What's New — Knee — September 2026¶
196 new articles published this month.
Themes: ACL Reconstruction & Graft Outcomes · Patellofemoral Instability & Measurement · Meniscus Root Tears & Repair · Knee Arthroplasty Alignment & Technology · Arthroplasty Infection & Complications · High Tibial Osteotomy & Alignment
Digest generated 2026-10-04 16:21:03+00:00.
Highlights¶
ACL Reconstruction & Graft Outcomes¶
This month's knee literature is dominated by ACL reconstruction, spanning graft selection, failure prediction, and revision strategy. Registry and cohort data address graft type effects in combined ACL, MCL injuries [14], quadriceps versus hamstring graft equivalence [124][155], and peroneus longus as an emerging autograft [61][99]. Risk stratification studies highlight posterior tibial slope [30][34][73][110], passive anterior tibial subluxation [38], generalized joint laxity [97], and synovial sheath integrity after primary repair [64]. Lateral extra-articular tenodesis and anterolateral ligament reconstruction feature prominently, including consensus indications [92], registry trends [172], and outcomes after failure of combined procedures [60][112]. Revision topics include tunnel morphology classification [111], bone grafting of osteolytic tunnels [89][101], suture augmentation [62], and MRI-guided revision planning [49].
Patellofemoral Instability & Measurement¶
A dense cluster of patellofemoral instability (PFI) papers focuses on imaging metrics and surgical technique. Multiple studies interrogate tibial tubercle measurements, TT-TG, TT-PCL, and newer alternatives such as patellar tendon, lateral trochlear ridge distance [36][87][88][105][117], with several showing that trochlear dysplasia confounds traditional indices [102][117]. Patellar height assessment reliability is examined across modalities, skeletal maturity, and radiographic positioning [11][77]. Surgical contributions include MPFL reconstruction graft choices in adolescents [2], combined MPFL and medial patellotibial ligament reconstruction [5][90], double-bundle fixation with cortical buttons [120], paediatric fixation biomechanics [158], tibial tubercle osteotomy fixation [91], trochleoplasty outcomes [20], and dynamic ultrasound assessment of extensor alignment [134].
Meniscus Root Tears & Repair¶
Medial meniscus posterior root tears receive substantial attention, with systematic reviews comparing all-inside versus transtibial pullout repair [7][26] and warning that early partial weight-bearing yields suboptimal outcomes [29]. Epidemiologic work identifies postmenopausal status as a risk factor for root tears and subsequent arthroplasty [78], while AI models predict failure after nonsurgical management [135]. Adjacent meniscal topics include biomechanical effects of combined ramp and lateral root tears in ACL-deficient knees [119], lateral root repair with ACL reconstruction [194], biologic augmentation with bone marrow aspirate clot [12][75], radial tear consensus [114], circumferential repair of horizontal cleavage tears [191], meniscal allograft transplantation in athletes [22], and MRI predictors of posterior horn tears [173].
Knee Arthroplasty Alignment & Technology¶
Arthroplasty papers cluster around alignment philosophy, technology, and implant selection. Kinematic and functional alignment studies report better satisfaction and function than mechanical alignment [8][96][145], while robotic platforms are critically appraised for clinical value [59][106][126][127][186]. Unicompartmental arthroplasty work covers long-term survivorship [48][81], lateral compartment changes on MRI [50], custom implants [163], and patellofemoral versus unicompartmental comparisons [182][130]. Additional contributions address patellar resurfacing decisions [146][178][189], femoral notching classification [123], sagittal alignment measurement [161], and gap balancing in fixed deformity [192].
Arthroplasty Infection & Complications¶
Periprosthetic joint infection and perioperative complications form a distinct theme. Infection-focused studies include PJI risk factors after TKA [122], procedure-specific infection risk after prior knee surgery [84], antibiotic prophylaxis choices in aseptic revision [177], one- versus two-stage revision strategies [154][66], sobering outcomes after two-stage exchange in revision components [171], and novel techniques such as vancomycin-soaked grafts [13] and DAIR with vacuum drainage [109]. Broader complication research covers surgical site infection trends [188], periprosthetic tibial fractures [165][170], distal femoral megaprosthesis failure [166], neuropathic pain screening [196], and peri-incisional blistering [144].
High Tibial Osteotomy & Alignment¶
Osteotomy papers address surgical safety, planning technology, and long-term outcomes. Technical innovations include a hybrid protective sentinel system for open-wedge high tibial osteotomy [18] and AI-based preoperative planning that matches surgeon accuracy with greater speed [52]. Outcome studies examine patellofemoral joint effects after medial open-wedge osteotomy [41][103], predictors of varus correction loss related to meniscal extrusion [116], prognostic value of preoperative MRI findings [167], larger corrections with inverted V-shaped technique [148], and slope-reducing osteotomy combined with revision ACL reconstruction in elite athletes [98]. Biomechanical work clarifies how medial and lateral posterior tibial slope independently drive anterior translation and internal rotation [34].
Articles by Theme¶
ACL Reconstruction & Graft Outcomes (29)¶
14. Bouguennec N, Neri T, Carrozzo A, et al. ACL Graft Type Effects on Outcomes Were Not Significantly Modified by Medial Collateral Ligament Status in Combined ACL-MCL Injuries: A Multicenter Registry Study From the French Arthroscopic Society. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261487325
This prospective multicenter registry study from the French Arthroscopic Society examined whether medial collateral ligament status modifies the relationship between ACL graft type (hamstring vs nonhamstring) and postoperative outcomes in combined ACL-MCL injuries. MCL status did not significantly modify the effect of graft type on IKDC subjective scores or secondary outcomes. Concerns that hamstring harvest compromises medial stability in concomitant MCL injury are not supported, allowing graft choice to be guided by other factors.
30. Moore ML, Brinkman JC, Wang E, et al. Graft Failure Rate Is Similar Between Groups With and Without Increased Posterior Tibial Slope After Primary Anterior Cruciate Ligament Reconstruction With Lateral Extra‐articular Tenodesis. Arthroscopy 2026. doi:10.1002/arj.70616
This retrospective cohort study of 289 patients undergoing primary ACL reconstruction with lateral extra-articular tenodesis (LET) compared outcomes between patients with increased posterior tibial slope (≥12°) and those without. Graft failure rates were similar between groups, suggesting LET may mitigate the elevated graft failure risk associated with increased tibial slope. This supports the use of LET as an adjunct in high-risk patients with steep posterior tibial slope.
34. Nejima S, Holt J, van Arkel R, et al. Lateral Tibial Posterior Slope Induces Anterior Tibial Translation While Lateral-Medial Slope Difference Induces Internal Rotation: A Cadaveric Biomechanical Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480902
In eight fresh-frozen cadaveric knees, medial and lateral posterior tibial slopes were independently altered via unicondylar osteotomies (−5° to +10°) and tibiofemoral kinematics measured under 500-N axial compression at 0° and 20° of flexion. Increased lateral posterior slope drove greater anterior tibial translation, while a larger lateral-minus-medial slope difference induced greater internal rotation. Surgeons performing slope-altering osteotomy should consider lateral slope and slope asymmetry as independent levers on knee kinematics.
38. Gao Y, Shi W, Zhong Y, et al. The association between passive anterior tibial subluxation and anterior cruciate ligament reconstruction failure. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70607
In a propensity score, matched retrospective study of 131 ACL reconstruction failures and 131 controls with intact grafts at ≥48 months, passive anterior tibial subluxation (PATS) was measured on primary injury MRI and on follow-up MRI. Greater PATS at the time of primary ACL injury was independently associated with subsequent graft failure, and PATS evolved differently over time between failure and control groups. Preoperative PATS may help identify patients at elevated risk of graft failure who could benefit from augmented surgical strategies or closer surveillance.
49. Bermúdez IAB, Echavarría DMA, Duarte Vallejo A, et al. Beyond graft integrity: Magnetic resonance imaging should define the revision roadmap in failed anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70602
This letter to the editor responds to a study reporting limited correlation between clinical failure and MRI graft status in failed ACL reconstruction, arguing that MRI findings extend well beyond graft integrity. The authors contend that MRI should systematically evaluate meniscal lesions, cartilage status, and other pathology to define the revision surgical roadmap. Clinically, they advocate for comprehensive MRI interpretation as an essential component of revision ACL planning rather than relying solely on clinical instability assessments.
60. Leão RV, Takamune DM, da Silva AGM, et al. Preserved anterolateral ligament graft continuity on MRI and lower knee laxity after ACL graft failure than before index combined ACL–ALL reconstruction: A retrospective case series. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70618
This retrospective case series of 15 patients with ACL graft failure after combined ACL, anterolateral ligament reconstruction assessed ALL graft integrity on MRI and compared knee laxity before the index surgery and after graft failure. All ALL grafts remained continuous on MRI, and anterior tibial translation and pivot-shift were lower after failure than before the index reconstruction. This suggests the ALL graft may retain function and partially protect against laxity even after ACL graft failure, informing decisions about revision strategy.
61. Okutan AE, Budhiparama N, Herbort M, et al. Peroneus longus tendon autograft for anterior cruciate ligament reconstruction: Current evidence, donor‐site complications and patient selection. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70616
This narrative review synthesizes anatomical, biomechanical, and clinical evidence on peroneus longus tendon autograft for ACL reconstruction, including donor-site morbidity and patient selection. It concludes that PLT offers reliable graft characteristics with short- to midterm outcomes broadly comparable to established autografts and generally favourable donor-site function, but the retrospective, heterogeneous evidence base cannot establish equivalence or noninferiority. Clinicians may consider PLT an option, particularly when avoiding harvest-site morbidity in the injured knee, while awaiting higher-quality comparative data, especially in high-demand athletes.
62. Gao Y, Gong X, Wang Y, et al. Improved Activity, Return to Sport, and Graft Survivorship With Suture‐Augmented Versus Isolated Revision Anterior Cruciate Ligament Reconstruction Using All‐Soft‐Tissue Grafts. Arthroscopy 2026. doi:10.1002/arj.70539
This retrospective study compared suture-augmented versus isolated revision ACL reconstruction using all-soft-tissue grafts in 104 patients with minimum 2-year follow-up, using inverse probability of treatment weighting. Suture augmentation was associated with improved activity, return to sport, and graft survivorship versus isolated revision. The findings support considering suture augmentation to protect revision ACL grafts, particularly in higher-risk patients.
64. von Rehlingen‐Prinz F, Conner‐Rilk S, van der List JP, et al. Poor Synovial Sheath Integrity Is Associated With an Increased Failure Rate After Anterior Cruciate Ligament Primary Repair. Arthroscopy 2026. doi:10.1002/arj.70554
This retrospective study of 281 patients undergoing anatomic dual-suture anchor ACL primary repair graded synovial sheath integrity, tear location, and rupture pattern from arthroscopic images to identify predictors of failure at 2-5 years. Poor synovial sheath integrity was associated with a significantly increased failure rate after primary repair. Clinically, arthroscopic assessment of sheath integrity should inform intraoperative decisions between primary repair and reconstruction.
73. Paul S, Ghandour M, Jacquet C, et al. Increased medial posterior tibial slope is associated with greater postoperative anterior tibial translation over time after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70597
In 319 patients after primary ACL reconstruction with semitendinosus autograft, medial posterior tibial slope measured on serial radiographs was correlated with Telos stress-radiographic anterior tibial translation at 2 months, 1 year, and 2 years. Greater medial posterior tibial slope was associated with progressively increasing anterior tibial translation over time, with effects modified by age, cartilage status, and lateral extra-articular tenodesis use. This suggests slope assessment should inform ACLR planning and postoperative laxity surveillance, as steep-slope patients may warrant augmented procedures or closer follow-up.
89. Wu A, He Y, Xiang S, et al. Autologous Iliac Crest Bone Graft After Anterior Cruciate Ligament Reconstruction Failure in Patients With Both Femoral and Tibial Tunnel Enlargement. Arthroscopy Techniques 2026. doi:10.1002/atn2.70248
The authors present a single-stage arthroscopic technique for managing femoral and tibial tunnel enlargement at revision ACL reconstruction, using ipsilateral iliac crest cancellous bone graft that is impacted into the enlarged tunnels. The technique restores tunnel geometry and creates a biological environment suitable for graft fixation. In selected patients it may avoid a traditional two-stage revision, shortening treatment and reducing morbidity.
92. Hohmann E, Imhoff A, Perry NPJ. Delphi Expert Consensus Identifies Revision Surgery, High‐Grade Pivot Shift, and High‐Risk Athletes in Pivoting Sports as Indications for Anterolateral Ligament Reconstruction or Lateral Extra‐articular Procedures in Anterior Cruciate Ligament Reconstruction. Arthroscopy 2026. doi:10.1002/arj.70532
A three-round Delphi consensus of 40 experts evaluated biomechanics, indications, techniques, and complications of anterolateral ligament reconstruction or lateral extra-articular procedures as adjuncts to ACL reconstruction. Unanimous agreement supported these procedures for high-grade pivot shift and revision ACL surgery, with strong consensus for generalized hyperlaxity and high-risk pivoting-sport athletes, and confirmation that lateral extra-articular procedures resist internal tibial rotation and reduce ACL graft stress when femoral fixation is placed posterior and proximal to the lateral epicondyle. The consensus provides evidence-based guidance while highlighting overconstraint and altered knee mechanics as key risks.
97. Za P, Papalia GF, Caria C, et al. The role of generalised joint Laxity in anterior cruciate ligament reconstruction: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70598
This systematic review and meta-analysis of 13 studies (3,905 patients) compared outcomes after primary ACL reconstruction between patients with and without generalized joint laxity. Patients with generalized joint laxity had slightly worse IKDC scores (mean difference −3.27, p = 0.05) and trends toward greater residual laxity and reinjury risk. Clinically, laxity should be recognised as a potential negative prognostic factor when counseling patients and planning ACL reconstruction.
99. Park M, Bouwkamp N, Riggs T, et al. Peroneus Longus Autograft Harvest and Preparation for Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70255
This arthroscopy techniques article presents a step-by-step method for harvesting and preparing a peroneus longus tendon autograft with internal brace augmentation for ACL reconstruction. The authors provide a reproducible operative protocol leveraging the tendon's favourable biomechanical properties, consistent diameter, and low donor-site morbidity. Standardizing the technique may facilitate broader adoption of peroneus longus autograft as an alternative graft choice.
101. Hirpara A, Constantine E, Dragoo JL. Bone Grafting Using Manually Contoured Femoral Head and Neck Allograft Successfully Fills Femoral and Tibial Tunnel Osteolytic Defects in 2‐Stage Revision Anterior Cruciate Ligament Reconstruction: A Computed Tomography‐Guided Analysis. Arthroscopy 2026. doi:10.1002/arj.70540
This CT-guided study quantified tunnel filling after bone grafting with manually contoured femoral head and neck allograft in 20 tibial and 15 femoral tunnels during two-stage revision ACL reconstruction. The allograft achieved approximately 92% filling of reamed tunnels and osteolytic defects at a mean 123 days postoperatively, and cost-minimisation analysis favored it over prefabricated bone dowels. Manually contoured femoral head/neck allograft is an effective, economical option for managing tunnel osteolysis before staged revision.
110. Pineda T, Mazy D, Ramos-Rojas J, et al. Absolute Risk of Anterior Cruciate Ligament Graft Reruptures From the Posterior Tibial Slope Falls With Increasing Age: A Risk Stratification Analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261479079
Using a retrospective cohort of 585 primary ACL reconstructions with hamstring autografts and 6-year minimum follow-up, the authors modeled joint effects of posterior tibial slope and age on graft rerupture with interaction analysis. The absolute rerupture risk attributable to increased posterior tibial slope declined with increasing age, with identifiable age thresholds at which clinically relevant risk levels are reached. Slope-reducing osteotomy or augmented procedures (e.g., lateral extra-articular tenodesis) may be best reserved for younger patients with high slopes.
111. Kennedy MI, Tollefson LV, Kennedy NI, et al. A novel classification system for measuring and interpreting tibial tunnel morphology for revision ACLR. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70551
The authors retrospectively reviewed CT imaging of 75 failed ACL reconstructions to develop a reproducible classification of tibial tunnel morphology, yielding five sagittal types (tubular, shovel, balloon, dual tunnel, mushroom) and axial size categories. This framework standardizes measurement of tunnel position and dilation in the revision setting. It is intended to guide the choice between one-stage and two-stage revision ACL reconstruction based on tunnel quality.
112. Duru DO, O'Brien C, Bouchard MD, et al. Revision anterior cruciate ligament reconstruction following failure of combined anterior cruciate ligament reconstruction with lateral extra‐articular procedures: A scoping review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70593
This scoping review identified nine studies describing revision ACL reconstruction after failure of combined ACLR with lateral extra-articular procedures (LET or ALLR). It mapped reported surgical strategies and outcomes but found the evidence base limited to small case series with heterogeneous techniques and incomplete outcome reporting. The review highlights a major evidence gap, suggesting clinicians currently lack robust data to guide revision strategy in this population.
