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What's New — Knee — August 2026

43 new articles published this month.

Themes: ACL Reconstruction Grafts & Techniques · ACL Deficiency: Instability & Slope · Meniscus & Cartilage Management · Knee Osteoarthritis Biologics & Imaging · Patellofemoral Instability & Imaging · TKA Outcomes, Pain & Complications · Health Policy, Equity & Sports

Digest generated 2026-09-04 19:51:53+00:00.

Highlights

ACL Reconstruction Grafts & Techniques

This theme covers graft choice and technique in ACL reconstruction. A systematic review found rectus femoris autograft yields comparable early outcomes to hamstring grafts but with limited evidence [1], while a large cohort analysis associated quadriceps tendon autografts with higher short-term reoperation rates for extension deficit or pain and inferior PROMs versus hamstring grafts [19]. Primary ACL repair showed comparable joint awareness and outcomes to reconstruction in selected proximal tears [9]. Concomitant all-inside lateral meniscus posterior root repair did not compromise graft survivorship after ACLR [5], and modified Lemaire lateral extra-articular tenodesis showed favourable subjective outcomes in adolescents [33]. A 3D simulation study defined safe tunnel placement for lateral extra-articular procedures in skeletally immature patients [23], and a randomised trial compared adductor canal block with local anaesthetic infiltration for postoperative analgesia [7].

ACL Deficiency: Instability & Slope

This theme addresses biomechanical and anatomic factors in ACL-deficient and reconstructed knees. An exploratory phenotype-based classification integrated secondary stabilizer injury burden to categorize rotational instability after ACL rupture [37]. Cadaveric work characterized flexion-dependent length changes of the fibular collateral ligament, anterolateral ligament, and iliotibial band fibres to guide graft fixation [8]. Increased posterior tibial slope was reviewed with consensus recommendations from the German Knee Society on measurement, indications, and surgical correction [14]. Morphologic studies linked tibiofemoral bone and meniscus shape to dynamic anterior tibial translation and internal rotation during jump-landing after ACLR [13], and MRI-derived anterior tibial translation at 9 months post-ACLR was associated with postoperative adverse events [26]. A letter reframed time after ACLR as cumulative exposure of a vulnerable knee rather than a linear degenerative clock [28].

Meniscus & Cartilage Management

This theme focuses on degenerative meniscal tears, meniscus root pathology, and chondral lesions. A prospective longitudinal study showed clinical improvement despite structural degeneration after nonoperative management of medial meniscus posterior root tears [2]. A commentary on medical reversal highlighted 10-year evidence showing no sustained benefit of arthroscopic partial meniscectomy over sham surgery for degenerative tears, alongside concerns about glucosamine and repeated corticosteroid injections [3]. For cartilage disease, a validated decision tree model integrated clinical and mathematical parameters to guide treatment of focal chondral defects from microfracture to arthroplasty [25], and a systematic review found arthroscopic bioabsorbable fixation achieved favourable outcomes for unstable osteochondritis dissecans lesions compared with open fixation and metal implants [6].

Knee Osteoarthritis Biologics & Imaging

This theme covers nonoperative and emerging approaches to knee osteoarthritis. A meta-analysis of randomised trials found autologous adipose-derived mesenchymal stromal cell injection improved pain and function without a clear increase in adverse events [4]. A systematic review of deep learning models for predicting knee osteoarthritis progression from imaging catalogued 50 predictive models, noting heterogeneous definitions and translational barriers despite promising AUCs [18]. Related commentary discussed GLP-1 receptor agonists in arthroplasty candidates, addressing obesity, metabolic optimization, osteoarthritic symptoms, and perioperative complications [32].

Patellofemoral Instability & Imaging

This theme addresses patellar instability and diagnostic imaging of the extensor mechanism. A consecutive paediatric case series reported medial patellotibial ligament reconstruction concomitant with MPFL reconstruction in fixed and obligatory patellar dislocation [24], and a cadaveric study showed the additional MPTL reconstruction reduced lateral patellar translation without increasing patellofemoral contact pressure versus isolated MPFL reconstruction [39]. Diagnostic challenges were highlighted by a comparison of static MRI and dynamic weight-bearing CBCT for patella alta, indicating limited diagnostic value of standard MRI [27].

