IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-27 DOI: 10.1016/j.knee.2025.11.011

Shota Imamura , Rui Tsukagoshi , Kei Setogawa , Takafumi Mizuno , Kazuhisa Kajihara , Hiroshi Nakayama , Naoki Sasanuma , Akira Sakaguchi , Kotaro Kawaguchi , Yuki Uchiyama , Kazuhisa Domen

Background

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.

Methods

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.

Results

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.

Conclusion

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.

背景：步态时机械负荷增加是膝骨关节炎（OA）的危险因素。膝关节内收力矩升高可作为股胫关节机械负荷的指标。相比之下，增加的膝关节屈曲偏移和膝关节屈曲力矩是髌股关节（PF）机械负荷的指标。混合式闭合楔形高位胫骨截骨术（混合式CWHTO）改善了FT和PF关节的静态对齐；然而，在步态过程中机械负荷的变化程度仍不清楚。因此，本研究旨在评估混合前后CWHTO的运动学和动力学变化，并将结果与健康对照进行比较。方法：本研究纳入14例行混合型CWHTO的膝关节内侧OA患者和21例健康老年人对照。术前和术后1年采用二维运动分析评估步态。结果：术后膝关节内收力矩明显减小。然而，在术前和术后评估中，膝关节屈曲偏移和膝关节屈曲力矩没有发现显著差异。这两个参数仍然低于健康老年人对照组。结论：混合CWHTO虽然能有效降低膝关节内收力矩，从而降低FT关节的机械应力，但不能改变膝关节屈曲偏移或屈曲力矩。然而，x线评估显示髌骨高度的变化，这表明位置因素可能独立于矢状面测量影响PF关节力学。这些发现强调了有针对性的康复干预措施的必要性，重点是改善矢状面力学。

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引用次数: 0

Can a machine learning approach contribute to monitoring post-market surveillance of total knee arthroplasty prostheses? 机器学习方法能否有助于全膝关节置换术假体上市后的监测？

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-15 DOI: 10.1016/j.knee.2025.10.020

Khashayar Ghadirinejad , Stephen Graves , Richard de Steiger , Nicole Pratt , Lucian B. Solomon , Mark Taylor , Reza Hashemi

Background

The impact of knee replacement surgery on patients can be monitored by joint registries through the surveillance of prostheses and identification of under-performing devices – outliers. The study of new statistical methods can help determine whether a device is at a higher risk of failure by considering possible confounding factors. Self-learning algorithms with the potential to involve multiple variables simultaneously are one approach to limiting the impact of confounding factors. This study aimed to assess two machine learning (ML) techniques to detect total knee outliers while controlling for patient- and device-related confounding.

Methods

The potential to identify outliers among 160 unique prostheses was evaluated for Random Survival Forest (RSF) and regularised/unregularised Cox models. The input variables included femoral/tibial components and patient characteristics provided by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) on 265,655 primary total knee procedures. The outcome was time to first revision surgery treated as a censored case for death, and the AOANJRR gold standard was defined as the criteria to assess the effectiveness of proposed ML methods.

Results

In the study cohort, the AOANJRR standardised approach detected five conventional prosthesis combinations. Both the Cox and RSF techniques identified two of the same total knee prostheses. The regularised/unregularised Cox results were more comparable to the AOANJRR standard by detecting one additional prosthesis at a higher risk of revision.

Conclusion

Machine learning may offer a supplementary approach for the identification of prosthesis outliers. However, further analysis is required to fully comprehend the effect of confounding factors and the potential contribution of ML to the early identification of outliers.

