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What's New — Knee — November 2025

62 new articles published this month.

Themes: ACL Reconstruction: Grafts, Outcomes, and Rehabilitation · Total Knee Arthroplasty: Technology, Alignment, and Survivorship · Periprosthetic Joint Infection: Diagnosis and Management · Osteoarthritis: Diagnosis, Biomarkers, and Non-Operative Care · Meniscus, Ligaments, and Complex Injuries · Osteotomy, Fractures, and Emerging Technologies

Digest generated 2026-04-16 00:28:35+00:00.

Highlights

ACL Reconstruction: Grafts, Outcomes, and Rehabilitation

Recent literature extensively addresses anterior cruciate ligament (ACL) reconstruction, focusing on graft selection, surgical techniques, and rehabilitation protocols. High-level evidence compares graft types, noting that bone-patellar tendon-bone autografts offer lower failure rates but higher anterior knee pain, while hamstring autografts provide a favorable balance [23]. Surgical nuances include the benefits of all-inside techniques for functional outcomes despite increased laxity [24], the impact of remnant preservation [43], and the higher failure risk associated with bilateral reconstruction [46]. Anatomical risk factors, such as increased posterior tibial slope, are linked to graft failure [17, 53]. Furthermore, rehabilitation strategies emphasize the importance of prehabilitation [48], the role of psychological factors like self-efficacy in recovery [31], and the critical nature of early versus late intervention for complications like Cyclops syndrome [28].

Total Knee Arthroplasty: Technology, Alignment, and Survivorship

This cluster explores advancements and outcomes in total knee arthroplasty (TKA), particularly regarding robotic assistance, implant materials, and patient demographics. Studies validate the precision of CT-based radiostereometric analysis [2] and compare sensor-guided robotic techniques against conventional methods, finding superior phenotype restoration with sensor guidance [50]. The use of antioxidant-loaded polyethylene may reduce revision risks [5], while robotic workflows utilizing pre-resection balancing better reproduce joint line orientation [44]. Survivorship data highlights that younger patients face higher revision risks [47], whereas elderly patients (>80 years) experience high early complications but low long-term re-revision rates [29]. Additionally, tibial slope assessment via visual inspection is deemed accurate for unicompartmental procedures [57], and noise prevalence varies significantly by implant design [55].

Periprosthetic Joint Infection: Diagnosis and Management

Diagnosing and managing periprosthetic joint infection (PJI) remains a critical challenge, with new biomarkers and timing strategies emerging. Research evaluates novel diagnostic tools, including a rapid myeloperoxidase test [10] and synovial fluid microRNA profiles, which show promise for accurate detection [11]. Management strategies focus on the timing of debridement, antibiotics, and implant retention (DAIR), with registry data suggesting optimal success windows [12]. The clinical picture is further complicated by the need for precise differentiation between septic and aseptic failures, as highlighted by the diagnostic utility of these new biomarkers. These studies collectively aim to improve early detection and optimize surgical intervention timing to enhance implant survival and patient outcomes.

Osteoarthritis: Diagnosis, Biomarkers, and Non-Operative Care

This theme covers the spectrum of knee osteoarthritis (OA) from early diagnosis to non-operative management. Artificial intelligence and deep contrastive learning frameworks are being developed to improve the detection of early-stage OA on X-rays [30]. Prediction models for sarcopenic OA are being validated to aid in community-based risk stratification [4]. Non-surgical interventions include the comparison of corticosteroid injections, showing comparable efficacy between betamethasone and triamcinolone [9], and the evaluation of pain science education combined with exercise [7]. Additionally, the impact of occupational and psychosocial factors on knee pain prevalence in working populations is being investigated [37], alongside the use of osteopathic manipulation to modulate nociceptive pathways in animal models [39].

Meniscus, Ligaments, and Complex Injuries

Articles in this group address specific pathologies including meniscal tears, PCL injuries, and patellar instability. The management of meniscal root tears highlights the effectiveness of centralization techniques, though outcomes are technique-dependent [60]. PCL injuries are the subject of expert consensus statements and comparative studies on reconstruction techniques, particularly regarding the addition of posterolateral corner repair [19, 54]. Patellar instability is assessed using novel ultrasound-assisted glide tests [6] and evaluated through large language model accuracy in answering clinical questions [52]. Furthermore, the M-shaped posterior cruciate ligament is identified as a risk factor for associated anterolateral ligament injuries [1], and the impact of meniscal tears on long-term outcomes is analyzed in large cohort studies [59].

Osteotomy, Fractures, and Emerging Technologies

This theme encompasses surgical techniques for deformity correction, fracture management, and the integration of emerging technologies. High tibial osteotomy outcomes are analyzed for valgus knees [18] and the biomechanical influence of hinge wires [22]. Patellar fractures in osteoporotic patients are treated with flexible suture fixation [13]. The role of AI and large language models is further explored in the context of precision medicine and clinical decision support [52, 62]. Additionally, video-based alignment assessment offers a radiation-free alternative for children [3], and the impact of sport injuries on quality of life is quantified using registry data [15]. These studies collectively push the boundaries of traditional orthopaedic care through innovation and data-driven insights.