TKA Outcomes, Pain & Complications

This theme spans total knee arthroplasty outcomes and perioperative care. Patellofemoral topics included reduced patella medialization with a kinematically aligned optimised femoral component [16], patellar crepitus incidence in unresurfaced patellae with cruciate-retaining versus posterior-stabilised designs [35], and biomechanical data showing reduced compression time insufficient for patellar button cement stability [15]. Pain management was addressed through a systematic review of liposomal bupivacaine in periarticular injection [30] and a letter critiquing a methadone premedication trial [20]. Complication and risk studies covered keloidosis as a risk factor for arthrofibrosis [29], conversion TKA after tibial plateau fracture ORIF [41], chronic antithrombotic therapy outcomes [34], robotic versus conventional UKA 30-day safety [40], polyethylene exchange during retrograde nailing for periprosthetic distal femur fractures [43], sensor-based gait recovery [36], and absolute knee extensor strength thresholds after high tibial osteotomy [12].

Health Policy, Equity & Sports

This theme captures health systems, equity, and sport-related research. Editorials on ethics and surgical decision-making under financial pressure appeared in two journals [11, 31]. A commentary reconsidered CMS functional status measures for arthroplasty, advocating meaningful outcome assessment over process compliance [21], and a review navigated testosterone replacement therapy in total joint arthroplasty patients [22]. Sociodemographic determinants including race, insurance, and neighborhood deprivation predicted postpresentation delay to paediatric ACL reconstruction and intra-articular injury severity [10]. An analysis of 742 ACL injuries in German football examined the impact of playing position on injury characteristics, risk, and career outcomes [17]. A clinical framework proposed graded stress exposure for return to sport after ACLR [38], and a case report detailed successful multiligamentous knee reconstruction in a skeletally immature athlete [42].

Articles by Theme

ACL Reconstruction Grafts & Techniques (7)

1. Ge Y, Häner M, Borges JS, et al. Rectus femoris tendon autograft yields comparable early outcomes to hamstring tendon autograft, but evidence remains limited: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70559

A systematic review of four comparative studies (324 patients) compared rectus femoris versus hamstring tendon autografts for primary and revision ACL reconstruction. Rectus femoris grafts showed comparable or marginally better patient-reported outcomes in one revision study, but the evidence base is small and heterogeneous. Clinicians should note that rectus femoris is a reasonable option, though higher-quality comparative trials are needed before firm recommendations.

5. Carrozzo A, Bérard É, Petrini T, et al. Anterior cruciate ligament reconstruction with concomitant all‐inside lateral meniscus posterior root repair shows comparable graft survivorship and clinical outcomes to isolated ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70574

A retrospective single-surgeon cohort study compared 786 isolated ACL reconstructions with 55 ACL reconstructions plus all-inside lateral meniscus posterior root repair over a median 46-month follow-up. Graft rerupture-free survival and clinical outcomes (return to sport, return to work, knee scores) were comparable between groups. Concomitant lateral meniscal root repair at the time of ACLR does not compromise graft survivorship and can be performed with acceptable outcomes.

7. Ojaghi R, Locke E, Elmi P, et al. Adductor Canal Block and Local Anesthetic Versus Local Anesthetic Alone in ACL Reconstruction: A Double-Blind Randomized Controlled Trial. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464409

In a double-blind randomised controlled trial of 100 ACL reconstruction patients, local infiltration analgesia combined with an adductor canal block was compared with local infiltration analgesia alone (plus sham block). The primary outcomes were 24-hour opioid consumption and quadriceps function. The trial clarifies whether adding an adductor canal block provides meaningful analgesic benefit without compromising early quadriceps recovery after ACLR.

9. Altun O, Ergişi Y, Altıntaş M, et al. Primary ACL Repair and Reconstruction in Isolated ACL Ruptures: Forgotten Joint Scores and the Association Between Residual Laxity and Joint Awareness. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261469658

This retrospective cohort study compared primary ACL repair (n=26) with hamstring autograft reconstruction (n=59) in 85 patients with isolated ACL ruptures at minimum 2-year follow-up, using clinical scores, laxity testing, and the Forgotten Joint Score-12. The key finding was an association between residual postoperative laxity and increased joint awareness. This suggests that achieving knee stability may be important not only for function but also for minimising patients' conscious awareness of the joint after surgery.

