Knee最新文献_第6页

Mechanism of muscle activation in the protection of knee joint injury during jogging 慢跑时肌肉激活保护膝关节损伤的机制

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-20 DOI: 10.1016/j.knee.2025.104307

Jiangtao Ruan , Kai Cui , Yangyang Meng , Xia Xiao

Background

It is important to understand the role of muscle activation in knee joint protection against the injuries, such as meniscus tear, cartilage wear, and ligament damage, often caused by muscle weakness, improper running posture, or overtraining. Research on the finite element knee model with muscles has not been reported yet, nor have there been any biomechanical explorations on the internal tissues of knee joint with muscle activation.

Objective

To explore the mechanism of muscle activation in jogging for the protection against knee joint injuries based on the stress fields of the knee internal tissues.

Methods

A finite element knee joint model with muscles (Vastus lateralis, vastus medialis, and vastus intermedius) was established. The stress fields of knee internal tissues during jogging were numerically simulated and investigated to explore the mechanism of muscle activation in knee protection against injury.

Results

Activation of muscle forces reduces peak stress on joint tissues, diminishes stress concentration, and enhances the load-bearing capacity of the knee joint. The proportion of contact area in the lateral tissues is increased, which means activating the muscle forces adjusts the load-bearing mode of the knee joint by involving the lateral tissues to participate in sharing the loads with the medial tissues, thus improve the stability of the knee joint.

Conclusion

Activation of muscle forces in jogging improves the load-bearing capacity and stability of the knee joint by reducing peak stress on joint tissues, decreasing the proportion of concentrated area, increasing the contact area in lateral tissues, and involving lateral tissues in sharing loads with medial tissues.

了解肌肉激活在膝关节保护中所起的作用是很重要的，这些损伤通常是由肌肉无力、不正确的跑步姿势或过度训练引起的，如半月板撕裂、软骨磨损和韧带损伤。对有肌肉的膝关节有限元模型的研究尚未见报道，对有肌肉激活的膝关节内部组织的生物力学探索也尚未见报道。目的从膝关节内部组织应力场的角度探讨慢跑时肌肉激活对膝关节损伤的保护作用机制。方法建立具有股外侧肌、股内侧肌和股中间肌的膝关节有限元模型。通过数值模拟和研究慢跑时膝关节内部组织的应力场，探讨肌肉激活在膝关节损伤保护中的作用机制。结果肌肉力量的激活降低了关节组织的峰值应力，减少了应力集中，提高了膝关节的承重能力。外侧组织接触面积的比例增加，即激活肌力，通过外侧组织参与与内侧组织分担负荷，调整膝关节的承重方式，从而提高膝关节的稳定性。结论慢跑时肌肉力量的激活，通过降低关节组织的峰值应力、减少集中面积的比例、增加外侧组织的接触面积、使外侧组织与内侧组织分担负荷，提高膝关节的负重能力和稳定性。

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引用次数: 0

Long-term outcomes and predictors of failure after medial opening-wedge high tibial osteotomy: a 138-knee cohort with up to 10-year follow-up 内侧开楔形胫骨高位截骨术后的长期预后和失败预测因素：138个膝关节队列，随访10年。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-20 DOI: 10.1016/j.knee.2025.104303

Juan Miguel Gómez-Palomo , Juan José García-Vera , Amparo Zamora-Mogollo , Carmen Tara-Abad , Ana Martínez-Crespo , Elvira Montañez-Heredia

Purpose

To quantify 10-year survivorship after medial opening-wedge high tibial osteotomy (MOWHTO) and identify modifiable predictors of conversion to total knee arthroplasty (TKA), focusing on joint-line obliquity (JLO), obesity and smoking.

Methods

Single-centre retrospective cohort of 138 MOWHTOs (2007–2022) with Ahlbäck I–II medial osteoarthritis, correctable varus and ≥24-month follow-up. Long-leg radiographs measured alignment, JLO (tibial plateau angle relative to floor) and medial proximal tibial angle (MPTA; pre-/post-operative). Primary outcome: TKA conversion. Kaplan–Meier estimated survivorship; multivariable Cox with proportional-hazards checks and Fine–Gray competing-risk analyses were used. A sensitivity model added post-operative JLO and deviation from planned hip–knee–ankle (HKA) alignment; a complementary model evaluated post-operative MPTA >95°.

