Introduction. Orthopedics is experiencing a significant transformation with the introduction of technologies such as robotics and apps. These, integrated into the post-operative rehabilitation process, promise to improve clinical outcomes, patient satisfaction, and the overall efficiency of the healthcare system. This study examines the impact of an app called Mymobility and intra-operative data collected via the ROSA® robotic system on the functional recovery of patients undergoing robot-assisted knee arthroplasty. Method. The study was conducted at a single center from 2020 to 2023. Data from 436 patients were included, divided into “active” patients (active users of Mymobility) and “non-active” patients. Clinical analyses and satisfaction surveys were carried out on active patients. The intra-operative parameters recorded by ROSA® were correlated with the Patient-Reported Outcome Measures (PROMs) collected via Mymobility. Result. Intra-operative data showed significant correlations with PROMs for the 48 active patients, highlighting the importance of parameters such as medial joint space and ligament laxity. No significant differences were observed between the sexes, but a positive correlation was detected between age and PROMs. The data analysis indicated that an increased medial joint space and reduced ligament laxity are associated with better PROMs. The adoption of Mymobility remained limited, with only 10% of patients fully utilizing the app. Critical factors have been identified to improve recruitment, engagement, and overall experience with the platform. Conclusion. The integration of technologies such as Mymobility and ROSA® in post-operative rehabilitation offers numerous advantages, including the objectification of data, active patient involvement, and personalized care. Challenges remain related to costs, patient compliance, and demographic limitations. Nevertheless, these technologies represent a milestone in modern peri-operative management, being able to improve clinical outcomes and the quality of care

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While residual fixed flexion deformity (FFD) in unicompartmental knee arthroplasty (UKA) has been associated with worse functional outcomes, limited evidence exists regarding FFD changes. The objective of this study was to quantify FFD changes in patients with medial unicompartmental knee arthritis undergoing UKA, and investigate any correlation with clinical outcomes.

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In patients with a failed radial head arthroplasty (RHA), simple removal of the implant is an option. However, there is little information in the literature about the outcome of this procedure. The aim of this study was to review the mid-term clinical and radiological results, and the rate of complications and removal of the implant, in patients whose initial RHA was undertaken acutely for trauma involving the elbow.

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The optimal bearing surface design for medial unicompartmental knee arthroplasty (UKA) remains controversial. The aim of this study was to compare outcomes of fixed-bearing (FB) and mobile-bearing (MB) UKAs from a single high-volume institution.

Advanced 3D imaging and CT-based navigation have emerged as valuable tools to use in total knee arthroplasty (TKA), for both preoperative planning and the intraoperative execution of different philosophies of alignment. Preoperative planning using CT-based 3D imaging enables more accurate prediction of the size of components, enhancing surgical workflow and optimizing the precision of the positioning of components. Surgeons can assess alignment, osteophytes, and arthritic changes better. These scans provide improved insights into the patellofemoral joint and facilitate tibial sizing and the evaluation of implant-bone contact area in cementless TKA. Preoperative CT imaging is also required for the development of patient-specific instrumentation cutting guides, aiming to reduce intraoperative blood loss and improve the surgical technique in complex cases. Intraoperative CT-based navigation and haptic guidance facilitates precise execution of the preoperative plan, aiming for optimal positioning of the components and accurate alignment, as determined by the surgeon’s philosophy. It also helps reduce iatrogenic injury to the periarticular soft-tissue structures with subsequent reduction in the local and systemic inflammatory response, enhancing early outcomes. Despite the increased costs and radiation exposure associated with CT-based navigation, these many benefits have facilitated the adoption of imaged based robotic surgery into routine practice. Further research on ultra-low-dose CT scans and exploration of the possible translation of the use of 3D imaging into improved clinical outcomes are required to justify its broader implementation.

Cite this article: Bone Joint J 2024;106-B(9):892–897.

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As an alternative to external fixators, intramedullary lengthening nails (ILNs) can be employed for distraction osteogenesis. While previous studies have demonstrated that typical complications of external devices, such as soft-tissue tethering, and pin site infection can be avoided with ILNs, there is a lack of studies that exclusively investigated tibial distraction osteogenesis with motorized ILNs inserted via an antegrade approach.

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes. Cite this article: Bone Jt Open 2024;5(2):94–100

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The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.

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Total knee arthroplasty (TKA) may provoke ankle symptoms. The aim of this study was to validate the impact of the preoperative mechanical tibiofemoral angle (mTFA), the talar tilt (TT) on ankle symptoms after TKA, and assess changes in the range of motion (ROM) of the subtalar joint, foot posture, and ankle laxity.

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This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.

