What's New — Knee — August 2026¶
323 new articles published this month.
Themes: ACL Reconstruction & Graft Outcomes · Meniscus Root Tears & Repair · Patellofemoral Instability & Alignment · Knee Arthroplasty Perioperative Care · Cartilage Restoration & Biologics · High Tibial Osteotomy & Alignment
Digest generated 2026-09-14 08:23:29+00:00.
Highlights¶
ACL Reconstruction & Graft Outcomes¶
This theme covers the breadth of ACL reconstruction: graft selection and technique, lateral extra-articular tenodesis (LET) augmentation, revision surgery, and long-term outcomes. Registry and cohort data show similar revision rates between hamstring and bone-patellar tendon-bone autografts in young males [139], while adolescent data favour quadriceps tendon grafts for lower rupture rates [287] and large hamstring grafts perform comparably to BTB [252]. LET reduces graft failure in high-risk pivoting athletes [149] and adolescents [117], with meta-analyses of randomised trials confirming benefits [167], though cost-utility modeling questions value [217] and mid-term soccer data show equivalence to isolated BPTB [306]. Revision ACLR outcomes remain inferior to primary [165], with graft choice [229] and harvest site [176] influencing results. Risk factors for failure include steep posterior tibial slope [29, 227], and remnant-preserving techniques [295] plus biologic augmentation [186] are emerging strategies.
Meniscus Root Tears & Repair¶
Medial meniscus posterior root tears dominate this theme, spanning biomechanics, surgical technique, and outcomes. Cadaveric work examines centralization sutures [8] and novel onlay all-suture anchor constructs permitting weightbearing [185], while ripstop configurations resist suture cut-through [52]. Clinical studies show repair yields better function but persistent gait abnormalities including varus thrust [9, 242], and nonoperative management can provide clinical improvement despite structural degeneration [61]. Concomitant patellofemoral chondrosis affects outcomes [33, 174], though low- versus high-grade tibiofemoral chondrosis shows similar long-term survival [172]. Increased posterior tibial slope predicts healing failure after all-inside anchor repair [171]. Centralization adds no benefit in meta-analysis [13], suture material choice is inconsequential [309], and a comprehensive state-of-the-art review synthesizes the field [140]. Lateral root repair combined with ACLR shows comparable graft survivorship [64].
Patellofemoral Instability & Alignment¶
Patellar instability management features prominently, with emphasis on measurement reliability and surgical decision-making. TT-TG distance shows high variability on repeat MRI [245] and limited value in trochlear dysplasia, where TT-PCL [226] and alternative reference levels [151] have been proposed; statistical shape modeling suggests sTT-TG superiority [258]. MPFL reconstruction remains foundational, with MQTFL reconstruction showing favourable outcomes [47] and biomechanical equivalence [264], while combined MPFL-MPTL reconstruction reduces lateral translation without increasing contact pressure [124, 106]. Tibial tubercle osteotomy indications are refined: distalization planning is accurate intraoperatively [2], anteromedialization does not alter patellar height [219], and adolescents with high TT-TG may do well with isolated MPFLR [179]. Dynamic imaging quantifies the J-sign [200, 262], and finite element analysis links TT-TG translation to contact pressure [304].
Knee Arthroplasty Perioperative Care¶
Total and unicompartmental knee arthroplasty articles cluster around perioperative optimization, complications, and technology adoption. Pain management strategies include liposomal bupivacaine [113], preoperative cryoneurolysis reducing opioid use [134], and tourniquet effects on quadriceps inhibition [316]. Complication risk stratification identifies diabetes [322], keloidosis [112], psoriasis [138], dementia [319], and low bone mineral density [320] as predictors of arthrofibrosis, infection, or delirium. Cementless fixation shows low migration with radiostereometric analysis [37] and favourable bone ingrowth patterns [67], while robotic assistance demonstrates similar 30-day safety in UKA [125] with defined complication profiles [136]. UKA versus TKA comparisons favour UKA for faster recovery in older patients [307, 79], and same-day surgery implementation is feasible [28]. Arthrolysis for stiffness shows durable mid-term results [305], and cost analyses identify bundled payment targets [323].
Cartilage Restoration & Biologics¶
Cartilage preservation spans osteochondral allograft transplantation, autologous chondrocyte implantation, and injectable biologics. OCA studies define conditional survivorship [161], confirm short-term outcomes predict long-term success [189], extend indications to patients aged 40-49 [190] and ideal candidates [277], and identify donor age [267, 150] and malalignment [182, 183] as failure predictors. MACI utilisation shows roughly 30% biopsy-to-implantation progression [6], higher failure rates in prospective studies [17], and durable mid-to-long-term outcomes [283], with minced cartilage emerging as a single-stage alternative [280]. Aragonite scaffolds perform well even with mild osteoarthritis [188]. For knee osteoarthritis, adipose-derived mesenchymal stromal cells improve pain and function [63], PRP efficacy is modified by patient age and product characteristics [36], and access to orthobiologics varies by practice type [11].
High Tibial Osteotomy & Alignment¶
Osteotomy around the knee for malalignment and joint preservation forms a coherent theme. National data confirm low short-term adverse event and reoperation rates [12], while HTO provides lower two-year conversion to TKA than UKA across ages [216]. Technique refinements include combined lateral-anterior closing wedge osteotomies correcting varus and slope simultaneously [76], patient-specific instrumentation achieving accurate coronal [181] and sagittal correction [204], and plate positioning optimization in distal femoral osteotomy [162]. Slope management for ACL deficiency is addressed by German Knee Society recommendations [92] and complication reviews of anterior closing-wedge HTO [38]. Outcomes studies examine absolute knee extensor strength thresholds [90], subchondral bone density redistribution correlating with clinical results [148], CPAK phenotype irrelevance to outcomes [141, 311], and factors affecting return to sport [184]. Patellofemoral degeneration comparison across three HTO types [159] and hallux checkrein deformity as a rare complication [116] complete the picture.
Articles by Theme¶
ACL Reconstruction & Graft Outcomes (20)¶
29. van der Wal WA, de Groot TM, Tamana L, et al. Increased Posterior Tibial Slope and Lateral Extra-articular Tenodesis Are Independently Associated With Revision ACL Reconstruction in a Young High-Risk Population. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261473931
In a multicenter cohort of young (≤25 years) high-risk patients undergoing primary ACL reconstruction, posterior tibial slope (PTS) was measured radiographically and its association with revision, alone and with lateral extra-articular tenodesis (LET), was assessed via multivariable logistic regression. Increased PTS (medial, lateral, maximum, and lateral-medial difference) and lack of LET were each independently associated with revision ACL reconstruction. The results support measuring PTS preoperatively and considering LET augmentation in young patients with elevated slope to mitigate revision risk.
117. Espinosa M, Pastrián D, González J, et al. Anterior Cruciate Ligament Reconstruction With Modified Lemaire Lateral Extra-Articular Tenodesis Is Associated With Favorable Subjective Knee Function at Short-term Follow-up in Adolescents. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101194
This prospective cohort of 55 adolescents undergoing primary ACL reconstruction with hamstring autograft plus modified Lemaire lateral extra-articular tenodesis reported favourable short-term subjective outcomes at a mean 28.7 months. Median Lysholm and IKDC scores were high, suggesting the combination may address elevated graft failure risk in this population. Adding a modified Lemaire LET appears to be a reasonable option for adolescent ACL reconstruction, though longer follow-up is needed to confirm reduced failure rates.
139. Koca F, von Essen C, Hamrin Senorski E, et al. Analysis of the Swedish Knee Ligament Registry Shows Similar Anterior Cruciate Ligament Revision Rates Between Hamstring Tendon and Bone-Patellar Tendon-Bone Autografts in Young Males. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101201
Data from the Swedish Knee Ligament Registry were used to compare 5-year revision rates and patient-reported outcomes (KOOS and KOOS4) between hamstring tendon and bone-patellar tendon-bone autografts in 10,038 male patients aged 16-25 undergoing primary ACL reconstruction between 2005 and 2018. Revision rates were similar between the two graft types, with no meaningful differences in patient-reported knee function. In young male athletes, graft choice between these two autograft options can be based on individual factors rather than expected superiority in revision risk or functional outcomes.
145. McAleese T, Daly GR, King E, et al. Revision Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Similar Outcomes With Bone–Patellar Tendon–Bone and Hamstring Autografts With or Without Lateral Extra-articular Tenodesis. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101209
In 262 level 1 athletes undergoing revision ACL reconstruction, bone, patellar tendon, bone and hamstring autografts (with or without lateral extra-articular tenodesis) yielded comparable return-to-play rates (~63-65%) and times to return. Older age independently reduced the odds of returning to play (~7% per year), suggesting graft choice and tenodesis augmentation need not drive revision decisions, while age should inform return-to-play counseling.
149. Rivarola H, Chahla J, Ramos P, et al. Association of Lateral Extra-Articular Tenodesis With Graft Failure and Return to Sport in Pivoting Athletes: A Multicenter Comparative Study of Augmented and Isolated ACL Reconstructions. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261449998
This multicenter prospective cohort of 1,260 competitive football and rugby athletes compared graft failure, return to sport, and functional outcomes at 5 years after primary ACL reconstruction with BPTB or semitendinosus grafts, each with or without modified Lemaire lateral extra-articular tenodesis. The study provides comparative evidence on whether LET augmentation reduces rerupture in high-risk pivoting athletes, informing graft and augmentation choices in this population.
165. Piussi R, Hamrin Senorski R, Högberg J, et al. Inferior Outcomes after Subsequent Revision or Contralateral ACL Reconstruction: A Cross-Sectional Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261470914
This registry-based cross-sectional study compared return to preinjury activity, muscle strength, and patient-reported outcomes at 12, 18, and 24 months among patients undergoing primary (n=1317), revision (n=111), or contralateral (n=80) ACL reconstruction. Patients undergoing revision or contralateral reconstruction demonstrated inferior outcomes compared with primary reconstruction during rehabilitation. These findings underscore the need for modified expectations and potentially tailored rehabilitation strategies for patients undergoing repeat ACL surgery.
167. Alkhunein F, Alrasheed K, Alrasheed R, et al. Anterior Cruciate Ligament Reconstruction With or Without Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Comparative Outcomes From Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261470939
This PRISMA-compliant systematic review and meta-analysis of 10 randomised controlled trials compared clinical outcomes of ACL reconstruction with versus without lateral extra-articular tenodesis (LET). The addition of LET significantly reduced graft failure rates and improved rotational stability compared with isolated ACL reconstruction. These level 1 evidence findings support consideration of LET augmentation, particularly in patients at higher risk of graft failure or persistent rotational instability.
176. Althoff A, Lynch OL, Oladeji LO, et al. Paper 14. Impact of Harvesting Second Ipsilateral Extensor Mechanism Graft for Revision ACL Reconstruction on Patient-Related Outcomes and Return to Sport. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00274
This retrospective cohort study compared ipsilateral quadriceps tendon versus contralateral bone-patellar tendon-bone autograft harvest for revision ACL reconstruction in patients with prior BTB primary reconstruction, assessing patient-reported outcomes and return to sport at minimum 12 months. Harvest site selection was associated with differences in patient-related outcomes and return-to-sport timing and rates. The results inform shared decision-making regarding graft choice in revision ACLR, weighing the technical risks and benefits of ipsilateral versus contralateral extensor mechanism harvest.
186. Tashman S, Smith CA, Provencher MT, et al. Paper 51. Effects of Platelet-Rich Plasma and Bone Marrow Aspirate on Knee Kinematics, Graft Elongation and Muscle Function after ACL Reconstruction: A Randomized Clinical Trial. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00308
In a randomised trial, 43 patients undergoing bone-patellar tendon-bone ACL reconstruction received intraoperative PRP, BMAC, or no orthobiologic injection, with knee kinematics, graft elongation, and muscle function assessed at 6 and 12 months. The study provides in vivo biomechanical and functional data on whether orthobiologics accelerate recovery after ACLR. Results inform clinical decisions about adjunctive biologic injections to speed return to play.
217. Filtes P, Aryee J, Tyagi A, et al. Paper 21. Anterior Cruciate Ligament Reconstruction with Lateral Extra-articular Tenodesis versus Isolated Anterior Cruciate Ligament Reconstruction: A Markov Model-Based Cost-Utility Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00281
A Markov model-based cost-utility analysis compared ACL reconstruction with lateral extra-articular tenodesis (ACLR+LET) versus isolated ACLR, using outcomes from level 1 RCTs and CMS-based cost estimates from healthcare and societal perspectives. The model calculated QALYs and direct plus indirect costs for each procedure. The findings inform whether the added LET procedure represents good value for high-risk patients, guiding cost-conscious surgical decision-making.
227. Okada RR, Nagai KK, Matsushita T, et al. Paper 22. Coexistence of Knee Hyperextension and Steeper Posterior Tibial Slope Increases the Risk of Graft Failure After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00282
A retrospective study of 341 primary ACL reconstructions with hamstring autograft examined independent risk factors for graft failure and whether coexisting risk factors act cumulatively. The combination of knee hyperextension and steeper posterior tibial slope increased graft failure risk beyond either factor alone, demonstrating a cumulative effect. Surgeons should recognize knees with both anatomic risk features as high-risk and consider preventive strategies such as slope-reducing techniques or enhanced stability augmentation.
229. Wright R, Wright R. Poster 13. Effect of Graft Choice on Ten Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00329
The MARS cohort prospectively followed revision ACL reconstruction patients across 83 surgeons and 52 sites for ten years to determine whether revision graft choice predicted sports function, activity level, osteoarthritis symptoms, and graft failure. Autograft use was associated with superior patient-reported outcomes and reduced graft failure compared with allograft at ten years. When feasible, autograft should be preferentially selected in revision ACL reconstruction to optimise long-term function and durability.
230. Economopoulos K. Poster 14. A Prospective, Randomized Study Comparing the Modified Ellison and Modified Lemaire Techniques for Extraarticular Tenodesis in Primary ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00330
A prospective randomised trial compared the modified Ellison (distally based ITB reattached at Gerdy's tubercle) with the modified Lemaire LET in high-risk primary ACL reconstruction patients, with 30 patients per group planned. The modified Ellison produced clinical outcomes similar to the modified Lemaire while avoiding femoral tunnel convergence and providing reproducible graft reattachment. The modified Ellison represents a viable, technically advantageous alternative LET technique for reducing graft failure in high-risk ACL reconstruction.
238. Cherelstein RE, Ripic Z, Kuenze CM, et al. Poster 15. Impact of Lateral Extra-Articular Tenodesis on Quadriceps Strength Recovery in Young Patients after Anterior Cruciate Ligament Reconstruction with Extensor Mechanism Autografts. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00331
A retrospective multicenter review compared quadriceps strength and patient-reported outcomes at 6 and 9 months in patients aged ≤30 undergoing primary ACLR with quadriceps tendon or bone-patellar tendon-bone autografts, with or without concomitant lateral extra-articular tenodesis. Contrary to the hypothesis, LET was not associated with reduced quadriceps strength or worse PROMs at early postoperative time points. Adding LET for graft failure risk reduction appears compatible with expected quadriceps strength recovery in young patients receiving extensor mechanism autografts.
249. Nault M, Manitiu A, Mazy D, et al. Paper 23. Lateral Extra-articular Tenodesis Does Not Alter Gait Biomechanics After ACL Reconstruction in a Pediatric Population: A Motion Analysis Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00283
This motion analysis study compared gait biomechanics after ACL reconstruction with versus without lateral extra-articular tenodesis (LET) in paediatric patients using knee kinesiography, alongside healthy controls. Contrary to the hypothesis, LET did not alter gait biomechanics compared with isolated ACLR, suggesting the procedure does not overconstrain the lateral compartment in children. Clinically, this supports combining LET with ACLR in high-risk paediatric patients without concern for adverse gait changes.
252. Magnussen RA, Cantrell WA, Habbab Z, et al. Poster 43. No Difference in Short-Term Failure Risk of Patellar Tendon Autograft and Large Hamstring Tendon Autograft in Adolescents Undergoing Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00356
This retrospective review compared revision rates between patellar tendon (BTB) autograft and large (≥8 mm) hamstring tendon autografts in 289 adolescents undergoing primary ACL reconstruction. Large-diameter hamstring grafts showed failure risk comparable to BTB grafts, with no significant short-term difference between graft types. This suggests that when adequately sized hamstring autografts are used, graft selection need not be driven by failure concerns in adolescent patients.
263. Ricca GW, Yendluri A, Yu A, et al. Poster 23. Bone-Patellar Tendon-Bone Autograft Associated With Higher Rates of Long-Term Osteoarthritis Compared to Hamstring Autograft After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00338
This systematic review pooled studies with minimum 10-year follow-up after primary ACL reconstruction to compare long-term radiographic osteoarthritis rates by graft type. Bone-patellar tendon-bone autograft was associated with higher rates of long-term osteoarthritis than hamstring autograft. Graft choice discussions with patients should include this long-term degenerative risk, not just short-term functional outcomes.
287. Maguire K, Swanson ME, DeFrancesco C, et al. Poster 12. Differences in Graft Rupture and Subsequent Meniscus Tears Following Adolescent ACL Reconstruction Using Quadriceps Tendon Versus Hamstrings Autograft: A Retrospective Study with Minimum 2-Year Follow-Up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00328
A retrospective review of 467 adolescent patients (ages 10-19) undergoing ACL reconstruction with quadriceps tendon versus hamstring autograft at a tertiary paediatric hospital compared graft rupture and subsequent meniscal tear rates with minimum 2-year follow-up, using multivariable logistic regression. The study extends prior shorter-term evidence favoring quadriceps tendon grafts in adolescents. Results inform graft selection by clarifying longer-term reinjury differences between the two autograft options.
295. Huang Z, Yang W, Feng W, et al. Combined Anterior Cruciate Ligament Tensioned Remnant Suspension Repair and Autograft Reconstruction for Sherman I‐II Anterior Cruciate Ligament Injuries. Arthroscopy Techniques 2026. doi:10.1002/atn2.70200
This arthroscopic technique paper describes combined ACL tensioned remnant suspension repair with autograft reconstruction for acute Sherman I-II ACL injuries with functional remnants. The approach preserves and tensions the remnant to exploit its biologic scaffold and fluid-seal effects, promoting graft synovialization, revascularization, reinnervation, and potentially improved rotational control while maintaining anatomic tunnel accuracy. Clinically, it offers a strategy to enhance graft biology and stability in selected acute ACL injuries with outcomes comparable to standard reconstruction.
306. Bitar IJ, Bustos DG, Pezzutti L, et al. Mid-term outcomes after isolated bone–patellar tendon–bone ACL reconstruction versus hamstring ACL reconstruction combined with lateral extra-articular tenodesis in competitive soccer players: A prospective comparative study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104819
This prospective study compared mid-term outcomes of isolated bone, patellar tendon, bone ACL reconstruction versus hamstring ACL reconstruction augmented with lateral extra-articular tenodesis in 140 competitive soccer players with at least 5 years of follow-up. Contrary to the hypothesized equivalence, the results address whether adding LET provides superior clinical outcomes or reduced graft failure versus BPTB alone. The findings guide graft-choice decisions in high-risk pivoting athletes.
Meniscus Root Tears & Repair (14)¶
8. Andersen M, Tollefson LV, Ngobi J, et al. Effect of Multiple Centralization Sutures on Meniscal Extrusion and Contact Pressures in a Cadaveric Model of Medial Meniscus Root Repair. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261475396
In nine cadaveric knees simulating persistent extrusion after posterior medial meniscus root repair, meniscal extrusion and tibiofemoral contact pressures were tested with centralization sutures placed at different locations and in various combinations. Contrary to the hypothesis, the number and placement of centralization sutures did influence extrusion and/or contact pressure outcomes. The findings inform surgical decision-making regarding how many centralization sutures to add and where to place them during medial meniscus root repair.
9. F. Gonzalez F, Mameri E, Kozicka A, et al. Medial Meniscus Posterior Root Repair Is Associated With Better Function But Persistent Knee Varus Thrust and Reduced Knee Internal Rotation During Gait. Arthroscopy 2026. doi:10.1002/arj.70464
Three-dimensional gait analysis compared patients with unrepaired medial meniscus posterior root tears, patients at least 6 months after transtibial pullout repair, and matched healthy controls. Repair patients reported better function but still showed persistent varus thrust and reduced knee internal rotation versus controls. Clinicians should counsel patients that root repair improves symptoms without fully normalizing gait mechanics, which may have long-term implications.
13. Vasiliadis AV, Gkekas NK, Maris A, et al. Medial meniscus posterior root repair with concomitant centralization does not demonstrate superior reduction of meniscal extrusion or improved clinical outcomes compared with isolated repair: A systematic review and meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70583
A PRISMA-compliant systematic review and meta-analysis of six comparative studies evaluated medial meniscus posterior root repair alone versus repair plus meniscal centralization, pooling mean differences for meniscal extrusion and standardised mean differences for patient-reported outcomes. Adding centralization did not significantly reduce meniscal extrusion or improve clinical outcomes versus isolated repair. Routine use of concomitant centralization is not supported by current evidence.
33. Shen M, Chen L, Padon B, et al. The Association of Advanced Patellofemoral Chondrosis With Outcomes After Posterior Medial Meniscus Root Repair. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261471374
This retrospective cohort study compared outcomes of isolated posterior medial meniscus root repair in patients with advanced (Outerbridge ≥3) patellofemoral chondrosis versus those without, using meniscal retear, revision surgery, conversion to arthroplasty, and patient-reported outcomes. The findings address a gap in the literature, as tibiofemoral but not patellofemoral chondrosis had previously been established as a negative prognostic factor. Clinically, the results help guide patient selection and counseling regarding root repair in knees with patellofemoral cartilage damage.
52. Sanitsakul H, Parinyakhup W, Boonriong T, et al. An Arthroscopic Oblique Ripstop Technique in Medial Meniscal Root Repair. Arthroscopy Techniques 2026. doi:10.1002/atn2.70213
This technique paper describes a modified oblique ripstop configuration for arthroscopic medial meniscal root repair, using an obliquely oriented horizontal mattress stitch positioned perpendicular to the cinch stitch to resist suture cut-through. The modification targets poor-quality meniscal tissue, where the standard pull-out technique risks suture pull-out. It offers a simple, reproducible alternative with potential biomechanical advantages in compromised tissue.
61. Nonaka S, Hatayama K, Okada K, et al. Clinical improvement despite structural degeneration after nonoperative treatment of medial meniscus posterior root tear: A prospective longitudinal study. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70570
This prospective longitudinal study followed 64 patients with acute medial meniscus posterior root tears managed nonoperatively, tracking clinical scores, radiographic parameters, and MRI findings over at least two years. Although 23.4% of patients converted to surgery at a median of six months, the majority (76.6%) continued nonoperative treatment and achieved clinical improvement despite progressive structural degeneration on imaging. Nonoperative management remains a viable initial strategy for selected patients, though structural deterioration should be anticipated and monitored.
64. Carrozzo A, Bérard É, Petrini T, et al. Anterior cruciate ligament reconstruction with concomitant all‐inside lateral meniscus posterior root repair shows comparable graft survivorship and clinical outcomes to isolated ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70574
This retrospective cohort study compared 786 isolated ACL reconstructions with 55 ACL reconstructions plus all-inside lateral meniscus posterior root repair, using graft rerupture-free survival as the primary endpoint over a median 46-month follow-up. Graft rerupture rates were similar between groups (5.2% vs. 9.1%), with comparable return to sport, return to work, and clinical scores. Concomitant lateral meniscus root repair at the time of ACLR does not compromise graft survivorship or early clinical outcomes.
140. Cohen D, de SA D, Chahla J, et al. Meniscal Root Tears: A State of the Art. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101202
This state-of-the-art review synthesizes current evidence on meniscal root tears, defined as complete radial tears within 1 cm of the bony insertion or root avulsions, which abolish hoop stress and biomechanically mimic total meniscectomy, leading to meniscal extrusion, cartilage degeneration, and early osteoarthritis. It highlights two distinct epidemiologic patterns, degenerative posterior medial root tears in older, obese, varus-aligned patients and lateral posterior root tears in younger patients associated with ACL injury, and emphasizes that underdiagnosis due to nonspecific examination findings makes MRI and a high index of suspicion essential. Clinicians should maintain awareness of this 'silent epidemic' to enable earlier diagnosis and treatment aimed at preventing rapid joint degeneration.
171. Choi N, Yang B, Lee D, et al. Increased Posterior Tibial Slope as a Risk Factor for Failure of Healing of Medial Meniscal Root Tears After All-Inside Suture Anchor Repair. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477913
This case-control study compared medial posterior tibial slope between healed and nonhealed groups among patients undergoing all-inside suture anchor repair of medial meniscal posterior root tears, with healing assessed on MRI at 6 months. Increased medial posterior tibial slope was identified as a risk factor for failure of meniscal root healing after repair. Surgeons should consider measuring posterior tibial slope preoperatively, as elevated slope may warrant slope-correcting osteotomy or counseling regarding higher repair failure risk.
172. Grandberg C, Boduch A, Bilodeau RE, et al. Paper 01. No Differences in Long-Term Survival After Medial Meniscus Posterior Root Repair Between Low- and High-Grade Chondral Changes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00263
This study compared long-term survival and patient-reported outcomes of medial meniscus posterior root repair between patients with low-grade (Outerbridge 0-2) and high-grade (Outerbridge 3-4) chondral changes identified at surgery. Contrary to the hypothesis, no differences in long-term repair survival or outcomes were found between the chondral grade groups. These results suggest that moderate-to-advanced chondrosis at the time of root repair should not be an absolute contraindication to meniscal root repair.
174. Shen M, Shelbaya S, Chen L, et al. Paper 03. The Effect of Patellofemoral Chondrosis on Outcomes Following Meniscus Root Repair. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00265
This retrospective study evaluated outcomes of isolated medial meniscal posterior root repair in patients with and without advanced (Outerbridge grade ≥3) patellofemoral chondrosis with minimum 2-year follow-up. Concomitant advanced patellofemoral chondrosis negatively affected outcomes following root repair, informing the re-tear, revision surgery, and arthroplasty conversion rates and patient-reported outcomes. Surgeons should assess the patellofemoral compartment when counseling patients and selecting candidates for meniscal root repair.
185. Horowitz E, Kremenic IJ, Orishimo KF, et al. Paper 49. Weight Bearing After Novel Onlay Medial Meniscus Root Repair: A Cadaveric Study Analyzing the Integrity of Meniscal Root Repairs Subjected to Physiologic Cyclic Loading with an Intraosseous All-Suture Anchor Device. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00306
Cadaveric knees underwent medial meniscus root repair with a novel onlay intraosseous all-suture anchor and were subjected to cyclic loading in full extension simulating weight bearing as tolerated. The repairs withstood forces exceeding twice physiologic weightbearing loads without failure. This supports early postoperative weightbearing protocols rather than routine non-weightbearing after this root repair technique.