Articles by Theme

ACL Reconstruction: Grafts, Outcomes, and Rehabilitation (17)

16. Haider AA, Bhat S, Jalal H, et al. ACL injury prevention content on TikTok : Untapped outreach potential for youth athletes. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70128

This study evaluated the quality and reach of anterior cruciate ligament injury prevention content on TikTok, finding that while viewership was high, the educational quality was generally poor. Most videos failed to meet established standards for health information accuracy and exercise instruction. These findings highlight an urgent need for healthcare professionals to create and promote high-quality, evidence-based content on social media platforms.

17. Murphy T, Brady G, Dan M, et al. The ALPS classification: Predicting ACL graft failure based on deviation from mean posterior tibial slope—A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70155

This systematic review and meta-analysis quantified the association between posterior tibial slope (PTS) and ACL graft failure, introducing the ALPS classification as a risk stratification tool based on slope deviations. Key findings revealed that lateral PTS significantly increases failure risk, with incidence rates rising sharply from 9% in low-risk categories to 50% in the highest-risk black category. Clinically, the ALPS classification offers surgeons a simple, slope-based method to preoperatively identify patients at elevated risk for graft failure.

23. Hasan M, Berkovich Y, Khatib M, et al. Graft selection in ACL reconstruction: Clinical and functional outcomes based on level I–II evidence. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70167

This systematic review synthesized Level I–II evidence to compare clinical and functional outcomes of various graft types for ACL reconstruction. Bone-patellar tendon-bone (BPTB) autografts demonstrated the lowest failure rates and highest return-to-sport rates but were associated with higher anterior knee pain, while hamstring autografts showed higher failure rates but better patient-reported outcomes. These data assist surgeons in selecting grafts based on specific patient priorities regarding stability, return to sport, and donor-site morbidity.

24. Zhu Z, Lin Y, Shen S, et al. All‐inside anterior cruciate ligament reconstruction exhibited superior functional outcomes but increased knee laxity to the traditional technique in mid‐to‐long term: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70179

This systematic review and meta-analysis compared all-inside anterior cruciate ligament reconstruction (ACLR) with traditional techniques regarding functional outcomes and knee laxity. While all-inside ACLR exhibited superior functional outcomes, it was associated with increased knee laxity in mid-to-long-term follow-up compared to traditional methods. Clinicians should weigh the functional benefits against the potential for increased laxity when selecting the surgical technique for ACLR.

25. Whitworth N, Webster KE, Klemm HJ, et al. Impact of change in contralateral knee extensor strength on achieving limb symmetry index targets following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70182

This study analyzed how changes in contralateral knee extensor strength between 6 and 12 months post-ACL reconstruction influence the achievement of limb symmetry index targets. The key finding was that while both limbs gained strength, the operated limb showed larger gains, and the proportion of patients achieving symmetry was significantly affected by whether the contralateral limb strength increased, decreased, or remained stable. Clinically, these results suggest that monitoring and potentially enhancing contralateral limb strength is crucial for optimizing symmetry outcomes after ACL reconstruction.

26. Riera J, Campion M, Néri T, et al. Association between walking gait biomechanical changes after anterior cruciate ligament injury or reconstruction and the development of osteoarthritis: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70183

This systematic review evaluated the association between walking gait biomechanical changes following ACL injury or reconstruction and the subsequent development of knee osteoarthritis. Only four cross-sectional studies met the inclusion criteria, providing limited evidence linking specific gait alterations to early OA development. The clinical implication is that current data is insufficient to definitively establish gait biomechanics as a primary driver of OA, highlighting a need for more robust longitudinal research in this area.

28. Tarchichi J, Daher M, Bouyge B, et al. Good satisfaction and functional outcomes after arthroscopic debridement of Cyclops syndrome post‐Anterior Cruciate Ligament reconstruction: Analysis of 197 patients of the MERIscience cohort. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70188

This study assessed the clinical efficacy and patient satisfaction following arthroscopic debridement for Cyclops syndrome after ACL reconstruction in a cohort of 197 patients. The key finding was that 92% of patients would recommend the procedure, with significant improvements in functional scores and high satisfaction rates regardless of whether the debridement was performed early or late. The clinical implication is that arthroscopic arthrolysis is a highly effective treatment for restoring function and satisfaction in patients suffering from Cyclops syndrome.

31. Kim S, Burland JP. Lower knee self‐efficacy is associated with greater asymmetries in quadriceps neuromuscular function and jump‐landing biomechanics post‐ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70192

This study investigated the relationship between psychological factors, such as knee self-efficacy, and neuromuscular asymmetries in patients post-ACL reconstruction. The key finding was that lower knee self-efficacy was significantly associated with greater asymmetries in quadriceps function and jump-landing biomechanics compared to healthy controls. These results imply that psychological interventions aimed at improving self-efficacy should be integrated into rehabilitation to address biomechanical deficits and optimize return to sport.

35. Bafrouei MJ, Mirkarimpour SH, Seyedi M. The effect of functional fatigue on lower-limb kinematics, balance, and proprioception in individuals with ACL-reconstruction and dynamic knee valgus. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09293-5

This study investigated how functional fatigue alters lower-limb kinematics, balance, and proprioception in individuals with ACL reconstruction and dynamic knee valgus. Results indicated that fatigue significantly worsens dynamic knee valgus and impairs proprioceptive control, increasing injury risk during late-stage activities. Clinically, rehabilitation protocols should prioritize fatigue-resistant training and proprioceptive exercises to mitigate valgus collapse in this population.

43. Liu X, Li X, Li D, et al. Clinical effects of different remnant‐preserving versus standard nonpreserving techniques in anterior cruciate ligament reconstruction: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70177

This systematic review and meta-analysis of 36 articles compared clinical outcomes between standard non-preserving and various remnant-preserving anterior cruciate ligament reconstruction (ACLR) techniques. Results indicated that remnant-preserving approaches generally offered superior stability and functional scores, with outcomes potentially influenced by the length of the preserved remnant. The evidence supports considering remnant preservation to enhance postoperative stability and function, though optimal remnant length requires further investigation.

45. Wackerle AM, Sprague A, Joreitz R, et al. Freddie Fu Panther Symposium Expert Group 2024: Rehabilitation and return to sport after anterior cruciate ligament reconstruction Part 1: Early and intermediate phases of rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70115

An international expert group convened at the 2024 Freddie Fu Panther Symposium to address conflicting guidelines and optimize early and intermediate rehabilitation protocols following anterior cruciate ligament reconstruction. The group discussed recent advances to establish standardized strategies that improve return-to-sport outcomes and reduce contralateral injury risks. These consensus recommendations aim to provide evidence-based frameworks for clinicians to standardize postoperative care.

46. Soh H, Kim J, Lee B, et al. Bilateral anterior cruciate ligament reconstruction is more vulnerable to graft failure than unilateral anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70159

This retrospective study compared graft survival rates between bilateral and unilateral anterior cruciate ligament reconstructions (ACLR) using propensity score matching to control for demographic variables. The analysis demonstrated that bilateral ACLR is associated with a significantly higher risk of graft failure compared to unilateral procedures. Clinicians should consider this increased vulnerability when counseling patients and planning rehabilitation for bilateral cases.

48. Fu Y, Tian Y, Zhao Z, et al. Prehabilitation enhances functional and structural recovery following anterior cruciate ligament reconstruction: A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70170

A randomized controlled trial evaluated the impact of an 8-week prehabilitation program on functional recovery, pain, and structural healing in 90 patients undergoing anterior cruciate ligament reconstruction. Patients in the prehabilitation group demonstrated significantly better functional scores, reduced pain levels, and improved structural outcomes at 12 months compared to the control group. These findings support the integration of preoperative neuromuscular training and education to enhance postoperative recovery trajectories.

49. Cristiani R, Sandström E, von Essen C, et al. Early surgery, meniscal injury and physiologic contralateral knee extension deficit are associated with extension loss prior to anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70173

This study analyzed over 10,000 primary ACL reconstruction cases to identify factors associated with preoperative knee extension loss. Key findings revealed that early surgery (within 3 months), medial meniscus injury, and a physiologic contralateral knee extension deficit significantly increased the odds of extension loss. Clinically, these results suggest that surgeons should prioritize restoring full extension before operating, particularly in patients with these specific risk factors, to optimize postoperative outcomes.

53. Buyukkuscu MO, Kulduk A, Sencan K, et al. Increased lateral, but not medial, posterior tibial slope is associated with early graft failure following anterior cruciate ligament reconstruction. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09261-z

This study investigated the association between posterior tibial slope and early graft failure following anterior cruciate ligament reconstruction. The key finding was that an increased lateral posterior tibial slope, but not the medial slope, was significantly associated with early graft failure. Clinically, this suggests that preoperative assessment of the lateral tibial slope is crucial for risk stratification and may influence surgical planning to prevent graft failure.

56. Bloch H, Krutsch W, Klein C, et al. ACL injuries in professional football (soccer): Women face higher risk, later surgical care and longer time loss compared to men. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70160

This prospective study analyzed seven seasons of insurance data to compare ACL injury risks and treatment timelines between professional female and male football players. Female players demonstrated a higher injury prevalence, faced delays in receiving surgical care, and experienced longer time loss from play compared to their male counterparts. These disparities highlight the need for sex-specific injury prevention strategies and protocols to ensure timely surgical intervention for female athletes.

58. Petterson SC, Buckmire MC, Giordano AO. Recovery Stages After Anterior Crucuiate Ligament Reconstruction. Arthroscopy 2025. doi:10.1016/j.arthro.2025.08.001

This article outlines a phased, criterion-based rehabilitation protocol for patients following anterior cruciate ligament reconstruction, spanning 9 to 12 months to restore function and minimize reinjury risk. The early phase focuses on pain control and quadriceps strength, while the intermediate phase introduces balance and aerobic training once specific range of motion and symmetry milestones are met. These structured stages provide a clear framework for clinicians to monitor patient progress and safely advance exercise intensity.

Total Knee Arthroplasty: Technology, Alignment, and Survivorship (13)

2. Øhrn F, Engseth LHW, Pripp AH, et al. Computed tomography-based radiostereometric analysis achieves sufficient precision for femoral implants in total knee arthroplasty: a randomized controlled trial. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06517-1

This randomized controlled trial evaluated the precision of computed tomography-based radiostereometric analysis (CT-RSA) for assessing femoral component migration in total knee arthroplasty across two different radiation dose levels. The study found that CT-RSA achieved sufficient precision for migration analysis, with no clinically relevant difference in precision between the high and low radiation dose protocols. These results support the use of low-dose CT-RSA as a viable, precise alternative to conventional RSA for monitoring femoral implant stability while minimizing radiation exposure.