There is a disparity in sport-related injuries between sexes, with females sustaining non-contact musculoskeletal injuries at a higher rate. Anterior cruciate ligament ruptures are between two and eight times more common than in males, and females also have a higher incidence of ankle sprains, patellofemoral pain, and bone stress injuries. The sequelae of such injuries can be devastating to an athlete, resulting in time out of sport, surgery, and the early onset of osteoarthritis. It is important to identify the causes of this disparity and introduce prevention programmes to reduce the incidence of these injuries. A natural difference reflects the effect of reproductive hormones in females, which have receptors in certain musculoskeletal tissues. Relaxin increases ligamentous laxity. Oestrogen decreases the synthesis of collagen and progesterone does the opposite. Insufficient diet and intensive training can lead to menstrual irregularities, which are common in female athletes and result in injury, whereas oral contraception may have a protective effect against certain injuries. It is important for coaches, physiotherapists, nutritionists, doctors, and athletes to be aware of these issues and to implement preventive measures. This annotation explores the relationship between the menstrual cycle and orthopaedic sports injuries in pre-menopausal females, and proposes recommendations to mitigate the risk of sustaining these injuries. Cite this article: Bone Joint J 2023;105-B(7):723–728

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Mid-level constraint designs for total knee arthroplasty (TKA) are intended to reduce coronal plane laxity. Our aims were to compare kinematics and ligament forces of the Zimmer Biomet Persona posterior-stabilized (PS) and mid-level designs in the coronal, sagittal, and axial planes under loads simulating clinical exams of the knee in a cadaver model.

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Knowledge on total knee arthroplasties (TKAs) in patients with a history of poliomyelitis is limited. This study compared implant survivorship and clinical outcomes among affected and unaffected limbs in patients with sequelae of poliomyelitis undergoing TKAs.

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To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration.

Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr.

Cite this article: Bone Joint J 2023;105-B(5):474–480.

Preoperative ligament laxity can be characterized intraoperatively using digital robotic tensioners. Understanding how preoperative knee joint laxity affects preoperative and early post-operative patient reported outcomes (PROMs) may aid surgeons in tailoring intra-operative balance and laxity to optimize outcomes for specific patients. This study aims to determine if preoperative ligament laxity is associated with PROMs, and if laxity thresholds impact PROMs during early post-operative recovery. 106 patients were retrospectively reviewed. BMI was 31±7kg/m. 2. Mean age was 67±8 years. 69% were female. Medial and lateral knee joint laxity was measured intraoperatively using a digital robotic ligament tensioning device after a preliminary tibial resection. Linear regressions between laxity and KOOS12-function were performed in extension (10°), midflexion (45°), and flexion (90°) at preoperative, 6-week, and 3-month time points. Patients were separated into two laxity groups: ≥7 mm laxity and <7 mm laxity. Student's t-tests determined significant differences between laxity groups for KOOS12-function scores at all time points. Correlations were found between preoperative KOOS12-function and medial laxity in midflexion (p<0.001) and flexion (p<0.01). Patients with <7 mm of medial laxity had greater preoperative KOOS12-function scores compared to patients with ≥7 mm of medial laxity in extension (46.8±18.2 vs. 29.5±15.6, p<0.05), midflexion (48.4±17.8 vs. 32±16.1, p<0.001), and flexion (47.7±18.3 vs. 32.6±14.7, p<0.01). No differences in KOOS12-function scores were observed between medial laxity groups at 6-weeks or 3-months. All knees had <5 mm of medial laxity postoperatively. No correlations were found between lateral laxity and KOOS12-function. Patients with preoperative medial laxity ≥7 mm had lower preoperative PROMs scores compared to patients with <7 mm of medial laxity. No differences in PROMs were observed between laxity groups at 6 weeks or 3 months. Patients with excessive preoperative joint laxity achieve similar PROMs scores to those without excessive laxity after undergoing gap balancing TKA

Abstract. Background. Multi-ligament knee injury is a rare but severe injury. Treatment strategies are challenging for most orthopedic surgeons & optimal treatment remains controversial. The purpose of our study was to assess clinico-radiological and functional outcomes after surgical management of multi-ligament knee injuries & to determine factors that could predict outcome of surgery. Materials And Method. It is a prospective observational study of 30 consecutive patients of Multi-ligament knee injury conducted between 2018–2020. All patients were treated surgically with single-stage reconstruction of all injured ligaments and followed standardized postoperative rehabilitation protocol. All patients were evaluated for Clinical (VAS score, laxity stress test, muscle-strength, range of motion), Radiological (stress radiographs) & Functional (Lysholm score) outcomes three times-preoperatively, post-operative 3 & 12 months. Results. At final follow up mean VAS score was 0.86±0.77. The anteroposterior & valgus-varus stress test showed ligament laxity >10mm (GradeD) in 93.3% patient which improved to <3mm (normal, GradeA) in 90% patients. Most patients (83.3%) had preoperative-range <100° and muscle strength of MRC Grade-3 which improved to >120° and muscle strength of MRC grade-5 at final followup. Lysholm score was poor (<64) in all patients preoperatively and improved to good (85–94) in 73.3%, excellent (>95) in 20% & fair (65–84) in 6.6% patients. The stress radiographs showed stable results for anterior/posterior & varus/valgus stress. All patients returned to their previous work. Factors that could predict outcomes of surgery are age, timing of surgery, type of surgery & associated injury. Conclusion. Early complete single stage reconstruction can achieve good functional results with overall restoration of sports & working capacity. Positive predictive factors for good outcome are younger age, early surgery & appropriate rehabilitation

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We have previously reported the mid-term outcomes of revision total knee arthroplasty (TKA) for flexion instability. At a mean of four years, there were no re-revisions for instability. The aim of this study was to report the implant survivorship and clinical and radiological outcomes of the same cohort of of patients at a mean follow-up of ten years.

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The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI?