PURPOSE:Lateral unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral-compartment osteoarthritis, yet detailed evidence-based indication criteria remain poorly defined. Therefore, this study evaluated the association between preoperative medial-compartment osteophytes and reoperation-free survival, implant survivorship, medial-compartment disease progression requiring reoperation, and postoperative functional outcomes following lateral UKA. METHODS:A total of 900 lateral UKAs (830 patients) performed between 2016 and 2021 with a minimum follow-up of 2 years (mean 5.1 ± 1.8 years) were retrospectively analysed. Using the OARSI (Osteoarthritis Research Society International) atlas, knee radiographs were stratified into no medial osteophytes (n = 601), small osteophytes (n = 180) and moderate/severe osteophytes (n = 119). Kaplan-Meier survival analysis estimated 9-year survival for the endpoints reoperation, implant revision and disease progression requiring reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and University of California, Los Angeles (UCLA) Activity Score. RESULTS:Reoperation-free survival at 9 years was 94.2% (95% confidence interval [CI]: 91.6-96.8) for knees without osteophytes, 93.0% (95% CI: 88.5-97.5) for small osteophytes, and 91.8% (95% CI: 86.5-97.1) for moderate/severe osteophytes (p = 0.489). Implant survivorship was comparably high across groups (98.3%, 98.1% and 98.0%), respectively (p = 0.972). Medial-compartment disease progression was not associated with radiographic medial osteophyte status (97.6% [95% CI: 96.1-98.5], 98.7% [95% CI: 95.0-99.7] and 96.9% [95% CI: 93.4-98.5]; p = 0.616). Functional outcomes improved significantly across groups without differences between groups (OKS: p = 0.389; UCLA: p = 0.353). CONCLUSIONS:Clinically relevant medial-compartment disease progression requiring reoperation after lateral UKA is uncommon at mid-term follow-up and appears to be independent of the presence or severity of medial-compartment osteophytes. These findings suggest that medial-compartment osteophytes alone should not preclude appropriately selected patients from undergoing lateral UKA when indications are based on stress radiographs. LEVEL OF EVIDENCE:Level IV.

Patients with Parkinson’s disease (PD) are a vulnerable subgroup facing elevated risks of complications and functional decline following knee arthroplasty. However, data on the outcomes of minimally invasive unicompartmental knee arthroplasty (UKA) in this population are limited. This study´s purpose was to assess perioperative complications, implant revision-free and reoperation-free survivorship as well as functional outcome in PD patients following UKA. In this retrospective single-center study, 42 knees in 39 patients with PD who underwent medial or lateral UKA between 2016 and 2022 were analyzed. The mean age was 70.6 ± 9.1 years, and the mean BMI was 27.9 ± 5.2 kg/m². A total of 26 medial and 16 lateral UKAs were performed, with a minimum follow-up of two years (mean 5.0 ± 2.0). All medical complications were recorded. Implant survivorship (tibia and/or femur) and reoperation-free survival were evaluated using Kaplan-Meier analysis, allowing estimation of long-term survival beyond the mean follow-up duration. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA Activity Score. Of the 42 knees, 6 (14.3

