Skip to content

What's New — Knee — April 2026

59 new articles published this month.

Themes: Total Knee Arthroplasty Outcomes · Perioperative Care and Complications · Anterior Cruciate Ligament and Meniscus · Patellofemoral and Osteochondral Lesions · Osteoarthritis and Alignment

Digest generated 2026-05-09 04:06:20+00:00.

Highlights

Total Knee Arthroplasty Outcomes

This theme addresses key clinical outcomes and risk factors associated with total knee arthroplasty (TKA). Studies evaluate the impact of preoperative factors, such as chronic pain diagnoses [58] and high opioid use scores [50], on patient satisfaction and readmission risks. Surgical techniques and technologies are also analyzed, including the learning curve for robotic-assisted TKA [5], the effect of computer navigation [33], and the use of genicular nerve ablation [1]. Additionally, research explores survivorship of newer implant generations [53], unicompartmental knee arthroplasty fixation methods [43], and the influence of surgeon fellowship training on complication rates [40] and revision risks [42].

Perioperative Care and Complications

Articles in this theme focus on optimizing perioperative management and mitigating complications in joint arthroplasty. Interventions such as low-dose deflazacort [23], corticosteroid-enhanced multimodal injections [37], and repetitive transcranial magnetic stimulation [46] are assessed for their ability to reduce pain, inflammation, and cognitive dysfunction. Other studies investigate specific risks, including periprosthetic joint infection following colonoscopy [38] or in patients with preoperative venous thromboembolism [57], as well as bleeding management using oxidized regenerated cellulose [55]. The theme also covers the safety of bariatric strategies [54] and the utility of machine learning for predicting discharge [56].

Anterior Cruciate Ligament and Meniscus

This theme covers surgical techniques and biomechanical analyses related to anterior cruciate ligament (ACL) reconstruction and meniscal pathology. Studies compare graft types, showing higher failure rates with allografts [27], and evaluate augmentation techniques like anterolateral ligament reconstruction [18] and suture tape reinforcement [22]. Biomechanical research highlights the role of the superficial medial collateral ligament in external rotation [28] and arthrokinematic changes after ACL reconstruction combined with meniscal surgery [31]. Meniscal studies include techniques for lateral bucket-handle tears [11] and the impact of radial tears on contact area [13], as well as the association of concomitant tears with meniscal extrusion [15].

Patellofemoral and Osteochondral Lesions

This theme encompasses conditions affecting the patellofemoral joint and articular cartilage. Research includes salvage techniques for failed patellofemoral arthroplasty [12] and comparisons of patellofemoral versus total knee replacement outcomes [9]. Biomechanical studies assess the role of Q-angle symmetry in kinematics [6] and the effectiveness of suture anchors versus interference screws in pediatric medial patellofemoral ligament reconstruction [32]. Diagnostic imaging comparisons are also presented, noting differences in Caton-Deschamps index measurements between radiographs and MRI [21]. Finally, studies evaluate nonoperative bracing for osteochondritis dissecans [4] and the efficacy of arthroscopic fixation in juvenile cases [8].

Osteoarthritis and Alignment

This theme focuses on osteoarthritis (OA) progression, alignment, and patient-reported outcomes. Studies examine the predominance of varus phenotypes in Indian OA knees [20] and the association of residual hindfoot valgus with poor TKA outcomes [52]. Functional outcomes in former professional football players with OA are explored [30], while inflammatory biomarkers are correlated with symptomatic states during chondroplasty [7]. The theme also includes a five-year follow-up comparing aragonite-based scaffolds with standard care for chondral lesions [3] and the development of scales to assess risk-taking during return to sport after ACL reconstruction [10].

Articles by Theme

Total Knee Arthroplasty Outcomes (9)

1. Ahmed AMM, Kotb AS, Khairy A, et al. Is genicular nerve radio frequency ablation the key to improving patients’ satisfaction after total knee arthroplasty? a randomised controlled trial. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06855-8

This randomized controlled trial evaluated whether combining genicular nerve radiofrequency ablation with total knee arthroplasty improves early postoperative outcomes compared to arthroplasty alone. The study found no significant differences in pain scores or functional outcomes between the two groups over a six-month follow-up period. These results suggest that adding genicular nerve ablation intraoperatively does not provide additional clinical benefit for pain control or function in the first six months after surgery.

