Pub Date : 2025-12-19DOI: 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.
{"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}
Pub Date : 2025-12-19DOI: 10.1016/j.knee.2025.104310
Adil Ajuied , Fazal Ali , Nicolas Nicolaou
{"title":"Paediatric Knee Surgery: A New Frontier in Orthopaedics","authors":"Adil Ajuied , Fazal Ali , Nicolas Nicolaou","doi":"10.1016/j.knee.2025.104310","DOIUrl":"10.1016/j.knee.2025.104310","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104310"},"PeriodicalIF":2.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792024","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}
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.
{"title":"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","authors":"Naoki Takemoto, Junsuke Nakase, Yasushi Takata, Yusuke Yanatori, Manase Nishimura, Kentaro Fujita, Mikino Saito, Satoru Demura","doi":"10.1016/j.knee.2025.104309","DOIUrl":"10.1016/j.knee.2025.104309","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (<em>n</em> = 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 (<em>n</em> = 4/group/time point), and biomechanical testing assessed maximum failure load and mode of failure (<em>n</em> = 6/group/time point). Non-parametric tests were used to compare groups, and repeated-measures analysis of variance was used to assess temporal changes.</div></div><div><h3>Results</h3><div>The rounded-rectangular tunnel group (Group R) showed significantly lower BTE than the circular tunnel group (Group C) at 4 and 8 weeks (both <em>p</em> < 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 (<em>P</em> = 0.038). The maximum failure load was higher in Group R at 4 weeks (<em>P</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"59 ","pages":"Article 104309"},"PeriodicalIF":2.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771994","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}
Pub Date : 2025-12-18DOI: 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}
Pub Date : 2025-12-11DOI: 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.
{"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}
Pub Date : 2025-12-11DOI: 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.
{"title":"Improving patellofemoral pain assessment with weight-bearing computed tomography and machine learning using three-dimensional knee joint metrics","authors":"Hyo-Bin Lee , Jang-Hwan Choi","doi":"10.1016/j.knee.2025.11.016","DOIUrl":"10.1016/j.knee.2025.11.016","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>t</em>-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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 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), <em>P</em> = 0.03). AKPS improved from 72 ± 10 (pretreatment) to 82 ± 6 (post-treatment) (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104290"},"PeriodicalIF":2.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738418","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}
Pub Date : 2025-12-06DOI: 10.1016/j.knee.2025.11.015
Logan M. Good , Emily L. Lu , Eric M. Milliron , Parker A. Cavendish , Robert A. Duerr , Christopher C. Kaeding , David C. Flanigan , Robert A. Magnussen
Background
Advancements in technology and techniques have shaped meniscus repair outcomes, but long term results remain unclear. This review aims to comprehensively evaluate studies with a mean follow-up of greater than 10 years following inside-out, outside-in, all-inside, open, or pull-out repair techniques. In addition, this article will review the impact of concomitant anterior cruciate ligament (ACL) reconstruction on long-term meniscus repair outcomes and compare osteoarthritis risk of patients treated partial meniscectomy compared with meniscus repair. We hypothesize there is increased evidence of osteoarthritis following partial meniscectomy compared to all types of meniscal repair.
Methods
PubMed and EMBASE databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included full-text English language, human patients with at least one outcome reported after meniscus repair, and publication before June 22, 2021. Exclusion criteria included mean follow up of less than 10 years, published before the year 2000, or significant concomitant procedures within the knee during meniscus repair.
Results
Inside-out, all-inside, trans-tibial pull-out, and open repair techniques of meniscal tears demonstrate clinical success and good long-term outcomes. Data regarding the impact of concomitant anterior cruciate ligament reconstruction on meniscus repair outcomes are conflicting. The risk of osteoarthritis is reduced in meniscal repair when compared with partial meniscectomy.
Conclusion
Outcomes of meniscus repair are favorable at 10 years post-operative regardless of technique. While the impact of concomitant ACL reconstruction on meniscus repair outcomes is unclear, meniscus repair is associated with decreased osteoarthritis risk compared to partial meniscectomy.
Level of evidence
IV; systematic review of level III-IV studies.