BACKGROUND:Isolated lateral-compartment knee osteoarthritis (OA) remains a condition challenging to treat. Lateral unicompartmental knee arthroplasty (UKA) may offer therapeutic advantages over total knee arthroplasty (TKA); however, it remains infrequently performed. This study determined implant survivorship and reoperation-free survival in a consecutive single-center series of primary lateral UKA. Furthermore, patient-reported outcome measures (PROMs) and radiological outcomes were assessed. METHODS:In this retrospective analysis, 1,015 knees in 927 patients (75% women) who had a mean follow-up of 5.1 years (range, 2.0 to 8.9) were included (mean age 70 years, range, 37 to 94; mean body mass index 27.5, range, 15 to 48). All patients were contacted via telephone to record implant survivorship, any reoperation, and the functional outcome (follow-up rate: 92%). Preoperative and postoperative radiographs were obtained following a standardized protocol. The Oxford Knee Score and the University of California, Los Angeles Activity Score were documented. Patients who had a previous ipsilateral medial UKA or patellofemoral arthroplasty and patients who declined consent were retrospectively excluded. Cumulative survival was calculated using Kaplan-Meier survival analysis. RESULTS:The cumulative 9-year survival rate was 97.6% (95% confidence interval: 96.6 to 98.6) with implant revision as the endpoint and 92.4% (95% confidence interval: 90.4 to 94.4) with reoperation for any reason as the end point. Medial-compartment OA progression was the most common reason for reoperation (2.8%), followed by medial osteonecrosis (1.1%) and infection (0.8%). The mean Oxford Knee Score improved from 23.9 ± 8.0 to 43.2 ± 6.4 (P < 0.001); the mean University of California, Los Angeles Activity Score improved from 4.5 ± 1.7 to 5.8 ± 1.6 (P < 0.001). The mean hip-knee-ankle angle was corrected from 7.4° ± 4.5 valgus to 2.4° ± 2.6 valgus (P < 0.001). CONCLUSIONS:This study demonstrated that primary lateral UKA is a highly successful procedure with excellent implant survival and favorable PROMs at a mean follow-up of five years. The low revision rates and promising functional outcomes strongly confirm its role as a viable alternative to TKA in appropriately selected patients who have isolated lateral-compartment OA. LEVEL OF EVIDENCE:IV, case series.

Der unikondyläre Gelenkersatz ist ein etabliertes Verfahren zur Therapie der anteromedialen Gonarthrose mit sehr guten funktionellen Ergebnissen und Prothesenstandzeiten. Die Grenzindikationen des Verfahrens erfordern im besonderen Maße eine differenzierte Indikationsstellung und Patientenselektion sowie genaue Kenntnisse über das verwendete Implantat. Der Teilgelenkersatz ist auch bei Grenzindikationen eine erfolgreiche Behandlungsoption, und sollte aufgrund der niedrigen perioperativen Morbidität und Mortalität und guten funktionellen Ergebnissen fester Bestandteil der individuellen Therapieentscheidung sein. Der unikondyläre Gelenkersatz (UKA) nach Umstellungsosteotomie ist technisch anspruchsvoll, bietet jedoch zahlreiche Vorteile gegenüber dem bikondylären Oberflächenersatz. Zementfreie Implantate können auch bei Osteonekrose verwendet werden, wenn eine sichere primäre Fixation gewährleistet ist. Die mediale Arthrose mit Läsionen des vorderen Kreuzbands (VKB) ohne klinische Instabilität stellt keine Kontraindikation für den medialen Schlitten dar. Meniskuswurzelläsionen ohne höhergradige Arthrose bleiben eine absolute Grenzindikation für die endoprothetische Versorgung.

PURPOSE:Disease progression in the untreated compartment is the leading cause for reoperation following unicompartmental knee arthroplasty (UKA). A less-invasive alternative to total knee arthroplasty (TKA) conversion is the addition of a second UKA. The study assessed survival, functional, and radiological outcomes after two-staged bicompartmental UKA. METHODS:A retrospective analysis was performed on 102 knees (98 patients, mean age 73.7 years) who received an additional medial (n = 29) or lateral UKA (n = 73) between 2016 and 2025 with a minimum follow-up of 1 year. Primary outcomes were cumulative revision rates for (1) any reoperation and (2) implant revision. Functional outcomes included the Oxford Knee Score (OKS) and UCLA (University of California, Los Angeles) Activity Score. Radiographic assessment included measurement of the hip-knee-ankle angle (HKAA). RESULTS:The mean follow-up was 4.0 years (SD 2.1). At 9 years, cumulative survival rate was 84.3% (95% CI: 0.763-0.923) for any reoperation and 89.3% (95% CI: 0.822-0.964) for implant revision. There were nine implant revisions (8.8%), most commonly due to medial mobile-bearing dislocation (44.4%). In 50%, implant revision to TKA was performed using primary non-modular components. Mean postoperative OKS and UCLA scores were 40.4 (SD 8.0) and 5.5 (SD 1.7), respectively. Medial osteonecrosis (ON) following primary lateral UKA accounted for 38% (11/29) of all indications for an additional medial UKA, and was associated with greater HKAA correction following prior lateral UKA. CONCLUSION:Two-staged bicompartmental UKA is a viable less-invasive alternative to TKA conversion for patients with disease progression or ON after primary UKA. This approach demonstrates excellent mid-term functional outcomes and satisfactory implant survivorship, providing valuable evidence to support its role as a contemporary revision option Fixed-bearing implants for additional medial UKA are advised to eliminate the risk of bearing dislocations. In the absence of major complications, conversion to non-modular TKA components is feasible. LEVEL OF EVIDENCE:Level IV.