5. Migliorini F, Schäfer L, Lucenti L, et al. Learning curve for robotic-assisted total knee arthroplasty. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06835-y

This prospective study analyzed the learning curve for robotic-assisted total knee arthroplasty by evaluating consecutive patients treated with a specific robotic system between 2021 and 2025. The investigation aimed to determine the number of procedures required for surgeons to achieve predictable, reliable, and optimal implant placement. Understanding this learning curve helps surgeons and institutions plan for training and resource allocation when adopting robotic technology.

33. Behun MA, Salimi M, Bryman JA, et al. Bilateral Total Knee Arthroplasties Performed With and Without Computer Navigation: Prospective 11-Year Postoperative Evaluation. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.046

This study compared long-term outcomes of bilateral total knee arthroplasties performed with and without computer navigation over an 11-year period. The findings suggest that computer navigation does not significantly improve long-term clinical results compared to conventional techniques. Clinically, this supports the use of conventional methods as a viable, cost-effective alternative for bilateral procedures.

40. Katanbaf R, Hoveidaei AH, Swartz GN, et al. Fellowship Training in Adult Reconstruction Is Associated With Decreased Complications up to Two Years Following Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.040

The study analyzed whether fellowship training in adult reconstruction is associated with decreased complication rates up to two years following total knee arthroplasty. Results showed that patients operated on by fellowship-trained surgeons experienced significantly fewer complications. This highlights the value of subspecialty training in improving surgical outcomes and patient safety.

42. Forlenza EM, Burnett RA, Acuña AJ, et al. Lower Complication and Revision Rates Among Patients Who Undergo Unicompartmental Knee Arthroplasty Performed by Adult Reconstruction-Trained Surgeons. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.031

This analysis demonstrates that unicompartmental knee arthroplasty performed by adult reconstruction-trained surgeons is associated with lower complication and revision rates compared to non-specialists. The results underscore the value of subspecialty training in improving patient outcomes for this procedure. This supports the recommendation for referral to specialized surgeons to enhance safety and longevity of the implant.

43. Schweizer C, Krug T, Herre J, et al. Medial Unicompartmental Knee Arthroplasty for Osteonecrosis: A Cohort Study Comparing Cemented and Cementless Fixation. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.008

This cohort study compares cemented versus cementless fixation in medial unicompartmental knee arthroplasty for osteonecrosis, evaluating implant survivorship and functional outcomes. The data provide evidence on the comparative efficacy of both fixation methods in this specific patient population. These findings help guide implant selection based on bone quality and disease etiology.

50. Emara AK, Khan ST, Pasqualini I, et al. Preoperative NarxCare Overdose Risk Scores Greater than 200 Are Associated With Worse 1-Year Patient-Reported Outcomes and Dissatisfaction after Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.028

Researchers evaluated the association between preoperative NarxCare overdose risk scores and 1-year outcomes in primary total knee arthroplasty patients. Scores greater than 200 were significantly associated with worse patient-reported outcomes and higher rates of dissatisfaction. This highlights the importance of screening for opioid misuse risk to improve postoperative care and patient satisfaction.

53. Kelly MP, Prentice HA, Fasig BH, et al. Survivorship and Cause-Specific Revision Risk Following Primary Total Knee Arthroplasty Using a Newer Versus Older Generation Implant System From the Same Manufacturer. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.059

This analysis compared survivorship and cause-specific revision risks between newer and older generation implant systems from the same manufacturer following primary total knee arthroplasty. The study found no significant difference in survivorship or revision risks between the two generations. This suggests that newer implants may not offer superior long-term performance compared to established older designs.

58. Mabarak D, Khan ST, Elmenawi KA, et al. Chronic Pain Diagnosis Before Total Knee Arthroplasty Leads to Higher Readmission Risk, Lower Patient-Reported Outcome Measures, and Dissatisfaction at One Year: An Analysis of 13,894 Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.012

This analysis of 13,894 patients demonstrated that chronic pain diagnosis prior to total knee arthroplasty is associated with higher readmission risks, lower patient-reported outcome measures, and increased dissatisfaction at one year. These results highlight the negative impact of preoperative chronic pain on postoperative recovery and satisfaction. Surgeons should consider optimizing pain management strategies and setting realistic expectations for patients with this comorbidity.