19. Kekki C, Cristiani R, Stålman A, et al. Quadriceps Tendon Autografts Are Associated With Increased Short-term Reoperation Rates for Extension Deficit or Pain and Inferior Patient-Reported Outcomes Compared With Hamstring Tendon Autografts: An Analysis of 5653 Cases of Primary Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261465107

In a retrospective cohort of 5653 primary ACL reconstructions using hamstring, bone-patellar tendon-bone, or quadriceps tendon autografts, nonrevision reoperations and KOOS scores were compared at 2 years. Quadriceps tendon autografts were associated with higher short-term reoperation rates for extension deficit or pain and inferior patient-reported outcomes versus hamstring autografts. Surgeons should weigh these findings when selecting graft type, as QT autografts may carry a higher burden of stiffness- or pain-related reoperations.

23. Fernández-Comparini T, Irarrázaval S, Fernández Schlein F, et al. Optimizing tunnel placement for lateral extra-articular procedures in pediatric epiphyseal anterior cruciate ligament reconstruction: A three-dimensional simulation study of physeal damage and safe zone identification. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101129

Using 3D simulation from MRI of patients aged 10-17, this study modeled ACL and anterolateral ligament tunnel trajectories for epiphyseal ACL reconstruction to quantify physeal damage and define safe zones for lateral extra-articular procedures. Safe tunnel orientations were identified that avoid the distal femoral physis, articular surface, and collision with the ACL tunnel. These anatomic safe-zone maps can guide surgeons performing LEAP in skeletally immature patients to minimise physeal injury.

33. Espinosa M, Pastrián D, González J, et al. Anterior Cruciate Ligament Reconstruction With Modified Lemaire Lateral Extra-Articular Tenodesis Is Associated With Favorable Subjective Knee Function at Short-term Follow-up in Adolescents. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101194

In a prospective cohort of 55 adolescents undergoing hamstring autograft ACL reconstruction augmented with modified Lemaire lateral extra-articular tenodesis, median Lysholm (94) and IKDC subjective (85) scores were favourable at a mean 28.7-month follow-up. The study supports combined ACL reconstruction plus LET as a promising strategy for the high-risk adolescent population, though longer follow-up is needed to confirm reductions in graft failure and reintervention.

ACL Deficiency: Instability & Slope (6)

8. Augustin EJ, Oppenheim ZR, Vega J, et al. Length Changes of the Lateral Knee: Fibular Collateral Ligament, Anterolateral Ligament, and Iliotibial Band Fibers. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261468548

This cadaveric laboratory study used 3-dimensional digitization of 10 fresh-frozen knees to characterize flexion-dependent length changes of the fibular collateral ligament, anterolateral ligament, and iliotibial band fibres. The FCL and ALL attachment distances progressively shortened with flexion (approximately −7.6 and −6.4 mm from 0° to 90°), while ITB fibres showed smaller, transient changes. These native length-change patterns inform graft fixation angles and tensioning during lateral knee reconstruction.

13. Vendrig T, Brouwer RW, Hoogeslag RAG, et al. Association between tibiofemoral bone and meniscus morphology and dynamic tibiofemoral movements during jump‐landing tasks in patients following ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70554

In 30 patients approximately 5 years after primary ACL reconstruction, preoperative MRI-derived tibiofemoral bone and meniscus morphology were related to dynamic anterior tibial translation and internal tibial rotation during single-leg hop and side-hop landing, measured with 3D motion capture. Steeper lateral posterior tibial slope and greater medial-lateral slope difference were associated with less anterior translation but greater internal tibial rotation. These morphological factors may help guide decisions on adjunctive procedures such as slope-reducing osteotomy at (revision) ACLR.

14. Mayer P, Fürmetz J, Bode G, et al. Management of increased posterior tibial slope in ACL deficiency: A narrative review and recommendation of the Osteotomy Committee of the German Knee Society. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70549

This narrative review by the Osteotomy Committee of the German Knee Society synthesized level 3-4 evidence and expert consensus to provide practical recommendations on managing increased posterior tibial slope in ACL deficiency. It addresses biomechanical background, radiographic measurement (long lateral radiographs using the mechanical axis), indications for slope-correction osteotomy, and surgical technique. The recommendations offer a framework for surgeons considering slope reduction alongside or after ACL reconstruction to reduce graft failure risk.