BACKGROUND:Leg length discrepancy (LLD) is a frequent source of dissatisfaction and litigation following total hip arthroplasty (THA). To minimize the risk of postoperative LLD, meticulous planning before surgery and intraoperative clinical and radiographic assessment are critical. THERAPY:The discrimination between structural and functional causes is a key aspect in the management of LLD and guides therapeutic decision-making. Functional LLDs are common in the early postoperative phase and typically respond well to conservative treatment. In patients with neurologic deficits or recurrent dislocations revision surgery is warranted. There is no universally accepted threshold for revision in patients with persistent LLD unresponsive to non-operative measures, and surgical re-intervention should be based on individual decision-making in these cases. This review summarizes current evidence on the etiology, diagnosis, prevention, and management of leg length discrepancy following THA.

BACKGROUND:Osteonecrosis (ON) of the knee commonly affects the medial femoral condyle, leading to secondary unicompartmental arthritis. While most studies on unicompartmental knee arthroplasty (UKA) in patients who have ON focus on cemented fixation, the outcomes of cementless UKA remain unknown. This study evaluated survival, functional and radiological outcomes, and assessed potential differences for cemented and cementless medial mobile-bearing UKA in patients who had ON. METHODS:This retrospective, single-center study analyzed 119 patients who underwent medial UKA for ON between 2020 and 2022, with a minimum follow-up of two years. Patients were stratified into cemented (n = 63, women/men 71/29%, mean age 70 ± nine years, BMI 29 ± 4) and cementless (n = 56, women/men 34/66%, mean age 72 ± eight years, BMI 28 ± 4) groups. Demographics were similar between groups, except for sex, with more men in the cementless UKA group (P < 0.001). Kaplan-Meier survival analysis compared survival rates for aseptic loosening, implant revision (exchange of the femoral or tibial component), and any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA (University of California, Los Angeles) Activity Score. RESULTS:At 50 months, cumulative survival rates showed no significant differences between cemented and cementless UKA for aseptic loosening (100 versus 97.7%; P = 0.35), implant revision (97.5 versus 93.3%; P = 0.36), or any reoperation (92.1 versus 87.0%; P = 0.35). There was one case of aseptic tibial subsidence that occurred in the cementless group in a patient who had femoral ON. Functional outcomes were excellent in both groups, with no significant differences in OKS (cemented/cementless: 42.6 ± 5.4 versus 43.5 ± 6.3; P = 0.12) or UCLA Activity Scores (6.1 ± 1.0 versus 6.1 ± 1.2; P = 0.57). CONCLUSIONS:Cementless medial mobile-bearing UKA is a safe treatment option for ON in the medial compartment, offering stable primary fixation and implant survival comparable to cemented fixation. However, future research with sex-balanced cohorts and extended follow-up is needed to confirm these findings.