242. Fernandes Gonzalez FF, Mameri E, Kozicka A, et al. Poster 48. Gait Biomechanics in Medial Meniscus Posterior Root Tears and Repairs: Assessing Established Risk Factors for Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00361
In a cross-sectional study of 58 knees, 3D gait analysis compared kinematics and kinetics in patients with medial meniscus posterior root tears, after transtibial pullout repair, and in healthy controls. Both tear and repair groups showed altered gait characteristics linked to joint degeneration, indicating that surgical repair does not fully normalize knee loading. Identifying these modifiable biomechanical factors could guide gait retraining to reduce the high risk of progression to knee osteoarthritis after root tears.
309. Han JH, Kim S, Jung M, et al. Absorbable versus non-absorbable suture materials in transtibial pull-out repair of medial meniscus posterior root tears: a systematic review and meta-analysis. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104856
This systematic review and meta-analysis of 16 studies (647 patients) compared absorbable versus non-absorbable suture materials in transtibial pull-out repair of medial meniscus posterior root tears. Outcomes including patient-reported measures, MRI-based healing, meniscal extrusion, Kellgren-Lawrence progression, and conversion to TKA were analyzed with subgroup analyses by suture absorbability. The findings clarify whether suture material choice influences clinical and radiological results, guiding operative decision-making.
Patellofemoral Instability & Alignment (14)¶
2. Sachdev D, Amin J, Song C, et al. High Accuracy of Intraoperative Planning for Tibial Tubercle Distalization: A Retrospective Comparison of Intraoperative Measurements and Postoperative Radiographic Outcomes. Arthroscopy 2026. doi:10.1002/arj.70507
In 22 knees undergoing medial patellofemoral ligament reconstruction with distalizing tibial tubercle osteotomy, the planned intraoperative change in patellar height (Caton-Deschamps Index) was compared with actual postoperative radiographic change using correlation, regression, and Bland-Altman analysis. Intraoperative planning showed high accuracy in achieving the intended distalization. This supports surgeons' ability to reliably predict postoperative patellar height using intraoperative measurements with either distalization technique.
47. Kahlon H, Blackman B, Vivekanantha P, et al. Medial Quadriceps Tendon‐Femoral Ligament Reconstruction Offers Favorable Clinical Outcomes and Low Complication Rates for Recurrent Patellar Instability: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70433
This systematic review of 9 studies comprising 347 patients (68.3% female, mean age 18.6 years) evaluated medial quadriceps tendon-femoral ligament reconstruction (MQTFLR), isolated or combined with MPFL reconstruction, for recurrent patellar instability. Combined MQTFLR + MPFLR yielded favourable Kujala (85.9-93.6), IKDC (81.5-91.2), and Lysholm (84.3-93.3) scores with moderate Tegner scores and low complication rates. MQTFLR represents a viable, low-complication option for recurrent patellar instability, though higher-quality comparative studies are needed.
106. Lijesen E, Tracey OC, Beber SA, et al. Medial patellotibial ligament reconstruction concomitant with medial patellofemoral ligament (MPFL) reconstruction in fixed and obligatory patellar dislocation: A consecutive case series. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101124
This consecutive case series included 16 knees in 14 paediatric patients (mean age 14.5 years) who underwent medial patellotibial ligament reconstruction combined with MPFL reconstruction for fixed or obligatory patellar dislocation, most with syndromic or hypermobility conditions and abnormal patellofemoral morphology. The authors report demographic, radiographic, and surgical details for this cohort. The series adds to limited literature supporting concomitant MPTL reconstruction as an adjunct to MPFL reconstruction in complex paediatric patellar instability.
124. Surabotsopon P, Laucha T, Suwanmana S, et al. Additional Medial Patellotibial Ligament Reconstruction Reduced Lateral Patellar Translation Compared With Isolated Medial Patellofemoral Ligament Reconstruction Without Increasing Patellofemoral Contact Pressure: A Cadaveric Study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101200
In this cadaveric study, 18 fresh-frozen knees with simulated patellar instability were randomised to isolated MPFL reconstruction or combined MPFL-MPTL reconstruction, with patellar kinematics and patellofemoral contact pressures measured across flexion angles from 0° to 90°. Combined MPFL-MPTL reconstruction reduced lateral patellar translation more than isolated MPFL reconstruction without increasing patellofemoral contact pressure. This supports adding MPTL reconstruction in selected patellar instability cases without concern for adverse contact pressure effects.
151. Angelelli L, Mazy D, Cance N, et al. Overcoming Limitations in Tibial Tubercle–Trochlear Groove Distance Measurement: A Study of Its Reproducibility and Reliability in High-Grade Trochlear Dysplasia. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261460677
TT-TG distance was measured on MRI at three trochlear reference levels (high, middle, low) plus TT-PCL in 136 knees with patellar instability, most with high-grade trochlear dysplasia, and reliability was assessed with ICCs. The study demonstrates that TT-TG remains feasible and reliable even in high-grade dysplasia when alternative trochlear reference levels are used, improving measurement standardization for surgical decision-making.
179. De Virgilio L, Heyworth BE, Milewski MD, et al. Paper 34. Clinical Outcomes and Return-to-Sport Rates in Skeletally Mature Adolescents with TT-TG ≥20mm Treated with MPFL Reconstruction With or Without TTO. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00292
This retrospective cohort study compared isolated MPFL reconstruction versus MPFL reconstruction with concomitant tibial tubercle osteotomy in skeletally mature adolescents (ages 13-19) with TT-TG distance ≥20 mm and at least one year of follow-up. Outcomes including recurrent instability, complications, reoperations, return-to-sport rates, and patient-reported measures (SANE, Pedi-IKDC, Pedi-FABS) were analyzed. Results inform the controversial decision of whether TTO can be safely omitted in this high-risk adolescent population.
200. Mun F, Mikula JD, Cosgarea AJ. Poster 76. When Measurement Meets Observation: Defining the Maltracking Pattern and Characterizing the Pathoanatomy in Patients with Patellar Instability and a Jumping J-Sign. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00386
Patients with recurrent patellar instability underwent dynamic kinematic CT to quantitatively define the jumping J-sign maltracking pattern using maximum bisect offset and to characterize associated patellofemoral pathoanatomy. The study established objective bisect offset, based criteria distinguishing J-sign severity groups and identified underlying anatomic features predisposing to this maltracking pattern. These quantitative thresholds can standardize the indication for trochleoplasty and guide surgical decision-making in patellar instability.
219. Magnussen RA, Cantrell WA, Comisford L, et al. Poster 79. Combined MPFL ReconstructionaAnd Anteromedialization Tibial Tubercle Osteotomy Does Not Decrease Patellar Height More Than Reconstruction Alone. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00389
A retrospective single-institution cohort compared patellar height changes, measured by Caton-Deschamps, Insall-Salvati, and Blackburne-Peel indices on standardised lateral radiographs, after isolated MPFL reconstruction, MPFLR with anteromedialization tibial tubercle osteotomy, and MPFLR with distalization osteotomy. As hypothesized, anteromedialization did not lower patellar height more than MPFLR alone, while distalization produced a greater decrease. Surgeons should not expect AMZ TTO to correct patella alta; distalization is required when patellar height reduction is a surgical goal.
226. Yanke AB, Ackermann J, Sachdev D, et al. Poster 57. Tibial Tubercle–Posterior-Cruciate-Ligament Distance Fails to Capture Pathologic Patellar Lateralization in Trochlear Dysplasia. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00368
In 154 patients with patellofemoral instability undergoing MRI, TT-TG and TT-PCL distances were compared across grades of trochlear dysplasia alongside knee rotation and patellar lateralization measures. TT-PCL failed to capture pathologic patellar lateralization in dysplastic knees because it ignores joint-line rotational malalignment, underestimating true lateralization. TT-PCL alone may under-select patients for tibial tubercle osteotomy, so TT-TG or combined measures should guide surgical indications in trochlear dysplasia.
245. Ali AH, Lee JG, Smith MS, et al. Poster 50. High Variability in Tibial Tuberosity to Trochlear Groove Distance on Repeat Knee MRI Scans in Adult Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00363
Tibial tuberosity-to-trochlear groove distances were independently measured on two or more MRI scans of the same knee obtained at different time points in adults who underwent no intervening extensor mechanism surgery. TT-TG measurements showed high variability across repeat scans in the same patient. Clinicians should be cautious using a single MRI-based TT-TG value to justify tibial tubercle osteotomy in patellofemoral instability.
258. Sachdev D, Yanke AB, Smelley CC, et al. Poster 94. sTT-TG is Superior to TT-TG and PTLTR in Identifying Significant Pathoanatomy in Patellofemoral Instability: A Statistical Shape Modeling Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00399
This retrospective statistical shape modeling (SSM) analysis of 3D MRI scans from 23 patellofemoral instability patients and 4 controls evaluated whether TT-TG, sagittal TT-TG (sTT-TG), and PTLTR measurements correspond to distinct 3D extensor mechanism morphology. sTT-TG proved superior to TT-TG and PTLTR in identifying significant pathoanatomy associated with instability. This supports incorporating sagittal-plane measurement into the radiographic evaluation of patellofemoral instability.
262. Yanke AB, Yuh C, Augustin EJ, et al. Poster 91. Multidomain Statistical Shape Modeling to assess Anatomic Variations Underlying the J-sign in Patellofemoral Instability Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00397
This retrospective study applied multidomain statistical shape modeling to femoral, tibial, and patellar morphology on 3D MRI scans from 22 recurrent patellofemoral instability patients stratified by J-sign severity (grades 1-4). Increasing J-sign severity corresponded to distinct 3D morphological differences across the bones of the extensor mechanism. The findings help explain why high-grade J-sign patients fare worse after MPFL reconstruction and may guide selection of additional realignment procedures.
264. Hashiguchi N, Gholipour A, Stefano M, et al. Poster 69. Biomechanical Comparison of Medial Quadriceps Tendon–Femoral Ligament and Medial Patellofemoral Ligament Reconstructions: A Cadaveric Load-to-Failure Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00379
In this cadaveric load-to-failure study, five fresh-frozen knees underwent sequential medial quadriceps tendon-femoral ligament (MQTFL) and medial patellofemoral ligament (MPFL) reconstructions with cyclic loading and failure testing at 30° flexion. MQTFL reconstruction demonstrated biomechanical equivalence to MPFL reconstruction in ultimate failure stress, with failure modes categorized as fixation-related or graft rupture. This supports MQTFL as a biomechanically viable alternative for patellofemoral instability reconstruction.
304. Park Y, Koh J, Amirouche F. Mechanistic evidence linking TT-TG translation to patellofemoral contact pressure and tibial tubercle position to improve knee joint stability. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104813
A finite element knee model built from micro-CT data isolated the effect of mediolateral tibial tubercle translation (TT-TG change) on patellofemoral contact pressure across 0°-90° flexion. The analysis quantified how medialization versus lateralization alter loading and identified flexion ranges most sensitive to TT-TG variation. These mechanistic findings refine surgical decision-making for tubercle osteotomy in patellar instability by clarifying the independent pressure effects of TT-TG correction.
Knee Arthroplasty Perioperative Care (19)¶
28. Jørgensen CC, Sveen T, Johansen B, et al. Implementation and early results of same-day hip and knee replacement in a public hospital without prior same-day surgical experience, a feasibility study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06468-0
A feasibility study implemented a same-day surgery (SDS) protocol for hip and knee replacement in a public hospital department without prior same-day experience, following Bowen's implementation framework with prospective outcome collection. By October 2024, 150 of 713 patients (21%) underwent SDS with a dedicated day-surgical pathway and safety-net transfer to the regular ward. Early results suggest SDS pathways can be successfully implemented de novo in inexperienced departments, supporting broader adoption with structured implementation support.
37. Monteiro R, Mohammadi A, Nedopil AJ, et al. A new cementless tibial baseplate in kinematically aligned total knee arthroplasty has low migration and stabilizes at 3 months: A cohort study using radiostereometric analysis. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70572
In this cohort study, 45 patients received a new cementless tibial baseplate in kinematically aligned total knee arthroplasty, and migration was measured with model-based radiostereometric analysis at 6 weeks, 3, and 6 months. Mean maximum total point motion at 6 months fell below the established threshold associated with low long-term loosening risk, with stability achieved by 3 months; migration was not meaningfully related to varus alignment angles or tibial recut. These results support continued investigation of the implant, though longer-term surveillance remains necessary.
67. Chan KCA, Cheung A, Luk MH, et al. Radiographic features of bone ingrowth in highly porous cementless total knee arthroplasty with minimum 2-year follow-up. Arthroplasty 2026. doi:10.1186/s42836-026-00422-6
This retrospective study of 301 robotic-assisted cementless total knee replacements with highly porous 3D-printed implants characterized the temporal pattern of radiographic osseointegration signs over a minimum 2-year follow-up. Trabecular line formation, early radiolucent lines, and bone resorption followed a predictable temporal sequence, supporting a proposed framework for defining successful osteointegration. This gives surgeons and researchers reference benchmarks for interpreting postoperative radiographs of cementless TKA.
79. Innocenti M, Leggieri F, Massenzi M, et al. Patient mortality exceeds implant revision risk with equivalent survival following unicompartmental versus total knee arthroplasty in octogenarians. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06466-2
This retrospective cohort study of 238 octogenarians compared mid-term mortality after UKA versus TKA at a single tertiary center. Patient mortality substantially exceeded implant revision risk, with no significant difference in survival between implant types, suggesting that traditional decision-making based on long-term implant survivorship may be inappropriate in this age group. Selection between UKA and TKA in octogenarians should prioritise patient-specific factors over implant longevity considerations.
112. Garcia D, Thota P, Dogiparthi A, et al. Keloidosis is Associated with an Increased Risk for Developing Arthrofibrosis After Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.059
Using a national electronic health records database, 1,205 TKA patients with a keloid history were propensity matched 1:1 to controls on demographics, comorbidities, and psychiatric factors, and assessed for arthrofibrosis and aseptic revision within one and two years. Patients with prior keloids showed a statistically significant increased risk of arthrofibrosis post-TKA. The clinical implication is that keloidosis may serve as a preoperative risk marker for arthrofibrosis, warranting heightened surveillance or prophylactic strategies in these patients.
113. Ng MK, Mastrokostas LE, Mastrokostas PG, et al. Liposomal Bupivacaine in Periarticular Injection Cocktails for Pain Management After Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.058
This systematic review of randomised controlled trials evaluated liposomal bupivacaine in periarticular injection cocktails after total knee arthroplasty, assessing pain control, opioid consumption, and functional recovery. Findings were inconsistent across trials, leaving the clinical utility of liposomal bupivacaine debated. Surgeons should not assume added analgesic benefit over standard multimodal cocktails without stronger evidence, given its cost.
125. Sribhashyam S, Gooch BR, Yazdanpanah S, et al. More Technology, but Similar Early Safety: Robotic Versus Conventional Unicompartmental Knee Arthroplasty, a 30-Day Outcome National Database Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.001
This NSQIP national database study (2022-2024) compared 30-day outcomes between robotic and conventional unicompartmental knee arthroplasty using propensity matching (727 R-UKA vs 1,454 C-UKA) with well-balanced covariates. Early 30-day adverse event rates were similar between the two techniques, indicating comparable short-term safety despite the added technology. The findings suggest that the value of robotic UKA must be judged on longer-term functional and survivorship outcomes rather than early perioperative safety.
134. Ng MK, Lin JH, Spitzer AI, et al. Administration of Preoperative Cryoneurolysis is Associated with Continued and Persistent Opioid Reduction and Improved Outcomes in Primary Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.014
A multicenter registry study of 351 unilateral primary total knee arthroplasty patients compared 171 who received preoperative cryoneurolysis within 30 days of surgery with 180 controls. Cryoneurolysis was associated with reduced opioid use across all postoperative intervals (61% vs 89% in the first week), along with improvements in pain severity and functional recovery. Preoperative cryoneurolysis is a promising non-opioid analgesic adjunct that may support opioid-sparing multimodal protocols in primary TKA.
136. Tse S, Lisacek-Kiosoglous AB, Lee P, et al. Complication Profile of a Computed Tomography-Guided Robotic-Arm Assisted Unicompartmental Knee Arthroplasty System: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.017
A systematic review and meta-analysis of 35 studies (10,894 robotic and 10,065 manual cases) characterized the complication profile of a CT-guided, semi-active robotic-arm-assisted unicompartmental knee arthroplasty platform versus manual UKA. Intraoperative complications occurred in 0.2% of robotic cases (pin-related fractures, soft-tissue injuries, system errors), with overall complications of 4.2%. The robotic platform demonstrates a low and well-characterized complication profile, providing benchmark data for surgeons adopting this technology.
138. Sontam TR, Tummala S, Janett J, et al. Elevated Risk of Periprosthetic Joint Infection and Revision in Patients Who Have Psoriasis after Total Knee Arthroplasty: A Propensity-Matched Cohort Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.022
Using a large multi-institutional electronic health records database, 4,191 patients with an active psoriasis diagnosis within three months before total knee arthroplasty were propensity matched 1:1 to 4,191 controls from a total cohort of 156,015 primary TKAs. Patients with psoriasis demonstrated elevated risk of complications including deep vein thrombosis at 90 days and periprosthetic joint infection, periprosthetic fracture, mechanical loosening, and revision at two years. The results indicate that active psoriasis should be considered a risk factor for perioperative and mid-term complications after TKA, warranting heightened surveillance and counseling.
288. Obioha OA, Magnussen RA, Paine HN, et al. Poster 90. Patients Who Suffer A Single Patellar Dislocation Without Recurrence – Are They Doing As Well As Those Who Had Surgery? Data from the JUPITER Cohort. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00396
Using the multi-center prospective JUPITER cohort, this study compared patient-reported outcomes of patients with a single patellar dislocation managed nonoperatively without recurrence against those treated surgically after first-time dislocation. The hypothesis was that the two groups would show similar outcomes within two years. The findings help contextualize counseling for first-time dislocators by benchmarking nonoperative outcomes against surgical results.
305. André P, Micicoi G, Siboni R, et al. Mid-terms results of arthroscopic arthrolysis for stiffness around total knee arthroplasty. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104817
This multicenter retrospective cohort of 85 patients evaluated arthroscopic arthrolysis for stiffness after primary total knee arthroplasty at mid-term follow-up. The study assessed whether patients achieved a significant 20° improvement in range of motion, along with functional scores and complications. The findings inform the use of this minimally invasive option for managing post-TKA stiffness.
307. Sueda R, Kawahara S, Mitsuyasu H, et al. Propensity score-matched comparison of unicompartmental and total knee arthroplasty in older patients: Lower invasiveness and faster early recovery after UKA. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104821
This propensity score-matched retrospective cohort (88 knees per group) compared unicompartmental and total knee arthroplasty in older patients with varus osteoarthritis or osteonecrosis. UKA showed lower surgical invasiveness and faster early postoperative recovery while maintaining comparable short-term patient-reported and radiographic outcomes. The results support UKA as a less invasive option in appropriately selected older patients.
312. Bouché P, Kutaish H, Donat T, et al. Comparison of functional and mechanical alignment in robotic- and computer-assisted posterior-stabilized total knee arthroplasty: clinical and patient-reported outcomes from a propensity-matched cohort study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104861
This propensity-matched retrospective cohort (86 patients per group) compared mechanical alignment with computer navigation versus functional alignment with robotic assistance in posterior-stabilised total knee arthroplasty. The primary outcome was persistent pain (VAS ≥4/10) at six months, with secondary patient-reported and functional outcomes at minimum one-year follow-up. The results test whether functional alignment offers superior outcomes without compromising perioperative safety, informing alignment philosophy selection in TKA.
316. ALTUN O, Daşar U, Bozkurt M. Tourniquet Use Independently Predicts Early Quadriceps Inhibition Following Primary Total Knee Arthroplasty: A Dose-Response Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.035
A retrospective cohort of 110 primary unilateral total knee arthroplasty patients compared early quadriceps inhibition, defined as inability to perform an active straight leg raise, between tourniquet (n=57) and tourniquet-free (n=53) groups, with blinded assessment on postoperative days 1 and 3. Tourniquet use independently predicted quadriceps inhibition (OR 6.25), with inhibition occurring in 40.4% versus 18.9% of tourniquet-free patients, alongside BMI as a dose-response predictor. Avoiding tourniquet use may improve early quadriceps activation and mobilization after TKA.
319. Lin H, Lu H, Lee C, et al. Effect of Dementia on Risk Factors for Postoperative Delirium in Older Patients Undergoing Total Knee Arthroplasty: A Retrospective Cohort Study Based on a Large National Dataset. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.031
A retrospective national dataset cohort of 22,077 patients aged ≥75 years undergoing total knee arthroplasty examined whether dementia modifies risk factors for postoperative delirium, using separate multivariate models for patients with (n=609) and without dementia. Postoperative delirium occurred in 20.7% of dementia patients versus 2.6% without, with dementia independently increasing risk nearly six-fold (OR 6.47). Risk factor profiles differed by dementia status, advanced age, smoking, and functional dependency dominated in dementia patients, supporting dementia-tailored delirium prevention protocols.
320. Chen W, Shen P, Wu C, et al. Graded Association Between Preoperative Bone Mineral Density and Two-Year Postoperative Complications After Primary Total Hip and Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.032
A single-center retrospective cohort of primary total hip and knee arthroplasty patients with preoperative dual-energy X-ray absorptiometry (2015-2023) evaluated whether decreasing bone mineral density shows a graded association with two-year postoperative complications, categorizing patients as normal, osteopenic, or osteoporotic by lowest T-score. The primary outcome was two-year reoperation, with secondary outcomes including periprosthetic fracture, infection, readmission, mortality, and dislocation. The findings address whether osteopenia, often considered borderline, carries meaningful reoperation risk, informing preoperative bone health optimization strategies.
322. Hall RP, Braithwaite CL, Van Schuyver PR, et al. Diabetes is Associated with an Increased Risk of Arthrofibrosis Following Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.041
This retrospective propensity-matched cohort study of primary total knee arthroplasty patients examined whether preoperative HbA1c levels predicted arthrofibrosis requiring manipulation under anaesthesia or arthroscopic lysis of adhesions. Even well-controlled diabetic patients (HbA1c 5.7-6.9) had modestly increased early odds of these interventions within three months of surgery (OR 1.21), with risk rising among those with poorer glycemic control. Clinicians should counsel diabetic patients, regardless of control status, about elevated early stiffness risk and optimise glycemic management before TKA.
323. Olatunbosun S, Playter K, Hollenbeck B. Analyzing 30-Day Episode Costs for Total Joint Arthroplasty: Identifying Targets for Cost Reduction Under Bundled Payment Models. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.042
This retrospective analysis of 2022 Medicare patients undergoing lower extremity joint arthroplasty characterized 30-day episode costs under bundled payment models. The index hospitalization accounted for 84% of the average $25,245 episode cost for MS-DRG 470 patients, with home health visits representing the largest post-acute expense. Cost-reduction efforts under bundled payment arrangements should therefore prioritise hospitalization efficiency and home health utilisation rather than downstream services.
Cartilage Restoration & Biologics (16)¶
6. Kang LS, Ina JG, Kietselaer M, et al. Approximately 30% of Patients Undergoing Knee Cartilage Biopsy Subsequently Undergo Matrix‐Induced Autologous Chondrocyte Implantation at a Mean 4.3‐Year Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70429
Among 208 knees undergoing cartilage biopsy for matrix-induced autologous chondrocyte implantation (MACI), 31% proceeded to second-stage implantation at a mean 4.3-year follow-up. Of the 144 knees not implanted, 60% reported symptom improvement after biopsy alone, while others were limited by insurance denial, alternative procedures, or pending scheduling. Clinically, a substantial proportion of patients may not require implantation after biopsy, and nonclinical barriers significantly influence access to staged MACI.
11. Tauro TM, Hershfeld B, Chen K, et al. Availability and Pricing of Orthobiologic Knee Injections Vary by Practice Type but Not by Community Socioeconomic Vulnerability in Suburban New York. Arthroscopy, Sports Medicine, and Rehabilitation 2026. doi:10.1002/ars2.70074
A telephone survey of 91 clinics in suburban New York assessed availability, price transparency, and pricing of PRP, bone marrow aspirate concentrate, and stem cell injections for knee osteoarthritis, correlating findings with the Social Vulnerability Index. Orthobiologics were widely offered (76 clinics), with stem cell injections more common at alternative clinics than orthopaedic sports medicine practices, and pricing did not vary by community socioeconomic vulnerability. Patients and clinicians should recognize that access and pricing differ by practice type rather than neighborhood socioeconomic status.
17. Lin EH, Feingold CL, Barcenas AB, et al. Prospective Studies Investigating Matrix‐Induced Autologous Chondrocyte Implantation Report Higher Rates of Graft Failure Compared With Retrospective Studies: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70430
This systematic review compared outcomes of matrix-induced autologous chondrocyte implantation (MACI) for knee cartilage defects between 19 prospective studies (979 patients) and 9 retrospective studies. Prospective studies reported significantly higher graft failure rates than retrospective studies, suggesting publication or selection bias may cause underreporting of failures in retrospective designs. Clinicians interpreting MACI literature should be cautious when relying on retrospective series, which may overestimate treatment success.
36. Delgado D, Andrade R, Gomes E, et al. Younger age and platelet‐rich plasma characteristics influence short‐term outcomes in knee osteoarthritis, but independent effects remain uncertain: A systematic review with meta‐analysis and meta‐regression of placebo‐controlled randomised trials. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70567
This systematic review with meta-analysis and meta-regression included 20 placebo-controlled randomised trials of intra-articular PRP for knee osteoarthritis (1,774 PRP-treated patients). PRP significantly improved pain and function at 6 and 12 months versus placebo, though with very low certainty of evidence, and meta-regression suggested younger age, higher platelet increase factor, and platelet activation were associated with better outcomes. However, the authors conclude that the independent effects of specific PRP characteristics remain uncertain, limiting evidence-based product standardization.
63. Han JH, Jung M, Chung K, et al. Autologous adipose‐derived mesenchymal stromal cell injection for knee osteoarthritis improves pain and function without a clear increase in adverse events: A systematic review and meta‐analysis of randomized controlled trials. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70569
This systematic review and meta-analysis of six randomised controlled trials (551 patients) evaluated intra-articular autologous adipose-derived mesenchymal stromal cell injections for knee osteoarthritis. Treatment was associated with significantly lower WOMAC total scores at 3 and 6 months and reduced pain, without a clear increase in adverse or serious adverse events. AD-MSC injection appears to be a safe and effective option for knee OA, though the modest effect sizes and limited trial numbers warrant cautious interpretation.
150. Tabbaa SM, McCauley JC, Crawford DC, et al. Association of Donor Characteristics and Graft Storage Time with Survivorship of Osteochondral Allograft Transplantation in the Knee. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261457786
Among 220 patients (236 knees) with fresh osteochondral allograft transplantation of the knee and minimum 2-year follow-up, survivorship was compared across donor age (≤20 vs >20 years), donor BMI, sex-matching, and storage time (early vs late release). The study clarifies which donor characteristics and storage durations affect graft survival and outcomes, potentially guiding allograft selection and tissue-bank practices.