5. Prentice HA, Chan PH, Chang RN, et al. Antioxidant-Loaded Highly Cross-Linked Polyethylene May Reduce Revision Risk in Total Knee Arthroplasty. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.25.00490

This large cohort study compared revision risks in total knee arthroplasty patients receiving highly cross-linked polyethylene (HXLPE) with antioxidants versus those without antioxidants. The analysis revealed no significant difference in all-cause revision rates or specific failure modes between the two implant groups. Consequently, the addition of antioxidants to HXLPE does not appear to provide a measurable survivorship benefit in this large real-world population.

8. Huang Z, Mu F, Wang W, et al. The influence of severe knee varus and patellofemoral joint degeneration on outcomes following fixed-bearing medial robotic-assisted unicompartmental knee arthroplasty: a minimum of 18-month follow-up. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06181-5

This study examined the influence of severe knee varus and patellofemoral joint degeneration on outcomes following fixed-bearing medial robotic-assisted unicompartmental knee arthroplasty with a minimum 18-month follow-up. The results indicated that severe varus deformity and patellofemoral degeneration negatively impacted clinical outcomes and survivorship in this specific surgical context. Surgeons should carefully consider these factors when selecting patients for robotic-assisted unicompartmental knee arthroplasty to optimize long-term success.

20. Feng Y, Lin J, Zheng C, et al. Osteoporosis exacerbates perioperative complications in total knee arthroplasty: a 10-Year nationwide analysis. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06340-8

This nationwide 10-year analysis investigated the impact of osteoporosis on perioperative complications following total knee arthroplasty. The study likely identified osteoporosis as a significant risk factor for increased complications, though specific statistical outcomes are not detailed in the provided text. Clinically, this highlights the need for preoperative bone density assessment and tailored perioperative strategies for osteoporotic patients undergoing knee replacement.

21. Kantha P, Vachalathiti R, Richards J, et al. Changes in knee outcome measures following later-stage exercise interventions implemented ≤ 12 weeks vs. > 12 weeks after total knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06430-7

This systematic review and meta-analysis compared knee outcome measures between exercise interventions initiated within 12 weeks versus those started later after total knee arthroplasty. The review aimed to determine if early rehabilitation yields superior functional recovery compared to delayed protocols. The findings will guide rehabilitation timing to optimize patient outcomes and recovery trajectories post-surgery.

29. Tyas B, Williams J, Jameson S, et al. High early complication risk but low risk of re‐revision beyond 5 years following revision knee arthroplasty in the elderly: An analysis of 2833 cases using real‐world data from an international database. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70190

This analysis of 2,833 revision total knee arthroplasties in patients aged 80 and older evaluated complication rates and long-term implant survivorship. The study found a high risk of early complications, particularly acute kidney injury, but a surprisingly low risk of re-revision beyond five years. Clinically, this suggests that while elderly patients face significant short-term risks, revision knee arthroplasty can offer durable long-term outcomes for this demographic.

36. Tran JYS, Lee JWL, Wong CK, et al. A comparison on the clinical outcomes of using intraoperative load sensors versus manual balancing in total knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06394-8

A systematic review and meta-analysis compared clinical outcomes of sensor-assisted versus manual balancing in total knee arthroplasty using data from four randomized controlled trials. The analysis revealed no significant differences between the two techniques regarding functional scores, complication rates, or postoperative range of motion. Consequently, the use of intraoperative load sensors may not be necessary for improving standard clinical outcomes in primary TKA procedures.

44. Lee G, Orsi AD, Plaskos C, et al. Pre‐resection ligament balance more frequently reproduces joint line orientation compared to inverse‐kinematic workflow in robotic total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70178

A retrospective review of 422 robotic total knee arthroplasties compared pre-resection ligament balancing against an inverse-kinematic workflow to assess implant positioning and joint line orientation. The study found that the pre-resection approach more frequently reproduced native joint line orientation and coronal plane alignment compared to the inverse-kinematic method. This suggests that pre-resection balancing may offer superior accuracy in restoring native knee kinematics during robotic TKA.

47. Carrozzo A, Bérard É, Manchec O, et al. Younger age doubles medium‐term revision risk after total knee arthroplasty: A nationwide multicenter cohort of 5980 knees from the French SCORE I registry. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70165

A nationwide multicenter cohort study of 5,980 total knee arthroplasties using a single implant design investigated the independent effect of age on revision risk and clinical outcomes. The results showed that patients under 65 years old had a doubled medium-term revision risk compared to older cohorts, even when adjusting for comorbidities. This indicates that younger age is a critical independent predictor of implant survivorship, warranting careful patient selection and counseling.

50. Wang J, Wang B, Shen H, et al. Sensor‐guided robot‐assisted TKA more precisely achieves targeted functional knee phenotypes than conventional robotic‐assisted technique. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70174

Researchers compared sensor-guided robotic-assisted total knee arthroplasty (SGR) against conventional robotic-assisted techniques to evaluate functional knee phenotype restoration. The SGR group achieved significantly higher rates of targeted functional phenotypes and reported superior pain relief at 12 months compared to the conventional group. These findings imply that sensor-guided protocols offering real-time soft-tissue feedback may enhance clinical outcomes by better aligning surgical execution with specific functional goals.

55. Schrednitzki D, Halder AM, Ortwig K, et al. Increased prevalence of tibiofemoral noises in posterior‐stabilised implants compared to cruciate‐retaining and ultracongruent implants in total knee arthroplasty: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70120

This systematic review and meta-analysis synthesized data from 14 studies to determine the prevalence of tibiofemoral noises across different total knee arthroplasty implant designs. The analysis revealed a significantly higher prevalence of audible noise in posterior-stabilized implants compared to cruciate-retaining and ultracongruent designs. Clinically, this suggests that implant selection should consider the potential for postoperative noise, particularly when choosing between posterior-stabilized and other stabilizing mechanisms.