背景：膝关节置换手术对患者的影响可以通过联合登记来监测假体和识别表现不佳的异常装置。新的统计方法的研究可以通过考虑可能的混杂因素来帮助确定一个设备是否有更高的失效风险。有可能同时涉及多个变量的自学习算法是限制混杂因素影响的一种方法。本研究旨在评估两种机器学习（ML）技术，以检测全膝关节异常值，同时控制患者和设备相关的混淆。方法：利用随机生存森林（RSF）和正则/非正则Cox模型评估160个独特假肢中识别异常值的潜力。输入变量包括由澳大利亚骨科协会国家关节置换登记处（AOANJRR）提供的265,655例初级全膝关节手术的股骨/胫骨部件和患者特征。结果是第一次翻修手术的时间，作为死亡审查病例，AOANJRR金标准被定义为评估建议的ML方法有效性的标准。结果：在研究队列中，AOANJRR标准化方法检测到5种常规假体组合。Cox和RSF技术都确定了两个相同的全膝关节假体。通过检测一个具有较高翻修风险的额外假体，规范化/非规范化Cox结果与AOANJRR标准更具可比性。结论：机器学习为义肢异常点识别提供了一种补充方法。然而，需要进一步的分析来充分理解混杂因素的影响以及ML对早期识别异常值的潜在贡献。

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引用次数: 0

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

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-12-19 DOI: 10.1016/j.knee.2025.104298

Yoshihiro Ishida , Yasushi Takata , Rikuto Yoshimizu , Yusuke Yanatori , Naoki Takemoto , Miho Okuda , Yu Ueda , Satoru Demura , Junsuke Nakase

Background

The semitendinosus (ST) tendon is commonly used as a graft in anterior cruciate ligament (ACL) reconstruction. However, there is growing interest in the quadriceps tendon (QT). The reconstructed ACL undergoes a remodeling process, and its tissue quality is an important factor in determining when to return to sports activities. It remains unclear whether there are differences in tissue quality between QT and ST grafts at the same postoperative stage. UTE-T2* mapping has gained attention as a method for quantitatively evaluating the organization of the reconstructed ACL. This study aimed to reveal differences in tissue quality and collagen organization between QT and ST grafts at 6 months after ACL reconstruction using UTE-T2* mapping.

Methods

In this retrospective comparative study, twenty patients who had undergone ACL reconstruction using the QT and ST were included. UTE-T2* mapping was performed 6 months after surgery. T2* value was measured at intraarticular, femoral tunnel and tibial tunnel site. Each value were compared between the two groups (The Mann–Whitney U test).

Results

In the QT group, the T2* values were 11.8 ± 1.3 ms (intra-articular), 7.8 ± 1.6 ms (tibial), and 8.9 ± 1.5 ms (femoral). In the ST group, the corresponding UTE-T2* values were 11.1 ± 2.2 ms, 7.5 ± 1.9 ms, and 10.8 ± 1.6 ms, respectively. Notably, a significant difference was observed between the two groups in the femoral site (P = 0.026).

Conclusions

QT grafts were more mature than ST grafts within the femoral tunnel six months after ACL reconstruction.

背景：半腱肌（ST）肌腱是前交叉韧带（ACL）重建中常用的移植物。然而，人们对股四头肌肌腱（QT）的兴趣越来越大。重建的前交叉韧带经历了一个重塑过程，其组织质量是决定何时恢复体育活动的重要因素。目前尚不清楚QT移植和ST移植在同一术后阶段的组织质量是否存在差异。作为一种定量评价重建ACL组织的方法，UTE-T2*映射已受到关注。本研究旨在通过UTE-T2*作图揭示ACL重建后6个月QT和ST移植的组织质量和胶原组织的差异。方法回顾性比较分析20例采用QT和ST行ACL重建的患者。术后6个月进行UTE-T2*测绘。在关节内、股骨隧道和胫骨隧道处测量T2*值。比较两组间各值（Mann-Whitney U检验）。结果QT组T2*值分别为关节内（11.8±1.3 ms）、胫骨（7.8±1.6 ms）、股骨（8.9±1.5 ms）。ST组对应的UTE-T2*值分别为11.1±2.2 ms、7.5±1.9 ms和10.8±1.6 ms。值得注意的是，两组在股骨部位的差异有统计学意义（P = 0.026）。结论前交叉韧带重建6个月后，在股骨隧道内，sqt移植比ST移植更成熟。