161. Linstrom NW, Bugbee WD, Wang T. Conditional Survivorship of Osteochondral Allograft Transplantation in the Knee. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261468538
This case series of 288 knees undergoing osteochondral allograft transplantation with minimum 10-year follow-up used Kaplan-Meier analysis and piecewise regression to characterize the timing of graft failure and calculate conditional survivorship. Graft failure risk was shown to be time-dependent, with conditional survivorship improving the longer a graft remained in place. These temporal failure patterns allow clinicians to provide more accurate, milestone-based counseling to patients about their evolving long-term graft survival expectations.
182. Sundaram V, Gosnell GG, Gould HP, et al. Paper 44. Greater Valgus Alignment Predicts Worse Survivorship Following Lateral Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00302
This retrospective review examined lateral meniscal allograft transplantation (2011-2024) in patients without concomitant realignment osteotomy who had preoperative standing long-leg radiographs, to determine whether subtle coronal malalignment affects graft survivorship. Greater valgus alignment was found to predict worse graft survival, supporting the biomechanical theory that increased compartment loading impairs graft viability. The results suggest a threshold of valgus malalignment above which concomitant osteotomy should be considered at the time of lateral MAT.
183. Bussey-Sutton C, Rodney K, Sundaram V, et al. Paper 45. Varus Malalignment Is Associated with Increased Failure Risk Following Medial Compartment OCA Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00303
This retrospective study evaluated medial femoral condyle osteochondral allograft transplantation (2011-2022) in patients without concomitant realignment osteotomy, using preoperative long-leg alignment radiographs to assess the impact of coronal alignment on graft survivorship. Varus malalignment was associated with an increased risk of graft failure. These findings suggest that even subtle varus alignment should be evaluated, and potentially corrected with realignment osteotomy, when planning medial compartment OCA transplantation.
188. Sherman SL, Zaslav KR, Gomoll AH, et al. Paper 53. Impact of Osteoarthritis on Outcomes After Implantation of an Aragonite-Based Scaffold for Knee Chondral and Osteochondral Defects: Analysis of an RCT at 5-Year Follow-up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00310
A covariate analysis of a 251-patient RCT compared aragonite-based scaffold implantation versus debridement/microfracture for femoral condylar and trochlear cartilage lesions, stratified by Kellgren-Lawrence grade (0-1 vs 2-3), at 60-month follow-up using KOOS endpoints. The analysis tested whether mild-to-moderate osteoarthritis compromises scaffold outcomes. Findings guide patient selection for this cartilage repair technology based on OA status.
189. Wang T, Linstrom NW, Bugbee WD. Paper 54. Short Term Outcomes Predict Long Term Success Following Osteochondral Allograft Transplantation in the Knee. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00311
Kaplan-Meier and conditional survivorship analysis was performed on 288 knees undergoing osteochondral allograft transplantation with minimum 10-year follow-up to define the temporal distribution of graft failures. Early postoperative years were used to forecast 10-year graft survival. These conditional survival estimates allow more accurate patient counseling about long-term OCA success based on early outcomes.
190. Wang T, Dhanjani SA, Bugbee WD. Paper 55. Osteochondral Allograft Transplantation Is Successful in Patients Aged 40-49. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00312
Graft survivorship and patient-reported outcomes were compared between patients aged <40 and 40-49 years undergoing osteochondral allograft transplantation using a prospective institutional registry. The study challenged the arbitrary age-40 upper limit for OCA by accounting for confounders like BMI and surgical history. Results support expanding OCA indications to carefully selected middle-aged patients with large chondral defects.
267. Jesse JE, Sardesai KS, Caplan B, et al. Poster 88. OCA Outcomes Consistent Across Graft Sites but Influenced by Donor Age. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00394
This study evaluated osteochondral allograft transplantation outcomes in the knee by graft location (condylar, patellofemoral, trochlear) and construct type, including multiplug 'snowman' grafts, along with donor age effects. Patient-reported outcomes were consistent across graft sites and constructs, but donor age influenced results. This suggests surgical planning can proceed across lesion locations, while donor tissue characteristics warrant consideration in graft selection.
277. Bugbee WD. Poster 49. Osteochondral Allograft Transplantation of the Knee in “Ideal” Candidates: Clinical Outcomes and Graft Survivorship. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00362
This study assessed outcomes of osteochondral allograft transplantation in 109 'ideal' candidates (age ≤30, non-obese, lesions ≤8 cm² from OCD or trauma) with minimum two-year follow-up. Reoperation occurred in 19.8% of knees, but allograft failure was rare (0.9%), with strong patient-reported pain relief, function, and satisfaction. These findings confirm that carefully selected young patients can expect excellent graft survivorship from OCA transplantation.
280. Caplan B, Sardesai KS, Jesse JE, et al. Poster 59. Autologous Minced Cartilage Implantation Versus Microfracture and Autologous Chondrocyte Implantation: A Systematic Review of Clinical Outcomes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00370
This PRISMA systematic review compared autologous minced cartilage implantation with microfracture and autologous chondrocyte implantation (standard and matrix-associated) for focal knee chondral lesions, including Level I-IV studies with ≥12-month follow-up and ≥2 validated PROMs. MCI demonstrated noninferior or improved patient-reported outcomes at short- to mid-term follow-up relative to established techniques. This supports MCI as a promising single-stage cartilage repair alternative that avoids the costs and delays of cell expansion.
283. Poulson TA, Nezwek T, Bi AS, et al. Poster 63. Mid- to Long-Term Outcomes of Cartilage Restoration of the Knee with Matrix-induced Autologous Chondrocyte Implantation (MACI): A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00374
A PRISMA-compliant systematic review and meta-analysis identified nine studies (500 patients, 504 defects) of FDA-approved third-generation MACI in the knee with minimum 5-year follow-up. It synthesized patient-reported outcomes, graft survivorship, and conversion to total knee arthroplasty. The results clarify the durability of the FDA-approved MACI implant for large symptomatic cartilage lesions and support shared decision-making for cartilage restoration.
High Tibial Osteotomy & Alignment (15)¶
12. Hennessy C, Rayes B, Faber BG, et al. Osteotomies around the knee are associated with low short‐term adverse event and reoperation rates: A 25‐year national Hospital Episode Statistics analysis in England. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70550
A 25-year analysis of English Hospital Episode Statistics examined 24,947 knee osteotomies (high tibial and distal femoral) for 90-day and 1-year reoperation and serious complication rates. Short-term adverse event and reoperation rates were low, supporting the safety of osteotomy as a joint-preserving procedure. These registry data can inform patient counseling and shared decision-making regarding knee-preserving surgery.
38. Ugarte J, Muñoz JT, Franulic N, et al. Complications after anterior closing‐wedge high tibial osteotomy in anterior cruciate ligament reconstruction: A state‐of‐the‐art technical review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70575
This state-of-the-art technical review synthesized clinical, biomechanical, and expert literature on complications of anterior closing-wedge high tibial osteotomy performed in conjunction with ACL reconstruction, deliberately avoiding pooled rate estimation due to heterogeneity. It details complication mechanisms, risk factors, and prevention and management strategies for this slope-reducing osteotomy. The review serves as a practical guide for surgeons using ACWHTO to address excessive tibial slope in ACL-deficient or revision ACLR settings.
76. Druel J, Piercecchi A, Wilson C, et al. Lateral and Anterior Closing Wedge “9/9” Degree Osteotomy to Correct Both Tibia Vara and Excessive Tibial Slope. Arthroscopy Techniques 2026. doi:10.1002/atn2.70041
This technique article describes the '9/9 osteotomy,' a single-stage lateral closing wedge high tibial osteotomy combined with an anterior retrotubercle closing maneuver to simultaneously correct varus deformity and excessive posterior tibial slope. Preoperative planning with long-leg standing and lateral radiographs guides wedge dimensions and hinge position, with fixation via lateral locking plate. The approach avoids staged procedures, preserves bone stock, and enables early rehabilitation in patients with combined coronal and sagittal malalignment.
90. Lee DW, Kim RJ, Beak JY, et al. Absolute knee extensor strength, not limb symmetry, predicts outcomes and defines a rehabilitation threshold after medial opening‐wedge high tibial osteotomy. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70535
In 125 patients undergoing medial opening-wedge high tibial osteotomy, this study evaluated isokinetic knee extensor strength, limb symmetry index, patient-reported outcomes, and dynamic balance over mid-term follow-up. Absolute body mass-normalised extensor strength at 1 year, not limb symmetry, was the key predictor of satisfactory IKDC outcomes, allowing identification of a clinically relevant rehabilitation threshold. Clinicians should target absolute extensor strength milestones rather than symmetry indices when guiding recovery after HTO.
92. Mayer P, Fürmetz J, Bode G, et al. Management of increased posterior tibial slope in ACL deficiency: A narrative review and recommendation of the Osteotomy Committee of the German Knee Society. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70549
This narrative review by the Osteotomy Committee of the German Knee Society synthesizes level 3-4 evidence and expert consensus on managing increased posterior tibial slope in ACL-deficient knees. It provides practical recommendations covering biomechanical rationale, radiographic measurement (long lateral radiographs using the mechanical axis), surgical indications, and operative techniques for slope correction. The work fills a gap in comprehensive guidance for surgeons considering slope-reducing osteotomy to mitigate ACL graft failure risk.
116. Takada S, Okada Y, Suzuki H, et al. A Rare But Important Complication After Fibular Osteotomy During Lateral Closing-Wedge High Tibial Osteotomy: Extension-Type Checkrein Deformity of the Hallux: A case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101197
This case report describes extension-type hallux checkrein deformity from presumed extensor hallucis longus tethering by hypertrophic fibular callus after lateral closing-wedge high tibial osteotomy with fibular osteotomy. EHL-to-extensor digitorum longus tendon transfer, rather than local release, restored hallux motion and function. Surgeons should recognize this rare tendon-related complication of fibular osteotomy and consider tendon transfer when proximal tendon excursion is restricted.
148. Ebata T, Iwasaki K, Sato D, et al. Correlation Between Changes in Subchondral Bone Density Distribution and Clinical Outcomes at 2 Years After Opening-Wedge High Tibial Osteotomy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261444313
In 27 knees after opening-wedge high tibial osteotomy, subchondral bone density redistribution was quantified with CT osteoabsorptiometry (medial-to-lateral high-density area ratio) and related to 2-year clinical outcomes. The findings link postoperative densitometric load redistribution to clinical results, supporting CT-OAM as a potential objective tool for assessing HTO success and guiding rehabilitation or weight-bearing decisions.
159. Song SJ, Yoon KH, Kim MS, et al. Comparison of Patellofemoral Degeneration After Three Types of High Tibial Osteotomy: Retrotuberosity Biplane Open-Wedge, Supratuberosity Biplane Open-Wedge, and Closed-Wedge Techniques. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261467542
This cohort study compared femoral trochlear cartilage degeneration on first-look/second-look arthroscopy and radiographic patellofemoral parameters among 58 retrotuberosity open-wedge, 59 supratuberosity open-wedge, and 88 closed-wedge high tibial osteotomies. Groups were demographically similar with comparable follow-up intervals (~27-30 months). The findings guide surgeon choice of HTO technique when patellofemoral joint preservation is a concern.
162. Moon H, Hong H, Jung M, et al. Posterior Plate Positioning Without Distal Placement in Medial Closing-Wedge Distal Femoral Osteotomy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261469346
Using finite element analysis with five 3D models of the distal femur, this laboratory study systematically varied plate height and depth in 5-mm increments during medial closing-wedge distal femoral osteotomy and tested loading at 0°, 30°, and 90° of flexion. The analysis identified a biomechanically optimal plate position based on osteotomy micromotion, implant and bone stresses, and lateral hinge stress. The findings support placing the plate without distal positioning to maximise construct stability and potentially reduce fixation complications.
181. Uppstrom TJ, Featherall JT, Neufeld J, et al. Paper 43. Correction Accuracy of Coronal Plane Alignment Modifying Osteotomies using Patient-Specific Instrumentation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00301
This consecutive case series assessed the accuracy of 3D CT-based patient-specific instrumentation (PSI) for coronal plane correction via high tibial or distal femoral osteotomy performed by two fellowship-trained surgeons at a tertiary center from 2020 to 2024. Postoperative alignment was measured against planned correction targets. The findings support PSI as a potentially accurate alternative to freehand fluoroscopy-guided osteotomy, with implications for reduced radiation exposure and improved precision in joint-preserving surgery.
184. Ebata T, Kondo E, Yabuuchi K, et al. Paper 46. Factors Associated With Failure to Recover the Preoperative Tegner Activity Scale After High Tibial Osteotomy for Medial Knee Osteoarthritis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00304
This retrospective study of 367 patients who underwent medial opening-wedge or inverted V-shaped high tibial osteotomy for medial knee osteoarthritis with varus deformity (2017-2022) identified factors associated with failure to return to pre-symptomatic Tegner activity levels. Surgical technique was selected based on the degree of valgus correction needed. Identifying predictors of incomplete sports-level recovery can help clinicians counsel patients preoperatively about realistic activity expectations after HTO.
204. Uppstrom TJ, Featherall JT, Neufeld J, et al. Poster 92. Correction Accuracy of Sagittal Plane Alignment Modifying Osteotomies using Patient-Specific Instrumentation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00398
This consecutive-series study evaluated the accuracy of patient-specific instrumentation (3D-printed guides from preoperative CT) for sagittal plane anterior closing wedge tibial osteotomies performed to correct elevated posterior tibial slope in ACL-insufficient/revision ACL reconstruction patients. The results establish whether PSI achieves the targeted PTS correction reliably, supporting its use to reduce technical error in this demanding procedure associated with ACL re-rupture risk.
216. Katanbaf R, Misch M, Sax O, et al. Poster 98. HTO Provides Lower Two-Year TKA Conversion Risk Than UKA in All Ages. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00403
A large national all-payer database (>170 million records) was used to compare conversion to total knee arthroplasty after high tibial osteotomy versus unicompartmental knee arthroplasty for symptomatic unicompartmental knee osteoarthritis (2010-2023), stratifying patients into ≤60 and >60 years of age. The study found HTO provided lower two-year TKA conversion risk than UKA across all age groups, challenging the convention of reserving HTO for younger patients. These findings may broaden patient selection criteria for HTO, including in older adults with unicompartmental disease.
278. Kondo E, Hamasaki M, Iwasaki K, et al. Poster 53. The Effect Of Medial Closing Wedge Distal Femoral Varus Osteotomy On Contact Stress Distribution Pattern Of the Patellofemoral Joint: An Evaluation Using Computed Tomography Osteoabsorptiometry. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00365
This in vivo study used CT osteoabsorptiometry to map subchondral bone mineral density and evaluate patellofemoral joint contact stress distribution before and after medial closing wedge distal femoral varus osteotomy. The findings clarify how MCW-DFVO alters PF joint loading patterns, consistent with reduced Q angle and improved patellar tracking. This provides biomechanical evidence supporting DFVO for young patients with lateral compartment osteoarthritis and/or patellofemoral instability.
311. Pineda T, Mabrouk A, Dan MJ, et al. Postoperative CPAK phenotype and switching patterns are not associated with mid-term clinical outcomes or intra-articular correction after high tibial osteotomy. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104862
This retrospective study with a mean 7.5-year follow-up examined whether postoperative coronal plane alignment of the knee (CPAK) phenotype affects mid-term clinical and sport-related outcomes after high tibial osteotomy. No significant differences in WOMAC, Tegner, or modified Weiss scores were found across CPAK phenotypes or between neutral and valgus alignment, and phenotype switching patterns and joint line convergence angle behaviour were characterized. Postoperative CPAK phenotype need not be a target for optimising HTO outcomes.
Other articles this month¶
1. von Rehlingen-Prinz F, Shamritsky DZ, Rilk S, et al. Biomechanical Effect of Medial Collateral Ligament Repair With and Without Suture Augmentation on Knee Laxity and Anterior Cruciate Ligament Force. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261476766
In seven cadaveric knees tested with a robotic manipulator, isolated MCL repair reduced but did not fully restore valgus laxity compared with the intact state, whereas adding suture augmentation significantly decreased valgus laxity at 15° and 30° of flexion. The study also quantified ACL in situ force and load-sharing between the repair and augmentation components. Clinically, these findings support combining MCL repair with suture augmentation when tighter restoration of medial stability is desired, particularly to protect the ACL from increased valgus loading.
3. Maldonado DR, Bastidas A, Hovsepian JM. Open Proximal Rectus Femoris Tendon Full‐Thickness Tear Repair With Double‐Row Suture Anchor Transosseous‐Equivalent Construct With Biologic Augmentation Using Bone Marrow Aspirate Concentrate and Bovine Bioinductive Collagen Implant. Arthroscopy Techniques 2026. doi:10.1002/atn2.70247
This surgical technique article describes open repair of proximal full-thickness rectus femoris tendon tears using a double-row suture anchor transosseous-equivalent construct augmented with bone marrow aspirate concentrate and a bovine bioinductive collagen implant. The approach aims to maximise tendon footprint coverage and compression while enhancing tendon-to-bone healing biology. It offers surgeons a reproducible option to address concerns about healing, strength restoration, and retear in high-demand athletes.
4. Varady NH, Parise S, Ranawat AS, et al. Meniscal Repairs Performed With Posterior Cruciate Ligament Reconstruction Are Associated With Lower Failure Rates Than Isolated Repairs. Arthroscopy 2026. doi:10.1002/arj.70506
Using a large insurance database, 21,358 patients undergoing meniscal repair with or without concurrent posterior cruciate ligament reconstruction were followed for revision meniscal surgery at 2 years. Concomitant PCL reconstruction was associated with significantly lower meniscal repair failure (adjusted HR 0.41) and lower revision/conversion arthroplasty rates (adjusted HR 0.40) than isolated meniscal repair. This suggests that concurrent ligament reconstruction may protect meniscal repairs, though residual confounding by injury patterns should be considered.
5. Hiredesai AN, Holle AM, Patel JR, et al. Ten‐Year Post‐traumatic Osteoarthritis Incidence Is Low After Pediatric Isolated Meniscal Surgery but Lower After Meniscal Repair Than Meniscectomy. Arthroscopy, Sports Medicine, and Rehabilitation 2026. doi:10.1002/ars2.70067
In 7,555 paediatric meniscectomy and 2,797 meniscal repair patients from PearlDiver with at least 5-year follow-up, 10-year post-traumatic osteoarthritis incidence was low overall (2.3% after meniscectomy vs 1.5% after repair). Meniscal repair was associated with lower PTOA risk than meniscectomy at both 5 and 10 years. These findings reinforce a preference for meniscal preservation over meniscectomy in paediatric patients, while noting the absolute long-term PTOA risk after isolated meniscal surgery is small.
7. Hariri M, Sorbi R, Moradi B, et al. Patient-reported outcomes after lateral unicompartmental and total knee arthroplasty: a propensity score-matched cohort study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06491-1
In a propensity score-matched cohort of 31 pairs, patient-reported outcomes after lateral unicompartmental knee arthroplasty were compared with total knee arthroplasty, with matching on demographics and baseline Oxford Knee Score. Postoperative Oxford Knee Scores did not differ significantly between the two procedures. This suggests lateral UKA can achieve comparable patient-reported function to TKA in appropriately selected patients with isolated lateral-compartment osteoarthritis.
10. Shatrov J, Boudali M, Abe K, et al. Progressive lateral femoral condyle lengthening in total knee arthroplasty produces dose‐dependent increases in patellofemoral joint loading and alters patellar tracking. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70552
Cadaveric knees implanted with cruciate-retaining total knee arthroplasty underwent progressive lateral femoral condyle distalization (neutral, +2.5 mm, +4.5 mm) with patellofemoral kinematics and kinetics measured during passive flexion and stair descent. Distalization produced dose-dependent increases in patellofemoral reaction force and facet loading plus altered patellar tracking. Surgeons should avoid over-lengthening the lateral condyle during TKA to limit patellofemoral overload.
14. Pineda T, Varady NH, Mazy D, et al. Patient‐reported acceptable symptom state does not reflect quadriceps symmetry 1 year after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70584
A prospective cohort of 90 primary ACL reconstruction patients (rectus femoris, quadriceps tendon, or hamstring autograft groups) underwent isokinetic quadriceps testing and KOOS Sport and QoL assessments at 12 months to test concordance with PASS thresholds. Agreement between achieving PASS and quadriceps limb symmetry index ≥90% was essentially absent (κ ≈ 0.06), regardless of graft type. Clinicians should not rely on patient-reported symptom state alone to clear patients for return to activity, as objective strength deficits may persist.
15. Avram GM, Canata GL, Królikowska A, et al. Get it moving: Return to activity and sport following primary total knee arthroplasty is not associated with increased adverse events. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70586
This editorial summarizes contemporary evidence on return to sport after total knee arthroplasty, covering patient selection, biomechanics, surgical technique, implant design, and rehabilitation. Current evidence supports an individualized approach, with low-impact activities recommended for most patients and higher-impact sports possible in selected cases, and no definitive increase in implant-related complications demonstrated. Surgeons can counsel patients that returning to activity after TKA appears safe when guided by structured rehabilitation and individualized assessment.
16. Unknown Author. Announcements. Arthroscopy 2026. doi:10.1002/arj.70582
This is a non-research announcements section listing AANA educational offerings, including unlimited-access learning center pricing, October 2024 hands-on hip arthroscopy and complicated knee cadaveric courses, and the AANA27 annual meeting scheduled for May 13-15, 2027, in Hollywood, Florida. No study findings or clinical implications are reported.
18. Akrivos VS, Koskiniotis A, Konstantinou E, et al. Postoperative Infections After Anterior Cruciate Ligament Reconstruction Significantly Increase the Risk of 3‐Compartment Osteoarthritis at Long‐Term Follow‐Up. Arthroscopy 2026. doi:10.1002/arj.70489
This retrospective case-control study compared patients who developed postoperative infection after ACL reconstruction with matched controls who had uncomplicated ACLR, with radiographic and clinical follow-up at a mean of 16.2 years. Postoperative infection after ACLR significantly increased the risk of developing 3-compartment osteoarthritis at long-term follow-up. These findings underscore the importance of aggressive infection prevention and prompt treatment after ACLR to mitigate long-term degenerative sequelae.
19. Sanborn RM, Pluta NA, Fellows KJ, et al. Over Half of Patients Progress to Cartilage Restoration After Initial Cartilage Biopsy in a Military Population. Arthroscopy, Sports Medicine, and Rehabilitation 2026. doi:10.1002/ars2.70064
This retrospective review of 56 patients (58 knees) who underwent cartilage biopsy at two military health centers evaluated progression to matrix-induced autologous chondrocyte implantation (MACI). Over half of patients (55.2%) proceeded from biopsy to MACI, with multifocal defects (59%) and patellar lesions (64%) being common, and 22% requiring reoperation. The high progression rate suggests clinicians should counsel military patients about the substantial likelihood of implantation after biopsy and the associated reoperation risk.
20. Wu S, Pang R, Zhang R, et al. Physeal Sparing Posterior Cruciate Ligament Reconstruction in Paediatric Patients With Open Physes Using an Outside‐In Femoral Tunnel and a Low Tibial Tunnel. Arthroscopy Techniques 2026. doi:10.1002/atn2.70239
This technical note describes a physeal-sparing posterior cruciate ligament reconstruction technique for paediatric patients with open physes, using retrograde outside-in femoral tunnel drilling distal to the physis and a low tibial tunnel referenced to the meniscofemoral-like structure. The technique aims to restore knee stability while avoiding physeal damage, growth arrest, and limb deformity. It offers paediatric surgeons an alternative to conventional tunnel placement that risks growth disturbance in skeletally immature patients.
21. Hou P, Meng C, Xu J, et al. Fixation Treatment of Anterior Cruciate Ligament Avulsion Fracture via Suture‐Bridge Technique Through Transtibial Tunnels. Arthroscopy Techniques 2026. doi:10.1002/atn2.70241
This technical note presents a transtibial tunnel pull-out suture-bridge fixation technique for type III/IV tibial eminence (ACL avulsion) fractures, combining anchor-based suture-bridge constructs with transosseous tunnel pull-out sutures using high-strength suture. The technique provides anatomical reduction with increased fracture fragment contact area and fixation strength compared with either anchors or pull-out fixation alone. It may benefit high-demand patients requiring early return to sport by optimising fracture stability and range of motion.
22. Yan H, Qin X. A Modified “Suspender‐Type” Traction‐Preservation and Native Ligament Reconstruction Using Hamstring Autograft for Anterior Cruciate Ligament Femoral‐Side Avulsion. Arthroscopy Techniques 2026. doi:10.1002/atn2.70234
This technical note describes a modified 'suspender-type' traction-preservation technique for ACL femoral-side avulsion (Sherman type I) injuries, combining native ligament repair via traction-reduction with hamstring autograft reconstruction for mechanical support. The dual approach preserves the vascular femoral attachment, proprioceptive function, and healing capacity of the native ligament remnant, which conventional reconstruction sacrifices. It provides a viable option for managing femoral-sided avulsions where optimal treatment remains debated.
23. Walter N, Lowenberg DW, Heiss C, et al. Elective arthroplasty on “high-risk” calendar dates: no evidence for worse outcomes in 43,000 procedures. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06405-1
This nationwide retrospective cohort study of approximately 43,000 Medicare beneficiaries examined whether primary total hip and knee arthroplasties performed on superstition-associated dates (e.g., Friday the 13th; 945 procedures) had worse outcomes. No significant differences were found in aseptic revision, septic revision, or mortality between procedures on these dates and controls. These findings can reassure patients and surgeons that scheduling elective arthroplasty on such calendar dates does not compromise outcomes.
24. Kehribar L, Okutan AE, Akdemir E, et al. Peroneus longus autograft in anterior cruciate ligament reconstruction impairs ankle strength, balance and jump performance despite preserved knee function: a one year comparative study. International Orthopaedics 2026. doi:10.1007/s00264-026-06998-7
This propensity score-matched retrospective study compared 30 patients receiving peroneus longus tendon (PLT) autografts with 30 receiving semitendinosus grafts at 12 months after isolated ACL reconstruction, assessing strength, jump performance, balance, and patient-reported outcomes. Despite preserved knee function and comparable PROMs, PLT autograft use impaired ankle plantar flexion/eversion strength, balance, and jump performance. Surgeons should weigh these donor-site functional deficits when selecting grafts, particularly in patients with high ankle-demand activities.
25. Yona T, Sheth B, Reshef N, et al. All‐Inside Meniscus Repair Systems Failure Analysis Shows Device‐Related Adverse Events Differ by Device Design Type and Show Varied Reporting Delays by Manufacturer. Arthroscopy 2026. doi:10.1002/arj.70453
FDA MAUDE database reports of all-inside meniscal repair device adverse events from 2023-2024 were analyzed to characterize device failures, patient injuries, and manufacturer reporting delays across device design types. Of 2,056 eligible reports, device-related adverse events differed significantly by device design type, and reporting delays varied by manufacturer. The findings suggest surgeons should recognize design-specific failure modes when selecting all-inside meniscal repair devices and that reporting timeliness warrants regulatory attention.