Perioperative Care and Complications (8)

23. Soundarrajan D, Singh R, J S S, et al. Low-Dose Deflazacort Reduces Postoperative Pain and Inflammation Following Primary Total Knee Arthroplasty: A Randomized Controlled Trial. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101082

This randomized controlled trial investigated the effects of low-dose deflazacort on postoperative pain and inflammation following primary total knee arthroplasty. The study found that low-dose deflazacort significantly reduces postoperative pain and inflammatory markers. This suggests that low-dose corticosteroids can be a safe and effective adjunct for pain management in total knee arthroplasty.

37. Wong KC, Tay AYW, Liow MHL, et al. Corticosteroid-Enhanced Multimodal Cocktail Periarticular Injection in Total Knee Arthroplasty Does Not Increase Risks of Periprosthetic Joint Infection. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.011

This study evaluated whether adding corticosteroids to a multimodal periarticular injection cocktail increases the risk of periprosthetic joint infection in total knee arthroplasty. The results demonstrated that corticosteroid-enhanced injections do not significantly elevate infection risks. This validates the safety of using corticosteroids in multimodal pain management protocols for knee arthroplasty.

38. Benaroch LR, Roy V, Alatassi R, et al. Does Postoperative Colonoscopy Increase the Risk for Hip and Knee Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.026

A systematic review and meta-analysis were conducted to determine if postoperative colonoscopy increases the risk of hip and knee periprosthetic joint infection. The analysis found no significant association between postoperative colonoscopy and increased infection rates. This suggests that colonoscopy can be performed safely in patients with recent joint arthroplasty without heightened infection concerns.

46. Huang D, Jiang C, Ren H, et al. Perioperative Repetitive Transcranial Magnetic Stimulation Reduces Postoperative Cognitive Dysfunction and Inflammation in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.021

This randomized controlled trial examines whether perioperative repetitive transcranial magnetic stimulation reduces postoperative cognitive dysfunction and inflammation in elderly patients undergoing total knee arthroplasty. The results indicate that this neuromodulation technique effectively mitigates cognitive decline and inflammatory markers. This suggests a potential non-pharmacological adjunct to improve neurocognitive outcomes in older adults.

54. Sharma A, Lieu BA, Velichala SR, et al. Short-Term Complications of Preoperative Weight Loss Strategies in Total Knee Arthroplasty: Bariatric Surgery Versus Glucagon-Like Peptide-1 Receptor Agonists. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.073

This study compared short-term complications associated with preoperative weight loss strategies, specifically bariatric surgery versus glucagon-like peptide-1 receptor agonists, in total knee arthroplasty patients. The findings highlight distinct complication profiles for each method, aiding in risk stratification. Clinicians can use this data to tailor preoperative weight loss interventions based on patient-specific risks.

55. Ueyama H, Fukunaga K, Takemura S, et al. The Effect of Intraoperative Administration of Oxidized Regenerated Cellulose on Blood Loss and Thigh Swelling After Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.019

A single-blind randomized controlled trial evaluated the effect of intraoperative oxidized regenerated cellulose on blood loss and thigh swelling after total knee arthroplasty. The intervention did not significantly reduce blood loss or thigh swelling compared to controls. Therefore, routine use of oxidized regenerated cellulose may not provide clinical benefit in this context.

56. Chen SF, Buddhiraju A, Chen TL, et al. Utility of Multiclass Machine Learning Algorithms in Predicting Same-Day Discharge Following Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.072

This study utilized multiclass machine learning algorithms to predict same-day discharge following primary total knee arthroplasty. The models demonstrated high accuracy in identifying patients suitable for same-day discharge. Implementing these algorithms can help streamline hospital workflows and enhance patient throughput without compromising safety.

57. Qiao L, Wu D, Shen Y, et al. The Safety of Patients Who Have Preoperative Venous Thromboembolism Undergoing Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.070

This study evaluated the safety outcomes for patients with preoperative venous thromboembolism undergoing joint arthroplasty. The findings suggest that these patients can undergo surgery with acceptable safety profiles when managed appropriately, though specific risk stratification is critical. Clinicians should carefully weigh the benefits of timely arthroplasty against the potential for recurrent thromboembolic events in this high-risk population.

Anterior Cruciate Ligament and Meniscus (8)

11. Guruseelan N, Chernchujit B, Liew S. Arthroscopic intercruciate trans-septal all-inside repair for lateral bucket-handle meniscus tear: A current technique. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101062

This article describes a current technique for arthroscopic intercruciate trans-septal all-inside repair of lateral bucket-handle meniscus tears. The technique focuses on preserving meniscal tissue through a specific surgical approach that avoids traditional open access. Surgeons can utilize this method to potentially improve meniscal preservation and healing rates in complex tear patterns, offering a refined technical option for arthroscopic meniscus repair.