26. Gonzalez W, Isla J, Barba D, et al. Magnetic resonance imaging–derived anterior tibial translation after anterior cruciate ligament reconstruction and its association with postoperative adverse events: A retrospective cohort study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101134

This retrospective cohort of 137 primary ACLR patients measured lateral compartment anterior tibial translation on preoperative and 9-month postoperative MRI to assess its evolution and prognostic value. Persistent abnormal ATT (>6 mm) was evaluated for association with postoperative adverse events. The findings suggest MRI-derived ATT may serve as a postoperative marker for identifying knees at risk, informing surveillance and rehabilitation decisions.

28. Tang X, Zhang J, Yu B. Time After ACL Reconstruction: Degenerative Clock or Vulnerable Knee Exposure? Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464189

This letter responds to longitudinal arthroscopic data showing cartilage lesion prevalence rising from 19% at primary to 36% at revision ACLR in 2845 patients. The authors argue the observed time effect reflects cumulative exposure to a mechanically vulnerable knee state rather than a linear degenerative clock. This interpretation emphasizes that restoring stability alone does not prevent cartilage deterioration and underscores the need to address the vulnerable knee environment early.

37. Rivarola H, Collazo C, Palanconi M, et al. Exploring the Rotational Instability Spectrum of ACL Deficiency: An Exploratory Phenotype-Based Classification Integrating Secondary Stabilizer Injury Burden. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101195

This retrospective cohort of 300 consecutive primary ACL reconstruction patients explored whether ACL-deficient knees can be classified into distinct rotational instability phenotypes based on cumulative injury to lateral secondary stabilizers (e.g., hypermobile lateral meniscus, popliteomeniscal fascicle and meniscotibial injuries). The exploratory, phenotype-based approach challenges the traditional view of ACL deficiency as homogeneous. Results may inform patient-specific decisions about lateral extra-articular tenodesis and anterolateral complex augmentation.

Meniscus & Cartilage Management (4)

2. Nonaka S, Hatayama K, Okada K, et al. Clinical improvement despite structural degeneration after nonoperative treatment of medial meniscus posterior root tear: A prospective longitudinal study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70570

In a prospective longitudinal study of 64 patients with acute medial meniscus posterior root tears managed nonoperatively, 77% continued conservative care over follow-up. Despite progressive structural degeneration on MRI and radiographs, patients who avoided surgery experienced clinical improvement. These findings support a trial of nonoperative management in select patients, with roughly one in four eventually electing surgery.

3. Abul MS, Parvizi J, Skowronek P, et al. Osteoarthritis management through medical reversal: Glucosamine, Alzheimer's disease risk, and long‐term outcomes after arthroscopic partial meniscectomy. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70578

This perspective piece examines medical reversal in osteoarthritis care, using glucosamine (with emerging neurocognitive safety concerns), arthroscopic partial meniscectomy for degenerative tears (no benefit over sham at 10 years), and repeated intra-articular corticosteroid injections as illustrative examples. The authors argue that adoption of interventions often outpaces robust long-term evidence. The clinical implication is that orthopaedic treatments should be judged by rigorous comparative evidence and durable patient-centered outcomes rather than biological plausibility or short-term symptom relief.

6. Fellheimer HS, Davis G, McCormick C, et al. Arthroscopic Bioabsorbable Fixation Achieves Favorable Outcomes for Unstable Knee Osteochondritis Dissecans Lesions Compared With Open Fixation and Metal Implants: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70414

A systematic review of 39 studies (1070 patients, 1097 knees) compared open, arthroscopic, and combined internal fixation techniques for unstable knee osteochondritis dissecans lesions, analyzing outcomes by implant type and skeletal maturity. Arthroscopic fixation with bioabsorbable implants achieved favourable functional outcomes with acceptable complication and revision rates relative to open fixation and metal implants. These findings support an arthroscopic approach with bioabsorbable fixation when feasible for unstable OCD lesions.

