What's New — Knee — October 2026¶
185 new articles published this month.
Themes: ACL Reconstruction and Outcomes · Meniscus Repair and Root Tears · Arthroplasty Alignment and Technology · Periprosthetic Joint Infection · Osteoarthritis Treatment and Rehabilitation · Patellofemoral Instability and Alignment
Digest generated 2026-11-04 16:17:23+00:00.
Highlights¶
ACL Reconstruction and Outcomes¶
This month's knee literature features a substantial ACL focus. Long-term data show a 20.5% failure rate for all-inside 4-stranded semitendinosus reconstruction at 10 years [27], while professional soccer players had low failure (5.6%), with lateral extra-articular augmentation trends favoring lower failure [66]. Biomechanical work suggests LET femoral fixation points and flexion angles do not meaningfully alter graft forces or tibiofemoral motion [29], and anatomic anterolateral ligament reconstruction constrains internal rotation less than modified Lemaire with lower lateral compartment loading [130]. LET did not alter paediatric gait biomechanics [84]. Additional studies address contact injury mechanisms increasing ACL injury severity [26], posterior tibial offset ratio as a revision risk factor [127], orthobiologic augmentation showing no benefit [103], and persistent neuromuscular alterations in return-to-sport cohorts [100].
Meniscus Repair and Root Tears¶
Meniscal preservation dominated technical reports this month. Medial meniscus posterior root repair augmented with centralization improves outcomes and limits extrusion [8], with rabbit data suggesting zone-specific cartilage protection and enhanced healing [45], though preoperative subchondral insufficiency fractures predict worse outcomes and higher reoperation rates [13]. A comprehensive review covers root tear epidemiology, diagnosis, and management [106]. Technical innovations include transtibial fixation with lasso-loop sutures [20], cross-bar suture configuration with knotless centralization [78], meniscal allograft transplantation fixation techniques showing equivalent outcomes regardless of method [31, 39], needle arthroscopy enabling faster recovery after medial repair [128], and all-inside repairs for hypermobile lateral meniscus, meniscofibular ligament tears, discoid meniscus instability, and anterior horn bucket-handle tears [16, 19, 34, 54, 71, 102, 110].
Arthroplasty Alignment and Technology¶
Alignment philosophy and technology featured prominently. Coronal alignment affects mediolateral load distribution and polyethylene wear in medial-pivot designs [4], while a mathematical model quantifies how femoral and tibial anatomy independently limit achievement of horizontal joint lines [51]. In TKA, preoperative coronal phenotype weakly predicts final balance in robotic-assisted surgery [75], digital tensioning yields different gap measurements than manual assessment [50], and preoperative alignment does not compromise bicruciate-retaining TKA outcomes [184]. For UKA, preoperative subluxation [9] and varus ≥10° [95] do not compromise outcomes, imageless robotics improve radiographic accuracy [112], and robotic-assisted baseplate footprint influences periprosthetic fracture behaviour [146]. AI-based automated HTO planning achieved expert-level agreement [48], and restricted kinematic alignment improved function without reducing kinesiophobia [182].
Periprosthetic Joint Infection¶
PJI diagnostics and management received substantial attention. Research culture methods detect more anaerobes than conventional workflows [1], deep bone sampling provides higher culture yield during one-stage exchange [177], and a prospective evaluation validated intraoperative synovial calprotectin point-of-care testing for revision cases [176]. Serological and synovial profiles may differentiate aseptic revision etiologies [46]. Regarding treatment, intra-articular antibiotic delivery combined with one-stage revision shows promising results [70], intrawound vancomycin powder demonstrated systemic exposure without renal safety concerns [144], intraosseous regional cefuroxime achieved higher tissue concentrations than intravenous administration in robotic TKA [53], and one-stage exchange for Candida PJI showed acceptable outcomes [185]. Delphi consensus statements addressed periprosthetic surgical irrigation solutions and technique [168, 169], and PJI was the leading indication associated with in-hospital death after revision arthroplasty [147].
Osteoarthritis Treatment and Rehabilitation¶
Non-arthroplasty OA management saw several key updates. A multicenter RCT showed standardised PRP clinical pathways improve outcomes in early-grade knee OA [23], though a structural meta-analysis found PRP benefits limited to patellofemoral cartilage thickness [38], and broader commentary questioned PRP evidence quality [171]. Microfragmented adipose tissue generated debate as a PRP alternative [116, 117], and sustained acoustic medicine proved cost-effective versus hyaluronan and TKA in economic modeling [173]. Cartilage-focused work demonstrated durable 5-year outcomes for umbilical cord blood MSC-hyaluronate implantation versus microfracture [2] and particulated juvenile cartilage allografts [30]. High tibial osteotomy studies addressed postoperative alignment interactions with OA severity [41], double-level versus high tibial osteotomy comparisons [25, 181], and combined HTO with root repair using 3D printing [68]. Digital exercise therapy improved physical activity trajectories [81].
Patellofemoral Instability and Alignment¶
Patellofemoral disorders featured multiple contributions. The Boston all-in-one medial patellofemoral complex reconstruction combines MPFL and medial quadriceps tendon femoral ligament reconstruction with dynamic tensioning [12], while a randomised trial showed hybrid graft MPFL reconstruction benefits over autograft at 2 years [22]. Novel radiographic parameters for trochlear dysplasia assessment were introduced [113], alongside CT-based methods for measuring patellar entry and transition points [35]. Psychological readiness predicted return to sport after adolescent patellar stabilisation [83], and normative standards were established for the Banff Patellofemoral Instability Instrument [121]. Additional techniques included double-bundle MPFL using rectus femoris autograft [109], patellar tendon imbrication for skeletally immature patella alta [92], lateral patellofemoral restraint reconstruction for medial instability [122], and commentary on quadriceps malalignment as a driver of patellofemoral imbalance [96].
Articles by Theme¶
ACL Reconstruction and Outcomes (9)¶
26. Malhamé ZM, Hardy A, Bouché P, et al. Contact injury mechanism is independently associated with greater Anterior Cruciate Ligament Injury Severity Scale severity in patients undergoing primary anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70660
This retrospective study of 482 patients undergoing primary ACL reconstruction for sport-related ruptures used proportional-odds ordinal logistic regression to test whether injury mechanism and sport category independently predict structural injury severity on the ACL Injury Severity Scale. Contact injury mechanism was independently associated with greater ACLISS severity after adjustment for age, sex, BMI, and injury-to-surgery interval. Clinically, contact-injury ACL ruptures may warrant heightened suspicion for concomitant structural damage at the time of reconstruction.
27. Wolf M, Kortbawi R, De Saint‐Vincent B, et al. Long‐Term Failure Rate of Anterior Cruciate Ligament Reconstruction Using All‐Inside 4‐Stranded Semitendinosus Autograft Is 20.5%. Arthroscopy 2026. doi:10.1002/arj.70646
This cohort study evaluated 10-year outcomes of primary isolated ACL reconstruction using an all-inside 4-stranded semitendinosus autograft fixed with adjustable-loop cortical suspension devices, with 156 questionnaire respondents and 111 clinically evaluated patients at a mean follow-up of 138 months. Graft failure occurred in 20.5% of cases, alongside a mean Tegner score decrease of about 1 point. The high long-term failure rate raises concern about this fixation construct and should inform graft and fixation selection counseling.
29. Kruckeberg BM, Brady AW, Cinque ME, et al. Varying Lateral Extra-articular Tenodesis Femoral Fixation Points and Fixation Flexion Angles Do Not Affect ACL Graft Force and Tibiofemoral Motion After ACL Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261491029
In this controlled cadaveric laboratory study, 10 fresh-frozen knees underwent ACL reconstruction with lateral extra-articular tenodesis at two femoral fixation locations (anterolateral ligament insertion vs distal Kaplan fibres) and two fixation flexion angles (30° vs 60°). Neither fixation point nor fixation angle significantly affected ACL graft forces or tibiofemoral kinematics. The results suggest surgeons have flexibility in LET femoral placement and tensioning angle without compromising graft function.
66. Santamaria F, Santos PM, Ayata M, et al. Low graft failure after primary anterior cruciate ligament reconstruction in professional soccer players: A retrospective cohort study of 232 knees from the SANTI Study Group. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70641
In a retrospective cohort of 232 primary ACL reconstructions in 215 professional soccer players from the SANTI Study Group, graft failure occurred in 5.6% over a mean 100-month follow-up. Although unadjusted failure rates were lower with lateral extra-articular augmentation (4.5% vs 12.9%), survival analysis showed no significant difference, and no independent predictors of failure emerged. Clinicians can counsel professional players that primary ACLR carries a low failure risk, but the benefit of adding a lateral extra-articular procedure remains unproven in this cohort.
84. Manitiu A, Mazy D, Bayol A, et al. Lateral Extra-articular Tenodesis Does Not Alter Early Gait Biomechanics After ACL Reconstruction in a Pediatric Population: A Motion Analysis Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261487281
This motion analysis study compared 3D knee kinematics during gait between paediatric patients who underwent ACL reconstruction with versus without lateral extra-articular tenodesis (LET), using knee kinesiography pre- and postoperatively. Contrary to the hypothesis, adding LET did not alter early postoperative gait biomechanics, including tibial internal rotation and valgus during unloading. These findings are reassuring regarding concerns that LET overconstrains the lateral compartment in skeletally immature or paediatric patients, at least in the early postoperative period.
100. Han Y, Chen Y, Wang Z, et al. Persistent alterations in muscle activation patterns during landing tasks after anterior cruciate ligament reconstruction in return‐to‐sport cohorts: A systematic review and meta‐analysis of electromyography studies. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70637
This systematic review and meta-analysis of 32 EMG studies compared lower-limb muscle activation during 13 landing tasks between 556 ACLR patients who had returned to sport and 501 healthy controls, using random-effects models with standardised mean differences. Three findings reached moderate evidence, including greater activation of specific muscles in the reconstructed limb, indicating persistent neuromuscular alterations despite return to sport. The results suggest that return-to-sport clearance based on functional milestones alone may not normalize muscle activation patterns, supporting continued neuromuscular rehabilitation.
103. Driscoll A, Mazzocco J, Fucaloro S, et al. Orthobiologic Augmentation for Anterior Cruciate Ligament Reconstruction Is Not Associated With Improved Clinical or Radiographic Outcomes: A Systematic Review and Meta‐analysis of Randomized Controlled Trials. Arthroscopy 2026. doi:10.1002/arj.70638
This systematic review and meta-analysis of 9 randomised controlled trials (543 patients) evaluated whether orthobiologic augmentation of the ACL graft, platelet-rich plasma, bone marrow aspirate concentrate, or mesenchymal stem cells, improves patient-reported or radiographic outcomes after ACL reconstruction. Pooled analyses using random-effects models found no association between orthobiologic augmentation and improved clinical or radiographic outcomes. The findings argue against routine use of these costly adjuncts in ACL reconstruction outside of research settings.
127. Polat G, Arzu U, Atasoy İT, et al. Posterior Tibial Offset Ratio (PTOR) Is Associated With Revision After Hamstring-Autograft Anterior Cruciate Ligament Reconstruction: A Matched Case-Control Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477925
This matched case-control study (67 revisions vs 67 controls) evaluated the posterior tibial offset ratio (posterior plateau distance divided by anterior plateau distance on lateral radiographs) as a predictor of revision after hamstring-autograft ACL reconstruction, compared with posterior tibial slope. The authors hypothesized that higher PTOR would be associated with revision independently of posterior slope and total plateau length. If confirmed, PTOR could complement posterior tibial slope in preoperative risk assessment and surgical planning for patients with adverse sagittal tibial morphology.
130. Tollefson LV, Slette EL, Shoemaker EP, et al. Anatomic Anterolateral Ligament Reconstruction Using the Iliotibial Band Results in Less Internal Rotation Constraint and Lateral Compartment Joint Loading As Compared With the Modified Lemaire Procedure: A Robotic Biomechanical Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261488798
In seven paired cadaveric knees tested on a 6-DOF robotic system, the authors compared anatomic anterolateral ligament reconstruction using the iliotibial band against the modified Lemaire lateral extra-articular tenodesis after ACL reconstruction, measuring anterior translation, internal rotation, simulated pivot shift, and lateral compartment pressures. ALLR provided less constraint to internal rotation and less lateral compartment joint loading than the modified Lemaire procedure. These findings suggest ALLR may reduce concerns about lateral compartment overload when lateral extra-articular augmentation is indicated.
Meniscus Repair and Root Tears (16)¶
8. Moews LD, O’Connor G, Cavendish PA, et al. Meniscal Centralization Improves Outcomes and Limits Extrusion After Medial Meniscus Posterior Root Repair: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70691
This systematic review of six studies (148 patients) evaluated medial meniscus posterior root repair augmented with meniscal centralization. All studies showed significant patient-reported outcome improvements (e.g., Lysholm gains of 21-42 points), and centralization limited postoperative meniscal extrusion. The findings support adding centralization to root repair to improve outcomes and protect against osteoarthritis progression, though the evidence base is heterogeneous and limited to qualitative synthesis.
13. Garcia JR, Cohen EM, Gilat R, et al. Preoperative Subchondral Insufficiency Fractures Are Associated With Decreased Clinically Significant Outcome Achievement, Higher Reoperation Rates, and Greater Osteoarthritis Progression After Medial Meniscus Posterior Root Repair at a Minimum 2‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70712
In 91 patients undergoing isolated medial meniscus posterior root repair with at least 2-year follow-up, 37.4% had a preoperative subchondral insufficiency fracture of the knee. Those with SIFK achieved clinically significant outcome improvement less often, had higher reoperation rates, and showed greater osteoarthritis progression. SIFK status should inform preoperative counseling and expectations after root repair.
16. Sasaki R, Muroya N, Nishimura T, et al. Modified Suture‐Gripping Technique for Arthroscopic Meniscal Suturing. Arthroscopy Techniques 2026. doi:10.1002/atn2.70374
This technical note describes a modified suture-gripping technique for arthroscopic meniscal suturing using the ARTHRO-PIERCE device, originally designed for hip arthroscopy, in place of a conventional suture shuttle. Its sharper tip, more rigid shaft, and robust suture grasping improve penetration and reach to the anterior horn and anterior body. The modification expands the versatility of suture-gripping for anterior meniscal repair.
19. Toyooka S, Miyazaki H, Osaki Y, et al. All‐Inside Stabilization of Discoid Lateral Meniscus Popliteal Hiatus‐Related Instability Using Anterior Cord Release With Meniscus Retention. Arthroscopy Techniques 2026. doi:10.1002/atn2.70360
A meniscus-retaining arthroscopic technique for symptomatic discoid lateral meniscus with popliteal hiatus-related instability is presented, combining anterior cord release with all-inside vertical mattress sutures around the popliteus tendon. This approach preserves meniscal volume while restoring peripheral stability, avoiding the degenerative risks of extensive saucerization. An avoidance criterion is noted for notch-locked displaced tears needing stronger fixation.
20. Arican N, Guven S, Karaman Y, et al. Arthroscopic Repair of Medial Meniscus Posterior Root Tear: Transtibial Fixation With 2 Lasso‐Loop Sutures and 1 Samsung Medical Center Sliding Knot for Tensioning Secured by a Tibial Button. Arthroscopy Techniques 2026. doi:10.1002/atn2.70369
An arthroscopic medial meniscus posterior root repair technique is described using two lasso-loop sutures and a Samsung Medical Center sliding knot passed through a single transtibial tunnel and secured with a tibial button. The construct provides strong tissue capture, balanced tensioning, and secure fixation. It is intended to achieve anatomic footprint restoration while minimising suture cut-through or loosening.
31. Miltenberg B, Davis G, Fellheimer HS, et al. Meniscal Allograft Transplantation Fixation Technique Type Does Not Meaningfully Impact Patient‐Reported Outcomes: A Systematic Review of Clinical Outcomes. Arthroscopy 2026. doi:10.1002/arj.70667
This systematic review of 27 articles (1622 meniscal allograft transplantations, predominantly lateral) compared clinical outcomes across graft fixation techniques. Patient-reported outcomes improved regardless of fixation technique, with no clear advantage of any technique for medial or lateral MAT in terms of PROs or graft failure. Soft-tissue-only fixation was associated with greater meniscal extrusion, which may guide technique selection even though PROs are equivalent.
34. Grassi A, Cerasoli T, Rinaldi VG, et al. Arthroscopic Diagnosis and All‐Inside Repair of Meniscofibular Ligament Tear. Arthroscopy Techniques 2026. doi:10.1002/atn2.70339
This technical note describes an all-inside arthroscopic technique for diagnosing and repairing tears of the meniscofibular ligament, an under-recognised cause of lateral meniscal instability often associated with ACL injury. The method uses systematic evaluation of the popliteal hiatus and posterolateral gutter with dynamic probing, followed by all-inside vertical sutures through standard anterior portals to restore meniscocapsular continuity. It offers an anatomic, meniscus-preserving repair without fibular head hardware and can be combined with ACL reconstruction, potentially preventing persistent posterolateral pain after ACL surgery.
39. Barney ME, DeFoor MT, Swope L, et al. Transosseous Equivalent Meniscus Allograft Transplantation Using an All‐Suture‐Based Anchor Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70278
This technical note presents an all-inside, all-suture-based transosseous equivalent technique for fixation of anterior and posterior meniscal roots during medial meniscal allograft transplantation. The approach aims to provide anatomic root fixation that restores hoop stresses and tibiofemoral contact pressures while avoiding tunnel and implant convergence problems common in combined realignment or instability procedures. It offers surgeons a soft-tissue-only alternative that may simplify complex meniscal transplantation.
45. Dzidzishvili L, Nelson B, Santangelo K, et al. Concomitant Centralization Procedure With Medial Meniscus Posterior Root Repair May Have Zone-Specific Effects on the Medial Femoral Condyle and Enhance Repair Healing Compared With Isolated Root Repair: An In Vivo Experimental Study in Rabbit Knees. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261492230
In a rabbit model of medial meniscus posterior root tear, cartilage status and healing were compared after isolated root repair versus root repair augmented with centralization. The centralization procedure showed zone-specific protective effects on the medial femoral condyle and enhanced repair healing. These findings support centralization as a chondroprotective adjunct to root repair, though clinical confirmation is needed.
54. Rossettie S, Hu A, Griffin D, et al. Arthroscopic Saucerization and Anatomic Repair of a Wrisberg Variant Discoid Lateral Meniscus: A Physeal‐Sparing Knotless Anchor Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70319
This technical note describes arthroscopic saucerization and anatomic repair of a Wrisberg variant discoid lateral meniscus using a physeal-sparing, knotless anchor technique to reconstruct the absent posterior root attachment without transtibial drilling. The anchor-first, retensionable construct permitted precise root tensioning, combined with peripheral stabilisation and microfracture augmentation. The approach offers a growth-plate-sparing solution for skeletally immature patients with this highly unstable meniscal variant.
71. Grassi A, Cerasoli T, Rinaldi VG, et al. Arthroscopic Stabilization of the Hypermobile Lateral Meniscus Using an All‐Inside Repair Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70338
This Technical Note describes an arthroscopic all-inside stabilisation of the hypermobile lateral meniscus using sequential vertical sutures, aided by a clinical stress maneuver (flexion, valgus stress, external rotation) to raise suspicion preoperatively. Fixation proceeds from the popliteal hiatus posteriorly and medially, with intraoperative testing to avoid overconstraint and adjunctive marrow stimulation to promote healing. The technique preserves native meniscal mobility while restoring stability, offering a tissue-preserving option for this often-missed cause of posterolateral knee pain.
78. Qin C, Goldenberg N, Leather G. Transtibial Medial Meniscus Root Repair With Simplified Cross‐Bar Suture Configuration and Knotless Centralization. Arthroscopy Techniques 2026. doi:10.1002/atn2.70324
This technical note and video describes transtibial medial meniscus root repair using a simplified cross-bar suture configuration combined with knotless centralization of the meniscus. The technique aims to achieve anatomic root fixation while eliminating repair laxity and reducing meniscal extrusion. It adds a streamlined, knotless option for surgeons seeking reliable root repair with centralization.
102. El Qirem Z, Al‐Atout W, Makahleh M, et al. Arthroscopic All‐Inside Meniscal Tying for Anterior Horn Bucket‐Handle Meniscal Injuries. Arthroscopy Techniques 2026. doi:10.1002/atn2.70267
The authors describe an all-inside arthroscopic technique for repairing anterior horn bucket-handle medial meniscus tears using an arthroscopic retriever and suture passer to pass and tie the repair wire arthroscopically. This approach avoids the 1-2 cm skin incisions required for outside-in or inside-out techniques, reducing skin complications and knot irritation while allowing controlled suture passage and good reduction. The technique offers surgeons a less invasive alternative for this uncommon but challenging tear pattern.
106. Livingston M, Ross P, Saraf SM, et al. Meniscal Root Tears: Epidemiology, Diagnosis, Management, and Outcomes. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.00800
This review summarizes the epidemiology, diagnosis, and management of meniscal root tears, which disrupt knee load distribution and accelerate osteoarthritis. Diagnosis rests on clinical suspicion plus MRI, with arthroscopy as the confirmatory gold standard, and root repair outperforms partial meniscectomy or nonoperative care in appropriately selected patients. Rehabilitation lacks a universal protocol, but most regimens restrict early weight-bearing and loaded flexion (e.g., deep squatting) for 4-5 months, highlighting the need for standardised recovery pathways.
110. Rocha de Faria JL, Farias IA, de Paula RE, et al. Hybrid Sequential Meniscal Suture Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70265
This technical note presents a hybrid continuous meniscal repair combining initial all-inside device fixation with successive outside-in suture passages using the implant's free suture limb, creating a continuous vertical construct. The approach provides multiple fixation points from a single device, potentially improving biomechanical stability while reducing implant use, operative time, and cost. It offers a reproducible, cost-effective option for addressing the full extent of a meniscal tear.
128. Lesman J, Wójtowicz B, Kanak M, et al. Needle Arthroscopy Versus Conventional Arthroscopy for Medial Meniscus Repair: Faster Early Recovery Without Compromising Clinical Outcomes in a Prospective Comparative Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486561
In this prospective cohort study, 108 patients with short (approximately ≤10 mm) medial meniscus tears chose needle arthroscopy (n=55) or conventional arthroscopy (n=53) for all-inside repair with an identical implant and rehabilitation protocol, with 100 completing 12-month follow-up. Needle arthroscopy was associated with faster early recovery (less pain, better early function, earlier return to work) without compromising clinical outcomes at 12 months. The findings support needle arthroscopy as a less invasive alternative for selected short medial meniscal tears, though treatment allocation by patient preference introduces selection bias.
Arthroplasty Alignment and Technology (11)¶
4. Lesnicar C, Kistler M, Thorwächter C, et al. Coronal alignment-related mediolateral load distribution and polyethylene wear in a medial-pivot total knee arthroplasty design. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06558-z
A knee wear simulator study tested a medial-pivot TKA insert under neutral (60/40), varus (70/30), and valgus (50/50) mediolateral load distributions over 5 million cycles per ISO 14243-1. Varus loading showed the lowest wear (4.83 mg/million cycles) and valgus the highest, though differences were numerical trends rather than statistically confirmed. The findings suggest residual coronal malalignment in kinematic alignment may not accelerate polyethylene wear in medial-pivot designs, but clinical validation is needed.
9. Kinoshita T, Bunyoz KI, Mortensen KRL, et al. Preoperative coronal tibiofemoral subluxation does not affect 2-year outcomes after mobile-bearing medial unicompartmental knee arthroplasty for anteromedial osteoarthritis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06530-x
In a retrospective cohort of 457 knees undergoing mobile-bearing medial UKA for anteromedial osteoarthritis, preoperative coronal tibiofemoral subluxation was graded as mild, moderate, or severe on weight-bearing radiographs and compared against Oxford Knee Score trajectories over 2 years. The degree of subluxation did not affect 2-year clinical outcomes. This suggests preoperative CTFS should not be treated as a contraindication to mobile-bearing medial UKA.
48. Rupp M, von Schacky CE, Lindner FJ, et al. Multicentric development and validation of a fully automated artificial intelligence system for planning medial open wedge high tibial osteotomy on weight‐bearing anterior‐posterior long leg radiographs: The ISAKOS John Joyce Award 2025. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70635
A deep learning system was developed and validated for fully autonomous preoperative planning of medial open wedge high tibial osteotomy on weight-bearing long leg radiographs, using 594 patients from two institutions. The AI model showed strong agreement with expert-derived reference standards and favourable reliability and processing time compared with surgeons. Automated planning could reduce the labor and error burden of HTO planning and support surgeons in high-volume practice.
50. Borim FM, Zeng C, Lording T. Digital tensioning demonstrates smaller medial and larger lateral gap measurements than manual assessment in robotic‐assisted total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70650
In 170 robotic-assisted TKAs, intraoperative medial and lateral gap measurements obtained with a digital tensioning device were compared to manual tensioning using a Z-retractor. Digital tensioning showed smaller medial and larger lateral gap values than manual assessment, indicating a systematic compartment-specific discrepancy. Surgeons should be aware that manual gap assessment may misrepresent balance, and digital tensioning may offer more objective guidance for soft-tissue balancing in robotic TKA.
51. Beckers G, Hengartner M, Lavigne M, et al. A mathematical model of knee joint line orientation: Independent effects of femoral and tibial coronal anatomy and limits on achieving a horizontal joint line. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70653
A two-dimensional mathematical model was used to independently vary MPTA and LDFA across 36 configurations and calculate knee joint line orientation relative to the ground in bipodal and single-limb stance. The model quantified distinct contributions of femoral and tibial coronal anatomy to JLO and showed that a horizontal joint line may be unattainable through compensation alone in some anatomies. This challenges the assumption that a floor-parallel joint line is always achievable and informs realistic goals in alignment planning for osteotomy and arthroplasty.
75. Morita Y, Mylonakis N, Shin J, et al. Preoperative coronal phenotype is associated with the initial balance state but only weakly with final balance in robot‐assisted TKA. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70648
In 429 robot-assisted total knee arthroplasties, preoperative coronal phenotype (HKA, aHKA, functional knee phenotype, and joint-line obliquity components) was analyzed against intraoperative mediolateral gaps before and after balancing. Preoperative phenotype was associated with the initial balance state but only weakly predicted final balance after ligament balancing. Intraoperative balancing, not preoperative alignment phenotype, ultimately determines final gap balance in robotic TKA.
95. Weishorn J, Bonnmann S, Trefzer R, et al. Preoperative varus ≥10° does not compromise outcome after medial unicompartmental knee arthroplasty, whereas postoperative joint‐line convergence angle and insert thickness influence functional results: A matched‐pair analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70636
In a matched-pair analysis of 132 pairs of knees, the authors compared outcomes of medial mobile-bearing unicompartmental knee arthroplasty in patients with preoperative varus ≥10° versus <10°. Preoperative varus of 10° or more did not compromise revision rates or Oxford Knee Scores, whereas postoperative joint-line convergence angle and insert thickness influenced functional results. These findings suggest that moderate preoperative varus should not preclude medial UKA, but postoperative alignment should be optimised.
112. Montagna A, Andriollo L, Cinelli V, et al. Radiographic accuracy of implant positioning in unicompartmental knee arthroplasty, does an imageless robotic system make a difference?. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06499-7
This retrospective study of 96 medial UKAs at a high-volume center compared radiographic component positioning among imageless robotic assistance (NAVIO, CORI) and conventional instrumentation across Journey implant generations. Using standing long-leg radiographs, alignment outcomes (HKA, femoral and tibial coronal angles, sagittal parameters) were compared between groups. The study addresses whether robotics adds radiographic accuracy over conventional instrumentation when surgeon and center expertise are already high.
146. Park Y, Redondo M, Mungalpara N, et al. Periprosthetic tibial fracture in robotic-assisted versus conventional medial UKA: in vitro testing and finite element analysis of baseplate footprint. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104919
Fourteen fresh-frozen cadaveric tibiae underwent medial UKA with either conventional or robotic-assisted instrumentation and were loaded in axial compression to periprosthetic fracture, with complementary finite element analysis of baseplate footprint effects. Robotic-assisted UKA did not meaningfully alter load-to-failure or fracture morphology compared with conventional UKA. These findings suggest robotic assistance does not increase periprosthetic tibial fracture risk through differences in bone preparation or component positioning.
182. Chen Z, Xiao M, Luo F, et al. Restricted Kinematic Alignment Improves Function, But Does Not Reduce Kinesiophobia After Total Knee Arthroplasty: A 3-Year Follow-Up Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.032
In a secondary analysis of a randomised controlled trial of 183 TKA patients, restricted kinematic alignment was compared with mechanical alignment for effects on kinesiophobia (TSK-11) and functional outcomes over 3 years. Kinesiophobia did not differ between groups at any time point, though rKA showed better OKS at one year and FJS at six months. Alignment strategy does not reduce postoperative kinesiophobia, so fear of movement must be addressed through means other than surgical alignment.
184. Rizkallah M, Synnott P, Cadoret D, et al. The Impact of Preoperative Coronal Alignment on the Outcomes of Bicruciate-Retaining Total Knee Arthroplasty. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104977
In 172 bicruciate-retaining TKAs performed with a gap-balancing technique by a single surgeon, knees were grouped by preoperative coronal alignment (severe varus to valgus) to assess 5-year implant survival, range of motion, and functional outcomes. Preoperative coronal alignment did not compromise mid-term survivorship or outcomes when gap balancing was used. BCR-TKA may be suitable even in significant coronal deformity provided careful gap balancing is performed.
Periprosthetic Joint Infection (10)¶
1. Visperas A, Lu Q, Lehman B, et al. Research culture methods detect more anaerobes compared to conventional clinical workflows in periprosthetic joint infection: a pilot study of 14 cases. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06550-7
In this pilot study, intraoperative synovial fluid, periprosthetic tissue, and implant swabs from 13 PJI patients were processed using both standard clinical culture workflows and optimised research protocols. Research culture methods detected additional anaerobes beyond the primary organisms identified by both approaches. These supplementary microbial findings may inform antibiotic treatment planning in PJI, where conventional cultures fail in 20-50% of cases.
46. Khury F, Zhong J, Ruff G, et al. Analysis of serological markers and synovial fluid cytology in aseptic revision total knee arthroplasty. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06536-5
Serological markers and synovial fluid cytology were analyzed in 156 patients undergoing aseptic revision TKA, stratified into five etiologies (loosening, instability, arthrofibrosis, liner wear, malposition) with infection rigorously excluded. Distinct serological and synovial profiles were identified across etiologies. These profiles may help differentiate causes of aseptic failure and guide preoperative planning in revision TKA.