技术和技术的进步影响了半月板修复的结果，但长期结果仍不清楚。本综述旨在综合评价平均随访时间超过10年的研究，这些研究采用了由内而外、由外而内、全内、开放式或拔出式修复技术。此外，本文将回顾联合前交叉韧带（ACL）重建对半月板长期修复结果的影响，并比较半月板部分切除术与半月板修复患者骨关节炎的风险。我们假设与所有类型的半月板修复相比，部分半月板切除术后骨关节炎的证据增加。方法按照PRISMA （Preferred Reporting Items for Systematic Reviews and meta - analysis）指南对spubmed和EMBASE数据库进行检索。纳入标准包括英文全文，半月板修复后报告至少一项结果的人类患者，并在2021年6月22日之前发表。排除标准包括平均随访少于10年，发表于2000年之前，或在半月板修复过程中膝关节内有重要的伴随手术。结果由内而外、全内、经胫骨拔出和开放修复半月板撕裂技术均取得了临床成功和良好的远期疗效。关于联合前交叉韧带重建对半月板修复结果的影响的数据是相互矛盾的。与半月板部分切除术相比，半月板修复术降低了骨关节炎的风险。结论不论采用何种技术，术后10年半月板修复效果良好。虽然合并前交叉韧带重建对半月板修复结果的影响尚不清楚，但与半月板部分切除术相比，半月板修复与降低骨关节炎风险相关。证据水平eiv；III-IV级研究的系统评价。
{"title":"Meniscus repair: a review of techniques and long-term outcomes","authors":"Logan M. Good , Emily L. Lu , Eric M. Milliron , Parker A. Cavendish , Robert A. Duerr , Christopher C. Kaeding , David C. Flanigan , Robert A. Magnussen","doi":"10.1016/j.knee.2025.11.015","DOIUrl":"10.1016/j.knee.2025.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Advancements in technology and techniques have shaped meniscus repair outcomes, but long term results remain unclear. This review aims to comprehensively evaluate studies with a mean follow-up of greater than 10 years following inside-out, outside-in, all-inside, open, or pull-out repair techniques. In addition, this article will review the impact of concomitant anterior cruciate ligament (ACL) reconstruction on long-term meniscus repair outcomes and compare osteoarthritis risk of patients treated partial meniscectomy compared with meniscus repair. We hypothesize there is increased evidence of osteoarthritis following partial meniscectomy compared to all types of meniscal repair.</div></div><div><h3>Methods</h3><div>PubMed and EMBASE databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included full-text English language, human patients with at least one outcome reported after meniscus repair, and publication before June 22, 2021. Exclusion criteria included mean follow up of less than 10 years, published before the year 2000, or significant concomitant procedures within the knee during meniscus repair.</div></div><div><h3>Results</h3><div>Inside-out, all-inside, <em>trans</em>-tibial pull-out, and open repair techniques of meniscal tears demonstrate clinical success and good long-term outcomes. Data regarding the impact of concomitant anterior cruciate ligament reconstruction on meniscus repair outcomes are conflicting. The risk of osteoarthritis is reduced in meniscal repair when compared with partial meniscectomy.</div></div><div><h3>Conclusion</h3><div>Outcomes of meniscus repair are favorable at 10 years post-operative regardless of technique. While the impact of concomitant ACL reconstruction on meniscus repair outcomes is unclear, meniscus repair is associated with decreased osteoarthritis risk compared to partial meniscectomy.</div><div>Level of evidence</div><div>IV; systematic review of level III-IV studies.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104289"},"PeriodicalIF":2.0,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685778","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}
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.