25. Rivarola H, Helito C, Collazo C, et al. A decision tree model for chondral lesion management in the knee based on clinical and mathematical integration. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101131

The authors developed a decision tree algorithm integrating clinical and mathematical thresholds to guide treatment selection for focal knee chondral lesions, stratifying options including microfracture, ACI/MACI, OATS, OCA, HTO, UKA, and focal resurfacing by age, lesion size, and activity level. The framework provides a structured, evidence-based approach to individualized cartilage repair. Clinically, it offers surgeons a reproducible tool for matching patients to appropriate surgical techniques.

Knee Osteoarthritis Biologics & Imaging (3)

4. Han JH, Jung M, Chung K, et al. Autologous adipose‐derived mesenchymal stromal cell injection for knee osteoarthritis improves pain and function without a clear increase in adverse events: A systematic review and meta‐analysis of randomized controlled trials. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70569

A meta-analysis of six randomised controlled trials (551 patients) evaluated intra-articular autologous adipose-derived mesenchymal stromal cell injections for knee osteoarthritis. Treatment significantly improved WOMAC total scores at 3 and 6 months and pain versus controls, without a clear increase in adverse or serious adverse events. Autologous AD-MSC injection appears a promising, safe option for knee OA, though longer-term and larger trials would strengthen the evidence.

18. Gillani A, von Eisenhart‐Rothe R, Woertler K, et al. Promises and limitations of deep learning for predicting knee osteoarthritis progression from medical imaging: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70555

This PRISMA-compliant systematic review evaluated 33 studies (50 deep learning models) predicting knee osteoarthritis progression from imaging, assessing performance (AUC), methodological quality via PROBAST-AI, and translational barriers. Nearly all models (97%) were trained on the Osteoarthritis Initiative dataset, with heterogeneous progression definitions and limited external validation, limiting generalizability. Deep learning shows promise for predicting KOA progression but requires external validation and standardised outcomes before clinical implementation.

32. Avram GM, Indelli PF, Violante B, et al. GLP‐1 receptor agonists in hip, knee and shoulder arthroplasty: Implications for obesity, osteoarthritis, metabolic optimisation and complications. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70557

This editorial reviews the implications of GLP-1 receptor agonists for hip, knee, and shoulder arthroplasty, including effects on obesity, osteoarthritis symptoms, metabolic optimization, and perioperative complications. Observational data suggest possible reductions in periprosthetic joint infection and readmission, but evidence is limited by confounding and inconsistent reporting. Clinicians should weigh potential metabolic benefits against the current lack of robust randomised evidence when managing arthroplasty candidates on these agents.

Patellofemoral Instability & Imaging (3)

24. Lijesen E, Tracey OC, Beber SA, et al. Medial patellotibial ligament reconstruction concomitant with medial patellofemoral ligament (MPFL) reconstruction in fixed and obligatory patellar dislocation: A consecutive case series. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101124

This consecutive case series of 14 paediatric patients (16 extremities, mean age 14.5 years) evaluated medial patellotibial ligament reconstruction performed concomitantly with MPFL reconstruction in fixed or obligatory patellar dislocation, many with syndromic or hypermobility conditions. The series addresses a population with abnormal patellofemoral morphology in whom MPFL reconstruction alone may be insufficient. Adding MPTL reconstruction may improve lateral stability and rotational control in this complex paediatric cohort.

27. Rahnel T, Reito A, Launonen AP, et al. Patella alta and its diagnostic challenges: A comparison of static and dynamic imaging modalities indicates limited diagnostic value in standard magnetic resonance imaging. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101136

In 29 patients with anterior knee pain, patellotrochlear index measurements from static supine MRI were compared with dynamic weight-bearing cone-beam CT with quadriceps contraction, alongside Caton-Deschamps and Insall-Salvati indices. Static and dynamic assessments showed discrepancies, indicating standard MRI has limited diagnostic value for patella alta. This challenges routine reliance on supine MRI for patellar height assessment and supports dynamic imaging when diagnosis is uncertain.

