What's New — Knee — May 2026¶

173 new articles published this month.

Themes: ACL Reconstruction and Return to Sport · Meniscal Pathology and Preservation · Total Knee Arthroplasty: Alignment and Robotics · Periprosthetic Joint Infection and Revision Surgery · Patellofemoral Instability and Pain · Social Determinants and Perioperative Care

Digest generated 2026-06-05 20:59:36+00:00.

Highlights¶

ACL Reconstruction and Return to Sport¶

Recent literature extensively evaluates outcomes following anterior cruciate ligament reconstruction (ACLR), focusing on graft selection, surgical technique, and return-to-sport (RTS) metrics. Studies compare hamstring, patellar tendon, and quadriceps tendon grafts, noting that while graft choice influences early strength recovery, long-term survivorship differences are often statistically fragile [57]. The role of lateral extra-articular tenodesis (LET) in high-risk young athletes remains a key topic, with evidence supporting reduced graft failure rates [30, 137]. Additionally, primary ACL repair is re-emerging for specific acute proximal tears, showing high RTS rates but requiring careful patient selection [37, 49, 50]. Psychological readiness, assessed via the ACL-RSI scale, is a critical predictor of reinjury in adolescents [119, 121], while biomechanical assessments of cutting techniques and gait symmetry provide objective markers for RTS clearance [55, 127].

Meniscal Pathology and Preservation¶

This theme encompasses the diagnosis, repair, and long-term outcomes of meniscal injuries, particularly posterior root tears (MMPRT) and radial tears. Research highlights that preoperative joint line convergence angle and alignment significantly influence MMPRT repair outcomes [3, 70]. Techniques such as transtibial pullout with peripheral stabilization sutures show promise in reducing meniscal extrusion [79], while healing integrity directly correlates with extrusion reduction [53]. Meniscal allograft transplantation (MAT) demonstrates durable function beyond ten years, though posterior tibial slope remains a risk factor for graft failure [22, 142]. Biomechanical studies compare various repair constructs, including knotless anchors and dual tie-grip configurations [64, 122]. Furthermore, delayed repair in pediatric patients is associated with increased cartilage injury [48], and specific tear morphologies like bucket-handle tears exhibit higher failure rates after all-inside repair [16].

Total Knee Arthroplasty: Alignment and Robotics¶

Advancements in total knee arthroplasty (TKA) focus on alignment philosophies and robotic assistance. The Coronal Plane Alignment of the Knee (CPAK) classification is scrutinized for its sensitivity to measurement errors and 3D limitations, with studies suggesting that restoring native CPAK does not necessarily improve clinical outcomes [27, 28, 31, 46, 77]. Robotic-arm-assisted TKA is associated with reduced length of stay and faster initial recovery compared to conventional techniques, though long-term outcomes may be similar [12, 156]. Functional alignment strategies, including restricted kinematic alignment, aim to preserve native joint mechanics, with limited joint-line alteration enhancing early outcomes [154, 161]. Additionally, robotic assistance in unicompartmental knee arthroplasty (UKA) shows excellent survivorship and satisfaction [32, 139], and specific techniques for valgus deformities via lateral approaches are being refined [76].

Periprosthetic Joint Infection and Revision Surgery¶

Management of periprosthetic joint infection (PJI) and revision arthroplasty remains a complex challenge. Studies compare one- versus two-stage exchanges, noting that one-component single-stage exchanges may have higher readmission rates for infection [102]. The fate of retained antibiotic spacers after first-stage revision is a critical consideration, with factors influencing retention and mortality identified [2, 60]. Revision TKA outcomes are influenced by referral patterns and the use of constrained implants in complex deformities [83, 99]. Registry data highlights that allograft use and specific fixation methods increase revision risk in multiple revision ACLRs [15], while metal hypersensitivity is associated with inferior survivorship in TKA but not THA [97]. Antibiotic prophylaxis strategies, including extended oral antibiotics and cefazolin alternatives, are evaluated for efficacy in preventing PJI [85, 151, 167].

Patellofemoral Instability and Pain¶

Research on patellofemoral disorders addresses surgical outcomes and biomechanical risk factors. Isolated MPFL reconstruction using suture tape demonstrates durable stability and high patient satisfaction at mid-to-long-term follow-up [11]. Biomechanical assessments reveal asymmetrical lower extremity mechanics during functional tasks in adolescents post-MPFL reconstruction [21]. Quadriceps malalignment is strongly associated with recurrent patellofemoral instability in native knees [29]. In the context of arthroplasty, preoperative patellar tilt and lateral facet morphology are evaluated for their impact on outcomes in UKA [74], while inflammatory arthritis is not an absolute indication for patellar resurfacing in TKA [147]. Patellofemoral arthroplasty (PFA) reoperation rates are analyzed, showing distinct patterns of ipsilateral knee reoperation [163].

This theme explores the impact of social determinants of health (SDOH) and perioperative management on orthopaedic outcomes. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are associated with worse PROMIS outcomes and lower likelihood of achieving minimal clinically important differences after ACL reconstruction [125]. Income inequality, quantified by the Gini Index, predicts adverse TKA outcomes [91]. Preoperative psychiatric diagnoses predict worse patient-reported outcomes and higher dissatisfaction after TKA [100]. Perioperative care innovations include the use of wearable sensors for monitoring recovery [88], nanotechnology-based devices for pain control [148], and the evaluation of vitamin D supplementation and metformin use on OA progression and TKA outcomes [81, 82, 131]. Additionally, the impact of GLP-1 agonists and bariatric surgery on arthroplasty outcomes is examined [87, 166].

Articles by Theme¶

ACL Reconstruction and Return to Sport (31)¶

1. Abdul W, Jones M, Haslhofer D, et al. Comparison of Isolated ACL and Combined ACL/MCL Injuries in Professional Soccer and Rugby Players: Return to Play and Career Longevity Outcomes. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261448236

This retrospective case series compared return-to-play rates, career longevity, and rerupture rates in elite soccer and rugby players with combined ACL/MCL injuries versus those with isolated ACL injuries. The study aimed to determine optimal management strategies for these common combined knee ligament injuries by analyzing outcomes from players treated between 2015 and 2022.

5. Jones M, Motesharei A, Abdul W, et al. ACL Reconstruction for Combined ACL/MCL Injuries in Professional Soccer and Rugby Players: No Difference in Career Longevity Compared to Uninjured Matched Controls. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261448234

This cohort study compared return-to-play rates, career longevity, and match participation in professional soccer and rugby players with combined ACL/MCL injuries against uninjured matched controls. The findings indicated that players with these combined injuries had similar return-to-play rates and career longevity to their uninjured counterparts.

17. Raghoebar S, Roozenboom‐van Vliet C, Wal WVD, et al. Nutrition and rehabilitation after anterior cruciate ligament reconstruction: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70441

This systematic review evaluated the impact of nutrition and supplements on rehabilitation outcomes following anterior cruciate ligament reconstruction. The authors found insufficient high-quality evidence due to serious risk of bias and variability across the included studies. Consequently, no definitive clinical recommendations can currently be made regarding nutritional interventions for return to sport.

20. Petit CB, Hussain ZB, Lloyd RS, et al. Association Between Autograft Choice and Risk of Contralateral ACL Injury in Patients ≤25 Years of Age: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261440398

This systematic review and meta-analysis compared the risk of contralateral anterior cruciate ligament injury among young patients based on autograft type. The analysis included data from over 4,000 patients to evaluate hamstring, bone-patellar tendon-bone, and quadriceps tendon grafts. The study aims to identify targetable risk factors to optimize rehabilitation and return to sport strategies in this population.

30. Mazy D, Cance N, Dan MJ, et al. Selective approach to lateral extra‐articular tenodesis achieves low anterior cruciate ligament graft rupture rates, while posterior tibial slope and static anterior tibial translation remain major risk factors. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70450

This retrospective study evaluated anterior cruciate ligament graft rupture rates in patients undergoing selective lateral extra-articular tenodesis during primary reconstruction. The findings indicated that while the selective approach achieved low rupture rates, posterior tibial slope and static anterior tibial translation remained significant risk factors for graft failure. Surgeons should consider these biomechanical factors when deciding on the necessity of adjunctive tenodesis procedures.

34. Okutan AE, Gürün E. Reply to the Letter to the Editor: All-inside ACL Reconstruction Offers No Advantage in Clinical Outcomes, Graft Healing, or Tunnel Widening Compared With the Complete Tibial Tunnel Technique: A Prospective Randomized Trial. Clinical Orthopaedics & Related Research 2026. doi:10.1097/corr.0000000000003992

The authors respond to a letter regarding their randomized trial, clarifying methodological aspects such as blinding and allocation to defend their conclusion that all-inside ACL reconstruction offers no advantage over the complete tibial tunnel technique. They maintain that their prospective data demonstrates equivalent clinical outcomes, graft healing, and tunnel widening between the two surgical methods. This reply reinforces the validity of their original findings against methodological critiques.

35. Mazza D, De Carli A, De Carli F, et al. Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer: A Retrospective Matched Cohort Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261441252

This retrospective matched cohort study investigated the incidence and impact of secondary muscle injuries on athletic performance in professional soccer players returning to play after anterior cruciate ligament reconstruction. The results indicated that players returning after ACLR experienced higher rates of secondary muscle injuries, which were associated with premature return to play and subsequent declines in performance metrics. These findings highlight the need for careful monitoring of muscle health and return-to-play timing to mitigate performance decline in this population.

36. Thamrongskulsiri N, Moews LD, Casanova F, et al. Adjustable Hinged Knee Bracing Does Not Improve Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta‐analysis of Randomized Controlled Trials. Arthroscopy 2026. doi:10.1002/arj.70224

This systematic review and meta-analysis of randomized controlled trials assessed whether adjustable hinged knee bracing improves outcomes compared to no bracing in the early postoperative period after primary ACL reconstruction. The analysis of six trials involving 384 patients found no significant benefits in patient-reported outcomes, knee stability, muscle strength, range of motion, or complication rates with bracing. Consequently, the routine use of adjustable hinged knee braces after primary ACL reconstruction is not supported by current evidence.

37. Murray IR, Super JT, Tollefson LV, et al. Editorial Commentary : Are We Asking the Wrong Question About Anterior Cruciate Ligament Repair? Indication Matters More Than Timing. Arthroscopy 2026. doi:10.1002/arj.70340

This editorial commentary argues that the success of anterior cruciate ligament repair depends more on patient selection and biological factors, such as tear pattern and tissue quality, than on surgical timing. The authors caution against expanding indications for repair due to concerns regarding durability in high-demand patients and a lack of long-term comparative data. They conclude that established surgical approaches should remain the standard until broader, long-term outcomes validate repair for wider populations.

39. Guen AL, Bohu Y, Etienne AS, et al. Biologic gracilis augmentation with iliotibial band enhances recovery and lowers complications in ACL reconstruction compared with hamstring plus lateral tenodesis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70449

Précis unavailable.

41. Erden T, Ağır M, Enes Kayaalp M, et al. Increased residual anterior knee laxity at one year is associated with a dose‐dependent increase in graft re‐rupture risk following hamstring autograft ACL reconstruction in athletes. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70447

This retrospective cohort study evaluated the association between KT-1000-measured anterior knee laxity at one year post-operation and graft re-rupture risk in 1011 athletes following hamstring autograft ACL reconstruction. The key finding was that increased residual anterior knee laxity at one year is associated with a dose-dependent increase in the risk of graft re-rupture. Clinically, these results suggest that monitoring residual laxity at one year may help identify patients at higher risk for re-injury who might benefit from targeted interventions or closer surveillance.

47. Swamykumar P, McCurdy MA, Ventimiglia DJ, et al. Preoperative expectations and 2‐year outcomes after primary anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70425

Précis unavailable.

50. Carrozzo A, Annibaldi A, Pucciatti R, et al. Primary Anterior Cruciate Ligament Repair for Acute Proximal Tears Shows High Return to Sport and a 10% Failure Rate at a Minimum 2‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70218

This retrospective study evaluated clinical outcomes for 120 patients undergoing arthroscopic primary ACL repair for acute proximal tears, finding a 10% failure rate and high return-to-sport rates at a minimum 2-year follow-up. The study confirmed that strict selection criteria, including acute injury timing and good tissue quality, are critical for success, with lateral extra-articular procedures used for high-risk cases. These findings support primary repair as a viable alternative to reconstruction for specific patient populations, offering comparable functional outcomes with acceptable durability.

55. Di Paolo S, Mendicino M, Viotto M, et al. Cutting Technique of Soccer Players After ACLR: On-Field Matched Control Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261443313

This matched control study compared cutting biomechanics in pediatric soccer players after anterior cruciate ligament reconstruction against healthy controls during on-field movements. The results indicated that players with ACL reconstruction exhibited distinct kinematic differences and potential risk factors for reinjury compared to their healthy counterparts. These findings suggest that current return-to-sport evaluations may need to incorporate sport-specific biomechanical assessments to better identify residual movement deficits.