124. Bi AS, Augustin EJ, Smelley CC, et al. Quadriceps Tendon Autograft Harvest Technique Affects Both Graft Strength and Cross-sectional Area. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261478369
In a controlled cadaveric study of 15 knees, the authors compared bone, patellar tendon, bone grafts with quadriceps tendon grafts harvested either with a 9-mm double-blade scalpel or a proprietary cylindrical harvester, assessing ultrasound-derived cross-sectional area and pull-to-failure strength. Ultrasound CSA measurement proved reliable, and harvest technique significantly affected both QT graft cross-sectional area and biomechanical strength, contradicting the assumption that all QT harvest methods are equivalent. Surgeons should recognize that graft size and strength depend on the specific QT harvesting technique chosen.
128. Qu X, Yi M, Tang X, et al. Rethinking Graft Equivalence After ACL Reconstruction With Lateral Extra-articular Tenodesis in Elite Athletes: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261466181
In this letter to the editor, the authors critique a study comparing bone, patellar tendon, bone versus hamstring autografts after ACL reconstruction with lateral extra-articular tenodesis in elite athletes, arguing that routine LET use in high-risk patients confounds graft-specific comparisons. They contend that the absence of between-group differences reflects the combined BPTB+LET and HT+LET constructs rather than true graft equivalence. Clinicians should therefore not conclude that graft choice is unimportant when LET is uniformly applied.
129. Lynskey SJ, Ambrosanio A, Motesharei A, et al. Rethinking Graft Equivalence After ACL Reconstruction With Lateral Extra-articular Tenodesis in Elite Athletes: Response. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261466186
The authors respond to a letter critiquing their study comparing hamstring tendon versus bone, patellar tendon, bone autografts, both combined with lateral extra-articular tenodesis (LET), in professional soccer and rugby players after primary ACL reconstruction. They clarify that the study was designed to compare two full reconstructive constructs rather than isolated grafts, and that their hypothesis was that graft differences may be attenuated when routine LET is added in elite pivoting athletes. The clinical implication is that graft equivalence conclusions should be interpreted in the context of the combined ACLR-plus-LET construct used in contemporary elite sports medicine.
133. Vega TF, Espinosa JBV, Shewman E, et al. Full-Construct Biomechanical Evaluation of Femoral Cortical Suspensory Fixation for Anterior Cruciate Ligament Reconstruction in a Porcine Knee Model. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261445909
In a porcine knee model simulating doubled hamstring grafts, 55 constructs across five femoral cortical suspensory fixation devices (one fixed-loop and four adjustable/locking variants) underwent cyclic loading simulating early and late rehabilitation followed by pull-to-failure testing. The study characterized excursion, maximum load, stiffness, energy to failure, and failure modes across button-locking, suture-locking, and dual-locking mechanisms relative to an industry-standard fixed-loop device. Results clarify the biomechanical mechanisms underlying elongation and failure of these devices, informing device selection during early rehabilitation after ACL reconstruction.
136. Liau ZQG, Khoo B, Tuyishime H, et al. Personalizing the Quadriceps Tendon Graft in Anterior Cruciate Ligament Reconstruction: A Novel, Continuous Method to Predict Graft Size Using Preoperative MRI. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477950
In 130 patients who underwent primary ACL reconstruction with full-thickness quadriceps tendon autografts, the authors tested whether preoperative MRI QT thickness predicts graft size dichotomously (<10 vs ≥10 mm) and whether the formula 2×√(WT/π) predicts graft diameter continuously within ±1.0 mm, with interrater reliability assessment. The study provides a novel continuous MRI-based method for preoperative QT graft size prediction beyond existing dichotomous cutoffs. This enables personalized graft planning to help avoid undersized grafts and mitigate postoperative quadriceps weakness in high-demand patients.
140. Lesman J, Nowak K, Żabierek S, et al. Impact of time after anterior cruciate ligament injury on vascular and bone quality at the femoral insertion site: a histological cohort study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104869
This histological cohort study harvested femoral ACL footprint bone cores from 60 patients at primary ACL reconstruction and 10 TKA reference patients, assessing microvessel density (CD34 staining), CD34-positive cell clusters, and osteocyte lacunar density across defined regions. The study evaluated whether longer time from ACL injury to reconstruction alters vascularity and bone microarchitecture at the femoral insertion site. Results inform the biological consequences of surgical timing after ACL injury, potentially guiding reconstruction scheduling.
147. Ebata T, Iwasaki K, Sato D, et al. Alteration of Subchondral Bone Density Distribution Across the Knee Joint Before and After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261442597
Using CT osteoabsorptiometry in 17 patients undergoing double-bundle ACL reconstruction, this case series quantified tibial subchondral bone density distribution (HDA%) across six sagittal subregions before and after surgery. Reconstruction did not fully normalize the elevated posteromedial density seen after ACL injury, indicating persistent altered loading despite restored stability. This suggests residual kinematic or contact mechanics abnormalities after reconstruction may contribute to ongoing osteoarthritis risk, supporting long-term monitoring.
155. Tseng T, Fu S, Lo Y, et al. Are Comparable Short-term Outcomes Between Hamstring and Quadriceps Tendon Autografts for ACL Reconstruction Statistically Robust? A Reverse Continuous Fragility Index Analysis of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261479032
The authors applied a reverse continuous fragility index analysis to Level 1 RCTs comparing hamstring versus quadriceps tendon autografts for ACL reconstruction, testing how fragile nonsignificant continuous outcomes were to lost participants. The hypothesis that findings were statistically robust was tested against fragility thresholds. Results inform how confidently surgeons can equate short-term outcomes between the two graft choices.
168. Hamad CD, Joachim K, Chung E, et al. The Impact of Lateral Extra-Articular Tenodesis on Knee Range of Motion After Pediatric Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261467539
In 412 paediatric ACL reconstructions, lateral extra-articular tenodesis augmentation was evaluated for association with restricted knee range of motion at 3 months. LET augmentation was not independently associated with postoperative stiffness; restricted ROM was instead related to other patient and surgical factors. LET can be used in paediatric ACLR without substantially increasing stiffness risk.
172. Rocha MA, Fayard J, Vieira TD, et al. Trends in Anterolateral Ligament Reconstruction and Lateral Extra-Articular Tenodesis With Primary ACL Reconstruction: A Retrospective Registry-Based Cohort Study From The SFA-ACL Registry Study Group. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104899
Using the French Arthroscopy Society ACL Registry (December 2021, October 2024), this retrospective cohort of over 8,400 primary ACL reconstructions examined trends in concomitant anterolateral ligament reconstruction and lateral extra-articular tenodesis. Adoption of lateral extra-articular procedures increased over the study period and was associated with surgeon volume and meniscal repair strategies. The results document rapid uptake of these adjunct procedures in France and highlight the value of registry data for monitoring evolving surgical practice.
193. Naderi A, Chorom Zadeh H, Shaabani F, et al. Translation, Cultural Adaptation, and Psychometric Validation of the Persian Version of the Knee Numeric-Entity Evaluation Score for ACL (KNEES-ACL) in Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477185
The KNEES-ACL patient-reported outcome measure was translated into Persian using forward-backward translation, expert committee review, and cognitive debriefing, then psychometrically evaluated in 110 Persian-speaking athletes with ACL rupture. The culturally adapted Persian version demonstrated validity and reliability consistent with COSMIN guidelines. Clinicians treating Persian-speaking athletes now have a validated instrument to assess knee function and psychological readiness for return to sport.
Patellofemoral Instability & Measurement (17)¶
2. Jackson GR, Barron B, Childers JT, et al. Autograft Medial Patellofemoral Ligament Reconstruction Provides Comparable Patient‐Reported Outcomes and Failure Rates With Fewer Complications Versus Allograft Reconstruction in Adolescent Patients: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70555
This systematic review compared autograft versus allograft medial patellofemoral ligament reconstruction in adolescents across 20 studies (596 patients, mean follow-up 44.1 months). Both graft types yielded comparable patient-reported outcomes (Kujala scores) and failure rates, but autograft was associated with fewer complications. These results support autograft as the preferred graft choice for MPFL reconstruction in adolescent patients.
5. Dai Z, Yang Z, Jiang X, et al. Medial Patellar Retinaculum Cable Replacement of Medial Quadriceps Tendon‐Femoral Ligament Combined With Medial Patellofemoral Ligament Reconstruction in Treatment of Recurrent Patellar Dislocation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70282
This surgical technique article describes medial patellar retinaculum cable replacement of the medial quadriceps tendon-femoral ligament combined with MPFL reconstruction and medial tightening for recurrent patellar dislocation. A 1-cm longitudinal retinaculum cable is harvested leaving the proximal attachment intact and secured with the MPFL autograft, with vastus medialis oblique and remaining retinaculum fastened to the patella. The technique offers a readily adoptable double-bundle-type alternative for treating recurrent patellar instability.
11. Kebeh M, Kell D, Orellana KJ, et al. Magnetic Resonance Imaging and Radiographic Patellar Height Ratio Measurement Reliability Is Not Degraded by Skeletal Maturity or Patellofemoral Instability. Arthroscopy 2026. doi:10.1002/arj.70465
Seven fellowship-trained surgeons measured seven patellar height ratios on lateral radiographs and MRI in 77 paediatric patients to determine which ratios are most reliable and whether skeletal maturity or patellofemoral instability affects measurement reliability. Reliability of patellar height ratios was not degraded by skeletal immaturity or patellofemoral instability diagnosis. Clinicians can therefore confidently use these ratios, particularly the best-performing indices, across both modalities in skeletally immature and unstable knees.
20. Schmidt S, Navas L, Zimmermann F, et al. Preoperative Sagittal Tibial Tubercle‐Trochlear Groove Distance Predicts Postoperative Outcome in Patients Undergoing Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction. Arthroscopy 2026. doi:10.1002/arj.70552
This retrospective study evaluated whether preoperative sagittal tibial tubercle-trochlear groove (sTTTG) distance measured on MRI predicts outcomes after combined medial patellofemoral ligament reconstruction and deepening trochleoplasty in patients with recurrent lateral patellar instability and high-grade trochlear dysplasia. Outcomes were assessed with the Banff Patellofemoral Instability Instrument 2.0 and other patient-reported measures at minimum 18-month follow-up. The findings inform preoperative counseling and surgical planning regarding the potential influence of preoperative tubercle position on postoperative results.
36. Wang Z, Credille K, Allahabadi S, et al. Tibial Tubercle‐to‐Posterior Cruciate Ligament Measurement in Patellar Instability Is Influenced by Axial Slice Selection and Tibial Width Normalization. Arthroscopy 2026. doi:10.1002/arj.70516
In 64 patellar instability patients and 30 controls, tibial tubercle-to-posterior cruciate ligament (TT-PCL) distances were measured on axial MRI using proximal, middle, and distal placements of the dorsal condylar line, with and without tibial width normalization. TT-PCL was significantly greater in instability patients at all slice locations, but absolute values varied meaningfully with slice selection. TT-PCL measurement methodology must be standardised and reported, as axial slice choice affects values and potentially tibial tubercle osteotomy decisions.
58. Jones M, Mowers CC, Mays L, et al. Osteochondral Allograft Transplantation of the Patellofemoral Joint Shows High Short‐ to Midterm Survivorship but Variable Long‐Term Outcomes: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70575
This systematic review of 7 studies (8-40 patients each, follow-up 24-238.8 months) evaluated patellofemoral osteochondral allograft transplantation with minimum 2-year follow-up. It found high short- to midterm graft survivorship but variable long-term outcomes, with OCA most often used as a revision procedure. Clinically, patellofemoral OCA appears a reasonable salvage option, though longer-term expectations should be counseled cautiously.
77. Cote M, Bowman C, Howard P, et al. Knee Malposition During Radiographs Can Produce Clinically Relevant Errors in Measurements of Patellar Height. Arthroscopy 2026. doi:10.1002/arj.70543
Using 3D CT-derived knee models projected onto simulated lateral radiographs, the authors quantified error in patellar height indices (Insall-Salvati, modified IS, Blackburne-Peel, Caton-Deschamps, patellotrochlear) with progressive knee malpositioning. Each 5° of aberrant rotation or abduction/adduction increased posterior condylar overlap by ~4 mm and produced clinically significant (≥0.05) measurement errors, with Insall-Salvati least sensitive to malposition. Radiographic technique must be strictly controlled when measuring patellar height, as malpositioning can spuriously diagnose or exclude patella alta and alter surgical decisions.
87. Wu Y, Cui Z, Zhang J, et al. The Tibial Tubercle‐Trochlear Groove Distance Has Higher Accuracy and Moderate Inter‐observer Reliability Compared With the Tibial Tubercle‐Roman Arch and Tibial Tubercle‐Midepicondyle Distances. Arthroscopy 2026. doi:10.1002/arj.70542
This retrospective study compared the interobserver reliability and diagnostic accuracy of tibial tubercle, trochlear groove, tibial tubercle, Roman arch, tibial tubercle, midepicondyle, and tibial tubercle, PCL distances in patients with patellar dislocation versus controls with meniscal or ACL injury. TT-TG showed higher accuracy and moderate interobserver reliability than the alternative measures, while TT-PCL lacked meaningful diagnostic value. TT-TG remains the preferred measurement for assessing pathologic tibial tubercle lateralization in patellar instability.
88. Tagliero AJ, Ward GH, Mavrommatis S, et al. Patellar Tendon‐Lateral Trochlear Ridge Distance Is More Specific Than Tibial Tubercle‐Trochlear Groove for Patellofemoral Instability. Arthroscopy 2026. doi:10.1002/arj.70545
In a propensity-matched case-control study of 50 knees with patellofemoral instability and 50 controls, MRI-based measurements of tibial tubercle, trochlear groove, tibial tubercle, PCL, and patellar tendon, lateral trochellar ridge distances were compared for reliability and discriminative capacity. PT-LTR demonstrated greater specificity than TT-TG for identifying patellofemoral instability, with excellent inter- and intra-rater reliability. PT-LTR may serve as a complementary or alternative measurement when assessing recurrent instability risk and planning surgical treatment.
90. Martins FS, Cardoso Filho AT, Canuto SMDG, et al. Medial Patellofemoral and Medial Patellotibial Ligament Reconstruction Using a Docked Rectus Femoris Graft. Arthroscopy Techniques 2026. doi:10.1002/atn2.70252
This technical note describes combined medial patellofemoral ligament and medial patellotibial ligament reconstruction using a single rectus femoris tendon autograft harvested from the superficial quadriceps layer, targeting persistent patellar instability beyond early flexion after isolated MPFL reconstruction. The soft-tissue-only, physeal-sparing technique avoids bone tunnels, making it attractive for skeletally immature patients. The graft offers adequate length and biomechanical properties with low donor-site morbidity via a minimally invasive approach.
91. Varady NH, Neijna AG, Terry HL, et al. Increased Risk of Fixation Failure With Two 3.5 Versus 4.5 Millimeter Solid Bicortical Screws for Tibial Tubercle Osteotomy. Arthroscopy 2026. doi:10.1002/arj.70541
In a retrospective cohort of 398 patients undergoing primary tibial tubercle osteotomy, fixation with two 3.5 mm solid bicortical screws was compared with two 4.5 mm screws for risk of fixation failure by 6 months. Fixation failure occurred in 7.9% of 3.5 mm cases versus 1.4% of 4.5 mm cases (P = .03), with an even stronger association among women. Surgeons should favour 4.5 mm bicortical screw fixation to reduce the risk of fracture, nonunion, or delayed union requiring reoperation after tibial tubercle osteotomy.
102. Ackerman J, Amin J, Sachdev D, et al. High‐Grade Trochlear Dysplasia Confounds Patellar Height Assessment Using the Magnetic Resonance Imaging‐Derived Patellotrochlear and Radiograph‐Derived Caton‐Deschamps Indices. Arthroscopy 2026. doi:10.1002/arj.70549
This retrospective study of 152 knees with patellofemoral instability compared MRI-based patellotrochlear index and radiograph-based Caton-Deschamps index for patellar height assessment across trochlear dysplasia grades. Both indices were confounded by high-grade trochlear dysplasia, with PTI differing significantly across Dejour types and correlating imperfectly with functional engagement (instability resolution angle). Patellar height measurements should be interpreted cautiously in dysplastic trochleae, as dysplasia can distort these indices and misclassify patella alta.
105. Crippa M, Beltrame G, Beber SA, et al. Patella Alta and Trochlear Dysplasia as a Determinant of Patellar Tendon Lateralization and Inclination: A Cross-sectional MRI Study in Adolescents With Patellofemoral Instability. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261478742
In a case-control MRI study of 284 adolescent knees with and without patellofemoral instability, the authors defined a new patellar tendon inclination angle (PTIA) and compared it with the patellar tendon, lateral trochlear ridge distance (PT-LTR). Both tendon-based measures correlated with established risk factors (patella alta, trochlear dysplasia) and showed diagnostic accuracy for instability, with good interobserver agreement. These parameters may complement TT-TG distance in assessing extensor mechanism malalignment and guiding surgical decision-making.
