IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 DOI: 10.1016/j.knee.2025.10.003

Carlos Suarez-Ahedo , Francisco Endara-Urresta , Carlos Peñaherrera-Carrillo , Alejandro Barros-Castro

Purpose

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 (<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.

目的开发并内部验证基于机器学习的预测模型，以估计多韧带膝关节损伤（MLKIs）手术重建后12个月恢复运动（RTS）的概率，并确定最具影响力的临床预测因素。方法：纳入2012年至2022年间在三家三级医疗中心接受mlki重建的患者。纳入标准包括重建≥2条韧带，年龄18-50岁，随访≥12个月。主要终点是12个月时的RTS。预测变量包括人口统计学、临床、外科和功能数据。比较了logistic回归、支持向量机（SVM）、随机森林和XGBoost四种模型。通过AUC-ROC、准确性、敏感性、特异性、f1评分和Brier评分进行10倍交叉验证，评估模型的性能。使用SHAP分析来解释特征的重要性。结果：在220例患者中，60.9%在12个月时达到RTS。机器学习模型表现出强大的预测性能，其中XGBoost的准确率最高（AUC = 0.84）。RTS的主要预测因素包括损伤前Tegner评分较高、患者年龄较小、手术时间较短（6周）和基线IKDC评分较高。心理准备和后外侧角重建也有积极作用。Logistic回归结果显示效果较差（AUC = 0.72）。结论：利用可获得的临床数据，机器学习模型可以准确预测mlki后的RTS。这些工具可以提高个性化决策和指导术后康复策略。临床相关性：该模型可以帮助临床医生设定切合实际的患者期望，个性化护理，并开发以rts为重点的治疗算法。

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引用次数: 0

High-grade trochlear dysplasia is associated with a more negative sagittal tibial tuberosity-trochlear groove distance: A retrospective cohort study. 高度滑车发育不良与更负的矢状胫骨结节-滑车沟距离相关：一项回顾性队列研究。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-12-01 Epub Date: 2025-08-08 DOI: 10.1016/j.knee.2025.07.005

Brian T Bueno, Michael R Moore, Andrew S Bi, Larry Chen, Jairo Triana, Laith M Jazrawi, Guillem Gonzalez-Lomas, Daniel J Kaplan

Purpose: To identify demographic or radiographic predictors of sagittal tibial tuberosity-trochlear groove (sTT-TG) distance utilizing a cohort of patellofemoral surgical patients.

Methods: 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.

Results: 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.

Conclusion: 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.

Level of evidence: Level III; diagnostic cross-sectional study.

目的：利用一组髌骨股骨手术患者，确定矢状胫骨结节-滑车沟（sTT-TG）距离的人口学或放射学预测因素。方法：纳入2010年至2020年接受同种异体骨软骨移植（OCA）或自体软骨细胞植入（ACI）的患者，如果他们有髌骨股高级病变并术前磁共振成像（MRI）。记录患者人口统计学特征、冠状动脉TT-TG、卡顿-德尚指数（CDI）和滑车发育不良等影像学指标。术前sTT-TG距离由两位作者间隔至少两周在轴向t2加权MRI序列上独立测量。计算类间相关系数（ICC）来评估sTT-TG测量的内部和内部可靠性，并使用单变量和多变量线性回归模型来评估sTT-TG与任何人口统计学或放射学预测因子之间的关系。结果：共纳入73例膝关节，其中女性44例，男性29例，平均年龄31.0±10.1岁，平均BMI 26.8±6.1，平均随访60.4±21.0个月。其中34例（46.6%）行OCA移植，39例（53.4%）行ACI/ maci移植。31例（42.4%）膝关节被确定有滑车发育不良的证据。高级别滑车发育不良24例（B、C、D级），低级别滑车发育不良7例（A级）。整个队列的平均sTT-TG为-5.3±4.9 mm。sTT-TG测量的观察者间信度非常好，ICC为0.95 （0.927-0.969,p）。结论：滑车发育不良与更负的矢状状胫骨结节-滑车沟（sTT-TG）距离相关，滑车发育不良的严重程度增加与相对更多的后胫骨结节相关。证据等级:三级;诊断性横断面研究。

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引用次数: 0

How do occupational demands affect return to work after total knee arthroplasty? 职业需求如何影响全膝关节置换术后重返工作岗位？

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-29 DOI: 10.1016/j.knee.2025.11.010

Anzar Sarfraz , Sophia Antonioli , Don H. Le , Farouk Khury , Joseph X. Robin , Ran Schwarzkopf , Armin Arshi , Joshua C. Rozell

Background

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.

