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。

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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

Meniscus repair: a review of techniques and long-term outcomes 半月板修复：技术回顾和长期结果

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-06 DOI: 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。

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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 : 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

The management of cartilage defects of the knee and injection therapy – A collaborative and retrospective study 膝关节软骨缺损的处理与注射治疗-一项合作与回顾性研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-03 DOI: 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.

膝关节软骨缺损是关节镜检查中常见的缺损，其发生率为60-66%。本研究的目的是确定英国症状性膝关节软骨缺损的手术和非手术治疗的当前策略。方法：采用合作研究模式，向参与中心分发调查问卷。这包括21个问题，涉及过去5年内为孤立性膝关节软骨缺损进行的软骨手术的数量和类型。还收集了每个中心提供的注射治疗类型的数据。结果：分析了来自英国19个中心的数据。在5年中，对孤立性软骨缺损患者进行了36,661次手术。软骨成形术和微骨折最为常见，分别为n = 6772和n = 1579。在不到50%的抽样中心进行了AMIC， OATS和ACI，实际程序编号分别为61,29和176。多中心联合软骨手术与韧带重建（n = 2131, 10个中心）、截骨术（n = 1188, 9个中心）和髌骨手术（n = 1173, 7个中心）。19个中心中有17个提供治疗膝关节疼痛的注射。皮质类固醇治疗最为常见（15/17）；17个中心中有7个提供额外治疗（17个PRP中心中有2个，17个HA中心中有3个，17个PRP和HA中心中有2个）。结论：这是第一个全国性的评估治疗孤立性软骨缺损和注射治疗方法的研究。虽然软骨成形术和微骨折是最常用的方法，但在使用AMIC、OATS、ACI和注射治疗方面存在显著差异，这表明在处理软骨缺损时不一致地遵守NICE指南。

{"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}

引用次数: 0

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 全膝关节金属胫骨托盘和塑料垫片界面表面细菌附着和初始生物膜形成：体外扫描电镜研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-03 DOI: 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.

背景：假体周围关节感染（PJI）是全膝关节置换术（TKA）的一个具有挑战性的并发症。细菌生物膜的形成与PJIs密切相关，并使细菌耐受抗生素治疗和先天免疫。然而，关于生物膜可能存在于重建关节中的位置的信息很少。在之前使用琼脂覆盖“植入物表面培养”（ISC）方法的测绘项目中，我们发现证据表明，生物膜正在聚乙烯间隔物和从接受PJI翻修的TKA患者中外植的胫骨托盘组件之间的间隙中形成。我们假设细菌可以进入这个间隙并附着在塑料和金属界面表面形成生物膜。方法：用表皮葡萄球菌清洗后重组的PJI患者回收的垫片和胫骨托盘组件进行接种。我们使用扫描电子显微镜（SEM）对培养3天后每天更换培养基的表面进行成像，并分析了平面表面上细菌的表面浓度及其与表面特征（槽，螺孔，脊）的关系。结果：在多次放大下的检查和定量显示，从平坦区域的稀疏细菌覆盖到更广泛的单层生物膜和托盘周围和内部特征的小聚集体。聚乙烯表面的细菌数量是金属表面的3倍（P < 0.05）。结论：细菌可以附着并引发金属-聚乙烯表面间隙形成生物膜，并且最集中与表面特征相关。这个间隙可能提供了一个生态位，生物膜可以驻留在那里，保护生物膜免受抗生素、吞噬细胞和宿主免疫的其他成分的侵害，甚至可以在部分交换中进行冲洗和清创手术。

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引用次数: 0

Lateral extra-articular tenodesis protects high-risk patients from the risk of re-rupture and improves patient-reported outcomes after primary anterior cruciate ligament repair: A retrospective cohort study with ≥2-year follow up 外侧关节外肌腱固定术可以保护高危患者避免再次断裂的风险，并改善原发性前交叉韧带修复后患者报告的结果：一项随访≥2年的回顾性队列研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-03 DOI: 10.1016/j.knee.2025.11.014

Alessandro Carrozzo , Valerio Nasso , Alessandro Annibaldi , Gianluca Ciccarelli , Pierfrancesco Orlandi , Silvia Cardarelli , Edoardo Monaco

Background

Primary repair of proximal anterior cruciate ligament (ACL) tears is appealing, but the risk of re-rupture is a concern, particularly in young athletes. This study aimed to assess whether adding a lateral extra-articular tenodesis (LET) to an ACL repair procedure reduces the risk of failure and improves patient-reported outcomes in high-risk patients.

Methods

A retrospective cohort of 39 consecutive patients treated within 14 days of injury (2018–2023) was reviewed. Nineteen patients underwent isolated ACL repair, while 20 patients received a combined repair plus a Coker–Arnold LET. The minimum follow up period was 24 months (mean ± standard deviation: 42.5 ± 11.8). Failure rates, return to sport, Rolimeter side-to-side laxity, and patient-reported outcome measures were compared.