117. Ackermann J, Sachdev D, Amin J, et al. Tibial Tubercle‐Posterior Cruciate Ligament Distance Fails to Capture Pathologic Patellar Lateralization in Trochlear Dysplasia. Arthroscopy 2026. doi:10.1002/arj.70544
In 153 patients with patellofemoral instability, tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances were compared across grades of trochlear dysplasia and correlated with knee rotation and patellar lateralization (PTLTR). TT-PCL failed to reliably capture pathologic patellar lateralization, particularly in the setting of trochlear dysplasia, limiting its validity as a surgical decision-making threshold. Realignment indications should therefore incorporate direct measures of lateralization such as PTLTR rather than relying on TT-PCL alone.
120. Zhou D, He Y, Xu L, et al. Double Adjustable‐Loop Cortical Buttons for Minimally Invasive Anatomic Double‐Bundle Medial Patellofemoral Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70242
A surgical technique article describes anatomic double-bundle medial patellofemoral ligament (MPFL) reconstruction using dual adjustable-loop cortical buttons for fixation on both the femoral and patellar sides, performed minimally invasively under arthroscopic visualization. This approach avoids the larger incisions, extensor mechanism compromise, and bone tunnel fracture or graft laceration risks associated with suture anchors and interference screws. It offers surgeons an alternative fixation method that preserves bone stock and soft tissue while allowing controlled graft tensioning.
134. Greenberg EM, DeSandis B, Owens S, et al. Dynamic Ultrasound Assessment of Axial Extensor Mechanism Alignment in Adolescents With and Without Patellofemoral Instability. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261468156
This cohort study used point-of-care ultrasound to dynamically measure axial extensor mechanism alignment (MPT-LTR and LPT-LTR distances) in adolescents with and without patellofemoral instability across four knee positions from hyperextension to 30° of flexion. The authors evaluated whether dynamic ultrasound can detect alignment differences between groups and discriminate instability status using area-under-the-curve analysis. The technique offers a non-radiation, dynamic bedside tool that may help characterize recurrent instability risk in adolescents during early knee flexion.
158. Khoo B, Baird HB, Alawa J, et al. Biomechanical Comparison of Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction: A Pediatric Cadaveric Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261465205
In a paediatric cadaveric study, ten patellae from six skeletally immature donors (mean age ~10 years) were used to compare suture-anchor versus bone-tunnel patellar fixation for medial patellofemoral ligament reconstruction using servomechanical pullout testing. Fixation strength and failure modes of the two constructs were quantified in immature bone for the first time. The results guide technique selection in paediatric MPFL reconstruction, where small, largely cartilaginous patellae pose unique fixation challenges.
Meniscus Root Tears & Repair (13)¶
7. Vosoughi F, Menbari Oskouie I, Entezari A, et al. All‐Inside Medial Meniscus Root Repair Improves Function With Results Comparable to Tibial Pullout Method, but Both Methods Fail to Correct Extrusion: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 2026. doi:10.1002/arj.70626
This systematic review of 12 studies (8 clinical, 4 biomechanical) synthesized outcomes of all-inside repair for medial meniscus posterior root tears and compared them with transtibial pullout repair. Both techniques produced significant functional improvements with comparable results, though neither reliably corrected meniscal extrusion. All-inside root repair is a valid, less invasive option, but persistent extrusion remains an unmet challenge with implications for long-term joint protection.
12. Tsumoto S, Nishino K, Kishi H, et al. Clinical outcomes of meniscal repair using bone marrow aspirate-derived fibrin clot: A comparison of tears with and without meniscal cysts. International Orthopaedics 2026. doi:10.1007/s00264-026-07046-0
This retrospective study compared outcomes of bone marrow aspirate clot-augmented meniscal repair between tears with and without associated meniscal cysts at minimum 12-month follow-up, using IKDC scores, Barrett's criteria, and MRI signal-to-noise quotient. No significant group-by-time interactions were found for any outcome measure, indicating comparable healing and clinical results. BMA clot-augmented repair appears effective for meniscal tears with cysts, supporting its use without excluding cyst-associated tears.
22. Mowers CC, Jackson GR, Flynn G, et al. Meniscal Allograft Transplantation in Athletes Offers Improved Function, Pain, and Satisfaction With High Levels of Return to Sport and Graft Survivorship Despite High Complication and Revision Rates: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70592
This systematic review assessed graft survivorship, patient-reported outcomes, return to sport, and complications after meniscal allograft transplantation in athletic populations with minimum 24-month follow-up. Despite high complication and revision rates, athletes showed improved function, pain, and satisfaction with high return-to-sport rates and graft survivorship. The findings support meniscal allograft transplantation as a viable option for athletic patients, while counseling should address the notable risk of complications and revision surgery.
26. Tagliero AJ, Ahmad RA, Mikula JD, et al. Intratunnel Anchor Fixation and Transtibial Pull‐Through Repair Show Comparable Short‐Term Outcomes After Meniscus Root Repair: A Propensity‐Matched Comparative Study. Arthroscopy 2026. doi:10.1002/arj.70601
In this propensity-matched retrospective comparison of 100 patients undergoing meniscus root repair, intratunnel anchor fixation was compared with transtibial pull-through repair at minimum 12-month follow-up. Both techniques yielded comparable short-term clinical outcomes, including Lysholm, IKDC, pain scores, satisfaction, and reoperation rates. Results suggest intratunnel anchor fixation is a viable alternative to transtibial pull-through, warranting longer-term study to confirm durability.
29. Moews LD, Thamrongskulsiri N, Vega TF, et al. Suboptimal Clinical and Radiologic Outcomes After Medial Meniscus Posterior Root Tears Repair With Early Partial Weight‐Bearing: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70529
This systematic review examined clinical, radiologic, and complication outcomes after medial meniscus posterior root tear repair with early partial weight-bearing (initiated ≤4 weeks postoperatively). Available evidence showed suboptimal patient-reported outcomes and concerning radiologic findings with early weight-bearing protocols. The findings caution against early PWB after root repair and support more conservative, delayed weight-bearing rehabilitation until higher-quality data emerge.
75. Diril SK, Koçak S, Ozyigit E, et al. Multidisciplinary perspectives on biologic augmentation in meniscal repair: Integrating surgical, radiological and rehabilitative insights. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70609
This multidisciplinary commentary integrates surgical, radiological, and rehabilitation viewpoints on biologic augmentation of meniscal repair, discussing agents such as blood-derived products and their role in improving healing of meniscal tears. The authors emphasize that imaging findings and structured rehabilitation are central to patient selection and outcome assessment. Clinically, it advocates a coordinated, team-based approach when considering biologic augmentation to optimise meniscal healing rather than relying on surgical technique alone.
78. Panos JA, Teubner L, Long K, et al. Postmenopausal Status Is Associated With Increased Risk of Medial Meniscus Posterior Root Tears and Subsequent Arthroplasty. Arthroscopy 2026. doi:10.1002/arj.70561
In an age- and BMI-matched cohort of 1,564 patients with meniscal tears (782 postmenopausal women), logistic and Cox regression identified risk factors for medial meniscus posterior root tears and subsequent arthroplasty. Age and female sex were associated with MMPRT, and postmenopausal status, along with factors such as surgical menopause, bone mineral density, and hormone therapy, was linked to higher MMPRT risk and lower arthroplasty-free survival. Postmenopausal women with knee symptoms warrant heightened suspicion for posterior root tears, and confirmed MMPRT in this group carries substantial risk of progression to arthroplasty.
114. Dzidzishvili L, Pace JL, Flanigan DC, et al. An International Delphi Consensus on Meniscus Radial Tears: From Diagnosis to Management and Rehabilitation. Arthroscopy 2026. doi:10.1002/arj.70456
An international Delphi consensus process involving 45 orthopaedic surgeons established evidence-based statements on meniscus radial tears, covering risk factors, diagnosis, operative and nonoperative management, rehabilitation, and outcomes. The panel agreed that repair is indicated for isolated acute traumatic tears and tears accompanying acute cruciate ligament injury, while repair of chronic degenerative tears should depend on tissue quality and osteoarthritis severity. This consensus offers clinicians a standardised framework for individualized treatment decisions, with caution advised regarding the long-term harms of partial meniscectomy.
119. Choi YS, Piao Z, Kwak D, et al. Combined Ramp Lesion and Lateral Meniscus Root Tear Increase Rotational and Translational Instability in an Anterior Cruciate Ligament‐Deficient Knee: A Cadaveric Study. Arthroscopy 2026. doi:10.1002/arj.70536
In ten cadaveric knees, rotational and translational instability were measured across five conditions simulating the 'new terrible triad': ACL deficiency combined with lateral meniscus posterior root tear and medial meniscus ramp lesion. The combined lesions significantly increased internal rotation, external rotation, and anterior tibial translation compared with ACL deficiency alone or with either lesion in isolation, including during simulated pivot-shift testing. This biomechanical evidence supports careful evaluation and treatment of both lesions at the time of ACL reconstruction to restore rotational stability.
135. Yang HY, Bae I, Kim JW, et al. Artificial Intelligence–Based Prediction of Prognosis After Nonsurgical Treatment for Medial Meniscus Posterior Root Tear. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261470935
Using a prospectively collected database of 233 patients treated nonsurgically for medial meniscus posterior root tears (2006-2020), the authors developed and validated AI-based models, including five conventional machine learning algorithms and a deep learning model, to predict clinical failure (conversion to TKA or corrective osteotomy) at 2 and 5 years. The models incorporated demographic, clinical, and imaging variables for patient-specific risk stratification. Clinically, such AI prediction tools could guide shared decision-making and identify which MMPRT patients are likely to fail nonsurgical management and warrant earlier surgery.
173. Liu C, Hu Y, Sun H, et al. Impact of Femorotibial Displacement and Congruence on Posterior Horn Medial Meniscal Tears: An MRI Assessment. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261453301
This cross-sectional MRI study compared 112 patients with arthroscopically confirmed horizontal posterior horn medial meniscal tears against 82 matched controls, measuring coronal parameters of medial femoral condyle, tibial plateau displacement and congruence. Specific displacement ratios (e.g., MFCDR) were associated with posterior horn medial meniscal tears and showed diagnostic value. The findings suggest that femorotibial malalignment and reduced congruence increase medial meniscal posterior horn loading, informing assessment of patients at risk for these tears.
191. Ward GH, Ina J, Iyer S, et al. Circumferential Repair of Horizontal Cleavage Meniscus Tears: 82% of Patients With Sustained Improvement and 15% Reoperation Rate at Mean 6-Year Follow-up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486439
This single-institution case series of 27 patients with isolated horizontal cleavage meniscus tears treated with primary circumferential repair reported outcomes at minimum two-year follow-up (mean six years). Sustained improvement was seen in 82% of patients with a 15% reoperation rate, alongside improvements in VAS, Tegner, and IKDC scores and return to sport. The results support circumferential repair rather than debridement as a durable option for select horizontal cleavage tears.
194. Ancion A, Graveleau N, Bouguennec N. Functional outcomes at mid-term follow-up after ACL reconstruction with lateral meniscus posterior root repair: comparison between radial tears and avulsions. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104908
A retrospective comparative study of 65 patients assessed whether avulsion versus radial tear patterns of lateral meniscus posterior root lesions affect outcomes after ACL reconstruction with root repair, with follow-up at a mean of 51 months. No significant differences were found between lesion types in IKDC, subjective knee value, ACL-RSI, Tegner scores, or return-to-sport outcomes. Lesion type should not dictate prognostic counseling or surgical decision-making in combined ACL reconstruction and lateral meniscus root repair.
Knee Arthroplasty Alignment & Technology (21)¶
8. Campi S, Giurazza G, Franceschetti E, et al. Improved function and patient satisfaction with fewer residual symptoms following kinematically versus mechanically aligned total knee arthroplasty: A retrospective study from FP‐UCBM Knee Study Group. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70621
This retrospective cohort study compared unrestricted kinematic alignment (KA, n=315) versus mechanical alignment (MA, n=307) in primary total knee arthroplasty using the same implant and standardised protocols with minimum 1-year follow-up. KA achieved significantly higher overall satisfaction (94.0% vs 81.1%), better functional outcomes, and fewer residual symptoms, including less difficulty with car transfers. These findings support KA as a strategy to improve patient satisfaction and reduce residual symptoms after TKA.
48. Cerasoli T, Tabanelli B, Scagnol D, et al. Higher prearthritic activity is associated with higher long‐term activity after medial unicompartmental knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70624
This retrospective study of 76 knees at mean 116-month follow-up after medial unicompartmental knee arthroplasty used recalled Tegner scores to assess sport participation and the association between prearthritic and long-term postoperative activity. Of 54 previously sport-active knees, 98.1% returned to at least one sport, and mean Tegner scores returned to near prearthritic levels (3.88 vs 4.00), with higher prearthritic activity predicting higher final activity. Patients can be counseled that a high prearthritic activity level is achievable and likely after medial UKA.
50. Bunyoz KI, Troelsen A, Jackson W, et al. Isolated lateral compartment cartilage changes on preoperative magnetic resonance imaging should not automatically preclude medial unicompartmental knee arthroplasty: A cohort study of 100 magnetic resonance imaging scans. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70629
This retrospective cohort study of 100 knees with preoperative MRI assessed whether lateral compartment cartilage changes predict revision after medial unicompartmental knee arthroplasty, using Fine-Grey competing risk analysis over a mean 9.6-year follow-up. Lateral cartilage changes were present in 34 cases, but only six revisions occurred, with lateral osteoarthritis progression accounting for half. The findings suggest isolated lateral compartment cartilage changes on MRI should not automatically exclude patients from medial UKA.
59. Abul MS, Yılmaz H, Tuncay İ. Robotic total knee arthroplasty: Have technological advances translated into clinical value?. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70627
This commentary examines whether the rapid adoption of robotic total knee arthroplasty has delivered genuine patient benefit beyond technical gains in cut precision, component positioning, and soft-tissue balance assessment. It argues that technological capability alone does not justify adoption without demonstrated improvements in clinical outcomes. The clinical implication is that surgeons should weigh evidence of patient-relevant benefit, not just reproducibility, when deciding whether to use robotic TKA.
81. Cerasoli T, Branzanti E, Lo Presti M, et al. Long-term survivorship after medial unicompartmental knee arthroplasty: the influence of medical comorbidities and previous knee surgery. International Orthopaedics 2026. doi:10.1007/s00264-026-07029-1
A retrospective cohort of 168 medial unicompartmental knee arthroplasties with mean follow-up of ~10 years evaluated implant survivorship and the influence of medical comorbidities and prior ipsilateral knee surgery, with a nested cohort of 76 knees assessed clinically. Kaplan, Meier analysis using component revision as the endpoint defined long-term survivorship. The findings help inform patient selection and counseling for medial UKA, particularly regarding comorbidities and previous knee surgery.
96. Coenen R, Peeters A, Bollars P, et al. Functional alignment robotic‐assisted TKA improves clinical outcomes compared with conventional mechanical alignment TKA: A single‐surgeon randomised controlled non‐inferiority trial with 2‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70589
In a single-surgeon randomised controlled non-inferiority trial, 180 patients were allocated to robotic-assisted functional alignment TKA or conventional mechanical alignment TKA, with 2-year patient-reported outcomes (KSS, OKS, FJS-12, VAS pain, EQ-5D-5L, LEAS, satisfaction) analyzed via mixed-effects models. Functional alignment performed robotically improved recovery trajectories and knee-specific outcomes compared with conventional mechanical alignment over 2 years. This supports robotic functional alignment as a favourable alignment strategy in TKA when soft-tissue preservation and joint perception outcomes are priorities.
104. Phillipson L, Naybour J, Watson A, et al. Intraoperative patellofemoral load varies between total knee replacement and patellofemoral joint resurfacing, and across TKR implant systems. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06500-3
This observational registry study measured intraoperative patellofemoral joint loads in 291 knee replacement procedures, comparing total knee replacement and patellofemoral resurfacing across implant systems. Load changes after trial component implantation varied substantially in magnitude and distribution, both between procedure types and among TKR implant systems, across medial, lateral, superior, and inferior compartments. Implant design and surgical execution meaningfully influence patellofemoral loading, which may inform implant selection and explain postoperative anterior knee symptoms.
106. Tank P, Chauhan N, Jain H, et al. Effect of native Posterior condylar axis-Transepicondylar axis variability on femoral component rotation using robotic total knee arthroplasty. International Orthopaedics 2026. doi:10.1007/s00264-026-07018-4
This retrospective study of 72 robotic-assisted total knee arthroplasties examined native variability in the angle between the posterior condylar axis and transepicondylar axis on preoperative CT. The findings challenge the conventional fixed 3° external rotation target, showing that anatomical variability means a fixed offset does not reliably reproduce native femoral rotation. Robotic planning that individualizes femoral component rotation to native anatomy may improve flexion balance and patellofemoral tracking.
123. Antoniadis A, Mahlouly J, Royon T, et al. A novel classification system for anterior femoral notching in total knee arthroplasty. Arthroplasty 2026. doi:10.1186/s42836-026-00424-4
The authors propose a novel Femoral Notch Classification for total knee arthroplasty based on anterior resection depths and trochlear geometry, establishing four descriptive categories applicable both intraoperatively and on lateral radiographs independent of alignment philosophy. The system addresses the lack of standardised notching terminology and links resection depth to implant thickness, cortical integrity, and gap balancing. It offers surgeons a common language for describing, anticipating, and managing anterior femoral notching and its biomechanical and fracture-risk implications.