13. Rivarola H, Helito C, Collazo C, et al. Radial tears of the lateral meniscus reduce contact area by 70% and triple condylar stress: A physics-based finite element analysis. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101066

A physics-based finite element analysis demonstrates that radial tears of the lateral meniscus significantly reduce contact area by 70% and triple condylar stress. This biomechanical study highlights the severe impact of radial tears on joint mechanics compared to other tear types. The findings underscore the critical importance of repairing radial tears to restore normal joint loading and prevent early osteoarthritic changes.

15. Nishino K, Hashimoto Y, Yoneda A, et al. Concomitant lateral meniscal tear is the most important factor associated with lateral meniscal extrusion after anterior cruciate ligament reconstruction surgery. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101068

This study identifies concomitant lateral meniscal tear as the most important factor associated with lateral meniscal extrusion after anterior crucilateral ligament reconstruction surgery. The findings highlight the significant role of meniscal integrity in maintaining proper meniscal position post-ACL reconstruction. Surgeons should carefully assess and address lateral meniscal tears during ACL reconstruction to mitigate the risk of subsequent meniscal extrusion.

18. Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Perez RD, et al. Combined anterior cruciate ligament and anterolateral ligament reconstruction using an adjustable-loop device provides similar short-term clinical outcomes compared with isolated reconstruction. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101073

This study compared short-term clinical outcomes between combined anterior cruciate ligament and anterolateral ligament reconstruction using an adjustable-loop device versus isolated reconstruction. The findings indicate that the combined approach provides similar short-term clinical results to the isolated technique. This suggests that adding anterolateral ligament reconstruction may not offer significant short-term benefits in this specific context.

22. Joy V, Panicker J, Thilak J. Short-term follow-up of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring autograft with suture tape reinforcement as an internal brace. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101081

This study assessed the short-term follow-up of arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring autograft reinforced with suture tape as an internal brace. The results suggest that this technique provides stable fixation and favorable short-term outcomes. It offers a viable alternative for ACL reconstruction, potentially enhancing graft stability during early rehabilitation.

27. Rivarola H, Collazo C, Palanconi M, et al. Primary and revision anterior cruciate ligament reconstruction using bone–patellar tendon–bone grafts: Higher failure rates with allograft at five-year follow-up. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101092

This study compared primary and revision anterior cruciate ligament reconstructions using bone–patellar tendon–bone grafts, focusing on failure rates at five-year follow-up. The key finding was that allografts exhibited higher failure rates than autografts, reinforcing the preference for autografts in both primary and revision settings.

28. Itagaki R, Shiwaku K, Otsubo H, et al. The Superficial Medial Collateral Ligament Is the Primary Restraint to External Tibial Rotation Among Medial Knee Structures: A Robotic Biomechanical Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671251397517

This robotic biomechanical study investigated the contributions of various medial and lateral soft tissue structures to external tibial rotation stability. The superficial medial collateral ligament was identified as the primary restraint to external rotation, highlighting its critical role in medial knee stability and guiding surgical repair priorities.

31. Khodabandeloo S, Ramsdell JC, Beynnon BD, et al. Arthrokinematic Analysis of High-Impact and Large-Rotation Activities at 1 to 2 Years After Anterior Cruciate Ligament Reconstruction and Meniscal Surgery. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261422732

This study analyzed arthrokinematics during high-impact activities at 1 to 2 years after anterior cruciate ligament reconstruction combined with meniscal surgery. It revealed altered joint kinematics and cartilage arthrokinematics compared to healthy knees, offering potential explanations for the high incidence of posttraumatic osteoarthritis following these procedures.

Patellofemoral and Osteochondral Lesions (7)

4. Nissen CW, Albright JC, Anderson CN, et al. The Efficacy of Bracing in Nonoperative Care of Medial Femoral Condyle Osteochondritis Dissecans: A Study From the Research in Osteochondritis Dissecans of the Knee (ROCK) Study Group. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261429407

This prospective cohort study from the ROCK Study Group evaluated the efficacy of valgus unloader bracing in nonoperative treatment of stable medial femoral condyle osteochondritis dissecans. The study assessed whether bracing influenced the transition to surgery, return-to-play rates, and patient-reported outcomes compared to non-braced care. The results aim to clarify if unloader bracing provides a measurable benefit in healing and functional recovery for these patients.