57. Hawi H, Hawi H, Liodakis E, et al. Visual inspection provides precise intraoperative evaluation of tibial slope during unicompartmental knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70169

This study evaluated the accuracy of visual intraoperative assessment of posterior tibial slope (PTS) changes during unicompartmental knee arthroplasty by comparing surgeon estimates to radiographic and optical scan measurements. Surgeons demonstrated high accuracy with a mean deviation of only 1.0° and strong correlation coefficients against reference measurements. Clinically, this suggests that experienced surgeons can reliably assess PTS without advanced navigation tools, potentially streamlining the surgical workflow.

62. Sadoghi P, Koutp A, Herbst E, et al. Precision medicine in orthopaedics: A review of current technologies and future directions. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70168

This narrative review synthesizes the shift toward precision medicine in orthopaedics, integrating individual anatomical and biomechanical data into clinical decision-making through technologies like robotics and AI. In total knee arthroplasty, these approaches enable personalized alignment and submillimetre accuracy, reducing outliers and potentially enhancing functional outcomes. The review highlights how tailoring surgical and rehabilitation strategies to unique patient profiles improves predictability and overall care quality.

Periprosthetic Joint Infection: Diagnosis and Management (3)

10. Ikeda S, Uchiyama K, Minegishi Y, et al. Diagnostic Utility of a Rapid Myeloperoxidase Test in Synovial Fluid for Chronic Periprosthetic Joint Infection. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.24.01514

Researchers evaluated the diagnostic accuracy of a rapid point-of-care myeloperoxidase (MPO) test in synovial fluid for chronic periprosthetic joint infection compared to alpha-defensin. The MPO test demonstrated high diagnostic utility, offering a cost-effective alternative to expensive biomarkers like alpha-defensin. This finding supports the adoption of rapid MPO testing in general medical facilities to improve PJI diagnosis accessibility.

11. Frank BJ, Krammer TL, Pfeiffer-Vogl J, et al. Synovial Fluid MicroRNA Biomarkers Enable Accurate Diagnosis of Hip and Knee Periprosthetic Joint Infections. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.24.01559

This study utilized next-generation sequencing and RT-qPCR to identify specific cell-free microRNA profiles in synovial fluid that distinguish hip and knee periprosthetic joint infections from aseptic failures. A panel of microRNAs was validated to provide highly accurate diagnostic classification for infection. These biomarkers offer a promising, noninvasive tool to enhance the diagnostic precision of periprosthetic joint infections.

12. Keemu H, Syystö E, Klén R, et al. Timing of Debridement, Antibiotics, and Implant Retention for Early Periprosthetic Joint Infection. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.25.00946

Using a large national registry, this study analyzed the success rates of debridement, antibiotics, and implant retention (DAIR) for early periprosthetic joint infection across three time intervals post-arthroplasty. The results indicated that the timing of DAIR within the first six months did not significantly influence treatment failure rates. This suggests that DAIR can be effectively performed throughout the early postoperative period without strict adherence to a narrow time window.

Osteoarthritis: Diagnosis, Biomarkers, and Non-Operative Care (7)

4. Liu G, Sun B, Yang J, et al. Development and validation of the BPDKC model for predicting sarcopenic knee osteoarthritis in community-dwelling older adults: a cross-sectional study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09311-6

This cross-sectional study developed and internally validated the BPDKC model to predict sarcopenic knee osteoarthritis risk in community-dwelling older adults using variables such as age, gender, BMI, physical activity, diabetes, pain scores, and calf circumference. The model demonstrated strong predictive performance in distinguishing individuals with sarcopenic knee osteoarthritis from those without. This tool offers a practical, non-invasive method for early risk stratification and targeted intervention in primary care settings.

7. Hurley-Wallace AL, Cheng V, Bertram W, et al. Pain science education and exercise interventions for people with knee or hip osteoarthritis: a systematic review, content and meta-analysis. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09313-4

This systematic review and component network meta-analysis mapped the content of Pain Science Education (PSE) interventions and evaluated their effectiveness alongside exercise for knee or hip osteoarthritis. The analysis identified specific PSE components that significantly improved pain and function, particularly when combined with exercise, compared to exercise alone. These findings support integrating targeted pain science education into rehabilitation programs to overcome pain-related barriers to physical activity.

9. Wattanasirisombat K, Boontanapibul K, Pinitchanon P, et al. Betamethasone and Triamcinolone Acetonide Have Comparable Efficacy as Single Intra-Articular Injections in Knee Osteoarthritis. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.25.00100

This randomized controlled trial compared single intra-articular injections of betamethasone versus triamcinolone acetonide for pain relief in knee osteoarthritis over six months. The study found no significant difference in pain scores or functional outcomes between the two corticosteroid groups. Clinically, this suggests that either agent can be selected based on availability or cost without compromising efficacy.

30. Jia L, Du G, Fan Z, et al. Deep contrastive learning improves identification of early‐stage knee osteoarthritis across multicohort X‐ray datasets. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70191

This research developed and validated the AW2C framework, a deep contrastive learning model designed to improve the identification of early-stage knee osteoarthritis across multiple X-ray datasets. The model demonstrated robust performance, significantly improving accuracy for Kellgren-Lawrence grade 2 detection and discrimination between early grades compared to baseline models. The clinical implication is that this AI framework could enhance early OA diagnosis and facilitate timely intervention across diverse patient populations.