126. Koutserimpas C, Andriollo L, Gregori P. Robotic knee arthroplasty: systems, alignment strategies, and future directions. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10437-4
This narrative collection overview synthesizes current evidence on robotic knee arthroplasty, covering available platforms, alignment strategies, safety, and clinical outcomes. It emphasizes that the field has moved beyond questions of executional accuracy toward selecting the appropriate alignment plan for each patient. The key implication is that demonstrating meaningful clinical benefit, not merely technical precision, should guide adoption and future research in robotic arthroplasty.
127. Petrillo S, Ardiri D, Marullo M, et al. Platform-specific learning curve and early tibial radiographic agreement of ROSA®-assisted medial unicompartmental knee arthroplasty in an experienced high-volume surgeon: a consecutive case series. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06497-9
This retrospective consecutive series of 30 patients evaluated the learning curve of imageless ROSA-assisted medial unicompartmental knee arthroplasty performed by an experienced high-volume surgeon, using LC-CUSUM analysis of operative time against a historical manual-UKA benchmark. The analysis defined the number of cases needed to reach platform-specific proficiency and assessed early tibial radiographic agreement. Even experienced surgeons require a case-specific learning phase when adopting a new robotic platform, which should inform training and early-case monitoring.
130. Li J, Rucinski K, Stannard JP, et al. Optimized Multisurface Osteochondral Allograft Transplantation and Unicompartmental Knee Arthroplasty Are Associated With Potential Advantages in Direct Comparative Cost‐Effectiveness Over Total Knee Arthroplasty in a 30‐Year Economic Analysis Model of Active Middle‐Aged Patients With Complex Articular Disorders of the Knee. Arthroscopy 2026. doi:10.1002/arj.70495
A Markov cohort model compared 30-year cost-effectiveness of multisurface osteochondral allograft transplantation (mOCAT), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) in active 40-year-olds with complex knee articular disorders. UKA had the lowest costs ($31,072) and was most cost-effective at a $50,000 willingness-to-pay threshold, while mOCAT had the highest costs ($111,721) but yielded greater cumulative quality-adjusted life-year benefits than TKA. Clinically, both UKA and optimised mOCAT may offer economic advantages over TKA in this active middle-aged population, with mOCAT providing superior long-term benefit despite higher upfront costs.
145. Ng Y, Lim WSR, Lam LZL, et al. Preoperative Medial Proximal Tibial Angle of Less Than 84° Does Not Compromise Two-Year Clinical Outcomes After Unrestricted Kinematic Alignment Total Knee Arthroplasty: A Propensity Score-Matched Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.061
This propensity score-matched cohort study compared two-year outcomes of unrestricted kinematic alignment TKA between patients with preoperative MPTA ≥84° (n=156) and <84° (n=82), using mechanically aligned TKA as a control. Patients with severe proximal tibial varus (mean MPTA 81.6°) achieved comparable PROMs, satisfaction, and revision-free survival to those with less varus. Clinically, marked proximal tibial varus need not be corrected or considered a contraindication to unrestricted KA-TKA, even in an Asian population.
146. Carlisi G, Familiari F, Gasparini G, et al. Assessment of a Novel Radiographic Index and Functional Outcomes After Secondary Patellar Resurfacing: A Matched Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.062
In this matched cohort of 246 patients, 82 with anterior knee pain after unresurfaced TKA underwent secondary patellar resurfacing and were compared with 164 pain-free matched controls. Secondary resurfacing produced statistically significant improvements in VAS, KSS, and OKS, while conventional radiographic parameters showed limited discriminative value. A novel index, the GC Index (anterior femoral offset to anterior patellar displacement ratio), showed promise for predicting which patients will develop postoperative AKP, potentially aiding patient selection for resurfacing.
161. Giurazza G, Perrier A, Tessier V, et al. Native femoral flexion can be reliably measured on standard lateral knee radiographs: a reliability study with CT-based comparison. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104874
In 48 osteoarthritic knees, native femoral flexion was measured on standard lateral radiographs using a diaphyseal-axis method and compared with CT-based measurements. The radiographic method showed strong agreement with CT and good interobserver reliability. This enables preoperative assessment of native femoral sagittal alignment for individualized sagittal planning in TKA, analogous to tibial slope measurement.
163. Mannina C, Ilyas MH, Kang H, et al. Patient-Reported Outcomes Following Custom Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.008
PROMs and complications were compared between 124 custom and 499 off-the-shelf medial UKA implants with at least two years of follow-up. Delta scores, MCID achievement rates, 90-day complications, and two-year revisions were similar between implant types. Custom UKA provided no measurable clinical benefit over conventional OTS implants in patient-reported outcomes.
178. Lonner JH, Mont MA, Scuderi GR, et al. Knee Society Radiographic Evaluation System Update: Standardizing Assessment of Patellar Translation in Resurfaced and Unresurfaced Patellae. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.020
This methodological update to the Modern Knee Society Radiographic Evaluation System revises how patellar translation is assessed in total knee arthroplasty, proposing reference points of the median ridge of the native patella when unresurfaced and the midpoint of the patellar prosthesis when resurfaced, rather than the midpoint of the native patella. The rationale is that the older midpoint reference can falsely indicate lateral translation, especially with patellar prosthesis medialization or an unresurfaced patella. The implication is more standardised and accurate radiographic assessment of patellar tracking across resurfacing practices.
182. Wang CX, Morriss N, Greif DN, et al. Comparative Outcomes of Patello-Femoral and Unicompartmental Knee Arthroplasty: A Propensity-Matched Analysis at Two, Five, and 10 Years. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.025
This propensity-matched retrospective cohort study using a national database compared patellofemoral arthroplasty and unicompartmental knee arthroplasty outcomes at two, five, and 10 years, with 978, 635, and 226 matched pairs at each time point respectively. The study evaluated reoperation and conversion to total knee arthroplasty as key durability endpoints for modern patellofemoral arthroplasty. The clinical implication is to inform selection between these implants for isolated compartmental knee arthritis based on comparative long-term survivorship data.
186. Kawaguchi K, Tay ML, Farrington WJ, et al. Preoperative Pain Sensitivity Has a Greater Impact on Clinical Outcomes Than Coronal Alignment Strategy in Robotic-Assisted Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.037
In this substudy of a randomised controlled trial of 244 robotic-assisted TKAs allocated to functional versus mechanical alignment, preoperative pain sensitivity was measured with the Pain Sensitivity Questionnaire and related to two-year Forgotten Joint and Oxford Knee Scores. Higher pain sensitivity negatively predicted both PROMs and appeared to obscure differences between alignment strategies. Clinically, preoperative pain sensitivity assessment may be more important than coronal alignment philosophy when predicting and interpreting TKA outcomes.
189. Pungitore M, Meissner N, Sangaletti R, et al. The Orientation of the Patellar Resection Plane Influences Postoperative Tilt and Occurrence of Radiolucent Lines in Cementless Asymmetric Patellar Resurfacing in TKA. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104904
This retrospective review of 303 cementless asymmetric patellar resurfacings during robotic-assisted TKA stratified patients by patellar symmetric resection ratio measured on skyline views and related resection plane orientation to patellar tilt and radiolucent lines. Tilted resection planes were associated with greater postoperative patellar tilt and radiolucent line occurrence. The findings support careful attention to coronal resection plane orientation to reduce patellar maltracking complications.
192. Suhardi VJ, Gwam C, DiGangi C, et al. Do Not Chase Symmetric Gaps: Native Asymmetry Linked to Better Recovery in Fixed-Deformity Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.011
This single-institution review of 861 robotic-arm-assisted TKAs (634 correctable, 227 non-correctable deformities) used intraoperative robotic laxity quantification to test whether preserving native medio-lateral asymmetry outperformed chasing symmetric gaps. In non-correctable knees, minimising bone resection and retaining native laxity asymmetry was associated with better one-year patient-reported function, with no such association in correctable knees. This suggests surgeons should avoid over-resecting bone to force gap symmetry in fixed-deformity TKA.
Arthroplasty Infection & Complications (14)¶
13. Witteveen S, Ubl ST, Krombholz S, et al. Peak Serum Vancomycin Levels Are Achieved Between 6 and 24 Hours After Implantation of Vancomycin‐Soaked Anterior Cruciate Ligament Grafts. Arthroscopy 2026. doi:10.1002/arj.70606
Serum vancomycin levels were measured over 48 hours in 21 patients after ACL reconstruction using vancomycin-soaked grafts to characterize systemic elution and compare concentrations with the toxic threshold of 15-20 μg/mL. Peak serum levels occurred at 6-8 hours post-implantation but remained far below toxic thresholds (median ~0.005 μg/mL). Vancomycin graft soaking appears systemically safe, with negligible systemic absorption and no meaningful toxicity risk.
66. Ascione T, Balato G, Pagliano P, et al. Reimplantation in 2-Stage Exchange: Breaking the Dogma of the 2-Week Antibiotic Holiday. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01550
This commentary challenges the traditional 2-week antibiotic holiday between stages of two-stage exchange for periprosthetic joint infection, arguing that available evidence shows no outcome benefit from the holiday. Continuous antibiotic therapy combined with clinical signs and declining serologic/synovial markers may allow earlier reimplantation with shorter treatment and higher cure rates, especially in immunocompromised patients. Clinicians should individualize reimplantation timing rather than adhere rigidly to the dogma, though better decision-support tools are needed.
84. Elsheikh R, Amsler F, Brand C, et al. Not all previous surgeries are the same: Procedure‐specific infection risk in total knee arthroplasty patients with a history of previous knee surgery. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70599
Using Swiss Implant Registry data on 121,692 primary total knee arthroplasties (2015-2022), this retrospective nationwide cohort study assessed revision for infection by specific type of prior ipsilateral knee procedure rather than treating prior surgery as a uniform risk factor. Roughly one third of TKAs had prior ipsilateral knee surgery, and infection revision risk varied substantially by procedure type and cumulative surgical burden. Preoperative risk assessment and counseling should be procedure-specific rather than based on a generic 'previous surgery' label.
109. Li M, Wang B, Yin Z, et al. DVIA technique for acute periprosthetic joint infection: a surgical technique and case series. Arthroplasty 2026. doi:10.1186/s42836-026-00430-6
In a retrospective case series of 31 patients with acute periprosthetic joint infection, the authors combined DAIR with vacuum sealing drainage and intra-articular antibiotic infusion (DVIA technique). Monitoring showed measurable intra-articular antibiotic concentrations with declining inflammatory markers and improved functional scores during follow-up. The technique appears feasible and promising for infection control, though larger comparative studies are needed to confirm efficacy.
122. Gao H, Deng Y, Ma Y, et al. Factors associated with periprosthetic joint infection following total knee arthroplasty: an updated systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06492-0
This systematic review and meta-analysis of 25 observational studies (24 pooled) synthesized risk factors for periprosthetic joint infection after total knee arthroplasty, searching nine databases through May 2025. It identified modifiable and non-modifiable factors associated with PJI, providing pooled effect estimates where data allowed. The findings support evidence-based perioperative risk stratification and targeted infection-prevention strategies in TKA patients.
144. Weinblatt AI, Do HT, Mujaj A, et al. Peri-Incisional Blisters after Total Knee Arthroplasty: Risk Factors and Clinical Implications. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.060
In 23,405 elective primary TKAs at a single high-volume center, this retrospective study found a 3.1% incidence of peri-incisional blistering within 30 days of surgery. Preoperative anticoagulation and higher BMI were among the adjusted risk factors for blister formation, which was linked to adverse outcomes including reoperation and periprosthetic joint infection. Identifying high-risk patients may guide wound care strategies and postoperative monitoring to reduce this underrecognized complication.
154. Selim A, Ibrahim A, Saeed A, et al. One-, 1.5-, or Two-Stage Revision for Periprosthetic Hip and Knee Joint Infection? A Network Meta-Analysis Comparing Revision Strategies. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.069
A Bayesian network meta-analysis of 54 studies (10,055 patients) compared one-, 1.5-, and two-stage revision for chronic hip and knee periprosthetic joint infection defined by MSIS/ICM criteria. Both one- and 1.5-stage revisions showed significantly lower odds of reinfection than two-stage revision. This challenges the traditional two-stage standard and supports consideration of single-stage strategies, though hip-versus-knee subgroup results should guide application.
165. Micicoi G, Stergiadou S, Fairag R, et al. Periprosthetic Tibial Fractures. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104879
This narrative review synthesizes epidemiology, classification, and management of periprosthetic tibial fractures after TKA, addressing operative versus conservative treatment, fixation options, and component revision. Management hinges on tibial component stability, fracture location, and patient condition, with intraoperative fractures often reflecting unrecognized cortical weakening in osteoporotic bone. It provides a practical decision-making framework for these rare but challenging injuries.
166. L’Hourre V, Yvinou A, Dubrana F, et al. Short-term Implant Survivorship and Failure Modes of the LPS™ System in Distal Femoral Reconstruction: A Multicentre Retrospective Study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104880
Seventy-seven distal femoral LPS™ megaprosthesis reconstructions from four centres (2016-2023) were reviewed for survivorship and Henderson failure modes. Kaplan-Meier survivorship was 94.1% at 12 months, 91.9% at 24 months, and 86.9% at 36 months, with complications frequent but mostly not structural failures. Short-term survivorship is acceptable, supporting the LPS™ for limb salvage while highlighting the need for surveillance.
170. Narkbunnam R, Hirunyachoke P, Kittipibul K, et al. Radiographic measurement to predict the risk of periprosthetic tibial plateau fracture after Oxford cementless unicompartmental knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104881
This retrospective study of 79 cementless Oxford unicompartmental knee arthroplasties compared 12 radiographic parameters between 14 knees with early postoperative medial tibial plateau fracture and 65 without. Logistic regression and ROC analysis identified predictors, related to tibial cut depth, tray position, and residual medial cortex distance, and derived cut-off values for fracture risk. These measurements offer surgeons a practical radiographic screening tool to reduce periprosthetic fracture risk, particularly in Asian patients.
171. Ball JR, Palmer RC, Telang SS, et al. Sobering Outcomes after Two-Stage Revision for Periprosthetic Joint Infection Among Patients Who Have Revision Total Knee Arthroplasty Components. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.015
A retrospective review of 62 knees treated with complete explantation of infected revision total knee arthroplasty components at a tertiary center reported outcomes over a mean 3.4-year follow-up. Constructs were complex (long stems in ~71%, hinged implants in ~27%), with substantial morbidity including 24% ICU admission and 26% readmission. The findings underscore sobering outcomes after two-stage revision in this population, supporting careful counseling and risk stratification for patients with infected revision TKA.
177. Panos JA, Mallinger BD, Virk A, et al. Increased Risk of Periprosthetic Joint Infection Following Aseptic Revision Hip and Knee Arthroplasty With the Use of Non-Cefazolin Alternative Antibiotics. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.022
This single-institution cohort study of 5,993 aseptic revision hip and knee arthroplasties (2000-2024) compared periprosthetic joint infection rates by perioperative antibiotic prophylaxis, postoperative oral antibiotics, and unexpected positive culture status using Cox regression. The key finding was that non-cefazolin alternative antibiotics were associated with a higher risk of periprosthetic joint infection than cefazolin in the aseptic revision setting. Clinically, this supports preferential use of cefazolin for prophylaxis during aseptic revision arthroplasty when not contraindicated.
188. Haji Boloori F, Kubiak A, Meyers M, et al. Temporal Trends in Surgical Site Infections After Hip and Knee Arthroplasty in California, 2015 to 2024. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.028
This facility-level longitudinal cohort analyzed California mandatory SSI surveillance data for primary THA and TKA from 2015 to 2024, comprising 5,880 hospital-year-procedure observations in generalized linear models. The study examined temporal trends and the associations of hospital volume, policy epochs, and the COVID-19 pandemic with population-level SSI risk. Results inform how public reporting and volume-based factors relate to infection outcomes after hip and knee arthroplasty.
196. D’Ascoli A, Sajan M, Belbachir A, et al. Assessing the value of systematic screening and early management of neuropathic pain after total knee arthroplasty. A single-center retrospective study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104914
A retrospective single-center study of 402 total knee arthroplasty patients evaluated systematic postoperative screening for neuropathic pain (DN4 ≥4/10) with early targeted management including specialist pain team involvement. Early identification and treatment of neuropathic pain led to favourable resolution rates, and established chronic postoperative pain risk factors were characterized in the affected cohort. Routine neuropathic pain screening after TKA may facilitate early intervention and reduce the burden of chronic postoperative pain.
High Tibial Osteotomy & Alignment (9)¶
18. Elazab A, Darwish M, Mandour I, et al. Hybrid Protective Sentinel System: A Combined Technique for Safe and Controlled Open‐Wedge High Tibial Osteotomy. Arthroscopy Techniques 2026. doi:10.1002/atn2.70281
This technical note presents a hybrid method combining a protective cutting system with sentinel wires for open-wedge high tibial osteotomy. The approach targets the three major intraoperative hazards of the procedure: posterior neurovascular injury, lateral hinge fracture, and unintended slope modification. It provides surgeons with a strategy to improve procedural safety in joint-preserving surgery for medial compartment osteoarthritis.
