IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-18 DOI: 10.1016/j.knee.2026.104420

Tom Vendrig, Michèle N J Keizer, Han Houdijk

引用次数: 0

Letter to the editor regarding “Imageless handheld robotic-assisted total knee arthroplasty showed better clinical outcomes than conventional total knee arthroplasty: A randomized controlled trial with preliminary results at 1-year follow up” 致编辑关于“无图像手持式机器人辅助全膝关节置换术比传统全膝关节置换术的临床效果更好：一项随机对照试验，1年随访的初步结果”。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-23 DOI: 10.1016/j.knee.2025.104295

Zi-ling Wang, Jian-zhou Xie

引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.knee.2025.104297

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

Background

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

Methods

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

Results

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

Conclusion

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

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

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引用次数: 0

External rotation of the patellar tendon insertion line: A novel predictor for recurrent patellar dislocation 髌骨肌腱止点线外旋：复发性髌骨脱位的新预测指标

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.knee.2025.104302

Yasuhito Sogi , Masahiro Ohnuma , Kento Chikazawa , Mitsuhiro Kashiwaba , Masanori Ogasawara , Atsushi Takahashi , Takehiko Sugita , Toshimi Aizawa

Background

Recurrent patellar dislocation (RPD) is a multifactorial disorder, with tibial tuberosity lateralization (TTL) as a major contributor. Although the tibial tuberosity–trochlear groove (TT–TG) distance is widely used to assess TTL, it is influenced by knee flexion and trochlear dysplasia. Based on our clinical observation of increased external rotation of the patellar tendon insertion line in RPD, we hypothesized that this abnormality alters patellar vector forces. Currently, no parameter accounts for the rotational orientation of the patellar tendon insertion line. This study evaluated the patellar tendon insertion angle (PTIA) as a novel parameter, compared it with TT–TG distance, and investigated their associations with femorotibial rotation (FTR) and external tibial torsion (ETT).

Methods

Forty-eight patients with RPD and 50 control subjects were retrospectively analyzed using low dose computed tomography. TT–TG distance, PTIA, FTR, and ETT were measured. Diagnostic accuracy was evaluated using receiver operating characteristic curve analysis, and correlations between parameters were analyzed using Pearson’s coefficient.

Results

The TT–TG distance and PTIA were significantly greater in the RPD group than controls (TT–TG: 19.3 ± 3.7 mm vs. 16.1 ± 4.1 mm; p < 0.001; PTIA: 17.2 ± 4.5° vs. 9.9 ± 3.3°; p < 0.001). The PTIA showed higher diagnostic accuracy than the TT–TG distance. The TT–TG distance correlated positively with FTR, whereas PTIA correlated negatively. Neither parameter was associated with ETT.

Conclusion

The PTIA, a new tibia-based parameter, is significantly increased in RPD and demonstrates superior diagnostic accuracy compared with the TT–TG distance.

Level of evidence: Level IV, radiological cross-sectional study.

复发性髌骨脱位（RPD）是一种多因素疾病，胫骨结节偏侧化（TTL）是主要原因。虽然胫骨结节-滑车沟（TT-TG）距离被广泛用于评估TTL，但它受到膝关节屈曲和滑车发育不良的影响。根据我们对RPD患者髌骨肌腱止点线外旋增加的临床观察，我们假设这种异常改变了髌骨矢量力。目前，没有参数说明髌骨肌腱止点线的旋转方向。本研究评估了髌腱止点角（PTIA）作为一个新的参数，将其与TT-TG距离进行比较，并研究了它们与股胫旋转（FTR）和胫外扭转（ETT）的关系。方法对48例RPD患者和50例对照者进行低剂量计算机断层扫描回顾性分析。测量TT-TG距离、PTIA、FTR、ETT。采用受试者工作特征曲线分析评估诊断准确性，采用Pearson系数分析参数之间的相关性。结果RPD组TT-TG距离和PTIA显著高于对照组（TT-TG: 19.3±3.7 mm vs. 16.1±4.1 mm; p < 0.001; PTIA: 17.2±4.5°vs. 9.9±3.3°；p < 0.001）。PTIA的诊断准确率高于TT-TG距离。TT-TG距离与FTR呈正相关，PTIA呈负相关。这两个参数均与ETT无关。结论与TT-TG距离相比，PTIA作为一种新的胫骨参数，在RPD诊断中有显著提高，具有更高的诊断准确性。证据等级：IV级，放射横断面研究。