53. Liu T, Zhang H, Guo M, et al. Higher tissue concentrations of cefuroxime achieved with preoperative stand-alone intraosseous regional prophylaxis in robotic-assisted total knee arthroplasty: a randomized controlled trial. Arthroplasty 2026. doi:10.1186/s42836-026-00436-0
In this randomised trial of 39 MAKO robotic-assisted TKAs, preoperative stand-alone intraosseous cefuroxime (750 mg or 1,500 mg) was compared with intravenous 1,500 mg using intraoperative tissue and blood sampling. Intraosseous administration achieved higher local tissue antibiotic concentrations than the intravenous route without added safety concerns. Stand-alone intraosseous cefuroxime is a promising perioperative prophylaxis strategy in robotic TKA, with 1,500 mg identified as a candidate dose for further study.
70. Chang X, Luk MH, Cheung A, et al. Intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection: a systematic review. Arthroplasty 2026. doi:10.1186/s42836-026-00440-4
This systematic review of 10 studies evaluated intra-articular antibiotic delivery combined with one-stage revision for periprosthetic joint infection, with a minimum 12-month follow-up. The strategy showed satisfactory infection control with acceptable safety. It supports considering adjunctive local antibiotics in one-stage revision, though the descriptive synthesis and limited evidence base call for cautious interpretation.
144. Bingol O, Karlidag T, Ozsoy HE, et al. Systemic Exposure and Renal Safety After Intrawound Vancomycin Powder in Primary Total Knee Arthroplasty: A Prospective Comparative Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.043
In a prospective cohort of 260 primary TKA patients, systemic absorption and renal safety of one gram of intrawound vancomycin powder were evaluated with 12-hour serum levels and KDIGO-defined acute kidney injury (AKI) monitoring. Serum vancomycin was undetectable (<1.00 mg/L) in 80% of patients, with only low-level detectable levels in the remainder and no significant renal safety concerns. These findings support the renal safety of intrawound vancomycin as local PJI prophylaxis in primary TKA.
168. Aggarwal VK, Alvand A, de Andrés-Torán A, et al. Delphi Consensus on Periprosthetic Surgical Irrigation: Irrigation Solution Selection and Comparative Effectiveness. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.017
An international Delphi workgroup developed consensus statements on periprosthetic surgical irrigation, addressing irrigation solution selection and comparative effectiveness across available options. Structured iterative voting produced expert consensus where evidence is limited, clarifying preferred solutions and techniques for irrigation during periprosthetic joint procedures. The consensus provides practical, expert-endorsed guidance to standardize irrigation practice in the management of periprosthetic joint infection and related scenarios.
169. Aggarwal VK, Alvand A, de Andrés-Torán A, et al. Delphi Consensus on Periprosthetic Surgical Irrigation: Technique and Intraoperative Administration. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.018
A Delphi workgroup of arthroplasty experts reached consensus statements on periprosthetic surgical irrigation technique and intraoperative administration. The process produced standardised recommendations for irrigation practices in joint arthroplasty. Clinicians can use these consensus guidelines to harmonize irrigation protocols and reduce practice variability in the operating room.
176. Giatroudakis K, Iliopoulos E, Kateros K, et al. Prospective Evaluation of an Intraoperative Synovial Calprotectin Point-of-Care Lateral Flow Test for Periprosthetic Joint Infection in Hip and Knee Revisions. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.026
In this prospective cohort of 80 consecutive hip and knee revisions, an intraoperative synovial calprotectin point-of-care lateral flow test was evaluated against 2018 ICM criteria for periprosthetic joint infection. Using a ≥50 mg/L threshold, the test showed strong discrimination, with median calprotectin markedly higher in infected (138 mg/L) than aseptic (7 mg/L) THA revisions. The assay offers rapid, intraoperative PJI diagnosis that can guide decision-making during revision surgery.
177. Russo A, Zanna L, Luo TD, et al. Optimizing Intraoperative Tissue Sampling in Hip and Knee Periprosthetic Joint Infection: Deep Bone Provides Higher Culture Yield in One-Stage Exchange. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.031
In 255 patients undergoing one-stage exchange for hip or knee periprosthetic joint infection, culture positivity of intraoperative specimens was compared across deep bone, superficial bone, and soft tissue sampling sites using generalized estimating equations adjusted for patient factors. Deep bone samples yielded the highest culture positivity in both hips (80.8%) and knees (80.5%), outperforming superficial bone. Surgeons should prioritise deep bone sampling during one-stage exchange to maximise pathogen identification in PJI.
185. Klein S, Letscher-Bru V, Rondé-Oustau C, et al. One-Stage Exchange in Candida spp. Periprosthetic Joint Infection: an appropriate solution?. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104982
In this retrospective single-center study, 16 consecutive unselected patients with chronic Candida spp. periprosthetic joint infection were treated with one-stage exchange plus antifungal therapy (2012-2021) with minimum 2-year follow-up. The findings suggest outcomes did not differ from those reported for two-stage exchange in the literature. One-stage exchange may therefore be an appropriate, advantageous alternative to the standard two-stage approach for Candida PJI, though larger studies are needed to confirm this.
Osteoarthritis Treatment and Rehabilitation (13)¶
2. Park Y, Ha C. More Durable Cartilage Repair and Better Clinical Outcomes at 5 Years Using Allogeneic Umbilical Cord Blood‐Derived Mesenchymal Stem Cells and Hyaluronate Composite Implantation Versus Microfracture for Knee Osteoarthritis. Arthroscopy 2026. doi:10.1002/arj.70706
This retrospective subset analysis of a phase 3 trial compared 5-year outcomes of allogeneic umbilical cord blood-derived MSC-hyaluronate implantation versus microfracture in 64 patients with KL grade I-III knee osteoarthritis. UCB-MSCs-HA showed superior pain, function, and MRI-based cartilage repair quality at 5 years, with durable repair tissue more common than after microfracture. The findings support UCB-MSCs-HA implantation as a cartilage repair strategy offering longer-lasting benefit than marrow stimulation alone.
23. Yang S, Wang H, Liu Y, et al. Clinical Pathway Management for Platelet-Rich Plasma Therapy in Kellgren-Lawrence Grade I and II Knee Osteoarthritis: A Prospective, Multicenter, Double-Blind Randomized Controlled Trial. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261486945
This multicenter, double-blind RCT randomised 240 patients with KL grade I-II knee osteoarthritis to a standardised PRP clinical pathway (selection criteria, quality-controlled leukocyte-poor PRP, ultrasound guidance, staged rehabilitation, follow-up) or conventional physician-directed PRP care. The trial assessed 12-month VAS, WOMAC, and IKDC outcomes, along with satisfaction, safety, and costs. It tests whether standardizing PRP delivery overcomes the inconsistent results seen in prior trials.
25. Alkatheeri A, Ghandour M, Mobarak HA, et al. Double‐level osteotomy versus high tibial osteotomy for varus malalignment of the knee: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70656
This systematic review and meta-analysis pooled nine observational studies (805 knees) comparing double-level osteotomy with high tibial osteotomy for varus knee malalignment. Double-level osteotomy produced significantly lower joint-line obliquity (1.6° vs 5.9°) and lower MPTA/LDFA values, indicating more oblique correction with HTO. The findings suggest DLO may better preserve joint-line orientation in severe varus deformity, though the evidence base is limited to observational studies.
30. Dragoo JL, Constantine EP, Whitney KE, et al. Arthroscopic Delivery of Particulated Juvenile Articular Cartilage Allografts Provides Durable Outcomes for Full‐Thickness Chondral Lesions of the Knee. Arthroscopy 2026. doi:10.1002/arj.70629
This retrospective case series of 34 patients (mean age 43.5 years, mean lesion area 2.98 cm²) evaluated arthroscopic particulated juvenile articular cartilage allograft implantation for ICRS grade IV full-thickness knee chondral lesions with minimum 24-month follow-up. KOOS and WOMAC subscales improved significantly from baseline, with durable outcomes across covariates including age, BMI, and lesion characteristics. Arthroscopic delivery of this allograft offers a minimally invasive, durable option for knee cartilage repair.
38. Pasqualotto E, Pasqualotto T, Lunelli L, et al. Platelet-rich plasma for knee osteoarthritis: a systematic review and meta-analysis of structural outcomes. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06543-6
This systematic review and meta-analysis of 12 randomised controlled trials (1,200 patients) assessed imaging-based structural outcomes of platelet-rich plasma in knee osteoarthritis. PRP improved patellofemoral cartilage thickness/volume (SMD 0.94) and reduced MRI bone marrow oedema (SMD -0.40), but showed no significant benefit for medial tibial cartilage measures, cartilage defect progression, osteophytes, subchondral cysts, or synovitis. The structural benefits of PRP appear limited and region-specific, suggesting cautious interpretation of its chondroprotective claims.
41. Itou J, Itoh M, Kuwashima U, et al. Postoperative alignment and patients reported outcome measures improvement after high tibial osteotomy: a significant interaction with osteoarthritis severity. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06540-9
Clinical outcomes after high tibial osteotomy were evaluated across postoperative weight-bearing line categories stratified by osteoarthritis severity. The findings supported the hypothesis that overcorrection is detrimental in early OA but not in advanced OA. Postoperative alignment targets should therefore be individualized according to OA severity rather than applying a uniform correction goal.
68. Sherafatvaziri A, Karimpour M, Moradkhani G, et al. Combined Management of Meniscus Root Tear and High Tibial Osteotomy: A Surgical Strategy Using 3‐Dimensional Printing. Arthroscopy Techniques 2026. doi:10.1002/atn2.70323
The authors present a surgical technique combining high tibial osteotomy with posterior meniscal root repair using CT-based 3D preoperative planning and patient-specific 3D-printed guides. Virtual simulation of the osteotomy plane, plate position, screw trajectories, and transtibial tunnel allows optimization of tunnel orientation and bone-stock preservation, which the guides reproduce intraoperatively. This strategy may reduce the risks of implant conflict and tibial fracture when these procedures are combined.
81. Kiadaliri A, Mahmoudian A, Dahlberg LE, et al. Trajectories of physical activity following digital education and exercise therapy—a longitudinal registry study among 15,197 persons with knee or hip osteoarthritis. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10590-w
This registry study used group-based trajectory modelling to identify distinct physical activity patterns over 1 year among 15,197 adults with knee or hip osteoarthritis participating in a digital education and exercise therapy program, and examined associated factors and patient-reported outcome changes across trajectories. Only a minority sustained recommended activity levels (≥150 min/week moderate-to-vigorous), with distinct trajectory groups showing differing PRO improvements. Clinically, digital OA programs should anticipate heterogeneous activity responses and target support toward patients least likely to maintain recommended activity.
116. Park Y, Kim J. Microfragmented Adipose Tissue as an Alternative to Platelet-Rich Plasma for Intra-articular Injection in Knee Osteoarthritis: Response. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261472884
The authors respond to a letter regarding their meta-analysis of randomised trials comparing microfragmented adipose tissue (MFAT) with platelet-rich plasma for intra-articular injection in knee osteoarthritis. They acknowledge the correspondents' points and defend the interpretation of their finding that MFAT provided superior pain and functional benefits at 6 months. The response addresses methodological critiques relevant to how clinicians should weigh MFAT as an injectable treatment option.
117. Baria MR, Barker T. Microfragmented Adipose Tissue as an Alternative to Platelet-Rich Plasma for Intra-articular Injection in Knee Osteoarthritis: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261472883
Baria and Barker congratulate Park et al. on their meta-analysis showing MFAT superiority over PRP for pain and function at 6 months in knee osteoarthritis, a benefit that did not persist beyond that timepoint. They question the evidentiary support for claims about adipose tissue cell concentration (e.g., 25,000-fold more cells than peripheral blood) and call for further discussion of mechanisms and research design. The letter highlights the need for stronger mechanistic evidence before extending MFAT's early benefit.
171. Bard H. PRP injection in musculoskeletal pathology: what level of evidence, and what recommendations?. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104972
This narrative review appraised the evidence base and society recommendations for platelet-rich plasma (PRP) in musculoskeletal pathology, including knee osteoarthritis, tendinopathy, muscle injury, non-union, and osteonecrosis. Evidence remains limited by PRP preparation variability and methodological bias, though intra-articular knee OA injection has received consensus-based recommendations. Clinicians should counsel patients that PRP is biologically plausible but supported by heterogeneous, low-to-moderate certainty evidence outside select indications.
173. Krystofiak J, Petterson S, Plancher K, et al. Sustained Acoustic Medicine Is a Cost-Effective, Noninvasive Treatment Option for Knee Osteoarthritis Compared With Intra-articular Hyaluronan Injections and Total Knee Arthroplasty: A Health Economic Evaluation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261471263
A Markov model with a 60-year horizon compared sustained acoustic medicine (SAM), intra-articular hyaluronan injections, and total knee arthroplasty for mild-to-moderate knee osteoarthritis in 10,000-patient simulated cohorts. SAM was found to be a cost-effective, noninvasive option when sequenced before hyaluronan and TKA. These results support offering wearable ultrasound therapy early in the knee OA treatment pathway to delay more invasive and costly interventions.
181. Nagashima R, Miyazaki R, Saito M, et al. Recovery of Pre-symptomatic Tegner Activity Level After Double-Level Osteotomy for Medial Compartment Osteoarthritis: Outcomes at 24 Months. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104976
In 51 patients undergoing double-level osteotomy for medial compartment osteoarthritis who wished to resume sports, Tegner activity scale scores were recalled for the pre-symptomatic period and assessed preoperatively and at 12 and 24 months. Only 56.9% recovered their five-year pre-symptomatic Tegner level at 24 months versus 88.2% recovering the immediate preoperative level, with higher pain catastrophizing associated with failure to recover. Return-to-sport counseling after double-level osteotomy should reference pre-symptomatic activity levels, and psychological factors may warrant attention.
Patellofemoral Instability and Alignment (10)¶
12. Al‐Hourani K, Li X. The Boston All‐in‐One Medial Patellofemoral Complex Reconstruction: A Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Dynamic Tensioning Technique Using Allograft. Arthroscopy Techniques 2026. doi:10.1002/atn2.70386
This technical note presents an allograft technique reconstructing the entire medial patellofemoral complex, addressing both the medial patellofemoral ligament and the medial quadriceps tendon femoral ligament. The method incorporates dynamic graft tensioning based on current anatomic understanding of medial patellar restraints. It may improve anatomic restoration in patellar instability surgery.
22. Zhang X, Zhai W, Wang D, et al. Short‐term benefits of hybrid graft in medial patellofemoral ligament reconstruction for recurrent patellar dislocation: A prospective randomized controlled trial with minimum 2‐year follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70644
In this randomised controlled trial of 51 patients with recurrent patellar dislocation, MPFL reconstruction with a hybrid graft (semitendinosus plus 6-mm artificial ligament tape) was compared with autograft. Hybrid reconstruction showed better short-term functional outcomes (Kujala, IKDC) and radiological parameters at minimum 2-year follow-up. Hybrid grafting may be preferred in appropriately selected patients without severe anatomic risk factors.
35. Kim LY, Salandra J, Sieberer J, et al. A Technique to Determine Coordinates of the Patellar Entry Point and Transition Point of the Patellofemoral Joint Using Computed Tomography Scans. Arthroscopy Techniques 2026. doi:10.1002/atn2.70289
The authors present a CT-based technique using standardised imaging software to measure the coordinates of the patellar entry point and the trochlear transition point in the patellofemoral joint. The method demonstrated reliability across multiple knees and independent raters. It may improve characterization of proximal trochlear morphology in patellofemoral instability and arthritis, helping guide treatment selection.