34. Dashtian M, Tavafian SS, Shirazi KK, et al. Educational program based on health belief model on knee osteoarthritis pain management in Iranian peri menopausal women: a randomized parallel controlled study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09248-w

A randomized controlled trial evaluated an educational program based on the Health Belief Model to manage knee osteoarthritis pain in peri-menopausal women in Iran. The study found that the intervention significantly reduced pain intensity and improved self-efficacy compared to standard care. This suggests that integrating psychosocial health belief frameworks into patient education can effectively enhance pain management outcomes in this specific demographic.

37. Ntani G, Felli VE, Harari F, et al. Longitudinal study of knee pain amongst workers in the Cultural and Psychosocial Influences on Disability (CUPID) study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09237-z

This longitudinal study examined the prevalence and risk factors of knee pain among workers across various occupations and cultural contexts using the CUPID cohort. It found that knee pain is highly prevalent and often persistent, with strong associations between baseline pain at other sites, psychosocial factors, and occupational characteristics. These findings highlight the need for workplace interventions that address both physical and psychosocial determinants to prevent disability in working-age populations.

39. Zhang L, Zhang H, Li P, et al. Mechanical stimulation simulating osteopathic pressing manipulation inhibits nociceptive hypersensitivity and synovial inflammation in knee osteoarthritis rats by modulating trafficking dynamics of transient receptor potentials via complexin2. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06414-7

This study demonstrated that mechanical stimulation mimicking osteopathic pressing manipulation reduces nociceptive hypersensitivity and synovial inflammation in a rat model of knee osteoarthritis. Mechanistically, the treatment downregulates complexin2, thereby inhibiting the trafficking of TRP channels and the release of pain mediators like NGF and CGRP. These findings provide a molecular basis for osteopathic manipulation as a potential therapeutic strategy to alleviate pain and inflammation in knee osteoarthritis.

Meniscus, Ligaments, and Complex Injuries (10)

1. Cai Y, Guo L, Zhang Z, et al. The M-shaped posterior cruciate ligament was associated with anterolateral ligament injury after anterior cruciate ligament injuries: a 1:2 age- and sex-matched cohort study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-08695-9

This 1:2 age- and sex-matched cohort study investigated the association between the M-shaped posterior cruciate ligament and anterolateral ligament injuries in patients with anterior cruciate ligament tears. The key finding was that the M-shaped PCL morphology is significantly associated with concurrent anterolateral ligament injuries. Clinically, surgeons should maintain a high index of suspicion for anterolateral ligament pathology when encountering this specific PCL morphology during ACL reconstruction.

6. Tanaka MJ, Crasta N, Velasquez Hammerle MV, et al. The Ultrasound-Assisted Patellar Glide Test: A Novel Examination Method for Quantifying Patellar Instability. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.25.00707

This study introduced and evaluated the ultrasound-assisted patellar glide test, a novel method using stress ultrasonography to quantify patellar instability by measuring the delta medial patellofemoral distance. The test successfully quantified instability in symptomatic knees and demonstrated significant differences compared to asymptomatic controls and post-surgical knees. This objective, dynamic measurement tool may improve the assessment of patellofemoral instability and guide surgical decision-making.

13. Zhao X, Tan P, Zhang Z, et al. The flexible separate vertical suture fixation for comminuted inferior patella fracture with osteoporosis: a retrospective clinical study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09287-3

The provided text for this article lacks an abstract, preventing the extraction of specific study methods, findings, or clinical implications. Consequently, a précis cannot be generated based on the available information.

14. Williams KG, Constantine EP, Whitney KE, et al. Arthroscopic partial meniscectomy outcomes are comparable in patients with synovitis treated by synovectomy and those without synovitis. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70202

This study evaluated the quality and reach of anterior cruciate ligament injury prevention content on TikTok, finding that while viewership was high, the educational quality was generally poor. Most videos failed to meet established standards for health information accuracy and exercise instruction. These findings highlight an urgent need for healthcare professionals to create and promote high-quality, evidence-based content on social media platforms.

19. Eberle C, Dan Milinkovic D, Achtnich A, et al. Treatment of isolated injuries of the posterior cruciate ligament—A 2025 Delphi‐based structured expert statement by the ligament injury committee of the German Knee Society. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70187

A modified Delphi process involving 15 expert knee surgeons was conducted to develop a structured expert statement on the management of isolated posterior cruciate ligament (PCL) injuries. High agreement was reached on 24 of 31 statements regarding diagnosis, non-operative management, and surgical indications, with evidence levels assigned using GRADE criteria. This consensus statement provides a standardized, evidence-informed framework to optimize clinical decision-making for PCL injuries.

51. Schweizer C, Krug T, Herre J, et al. Medial mobile‐bearing unicompartmental knee arthroplasty following anterior cruciate ligament reconstruction is associated with an increased revision risk compared to controls. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70185

This retrospective study compared the survivorship and functional outcomes of medial mobile-bearing unicompartmental knee arthroplasty (UKA) in patients with prior ACL reconstruction versus matched controls. The study found that the ACLR group had a significantly lower 9-year reoperation-free survival rate compared to controls. Consequently, clinicians should exercise caution when considering UKA for patients with prior ACLR due to the elevated risk of revision and conversion to total knee arthroplasty.