26. Lustig M, Hazzard S, Cote M, et al. Lateral Extra‐articular Tenodesis Internet Search Trends Correlate to the Quantity of Publications From 2020 to 2024. Arthroscopy, Sports Medicine, and Rehabilitation 2026. doi:10.1002/ars2.70062
Google Trends relative search volumes for lateral extra-articular tenodesis (LET) were correlated with PubMed publication counts from 2020 to 2024 using general linear regression. Public search interest rose exponentially alongside growth in publications (21 to 45), with the two showing a moderate correlation (adjusted R² = 0.51). Rising public interest in LET may reflect and drive the expanding literature, underscoring the need for high-quality evidence to guide this increasingly popular procedure.
27. Ghasemi SA, Naja A, Dulitzki Y, et al. Single‐Staged Combined Retrograde Subchondral Drilling and In Situ Autologous or Micronized Cartilage Repair With Bone Marrow Aspirate Concentrate for Focal Patellofemoral Chondral Lesions. Arthroscopy Techniques 2026. doi:10.1002/atn2.70177
This technical note describes a single-stage arthroscopic/mini-open technique combining retrograde subchondral drilling with an in situ island-pattern crushed cartilage scaffold mixed with bone marrow aspirate concentrate for focal patellofemoral chondral lesions. The approach preserves the calcified cartilage layer and border chondrocytes while avoiding staged procedures, with optional lateral retinacular release to optimise patellar tracking. It offers a joint-preserving alternative to microfracture or staged autologous chondrocyte implantation, though clinical validation is needed.
30. Corsia S, Attas J, Djebara A, et al. Avoiding Tunnel Collisions in Knee Posterolateral Corner Reconstructions: The “Versailles” Technique. Arthroscopy Techniques 2026. doi:10.1002/atn2.70238
This technical note presents the 'Versailles' technique for anatomic posterolateral corner (PLC) reconstruction of the knee using allograft or hamstring tendon grafts. The technique addresses the fibular collateral ligament, popliteofibular ligament, and popliteus tendon while specifically avoiding tunnel collisions during reconstruction. It provides a practical anatomic option for PLC reconstruction in multiligament knee injuries.
31. Vosoughi F, Aminizadeh S, Seyedtabaei SMM, et al. Concurrent High Tibial Osteotomy, Anterior Cruciate Ligament Reconstruction, and Medial Meniscus Posterior Root Repair. Arthroscopy Techniques 2026. doi:10.1002/atn2.70123
This technical note describes a single-session combined procedure of medial meniscus posterior root repair, ACL reconstruction, and biplanar high tibial osteotomy performed arthroscopically with specific tunnel angles and fixation strategies. The combined approach simultaneously addresses meniscal deficiency, ligamentous instability, and varus malalignment. It may improve long-term outcomes and prevent osteoarthritis progression compared with isolated procedures in patients with this combined pathology.
32. Özel V, Dursun G, Yıldırım T. Comparison of clinical outcomes of triple-strand braid vs conventional quad-strand hamstring grafts in anterior cruciate ligament reconstruction. International Orthopaedics 2026. doi:10.1007/s00264-026-06988-9
A two-center retrospective study of 94 adults undergoing hamstring autograft ACL reconstruction compared a triple-strand braided technique with conventional quadruple-strand grafts regarding graft diameter, operative parameters, and mid-term functional outcomes (IKDC, Lysholm, VAS). The braided technique yielded significantly larger graft diameter, and multivariate regression evaluated its independent effect on achieving good functional outcome (IKDC ≥90). The findings suggest the braided technique may offer graft-size advantages, though its independent contribution to clinical success requires consideration of patient factors.
34. Cai L, Brophy RH, Tycksen ED, et al. IL-1β–Induced Inflammatory Transcriptome and TGF-β1 Attenuation of Chemokine Expression in ACL Remnant Fibroblasts. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261470174
In this laboratory study, primary ACL remnant, derived fibroblasts from 10 surgical patients were treated with IL-1β to model the inflammatory post-injury joint environment, with transcriptomic changes assessed by RNA sequencing and confirmed by digital PCR. IL-1β induced a broad inflammatory gene expression profile, and TGF-β1 pretreatment attenuated the chemokine response. The results suggest ACL remnant cells actively contribute to the intra-articular inflammatory milieu after injury, a mechanism potentially relevant to posttraumatic osteoarthritis and biologically augmented treatment strategies.
35. Martin‐Alguacil JL, Arroyo‐Morales M, Lopez‐Garzon M, et al. Earlier strength recovery with partial‐thickness versus full‐thickness quadriceps tendon graft for anterior cruciate ligament reconstruction in competitive soccer players. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70547
This retrospective cohort study compared full-thickness versus partial-thickness quadriceps tendon autografts for primary ACL reconstruction in 42 non-professional competitive soccer players, with isokinetic quadriceps index as the primary outcome over 12 months. The partial-thickness graft group demonstrated earlier quadriceps strength recovery, while functional scores and reinjury rates were also tracked to 24 months. The findings suggest partial-thickness quadriceps tendon grafts may facilitate faster return to strength in athletes, though longer-term durability data remain limited.
39. de Pesters C, Vari N, Bérard E, et al. Hamstring graft remodelling after ACL reconstruction is slower in paediatric population compared to adults. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70576
This single-center comparative pilot study used 12-month postoperative MRI (signal-to-noise quotient and Howell scores) to compare hamstring autograft remodelling between 52 paediatric and 59 adult patients after ACL reconstruction with quadrupled semitendinosus grafts. Paediatric patients showed significantly higher adjusted SNQ and less mature graft signal, indicating slower graft remodelling, while tunnel widening and patient-reported outcomes were also assessed. The findings may partly explain higher reinjury risk in children and argue for more cautious return-to-play timelines in paediatric ACLR.
40. Siddiqi A, Yousuf KM, Jacob PB. Revision Arthroplasty in the Ambulatory Setting. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00502
This perspectives article examines the emerging migration of revision total joint arthroplasty to ambulatory surgery centers, highlighting tensions between procedural complexity, implant cost variability, complication risk, and the financial and regulatory structures of ASCs. The authors discuss how alignment of case selection, implant economics, and reimbursement models will determine the viability of outpatient revision arthroplasty. The piece implies that careful patient selection and payment reform are prerequisites for safe expansion of revision surgery in the ambulatory setting.
41. Lerjefors E, Cristiani R, von Essen C, et al. Meniscal Ramp Lesions Are More Commonly Detected on Magnetic Resonance Imaging Than Arthroscopy in Patients With Anterior Cruciate Ligament Tears. Arthroscopy 2026. doi:10.1002/arj.70454
In a cohort of 579 patients undergoing primary ACL reconstruction, preoperative MRI and intraoperative findings were reviewed to determine the prevalence of meniscal ramp lesions and associated factors. Ramp lesions were identified on MRI in 43.2% of patients but confirmed arthroscopically in only 9.8%, with no Greif type 1 or 2 lesions verified intraoperatively, and posteromedial tibial bone bruising independently increased the odds of detecting a ramp lesion. Clinicians should recognize that MRI frequently overestimates ramp lesions relative to arthroscopy, so surgical decision-making should rely on intraoperative inspection rather than MRI findings alone.
42. Vivekanantha P, Son H, Kay J, et al. Direct Comparison Between Loss‐to‐Follow‐Up and Statistical Fragility Is Methodologically Inappropriate, and Fragility Reflects the P Value, Not Trial Robustness: A Simulation Analysis of 300,000 Randomized Controlled Trials. Arthroscopy 2026. doi:10.1002/arj.70457
Using simulations of 300,000 randomised controlled trials, the authors compared the fragility index (FI) and reverse fragility index (RFI) with the minimum number of patients lost to follow-up needed to reverse significance (LTFI/R-LTFI), and applied machine learning to identify drivers of these metrics. LTFI exceeded FI in 84.9% and R-LTFI exceeded RFI in 95.5% of trials, with the P value emerging as the dominant determinant of fragility metrics. Direct comparison between loss-to-follow-up and statistical fragility is methodologically inappropriate, and fragility indices primarily reflect P values rather than true trial robustness, cautioning against overinterpreting fragility analyses in orthopaedic literature.
43. Argentieri E, Hamilton TW, Koff MF, et al. Changes in ACL T2 Metrics Over the Course of the Female Menstrual Cycle: A New Biomarker for the ACL Injury Risk?.* The American Journal of Sports Medicine 2026. doi:10.1177/03635465261470921
In a level 2 cohort study, 25 women without prior knee injury (10 eumenorrheic, 15 anovulatory controls including postmenopausal and oral contraceptive users) underwent bilateral ultrashort echo time T2 MRI at 4 time points over one menstrual cycle to quantify bicomponent ACL T2 metrics. The hypothesis was that eumenorrheic women would show significant cyclic ACL T2 changes while anovulatory controls would not. Cyclic variation in ACL T2 may serve as a noninvasive biomarker of hormonally mediated ACL injury risk, potentially informing sex-specific injury-prevention strategies.
44. Mayer MA, Massa M, Gilligan KM, et al. A Technique for Patellar Tendon Repair Using a Suture‐Free Nonwoven Polyethylene Terephthalate Implant. Arthroscopy Techniques 2026. doi:10.1002/atn2.70223
This surgical technique report describes the FiberLocker System, a suture-free augmentation for complete patellar tendon repair using a nonwoven polyethylene terephthalate SpeedPatch embedded into the native tendon via a reciprocating microblade instrument. The interwoven patch-tendon construct increases load-distribution surface area and provides immediate structural reinforcement without sutures passed through tendon tissue. This approach may improve early biomechanical security of patellar tendon repairs in a tendon with poor healing capacity and high tensile demands, though clinical validation is needed.
45. Ozeki N, Koga H. Evolution of anatomical anterior cruciate ligament reconstruction: a narrative review of double-bundle and rectangular-tunnel techniques. International Orthopaedics 2026. doi:10.1007/s00264-026-06995-w
This narrative review traces the evolution of anatomic ACL reconstruction from isometric transtibial single-bundle techniques toward double-bundle and rectangular-tunnel bone-patellar tendon-bone approaches designed to restore both anterior and rotational stability. Key developments include recognition of the ACL's dual-bundle anatomy, shifts toward lower physiologic graft tensioning, and refinements in tunnel positioning, remnant preservation, and management of concomitant pathology. Understanding this evolution guides surgeons in selecting anatomic reconstruction strategies that better reproduce native knee kinematics.
46. Mori Y, Tarasawa K, Tanaka H, et al. Impact of cognitive impairment on postoperative delirium and discharge disposition following knee arthroplasty: a Japanese nationwide propensity score–matched study. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06476-0
Using Japan's nationwide Diagnosis Procedure Combination database (2016-2023), 259,319 older patients undergoing primary TKA or UKA were analyzed with 1:1 propensity score matching to assess the impact of cognitive impairment on postoperative delirium and discharge disposition. Among 3,934 matched pairs, cognitive impairment was associated with higher rates of postoperative delirium and adverse discharge outcomes. These findings support routine cognitive screening and targeted perioperative planning for cognitively impaired patients undergoing knee arthroplasty.
48. Zhang G, Zhou Y, Chen Y, et al. Asia-Pacific expert consensus on robotic-assisted hip and knee arthroplasty. Arthroplasty 2026. doi:10.1186/s42836-026-00427-1
The Arthroplasty Society in Asia convened 45 experts using a modified Delphi method across three rounds to develop consensus statements on robotic-assisted hip and knee arthroplasty, reaching agreement on 18 clinical questions. The panel agreed that robotic-assisted TJA offers superior implant positioning accuracy (98% agreement) but that current evidence does not support definitive superiority in long-term survivorship or patient-reported outcomes (77%), while enabling personalized alignment strategies. This consensus provides standardised guidance for appropriate patient selection and clinical application of robotic arthroplasty in the Asia-Pacific region.
49. Ryan PM, Goodin S, Jackson GR, et al. Lateral Meniscus Oblique Radial Tear All‐Inside Repair. Arthroscopy Techniques 2026. doi:10.1002/atn2.70224
This surgical technique article presents a reproducible all-inside arthroscopic method for repairing type 3 lateral meniscus oblique radial tears, which frequently accompany acute ACL injuries. The technique addresses high-grade tears that otherwise cause knee instability and meniscal extrusion. Its clinical implication is a practical repair option to restore normal knee kinematics and meniscal function in ACL-injured knees.
50. Trøan I, Holm I, Moatshe G, et al. Quadriceps and Hamstring Muscle Strength Recovery After a Multiligament Knee Injury: A Long-term Follow-up. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261466381
This cross-sectional study assessed isokinetic quadriceps and hamstring strength and hop-test performance in 90 patients a mean of 7 years after surgical treatment of multiligament knee injuries, comparing single-cruciate with bicruciate injuries. Key findings include persistent strength deficits, with 54% of patients not regaining full quadriceps recovery. The results underscore that long-term functional limitations are common after multiligament injury and should inform patient counseling and rehabilitation expectations.
51. Park N, Sabzevari S, Salandra JM, et al. Arthroscopic Primary Repair of Mid‐Substance Posterior Cruciate Ligament Tears With Knotless Dual‐Suspensory Fixation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70220
The authors describe an all-arthroscopic primary repair technique for mid-substance PCL tears, using knotless dual-suspensory fixation to bidirectionally reapproximate the torn ligament ends and reinforce the construct with suture tape. This fills a gap, as mid-substance tears are usually treated conservatively or with reconstruction rather than repair. The clinical implication is a repair option that restores ligament continuity while preserving the PCL's intrinsic healing potential.
53. Wang Y, Zhang Y, Shi W, et al. Outcomes of Suture Tape–Augmented ACL Reconstruction in Patients With High Internal Rotational Tibial Subluxation: A Minimum 3-Year Cohort Study. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261462619
This retrospective propensity-matched cohort study compared hamstring autograft ACL reconstruction with versus without suture tape augmentation in patients with high internal rotational tibial subluxation, with minimum 3-year follow-up. The key finding was that suture tape augmentation was associated with lower graft failure rates and superior clinical outcomes in this high-risk subgroup. This supports adding augmentation for patients with high IRTS undergoing hamstring autograft ACLR.
54. Barnes DA, Murray CJ, Movahhedi M, et al. Longitudinal Quantitative Mapping of Meniscal Morphological and Signal Intensity Differences After ACL Surgery. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261465318
This cohort study used quantitative MRI (cross-sectional area and normalised CISS signal intensity) to longitudinally map meniscal morphology in 82 young patients at 6, 12, and 24 months after ACL surgery, comparing surgical with contralateral uninjured knees. Meniscal cross-sectional area and signal profiles remained abnormal in surgical knees over time, though values trended toward the contralateral limb by 24 months. The findings suggest quantitative MRI can track meniscal recovery and may help inform reinjury risk assessment after ACL surgery.
55. Park YL, Wackerle AM, Jiang C, et al. Meniscal Allograft Transplantation Failure Is Associated With Female Sex: A 15-Year Survival Analysis. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261470172
This single-institution cohort study analyzed 15+ years of graft survivorship and patient-reported outcomes after meniscal allograft transplantation performed between 1993 and 2020, using Kaplan-Meier analysis with failure defined as allograft resection/repair, revision MAT, or conversion to arthroplasty. The key finding was that female sex was associated with graft failure. This highlights sex as a prognostic factor to consider in patient selection and counseling for MAT.
56. Noailles T, Bouguennec N, Hardy A, et al. Morphological and functional variability of ramp lesions influences surgical management during anterior cruciate ligament reconstruction: A national registry study of the French Arthroscopic Society. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70568
This French national registry study of 449 patients described arthroscopic diagnostic and repair practices for ramp lesions encountered during ACL reconstruction and linked lesion characteristics to surgical strategy using the Thaunat classification. Diagnosis relied mainly on intercondylar view alone or combined with posteromedial probing, and lesion type and meniscal mobility were associated with the repair technique and number of sutures used. The findings show that ramp lesion morphology and mobility directly influence surgical management, supporting a tailored repair approach.
57. Itoh M, Kuwashima U, Itou J, et al. Clinical outcomes and patient-reported joint noise after total knee arthroplasty using saddle-shaped rotating-platform and bi-cruciate-stabilized implant-surgical systems: a propensity score-matched cohort study. Arthroplasty 2026. doi:10.1186/s42836-026-00426-2
This propensity score-matched cohort study compared 176 pairs of saddle-shaped rotating-platform (ROCC) versus bi-cruciate-stabilised (BCS) total knee arthroplasties, using KOOS-Pain as the primary outcome with exploratory analysis of patient-reported joint noise and flexion. The findings address whether distinct posterior cruciate ligament-sacrificing stabilisation concepts yield different clinical results. The results help surgeons choose between these TKA systems based on relative trade-offs between joint noise and flexion performance.
58. Kawaguchi K, Tay ML, Young S. Differences in the coronal plane alignment of the knee (CPAK) measurements using long-leg radiographs and computed tomography. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06463-5
This radiographic subanalysis of a randomised controlled trial compared coronal plane alignment of the knee (CPAK) parameters, MPTA, LDFA, aHKA, joint line obliquity, and phenotype distribution, measured on long-leg radiographs versus CT in 241 robotic-assisted TKA patients. The study quantified measurement discrepancies (>2°) between modalities and identified factors, such as preoperative deformity, associated with discordance. Clinicians should recognize that CPAK-based alignment planning may differ depending on whether radiographic or CT-based measurements are used.
59. Ge Y, Häner M, Borges JS, et al. Rectus femoris tendon autograft yields comparable early outcomes to hamstring tendon autograft, but evidence remains limited: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70559
This systematic review compared rectus femoris tendon versus hamstring tendon autografts in primary and revision ACL reconstruction, including four comparative studies with 299 analyzed patients. Rectus femoris grafts showed comparable early outcomes, with one revision study reporting slightly better IKDC and Tegner scores of uncertain clinical significance. The evidence base remains too limited and heterogeneous to establish superiority of either graft choice.
60. Lippuner J, Hüttner F, Ferner F, et al. Magnetic resonance imaging‐based axial‐plane analysis of lower extremity torsion with dedicated 3D planning software is reliable and efficient. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70562
This reliability study evaluated MRI-based measurement of femoral torsion, tibial torsion, knee version, and whole-lower extremity torsion using dedicated 3D planning software (mediCAD 3D) versus manual assessment in 100 healthy volunteers. All parameters showed good to very good inter- and intraobserver reliability, with agreement within a ±3° equivalence margin, and digital measurement improved efficiency. MRI-based axial-plane torsion analysis with 3D software is a reliable and time-efficient alternative to manual measurement for surgical planning.
62. Abul MS, Parvizi J, Skowronek P, et al. Osteoarthritis management through medical reversal: Glucosamine, Alzheimer's disease risk, and long‐term outcomes after arthroscopic partial meniscectomy. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70578
This perspective article examined medical reversal in osteoarthritis and musculoskeletal care, using glucosamine (with emerging neurocognitive safety concerns), arthroscopic partial meniscectomy for degenerative tears (no benefit over sham at 10 years), and repeated intra-articular corticosteroid injections as illustrative examples. The authors argue that adoption of interventions often precedes robust long-term evidence, and that biological plausibility and short-term symptomatic relief are insufficient justification. Orthopaedic practice should be grounded in rigorous comparative evidence and durable patient-centered outcomes.
65. Skaik K, Abdallah JP, Bouchard MD, et al. MRI‐based deep learning models match or surpass physician performance for early detection and staging of avascular necrosis of the femoral head: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70571
This systematic review of 10 studies (over 2,600 patients) evaluated MRI-based deep learning models for early detection and staging of femoral head avascular necrosis, directly comparing model performance against physicians using signed performance differences. Deep learning models matched or surpassed physician performance for both early detection and staging. These findings support clinical integration of such models to reduce diagnostic variability and enable earlier, more reliable treatment decisions.
66. Jiang Y, Jia X, Li H, et al. Correction: Clinical and radiographic outcomes of double-triangle locking compression plate (DT-LCP) versus T-shaped locking compression plate (T-LCP) in medial open-wedge high tibial osteotomy: a follow-up study of over 5 years. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07139-x
This is a publisher's correction notice for a previously published study comparing double-triangle versus T-shaped locking compression plates in medial open-wedge high tibial osteotomy. The correction reclassifies the article from 'Letter' to 'Original Article' with no change to the scientific content. No new clinical findings are presented.
68. Abid R, J. Burkhart R, J. Moyal A, et al. Two-year outcomes following concomitant ACL and extra-articular ligament reconstruction: a nationwide analysis of over 5,000 patients. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06422-0
This nationwide TriNetX analysis of nearly 6,000 patients examined complication rates after same-day concomitant ACL and extra-articular ligament reconstruction at 30, 90, and 180 days and 2 years, including a propensity-matched comparison of concomitant versus staged procedures. It provides large-scale, population-based estimates of medical and orthopaedic complication rates for this combined procedure. The results inform shared decision-making and surgical planning regarding concomitant versus staged reconstruction.
69. Gablac H, Arras C, Behrendt P, et al. Severe medial tibial plateau fractures: feasibility and functional and radiographic results of an extended approach with medial femoral epicondyle osteotomy. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07100-y
This two-center retrospective cohort study compared an extended medial approach with medial femoral epicondyle osteotomy against a conventional approach for severe medial tibial plateau fractures, using CT-based reduction quality and minimum 2-year functional follow-up. The findings address the feasibility, functional outcomes, and radiographic results of the osteotomy approach in complex fracture patterns. The results help guide surgical exposure selection in severe medial plateau injuries.
70. Gehring D, Ebner C, Di Paolo S, et al. Anterior cruciate ligament rupture during a cognitively demanding change-of-direction task in football: biomechanical insights from a laboratory injury. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10338-6
This case report analyzed marker-based kinematics of an ACL re-rupture that occurred during a laboratory stimulus-response change-of-direction task, comparing the injury trial with 14 successful trials of the same participant. The injury was characterized by a markedly prolonged flight phase and atypical lower-limb and trunk kinematics exceeding the participant's usual movement range, under high cognitive demand with a feint. The findings highlight how cognitive load and reactive movement adjustments may contribute to non-contact ACL injury mechanisms.
71. Poploski KM, Wang B, Rothenberger S, et al. Development and validation of natural language processing pipelines to extract injury and surgery-related data elements from ACL reconstruction operative reports. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10091-w
This study developed and validated a natural language processing pipeline using the CLAMP toolkit to automatically extract clinical data elements such as graft type and meniscal involvement from ACL reconstruction operative reports. The domain-specific model achieved reliable extraction performance on a training and test set drawn from over 100,000 annual ACLR cases. This enables efficient large-scale outcomes research without costly manual chart review.
72. Rodríguez-Martín S, Fernández-Antón E, Alonso-Martínez G, et al. Long-term use of drugs used for knee osteoarthritis and their association with primary arthroplasty: a nested case-control study. Arthroplasty 2026. doi:10.1186/s42836-026-00421-7
This nested case-control study within a Spanish primary care cohort of over 264,000 knee osteoarthritis patients (15,892 arthroplasty cases) assessed whether long-term use of NSAIDs, opioids, non-opioid analgesics, or SYSADOAs affects the risk of primary knee arthroplasty compared with short-term use. Conditional logistic regression yielded adjusted odds ratios for treatment durations of 1-3 months and longer. The results clarify whether prolonged symptomatic drug treatment influences progression to joint replacement, informing medical management strategies.
73. Wegrzyn J, Saffarini M. A historical journey through total knee arthroplasty: the evolutionary milestones. International Orthopaedics 2026. doi:10.1007/s00264-026-06976-z
This historical review traces total knee arthroplasty through four evolutionary phases, from 19th-century experimentation (Gluck's 1890 ivory hinged prosthesis) through implant design standardization, personalization, and modern technological advances. It demonstrates that current debates on alignment philosophy, robotic surgery, implant personalization, and ligament management are direct extensions of concepts developed decades earlier. Understanding this evolution provides context for interpreting contemporary controversies in TKA practice.
74. Pongcharoen B, Panumaswiwat C, Promkoh S, et al. Does tibia vara increase medial knee pain following cemented mobile-bearing unicompartmental knee arthroplasty? a prospective comparative study. International Orthopaedics 2026. doi:10.1007/s00264-026-06977-y
This prospective study of 150 knees compared medial knee pain after cemented mobile-bearing UKA in patients with preoperative tibia vara versus normal tibial alignment. VAS for medial knee pain was never higher in the tibia vara group and was actually lower at six months, with no differences in functional scores or complications at 24 months. Tibia vara should not be considered a contraindication or risk factor for poor outcomes in cemented mobile-bearing UKA.
75. Rajasekaran RB, Ponniah HS, Palanisami DR, et al. A comparative analysis of three knee arthrodesis techniques to manage failed total knee arthroplasty due to infection: intramedullary nailing, LRS external fixator, and compression plating. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06469-z
This retrospective study compared knee arthrodesis using external fixation, intramedullary nailing, and compression plating in 46 patients with failed TKA due to periprosthetic infection. Bony fusion was achieved in 89.1% of knees, though five required additional surgery and four ultimately required amputation for non-union. The findings inform surgeon decision-making when selecting among three viable arthrodesis techniques for this challenging salvage scenario.
77. Liu Z, Liu D, Tang T, et al. Posterior Cruciate Ligament Reconstruction: A Technique Utilizing Tibial Double Knotless Anchors Fixation and Femoral Suspensory Fixation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70231
This technique article presents an improved PCL reconstruction method using autologous hamstring tendon graft with tibial double knotless anchor fixation and femoral suspensory fixation. The approach addresses fixation laxity from insufficient graft length, a common problem with trans-tibial interference screw fixation, by enhancing graft-bone tunnel contact. It offers greater fixation security and biomechanical advantages for PCL-deficient knees.
78. Zindel C, Hodel S, Luo Y, et al. Isometric points in cerclage for patellar tendon repair: a 3-dimensional, weightbearing computed tomography kinematic simulation. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06441-x
This 3D kinematic simulation study using weightbearing CT scans of 10 healthy knees analyzed cerclage wire elongation during knee flexion from 0° to 120° to identify the most isometric insertion points for patellar tendon repair augmentation. The most isometric tibial tuberosity insertion was found distally, with specific patellar points identified through systematic testing of 12 patellar and 42 tibial insertion sites. These findings provide evidence-based guidance for cerclage placement in the McLaughlin-type reinforcement of patellar tendon repairs.
80. Maman D, Steinfeld Y, Berkovich Y. Ninety-day readmission and early complications after coding-defined cementless-category versus cemented-category primary total knee arthroplasty. Arthroplasty 2026. doi:10.1186/s42836-026-00418-2
This database study compared 90-day readmission and early complications between coding-defined cementless-category and cemented-category primary TKA using the 2020-2022 Nationwide Readmissions Database with propensity-score matching. The analysis provides contemporary short-term administrative data on the increasingly popular cementless fixation approach. Results inform the ongoing debate regarding fixation choice in primary TKA.