39. Surabotsopon P, Laucha T, Suwanmana S, et al. Additional Medial Patellotibial Ligament Reconstruction Reduced Lateral Patellar Translation Compared With Isolated Medial Patellofemoral Ligament Reconstruction Without Increasing Patellofemoral Contact Pressure: A Cadaveric Study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101200

In 18 fresh-frozen cadaveric knees with simulated patellar instability, combined MPFL-MPTL reconstruction reduced lateral patellar translation compared with isolated MPFL reconstruction without increasing patellofemoral contact pressures across flexion angles from 0° to 90°. This biomechanical evidence supports adding MPTL reconstruction in selected patellar instability cases. Clinical application awaits validation in vivo.

TKA Outcomes, Pain & Complications (12)

12. Lee DW, Kim RJ, Beak JY, et al. Absolute knee extensor strength, not limb symmetry, predicts outcomes and defines a rehabilitation threshold after medial opening‐wedge high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70535

This study of 125 patients undergoing medial opening-wedge high tibial osteotomy evaluated isokinetic knee extensor strength, limb symmetry index, PROMs, and dynamic balance preoperatively, at 1 year, and at mid-term follow-up to identify a clinically relevant strength threshold. Absolute body mass-normalised extensor strength, rather than limb symmetry, was independently associated with satisfactory IKDC outcomes and defined a rehabilitation threshold. Clinicians should target absolute extensor strength benchmarks rather than limb symmetry alone when guiding return to activity after HTO.

15. Bauer L, Gramzow J, Brensing M, et al. Reduced compression time is not sufficient for stability in patellar buttons. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70561

In this biomechanical study, 12 human patellae received cemented all-polyethylene patellar buttons with either 30 or 600 seconds of manual compression, with cement morphology assessed by micro-CT and stability tested by cyclic loading and shear testing. Reduced compression time did not achieve equivalent stability, despite similar cement morphology between groups. Surgeons should not shorten manual compression time for patellar button cementation, as it compromises primary fixation stability.

16. Simon J, Siedow TM, Thorwächter C, et al. Reduced patella medialization in valgus and varus knees using a KA‐optimized femoral component in kinematically aligned TKA. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70563

This cadaveric study compared a kinematically aligned (KA)-optimised femoral component (prosthetic trochlear angle 20°) with a standard design (PTA 6°) in 17 valgus and varus knees undergoing KA-TKA, assessing patellofemoral kinematics, contact mechanics, and quadriceps function against the native knee. The KA-optimised component reduced patellar medialization by approximately 2-2.5 mm between 30° and 70° of flexion in both groups without changing patellar tilt, though contact area decreased after TKA with both designs. The KA-optimised trochlear design may reduce patellofemoral complications by better preserving native patellar tracking.

20. Maricar MA, Tariq M. Letter regarding “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.082

This letter critiques a randomised trial of preoperative methadone versus oxycodone for postoperative pain after total knee arthroplasty, highlighting that unblinded anaesthesia providers may introduce performance bias through intraoperative analgesic decisions. The authors suggest pharmacy-only allocation designs to strengthen internal validity. The critique underscores the need for rigorous blinding in perioperative analgesia trials.

29. Garcia D, Thota P, Dogiparthi A, et al. Keloidosis is Associated with an Increased Risk for Developing Arthrofibrosis After Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.059

Using a national database, 1205 TKA patients with prior keloids were propensity matched to controls to assess arthrofibrosis and revision risk. Keloidosis was associated with significantly increased arthrofibrosis at one and two years post-TKA. Surgeons should consider a history of keloids as a risk factor for post-TKA stiffness when counseling patients and planning perioperative management.

30. Ng MK, Mastrokostas LE, Mastrokostas PG, et al. Liposomal Bupivacaine in Periarticular Injection Cocktails for Pain Management After Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.058

This systematic review of RCTs evaluated liposomal bupivacaine in periarticular injection cocktails for TKA, assessing pain control, opioid consumption, functional recovery, satisfaction, and adverse events. Findings were inconsistent across trials regarding analgesic benefit over non-liposomal bupivacaine. The results suggest limited conclusive evidence for routine LB use, and its adoption should await higher-quality comparative data.

34. Vosoughi F, Ramezanpour MR, Hashemi FS, et al. Outcomes of Total Knee Arthroplasty in Patients Receiving Chronic Antithrombotic Therapy: A Systematic Review. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.047

This systematic review of 17 retrospective studies (over 104,000 chronic antithrombotic users and 261,000 controls) synthesized perioperative and longer-term outcomes after primary total knee arthroplasty, categorizing regimens as antiplatelet therapy, warfarin, DOACs, or mixed. It addresses an increasingly common clinical scenario given aging and cardiovascular comorbidity. Findings should guide perioperative antithrombotic management decisions, though the retrospective evidence base limits causal inference.