PURPOSE:Limited evidence exists regarding the safety and efficacy of medial unicompartmental knee arthroplasty (UKA) in patients with end-stage medial arthritis following knee osteotomy. This study aims to evaluate survival, functional and radiological outcomes in patients undergoing medial UKA following knee osteotomy. METHODS:A retrospective analysis was conducted evaluating 63 knees (60 patients; 62% men, 38% women; mean age 61 ± 8 years; body mass index 28 ± 5 kg/m2) who underwent medial UKA (n = 47 mobile-bearing, n = 16 fixed-bearing) following knee osteotomy. Patients were considered suitable for medial UKA if they met the Oxford criteria and had a preoperative hip-knee-ankle angle (HKAA) < 5° valgus and a medial proximal tibial angle (MPTA) < 95°. Primary outcomes were cumulative revision rates for (1) conversion to total knee arthroplasty (TKA) and (2) any reoperation. Functional outcomes were assessed using the Oxford Knee Score (OKS) and the UCLA Activity Score. HKAA was measured to determine overall limb alignment pre- and post-operatively. RESULTS:The average time from osteotomy to UKA was 11 ± 8 years, and the mean follow-up after UKA was 5 ± 2 years. The cumulative 8-year implant survival rate was 96.3% (95% confidence interval [CI]: 0.912-1.0) for revision to TKA and 93.2% (95% CI: 0.899-0.965) for any reoperation. Two patients required revision to TKA due to overcorrection and infection. The mean OKS improved from 25.5 ± 5.9 preoperatively to 42.8 ± 6.0 post-operatively (p < 0.001). The mean preoperative HKAA of 2.4 ± 3.0° varus was corrected to 0.0 ± 3.1°. CONCLUSION:Medial UKA after knee osteotomy represents a viable treatment option, but it requires a strict preoperative alignment assessment. In the absence of excessive mechanical valgus alignment (HKAA < 3° valgus) and severe valgus deformities (MPTA < 95°) of the proximal tibia, medial UKA provides favourable midterm implant survivorship and excellent functional outcomes. In borderline cases, fixed-bearing implants should be considered to avoid valgus overcorrection. LEVEL OF EVIDENCE:Level IV.

PURPOSE:Patients with prior anterior cruciate ligament reconstruction (ACLR) are at increased risk of early medial osteoarthritis. Medial mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) offers a minimal-invasive and joint-preserving alternative to total knee arthroplasty (TKA), yet evidence in ACLR patients remains limited. This study compared survivorship, reoperation causes and functional outcomes of medial MB UKA in ACLR patients versus matched controls. METHODS:This retrospective 1:2 matched case-control study included 106 medial MB UKAs after ACLR (mean age 61 ± 9 years; body mass index [BMI]: 29 ± 5 kg/m2; follow-up 5 ± 2 years) and 208 matched controls (n = 4 with only one match) with a minimum follow-up of 2 years. Kaplan-Meier analysis estimated 9-year survival for reoperation, implant revision (femur and/or tibia) and conversion to TKA. Reoperation causes and PROMs (Oxford Knee Score [OKS] and UCLA Activity Score) were compared. RESULTS:Cumulative 9-year reoperation-free survival was significantly lower (p = 0.026) in the ACLR group (81.2%; 95% confidence interval [CI]: 71.8-90.6) compared with matched controls (92.1%; 95% CI: 88.2-96.0). Cumulative 9-year implant revision-free survival was also significantly lower (p = 0.004) in the ACLR group (89.8%; 95% CI: 81.8-97.8) compared with matched controls (98.4%; 95% CI: 96.6-100.0). For conversion to TKA, survival rates were 92.7% (95% CI: 85.3-100.0) and 98.2% (95% CI: 96.2-100.0), respectively (p = 0.071). The risk for bearing dislocation was eightfold higher in the ACLR group compared with controls (3.8% vs. 0.5%; p = 0.046). The mean postoperative OKS in the ACLR group was 42.5 ± 6.2 and 42.3 ± 6.1 in controls; the UCLA Activity Score was 6.3 ± 1.2 and 6.1 ± 1.2, respectively. CONCLUSION:Despite excellent functional outcomes, ACLR patients undergoing MB UKA face a significantly higher risk for reoperation and inferior implant survival compared with matched controls. The increased risk for additional surgery in patients with prior ACLR, particularly for bearing dislocation, should be acknowledged when indicating medial UKA, and the usage of fixed-bearing implants reduces this risk. LEVEL OF EVIDENCE:Level III.