56. Graham GD, Haffner M, Testa EJ, et al. The Anterior Cruciate Ligament Injury Severity Scale (ACLISS) as a Predictor of Short-Term Reoperation and Functional Outcomes After ACL Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261443315

This cohort study evaluated the Anterior Cruciate Ligament Injury Severity Scale (ACLISS) as a predictor of reoperation and functional outcomes following primary ACL reconstruction. The analysis found that higher ACLISS scores, indicating more extensive concomitant knee damage, were associated with increased reoperation rates and poorer patient-reported functional outcomes. Clinically, this supports the use of ACLISS to stratify patient risk and set realistic expectations for recovery and potential need for secondary procedures.

57. Mahatme RJ, Moore SA, Gangavaram A, et al. Low Fragility Index Undermines Confidence in ACL Graft Superiority: A Systematic Review and Fragility Index Analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261443989

This systematic review and fragility index analysis evaluated the statistical robustness of dichotomous outcomes in randomized controlled trials comparing various anterior cruciate ligament graft types. The study found that median fragility indices were low (2.0), indicating that many statistically significant results could be overturned by a single additional event. This suggests that confidence in the superiority of specific grafts may be overstated due to fragile statistical evidence.

65. Masferrer-Pino A, Martínez-Peñas J, Ormazabal I, et al. Oral Contraceptive Use and Improved Graft Maturation After Anterior Cruciate Ligament Reconstruction in Female Patients: An MRI-Based Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261441238

This retrospective cohort study investigated whether oral contraceptive (OC) use influences graft maturation, measured by MRI signal-to-noise quotient, in female patients undergoing ACL reconstruction with hamstring autograft and lateral extra-articular tenodesis. The study stratified patients based on OC use to determine if hormonal stabilization via OCs correlates with improved biological healing outcomes post-surgery.

118. Ackermann J, Jones M, Ball SV, et al. The Effect of Axial Tibiofemoral Rotation on Primary ACL Injury in Professional Soccer Players: A Matched-Cohort Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261419362

This matched-cohort study examined the association between axial tibiofemoral rotation and primary anterior cruciate ligament injuries in professional soccer players. The analysis found no significant association between increased internal tibiofemoral rotation and the risk of primary ACL injury. These findings challenge the hypothesis that axial malalignment is a primary risk factor for initial ACL tears in this population.

119. McAleese T, Mactier L, Bryan K, et al. Postoperative Anterior Cruciate Ligament–Return to Sport after Injury Scores Predict Reinjury in Adolescent Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671251410107

This longitudinal cohort study analyzed the relationship between Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scores and reinjury risk in adolescent athletes. The results demonstrated that preoperative and early postoperative ACL-RSI scores are significant predictors of subsequent ipsilateral and contralateral ACL injuries. Incorporating psychological readiness assessments into rehabilitation protocols may help identify adolescents at higher risk for reinjury.

120. Rteil A, Luft R, Koh J, et al. Sex-Specific Outcomes in Adolescent ACL Reconstruction: A Propensity-Matched Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261430730

This propensity-matched cohort study evaluated sex-specific outcomes following adolescent anterior cruciate ligament reconstruction using a large multicenter database. Male adolescents exhibited higher rates of rehabilitation utilization and certain postoperative complications compared to females at early follow-up intervals. These findings suggest that sex-specific considerations may be important for optimizing postoperative care and rehabilitation strategies in adolescent ACL reconstruction patients.

121. Matsuzaki Y, Jones RH, Tracey OC, et al. Validation of the ACL Return to Sport after Injury (ACL-RSI) Scale in Pediatric and Adolescent Patients After Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261426987

The study validated the ACL-RSI scale for assessing psychological readiness to return to sport in pediatric and adolescent patients following medial patellofemoral ligament reconstruction. Key findings demonstrated convergent and discriminant validity, supporting the scale's utility in this specific population. Clinically, this allows providers to reliably use the ACL-RSI to guide return-to-sport decisions for young patients after MPFLR.

125. Castle P, Prabhavalkar ON, Holloway MR, et al. Influence of Area Deprivation Index and Social Vulnerability Index on PROMIS Outcomes and MCID Achievement Following ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261438134

This cohort study investigated the influence of social determinants of health, specifically the Area Deprivation Index and Social Vulnerability Index, on outcomes following ACL reconstruction. Greater social deprivation and vulnerability were associated with worse PROMIS scores and lower odds of achieving the minimal clinically important difference. These results highlight the need to address social determinants to optimize recovery and equity in ACL reconstruction outcomes.

127. Fan C, Hsu J, Hsu W, et al. Association of Preoperative Asymmetry in Vertical Ground-Reaction Force With Knee Extensor Symmetry 1 Year After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261442212

This prospective study examined whether preoperative vertical ground-reaction force asymmetry predicts knee extensor strength symmetry one year after ACL reconstruction. Preoperative asymmetry was found to be a significant predictor of poorer postoperative strength symmetry and neuromuscular recovery. Clinically, assessing preoperative gait mechanics may help identify patients at risk for delayed functional recovery and guide targeted rehabilitation.

129. Trumper R, Ladd J, Jackson B, et al. Comparison of Early Strength Return Following Anterior Cruciate Ligament Reconstruction Comparing Patellar Tendon Grafts and Quadriceps Tendon Grafts. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00043

This study compares early strength return following anterior cruciate ligament reconstruction using patellar tendon grafts versus quadriceps tendon grafts. The research aims to determine if the greater graft volume of quadriceps tendon grafts results in different early rehabilitation trajectories and strength deficits compared to the traditional patellar tendon graft. These findings will help clarify the impact of graft choice on the timeline for returning to daily activities and sports.

130. Seagers K, Swaminathan K, Kolesar J, et al. Quantifying Anterior Cruciate Ligament Injury Resilience: A Screening and Composite Score Framework. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261433009

Researchers developed a screening framework to quantify anterior cruciate ligament injury resilience by identifying an optimal set of activities that explain full-body biomechanical risk factors. Using 3D motion capture data from adolescent athletes, they computed a composite score to assess modifiable risk factors more efficiently than current lengthy assessments. This framework aims to improve the adoption and compliance of ACL injury prevention programs by streamlining biomechanical screening.

132. Bonazza N, Sayegh J, Zvavamwe T, et al. Short-Term Postoperative Risks Associated With Contraceptive Use Prior to ACL Reconstruction in Female Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00049

This retrospective cohort study assessed whether preoperative hormonal contraceptive use is associated with increased short-term surgical complications following anterior cruciate ligament reconstruction in female patients. Using propensity score matching, the researchers compared outcomes such as infection, thromboembolism, and readmission rates between contraceptive users and non-users. The results provide evidence on the safety profile of continuing hormonal contraceptives during the perioperative period for ACL surgery.

136. Rivarola H, Collazo C, Palanconi M, et al. Higher Body Mass Index Is Associated with Smaller Hamstring Autograft Diameter in Primary Anterior Cruciate Ligament Reconstruction: A Consecutive Cohort Study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101141

This consecutive cohort study investigates the association between higher body mass index and smaller hamstring autograft diameter in patients undergoing primary anterior cruciate ligament reconstruction. The authors found that increased BMI is linked to reduced graft diameter, which may increase the risk of graft failure due to lower mechanical strength. These findings suggest that BMI should be considered when selecting graft types or planning surgical techniques for obese patients.

137. Kienberger S, Kratochwil L, Gotterbarm T, et al. Lateral Extra-Articular Procedures Reduce Anterior Cruciate Ligament Graft Failure in Patients Younger than 21 Years Undergoing Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101139

This systematic review evaluated the efficacy of concomitant lateral extra-articular procedures (LEAP) during primary anterior cruciate ligament reconstruction (ACLR) in patients aged 21 or younger. The findings indicate that LEAP significantly reduces ACL graft failure rates in this high-risk demographic. Clinically, these results support the routine consideration of LEAP to enhance graft survival in young patients undergoing primary ACLR.

141. Sae-Chua Pukrittayakamee N, Sukkarnkosol S, Apivatgaroon A, et al. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Partially Restores Tibiofemoral Rotational Alignment: A Reduction of Tibial Internal Rotation Toward Baseline.. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101148

This systematic review and meta-analysis evaluated long-term outcomes of meniscal allograft transplantation (MAT) beyond 10 years, finding consistent improvements in patient-reported outcome measures and moderate graft failure rates. The pooled data from over 1,000 patients demonstrated sustained functional benefits and activity levels despite the long-term follow-up period. These findings support MAT as a durable option for maintaining knee function in patients with symptomatic meniscal deficiency over a decade.

144. CRIPPA M, TURATI M, FLUMIAN C, et al. The Importance of Objective Functional and Balance Testing in Pediatric Anterior Cruciate Ligament Reconstruction for a Safe Return-To-Sport: A Two-Year Prospective Study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101149

Précis unavailable.

145. Almirón Santa-Bárbara R, Espejo-Reina A, Espejo-Reina MJ, et al. DOUBLE FEMORAL-DOUBLE TIBIAL TUNNEL CONFIGURATION IMPROVES LONG-TERM RETURN TO ACTIVITY COMPARED TO ANATOMIC SINGLE BUNDLE AND DOUBLE FEMORAL-SINGLE TIBIAL TUNNEL CONFIGURATIONS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A 12-YEAR RETROSPECTIVE COHORT STUDY.. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101150

This 12-year retrospective cohort study compared long-term outcomes of anatomic single-bundle ACL reconstruction against two double-bundle configurations, finding that the double femoral-double tibial tunnel technique yielded superior return-to-activity rates. The key finding suggests that tibial tunnel configuration significantly influences long-term functional recovery, challenging the assumption that double-bundle techniques are clinically equivalent regardless of tunnel placement. Clinically, surgeons may consider the double femoral-double tibial tunnel approach to optimize long-term activity levels in patients undergoing primary ACL reconstruction.

Meniscal Pathology and Preservation (15)¶

3. Ackermann J, Moews LD, Morgan JT, et al. Association Between Preoperative Joint Line Convergence Angle and Clinical Outcomes After Isolated Medial Meniscus Posterior Root Tear Repair. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261443314

This retrospective case series evaluated the association between preoperative joint line convergence angle (JLCA) and patient-reported outcomes after isolated medial meniscus posterior root tear repair. The study hypothesized that a higher JLCA would predict inferior outcomes and provide prognostic information independent of the hip-knee-ankle angle.

9. Torkaman P, Elahifar O, Fathi M, et al. Efficacy of repair techniques for meniscal root tears: a systematic review and meta-analysis. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-09704-1

This systematic review and meta-analysis compared the efficacy of various treatment techniques for meniscal root tears, including pull-out repair, all-inside repair, partial meniscectomy, and conservative management. The study found that both pull-out and all-inside repairs yielded significantly greater improvements in functional outcomes like Lysholm and IKDC scores compared to partial meniscectomy or conservative treatment. Clinically, these findings support surgical repair over non-operative management or meniscectomy for restoring function in patients with meniscal root tears.

16. von Essen C, Cristiani R, Rizvanovic D, et al. Bucket‐handle and medial meniscal tears exhibit higher failure rates after all‐inside repair with concomitant ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70457

This retrospective cohort study evaluated failure rates of all-inside meniscal repair during anterior cruciate ligament reconstruction across different tear morphologies. Medial repairs and bucket-handle tears exhibited significantly higher failure rates compared to lateral repairs and root or radial tears. Clinically, these results highlight the need for careful patient selection and potentially alternative repair strategies for high-risk tear types to minimize reoperation rates.

22. Shelbaya S, Trasatti E, Macey R, et al. Increased posterior tibial slope is associated with decreased short‐ and mid‐term survivorship after meniscal allograft transplantation. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70460

This retrospective cohort study evaluated the association between posterior tibial slope and survivorship following meniscal allograft transplantation. Increased posterior tibial slope was significantly associated with decreased short- and mid-term graft survivorship. These findings suggest that preoperative slope measurement may help identify patients at higher risk for graft failure.

48. Moran J, Amaral JZ, Ortiz E, et al. Delayed Surgical Treatment of Pediatric and Adolescent Medial Meniscus Posterior Root Tears Is Associated With Increased Odds of Medial Tibiofemoral Compartment Cartilage Injury: A Multicenter Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261442975

This multicenter case series investigated risk factors for medial tibiofemoral compartment cartilage injury in pediatric and adolescent patients undergoing repair for medial meniscus posterior root tears. The study found that delayed surgical treatment is associated with increased odds of developing cartilage injury in the medial compartment. These results underscore the importance of timely surgical intervention to prevent progressive cartilage degeneration in young patients with this specific meniscal injury.

53. Kim JS, Hwang UJ, Woo CW, et al. Healing Integrity Determines Meniscal Extrusion After Isolated Medial Meniscus Posterior Root Repair in Knees With No Lower Limb Malalignment. Arthroscopy 2026. doi:10.1002/arj.70337

This study investigated the relationship between meniscal healing integrity and extrusion following isolated medial meniscus posterior root repair, utilizing second-look arthroscopy to assess healing status. The results demonstrated that knees with lax healing exhibited significantly greater meniscal extrusion compared to those with non-lax healing at one-year follow-up. These findings imply that achieving robust mechanical healing is crucial for maintaining meniscal position and potentially preventing long-term joint degeneration after root repair.