35. Barton K, Aprey N, Hemmerle M, et al. Incidence of Postoperative Patellar Crepitus in Total Knee Arthroplasty with Unresurfaced Patellae in Cruciate-Retaining and Posterior-Stabilized Designs. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.060

In a retrospective review of 845 TKAs with unresurfaced patellae, postoperative patellar crepitus occurred in 9.8% overall and was significantly more common with posterior-stabilised than cruciate-retaining designs (12.3% vs 5.7%). Most crepitus was asymptomatic, but 14 patients had pain and six required reoperation. Surgeons should counsel PS-TKA patients about crepitus risk even when leaving the patella unresurfaced.

36. Chen W, Wang C, Lee S, et al. Sensor-Based Gait Recovery Analysis After Total Hip and Knee Arthroplasty: A One-Year Follow-Up Study Integrating Muscle Strength and Patient-Reported Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.038

This prospective cohort of 84 patients aged ≥70 undergoing THA or TKA used foot-mounted inertial sensors, isokinetic strength testing, and PROMs (HOOS-JR/KOOS-JR) at five timepoints over one year to map recovery trajectories. TKA patients showed significant, persistent gait asymmetry up to three months postoperatively, whereas THA recovery differed. The integrated sensor-based approach can identify patients with delayed recovery who may benefit from targeted rehabilitation.

40. Sribhashyam S, Gooch BR, Yazdanpanah S, et al. More Technology, but Similar Early Safety: Robotic Versus Conventional Unicompartmental Knee Arthroplasty, a 30-Day Outcome National Database Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.001

Using a propensity-matched NSQIP national database cohort (727 robotic vs 1,454 conventional UKA cases, 2022-2024), this study compared 30-day adverse events with uniformly defined outcomes and balanced covariates. Robotic assistance showed similar early safety to conventional UKA despite its growing adoption. These findings reassure regarding short-term safety but do not establish superiority, warranting longer-term comparative data.

41. Luo Y, Soriano K, Strok M, et al. Conversion Total Knee Arthroplasty After Tibial Plateau Fracture Open Reduction and Internal Fixation: A Propensity-Matched Analysis of 90-Day and One- and Three-Year Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.010

Using a national database, 615 conversion TKAs after tibial plateau fracture ORIF were propensity-matched 1:1 to primary TKAs, with secondary analyses of nonoperative fractures and direct ORIF-versus-nonoperative comparisons. Conversion TKA carried roughly 2.5- to 3-fold higher risks of periprosthetic joint infection and revision, with prior hardware contributing additional risk beyond the fracture itself. These findings support heightened surveillance and counseling for patients undergoing TKA after tibial plateau fracture fixation.

43. Miceli JG, Doerr NA, Andriani NT, et al. Polyethylene Exchange During Retrograde Intramedullary Nailing in the Treatment of Periprosthetic Distal Femur Fractures: A Registry Pilot Analysis. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-26-00245

A retrospective registry pilot of 26 patients treated with retrograde intramedullary nailing (or nail-plate constructs) for periprosthetic distal femur fractures above well-fixed TKA components examined polyethylene exchange practices. Polyethylene was exchanged in 34.6% of cases, and 26.9% of patients had documented prefracture TKA instability, most commonly catching, suggesting polyethylene-related pathology may contribute to these fractures. Surgeons performing rIMN for periprosthetic fractures should assess for instability and consider intraoperative polyethylene evaluation.

Health Policy, Equity & Sports (8)

10. Hamad CD, Wu S, Joachim K, et al. Sociodemographic Predictors of Postpresentation Delay to Pediatric ACL Reconstruction and Associated Intra-articular Injury Severity. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261469687

This cohort study of 443 paediatric ACLR patients at an urban academic center examined whether race/ethnicity, insurance type, and neighborhood deprivation (Childhood Opportunity Index) predicted postpresentation surgical delay (>120 days) and intra-articular injury severity. Structural determinants of health were associated with prolonged delay to surgery and greater cartilage and meniscal injury, with downstream effects on functional recovery. The findings highlight the need to address access disparities to prevent progressive intra-articular damage in paediatric ACL deficiency.

