PurposeWe hypothesized that patients undergoing anterior cruciate ligament reconstruction (ACL‐R) are more likely to develop patellofemoral osteoarthritis (PFOA) than those with an ACL injury managed non‐surgically.Study designSystematic review and Meta‐analysis.MethodsA systematic literature review and meta‐analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Studies reporting PFOA assessment by radiographic or magnetic resonance imaging after ACL‐R compared to non‐surgical treatment of ACL injury were included. Studies involving individuals with concurrent other ligamentous or chondral injuries treated surgically were excluded to minimize bias.ResultsA total of six studies were included in the systematic review. The meta‐analysis demonstrated that patients undergoing ACL‐R had a significantly higher likelihood of developing PFOA compared to those who received non‐surgical treatment after ACL injury (odds ratio [OR] = 2.21; 95% confidence interval [CI]: 1.13−4.35; p = 0.02). Patients who underwent ACL‐R with bone–patellar tendon–bone (BPTB) autograft exhibited a significantly higher prevalence of PFOA than those with HT autograft (p < 0.01). Moreover, male patients exhibited a higher association with PFOA than females in both the ACL‐R (34.38% vs. 7.77%, p < 0.001) and non‐surgical ACL injury groups (28.13% vs. 0.97%, p < 0.001).ConclusionsACL‐R significantly increases the likelihood of PFOA compared to non‐surgical ACL treatment, especially when using BPTB autografts. Male patients demonstrated a higher association with PFOA in both groups. Targeted preventive strategies, including optimized graft selection and enhanced rehabilitation protocols, are crucial for reducing the risk of PFOA following ACL‐R.Level of EvidenceLevel III.

The relationship between spine orientation and the shoulder active range of motion (ROM) has been an ever-growing topic in the last few years. This systematic review aimed to assess the epidemiological association between spine morphology and shoulder function. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A literature search was performed on PubMed, Scopus, and Cochrane library. Randomised controlled trials (RCTs) and cross-sectional studies, analysing the correlation between shoulder ROM and Cobb angle, kyphosis index, scapular tilt, forward scapular posture, functional scores in adults were selected. Finally, data of interest were extracted and analysed. A total of five studies were included in this study. The study included a total number of 624 participants and 887 shoulders. The mean age 40 years old, ranging from 17.1 to 67. The most significant correlations (p < 0.0003) were that greater thoracic kyphosis was associated with increased scapular internal rotation (R = Left -0.081 Right = -0.065) (p < 0.0003), and that greater scapular anterior tilt was associated with increased scapular internal rotation (R = 0.29, p < 0.001). Higher thoracic kyphosis was correlated with reduced shoulder abduction (R = -0.163, p < 0.005) and flexion (R = -0.118, p < 0.05), whereas greater lumbar ROM was associated with increased abduction and flexion (R = 0.119, p < 0.05 and R = 0.166, p < 0.005). In addition, higher thoracic kyphosis was correlated with reduced shoulder adduction (R = -0.72, p < 0.05). Sagittal spine morphology shows frequent and significant correlations with shoulder active ROM. In particular, greater thoracic kyphosis is associated with increased scapular internal rotation and reduced shoulder abduction, adduction and flexion, while higher lumbar mobility correlates with improved shoulder elevation. These findings confirm the biomechanical interdependence between spinal alignment and shoulder kinematics. Level III.

Intraoperative extension deficiency (IED) may arise after trial component implantation during total knee arthroplasty (TKA), a condition conceptually distinct from preoperative fixed flexion contracture (FFC). This study utilised a robotic system to quantify the incremental mechanical effect of sequential surgical actions-posterior capsule release (PCR), posterior cruciate ligament (PCL) excision and incremental distal femoral resections-to correct IED. A secondary objective was to evaluate their impact on manually assessed mediolateral laxity. Twenty-nine robotic TKAs were performed on 15 fresh-frozen cadaveric specimens. Nineteen knees presented with IED. All knees underwent PCR as the initial corrective manoeuvre. Subsequently, a quasi-experimental design based on laterality was employed to evaluate two sequences: right knees underwent PCL excision followed by up to four 1-mm distal femoral recuts; left knees followed the reverse order. Extension gains and manually assessed mediolateral laxities were recorded after each step. Baseline IED averaged 6.6° ± 4.9°. Posterior capsule release corrected IED in 36.8% of the knees, yielding a mean extension gain of 1.68° ± 1.11°. The mechanical impact of distal femoral resections varied depending on PCL status: when the PCL remained intact, distal femoral recuts produced a substantial mean gain of 4.3° ± 0.6° per millimetre; however, following PCL excision, the gain per millimetre decreased to 2.8° ± 0.8°. PCL excision alone improved extension by a mean of 1.1° ± 1.3°. No significant changes in manually assessed mediolateral laxity at 0° and 90° of flexion were observed across manoeuvres. Robotic quantification demonstrates that the mechanical effectiveness of distal femoral resection is significantly enhanced by an intact PCL. While PCR is an impactful initial step for mild IED, distal femoral recuts provide greater extension gains. These objective data provide the foundation for a structured strategy to guide the intraoperative management of IED in both robotic and conventional TKA. N/A (cadaveric).