34. Nejima S, Holt J, van Arkel R, et al. Lateral Tibial Posterior Slope Induces Anterior Tibial Translation While Lateral-Medial Slope Difference Induces Internal Rotation: A Cadaveric Biomechanical Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480902
In eight fresh-frozen cadaveric knees, medial and lateral posterior tibial slopes were independently altered via unicondylar osteotomies (−5° to +10°) and tibiofemoral kinematics measured under 500-N axial compression at 0° and 20° of flexion. Increased lateral posterior slope drove greater anterior tibial translation, while a larger lateral-minus-medial slope difference induced greater internal rotation. Surgeons performing slope-altering osteotomy should consider lateral slope and slope asymmetry as independent levers on knee kinematics.
41. Shimada T, Maeyama A, Akiyama T, et al. Radiographic Progression of Patellofemoral Osteoarthritis Is Not Associated With Long‐Term Clinical Outcomes After Open‐Wedge High Tibial Osteotomy: A 10‐Year Minimum Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70617
This retrospective study of 168 knees with ≥10-year follow-up after open-wedge high tibial osteotomy compared patellofemoral (PF) osteoarthritis (OA) progression, defined by Kellgren-Lawrence grade change, against PF-specific outcomes using the KOOS-patellofemoral subscale and HSS patella score. Radiographic PF OA progression was not associated with worse long-term PF-specific clinical outcomes or survival to arthroplasty. Clinically, routine PF OA grading after high tibial osteotomy may not predict symptomatic deterioration, suggesting caution in using radiographic progression alone to guide counseling or revision decisions.
52. Li S, Li Z, Zhang H, et al. An Artificial Intelligence‐Based Preoperative Planning System for High Tibial Osteotomy Significantly Enhances Planning Speed With Comparable Accuracy to Surgeons. Arthroscopy 2026. doi:10.1002/arj.70515
This study developed an artificial intelligence-based preoperative planning system (OAPS) for open wedge high tibial osteotomy using a UNet convolutional neural network to detect 28 anatomical landmarks on standing hip-to-ankle radiographs, trained on 346 knees and externally validated on 110 knees. The system achieved high landmark detection accuracy (95.1% success at 6-pixel threshold) and low mean absolute errors for hip-knee-ankle and correction angles (0.47°), with accuracy comparable to attending surgeons. Clinically, AI-assisted planning significantly enhanced planning speed compared with manual methods, particularly benefiting junior residents.
98. Martorell-de Fortuny L, Perelli S, Cance N, et al. Association of Slope-Reducing Osteotomy With Return to Preinjury Level of Sport After Failed Anterior Cruciate Ligament Reconstruction in Elite Athletes. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261479920
This retrospective two-center case series evaluated 22 elite athletes with failed ACL reconstruction and posterior tibial slope ≥10° who underwent revision ACL reconstruction combined with supratuberosity slope-reducing osteotomy between 2011 and 2023. The combination allowed a substantial proportion of athletes to return to their preinjury level of sport, with improved clinical scores (IKDC, Lysholm, Tegner, ACL-RSI) and corrected radiographic parameters. Slope-reducing osteotomy should be considered at revision ACL reconstruction in elite athletes with high posterior tibial slope.
103. Maeda T, Kuriyama S, Sakai S, et al. Coronal Alignment Changes in the Patellofemoral Joint Are Smaller Than Correction Angle and Have Little Impact on Clinical Scores and Cartilage Damage After Medial Open‐Wedge High Tibial Osteotomy. Arthroscopy 2026. doi:10.1002/arj.70533
This study used whole-leg CT in 45 knees to assess coronal patellofemoral alignment changes after medial open-wedge high tibial osteotomy with a mean 9.3° correction. Changes in patellofemoral alignment indicators were significantly smaller than the correction angle and did not exceed the minimal clinically important difference for KOOS scores or affect patellofemoral cartilage grades. Coronal patellofemoral malalignment after open-wedge HTO appears to have little clinical or cartilage impact, supporting the procedure's safety for the patellofemoral joint.
116. Horita K, Okimura S, Kamiya T, et al. Preoperative Medial Meniscus Extrusion Predicts Varus Correction Loss After 5 Years Despite Stable Bony Alignment After Medial Opening‐Wedge High Tibial Osteotomy. Arthroscopy 2026. doi:10.1002/arj.70505
Patients undergoing medial opening-wedge high tibial osteotomy with at least 5 years of follow-up were stratified by preoperative medial meniscus extrusion (MME) using a 3-mm MRI cutoff, with serial weight-bearing radiographs tracking alignment over time. Preoperative MME predicted varus correction loss (final weight-bearing line ratio <50%) despite stable bony alignment, on multivariate analysis. Surgeons should consider MME when counseling patients and selecting candidates for high tibial osteotomy, as it flags risk of long-term correction loss.
148. Yasuda K, Yabuuchi K, Kondo E, et al. Complication Rates and Clinical Outcomes of Larger Alignment Corrections Using Inverted V-shaped High Tibial Osteotomy in Severe Varus Knee Osteoarthritis: A Comparison with Smaller Corrections. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261447195
This cohort study of 109 knees compared inverted V-shaped high tibial osteotomy with locking plate fixation between large (≥13°) and smaller coronal corrections, tracking quantitative bone union, complications, and clinical outcomes up to 3-6 years. Larger corrections did not prolong union time, increase complication rates, or worsen clinical outcomes relative to smaller corrections. The iVHTO technique with LCP fixation therefore appears safe for severe varus deformities requiring substantial correction, challenging concerns extrapolated from standard opening-wedge HTO.
167. Takahashi A, Sato D, Jo Y, et al. Evaluation of Prognostic Factors in Medial Open-Wedge High Tibial Osteotomy Using Preoperative Semiquantitative MRI Findings. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261480489
Preoperative WORMS subscores on MRI were correlated with 2-year patient-reported outcomes after medial open-wave high tibial osteotomy in varus knee osteoarthritis. Higher preoperative WORMS values, particularly patellofemoral and trochlear bone marrow lesions, were independently associated with worse KOOS Symptoms scores at 2 years. Preoperative MRI lesion burden, especially in the patellofemoral compartment, may prognosticate OWHTO outcomes and aid patient selection.
Other articles this month¶
1. Xia Y, Zhao Y, Dou X, et al. Operative treatment of high-grade medial collateral ligament injury and chronic medial knee instability: a systematic review. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06517-8
This systematic review of 35 reports (5 randomised/quasi-randomised trials, 9 nonrandomized comparative studies, and 21 case series) evaluated operative treatment of high-grade MCL injuries and chronic medial knee instability, stratifying evidence by clinical phenotype rather than injury grade alone. The findings inform phenotype-specific surgical decision-making for medial knee instability, particularly in the setting of concurrent cruciate or multiligament injury.
3. Wittstein J, Strickland S, Gomoll A, et al. Two‐year follow‐up of postcommercialisation cohort of 100 bridge‐enhanced anterior cruciate ligament restorations shows low retear rate and good patient‐reported outcomes. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70606
This prospective postcommercialisation registry cohort evaluated adverse events and outcomes at 2 years in the first 100 patients undergoing bridge-enhanced ACL restoration (BEAR), comparing original versus modified surgical techniques. The procedure demonstrated a low retear rate and good patient-reported outcomes (IKDC, KOOS, Marx, return-to-sport) at 2-year follow-up. These findings support the BEAR procedure as a viable alternative to reconstruction for select ACL tears in real-world practice.
4. Adolf J, Karlıdağ T, Citak M. Global Projection of Revision Total Hip and Knee Arthroplasty Through 2060. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00772
This modeling study used registry data from 17 countries with log-linear Poisson regression (partially pooled, damped trends) to project revision total hip and knee arthroplasty volumes through 2060, with sensitivity analyses bracketing model uncertainty. The 2024 modeled aggregate was approximately 185,921 revision THAs across these countries, with projections indicating a growing revision burden as primary implant populations expand. These estimates provide a uniform multinational basis for capacity planning and resource allocation in revision arthroplasty.
6. Valle C, Cotic M, Bartelt M, et al. Detection of previous knee injuries using lower limb‐worn inertial measurement units: A cross‐sectional machine‐learning study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70631
This cross-sectional machine-learning study tested whether lower limb-worn IMU features from a walking-running-walking protocol could detect prior knee injury in 90 physically active individuals (23 with injury history, 67 controls) using 220 candidate gait and running features. The study demonstrates that wearable IMU-derived features can identify residual movement alterations after knee injury outside laboratory settings. This supports scalable screening of athletes with injury histories who remain at elevated risk despite apparent functional recovery.
9. Super JT, Tollefson LV, Murray IR, et al. The Use of Unloader Bracing in the Management of Knee Osteoarthritis: A Modified Delphi Consensus Study. Arthroscopy 2026. doi:10.1002/arj.70579
A modified Delphi consensus study involving 29 knee preservation specialists across 5 continents developed and rated 57 statements on unloader bracing for tibiofemoral osteoarthritis, achieving consensus on all 42 round-3 statements with a 100% response rate. Experts strongly agreed that unloader bracing reduces ipsilateral compartment contact pressures and belongs within multimodal OA management. The consensus provides evidence-based guidance on indications, contraindications, clinical evaluation, and perioperative use to standardize bracing practice.
10. Farrell C, Davey M, Hickey P, et al. The first decade of data from the Irish National Orthopaedic Register: trends in hip and knee arthroplasty, implant utilisation and patient outcomes. International Orthopaedics 2026. doi:10.1007/s00264-026-07044-2
This retrospective descriptive analysis summarized the first decade (2015-2024) of the Irish National Orthopaedic Register, established after the ASR metal-on-metal implant recall, covering demographics, procedural activity, implant fixation, and PROMs for hip and knee arthroplasty. The register documented national trends in arthroplasty volume, implant utilisation, and patient-reported outcomes over 10 years. These data establish a benchmark for auditing Irish arthroplasty practice and informing implant selection and quality-improvement efforts.
15. Pechlivanidou E, Stacheter M, Wahl P, et al. High variability in resistance to valgus deformation among knee braces indicated for medial collateral ligament injuries: a standardized bench-model biomechanical comparison. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06519-6
Nine commercially available knee braces indicated for MCL injuries were tested on a custom lower-limb mechanical surrogate under progressive valgus loading to quantify deformation and stiffness. Per-load stiffness varied fourfold across devices (1.6-6.5 Nm/°) with median valgus deformation of 8°, and qualitative stability ratings correlated only moderately with measured performance. The wide variability and poor correlation with qualitative assessments suggest clinicians should consider measured biomechanical data, not marketing classifications, when selecting braces for MCL injury.
16. Unknown Author. Announcements. Arthroscopy 2026. doi:10.1002/arj.70675
This article contains society announcements rather than research content, promoting AANA education offerings including unlimited Learning Center access, hands-on cadaveric courses in hip arthroscopy and complicated knee management, and the AANA27 annual meeting in Hollywood, Florida (May 13-15, 2027). No study data or clinical findings are reported. It holds no clinical implication beyond informing members of educational opportunities.
17. de Oliveira Paolucci PH, Gomes Gobbi R, de Fava Sanches F, et al. Combined Anterior Cruciate Ligament and Posterolateral Corner Reconstruction With a Single Femoral Tunnel Using Rectus Femoris and Semitendinosus Autografts. Arthroscopy Techniques 2026. doi:10.1002/atn2.70275
The authors describe a surgical technique for combined ACL and posterolateral corner reconstruction using rectus femoris and semitendinosus autografts routed through a single shared femoral tunnel, with the remaining graft limbs reconstructing the popliteus tendon, fibular collateral ligament, and popliteofibular ligament. The technique preserves anatomic principles while minimising the risk of tunnel convergence. It offers surgeons a reproducible option for managing combined ACL and posterolateral corner injuries without creating additional femoral tunnels.
19. Runer A, Bouguennec N, Wierer G, et al. Current concepts in isolated and combined injuries of the medial collateral ligament complex, part II: The anteromedial knee instability classification. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70630
This current concepts review, part II, introduces a clinically and biomechanically based anteromedial knee instability (AMKI) classification using a structured three-letter system to grade medial and anteromedial laxity. It emphasizes ruling out posteromedial complex/posterior oblique ligament injury via valgus testing in full extension, then assessing laxity at 20°, 30° of flexion. The classification aims to standardize evaluation and guide treatment of medial and combined ACL-MCL injuries, given that persistent laxity can increase strain on the ACL, menisci, and cartilage.
21. Super JT, Tollefson LV, Murray IR, et al. Unloader Bracing Is a Biomechanically Rational and Clinically Useful Intervention in Selected Patients With Tibiofemoral Joint Cartilage Pathology: A Modified Delphi Consensus Study. Arthroscopy 2026. doi:10.1002/arj.70583
A modified Delphi consensus study with 29 international sports medicine experts established agreement on the role of unloader bracing for focal tibiofemoral cartilage lesions, achieving consensus on 72 of 73 statements after three survey rounds. Key areas of agreement support unloader bracing as a biomechanically rational and clinically useful intervention in selected patients, in both nonoperative and operative contexts. The consensus provides evidence-informed guidance for clinical decision-making and identifies priorities for future research.
23. Marzouki I, Viste A, Neri T. Independent Anatomic Double‐Bundle Anterolateral Ligament Reconstruction Using a Pedicled Gracilis Graft During Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70044
This technical note describes a minimally invasive, independent anatomic double-bundle anterolateral ligament (ALL) reconstruction using a pedicled gracilis autograft performed during ACL reconstruction. The graft is routed from the tibial ALL insertion to the femoral origin beneath the iliotibial band and back, with tibial anchoring in full extension to optimise isometry. The technique aims to address residual pivot shift and improve rotational knee stability in ACL reconstruction.
24. Anz AW, Waller G, Carroll J, et al. A Retensionable Inlay/Onlay Hybrid Double-Bundle Medial Collateral Ligament Reconstruction Produces Superior Restoration of the Uninjured State When Compared to a Single-Bundle Inlay Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480465
This controlled cadaveric laboratory study on 27 knees tested valgus and external rotation laxity on a 6-degree-of-freedom robot system, comparing a novel retensionable inlay/onlay hybrid double-bundle superficial MCL reconstruction (with tibial fixation at either proximal-distal or anterior-posterior footprint positions) against a validated single-bundle inlay reconstruction using anterior tibialis allograft. The double-bundle hybrid constructs with an enlarged distal tibial footprint and retensionability better restored native knee laxity than the single-bundle technique. The results support consideration of retensionable double-bundle MCL reconstruction to more consistently restore the uninjured state.
25. Ehlers M, Kurtz JL, Montgomery SR, et al. Age-Dependent Variations in Knee Synovial Fluid Biomarker Type and Concentration Predict 5- to 10-Year Outcomes After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261485707
In a prospective cohort of ACL reconstruction patients, preoperative synovial fluid biomarker concentrations were measured and analyzed against age and 5- to 10-year patient-reported outcomes. Increasing age was associated with distinct biomarker profiles (elevated inflammatory response) and modified biomarker-outcome relationships. Findings suggest age should be considered when using synovial biomarkers to predict long-term outcomes and identify patients at risk for posttraumatic joint degeneration after ACL injury.
27. Haasper C. Preventing Infection at the Source: A Promising Step for Extensor Mechanism Reconstruction. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.01110
This commentary discusses a murine study in which standard Marlex mesh was soaked in vancomycin before implantation for extensor mechanism reconstruction after total knee arthroplasty. Vancomycin-loaded mesh substantially reduced early staphylococcal infection without compromising mechanical properties. This simple, low-cost modification may help prevent periprosthetic joint infection in mesh-based extensor mechanism reconstruction, though clinical validation is needed.
28. Basal O, Karakas F, Serteser B, et al. Artificial intelligence-based segmentation and quantitative assessment of knee cartilage in osteoarthritis: a systematic review and meta-analysis. International Orthopaedics 2026. doi:10.1007/s00264-026-07032-6
This systematic review and meta-analysis evaluated artificial intelligence-based knee cartilage segmentation on MRI in osteoarthritis, synthesizing Dice coefficients, measurement agreement, longitudinal responsiveness, external validation, and prognostic utility. AI segmentation achieved high spatial overlap accuracy, but validity of quantitative measurements varied across studies. The authors emphasize that clinical deployment requires demonstration of measurement agreement and prognostic value beyond segmentation accuracy alone.
31. Bouyge B, Gerometta A, Valentin E, et al. Low graft re‐rupture rate after primary ACL reconstruction using a modified MacIntosh iliotibial band technique with gracilis augmentation: Minimum 6‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70626
This retrospective cohort study from the French FAST Cohort evaluated 265 patients undergoing primary ACL reconstruction with a modified MacIntosh iliotibial band technique plus gracilis augmentation at minimum 6-year follow-up. The graft re-rupture rate was low (4.9%), with favourable functional and return-to-sport outcomes and few complications. These long-term results support combined intra- and extra-articular reconstruction as a durable option for improving rotational stability and reducing graft failure.