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引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1016/j.knee.2025.104317

Ismail Sivri , Emre Kaygin , Serap Colak

Background

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

Methods

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

Results

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

Conclusions

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

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

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引用次数: 0

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 : 2026-03-01 Epub 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。

{"title":"Thrombospondin-4 correlates with MRI measures of structural damage and pain sensitisation: a new biomarker in knee osteoarthritis","authors":"Franklyn Arron Howe , Soraya Koushesh , Anna Blundell , Amber Law , Abiola Harrison , Vivian Ejindu , Seyi Taylor-Kuti , Andisheh Niakan , Mary Sheppard , Richard Ljuhar , Nidhi Sofat","doi":"10.1016/j.knee.2025.104305","DOIUrl":"10.1016/j.knee.2025.104305","url":null,"abstract":"<div><h3>Background</h3><div>We hypothesised thrombospondin-4 (TSP-4), a molecule mediating pain sensitisation in peripheral nerve injury, is associated with pain sensitisation in OA.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>p</em> = 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 (<em>p</em> < 0.001) and number of BMLs (<em>p</em> < 0.001 to <em>p</em> < 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.</div></div><div><h3>Conclusion</h3><div>Our data suggests TSP-4 is associated with pain sensitisation in OA and is a biomarker stratifying for pain sensitisation.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104305"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792027","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

Knee flexion during skin preparation improves anterior antiseptic coverage: A controlled fluorescent dye study 在皮肤准备期间膝关节屈曲改善前路防腐覆盖：一项对照荧光染料研究

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.knee.2025.104300

Matthew McCann , Vivek Sharma , Mahbub Alam , Jehan Butt , Vishal Kumar

Background

Periprosthetic joint infection (PJI) is a rare but devastating complication of total knee arthroplasty (TKA) and a leading cause of TKA failure. Thorough skin preparation is a key preventative measure; however, the influence of limb position on antiseptic coverage has not been evaluated. This study compared the effectiveness of anterior knee antiseptic coverage in flexion and extension using a validated fluorescent dye model.

Methods

A prospective single-centre trial at Colchester General Hospital recruited ten healthy adult volunteers (20 knees) who underwent standardised preparation with 0.5 % chlorhexidine gluconate in 70 % ethanol after fluorescent dye application. The knees were prepared either in full extension or in maximal flexion in a fixed sequence. Ultraviolet (UV) imaging and digital analysis were used to quantify the residual dye as a surrogate for incomplete antiseptic coverage. Intra and interrater reliabilities were assessed using intraclass correlation coefficients (ICC).

Results

Eighty preparations (40 flexion, 40 extension) were analysed, with flexion yielding significantly less residual dye than extension (median [IQR: interquartile ratio] 1.7 % [IQR 0.1–7.2] vs. 9.8 % [IQR 2.6–19.0], p < 0.0001). The subgroup analysis confirmed consistent findings across both investigators. The intrarater reliability was good to excellent (ICC 0.62–0.89), whereas the interrater reliability was poor (ICC 0.07–0.35). No adverse events were reported.

Conclusion

Maximal knee flexion during skin preparation significantly improved anterior surface antiseptic coverage compared with extension. This simple, cost-neutral modification can be readily incorporated into TKA workflows, as we have done previously. Further studies with microbiological endpoints and broader patient populations are warranted to establish the effect on PJI prevention.

