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What's New — Knee — March 2026

14 new articles published this month.

Themes: Osteoarthritis Management and Cartilage Repair · Anterior Cruciate Ligament Reconstruction and Instability · Rotator Cuff Pathology and Surgical Techniques · Paediatric Knee Anatomy and Surgical Safety · Periprosthetic Infection and Orthopaedic Research Methods

Digest generated 2026-04-16 01:32:08+00:00.

Highlights

Osteoarthritis Management and Cartilage Repair

Recent literature addresses the evolving landscape of knee osteoarthritis, focusing on structural repair and surgical decision-making. A randomized controlled trial demonstrated that adding microfracture to a stromal vascular fraction pathway significantly improved pain, function, and cartilage morphology in moderate OA compared to SVF alone [1]. In the realm of joint preservation, high tibial osteotomy remains a critical option for 'grey zone' OA, with ongoing discussions regarding anatomical correction versus psychological barriers to return to sport [4, 5]. Furthermore, contemporary patellofemoral arthroplasty shows improved survival rates compared to previous decades, suggesting better implant longevity and reduced revision needs [3]. These studies collectively highlight advancements in both biological augmentation and mechanical realignment strategies for knee OA.

Anterior Cruciate Ligament Reconstruction and Instability

This cluster explores innovations and outcomes in ACL reconstruction, particularly regarding graft selection and management of persistent instability. A systematic review compared quadriceps tendon variants, finding that full-thickness grafts offer excellent stability and low failure rates, comparable to other autografts [14]. For patients with persistent rotatory instability after primary ACL reconstruction, isolated lateral extra-articular procedures (LEAP) demonstrated low failure rates and good clinical outcomes [8]. Additionally, in the specific context of revision ACL reconstruction among workers' compensation patients, the addition of LEAP was associated with faster return to work and reduced graft failure rates [10]. Finally, a scoping review mapped the emerging role of machine learning in predicting ACL injury and optimizing rehabilitation protocols [9].

Rotator Cuff Pathology and Surgical Techniques

Although the region is knee-focused, this month's digest includes significant shoulder research regarding rotator cuff repair techniques. One study compared suture tape-based superior capsular reconstruction (SCR) against biceps tendon-based SCR for massive tears, finding comparable functional outcomes but a lower re-tear rate with suture tape [7]. Another investigation evaluated the impact of posterior side-to-side suture healing after lower trapezius transfer for irreparable tears, revealing that healed sutures correlated with superior clinical and radiologic outcomes [13]. These findings provide valuable insights into optimizing surgical constructs for complex cuff pathology, even if the primary region of the digest is the knee.

Paediatric Knee Anatomy and Surgical Safety

Addressing safety in paediatric knee surgery, a cross-sectional radiological study investigated the reliability of the Schöttle point as a landmark for medial patellofemoral ligament (MPFL) reconstruction. The study found a critical discrepancy between 2D and 3D imaging, noting that the Schöttle point is consistently distal to the distal femoral physis on 3D CT reconstructions. This finding suggests that surgeons must exercise extreme caution when using this landmark in children to avoid iatrogenic physeal injury [6].

Periprosthetic Infection and Orthopaedic Research Methods

This theme covers two distinct but important areas: infection management and research methodology. A large cohort study analyzed patient comorbidities and medication intake in revision surgery for periprosthetic joint infection of the hip and knee, identifying significant impacts on in-hospital mortality [11]. Separately, a methodological validation study evaluated the capabilities of large language models (specifically GPT 5.1) in performing frequentist meta-analyses, concluding that they can reproduce statistical calculations with accuracy comparable to established software [2].