64. Bachmaier S, Krych AJ, Bedi A, et al. Biomechanical Comparison of 4 Radial Meniscal Repair Techniques Including a Novel Dual Tie-Grip Configuration. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261439079

This biomechanical laboratory study compared four radial meniscal repair techniques, including a novel dual tie-grip configuration, in porcine medial menisci to evaluate fixation strength and cyclic displacement. The dual tie-grip repair demonstrated the highest initial compression load, least cyclic displacement, and highest failure strength compared to conventional double-horizontal, hybrid, and tie-grip repairs. These results suggest that the novel dual tie-grip technique offers superior biomechanical stability for complex radial meniscal tears.

67. Ebangwese S, Twomey‐Kozak J, Ralph JE, et al. Isolated Medial Meniscus Root Tears Show Elevated Posterior Tibial Slope and Pain Interference Scores Especially in Females. Arthroscopy 2026. doi:10.1002/arj.70211

This retrospective study compared patient-reported outcomes and radiographic parameters in patients with isolated medial meniscus root tears versus nonroot tears, finding that root tears are associated with elevated posterior tibial slope and higher pain interference scores, particularly in females. The results suggest that increased posterior tibial slope may be a contributing factor to the severe symptomatic presentation of isolated meniscal root tears.

68. Krych AJ, Tagliero AJ. Editorial Commentary : Meniscus Root Tears Hurt! Posterior Tibial Slope Is One Factor in a Complex Mechanical Environment. Arthroscopy 2026. doi:10.1002/arj.70225

This editorial commentary argues that while increased posterior tibial slope is associated with medial meniscus root tears and pain, it should be viewed as one component of a complex mechanical environment rather than the primary causal driver of symptoms. The authors emphasize that root tears represent critical joint-failure events requiring early recognition and treatment, regardless of the multifactorial nature of their biomechanical etiology.

70. Dzidzishvili L, Casanova F, López-Torres II, et al. Medial Meniscus Posterior Root Repair in Knees With ≥5° of Varus Alignment Is Associated With Greater Osteoarthritis Progression Compared With <5° Varus Alignment. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261444337

This case-control study assessed osteoarthritis (OA) progression after isolated medial meniscus posterior root (MMPR) repair, finding that patients with ≥5° of varus alignment experienced greater OA progression compared to those with normal alignment. The findings indicate that varus malalignment is a significant risk factor for structural deterioration following MMPR repair, suggesting the need for careful alignment assessment and potential corrective strategies.

79. Hashimoto S, Shimada T, Takase R, et al. Transtibial Centralization Using Peripheral Stabilization Suture Reduces Medial Meniscus Extrusion and Varus Progression 1 Year After Medial Meniscus Posterior Root Tear Repair. Arthroscopy 2026. doi:10.1002/arj.70198

This retrospective study evaluated the addition of a peripheral stabilization suture (PSS) to conventional transtibial pullout repair for medial meniscus posterior root tears. The PSS group demonstrated significantly less meniscal extrusion and reduced progression of varus alignment at one year compared to the conventional repair group. These structural benefits suggest that adding centralization techniques may improve the durability of meniscus root repairs.

80. Entessari M, Reynolds AW. Editorial Commentary : Is Standard Repair Enough for Posterior Medial Meniscus Root Tears? Early Promise of Meniscus Centralization. Arthroscopy 2026. doi:10.1002/arj.70212

This editorial commentary discusses the emerging evidence supporting meniscus centralization techniques as an augmentation to standard posterior medial meniscus root repair. It highlights that while root repair alone does not prevent osteoarthritis progression, centralization may reduce extrusion and mitigate early radiographic degeneration. The authors advocate for further study and clinical adoption of this technique to better protect the at-risk medial compartment.

122. Cox KG, Weldy JM, Beason DP, et al. Biomechanical Comparison of Knotless Suture Anchor Fixation Versus Transosseous Suture Button Fixation for Posterior Medial Meniscal Root Tears. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261443326

This biomechanical study compared knotless suture anchor fixation against traditional transosseous suture button fixation for posterior medial meniscal root tears in cadaveric knees. Results showed no significant differences in contact area or pressure between the two techniques, with both restoring near-intact values. The findings suggest that knotless suture anchors are a biomechanically viable alternative to traditional fixation methods for these tears.

138. Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Perez RD, et al. Repair of Anterior Meniscofemoral Ligament–Posterior Horn Junction Tear of the Lateral Meniscus: A report of four different cases. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101143

This case series describes the diagnosis and repair of tears at the anterior meniscofemoral ligament–posterior horn junction of the lateral meniscus, a lesion often missed on MRI. Four young, active patients underwent all-inside repairs, resulting in stable menisci and resolution of pain with no reoperations at 12-month follow-up. These findings suggest that recognizing and repairing this specific injury pattern can restore rotational stability and prevent chronic symptoms.

142. Yu V, Meglino N, Cohen D, et al. Meniscal Allograft Transplantation Maintains Function and Activity Beyond 10 Years with Moderate Graft Failure: A Systematic Review and Meta-Analysis. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101147

This two-year prospective study assessed functional movement, balance, and subjective knee function in skeletally immature patients following anterior cruciate ligament reconstruction (ACLR). Results showed significant improvements in functional movement screen scores and knee values over time, though no strong correlation was found between objective tests and subjective outcomes. These findings underscore the importance of comprehensive functional and balance testing to guide safe return-to-sport decisions in pediatric ACLR patients.

Total Knee Arthroplasty: Alignment and Robotics (20)¶

10. Jin W, Jiang X, Tao Y, et al. Automated assessment of coronal lower extremity alignment on long-leg radiographs using a deep-learning model: validation, efficiency gains, and superiority of an edge-based tibial joint-line definition. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-09980-x

Researchers developed and validated a fully automated deep learning system to measure 15 coronal lower-limb alignment parameters on standing long-leg radiographs, comparing two tibial joint-line definitions. The model demonstrated high accuracy with low absolute errors and superior performance using an edge-based tibial joint-line definition compared to expert consensus. This technology offers a highly efficient and accurate tool for assessing lower-limb alignment, potentially streamlining preoperative planning and reducing measurement variability in clinical practice.

12. Tuecking L, Ezechieli M, Barkhausen C, et al. Reduced length of stay and improved perioperative outcomes in robotic‐arm‐assisted TKA: A real‐world evidence study of 63,931 cases from German hospitals. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70437

This large-scale real-world evidence study analyzed perioperative outcomes of robotic-arm-assisted total knee arthroplasty (raTKA) versus non-robotic-assisted TKA in over 63,000 cases from German hospitals. The analysis revealed that raTKA was associated with reduced length of stay, lower rates of extended hospitalization, and fewer inpatient complications compared to non-robotic procedures. These results indicate that robotic assistance may offer significant perioperative benefits and improved efficiency in total knee arthroplasty practice.

18. Koutserimpas C, De Fazio A, Andriollo L, et al. Prior anterior cruciate ligament reconstruction: Comparable outcomes but reduced knee flexion after robotic functionally aligned total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70463

This retrospective study compared outcomes of robotic-assisted total knee arthroplasty in patients with prior anterior cruciate ligament reconstruction versus those without. While clinical outcomes and survivorship were comparable, patients with prior reconstruction exhibited significantly reduced knee flexion. These findings suggest that prior ACL surgery does not compromise implant survival but may limit range of motion.

19. Koutserimpas C, Veizi E, Tandogan R, et al. Reverse coronal deformity does not adversely affect clinical outcomes or early survivorship following image‐based robotic total knee arthroplasty performed under functional alignment. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70436

This study assessed whether reverse coronal deformity adversely affects outcomes in patients undergoing robotic-assisted total knee arthroplasty under functional alignment principles. The results indicated that patients with this deformity achieved clinical outcomes and early survivorship comparable to those without the deformity. This suggests that reverse coronal deformity is not a contraindication for this surgical approach.

27. Waldén J, Reito A, Niemeläinen M, et al. Preoperative age, BMI and KL grade predict long‐term functional outcome of knee arthroplasty better than CPAK‐classification. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70455

This prospective cohort study assessed predictors of long-term functional outcomes in 250 patients undergoing total knee arthroplasty, comparing the CPAK classification against baseline variables like age, BMI, and Kellgren-Lawrence grade. The analysis revealed that preoperative age, BMI, and Kellgren-Lawrence grade were stronger predictors of Oxford Knee Score outcomes at 1, 2, and 5 years than the CPAK classification. These findings suggest that traditional demographic and radiographic factors may be more reliable for prognosticating long-term functional success than coronal alignment classifications.

28. Hurtado‐Avilés J, Lajara‐Marco F, Moya‐Angeler J, et al. Redefining coronal knee alignment: A population‐specific centre‐of‐mass framework beyond coronal plane alignment of the knee thresholds. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70439

This methodological study introduced a population-specific framework for coronal knee alignment based on the center of mass of the arithmetic hip-knee-ankle angle and joint line obliquity distribution. By applying this geometric-statistical model to four datasets, the authors demonstrated a new way to characterize alignment deviations without relying on fixed CPAK thresholds. While not a clinical validation, this approach offers a descriptive alternative to traditional classification systems that may be sensitive to minor measurement variations.

31. León‐Muñoz VJ, Moya‐Angeler J, Santonja‐Medina F, et al. Sensitivity to measurement errors in the CPAK classification may affect the accuracy of coronal knee alignment classification. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70438

This study evaluated the sensitivity of the coronal plane alignment of the knee (CPAK) classification to clinically plausible measurement errors in mechanical angles. The analysis revealed that small measurement errors significantly altered CPAK category distributions across diverse populations, indicating high sensitivity to technical variability. These findings suggest that the CPAK classification may lack robustness in clinical settings where precise radiographic measurement is challenging.

32. Martinson ES, Williamson TR, Super JT, et al. Lateral robotic‐assisted unicompartmental knee arthroplasty shows excellent early to mid‐term survivorship, satisfaction and joint‐specific outcome: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70464

This systematic review and meta-analysis assessed the survivorship, complications, and patient-reported outcomes of robotic-assisted lateral unicompartmental knee arthroplasty. The results demonstrated excellent early to mid-term survivorship rates and high patient satisfaction, supporting the efficacy of robotic assistance for this technically demanding procedure. Robotic-assisted lateral UKA appears to be a viable and effective treatment option for isolated lateral compartment osteoarthritis.

46. Liebensteiner M, Pedross F, Neururer S, et al. Restoration of CPAK type in total knee arthroplasty does not lead to superior clinical outcome: A study based on arthroplasty registry data. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70446

This registry-based study evaluated whether restoring the Coronal Plane Alignment of the Knee (CPAK) type during total knee arthroplasty improves clinical outcomes or implant survival compared to maintaining the pre-operative CPAK type. The results showed no difference in patient-reported outcomes or implant survival between patients whose CPAK type changed versus those who remained the same. These findings suggest that strict restoration of pre-operative CPAK type is not necessary for achieving superior clinical results in total knee arthroplasty.

62. Pongkunakorn A, Iamsumang C, Sumethvanich S, et al. Accuracy of digital inclinometers for measuring knee extension during total knee arthroplasty: comparison with visual estimation and computer navigation. Arthroplasty 2026. doi:10.1186/s42836-026-00392-9

This prospective comparative study evaluated the accuracy and reliability of a digital inclinometer technique for measuring knee extension during total knee arthroplasty, using computer navigation as the reference standard. The digital inclinometer demonstrated significantly higher accuracy and reliability compared to visual estimation, which consistently underestimated extension angles. These findings support the adoption of digital inclinometers over visual estimation to improve intraoperative assessment and potentially enhance postoperative functional outcomes.

74. Hu H, Lin M, Huang C, et al. The correlation between preoperative patellar tilt and clinical outcomes following unicompartmental knee arthroplasty. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06896-z

This retrospective study investigated the impact of preoperative patellar tilt on outcomes following unicompartmental knee arthroplasty (UKA). Patients with abnormal preoperative patellar tilt (≥10°) experienced significantly worse clinical outcomes, including higher pain scores and lower functional scores, despite achieving similar radiographic alignment as those with normal tilt. These findings indicate that preoperative patellar alignment is a critical prognostic factor for UKA success independent of mechanical axis correction.

75. Zhi X, Liu T, Ren P, et al. Comparison of the learning curves of the osteotomy guide robot and guide plate-based robot-assisted total knee arthroplasty. Arthroplasty 2026. doi:10.1186/s42836-026-00388-5

This prospective study compared the learning curves and clinical outcomes of two robotic systems used in total knee arthroplasty (TKA). While both systems demonstrated similar learning curve inflection points, the osteotomy guide robot required significantly longer operative times compared to the guide plate-based robot. The results suggest that while both are viable, the guide plate-based system may offer greater efficiency during the initial adoption phase.

76. Oshima Y, Yoshida H, Majima T. Surgical technique of robotic arm-assisted total knee arthroplasty via the lateral parapatellar approach for valgus knee deformity. Arthroplasty 2026. doi:10.1186/s42836-026-00387-6

Précis unavailable.