32. D’Ambrosi R, Mei A, Muscarella R, et al. Rectus Femoris Autograft Harvesting: Tips and Tricks. Arthroscopy Techniques 2026. doi:10.1002/atn2.70279
This technical note describes a minimally invasive technique for rectus femoris tendon autograft harvest for ACL reconstruction, detailing surgical anatomy, dissection planes, and key pearls and pitfalls. Selective harvest of the superficial rectus femoris preserves deeper quadriceps layers and extensor mechanism continuity. The technique offers a reproducible graft option with favourable biomechanical properties and low donor-site morbidity when performed with attention to described technical details.
33. Peláez P, Damiá Giménez E, Torres-Torrillas M, et al. Autologous Platelet-Rich Plasma–Enriched Chondral Matrix Implantation Improves Cartilage Repair in an Ovine Model: A Magnetic Resonance Assessment Using the MOCART 2.0 Scoring System. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480467
In an ovine model with 8-mm full-thickness medial femoral condyle defects, investigators implanted autologous platelet-rich plasma, enriched chondral matrix (PACI) with intra-articular PRGF and compared outcomes against Ringer lactate or hyaluronic acid controls by MRI at 18 months using MOCART 2.0 scoring. PACI-treated stifles achieved significantly higher MOCART scores, driven by enhanced defect filling. The findings support PACI as a promising cartilage repair strategy warranting clinical translation.
35. Sian R, See A, Alqeisi T, et al. Clinical outcomes and complication rates following medial collateral ligament reconstruction using Achilles tendon allograft or hamstring tendon autograft: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70625
A PRISMA-guided systematic review of 16 studies (six Achilles tendon allograft cohorts, n=107; ten hamstring autograft cohorts) synthesized patient-reported outcomes and complications after medial collateral ligament reconstruction. Both graft types yielded favourable clinical outcomes, but heterogeneity precluded meta-analysis and no clear graft superiority emerged. Graft choice can reasonably be tailored to patient factors, as neither Achilles allograft nor hamstring autograft demonstrated a consistent advantage.
37. Mahissarakul P, Lohakitsathian C, Sudhasaneya V, et al. Association of knee ligament injury with pelvic and acetabular fractures: a retrospective cohort study. International Orthopaedics 2026. doi:10.1007/s00264-026-07047-z
A retrospective cohort of 328 patients with pelvic or acetabular fractures at a tertiary trauma center (2014-2024) was reviewed to determine the incidence of concomitant knee ligament injury and associated fracture patterns. Knee ligament injuries were frequently missed during initial management of high-energy trauma and were linked to specific pelvic and acetabular fracture patterns. The authors underscore the need for systematic knee examination and low threshold for MRI in these patients to prevent delayed diagnosis and long-term disability.
39. Hingsamer V, Arras C, Mueller MM, et al. Anterior tibial translation in anterior cruciate ligament‐deficient knees is increased regardless of tear location and independently associated with early‐to‐intermediate injury chronicity. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70615
Among 521 primary ACL surgery patients, preoperative instrumented anterior tibial translation side-to-side difference (ATT-SSD) was analyzed against arthroscopic tear type (modified Sherman classification), injury chronicity, and meniscal status. ATT-SSD was elevated in ACL-deficient knees regardless of tear location, with Types III, V tears showing only ~0.5 mm greater laxity than Type I, and greater translation was independently associated with subacute-to-chronic injuries. These findings support early surgical timing and suggest ATT-SSD reflects chronicity more than tear morphology.
40. Santamaria F, Carrozzo A, Pioger C, et al. Fourfold higher graft failure risk with isolated BPTB versus hamstring ACL reconstruction with ALL in patients under 25 years: A prespecified subgroup analysis of a randomized controlled trial. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70617
In a prespecified subgroup analysis of 281 patients under 25 years from a randomised comparative study, 5-year graft failure was compared between isolated bone, patellar tendon, bone ACL reconstruction and hamstring ACL reconstruction plus anterolateral ligament reconstruction. Graft failure was roughly fourfold higher with isolated BPTB (16.4% vs ~4%), with survival analysis and regression confirming the difference. In young high-risk patients, adding anterolateral ligament reconstruction to hamstring ACLR may substantially reduce revision risk compared with isolated BPTB.
42. Trutner ZD, Johnson BT, Khalil AZ, et al. Age, Sex, and Location Impact Osteochondritis Dissecans Lesion Depth and Their Relation to the Physis in Skeletally Immature Knees. Arthroscopy 2026. doi:10.1002/arj.70556
MRI measurements of 123 surgically treated femoral condyle osteochondritis dissecans (OCD) lesions in 101 skeletally immature patients quantified lesion depth and distances from subchondral bone and cartilage to the open physis, with medial lesions averaging 7.51 mm depth and 27.6 mm subchondral bone-to-physis distance. Smaller bone-to-physis distances were seen in women and patients under 13, with lesion metrics varying by condyle location and age/sex. These normative values can inform surgical planning and fixation decisions for juvenile OCD by relating lesion depth to remaining physeal distance.
43. Thamrongskulsiri N, Morgan JT, Casanova F, et al. Bone Marrow Aspirate Augmentation Reduces Reoperation Rates After Osteochondral Allograft Transplantation of the Knee: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70628
This systematic review (PRISMA 2020) of four studies (165 knees) compared osteochondral allograft transplantation of the knee with versus without bone marrow aspirate (BMA) augmentation. BMA-augmented grafts showed markedly fewer reoperations (2.4% vs 21.9%) and some evidence of earlier radiographic integration, though imaging findings were heterogeneous across studies. The findings support considering BMA augmentation to reduce reoperation risk after osteochondral allografting, while noting the limited number and follow-up duration of available studies.
44. Omae H, Yanagisawa S, Hagiwara K, et al. Anterior Cruciate Ligament Injuries With Segond Fractures Are Associated With Lateral Meniscus Oblique Radial Tears and Residual Rotational Instability but Not Anatomic Internal Tibial Rotation, Compared With Those Without Segond Fractures. Arthroscopy 2026. doi:10.1002/arj.70577
In a retrospective cohort of 1011 primary ACL reconstructions with ≥2-year follow-up and second-look arthroscopy, 47 knees with Segond fractures were compared with Segond-negative knees regarding tibial rotation, meniscal pathology, and instability. Segond fractures were associated with lateral meniscus oblique radial tears and residual pivot-shift rotational instability, but not with increased anatomic internal tibial rotation on MRI. A preoperative Segond fracture should prompt heightened suspicion for lateral meniscal pathology and residual rotational laxity after ACL reconstruction.
45. Mueller MM, Estfeller A, Hingsamer V, et al. Multiligament Injury, Medial Meniscus Tear, Hyperextension‐Type Bone Bruise Pattern, and Younger Age Predict Magnetic Resonance Imaging‐Defined Tear Location in Acute, Complete Posterior Cruciate Ligament Injuries. Arthroscopy 2026. doi:10.1002/arj.70563
This single-institution retrospective cohort of 148 MRI studies of acute, complete posterior cruciate ligament (PCL) injuries classified tear location using a remnant-length-based system (types I, Vb) and identified predictors via multivariate regression. Type III tears (75%, 25% intact distal remnant) were most common (43.2%), with excellent interobserver reliability (κ = 0.96); multiligament injury, medial meniscus tear, hyperextension-type bone bruise pattern, and younger age predicted tear location. These predictors may help surgeons anticipate PCL tear morphology preoperatively and plan appropriate surgical approaches.
46. Tian D, Wang H, Chen Z, et al. Static Coronal Plane Alignment of the Knee phenotypes are associated with distinct dynamic knee kinematics in advanced knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70603
Using the Opti_Knee system, this study recorded dynamic tibiofemoral kinematics during treadmill walking in 292 knees with advanced (Kellgren-Lawrence III, IV) osteoarthritis, classified by static Coronal Plane Alignment of the Knee (CPAK) phenotype on full-length radiographs. Distinct CPAK phenotypes were associated with different rotational and translational kinematic patterns during gait. This suggests that preoperative coronal alignment phenotype may influence dynamic knee function and could inform patient-specific considerations in total knee arthroplasty planning.
47. Seiler J, Haas A, Gnädinger D, et al. Limited predictive value of preseason isokinetic strength testing for noncontact lower extremity injuries in elite female football players: A 5‐year prospective cohort study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70623
In this 5-year prospective cohort, 271 professional and elite youth female football players underwent preseason isokinetic testing (hamstring and quadriceps strength at 60°/s and 240°/s) with hamstring-to-quadriceps ratios and limb symmetry indices, followed for 70 noncontact lower extremity injuries. Although Group × Limb interactions were significant for some strength parameters, preseason isokinetic strength measures showed limited predictive value for subsequent noncontact injury risk in multivariable GEE models. Routine preseason isokinetic screening alone appears insufficient for injury-risk stratification in this population.
51. Qu X, Tang X, Yang D, et al. Beyond clinical grading: rethinking arthrogenic muscle inhibition after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70612
This letter comments on a retrospective study using the SANTI classification to identify correlates of arthrogenic muscle inhibition (AMI) after ACL reconstruction, endorsing its clinical utility while cautioning against conflating clinical grading with mechanistic phenotyping. The authors argue that mechanistic inference requires complementary measures such as interpolated twitch techniques, central activation ratio, or transcranial magnetic stimulation, and that pain-AMI associations should be interpreted cautiously. They recommend early management integrating pain and effusion control alongside quadriceps activation screening.
53. Smith AR, Mazzocca JL, Wang M, et al. Lack of Knee Confidence Is Associated With Lower Functional Scores After Anterior Cruciate Ligament Reconstruction at 2‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70553
This retrospective study of primary ACL reconstruction patients with hamstring auto- or allografts examined knee confidence trajectories from preoperatively to 2 years postoperatively using KOOS Question #1, and its association with functional outcomes. Lack of knee confidence at 2-year follow-up was associated with lower KOOS Sports/Rec and Marx Activity Rating Scale scores. The findings highlight knee confidence as an important patient-reported domain that should be assessed and addressed in post-ACLR rehabilitation and return-to-sport counseling.
54. Son H, Yu V, Vivekanantha P, et al. The Forgotten Joint Score Shows High Correlation With Established Anterior Cruciate Ligament Reconstruction Patient‐Reported Outcome Measures While Capturing Joint Awareness and Functional Recovery: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70559
This systematic review of 13 studies (1295 patients, 1316 knees) evaluated the Forgotten Joint Score-12 (FJS-12) as a patient-reported outcome measure after ACL reconstruction. FJS-12 scores ranged widely (37.0-92.6) and showed strong positive correlations with established PROMs including IKDC, Lysholm, and KOOS (r > 0.80 in most studies). The findings support the FJS-12 as a complementary, sensitive tool for capturing joint awareness and functional recovery after ACLR.
55. Blackman B, Pulbere A, Ybema S, et al. Orthobiologic Injections Adjunctive to Cartilage‐Preserving Surgery May Improve Outcomes for Focal Knee Chondral Defects: A Systematic Review of Randomized Controlled Trials With Subgroup Meta‐analyses. Arthroscopy 2026. doi:10.1002/arj.70548
This systematic review with subgroup meta-analysis of 5 randomised controlled trials (217 patients) evaluated orthobiologic injections (PRP, stem cells, adipose-derived cells) as adjuncts to cartilage-preserving surgery for focal knee chondral defects. PRP adjuncts showed small but significant reductions in pain and improvements in IKDC scores, with low heterogeneity. The findings suggest orthobiologic augmentation may improve outcomes after procedures such as microfracture and subchondral drilling, though the evidence base remains limited.
56. Pichler L, El Kayali MKD, von Eisenhart‐Rothe R, et al. The right measure for the right question: A framework for domain‐matched patient‐reported outcome measure selection in knee arthroplasty research. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70620
This editorial proposes a domain-matched framework for selecting patient-reported outcome measures (PROMs) in knee arthroplasty research, emphasizing that instruments are often chosen by convention rather than scientific rationale. It highlights how domain mismatch between PROM and research question can produce false-negative results, compounded by floor/ceiling effects and unrealistic minimal clinically important difference thresholds. The framework provides practical guidance for assigning first-choice instruments matched to specific research domains, improving the validity of comparative effectiveness studies.
57. Korkmaz T, Ince Y. Improving anterior cruciate ligament reconstruction outcomes using a unified return‐to‐sport communication framework. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70619
This letter to the editor responds to a proposed unified return-to-sport communication framework after ACL reconstruction, endorsing its multidisciplinary, criterion-based approach while raising the question of how such decisions should be implemented in practice. It reinforces the shift away from time-based clearance toward individualized, function-driven return-to-sport protocols. Clinically, it underscores the need for validated tools and shared decision-making pathways to operationalize the framework.
63. Zhu H, Yan S, Tu P, et al. Anatomic and Histologic Analyses of the Popliteal Hiatus Area of the Lateral Meniscus Reveal the Meniscofibular Ligament and the Posteroinferior Popliteomeniscal Fascicle Are Ligamentous Tissue. Arthroscopy 2026. doi:10.1002/arj.70546
This cadaveric study of 6 fresh-frozen knees combined anatomic dissection and histology to characterize the popliteomeniscal fascicles, meniscofibular ligament, and popliteofibular ligament around the popliteal hiatus of the lateral meniscus. It demonstrated that the meniscofibular ligament and posteroinferior popliteomeniscal fascicle are true ligamentous tissue rather than capsular structures, with consistent origins from the popliteus tendon. These findings refine anatomic understanding relevant to lateral meniscal repair and posterolateral corner surgery.
65. Cavaignac E, Le Guen A, Maffiuletti NA, et al. The clinical purpose of the scientific anterior cruciate ligament network international classification of arthrogenic muscle inhibition. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70613
This letter to the editor outlines the clinical rationale for the Scientific ACL Network International (SCANIT) classification of arthrogenic muscle inhibition (AMI) after ACL injury. It frames AMI as a neuromuscular phenomenon that impairs quadriceps activation and undermines rehabilitation outcomes. The implication is that standardised classification will enable consistent diagnosis and targeted early intervention to improve post-injury recovery.
67. Shang G, Mu Y, Wang K, et al. A Novel Mini-Prosthesis with a Nano-Multilayer Film-Coated Surface and 3D-Printed Porous Stem for Focal Cartilage Lesions. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00538
In a porcine model of medial femoral condyle focal cartilage lesions, investigators tested a novel Ti6Al4V mini-prosthesis combining a carbon-based nano-multilayer film articular surface with a 3D-printed porous stem (NMF@3D-Ti) against NMF@HA-Ti, HA-CoCr, microfracture, and sham controls. At 24 weeks, radiographic, histologic, biocompatibility, and osseointegration assessments supported the implant's performance (abstract truncated before full results). If validated clinically, this design could expand limited options for focal knee resurfacing as an alternative to biological treatments.
68. Matsumoto H, Mimatsu S, Kojima I, et al. Association between pre-operative body mass index and post-operative decline in activities of daily living in patients with total knee arthroplasty. International Orthopaedics 2026. doi:10.1007/s00264-026-07036-2
This retrospective cohort of 201 total knee arthroplasty patients examined the relationship between pre-operative BMI and post-operative decline in activities of daily living (ADL) measured by the Barthel Index during hospitalization. About 27% of patients experienced reduced ADL ability after surgery, with pre-operative BMI associated with this decline (full adjusted results truncated). The implication is that higher-BMI TKA patients may warrant targeted pre-operative preparation and post-operative ADL support.
69. Ng EP, Lee RH, Wan KH, et al. Arthroscopic Autologous Minced Cartilage Implantation for Subchondral Insufficiency Fracture of the Knee. Arthroscopy Techniques 2026. doi:10.1002/atn2.70269
This technical note describes an all-arthroscopic autologous minced cartilage implantation technique for focal chondral defects overlying medial femoral condyle subchondral insufficiency fracture of the knee. Debrided cartilage is mixed with platelet-rich plasma, packed into the defect after meniscal repair, and stabilised with fibrin sealant. The approach offers a cost-effective, joint-preserving, minimally invasive option without donor-site morbidity, particularly for middle-aged patients with concomitant meniscal pathology.
70. Zhang R, Lu S. The tibial slope‐meniscal coupling index after ACL reconstruction: A promising rule‐out marker, not yet a surgical trigger. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70580
This commentary discusses the tibial slope-meniscal coupling index as a marker assessed after ACL reconstruction. The authors conclude it shows promise as a rule-out marker for identifying patients at low risk of adverse outcomes, but the evidence does not yet justify using it as a surgical trigger for meniscal or slope-altering intervention. Clinically, it may inform risk stratification while awaiting validation before guiding operative decisions.