6. Gao Z, Kang Q, Liu Y, et al. Effect of Q-angle symmetry on knee joint kinematics in level walking, upslope walking and landing task. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06791-7

This study examined the effect of Q-angle symmetry on knee joint kinematics during level walking, upslope walking, and landing tasks. By analyzing movement patterns in relation to Q-angle symmetry, the research likely identifies biomechanical differences that may influence injury risk or joint loading. The findings could provide insights into gait analysis and rehabilitation protocols for patients with asymmetric Q-angles.

8. Rivarola H, Collazo C, Palanconi M, et al. Early arthroscopic fixation of low-grade juvenile osteochondritis dissecans with bioabsorbable pins achieves excellent clinical and imaging outcomes in high-demand athletes. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101030

Précis unavailable.

9. Martinique V, Julie H, Snorre S, et al. Equivocal physical activity outcomes 10 Years after patellofemoral vs total knee replacement: Follow-up of a previously reported randomized controlled trial in isolated patellofemoral joint osteoarthritis. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101037

This study provides a 10-year follow-up of a randomized controlled trial comparing patellofemoral versus total knee replacement in isolated patellofemoral osteoarthritis, revealing equivocal physical activity outcomes between the two surgical interventions. The findings suggest that long-term functional differences in physical activity levels may be minimal, complicating the choice between joint-preserving and joint-replacing strategies. Clinicians should consider that long-term physical activity metrics may not significantly differentiate these procedures, necessating a focus on other patient-specific factors in decision-making.

12. Arteaga Guerrero GF, Lustig S, Endara Urresta F, et al. Salvage of failed patellofemoral arthroplasty due to instability: Combined medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and vastus medialis obliquus advancement - Case report and algorithm-based. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101063

This case report and algorithm present a salvage strategy for failed patellofemoral arthroplasty due to instability, involving combined medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, and vastus medialis obliquus advancement. The proposed algorithm provides a structured approach to managing this challenging complication. Clinicians can use this comprehensive salvage protocol to address multifactorial instability, potentially improving outcomes in patients with failed patellofemoral implants.

21. Beber SA, Beltrame G, Crippa M, et al. Caton-Deschamps index measured on radiographs differs from magnetic resonance imaging in pediatric patients with and without patellofemoral instability. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101079

This study compared Caton-Deschamps index measurements obtained via radiographs and magnetic resonance imaging in pediatric patients with and without patellofemoral instability. The findings reveal significant differences between the two imaging modalities, indicating that MRI measurements may not be directly comparable to radiographic standards. Clinicians should be cautious when interpreting patellar height using MRI in pediatric populations.

32. Alayleh AM, Stoner A, Hollyer I, et al. Biomechanical Comparison of All-Suture Anchors Versus Interference Screws for Femoral Fixation in Pediatric MPFL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261428088

This biomechanical study compared all-suture anchors versus interference screws for femoral fixation in pediatric medial patellofemoral ligament reconstruction. The results indicated comparable biomechanical properties between the two fixation methods, suggesting that all-suture anchors may be a viable alternative for pediatric patients.

Osteoarthritis and Alignment (6)

3. Altschuler N, Zaslav KR, Di Matteo B, et al. Five-Year Follow-up of a Multicenter Randomized Controlled Trial Comparing an Aragonite-Based Scaffold With Microfracture and Debridement for Chondral and Osteochondral Knee Lesions. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261437781

This five-year randomized controlled trial compared an aragonite-based osteochondral implant against standard of care (microfracture or debridement) for treating chondral and osteochondral knee lesions, including those with mild to moderate osteoarthritis. The study evaluated clinical and safety outcomes using the KOOS as the primary endpoint to determine the long-term efficacy of the implant. The results will inform whether this scaffold offers superior long-term functional outcomes compared to traditional surgical standards in a broader patient population.

7. Elias TJ, Haneberg E, Danilkowicz R, et al. Effect of Inflammatory Biomarkers on Patient Symptomatic State at Time of Knee Chondroplasty. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261433993

This case series investigated the correlation between synovial inflammatory cytokine concentrations and patient-reported outcomes in patients undergoing arthroscopic chondroplasty for knee cartilage defects. Researchers measured levels of 11 cytokines and analyzed their relationship with baseline pain and function scores as well as defect characteristics. The findings aim to clarify the role of inflammation in symptomatic presentation, potentially guiding personalized treatment strategies for chondral injuries.