Results

Failure rates were similar between the two groups (15.8 % vs. 10.0 %; P = 0.589), as well as for anterior laxity, IKDC and ACL-Return to Sport after Injury scores (P > 0.05). Despite being younger, patients who underwent combined procedures achieved higher postoperative activity and better patient-reported outcomes: KOOS-Function: 94.6 vs. 86.1 (P = 0.007); KOOS-Sport: 83.5 vs. 70.8 (P = 0.020); KOOS-Total: 89.5 vs. 79.0 (P = 0.010); and FJS-12: 83.3 vs. 67.5 (P = 0.008). Return to sport was 74 % in the isolated ACL repair group and 85 % in the combined procedures group (P = 0.382).

Conclusions

The addition of a lateral extra-articular procedure to primary ACL repair in patients at a higher risk of re-rupture results in failure rates comparable to those of lower-risk, less active individuals and enhances functional recovery and activity levels.

背景：近前交叉韧带（ACL）撕裂的初级修复是有吸引力的，但再次破裂的风险是一个问题，特别是在年轻运动员中。本研究旨在评估在ACL修复手术中加入外侧关节外肌腱固定术（LET）是否能降低手术失败的风险，并改善高危患者报告的预后。方法：回顾性分析39例受伤后14天内（2018-2023）连续治疗的患者。19例患者接受了单独的ACL修复，而20例患者接受了联合修复+ Coker-Arnold LET。最小随访时间为24个月（平均±标准差：42.5±11.8）。失败率、恢复运动、Rolimeter侧到侧松弛度和患者报告的结果测量进行比较。结果：两组失败率相似（15.8% vs. 10.0%, P = 0.589），前路松弛、IKDC和acl -损伤后恢复运动评分相似（P < 0.05）。尽管年龄较小，但接受联合手术的患者获得了更高的术后活动和更好的患者报告结果：KOOS-Function: 94.6 vs 86.1 (P = 0.007)；KOOS-Sport: 83.5 vs. 70.8 (P = 0.020)；KOOS-Total: 89.5 vs. 79.0 (P = 0.010)；FJS-12: 83.3 vs. 67.5 （P = 0.008）。单纯ACL修复组恢复运动率为74%，联合手术组为85% （P = 0.382）。结论：对于再次破裂风险较高的患者，在初级ACL修复中增加外侧关节外手术，其失败率与低风险、较少活动的患者相当，并提高了功能恢复和活动水平。

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引用次数: 0

Re-evaluation of the cartilage safety of low-dose tranexamic acid 小剂量氨甲环酸对软骨安全性的再评价。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 DOI: 10.1016/j.knee.2025.08.003

Murat Yüncü

引用次数: 0

Response to letter regarding: “Re-evaluation of the Cartilage Safety of Low-Dose Tranexamic Acid” 关于“低剂量氨甲环酸软骨安全性的再评价”的回复。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 DOI: 10.1016/j.knee.2025.08.004

引用次数: 0

The phantom osteotomy is here: an algorithm for managing the joint line convergence angle in osteotomies around the knee & improving surgical accuracy 幻影截骨术是在这里：一个算法管理关节线收敛角在膝关节周围截骨术&提高手术精度。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 DOI: 10.1016/j.knee.2025.10.008

Sam K. Yasen

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.

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.

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.

Guidelines are also provided for parameters to safeguard outcomes in osteotomy surgery with respect to correction targets and philosophies around surgical planning and execution.

膝关节周围的骨切开术目前在英国和更远的地方正经历着显著的增长。截骨术可用于治疗多种疾病，但最常用于保守治疗失败的单室膝关节炎伴冠状面机械失调患者。本文回顾了提高膝关节截骨手术准确性的管理策略，特别关注处理升高的关节线收敛角（JLCA）。从历史上看，增加的JLCA会导致冠状面对齐截骨后难以预测的矫正结果，这被称为此类手术后的“软组织彩票”。提出了一种新的方法来理解和分类膝内翻，以及这如何影响关节负荷和随之对JLCA的影响。外翻膝关节也被认为是类似的。关于“引爆点”（关于膝关节承重轴）的神话被消除，并提出了一种处理升高的JLCA的算法，该算法基于调整由关节间隙开放引起的升高部分的截骨目标，而不是由关节间隙损失引起的，并结合临床实例。本文介绍了利用数字获取的长腿x线片进行术前规划时，在关节内使用“幻影”校正来部分校正JLCA的理论和实践。指南还提供了参数，以确保在截骨手术的结果有关的矫正目标和理念周围的手术计划和执行。

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引用次数: 0