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引用次数: 0

Implant camouflage – how apparently excellent registry data can mask poor implant results: an international multi-centre case-control study 植入伪装——明显优秀的注册数据如何掩盖糟糕的植入结果：一项国际多中心病例对照研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-20 DOI: 10.1016/j.knee.2025.11.004

Gerard A. Sheridan , Michael E. Neufeld , Lisa C. Howard , David Keohane , Eric Masterson , Dan Cadoux-Hudson , Simon Tilley , Doug Dunlop , John Keith Tucker , Bassam A. Masri , Donald A. Garbuz

Background

The purpose of this research is to highlight a new issue facing national joint registries called ’Implant Camouflage’, whereby a poorly performing implant combination within an overall brand portfolio is hidden by other high performing implant combinations.

Methods

This was an international multi-centre case-control study assessing implant combinations within the NexGen® TKA portfolio. There were 9392 primary TKA components included with 1744 ‘high-risk’ cases and 7648 ‘standard-risk’ controls. The median time to follow-up was 7.4 (IQR 4.8–9.4) years in the cases and 10.4 (IQR 7.5–13.8) years in the control group. The primary outcome variable was revision for aseptic loosening. All-cause revision was a secondary outcome variable. Cox regression and Kaplan-Meier (KM) survival analysis was used to determine survivorship free of revision for aseptic loosening.

Results

The high-risk cases had significantly higher rates of revision for aseptic loosening (5.2 % v 0.4 %, p < 0.001) and all-cause revision (7.9 % v 2.9 %, p < 0.001). KM curves demonstrated higher rates of aseptic loosening in the high-risk cases with no intersection of 95 % confidence intervals with the controls. On univariate analysis, older age (p < 0.001) and higher BMI (p < 0.001) patients had significantly higher rates of revision for aseptic loosening. After multivariate analysis, the high-risk component cases were the most significant predictor of early failure for aseptic tibial loosening (p < 0.001).

Conclusions

The NexGen® Option-LPS Flex and Option-LPS GSF combinations have over a 10-fold higher revision rate for aseptic loosening when compared to other implant combinations in the NexGen® portfolio.

背景：本研究的目的是强调国家联合注册所面临的一个新问题，称为“种植体伪装”，即在整个品牌组合中表现不佳的种植体组合被其他高性能种植体组合所隐藏。方法：这是一项国际多中心病例对照研究，评估NexGen®TKA产品组合中的种植体组合。9392个主要TKA组成部分包括1744个“高风险”病例和7648个“标准风险”控制。中位随访时间：病例为7.4 （IQR 4.8-9.4）年，对照组为10.4 （IQR 7.5-13.8）年。主要结局变量为无菌性松动的翻修。全因修正是次要结局变量。采用Cox回归和Kaplan-Meier （KM）生存分析来确定无菌性松动不进行翻修的生存率。结果：高危病例的无菌松动翻修率明显更高（5.2% vs 0.4%, p）。结论：与NexGen®产品组合中的其他种植体组合相比，NexGen®Option-LPS Flex和Option-LPS GSF组合的无菌松动翻修率高出10倍以上。

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引用次数: 0

Evaluating the impact of revision knee arthroplasty networks in England: an analysis of temporal trends in referral patterns, surgical volumes and early outcomes using hospital episode statistics data for England between 2012 and 2024 评估英国翻修膝关节置换术网络的影响：使用2012年至2024年英格兰医院事件统计数据分析转诊模式、手术量和早期结果的时间趋势。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.knee.2025.11.006

Alexander H. Matthews , William K. Gray , Jonathan P. Evans , Tim Briggs , Andrew Porteous , Jonathan Phillips , Abtin Alvand , Benjamin Bloch , Paul Baker , Andrew Price , Andrew D. Toms

Background

In 2019, revision knee replacement (RevKR) services in England were reorganised into regional networks following the publication of clinical standards. These networks aim to improve outcomes through multidisciplinary decision-making and minimum surgical activity thresholds. This study examines changes in referral patterns, surgical volumes, and clinical outcomes before and after network implementation.