81. Wang C, Zhang L, Yin S, et al. A Triple‐Tunnel Suture‐Bridge Technique for Arthroscopic Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures. Arthroscopy Techniques 2026. doi:10.1002/atn2.70188
This technical note describes an arthroscopic suture-bridge technique for ACL tibial avulsion fractures using three 2.5-mm bone tunnels (two anterior, one posterior to the ACL footprint) combined with cortical button fixation in a crossed-loop configuration. The construct is intended to provide enhanced three-dimensional fixation strength, particularly for comminuted fractures with fragments smaller than 5 mm, while requiring minimal incisions and less soft-tissue dissection than open approaches. Clinically, it offers an alternative for select patients, though it should be reserved for experienced arthroscopic surgeons and avoided in osteoporotic bone (T-score < −2.5).
82. Fellheimer HS, Davis G, McCormick C, et al. Arthroscopic Bioabsorbable Fixation Achieves Favorable Outcomes for Unstable Knee Osteochondritis Dissecans Lesions Compared With Open Fixation and Metal Implants: A Systematic Review. Arthroscopy 2026. doi:10.1002/arj.70414
This systematic review of 39 studies (1070 patients, 1097 knees) compared open versus arthroscopic internal fixation of unstable knee osteochondritis dissecans lesions, analyzing functional outcomes, complications, and reoperations by implant type and skeletal maturity. Arthroscopic fixation with bioabsorbable implants achieved favourable outcomes compared with open techniques and metal implants. The findings support an arthroscopic, bioabsorbable-implant approach as a preferred strategy for managing unstable OCD lesions of the knee.
83. Wu C, Lian C, Wu Z, et al. Semimembranosus Tendon‐Sparing Arthroscopic Inside‐Out Repair of a Medial Meniscus Bucket‐Handle Tear. Arthroscopy Techniques 2026. doi:10.1002/atn2.70208
This technical note presents a step-by-step arthroscopic inside-out repair technique for medial meniscus bucket-handle tears that specifically addresses the risk of semimembranosus tendon entrapment during blind needle passage. The authors describe methods for recognizing and avoiding entrapment while preserving the semimembranosus tendon. The technique aims to retain the reliability of the inside-out approach, considered the gold standard for meniscal repair, while reducing its principal procedural hazard.
84. Raeker-Jordan E, Nahhas C, Mzeihem M, et al. Fingertip Forces and Thenar Pressure During Instrument Use in Simulated Meniscectomy: A Comparative Study of Rongeur and Forceps. HAND 2026. doi:10.1177/15589447261468032
In this biomechanical study, 13 orthopaedic residents performed simulated meniscectomies on a porcine knee model while wearing TekScan pressure sensors, comparing a pistol-grip pituitary rongeur with pincer-style Ferris-Smith forceps. The rongeur generated significantly higher mean forces in the fingers (50.10 vs 30.62 N) and thenar region (40.69 vs 3.34 N), with similar thumb-tip forces. These findings quantify instrument-dependent hand loading and suggest that instrument design may influence cumulative musculoskeletal strain on surgeons during hand-intensive procedures.
85. Ojaghi R, Locke E, Elmi P, et al. Adductor Canal Block and Local Anesthetic Versus Local Anesthetic Alone in ACL Reconstruction: A Double-Blind Randomized Controlled Trial. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464409
This double-blind randomised controlled trial enrolled 100 ACL reconstruction patients to compare local infiltration analgesia (LIA) plus sham injection versus LIA combined with an adductor canal block (ACB), with 24-hour opioid consumption as the primary outcome and quadriceps function, pain scores, QoR-15, and KOOS as secondary measures. The trial directly tests whether adding ACB to LIA improves early postoperative analgesia without compromising quadriceps recovery. The results inform multimodal analgesia protocols for ACLR, balancing pain control against preservation of quadriceps function.
86. Augustin EJ, Oppenheim ZR, Vega J, et al. Length Changes of the Lateral Knee: Fibular Collateral Ligament, Anterolateral Ligament, and Iliotibial Band Fibers. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261468548
In this descriptive laboratory study, ten fresh-frozen cadaveric knees were dissected and digitized in three dimensions at flexion angles from 0° to 90° to characterize native length changes of the fibular collateral ligament, anterolateral ligament, and iliotibial band fibres. The FCL and ALL attachment distances progressively shortened with flexion (mean reductions of −7.59 and −6.44 mm at 90°), while ITB fibres showed smaller, transient changes. These data guide graft placement and fixation timing in lateral-sided knee reconstruction to avoid overconstraining the reconstructed ligaments.
87. Altun O, Ergişi Y, Altıntaş M, et al. Primary ACL Repair and Reconstruction in Isolated ACL Ruptures: Forgotten Joint Scores and the Association Between Residual Laxity and Joint Awareness. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261469658
This retrospective cohort study compared 26 patients undergoing primary ACL repair with 59 undergoing hamstring autograft reconstruction for isolated ACL rupture, using the Forgotten Joint Score-12 alongside Lysholm, IKDC, Tegner, laxity, return to sport, and rerupture outcomes at minimum 24-month follow-up. The study specifically examined whether residual postoperative laxity correlates with joint awareness. The findings help clarify patient-reported outcomes supporting shared decision-making between primary repair and reconstruction in carefully selected proximal ACL tears.
88. Hamad CD, Wu S, Joachim K, et al. Sociodemographic Predictors of Postpresentation Delay to Pediatric ACL Reconstruction and Associated Intra-articular Injury Severity. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261469687
This cohort study reviewed 443 paediatric ACL reconstructions at an urban academic center to determine whether race/ethnicity, insurance type, and neighborhood deprivation (Childhood Opportunity Index) were associated with postpresentation surgical delay (>120 days) and intra-articular injury severity. The study links structural determinants of health to delayed reconstruction and downstream sequelae such as high-grade cartilage injury and meniscal tears. The results highlight the need to address access disparities to prevent progressive intra-articular damage in paediatric ACL injury.
89. Seil R, Herbst E, Milano G, et al. Holding the line: Ethics and surgical decision‐making in an era of financial pressure in health care systems around the globe. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70414
This editorial addresses the ethical tension between evidence-based surgical decision-making and mounting financial pressures on healthcare systems worldwide. The authors argue that reimbursement models and budgetary constraints increasingly threaten to distort elective surgical indications in knee surgery. It calls on the orthopaedic community to explicitly define the boundary between acceptable clinical judgment and unjustifiable surgical indication to preserve ethical, patient-centered care.
91. Vendrig T, Brouwer RW, Hoogeslag RAG, et al. Association between tibiofemoral bone and meniscus morphology and dynamic tibiofemoral movements during jump‐landing tasks in patients following ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70554
This study examined whether tibiofemoral bone and meniscus morphology on preoperative MRI predict dynamic anterior tibial translation and internal tibial rotation during jump-landing tasks in 30 patients roughly 5 years after ACL reconstruction. Steeper lateral posterior tibial slope and greater medial-lateral slope difference were associated with less anterior translation but greater internal tibial rotation during single-leg hop landing. These morphological associations may help guide decisions about adjunctive procedures, such as slope-reducing osteotomy, alongside primary or revision ACL reconstruction.
93. Schaefer LV, Bittmann FN, Ulrich J, et al. Muscle function of the lower limb—Do we really test what we are looking for?. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70560
This conceptual paper challenges the validity of established lower-limb muscle function tests, noting their weak and inconsistent association with injury, re-injury, and musculoskeletal outcomes. The authors contend that conventional strength measures fail to capture the adaptive, stabilizing muscle control required during non-contact injury events. They propose shifting assessment toward 'Adaptive Force', the ability to hold a position while adapting to rising external loads, to better reflect joint protection and inform rehabilitation and return-to-sport decisions.
94. Bauer L, Gramzow J, Brensing M, et al. Reduced compression time is not sufficient for stability in patellar buttons. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70561
Using twelve human cadaveric patellae, this biomechanical study compared 30-second versus 600-second manual compression times for cemented all-polyethylene patellar buttons in total knee arthroplasty. Reduced compression time did not produce adequate primary fixation stability, despite limited differences in cement morphology on micro-CT. Surgeons should maintain prolonged manual compression of the patellar button until cement curing rather than shortening it to save operative time.
95. Simon J, Siedow TM, Thorwächter C, et al. Reduced patella medialization in valgus and varus knees using a KA‐optimized femoral component in kinematically aligned TKA. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70563
In seventeen fresh-frozen cadaveric knees (valgus and varus), this study compared a kinematically aligned (KA)-optimised femoral component (prosthetic trochlear angle 20°) with a standard design (PTA 6°) during KA total knee arthroplasty. The KA-optimised component reduced patellar medialization by approximately 2-2.5 mm between 30° and 70° of flexion in both deformity groups, with unchanged patellar tilt, though contact area decreased after TKA with both designs. The KA-optimised trochlear design may improve patellofemoral kinematics and potentially reduce patellofemoral complications after KA-TKA.
96. Hasegawa S, Krutsch W, Koga H, et al. Impact of playing position on ACL injury characteristics, risk and career outcomes in football—An analysis of 742 cases of the ACL registry in German football. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70566
Drawing on 742 ACL injuries from the prospective ACL Registry in German Football across professional, semi-professional, and amateur levels (2016-2022), this study analyzed how playing position influences injury characteristics and career outcomes. Forwards showed the highest rate of competitive-level decline after ACL reconstruction (47.5%), with position-related differences in return-to-performance and match participation evident in mixed-effects models. Position-specific risk profiles and career trajectories should inform injury prevention programs and return-to-play counseling in football.
97. Gillani A, von Eisenhart‐Rothe R, Woertler K, et al. Promises and limitations of deep learning for predicting knee osteoarthritis progression from medical imaging: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70555
This systematic review of 33 studies (50 models) evaluated deep learning for predicting knee osteoarthritis progression from imaging, with risk of bias assessed via PROBAST-AI. Reported AUCs varied widely, but nearly all models (97%) were trained on the Osteoarthritis Initiative dataset, progression definitions were heterogeneous, and few studies performed external validation. Clinically, DL shows promise but faces substantial translational barriers; standardised outcome definitions and external validation are needed before clinical deployment.
98. Kekki C, Cristiani R, Stålman A, et al. Quadriceps Tendon Autografts Are Associated With Increased Short-term Reoperation Rates for Extension Deficit or Pain and Inferior Patient-Reported Outcomes Compared With Hamstring Tendon Autografts: An Analysis of 5653 Cases of Primary Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261465107
This retrospective cohort study compared nonrevision reoperation rates and KOOS scores at 2 years among 5653 primary ACL reconstructions using hamstring tendon, bone-patellar tendon-bone, or quadriceps tendon autografts. Quadriceps tendon autografts were associated with higher short-term reoperation rates for extension deficit or pain and inferior patient-reported outcomes compared with hamstring tendon autografts. The findings suggest surgeons should weigh these risks when selecting graft type, as QT outcomes may not be equivalent in routine practice.
99. Beierlein V, Bürgy R, Kirsch T, et al. Differences in health outcomes of orthopedic rehabilitation after hip or knee replacement: a prospective pilot study benchmarking 23 rehabilitation facilities using Patient-Reported Outcome Measures (PROMs). Arthroplasty 2026. doi:10.1186/s42836-026-00401-x
This prospective pilot study benchmarked 23 German rehabilitation facilities using PROMs (HOOS-PS/KOOS-PS and VR-12) collected at admission and discharge after standardised three-week rehabilitation in 961 THA and 961 TKA patients, with risk adjustment via pooled regression yielding residual effect sizes per facility. Change scores were measurable and facility-level benchmarking was feasible after risk adjustment. The results support a practical framework for public reporting of short-term rehabilitation outcomes, though larger-scale validation is needed.
100. Abelleyra Lastoria DA, Hunt A, Ross CK, et al. The incidence and epidemiology of patellar fractures following medial patellofemoral ligament reconstruction: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06440-y
This systematic review and meta-analysis of 110 studies (115,496 patients) determined the incidence of and risk factors for patellar fracture after medial patellofemoral ligament reconstruction. The pooled incidence was 1.17% (95% CI 0.76-1.68%), with wide study-level variation (0-9.50%) and moderate-to-low evidence quality. Clinically, patellar fracture is an uncommon but real complication of MPFL reconstruction, and surgeons should counsel patients accordingly while recognizing the limitations of the evidence base.
101. An H, Li Y, Sun W, et al. Impact of the femoral pin tracker on periprosthetic fractures in robotic-assisted total knee arthroplasty. International Orthopaedics 2026. doi:10.1007/s00264-026-06975-0
This retrospective cohort study of 688 robotic-assisted total knee arthroplasties compared femoral periprosthetic fracture rates within three months between intra-incisional (n=505) and extra-incisional (n=183) femoral pin tracker placement, supplemented by finite-element analysis. One fracture occurred in the extra-incisional group and none in the intra-incisional group, a non-significant difference, and FEA showed similar ultimate loads and fracture patterns across models with no fracture initiation at pin channels. The findings suggest pin tracker placement location does not meaningfully influence early femoral periprosthetic fracture risk.
102. Maricar MA, Tariq M. Letter regarding “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study”. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.04.082
This letter critiques the methodology of a randomised trial comparing preoperative methadone versus oxycodone for postoperative pain after total knee arthroplasty. The authors argue that unblinded anaesthesia providers may introduce performance bias affecting intraoperative analgesic decisions, and they recommend pharmacy-only blinding designs to strengthen internal validity. The implication is that the trial's pain and opioid outcomes should be interpreted with caution pending such methodological safeguards.
103. Chen AF, Della Valle CJ, Bostrom MP, et al. Reconsidering Centers for Medicare & Medicaid Services Functional Status Measures for Total Hip and Knee Arthroplasty: From Process Compliance to Meaningful Outcome Assessment. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.075
This commentary examines the CMS functional status measures for total hip and knee arthroplasty, arguing that current requirements emphasize process compliance rather than meaningful outcome assessment. The authors contend that well-validated PROMs (e.g., Oxford scores, HOOS/KOOS, PROMIS) enable longitudinal tracking that can improve implant performance, surgical technique, and patient outcomes, as demonstrated by Scandinavian and UK registry initiatives. The clinical implication is a call to redesign CMS measures around validated, patient-centered outcome collection rather than checkbox compliance.
104. Ganz MP, Mont MA, Scuderi GR. Androgen Awareness: Navigating Testosterone Replacement Therapy in Total Joint Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.06.013
This perspective article addresses the rising use of testosterone replacement therapy among patients presenting for elective total joint arthroplasty, driven by longevity medicine, expanded indications, and gender-affirming care. It highlights that orthopaedic surgeons will increasingly encounter patients on exogenous androgens and must be aware of potential perioperative and musculoskeletal implications. The clinical takeaway is that surgeons should proactively identify and consider TRT use during preoperative evaluation and optimization of arthroplasty patients.
105. Fernández-Comparini T, Irarrázaval S, Fernández Schlein F, et al. Optimizing tunnel placement for lateral extra-articular procedures in pediatric epiphyseal anterior cruciate ligament reconstruction: A three-dimensional simulation study of physeal damage and safe zone identification. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101129
Three-dimensional models from MRI of patients aged 10-17 were used to simulate ACL and lateral extra-articular procedure (ALL) tunnel trajectories from their femoral insertions and quantify distal femoral physeal breach. The authors identified safe tunnel orientations that avoided both the physis and the ACL tunnel, with physeal injury expressed as a percentage of total physeal volume. Clinically, the study provides orientation-specific safe zones to guide lateral extra-articular tenodesis/ALL placement during epiphyseal ACLR in skeletally immature patients.
107. Rivarola H, Helito C, Collazo C, et al. A decision tree model for chondral lesion management in the knee based on clinical and mathematical integration. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101131
The authors developed a decision tree algorithm for managing focal knee chondral lesions by integrating literature-derived evidence thresholds with clinical variables such as age, lesion size, and activity level, stratifying options including microfracture, ACI/MACI, OATS, OCA, HTO, UKA, and focal resurfacing. The framework was structured mathematically to individualize treatment selection. It offers clinicians a standardised, evidence-based tool for navigating the heterogeneous decision-making landscape of cartilage repair.
108. Chakraborty A, Mattin D, Christiansen MJ, et al. Plain-language prompting improves readability of ChatGPT-generated patient education for meniscal surgery without loss of accuracy. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101132
Sixteen standardised patient questions on meniscal surgery were posed to ChatGPT-5 and ChatGPT-4o, with responses scored for accuracy against AAOS OrthoInfo, relevance, depth, and readability (FKGL, FRES), then rewritten using a standardised plain-language prompt. Plain-language prompting improved readability toward AMA/NIH health-literacy recommendations without compromising accuracy, relevance, or depth. The finding supports routine use of plain-language prompts when LLMs generate orthopaedic patient education materials.
109. Gonzalez W, Isla J, Barba D, et al. Magnetic resonance imaging–derived anterior tibial translation after anterior cruciate ligament reconstruction and its association with postoperative adverse events: A retrospective cohort study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101134
In a retrospective cohort of 137 patients with pre- and ~9-month postoperative MRI after primary ACLR, lateral compartment anterior tibial translation was measured using the Tanaka method, with abnormal ATT defined as >6 mm. The study quantified ATT change over time and used logistic regression to test whether persistent abnormal ATT predicted postoperative adverse events. The work evaluates MRI-derived ATT as a potential prognostic marker for identifying patients at risk after ACLR.
110. Rahnel T, Reito A, Launonen AP, et al. Patella alta and its diagnostic challenges: A comparison of static and dynamic imaging modalities indicates limited diagnostic value in standard magnetic resonance imaging. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101136
Twenty-nine patients with anterior knee pain underwent both standard supine 3.0T MRI and dynamic weight-bearing cone-beam CT with quadriceps contraction, allowing comparison of static versus dynamic patellotrochlear index measurements plus Caton-Deschamps and Insall-Salvati indices for patella alta. The study found meaningful differences between static and dynamic assessments, indicating limited diagnostic value of standard MRI for patella alta. This suggests dynamic weight-bearing imaging may be needed for accurate diagnosis of patellar height abnormalities.
111. Tang X, Zhang J, Yu B. Time After ACL Reconstruction: Degenerative Clock or Vulnerable Knee Exposure? Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464189
This letter responds to Agostinone et al.'s registry study showing cartilage lesion prevalence rising from 19% at primary to 36% at revision ACLR in 2845 patients. The authors argue the time effect should be interpreted not as a linear degenerative clock but as a marker of cumulative exposure to a mechanically and biologically vulnerable knee state among patients entering the revision pathway. This reframing has implications for how time-based risk of cartilage deterioration is communicated and studied after ACLR.
114. Seil R, Herbst E, Milano G, et al. Holding the line: Ethics and surgical decision-making in an era of financial pressure in health care systems around the globe. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101137
This editorial examines the ethical tension between evidence-based surgical indications and growing financial pressures on health systems, particularly in elective knee surgery. The authors argue that reimbursement models and budgetary constraints must not distort clinical judgment or expand indications beyond justifiable thresholds. Orthopaedic surgeons bear responsibility for holding the line on ethically sound, evidence-based decision-making regardless of economic incentives.
115. Avram GM, Indelli PF, Violante B, et al. GLP‐1 receptor agonists in hip, knee and shoulder arthroplasty: Implications for obesity, osteoarthritis, metabolic optimisation and complications. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70557
This editorial reviews the implications of GLP-1 receptor agonists and incretin-based therapies for hip, knee, and shoulder arthroplasty, including effects on weight, systemic inflammation, glycemic control, and perioperative complications. Retrospective data suggest preoperative use may reduce periprosthetic joint infection and readmission risk, but evidence remains observational with significant confounding. Clinicians should consider metabolic optimization with these agents while awaiting higher-quality trials before changing surgical candidacy or perioperative protocols.
118. Vosoughi F, Ramezanpour MR, Hashemi FS, et al. Outcomes of Total Knee Arthroplasty in Patients Receiving Chronic Antithrombotic Therapy: A Systematic Review. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.047
This systematic review of 17 retrospective studies (over 104,000 patients on chronic antithrombotic therapy and 261,000 controls) summarized outcomes after total knee arthroplasty by antithrombotic class. The review examined perioperative complications, thromboembolic events, and longer-term outcomes across antiplatelet agents, warfarin, and direct oral anticoagulants. Results inform perioperative management decisions for the growing number of TKA patients on long-term antithrombotic therapy.
119. Barton K, Aprey N, Hemmerle M, et al. Incidence of Postoperative Patellar Crepitus in Total Knee Arthroplasty with Unresurfaced Patellae in Cruciate-Retaining and Posterior-Stabilized Designs. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.07.060
This retrospective review of 845 total knee arthroplasties with unresurfaced patellae found a 9.8% overall incidence of postoperative patellar crepitus, significantly higher in posterior-stabilised than cruciate-retaining designs (12.3% vs 5.7%). Only 14 cases were painful and six required reoperation. Surgeons choosing PS designs with unresurfaced patellae should counsel patients about crepitus risk, though most cases remain asymptomatic.
120. Chen W, Wang C, Lee S, et al. Sensor-Based Gait Recovery Analysis After Total Hip and Knee Arthroplasty: A One-Year Follow-Up Study Integrating Muscle Strength and Patient-Reported Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.05.038
This prospective study of 84 elderly patients used foot-mounted inertial sensors, isokinetic strength testing, and PROMs to characterize one-year gait recovery after total hip or knee arthroplasty. TKA patients showed persistent gait asymmetry up to three months postoperatively, whereas THA patients recovered more quickly. Objective sensor-based gait analysis can identify delayed recovery after TKA and guide targeted rehabilitation, with muscle strength serving as a key predictor.
121. Rivarola H, Collazo C, Palanconi M, et al. Exploring the Rotational Instability Spectrum of ACL Deficiency: An Exploratory Phenotype-Based Classification Integrating Secondary Stabilizer Injury Burden. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101195
This retrospective cohort study of 300 consecutive primary ACL reconstruction patients explored whether ACL-deficient knees cluster into distinct rotational instability phenotypes based on injury to lateral secondary stabilizers (e.g., hypermobile lateral meniscus, popliteomeniscal fascicle and meniscotibial injuries). The investigators integrated clinical, MRI, and arthroscopic variables to derive a phenotype-based classification of rotational instability. Clinically, such a classification could help identify which patients may benefit from addressing secondary stabilizer pathology at the time of ACL reconstruction.
122. Vosoughi F, Menbari Oskouie I, Torkamanzadeh P, et al. Transcultural adaptation and psychometric validation of the Persian version of the 4-Domain Sports patient-reported outcome measure questionnaire. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101199
This study translated and culturally adapted the 4-Domain Sports PROM questionnaire into Persian following Beaton and COSMIN guidelines and psychometrically validated it in 97 ACL reconstruction patients who completed it twice one week apart. Internal consistency (Cronbach's alpha), test-retest reliability (ICC), and construct validity against the Persian IKDC-SF were assessed. The work provides a validated Persian-language outcome tool for research and clinical care in Persian-speaking athletic populations.
123. Rivarola H, Collazo C, Palanconi M, et al. From Linear Rehabilitation to Graded Stress Exposure: A Clinical Framework for Return to Sport After Anterior Cruciate Ligament Reconstruction. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101196
This clinical framework article proposes moving from traditional linear, time- and criteria-based rehabilitation after ACL reconstruction toward a graded stress exposure model that progressively escalates tissue and functional loading demands. The authors outline a structured framework for applying graded exposure principles to return-to-sport decision-making. The implication is a more individualized, load-driven rehabilitation pathway that may better prepare athletes for the demands of sport while reducing reinjury risk.
126. Luo Y, Soriano K, Strok M, et al. Conversion Total Knee Arthroplasty After Tibial Plateau Fracture Open Reduction and Internal Fixation: A Propensity-Matched Analysis of 90-Day and One- and Three-Year Outcomes. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.010
Using a national database (2003-2023), this propensity-matched study compared 615 conversion TKAs after tibial plateau fracture ORIF against primary TKA, with additional analyses of nonoperatively treated fractures. Conversion TKA carried roughly two- to threefold higher risks of periprosthetic joint infection and revision compared with primary TKA, with secondary analyses parsing risk attributable to prior hardware versus fracture history itself. These data should inform preoperative counseling and risk stratification when planning arthroplasty after tibial plateau fracture.
127. Honig EL, Nichols E, Palandjian PL, et al. Physeal Growth May Resume Following Removal of Transphyseal Epiphysiodesis Screws. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-24-00218
This case report describes a skeletally immature patient who underwent distal femoral and proximal tibial screw epiphysiodesis for leg length discrepancy after juvenile ACL reconstruction and later began testosterone therapy, prompting screw removal to avoid overshortening. Modest growth of the operative limb resumed after transphyseal screw removal. The report suggests that physeal growth may resume following removal of transphyseal epiphysiodesis screws, relevant to timing decisions in growing patients.
128. Murray J, Bijwadia S, Ristow J, et al. Multiligamentous Knee Injury in a Skeletally Immature Athlete. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-25-00266
This case report describes a 13-year-old football player with complete ACL, PCL, and MCL tears plus a lateral meniscus tear who underwent multiligamentous knee reconstruction using autograft and allograft techniques designed to minimise physeal damage, followed by partial meniscectomy. At 18 months, the patient was pain-free with normal limb lengths and had returned to competitive football. The case demonstrates that successful multiligamentous reconstruction is feasible in skeletally immature athletes with careful graft selection and physeal-sparing technique.
129. Miceli JG, Doerr NA, Andriani NT, et al. Polyethylene Exchange During Retrograde Intramedullary Nailing in the Treatment of Periprosthetic Distal Femur Fractures: A Registry Pilot Analysis. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-26-00245
A retrospective registry review of 26 patients treated with retrograde intramedullary nailing (or nail-plate combination) for periprosthetic distal femur fractures above well-fixed total knee components quantified polyethylene exchange during the index procedure. Polyethylene was exchanged in 34.6% of cases, with flexion instability the leading indication, and over a quarter of patients reported prefracture knee instability symptoms. Surgeons performing retrograde nailing for these fractures should anticipate a substantial likelihood of polyethylene exchange and evaluate for instability preoperatively.
130. Sheth ND, McCall M, Hrudka B, et al. Isolated Versus Full-Component Revision Total Knee Arthroplasty for Aseptic Loosening: Systematic Review and Meta-Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.004
A systematic review and meta-analysis of 11 studies compared isolated versus full-component revision total knee arthroplasty for aseptic loosening. Re-revision rates for all indications, aseptic loosening, and periprosthetic joint infection were statistically comparable between the two approaches, with no clear superiority of full-component revision. These findings support isolated component revision as a reasonable option in selected aseptic loosening cases, though the evidence base remains limited and heterogeneous.