11. Seil R, Herbst E, Milano G, et al. Holding the line: Ethics and surgical decision‐making in an era of financial pressure in health care systems around the globe. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70414

This editorial discusses the ethical tension between evidence-based surgical decision-making and growing financial pressures on health systems worldwide, particularly regarding elective knee surgery indications. The authors argue that reimbursement models and budgetary constraints must not erode the boundary between acceptable clinical judgment and unjustifiable surgical indication. It calls on the orthopaedic community to establish and defend clear ethical standards in an era of economic constraint.

17. Hasegawa S, Krutsch W, Koga H, et al. Impact of playing position on ACL injury characteristics, risk and career outcomes in football—An analysis of 742 cases of the ACL registry in German football. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70566

Using a prospective German football registry covering six seasons and 742 ACL injuries across professional, semi-professional, and amateur levels, the authors stratified injury mechanisms, incidence, and career outcomes by playing position. Forwards showed the highest rate of dropping a competitive level after ACL reconstruction (47.5%), with goalkeepers numerically higher but not statistically significant after correction. Position-specific risk profiles and career-impact expectations should inform counseling and return-to-performance planning for injured footballers.

21. Chen AF, Della Valle CJ, Bostrom MP, et al. Reconsidering Centers for Medicare & Medicaid Services Functional Status Measures for Total Hip and Knee Arthroplasty: From Process Compliance to Meaningful Outcome Assessment. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.075

This commentary reexamines CMS-mandated functional status measures for total hip and knee arthroplasty, arguing that current requirements emphasize process compliance over meaningful outcome assessment. The authors advocate leveraging validated PROMs (e.g., Oxford scores, KOOS, PROMIS) to enable longitudinal, patient-centered outcome tracking akin to Scandinavian and UK registry models. Policy should shift from checkbox compliance to validated, clinically meaningful outcome measurement.

22. Ganz MP, Mont MA, Scuderi GR. Androgen Awareness: Navigating Testosterone Replacement Therapy in Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.06.013

This narrative review addresses the rising prevalence of testosterone replacement therapy among arthroplasty patients, driven by longevity medicine, expanded indications, and gender-affirming care. It highlights perioperative considerations, such as erythrocytosis, thromboembolic risk, and hormonal optimization, that orthopaedic surgeons should recognize. Surgeons should screen for exogenous androgen use and incorporate androgen awareness into perioperative management of elective joint replacement.

31. Seil R, Herbst E, Milano G, et al. Holding the line: Ethics and surgical decision-making in an era of financial pressure in health care systems around the globe. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101137

This editorial examines the ethical tension between evidence-based surgical indications and mounting financial pressures on health systems globally, particularly in elective knee surgery. The authors call for the orthopaedic community to define boundaries between acceptable clinical judgment and unjustifiable surgical indication. It urges surgeons to safeguard ethical decision-making against reimbursement-driven practice.

38. Rivarola H, Collazo C, Palanconi M, et al. From Linear Rehabilitation to Graded Stress Exposure: A Clinical Framework for Return to Sport After Anterior Cruciate Ligament Reconstruction. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101196

This clinical commentary from the same group proposes a framework shifting ACL reconstruction return-to-sport rehabilitation from linear, time-based criteria to graded stress exposure. It reconceptualizes progression as systematic, progressive loading of tissue and functional capacity rather than fixed timelines. The framework offers clinicians a structured, criterion-based alternative for RTS decision-making.

42. Murray J, Bijwadia S, Ristow J, et al. Multiligamentous Knee Injury in a Skeletally Immature Athlete. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-25-00266

A 13-year-old football player with a complete ACL, PCL, and MCL tear plus lateral meniscus injury underwent physeal-sparing multiligamentous reconstruction (ACL autograft; PCL/MCL allograft) with partial meniscectomy. At 18 months he was pain-free with normal limb lengths and had returned to competitive football. The case demonstrates that careful graft selection and technique can achieve excellent outcomes in skeletally immature patients while minimising physeal damage and leg-length discrepancy risk.

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