Methods

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.

Results

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 %).

Conclusion

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.

背景：接受原发性全膝关节置换术（TKA）的患者可能会在手术后的不同时间重返工作岗位，其时间部分受其职业体力强度的影响。本研究的目的是评估TKA术后患者重返工作岗位的满意度和局限性。方法：本回顾性研究调查了2011年6月至2022年1月期间接受原发性TKA的患者，随访至少1年，随访时间为重返工作岗位。在914名受访者中，507名（55.5%）在术前工作，并被分为高强度（HI）（即劳动者，建筑），标准强度（SI）（即步行，爬楼梯）或低强度（LI）（即久坐的办公桌工作）组。各组间比较基线特征和调查反应。在术前工作的患者中，HI组35例（6.9%），SI组213例（42%），LI组259例（51.1%）。结果：507例术前工作的患者中，447例（88.2%）术后恢复工作，60例（11.8%）术后未恢复工作。与SI组和LI组相比，HI组由更多的年轻男性和吸烟者组成。在LI组中，30%的患者术后1个月内恢复，另外44%的患者术后2个月内恢复。同样，在SI组中，11%的人在不到一个月的时间内重返工作岗位，另外39%的人在两个月内重返工作岗位。在HI组中，4%在第一个月内恢复，另外42%在2个月内恢复。HI员工在回报方面受到阻碍的情况较多（HI: 30.8%, SI: 23.1%, LI: 7.7%），工作能力“中度下降”（HI: 23.1%, SI: 9.7%, 3.0%），以及对回报“非常不满意”（HI: 11.5%, SI: 10.8%, LI: 8.1%）。结论：TKA可以改善所有强度水平的工作功能和满意度，但与SI和LI组相比，HI工作与较长的恢复时间和相对较低的重返工作满意度相关。

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引用次数: 0

Micro-computed tomographic analysis of trabecular bone pattern in the juvenile distal femoral metaphysis 幼年股骨远端干骺端骨小梁形态的显微计算机断层分析。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-29 DOI: 10.1016/j.knee.2025.10.025

Sunpatch Benjavongkulchai , Catriona Davies , Craig A. Cunningham

Background

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.

Methods

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.

Results

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.

Conclusion

Trabecular bone patterns were shown to reflect the forces associated with key developmental milestones.

背景：在整个青少年时期，膝关节必须适应几个发展里程碑，包括断奶，爬行，坐着和两足步态的实现。这些活动与通过关节的机械力的大小、方向和分布有关，并被认为有助于形成特定的骨小梁特征。本研究旨在研究发育中的股骨远端骨小梁结构，并将其与关键发育里程碑的作用力联系起来。方法：对63例产前至7岁标本进行显微计算机断层扫描。在远端干骺端22体积感兴趣区（VOI）进行骨小梁定量。在每个VOI中分析四个骨小梁参数，包括；骨体积分数（BV/TV）、骨小梁厚度(Tb；Th)、小梁间距（Tb.Sp）和小梁数（Tb.N）。对不同voi之间、不同年龄组之间的差异进行统计学分析。结果：1岁以下voi患者骨参数值相近。BV/TV在出生后的头两年减少，在1至2岁之间发现最低值。BV/TV的下降可能与机械刺激减少有关，与子宫内环境相比，出生后营养供应减少。2年后观察到BV/TV升高。显著提高BV/TV， Tb。Th,结核病。N和更低的Tb。与中央VOIs相比，皮质下VOIs中发现了Sp。结论：小梁骨模式被证明反映了与关键发育里程碑相关的力量。

{"title":"Micro-computed tomographic analysis of trabecular bone pattern in the juvenile distal femoral metaphysis","authors":"Sunpatch Benjavongkulchai , Catriona Davies , 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}

引用次数: 0

Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis 混合式闭合楔形胫骨高位截骨术对膝关节内侧骨关节炎患者步态中机械负荷的影响。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub 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

Artificial Intelligence (AI) and surgery of the knee 人工智能（AI）和膝关节手术。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-27 DOI: 10.1016/j.knee.2025.11.008

Vipin Asopa , Keith Tucker

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 : 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

Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis: national utilization patterns and 2-year postoperative outcomes 前交叉韧带重建与外侧关节外肌腱固定术：国家使用模式和术后2年的结果。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-24 DOI: 10.1016/j.knee.2025.11.007

Matthew A. Peterman, Jane C. Brennan, Andrea H. Johnson, Benjamin M. Petre, James J. York, Justin J. Turcotte, Daniel E. Redziniak

Background

Lateral Extra-Articular Tenodesis (LET) is increasingly performed in conjunction with anterior cruciate ligament reconstruction (ACLR) to provide improved rotational knee stability. This study seeks to assess national utilization trends, revision rates, and complication profiles for primary ACLR vs ACLR with LET in a large national database.