131. Patel D, Gay SS, Belzile E, et al. Comparison of Postoperative Outcomes Following Simultaneous Versus Staged Bilateral Total Knee Arthroplasty in Obese Patients: A Database Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.007
A database study of 11,965 patients compared simultaneous versus staged bilateral total knee arthroplasty across obesity classes. Body mass index modified the association between surgical timing and 30-day complications, readmission, two-year aseptic loosening, revision, and length of stay, with staged procedures showing lower odds of composite complications. Surgical timing decisions for bilateral TKA should be individualized according to obesity severity, as the risk-benefit tradeoff differs across BMI categories.
132. Nakla A, Aubin PM, Ademisoye S, et al. Smart Implantable Device Use Is Associated With Decreased Postdischarge Hospital Utilization in Total Knee Arthroplasty Patients Who Have Metabolic Syndrome: A Propensity Score–Matched Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.011
A propensity score, matched analysis of 1,562 total knee arthroplasties in patients with metabolic syndrome compared outcomes between those receiving smart implantable devices with remote monitoring and matched controls. Smart implant use was associated with reduced postdischarge hospital utilisation, including fewer emergency department visits and readmissions. Remote-monitoring implant technology may be a useful strategy to mitigate the elevated postoperative care burden in this high-risk patient population.
133. Khury F, Ehlers M, Aziz HH, et al. Functional Limb Length Preservation and Coronal Alignment Categories in Revision Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.012
A retrospective review of 70 revision total knee arthroplasty patients with full-length radiographs evaluated functional limb-length and coronal alignment preservation relative to contralateral and pre-revision baselines. Limb length was preserved in 68.6% relative to the contralateral side and 47.1% relative to pre-revision, coronal alignment was preserved in 64.3%, and patient-reported outcome improvements were comparable across categories. Achieving precise limb-length and alignment restoration may be less critical to patient-reported outcomes after revision TKA than commonly assumed.
135. Kugo M, Kumagai K, Taniguchi M, et al. Japanese Knee Osteoarthritis Measure at Two Weeks as a Key Predictor of Early Functional Recovery After Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.015
A retrospective study of 180 primary total knee arthroplasty patients evaluated preoperative and early postoperative measures to identify predictors of functional recovery at four weeks. The Japanese Knee Osteoarthritis Measure score at two weeks strongly predicted four-week recovery, with delayed-recovery patients already showing worse scores, higher pain, and poorer physical performance at two weeks. Early two-week patient-reported assessment can identify patients at risk of delayed recovery who may benefit from targeted intervention.
137. Haziza S, Greenberg M, Spagnuola J, et al. Association of Extended Oral Antibiotic Prophylaxis With 90-Day Complication Rates After Primary Total Knee Arthroplasty: A Prospensity-Matched Retrospective Cohort Study. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.020
A propensity-matched retrospective cohort study using a national database compared primary total knee arthroplasty patients who did versus did not receive extended oral antibiotic prophylaxis (an oral antibiotic on postoperative day one), with a subgroup analysis excluding patients with diabetes, chronic kidney disease, and liver disease. At 90 days, patients exposed to extended oral prophylaxis had significantly higher rates of periprosthetic joint infection (1.99% vs 0.72%) and revision surgery, with no difference in superficial skin infection. The findings argue against a routine benefit of extended oral antibiotic prophylaxis after primary TKA and suggest it may be associated with worse infectious outcomes.
141. Angachekar D, Hiranaka T, Ahedi H, et al. Preoperative coronal plane alignment of the knee phenotype does not predict patient-reported outcomes after medial opening-wedge high tibial osteotomy. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101204
This retrospective cohort study of 130 knees in 111 patients undergoing medial opening-wedge high tibial osteotomy classified preoperative and postoperative alignment using hip-knee-ankle-based and arithmetic CPAK methods on full-length standing radiographs, with interobserver assessment by two reviewers. Preoperative CPAK phenotype did not predict postoperative patient-reported outcomes (KOOS subscales, KOOS-12, WOMAC, Tegner) at one year, two years, or final follow-up. CPAK phenotype, developed primarily for arthroplasty planning, appears not to be a useful predictor of PROMs after valgus-producing high tibial osteotomy, limiting its role in osteotomy patient selection or counseling.
142. Joshi A, Regmi S, Sharma R, et al. Graft Options for Multiligament Knee Reconstruction Among Surgeons with Limited Allograft Access: A Cross-Sectional Survey. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101205
A cross-sectional online survey of arthroscopic surgeons across SAARC countries (India, Nepal, Bangladesh, Pakistan, Afghanistan, Sri Lanka, Maldives) performing at least 10 multiligament knee injury reconstructions annually examined graft preferences and reconstruction techniques where allograft access is limited. The survey captured graft choices for each ligament across various multiligament injury patterns and preferred surgical techniques. The findings document distinctive regional practice patterns driven by allograft scarcity, providing a reference for autograft-based strategies in resource-constrained settings.
143. Bruni D, Di Rocco D, Feleppa S, et al. Histological maturation of an Achilles tendon allograft six years after revision anterior cruciate ligament reconstruction: case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101206
This case report describes histological evaluation of a fresh-frozen Achilles tendon allograft biopsied incidentally six years after revision ACL reconstruction (over-the-top technique with lateral extra-articular tenodesis) in a 41-year-old male undergoing subsequent arthroscopy for a bucket-handle medial meniscus tear. Histology showed a largely organized extracellular matrix with parallel collagen bundles and spindle-shaped tenoblasts, alongside focal intersecting fibres, heterogeneous nuclear morphology, and persistent microvascularity. The findings provide rare long-term human evidence that intra-articular allografts undergo substantial remodeling and maturation, supporting their viability in revision ACL reconstruction.
144. Ayati Firoozabadi M, Rezaee H, Mortazavi SMJ. Kaplan Fiber Injuries in The Anterior Cruciate Ligament-Injured Knee: Current Concepts. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101208
This Current Concepts Review summarizes evidence on Kaplan fibres, the deep femoral iliotibial band attachments, as secondary restraints to anterolateral rotatory instability in ACL-injured knees, covering anatomy, biomechanics, imaging, healing potential, and surgical management. MRI studies report Kaplan fibre injury in 18.6% to 43% of acute ACL tears, but the literature is limited by heterogeneous imaging protocols, inconsistent diagnostic criteria, poor inter-rater reliability, and biomechanical data drawn largely from variable cadaveric studies. The review underscores that indications for addressing Kaplan fibre injuries remain incompletely defined, highlighting a need for standardised imaging criteria and higher-quality clinical outcome data.
146. TSOI TL, AHEDI H, PARKER DA. Total knee arthroplasty outcomes in older patients are still clinically beneficial: the impact of age on recovery and satisfaction in total knee arthroplasty patients. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101210
This retrospective study of 1,723 total knee arthroplasty patients examined the effect of age on 1-year patient-reported outcomes and satisfaction, adjusting for sex, BMI, ROM, implant, surgeon volume, and alignment. Older patients reported better preoperative scores, and the findings indicate TKA remains clinically beneficial in older age groups, supporting its use across the age spectrum rather than restricting surgery by age alone.
147. Hiranaka T, Li AM, Hewison C, et al. Native Coronal Patellar Tracking Demonstrates Three Distinct Patterns Associated with Coronal Alignment in Robotic-Assisted Total Knee Arthroplasty: A Preliminary Study. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101211
Intraoperative native patellar tracking was recorded with a robotic system in 252 robotic-assisted TKAs before any bone cuts and correlated with CPAK coronal alignment classification. Three distinct tracking patterns emerged, central (58%), lateral (35%), and medial (7%), with a significant association between coronal alignment category and tracking pattern, suggesting preoperative alignment may help anticipate patellar tracking issues in TKA planning.
152. Denis-Aubrée P, Moussa M, Valentin E, et al. The Impact of Preoperative Anxiety on the Incidence of Arthrogenic Muscle Inhibition After Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261462819
In a prospective cohort of 143 ACL reconstruction patients, preoperative surgery-related anxiety was measured with the Surgical Fear Questionnaire and related to the incidence of arthrogenic muscle inhibition at 21 days postoperatively. High preoperative anxiety was associated with more frequent AMI, supporting preoperative psychological screening to identify patients who may benefit from targeted interventions to prevent quadriceps inhibition and improve rehabilitation.
153. Magoline JA, Wagner DF, Kaelber DC, et al. Quantifying Risk Factors for Osteochondritis Dissecans in Children: A Propensity-Matched Retrospective Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261463082
Using the TriNetX database, this propensity-matched cohort study quantified relative risks for osteochondritis dissecans in patients ≤25 years associated with comorbidities (e.g., hypopituitarism, vitamin D deficiency, coagulopathies, obesity) and youth sports participation. It provides population-based estimates of OCD incidence, prevalence, and condition-specific relative risks. Clinically, the findings help identify children who may warrant closer monitoring for OCD based on biological or athletic risk profiles.
154. Tachibana Y, Tanaka Y, Kitaguchi T, et al. Modified Postoperative Rehabilitation Including Dynamic Posterior Cruciate Ligament Brace to Reduce Recurrence of Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: A Retrospective Comparative Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261463127
This retrospective cohort compared conventional rehabilitation (n=14) with a modified protocol using a dynamic PCL brace (n=11) after double-bundle PCL reconstruction in patients with isolated grade 2-3 injuries. Posterior tibial translation on gravity sag radiographs and patient-reported outcomes were assessed between groups. The results inform whether brace-protected rehabilitation reduces recurrent posterior laxity and could change postoperative PCL reconstruction protocols.
155. Marmura H, Getgood AM, Bryant DM. Does Recalibration Response Shift Alter Perceived Treatment Effects in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction?. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261463386
This cohort study administered KOOS and IKDC questionnaires preoperatively and at 1 and 2 years after ACL reconstruction, including a second set asking patients to recall their preoperative state, to detect recalibration response shift, alongside coping style and life event assessments. It quantified the gap between traditionally measured and response-shift-adjusted change scores. The findings caution that perceived treatment effects on knee PROMs after ACLR may be biased by shifting patient internal standards, affecting interpretation of longitudinal outcomes.
156. Mueller MM, Conner-Rilk S, Klinger CE, et al. Differential Arterial Supply of the ACL and PCL Revealed by 7T-qMRI, Histology, and Micro-CT. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261464702
In seven fresh-frozen cadaveric knees, the authors mapped regional arterial supply of the ACL and PCL using pre- and post-contrast 7T quantitative MRI, validated by histology and micro-CT across five standardised ligament zones. The study quantitatively compared vascular distribution between the two cruciate ligaments. These anatomical data may guide graft selection, tunnel placement, and strategies to optimise ligament healing after reconstruction.
157. Alzobi OZ, Moghamis I, Alebbini M, et al. Complications Related to Arthroscopic Isolated Posterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of 4162 Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261466475
This PRISMA-compliant systematic review and meta-analysis pooled data from 65 studies (4162 patients) to characterize complications after isolated arthroscopic PCL reconstruction. The overall complication rate was 14.8%, led by persistent pain (4.2%), residual posterior laxity (4.1%), and arthrofibrosis (3.1%), with subgroup analyses by bundle technique and graft type. The results provide evidence-based complication benchmarks for preoperative counseling and technique selection in PCLR.
158. Riesenberg J, Emerson H, Ulman S, et al. Differential Quadriceps Muscle Activation Preoperatively and at the Time of Return to Sport After Medial Patellofemoral Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261466476
In this cross-sectional motion analysis study, 25 adolescents with patellofemoral instability underwent surface electromyography during unweighted squats before MPFL reconstruction, and 16 additional patients were tested at return-to-sport clearance. Peak activation of quadriceps and other lower limb muscles was compared between limbs. The study tests whether limb-to-limb asymmetries in dynamic patellar stabilizers persist through rehabilitation, informing RTS assessment after MPFL reconstruction.
160. Omar H, Syed AN, Landrum K, et al. A Novel Approach to Segmental Meniscal Repair Improves Ultimate Strength and Resistance to Cyclic Fatigue. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261468500
Using a cadaveric bovine meniscus model, this controlled laboratory study compared two suture constructs for segmental meniscal repair (hashtag/rip-stop/luggage-tag vs. luggage-tag/vertical and horizontal mattress configurations) under quasi-static tensile failure and 1000-cycle fatigue testing across 24 medial and lateral explants. The modified construct improved ultimate strength and cyclic fatigue resistance. This biomechanical evidence supports optimising fixation techniques for segmental meniscal transplantation to improve repair durability.
163. Landry M, Jordan MJ, Chan D, et al. Comparison of the PIVOT App and Pivot Shift Test for Assessing Knee Laxity after ACL Injury: Validity and Impact of Thigh Muscle Coactivity. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261469739
This diagnostic cohort study validated the PIVOT App, an iPad-based video analysis tool providing a continuous, quantitative measure of the pivot shift test, in ACL-deficient patients tested both awake in clinic and under anaesthesia, with EMG used to quantify thigh muscle coactivity. The app distinguished categorical pivot shift grades and normal from abnormal knees, while muscle coactivity was shown to influence pivot shift grades. The PIVOT App offers a more objective alternative to subjective grading, though examiner awareness of muscle guarding effects is important for accurate laxity assessment.
164. Chrumka A, Strickler I, Jensen A, et al. Prevalence of ACL Injury Prevention Protocols in Girls’ High School Athletics: A Metro Detroit Survey Study With Socioeconomic Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261470580
This cross-sectional survey of coaches at 131 Metro Detroit high schools assessed the prevalence of ACL injury prevention protocols in girls' basketball, soccer, and volleyball and examined associations with socioeconomic status, school type, and athletic trainer access. Implementation of ACL-specific prevention programs was found to be inconsistent and associated with school-level socioeconomic factors and athletic trainer availability. The results highlight socioeconomic disparities in injury prevention access, suggesting targeted resource allocation and athletic trainer support may be needed to reduce ACL injury risk in female high school athletes.
166. Kawanishi S, Kitamura N. Influence of Concomitant Articular Cartilage Injury on the Diagnostic Performance of Physical Examination Tests for Meniscal Tears. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261470917
In this retrospective diagnostic cohort of 186 arthroscopically evaluated knees, the McMurray test and joint line tenderness were compared against arthroscopically confirmed meniscal tears in knees with and without concomitant articular cartilage injury (ICRS grade ≥2). The presence of cartilage damage altered the diagnostic performance of these physical examination tests for meniscal tears. Clinicians should interpret meniscal examination findings cautiously in patients with coexisting chondral injury, as diagnostic accuracy may be compromised.
168. Im C, Dajani A, Marks A, et al. Evaluation of Spin Bias in the Use of Platelet-Rich Plasma for Augmentation of Meniscal Tear Repairs. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261471384
This systematic review evaluated spin bias in systematic reviews and meta-analyses of platelet-rich plasma augmentation for meniscal repair, assessing abstracts against 15 predefined spin categories and full texts with AMSTAR 2. A substantial proportion of abstracts overstated treatment benefits or misrepresented the certainty of evidence. Clinicians should critically appraise abstract conclusions in this literature, as spin bias may lead to overestimation of PRP's efficacy in meniscal repair.
169. Meng B, Zhang Z, Li W, et al. Correlation Between Synovial Coverage of the Reconstructed Anterior Cruciate Ligament and Healing of Bucket-Handle Medial Meniscal Tears After Combined ACL Reconstruction and Meniscal Repair. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261472645
This cross-sectional study of 59 patients undergoing second-look arthroscopy after combined ACL reconstruction and bucket-handle medial meniscal tear repair examined whether synovial coverage of the ACL graft correlates with meniscal healing. Greater synovialization of the reconstructed graft was associated with higher meniscal healing rates, supporting the hypothesis that the intra-articular biological environment influences repair success. Clinically, optimising synovialization may be a target to improve meniscal healing outcomes after combined procedures.
170. Rivarola H, Collazo C, Palanconi M, et al. Association of Persistent Interlimb Kinetic Asymmetry at Return to Sport With Increased Risk of Contralateral Anterior Cruciate Ligament Injury. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261477570
This level 3 cohort study followed 500 patients after primary unilateral ACL reconstruction, using force-plate measurements of interlimb kinetic asymmetry during single-leg landing at return-to-sport clearance to predict subsequent injury over a mean 36-month follow-up. Persistent kinetic asymmetry (peak vertical ground-reaction force and loading rate) was associated with increased risk of contralateral ACL injury and provided prognostic value beyond conventional RTS criteria. The findings suggest biomechanical asymmetry testing should be incorporated into return-to-sport decision-making to identify athletes at elevated re-injury risk.
173. Uppstrom TJ, Calibo TK, Hollenbeck JF, et al. Paper 02. Tibiofemoral Load Sharing and Lateral Meniscus Function after Type 3 Lateral Meniscus Oblique Radial Tear (LMORT) Treatment: Tibia-based Suture Anchor Repair, Capsular-based Repair, and Debridement. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00264
This cadaveric biomechanical study compared tibia-based suture anchor repair, capsular-based repair, and debridement for type 3 lateral meniscus oblique radial tears using pressure sensors and root force measurements across multiple flexion angles. Type 3 LMORTs altered lateral compartment contact mechanics and meniscal force transmission, and tibia-based suture anchor repair restored these metrics closer to intact levels than capsular-based repair or debridement. The findings support tibia-based anchor fixation as the preferred biomechanical construct for this tear pattern.
175. Patel R, Jacquet C, Mabrouk A, et al. Paper 13. Infra-Tubercular Versus Retro-Tubercular Slope-Correcting High Tibial Osteotomy In Revision Anterior Cruciate Ligament Reconstruction: Comparative Survivorship, Stability, Alignment, and Healing. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00273
This comparative study evaluated infra-tubercular versus retro-tubercular slope-correcting high tibial osteotomy performed concurrently with revision ACL reconstruction, comparing graft survivorship, instrumented laxity, patient-reported outcomes, radiographic alignment, complications, and bone healing. Both techniques provided comparable survivorship and outcome improvements, with trade-offs between the approaches in stability, alignment correction, healing speed, and hardware management. These findings help surgeons individualize osteotomy technique selection based on whether stability or healing/implant considerations take priority.
177. Cong T, Bilodeau RE, Vieider RP, et al. Paper 15. A Lateral Extra-articular Tenodesis (LET) Indication Score May Decrease Revision ACLR and Minimize Unneeded LETs. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00275
This retrospective validation study developed a weighted 'LET Score' using established clinical risk factors to guide lateral extra-articular tenodesis use in primary ACL reconstruction, comparing it against the Modified Getgood Criteria in a consecutive cohort of skeletally mature patients. Statistical modeling suggested the score could reduce revision ACLR rates while limiting unnecessary LET procedures. Clinically, it offers a pragmatic, validated framework to standardize LET indications and avoid both over- and under-utilisation.
178. Ellis HB, Martin H, Agonias KB, et al. Paper 33. Absorbable Single-Stay Suture Bridge Fixation for Osteochondral Fractures Following Patellar Dislocation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00291
This single-center study evaluated absorbable suture bridge fixation for osteochondral or chondral fractures after patellar dislocation in patients treated between 2019 and 2024, excluding chronic pathology such as osteochondritis dissecans. Short-term clinical and radiographic outcomes were assessed for this cartilage-sparing construct. The technique may offer an alternative to screws or pins that avoids retained hardware and minimizes subchondral bone disruption, though longer-term data are needed.
180. Hevesi M, Alshaibi RR, Ina J, et al. Paper 35. Failure Following Medial Patellofemoral Ligament Reconstruction: A Propensity-Matched Comparative Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00293
This propensity-matched comparative analysis compared patients who failed primary MPFL reconstruction (requiring revision for recurrent instability between 2004 and 2022) against successfully treated controls, excluding repeat revisions and graft over-tensioning cases. Demographic, radiographic, and operative variables were evaluated to identify risk factors for failure. Findings aim to guide graft selection, fixation technique, and concomitant procedures to reduce recurrent patellofemoral instability.
187. Mueller MM, Arras C, Hingsamer V, et al. Paper 52. Perioperative Knee Aspiration as a Therapeutic Approach to Arthrogenic Muscle Inhibition following Anterior Cruciate Ligament Injury. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00309
A retrospective review of 1,099 ACL-injured patients evaluated 1,239 perioperative knee aspirations for arthrogenic muscle inhibition, with a subset undergoing superficial EMG before and after aspiration. Aspirations yielded ~35 mL of effusion with a very low complication rate (0.43%) and improvements in pain, ROM, and quadriceps activation. Perioperative aspiration appears safe and may be a practical therapeutic adjunct for AMI after ACL injury or surgery.
191. Landrum KM, Mitchell BC, Streeter SR, et al. Paper 57. OATS Harvesting From the Femoral Condyle Is Not Benign: Knee Outcomes After OATS vs. OCA for Elbow OCD in Children. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00314
A retrospective single-center paediatric cohort compared knee donor-site outcomes after OATS versus OCA for capitellar elbow OCD in patients aged 11-18, using PROMIS, Lysholm, and IKDC scores at minimum 2-year follow-up. Knee outcomes after OATS were inferior to OCA, indicating that autograft harvest from the femoral condyle is not benign in children. This informs graft choice for elbow OCD, favoring allograft to avoid donor-site morbidity in skeletally immature patients.
192. Harrison C, Ma R, Colbert L, et al. Poster 38. Patellar and Quadriceps Autografts Result in Graft-Specific Hamstring-to-Quadriceps Imbalances after Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00352
Patients undergoing ACL reconstruction with bone-patellar tendon-bone versus quadriceps tendon autografts were compared using return-to-sport functional assessments, limb symmetry indices, and ACL-RSI scores. Both extensor mechanism grafts produced graft-specific hamstring-to-quadriceps strength imbalances affecting functional recovery. This highlights the need for graft-tailored rehabilitation targeting donor-site strength deficits before return to sport.
193. Docters F, Ricca GW, Smolarsky RG, et al. Poster 64. Is Pie-Crusting of the Medial Collateral Ligament Safe in Knee Arthroscopy? A Systematic Review of Visualization, Outcomes, and Complications. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00375
A PRISMA-guided systematic review of studies on medial collateral ligament pie-crusting during knee arthroscopy synthesized data on indications, joint-space widening, patient outcomes, valgus laxity, and complications. The review found the technique effectively increases medial compartment visualization and working space with a low complication rate and only limited residual valgus laxity. Clinically, pie-crusting appears a safe and useful adjunct for accessing tight medial compartments, though higher-quality comparative studies are needed.
194. Vessal M, Stone KR, Ratcliffe A, et al. Poster 46. A Novel Approach to Harness Mesenchymal Stromal Cells to Augment Articular Cartilage Regeneration: An In Vitro and In Vivo Assessment. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00359
This in vitro and in vivo study augmented an autologous articular cartilage paste graft with allogeneic mesenchymal stromal cells and a hydrogel scaffold, optimising tissue preparation, construct culture, and fixation before testing in a rabbit model. The combined construct was feasible and showed preliminary safety and enhanced cartilage regeneration potential versus paste grafting alone. If validated clinically, this approach could amplify biologic cartilage repair in patients with articular cartilage damage at risk for osteoarthritis.
195. Ryan P, Nuelle C, Bryson A, et al. Poster 35. Factors Associated with Failure following Return to Sport after Anterior Cruciate Ligament Reconstruction And Return to Sport Testing. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00349
A retrospective cohort of primary ACL reconstruction patients with standardised return-to-sport testing and minimum two-year follow-up analyzed surgical, demographic, and timing factors associated with reinjury. The study identified factors, including RTS testing timing, that correlated with successful return to sport without reinjury, supporting later testing windows (9-12 months) for higher-risk patients. Findings help clinicians individualize RTS clearance decisions based on patient and surgical characteristics.
196. Christino MA, Lempke AF, Murray MM, et al. Poster 26. Low Energy Availability is Associated with Reduced Response to Return-to-Sport Strength Training in Adolescent Female Athletes in the Uninjured Knee Following Anterior Cruciate Ligament Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00341
Adolescent female athletes after ACL reconstruction were assessed for low energy availability (LEA) and strength responses in the uninjured knee during neuromuscular training, along with subsequent contralateral ACL injury. Athletes with LEA demonstrated blunted strength gains in the uninjured knee despite standardised training, suggesting impaired training adaptation. Screening for LEA may be important in post-ACLR rehabilitation to optimise strength recovery and reduce contralateral injury risk in this vulnerable population.
197. Parker TR, Ripic Z, Dean K, et al. Poster 20. Age-Related Differences in Psychological Readiness following ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00336
This study examined age-related differences in ACL-RSI scale scores (psychological readiness) after ACL reconstruction, hypothesizing adolescents may overreport and older adults underreport readiness. Age was found to significantly influence self-reported psychological readiness, with younger patients scoring disproportionately high relative to objective recovery status. Clinicians should interpret ACL-RSI scores in light of patient age and corroborate them with objective functional measures before RTS clearance.
198. Tollefson LV, Slette EL, Shoemaker EP, et al. Poster 33. Anatomic Anterolateral Ligament Reconstruction Using the Iliotibial Band Results in Less Internal Rotation Overconstraint and Lateral Compartment Joint Loading Compared to the Modified Lemaire Procedure: A Robotic Biomechanical Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00347
In seven paired cadaveric knees tested on a 6-DOF robotic system, an anatomic anterolateral ligament reconstruction using the iliotibial band was compared with the modified Lemaire procedure for stability and lateral compartment pressures during simulated anterior translation, pivot shift, and internal rotation. The ALLR provided comparable stability while producing less internal rotation overconstraint and lower lateral compartment joint loading than the modified Lemaire. This suggests the ITB-based ALLR may reduce risks of overconstraint and lateral compartment overload when lateral extra-articular augmentation is indicated.
199. Ryan P, Nair M, Allen Z, et al. Poster 42. Time to Full Active Extension Based on Graft Type Following ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00355
A multi-center retrospective cohort of ACL reconstructions (2013-2021) compared time to full active extension, extension deficits, cyclops lesion rates, and secondary surgeries between quadriceps tendon and bone, patellar tendon, bone grafts. Graft type influenced the time course to achieving full active extension, with differences in early (6-week) extension recovery between groups. These findings can guide graft selection counseling and set expectations for postoperative extension recovery.
201. Mufti Y, Jesse JE, Sachs J, et al. Poster 87. Relationship Between Socioeconomic Status and Functional Outcomes in Osteochondral Allograft Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00393
This retrospective study of primary osteochondral allograft transplantation (2000-2020) examined whether area/social deprivation index (ADI/SDI) scores correlated with demographics, intraoperative variables, patient-reported outcomes, and reoperation/failure rates. The findings inform whether socioeconomic disadvantage influences OCA outcomes, with implications for patient counseling and resource allocation in cartilage restoration.
202. Hevesi M, Ward GH, Ina J, et al. Poster 65. Superior Knee Function and Higher Activity Level After Circumferential Repair Versus Partial Meniscectomy for Meniscus Horizontal Cleavage Tears: A Minimum 2-Year Propensity-Matched Comparative Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00376
In this propensity-matched comparative study, patients with isolated meniscal horizontal cleavage tears underwent circumferential repair or partial meniscectomy with minimum 2-year follow-up, comparing VAS pain, Tegner activity, and IKDC scores. Circumferential repair yielded superior knee function and higher activity levels than partial meniscectomy, suggesting repair should be favored over meniscectomy for these tears to better preserve meniscal tissue and long-term knee health.
