Knee最新文献_第9页

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

The need for better quality studies: A systematic scoping review of current utility of artificial intelligence in orthopaedics and research gaps in the knee joint 对高质量研究的需求：对人工智能在骨科和膝关节研究空白中的当前应用进行系统的范围审查。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-21 DOI: 10.1016/j.knee.2025.10.022

Nadia Aghili , Katie Hughes , Kianoush Nazarpour , Hamish Simpson , Irene Yang

Background

The application of artificial intelligence (AI) in orthopaedic research, particularly for knee conditions, is growing rapidly. While AI offers the potential to enhance the efficiency and precision of care, its role and impact remain underexplored. This systematic scoping review evaluates studies employing AI algorithms, including machine learning and deep learning, to support clinical decision making for knee diseases.

Methods

A scoping review was conducted using the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. MEDLINE, EMBASE, and ISI Web of Science were searched for English-language studies published between 2008 and 2025. Eligible studies involved adult patients and applied AI to diagnose knee conditions, predict outcomes, or support clinical processes. Extracted data included study demographics, targeted knee conditions, AI algorithms used, and their applications.

Results

From 2761 studies screened, 816 (30 %) were included after title and abstract screening. Among these, 66 % addressed diagnosis and 34 % focused on clinical prediction. Osteoarthritis was the most studied condition (71 %), followed by soft tissue damage (15 %). Deep learning was the most utilized AI method (43 %), followed by traditional machine learning (39 %). Among excluded studies, AI was indirectly applied in 21 %, primarily for identification (25 %), segmentation (42 %), and measurement (17 %).

Conclusions

Over the past 16 years, AI use in knee orthopaedic research has grown, yet only 30 % of studies directly addressed diagnostic or predictive applications. Challenges include limited reproducibility, generalizability, and clinical applicability of AI models. Future research should focus on improving reporting standards and exploring the application of AI in intra-operative, post-operative, and non-imaging use cases to enhance clinical utility.

背景：人工智能（AI）在骨科研究中的应用，特别是膝关节疾病的研究，正在迅速发展。虽然人工智能具有提高护理效率和准确性的潜力，但其作用和影响仍未得到充分探索。本系统的范围综述评估了使用人工智能算法（包括机器学习和深度学习）来支持膝关节疾病临床决策的研究。方法：采用乔安娜布里格斯研究所的方法和PRISMA-ScR指南进行范围审查。MEDLINE， EMBASE和ISI Web of Science检索了2008年至2025年间发表的英语研究。符合条件的研究涉及成年患者，并应用人工智能来诊断膝关节状况、预测预后或支持临床过程。提取的数据包括研究人口统计、目标膝关节状况、使用的人工智能算法及其应用。结果：在筛选的2761项研究中，经过标题和摘要筛选后纳入了816项（30%）研究。其中，66%致力于诊断，34%专注于临床预测。骨关节炎是研究最多的疾病（71%），其次是软组织损伤（15%）。深度学习是使用最多的人工智能方法（43%），其次是传统机器学习（39%）。在被排除的研究中，人工智能间接应用于21%的研究，主要用于识别（25%）、分割（42%）和测量（17%）。结论：在过去的16年里，人工智能在膝关节骨科研究中的应用有所增长，但只有30%的研究直接涉及诊断或预测应用。挑战包括人工智能模型有限的可重复性、普遍性和临床适用性。未来的研究应着眼于提高报告标准，探索人工智能在术中、术后和非影像学用例中的应用，以提高临床应用价值。

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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 : 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。

{"title":"Implant camouflage – how apparently excellent registry data can mask poor implant results: an international multi-centre case-control study","authors":"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","doi":"10.1016/j.knee.2025.11.004","DOIUrl":"10.1016/j.knee.2025.11.004","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>The high-risk cases had significantly higher rates of revision for aseptic loosening (5.2 % v 0.4 %, <em>p</em> < 0.001) and all-cause revision (7.9 % v 2.9 %, <em>p</em> < 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 (<em>p</em> < 0.001) and higher BMI (<em>p</em> < 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 (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":56110,"journal":{"name":"Knee","volume":"58 ","pages":"Article 104278"},"PeriodicalIF":2.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574571","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

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 : 2025-11-19 DOI: 10.1016/j.knee.2025.10.019

引用次数: 0

Online information on MACI knee surgery: analysis and opportunities to improve patient education and decision-making MACI膝关节手术的在线信息：分析和改善患者教育和决策的机会。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-19 DOI: 10.1016/j.knee.2025.10.027

Camila Vicioso , Ava G. Neijna , Hannah L. Terry , Luca Valdivia , Laurel Wong , Renee Ren , Sabrina M. Strickland

Background

Patients increasingly turn to online search engines to learn about orthopedic procedures. Matrix-Induced Autologous Chondrocyte Implantation (MACI) is an increasingly popular treatment for cartilage lesions. However, the visibility, range, and credibility of online information about MACI remain unclear. As MACI’s clinical use grows, understanding what patients are encountering online is essential to guiding informed discussions.

Purpose

To (1) identify frequently asked questions about MACI and their thematic categories, and (2) evaluate the types and credibility of linked websites in order to inform a patient-friendly handout with frequently asked questions (FAQs) and high-quality sources.

Methods

We conducted a cross-sectional analysis of 1620 MACI-related entries from Google’s “People Also Ask” feature. Questions were categorized using the Rothwell framework, and scored for credibility using JAMA Benchmark Criteria. Kruskal-Wallis tests compared credibility across groups; logistic regression identified predictors of high-credibility content.

Results

Most included questions (n = 1107) concerned technical details (n = 285), evaluation of surgery (n = 220), and cost (n = 138). Commercial websites were most common (40.9 %) and, while they often offered patient-friendly content, they had lower average JAMA credibility scores (1.54) compared to government (3.95) and academic (1.97) sources (p < 0.01).

