Knee最新文献

英文中文

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。

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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

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

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

Out with the old and in with the new? 旧的去了，新的来了？

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 DOI: 10.1016/j.knee.2026.104335

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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