71. Totlis T, Kort N, Kort R, et al. Formal consensus on fast‐track hip and knee arthroplasty: ESSKA/EKA, EHS and APAS recommendations for optimised recovery pathways in joint replacement surgeries. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70594
An international multidisciplinary panel of 106 experts (steering, rating, and peer review groups) used formal consensus methodology to develop 63 statements from 37 questions on fast-track/ERAS care for hip and knee arthroplasty, graded A, D by evidence level. The consensus provides unified, evidence-based recommendations covering perioperative optimization of joint replacement pathways. The clinical implication is a transnational reference standard to promote broader, consistent implementation of enhanced recovery protocols.
72. Runer A, Amis A, Smigielski R, et al. Current concepts in isolated and combined injuries of the medial collateral ligament complex—Part I: Anatomy, biomechanics, clinical and radiological examination of the medial collateral ligament of the knee. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70588
Part I of this current concepts review synthesizes the anatomy and biomechanics of the medial collateral ligament complex, superficial MCL, deep MCL, and posteromedial complex/POL, along with dynamic stabilizers, and details clinical and radiological assessment of isolated and combined ACL, MCL injuries. It clarifies the distinct roles of each structure in restraining valgus, rotational, and anteromedial rotatory instability. The implication is that accurate, structure-specific diagnosis should guide updated examination protocols and subsequent treatment decisions.
74. Hopper HM, Bruce‐Leicht AS, Hart JM, et al. The mechanism of injury's role in jump landing mechanics after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70605
In 129 patients roughly 8 months after primary ACL reconstruction, landing mechanics assessed with the Landing Error Scoring System were compared between those with contact (n=38) versus noncontact (n=91) mechanisms of injury. Total, frontal, and sagittal LESS scores did not differ between groups, nor did demographics, strength, or patient-reported outcomes. Mechanism of injury therefore does not appear to predict landing quality after rehabilitation, so post-ACLR movement screening should not be tailored based on original injury mechanism.
76. Qu X, Tang X, Yang D, et al. Reframing knee injury and osteoarthritis outcome score‐quality of life–defined ‘subjective failure’ after primary and revision posterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70610
This commentary responds to a registry-based comparison of primary and revision posterior cruciate ligament reconstruction by Winkler et al., in which more than half of patients in both cohorts met a KOOS-Quality of Life, defined threshold for 'subjective treatment failure.' The authors caution that this label may be misinterpreted as true clinical failure without proper framing of the KOOS-QoL cutoff and baseline severity. They argue for reframing how subjective failure is defined and communicated when counseling PCLR patients, particularly given the limited comparative data in this population.
79. McAleese T, Okoli M, Moran KA, et al. Chondral Lesion Severity and Location Are Not Associated With Return‐to‐Play Outcomes After Anterior Cruciate Ligament Reconstruction. Arthroscopy 2026. doi:10.1002/arj.70567
Patients who underwent primary ACL reconstruction with arthroscopically confirmed chondral lesions were followed for 5 years to assess return-to-play rate, timing, and performance level stratified by lesion severity (ICRS grade), location, and coexisting meniscal pathology. Chondral lesion severity and location were not associated with return-to-play outcomes, suggesting these factors should not preclude athletic return expectations after ACLR. Counseling can therefore rely on other determinants, though reinjury and patient-reported outcomes were also tracked for context.
80. Caplan BE, Sardesai KS, Jesse JE, et al. Short‐ to Midterm Clinical Outcomes After Autologous Minced Cartilage Implantation for Focal Chondral Defects of the Knee Are Comparable to Microfracture and Autologous Chondrocyte Implantation: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70511
This systematic review of 41 studies (2,116 patients) compared autologous minced cartilage implantation with microfracture and ACI/MACI for focal knee chondral defects, with minimum 12-month follow-up. Clinical outcomes (IKDC, KOOS subscores, Lysholm) were comparable across the three techniques, with no significant differences despite differing patient ages and follow-up durations. AMCI appears a safe, effective, single-stage alternative to established cartilage repair options, though its shorter follow-up and smaller evidence base warrant longer-term comparative studies.
82. Lehoczky G, Khoo B, Lin Z, et al. More Horizontal ACL Posterolateral Bundle Position in Osteochondritis Dissecans of the Lateral Femoral Condyle. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261479922
This case-control study compared MRI measurements of ACL posterolateral bundle insertion height on the coronal plane among 90 age- and sex-matched knees in three groups: lateral femoral condyle OCD, medial femoral condyle OCD, and no structural pathology. A more horizontal ACL posterolateral bundle position was found in lateral femoral condyle OCD, consistent with the hypothesis that anatomic proximity of the PL bundle contributes to OCD pathogenesis. This suggests ACL insertion anatomy may be a predisposing factor worth considering in young patients with lateral femoral condyle OCD.
83. Zhong C, Wang K, Hu X, et al. Platelet‐Rich Plasma Provides Small but Superior Short‐term Pain Relief and Functional Improvement Compared With Hyaluronic Acid for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta‐analysis. Arthroscopy 2026. doi:10.1002/arj.70520
This systematic review and meta-analysis of 21 randomised controlled trials (1790 patients) compared intra-articular platelet-rich plasma versus hyaluronic acid for knee osteoarthritis, with subgroup and metaregression analyses of preparation-related factors. PRP provided small but superior short-term pain relief and functional improvement versus HA, though no significant advantage was seen in some outcomes at 3 and 6 months. Results support considering PRP when choosing injection therapy for knee osteoarthritis, while noting the modest effect size.
85. Maffiuletti NA. Arthrogenic muscle inhibition and quadriceps activation failure: Reconciling terminology and clinical perspectives across recovery phases. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70614
This narrative commentary addresses quadriceps activation failure after ACL injury and reconstruction, arguing that this term is preferable to 'arthrogenic muscle inhibition' because it describes the clinical phenomenon without presuming a single mechanism and reflects multifactorial contributors such as pain, disuse, fatigue, and psychological factors. It proposes a framework of severe, substantial, and persistent manifestations based on magnitude and temporal evolution. The framework offers clinicians a structured way to recognize and manage activation deficits across recovery phases.
86. Uslu MB, Ergişi Y, Gökalp B, et al. Psychological readiness is associated with long‐term joint awareness after isolated anterior cruciate ligament reconstruction: A within‐patient comparison with the contralateral healthy knee. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70604
In 69 patients at least 5 years after isolated hamstring tendon ACL reconstruction, joint awareness (FJS-12) was compared within patients between reconstructed and contralateral healthy knees, alongside stability, psychological readiness (ACL-RSI), and other outcomes. The within-patient design isolated the effect of reconstruction on joint awareness, and psychological readiness was associated with long-term joint awareness. Addressing psychological readiness during rehabilitation may improve subjective knee outcomes and return-to-sport perceptions.
93. Rteil A, Jason K, Amirouche F. Outcomes after anterior cruciate ligament reconstruction with versus without lateral extra‐articular tenodesis: A propensity‐matched cohort study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70600
Using the TriNetX network, 5,021 propensity-matched pairs undergoing primary ACL reconstruction with or without lateral extra-articular tenodesis were compared for complications, healthcare utilisation, and osteoarthritis risk at 3 months to 5 years, including a high-risk subgroup aged 12-25 years. The study addresses whether the rotational stability benefits of LET come at the cost of increased early morbidity, reoperations, or mid-term osteoarthritis. The propensity-matched design strengthens causal inference for perioperative and longer-term outcome differences between the two procedures.
94. Aşkın M, Çağlar Ö, Tokgözoğlu AM, et al. Are kneeling stress radiography and the posterior sag sign associated with subjective flexion instability after posterior-stabilized total knee arthroplasty?. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06448-4
In 145 posterior-stabilised total knee arthroplasties, the authors compared kneeling stress radiography (change in tibiofemoral translation under load, Δ-TPFA), the posterior sag sign, and the 90° anterior drawer test between knees with and without subjective flexion instability. ROC analysis, diagnostic accuracy estimates, and multivariable logistic regression were used to determine which tests identify this underdiagnosed cause of dissatisfaction after TKA. The findings inform whether kneeling stress radiography and physical exam signs can reliably detect flexion instability in clinical practice.
95. Song SJ, Lee HB, Park CH. Specific functional knee phenotypes are associated with increased osteoarthritis progression: A ≥10‐year longitudinal study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70591
This ≥10-year longitudinal study of 388 patients (764 knees) with healthy or minimally affected knees at baseline classified functional knee phenotypes using hip, knee, ankle, femoral mechanical, and tibial mechanical angles, comparing osteoarthritis progression across 15 phenotype groups against a neutral reference. The neutral group showed 52.4% progression over follow-up, with three specific phenotypes showing significantly higher progression rates. Identifying these higher-risk alignment phenotypes may guide surveillance and preventive counseling for patients at increased risk of knee OA progression.
100. de Geofroy B, Ogou A, Barbier O, et al. The “McFL‐LARS” Hybrid Technique: Fascia Lata Autograft and Synthetic Reinforcement for Combined Revision Anterior Cruciate Ligament Reconstruction and Lateral Extra‐articular Tenodesis. Arthroscopy Techniques 2026. doi:10.1002/atn2.70258
This technical report describes the novel 'McFL-LARS' hybrid technique, in which a narrow fascia lata autograft strip is reinforced with a 6-mm synthetic LARS ligament to create an 8-mm composite graft for combined revision ACL reconstruction and lateral extra-articular tenodesis. The construct maintains strength and biological activity while simplifying harvest and donor-site closure. It offers a reproducible option for revision ACL reconstruction when autograft availability or diameter is limited.
107. Kodra JD, Schweinert A, Memon AA, et al. Revision and complication rates after total joint arthroplasty in patients with monoclonal gammopathy of undetermined significance and multiple myeloma. International Orthopaedics 2026. doi:10.1007/s00264-026-07024-6
A retrospective single-center study of 68 patients with multiple myeloma or monoclonal gammopathy of undetermined significance undergoing primary hip or knee arthroplasty reported roughly 28% complication and 25% revision rates over about 5 years of follow-up. Revision risk did not differ significantly between MM and MGUS patients on competing-risk analysis. These data help inform preoperative counseling, indicating substantial but comparable perioperative risk across both plasma cell dyscrasias.
108. Schaefer JJ, Hevesi M, Krych AJ. Optimizing Recovery After Meniscal Repair: Standard Versus Complex Rehabilitation Pathways. Arthroscopy 2026. doi:10.1002/arj.70589
This article summarizes consensus-based rehabilitation pathways after meniscal repair, contrasting a standard protocol for biomechanically stable repairs (e.g., vertical longitudinal tears) with a more protective complex pathway for higher-risk repairs. Both pathways progress using time- and criterion-based milestones developed by an international EU-US task force. The clinical implication is that rehabilitation should be matched to repair stability rather than applied uniformly, balancing protection against delayed recovery.
113. Pedemonte-Parramón G, Nescolarde L, García-Oltra E, et al. Quadriceps muscle status after medial-pivot versus ultracongruent total knee arthroplasty using localized bioimpedance analysis: a randomized exploratory study. Arthroplasty 2026. doi:10.1186/s42836-026-00429-z
In a randomised, patient-blinded trial of 30 patients undergoing primary total knee arthroplasty, quadriceps muscle recovery after medial-pivot versus ultracongruent implant designs was assessed longitudinally using localized bioelectrical impedance analysis (reactance) of the rectus femoris, vastus medialis, and vastus lateralis. The study provides the first direct, objective comparison of muscle status between these two implant designs. Findings may guide implant selection and rehabilitation planning based on measurable quadriceps recovery rather than implant design assumptions alone.
115. Li M, Guttikonda S, Lahoti Y, et al. Artificial Intelligence Accurately Assists in Billing for Orthopaedic Lower Extremity Surgery: Performance of the Mistral‐NeMo Language Model. Arthroscopy 2026. doi:10.1002/arj.70480
The Mistral-NeMo large language model was tested on 1000 orthopaedic lower extremity operative notes to verify CPT coding accuracy using binary and confidence-score prompts. The model correctly confirmed 90% of true codes and rejected 99.8% of incorrect codes, achieving 99.8% precision and 90% recall. These results support AI-assisted billing review as a reliable adjunct for reducing coding errors and improving efficiency in orthopaedic practice.
118. Chen B, Tang X, Guo D, et al. KneeFusionNet Enables Accurate and Efficient Comprehensive Detection of Knee Ligament Injuries on Magnetic Resonance Imaging: A Multicenter Validation Study. Arthroscopy 2026. doi:10.1002/arj.70510
KneeFusionNet, a DenseNet-based multimodal deep learning model, was developed at two centers and externally validated at a third in 919 patients to detect ACL, PCL, MCL, and LCL injuries on knee MRI, with arthroscopic confirmation as reference. Multimodal fusion outperformed comparison models, and the external validation demonstrated accurate, efficient detection of knee ligament injuries. AI assistance improved reader diagnostic performance, supporting its use as a clinical decision-support tool for knee MRI interpretation.
121. Bruns Y, Fahlbusch H. Re-examining the pain–depression vicious cycle in knee osteoarthritis: a random-intercept cross-lagged panel analysis. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10439-2
Using random-intercept cross-lagged panel modeling of 4,638 Osteoarthritis Initiative participants across four annual waves, the authors re-examined the presumed pain, depression vicious cycle in knee osteoarthritis while separating stable between-person differences from within-person change. The RI-CLPM showed that the apparent reciprocal longitudinal relationship largely reflects trait-level co-occurrence rather than true year-to-year within-person dynamics, challenging the traditional vicious-cycle interpretation. Clinically, this suggests pain and depression should be treated as correlated but largely stable patient characteristics, and interventions targeting one may not automatically improve the other over time.
125. Ibrahim A, Abdelnabi M, Sheta RA. Duloxetine for postoperative pain management in total hip and knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07176-6
This PRISMA-compliant systematic review and meta-analysis compared perioperative duloxetine versus placebo in total hip and knee arthroplasty patients, pooling VAS/NRS pain scores (converted to a 0-100 mm scale), opioid consumption in morphine milligram equivalents, and adverse events. Duloxetine reduced postoperative pain at rest and with ambulation and decreased opioid use, with an acceptable safety profile. The results support duloxetine as a reasonable multimodal analgesic adjunct to reduce pain and opioid exposure after THA and TKA.
131. Ren Z, Liu M, Youxia C, et al. Arthroscopic 3‐Tunnel Suture‐Bridge Technique for Treating Tibial Avulsion Fractures of the Posterior Cruciate Ligament Is Associated With Excellent Clinical and Radiological Outcomes. Arthroscopy 2026. doi:10.1002/arj.70502
This retrospective study of 33 patients with minimum 24-month follow-up evaluated an all-arthroscopic 3-tunnel suture-bridge technique, using anterior, posteromedial, and posterolateral tibial tunnels, for fixation of PCL tibial avulsion fractures. Outcomes assessed with IKDC, Lysholm, and Tegner scores, KT-1000 posterior translation measurements, and radiographic/CT healing demonstrated excellent functional recovery, knee stability, and fracture healing. The technique appears to be a clinically effective arthroscopic option for stable fixation of these fractures.
132. Tantikosol P, Apinyakul R, Wong HJ, et al. Periarticular Hardware Retention does not Increase Reoperation Risk in Conversion Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.052
This retrospective cohort of 320 patients undergoing conversion or primary TKA (2009-2019) compared outcomes among no retained hardware, minor hardware, and major hardware groups using a risk-adjusted Fine-Gray model accounting for death as a competing event. Retained periarticular hardware was not associated with increased reoperation risk, and secondary outcomes (operative time, blood loss, complications, and patient-reported measures) showed no significant differences. Surgeons can therefore leave well-fixed periarticular hardware during conversion TKA without expecting worse reoperation or perioperative outcomes.
137. Mont MA, Scuderi GR. Outpatient Arthroplasty: The Site of Service Has Changed, but the Work and Financial Burden Have Not. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.001
This commentary discusses the shift of primary hip and knee arthroplasty from inpatient hospitals to outpatient and ambulatory settings, driven by removal from the CMS inpatient-only list and advances in perioperative care. The authors emphasize that although the site of service has changed, the operative work and financial burden on patients remain substantial. Clinically, this underscores the need for reimbursement and care coordination models that reflect the true intensity of outpatient arthroplasty.
138. Valderrama J, Narváez F, Cancino J, et al. CTA-detected incidence and descriptive fracture patterns of arterial injury in 539 surgically treated tibial plateau fractures. Injury 2026. doi:10.1016/j.injury.2026.113403
This retrospective cohort of 539 surgically treated tibial plateau fractures at a Level I trauma center selectively used CT angiography to characterize arterial injury. CTA yield was 3.66% (6/164), yielding an overall observed incidence of arterial injury of about 1.1%, with certain high-energy fracture patterns and clinical scenarios more common among injury cases. The findings support selective, judgment-based CTA use in tibial plateau fractures, though the small number of events limits firm predictive rules.
139. Mayor J, Schnorbus CM, Clausen J, et al. Predictive factors for early revision surgery after tibial plateau fracture fixation: a retrospective cohort study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104633
In 153 patients with surgically fixed tibial plateau fractures, this retrospective cohort examined radiographic and clinical predictors of revision surgery within 12 months. Lower Rasmussen scores and deeper fracture impression predicted early revision, which was required in 12.4% of patients (reosteosynthesis or TKA), while other alignment parameters showed no association. These findings suggest fracture depression depth and postoperative alignment scoring can help identify patients at higher risk of early reoperation.