Articles by Theme

Osteoarthritis Management and Cartilage Repair (4)

1. Yenigün MY, Demirel M, Bayram S, et al. Adding microfracture to an SVF‐based arthroscopic pathway was associated with greater 24‐month improvements in pain, function and MRI cartilage morphology in KL II–III knee osteoarthritis: A randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70377

This randomized controlled trial evaluated whether adding arthroscopic microfracture to a stromal vascular fraction (SVF) pathway improves outcomes for knee osteoarthritis. The study found that the microfracture plus SVF group demonstrated significantly greater 24-month improvements in pain, function, and MRI cartilage morphology compared to SVF alone. Clinically, this suggests that combining microfracture with SVF offers superior structural and symptomatic benefits for moderate knee osteoarthritis.

3. Clar C, Budin M, Rasic L, et al. Contemporary patellofemoral arthroplasty is associated with lower revision rates compared with the previous decade: A meta‐analysis using revisions per 100 component‐years. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70381

This meta-analysis assessed global revision rates for contemporary patellofemoral arthroplasty (PFA) using revisions per 100 component-years to compare survival against previous decade estimates. The pooled revision rate was found to be 1.59 per 100 component-years, indicating a lower failure rate than historical data. This suggests that modern PFA techniques and implants have improved survivorship, supporting their continued use in appropriate patient populations.

4. Chen G, Yang K. High tibial osteotomy for grey zone osteoarthritis: Anatomical correction or psychological challenge in return to sport?. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70365

The provided text contains only the title and authors for this article, with no abstract or content available to summarize the study's methods, findings, or implications. Consequently, a précis cannot be generated as the specific details regarding high tibial osteotomy for grey zone osteoarthritis are missing.

5. Pineda T, Ollivier M. Response to Letter to the Editor: Reliable pain and function outcomes after high tibial osteotomy for medial osteoarthritis in the grey area between osteotomy and unicompartmental replacement. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70366

The provided text contains only the title and authors for this article, with no abstract or content available to summarize the study's methods, findings, or implications. Consequently, a précis cannot be generated as the specific details regarding the response to the letter on high tibial osteotomy are missing.

Anterior Cruciate Ligament Reconstruction and Instability (4)

8. Sharma A, Tahir M, Davies P, et al. An isolated lateral extra‐articular procedure for persisting rotatory instability following ACL reconstruction has low failure rates with good clinical and patient‐reported outcomes: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70373

This systematic review and meta-analysis evaluated the outcomes of isolated lateral extra-articular procedures (LEAP) for persistent rotatory instability following ACL reconstruction without graft rupture. The analysis of five studies involving 74 knees found that the procedure resulted in low failure rates and good clinical and patient-reported outcomes. These findings support the use of isolated LEAP as an effective salvage treatment for residual instability in patients with intact ACL grafts.

9. Kumar R, Singh V, Reddy O. Machine learning applications for anterior cruciate ligament injury prediction and rehabilitation in sports: A scoping review with evidence synthesis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70374

This scoping review synthesized evidence on machine learning applications for ACL injury prediction, rehabilitation monitoring, and return-to-sport decision support. The analysis of 40 studies found that tree-based ensemble models, particularly Random Forest and XGBoost, are the most frequently utilized algorithms. Clinically, while ML shows promise for risk stratification, current evidence highlights a need for improved methodological quality and standardized reporting before widespread implementation.

10. Olivieri R, Brunaud I, Rojas R, et al. Faster return to work and reduced failure rates with the addition of a lateral extra‐articular procedure in revision anterior cruciate ligament reconstruction among workers' compensation patients. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70376

This retrospective cohort study compared outcomes in workers' compensation patients undergoing revision ACL reconstruction with or without a lateral extra-articular procedure (LEAP). The addition of LEAP was associated with significantly faster return-to-work times and reduced graft failure rates compared to reconstruction alone. These findings suggest that LEAP should be considered for high-demand workers to optimize occupational recovery and graft longevity.

