PURPOSE To compare commonly used computed tomography (CT)-based tibial torsion measurement discrepancies and evaluate their intra- and interobserver agreement, as measurement discrepancies between techniques have not been systematically assessed. METHODS CT scans from 20 adult patients were retrospectively analysed. Tibial torsion was calculated using two proximal reference axes (posterior tibial plateau tangent and tibial tuberosity axis) and four distal axes (transmalleolar, ankle joint, Jend and Waidelich). Three observers performed all measurements independently and repeated them after 8-12 weeks. Differences among techniques were assessed using repeated-measures analysis of variance with Bonferroni correction. Reliability was evaluated using intraclass correlation coefficients (ICCs). RESULTS All measurement techniques differed significantly (p < 0.05). Mean tibial torsion was 34.1° (standard deviation [SD] 8.6°) for the transmalleolar axis, 31.2° (SD 8.8°) for the ankle joint axis, 44.2° (SD 9.8°) for the Jend axis and 34.9° (SD 9.0°) for the Waidelich axis. Segmental values revealed a mean supratuberositary torsion of 26° (SD 6.7°) and a mean infratuberositary torsion of 7.9° (SD 8.8°) for the transmalleolar axis, 5.1° (SD 8.9°) for the ankle joint axis, 18.1° (SD 10.4°) for the Jend axis and 8.8° (SD 9.1°) for the Waidelich axis. All techniques showed excellent intra- and interobserver reliability (ICC > 0.89). CONCLUSION Tibial torsion values depended strongly on the measurement technique used. Technique-specific normative values are essential, and radiology reports should explicitly identify the technique applied. Clinicians must account for these systematic differences when interpreting torsion values and planning derotational osteotomies. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Abstract Residual meniscal extrusion (ME) is considered an important factor jeopardizing the long‐term success of otherwise technically successful medial meniscus posterior root (MMPR) repair. Biomechanical and clinical studies have shown that meniscal centralization can reduce extrusion, restore contact mechanics and improve short‐term clinical outcomes. However, an important paradox remains: many patients with pre‐existing osteoarthritis (OA) and persistent ME after MMPR repair maintain good clinical outcomes despite continued radiographic progression. Although the biomechanical rationale for centralization is compelling, its clinical value may be more complex in the middle‐aged, degenerative knee. Progressive changes in tissue elasticity, capsular attenuation and joint biology may contribute to meniscal displacement, suggesting that ME may be less a primary driver of degeneration than a manifestation of an underlying OA. This raises a fundamental question: Are we treating the right target? Is residual ME a modifiable driver of disease progression, or does it primarily reflect the natural history of joint degeneration? This Editorial critically examines the emerging evidence on meniscal centralization, explores the clinical relevance of residual ME and highlights key questions that can guide future research.
Purpose To conduct a sex-stratified analysis of factors associated with subsequent surgery for loss of motion after anterior cruciate ligament reconstruction (ACLR), including meniscus repair and graft type. Methods All individuals age >= 14 years who underwent primary ACLR between 2014 and 2021 were reviewed. Exclusion criteria included <6 months follow-up and concomitant meniscal root, multiligament, osteochondral or osteotomy procedures. The primary outcome was subsequent surgery for loss of motion. Demographic and surgical variables were compared between individuals who underwent subsequent surgery for loss of motion versus not, for the full cohort and among females and males separately. Significance was set to p < 0.050. Results A total of 1226 individuals (age: 25 +/- 10 years; 49% female) were included at a mean follow-up of 2.3 years. The rate of subsequent surgery for loss of motion was 9.0% for the full cohort, 12.3% for females and 5.9% for males. Among the full cohort, female sex (OR: 2.31; p < 0.001) and lateral meniscus (LM) repair (OR: 1.62; p = 0.048) were predictors of subsequent surgery for loss of motion. Among females, bone-patellar tendon-bone (BPTB) autograft use (OR: 1.91; p = 0.034) and LM repair (OR: 1.72; p = 0.046) were predictors of subsequent surgery for loss of motion, with combined BPTB autograft use and LM repair resulting in a significantly higher rate of subsequent surgery for loss of motion (32% vs. 12%; p = 0.004). Among males, graft type and meniscus repair were not associated with subsequent surgery for loss of motion (both p > 0.050). Conclusion In this sex-stratified analysis, BPTB autograft use and LM repair were identified as factors predictive of subsequent surgery for loss of motion after primary ACLR when analysing females independently, while no predictive factors were identified when analysing males independently. Understanding factors associated with loss of motion after primary ACLR among males and females separately may guide individualised surgical decision-making and patient counselling.