Results

Mean age 46.9 years; mean follow-up 83.4 months. Twelve of 138 knees (8.7 %) underwent TKA; survivorship was 98.5 % at 2 years, 90.4 % at 5 years and 79.7 % at 10 years. Independent predictors of conversion were age (HR 1.09/year), BMI ≥30 (HR 1.12), smoking (HR 2.85) and pre-operative JLO >5° (HR 1.32) (all p < 0.05). Post-operative MPTA >95° was not significant. Findings were consistent in competing-risk analyses. Complications occurred in 13.0 % (hinge fracture 5.1 %, delayed/non-union 3.6 %, infection 4.3 %). WOMAC improved from 45.8 to 22.1 (p < 0.001); all KOOS domains improved (p < 0.001); satisfaction 86.2 %.

Conclusions

MOWHTO achieved ∼80 % 10-year TKA-free survivorship with durable functional gains. Older age, obesity, smoking and increased pre-operative JLO predicted earlier conversion; post-operative MPTA >95° was not significant. Considering MPTA thresholds alongside pre-operative JLO may help avoid excessive obliquity and optimise longevity.

Level of evidence: Level IV (retrospective cohort/case series).

目的：量化内侧开楔形高位胫骨截骨术（MOWHTO）后的10年生存率，并确定转换为全膝关节置换术（TKA）的可改变预测因素，重点是关节线倾角（JLO）、肥胖和吸烟。方法：单中心回顾性队列研究138例（2007-2022）患有Ahlbäck I-II型内侧骨关节炎、可矫正内翻的MOWHTOs患者，随访≥24个月。长腿x线片测量对齐，JLO（胫骨平台相对于底的角度）和内侧胫骨近端角度（MPTA；术前/术后）。主要结局：TKA转换。Kaplan-Meier估计存活率；采用多变量Cox、比例风险检验和Fine-Gray竞争风险分析。灵敏度模型增加了术后JLO和偏离计划髋关节-膝关节-踝关节（HKA）对准；补充模型评估术后MPTA bb0 95°。结果：平均年龄46.9岁；平均随访83.4个月。138例膝关节中12例（8.7%）行全膝关节置换术；2年生存率为98.5%，5年为90.4%，10年为79.7%。转换的独立预测因子为年龄（HR 1.09/年）、BMI≥30 （HR 1.12）、吸烟（HR 2.85）和术前JLO bb0.5°（HR 1.32）（p 95°均无统计学意义）。竞争风险分析的结果是一致的。并发症发生率为13.0%（铰链骨折5.1%，延迟/不愈合3.6%，感染4.3%）。WOMAC从45.8提高到22.1 (p)。结论：MOWHTO实现了约80%的10年无tka生存率和持久的功能获益。年龄较大、肥胖、吸烟和术前JLO增加预测早期转化；术后MPTA >95°无明显差异。考虑MPTA阈值与术前JLO可能有助于避免过度倾斜和优化寿命。证据等级：四级（回顾性队列/病例系列）。

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引用次数: 0

Variations in graft maturity between quadriceps tendon and semitendinosus tendon at 6 months after anterior cruciate ligament reconstruction: A quantitative assessment using UTE-T2* mapping 前交叉韧带重建后6个月股四头肌肌腱和半腱肌腱间移植物成熟度的变化：使用UTE-T2*制图的定量评估

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。

{"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":"2025-12-19","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

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。

{"title":"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","authors":"Emanuele Tortoli , Carlo Ramponi , Alberto Grassi , Giuseppe Giovannico , Gian Luigi Canata , Alberto Vascellari , Luca Francini , Kate E. Webster","doi":"10.1016/j.knee.2025.104301","DOIUrl":"10.1016/j.knee.2025.104301","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104301"},"PeriodicalIF":2.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792025","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

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。

{"title":"Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis – A double-blinded randomized clinical study","authors":"Chun-Yu Chen , Cheng-Chang Lu , I-Hsiu Liou , Ming-Hsuan Huang , Ruei-Sian Ding , Shu-Fen Sun","doi":"10.1016/j.knee.2025.11.018","DOIUrl":"10.1016/j.knee.2025.11.018","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety of a single intra-articular injection of JETKNEE versus saline in patients with symptomatic knee OA.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104292"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738419","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

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