{"title":"Comparison of methods for evaluating soft tissue balance in robotic-assisted total knee arthroplasty: A cadaveric study","authors":"Yasuaki Tamaki , Daisuke Hamada , Keizo Wada , Shota Shigekiyo , Yuto Sugimine , Yutaka Kinoshita , Koichi Tomita , Koichi Sairyo","doi":"10.1016/j.knee.2025.11.012","DOIUrl":"10.1016/j.knee.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>Intra-rater and inter-rater reliability was high for the medial gap assessment but lower for the lateral gap assessment.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104286"},"PeriodicalIF":2.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679821","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}
Pub Date : 2025-12-03DOI: 10.1016/j.knee.2025.11.013
Anam Jawaid , Hamza Umar , Siddarth Raj , Martinique Vella-Baldacchino , Matthew Hampton , Andrew Metcalfe , Leela C. Biant , BASK Trainee Collaborative
Introduction
Knee cartilage defects are common and often encountered during arthroscopy, with an incidence of 60–66%. The aim of this study was to determine current strategies in the surgical and non-surgical management of symptomatic knee cartilage defects in the UK.
Methods
Adopting a collaborative study model, a survey was circulated to participating centres. This comprised of 21 questions, addressing the number and type of cartilage procedures performed within the past 5 years for isolated knee cartilage defects. Data was also collected on the type of injection therapy that was offered by each centre.
Results
Data was analyzed from 19 centres across the UK. Over 5 years, 36,661 procedures were performed on patients with isolated cartilage defects. Chondroplasty and microfracture were performed most commonly, n = 6772 and n = 1579, respectively. AMIC, OATS and ACI were performed in fewer than 50 % of centres sampled, with actual procedure numbers 61, 29 and 176 respectively. Multiple centres combined cartilage procedures with ligament reconstruction (n = 2131, 10 centres), osteotomy (n = 1188, nine centres) and patellofemoral surgery (n = 1173, seven centres). Seventeen of 19 centres offered injections for knee pain. Corticosteroid therapies were most common (15/17); seven of 17 centres offered additional therapies (two of 17 PRP, three of 17 HA, two of 17 both PRP and HA).
Conclusions
This is the first nationwide study evaluating approaches to managing isolated cartilage defects and injection therapies. While chondroplasty and microfracture are most commonly used, there is significant variation in the use of AMIC, OATS, ACI, and injection treatments, suggesting inconsistent adherence to NICE guidelines in the management of chondral defects.
{"title":"The management of cartilage defects of the knee and injection therapy – A collaborative and retrospective study","authors":"Anam Jawaid , Hamza Umar , Siddarth Raj , Martinique Vella-Baldacchino , Matthew Hampton , Andrew Metcalfe , Leela C. Biant , BASK Trainee Collaborative","doi":"10.1016/j.knee.2025.11.013","DOIUrl":"10.1016/j.knee.2025.11.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Knee cartilage defects are common and often encountered during arthroscopy, with an incidence of 60–66%. The aim of this study was to determine current strategies in the surgical and non-surgical management of symptomatic knee cartilage defects in the UK.</div></div><div><h3>Methods</h3><div>Adopting a collaborative study model, a survey was circulated to participating centres. This comprised of 21 questions, addressing the number and type of cartilage procedures performed within the past 5 years for isolated knee cartilage defects. Data was also collected on the type of injection therapy that was offered by each centre.</div></div><div><h3>Results</h3><div>Data was analyzed from 19 centres across the UK. Over 5 years, 36,661 procedures were performed on patients with isolated cartilage defects. Chondroplasty and microfracture were performed most commonly, <em>n</em> = 6772 and <em>n</em> = 1579, respectively. AMIC, OATS and ACI were performed in fewer than 50 % of centres sampled, with actual procedure numbers 61, 29 and 176 respectively. Multiple centres combined cartilage procedures with ligament reconstruction (<em>n</em> = 2131, 10 centres), osteotomy (<em>n</em> = 1188, nine centres) and patellofemoral surgery (<em>n</em> = 1173, seven centres). Seventeen of 19 centres offered injections for knee pain. Corticosteroid therapies were most common (15/17); seven of 17 centres offered additional therapies (two of 17 PRP, three of 17 HA, two of 17 both PRP and HA).</div></div><div><h3>Conclusions</h3><div>This is the first nationwide study evaluating approaches to managing isolated cartilage defects and injection therapies. While chondroplasty and microfracture are most commonly used, there is significant variation in the use of AMIC, OATS, ACI, and injection treatments, suggesting inconsistent adherence to NICE guidelines in the management of chondral defects.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104287"},"PeriodicalIF":2.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679761","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}
Pub Date : 2025-12-03DOI: 10.1016/j.knee.2025.10.014
Amir Mafi , Matthew Cabral , Douglas Chonko , Matthew Pigott , Anne Sullivan , Niraj Gupta , David McComb , Paul Stoodley
Background
Periprosthetic joint infection (PJI) is a challenging complication of total knee arthroplasty (TKA). Bacterial biofilm formation is strongly implicated in PJIs, and renders the bacteria tolerant of antibiotic therapy and innate immunity. However, there is little information on where biofilms may reside in the reconstructed joint. In previous mapping projects using an agar overlay ‘implant surface culture’ (ISC) method we found evidence that biofilm was forming in the gap between the polyethylene spacer and the tibial tray components explanted from TKA patients undergoing revision for PJI. We hypothesized that bacteria could enter this gap and attach to form biofilms on both plastic and metal interfacing surfaces.