52. Vivekanantha P, Cohen D, Slawaska-Eng D, et al. Evaluating the performance of five large language models in answering Delphi consensus questions relating to patellar instability and medial patellofemoral ligament reconstruction. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09227-1

This study evaluated the accuracy of five large language models in answering ten Delphi consensus questions regarding patellar instability and medial patellofemoral ligament reconstruction. The results indicated varying levels of accuracy among the models, with some providing responses that aligned well with expert consensus while others contained significant errors. These findings highlight the current limitations of AI in delivering reliable orthopedic information and underscore the need for rigorous validation before clinical integration.

54. Yoon KH, Bae BS, Suh DK. Posterior Cruciate Ligament (PCL) Versus Combined PCL and Posterolateral Corner Reconstruction in Isolated PCL Grade-III Injuries. Journal of Bone and Joint Surgery 2025. doi:10.2106/jbjs.24.01051

This retrospective study compared clinical outcomes between isolated posterior cruciate ligament (PCL) reconstruction and combined PCL with posterolateral corner (PLC) reconstruction in patients with isolated grade-III PCL injuries. The results indicated that combined reconstruction yielded superior stability and functional scores compared to isolated PCL reconstruction. These findings support the recommendation for combined PCL and PLC reconstruction in cases of severe isolated PCL injuries to improve long-term joint stability.

59. Ahmed I, Dhaif F, Bowes MA, et al. The MEniscal TeaR Outcome (METRO) study. The Bone & Joint Journal 2025. doi:10.1302/0301-620x.107b11.bjj-2024-1429.r1

This prospective cohort study analyzed baseline characteristics and outcomes in 201 patients with MRI-confirmed meniscal tears to identify predictors of 12-month recovery. Higher baseline functional scores and undergoing surgical intervention were significantly associated with improved outcomes at one year, regardless of osteoarthritis severity. These findings support early surgical consideration for patients with significant symptoms to optimize long-term functional recovery.

60. Vosoughi F, Menbari Oskouie I, Gouravani M, et al. Centralization for reducing medial meniscal extrusion after root tear repair appears effective but is technique-dependent. The Bone & Joint Journal 2025. doi:10.1302/0301-620x.107b11.bjj-2025-0018.r2

This systematic review examined the efficacy of meniscal centralization techniques, specifically posteromedial suture anchor (PMA) and posteromedial transtibial pullout (PMP), in reducing medial meniscal extrusion after root tear repair. Results indicated that the PMA technique significantly reduced extrusion and improved outcomes, whereas the PMP technique showed no benefit over conventional repair. The findings suggest that centralization is effective but highly technique-dependent, favoring PMA for reducing extrusion.

Osteotomy, Fractures, and Emerging Technologies (14)

3. Wystrach L, Wendt M, Bode L, et al. Prospective video-based analysis of coronal lower limb alignment may be as accurate as radiography in children. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09343-y

This prospective pilot study compared a low-budget, video-based method against full standing radiography for assessing coronal lower limb alignment in 40 children with idiopathic genu varum or valgum. The findings demonstrated that video-based hip-knee-ankle angle measurements correlated very closely with radiographic values, showing significant positive correlation. This suggests that video-based assessment could serve as an accurate, radiation-free alternative for monitoring lower limb malalignment in pediatric patients.

13. Zhao X, Tan P, Zhang Z, et al. The flexible separate vertical suture fixation for comminuted inferior patella fracture with osteoporosis: a retrospective clinical study. BMC Musculoskeletal Disorders 2025. doi:10.1186/s12891-025-09287-3

The provided text for this article lacks an abstract, preventing the extraction of specific study methods, findings, or clinical implications. Consequently, a précis cannot be generated based on the available information.

15. Szymski D, Lutter C, Graeber S, et al. Impairment in quality of life with different sport orthopaedic musculoskeletal injuries—A comprehensive analysis of the German arthroscopy register. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70205

An analysis of the German arthroscopy register assessed quality of life impairments across various sport-related musculoskeletal injuries prior to surgery. The study found significant variations in quality of life metrics, with ankle injuries showing the lowest scores and shoulder injuries the highest. These baseline data provide a crucial reference for evaluating postoperative recovery and resource allocation in sports medicine.

18. Lambrey P, Ayata M, Abid H, et al. Medial closing wedge high tibial osteotomy for lateral osteoarthritis in valgus knee offers good long‐term outcomes in patients with normal body mass index. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70176

This longitudinal study evaluated the long-term survivorship and functional outcomes of medial closing wedge high tibial osteotomy (MCWHTO) for lateral osteoarthritis in valgus knees. The results showed a 39.1% progression rate to total knee arthroplasty over a mean follow-up of 11.5 years, with better outcomes observed in patients with normal body mass index. These findings suggest that MCWHTO provides durable relief for selected patients, particularly those with normal BMI, though nearly 40% eventually require conversion to arthroplasty.

22. Hiranaka T, Redgrift AG, Shadd A, et al. Biomechanical influence of hinge wire application and removal in medial opening wedge high tibial osteotomy: A cadaveric study. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70150

This cadaveric study compared tensile strain on the lateral tibial cortex during medial opening wedge high tibial osteotomy with and without a hinge wire. Results indicated that the presence of a hinge wire significantly reduced tensile strain changes during the opening procedure in most specimens. This suggests that hinge wires may provide biomechanical stability to the lateral cortex, potentially reducing the risk of intraoperative fracture during the osteotomy.

