Knee最新文献

{"title":"The phantom osteotomy is here: an algorithm for managing the joint line convergence angle in osteotomies around the knee & improving surgical accuracy","authors":"Sam K. Yasen","doi":"10.1016/j.knee.2025.10.008","DOIUrl":"10.1016/j.knee.2025.10.008","url":null,"abstract":"<div><div>Realignment osteotomy around the knee is currently experiencing significant growth in the UK and further afield. Osteotomy can be utilised to treat a wide range of conditions, but is most often considered in patients presenting with unicompartmental knee arthritis with coronal plane mechanical malalignment, who have failed conservative treatment.</div><div>This article reviews management strategies to improve accuracy in knee osteotomy surgery, with a specific focus on handling an elevated joint line convergence angle (JLCA). Increased JLCA has historically resulted in less predictable correction outcomes after coronal plane realignment osteotomy, and this has been referred to as the ‘soft tissue lottery’ after such surgery.</div><div>A fresh approach is presented to understanding and classifying knee varus, and how this influences joint loading and consequent implications to the JLCA. The valgus knee is similarly considered. Myths regarding the ‘tipping point’ (with respect to the weight bearing axis of the knee) are dispelled, and an algorithm is presented for handling an elevated JLCA, predicated on adjusting osteotomy targets for the portion of the elevation caused by joint space opening, rather than from joint space loss, with clinical examples. The theory and practice of using ‘phantom’ corrections within the joint to partially correct the JLCA when preoperatively planning using digitally acquired longleg radiographs is presented.</div><div>Guidelines are also provided for parameters to safeguard outcomes in osteotomy surgery with respect to correction targets and philosophies around surgical planning and execution.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 536-545"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369322","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}

{"title":"Paediatric knee injuries","authors":"Oday Al-Dadah,&nbsp;Caroline Hing","doi":"10.1016/j.knee.2025.11.009","DOIUrl":"10.1016/j.knee.2025.11.009","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages A1-A2"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617652","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}

{"title":"Corrigendum to “The effects of heading motion and sex on lower extremity biomechanics in soccer players” [The Knee 50 (2024) 154–162]","authors":"Joshua T. Weinhandl ,&nbsp;Abdulmajeed Alfayyadh ,&nbsp;Lauren E. Dami ,&nbsp;Songning Zhang ,&nbsp;Eugene C. Fitzugh","doi":"10.1016/j.knee.2025.10.001","DOIUrl":"10.1016/j.knee.2025.10.001","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Page 535"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395340","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}

{"title":"Accounting for anatomical and functional differences: a closer look at high-flexion demands and posterior tibial slope in the Indian population","authors":"Amit Meena ,&nbsp;Manish Attri ,&nbsp;Darren de SA ,&nbsp;Sachin Tapasvi","doi":"10.1016/j.knee.2025.10.009","DOIUrl":"10.1016/j.knee.2025.10.009","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 546-548"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423570","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}

{"title":"Predicting return to sport after multiligament knee injuries using machine learning: development and internal validation of a clinical algorithm","authors":"Carlos Suarez-Ahedo ,&nbsp;Francisco Endara-Urresta ,&nbsp;Carlos Peñaherrera-Carrillo ,&nbsp;Alejandro Barros-Castro","doi":"10.1016/j.knee.2025.10.003","DOIUrl":"10.1016/j.knee.2025.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and internally validate a machine learning–based predictive model to estimate the probability of return to sport (RTS) at 12 months after surgical reconstruction of multiligament knee injuries (MLKIs), and to identify the most influential clinical predictors. Methods: Patients who underwent MLKIs reconstruction between 2012 and 2022 across three tertiary care centers were included. Inclusion criteria comprised reconstruction of ≥2 ligaments, age 18–50, and ≥12 months of follow-up. The primary outcome was RTS at 12 months. Predictive variables included demographic, clinical, surgical, and functional data. Four models were compared: logistic regression, support vector machine (SVM), random forest, and XGBoost. Model performance was assessed via 10-fold cross-validation using AUC-ROC, accuracy, sensitivity, specificity, F1-score, and Brier score. SHAP analysis was used to interpret feature importance. Results: Among 220 patients, 60.9 % achieved RTS at 12 months. Machine learning models demonstrated strong predictive performance, with XGBoost yielding the highest accuracy (AUC = 0.84). Key predictors for RTS included a higher preinjury Tegner score, younger patient age, shorter time to surgery (&lt;6 weeks), and higher baseline IKDC score. Psychological readiness and posterolateral corner reconstruction also contributed positively. Logistic regression showed inferior performance (AUC = 0.72). Conclusion: Machine learning models can accurately predict RTS following MLKIs using accessible clinical data. These tools may enhance individualized decision-making and guide postoperative rehabilitation strategies. Clinical Relevance: This model may assist clinicians in setting realistic patient expectations, personalizing care, and developing RTS-focused treatment algorithms.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"Pages 522-531"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617577","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}

