IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.knee.2025.104318

Dorota Borzucka , Krzysztof Kręcisz , Dawid Bączkowicz

Background

The specific influence of heavy external loads during back squats on patellofemoral joint arthrokinematics remains unclear. Therefore, this study aimed to evaluate these effects in vivo using vibroarthrography across a wide range of loads (0–70 kg).

Methods

An eight-load, randomized-order, within-subject design was used. Thirty-eight male team sport athletes (age: 22.0 ± 1.1 years, body mass: 82.8 ± 10.1 kg) performed back squats under eight external load conditions (0–70 kg) with 1-min rests between tests. The arthrokinematic quality of the patellofemoral joint was assessed using an accelerometer sensor placed 1 cm above the apex of the patella.

Results

The results revealed that the vibroarthrographic signal increased in an almost linear manner with an increasing knee load during the squat. This increase was statistically significant for loads equal to or greater than 40 kg (P < 0.001) for the signal variability parameters (VMS and R4) and for loads equal to or greater than 20 kg (P ≤ 0.007) for the frequency parameters (P1 and P2). Analyzing the median values, the VMS parameter increased by 150 %, R4 by 23 %, P1 by 135 %, and P2 by 140 % at the maximum load of 70 kg compared with the squat without a load.

Conclusion

The vibroarthrographic signal level steadily increases with increasing knee load during squats, seemingly associated with higher contact stress and kinetic friction of articular surfaces. This linear phenomenon is visible across the entire range of applied loads. Consequently, athletes and coaches should consider that progressively increasing loads may contribute to joint wear over time.

背景：大负荷外负荷下蹲对髌股关节运动学的具体影响尚不清楚。因此，本研究旨在通过大范围负荷（0-70 kg）的关节振动成像技术来评估这些在体内的影响。方法采用8负荷、随机顺序、受试者内设计。38名男性团体运动员（年龄：22.0±1.1岁，体重：82.8±10.1 kg）在8种外部负荷条件下（0-70 kg）进行了后蹲训练，试验之间休息1分钟。髌股关节的关节运动质量通过放置在髌骨顶端上方1cm处的加速度传感器进行评估。结果结果显示，关节振动信号随着深蹲时膝关节负荷的增加几乎呈线性增加。对于信号变异性参数（VMS和R4），负载等于或大于40 kg (P < 0.001)，对于频率参数（P1和P2），负载等于或大于20 kg (P≤0.007)，这种增加具有统计学意义。分析中位数，在最大负荷为70 kg时，与无负荷深蹲相比，VMS参数增加了150%，R4增加了23%，P1增加了135%，P2增加了140%。结论深蹲时关节振动成像信号水平随膝关节负荷的增加而增加，似乎与关节表面接触应力和动摩擦的增加有关。这种线性现象在整个施加载荷的范围内都是可见的。因此，运动员和教练员应该考虑逐渐增加的负荷可能会随着时间的推移导致关节磨损。

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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 : 2026-03-01 Epub 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 : 2026-03-01 Epub 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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引用次数: 0

The modified Bereiter trochleoplasty for severe trochlear dysplasia demonstrates significant clinical improvement in knee function and quality of life at mid-term follow-up 经中期随访，改良的Bereiter滑车成形术治疗严重滑车发育不良患者的膝关节功能和生活质量均有显著改善

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.knee.2025.104308

Andrew George, Nikhil Sharma, Rakan Kabariti, Andrew Barnett

Background

Trochleoplasty is effective for patients with patellofemoral instability attributed to severe trochlear dysplasia. Previously published data on short-term outcomes demonstrate excellent results in knee function and quality of life with an acceptable complication profile. This study reports on mid-term function and quality of life outcomes following trochleoplasty for severe trochlear dysplasia, including post-operative sequelae.

Methods

A longitudinal database was investigated, identifying all trochleoplasty procedures. Patients with <3 years follow-up data were excluded. All operations were performed by a fellowship-trained sports knee surgeon utilising a modified Bereiter technique. Post-operative mid-term IKDC, Kujala and EQ-5D results were compared to baseline. Non-parametric statistical methods were used. Statistically significant differences were assessed using a paired Wilcoxon-signed rank test (p < 0.05).

Results

Fifty-two trochleoplasties were performed between 2013–2019; 28 with >3 years follow-up data were available for analysis. Mean age at surgery was 22y (SD 4.7, 14–37y); median follow-up of 5.3y (IQR 3.9–7.0y). Median Kujala score improved from 57.0 (IQR 45–66) to 96.3 (IQR 83–100). Median IKDC score improved from 42.6 (IQR 35.9–51.3) to 92.6 (IQR 71.6–98.7). Median EQ-5D scores improved from 0.691 (IQR 0.414–0.727) to 1.000 (IQR 0.818–1.000). Improvement in all scores were statistically significant (p < 0.001). There were no further symptoms of patella instability, complications of chondral necrosis or patellofemoral osteoarthritis.

Conclusion

The Modified Bereiter trochleoplasty remains safe and effective in addressing recurrent patellofemoral instability associated with severe trochlear dysplasia. There is sustained improvement in knee function and quality of life at median follow-up of 5.3 years.