Background: Unicompartmental knee arthroplasty (UKA) is an established surgical treatment option for end-stage anteromedial osteoarthritis with excellent functional outcomes and implant survival. Routine preoperative varus and valgus stress views are crucial for the selection of patients for unicompartmental or total knee arthroplasty. Therapy: UKA is a soft-tissue based operation that aims to reconstruct the individual joint line and pre-arthritic alignment by restoring the physiological tension of the medial collateral and the cruciate ligaments. Results: Current data for medial UKA show excellent results for both mobile and fixed bearing implant designs with the correct indication and surgical technique. Cementless fixation offers potential advantages over cemented implants. Registry data demonstrate that institutions and surgeons specializing in partial knee replacement (> 30 cases/year per surgeon, > 100/year per institution) with a high percentage of UKA relative to the total number of knee implants (> 20%) have significantly lower revision rates.

Background: The importance of meniscal repair is widely accepted because of the association of loss of meniscal tissue with the development of early-onset knee arthritis. Many factors influencing the results of meniscal repair have been reported, but results remain controversial. Purpose: This meta-analysis determines the pooled meniscal repair failure rate of studies with a minimum follow-up of 2 years up to 5 years, with a mean follow-up of 43 months. Moreover, selected failure-influencing factors are analyzed. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed and Scopus were searched for studies published between January 2000 and November 2021 reporting on meniscal repair outcome with a minimum follow-up of 24 months. The overall pooled failure rate and pooled failure rates for possible predictors were calculated. Random-effect models were used to pool failure rates, and effect estimates in the form of odds ratios with 95% CIs were established. Results: The initial literature search identified 6519 studies. A total of 51 studies met the inclusion criteria. In total, 3931 menisci were included with an overall failure rate of 14.8%. Subgroup analysis revealed a significantly lower failure rate for meniscal repair with concomitant anterior cruciate ligament (ACL) reconstruction compared with knees without any reported injury to the ACL (8.5% vs 14%; P = .043). The pooled failure rate for lateral meniscal repair was significantly lower than that for medial meniscal repair (6.1% vs 10.8%; P = .031). Pooled failure rates of all-inside and inside-out repair were not significantly different (11.9% vs 10.6%; P > .05). Conclusion: This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. Meniscal repair remains a procedure with a high failure rate, especially within the first 2 postoperative years. This review and meta-analysis also identified clinically relevant factors associated with favorable outcomes such as concomitant ACL reconstruction or repair of the lateral meniscus. All-inside meniscal repair with the latest-generation devices yields failure rates of <10%. The failure mechanism and the time of failure is poorly documented; further studies are needed for a better understanding of the retear mechanism.

Der unikondyläre Gelenkersatz (UKA) ist ein etabliertes Verfahren zur Therapie der anteromedialen Gonarthrose mit sehr guten funktionellen Ergebnissen und Prothesenstandzeiten. Eine differenzierte Indikationsstellung und Patientenselektion sind für den Erfolg des Teilgelenkersatzes essenziell. Hierbei haben routinemäßige Varus‑/Valgusstressaufnahmen einen hohen Stellenwert. Der unikondyläre Gelenkersatz ist eine wenig invasive und bandspannungsbasierte Operation mit dem Ziel, die patientenindividuelle präarthrotische Gelenklinie und Beinachse durch ein physiologisches Wiederanspannen des Innenbandes und der Kreuzbänder zu rekonstruieren. Aktuelle Daten für mediale UKA zeigen sowohl für mobile als auch „fixed bearing“ Implantate bei korrekter Indikation und Operationstechnik sehr gute Ergebnisse. Die zementfreie Verankerung bietet potenzielle Vorteile gegenüber der zementierten Versorgung. Registerdaten zeigen eindeutig, dass auf den Teilgelenkersatz spezialisierte Kliniken bzw. Operateure (Fallzahl > 30/Jahr pro Operateur, > 100/Jahr pro Klinik) mit einem hohen Anteil an UKA bezogen auf die Gesamtanzahl von Knieprothesen (> 20