77. Wang B, Li C, Gao D, et al. The coronal plane alignment of the knee (CPAK) classification has three‐dimensional limitations: Evidence from EOS imaging. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70407

This study assessed the three-dimensional limitations of the Coronal Plane Alignment of the Knee (CPAK) classification using EOS imaging in a large cohort. The results showed that most 3D alignment parameters did not significantly differ across CPAK types after adjusting for demographic factors, indicating limited predictive value for sagittal and axial alignment. This suggests that CPAK alone may be insufficient for comprehensive preoperative planning in total knee arthroplasty.

114. Zhu J, Wang Q, Lin X, et al. Ligament-tension-guided versus fixed-angle distal femoral coronal target selection in primary total knee arthroplasty using a manual alignment workflow: a retrospective cohort study. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-09912-9

This retrospective cohort study compared ligament-tension-guided extramedullary alignment with conventional intramedullary alignment in primary total knee arthroplasty. The ligament-tension-guided approach demonstrated superior coronal precision by utilizing full-extension tension feedback rather than fixed angular settings. These findings suggest that tension-based workflows may improve alignment accuracy and extension-gap symmetry in TKA.

139. Sedransk OB, White AE, Oji NM, et al. Robotic-assisted ligament-guided unicompartmental knee arthroplasty for medial compartment osteoarthritis: current concepts. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101142

This review examines robotic-assisted, ligament-guided unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis, highlighting its improved technical reproducibility and survivorship compared to historical data. Contemporary studies demonstrate durable outcomes with high patient satisfaction and superior functional scores compared to total knee arthroplasty. These findings support the use of robotic-assisted UKA as a viable alternative to TKA for eligible patients seeking faster recovery and better joint awareness.

153. Hwang R, Quevedo-Gonzalez FJ, Burgio C, et al. Standardized Sagittal Alignment Targets Fail to Restore Native Medial and Lateral Posterior Tibial Slope in Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.120

This study utilized preoperative CT scans to measure medial and lateral posterior tibial slope (PTS) in 591 patients undergoing robotic-assisted total knee arthroplasty, revealing significant variability and gender differences in native anatomy. The findings indicate that standardized sagittal alignment targets often fail to restore individual native medial and lateral PTS values. Clinically, this suggests that personalized alignment strategies may be necessary to better replicate native kinematics rather than relying on uniform targets.

154. Kawaguchi K, Young SW, Tay ML, et al. Does the Magnitude of Change in Coronal Plane Alignment of the Knee Affect Clinical Outcomes in Functional and Mechanical Alignment Total Knee Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.112

This substudy of a randomized controlled trial compared coronal alignment changes and clinical outcomes between functional and mechanical alignment total knee arthroplasty in 236 patients. Functional alignment resulted in smaller alignment changes and more frequent restoration of preoperative phenotypes, though the study focused on whether the magnitude of change influenced patient-reported outcomes. The results imply that preserving native alignment characteristics may be a key factor in optimizing postoperative satisfaction and functional recovery.

156. Omran K, Wixted CM, Waren D, et al. Technology-Assisted Total Knee Arthroplasty Is Associated With Faster Initial Recovery, but Similar 1-Year Outcomes: A Retrospective Cohort Study of Patient-Reported Outcomes in 2,002 Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.005

This retrospective cohort study of 2,002 patients compared the time to achieve minimal clinically important difference (MCID) among robotic-assisted, navigation-assisted, and conventional total knee arthroplasty. Technology-assisted techniques were associated with a faster initial recovery to MCID, although all groups achieved similar outcomes at one year. Clinically, this suggests that while robotic and navigation systems may accelerate early functional recovery, they do not necessarily yield superior long-term patient-reported outcomes compared to conventional methods.

161. Lee DW, Ro DH, Han H. Limited Femoral Joint-Line Alteration and Preserved Extension Lateral Laxity Enhanced Early Outcomes in restricted kinematic alignment TKA. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.029

This retrospective study evaluated the impact of alignment changes and intraoperative gap characteristics on early outcomes in robotic restricted kinematic alignment TKA. Smaller alterations in hip-knee-ankle and lateral distal femoral angles were independently associated with higher two-year Knee Society Knee Scores. These findings suggest that minimizing femoral joint-line alteration may enhance early functional outcomes in rKA TKA.

Periprosthetic Joint Infection and Revision Surgery (11)¶

2. Hartman CW. CORR Insights®: What Is the Fate of Retained Antibiotic Spacers After First-stage Revision for Periprosthetic Joint Infection?. Clinical Orthopaedics & Related Research 2026. doi:10.1097/corr.0000000000003993

This CORR Insights® commentary discusses the clinical outcomes and fate of retained antibiotic spacers following first-stage revision surgery for periprosthetic joint infection. It highlights the significant morbidity associated with PJI and contextualizes findings from Sarfraz and colleagues regarding the management of these complex infections.

15. Oettl FC, Senorski EH, Pruneski J, et al. Allograft use and fixed suspensory fixation increase revision risk in multiple revision anterior cruciate ligament reconstruction: A Swedish knee ligament registry study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70433

This registry study assessed risk factors for graft failure and patient-reported outcomes following multiple revision anterior cruciate ligament reconstruction (mrACLR). The analysis found that the use of allografts and fixed suspensory fixation were associated with significantly higher revision risks compared to other techniques. These findings suggest that surgeons should consider alternative graft sources and fixation methods to improve durability in complex revision scenarios.

60. Lunz A, Fell J, Koch K, et al. Preoperative predictors of spacer retention and mortality in two-stage revision for infected total hip arthroplasties: a single-center experience of 90 patients. Arthroplasty 2026. doi:10.1186/s42836-026-00394-7

This single-center retrospective cohort study analyzed preoperative risk factors for spacer retention and mortality in 90 patients undergoing two-stage revision for infected total hip arthroplasties. Successful reimplantation was significantly associated with the use of articulating hip spacers and favorable periarticular soft tissue conditions, while mortality rates were also evaluated. The findings suggest that specific preoperative factors, particularly spacer type and soft tissue status, are critical predictors of short-term outcomes in this complex surgical setting.

85. Mullen MT, Urvater MK, Hillis E, et al. Antibiotic Prophylaxis for Dental Procedures Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.079

This systematic review and meta-analysis assessed the association between antibiotic prophylaxis during dental procedures and the risk of periprosthetic joint infection in patients with total joint arthroplasty. The analysis of four retrospective cohort studies involving over 157,000 patients found no significant protective effect of antibiotic prophylaxis against periprosthetic joint infection. These results challenge traditional guidelines and suggest that routine antibiotic prophylaxis for dental procedures may not be necessary for most arthroplasty patients.

97. Shankar DS, Kubsad S, Hernandez GE, et al. Metal Hypersensitivity Is Associated With Inferior Implant Survivorship in Total Knee Arthroplasty, but Not Total Hip Arthroplasty: A Large-Database Matched-Cohort Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.018

This large-scale matched-cohort study analyzed national claims data to determine if preoperative metal hypersensitivity (MHS) increases revision risk in total hip or knee arthroplasty. The findings revealed that while MHS was associated with inferior implant survivorship in total knee arthroplasty, it did not significantly impact outcomes in total hip arthroplasty. Clinically, this suggests that MHS should be carefully considered in TKA surgical planning but may be less critical for THA decision-making.

102. Plancher KD, Kalala SC, Fleissig JC, et al. One- Versus Two-Component Single-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infections: Medical Complications, Hospital Readmissions, and Failures. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.009

This propensity-matched study compared medical complications, readmissions, and failure rates between one- and two-component single-stage exchange total knee arthroplasty for periprosthetic joint infection. One-component exchanges were associated with significantly higher odds of infection-related readmissions and higher five-year failure rates compared to two-component exchanges. These results suggest that two-component exchanges may offer better durability and lower infection recurrence risks in single-stage revision settings.

104. Huguet R, Fabre T, Crenn V, et al. Quality of Life and Outcomes After Treatment Failure for Recurrent Periprosthetic Joint Infection of Total Knee Arthroplasty: A Multicenter Retrospective Comparison of Transfemoral Amputation, Arthrodesis, and Permanent Spacer. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.017

This multicenter retrospective study compared quality of life and outcomes after treatment failure for recurrent periprosthetic joint infection using transfemoral amputation, arthrodesis, or permanent spacers. Transfemoral amputation resulted in significantly better quality of life scores and functional outcomes compared to permanent spacers and arthrodesis. These findings suggest that amputation may be the most effective option for restoring quality of life in patients with recurrent knee infections who have failed previous treatments.

151. Kanumuri SD, Dasari SP, Roth OS, et al. The Efficacy of Cefazolin Alternatives for Periprosthetic Joint Infection Prevention after Primary Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.070

This systematic review and meta-analysis compared periprosthetic joint infection rates in patients receiving cefazolin versus non-cefazolin prophylaxis for primary total joint arthroplasty. The analysis found that patients treated with cefazolin were significantly less likely to develop infections compared to those treated with vancomycin or higher-generation cephalosporins. These results reinforce current guidelines recommending first-generation cephalosporins as the preferred prophylactic antibiotic for joint arthroplasty.

167. Raju A, Jahagirdar O, Pour AE, et al. No Improvement in Infection or Complication Rate with Extended Oral Antibiotic Prophylaxis After Primary Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.044

This retrospective cohort study evaluated the efficacy of extended oral antibiotic prophylaxis in preventing periprosthetic joint infection and other complications after primary total joint arthroplasty. The analysis found no improvement in infection or complication rates with the use of extended oral antibiotics compared to standard care. These results suggest that extended oral antibiotic prophylaxis does not provide additional benefit for high-risk patients.

169. Hoskins W, Gusho C, McAuliffe M, et al. The AAHKS Surgical Techniques and Technologies Award: What is the Ideal Technique and Implant in Aseptic Revision Total Knee Arthroplasty? An Analysis of Second Revision and Component Loosening Rates from the Australian Orthopaedic Association National Joint Replacement Registry. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.046

This registry analysis of 22,238 aseptic revision TKAs compared second-revision rates across various component revision strategies and fixation methods. Complete revision utilizing femoral and tibial stems with porous metal augments demonstrated superior survivorship compared to other constructs. These findings suggest that comprehensive revision with robust fixation strategies may optimize long-term outcomes in aseptic revision TKA.

170. Forlenza EM, Serino J, Hietpas K, et al. Trends in Reimbursement for One- Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.062

This study compared reimbursement and opportunity costs for one- versus two-stage exchange arthroplasty for periprosthetic joint infection. One-stage exchanges were found to be more cost-effective for surgeons due to higher cumulative reimbursement despite lower per-case payments. These results indicate that financial disincentives may currently discourage the adoption of one-stage procedures despite their comparable efficacy.

Patellofemoral Instability and Pain (8)¶

11. Erden T, Ağır M, Kayaalp ME, et al. Durable patellar stability and high patient‐reported success at minimum 5‐year follow‐up after isolated suture tape MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70466

This retrospective study evaluated the mid-to-long-term outcomes of isolated medial patellofemoral ligament reconstruction using high-strength suture tape in patients with recurrent patellar instability. The results showed durable patellar stability and high patient-reported success rates at a minimum five-year follow-up, with significant improvements in clinical scores and low reoperation rates. These findings suggest that isolated MPFL reconstruction with suture tape is a reliable and effective treatment option for selected patients without major osseous risk factors.

21. Hsu C, Morgan JJ, Callahan DM, et al. Asymmetrical lower extremity biomechanics during squats and drop jumps in adolescents with MPFL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70442

This study investigated lower extremity biomechanics during squats and drop vertical jumps in adolescent athletes following medial patellofemoral ligament reconstruction. The surgical limb demonstrated greater hip power and altered joint mechanics compared to the uninjured limb and controls. These asymmetries highlight the need for targeted rehabilitation strategies to restore movement symmetry.

29. Sasanelli F, Zordan R, Suzuki L, et al. Quadriceps malalignment is strongly associated with recurrent patellofemoral instability in native knees. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70448

This retrospective comparative study analyzed computed tomography scans to determine the association between quadriceps malalignment and recurrent patellofemoral instability in native knees. The results demonstrated that quadriceps malalignment, measured by the quadriceps tendon axial angle, is strongly associated with recurrent instability compared to controls. This highlights quadriceps alignment as a critical anatomical risk factor that should be assessed in patients with recurrent patellar instability.

38. Kayll SA, Hinman RS, Bryant AL, et al. The Effect of Minimalist Versus Motion Control Shoes on Patellofemoral Joint Forces in Adolescents With Patellofemoral Pain During Running: A Randomized Crossover Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261443316

This randomized crossover study compared the effects of minimalist versus motion-control shoes on patellofemoral joint forces in adolescents with patellofemoral pain during running. The results showed that minimalist shoes significantly reduced resultant patellofemoral joint forces compared to motion-control shoes, supporting the hypothesis that footwear modification can alter joint loading. These findings suggest that minimalist footwear may be a beneficial non-operative intervention for reducing stress on the patellofemoral joint in this patient group.