83. Kim CL, Turlip RW, Thothadri M, et al. Can Psychological Readiness Predict Successful Return to Sports After Patellar Stabilization Surgery in Adolescent Patients? A Retrospective Cohort Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261487282
This retrospective cohort study of adolescents undergoing patellar stabilisation surgery (MPFL reconstruction ± tibial tubercle osteotomy) evaluated whether ACL-RSI scores during rehabilitation predict return to sport. Higher ACL-RSI scores were associated with increased likelihood of returning to sports after surgery. The ACL-RSI appears to be a useful tool for assessing psychological readiness to return to sport in this population and may help identify adolescents needing additional psychological support during rehabilitation.
92. Drummond M, Brenner JD, Ball CJ, et al. Patellar Tendon Imbrication With a Double‐Row Configuration for the Treatment of Patella Alta in Skeletally Immature Patients. Arthroscopy Techniques 2026. doi:10.1002/atn2.70288
The authors describe a transection-free patellar tendon imbrication using a double-row configuration to correct patella alta in skeletally immature patients with patellar instability. By plicating the tendon rather than performing tibial tubercle distalization osteotomy, the technique avoids physeal and apophyseal injury while allowing concomitant medialization of the patellar tendon. This provides a growth-sparing option that directly addresses the pathoanatomy of patella alta.
96. Talbot S, Zordan R. Quadriceps malalignment: The driver of patellofemoral joint imbalance. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70634
In this commentary, the authors respond to a report that quadriceps malalignment did not affect outcomes after kinematically aligned total knee replacement. They argue that 3D CT and MRI now allow true measurement of quadriceps alignment, replacing the traditional Q-angle concept, which ignores the anatomical course of the quadriceps force vector. They contend that quadriceps malalignment is an important driver of patellofemoral joint imbalance that should be considered in knee replacement planning.
109. Novak S, Povh M. Double‐Bundle Medial Patellofemoral Ligament Reconstruction Using Free Rectus Femoris Autograft. Arthroscopy Techniques 2026. doi:10.1002/atn2.70263
This technical note describes double-bundle medial patellofemoral ligament reconstruction using a free rectus femoris autograft. The technique leverages the rectus femoris tendon's superior tensile strength and load-to-failure compared with hamstring grafts while permitting anatomic patellar fixation, unlike quadriceps tendon techniques that preserve the native insertion. It offers surgeons an anatomic, biomechanically robust graft alternative for MPFL reconstruction.
113. Martinez-Cano JP, Diaz-Solorzano JP, Triviño-Arias J, et al. The crossing-sign angle and trochlear dysplasia length: New radiographic parameters to measure the dysplastic trochlea. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101203
A concordance study of patients with patellofemoral dislocation and radiographic trochlear dysplasia tested two novel lateral radiograph measurements, the crossing-sign angle and trochlear dysplasia length, against bump height and modified Dejour grading using multiple observers. The crossing-sign angle showed moderate inter-observer reliability, with correlations between measurements and associations with Dejour grades. These parameters may offer more quantitative, reproducible characterization of trochlear dysplasia to guide surgical decision-making in patellar instability.
121. Lafave MR, Hiemstra LH, Kerslake S. Establishing North American Normative Standards for the Banff Patellofemoral Instability Instrument 2.0 and the Marx Activity Scale. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261463387
A cross-sectional survey of 659 injury-free North American adults, stratified by age, sex, and ethnicity, was used to generate normative reference values for the Banff Patellofemoral Instability Instrument 2.0 and the Marx Activity Scale. The study established population-based benchmarks against which treated patients' scores can be compared. Clinicians and researchers can now interpret post-treatment PROM scores relative to healthy norms rather than raw change scores alone.
122. Narayana K, Son H, Bouchard MD, et al. Surgical Reconstruction of the Lateral Patellofemoral Restraint Complex for Medial Patellar Instability: A Systematic Review of Techniques and Clinical Outcomes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486592
A PRISMA-compliant systematic review of 20 studies (mostly case series) described surgical techniques for reconstructing the lateral patellofemoral restraint complex in medial patellar instability, typically iatrogenic after lateral retinacular release. Findings were synthesized descriptively because technique and outcome reporting were too heterogeneous for meta-analysis. The review highlights that evidence for this rare complication remains low-quality (Level 4), underscoring the need for standardised outcome reporting.
Other articles this month¶
3. Qu X, Sun G, Chen B. Rethinking early arthrogenic muscle inhibition after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70664
This letter critiques a study on early arthrogenic muscle inhibition (AMI) after total knee arthroplasty, arguing that the association between 30-day AMI and persistence at 60 days should be viewed as prognostic rather than proof that 30-day AMI is the dominant biological determinant of subsequent inhibition. The authors also note that 30-day assessment is unsuited to studying initial AMI pathophysiology, that SANTI classification validity in TKA is unestablished, and that the absence of functional and patient-reported outcomes limits clinical interpretation. The commentary underscores the need for mechanistic and outcome-based studies of persistent AMI.
5. Bouguennec N, Colombet P, Graveleau N. The “Minimizing Excessive Rotational Instability Technique” (MERI Technique): A Simple Lateral Tenodesis Reconstructing the Condylar Strap, the Distal Kaplan Fibers, and the Femoral Insertion of the Anterolateral Ligament to Control Internal Rotation During Anterior Cruciate Ligament Surgery. Arthroscopy Techniques 2026. doi:10.1002/atn2.70325
This technical report describes the MERIT technique, a minimally invasive lateral tenodesis using a 1-cm fascia lata strip fixed at a single isometric anchor to reconstruct the distal Kaplan fibres, condylar strap, and anterolateral ligament femoral insertion during ACL reconstruction. The construct augments internal rotation control while avoiding the excessive constraint of traditional lateral extra-articular tenodesis, potentially reducing stiffness and morbidity. It offers a simple, cost-effective option for selected patients with anterolateral rotatory instability.
6. Mahatme RJ, Moore SA, Muthusamy N, et al. Patellar Tendon Allograft Reconstruction Using Achilles Graft With Traversing Suprapatellar Cerclage Limbs. Arthroscopy Techniques 2026. doi:10.1002/atn2.70368
This technique article presents patellar tendon reconstruction using an Achilles allograft with traversing suprapatellar cerclage limbs for chronic extensor mechanism deficiency. The construct allows controlled restoration of patellar height, immediate extensor mechanism continuity, and load sharing during early healing. It provides a reproducible option for revision settings or poor native tissue quality.
7. Kodkani P. Semimembranosus Autograft Harvesting and Reconstruction for Knee Posteromedial Complex Laxity Using a “Romal Reins” Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70367
This technical report describes harvesting the semimembranosus tendon with its distal insertions and lateral third kept intact, then using the medial two-thirds as an autograft in a 'Romal Reins' configuration to tighten and reconstruct the posteromedial complex. The technique restores posteromedial stability without individual structural reconstructions, multiple grafts, or extensive tunnels and implants. It is particularly useful in multiligament injuries where autograft availability is limited.
10. Jensen CB, Danielsen O, Varnum C, et al. Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06525-8
A Danish multicenter cohort of 6718 hip and knee arthroplasties compared how different center setups influenced implementation of a standardised day-case pathway and day-of-surgery discharge rates. Centers logistically separated from general orthopaedic departments achieved more successful day-case implementation and higher day-of-surgery discharge. Organizational structure should be considered when introducing day-case arthroplasty programs.
11. Zhou H, Xue Z, Wang D, et al. Using a Y‐Shaped Artificial Ligament for Posterolateral Corner Reconstruction in Multiligament Knee Injuries: A Surgical Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70333
This technical note describes posterolateral corner reconstruction in multiligament knee injuries using a Y-shaped artificial ligament, achieving anatomic lateral collateral ligament reconstruction and functional popliteus tendon reconstruction through a single femoral tunnel. The approach avoids graft availability issues, size limitations, and donor site morbidity of autografts/allografts. It offers a minimally invasive alternative for restoring varus and rotational stability.
14. Qu X, Tang X, Yang D, et al. Rethinking the functional relevance of posterolateral tibial plateau fractures in anterior cruciate ligament injury. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70662
This letter critiques a study linking posterolateral tibial plateau fractures to lateral-sided soft-tissue pathology in ACL-injured knees, arguing that PLTFs were inappropriately treated as a uniform lesion despite marked morphologic heterogeneity. The authors contend that small cortical impressions differ biomechanically from deeper depression defects and that pivot shift is an incomplete surrogate for instability. The evidence supports only the narrow conclusion that PLTF presence alone does not predict greater pivot-shift laxity.
15. Han X, Yang M. Delayed return to sport after fat pad debridement: A surgical effect or a load‐tolerance signal?. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70663
This letter responds to a meta-analysis associating fat pad debridement with delayed return to sport after patellar tendinopathy surgery, arguing the delay should not be attributed to the procedure alone. Fat pad debridement may mark a more irritable anterior knee pain phenotype, and time to return to sport is an incomplete recovery surrogate compared with restored tendon load tolerance. The association should be interpreted as a composite of procedural, phenotypic, and rehabilitative factors.
17. Lucina L, Tierney S, Patel RM. Lateral Extra‐articular Tenodesis With All‐Suture Knotless Anchor. Arthroscopy Techniques 2026. doi:10.1002/atn2.70345
The authors describe a modified Lemaire lateral extra-articular tenodesis performed with an all-suture knotless anchor as an adjunct to ACL reconstruction. The technique aims to address residual rotational instability and reduce graft rerupture rates. It offers surgeons a simplified, anchor-based option for anterolateral augmentation.
18. Morita Y, Kuriyama S, Yamawaki Y, et al. Anteromedial Gap Opening and Osteotomy Sufficiency Are Associated With Multiplanar Correction Errors in Open‐Wedge High Tibial Osteotomy: A Computed Tomography‐Based Study. Arthroscopy 2026. doi:10.1002/arj.70697
In 110 knees undergoing open-wedge high tibial osteotomy, 3D correction errors (coronal, sagittal, axial) were quantified on early postoperative CT. Larger planned opening angles and hinge angles predicted coronal undercorrection, internal rotation, and posterior slope increase, while greater osteotomy sufficiency limited slope change. Surgeons should account for these factors to minimise multiplanar malcorrection.
21. Lemus SA, Spang JT, Longobardi L, et al. Longitudinal Serum Biomarker Profiles of Inflammation and Cartilage Matrix Metabolism During the First Year After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261493224
Serum biomarkers of inflammation (MCP-1), matrix degradation (MMP-3), and cartilage turnover (COMP, C2C:CPII) were measured in 33 ACL-injured patients before and at 6 and 12 months after reconstruction, compared with matched controls. The study characterizes the first-year longitudinal biomarker trajectory after ACLR and whether preoperative levels predict later values. Results may identify patients at risk for post-traumatic joint degeneration.
24. LaPrade RF, Wilebski BJ, Sawyer ER, et al. The Deep Medial Collateral Ligament, Part 1: Quantitative, Qualitative, and Radiographic Anatomy. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261492535
Using 10 fresh-frozen cadaveric knees with 3D coordinate mapping and radiopaque markers, this anatomic study defined the attachment geometry and radiographic landmarks of the deep medial collateral ligament. The dMCL was shown to have a broad anteromedial capsular extension beyond the traditionally described meniscofemoral and meniscotibial components. These findings refine anatomic understanding relevant to medial-sided knee reconstruction and radiographic assessment.
28. LaPrade RF, Tollefson LV, Engebretsen L, et al. A Translational Approach for Treatment of Posterior Cruciate Ligament Injuries: From Foundational Anatomic and Biomechanical Studies to Validated Surgical Outcomes. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00831
This narrative review describes a two-decade translational research program on PCL injuries, spanning quantitative cadaveric anatomy, robotic biomechanical testing, validated objective diagnostics (kneeling stress radiography, MRI-based laxity measurement), and an anatomically grounded double-bundle reconstruction technique with refined tensioning and rehabilitation protocols. The work demonstrates how foundational anatomic and biomechanical data can drive validated surgical outcomes for an injury historically managed nonsurgically. It supports anatomic double-bundle PCL reconstruction guided by objective laxity quantification as the current standard of care.
32. Talıblı T, Alkan H, Erdoğan Y, et al. Correction: Forgetting the knee after high tibial osteotomy versus unicompartmental knee arthroplasty. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10529-1
This is a correction notice amending the ethics approval section of a previously published study comparing postoperative 'forgetting the knee' after high tibial osteotomy versus unicompartmental knee arthroplasty. The correction updates the approving institution name (Ankara Bilkent City Hospital) and approval number (E1-23-4040). It carries no new clinical findings but ensures accurate documentation of the study's ethical oversight.
33. Hyakuda Y, Miyamoto T, Ogawa M, et al. Correction: Three-dimensional artificial intelligence-based computed tomography analysis of lower limb muscle volume and fatty degeneration in varus and valgus knee osteoarthritis: a single-center retrospective study. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10492-x
The authors issued a correction to their previously published study on AI-based 3D CT analysis of lower limb muscle volume and fatty degeneration in varus and valgus knee osteoarthritis, fixing an error in Figure 2 where the phrase 'surgical history on the affected lower extremity (n = 16)' had been omitted. The corrected figure has been added and the original article updated. No change to the study's findings or clinical conclusions is implied.
36. Nagesh N, Romero-Padron MA, Fonte EL, et al. The Role of Systemic Antifibrotic Agents on Patient and Surgical Outcomes After Joint Surgery: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-25-01368
This systematic review of 14 observational studies (mostly retrospective cohorts with serious risk of bias) evaluated statins, ACE inhibitors, and angiotensin receptor blockers for preventing postoperative arthrofibrosis after shoulder, knee, and hip surgery. Most evidence concerned ARBs, with three TKA studies suggesting reduced manipulation under anaesthesia or lysis of adhesions but four others showing no effect on MUA, range of motion, or arthrofibrosis, and ACEI results were inconsistent. Overall, current evidence is low quality and inconclusive, so routine use of systemic antifibrotics to prevent postoperative stiffness cannot be recommended.
37. Unver B, Ozcan D, Sevik Kacmaz K, et al. The reliability and validity of the 30-Second Fast-Paced Walk Test in patients with total knee arthroplasty. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06507-w
In a repeated-measures study of 38 patients at least 6 months after primary total knee arthroplasty, the 30-Second Fast-Paced Walk Test was administered twice on the same day alongside the HSS Knee Score and SF-12 to assess its psychometric properties. The study examined test-retest reliability and validity of this brief, low-cost walking speed measure in the TKA population. Support for its reliability and validity would allow clinicians and researchers to use the 30SFW as a simple functional outcome measure after TKA.
40. Schiegl J, Greimel F, Zeman F, et al. Mid-term clinical outcomes and isokinetic performance after primary total knee arthroplasty within a modified ERAS protocol: a single-blinded randomized controlled trial. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10535-3
In this single-blinded randomised controlled trial, 58 patients undergoing primary total knee arthroplasty were assigned to a modified ERAS protocol (n=31) or conventional perioperative care (n=27), with follow-up at 5 days through 12 months. Outcomes included isokinetic muscle strength (peak torque, total work) alongside validated functional and patient-reported measures. The trial addresses whether ERAS protocols improve mid-term objective muscle strength recovery, a key determinant of persistent functional deficits after TKA.