Methods

RevKR procedures from 1 April 2012 to 31 December 2024 were identified using the Hospital Episode Statistics. Descriptive analysis of patient level national data assessed trends in referral patterns (based on mismatches between patient residence and surgical location), volumes, and outcomes. Low-volume surgeons (<10 cases/year) and units (<30 cases/year) were identified. The primary outcome was one-year re-revision. Secondary outcomes included 90-day mortality, readmissions, and length of stay.

Results

Across 67,363 procedures, out-of-area referrals remained stable, with slight increases in London. Since 2021, low-volume practise has declined nationally, particularly in the Northwest, London, and Northeast & Yorkshire. One-year re-revision rates improved from 11.4 % in 2012 to 7.7 % in 2023. However, 90-day mortality rose, possibly due to increasing patient complexity. Some regions showed reduced hospital stays between 2022 and 2024 compared to the pre-COVID era.

Conclusion

The data suggest early signals of regions aligning with the implementation of revision networks, especially in the Northwest, Northeast & Yorkshire, and London regions. There are encouraging improvements in re-revision rates and hospital stays which may indicate potential benefits of the new model. As revision networks mature, strategies to increase surgical volume may be key to sustaining further improvements in patient outcomes.

背景：2019年，在临床标准发布后，英国的翻修膝关节置换术（RevKR）服务被重组为区域网络。这些网络旨在通过多学科决策和最低手术活动阈值来改善预后。本研究考察了网络实施前后转诊模式、手术量和临床结果的变化。方法：使用医院事件统计对2012年4月1日至2024年12月31日的RevKR手术进行识别。对患者水平的国家数据进行描述性分析，评估转诊模式（基于患者居住地和手术地点之间的不匹配）、数量和结果的趋势。结果：在67,363例手术中，地区外转诊保持稳定，伦敦略有增加。自2021年以来，在全国范围内，尤其是在西北部、伦敦、东北部和约克郡，小批量的做法有所下降。一年的重新修订率从2012年的11.4%提高到2023年的7.7%。然而，90天死亡率上升，可能是由于患者复杂性的增加。与疫情前相比，一些地区在2022年至2024年期间的住院时间有所减少。结论：这些数据显示了地区与修订网络实施一致的早期信号，特别是在西北、东北和约克郡以及伦敦地区。在重新修订率和住院时间方面有令人鼓舞的改进，这可能表明新模式的潜在好处。随着翻修网络的成熟，增加手术量的策略可能是维持进一步改善患者预后的关键。

{"title":"Evaluating the impact of revision knee arthroplasty networks in England: an analysis of temporal trends in referral patterns, surgical volumes and early outcomes using hospital episode statistics data for England between 2012 and 2024","authors":"Alexander H. Matthews , William K. Gray , Jonathan P. Evans , Tim Briggs , Andrew Porteous , Jonathan Phillips , Abtin Alvand , Benjamin Bloch , Paul Baker , Andrew Price , Andrew D. Toms","doi":"10.1016/j.knee.2025.11.006","DOIUrl":"10.1016/j.knee.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>In 2019, revision knee replacement (RevKR) services in England were reorganised into regional networks following the publication of clinical standards. These networks aim to improve outcomes through multidisciplinary decision-making and minimum surgical activity thresholds. This study examines changes in referral patterns, surgical volumes, and clinical outcomes before and after network implementation.</div></div><div><h3>Methods</h3><div>RevKR procedures from 1 April 2012 to 31 December 2024 were identified using the Hospital Episode Statistics. Descriptive analysis of patient level national data assessed trends in referral patterns (based on mismatches between patient residence and surgical location), volumes, and outcomes. Low-volume surgeons (<10 cases/year) and units (<30 cases/year) were identified. The primary outcome was one-year re-revision. Secondary outcomes included 90-day mortality, readmissions, and length of stay.</div></div><div><h3>Results</h3><div>Across 67,363 procedures, out-of-area referrals remained stable, with slight increases in London. Since 2021, low-volume practise has declined nationally, particularly in the Northwest, London, and Northeast & Yorkshire. One-year re-revision rates improved from 11.4 % in 2012 to 7.7 % in 2023. However, 90-day mortality rose, possibly due to increasing patient complexity. Some regions showed reduced hospital stays between 2022 and 2024 compared to the pre-COVID era.</div></div><div><h3>Conclusion</h3><div>The data suggest early signals of regions aligning with the implementation of revision networks, especially in the Northwest, Northeast & Yorkshire, and London regions. There are encouraging improvements in re-revision rates and hospital stays which may indicate potential benefits of the new model. As revision networks mature, strategies to increase surgical volume may be key to sustaining further improvements in patient outcomes.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104280"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574579","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