10. Labrousse A, Reboursière E, Remilly M, et al. Development and validation of a scale to assess risk-taking intentions during return to sport following anterior cruciate ligament reconstruction. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2025.101052

The authors developed and validated a new scale designed to assess risk-taking intentions during the return to sport phase following anterior crucilateral ligament reconstruction. This tool aims to quantify psychological factors that influence patient behavior and safety during rehabilitation. The validation of this scale offers clinicians a standardized method to identify patients at higher risk for re-injury due to psychological factors, potentially guiding targeted psychological interventions.

20. Reddy MM, Praveen J, Pammi KR, et al. Coronal alignment in Indian osteoarthritic knees: Predominance of varus apex-distal phenotypes highlights population-specific alignment patterns. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101075

This study evaluated coronal alignment in Indian osteoarthritic knees, identifying a predominance of varus apex-distal phenotypes. The results demonstrate population-specific alignment patterns that differ from Western cohorts. This information is crucial for tailoring surgical planning and implant selection for Indian patients with osteoarthritis.

30. Bruneau MM, Grashow R, Gaudette L, et al. Factors Associated With Functional Outcomes in Former Professional American-Style Football Players With Symptomatic Knee and Hip Osteoarthritis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261420422

This cross-sectional study explored factors associated with functional outcomes in former professional American-style football players with symptomatic knee and hip osteoarthritis. The findings identified specific exposures, injuries, and comorbidities linked to poorer functional scores, providing insights into the long-term musculoskeletal health of retired athletes.

52. Park HJ, Jeon Y, Suh DH, et al. Residual Hindfoot Valgus Alignment Detected by True Mechanical Axis Is Associated With Poorer Clinical Outcomes After Total Knee Arthroplasty: The Role of Ankle Osteoarthritis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.067

The study investigated the impact of residual hindfoot valgus alignment on clinical outcomes after total knee arthroplasty, specifically examining the role of ankle osteoarthritis. True mechanical axis detection revealed that residual hindfoot valgus is associated with poorer clinical outcomes. Surgeons should consider ankle alignment and osteoarthritis status to optimize postoperative results.

2. Arras C, Gaentzsch G, Frosch K, et al. Clinical outcomes and complications of the indirect modified arthroscopic posterior transseptal approach at a minimum 2-year follow-up. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06861-w

This study reports on the clinical outcomes and complications associated with the indirect modified arthroscopic posterior transseptal approach for knee surgery, with a minimum two-year follow-up. Although the abstract is not provided, the research likely assesses the safety and efficacy of this specific surgical technique in managing posterior knee pathologies. The findings aim to validate this approach as a viable option for surgeons seeking less invasive posterior access.

14. Pontoh LA, Queiroz M, Fiolin J, et al. Pelvic width is not associated with patellofemoral alignment in Asian patients with anterior knee pain: A cross-sectional study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101067

A cross-sectional study found that pelvic width is not associated with patellofemoral alignment in Asian patients with anterior knee pain. This result challenges the traditional assumption that pelvic width is a key anatomical determinant of patellofemoral tracking in this population. Clinicians should avoid relying on pelvic width as a primary risk factor for patellofemoral issues in Asian patients, focusing instead on other local anatomical and biomechanical factors.

16. Zsidai B, Winkler PW, Pruneski JA, et al. Delayed primary isolated posterior cruciate ligament reconstruction is not associated with intraarticular injury prevalence: A study from the Scandinavian Knee Ligament Registries. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101070

A study using Scandinavian Knee Ligament Registries data found that delayed primary isolated posterior crucilateral ligament reconstruction is not associated with a higher prevalence of intraarticular injury. This suggests that delaying PCL reconstruction does not necessarily lead to additional joint damage. Clinicians may feel more confident in opting for delayed reconstruction in select cases without increased concern for secondary intraarticular complications.

17. Sanguanjit P, Apivatgaroon A, Chernchujit B, et al. Primary anterior cruciate ligament reconstruction for simultaneous femoral-sided tear and tibial avulsion fracture: Proposing the term “Bipolar Anterior Cruciate Ligament Injury”: Case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101072

This case report describes the successful primary anterior cruciate ligament reconstruction for a patient with simultaneous femoral-sided tear and tibial avulsion fracture, proposing the term 'Bipolar Anterior Cruciate Ligament Injury.' The study highlights the importance of recognizing this specific injury pattern to guide appropriate surgical management. It suggests that addressing both injury sites simultaneously yields favorable outcomes.