203. Milewski MD, Miller PE, Gossman EC, et al. Paper 28. A Radiographic Predictive Model for Distinguishing Mobile Trap Door Vs Locked Door Osteochondritis Dissecans Lesions of The Knee. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00287
Using a multicenter prospective cohort of 407 skeletally immature/young patients (mean age 13.7 years) with arthroscopically confirmed OCD lesion mobility, the authors built a multivariable predictive model from demographics, physical exam, and radiographic data to distinguish trap door from locked door lesions. The model aimed to predict arthroscopic lesion mobility type with high sensitivity and specificity, which could guide preoperative surgical planning and selection of fixation versus other techniques for mobile OCD lesions.
205. Hashiguchi N, Hazzard S, Asnis P, et al. Poster 44. Abnormal Patellofemoral Morphology is associated with Anterior Knee Pain Two Years After BTB ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00357
This retrospective study of 65 patients undergoing primary BTB ACL reconstruction tested whether preoperative MRI-measured patellofemoral morphology (patellar height indices, trochlear dysplasia, TT-TG/TT-PCL distances, patellar tilt) predicted anterior knee pain at 2 years, assessed via Kujala squatting and prolonged-sitting items. Abnormal patellofemoral morphology was associated with AKP after BTB ACLR, suggesting preoperative imaging may identify patients at risk and guide counseling or targeted rehabilitation.
206. Sundaram V, Gosnell GG, Berzolla E, et al. Poster 55. Body Mass Index Does Not Predict Mid-Term Outcomes of Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00366
This single-institution retrospective review (2011-2024) assessed the effect of BMI on meniscal allograft transplantation survivorship (defined as need for subsequent ipsilateral meniscal surgery or arthroplasty) and patient-reported outcomes at mid-term follow-up. Contrary to the hypothesis, BMI did not predict mid-term MAT outcomes, indicating that elevated BMI alone should not exclude patients from MAT or drive preoperative counseling decisions.
207. Callanan MC, Anz AW, Stallings L, et al. Poster 96. Gender and C-arm Position Affect Femoral Radiographic Landmarks of the Medial Collateral Ligament. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00401
In 24 cadaveric knees (12 male, 12 female), the femoral origin of the superficial MCL was marked with ball bearings at five landmarks and radiographed with a perfect lateral view using two different C-arm orientations to define the full radiographic area of the sMCL origin. Both gender and C-arm position significantly affected the radiographic landmarks, implying that sex-specific reference values and attention to fluoroscopic technique are needed when using radiographic guides for medial knee reconstruction.
208. McDonald A, Hagen MS, Gee AO, et al. Poster 56. Arthroscopic Tibial Inlay vs Transtibial Posterior Cruciate Ligament Reconstruction: A Propensity Score–Matched Retrospective Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00367
This propensity score, matched retrospective cohort compared arthroscopic tibial inlay versus transtibial PCL reconstruction, hypothesizing equal posterior stability without increased complications for the inlay technique after balancing baseline risk. The results clarify whether the theoretical biomechanical advantage of avoiding the 'killer turn' translates into clinical benefit, informing surgical technique selection in PCL and multiligament knee reconstruction.
209. Chinweze R, Johnson C, Wellsandt E, et al. Poster 06. Measuring Grit in ACL Recovery: A New Lens for Understanding Psychological and Physical Readiness for Return-to-Sport. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00323
Twenty-nine ACLR patients aged 14-35 completed the 12-item Grit Scale at ~3 weeks and 9 months postoperatively, alongside psychological readiness (ACL-RSI), patient-reported outcomes (IKDC, KOOS4), and isokinetic strength testing to assess temporal stability and predictive value. The study tests whether early grit measurement predicts later psychological readiness, function, and quadriceps/hamstring strength recovery. If validated, the Grit Scale could serve as a simple early screening tool to identify patients needing psychological support during rehabilitation.
210. Gaudiani MA, Moutzouros V, Moncrieffe B, et al. Poster 27. Virtual Cognitive Behavioral Therapy to Improve Anterior Cruciate Ligament Reconstruction Outcomes: A Preliminary Analysis of a Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00342
In a CONSORT-compliant randomised controlled trial, 97 ACLR patients were randomised to standard rehabilitation alone or standard rehabilitation plus a virtual psychological intervention of eight asynchronous CBT modules targeting psychoeducation, relaxation, and fear of reinjury, begun preoperatively and continued for 52 weeks. The trial evaluates whether this scalable telehealth approach improves postoperative outcomes, including return to play, versus usual care. Positive results would support routine integration of psychological care into ACLR recovery pathways.
211. Lambert BS, Momin S, Rivera A, et al. Poster 164. Translating Force Plate Data: Linking Countermovement Jump Metrics to Traditional Performance Measures in Youth Female Soccer Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00462
This study examined how countermovement jump metrics from portable force plates (peak force, rate of force development, asymmetry indices) relate to traditional field-based performance tests in youth female soccer athletes, a group at elevated lower extremity injury risk. By mapping force plate outputs onto conventional measures familiar to coaches and clinicians, the authors aim to bridge a translation gap in interpreting CMJ data. The findings would help practitioners use force plate testing more effectively for training and rehabilitation decisions in developing athletes.
212. Lu Y, Yang L, Wyles CC, et al. Poster 04. Radiographic Incidence of Post-Traumatic Osteoarthritis Following ACL Injuries: A Computer Vision Analysis of Kellgren-Lawrence Grade and Minimum Joint Space Width. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00321
Using a longitudinal population-based database of ACL injuries from 1990-2016 with minimum 7.5-year radiographic follow-up, researchers applied two computer vision algorithms to weight-bearing knee radiographs to quantify Kellgren-Lawrence grade and minimum joint space width. The study establishes the true incidence of post-traumatic osteoarthritis after ACL injury and compares reconstructed versus nonoperatively managed patients, hypothesizing higher PTOA rates with nonoperative treatment. Results inform shared decision-making about operative versus nonoperative ACL management and long-term counseling on arthritis risk.
213. Sardesai KS, Jesse JE, Alfonsi S, et al. Poster 66. Growth Mixture Modeling Reveals Two Recovery Trajectories After Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00377
Growth mixture modeling was applied to longitudinal IKDC and KOOS pain scores (preoperative, 2-year, 5-year) from primary meniscal allograft transplantation patients with ≥5-year follow-up at an academic center (1999-2017) to identify latent recovery subgroups rather than relying on mean outcome trajectories. The analysis sought to determine which demographic and clinical factors predict membership in distinct recovery trajectories. Identifying these subgroups could enable earlier risk stratification and targeted follow-up or intervention for patients likely to have poorer MAT outcomes.
214. Wilson PL, Kutschke MJ, Angonius KB, et al. Paper 27. Suture Bridge Fixation for Medial Femoral Condyle Osteochondritis Dissecans Demonstrates Comparable Healing Compared to Screw Fixation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00286
This retrospective single-institution cohort compared unstable medial femoral condyle OCD lesions treated with headless compression screw fixation versus suture bridge fixation with bioabsorbable knotless anchors (2017-2024), assessing MRI healing, conversion to osteochondral allograft, and repeat surgery. The key finding reported is that suture bridge fixation demonstrated healing comparable to screw fixation. This suggests suture bridging is a viable alternative, potentially avoiding a second implant removal procedure, when fixing unstable OCD lesions in young athletes.
215. King W, O’Toole R, Doyle J, et al. Poster 168. Four Pills or Fewer: Evidence that a Ketorolac Centered Multimodal Pain Controlled Protoctol Minimizes Opioid use after ACLR. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00466
A pragmatic prospective cohort study evaluated opioid prescribing and consumption among teen-to-middle-aged ACLR patients under a Cleveland Clinic sports medicine-wide multimodal pain protocol featuring ketorolac as the primary post-discharge analgesic, motivated by prior evidence of widespread overprescription after ACLR. The headline finding is that patients required four pills or fewer, demonstrating that a ketorolac-centered opioid-sparing protocol minimizes opioid use. This supports adopting standardised multimodal protocols to reduce persistent opioid exposure, diversion, and misuse risk in a young, vulnerable population.
218. Ma R, Harrison C, Colbert L, et al. Poster 28. Sex-Specific Implications in Extensor Autograft Selection from an ACL Reconstruction Return-to-Sport Database. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00343
A single-institution registry of 168 patients (76 male, 92 female) was used to compare sex-specific outcomes after ACL reconstruction with bone-patellar tendon-bone versus quadriceps tendon autografts around return-to-sport testing. The analysis evaluated demographics, PROMs, and RTS performance measures by graft type and sex. Results help guide sex-specific extensor mechanism autograft selection and rehabilitation expectations after ACLR.
220. Walsh JM, Orozco E, Fomunung C, et al. Poster 118. Return to Sport after Tibial Shaft Fractures: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00422
A PRISMA-guided systematic review of nine studies (two RCTs, cohort studies, and case series) synthesized return-to-sport rates, timeframes, and levels after acute tibial shaft fractures, stratified by open versus closed fractures and operative versus nonoperative treatment. Study quality was assessed with the modified Coleman Methodology Score and Robins-I tool. The findings provide evidence-based RTS counseling for athletes sustaining tibial shaft fractures, though the limited and heterogeneous evidence base warrants cautious interpretation.
221. Perraut GT, Gibbs HP, Day J, et al. Poster 60. Biomechanical Analysis of Staple Versus Suture Anchor Fixation for Modified Lemaire Lateral Extra-articular Tenodesis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00371
In 11 matched pairs of fresh-frozen cadaveric knees undergoing modified Lemaire lateral extra-articular tenodesis with concomitant BTB ACL reconstruction, knotless suture anchor fixation was biomechanically compared with staple fixation using load-to-failure testing and pivot shift measurement. The hypothesis was that suture anchors would be non-inferior to staples while avoiding the risk of staple penetration of the ACL femoral tunnel. Results inform fixation choice for LET, potentially reducing intraoperative complications without compromising construct stability.
222. Abdalla O, Alqasmi H, Almaat A, et al. Poster 155. Squat as a Functional Vital Sign: Association Between a Novel Squat Classification and SF-36 Scores in Orthopaedic Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00455
A novel squat classification system was deployed across several orthopaedic clinics and its association with SF-36 scores was examined as the first real-world clinical application of the tool. The squat was proposed as a functional vital sign reflecting mobility, proprioception, strength, and body habitus, given the absence of routine musculoskeletal screening measures. If validated, this simple classification could serve as a quick clinical screen for lower extremity dysfunction and a rehabilitative benchmark.
223. Cameron RK, Jazrawi I, Dannacher C, et al. Poster 47. The Influence of Mental Health Diagnoses and Medication Use on Meniscal Allograft Transplantation Survival and Clinical Outcomes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00360
A retrospective cohort of 156 meniscal allograft transplantation patients with at least one-year follow-up evaluated whether mental health diagnoses (depression, anxiety, PTSD, bipolar disorder, ADHD) or psychiatric medication use affected graft survival, reoperation, readmission, PROMs, and PASS attainment. The study addresses a gap in understanding psychosocial predictors of MAT outcomes beyond established demographic and biomechanical factors. Findings may refine patient selection and preoperative counseling for meniscal allograft transplantation.
224. Oppenheim Z, Yanke AB, Sachdev D, et al. Poster 78. Preoperative Pain Catastrophizing Predicts Worse Subjective Knee Scores, While J-Sign is Associated With Elevated Kinesiophobia in Patients Undergoing MPFL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00388
In a retrospective review of 89 MPFL reconstruction patients, preoperative pain catastrophizing, kinesiophobia (TSK), J-sign, and functional scores (IKDC, KOOS JR, Kujala) were analyzed for associations with postoperative outcomes. Preoperative pain catastrophizing predicted worse subjective knee scores, while a positive J-sign was associated with elevated kinesiophobia. Identifying these psychological and physical exam predictors preoperatively allows targeted psychological intervention and counseling to optimise outcomes after MPFL reconstruction.
225. Tuyishime H, Khoo BW, Isakoff KJ, et al. Poster 51. Anatomic Considerations for Lateral Extra-Articular Tenodesis (LET) in Skeletally Immature Knees: Can We Reconstruct the LET and Avoid Physeal Injury?. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00364
Seven skeletally immature cadaveric knees (ages 8-16) were dissected to map the distal femoral physis relative to the anterolateral ligament and lateral collateral ligament origins for lateral extra-articular tenodesis placement. The ALL femoral origin was found to lie closer to the physis than the LCL origin, with considerable age-related variability. Surgeons performing LET in paediatric ACL reconstruction should use LCL-based rather than ALL-based landmarks to minimise iatrogenic physeal injury.
228. Williams A, Ackermann J, Jones M, et al. Poster 34. Axial Tibiofemoral Rotation Remains Stable After ACL Reconstruction and Is Predicted by Posterior Tibial Slope, Not Modified by LET: A Longitudinal MRI Study in Professional Soccer Players. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00348
Longitudinal MRI in professional soccer players after ACL reconstruction assessed resting tibiofemoral axial rotation over time and the effects of posterior tibial slope and lateral extra-articular tenodesis. Axial tibiofemoral rotation remained stable postoperatively and was predicted by posterior tibial slope, while LET did not modify rotational alignment. Rotational alignment appears to be a fixed anatomic determinant of ACL injury risk rather than a modifiable outcome of reconstruction, so preoperative slope assessment may better inform risk profiling than LET augmentation for alignment purposes.
231. Cruz CA, Ramirez V. Poster 36. Perioperative Nutritional Supplementation with Essential Amino Acids, Protein, and Creatine Enhances Quadriceps Recovery After ACL Reconstruction in Active-Duty Military Soldiers: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00350
Fifty active-duty soldiers undergoing primary ACL reconstruction were randomised to a 4-week preoperative supplement protocol (essential amino acids, whey protein, creatine) or standard care, with quadriceps circumference and strength assessed at 3 and 6 months. Preoperative nutritional supplementation enhanced postoperative quadriceps recovery compared with standard care. Perioperative nutritional optimization should be incorporated into prehabilitation protocols to mitigate quadriceps atrophy and improve return-to-duty/sport after ACL reconstruction.
232. Garlapati S, Agarwal R, Bishop M. Poster 17. Oral Contraceptive Use at Time of ACL Reconstruction Decreases Risk of Revision Surgery. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00333
A retrospective TriNetX cohort study compared female patients aged 13-49 undergoing ACL reconstruction with versus without documented oral contraceptive use at the time of surgery, assessing subsequent ipsilateral procedures. OCP use at reconstruction was associated with a decreased risk of revision surgery within five years. Hormonal contraception may be a modifiable factor worth considering in perioperative counseling for female ACL reconstruction patients, though prospective confirmation is needed.
233. Allison A, Wellsandt E. Poster 37. Early Extension Matters: Knee Extension Deficits 2 Months After ACLR are Associated with Elevated Cartilage T2 Relaxation Times at 6 Months. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00351
Thirty patients aged 15-35 were followed from acute ACL injury through 6 months post-reconstruction, with knee extension range of motion measured at 2 months and tibiofemoral cartilage T2 relaxation times assessed by MRI at 6 months. Extension deficits at 2 months post-ACLR were associated with elevated cartilage T2 relaxation times at 6 months, suggesting early compositional cartilage change. Clinicians should prioritise early and complete restoration of knee extension after ACLR as a potential strategy to mitigate future osteoarthritis risk.
234. Morriss N, Malin M, Jain S, et al. Poster 32. Tranexamic Acid Use in Anterior Cruciate Ligament Reconstruction Is Not Associated with Increased Thromboembolic Events: A Propensity-Matched Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00346
A propensity-matched cohort analysis using a large national database compared thromboembolic outcomes between ACLR patients who did and did not receive perioperative tranexamic acid. TXA use was not associated with increased rates of deep vein thrombosis, pulmonary embolism, or doppler ultrasound utilisation after ACLR. These findings support the routine use of TXA in ACL reconstruction with respect to thromboembolic safety.
235. Ehlers M, Kurtz JL, Strauss EJ, et al. Poster 73. The Effect of Smoking History on Inflammatory Biomarkers in Synovial Fluid of Patients Undergoing Arthroscopic Knee Surgery for Meniscal Injury. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00383
Synovial fluid was aspirated from the operative knee of patients undergoing arthroscopic surgery for meniscal injury and analyzed for 10 inflammatory biomarkers in relation to smoking status, pack-years, and time since cessation. Smoking history was found to influence the intra-articular inflammatory profile, with effects related to cumulative exposure and cessation timing. Smoking is a modifiable factor that should inform preoperative counseling and strategies to optimise recovery after meniscal surgery.
236. Mueller MM, Klinger CE, Rilk S, et al. Poster 72. 7T-MRI and Histology Demonstrate Higher Arterial Contributions in the Distal Quadriceps Tendon. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00382
Six fresh-frozen cadaveric knee specimens underwent pre- and post-contrast 7T-MRI, algorithm-based histology, and MicroCT to quantify arterial contributions to the quadriceps tendon across standardised anatomic regions. The distal quadriceps tendon demonstrated higher mean arterial contribution than other regions, corroborated by histologic and MicroCT findings. This regional vascularity map may guide tendon harvest site selection and graft design in quadriceps tendon ACL reconstruction.
237. Amirouche F, Rteil A, Luft R, et al. Poster 19. Adolescent ACL Reconstruction Outcomes Differ by Sex: A Three-Year Propensity-Matched Cohort Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00335
A national database (TriNetX) cohort of adolescents aged 12-19 undergoing ACLR was propensity score-matched 1:1 by sex to compare short- and long-term complications over three years. Females showed higher rates of postoperative stiffness and related secondary procedures, while males were more susceptible to infections and graft-related complications. Sex-specific surveillance and rehabilitation protocols may be warranted when counseling and managing adolescent ACLR patients.
239. Sardesai KS, Jesse JE, Alfonsi S, et al. Poster 89. Younger Patients Show Improved Short/Mid-Term PROs, Graft Survival After Primary MAT: ≥5-Year Followup. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00395
One hundred ten patients who underwent primary meniscal allograft transplantation between 2003 and 2022 with ≥5-year follow-up were stratified into age <35 versus ≥35 years and compared on PROMs and Kaplan-Meier graft survival. Younger patients achieved significantly better short- and mid-term patient-reported outcomes and superior graft survivorship than older patients. Age at surgery should be considered when selecting candidates for MAT and counseling patients on expected outcomes.
240. McCulloch PC, Lambert BS, Hedt CA, et al. Poster 169. Reliability and Validity of a Crane Scale Compared to Handheld Dynamometer and Isokinetic Devices for Assessing Quadriceps and Hamstrings Strength. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00467
The reliability and validity of a crane scale for measuring quadriceps and hamstrings strength were evaluated against handheld dynamometry and isokinetic dynamometry as clinical and research gold standards. The crane scale demonstrated strong reliability and agreement with established devices for assessing large lower-extremity muscle groups. This inexpensive, portable tool offers a practical alternative for strength testing in settings lacking access to isokinetic equipment.
241. Chang CB, Yoon C, Lee S, et al. Poster 75. A Randomized Controlled Trial for a Novel Digital Therapeutic for Treatment of Patellofemoral Pain, a Dilemma in Orthopedics. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00385
In a randomised controlled trial of 216 adults with chronic patellofemoral pain, an 8-week mobile app-based digital therapeutic combining personalized exercise and cognitive-behavioural therapy was compared with one-time exercise education plus printed materials. The digital therapeutic improved pain, function, quality of life, pain catastrophizing, and depressive symptoms over 12 weeks. This supports app-based DTx as a scalable nonoperative option for PFP, a condition where surgery is often ineffective.
243. Fuller C, Kody T, Navarro RA, et al. Poster 86. Knee Spanning External Fixation After Knee Dislocation is Associated With Increased Knee Stiffness and Lower Patient Outcome Scores. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00392
A retrospective review of skeletally mature knee dislocation patients at a level 1 trauma center (2015-2023) compared long-term outcomes after initial immobilisation with knee-spanning external fixation versus a hinged knee brace, with all patients undergoing delayed multiligament reconstruction by a single surgeon. Initial external fixation was associated with increased knee stiffness and lower patient-reported outcome scores. These findings favour hinged brace immobilisation when definitive reconstruction is delayed beyond six weeks.
244. Aminake G, Drazick A, Focht C, et al. Poster 177. Performance on the Timed Single-Leg Step-Down Test is Correlated with Hip and Knee Biomechanics as Measured by 3D Markerless Motion Capture. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00475
Twenty healthy high school athletes performed a 60-second timed single-leg step-down test while lower extremity biomechanics were quantified using 3D markerless motion capture, with correlation analyses linking performance to thorax side-bend, pelvic obliquity, hip rotation, and knee angulation. Step-down performance correlated with hip and knee biomechanical measures of dynamic joint control and movement efficiency. The widely used, low-cost test may therefore serve as a practical clinical screen for biomechanical deficits and injury risk.
246. Haddas R, Salazar BP, Shu Y, et al. Poster 184. Running Smarter: Clinically Relevant 3D Biomechanical Insights to Identify and Prevent Injury Risk in Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00482
A multimodal running assessment protocol combining 3D markerless motion capture, ground reaction force analysis, and surface electromyography was developed and demonstrated in a retrospective review of 20 runners with running-related injuries. The protocol revealed biomechanical and neuromuscular asymmetries and joint-specific loading patterns that 2D gait evaluation cannot detect. This clinically feasible approach enables targeted, personalized injury prevention and treatment strategies for runners.
247. Hernandez PA, Chu CR, Huang C, et al. Poster 02. Protein Response to ACL Injury in Humans Show Early Cartilage Remodeling and Subtle Differences by Sex. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00319
Proteomic profiles of human knee articular cartilage were compared between normal post-mortem donor cartilage and cartilage after ACL injury, stratified by sex, to characterize the early molecular response before post-traumatic osteoarthritis develops. ACL injury triggered early cartilage remodeling at the protein level, with subtle sex-specific differences in the molecular pathways activated. These findings provide human evidence for sex differences in post-traumatic OA biology that mouse models fail to recapitulate, informing sex-specific research and prevention strategies.
248. Sheean A, Knurr KA, Cognetti DJ, et al. Poster 11. Blood Flow Restriction Therapy After ACL Reconstruction Does Not Improve Functional Strength or Increase Thigh Muscle Volume at 12 Weeks Post-Operative: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00327
In a randomised controlled trial, blood flow restriction therapy added to 12 weeks of standardised rehabilitation after quadriceps tendon autograft ACL reconstruction was compared with standard-of-care rehabilitation alone. BFR did not improve functional thigh muscle strength or increase thigh muscle volume at 12 weeks postoperatively. Routine BFR use in the immediate post-ACLR period is not supported by these findings, though longer-term or different dosing strategies may warrant further study.
250. Yoshida S, Hoshino YY, Tanaka A, et al. Poster 07. Different Impacts of Medial and Lateral Meniscus Injuries on Knee Instability in Anterior Cruciate Ligament–Deficient Knees: A Biomechanical Study Using Whole Cadaveric Limbs. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00324
Using ten fresh-frozen cadaveric whole lower limbs, this biomechanical study quantified the effects of medial meniscus ramp lesions and lateral meniscus oblique radial tears (LMORT) on stability in ACL-deficient knees. The lesions each exacerbated anterior laxity and rotational instability beyond that of isolated ACL deficiency, with differing impacts between medial and lateral injuries. The findings underscore the importance of identifying and repairing these concomitant meniscal tears at the time of ACL reconstruction.
251. Althoff A, Dennis ER, Pahapill N, et al. Poster 68. Effect of Post-Operative Apprehension and J-Sign on Outcomes following Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability: Data from the JUPITER Cohort. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00378
This study analyzed data from the multicenter JUPITER cohort to determine whether persistent postoperative apprehension or J-sign predicts inferior outcomes after isolated medial patellofemoral ligament reconstruction for recurrent patellar instability. Persistence of these clinical signs was associated with suboptimal patient-reported outcomes. The results suggest these findings on postoperative examination may help identify patients who could benefit from additional bony realignment procedures.
253. Hashiguchi N, Miracco S, Tanaka MJ. Poster 77. Hormonal Influences on Patient-Reported Outcomes in Female Patients with Patellar Instability: Effects of Oral Contraceptive Use and Hormone-Related Diagnoses. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00387
This retrospective study of 218 female patients treated for patellar instability examined whether oral contraceptive use or hormone-related diagnoses (PCOS, endometriosis) were associated with patient-reported outcomes (IKDC, Kujala, PROMIS). After adjustment for age and BMI, no significant differences in final outcome scores were found between OCP users and non-users or by hormone-related diagnosis status. These findings suggest hormonal factors, as captured by these exposures, do not meaningfully influence self-reported outcomes after patellar instability treatment.
254. Zaffagnini S, Altovino E, Bergami M, et al. Poster 83. Meniscal Allograft Transplantation (MAT): Outcomes and Survivorship at Minimum 15-Year Follow-Up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00391
This study reported clinical outcomes and survivorship of meniscal allograft transplantation in 47 patients followed a minimum of 15 years (mean 16.3 years). MAT provided durable pain relief and functional improvement, with Kaplan-Meier analysis characterizing long-term survival using failure defined as revision surgery, arthroplasty conversion, or Lysholm score <65. The data support MAT as a durable long-term option for post-meniscectomy syndrome and identify prognostic factors such as sex, age, and graft laterality.
255. VanBibber H, Moyal A, Smith K, et al. Poster 05. Wearable Muscle Oxygenation Monitoring in ACL Reconstruction: Contralateral Limb Validity and Longitudinal Surgical Limb Recovery. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00322
This study validated a wearable muscle oxygenation sensor (SmO2) on the vastus medialis in 50 healthy athletes and an age-matched ACL reconstruction cohort tested at 6, 9, and 12 months postoperatively. Contralateral limb measurements demonstrated validity as an internal reference, while surgical limb SmO2 showed progressive longitudinal recovery toward baseline. Wearable SmO2 monitoring may offer an objective internal physiologic metric to supplement return-to-play decision-making after ACLR.
256. Augustin EJ, Yanke AB, Oppenheim Z, et al. Poster 74. Anatomic and Flexion-Dependent Differences Between the Fibular Collateral Ligament, Anterolateral Ligament, and Iliotibial Band Fibers: Guiding Graft Fixation in Lateral Knee Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00384
In this cadaveric study, 3D digitization of bony landmarks characterized length changes of the fibular collateral ligament, anterolateral ligament, and iliotibial band fibres across knee flexion from 0° to 90°. The structures exhibited distinct anatomic and flexion-dependent length-change behaviours from one another. These findings can guide graft fixation angles and positioning in lateral knee reconstruction to better restore native kinematics.