Factors associated with higher inpatient opioid consumption after primary total knee arthroplasty: a retrospective tertiary centre analysis 原发性全膝关节置换术后住院阿片类药物消耗增加的相关因素：回顾性三级中心分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1016/j.knee.2025.11.005

Moe Takenoshita , Andreas Fontalis , Anthony B. Lisacek-Kiosoglous , Tiffany Oliver , Andrew Robinson , Warran Wignadasan , Fares S. Haddad

Purpose

To characterize inpatient postoperative opiate consumption(OC) and identify risk factors associated with high OC among total knee arthroplasty(TKA) patients.

Methods

In this retrospective single centre cohort study, 1,550 TKAs from May 2019 to July 2023 were analysed using electronic healthcare records. Clinical data was collected, including anaesthesia type, post anaesthesia care unit(PACU) admissions, implant fixation, operative duration, peri-operative haemoglobin levels, surgical technique, as well as OC(oral morphine milliequivalents, MME) during inpatient stay. The correlation between OC 24 h post operatively and total inpatient OC, as well as average daily inpatient OC, were assessed with Spearman’s Rank-Order correlation coefficient. Multivariate logistic regression identified predictors of high opioid use, defined as the top quartile of total inpatient opioid consumption.

Results

The cohort included 1,077 females (69.5 %) and 473 males (30.5 %), with robotic TKA performed in 786 cases (50.7 %). Median OC MME for 0–24 h post op, 24–48 h post op and 48–72 h post op was 42 mg (IQR 21.0–70.1), 29 mg (12.0–45.0), 12 mg (0.0–30.0) respectively. Median total inpatient OC for the cohort was 96.0 mg MME (IQR = 49.0–165). Opiate use decreased by 71.4 % from day 1 to day 3 post operatively. Strong positive correlations were found between early OC (24–48 h post op) and total inpatient OC (rs(1548) = 0.717, p < 0.001). On average, 86.5 % of total inpatient opiates were consumed in the first 72 h post operatively. Higher opioid use was significantly associated with earlier admission year, younger age, increased body mass index(BMI), PACU admission, ASA 3 or 4 and general anaesthesia.

Conclusions

Daily opiate use fell rapidly by the third postoperative day, whilst high OC within the first 24–48 h was associated with higher opiate use overall. Younger age, higher BMI and general anaesthesia were associated with higher opiate use. These insights can help tailor pain management strategies for patients at higher risk of opioid reliance during their inpatient stay.