42. Kramer JH, Bronstein DA, Jochl OM, et al. Backfilling Patellar and Tibial Harvest Sites Using Autologous Bone Reamings and Anterior Cruciate Ligament Remnant Tissue During Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70318
A surgical technique is described for backfilling patellar and tibial bone-patellar tendon-bone graft harvest defects using autologous bone reamings and ACL remnant tissue, with preservation of the paratenon. The approach aims to improve graft containment and incorporation. It may reduce chronic anterior knee pain, a known morbidity of BPTB ACL reconstruction.
43. Sjöström P, Nordeman L, Rolfson O, et al. Preoperative factors associated with quadriceps strength 1 year after total knee arthroplasty: a prospective longitudinal study. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10657-8
In this prospective longitudinal study of 39 patients undergoing fast-track TKA, preoperative factors associated with normalised quadriceps strength, its change, and limb symmetry index at 1 year were explored using multiple linear regression. Preoperative NQS was the key predictor of 1-year quadriceps strength. Identifying patients with low preoperative strength may help target rehabilitation to improve postoperative physical function.
44. Wen H, Zhang T, Xie T, et al. Exercise-based rehabilitation interventions for kinesiophobia after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10640-3
This systematic review and meta-analysis of 11 RCTs (N=1,096) compared exercise-based rehabilitation with routine postoperative rehabilitation after primary TKA. Exercise-based interventions reduced kinesiophobia (SMD -1.22) and improved knee function (SMD 1.19), though certainty of evidence was low and heterogeneity high. Incorporating structured exercise programs addressing fear of movement may enhance postoperative TKA rehabilitation.
47. Aastroem KIM, Sarpong NO, Neuwirth AL, et al. Silk Dressings Are More Cost Effective Than 2-Octyl Cyanoacrylate Mesh in Hip and Knee Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00591
A cost-effectiveness analysis compared silk dressings with 2-octyl cyanoacrylate mesh for wound closure in hip and knee arthroplasty, incorporating material costs, application time, and complication-related expenses. Silk dressings were substantially cheaper, saving approximately $690-$939 per patient when complication rates were applied to national TJA volumes. Silk dressings should be favored for wound management in arthroplasty on economic grounds.
49. Gellhaus F, Deichsel A, Stening J, et al. Posterolateral corner deficiency amplifies varus‐related anterior cruciate ligament forces under dynamic loading: A biomechanical study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70654
Cadaveric knees were tested dynamically with incremental varus alignment (0°, 8° via distal femoral osteotomy) under native, transected, and reconstructed posterolateral corner conditions, measuring ACL forces with a custom tensioner. Increasing varus and PLC deficiency each raised ACL forces, with transection amplifying the effect and reconstruction restoring forces toward intact values. Clinically, varus malalignment with PLC insufficiency should be recognised as a driver of ACL graft overload, supporting combined PLC reconstruction and alignment correction.
52. Xu D, Yu W, Lin J, et al. All‐Inside Anterior Cruciate Ligament Reconstruction With Accurate Measurement Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70284
This technical note presents an intraoperative method for accurately measuring the intra-articular length of the graft during all-inside ACL reconstruction, allowing socket lengths to be tailored to individual measurements. Individualized measurement prevents graft bottoming out and graft-tunnel mismatch while preserving tibial socket length. The technique enhances fixation stability and may improve outcomes of all-inside ACL reconstruction.
55. Santamaria F, Wehbe H, Ayata M, et al. Long‐term survivorship of medial meniscus posterior horn repair during revision anterior cruciate ligament reconstruction: 10‐year results from the SANTI Group. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70645
This retrospective cohort from a high-volume center evaluated secondary medial meniscectomy rates after medial meniscus posterior horn repair performed during revision ACL reconstruction (2003-2023), comparing contemporary posteromedial suture-hook repair with all-inside, inside-out, and earlier techniques. Time-to-event analysis tested the hypothesis that suture-hook repair improves long-term meniscal survivorship. The 10-year results inform technique selection for ramp and posterior horn lesions encountered at revision ACLR.
56. Dadoo S, Nash AE, Yang Z, et al. The use of patellar tendon autograft and lateral meniscus repair are associated with loss of motion of the knee among female patients undergoing anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70652
A sex-stratified cohort study of 1,226 primary ACL reconstructions examined predictors of subsequent surgery for loss of motion. Female sex (OR 2.31) and lateral meniscus repair (OR 1.62) predicted arthroscopic or surgical management of stiffness overall, and among females, bone, patellar tendon, bone graft was associated with loss of motion. Surgeons should counsel female patients, particularly those undergoing lateral meniscal repair or BTB grafting, about elevated stiffness risk and prioritise motion rehabilitation.
57. Wang W, Sun Y, Zhou P, et al. Cross‐cultural adaptation and initial evaluation of selected measurement properties of the simplified chinese version of the knee injury and osteoarthritis outcome score joint replacement in patients with knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70658
The KOOS-JR was translated into simplified Chinese and evaluated in 85 knee osteoarthritis patients awaiting total knee replacement. Internal consistency (Cronbach's alpha 0.82-0.85), test-retest reliability (ICC 0.79), and construct validity (strong correlation with IKDC, rs=0.77) were acceptable, with no floor or ceiling effects. The simplified Chinese KOOS-JR is a valid and reliable tool for assessing Chinese-speaking patients before knee arthroplasty, though the smallest detectable change of ~12 points should be considered when interpreting individual-level change.
58. Kurihara S, Furusato S, Hatayama K, et al. Development of a clinical risk score for common peroneal nerve palsy after total knee arthroplasty using a Japanese nationwide database. International Orthopaedics 2026. doi:10.1007/s00264-026-07057-x
A retrospective cohort study using a Japanese nationwide database (2014-2024) developed a clinical risk score for common peroneal nerve palsy after primary total knee arthroplasty, using LASSO-selected preoperative predictors in multivariable logistic regression with internal validation. The resulting score stratifies patients' preoperative risk of this rare but serious complication. Clinicians can use this tool to identify high-risk patients and counsel or monitor them more intensively after surgery.
59. Poursalehian M, Ismail J, Sershon RA. What Motion Is For. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.01127
This perspectives essay recounts a surgeon's encounter with a Muslim patient with knee osteoarthritis whose chief concern was losing the ability to kneel in prayer, despite clinical measures focusing on pain and flexion. It argues that standardised functional metrics fail to capture what movement means to patients' identities and spiritual lives. The piece calls for clinicians to elicit and honor patient-centered goals, such as religious practice, when evaluating and treating knee pathology.
60. Hannon CP, Grosso MJ, Fillingham YA, et al. AAOS Clinical Practice Guideline Summary: Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection in Patients Undergoing Dental Procedures: Erratum. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00661
This erratum corrects the author byline of the November 2025 AAOS Clinical Practice Guideline Summary on prevention of periprosthetic joint infection during dental procedures, which omitted collaborators listed in the article metadata. The full authorship now includes all guideline development work group members and AAOS staff. No changes to the guideline's clinical recommendations were made.
61. Brophy RH, Fillingham YA. AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition: Erratum. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00719
This erratum corrects the author byline of the May 2022 AAOS Clinical Practice Guideline Summary on management of knee osteoarthritis (nonarthroplasty), third edition, which omitted collaborators from the metadata. The corrected authorship recognizes all work group members and AAOS staff who contributed to guideline development. The guideline's clinical content is unchanged.
62. Brophy RH, Best MJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Acute Isolated Meniscal Pathology: Erratum. Journal of the American Academy of Orthopaedic Surgeons 2026. doi:10.5435/jaaos-d-26-00730
This erratum corrects the author byline of the July 2025 AAOS Clinical Practice Guideline Summary on management of acute isolated meniscal pathology, which omitted collaborators listed in the article metadata. The full authorship now credits all co-chairs, work group members, and AAOS staff. The guideline's clinical recommendations are unaffected.
63. Bram JT, Saville GH, Whalen MM, et al. Changes in Coronal and Sagittal Plane Alignment After Transphyseal ACL Reconstruction Performed Within Two Years of Skeletal Maturity: Results From the PLUTO Study Group. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261492231
In this prospective multicenter cohort study (PLUTO Study Group), skeletally immature patients within 2 years of skeletal maturity underwent transphyseal soft tissue autograft ACL reconstruction, and lower extremity alignment changes were assessed radiographically at 1 year using a difference-of-differences approach to account for growth. The hypothesis that transphyseal ACLR would not cause clinically significant alignment change was supported. These findings reassure surgeons that transphyseal ACLR with metaphyseal fixation is a safe option near skeletal maturity, with low risk of iatrogenic deformity.
64. Maciag B, Jegierski D, Frankiewicz A, et al. Expert evaluation of ChatGPT-generated responses to patient questions in conventional and fast-track total knee arthroplasty. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06534-7
Three arthroplasty surgeons independently rated ChatGPT-generated responses to 50 conventional and 20 fast-track TKA patient questions on accuracy, completeness, safety, and readability. Responses scored near-perfectly (means 4.98-5.00), with all fast-track responses receiving perfect scores, though the fast-track question set lacked the same rigorous selection process as the conventional set. ChatGPT appears capable of providing high-quality patient education about fast-track TKA concepts, but its role should complement, not replace, counseling by the surgical team.
65. Xiong Q, Wang X, Fu W. Visual presentation, statistical reporting and methodological considerations in a meta‐analysis of remnant‐preserving anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70639
The authors audited the statistical reporting and forest-plot presentation of a published meta-analysis on remnant-preserving ACL reconstruction and identified errors in both. Their reconstructed analysis supports more accurate interpretation of the stability outcomes. The clinical implication is that conclusions about remnant-preservation techniques should be re-checked against corrected statistics before guiding practice.
67. Marty‐Diloy T, Graveleau N, Bouguennec N. Sex‐related differences after ACL reconstruction differ between early functional recovery and 5‐year outcomes. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70651
This retrospective cohort of 479 primary ACLR patients (173 women, 306 men) compared 6-month functional recovery with 5-year outcomes by sex. Men showed better early quadriceps symmetry and hop-test performance, but sex-related differences in regaining preinjury activity level at 5 years differed from these early functional patterns. Sex should not be assumed to predict long-term return-to-activity success from early recovery measures alone, and sex-specific rehabilitation targets may warrant refinement.
69. Kumar K, Verma V, Garg M, et al. Arthro‐Cross Compression Technique for Anterior Cruciate Ligament Avulsion Fracture Fixation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70311
The authors describe an arthroscopic technique for fixing tibial eminence ACL avulsion fractures using an arthro-cross compression method. The technique achieves near-anatomic reduction with even circumferential compression and no fragment lift-off, avoiding the morbidity of open arthrotomy. It offers a reproducible arthroscopic alternative for these uncommon fractures.
72. Daud A, Lameire DL, Schemitsch GW, et al. Neuromuscular Electric Stimulation Improves Early Isometric Knee Strength After Anterior Cruciate Ligament Reconstruction and Repair: A Meta‐analysis of Randomized Controlled Trials. Arthroscopy 2026. doi:10.1002/arj.70614
This meta-analysis of 21 randomised controlled trials (687 patients) assessed neuromuscular electrical stimulation (NMES) added to standard rehabilitation after ACL reconstruction or repair. Pooled analysis showed significantly improved absolute isometric knee extension strength with NMES at a mean follow-up of 18.4 weeks. NMES can be recommended as an adjunct to postoperative rehabilitation to enhance early quadriceps strength recovery.
73. Yu Z, Wu B, Lin Y, et al. Overlooked and underestimated: the prevalence and impact of mechanical cement-related complications in unicompartmental knee arthroplasty. Arthroplasty 2026. doi:10.1186/s42836-026-00439-x
In a retrospective review of 321 unicompartmental knee arthroplasties, residual bone cement was identified on postoperative imaging in 26% of patients, mostly as extruded cement that was asymptomatic, while free cement fragmentation occurred in 5.6% and six patients required revision surgery. Thinner polyethylene inserts were identified as a risk factor. Surgeons should scrutinize cement removal, especially with thin inserts, since most residual cement is benign but fragmentation can necessitate reoperation.
74. Qu X, Sun G, Chen B. Previous bariatric surgery before knee arthroplasty: A cautious interpretation. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70640
This letter critiques a register-based study of prior bariatric surgery before knee arthroplasty, noting that BMI matching at arthroplasty conditions on a post-exposure variable, restriction to eventual arthroplasty recipients, short 2-year follow-up, and ~9% record exclusion limit causal inference. The confidence interval for reintervention only rules out a statistically detectable difference, not equivalence. The findings should be read as conditional observational evidence in selected patients rather than an estimate of bariatric surgery's overall causal effect.
76. Nam VT, Thang VD, Huy LD, et al. Notch-referenced mediolateral verification of tibial tunnel position in anterior cruciate ligament reconstruction: a 3D imaging validation study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06442-w
In 108 primary ACL reconstructions, a novel arthroscopic Notch-Referenced Mediolateral technique, using the intercondylar notch as a visual landmark, was used to verify tibial tunnel position before drilling, with postoperative 3D CT tunnel centers compared against preoperative 3D MRI footprint centers. The study validated the accuracy of this intraoperative check for mediolateral tunnel placement. The technique offers a practical bony-landmark-based method to reduce non-anatomic tibial tunnel positioning, a leading cause of ACLR failure.
77. Nishioka T, Thamrongskulsiri N, Casanova F, et al. High-Grade Percutaneous Medial Collateral Ligament Pie-Crusting Is Not Associated With Clinically Meaningful Valgus Instability. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261492229
In a retrospective case series of medial meniscus posterior root tear repairs, high-grade percutaneous MCL pie-crusting (audible/palpable release with ≥6 mm arthroscopic opening) was evaluated with bilateral valgus stress radiographs at ~6 months. Side-to-side gapping did not reach a threshold for clinically meaningful valgus instability. More aggressive pie-crusting during MMPRT repair appears safe with respect to postoperative medial laxity.
79. Selim A, Ibrahim A, Gomaa A, et al. Using machine learning to evaluate a non-selective enhanced recovery pathway for hip and knee arthroplasty: perioperative factors associated with same-day and early discharge. Arthroplasty 2026. doi:10.1186/s42836-026-00435-1
Machine learning models (with SHAP interpretation) were applied to 3,025 consecutive primary hip and knee arthroplasties performed under a universal, non-selective ERAS pathway to identify perioperative factors associated with failure of Day 0/Day 1 and same-day discharge. The models quantified which preoperative, anaesthetic, and pathway variables most strongly predicted delayed discharge. The results can guide targeted optimization of perioperative pathways to extend same-day and early discharge to unselected arthroplasty populations.
80. Schroeder GG, Williams AA, Koltsov JCB, et al. Shorter Relative Patellar Defect Length After Bone–Patellar Tendon–Bone Autograft Anterior Cruciate Ligament Reconstruction Is associated With Better Postoperative Patient‐Reported Outcomes at 1‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70618
In 23 patients after bone, patellar tendon, bone ACL reconstruction, patellar defect dimensions were measured on MRI at 6 weeks and 1 year and correlated with 1-year KOOS scores. A shorter relative patellar defect length at 6 weeks was associated with better KOOS activities of daily living and sport/recreation scores, with trends toward better pain and quality of life. Graft harvest technique that minimizes patellar defect length may improve patient-reported outcomes after BTB ACLR.