To assess the postoperative restoration of native anterior femoral offset (AFO) in kinematically aligned (KA) total knee arthroplasty (TKA) with the hypothesis that current off-the-shelf femoral components inadequately address the anterior compartment native anatomy. A prospective analysis was performed on 93 knees undergoing TKA with KA using GMK Sphere (Medacta) femoral components, excluding patients with posttraumatic osteoarthritis, radiographic signs of trochlear dysplasia ≥ type A of the Dejour classification, anterior femoral cortex notching or femoral component flexion >5° on postoperative lateral radiographs. After performing the anterior chamfer cut, the resected bone was measured with a caliper at the most prominent point of the trochlear groove, as well as the lateral and medial trochlear facets. After compensating for cartilage wear and saw blade thickness, the adjusted values were recorded as the native AFO. The thickness of the GMK Sphere femoral component at the trochlear surface corresponding to the middle of the anterior chamfer-specific to each implant size-defined the prosthetic AFO. AFO difference (AFOd) was defined as the difference between prosthetic and native AFO. T-test and equivalence testing were performed to compare prosthetic and native AFO. Statistical significance was defined as p < 0.05. AFO was consistently reduced across all regions, with a mean AFOd of -5.40 ± 2.40 mm at the medial trochlear facet, -2.32 ± 1.46 mm at the lateral facet, and -2.49 ± 1.11 mm at the trochlear sulcus (p < 0.001). The AFO was preserved in only 11.8% of cases at the medial trochlear facet, 29.0% at the lateral facet, and 18.3% at the sulcus. In none of the cases was the AFO increased. KA using off-the-shelf femoral components does not allow a full resurfacing of the trochlea, resulting in consistent offset reduction of the anterior compartment. Level IV, prospective observational study.

To evaluate the long-term outcomes of arthroscopic Bankart repair with additional posteroinferior capsular plication in patients with anterior shoulder instability and hyperlaxity, and to compare the outcomes of posteroinferior capsular plication using suture-only fixation versus suture anchor fixation. In this retrospective study, patients were included who underwent arthroscopic Bankart repair and additional posteroinferior capsular plication for anterior shoulder instability and hyperlaxity (type B3) between 2006 and 2014 at our institution. Primary outcome was recurrent instability. Secondary outcomes were Subjective Shoulder Value (SSV), visual analog scale (VAS), Constant score (CS), Western Ontario Shoulder Instability Index (WOSI) and Rowe score, as well as return to sport. Of 54 included shoulders, 33 shoulders in 32 patients (61.1%) were evaluated after a mean follow-up of 13.2 ± 2.3 years. The overall recurrence rate was 18.2% (6/33). The total revision rate was 9.1%, with two revisions due to recurrent instability and one due to posteroinferior knot impingement. The number of preoperative dislocations correlated negatively with the CS (ρ = -0.425, p = 0.019) and the WOSI (ρ = -0.471, p = 0.009). A total of 97% of all patients returned to sports, with 57.6% returning to 90%-100% of their preoperative sports activity. Posteroinferior capsular plication using suture-only fixation was associated with a higher recurrence rate (3/6, 50%), compared to the use of suture anchor fixation (3/27, 11.1%; p = 0.025). Arthroscopic Bankart repair combined with posteroinferior capsular plication provided durable long-term shoulder function and reliable return to sport in patients with anterior instability and hyperlaxity. Performing the posteroinferior plication with suture anchor fixation might be associated with lower recurrence rates compared to suture-only plication. Clinical outcomes declined with an increasing number of preoperative dislocations. Level III, cohort study.