目的：分析全膝关节置换术（TKA）患者术后住院阿片类药物消耗（OC）的特征，并确定与高OC相关的危险因素。方法：在这项回顾性单中心队列研究中，使用电子医疗记录对2019年5月至2023年7月的1550名tka患者进行了分析。收集临床资料，包括麻醉类型、麻醉后护理单位（PACU）入院情况、植入物固定、手术时间、围术期血红蛋白水平、手术技术以及住院期间口服吗啡毫当量（口服吗啡毫当量，MME）。采用Spearman秩序相关系数评价术后24 h住院总住院OC与平均每日住院OC的相关性。多变量逻辑回归确定了阿片类药物高使用的预测因素，定义为住院阿片类药物总消费量的前四分之一。结果：该队列包括1,077例女性（69.5%）和473例男性（30.5%），其中786例（50.7%）进行了机器人TKA。术后0 ~ 24 h、24 ~ 48 h和48 ~ 72 h的中位OC MME分别为42 mg （IQR 21.0 ~ 70.1）、29 mg（12.0 ~ 45.0）、12 mg（0.0 ~ 30.0）。该队列的住院总OC中位数为96.0 mg MME （IQR = 49.0-165）。术后第1天至第3天阿片类药物使用下降71.4%。结论：术后第3天，每日阿片类药物使用量迅速下降，而术后第24-48小时内的高OC与总体阿片类药物使用量较高相关。较年轻、较高的BMI和全身麻醉与较高的阿片类药物使用有关。这些见解可以帮助为住院期间阿片类药物依赖风险较高的患者量身定制疼痛管理策略。

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引用次数: 0

Comparative performance of the Risk Analysis Index versus traditional frailty measures in predicting outcomes following unicompartmental knee arthroplasty: A national database analysis 风险分析指数与传统虚弱指标在预测单室膝关节置换术后预后方面的比较表现：一项国家数据库分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-10 DOI: 10.1016/j.knee.2025.10.015

Cameron J. Sabet , Bhav Jain , Jad Lawand , Stefan Prulovic , Bill Young , Dang Nguyen , Bara M. Hammadeh , Jiaqi Liu

Background

While multiple frailty assessment tools exist for perioperative risk stratification, their comparative effectiveness in unicompartmental knee arthroplasty (UKA) remains unclear. The Risk Analysis Index (RAI) represents a comprehensive frailty measure, but its performance relative to established indices requires validation. We aimed to compare the predictive accuracy of the RAI against traditional frailty measures including the modified Frailty Index-5 (mFI-5) and Geriatric Nutritional Risk Index (GNRI) for 30-day outcomes following UKA.

Methods

We analyzed 9358 patients undergoing elective UKA from the ACS-NSQIP database (2015–2021). Three frailty indices were calculated: RAI (incorporating age, sex, renal function, dyspnea, cancer, weight loss, and functional status), mFI-5 (five comorbidity domains), and GNRI (nutritional assessment). Primary outcomes were discharge disposition and 30-day readmission. Secondary outcomes included 30-day all-cause mortality, complications, reoperations, and extended length of stay.

Results

The RAI demonstrated superior discrimination for discharge disposition (area under the curve (AUC) = 0.694) and 30-day readmission (AUC = 0.615) compared with mFI-5 (AUC = 0.593 and 0.570) and GNRI (AUC = 0.521 and 0.558). Progressive increases in adverse outcomes occurred across RAI tiers, with non-home discharge rates of 1.7 % in robust patients versus 15.9 % in frail patients (P < 0.001).

Conclusions

The RAI provides superior risk stratification compared with traditional frailty measures for discharge disposition and 30-day readmission in particular following UKA, supporting its adoption as the preferred perioperative assessment tool.

背景：虽然存在多种衰弱评估工具用于围手术期风险分层，但它们在单室膝关节置换术（UKA）中的相对有效性尚不清楚。风险分析指数（RAI）代表了一个综合的脆弱性度量，但其相对于既定指标的表现需要验证。我们的目的是比较RAI与传统虚弱指标（包括修改后的虚弱指数-5 （mFI-5）和老年营养风险指数（GNRI））对UKA后30天预后的预测准确性。方法：我们分析了ACS-NSQIP数据库（2015-2021）中9358例选择性UKA患者。计算三个衰弱指数：RAI（包括年龄、性别、肾功能、呼吸困难、癌症、体重减轻和功能状态）、mFI-5（五个共病域）和GNRI（营养评估）。主要结局为出院处置和30天再入院。次要结局包括30天全因死亡率、并发症、再手术和延长住院时间。结果：与mFI-5 （AUC = 0.593和0.570）和GNRI （AUC = 0.521和0.558）相比，RAI对出院处置（曲线下面积(AUC) = 0.694）和30天再入院（AUC = 0.615）具有更强的区分能力。不良结局在RAI各等级中均有逐渐增加，身体健康的患者非家庭出院率为1.7%，体弱的患者为15.9% (P结论：与传统的出院处理和30天再入院措施相比，RAI提供了更好的风险分层，特别是在UKA后，支持其作为首选的围手术期评估工具。