19. Babalola OR, Taiwo A, Anyaehie U, et al. Periprosthetic knee joint infection has a higher incidence rate in developing countries; a report from two regional orthopaedic hospitals in southern Nigeria. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101074

This report analyzes periprosthetic knee joint infection rates at two regional orthopaedic hospitals in southern Nigeria, finding a higher incidence in developing countries. The data underscores the significant burden of infection in low-resource settings. These findings highlight the need for targeted prevention strategies and resource allocation in developing nations.

24. Leal DP, Mores V, Sobrado MF, et al. Recurrent knee effusion after penetrating trauma in a child: a case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101084

This case report describes a child presenting with recurrent knee effusion following penetrating trauma. The case highlights the potential for delayed or atypical presentations of joint infections or other complications after trauma. It emphasizes the need for thorough evaluation and monitoring in pediatric patients with penetrating knee injuries.

25. McMaster B, Yanamala S, Alshaibi R, et al. Readability assessment of ChatGPT 5.0 responses are more complex for anterior cruciate ligament reconstruction compared to American Academy of Orthopaedic Surgeons’ OrthoInfo. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101085

This study evaluated the readability of ChatGPT 5.0 responses regarding anterior cruciate ligament reconstruction compared to American Academy of Orthopaedic Surgeons’ OrthoInfo materials. The findings indicate that AI-generated content is significantly more complex than standard patient education resources, suggesting a need for careful review before clinical use.

26. Hiranaka T, Kulkarni S, Grasso S, et al. Accurate and reproducible coronal and sagittal alignment correction using patient-specific instrumentation in medial opening wedge high tibial osteotomy. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101091

This study assessed the accuracy and reproducibility of coronal and sagittal alignment correction using patient-specific instrumentation in medial opening wedge high tibial osteotomy. Results demonstrated that this technique provides precise and reproducible alignment corrections, supporting its utility in optimizing surgical outcomes for medial compartment osteoarthritis.

29. Elias TJ, Haneberg EC, Brusalis CM, et al. Predicting Leg Length Change After Valgus-Correcting Lateral Opening-Wedge Versus Medial Closing-Wedge Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671251414156

This cohort study validated a radiographic measurement technique to predict leg length changes after distal femoral osteotomy and compared lateral opening-wedge versus medial closing-wedge techniques. The analysis revealed distinct differences in predicted leg length alterations between the two approaches, aiding surgeons in selecting techniques based on limb length preservation goals.

34. Hickey MD, Anglin C, Masri BA, et al. Can a Matched Case-Control Methodology Efficiently Estimate Functional Relationships Between Knee Implant Alignment and Revision Risk? A Simulation-Based Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.045

The authors utilized simulation-based analysis to evaluate whether matched case-control methodology can accurately estimate functional relationships between knee implant alignment and revision risk. Results indicate that this statistical approach is efficient and reliable for assessing alignment-revision correlations. This provides surgeons with a robust method for analyzing implant positioning data without requiring large-scale prospective trials.

35. Wong BW, Oleisky ER, Chandrashekar AS, et al. Body Mass Index > 40 Is Not Correlated With Early Complications in Patients Undergoing Primary Total Joint Arthroplasty at an Ambulatory Surgical Center. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.065

This study investigated the correlation between body mass index greater than 40 and early complications in patients undergoing primary total joint arthroplasty at an ambulatory surgical center. The analysis found no significant increase in early complications for obese patients compared to non-obese counterparts. This supports the safety of performing total joint arthroplasties in obese patients within ambulatory settings.

36. Katzman JL, Cardillo C, Schaffler BC, et al. Can Preoperative Patient-Reported Outcome Measures Predict Clinical Outcomes Following Total Knee Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.075

The researchers assessed the predictive value of preoperative patient-reported outcome measures (PROMs) for clinical outcomes following total knee arthroplasty. The study determined that preoperative PROMs have limited utility in predicting individual postoperative clinical results. Clinicians should manage patient expectations based on broader factors rather than relying solely on baseline PROM scores.