{"title":"High-grade trochlear dysplasia is associated with a more negative sagittal tibial tuberosity-trochlear groove distance: A retrospective cohort study.","authors":"Brian T Bueno, Michael R Moore, Andrew S Bi, Larry Chen, Jairo Triana, Laith M Jazrawi, Guillem Gonzalez-Lomas, Daniel J Kaplan","doi":"10.1016/j.knee.2025.07.005","DOIUrl":"10.1016/j.knee.2025.07.005","url":null,"abstract":"<p><strong>Purpose: </strong>To identify demographic or radiographic predictors of sagittal tibial tuberosity-trochlear groove (sTT-TG) distance utilizing a cohort of patellofemoral surgical patients.</p><p><strong>Methods: </strong>Patients who underwent an osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI) from 2010 to 2020 were included if they had patellofemoral high-grade lesions and preoperative magnetic resonance imaging (MRI). Patient demographics, radiographic measurements such as coronal TT-TG, Caton-Deschamps index (CDI), and trochlear dysplasia were recorded. The preoperative sTT-TG distance was measured independently on axial T2-weighted MRI sequences by two authors at least two weeks apart. An interclass correlation coefficient (ICC) was calculated to assess intra- and inter-rater reliability of sTT-TG measurements, and univariate and multivariable linear regression models were used to assess the relationship between sTT-TG and any demographic or radiographic predictors.</p><p><strong>Results: </strong>Seventy-three knees composed of 44 females and 29 males with a mean age of 31.0 ± 10.1 years, a mean BMI of 26.8 ± 6.1, and a mean follow-up of 60.4 ± 21.0 months were included. Thirty-four of these (46.6 %) underwent OCA transplantations and 39 (53.4 %) underwent ACI/MACIs. Thirty-one (42.4 %) knees were determined to have evidence of trochlear dysplasia. Twenty-four patients were found to have high grade trochlear dysplasia (grades B, C and D) and 7 patients were found to have low grade trochlear dysplasia (grade A). The mean sTT-TG of the entire cohort was -5.3 ± 4.9 mm. Interobserver reliability for sTT-TG measurements was excellent with an ICC of 0.95 (0.927-0.969, p < 0.001). There was a significant difference in sTT-TG between patients who had no trochlear dysplasia, low-grade trochlear dysplasia and high grade trochlear dysplasia (-3.51 ± 3.96 vs. -6.17 ± 4.29 vs. -9.25 ± 5.32, p < 0.001). On multivariate regression, trochlear dysplasia remained the only significant predictor of sTT-TG (β = -2.25, p = 0.005). Post-hoc analysis showed that both low- and high-grade dysplasia were associated with significantly more negative sTT-TG values compared to patients without dysplasia, though no significant difference was observed between the low- and high-grade groups.</p><p><strong>Conclusion: </strong>Trochlear dysplasia was associated with a more negative sagittal tibial tuberosity-trochlear groove (sTT-TG) distance, with increasing severity of trochlear dysplasia correlated with a relatively more posterior tibial tuberosity.</p><p><strong>Level of evidence: </strong>Level III; diagnostic cross-sectional study.</p>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"57 ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812738","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}

{"title":"How do occupational demands affect return to work after total knee arthroplasty?","authors":"Anzar Sarfraz ,&nbsp;Sophia Antonioli ,&nbsp;Don H. Le ,&nbsp;Farouk Khury ,&nbsp;Joseph X. Robin ,&nbsp;Ran Schwarzkopf ,&nbsp;Armin Arshi ,&nbsp;Joshua C. Rozell","doi":"10.1016/j.knee.2025.11.010","DOIUrl":"10.1016/j.knee.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Patients who undergo primary total knee arthroplasty (TKA) may return to work at variable times following surgery, the timeline for which is partly affected by the physical intensity of their occupation. The purpose of this study was to evaluate patient satisfaction and limitations when returning to work following TKA.</div></div><div><h3>Methods</h3><div>This retrospective review surveyed patients undergoing primary TKA between June 2011 and January 2022, with at least 1 year of follow up, regarding return to work. Of the 914 respondents, 507 (55.5 %) worked preoperatively and were stratified into high intensity (HI) (i.e., laborer, construction), standard intensity (SI) (i.e., walking, climbing stairs), or low intensity (LI) (i.e., sedentary desk jobs) groups. Baseline characteristics and survey responses were compared across groups. Among those who worked preoperatively, 35 (6.9 %), 213 (42 %), and 259 (51.1 %) were in the HI, SI, and LI groups, respectively.</div></div><div><h3>Results</h3><div>Of the 507 patients who worked prior to TKA, 447 (88.2 %) returned to work after surgery and 60 (11.8 %) did not. The HI group was comprised of more young males and more smokers than the SI and LI groups. In the LI group, 30 % returned within 1 month following surgery and an additional 44 % within 2 months. Similarly in the SI group, 11 % returned to work in less than 1 month with an additional 39 % returning within 2 months. In the HI group, 4 % returned within the first month and additional 42 % returned within 2 months. HI workers were more commonly hindered in their return (HI: 30.8 %, SI: 23.1 %, LI: 7.7 %), ‘moderately declined’ in their work ability (HI: 23.1 %, SI: 9.7 %, 3.0 %), and ‘very unsatisfied’ with their return (HI: 11.5 %, SI: 10.8 %, LI: 8.1 %).</div></div><div><h3>Conclusion</h3><div>TKA leads to improvements in work function and satisfaction across all intensity levels, but HI work is associated with longer recovery times and comparatively lower return-to-work satisfaction compared to SI and LI groups.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104284"},"PeriodicalIF":2.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642745","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}