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引用次数: 0

Response to letter to the editor on “Periarticular Injection Versus Placebo in Total Knee Arthroplasty with Intrathecal Morphine” 对“鞘内吗啡全膝关节置换术中关节周围注射与安慰剂”致编辑的信的回应。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-19 DOI: 10.1016/j.knee.2025.10.019

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 : 2026-01-01 Epub 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。

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引用次数: 0

Three-dimensional simulation of wall impingement and graft bending in anatomical double-bundle ACL reconstruction using weight-bearing upright multi-detector CT 负重直立多探头CT对解剖双束ACL重建中壁撞击和移植物弯曲的三维模拟。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2026-01-01 Epub Date: 2025-11-21 DOI: 10.1016/j.knee.2025.11.003

Ryo Sasaki , Yasuo Niki , Kazuya Kaneda , Yoshitake Yamada , Kengo Harato , Shu Kobayashi , Takeo Nagura , Masaya Nakamura , Masahiro Jinzaki

Purpose

Graft-notch impingement and large graft bending angle (GBA) in anterior cruciate ligament reconstruction (ACLR) carry a risk of graft failure and subsequent poor postoperative outcomes. Most studies have analyzed the impingement rate and GBA using computed tomography (CT) in the supine position, but not in the standing condition. This study aimed to assess the graft impingement and GBA using upright multi-detector CT (MDCT).

Methods

We analyzed 43 knee joints of 23 healthy volunteers (women, n = 13; men, n = 10) in a single-leg standing position using an upright 320-detector-row CT. We defined the putative position of the graft tunnel in three-dimensional models and assessed the impingement rate and GBA of both the anteromedial (AMB) and posterolateral bundles (PLB).

Result

The impingement rate for the AMB with a 6-mm graft diameter (81.4 %) was significantly higher than that for the PLB (0.7 %; P < 0.001). The modified AMB tunnel position, which connects the midpoint between the traditional AM and PL tunnel apertures of the femur to the most medial point within the tibial AM footprint, reduced the impingement rate by 14.0 % (P < 0.001). The impingement rate of the modified AMB with a 10-mm graft diameter (32.6 %) was significantly lower than that of the traditional AMB with a 6-mm graft diameter (81.4 %; P < 0.001). The GBA of the modified AMB was significantly smaller than that of the traditional AMB (P < 0.001).

Conclusion

This study indicated high graft-notch impingement rates and large GBA for traditional AMB in the standing position, highlighting potential biomechanical challenges associated with traditional double-bundle ACLR configurations.

目的：前交叉韧带重建术（ACLR）中移植物缺口撞击和大移植物弯曲角（GBA）存在移植物失败和术后不良预后的风险。大多数研究使用计算机断层扫描（CT）分析了仰卧位时的撞击率和GBA，但没有使用站立状态。本研究旨在利用直立多层螺旋CT （MDCT）评估移植物撞击和GBA。方法：我们使用直立320排CT分析了23名健康志愿者（女性，n = 13；男性，n = 10）在单腿站立姿势下的43个膝关节。我们在三维模型中定义了移植物隧道的假定位置，并评估了前内侧束（AMB）和后外侧束（PLB）的撞击率和GBA。结果：移植物直径为6mm的AMB撞击率（81.4%）明显高于PLB(0.7%)；结论：本研究表明，传统AMB在站立位置具有高的移植物缺口撞击率和大的GBA，突出了传统双束ACLR配置相关的潜在生物力学挑战。

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