Methods
We inoculated spacers and tibial tray components recovered from PJI patients that had been cleaned and reassembled with Staphylococcus epidermidis. We used scanning electron microscopy (SEM) to image the surfaces after an incubation of 3 days with daily media changes and analyzed the surface concentration of bacteria on flat surfaces and associated with surface features (slots, screw holes, ridges).
Results
Examination and quantification at multiple magnifications revealed a range from a sparse covering of bacteria on the flat areas to more extensive biofilms in monolayers and small aggregates around and within features in the tray. The polythene surfaces had three times more bacteria than the metal (P < 0.05). In the four features measured there were six times more bacteria that were associated with adjacent flat surfaces, but this was not statistically significant (P > 0.05).
Conclusions
Bacteria can attach and initiate biofilm formation in the metal–polyethylene gap on both surfaces and are most concentrated in association with surface features. The gap may provide a niche where biofilm could reside with protection from antibiotics as well as phagocytic cells and other components of host immunity, and even irrigation and debridement procedures in a partial exchange.
{"title":"Bacterial attachment and initial biofilm formation on the metal tibial tray and plastic spacer interfacing surfaces of total knee components: An in vitro scanning electron microscopy study","authors":"Amir Mafi , Matthew Cabral , Douglas Chonko , Matthew Pigott , Anne Sullivan , Niraj Gupta , David McComb , Paul Stoodley","doi":"10.1016/j.knee.2025.10.014","DOIUrl":"10.1016/j.knee.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) is a challenging complication of total knee arthroplasty (TKA). Bacterial biofilm formation is strongly implicated in PJIs, and renders the bacteria tolerant of antibiotic therapy and innate immunity. However, there is little information on where biofilms may reside in the reconstructed joint. In previous mapping projects using an agar overlay ‘implant surface culture’ (ISC) method we found evidence that biofilm was forming in the gap between the polyethylene spacer and the tibial tray components explanted from TKA patients undergoing revision for PJI. We hypothesized that bacteria could enter this gap and attach to form biofilms on both plastic and metal interfacing surfaces.</div></div><div><h3>Methods</h3><div>We inoculated spacers and tibial tray components recovered from PJI patients that had been cleaned and reassembled with <em>Staphylococcus epidermidis</em>. We used scanning electron microscopy (SEM) to image the surfaces after an incubation of 3 days with daily media changes and analyzed the surface concentration of bacteria on flat surfaces and associated with surface features (slots, screw holes, ridges).</div></div><div><h3>Results</h3><div>Examination and quantification at multiple magnifications revealed a range from a sparse covering of bacteria on the flat areas to more extensive biofilms in monolayers and small aggregates around and within features in the tray. The polythene surfaces had three times more bacteria than the metal (<em>P</em> < 0.05). In the four features measured there were six times more bacteria that were associated with adjacent flat surfaces, but this was not statistically significant (<em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Bacteria can attach and initiate biofilm formation in the metal–polyethylene gap on both surfaces and are most concentrated in association with surface features. The gap may provide a niche where biofilm could reside with protection from antibiotics as well as phagocytic cells and other components of host immunity, and even irrigation and debridement procedures in a partial exchange.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104260"},"PeriodicalIF":2.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679795","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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