141. Persaud SG, Kucherina A, Ortiz S, et al. Dual Eligibility Status Is Associated With Lower Surgeon Reimbursement Despite Greater Patient Complexity in Primary Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.048
Using 2023 Medicare data on over 161,000 THA and 297,000 TKA procedures, this cross-sectional analysis stratified surgeons by the proportion of dual-eligible (Medicare-Medicaid) patients in their panel. Surgeons with higher dual-eligibility proportions received lower standardised Medicare reimbursement per procedure despite treating more socioeconomically vulnerable and complex patients. This highlights a potential inequity in surgeon payment under current reimbursement models and raises concerns about financial disincentives to caring for disadvantaged populations.
142. Sethi E, Mohan R, Leng TT, et al. Predictors of Inability to Kneel and/or Squat One Year after Knee Arthroplasty in a Southeast Asian Population. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.053
This retrospective study of 888 primary knee arthroplasties in a Southeast Asian population identified predictors of the ability to kneel and squat at one year postoperatively, activities culturally important in this region. Only 30% of patients could perform both activities, with greater postoperative flexion, range of motion, and Oxford Knee Score kneeling confidence associated with success. Surgeons should counsel patients, especially Asian populations, that inability to kneel or squat is common after knee arthroplasty and may be anticipated from early postoperative motion measures.
143. Botolin P, Helbing J, Khanuja HS, et al. Impact of Gastrointestinal Bleeding History on Postoperative Outcomes in Total Hip and Knee Arthroplasty: A Retrospective Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.057
This matched retrospective analysis evaluated whether gastrointestinal bleeding within two years before THA or TKA influenced postoperative complications, including periprosthetic joint infection. GI bleeding history was associated with increased odds of mechanical loosening and revision after THA, and with greater 2-year odds of PJI after TKA. A preoperative GI bleeding history may warrant heightened surveillance and risk counseling in arthroplasty patients.
149. Siripullop T, Ngarmukos S, Jaruthien N, et al. Coronal Spinal Imbalance Dictated Side Preference in Symmetrically Well-Aligned Bilateral Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.054
In 122 patients with symmetrically well-aligned bilateral TKA evaluated on full-body radiographs, coronal spinal imbalance was measured as the C7 plumb line to central sacral vertical line distance, and knee side preference was assessed. Patients with spinal imbalance overwhelmingly (91.5%) preferred one side, consistent with loading the knee on the side toward which the trunk is shifted, whereas 71% of spine-balanced patients had no preference. Coronal spinal alignment appears to dictate functional side preference after TKA, suggesting spinal imbalance should be considered when evaluating asymmetric outcomes or satisfaction despite well-aligned knees.
150. Yang Y, Zang W, Zhou Y, et al. Heterogeneity of Quadriceps Muscle Volume in Knee Osteoarthritis: A Latent Profile Analysis and Its Clinical Implications for Arthroplasty Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.058
Latent profile analysis of CT-derived quadriceps volumetric ratios in 191 patients undergoing robot-assisted TKA identified three muscle phenotypes: moderate (n=125), high (n=27), and reduced (n=39) muscle volume classes. Muscle phenotype stratified six-month functional outcomes, with the reduced-volume class showing the worst results and the high-volume class the best. Preoperative quadriceps phenotyping could identify patients needing targeted prehabilitation to optimise arthroplasty recovery.
151. Davidson A, Harats E, Levi Y, et al. Patellar fractures: to plate them all? Results of a new treatment protocol. Injury 2026. doi:10.1016/j.injury.2026.113652
This study reports outcomes of a new treatment protocol applying plate fixation broadly to patellar fractures, addressing the question of whether all fracture patterns warrant plating. The protocol demonstrated favourable results regarding fixation success and complications across the treated cohort. Clinically, the findings support expanded use of plating for patellar fractures, though the pre-proof status and incomplete abstract detail warrant caution pending full publication.
152. Fan D, Ng H. Trends in female anterior cruciate ligament injuries: a bibliometric and visualized analysis. EFORT Open Reviews 2026. doi:10.1530/eor-2025-0133
This bibliometric and visualization analysis mapped the research landscape on anterior cruciate ligament injuries in female athletes, identifying publication trends, prolific authors/institutions, and thematic clusters. The analysis highlights growing research attention to female-specific ACL risk factors, prevention programs, and outcomes. Clinically, it underscores the need for sex-specific injury prevention strategies and identifies gaps, such as limited implementation research, guiding future study priorities.
153. Ricca GW, Torres RB, Wong L, et al. Trends in Racial and Socioeconomic Differences in Cementless Total Knee Arthroplasty Utilization Among Medicare Beneficiaries from 2016 to 2022. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.066
Using Medicare fee-for-service claims from 2016-2022, the authors analyzed cementless versus cemented fixation among over 1 million primary elective TKAs, stratified by race and dual Medicare-Medicaid eligibility. Cementless utilisation grew substantially but adoption differed by race and socioeconomic subgroup on multivariable analysis. The findings highlight persistent disparities in access to emerging arthroplasty technology, suggesting a need for equity-focused monitoring as cementless implants diffuse into practice.
156. Karataş ME, Yıldırım AM, Basak F, et al. Mid-Term Osteoarthritis Prevalence After Partial Meniscectomy in Knees With High Posterior Tibial Slope. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261479404
In a retrospective cohort of 378 knees with minimum 5-year follow-up, mid-term radiographic osteoarthritis progression (Kellgren-Lawrence 0/1 to ≥2) and clinical scores were compared after meniscal repair versus partial meniscectomy, with analysis of posterior tibial slope (>10°) and tear morphology effects. The study quantified OA incidence, revision rates, and IKDC/Lysholm outcomes between procedures and evaluated procedure-by-slope interaction. Results help guide treatment selection for meniscal tears based on patient-specific anatomy.
157. Tsai S, Chang C, Hung Y, et al. Age-Adjusted Charlson Comorbidity Index Outperforms Other Comorbidity Measures in Predicting 90-Day Readmissions After Simultaneous Bilateral Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.064
In 1,785 patients undergoing simultaneous bilateral TKA, the predictive performance of four comorbidity indices, aCCI, Elixhauser, mFI-5, and HRQoL-CI, was compared for 90-day readmissions, 1-year reoperations, and prolonged length of stay. The age-adjusted Charlson Comorbidity Index outperformed the other measures for predicting 90-day readmission. This supports aCCI-based risk stratification when counseling or selecting patients for bilateral single-stage arthroplasty.
159. Kutschke MJ, Agonias KB, Wyatt CW, et al. Screw Versus Suture Bridge Fixation for Medial Femoral Condyle Osteochondritis Dissecans Demonstrate Comparable Healing Rates. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261474714
Using the multicenter ROCK registry, patients with unstable medial femoral condyle OCD lesions treated with headless compression screws versus suture bridge fixation were compared for union, secondary cartilage restoration procedures, and patient-reported outcomes. Healing rates were comparable between the two fixation techniques, consistent with the authors' hypothesis of no significant difference. This supports either fixation strategy, with suture bridge offering a cartilage-preserving alternative without compromising union.
160. Altun O, Ergişi Y, Özdemir E, et al. The Effect of Posterior Tibial Slope Change on Functional Outcomes After Posterior-Stabilized Total Knee Arthroplasty: An Analysis of 370 Patients Who Had A Minimum 4-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.001
In 370 patients with minimum 4-year follow-up after cemented posterior-stabilised TKA with a single implant design, postoperative change in posterior tibial slope was analyzed by direction and magnitude against VAS, WOMAC, and other functional outcomes. The study tested whether altering PTS, beyond simply avoiding excessive slope, affects mid-term clinical results. Findings clarify the clinical relevance of intraoperative PTS management in PS-TKA.
162. Watanabe N, Yagi M, Naito Y, et al. Biological Age Acceleration Predicts Functional Decline and Surgical Risk in Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.068
In 173 TKA patients, biological age calculated from nine blood biomarkers was compared with chronological age for predicting functional and perioperative outcomes. Biological age acceleration predicted lower skeletal muscle mass, slower gait speed, and higher perioperative complication risk beyond chronological age and adjusted confounders. Phenotypic biological aging may improve preoperative frailty and surgical risk stratification in TKA candidates.
164. Shin J, Driscoll DA, Selkridge I, et al. Patients Undergoing Revision Total Knee Arthroplasty for Stiffness Have Similar Perioperative Pain Scores and Postoperative Opioid Consumption Compared to Patients Undergoing Revisions for Other Aseptic Indications. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.007
Pain scores and opioid use were compared in 337 revision TKAs performed for stiffness versus aseptic loosening or instability, using surveys at 10, 28, and 90 days. Despite higher preoperative opioid use in the stiffness group, postoperative pain scores, opioid consumption, and duration of use were similar between groups. Opioid stewardship after rTKA need not differ by indication for revision.
169. Li Z, Zhou H, Shang Z, et al. Anteromedial Rotatory Instability After Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injury in a Murine Model. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261480904
Researchers created a murine model of anteromedial rotatory instability by combining ACL and MCL transection and compared it with isolated ACL transection and meniscal destabilization over 6 weeks of treadmill running. Combined transection increased anterior tibial translation, especially in internal rotation, and produced more severe osteoarthritis than isolated injuries. This model provides a tool for studying AMRI biomechanics and suggests combined ligament injuries accelerate post-traumatic OA.
174. Aalders MB, Z-T Ting T, D’Mello F, et al. Association of Recovery and Dissatisfaction with Psychological Distress in Patients Undergoing Total Knee and Hip Arthroplasty in South Australia: A Retrospective Cohort Study of 1,462 Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.010
This retrospective cohort of 1,462 Australian total knee and hip arthroplasty patients evaluated longitudinal associations between psychological distress (EQ-5D-5L anxiety/depression) and postoperative function, quality of life, and 1-year dissatisfaction. Worse preoperative and early postoperative psychological symptoms were associated with poorer patient-reported outcomes and higher odds of dissatisfaction at one year. The results confirm that psychological distress predicts inferior arthroplasty outcomes in an Oceania cohort, supporting preoperative psychological screening and targeted support.
175. Pang A, Zamzam M, Hodson N, et al. Equivalence of Outcomes Between Ambulatory and Hospital-Based Arthroplasty in Younger and Older Adults. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.014
In this propensity-matched retrospective cohort of 10,804 elective primary total hip and knee arthroplasties at one academic health system, 90-day outcomes were compared between ambulatory surgery centers and hospitals, stratified by age (<75 vs ≥75 years). ASC patients had shorter stays, shorter operative times, and more home discharges, and patients ≥75 years at ASCs showed no significant differences in complications such as readmission, infection, dislocation, or periprosthetic fracture. The findings support the safety of ambulatory arthroplasty even for older adults when appropriately selected.
176. Garside JC, Joaquin TA, Reeves EE, et al. Area Deprivation Index, Institutional Practice, and Utilization of Neuraxial Anesthesia in Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.017
This retrospective study of 340 primary total knee arthroplasties across four hospitals used the Area Deprivation Index to examine whether socioeconomic status influences neuraxial anaesthesia utilisation. After multivariable adjustment, patients from more disadvantaged quintiles had lower rates of neuraxial anaesthesia than those in the least disadvantaged quintile. The results reveal a socioeconomic disparity in perioperative pain management for TKA, suggesting a target for equity-focused quality improvement.
179. Bryant NK, Getgood A, Ma J, et al. The Validity of a Smartphone App to Serve as Proxy for Exposure Time and Activity Level in Functionally Active Patients With Knee Osteoarthritis and Young Athletes Post-ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261466479
This cohort study of 102 participants (55 with knee osteoarthritis, 47 athletes after ACL reconstruction) tested smartphone step-count data against 4-week activity diaries, with Marx Activity Rating Scale and sport participation measures as secondary comparators. Smartphone step counts showed poor correlations and agreement with diary-reported exposure time and activity level. The clinical implication is that smartphone step counting cannot currently serve as a valid proxy for exposure time or activity measurement in these orthopaedic populations, so validated methods remain necessary.
180. Kinoshita T, Bunyoz KI, Mortensen KR, et al. Preoperative Medial Proximal Tibial Angle Does Not Influence Clinical Outcomes Following Mobile-Bearing Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.021
This retrospective study of 454 patients undergoing mobile-bearing medial unicompartmental knee arthroplasty stratified preoperative medial proximal tibial angle into three groups (≤83°, 84-86°, ≥87°) and compared Oxford Knee Score improvements at 3 months, 1 year, and 2 years, including subgroup analysis by postoperative tibial component alignment. Improvements in Oxford Knee Scores were comparable across all preoperative MPTA groups after adjustment for age, sex, and BMI. This suggests preoperative coronal tibial alignment should not be used to exclude patients from mobile-bearing medial UKA.
181. Haji Boloori F, Kubiak A, Rezazadeh Shirazi A, et al. Low Back Pain and Depression Are Associated with Worse Patient-Reported Outcomes After Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.024
This national registry study of 4,173 primary total knee arthroplasty patients compared six-month Oxford Knee Score change among patients with neither low back pain nor depression, either condition alone, or both, using adjusted mean, logistic MCID, satisfaction, and quantile regressions. Patients with low back pain or depression each had smaller improvements, and co-occurrence of both conditions was associated with the worst outcomes (β = -2.08), with reduced odds of achieving the minimal clinically important difference. The implication is that combined screening for low back pain and depression may identify TKA patients at heightened risk of suboptimal improvement for targeted preoperative counseling or intervention.
183. Ng MK, Mastrokostas LE, Mastrokostas PG, et al. 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.2026.09.034
This PRISMA-compliant systematic review included 78 randomised controlled trials comprising 8,515 total knee arthroplasty patients to evaluate periarticular infiltration analgesic cocktails against placebo, nerve blocks, or alternative cocktail formulations. Periarticular injection cocktails consistently reduced postoperative pain and opioid consumption and improved early functional outcomes versus placebo, with comparative findings against nerve blocks and among different cocktail compositions also summarized. The implication is that periarticular infiltration is an effective analgesic component of multimodal TKA protocols, though the optimal formulation remains to be defined.
184. Lam AD, Parikh N, Valenzuela M, et al. More Tech-Savvy Than You Think: Digital Proficiency Among Total Joint Arthroplasty Patients. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.033
This prospective survey of 201 total joint arthroplasty patients (mean age 70) used the 16-item Mobile Device Proficiency Questionnaire to compare digital proficiency between patients younger and older than 65 years. Daily smartphone use was nearly universal in both groups (80-85%), with similar ease navigating menus, typing, and emailing across ages, and only modest differences in some appointment-management tasks. The implication is that elderly TJA patients are more digitally capable than often assumed, supporting the use of smartphone-based patient-reported outcome collection and digital perioperative engagement tools across age groups.
185. Ren BO, Zhu Q, Kim MHSA T, et al. Patient-Reported Outcomes Measures Collection Method by Timeframe: Different Strategies for Different Times. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.038
This retrospective registry study evaluated PROM collection methods and response rates across preoperative, early postoperative, and one-year timepoints in 18,602 primary total joint arthroplasty cases. Completion of all surveys was more likely in women, never smokers, and those operated at hospitals or outpatient settings, with response rates varying by collection method and timeframe. The findings suggest that tailored, timepoint-specific collection strategies are needed to improve PROM completeness for registry and CMS reporting.
187. Rivarola H, Helito C, Arteaga G, et al. Development of a Clinically Applicable Risk Score for Knee Injuries in Recreational Athletes: A Probabilistic Model for Preventive Decision-Making. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261459787
This prospective multicenter cohort of 628 recreational athletes followed for 12 months used LASSO-penalized logistic regression to identify predictors of clinically confirmed knee injuries and derived a simplified point-based risk score. The model was internally validated as a probabilistic tool for estimating individual injury risk. The resulting clinical score offers an accessible means for clinicians in preventive care settings to counsel nonprofessional athletes and target prevention efforts.
190. Gomez-Caceres A, Medina-Porqueres I, Benavides-Propp M, et al. Incidence of Anterior Cruciate Ligament Injuries in Female Soccer Players Across Age Groups and Competition Levels. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486414
This retrospective cohort of 4,937 federated female soccer players in Málaga, Spain (2020-2024) identified 64 ACL injuries and calculated incidence rates per 1000 hours of play across age groups and competition levels. Most injuries occurred during matches (79.7%) and were noncontact (82.8%), with professional players and 16- to 18-year-olds showing the highest incidences. These population-based data can guide age- and level-targeted ACL prevention programs in female soccer.
195. Rougereau G, Delaigue F, Sadoun M, et al. Plantaris tendon resection increases ankle dorsiflexion independently of knee position, with greater effect in tendons inserting close to the Achilles. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104913
In 18 cadaveric feet, ankle dorsiflexion was measured before and after complete plantaris tendon resection with the knee extended and flexed at 90°, stratified by insertion type relative to the Achilles tendon. Plantaris resection significantly increased dorsiflexion independent of knee position, with greater gains in tendons inserting close to the Achilles. The plantaris tendon may represent an additional treatable restrictor in equinus deformity when gastrocnemius recession fails or as an adjunct release.