14. Jaafreh Alhabashneh AKA, Prizov AP, Lutsenko AM, et al. Comparative outcomes of full‐, partial‐ and superficial quadriceps tendon grafts in anterior cruciate ligament reconstruction: A PRISMA systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70371

This systematic review compared failure rates and stability among full-thickness, partial-thickness, and isolated rectus femoris quadriceps tendon grafts for ACL reconstruction. Full-thickness grafts demonstrated excellent stability and low failure rates but were associated with significant quadriceps strength deficits and higher complication rates. Partial-thickness grafts offered a viable alternative with fewer donor site morbidities, though long-term data remains limited.

Rotator Cuff Pathology and Surgical Techniques (2)

7. Öztürk Ö, Bayram B, Yılmaz E, et al. Suture tape–based SCR in massive rotator cuff tear repair provides comparable functional outcomes to biceps tendon–based SCR with a lower re‐tear rate. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70367

This retrospective cohort study compared functional outcomes and re-tear rates between suture tape-based and biceps tendon-based superior capsular reconstruction (SCR) for massive rotator cuff tears. The results demonstrated that while both groups achieved comparable functional improvements, the suture tape group exhibited a significantly lower re-tear rate. This suggests that suture tape-based SCR is a viable alternative to biceps tendon-based SCR that may offer better anatomical stability without compromising functional recovery.

13. Baek CH, Lim C, Kim JG, et al. Posterior side‐to‐side suture healing affects clinical and radiologic outcomes after arthroscopy‐assisted lower trapezius transfer for posterosuperior irreparable rotator cuff tears. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70368

This study evaluated clinical and radiologic outcomes based on the healing status of posterior side-to-side sutures after arthroscopy-assisted lower trapezius transfer for irreparable rotator cuff tears. Patients with successful suture healing demonstrated significantly higher functional scores and better radiologic outcomes compared to those with unhealed sutures. Ensuring robust suture healing is therefore a key determinant of success for this surgical technique.

Paediatric Knee Anatomy and Surgical Safety (1)

6. Liao C, Liu P, Yang R, et al. The Schöttle point needs to be used with care for paediatric knees: A cross‐sectional radiological study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70375

This cross-sectional radiological study investigated the relationship between the Schöttle point and the distal femoral physis in pediatric knees using 3D CT imaging. The key finding revealed a critical discrepancy where 2D radiographs incorrectly positioned the Schöttle point proximal to the physis, whereas 3D reconstructions consistently showed it distal by a mean of 6.1 mm. Clinically, this indicates that relying on 2D landmarks for MPFL reconstruction in children carries a high risk of physeal injury, necessitating the use of 3D planning.

Periprosthetic Infection and Orthopaedic Research Methods (2)

2. Salzmann M, Ramadanov N, Prill R, et al. Large language models are comparable with commonly used statistical software: A validation of GPT 5.1 for frequentist meta‐analysis in orthopaedics. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70379

This methodological study validated whether ChatGPT-5.1 can replicate frequentist meta-analytic calculations with accuracy comparable to established statistical software. The results showed that the AI model reproduced effect directions in all cases and had minor deviations in 43% of outcomes when compared to R-based reference analyses. These findings imply that large language models may serve as a reliable, accessible tool for performing complex statistical meta-analyses in orthopaedic research.

11. Migliorini F, Weber CD, Bell A, et al. Patient comorbidities, medication intake, and mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-025-06209-w

This study analyzed 346 patients undergoing revision surgery for periprosthetic joint infection to determine the impact of comorbidities and medication on mortality. Renal insufficiency was identified as a significant independent predictor of increased in-hospital mortality in this population. Preoperative assessment of renal function is therefore critical for risk stratification and surgical planning in revision PJI cases.

12. Hirschmann MT, Herbst E, Kayaalp ME, et al. KSSTA leadership update: Heartfelt thank you to Volker Musahl and very warm welcome to Robert Prill!. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70361

This leadership update expresses gratitude to outgoing editor Volker Musahl and welcomes incoming editor Robert Prill to the journal. The article serves as an administrative announcement regarding the transition of editorial leadership for the journal. No clinical data or research findings are presented in this piece.

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