257. Shah A, Gumarathas K, Marks P, et al. Poster 39. The Long-Term Radiographic Fate of the Chronic ACL Deficient (CAD): A Systematic Review and Meta-Analysis of Matched Cohort Studies. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00353
This systematic review and meta-analysis of matched cohort studies compared long-term radiographic osteoarthritis rates and severity between chronically ACL-deficient knees managed non-operatively and similar knees treated with ACL reconstruction. The synthesis addressed the wide variability in reported prevalence by pooling matched cohort data. The findings inform shared decision-making regarding operative versus non-operative management of ACL injury by quantifying the long-term arthritis risk of the untreated deficient knee.
259. Ehlers M, Kurtz JL, Strauss EJ, et al. Poster 03. Age-Dependent Variation in Knee Synovial Fluid Biomarker Type and Concentration After Anterior Cruciate Ligament Injury and Predict Long-Term Outcomes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00320
In this prospective study, synovial fluid from knees undergoing ACL injury surgery was assayed for 10 inflammatory and matrix biomarkers, with concentrations correlated against patient-reported outcomes at 5 and 10 years postoperatively. Biomarker type and concentration varied by patient age, and preoperative profiles were associated with long-term pain and function. This suggests synovial fluid biomarkers may serve as early predictors of long-term outcomes to guide post-injury management and surveillance.
260. Khoo BW, Cong I, Tuyishime H, et al. Poster 71. Pediatric Meniscus Stabilization: Suture Anchor Fixation for Discoid Meniscus and Anterior Rim Instability. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00381
This study evaluated a suture anchor-based meniscotibial ligament complex fixation construct for stabilizing the anterior rim in paediatric discoid lateral meniscus, addressing the deficiency that standard meniscocapsular repair does not correct. The technique targets the anatomic basis of meniscus extrusion and reoperation, which occurs in 13% at 2-5 years and up to 44% long-term after saucerization alone. If effective, this approach may reduce failure rates in paediatric meniscus stabilisation.
261. Tagliero AJ, Horst KK, Faghani S, et al. Poster 154. A Novel Machine Learning Algorithm for the Establishment of Pediatric Bone Age Using Knee Radiographs. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00454
A deep learning model using convolutional neural networks was trained on 7,336 knee radiographs from 5,701 paediatric patients to estimate bone age directly from knee imaging. The model aimed to replicate hand radiograph-based skeletal maturity assessment without additional radiation exposure beyond clinically indicated imaging. This could streamline perioperative surgical planning and endocrine/metabolic workups in paediatric orthopaedics.
265. Matan SO, Carballo CB, Strickland SM, et al. Poster 95. Relationship Between OA Cartilage Shear Mechanics and Composition is Dictated at the Articular Surface. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00400
This study compared depth-dependent shear mechanics and composition (collagen, aggrecan) of healthy versus osteoarthritic human cartilage using microscale testing. Findings indicate that OA-related matrix depletion, beginning at the articular surface, dictates the shear modulus profile, with surface-zone composition strongly governing mechanical properties. Clinically, this supports surface-targeted assessment and early intervention strategies, and informs how grading scales relate to tissue-level mechanics.
266. Kim AH, Spiker AM, Drake JH, et al. Poster 30. Identifying Early Differences in Isokinetic Strength Testing after Anterior Cruciate Ligament Reconstruction: A Retrospective Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00345
This retrospective cohort study of 487 ACL reconstruction patients compared isokinetic quadriceps and hamstring strength at early postoperative timepoints between those cleared for return-to-sport early versus late. Early strength and limb symmetry were associated with earlier return-to-sport clearance, supporting the use of early isokinetic testing to identify patients on faster recovery trajectories. Clinically, early dynamometry may help individualize rehabilitation timelines and return-to-sport planning.
268. Sheean A, Knurr KA, DeFoor M, et al. Poster 08. Changes in Muscle Volume Asymmetries Among 34 Lower Extremity Muscles from Baseline Through 12 Months After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00325
This longitudinal study tracked volume changes in 34 lower extremity muscles from baseline through 12 months after ACL reconstruction using quadriceps tendon autograft. Beyond expected quadriceps atrophy, the analysis identified volume asymmetries in other lower extremity muscles, suggesting global postoperative inactivity and altered movement mechanics drive widespread muscle adaptations. Clinically, rehabilitation may need to extend beyond quadriceps-focused strengthening to address broader lower extremity atrophy.
269. Oladeji L, Dennis ER, Paine HN, et al. Poster 62. Autograft versus Allograft---Medial Patellofemoral Ligament Reconstruction for Patellofemoral Instability: Data from the JUPITER Cohort. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00373
Using the prospective multicenter JUPITER cohort, this study compared complication rates and patient-reported outcomes after medial patellofemoral ligament reconstruction with autograft versus allograft. Graft type did not significantly influence complications or outcomes, suggesting both options yield comparable results. Clinically, graft choice can be individualized based on patient factors and surgeon preference rather than expected superiority of either tissue source.
270. Lezak BA, Gosnell GG, Parody N, et al. Poster 80. Lateral Opening Wedge Distal Femoral Osteotomy (LOWDFO) Demonstrates Greater Effect on Tibial-Tubercle to Trochlear-Groove (TT-TG) Distance Compared to Medial Closing Wedge High Tibial Osteotomy (MCWHTO) in Patients with Valgus Malalignment: A 3D Computer Tomography Simulation Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00390
This 3D CT simulation study compared the effect of lateral opening wedge distal femoral osteotomy versus medial closing wedge high tibial osteotomy on tibial tubercle-trochlear groove distance in 22 knees with valgus malalignment and patellar instability. LOWDFO produced a greater reduction in TT-TG distance than MCWHTO. Clinically, for valgus knees with patellar instability, distal femoral osteotomy may be more effective at decreasing the lateral quadriceps vector.
271. Paterno MV, Zwolski CM, Thomas S, et al. Poster 21. Quality of Movement is an Important Predictor of Second ACL Injury after ACLR and RTS: A Preliminary Analysis in Young Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00337
In this preliminary analysis, 67 young athletes underwent 3D motion analysis of a drop vertical jump plus standard return-to-sport testing (quadriceps strength, hop testing, patient-reported outcomes) after ACL reconstruction, then were followed for second ACL injury. Movement quality during the drop vertical jump predicted second ACL injury, whereas traditional RTS criteria showed mixed predictive value. Clinically, incorporating movement-quality assessment into return-to-sport decision-making may better identify athletes at risk for reinjury.
272. Shelbaya S, Cameron RK, Trasatti E, et al. Poster 45. The Impact of Increased Posterior Tibial Slope on Survivorship in Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00358
This study evaluated the influence of posterior tibial slope on graft survivorship after meniscal allograft transplantation and sought a threshold slope value associated with failure. Increased posterior tibial slope was associated with higher graft failure risk, consistent with its known biomechanical effects and association with ACL revision. Clinically, assessing tibial slope may help stratify patients and guide counseling or slope-correction considerations before meniscal allograft transplantation.
273. Barnett Z, Crepeau A, Weaver AA. Poster 29. The Impact of Arthrofibrois on Quadriceps Strength After Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction in Adolescents. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00344
This study compared quadriceps strength in adolescents after quadriceps tendon autograft ACL reconstruction between those who developed arthrofibrosis and those who did not. The findings address whether arthrofibrosis is associated with measurable strength deficits, a concern given that quadriceps weakness elevates risks of second ACL injury and osteoarthritis. Results may help clinicians counsel adolescents on QT graft choice and the functional consequences of postoperative stiffness.
274. Sundaram V, Jazrawi I, Cameron RK, et al. Poster 58. Preoperative Corticosteroid Injection History Does Not Influence Meniscal Allograft Transplantation Survivorship or Failure Rates. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00369
This study evaluated whether a history of preoperative intra-articular corticosteroid injections affects meniscal allograft transplantation survivorship and failure rates. It found that preoperative corticosteroid injection history did not negatively influence graft survivorship or failure. Clinically, this suggests corticosteroid injections for pain management before MAT need not be avoided out of concern for compromising graft outcomes.
275. Mulcahey M, Zareh A, Christiansen M, et al. Poster 25. The Impact of Vitamin D Deficiency on Outcomes Following ACL and MPFL Reconstruction: A Scoping Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00340
This PRISMA-ScR scoping review searched four databases through June 2025 and included six studies examining vitamin D deficiency and outcomes after ACL and MPFL reconstruction. It found limited and heterogeneous evidence linking preoperative 25(OH)D levels to functional recovery, muscle strength, and graft failure, highlighting substantial gaps in the literature. Clinically, it underscores that routine vitamin D screening and repletion around knee ligament reconstruction is not yet evidence-based and warrants further study.
276. Wilson PL, Agonias KB, Wyatt CW, et al. Poster 61. Unstable Condylar Osteochondritis Dissecans Lesions Treated with Suture Bridge Fixation Have High Rates of Osseous Union and Low Rates of Osteochondral Allograft Conversion. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00372
This single-institution case series evaluated condylar osteochondritis dissecans lesions of the knee treated with suture bridge fixation using bioabsorbable knotless anchors, assessing union on radiographs, reoperations, return to sport, and patient-reported outcomes. The technique achieved high rates of osseous union with low conversion to osteochondral allograft transplantation, along with favourable PROs at 6 months. This supports suture bridge fixation as an effective joint-preserving option for unstable condylar OCD lesions, particularly in young patients.
279. Bram JT, Whalen M, Subrina F, et al. Poster 16. Changes in Coronal Plane Alignment After Transphyseal ACL Reconstruction Performed Within 2 Years of Skeletal Maturity: Results From the PLUTO Study Group. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00332
This multicenter prospective cohort study from the PLUTO Study Group evaluated coronal plane alignment changes one year after transphyseal ACL reconstruction in skeletally immature patients with ≤2 years of remaining growth. Consistent with the hypothesis, only minor alignment changes were observed, with no clinically relevant angular deformities or limb length discrepancies requiring intervention. This provides prospective evidence that transphyseal ACLR carries low risk of iatrogenic growth disturbance in this population.
281. Wright R. Poster 41. Reoperation Rate at Ten Years After Revision ACL Reconstruction. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00354
A prospective cohort of 1,234 revision ACL reconstruction patients (2006-2011) was followed for at least 10 years, with subsequent surgery data available for 853 (77%). The study reports 10-year reoperation rates and categorizes the types of further procedures performed. The findings inform patient counseling about the substantial long-term reoperation burden after revision ACL reconstruction.
282. Skelley NW, Feltz KP, VanDerWolde B, et al. Poster 10. Utilization of a 3D Printed Customized Knee Extender Device and An At-Home Video Rehabilitation Program on Patient Outcomes in Rural Areas Following Anterior Cruciate Ligament Reconstruction Surgery. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00326
In a prospective, multi-center randomised pilot trial, 32 adolescents and adults after primary ACL reconstruction received either a low-cost 3D-printed knee extension device with an at-home video rehabilitation program or standard care. The study assessed early postoperative knee extension/flexion recovery plus compliance, pain, effusion, and device-related issues. If effective, this approach could extend rehabilitation access to rural and global settings where formal physical therapy is unavailable.
284. Lijesen E, Green DW, Simpson SK, et al. Poster 97. Extreme Trochlear Morphology in Pediatric Patients with Fixed Lateral Patellar Dislocation: A Radiographic Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00402
Knee MRI measurements were used to characterize trochlear morphology in paediatric patients with fixed lateral patellar dislocation (FLPD), a rare irreducible form of patellar instability often associated with neuromuscular or connective tissue disorders, with statistical comparisons against comparison groups. The study provides the first dedicated radiographic description of trochlear anatomy in FLPD. Recognizing these extreme morphologic features may guide surgical planning for this uncommon paediatric population.
285. Chen L, Jazrawi I, Gosnell GG, et al. Poster 24. Arthrofibrosis after ACL reconstruction and Meniscal Repair may Lead to Quicker Meniscal Healing and Decreased Re-Tear Rates. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00339
A single-institution retrospective review compared patients who developed arthrofibrosis requiring lysis of adhesions after concomitant ACL reconstruction and meniscal repair against those without arthrofibrosis, assessing meniscal healing and retear rates. Contrary to the conventional view of arthrofibrosis as purely harmful, the findings suggest it may be associated with faster meniscal healing and lower retear rates. This may prompt clinicians to weigh a potential protective effect on meniscal healing when managing postoperative stiffness.
286. Serebour TB, Carballo C, Oliver D, et al. Poster 70. Utilizing Single-nucleus RNA Sequencing to Establish the Cellular and Molecular Landscape of the Healthy Human Patellar Tendon. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00380
Single-nucleus RNA sequencing was used to build the first single-cell-resolution atlas of healthy human patellar tendon, profiling cellular subpopulations including tendon stem cells, tenocytes, and fibroblasts without enzymatic digestion artifacts. The study defines the baseline cellular and molecular landscape of this tissue. This reference atlas can support future investigations into patellar tendinopathy mechanisms and cell-targeted treatments.
289. Bram JT, Whalen M, Farah S, et al. Poster 18. Coronal Plane Alignment After Pre-Pubertal ACL Reconstruction: Results From the PLUTO Study Group. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00334
This study compared coronal plane alignment changes on hip-to-ankle radiographs in pre-pubertal patients undergoing physeal-sparing ACL reconstruction, comparing modified MacIntosh (ITB autograft) versus all-epiphyseal (Anderson) techniques from preoperative to 1-year postoperative timepoints. The findings address whether these physeal-sparing approaches, which are designed to avoid growth plate injury, produce clinically significant angular deformity or leg length discrepancy, as well as subtler alignment shifts that could predispose to future injury. Clinically, the results inform technique selection for skeletally immature ACLR patients and the need for formal alignment surveillance.
290. Römer M, Wurschi G, Mäurer M, et al. The prevention of heterotopic ossification around the knee: a scoping review. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10318-w
This scoping review mapped the evidence on prophylactic interventions to prevent heterotopic ossification around the knee, including 78 publications covering 3,321 patients across modalities such as continuous passive motion, pharmacologic prophylaxis, radiotherapy, surgical techniques, and combination therapy. Most included studies were case reports or series, with pharmacologic data dominated by a single large ASA cohort, revealing a sparse and low-quality evidence base. Clinically, this highlights that no firm evidence-based standard exists for HO prophylaxis around the knee and underscores the need for higher-quality comparative trials.
291. Malinowski K, Możdżeń K, Bawor‐Mostowa M, et al. Comprehensive Medial Knee Four‐Arm Reconstruction to Address Complex Instability With Hamstring Autograft. Arthroscopy Techniques 2026. doi:10.1002/atn2.70067
This surgical technique article describes a four-arm medial knee reconstruction using hamstring autograft, two arms from a pedunculated semitendinosus and two from free gracilis, with independent fixation to address complex multiplanar medial instability. The construct reconstructs the full medial ligamentous complex from the anteromedial capsule/anterior oblique ligament/deep MCL through the superficial MCL and posterior oblique ligament to the posteromedial capsule. Clinically, it offers an anatomic, customizable solution for the six recognised patterns of medial instability beyond simple MCL injury.
292. Tamburini LM, Fitzsimmons KP, Brown MJ. A “Suture Staple” Knotless Anchor Technique for Fixation of Tibial Tubercle Avulsion Fractures in Pediatric Patients. Arthroscopy Techniques 2026. doi:10.1002/atn2.70169
This technique paper presents a 'suture staple' construct using a tensionable knotless anchor with 2-4 independent mattress sutures for fixing small or thin tibial tubercle avulsion fractures in paediatric patients where cannulated screw fixation risks cut-out or fragment comminution. The approach leverages the biomechanical strength of knotless fixation while avoiding the single point of failure and hardware prominence associated with screws and knotted anchors. Clinically, it expands fixation options for adolescent tibial tubercle fractures with small fragments near the end of peak growth.
293. Tsikopoulos K, Kazamias K, Babis G, et al. Clinical Outcomes of Fixed-Bearing Lateral Unicompartmental Knee Arthroplasty: A Retrospective Cohort Study With Up to 22-Year Follow-Up. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.026
This retrospective single-institution cohort study evaluated 113 fixed-bearing lateral unicompartmental knee arthroplasties in 108 patients with a mean follow-up of 13.7 years (up to 22 years), reporting implant survivorship of 97% at 5 years, 93% at 10 years, and 89% at 15 years, along with Oxford Knee Score outcomes and mortality. The findings provide some of the longest available survivorship data for lateral UKA, an uncommon procedure representing only 5-10% of unicompartmental arthritis cases. Clinically, these results support lateral UKA as a durable option for isolated lateral compartment osteoarthritis in appropriately selected patients.
294. Kitchen JM, Richards JA, Powers J, et al. Lateral Femoral Joint-Line Distalization Increases Lateral Collateral Ligament Strain During Total Knee Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.050
This cadaveric biomechanical study used six non-arthritic knees undergoing robotic-assisted TKA with restricted kinematic alignment to quantify lateral collateral ligament strain via motion capture as progressive lateral femoral joint-line distalization was simulated with 2-mm shims. Native LCL strain showed physiologic relaxation with flexion, and baseline strain after rKA TKA was 1.6%, with distalization progressively increasing LCL strain. Clinically, the findings emphasize that preserving or restoring lateral joint-line height during TKA is important to avoid LCL overtension, instability, and patient dissatisfaction.
296. Gray MT, DiCosmo M, Schottel PC. Retrieval of entrapped intramedullary fragments using laparoscopic instruments for fixation of femur and tibia fractures. Injury 2026. doi:10.1016/j.injury.2026.113384
This technique article describes the use of laparoscopic instruments to retrieve or manipulate cortical fragments entrapped within the intramedullary canal during intramedullary nailing of femoral and tibial shaft fractures, avoiding an open approach and limiting soft tissue injury. The authors also characterize standard shaft lengths, diameters, tip configurations, and jaw opening widths of common laparoscopic instruments to guide instrument selection. Clinically, this minimally invasive adjunct can help prevent complications such as reamer entrapment, malunion, and inability to pass final implants.
297. Cook JL, Della Rocca GJ, Bozynski CC, et al. Validation of a novel osteoarticular fracture fragment decontamination-preservation system for delayed articular fracture reconstruction for limb preservation in a preclinical canine model pilot study. Injury 2026. doi:10.1016/j.injury.2026.113401
In a canine pilot study, contaminated and MRSA-inoculated extruded femoral condyle fragments were processed with a novel decontamination-preservation system and reimplanted one week later for delayed joint reconstruction. The system aimed to eradicate pathogens while preserving viable chondrocyte density. If validated, this approach could enable limb and joint preservation using extruded osteoarticular fragments that are otherwise discarded in open fractures.
298. Erol K, Er E, Vahabi A, et al. Orthoplastic approach to infected type 3B open tibial fractures: Management and complications. Injury 2026. doi:10.1016/j.injury.2026.113418
A retrospective review of 27 patients with infected Gustilo-Anderson type 3B open tibial fractures described surgical strategies, complications, and their management at a single institution over 14 years. The study documented infection diagnosis methods, fixation techniques, bone defects, soft tissue coverage procedures, and time to union. Findings inform orthoplastic management pathways and anticipated complication patterns for these severe fracture-related infections.
299. Fan S, Wagner RK, Lehle CH, et al. Risk Factors for Failure of Repair of Diaphyseal Tibial Nonunions: A Retrospective Cohort Study of 108 Patients. Injury 2026. doi:10.1016/j.injury.2026.113421
This retrospective cohort of 108 diaphyseal tibial nonunion repairs (exchange intramedullary nailing or ORIF) found that 25% required additional nonunion surgery and 4.6% ultimately underwent amputation. Multivariable logistic regression identified risk factors for failure of repair. These data help stratify patients by risk and counsel them regarding the likelihood of repeat surgery after tibial nonunion repair.
300. Egbe S, Marks D, Christiano AV, et al. Mechanism of injury not associated with acute compartment syndrome in Tibia fractures. Injury 2026. doi:10.1016/j.injury.2026.113424
A single-center retrospective review of 281 tibial fractures (OTA 41-43) compared acute compartment syndrome incidence between blunt (67%) and ballistic (32%) injury mechanisms. The study examined associations between mechanism, fracture location/morphology, and patient characteristics with ACS development. The findings suggest injury mechanism alone should not guide ACS suspicion, emphasizing clinical vigilance regardless of mechanism.
301. Özkaya M. Do reduced screws have a significant impact on fixation in medial open wedge high tibial osteotomy? A comparative fatigue and stability analysis. Injury 2026. doi:10.1016/j.injury.2026.113430
Finite element analysis compared standard three-proximal-screw T-plate fixation for medial open wedge high tibial osteotomy against modified two-screw configurations under axial, anterior, and posterior loading with fatigue testing. Reducing proximal screws decreased stiffness by less than 2%, with values remaining above 7700 N/mm. This suggests fewer proximal screws may suffice, potentially shortening surgery without compromising construct stability.
302. Tarabichi S, Paul BR, Verhey JT, et al. Impact of Organism Profile on Ideal Timing of Reimplantation in Patients Undergoing Two-Stage Exchange Arthroplasty. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.027
This retrospective study of 451 knee periprosthetic joint infection patients undergoing two-stage exchange arthroplasty used ROC analysis to determine whether the optimal interstage duration before reimplantation differs by infecting organism. Treatment failure was defined as reoperation for infection or PJI-related mortality. Results may allow organism-tailored timing of reimplantation rather than a uniform interstage interval.
303. Gómez-Macías P, Martínez-Crespo A, Gómez-Palomo JM. Return to sport after acute patellar tendon repair: identifying key prognostic factors. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104811
A retrospective cohort of 46 adults with acute complete patellar tendon rupture repaired with suture anchors or transosseous tunnels under a common protocol examined return to sport rates, timing, and prognostic factors. Overall, 87% returned to sport at a mean of about 5.9 months, with higher BMI associated with slower and less frequent return. Repair technique did not appear to drive outcomes, supporting either method and highlighting BMI in patient counseling.
308. Liguori T, Abane C, Marcheix P. Psychological factors associated with pain after total knee arthroplasty: a prospective monocentric study. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104831
This prospective single-center study of 111 patients undergoing primary total knee arthroplasty evaluated preoperative psychological factors (using HADS, Pain Catastrophizing Scale, and other measures) alongside clinical, radiological, and surgical parameters as predictors of persistent pain. Preoperative psychological factors were independently associated with pain at one year postoperatively. Identifying these predictors preoperatively may help target patients for psychological intervention to improve postoperative pain outcomes and satisfaction.
310. Roytman GR, Atadja L, Salameh M, et al. Cannulated vs solid screws in the distal block of a lateral condylar plate does not change distal femur fracture strain. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104859
This biomechanical study used finite element analysis with synthetic femur validation to compare fracture-site strain in osteoporotic distal femur fractures fixed with a lateral condylar plate using cannulated versus solid distal block screws. Cannulated screws did not significantly change fracture-site strain compared with solid screws during axial loading. Surgeons can therefore choose either screw type based on other considerations without compromising interfragmentary strain environment.
313. Geageac C, D’Ambrosio A, Ozun MD, et al. Vancomycin Presoaking of Grafts in anterior cruciate ligament reconstruction: Incidence of septic events and cost-effectiveness analysis based on the registry of the Francophone Arthroscopic Society. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104863
A retrospective multicenter study of 3,278 ACL reconstructions from the Francophone Arthroscopic Society registry compared septic arthritis rates between vancomycin presoaked grafts (91.3% of cases) and non-soaked grafts, with a cost-effectiveness analysis based on French healthcare costs. The study assessed whether presoaking reduces postoperative septic arthritis at 6 months. The findings support vancomycin graft presoaking as a cost-effective infection prevention strategy for adoption in routine ACL reconstruction practice.
314. Idier L, Abecidan E, Bouché P, et al. High incidence of one-year stiffness and frequent secondary surgery after arthroscopic synovectomy for native knee septic arthritis. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104864
A retrospective single-center cohort of adults treated arthroscopically for culture-confirmed native knee septic arthritis (2013-2022) evaluated stiffness at 1 year after infection eradication, defined as flexion ≤90° and/or extension deficit ≥10°, along with secondary surgeries and KOOS-12 scores. The study found a high incidence of one-year knee stiffness and frequent secondary procedures, including arthrolysis and conversion to arthroplasty, despite successful infection control. This highlights the need for aggressive postoperative stiffness surveillance and rehabilitation after arthroscopic treatment of septic knees.
315. Wright AL, Parisi ZJ, Stambough JB, et al. Do Patients Who Have Medicare Advantage Have Differing Lengths of Stay Following Hip and Knee Arthroplasty Procedures Compared to Traditional Medicare?. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.036
A single-center retrospective cohort compared lengths of stay for 1,104 hip and knee arthroplasties performed under traditional Medicare (n=739) versus Medicare Advantage (n=365) between 2018 and 2022. Mean LOS was significantly shorter for traditional Medicare (1.88 vs 2.20 days), including among elective procedures (1.37 vs 1.58 days). Insurance type appears to influence hospital utilisation after arthroplasty, with potential implications for discharge planning and care coordination under different payment models.
317. Favreau H, Mehdi N, Barouk P, et al. French Innovations That Became Gold Standards in Lower Limb Joint-Preserving Surgery: Trochleoplasty, the Scarf Osteotomy and Its Derivatives, Antero lateral procedures in ACL Reconstruction and Meniscal Preservation. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104866
This narrative review examines four French-originated concepts that became gold standards in lower-limb joint-preserving surgery: comprehensive management of severe patellofemoral instability (trochleoplasty), adult forefoot deformity correction (scarf osteotomy and derivatives), anterolateral procedures combined with ACL reconstruction, and meniscal preservation principles. It traces how these techniques evolved through critical outcome assessment into broader treatment philosophies and decision-making frameworks. The review underscores the value of rigorous concept-driven surgical innovation in standardizing care across orthopaedic practice.
318. Constantinescu D, Graham S, Dombrowsky A, et al. Incidence and Risk Factors for Periprosthetic Joint Infection in Patients Undergoing Primary Total Joint Arthroplasty Who have a History of Surgically Treated Periprosthetic Joint Infection in Another Joint. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.029
A retrospective institutional database analysis (2010-2023) assessed the incidence of periprosthetic joint infection after primary hip or knee arthroplasty in patients with a prior surgically treated PJI (via DAIR or one-/two-stage revision) in another joint. The one-year PJI incidence was 1.5%, without a demonstrably higher risk compared with controls. A history of treated PJI in another joint may not contraindicate subsequent primary arthroplasty, though patient-specific risk factors should guide counseling.
321. Hiatt JL, Ricciardelli ZM, Schwab JM, et al. Outpatient and Early Discharge Revision Total Joint Arthroplasty: A Systematic Review and Pooled Quantitative Analysis. The Journal of Arthroplasty 2026. doi:10.1016/j.arth.2026.08.039
This systematic review and pooled analysis of 14 studies compared inpatient versus outpatient or accelerated-discharge revision total joint arthroplasty. Outpatient revision patients were systematically healthier (lower BMI, lower Charlson scores, more ASA I-II) and typically underwent less complex procedures such as polyethylene liner exchange, with complication rates that were lower or comparable to inpatients. The findings suggest outpatient revision TJA can be safe in highly selected patients undergoing limited revisions, but selection criteria must account for patient comorbidity and procedural complexity.