74. Hu H, Lin M, Huang C, et al. The correlation between preoperative patellar tilt and clinical outcomes following unicompartmental knee arthroplasty. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-06896-z

This retrospective study investigated the impact of preoperative patellar tilt on outcomes following unicompartmental knee arthroplasty (UKA). Patients with abnormal preoperative patellar tilt (≥10°) experienced significantly worse clinical outcomes, including higher pain scores and lower functional scores, despite achieving similar radiographic alignment as those with normal tilt. These findings indicate that preoperative patellar alignment is a critical prognostic factor for UKA success independent of mechanical axis correction.

113. Daungsupawong H, Wiwanitkit V. Measures of Patellofemoral Morphology Predict the Risk of Local Cartilage Damage Progression: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261426981

This letter critiques a study linking patellofemoral morphology to cartilage damage, highlighting statistical limitations such as the use of cross-sectional data and potential model instability. The authors argue that these methodological constraints prevent definitive causal conclusions and suggest the need for more robust longitudinal research. Consequently, clinicians should interpret such morphological predictors with caution until causality is better established.

147. Song BM, Ford CA, Schneider AM, et al. Is Inflammatory Arthritis an Absolute Indication for Patellar Resurfacing in Total Knee Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.094

This retrospective study compared outcomes of total knee arthroplasty with and without patellar resurfacing in patients with inflammatory arthritis versus osteoarthritis, finding no significant difference in reoperation or complication rates between the groups. The data indicates that inflammatory arthritis is not an absolute indication for patellar resurfacing, as outcomes are comparable to non-resurfaced osteoarthritis knees. These findings support a more selective approach to patellar resurfacing in inflammatory arthritis patients rather than routine application.

163. Avila A, Yassin S, Rodney K, et al. Ipsilateral Knee Reoperation Rates Following Patello-Femoral Arthroplasty: Analysis of a Statewide Database. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.031

This retrospective cohort study analyzed ipsilateral knee reoperation rates following primary patello-femoral arthroplasty using a statewide claims database. The study determined the cumulative incidence and temporal patterns of reoperations, categorizing them by procedure type and identifying associated risk factors. These findings characterize the reoperation landscape for PFA, aiding in patient counseling and surgical planning.

73. Kirchner GJ. CORR Insights®: Which Neighborhood-level Metric Is Most Appropriate for Pediatric Sports Medicine Disparities Research?. Clinical Orthopaedics & Related Research 2026. doi:10.1097/corr.0000000000003977

Maxwell et al. evaluated area-based socioeconomic indices to determine the most appropriate metric for pediatric sports medicine disparities research. They found that the Child Opportunity Index (COI) is more suitable than the Area Deprivation Index (ADI) for this population because it better captures developmental and social support factors. This suggests researchers should prioritize COI when studying how social determinants affect pediatric orthopedic outcomes.

81. Zha G, Wu H, Bao G, et al. The Majority of Total Joint Arthroplasty Patients Have Hypovitaminosis D: An Analysis From a Single Tertiary Care Center in China. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.019

This study analyzed serum vitamin D levels in 384 patients undergoing elective total joint arthroplasty to determine the prevalence of hypovitaminosis D and associated screening and treatment rates. The findings revealed a high prevalence of vitamin D deficiency and insufficiency among this population, highlighting a gap in prehospital screening and management. These results suggest that routine vitamin D assessment and supplementation should be considered standard care to potentially mitigate postoperative complications in TJA patients.

82. Yao K, Yue C, Li Y, et al. Association of Metformin Use With Osteoarthritis Incidence, Progression, and Joint Arthroplasty Risk in the Knee and Hip: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.050

This systematic review and meta-analysis evaluated the impact of metformin on osteoarthritis incidence, progression, and joint arthroplasty risk across 13 studies involving over 167,000 patients. The analysis demonstrated that metformin use was associated with a significantly lower incidence of hip and knee osteoarthritis, reduced cartilage loss, and a decreased risk of requiring joint arthroplasty. These findings support the potential disease-modifying role of metformin in osteoarthritis management, warranting further clinical investigation into its therapeutic applications.

87. Browne VG, Suleiman LI, Cohen-Rosenblum AR. GLP-1 Receptor Agonist Weight Loss Therapy and Arthroplasty: Are Women at Greater Risk for Complications?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.03.063

This editorial discusses the disproportionate use of GLP-1 receptor agonists among women undergoing arthroplasty and raises concerns about potential gender-specific risks for complications. It highlights that women are more likely to use these medications for weight loss prior to joint replacement, potentially due to higher rates of severe obesity in this demographic. The authors call for further research to determine if GLP-1 use confers unique perioperative risks for women, emphasizing the need for tailored clinical guidelines.

88. Garabedian M, Legler J, Benzouak T, et al. Efficacy of Lower-Limb Wearables to Assess Recovery Following Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.023

This systematic review and meta-analysis evaluated the efficacy of lower-limb wearable sensors in monitoring recovery following total hip or knee arthroplasty by assessing objective physical activity and range of motion. The inclusion of 10 studies demonstrated that wearable devices can provide valuable, objective data on postoperative recovery metrics such as step counts and joint mobility. These findings suggest that wearables offer a promising tool for remote patient monitoring and rehabilitation assessment, complementing subjective patient-reported outcomes.

91. Katanbaf R, Misch M, Hoveidaei AH, et al. Income Inequality Quantified by the Gini Index Is an Indicator for Adverse Total Knee Arthroplasty Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.039

This study investigated the association between the Gini Index, a measure of income inequality, and short-term complications following total knee arthroplasty. Patients residing in areas with high income inequality demonstrated significantly increased rates of all-cause revisions and mechanical complications within one year post-surgery. This suggests that socioeconomic disparity is a critical social determinant of health that should be considered when assessing surgical risk and planning postoperative care.

100. Jia L, Khan ST, Pasqualini I, et al. Preoperative Psychiatric Diagnosis Predicts Worse Patient-Reported Outcome Measures, Higher Dissatisfaction, and Increased Health Care Utilization Following Total Knee Arthroplasty: Analysis of Over 13,000 Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.015

This analysis of over 13,000 patients examined the impact of preoperative psychiatric diagnoses on outcomes following total knee arthroplasty. Patients with psychiatric conditions experienced worse patient-reported outcome measures, higher dissatisfaction rates, and increased healthcare utilization compared to those without such diagnoses. These findings highlight the need for targeted preoperative optimization and realistic expectation setting for patients with psychiatric comorbidities undergoing TKA.

111. Megafu M, Solomito MJ, Carangelo R, et al. The Effectiveness of the Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score Versus the Brief Resiliency Scale at Identifying the Potential for Poor Outcomes Following Elective Total Knee and Hip Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.034

This study compared the predictive value of the Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-score (MHT) and the Brief Resiliency Scale (BRS) for identifying poor outcomes after elective joint arthroplasty. Both tools were associated with postoperative outcomes, but the MHT demonstrated superior predictive strength for key clinical metrics.

125. Castle P, Prabhavalkar ON, Holloway MR, et al. Influence of Area Deprivation Index and Social Vulnerability Index on PROMIS Outcomes and MCID Achievement Following ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261438134

This cohort study investigated the influence of social determinants of health, specifically the Area Deprivation Index and Social Vulnerability Index, on outcomes following ACL reconstruction. Greater social deprivation and vulnerability were associated with worse PROMIS scores and lower odds of achieving the minimal clinically important difference. These results highlight the need to address social determinants to optimize recovery and equity in ACL reconstruction outcomes.

131. Vosoughi F, Ayati Firoozabadi A, Amiri A, et al. Effect of Vitamin D Supplementation on Total Knee Arthroplasty Outcomes: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261432670

This systematic review evaluates the impact of perioperative vitamin D supplementation on outcomes following total knee arthroplasty, including wound healing, pain, and infection rates. The authors analyzed studies to determine if correcting hypovitaminosis D improves early postoperative recovery and reduces complications like periprosthetic joint infections. The findings aim to establish clinical guidelines for vitamin D management in TKA patients to enhance surgical outcomes.

148. Klatt BA, O’Malley M, Ayazbekova A, et al. Nanotechnology-Based Device Reduces Pain and Immediate Opioid Requirements and Facilitates Earlier Discharge From the Hospital Following Total Knee Arthroplasty: A Randomized Placebo-Controlled Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.083

This randomized placebo-controlled trial evaluated a nanotechnology-based device for pain management after total knee arthroplasty, finding it significantly reduced 24-hour opioid consumption and shortened hospital length of stay. Patients using the active device also reported lower pain at rest and reduced postoperative nausea compared to the sham group. The device offers a viable opioid-sparing strategy that facilitates earlier discharge and reduces immediate postoperative analgesic requirements.

164. Ramirez MM, Horn ME, George SZ, et al. Development of Machine Learning Algorithms Predicting Psychological Distress After Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.039

This study developed and evaluated machine learning models to predict high postoperative psychological distress using only preoperative data from total joint arthroplasty patients. Among several algorithms tested, models utilizing preoperative demographic, clinical, and patient-reported data demonstrated performance in identifying high-distress phenotypes. This approach offers a potential tool for preoperative risk stratification to improve postoperative care.

166. Benotti PN, Wood G, Irving B, et al. Impact Of Prior Bariatric Surgery Versus Immediate Total Knee Arthroplasty On Knee Function Among Patients Who Have Severe Obesity And Advanced Knee Osteoarthritis: The SWIFT Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.033

The SWIFT Trial compared functional knee outcomes in severely obese patients with advanced osteoarthritis undergoing bariatric surgery versus immediate total knee arthroplasty. The study examined how surgical weight loss impacts the pursuit and results of subsequent TKA compared to immediate intervention. These findings inform clinical decision-making regarding the timing of TKA in the context of severe obesity management.

171. Landy DC, Baur AJ, Helvie PF, et al. Preoperative Nutritional Labs Are Infrequently Obtained and Weakly Associated with 90-Day Reoperation Following Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.064

This large-scale study evaluated the frequency of preoperative nutritional lab testing and its association with 90-day reoperation following total knee arthroplasty. Nutritional labs were infrequently obtained and rarely abnormal, with no significant association found between low values and reoperation rates. These findings challenge the routine use of nutritional screening for predicting early reoperation in TKA patients.

173. Kang H, Ilyas MH, Freeman I, et al. Does Obstructive Sleep Apnea Affect Complications or Patient-Reported Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.056

This propensity-matched analysis compared postoperative complications and patient-reported outcome measures between patients with and without obstructive sleep apnea undergoing primary TKA. The study found no significant differences in medical complications or PROMs between the two groups after matching for comorbidities. These results suggest that OSA alone may not negatively impact short- to mid-term outcomes following primary TKA.

Other articles this month¶

4. Tagliero AJ, Smith J, Iyer S, et al. Comparison of Multiligament Reconstruction in Individuals With BMI >30 and <30 kg/m ². The American Journal of Sports Medicine 2026. doi:10.1177/03635465261442974

This propensity-matched retrospective study compared clinical and functional outcomes of multiligament knee reconstruction in patients with a BMI greater than 30 kg/m² versus those with a BMI less than 30 kg/m². The analysis focused on patient-reported outcome measures, complication rates, and revision rates at a minimum two-year follow-up.

6. Deardurff RM, Grood ES, Nolan J, et al. Injuries to Multiple Ligamentous and Capsular Structures Cause Abnormal Knee Hyperextension: A Robotic Study in Human Knees. Arthroscopy 2026. doi:10.1002/arj.70319

This robotic cadaveric study investigated the relationship between multiple ligamentous and capsular structures and abnormal knee hyperextension under simulated multidirectional injuries. The results demonstrated that posterior capsule disruption alone did not cause major increases in hyperextension, but combined injuries involving the ACL and posterolateral structures significantly increased knee laxity.

7. Ilahi OA. Editorial Commentary : Routine Medical Thromboprophylaxis Following Knee Arthroscopy Has Low Utility—If Any. Arthroscopy 2026. doi:10.1002/arj.70342

This editorial commentary argues that routine medical thromboprophylaxis following knee arthroscopy has low utility due to the very low rate of symptomatic venous thromboembolism. It suggests that while universal prophylaxis is unnecessary, targeted use of aspirin may be prudent for patients at higher risk of clotting.

8. Albrecht A, Kapral L, Gruber F, et al. Prophylactic Enoxaparin Reduces Symptomatic Venous Thromboembolism Compared With No Chemoprophylaxis Within 95 Days After Knee Arthroscopy. Arthroscopy 2026. doi:10.1002/arj.70341

This population-based cohort study investigated whether prophylactic enoxaparin reduces symptomatic venous thromboembolism within 95 days after knee arthroscopy compared to no chemoprophylaxis. The study analyzed outcomes in nearly 100,000 patients to assess the efficacy and safety of low-molecular-weight heparin in preventing postoperative clots.

13. Li W, Lv Y, Wang M, et al. Polypropylene Mesh Augmentation in Posterior Cruciate Ligament Reconstruction Improves Biomechanical Performance Without Additional Inflammation: A Biomechanical Study in an Animal Model. Arthroscopy 2026. doi:10.1002/arj.70320

This biomechanical study in a rabbit model evaluated the effects of mesh augmentation on autografts in posterior cruciate ligament (PCL) reconstruction. Mesh-augmented grafts demonstrated significantly improved biomechanical stability, including higher ultimate load-to-failure and stiffness, without inducing additional inflammation or adverse histological changes. These findings suggest that mesh augmentation can enhance graft integrity and healing potential, providing a biomechanical rationale for further clinical investigation.