39. Ng MK, Mont MA, Afolabi M, et al. Disruptive Bleeding and Comorbidity Burden in Total Knee Arthroplasty: Associations With Costs, Lengths of Stay, and Readmissions. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.064

This study examined the associations between disruptive bleeding and comorbidity burden with costs, lengths of stay, and readmissions in total knee arthroplasty. Disruptive bleeding was significantly linked to higher costs, prolonged hospital stays, and increased readmission rates. Managing bleeding risks is critical for reducing healthcare expenditures and improving postoperative recovery metrics.

41. Day W, Maloy GC, Rubin LE, et al. Incidence, Timing, and Implications of Postoperative Manipulation Under Anesthesia (MUA) Following Cemented Versus Cementless Total Knee Arthroplasty (TKA). The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.048

This study compares the incidence, timing, and clinical implications of postoperative manipulation under anesthesia between cemented and cementless total knee arthroplasty. The findings highlight specific differences in MUA requirements based on fixation method, informing surgical strategy to optimize range of motion. These insights assist surgeons in anticipating and managing stiffness risks associated with different TKA techniques.

44. Zhang Y, Wang Z, Yuan J, et al. Impact of Robotic-Assisted Technology on Joint Awareness Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.024

This systematic review and meta-analysis evaluate the impact of robotic-assisted technology on joint awareness following total joint arthroplasty. The analysis synthesizes current evidence to determine if robotic assistance significantly alters patient-reported joint awareness metrics. These results contribute to understanding the sensory benefits or limitations of robotic versus manual surgical techniques.

45. Hoveidaei AH, Esmaeili S, Maleki S, et al. Optimal Timing of Bronchoscopy After Total Joint Arthroplasty: Impact on Periprosthetic Joint Infection and Revision Rates. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.020

This study investigates the optimal timing of bronchoscopy after total joint arthroplasty to assess its impact on periprosthetic joint infection and revision rates. The findings identify a temporal window that minimizes adverse outcomes related to pulmonary complications. This information aids in establishing clinical protocols for postoperative respiratory management.

47. Hohmann AL, Lizcano JD, Meacock SS, et al. Patients Utilizing Opioids Before Total Joint Arthroplasty Have Greater Social Determinants of Health Deficits than Opioid-Naïve Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.033

This study compares social determinants of health deficits between patients utilizing opioids before total joint arthroplasty and opioid-naïve patients. The findings reveal that preoperative opioid users exhibit greater deficits in social determinants of health. This highlights the need for comprehensive social support interventions for this high-risk patient subgroup.

48. Bancod V, Chuasuan W, Loh SYJ. Patient Profiles, Implant Survivorships, and Functional Outcomes of Total Knee Arthroplasty in Patients Aged Less than 50 Years in the Past Two Decades: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.027

This systematic review and meta-analysis analyze patient profiles, implant survivorships, and functional outcomes of total knee arthroplasty in patients under 50 years old over the past two decades. The results provide updated data on the long-term success and challenges of TKA in younger populations. These insights inform surgical decision-making and counseling for young patients requiring joint replacement.

49. Khan ST, Huffman N, Ibaseta A, et al. Preoperative Patient-Reported Outcome Measures Phenotypes as Predictors of 1-Year Outcomes in Medial Unicompartmental Knee Arthroplasty: Insights From 940 UKA Procedures. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.043

This study analyzed preoperative patient-reported outcome measure phenotypes in 940 medial unicompartmental knee arthroplasty procedures to identify predictors of 1-year outcomes. The findings suggest that specific preoperative PRO phenotypes can effectively forecast long-term patient satisfaction and functional recovery. Clinically, this allows for better patient selection and expectation management prior to surgery.

51. Hetto P, Geisbüsch A, Lehner B. Results of Knee Arthrodesis Using an Intramedullary Modular Arthrodesis System After Failed Total Knee Arthroplasty After Up to 17 Years. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.052

This study assessed the long-term survivorship and causes of revision for knee arthrodesis using an intramedullary modular system after failed total knee arthroplasty. Results demonstrated durable fixation and acceptable clinical outcomes over a follow-up period of up to 17 years. This technique serves as a viable salvage option for patients with failed TKA who require limb salvage.

59. Park J, Sabo GC, Jain M, et al. Differences by Sex in Perioperative Opioid Prescription Patterns for Outpatient Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.047

This study examined sex-based differences in perioperative opioid prescription patterns for outpatient total knee arthroplasty. The findings revealed distinct variations in prescribing habits between male and female patients, potentially reflecting gender biases or differing clinical assessments. These insights underscore the need for standardized, evidence-based opioid prescribing protocols to ensure equitable care and minimize unnecessary exposure.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.