As an increasing number of younger patients are undergoing total knee replacement (TKR) surgery, many wish to participate in sport, but still expect that the implant will survive for a extended period. Most of the current literature shows that patients predominantly participate in low impact activities, both before and after surgery. A few studies show that with appropriate previous experience, high-impact sports are possible and might not result in increased implant failure rates. These include a decrease in point loads on the polyethylene by using more conforming bearing surfaces, avoidance of varus component alignment to minimise stresses at the implant bone interface and avoiding patella resurfacing to facilitate activities in deep knee flexion. A TKR is no longer an absolute contraindication for higher impact activities such as golf, tennis and ski. What is more important than implant specific factors seem to be patient specific factors, including preoperative activity level, and preoperative sport skills. The current review paper reports on the current sport habits of TKR patients, analyses biomechanical loads on the knee during different sport activities and reports on implant selection and technical considerations for the active patient undergoing TKR.

Purpose: To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair. Methods: By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos. Results: Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, 5 = 1.496 [P < .001]; GQS, 5 = 1.105 [P < .001]; DISCERN score, 5 = 11.234 [P < .001]; and RCS, 5 = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by nonemedically trained individuals (P = .041). Conclusions: The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair. Clinical Relevance: Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.

Meniscus repair has gained increasing interest over the last two decades as loss of meniscus tissue predisposes to early onset knee arthritis. Although there are many reports of meniscus repair outcome in short-term studies, data on the long-term outcome of meniscus repair are still scarce. The purpose of this meta-analysis was to evaluate the overall failure rate of meniscus repair with a minimum follow-up of 5 years. Additionally, possible factors influencing meniscus repair outcome were assessed. PubMed and Scopus were searched for studies of the last 20 years reporting on meniscus repair outcome with a minimum follow-up of 5 years. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search terms used for this study were ([meniscus OR meniscal] AND repair). Titles and abstracts were evaluated by two authors independently. Using meta package of R (version 3.6.2), random-effect models were performed to pool failure rates. Subgroup analyses were performed and effect estimates in form of an odds ratio with 95% CIs were established. In total, 12 studies with 864 patients were included. Degenerative tears were excluded in two studies and one study only included traumatic meniscus tears. Other studies did not state whether the cause of meniscus tear was degenerative or traumatic. Studies reporting meniscus repair outcome on root repairs, revision anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. Revision surgery was used as failure definition in all included studies. The overall failure rate of meniscal repair at a mean follow-up of 86 months was 19.1%. There was no significant difference in meniscus repair outcome when performed in combination with anterior cruciate ligament reconstruction compared to isolated meniscus repair (18.7% vs. 28%; n.s.) or when performed on the lateral meniscus compared to the medial meniscus (19.5% vs. 24.4%; n.s.). There was no significant difference of meniscus repair outcome between vertical/longitudinal tears and bucket-handle tears (n.s.). Thirty-six percent of meniscus repair failures occur after the second postoperative year. The only significant finding was that inside-out repair results in a lower failure rate compared to all-inside repair (5.6% vs. 22.3%; p = 0.009) at 5 years. The overall meniscus repair failure rate remains nineteen percent in long-term studies. The cause of failure is poorly documented, and it remains unclear whether failure of the meniscus repair itself or additional adjacent tears lead to revision surgery. Despite the given technical advantages of all-inside repair devices, this meta-analysis cannot demonstrate superior outcomes compared to inside-out or outside-in repair at 5 years. IV.