Conclusion

Online information about MACI is dominated by commercial websites. While many offer helpful information, key patient concerns, such as pain, are underaddressed in online resources. Surgeon-led efforts, including recommending trusted sources and creating patient-friendly online content (e.g. using keywords, images, structured headings), may improve the visibility and credibility of MACI information, supporting patient understanding and shared decision-making.

背景：越来越多的患者通过在线搜索引擎来了解骨科手术。基质诱导的自体软骨细胞植入（MACI）是一种越来越流行的治疗软骨病变的方法。然而，关于MACI的在线信息的可见性、范围和可信度仍然不清楚。随着MACI的临床应用的增长，了解患者在网上遇到的情况对于指导知情讨论至关重要。目的：(1)确定关于MACI的常见问题及其主题类别，(2)评估链接网站的类型和可信度，以便为患者提供方便的常见问题（FAQs）和高质量来源的讲义。方法：我们对b谷歌的“People Also Ask”功能中的1620个maci相关条目进行了横断面分析。使用Rothwell框架对问题进行分类，并使用JAMA基准标准对可信度进行评分。Kruskal-Wallis测试比较各组之间的可信度；逻辑回归确定了高可信度内容的预测因子。结果：大多数被纳入的问题（n = 1107）涉及技术细节（n = 285）、手术评估（n = 220）和费用（n = 138）。商业网站最常见（40.9%），虽然他们经常提供对患者友好的内容，但与政府（3.95）和学术（1.97）来源相比，他们的JAMA可信度平均得分（1.54）较低(p结论：关于MACI的在线信息主要是商业网站。虽然许多网站提供了有用的信息，但患者关心的关键问题，如疼痛，在在线资源中没有得到充分解决。由外科医生主导的工作，包括推荐可信来源和创建对患者友好的在线内容（例如使用关键词、图像、结构化标题），可以提高MACI信息的可见性和可信度，支持患者理解和共同决策。

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引用次数: 0

No differences in clinical outcomes and return to sport in patients with sex-mismatched meniscal allograft transplantation: Average 6-year follow up 性别不匹配的半月板同种异体移植患者的临床结果和恢复运动无差异：平均6年随访。

IF 2 4区医学 Q3 ORTHOPEDICS

Knee

Pub Date : 2025-11-17 DOI: 10.1016/j.knee.2025.11.001

Jairo Triana, Zachary I. Li, Allison Morgan, Vishal Sundaram, Guillem Gonzalez-Lomas, Michael Alaia, Eric Strauss, Laith Jazrawi, Kirk Campbell

Background

Risks associated with graft transplantation due to donor–recipient sex differences have been reported in whole organ transplantation literature but are not well-described in meniscal allograft transplantation (MAT). This study assessed the effect of donor–recipient sex mismatch on patient-reported outcomes (PROs) following MAT.

Methods

A retrospective review of patients <50 years of age that underwent unicompartmental MAT from 2010 to 2023 at a single institution with minimum 2-year follow up was conducted. Exclusion criteria were revision procedures or insufficient donor information. PROs collected included: Knee Injury and Osteoarthritis and Outcome Score (KOOS), Visual Analog scale (VAS) for pain and satisfaction, and return to sport (RTS). PROs were compared between donor–recipient graft matching groups (same-sex (SS) or different-sex (DS)) and by donor sex.

Results

Fifty-seven patients (31 males, 26 females) met inclusion criteria with mean age of 29.1 ± 8.9 years, BMI (body mass index) of 26.8 ± 5.7 kg/m², and follow up of 73.4 ± 29.2 months. Donors were mostly male (77.2 %). Thirty-six patients (63.3 %) received SS grafts and 21 (36.8 %) received DS grafts. There were no significant differences between groups in KOOS subscores, VAS pain, satisfaction scores, or RTS rates (P > 0.05). Donor sex also showed no association with PROs. Linear and logistic regression models controlling for age, BMI, and average follow up demonstrated that graft mismatch was not associated with KOOS scores, RTS, or graft failure. Decreasing patient age was associated with improved KOOS-pain (β: −0.376; 95 % CI (−1.892, −0.155); P = 0.022).

Conclusions

Patients that undergo MAT with grafts from a different sex had similar outcomes to patients receiving grafts from a donor of the same sex. Sex-mismatch was not associated with functional outcomes or RTS. The results of this paper support the use of geometrically matched donor grafts, independent of donor sex, which should expand available graft options when matching a patient for MAT.

背景：在全器官移植文献中已经报道了供体-受体性别差异导致的移植风险，但在半月板同种异体移植（MAT）中没有很好的描述。方法：回顾性分析57例患者（男31例，女26例）符合纳入标准，平均年龄29.1±8.9岁，身体质量指数（BMI） 26.8±5.7 kg/m2，随访73.4±29.2个月。献血者多为男性（77.2%）。36例（63.3%）接受SS移植，21例（36.8%）接受DS移植。两组间KOOS评分、VAS疼痛评分、满意度评分、RTS率差异均无统计学意义（P < 0.05）。供体性别也与PROs无关。控制年龄、BMI和平均随访的线性和逻辑回归模型表明，移植物不匹配与KOOS评分、RTS或移植物失败无关。患者年龄的降低与KOOS-pain的改善相关(β: -0.376; 95% CI (-1.892, -0.155)；p = 0.022)。结论：接受不同性别移植的MAT患者与接受同性供者移植的患者预后相似。性别不匹配与功能结局或RTS无关。本文的结果支持使用几何匹配的供体移植物，独立于供体性别，这应该扩大可用的移植物选择时，匹配患者的MAT。

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