14. Zhu J, Dong J. Editorial Commentary : A Stronger Posterior Cruciate Ligament Graft Is Encouraging, But Mesh Augmentation Still Needs More Study. Arthroscopy 2026. doi:10.1002/arj.70321

This editorial commentary discusses the biomechanical benefits of mesh augmentation in posterior cruciate ligament reconstruction, noting improved graft strength and reduced elongation in animal models. However, the author cautions that current clinical evidence does not yet demonstrate superior patient-reported outcomes or reduced laxity compared to standard techniques. Consequently, mesh augmentation remains a promising but unproven adjunct that is not yet ready to change routine clinical practice.

23. Biswas A, Gaurav A, Chattopadhyay A, et al. Incomplete graft maturation at 1 year after all‐inside anterior cruciate ligament reconstruction using peroneus longus autograft: A prospective diffusion tensor imaging study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70456

This prospective study used diffusion tensor imaging to evaluate the maturation of peroneus longus tendon autografts one year after anterior cruciate ligament reconstruction. The imaging parameters indicated incomplete graft maturation at the one-year mark compared to native ligament values. This suggests that biological healing may lag behind functional recovery timelines in these patients.

24. Medvecky MJ, Ayhan EM, Salandra JM, et al. Establishing the indications for temporising knee‐spanning external fixation: A modified Delphi study of the International Knee Dislocation Study Group. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70461

This modified Delphi study established consensus-driven indications for using temporising knee-spanning external fixation in the management of knee dislocations. The panel reached unanimous agreement on specific scenarios requiring this intervention, such as inability to maintain reduction. These guidelines aim to standardize the use of this invasive technique for limb-threatening injuries.

25. Bakhshi M, Lux A, Mueller MM, et al. Limited correlation between clinical failure and MRI graft status in the setting of revision anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70454

This prospective case series evaluated the correlation between clinical failure and MRI graft status in 81 patients with clinically failed anterior cruciate ligament reconstructions. The study found that only 63% of clinically failed grafts were ruptured on MRI, indicating a limited correlation between clinical instability and graft integrity. Clinicians should not rely solely on MRI to confirm graft rupture when clinical instability is present, as intact grafts may still cause functional failure.

26. Romero‐Padron MA, Kallman T, Amirtharaj M, et al. Persistent magnetic resonance imaging‐derived static anterior tibial translation after anterior cruciate ligament reconstruction is associated with elevated cartilage T2 relaxation times but not serum biomarkers. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70453

This secondary analysis investigated the relationship between persistent static anterior tibial translation and early osteoarthritis markers in 29 patients following anterior cruciate ligament reconstruction. Results showed that elevated static anterior tibial translation was associated with increased cartilage T2 relaxation times but not with serum biomarkers of cartilage degradation. This suggests that mechanical instability may drive early cartilage changes detectable by quantitative MRI, independent of systemic inflammatory markers.

33. Abbasian M, Moteshakereh SM, Zarei H, et al. Slope‐Reducing Osteotomy Accompanied by Revision Anterior Cruciate Ligament Reconstruction Improves Knee Stability and Function: A Systematic Review and Meta‐analysis. Arthroscopy 2026. doi:10.1002/arj.70223

This systematic review and meta-analysis evaluated the clinical and radiographic outcomes of revision anterior cruciate ligament reconstruction combined with anterior closing-wedge high tibial osteotomy for posterior tibial slope reduction. The study found statistically significant improvements in posterior tibial slope, knee stability, and functional scores following the procedure. These findings suggest that slope-reducing osteotomy is a viable adjunct to revision ACL reconstruction for improving knee stability and function.

40. Sangaletti R, Meissner N, Pungitore M, et al. Contemporary cementless patellar resurfacing in total knee arthroplasty is associated with a low early complication rate across residual bone thicknesses. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70444

Précis unavailable.

42. Ehlers M, Kurtz J, Jazrawi L, et al. No difference in anterior knee pain after anterior cruciate ligament reconstruction: A randomised controlled trial comparing autograft, calcium phosphate cement and demineralised bone matrix for patellar defect filling. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70434

This randomized controlled trial compared anterior knee pain outcomes in patients undergoing bone-patellar tendon-bone ACL reconstruction who received autologous bone graft, calcium phosphate cement, or demineralized bone matrix to fill the patellar defect. The study found no significant difference in anterior knee pain frequency or severity among the three groups. Consequently, surgeons may choose any of these fillers based on availability and preference without expecting a distinct advantage in reducing anterior knee pain.

43. Sánchez M, Aznar JM, Jorquera C, et al. IGF‐1 levels, genetic polymorphisms, and intrameniscal platelet‐rich plasma are associated with clinical response in a caucasian cohort with mild‐to‐moderate knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70459

This study analyzed clinical and genetic factors influencing the response to platelet-rich plasma (PRP) therapy in 300 patients with mild-to-moderate knee osteoarthritis. Key findings indicated that higher baseline IGF-1 levels, specific genetic polymorphisms, and the administration of intrameniscal PRP were associated with better clinical outcomes at six months. These results suggest that patient selection based on biological markers and injection technique could optimize PRP efficacy in treating knee osteoarthritis.

44. Liang Z, He J, Rong F, et al. Severity‐dependent shift in knee osteoarthritis toward a dominant varus–flexion alignment phenotype on weight‐bearing 3D imaging. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70435

This prospective study utilized weight-bearing 3D imaging to assess hip-knee-ankle alignment phenotypes across different stages of knee osteoarthritis and compared them with conventional 2D measurements. The researchers found a severity-dependent shift toward a varus-flexion alignment phenotype in advanced osteoarthritis, which correlated with distinct cartilage stress distributions and symptoms more strongly than 2D alignment. This highlights the importance of 3D alignment assessment for understanding disease progression and planning surgical interventions in knee osteoarthritis.

45. Patel R, Mabrouk A, Piercecchi A, et al. Poor side‐to‐side symmetry in posterior tibial slope limits the use of the contralateral limb as a reliable reference for surgical planning in anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70430

This retrospective study assessed the side-to-side symmetry of posterior tibial slope in patients with unilateral and bilateral ACL injuries to determine if the contralateral limb is a reliable surgical reference. The analysis revealed poor symmetry, with limits of agreement far exceeding clinically relevant thresholds and low concordance for high-slope values. Therefore, using the contralateral knee as a reference for surgical planning in ACL reconstruction is unreliable due to significant natural variation in posterior tibial slope.

49. Tramer JS, Khalil LS. Editorial Commentary : Primary Anterior Cruciate Ligament Repair Is Back—But Younger Age Remains a Risk Factor: Defining the Who, When, and How. Arthroscopy 2026. doi:10.1002/arj.70219

This editorial commentary reviews the resurgence of primary anterior cruciate ligament (ACL) repair, highlighting its viability for acute proximal tears in carefully selected patients. The authors emphasize that while outcomes are promising, younger age and high activity levels remain significant risk factors for failure, necessitating cautious patient selection and timing. Clinically, surgeons must balance the benefits of tissue preservation with the strict inclusion criteria required to mitigate reinjury risks.

51. Popper HR, Baker W, Fliegel B, et al. Damaging Noise Levels Are Seen in Arthroscopic Surgery. Arthroscopy 2026. doi:10.1002/arj.70226

This study analyzed intraoperative audio measurements from 124 arthroscopic procedures to assess noise exposure levels for orthopaedic surgeons performing shoulder, hip, and knee surgeries. Results showed that while time-weighted average noise levels remained below high-risk thresholds, maximum decibel levels frequently exceeded 85 dB, particularly during shoulder procedures. The findings highlight a potential occupational hearing hazard for surgeons, suggesting the need for protective measures despite average exposure levels appearing safe.

52. Marter JA, Entessari M, Waterman BR. Editorial Commentary : Cost‐Effective, Until It Isn't: Variability in Lateral Extra‐articular Tenodesis Techniques Challenges Cost Analyses for Primary Anterior Cruciate Ligament Reconstruction. Arthroscopy 2026. doi:10.1002/arj.70269

This editorial commentary critiques the assumption that lateral extra-articular tenodesis (LET) is universally cost-effective when added to primary anterior cruciate ligament reconstruction. The authors argue that variability in surgical techniques, graft choices, and patient risk profiles introduces significant cost differences that simplified economic models often overlook. Clinically, this suggests that cost-effectiveness claims for routine LET use are premature and may not hold true across diverse surgical environments or patient populations.

54. Xu J. Editorial Commentary : The First Week Matters: Rethinking the Prophylaxis Window of Post‐Traumatic Osteoarthritis for Post‐Traumatic Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Arthroscopy 2026. doi:10.1002/arj.70355

This editorial commentary argues for a paradigm shift in managing post-traumatic osteoarthritis by targeting the acute inflammatory window within days of anterior cruciate ligament injury. It highlights preclinical evidence that pathological cascades involving synovial macrophages and osteoclasts begin rapidly, challenging the traditional reactive treatment approach. The clinical implication is that early, disease-modifying interventions are necessary to intercept joint degeneration before irreversible structural damage occurs.

58. Varady NH, Kunze KN. Editorial Commentary : Traveling to A New Dimension in Anterior Cruciate Ligament Injury Risk Stratification: Holistic 3‐Dimensional Knee Phenotyping via Automated Artificial Intelligence Pipelines. Arthroscopy 2026. doi:10.1002/arj.70160

This editorial commentary discusses the transition from isolated two-dimensional radiographic parameters to holistic, automated three-dimensional knee phenotyping using artificial intelligence for anterior cruciate ligament injury risk stratification. It highlights that while AI pipelines offer scalable quantification of complex anatomic interactions, challenges remain regarding model validation, distinguishing pre- from post-injury morphology, and ensuring external validity. The authors argue that these advanced methods could improve screening and targeted preventive interventions despite current technical hurdles.

59. Meyer O, Tarouco Amaro J, Cohen Kaleka C, et al. Distinct 3‐Dimensional Anatomic Patterns Including Flatter Surfaces and Greater Sagittal Inclinations of Intra‐articular Structures Are Reliably Identified Through an Artificial Intelligence‐Based Pipeline in Anterior Cruciate Ligament‐Injured Knees. Arthroscopy 2026. doi:10.1002/arj.70161

This retrospective case-control study utilized an automated AI-based pipeline to identify three-dimensional anatomic patterns from conventional MRI scans in patients with anterior cruciate ligament ruptures compared to healthy controls. The analysis revealed that ACL-injured knees exhibited significantly flatter articular surfaces and greater sagittal inclinations of intra-articular structures than controls. These distinct 3D patterns were reliably identified by the AI model, demonstrating its potential to discriminate between injured and healthy knees based on morphological features.

61. Blancato M, Dodelin D, Graveleau N, et al. Why the hip matters: Pelvic instability after anterior cruciate ligament reconstruction is driven by dynamic control of the hip abductors rather than by maximal strength. A 3D analysis of 644 patients. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70427

This study of 644 patients assessed the association between maximal isometric gluteus medius strength and pelvic instability during dynamic tasks five to seven months after anterior cruciate ligament reconstruction. Results indicated that pelvic and trunk oscillations, rather than maximal strength, were the primary predictors of pelvic drop and instability during running and landing. This suggests that dynamic control of the hip abductors is more critical for pelvic stability than maximal strength alone in the postoperative period.

63. Janisch L, Maack L, Fohrmann D, et al. Assessment of dynamic knee angle deviations in the frontal plane in physiotherapy clinical practice: intra- and inter-rater reliability of an application and agreement with two AI-models. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-09958-9

This study assessed the intra- and inter-rater reliability of a manual application-based method (PhysioMaster®) for measuring dynamic knee angle deviations and compared it with two AI-based human pose estimation models (OpenPose and BlazePose). The analysis found that the Single-Leg Landing task elicited the most pronounced leg axis deviations, and the AI models showed varying levels of agreement with the manual application. The results highlight the potential of AI tools for quantitative assessment in physiotherapy practice, though agreement with manual methods requires further exploration.

66. Vega TF, Thamrongskulsiri N, Brinkman JC, et al. Concomitant Intra-articular Injuries in 37,423 Primary and Revision ACL Reconstructions: A Systematic Review and Meta-analysis of Comparative Studies. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261439947

This systematic review and meta-analysis of 37,423 ACL reconstructions compared intra-articular injury prevalence between primary and revision procedures, finding that revision surgery carries significantly higher odds of meniscal injury. These findings highlight distinct injury patterns and risk factors that should inform surgical planning and prognostic counseling for patients undergoing revision ACL reconstruction.

69. Sarfraz A, Di Pauli von Treuheim T, Ruff G, et al. Does weight gain from time of indication to date of surgery affect outcomes in total knee arthroplasty?. Arthroplasty 2026. doi:10.1186/s42836-026-00379-6

This study examined the impact of body mass index (BMI) changes between surgical booking and total knee arthroplasty (TKA) on perioperative outcomes, finding that patients with a greater than 5% BMI increase experienced longer hospital stays and lower discharge-to-home rates. The results suggest that weight gain during the waiting period for TKA is associated with worse postoperative recovery metrics, highlighting the potential benefits of preoperative weight management.