82. De Berardinis L, Leggieri F, Salari P, et al. Fewer poor joint awareness results with cementless TKA compared with the same-design cemented implant. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06531-w
In this prospective two-cohort study of 109 primary TKAs (54 cementless, 55 cemented, same design), FJS-12 joint awareness was analyzed at both the mean and across the outcome distribution at 24 months. Mean FJS-12 did not differ significantly after adjustment, but the cementless implant yielded fewer patients with the poorest joint awareness results. This suggests cementless TKA may reduce the tail of poor outcomes even when average results appear equivalent, supporting distributional rather than only mean-based comparisons.
85. Kang LS, Ina JG, Johnson A, et al. Association Between Early Postoperative Limb Symmetry Index Scores and 2-Year Patient-Reported Outcomes After Quadriceps Tendon Autograft ACL Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261490238
This case series of patients undergoing quadriceps tendon autograft ACL reconstruction assessed whether limb symmetry index (LSI) tests at 3, 6, and 9 months predict 2-year patient-reported outcomes and established PASS thresholds. Quadriceps strength LSI, particularly at 9 months, was associated with better IKDC and Lysholm scores, and PASS achievement differentiated outcome levels. Early functional and strength symmetry testing can help counsel patients and guide return-to-sport decisions after QT-ACLR.
86. Alanazi A, Alomaim H, Alaujan R, et al. All‐Inside Anterior Cruciate Ligament Reconstruction Using Semitendinosus Autograft Augmented With Biocomposite Scaffold: A Technical Note. Arthroscopy Techniques 2026. doi:10.1002/atn2.70292
This technical note describes an all-inside ACL reconstruction using a quadrupled semitendinosus autograft augmented with BioBrace, a bioresorbable poly(L-lactide) microfilament and type I collagen biocomposite scaffold. The technique aims to preserve bone and minimise invasiveness while reinforcing small-diameter (<8 mm) hamstring grafts that carry elevated failure risk. It offers surgeons a biological and mechanical augmentation option when graft diameter is a concern.
87. Suruga M, Kozu T, Yahagi Y, et al. Prior Creation of the Lateral Extra‐articular Tenodesis Tunnel to Minimize Tunnel Convergence During Combined Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70297
This technical note presents a modified Lemaire lateral extra-articular tenodesis technique in which the LET femoral tunnel is created first and its passing pin left in situ during ACL femoral tunnel drilling under fluoroscopic guidance, allowing real-time trajectory adjustment to avoid tunnel convergence. Arthroscopic confirmation of non-convergence precedes graft passage and fixation with a SwiveLock anchor. The sequence requires no specialised instruments and is applicable to revision and high-risk primary combined ACL/LET procedures.
88. Zou Z, Dong X, Zhu C, et al. “3D” Techniques for Improving Safety in Posterior Knee Arthroscopy During Posterior Cruciate Ligament Avulsion Fracture Fixation: A Series of Key Technical Modifications. Arthroscopy Techniques 2026. doi:10.1002/atn2.70340
This technical note describes a series of three practical modifications, the "3D" technique, for improving safety during posterior knee arthroscopy in the setting of posterior cruciate ligament avulsion fracture fixation. The modifications enhance visualization and tunnel accuracy while reducing the risk of iatrogenic popliteal neurovascular injury, using only standard arthroscopic instruments. The approach offers a reproducible framework for safer posterior compartment arthroscopy.
89. Nakajima Y, Muramatsu K, Hayakawa K, et al. A Simple and Atraumatic Loop‐Passing Technique for Tibial Anterolateral Ligament Graft Passage in Sonnery‐Cottet Anterior Cruciate Ligament + Anterolateral Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70305
The authors describe a knot-pusher-assisted technique using a 0 silk suture to create a passing loop between the two converging tibial tunnels in Sonnery-Cottet combined ACL and anterolateral ligament reconstruction. The silk loop is advanced through one tunnel to the convergence zone and retrieved from the second tunnel with a probe, avoiding blind needle passage through subcutaneous tissue. This offers a simple, reliable, and atraumatic alternative that reduces the risk of cortical breach or extraosseous graft passage, particularly in patients with thick subcutaneous tissue.
90. Varacallo M, Ham J. All‐Arthroscopic Trochlear Osteochondral Scaffold Matrix Implantation for Osteochondral Defects of the Femoral Trochlea. Arthroscopy Techniques 2026. doi:10.1002/atn2.70306
The authors adapt an aragonite-based osteochondral scaffold implantation, traditionally performed via mini-arthrotomy, to a fully arthroscopic procedure for femoral trochlear osteochondral defects. The technique emphasizes patient selection, portal planning, perpendicular socket preparation, syringe-based delivery, and recessed press-fit fixation. This all-arthroscopic approach may reduce surgical morbidity while enabling accurate scaffold placement in the patellofemoral joint.
91. Lin W, Lian C, Wu C, et al. Application of the Oval Femoral Tunnel Technique in Anatomical Single‐Bundle Anterior Cruciate Ligament Reconstruction: Fujian Union Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70271
The authors present the Fujian Union technique, which uses a purpose-designed oval femoral tunnel dilator to create an oval rather than round femoral tunnel in anatomical single-bundle ACL reconstruction. The oval tunnel better matches the native oval ACL femoral footprint, potentially improving rotational stability and graft integration. This technique offers surgeons a means of more accurately restoring the anatomical insertion site of the ACL.
93. Haroun HK, Mahmoud AN, Elabd MA. Inframalleolar Harvest of Split‐Thickness Peroneus Longus Tendon Autograft for Anterior Cruciate Ligament Reconstruction. Arthroscopy Techniques 2026. doi:10.1002/atn2.70309
The authors describe an inframalleolar technique for harvesting a split-thickness peroneus longus tendon autograft for ACL reconstruction. Harvesting the partial-thickness tendon distal to the malleolus provides greater usable length than retromalleolar harvest of the anterior half of the tendon, allowing preparation of a graft with adequate diameter. This approach may expand autograft options while minimising ankle donor-site morbidity.
94. Ripoll T, Sonnery‐Cottet V, Manchec O, et al. Arthroscopic Continuous Anterior Cruciate Ligament‐Medial Collateral Ligament Reconstruction Using a Single Rectus Femoris Autograft With Posterior Oblique Ligament Reconstruction: A Technical Note. Arthroscopy Techniques 2026. doi:10.1002/atn2.70304
The authors describe an all-arthroscopic technique for combined ACL, medial collateral ligament, and posterior oblique ligament reconstruction using a single rectus femoris autograft passed continuously between the ACL and MCL, with an allograft for the posterior oblique ligament. The construct reduces the need for multiple autograft harvests, preserves the hamstrings, and limits the risk of tunnel convergence. This offers an efficient solution for acute medial-sided multiligament knee injuries.
97. Harris AB. A Conservative View of Global Revision Arthroplasty Growth. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.01107
This commentary discusses Adolf et al.'s 17-country analysis projecting revision hip and knee arthroplasty volumes through 2060 using a single consistent methodology applied to worldwide registry data and UN population estimates. The approach projects age-stratified revision rates rather than extrapolating raw procedure counts, addressing the incomparability of prior country-specific studies. The clinical implication is that standardized, demographically grounded projections can better inform resource allocation for revision arthroplasty globally.
98. Shetty S, Vijayan S, Mohandas Rao KG, et al. Research trends in total knee arthroplasty in India: a five-year bibliometric analysis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06488-w
The authors performed a bibliometric analysis of 860 Indian total knee arthroplasty publications from 2021-2025 identified in Scopus, assessing publication trends, journals, authorship, institutional productivity, and state-wise contributions using VOSviewer visualizations. Research output increased steadily, peaking in 2025 (n=221), with Maharashtra and Delhi as leading contributors. The findings map India's evolving TKA research landscape and highlight institutional and regional leadership, helping identify research priorities as procedural volumes grow.
99. Hesmerg MK, Benner JL, Joosse P, et al. Association of systemic bone mineral density and tibial cortical thickness with postoperative subsidence after surgical treatment of tibial plateau fractures. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06528-5
This retrospective cohort study of surgically treated low-energy tibial plateau fractures (2017-2024) examined whether systemic BMD (DEXA T-scores) or tibial cortical thickness was associated with postoperative articular subsidence, using multivariable linear regression. The study also evaluated preoperative fracture displacement and the prevalence of reduced BMD per WHO criteria in this osteoporosis-relevant population. Results inform whether bone density assessment should be incorporated into preoperative planning and fracture care for these patients.
101. Migliorini F, Maffulli N, Schäfer L, et al. Patellar resurfacing in primary total knee arthroplasty is associated with fewer reoperations but comparable clinical and functional outcomes: an umbrella review of meta-analyses. Arthroplasty 2026. doi:10.1186/s42836-026-00438-y
This umbrella review synthesized 14 meta-analyses (2011-2025) comparing patellar resurfacing versus retention in primary total knee arthroplasty, evaluating anterior knee pain, reoperation rates, range of motion, and PROMs with random-effects models and prediction intervals. Patellar resurfacing was associated with fewer reoperations but comparable clinical and functional outcomes, with no significant difference in anterior knee pain when analyzed by odds ratios. The findings suggest the decision to resurface should weigh reduced reoperation risk against the lack of proven functional benefit.
104. Kennedy JG, Adams S, Batista J, et al. When legal reasoning contradicts sports orthopaedic evidence. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70633
This perspective from the International Society of Cartilage Repair of the Ankle critiques an English High Court ruling that attributed a professional footballer's ankle arthritis and career termination to arthroscopy performed during ankle fracture fixation. The authors contend the judgment disregarded expert testimony and misinterpreted evidence, since posttraumatic arthritis is a recognised sequela of ankle fractures and intraoperative arthroscopy is standard of care for detecting intraarticular pathology. The piece highlights the risk of legal reasoning contradicting evidence-based orthopaedic practice, with implications for how courts should weigh scientific testimony in sports medicine litigation.
105. Hantes M, Kocaoglu B, Cavaignac E, et al. To be certified or not: The value of the ESSKA European Certification Programme. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70638
This commentary describes the ESSKA European Certification Programme, a modular, three-step assessment (theory, surgical skills, clinical application) based on the ESSKA Specialist Core Curriculum and introduced four years ago. It argues that the programme offers verified proof of surgical competence with no structural equivalent in orthopaedics. Clinically, certification can help standardize and document high-quality musculoskeletal surgical care across Europe.
107. Han JH, Jung M, Chung K, et al. Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds After Anterior Cruciate Ligament Reconstruction Vary Considerably Across Published Studies: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70512
This systematic review of 9 studies synthesized minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for patient-reported outcome measures after ACL reconstruction. Thresholds varied considerably across studies and instruments (e.g., IKDC MCID 9.0-10.4 and PASS 74.2-86.8; KOOS MCID 2.5-21.9 across subdomains). Clinicians and researchers should interpret published MCID/PASS values cautiously and justify threshold selection when reporting post-ACL reconstruction outcomes.
108. Vosoughi F, Taghva Nakhjiri M, Saghafi AA, et al. Unicompartmental knee arthroplasty after failed high tibial osteotomy in appropriately selected patients: a systematic review and meta-analysis. Arthroplasty 2026. doi:10.1186/s42836-026-00434-2
This systematic review and meta-analysis of 41 studies compared unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) after failed high tibial osteotomy. Although most included studies were TKA-only series and comparative data were limited, the findings suggest UKA can yield acceptable results in appropriately selected patients. Conversion to UKA may therefore be a viable alternative to the traditionally preferred TKA in this setting, pending stronger comparative evidence.
111. Tachibana Y, Nishikawa T, Shimoji T, et al. Arthroscopic Fixation of Unstable Adolescent Knee Osteochondritis Dissecans With Structural Tibial Cancellous Bone Autograft. Arthroscopy Techniques 2026. doi:10.1002/atn2.70261
This technical note details a step-by-step arthroscopic technique for fixing unstable adolescent knee osteochondritis dissecans lesions using structural strip-shaped tibial cancellous bone autograft. Arthroscopy reduces invasiveness and improves visualization, while structural grafting fills subchondral bone loss, supports large defects, and resists fragment collapse. The technique supports fragment preservation and anatomic joint congruity in young patients with unstable OCD lesions.
114. Scuderi GR, Henry JP, Mont MA. Meeting Patient Expectations for Return to Recreational Activities. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.023
This narrative review discusses evolving patient expectations for return to recreational activities after total hip and knee arthroplasty, noting that preoperative expectations and activity levels are directly linked to postoperative satisfaction and patient-reported outcomes. The authors emphasize that surgeons must counsel patients not only on pain relief but also on realistic activity goals, echoing Charnley's caution that implants cannot withstand all activities. The clinical implication is that structured, expectation-aligned preoperative counseling is essential to satisfaction after TJA.
115. Ma L, Sun J, Shi L. To the Editor: “Long-Term Outcomes After Conversion of High Tibial Osteotomy to Total Knee Arthroplasty in a United States Population”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.01.074
In this letter to the editor, the authors respond to Bax et al.'s report of durable 13.5-year survivorship (6.0% revision, 2.2% infection rates) after TKA following prior high tibial osteotomy. They commend the study but raise interpretive points to help readers apply the findings. The exchange underscores the need for careful patient counseling when offering HTO as a joint-preserving strategy before eventual arthroplasty.
118. Noyes FR, Fleckenstein CM, Nolan J. Further Considerations Regarding Return to Sports After Robotic-Assisted Patellofemoral Arthroplasty in Young Patients: Response. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480092
The authors respond to a letter about their 10-year experience with robotic-assisted patellofemoral arthroplasty in patients aged 50 or younger, which reported high return to low-impact sports (80%), satisfaction (89%), and willingness to repeat surgery (93%). They agree that data on survivorship, cost-effectiveness, and comparative outcomes would strengthen interpretation of these findings. The exchange supports shared decision-making while calling for longitudinal comparative studies of robotic assistance in this population.
119. Liu Y, Bian J. Further Considerations Regarding Return to Sports After Robotic-Assisted Patellofemoral Arthroplasty in Young Patients: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261480097
Liu and Bian comment on Noyes et al.'s report of robotic-assisted patellofemoral arthroplasty in patients 50 years or younger, highlighting 80% return to low-impact sports, 89% satisfaction, and 93% willingness to undergo the procedure again. They praise the use of substantial clinical benefit and Patient Acceptable Symptom State benchmarks, noting that satisfaction and expectation-related outcomes are understudied in this group. The letter frames these results as valuable for counseling young, active patients with isolated patellofemoral osteoarthritis.
120. Feng J, Hou J, Wang Y, et al. The application of allgöwer-donati suture in obese patients with closed Schatzker type V and VI tibial plateau fractures. Injury 2026. doi:10.1016/j.injury.2026.113515
In a four-group study of 83 patients with closed Schatzker V/VI tibial plateau fractures, the authors compared Allgöwer-Donati versus control suture technique in obese versus normal-weight patients using exploratory modified ASEPSIS scores, VAS pain, and SF-36 outcomes. Obese patients had significantly higher early wound scores (AP1-7), with a main effect of BMI on two-way ANOVA and a nonsignificant trend favoring the experimental suture. The findings suggest wound complications in obese patients with high-energy tibial plateau fractures may be mitigated by suture technique, though the outcome measure requires validation.
123. Diab M. Orthopaedic Surgery Should Consider a Change in Name. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00747
This perspective piece argues that the term 'orthopaedic' (from the Greek for 'straightening the child') is a historical misnomer that fails to capture the breadth of modern musculoskeletal practice, which spans arthroplasty, foot and ankle, and care of adults. The author proposes that the specialty consider renaming itself. The piece invites professional discussion about nomenclature rather than reporting new data.