Purpose This study aimed to translate and culturally adapt the knee injury and osteoarthritis outcome score joint replacement (KOOS-JR) into simplified Chinese and provide an initial evaluation of selected measurement properties in patients with knee osteoarthritis (OA) scheduled for total knee replacement (TKR). Methods Eighty-five patients completed the simplified Chinese KOOS-JR and International Knee Documentation Committee (IKDC) at baseline, and clinically stable participants repeated the KOOS-JR after 10-14 days. Selected properties included supervised data completeness, floor and ceiling effects, provisional internal consistency, test-retest reliability, measurement error and construct validity. Results All 85 participants completed baseline and retest assessments. No floor or ceiling effects were observed. Cronbach's alpha was 0.849 at baseline and 0.816 at retest. intraclass correlation coefficient (A,1) was 0.791 (95% CI, 0.695-0.859). The mean test-retest difference was -0.39 points, with an individual-level smallest detectable change of 11.69 points. KOOS-JR and IKDC scores were strongly correlated (r(s) = 0.766; 95% CI, 0.646-0.850; p < 0.001). Conclusion The simplified Chinese KOOS-JR showed reasonably stable test-retest performance and initial supportive construct validity in this preoperative TKR cohort. Internal-consistency evidence remains provisional because structural validity was not assessed. Further studies should evaluate structural validity, measurement invariance, responsiveness and practical burden.
Purpose To evaluate the long-term rate of secondary medial meniscectomy following medial meniscus posterior horn repair performed during revision anterior cruciate ligament reconstruction (ACLR) and to compare contemporary posteromedial suture-hook repair with other repair strategies used during the study period. We hypothesized that suture-hook repair would be associated with improved long-term meniscal survivorship compared to other repair strategies performed with revision ACLR. Methods This retrospective cohort study included patients undergoing revision anterior cruciate ligament reconstruction (rACLR) between 2003 and 2023 at a single high-volume centre. Knees presenting with ramp lesions, meniscocapsular separations, meniscotibial disruptions and longitudinal vertical tears extending into the posterior horn of the medial meniscus treated by repair were identified and stratified according to repair strategy: contemporary posteromedial suture-hook repair versus other techniques used during the study period, including all-inside, inside-out and earlier repair techniques. The primary outcome was secondary medial meniscectomy. Time-to-event analysis was performed using Kaplan-Meier survival estimates and compared using the log-rank test. A multivariable Cox proportional hazards model was used to assess independent predictors of secondary medial meniscectomy, with administrative censoring at 10 years. Results A total of 402 medial meniscus repairs were included, with a mean follow-up of 96.0 +/- 31.4 months after administrative censoring at 10 years. At 10 years, the cumulative rate of secondary medial meniscectomy was 17.5% (95% confidence interval [CI] 13.6-22.4). Unadjusted analysis demonstrated a lower rate of secondary medial meniscectomy in the suture-hook repair group compared with other repair techniques used during the study period (15.8% [95% CI 11.3-21.9] vs. 24.1% [95% CI 16.3-34.9]; log-rank p = 0.0499). However, after multivariable adjustment, repair technique was not independently associated with secondary medial meniscectomy (hazard ratio 1.62, 95% CI 0.90-2.83; p = 0.0986). Conclusion Long-term outcomes of medial meniscus posterior horn repair during rACLR showed a 17.5% cumulative rate of secondary medial meniscectomy at 10 years. Posteromedial suture-hook repair was associated with lower failure rates than other repair techniques on unadjusted analysis; however, repair technique was not an independent predictor of secondary medial meniscectomy after multivariable adjustment. These findings support meniscal preservation and systematic assessment of posteromedial meniscal lesions during revision ACLR while providing realistic long-term expectations regarding repair survivorship.Level of Evidence Level III, retrospective cohort study.