71. Lu M, Li X, Zhang F, et al. Letter to the Editor regarding ‘Increased contralateral dynamic valgus in female athletes following ACL reconstruction’. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70421

This letter to the editor discusses methodological nuances and clinical implications of a study on increased contralateral dynamic valgus in female athletes following ACL reconstruction, emphasizing the importance of sex-specific neuromuscular patterns in secondary injury mechanisms. The authors provide context for interpreting these findings, particularly regarding the limitations of subgroup analyses and the need for cautious interpretation of negative results.

72. Gaugg F, Bierke S, Hees T, et al. Response Letter to the Editor regarding ‘Increased contralateral dynamic valgus in female athletes following ACL reconstruction’. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70422

This response letter acknowledges the constructive critique regarding sample size and statistical power in the original study on contralateral dynamic valgus in female athletes following ACL reconstruction. The authors clarify that their conclusions were deliberately worded with caution to account for these limitations, agreeing that underpowered subgroup analyses should be interpreted carefully.

78. Ojeda F, Martínez-Vilavella G, Blanco-Hinojo L, et al. Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis: an fMRI study. Arthroplasty 2026. doi:10.1186/s42836-026-00382-x

This study utilized fMRI to examine brain activation patterns in patients with knee osteoarthritis undergoing conservative versus surgical management. Activation in the amygdala and nucleus accumbens was associated with treatment choice, highlighting the role of affective-motivational pain processing in clinical decision-making. These findings underscore the importance of central pain mechanisms in understanding patient preferences and outcomes in osteoarthritis care.

83. Thota PK, Cohen JS, Selemon NA, et al. Ensuring Access to High Quality Care in Revision Total Knee Arthroplasty: An Analysis of Referral Patterns and Clinical Outcomes at a Tertiary Care Center. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.038

This MRI-based morphometric analysis compared the radius of curvature of the patellar lateral facet with that of the native glenoid in 609 adults to evaluate its suitability as an osteochondral allograft source. The results showed a high degree of congruence between the patellar lateral facet and native glenoid curvatures, supporting the hypothesis that the patella is a viable alternative graft source. This finding offers a potential solution to donor-site morbidity and limited availability associated with traditional graft sources in glenoid reconstruction.

84. Misir A, Hancerli CO. Patellar lateral facet allograft as a potential graft source in glenoid bone reconstructions for anterior shoulder instability: an MRI-based morphometric analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2025.08.024

Précis unavailable.

86. Ibaseta A, Khan ST, Pasqualini I, et al. Contralateral Total Knee Arthroplasty More Than One Year Apart: Do Patient-Reported Outcomes and Health Care Utilization Differ After Each Surgery?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.016

This study compared health care utilization and patient-reported outcomes between first and second asynchronous contralateral total knee arthroplasty surgeries performed more than one year apart in 573 patients. Patients reported significantly better baseline symptoms before the second surgery but achieved similar improvements in patient-reported outcomes and health care utilization metrics after both procedures. These findings indicate that delayed contralateral TKA yields comparable clinical benefits to the initial surgery, supporting the efficacy of staged bilateral procedures.

89. Daigle C, Branstetter R, Van Deventer L, et al. In-Hospital Exposure and Opioids Prescribed after Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.011

This retrospective study analyzed opioid-naïve patients undergoing total knee arthroplasty to determine if in-hospital opioid exposure predicts postoperative opioid prescribing. The findings indicate that a significant portion of patients filled postoperative opioid prescriptions, with Medicaid enrollees showing distinct prescribing patterns. These results suggest that in-hospital opioid management strategies may influence long-term prescribing habits, highlighting the need for targeted interventions to reduce unnecessary postoperative opioid use.

90. Hakim AJ, Portillo AL, Blackburn BE, et al. Incarcerated Patients Are More Likely to Undergo Reoperation After Elective Total Joint Arthroplasty than Nonincarcerated Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.014

This study compared complication rates between incarcerated and nonincarcerated patients undergoing primary total joint arthroplasty using propensity score matching. Incarcerated patients exhibited significantly higher rates of reoperation, wound complications, and infections compared to their nonincarcerated counterparts. Clinically, these findings underscore the need for enhanced perioperative monitoring and preventive strategies for incarcerated patients to mitigate their elevated risk of adverse surgical outcomes.

92. Tank P, Anand A. Letter Regarding “the Mark Coventry Award: Does Matching the Native Coronal Plane Alignment of the Knee Improve Outcomes in Primary Total Knee Arthroplasty?”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.12.043

This letter critiques a recent study on coronal plane alignment in total knee arthroplasty, highlighting methodological concerns regarding the radiographic estimation of mechanical axes. The authors argue that assuming a uniform relationship between anatomic and mechanical femoral axes is inconsistent across the population. This critique implies that such methodological limitations may affect the validity of conclusions regarding alignment and patient-reported outcomes.

93. Lo H, Huang T. Letter regarding: “Modifications to the Geriatric Nutritional Risk Index Predicts Complications after Total Joint Arthroplasty”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.02.025

This letter comments on a study linking the modified Geriatric Nutritional Risk Index to complications after total joint arthroplasty, noting the absence of analysis on postoperative nutritional interventions. The authors suggest that the lack of data on postoperative optimization limits the clinical utility of the findings for mitigating risks in low-scoring patients. This highlights a gap in current research regarding the potential benefits of targeted nutritional support during recovery.

94. Forlenza EM, Shaw J, Potluri AS, et al. Lidocaine-Bupivacaine Spinal Proves Safe and Effective in Outpatient Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.006

This prospective observational study evaluated the safety and efficacy of a single-dose spinal anesthetic containing lidocaine and bupivacaine for outpatient total joint arthroplasty. The mixture demonstrated a favorable safety profile with low rates of nausea, urinary retention, and transient neurological symptoms, facilitating rapid ambulation and discharge. These findings support the use of this anesthetic combination in enhancing rapid recovery protocols for same-day joint surgeries.

95. Turner LE, Hu M, Slusser JP, et al. Long-Term Risk of Dementia up to Three Decades After Total Joint Arthroplasty: A Population-Based Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.083

This population-based cohort study examined the long-term risk of dementia in patients who underwent total hip or knee arthroplasty over a period of up to three decades. The analysis found no significant association between total joint arthroplasty and an increased subsequent risk of dementia after adjusting for comorbidities and other factors. This suggests that lifelong exposure to metal-based implants does not appear to elevate the long-term risk of developing dementia.

96. Herndon CL, Rana AJ. Medicare’s Impending Surgeon Payment for Arthroplasty Crisis: The Potential of Rapid Loss of Access for the Elderly. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.02.014

This editorial critiques the Centers for Medicare & Medicaid Services' proposed payment reductions for arthroplasty surgeons, warning of potential threats to practice viability and patient access. The authors argue that arbitrary cuts to relative value units undermine the financial stability of independent practices and may disproportionately affect elderly patients. The piece calls for policy adjustments that reflect the true value and complexity of surgical care to prevent a crisis in access.

98. Bilodeau RE, Neitzke CC, Coxe FR, et al. Nail-Plate Combination Fixation for Periprosthetic Distal Femoral Fractures Allows Early Weight-Bearing With Low Reoperation and Revision Rates. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.007

This retrospective study compared clinical and radiographic outcomes of nail-plate combination fixation versus locked plating or intramedullary nailing for periprosthetic distal femoral fractures. The nail-plate combination demonstrated superior construct strength, enabling early weight-bearing with low reoperation and revision rates compared to other methods. These results support the use of nail-plate combination fixation as a viable option for achieving stable fixation and early mobilization in these complex fractures.

99. da Silva AGM, Giglio PN, Fernandes DA, et al. Primary Total Knee Arthroplasty in Patients Who Have Neuromuscular Disorders and Genu Recurvatum Using a Rotating-Hinge Implant: A Case Series With a Mean 4-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.049

This case series evaluated the clinical outcomes of primary total knee arthroplasty using rotating-hinge implants in patients with neuromuscular disorders and genu recurvatum. The study reported satisfactory mean four-year follow-up results, indicating that constrained implants can effectively manage ligament balancing challenges and prevent hyperextension recurrence. This suggests that rotating-hinge implants are a reasonable surgical option for this specific patient population with significant deformity and muscle weakness.

101. Nwankwo TN, Olson NR, Crowley BM, et al. Primary Total Knee Fixation Methods in Morbidly Obese Patients: Cemented, Stemmed, and Cementless Designs. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.010

This retrospective cohort study compared survivorship and outcomes of cemented stemmed, cemented non-stemmed, and cementless tibial designs in morbidly obese patients undergoing total knee arthroplasty. Although the cementless group showed the highest survivorship rates, the differences among the three fixation methods were not statistically significant. This indicates that multiple fixation strategies can be considered for morbidly obese patients, with no single method demonstrating clear superiority in this high-risk population.

103. Kraus KR, Deckard ER, Buller LT, et al. Reply to Letter to the Editor on “The Mark Coventry Award: Does Matching the Native Coronal Plane Alignment of the Knee Improve Outcomes in Primary Total Knee Arthroplasty?”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.01.046

This reply addresses methodological concerns raised in a letter to the editor regarding a study on matching native coronal plane alignment in total knee arthroplasty. The authors defend their use of short-leg radiographs and uniform angle adjustments, arguing that these methods are valid for estimating mechanical alignment. This clarification reinforces the validity of their original findings regarding the association between alignment matching and patient-reported outcomes.

105. Oliver D, Fuller Z, Weintraub MJ, et al. Risk Factors for Readmission After Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.001

This study analyzed national data to identify risk factors for 30- and 90-day readmissions following unicompartmental knee arthroplasty, finding that comorbidities such as heart disease, diabetes, and COPD significantly increased readmission risk. These findings suggest that preoperative optimization strategies should target these specific patient populations to reduce postoperative readmissions.

106. Price A, White M, Shaji A, et al. Soft Tissue-To-Bone Ratio Outperforms Body Mass Index in Predicting Periprosthetic Joint Infection in Total Knee Arthroplasty: A Retrospective Case-Control Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.022

This retrospective case-control study compared the soft tissue-to-bone (STiB) ratio against body mass index (BMI) as predictors of periprosthetic joint infection (PJI) in total knee arthroplasty. The results demonstrated that the STiB ratio outperformed BMI in predicting PJI, suggesting it may be a more accurate radiographic tool for assessing surgical risk.

107. Cornish ER, Zheng H, Carpenter C, et al. Similar Revision Rates for High- and Low-Viscosity Cement in Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.028

Using a statewide database, this study compared revision rates between high-viscosity and low-viscosity bone cement in total knee arthroplasty, finding no significant difference in failure rates between the two types. The data supports the safety of high-viscosity cement, although medium-viscosity cement showed increased failure rates associated with low surgeon volumes.

108. Schwenk ES, Torjman MC, Kothari R, et al. The Association Between Intraoperative Heparin and Postoperative Thrombotic Complications after Total Hip and Knee Arthroplasty: A Retrospective Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.002

This retrospective analysis evaluated the association between intraoperative intravenous heparin and postoperative thrombotic complications in total hip and knee arthroplasty, finding no significant reduction in thrombotic events with heparin use. The findings suggest that routine intraoperative heparin administration does not provide additional thromboprophylaxis benefits in modern arthroplasty practices.

109. Xu JJ, Johnson MC, Lama G, et al. The Effect of Body Mass Index on the Efficacy of Semaglutide Use at the Time of Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.09.056

This study evaluated the impact of semaglutide on postoperative complications following total knee arthroplasty across different BMI classes, finding significant reductions in thrombotic and pulmonary complications among nonobese users. The results indicate that semaglutide use may improve specific short-term outcomes in nonobese patients undergoing primary TKA.

110. Aslani S, Kurtz MA, Spece H, et al. Systematic Review of Metal Concentrations in Blood, Serum, and Tissue Following Primary and Revision Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2025.08.078

This systematic review analyzed metal concentrations in blood and tissue following total knee arthroplasty, reporting low median levels of cobalt and chromium that correlate linearly. The study highlights that metal release in TKA is generally lower than in hip arthroplasty, though implant design and revision status may influence concentrations.

112. Hantes M, Raoulis V, Zibis A, et al. Multiligament-injured knee: what the general orthopedic surgeon should know. EFORT Open Reviews 2026. doi:10.1530/eor-2026-0053

This review outlines the critical management principles for multiligament knee injuries, emphasizing the high risk of vascular and nerve damage despite palpable pulses. It stresses the importance of early recognition, serial vascular examinations, and appropriate stabilization to ensure limb salvage and optimal long-term function.

115. Challoumas D, Wong T, Barrett B, et al. Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.04.055

This systematic review evaluated the efficacy and safety of elective primary total elbow arthroplasty over the last 25 years, analyzing data from 76 studies. The results indicated meaningful long-term improvements in pain, function, and range of motion, particularly in patients with rheumatoid arthritis. The findings support the procedure as a reliable treatment option for improving quality of life in appropriate patient populations.