27. Marot V, Carrozzo A, Chahla J, et al. Rectus femoris tendon morphometry and practical landmarks for harvesting: A cadaveric study. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70186

This cadaveric study quantitatively analyzed the rectus femoris tendon to assess its viability as a standalone autograft and identify reliable anatomical landmarks for harvest. The findings revealed a consistent 36.1 mm segment free of deep attachments with sufficient length and width to support double- to quadruple-strand graft configurations. These results support the rectus femoris tendon as a viable graft option and provide surgeons with precise landmarks for safe and reproducible harvesting.

32. Kayaalp ME, Amendola A, Ayeni OR, et al. Collaboration is our most powerful resistance in an increasingly fragmented world: Science is the light that reveals the unity beneath our differences. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70193

This editorial emphasizes the critical importance of global collaboration and scientific unity in addressing the challenges of a fragmented world. It argues that science serves as a unifying force that transcends differences to reveal common goals in medical research. The clinical implication is a call to action for the orthopedic community to prioritize cooperative efforts to advance knowledge and patient care.

33. Lewandowski Ł, Królikowska A, Karlsson J, et al. When sample size is tiny, outcomes rare and clinical pictures fuzzy—Practical ways to survive statistical pitfalls. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70194

This article outlines practical statistical strategies for researchers dealing with small sample sizes, rare outcomes, and ambiguous clinical presentations. It emphasizes avoiding common pitfalls by utilizing appropriate non-parametric tests, confidence intervals, and effect size reporting rather than relying solely on p-values. The clinical implication is that valid conclusions can still be drawn from limited data if rigorous statistical methods are applied to prevent misleading interpretations.

38. Aydın Şimşek Ş, Altun G, Cengiz T, et al. The power of tendon autograft in osteochondral defects: one step closer to hyaline cartilage. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06375-x

This article discusses the efficacy of tendon autografts in treating osteochondral defects, suggesting they offer a promising pathway toward regenerating hyaline-like cartilage. The authors review current evidence indicating that tendon-derived cells can differentiate into chondrocytes and improve structural integration within the defect. The clinical implication is that tendon autografts may serve as a superior biological alternative to traditional grafting methods for restoring joint function.

40. Zhu Z, Zhu Z, Peng C, et al. Perioperative sleep disturbances in total knee arthroplasty: incidence, mechanisms, and management strategies. Journal of Orthopaedic Surgery and Research 2025. doi:10.1186/s13018-025-06416-5

This review addresses the high incidence of perioperative sleep disturbances following total knee arthroplasty and explores their underlying mechanisms, including pain, inflammation, and anesthesia effects. It outlines current management strategies such as multimodal analgesia, sleep hygiene education, and pharmacological interventions to mitigate sleep disruption. The clinical implication is that proactive management of sleep quality is essential to improve postoperative recovery, reduce delirium risk, and enhance overall patient outcomes.

41. Ismailidis P, Leicht A, Doma K, et al. Dynamic coronal plane knee alignment: Femoral anatomy determines kinematic curve morphology, tibial anatomy determines curve position. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70152

This experimental study utilized a surgical bone model to create 70 morphotypes by altering distal femoral and proximal tibial angles, recording dynamic coronal kinematic curves from 0° to 120° of flexion. The key finding was that femoral anatomy dictates the morphology of the kinematic curve, whereas tibial anatomy determines the curve's position. Clinically, this suggests that a single static hip–knee–ankle angle is insufficient for assessing knee biomechanics, necessitating dynamic curve analysis for accurate surgical planning.

42. Reese M, Nolan M, Nelson M, et al. Examining the current scope of interventional clinical trials for knee injuries: Review of a clinical trials registry. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70172

Researchers conducted a cross-sectional review of 159 interventional clinical trials registered on ClinicalTrials.gov between 2021 and 2024 to characterize the current landscape of knee injury research. The analysis revealed that rehabilitation exercises and new diagnostic tests were the most common interventions, followed by surgical procedures. These findings highlight a need to prioritize prevention-focused trials in younger populations to mitigate long-term knee injury impacts.

61. Ibach MJ, Torney O, Horn CE, et al. Revision from unicompartmental knee arthroplasty to total knee arthroplasty: An analysis of 118 cases at midterm follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70156

This retrospective study analyzed 118 revisions from unicompartmental to total knee arthroplasty, finding an 8-year survivorship of 94% free of re-revision. Outcomes were favorable, with significant improvements in functional scores, and progression of osteoarthritis was associated with reduced odds of re-operation compared to aseptic loosening. The data supports revision to TKA as a reliable salvage procedure with excellent midterm survivorship and functional gains.

62. Sadoghi P, Koutp A, Herbst E, et al. Precision medicine in orthopaedics: A review of current technologies and future directions. Knee Surgery, Sports Traumatology, Arthroscopy 2025. doi:10.1002/ksa.70168

This narrative review synthesizes the shift toward precision medicine in orthopaedics, integrating individual anatomical and biomechanical data into clinical decision-making through technologies like robotics and AI. In total knee arthroplasty, these approaches enable personalized alignment and submillimetre accuracy, reducing outliers and potentially enhancing functional outcomes. The review highlights how tailoring surgical and rehabilitation strategies to unique patient profiles improves predictability and overall care quality.

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