ZusammenfassungMit dem demografischen Wandel der Patientenpopulation, die einen Kniegelenkersatz erhält, verändern sich die Ansprüche der Patienten. Jüngere Patienten möchten sich nach Implantation einer Knietotalendoprothese (K-TEP) sportlich betätigen und zählen auf die Langlebigkeit des Implantates. Die Literatur zeigt, dass Patienten sowohl prä- als auch postoperativ vorwiegend Sportarten der Kategorie Low Impact ausüben. Ein gewisser Prozentsatz praktiziert mit entsprechender Vorerfahrung auch High-Impact-Sportarten. In der operativen Versorgung kann durch konforme Implantate die Punktbelastung der Polyethylenoberfläche verringert werden, durch eine adäquate Komponentenausrichtung erhöhter Stress an der medialen Knochen-Implantat-Schnittstelle vermieden und durch die Vermeidung eines Retropatellarersatzes eine stärkere Belastung in tiefer Kniebeuge ermöglicht werden.Eine K-TEP sollte heutzutage kein absolutes Hindernis für High-Impact-Sportarten wie Tennis, Golf oder Skifahren sein. Viel mehr als implantatspezifische Faktoren scheinen jedoch patientenspezifische Faktoren ausschlaggebend zu sein, insbesondere das präoperative Aktivitätslevel und die präoperativen Sportgewohnheiten. Die vorliegende Übersichtsarbeit gibt Einblick in das tatsächliche Sportverhalten von K-TEP-Patienten, beschreibt die biomechanischen Belastungsmuster am Kniegelenk bei diversen Sportarten und fasst die wichtigsten Aspekte in der Versorgung von sportlich aktiven Patienten mit einer K-TEP zusammen.

A significant percentage of patients have an unfavorable outcome following primary total knee arthroplasty (TKA). This study aimed to evaluate whether specific knowledge about the implant and resilience can influence the functional outcome following TKA. A consecutive series of 163 patients following primary TKA at a mean age of 70 years (SD 9.1 years) were included at a regional rehabilitation center between December 2015 and December 2016. Specific patient knowledge (scale 0–7), Connor Davidson Resilience Scale (CD-RISC), Western Ontario and McMaster Universities (WOMAC) score, University of California and Los Angeles (UCLA) score and constitutional parameters were assessed on admission. Pearson’s correlation analysis and stepwise linear regression analysis were performed to investigate associations between knowledge, resilience and functional scores. The mean overall knowledge score was 3.5 out of 7 and the mean resilience score was 72.9 out of 100. Mean WOMAC and UCLA scores on admission were 23.8 and 5.5, respectively. Stepwise linear regression analysis identified knowledge and age as significant predictors of WOMAC scores (R2 = 14.3%, p = 0.003). Knowledge and resilience were identified as significant predictors of UCLA scores (R2 = 13.8%, p = 0.013). This study highlights the importance of patient-related factors as part of an integral patient care concept in TKA. Although the identified predictors still need to be refined, it could be demonstrated how better patient knowledge might ultimately lead to better functional outcome following TKA. Routinely assessing patients’ resilience might be a useful tool to identify patients at risk for low activity levels. III. Patient-reported outcome study.

The aim of the present study was to investigate the potential associations between specific knowledge, resilience and patient-reported outcome measures (PROMS) following primary total hip arthroplasty (THA). In a cross-sectional prospective study, consecutive patients following primary THA were included at a rehabilitation center. A novel knowledge score and the validated Connor Davidson Resilience Scale (CD-RISC) were utilized to assess patients’ specific knowledge and resilience, respectively. Additionally, patients completed a qualitative questionnaire regarding the information they had received. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as the University of California and Los Angeles Score (UCLA) served as primary outcome measures. Stepwise multiple regression analysis was performed to identify potential predictors of outcome. A total of 103 patients at a mean age of 67.5 years (SD 10.5, 38–88) were included in the analysis at a median of 55.5 days (IQR 43–81) following primary THA. The mean knowledge and resilience scores were 3.8 (SD 1.6, 0–7) and 69.5 (SD 18.5, 0–100), respectively. Forty-seven percent of patients were afraid of harming their prosthesis and these patients had up to 59% worse WOMAC scores (p < 0.001). WOMAC scores on admission to rehabilitation were predicted by resilience and knowledge scores (R2 = 0.106, p = 0.036). UCLA scores at the time of admission were predicted by knowledge scores (R2 = 0.078, p = 0.007). The present study demonstrated that patients with a feeling of uncertainty had an inferior short-term functional outcome following primary THA. Moreover, it could be shown that higher specific knowledge and resilience are associated with a better functional outcome according to validated PROMS. While these findings need to be prospectively validated in future studies, specific patient knowledge and resilience may have a direct impact on the outcome of primary THA.