116. El Kayali MK, Bürck LV, Fahy S, et al. #KneeOsteotomy: Evaluation of the Quality and Educational Value of TikTok Videos. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261428460

This cross-sectional study assessed the quality and educational value of TikTok videos regarding knee osteotomies, finding that most content was posted by private users and focused on patient experiences. The analysis revealed significant variability in content quality, with many videos failing to meet established medical information benchmarks. These results highlight a need for improved professional oversight and higher-quality educational content on social media platforms.

117. Atzmon R, Chang W, Chan C, et al. The Effect of Pressurized Carbon Dioxide Lavage on Osteochondral Allograft. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261438104

This controlled laboratory study investigated the impact of adding pressurized carbon dioxide lavage to standard pulse lavage during osteochondral allograft preparation. The sequential lavage method significantly enhanced the allograft's absorption capacity for liquid-based orthobiologic agents compared to pulse lavage alone. This technique may improve graft incorporation and healing by facilitating better integration of host-derived marrow constituents.

123. Zila L, Glaeser JD, Sheyn J, et al. Immune Cell Composition and Protein Biomarkers Correlate With PRP Treatment Outcomes in Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261430728

Researchers analyzed immune cell composition and protein biomarkers in platelet-rich plasma (PRP) samples to identify predictors of treatment outcomes in knee osteoarthritis. The study found specific cellular and protein markers that correlated with patient-reported outcomes, indicating potential predictive value for PRP effectiveness. This suggests that biomarker profiling could help personalize PRP therapy and improve clinical decision-making for OA patients.

124. İpek E, Köse MA, Demirhan A, et al. Diagnostic Value of Condylar Distance Asymmetry Relative to the Femoral and Tibial Anatomic Axes in Anterior Cruciate Ligament Rupture. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261442214

The study evaluated the diagnostic value of condylar distance asymmetry relative to femoral and tibial anatomic axes in patients with anterior cruciate ligament rupture. It found that these morphometric indices were independently associated with ACL rupture and performed comparably to other known risk factors. These findings support the use of condylar distance asymmetry as a valuable diagnostic tool for identifying anatomical risk factors for ACL injury.

126. Bourland BD, Kackman RM, Penn JK, et al. Is There a Difference Between Medial and Lateral Femoral Condyle Allografts? An Outcome and Survivorship Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261443325

The study compared graft survivorship and patient-reported outcomes between osteochondral allograft transplantation of the lateral femoral condyle and the medial femoral condyle. Results indicated no significant differences in reoperation rates or functional outcomes between the two groups, despite demographic differences. This suggests that lateral femoral condyle allografts offer comparable short- to mid-term outcomes to medial condyle grafts.

128. Augustin E, Moran T, Atkins M, et al. Patellofemoral Bipolar Osteochondral Allograft Surgery Yields Similar Short- to Mid-term Outcomes As Unipolar Surgery: A Minimum 2-year Follow-up Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00048

The study compared short- to mid-term outcomes of unipolar versus bipolar patellofemoral osteochondral allograft transplantation with a minimum two-year follow-up. Results showed similar graft failure rates, reoperation rates, and patient-reported outcomes between the two surgical approaches. This indicates that bipolar patellofemoral allograft surgery is a viable option with outcomes comparable to unipolar transplantation.

133. Senthil K, Whitaker S, Nazarov M, et al. Common Risk Factors for Knee Injuries in Runners: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261444314

This systematic review synthesizes evidence on biomechanical and exposure-related risk factors for knee injuries in endurance runners, focusing on patellofemoral pain, iliotibial band syndrome, and patellar tendinopathy. The authors analyzed studies to identify modifiable factors beyond biomechanics, such as training load and volume, which are often underexplored. These findings aim to inform targeted prevention strategies and training modifications to reduce running-related knee injuries.

134. van der List JP, Taoufik T, Flanigan DC, et al. Outcomes of Restorative Treatment for Isolated Patellar Cartilage Lesions: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261443877

This systematic review and meta-analysis assess the outcomes of restorative treatments for isolated patellar cartilage lesions, excluding combined patellar-trochlear pathologies. The study compares failure, reoperation, and complication rates across various advanced techniques like matrix-induced autologous chondrocyte implantation and osteochondral autograft transfer. The results provide specific clinical guidance on the efficacy of different surgical options for managing isolated patellar cartilage damage.

135. Vaishya R, Singh A, Gupta BM, et al. Global Trends and Research Hotspots in Soccer Injury Literature: A Bibliometric Analysis (1904–2025). Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101135

This bibliometric analysis maps the global landscape of soccer injury research from 1904 to 2025, examining publication trends, scientific impact, and emerging research hotspots. The study identifies key themes in epidemiology, prevention, and risk factors, highlighting the evolution of focus from lower-extremity injuries to broader safety concerns. These insights help researchers and policymakers understand current knowledge gaps and prioritize future investigations in soccer injury prevention.

140. Soong J, Siang Koh DT, Teo SJ, et al. Large Medial Opening Wedge High Tibial Osteotomy Increases Gastrocnemius Tension: A Cadaveric Study with Clinical Correlation to Early Knee Flexion Contracture. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101146

This retrospective study found that anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) partially restores tibiofemoral rotational alignment by reducing internal rotation toward baseline values. While anterior stability improved significantly, the study noted a lack of strong correlation between postoperative rotational parameters and patellofemoral pain or knee function scores. These results indicate that while ACLR improves rotational mechanics, other factors likely drive postoperative patellofemoral symptoms.

143. Martin R, Beauchamp-Chalifour P, Rayes J, et al. Incidence and Strategies for Prevention of Adjustable Loop Suspensory Fixation Maldeployment in Multiligament Knee Reconstruction. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101151

Précis unavailable.

146. Sobrino-Serrano FJ, Bastida-Mera J, García de Lucas F, et al. High-Density Autologous Chondrocyte Implantation in an Elite 60-Year-Old Professional Ballet Dancer: Case Report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101152

This case report describes the successful use of high-density autologous chondrocyte implantation in a 60-year-old elite ballet dancer with a medial femoral condyle lesion, despite exceeding the conventional age limit for the procedure. The patient achieved complete defect filling on MRI and returned to professional dance without pain or functional impairment three years post-surgery. This suggests that chronological age alone should not preclude elite athletes from considering ACI if their biological status and athletic demands warrant it.

149. Liu JW, Park KJ, Sullivan TC, et al. Reassessing Valgus Lower Extremity Alignment: Is Lateral Condyle Hypoplasia a Myth?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.108

This study reassessed the anatomical contributors to valgus lower extremity alignment by measuring femoral version, tibial bowing, and condyle heights in patients undergoing total knee arthroplasty. Results showed that valgus alignment was significantly associated with lower femoral anteversion and tibial bowing rather than lateral femoral condyle hypoplasia. These findings challenge the traditional view of lateral condyle hypoplasia as the primary cause of valgus deformity, suggesting other anatomical factors are more influential.

150. Singh M, Scannell DE, McAnena AP, et al. Is It Really Less Painful to Undergo Total Hip Arthroplasty than Total Knee Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.109

This retrospective review compared postoperative pain trajectories between total hip and total knee arthroplasty patients using daily visual analog scale scores over 90 days. Total hip arthroplasty patients experienced a faster drop in pain, an earlier pain plateau, and lower mean plateau pain scores compared to total knee arthroplasty patients. These results confirm that total hip arthroplasty is associated with a less painful and more rapid recovery course than total knee arthroplasty.

152. Barakat N, Temple JR, Carpenter LS, et al. Surrogate End Points Are Associated With Favorable Results in Hip and Knee Arthroplasty Randomized Controlled Trials. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.115

This study analyzed randomized controlled trials in hip and knee arthroplasty to determine if studies using surrogate end points were more likely to report favorable results than those using true clinical outcomes. The analysis revealed that trials utilizing surrogate end points were significantly more likely to report favorable outcomes for the intervention compared to those measuring true clinical endpoints. This suggests a potential bias in arthroplasty research where surrogate markers may overestimate clinical benefits, warranting caution in interpreting such results.

155. Nadar AC, Gul EH, Smith LS, et al. Cementless Total Knee Arthroplasty in the Morbidly Obese Patient Using a Highly Porous Tibial Baseplate: Minimum 10-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.002

This retrospective study evaluated the minimum 10-year outcomes of cementless total knee arthroplasty using a highly porous tibial baseplate in 89 knees from morbidly obese patients. The procedure demonstrated low rates of aseptic loosening and acceptable long-term survivorship despite the high body mass index of the cohort. These findings support the use of cementless implants with porous coatings as a viable option for improving durability in morbidly obese patients.

157. Zabawa L, Baker N, Manganello C, et al. Impact of Fellow Involvement on Patient Outcomes in Total Hip and Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.012

Précis unavailable.

158. Fan C, Hsu J, Yu P, et al. The One-Year Postoperative Trajectories of Knee Joint Angle Recovery During Walking After Total Knee Arthroplasty in Women: A Cross-Sectional Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.013

This cross-sectional study assessed knee joint angle recovery during walking in women undergoing total knee arthroplasty at three, six, nine, and twelve months postoperatively. Knee kinematics stabilized by approximately three months, while muscle strength, walking speed, and patient-reported outcomes continued to improve throughout the year. These findings indicate that dynamic gait parameters stabilize early, suggesting that longer-term functional gains are driven by strength and neuromuscular adaptation rather than joint kinematics.

159. Carlock KD, Potluri AS, Ahmad F, et al. Certificate-of-Need Legislation That Targets Construction of Ambulatory Surgery Centers Is Associated With Increased Patient Migration Out-of-State for Primary Hip and Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.017

This study examined the impact of Certificate-of-Need (CON) legislation on patient migration for primary hip and knee arthroplasty by comparing outcomes in CON and non-CON states. Patients from the CON state were significantly more likely to travel out-of-state for surgery at ambulatory surgery centers, incurring higher costs. The findings suggest that restrictive CON laws can disrupt local healthcare access and increase financial burdens by driving patients to seek care in neighboring jurisdictions.

160. Kashir I, Shanthanna H, Khanna V, et al. Satisfaction and Persistent Pain Outcomes after Knee Arthroplasty: A Prospective Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.027

This prospective cohort study evaluated the prevalence of chronic post-surgical pain (CPSP), dissatisfaction, and opioid use in 302 patients following knee arthroplasty over 12 months. The study aimed to identify baseline psychological and clinical predictors of these negative outcomes, noting that up to one in four patients experience persistent pain. Understanding these predictors is clinically vital for preoperative risk stratification and targeted interventions to improve satisfaction and reduce opioid dependence.

162. Xia Y, Wang Y, Zhang G, et al. Latent Classes of Fear of Falling Trajectories and Associated Factors Among Older Patients After Total Knee Arthroplasty: A Prospective Longitudinal Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.024

This prospective longitudinal study identified distinct trajectories of fear of falling and their associated factors in older patients following total knee arthroplasty. Latent class growth modeling revealed specific patient subgroups with varying fear profiles, influenced by psychological and demographic variables. These results provide evidence to tailor postoperative rehabilitation strategies for different patient groups based on their fear of falling trajectories.

165. Hamilton WG, Redfern RE, Klaassen MA, et al. A Randomized Controlled Trial to Compare a Mobile Bearing Cementless and Cemented Unicompartmental Knee: Results of an Investigational Device Exemption Study in the United States. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.032

This randomized controlled trial compared the survivorship and clinical outcomes of mobile bearing cementless versus cemented unicompartmental knee arthroplasty. The study found no significant difference in two- or five-year survivorship or radiographic success between the two implant fixation methods. These results support the non-inferiority of cementless implants, offering an alternative for long-term bone fixation.

168. Kraus KR, Deckard ER, Buller LT, et al. How Long is Orthopaedic Team Work Time During the Surgical Encounter for Outpatient Total Joint Arthroplasty?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.049

This study quantified the total orthopaedic team work time dedicated to outpatient primary total joint arthroplasty, including preoperative, intraoperative, and discharge phases. The mean total work time was significantly longer for total hip arthroplasties compared to total knee arthroplasties. Understanding these time allocations helps address reimbursement challenges and optimize resource utilization in outpatient settings.

172. Verhey JT, Tarabichi S, Novicoff WM, et al. Statistical Choices in Propensity Score Matching Influence the Conclusions in Arthroplasty Outcomes Research. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.061

Précis unavailable.

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What's New — Knee — May 2026¶

Highlights¶

ACL Reconstruction and Return to Sport¶

Meniscal Pathology and Preservation¶

Total Knee Arthroplasty: Alignment and Robotics¶

Periprosthetic Joint Infection and Revision Surgery¶

Patellofemoral Instability and Pain¶

Social Determinants and Perioperative Care¶

Articles by Theme¶

ACL Reconstruction and Return to Sport (31)¶

Meniscal Pathology and Preservation (15)¶

Total Knee Arthroplasty: Alignment and Robotics (20)¶

Periprosthetic Joint Infection and Revision Surgery (11)¶

Patellofemoral Instability and Pain (8)¶

Social Determinants and Perioperative Care (15)¶

Other articles this month¶