背景：滑车成形术对严重滑车发育不良导致的髌股不稳患者有效。先前发表的短期结果数据表明，在膝关节功能和生活质量方面取得了良好的效果，并发症可接受。本研究报告了严重滑车发育不良患者行滑车成形术后的中期功能和生活质量，包括术后后遗症。方法对所有滑车成形术进行纵向数据库调查。排除随访3年的患者。所有手术均由一名训练有素的运动膝关节外科医生使用改良的Bereiter技术进行。术后中期IKDC、Kujala和EQ-5D结果与基线比较。采用非参数统计方法。采用配对wilcoxon符号秩检验评估差异有统计学意义（p < 0.05）。结果2013-2019年共行滑骨成形术52例；28例随访3年，可获得数据进行分析。手术平均年龄22岁（SD 4.7, 14 - 37岁）；中位随访时间为5.3年（IQR为3.9 - 7.0年）。Kujala评分中位数由57.0 （IQR 45-66）提高至96.3 （IQR 83-100）。中位IKDC评分从42.6 （IQR 35.9-51.3）提高到92.6 （IQR 71.6-98.7）。中位EQ-5D评分从0.691 （IQR 0.414-0.727）提高到1.000 （IQR 0.818-1.000）。所有评分的改善均有统计学意义（p < 0.001）。没有进一步的髌骨不稳、软骨坏死并发症或髌骨股骨骨关节炎的症状。结论改良的Bereiter滑车成形术治疗复发性髌股不稳伴严重滑车发育不良安全有效。中位随访5.3年，膝关节功能和生活质量持续改善。

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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 : 2026-03-01 Epub Date: 2026-01-13 DOI: 10.1016/j.knee.2025.104320

引用次数: 0

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 : 2026-03-01 Epub 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

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 : 2026-03-01 Epub 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

Patients' consultation for artificial intelligence: Untouched threats. 人工智能患者会诊：未触及的威胁。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-02-24 DOI: 10.1016/j.knee.2026.104410

Shigeki Matsubara

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 : 2026-01-01 Epub 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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引用次数: 0

Uniform and reliable assessment of bone union on radiographs in osteotomies around the knee: a novel classification system 膝关节周围截骨术中统一可靠的x线片骨愈合评估：一种新的分类系统。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-04 DOI: 10.1016/j.knee.2025.10.016

E.A. Bax , N. van Egmond , R.J.H. Custers , K.L. Vincken , M.C. Kruyt , W. Foppen

Background

To evaluate the inter- and intra-rater reliability of the Unified Bone Union (UBU) classification for assessing time-dependent bone healing on radiographs in osteotomies around the knee, including negative union signs. Secondary aims included assessing union progression over time, applicability across osteotomy types, and correlation between radiographic and CT-based UBU scores.

Methods

The UBU classification assesses bone healing on anteroposterior radiographs in three anatomical zones, graded from phase 0 (no callus) to phase 3 (bridging callus), including radiological negative union signs. Radiographs (n = 110) from 38 medial opening-wedge high tibial osteotomy patients were retrospectively reviewed twice by three independent raters. Inter- and intra-rater reliability were assessed using quadratic-weighted kappa (κ). Percent agreement was calculated for classification modifiers. Time-dependent changes in union were analyzed. Reliability was also tested across osteotomy types. Correlation between 6-month radiographic and CT-based UBU scores was determined using Spearman’s rho.

Results

Interrater reliability was substantial (κ 0.74–0.79), while intra-rater reliability showed almost perfect agreement (κ 0.78–0.98). Modifier agreement was good (inter-rater: 91–98 %; intra-rater: 89–95 %). The UBU score increased over time. The UBU showed substantial interrater reliability (κ = 0.75) across various osteotomy types. A strong correlation was found between radiographic and CT-based UBU scores (r = 0.82, p < 0.01).

Conclusion

The UBU classification provides a reliable and standardized method for evaluating bone union after osteotomies around the knee. It incorporates negative union signs and demonstrates strong inter- and intra-rater agreement, as well as strong correlation with CT imaging. Further research should validate its diagnostic accuracy and clinical utility.

背景：评估统一骨愈合（UBU）分类在评估膝关节周围截骨术中随时间变化的骨愈合时的可靠性，包括阴性愈合迹象。次要目的包括评估骨愈合随时间的进展，不同截骨类型的适用性，以及x线摄影和基于ct的UBU评分之间的相关性。方法：UBU分级评估骨愈合在三个解剖区域的正位x线片上，从0期（无骨痂）到3期（桥接骨痂），包括放射学阴性愈合征象。本文回顾性分析了38例内侧楔形高位胫骨截骨术患者的x线片（n = 110），由三位独立评分者进行了两次评估。使用二次加权kappa （κ）评估评分间和评分内的信度。计算了分类修饰符的一致性百分比。分析了结合度随时间的变化。也测试了不同截骨类型的可靠性。使用Spearman’s rho确定6个月x线摄影和基于ct的UBU评分之间的相关性。结果：评分间信度显著（κ 0.74-0.79），评分内信度几乎完全一致（κ 0.78-0.98）。修饰语一致性较好（内部修饰语一致性：91- 98%；内部修饰语一致性：89- 95%）。UBU评分随着时间的推移而增加。UBU在各种截骨类型中显示出显著的互信度（κ = 0.75）。x线片评分与ct评分之间存在很强的相关性（r = 0.82, p）。结论：UBU分级为评估膝关节周围截骨术后骨愈合提供了一种可靠、标准化的方法。它包含负结合征象，表现出很强的骨间和骨内一致性，并与CT成像有很强的相关性。进一步的研究应验证其诊断准确性和临床应用价值。

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