{"title":"Micro-computed tomographic analysis of trabecular bone pattern in the juvenile distal femoral metaphysis","authors":"Sunpatch Benjavongkulchai ,&nbsp;Catriona Davies ,&nbsp;Craig A. Cunningham","doi":"10.1016/j.knee.2025.10.025","DOIUrl":"10.1016/j.knee.2025.10.025","url":null,"abstract":"<div><h3>Background</h3><div>Throughout the juvenile period, the knee joint must accommodate several developmental milestones including weaning, crawling, sitting and the attainment of bipedal gait. These activities are related to the magnitude, direction and distribution of mechanical forces passing through the joint and are thought to contribute to the formation of specific trabecular bone signatures. This study aimed to investigate this trabecular bone architecture in the developing distal femur and relate this to the forces acting at key developmental milestones.</div></div><div><h3>Methods</h3><div>Micro-computed tomography was performed on 63 specimens within the prenatal to 7-year-old age range. Trabecular bone quantification was conducted in twenty-two volumes of interest (VOI) in the distal metaphysis. Four trabecular bone parameters were analysed within each VOI including; bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N). Statistical analysis was performed to identify significant differences between different VOIs, and between different age groups.</div></div><div><h3>Results</h3><div>Bone parameter values were similar between VOIs in subjects under 1 year old. A reduction of BV/TV during the first two years after birth was highlighted, with the lowest value found between 1 and 2 years old. The decreased BV/TV may be related to reduced mechanical stimulation, compared to the intra-uterine environment, and reduced nutritional supply after birth. Increased BV/TV was observed after 2 years. Significantly higher BV/TV, Tb.Th, Tb.N and lower Tb.Sp were found in sub-cortical VOIs compared to central VOIs.</div></div><div><h3>Conclusion</h3><div>Trabecular bone patterns were shown to reflect the forces associated with key developmental milestones.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104271"},"PeriodicalIF":2.0,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649986","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}

{"title":"Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis","authors":"Shota Imamura ,&nbsp;Rui Tsukagoshi ,&nbsp;Kei Setogawa ,&nbsp;Takafumi Mizuno ,&nbsp;Kazuhisa Kajihara ,&nbsp;Hiroshi Nakayama ,&nbsp;Naoki Sasanuma ,&nbsp;Akira Sakaguchi ,&nbsp;Kotaro Kawaguchi ,&nbsp;Yuki Uchiyama ,&nbsp;Kazuhisa Domen","doi":"10.1016/j.knee.2025.11.011","DOIUrl":"10.1016/j.knee.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Increased mechanical loading during gait is a risk factor for knee osteoarthritis (OA). An elevated knee adduction moment serves as an indicator of mechanical loading on the femorotibial (FT) joint. By contrast, increased knee flexion excursion and knee flexion moment are indicators of mechanical loading on the patellofemoral (PF) joint. Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) improves the static alignment of the FT and PF joints; however, the extent of changes in mechanical loading during gait remains unclear. Hence, this study aimed to evaluate the changes in the kinematics and kinetics of pre- and post-hybrid CWHTO and compare the outcomes with those observed in healthy controls.</div></div><div><h3>Methods</h3><div>This study included 14 patients with medial knee OA who underwent hybrid CWHTO and 21 healthy elderly controls. Gait was evaluated using two-dimensional motion analysis preoperatively and at 1 year postoperatively.</div></div><div><h3>Results</h3><div>The postoperative knee adduction moment was significantly reduced. However, no significant differences were found in knee flexion excursion and knee flexion moment between the preoperative and postoperative assessments. Both parameters remained lower than those observed in healthy elderly controls.</div></div><div><h3>Conclusion</h3><div>Although the hybrid CWHTO effectively reduces knee adduction moments, thereby decreasing mechanical stress on the FT joint, it does not change knee flexion excursion or knee flexion moments. However, radiographic evaluation demonstrated changes in patellar height, suggesting that positional factors may influence PF joint mechanics independent of sagittal-plane measures. These findings highlight the need to incorporate targeted rehabilitation interventions focused on improving the sagittal plane mechanics.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104285"},"PeriodicalIF":2.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642796","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}

{"title":"Artificial Intelligence (AI) and surgery of the knee","authors":"Vipin Asopa ,&nbsp;Keith Tucker","doi":"10.1016/j.knee.2025.11.008","DOIUrl":"10.1016/j.knee.2025.11.008","url":null,"abstract":"","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104282"},"PeriodicalIF":2.0,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643284","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}