124. Philippeau J, Mehdi N, Favreau H, et al. French Innovations in Lower Limb arthroplasty that have Become “Gold Standards”: an overview. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104802
This narrative overview reviews major French contributions to lower limb arthroplasty, including dual mobility cups for dislocation prevention, alumina ceramic bearings with low wear-particle generation, and the Kerboull reinforcement device with bone allograft for acetabular defects in revision hip arthroplasty. These innovations achieved international adoption, particularly in Japan, through rigorous study design and long-term follow-up. The paper emphasizes that durable 'gold standard' status requires robust evaluation methodology, not just invention.
125. Unknown Author. Title Page (place for Supplements only). The Journal of Arthroplasty 2026. doi:10.1016/s0883-5403(26)01041-7
This is the front matter for a proceedings issue publishing abstracts from the 2025 AAHKS Annual Meeting in The Journal of Arthroplasty, supported by an educational grant from the American Association of Hip and Knee Surgeons. It describes the journal's double-anonymized peer-review process and conflict-of-interest handling for the proceedings. No original scientific findings are reported in this item itself.
126. Greskovich KE, Cavendish PA, Milliron EM, et al. Are We Really Sterile? Bacterial Contamination Rates During Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486436
In 16 ACL reconstructions, fingertip cultures from gloved surgical personnel were taken at four intraoperative time points (after draping, after graft harvest, after graft preparation, before graft passage), and autograft trimmings were cultured before antibiotic immersion. The authors hypothesized that glove contamination would be common just before graft passage. The study aims to identify which intraoperative steps pose the greatest contamination risk to the graft, informing sterile technique refinements to reduce the rare but devastating risk of infection and biofilm-related graft failure.
129. Gamadia M, Middleton CJ, Thatcher M, et al. Increasing Emergency Department Burden of Brazilian Jiu-Jitsu Injuries: A National 10-Year Analysis of Mechanisms and Severity Predictors, 2015-2024. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486951
Using NEISS data from 2015-2024, investigators identified BJJ-related ED visits via narrative review and developed an 11-category mechanism taxonomy, applying survey-weighted regression to analyze trends and predictors of nonroutine disposition. BJJ injuries rose nearly 5-fold, representing about 58,170 weighted national cases, with sport-specific mechanisms predicting more severe presentations. Clinicians and policymakers should anticipate growing BJJ injury burden and use mechanism patterns to triage and target injury-prevention efforts.
131. Bugajski T, Figueroa A, Gregory BP, et al. In Vivo Validation of Automated Knee Arthrometry: What Do These Measurements Really Represent?. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261478438
Twenty patients 6 months after ACL reconstruction underwent simultaneous GNRB arthrometry and biplanar videoradiography to validate arthrometer-derived anterior knee laxity against six BVR-based metrics of tibiofemoral translation and graft elongation. GNRB measurements differed significantly from BVR-derived measures, indicating the two modalities capture distinct biomechanical phenomena. Clinicians should interpret automated arthrometry values as reproducible but not direct surrogates of tibiofemoral translation or graft elongation.
132. Bax E, Ahmad R, Clark S, et al. There Were No Differences in Total Knee Arthroplasty Function Following High Tibial Osteotomy or Unicompartmental Knee Arthroplasty: More Than 10 Years of Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.046
In a prospective single-center U.S. cohort of 216 patients followed a mean of 11.5 years, revision-free survivorship, infection, reoperation rates, and Knee Society Scores were compared after TKA following prior ipsilateral HTO versus UKA. Functional outcomes and complication rates were similar between groups, with no clinically meaningful differences in TKA performance. Both HTO and UKA appear acceptable staging procedures before TKA, and the choice between them need not be driven by expected TKA outcomes.
133. Lee S, D'Lima D, Yun MS, et al. Factors Affecting Changes in Ankle Symptoms Following Total Knee Arthroplasty for Varus Knee Osteoarthritis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.052
In 85 knees with varus deformity undergoing TKA, pre- and postoperative radiographic alignment parameters (including talar tilt and hindfoot alignment view angle) were correlated with Foot Function Index scores at 12 months. Hindfoot alignment improved after TKA, but 17.6% of patients developed or had worsening ankle symptoms, which was associated with concomitant ankle osteoarthritis and higher postoperative hindfoot alignment angle. Patients with preexisting ankle osteoarthritis or adverse postoperative hindfoot alignment warrant counseling and surveillance for ankle symptoms after TKA.
134. Chebi P, Mzeihem M, Alvarez J, et al. Cluster B Personality Disorder Is Independently Associated With Opioid Abuse at Two and Five Years After Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.049
Using a national all-payer claims database, 2,961 primary TKA patients with personality disorders (75.7% Cluster B, mostly borderline) were matched 1:1 to controls without PD and evaluated for medical, wound, orthopaedic, and opioid-related outcomes. Cluster B PD was independently associated with opioid abuse at both two years (OR 1.26) and five years postoperatively. Preoperative identification of Cluster B personality disorder should prompt opioid stewardship and closer postoperative monitoring after TKA.
135. Wang Z, Du M, Cao G, et al. Early Recovery Trajectories Identify Patients at Risk for Outcome Deterioration During Postoperative Years One to Five After Medial Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.045
Growth mixture modeling was applied to early (1-6 month) pain and Oxford Knee Score trajectories in 207 medial UKA patients to predict outcome trajectories during postoperative years one to five. Slow early analgesia and delayed early functional recovery trajectories identified patients at significantly increased risk of later deterioration in patient-reported outcomes. Early postoperative recovery assessments can serve as a screening window to target intensified follow-up or intervention for at-risk mUKA patients.
136. Sarzaeem MM, Ghanei A, Omrani FA, et al. Closer to Native, Not Clinically Superior: Bi-Unicompartmental versus Total Knee Arthroplasty for Bicompartmental Femoro-Tibial Osteoarthritis, A Randomized Trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.050
In an exploratory randomised trial, 56 patients with bicompartmental femoro-tibial osteoarthritis and intact cruciate ligaments were randomised intraoperatively to simultaneous bi-UKA or cruciate-retaining TKA, with the Forgotten Joint Score at 24 months as the primary outcome. Bi-UKA yielded kinematic or subjective measures closer to the native knee but was not clinically superior to CR-TKA in patient-reported outcomes at 2 years. The choice between Bi-UKA and CR-TKA should not be based on expected superior PROMs alone.
137. Herndon CL, Springer BD, Heckmann N, et al. American Association of Hip and Knee Surgeons Policy Statement Regarding Skin Substitutes and Collagen Dressings for Hip and Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.004
The American Association of Hip and Knee Surgeons issued a policy statement addressing the use of skin substitutes and collagen dressings in hip and knee arthroplasty. The statement provides guidance on the appropriate indications and evidence supporting these products in wound management. Clinically, it aims to standardize practice and discourage use of these adjuncts absent robust evidence of benefit in routine arthroplasty wounds.
138. Chen AF, Mont MA, Smitterberg CW, et al. Bleeding and Hemostasis Optimization in Primary and Revision Total Knee Arthroplasty: A Structured Expert-Opinion Survey. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.001
A structured survey of 14 fellowship-trained arthroplasty surgeons sought consensus on defining disruptive bleeding after total knee arthroplasty and on factors guiding hemostatic decision-making. Respondents agreed that disruptive bleeding should be defined as a composite of clinically meaningful outcomes rather than isolated measures like blood loss or hemoglobin drop. This supports using management-oriented, composite definitions in trials and clinical monitoring of postoperative TKA bleeding.
139. Hershfeld BE, Tauro TM, Klein BJ, et al. The FEAR Framework for Recovery After Total Hip and Knee Arthroplasty: A Systematic Review. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.003
This systematic review synthesized evidence on fear-related psychological constructs after total hip and knee arthroplasty and introduced the FEAR Framework, organizing them into four domains: Fall Confidence, Exposure Avoidance, Anticipatory Anxiety, and Reinjury Fear. Kinesiophobia and pain catastrophizing were consistently associated with worse postoperative outcomes. The framework offers clinicians a practical tool to identify modifiable psychological barriers and explain discordant or non-mechanical recovery.
140. Jabalameli M, Bagherifard A, Askari A, et al. Clinical Outcomes of Rotating-Hinge Total Knee Arthroplasty in Primary and Revision Settings: A Retrospective Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.042
This retrospective cohort of 120 rotating-hinge total knee arthroplasties compared outcomes between primary (52 knees) and revision (68 knees) settings with long-term follow-up. Both groups showed significant functional improvement (KSFS gains of ~31-35 points), with Kaplan-Meier survivorship reported separately for each group. The findings support rotating-hinge implants as a reliable high-constraint option in both settings while highlighting the value of analyzing primary and revision cases separately.
141. Yao W, Chen S, Chen X, et al. Early Readmission and Mortality Across Periprosthetic Joint Infection Trajectories After Revision Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.051
In 1,228 revision hip or knee arthroplasty patients, investigators stratified outcomes by a trajectory framework combining index revision indication and subsequent periprosthetic joint infection (PJI) status. Post-revision PJI occurred in 3.5% of patients, and those developing PJI had higher 90-day readmission rates (14.0% vs ~4.6%) and elevated mortality risk on Cox modeling. The results suggest early readmission and mortality differ by infection trajectory, supporting risk-stratified follow-up beyond infection history alone.
142. Chiang L, Chu Y, Kung P, et al. Impact of Revised Cardiac Risk Index, Individual Risk Factors, and Their Duration on Major Adverse Cardiac Events After Primary Total Knee Arthroplasty: A Nationwide Propensity-Matched Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.055
Using a nationwide claims database of 72,672 propensity-matched primary TKA patients, this study examined major adverse cardiac events (MACE) according to Revised Cardiac Risk Index (RCRI) score, individual risk factors, and their preoperative duration. MACE incidence was 0.18%, 0.40%, and 1.43% at 30 days, 90 days, and 1 year, with risk rising across RCRI categories (RCRI 1: adjusted HR 1.34 at 1 year). Findings support RCRI-based preoperative cardiac risk stratification in TKA, with consideration of risk-factor duration and age.
143. Juryn MS, Facchinato D, Stoica S, et al. Beyond the Surgical Factors: Preoperative Habits, Cutaneous Sensation, and Adaptive Strategies as Predictors of Kneeling Ability Following Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.09.048
This study surveyed 165 TKA patients by telephone to identify non-surgical predictors of postoperative kneeling ability, including preoperative habits, cutaneous patellar sensation, and adaptive strategies. Greater preoperative exercise activity and higher perceived importance of kneeling were associated with more frequent kneeling after surgery. Clinically, psychological and contextual factors, not just surgical technique, appear to drive kneeling outcomes, suggesting counseling and expectation management may help.
145. Deviandri R, Mecca ND, Putri NZ, et al. Translation, Validity, and Reliability of the Indonesian Version of the Injury–Psychological Readiness to Return to Sport (I-PRRS-INA) Scale. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261489973
The I-PRRS was translated into Indonesian via forward-backward translation and cross-cultural adaptation, then administered to patients with ACL injury alongside comparator instruments (Tampa Scale of Kinesiophobia, IKDC, ACL-RSI) to assess construct validity, with test-retest reliability evaluated over 2-4 weeks. The Indonesian version demonstrated adequate validity and reliability, supporting its use as a valid instrument. Clinicians in Indonesia can now use the I-PRRS-INA to assess psychological readiness to return to sport after injury.
147. Rusche A, Roth A, Pempe C. Periprosthetic joint infection as the leading indication associated with in-hospital death after revision hip and knee arthroplasty: a ten-year single-centre retrospective cohort study of 103 in-hospital deaths among 2495 patients. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07259-4
In a ten-year single-centre retrospective cohort of 2495 revision hip and knee arthroplasties, 103 in-hospital deaths (4.1%) were reviewed for circumstances, timing, and causes of death stratified by revision indication. Periprosthetic joint infection emerged as the leading indication associated with in-hospital death, with decedents predominantly elderly and frequently requiring ICU admission and septic shock management. These results underscore the need for aggressive infection workup, risk stratification, and perioperative vigilance in patients undergoing revision arthroplasty for PJI.
148. Erden T, Tollefson LV, Wilebski BJ, et al. Controversies in PCL Reconstruction: Why Does PCL Reconstruction Still Underperform? Failure Mechanisms, Residual Laxity, and a Risk Management Framework: A Current Concepts Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261481591
This narrative review critically appraised controversies in PCL reconstruction, including failure mechanisms, residual posterior laxity, posterolateral corner deficiency, tibial slope, and surgical technique choices (single- vs double-bundle, tibial inlay vs transtibial, augmentation). PCL reconstruction continues to underperform ACL reconstruction, with persistent objective laxity and functional deficits driven by nonstandardized technique, unrecognized combined injuries, and inadequate risk management. The authors propose an individualized risk management framework to guide technique selection and improve outcomes.
149. Menzel K, Perka C, Megaloikonomos PD, et al. Periprosthetic fractures of the knee. EFORT Open Reviews 2026. doi:10.1530/eor-2026-0075
This review synthesized current evidence on periprosthetic fractures around total knee arthroplasty, emphasizing that implant stability and bone quality, rather than fracture morphology alone, are the primary determinants of treatment strategy. Stable implants with adequate bone stock are managed with locked plating, retrograde nailing, or combined constructs with high union rates, while loose components or poor bone stock require revision arthroplasty with stemmed components, cones, or sleeves. Treatment must integrate trauma principles with arthroplasty-specific factors including patient frailty and preservation of future revision options.
150. Zhuang R, Yan L, Li Z, et al. Local hyperthermia therapy for the pain management of knee osteoarthritis: a network meta-analysis of randomized controlled trials. EFORT Open Reviews 2026. doi:10.1530/eor-2026-0062
A network meta-analysis of randomised controlled trials compared local hyperthermia therapy modalities for pain management in knee osteoarthritis. Local hyperthermia reduced pain compared with controls, with comparative efficacy varying by modality and treatment parameters. Hyperthermia represents a nonpharmacological, low-risk adjunct option in the multimodal management of knee osteoarthritis pain.
151. Legnani C, Fadel K, D’Ambrosi R, et al. Unicompartmental and total knee arthroplasty in the same patient for the treatment of bilateral knee osteoarthritis: a systematic review of literature. EFORT Open Reviews 2026. doi:10.1530/eor-2025-0193
This systematic review examined outcomes of patients undergoing both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA), in staged or combined procedures, for bilateral knee osteoarthritis. Mixed UKA/TKA approaches yielded functional outcomes and complication rates comparable to bilateral TKA while preserving more native bone and kinematics. The findings support considering combined UKA/TKA as a viable, joint-preserving strategy in selected patients with asymmetric bilateral disease.
152. Viola V, Marelli N, Caplanusi T, et al. Orthopedic implant allergies: a review of current knowledge on metal hypersensitivity and prosthesis failure. EFORT Open Reviews 2026. doi:10.1530/eor-2025-0252
This narrative review synthesized evidence on metal hypersensitivity in total joint arthroplasty, covering immune mechanisms, clinical presentations (persistent pain, aseptic loosening, early revision), and diagnostic strategies including patch testing, lymphocyte transformation testing, and histopathology. No gold-standard diagnostic method exists, and the evidence linking metal allergy to implant failure remains limited by heterogeneous methodology and reporting bias. Clinicians should consider hypersensitivity in unexplained implant complications, though diagnostic and management pathways remain unstandardized.