背景：假体周围关节感染（PJI）是全膝关节置换术（TKA）中一种罕见但毁灭性的并发症，也是TKA失败的主要原因。彻底的皮肤准备是关键的预防措施；然而，肢体位置对抗菌覆盖的影响尚未得到评估。本研究采用一种经过验证的荧光染料模型，比较了膝关节前侧抗菌剂覆盖在屈曲和伸展中的有效性。方法在科尔切斯特综合医院进行了一项前瞻性单中心试验，招募了10名健康成人志愿者（20个膝关节），在荧光染料应用后，采用0.5%葡萄糖酸氯己定与70%乙醇的标准化制备。膝关节按固定顺序完全伸展或最大屈曲。紫外线（UV）成像和数字分析用于量化残留染料作为不完全防腐覆盖的替代。使用类内相关系数（ICC）评估组内和组间信度。结果对80种制剂（40种屈曲制剂，40种伸曲制剂）进行分析，屈曲制剂的残留染料产量显著低于伸曲制剂（中位数[IQR：四分位数比]1.7% [IQR 0.1-7.2]对9.8% [IQR 2.6-19.0], p < 0.0001）。亚组分析证实了两位研究者的一致发现。量表内信度为良至优（ICC 0.62 ~ 0.89），量表间信度较差（ICC 0.07 ~ 0.35）。无不良事件报告。结论膝关节最大屈曲与伸直相比，可显著提高前表面抗菌覆盖。这个简单的、成本中立的修改可以很容易地合并到TKA工作流中，正如我们之前所做的那样。有必要进一步研究微生物终点和更广泛的患者群体，以确定PJI预防的效果。

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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 : 2026-03-01 Epub 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

Response to Letter to the Editor regarding “Imageless handheld robotic-assisted total knee arthroplasty showed better clinical outcomes than conventional total knee arthroplasty: A randomized controlled trial with preliminary results at 1-year follow up” 关于“无图像手持机器人辅助全膝关节置换术比传统全膝关节置换术的临床效果更好：一项随机对照试验，1年随访初步结果”的致编辑的回复。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-23 DOI: 10.1016/j.knee.2025.104296

Peter Bollars

引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.knee.2025.104306

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

Background

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

Methods

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

Results

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

Conclusions

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

Level of Evidence: Level III, diagnostic study.

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

{"title":"Tibial acceleration induced by the extension maneuver referred to as the N test correlates with the International Knee Documentation Committee grade, even after anterior cruciate ligament reconstruction","authors":"Ryota Yamagami, Shuji Taketomi, Kenichi Kono, Kohei Kawaguchi, Ryo Murakami, Takashi Kobayashi, Tomoki Murakami, Sora Koiwa, Sakae Tanaka","doi":"10.1016/j.knee.2025.104306","DOIUrl":"10.1016/j.knee.2025.104306","url":null,"abstract":"<div><h3>Background</h3><div>The N test, an extension-based maneuver, reportedly elicited greater tibial acceleration than the pivot shift test in anterior cruciate ligament (ACL)-deficient (ACLD) knees. However, its utility in ACL-reconstructed (ACLR) knees, where residual instability is subtle, remains unclear. This study compared tibial acceleration between the N test and pivot shift test in ACLD and ACLR knees and assessed correlation with clinical grading.</div></div><div><h3>Methods</h3><div>A total of 103 knees (68 ACLD, 35 ACLR) were evaluated under general anesthesia. A triaxial inertial sensor was placed on the anterolateral tibia, and peak-to-peak anteroposterior acceleration was extracted as the sole quantitative parameter, interpreted as a surrogate for combined anterior subluxation and external rotation of the lateral tibial compartment. Each maneuver was performed five times; the mean of the central three trials was analyzed. Paired t-tests and Spearman’s rank correlation were used.</div></div><div><h3>Results</h3><div>In ACLD knees, the injured limb showed significantly greater acceleration than the uninjured limb in both tests (N test, 8.32 ± 4.08 vs 4.53 ± 2.49 m/s<sup>2</sup>; pivot shift, 6.11 ± 4.41 vs 3.17 ± 2.75 m/s<sup>2</sup>; both, P < 0.001). The N test induced greater acceleration than the pivot shift test in both ACLD and ACLR knees (ACLR, 4.26 ± 1.68 vs 2.68 ± 2.04 m/s<sup>2</sup>; both, <em>P</em> < 0.001). N test–induced acceleration correlated with IKDC grading (ACLR. r = 0.577; ACLD, r = 0.575; overall, r = 0.733; all <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>The N test elicited greater tibial acceleration than the pivot shift test and correlated strongly with clinical grading, even in ACLR knees, supporting its potential as a sensitive supplementary tool for detecting subtle residual laxity after ACL reconstruction.</div><div>Level of Evidence: Level III, diagnostic study.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104306"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841708","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}

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