范围内对膝关节施加连续的内翻/外翻负荷来评估内侧和外侧间隙。通过施加轻度手动应力（mild组）、最大手动应力（max组）和Z形牵开器（Z组）来评估软组织平衡。每个审查员执行两次程序，并使用类内相关系数（ICC）评估评估者内部和内部的信度。结果：在中等差距评估中，轻度组评分内信度的ICCs为0.88 ~ 0.95，最大组为0.89 ~ 0.94，Z组为0.89 ~ 0.95，评分间信度的ICCs分别为0.88、0.88和0.92。在横向间隙评估中，轻度组评分内信度的ICCs为0.37 ~ 0.66，最大组为0.33 ~ 0.86，Z组为0.62 ~ 0.96，评分间信度的ICCs分别为0.41、0.24和0.57。结论：内侧间隙评估的信度高，外侧间隙评估的信度低。

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