153. Bixby EC, Cook DL, Hutchinson LE, et al. Some Skeletally Immature Patients Have Lower Limb Length Discrepancies and/or Malalignment Prior to Anterior Cruciate Ligament Reconstruction: Baseline Radiographic Data from the PLUTO Cohort. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261483898
Researchers measured preoperative limb length discrepancy, mechanical axis deviation, and anatomic lateral distal femoral angle on hips-to-ankles radiographs in 725 skeletally immature patients undergoing ACL reconstruction across 10 academic centers. A subset of patients had clinically relevant limb length discrepancies and/or malalignment before surgery compared with historical controls. The findings support routine preoperative alignment imaging in this population, since malalignment can be addressed with guided growth at the time of ACLR and baseline data are needed to detect postoperative growth disturbance.
154. Tabbaa SM, Jerban S, McCauley JC, et al. The Effects of Donor Factors (Age, BMI, Sex) and Graft Storage Time on Bone Healing and Graft Incorporation Following OCA Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261453309
The authors evaluated osseous incorporation of 206 osteochondral allografts on postoperative CT using visual and semiautomated quantitative metrics (gap, low-bone, and partial-resorption indices), stratified by donor age, BMI, sex, and graft storage time. Older donor age (>20 years) was associated with inferior graft-bone incorporation, while other donor factors and storage time showed less consistent effects. These results suggest donor age should be considered when selecting allografts, though the clinical significance of CT-based incorporation measures requires further study.
155. Grzela P, Vivekanantha P, Nairn L, et al. The Application of Machine Learning in Sports Medicine: A Scoping Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261485074
This scoping review following PRISMA guidelines synthesized studies applying machine learning to diagnosis and prognosis of sports injuries requiring orthopaedic consultation. It mapped current ML applications, noting strengths in capturing complex nonlinear relationships in clinical data, but also limitations including small datasets, limited external validation, and poor interpretability that hinder clinical utility. The review concludes that future work should focus on prospective validation, standardised reporting, and integration into clinical workflows.
156. Cui ES, Entessari M, Griff S, et al. Clinical Outcomes After Suture Tape Augmentation of Quadriceps Tendon Autografts for Primary Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261485087
In a retrospective single-institution cohort of patients under 40 undergoing primary ACL reconstruction with all-soft-tissue quadriceps tendon autograft, outcomes were compared between those with and without suture tape augmentation. Short-term patient-reported outcomes, return-to-sport rates, complications, and graft rerupture rates were similar between groups, suggesting augmentation did not clearly improve early outcomes. The findings indicate that routine suture tape augmentation of QT autografts may not be necessary, though longer follow-up is needed to assess graft elongation and failure.
157. Jessup LA, Marmura H, Willits K, et al. Establishing PASS Thresholds for the Knee Numeric-Entity Evaluation Scale (KNEES-ACL) Questionnaire Following ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486432
Using prospective cross-sectional data from ACL-injured patients completing the KNEES-ACL questionnaire at multiple pre- and postoperative time points, the authors calculated Patient Acceptable Symptom State (PASS) thresholds for each of the six KNEES-ACL domains. PASS thresholds were established for all domains and varied across recovery time points, aligning with KOOS and IKDC trajectories. These thresholds give clinicians and researchers benchmarks for interpreting KNEES-ACL scores and defining acceptable symptom states after ACL reconstruction.
158. Karimijashni M, Drouin V, Béland C, et al. Psychological Factors Associated with Function and Health-Related Quality of Life Outcomes following Total Hip or Knee Arthroplasty. JBJS Reviews 2026. doi:10.2106/jbjs.rvw.26.00093
This umbrella review of 25 systematic reviews encompassing over 40,000 patients examined associations between psychological factors and function or health-related quality of life after total hip or knee arthroplasty. Depression and anxiety consistently and negatively affected postoperative function and HRQoL, with distress, kinesiophobia, pain catastrophizing, and pessimism also showing negative associations. The findings support routine preoperative psychological screening and targeted interventions to optimise arthroplasty outcomes.
159. Vendrig T, Brouwer RW, Hoogeslag RA, et al. Side-to-Side Differences in Dynamic Tibiofemoral Movement and Velocity Patterns Between ACL-Reconstructed and Contralateral Knees During Jump-Landing Tasks at Midterm Follow-up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261490305
In a descriptive laboratory study, patients from a prior randomised trial underwent 3D motion capture during single-leg hop for distance and side hop tasks at midterm follow-up after primary unilateral ACL reconstruction. Dynamic anterior tibial translation and internal tibial rotation and their velocities differed between reconstructed and contralateral knees during jump-landing. These persistent side-to-side kinematic asymmetries suggest ACLR does not fully restore dynamic knee stability, which may contribute to reinjury risk and long-term joint degeneration.
160. Masquijo JJ, Garlapati S, Agonias K, et al. Coronal Alignment in Pediatric Patients With Discoid Lateral Meniscus. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486604
This 2-institution retrospective cross-sectional study assessed coronal alignment on standing hip-to-ankle radiographs in 141 paediatric patients (156 knees) with MRI-diagnosed symptomatic discoid lateral meniscus. A substantial proportion of patients exhibited high-grade valgus or varus malalignment, which was associated with specific radiographic and MRI findings. The results suggest coronal alignment assessment should be part of the evaluation of paediatric DLM, as malalignment may influence management and outcomes.
161. Escudeiro D, Jorge PB, Franciozi CEDS, et al. A Nationwide Profile of ACL Reconstruction in Brazil: Graft Choice, Extra-articular Procedures, and Meniscal Management. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261486659
A nationwide web-based survey of board-certified Brazilian knee surgeons characterized current ACL reconstruction practice across 60 items covering graft selection, lateral extra-articular procedures, meniscal management, and return-to-sport strategies. The results profile Brazilian practice patterns, testing whether surgeons follow contemporary evidence on meniscal preservation and RTS timing. The findings offer a national benchmark for graft choice and adjunctive techniques, informing guideline development and surgeon education in Brazil.
162. Boontanapibul K, Chankong K, Susrivaraput C, et al. Multiple-Offset Titanium Slot-Stems Versus Limited-Offset Cobalt–Chromium Stems in Hybrid-Fixation Revision Total Knee Arthroplasty: A Comparative Study With 5- to 14-Year Follow-up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.006
A retrospective cohort of 63 revision total knee arthroplasties (39 multiple-offset titanium slot-stem, 24 limited-offset cobalt-chromium) with hybrid fixation was followed for a mean of 8.6 years (range 5-14). Clinical scores (mWOMAC, KSS), radiographic parameters, and Kaplan-Meier survivorship with aseptic revision as the endpoint showed no significant differences between stem systems. Either stem type appears acceptable in hybrid-fixation rTKA, so implant selection can be driven by intraoperative fit and surgeon preference rather than expected outcome differences.
163. Kornis K, Makolli A, Fazekas KK, et al. Sex Does Not Influence Graft Failure or Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261444304
A preregistered systematic review and meta-analysis pooled sex-stratified outcomes from 43 studies comparing males and females after ACL reconstruction. No significant sex differences were found in graft failure (OR 0.90, 95% CI 0.70-1.17), return-to-sport rates (OR 0.69, 95% CI 0.46-1.03), or functional outcomes. Sex alone should not guide postoperative rehabilitation intensity, RTS clearance, or counseling about retear risk after ACLR.
164. Pontoh LA, Dilogo IH, Lubis AMT, et al. Incidence of Flatfoot Deformity After Anterior Cruciate Ligament Reconstruction Using Peroneus Longus Autograft: A Mid-Term Observational Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261487856
A prospective case series of 130 patients undergoing single-bundle ACL reconstruction with peroneus longus autograft used weightbearing digital podograms and the Arch Index (with Staheli Index, Chippaux-Smirak Index, and Clarke angle) to detect flatfoot, and the Beighton score to assess generalized joint laxity. The study quantified the mid-term incidence of medial arch collapse after peroneus longus harvest and its relationship to joint laxity and patient characteristics. The results inform donor-site counseling and surveillance when peroneus longus grafts are chosen, particularly in patients with generalized ligamentous laxity.
165. Carson NM, Barton KI, Capin JJ, et al. Physical activity levels two years after total knee arthroplasty and preoperative patient characteristics: a secondary analysis of the MOVE randomized controlled trial. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.012
A secondary analysis of the MOVE randomised controlled trial used accelerometer data from 135 TKA patients collected preoperatively and at 10 weeks, 6 months, and 2 years to characterize light physical activity, MVPA, and steps/day trajectories and identify baseline predictors of activity recovery. Steps per day increased modestly (about 8%) over follow-up, but most patients did not return to baseline activity levels, with baseline characteristics only partially explaining recovery. Structured postoperative activity promotion beyond standard care appears needed, as spontaneous return to preoperative activity after TKA is limited.
166. Castellanos Dolk D, Hedevik H, Wretenberg P, et al. Return to sport after primary anterior cruciate ligament reconstruction in athletes with a preinjury Tegner Activity Scale ≥7: a longitudinal, nationwide, registry-based cohort study. British Journal of Sports Medicine 2026. doi:10.1136/bjsports-2025-111497
A Swedish registry-based cohort of 511 athletes aged 16-40 with preinjury Tegner Activity Scale ≥7 was followed after primary ACL reconstruction to determine rates, timing, and predictors of return to sport. Only 62% returned to TAS ≥7 (mean 12.3 months) and 51% to their preinjury level, with female sex, older age, low sporting level, delayed surgery, and low early ACL-RSI scores predicting poorer RTS; secondary ACL injury rates were also reported. Early psychological readiness screening (ACL-RSI at 3 months) may identify athletes needing additional support, and RTS counseling should account for the substantial proportion who never resume preinjury-level sport.
167. Alhankawi AR, Holle AM, Renfree SP, et al. Sepsis Prior to Total Knee Arthroplasty is Associated With Elevated Rates of Myocardial Infarction and Deep Vein Thrombosis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.014
A retrospective insurance database study matched patients with sepsis within two years before elective TKA 1:3 to controls and stratified by time since sepsis, assessing complications at 90 days and two years. Preoperative sepsis was associated with elevated rates of periprosthetic joint infection (OR 1.6), myocardial infarction, and deep vein thrombosis. These findings support heightened perioperative surveillance and risk counseling for TKA candidates with a recent sepsis history, potentially favoring delay of elective surgery until stability is achieved.
170. Ruedl G, Burtscher M. Underestimating hospitalization costs for ski trauma due to the omission of knee injuries.. Injury 2026. doi:10.1016/j.injury.2026.113832
This analysis examined hospitalization costs of ski trauma, highlighting that knee injuries are frequently omitted from such cost calculations. The authors argue that excluding knee injuries substantially underestimates the true economic burden of ski-related trauma. Accurate cost accounting including knee injuries is needed to inform resource planning and injury-prevention policy at ski areas.
172. Murakami R, Taketomi S, Kono K, et al. Anterior Tibial Subluxation Across Knee Flexion Angles and Loading Conditions Is Greatest at Maximal Extension. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261493261
In this cross-sectional fluoroscopic study of 20 normal and 20 ACL-deficient knees, anterior tibial subluxation (ATS) was measured across flexion angles under weightbearing and non-weightbearing conditions. ATS was greatest at maximal extension and was significantly larger in ACL-deficient knees, with loading condition influencing measured values. Imaging protocols for assessing ACL deficiency should standardize flexion angle and weightbearing status, with near-extension weightbearing views maximising diagnostic discrimination.
174. Dean KK, Meli GM, Ference DA, et al. Total Hip and Knee Arthroplasty for Symptomatic Charcot Arthropathy. JBJS Reviews 2026. doi:10.2106/jbjs.rvw.26.00091
This review summarized presentation, workup, and outcomes of total hip and knee arthroplasty for symptomatic Charcot arthropathy, a frequently misdiagnosed neuropathic joint destruction process. Arthroplasty improves pain and function but carries high complication rates (roughly 20-30% for TKA and 45-58% for THA), chiefly instability, infection, and mechanical failure. Careful patient selection, optimization of modifiable risk factors such as glycemic control, and constrained or dual-mobility implant selection are essential to success.
175. Yamagami R, Moro T, Kono K, et al. Low Artificial Intelligence-Estimated Bone Mineral Density From Chest Radiographs Is Associated With Delayed Pain Recovery and Lower Quality of Life After Medial Unicompartmental Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.027
In 336 cemented medial unicompartmental knee arthroplasties, AI-estimated proximal femur bone mineral density from preoperative chest radiographs (YAM <80%, 58 propensity-matched cases) was analyzed against longitudinal KOOS outcomes. Low AI-estimated BMD was associated with delayed pain recovery and lower quality-of-life scores up to three years postoperatively despite comparable baseline characteristics. Opportunistic AI-based BMD screening from chest radiographs may identify UKA patients at risk for slower recovery who warrant counseling or targeted intervention.
178. Chen P, Lau N, Peng S, et al. Risk Factors for Re-Revision After Aseptic Revision Total Knee Arthroplasty: Knees Revised for Instability Re-Fail Early in a Single-Center Cohort With a Mean 14-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.028
A single-center cohort of 168 aseptic revision TKAs with mean 14.1-year follow-up was analyzed with Kaplan-Meier and Cox methods to define survivorship and predictors of re-revision. Survivorship free of any-cause re-revision was 84.3% at 10 years and 82.1% at 15 years, with prior revision (HR 3.69), severe bone loss (AORI 2B/3; HR 2.99), and revision for instability (HR 2.70) as independent risk factors. Knees revised for instability re-fail early, warranting heightened surveillance and counseling for these patients.
179. Muthu S, Kolarpatti Ponnusamy DV, Rathinam MM, et al. Evaluating Large Language Models for Patient-Facing Total Knee Arthroplasty Information in Knee Osteoarthritis: Development and Application of the Composite Clinical Reliability Score. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.10.030
Three large language models were tested on 90 patient-facing TKA questions, with responses scored by two orthopaedic surgeons across six domains of a new Composite Clinical Reliability Score, plus readability assessment. The study established and applied the CCRS as a structured tool for evaluating LLM-generated patient information on TKA. The findings inform how clinicians should appraise the reliability and readability of AI-generated patient education material in knee osteoarthritis.
180. Lan J, Zhao W, Gao X, et al. Synovial fluid biomarker changes after acute anterior cruciate ligament injury: comparison with primary osteoarthritis as a biological comparator. Injury 2026. doi:10.1016/j.injury.2026.113827
Synovial fluid biomarkers were analyzed after acute anterior cruciate ligament injury and compared against primary osteoarthritis as a biological comparator to characterize post-traumatic joint inflammation. The study profiles the early biochemical changes following ACL injury relative to a degenerative reference state. This may help identify biomarkers that track the transition from injury to post-traumatic osteoarthritis and guide monitoring or early intervention.
183. Kiehl D, Ibrado R, Axelrod A, et al. Comparative Trends of Musculoskeletal Injury in Pickleball and Tennis: An 11-Year Analysis of U.S. Emergency Department Visits. Injury 2026. doi:10.1016/j.injury.2026.113791
An 11-year analysis of U.S. emergency department visits compared musculoskeletal injury trends between pickleball and tennis. The study documents the comparative epidemiology of injuries in these two rapidly growing racquet/paddle sports. These data can guide injury prevention strategies and resource planning as pickleball participation expands, particularly among populations at risk.