PurposeThe rapid growth of Artificial Intelligence (AI) in orthopaedic research has led to inconsistencies in study reporting, hindering evaluation and clinical translation. This initiative aimed to develop the STORM‐AI (Standardised Transparent Orthopaedic Reporting and Modelling‐AI) guidelines to enhance the transparency, completeness, and quality of reporting for AI studies in orthopaedics.MethodsThe ESSKA AI Working Group, a multinational and multidisciplinary team of experts, developed the STORM‐AI guidelines through a multi‐step consensus process. This involved a comprehensive review of existing AI reporting standards (e.g., CONSORT‐AI, STARD‐AI and TRIPOD), followed by iterative rounds of drafting, review, and refinement to incorporate orthopaedic‐specific considerations.ResultsThe consensus process resulted in the STORM‐AI checklist and an accompanying Explanation and Elaboration (E&E) document. The guidelines provide specific reporting recommendations across all study sections, including study design, data characteristics, model development, performance metrics, ethical considerations and clinical workflow integration. Key areas of emphasis include rigorous validation, clear outcome definition, and error analysis within the orthopaedic context.ConclusionThe STORM‐AI guidelines provide a crucial framework for authors, reviewers, and journals to improve the evidence base for AI in orthopaedic care. Widespread adoption is anticipated to foster more robust, reproducible, and clinically valuable innovations, facilitating the responsible integration of AI into orthopaedics.Level of EvidenceLevel V.

PurposeKinesophobia is an important psychosocial construct to consider in rehabilitation of patients with patellar instability, in order to optimise their rehabilitation and ability to return to sport and an active lifestyle. Therefore, it is important to investigate the percentage of patients with kinesophobia before and 6 months after patella stabilising surgery. In addition to how it affects knee function and quality of life 6 months postoperatively.MethodsA prospective cohort of 76 patients (mean age 22.8 years, 74% female) with patellar instability was included. Patients completed patient reported outcome measures (PROMs), including the Tampa scale of kinesophobia (TSK)‐13, International Knee Documentation Committee Subjective Knee Form (IKDC‐SKF) and Banff Patellofemoral Instability Instrument (BPII), preoperatively and 6 months postoperatively. Those with concomitant knee ligament injuries were excluded. Statistical analyses included paired sample t‐tests for score changes and Pearson's correlation for associations between variables.ResultsPreoperative kinesophobia was reported in 47% of patients, decreasing to 18% at 6 months postsurgery. Significant improvements were noted in all PROMs, with the BPII showing the largest increase. Patients with preoperative kinesophobia reported worse knee function postoperatively. A strong negative correlation was found between changes in TSK‐13 and BPII scores (r = −0.605), indicating that reductions in kinesophobia were associated with improvements in quality of life. In multiple regression analyse only preoperative TSK scores remained an independent significant 138 predictor of postoperative kinesophobia, with a shared explained variance of 16%.ConclusionThis study highlights the prevalence of kinesophobia in patients undergoing surgery for patellar instability and its effect on postoperative outcomes. While surgery restored mechanical stability, many patients continued to exhibit kinesophobia after surgery.Level of EvidenceLevel III.

PurposeTo evaluate whether a high lateral distal femoral angle (LDFA) contributes to undercorrection of lower‐limb alignment following medial open wedge high tibial osteotomy (MOWHTO), and to determine the LDFA threshold above which tibial correction alone may be insufficient.MethodsThis retrospective study analysed 68 patients who underwent MOWHTO at our hospital between 2020 and 2022. Based on their postoperative mechanical axis (MA), patients were categorised into two groups: the acceptable correction group (A‐group; MA 57%–67%) and the undercorrection group (U‐group; MA ≤ 56%). Radiographic parameters before and after surgery were compared between the two groups. Simple and multiple regression analyses were used to identify factors affecting postoperative MA. A receiver operating characteristic (ROC) curve was utilised to identify the LDFA cut‐off value associated with undercorrection.ResultsA total of 54 patients met the inclusion criteria (A‐group, n = 35; U‐group, n = 19). The U‐group demonstrated a significantly higher preoperative mechanical LDFA (89.5° vs. 87.6°, p = 0.001) and a lower medial proximal tibial angle (mMPTA) (84° vs. 86°, p = 0.014) than that in the A‐group. Both mLDFA (p = 0.006) and mMPTA (p = 0.010) were independent predictors of postoperative MA in multiple regression analysis. The ROC analysis identified an LDFA cut‐off of 89.2° for predicting undercorrection (area under the curve = 0.78; sensitivity, 36.8%; specificity, 88.6%). Patients with an LDFA ≥ 89.2° had significantly higher body mass index, joint line convergence angle, varus stress angle, percentage condylar tibial translation and preoperative knee joint line obliquity.ConclusionsA high LDFA (≥89.2°) is associated with an increased risk of undercorrection after MOWHTO, despite accurate tibial correction. These findings suggest that in cases with significant distal femoral varus, isolated tibial osteotomy may be insufficient. Double‐level osteotomy, including femoral correction, should be considered in such cases to achieve optimal alignment.Level of EvidenceLevel Ⅳ, retrospective comparative study.