Knee最新文献

英文中文

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。

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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

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IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01

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IF 2 4区医学 Q3 ORTHOPEDICS

Knee

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