Methods

A retrospective study of patients undergoing primary ACLR with or without LET in the PearlDiver database was performed. Multivariate analysis was performed to identify predictors of LET performance. ACLR-only and ACLR/LET patients were then propensity matched for age, sex, and comorbidity burden. 2-year postoperative outcomes including revision-ACLR, meniscus surgery, lysis of adhesion (LOA), manipulation under anesthesia (MUA), and total knee arthroplasty (TKA) were compared between groups.

Results

Of 140,866 primary ACLR analyzed, 1,814 (1.3 %) had LET, with LET utilization increasing five-fold from 0.6 % in 2015 to 3.7 % in 2023. Younger age, male sex, meniscal repair and hypermobility were associated with increased odds of LET performance, while meniscectomy use was associated with decreased odds. There were no significant differences in rates of revision ACLR (ACLR/LET: 4.8 % vs ACLR: 3.6 %; p = 0.207), meniscus surgery, LOA, MUA, or TKA between the ACLR and ACLR with LET groups at 2-year follow-up.

Conclusions

The utilization of concomitant LET with ACLR is increasing nationally; however, in this large cohort, the addition of LET was not associated with lower revision rates or increased complications at 2-year follow-up. Further prospective study with granular clinical data, patient-reported outcomes, and longer follow-up is needed to assess the potential benefits of combined ACLR/LET procedures.

背景：外侧关节外肌腱固定术（LET）越来越多地与前交叉韧带重建（ACLR）一起进行，以改善膝关节旋转稳定性。本研究旨在评估国家大型数据库中原发性ACLR与LET ACLR的使用趋势、修订率和并发症概况。方法：对PearlDiver数据库中接受原发性ACLR伴或不伴LET的患者进行回顾性研究。进行多变量分析以确定LET表现的预测因素。然后对ACLR-only和ACLR/LET患者进行年龄、性别和合并症负担的倾向匹配。比较两组术后2年的结果，包括修复- aclr、半月板手术、粘连松解（LOA）、麻醉下操作（MUA）和全膝关节置换术（TKA）。结果：在分析的140,866例原发性ACLR中，1,814例（1.3%）有LET， LET利用率从2015年的0.6%增加到2023年的3.7%，增加了5倍。年龄较小、男性、半月板修复和活动过度与LET表现的可能性增加有关，而半月板切除术与可能性降低有关。在2年的随访中，ACLR组和ACLR组在ACLR/LET翻修率（ACLR/LET: 4.8% vs ACLR: 3.6%; p = 0.207）、半月板手术、LOA、MUA或TKA方面没有显著差异。结论：在全国范围内，ACLR合并LET的使用呈上升趋势；然而，在这个大型队列中，在2年随访中，LET的加入与较低的翻修率或并发症的增加无关。需要进一步的前瞻性研究，包括详细的临床数据、患者报告的结果和更长的随访，以评估ACLR/LET联合手术的潜在益处。

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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 : 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。

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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 : 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。

{"title":"Three-dimensional simulation of wall impingement and graft bending in anatomical double-bundle ACL reconstruction using weight-bearing upright multi-detector CT","authors":"Ryo Sasaki , Yasuo Niki , Kazuya Kaneda , Yoshitake Yamada , Kengo Harato , Shu Kobayashi , Takeo Nagura , Masaya Nakamura , Masahiro Jinzaki","doi":"10.1016/j.knee.2025.11.003","DOIUrl":"10.1016/j.knee.2025.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Methods</h3><div>We analyzed 43 knee joints of 23 healthy volunteers (women, <em>n</em> = 13; men, <em>n</em> = 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).</div></div><div><h3>Result</h3><div>The impingement rate for the AMB with a 6-mm graft diameter (81.4 %) was significantly higher than that for the PLB (0.7 %; <em>P</em> < 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 % (<em>P</em> < 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 %; <em>P</em> < 0.001). The GBA of the modified AMB was significantly smaller than that of the traditional AMB (<em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104277"},"PeriodicalIF":2.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574557","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