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Medicina
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Advances in Knee Surgery: From Diagnosis to Recovery
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Advances in Knee Surgery: From Diagnosis to Recovery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 3537

Special Issue Editors

Prof. Dr. Yong In

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
Interests: knee osteoarthritis; cartilage regeneration; arthroplasty implant design
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. In Jun Koh

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
Interests: total knee arthroplasty; knee osteoarthritis; cartilage regeneration
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Following the great success of our first Special Issue, “Advances in Knee Surgery” (2022), which featured 24 outstanding papers, we are pleased to announce the launch of its second edition, “Advances in Knee Surgery: From Diagnosis to Recovery.” This Issue aims to highlight the most recent innovations and future directions in knee surgery.

In recent years, remarkable progress has been achieved in both surgical techniques and digital technologies, including computer-assisted and robotic systems, artificial intelligence-driven planning, and biologic augmentation. This Special Issue aims to showcase the latest advances across the full spectrum of knee surgery—from ligament, meniscus, and cartilage repair to osteotomy and arthroplasty—by integrating precision medicine, advanced  imaging, and data-driven approaches.

We invite submissions of original research articles and systematic reviews that explore evolving surgical strategies and emerging technologies shaping the future of personalized knee reconstruction.

Prof. Dr. Yong In
Prof. Dr. In Jun Koh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • knee surgery
  • arthroplasty
  • osteotomy
  • cartilage regeneration
  • meniscus repair
  • ligament reconstruction
  • artificial intelligence
  • robotics

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Published Papers (5 papers)

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Research

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14 pages, 5597 KB  
Article
Subcortical Bone Cysts at the Medial Meniscus Posterior Root Are Associated with Longer Symptom Duration but Not with Healing Status or Meniscal Extrusion After Root Repair
by Young-Mo Kim, Yong-Bum Joo and Young-Cheol Park
Medicina 2026, 62(5), 983; https://doi.org/10.3390/medicina62050983 (registering DOI) - 18 May 2026
Viewed by 142
Abstract
Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are [...] Read more.
Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are associated with symptom duration and whether their presence influences healing status or medial meniscus extrusion (MME) after transtibial pullout repair (TPR). Materials and Methods: Seventy-four consecutive patients who underwent arthroscopic TPR for MMPRT between January 2022 and December 2024 were retrospectively reviewed. After applying exclusion criteria, 50 patients were included and divided into cyst-positive (n = 20) and cyst-negative (n = 30) groups based on preoperative MRI findings. Clinical outcomes, MME, and second-look arthroscopic healing status at 6 months postoperatively were compared between groups. Multivariable linear regression analysis was performed to identify independent predictors of postoperative MME. Results: The cyst-positive group had significantly longer symptom duration than the cyst-negative group (13.8 ± 3.0 vs. 8.8 ± 2.8 weeks, p < 0.001) and demonstrated higher grades of MMPR degeneration (p < 0.05). Complete healing was observed in 60.0% of patients in each group, and no failed healing cases were noted. Postoperative MME at 6 months was comparable between groups (3.8 ± 0.8 vs. 3.8 ± 1.0 mm). Multivariable regression analysis identified baseline MME as the strongest independent predictor of postoperative MME (β = 0.67, p < 0.001), whereas bone cyst presence was not independently associated with postoperative extrusion. Conclusions: Subcortical bone cysts at the MMPR attachment are associated with longer symptom duration and more advanced root degeneration. However, their presence was not significantly associated with healing status or postoperative MME after MMPRT repair. These findings suggest that bone cyst formation may be associated with chronic degenerative changes at the root attachment, but should not discourage surgeons from performing root repair. Full article
(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)
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15 pages, 1607 KB  
Article
Particulated Costal Hyaline Cartilage Allograft and Microdrilling Combined with High Tibial Osteotomy Improves Early Pain Outcomes in Patients Suffering from Medial Knee Osteoarthritis with Full-Thickness Cartilage Defects: A Randomized Controlled Trial
by Gi Beom Kim, Oog-Jin Shon and Sang-Woo Jeon
Medicina 2026, 62(2), 289; https://doi.org/10.3390/medicina62020289 - 1 Feb 2026
Viewed by 478
Abstract
Background and Objectives: While particulated costal hyaline cartilage allograft (PCHCA) combined with microdrilling demonstrates superior cartilage regeneration compared to microdrilling alone in high tibial osteotomy (HTO), the impact on early clinical recovery remains uncertain. The aim of this study is to compare [...] Read more.
Background and Objectives: While particulated costal hyaline cartilage allograft (PCHCA) combined with microdrilling demonstrates superior cartilage regeneration compared to microdrilling alone in high tibial osteotomy (HTO), the impact on early clinical recovery remains uncertain. The aim of this study is to compare early clinical outcomes (within 6 months) between microdrilling alone versus combined particulated costal hyaline cartilage allograft (PCHCA) with microdrilling in medial open-wedge high tibial osteotomy (MOWHTO) for medial compartment osteoarthritis, and to investigate age-related differences in treatment response. Materials and Methods: This prospective, dual-center, randomized controlled trial with blinded outcome assessment enrolled 64 patients (33 treatment and 31 control) undergoing MOWHTO with medial femoral condyle cartilage defects (ICRS III-IV, ≥200 mm2). The treatment group received PCHCA implantation combined with microdrilling, while the control group received microdrilling alone. Patients and outcome assessors were blinded to group allocation. Primary outcomes were KOOS-Pain and VAS scores at 12 and 24 weeks. Age-stratified analysis compared patients ≤ 60 years (n = 44) versus > 60 years (n = 20) Results: The treatment group showed significantly superior KOOS-Pain scores at 12 weeks (70.6 vs. 61.6, p = 0.014) and 24 weeks (82.9 vs. 71.5, p = 0.011), with corresponding VAS improvements (p = 0.010 and p = 0.004). Age-stratified analysis revealed patients ≤ 60 years achieved comparable outcomes regardless of treatment (p = 0.574), while patients > 60 years demonstrated significantly superior outcomes with PCHCA (KOOS-Pain improvement: 24.7 vs. 17.9 points, p = 0.012). BMI ≥ 26 kg/m2 significantly predicted reduced odds of achieving MCID for both pain (OR 0.88, p = 0.028) and ADL (OR 0.80, p = 0.003). Conclusions: PCHCA combined with microdrilling provides superior early pain relief compared to microdrilling alone in MOWHTO, with effects most pronounced in patients > 60 years. Age-stratified treatment selection and BMI optimization should be considered to maximize outcomes. Full article
(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)
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12 pages, 5420 KB  
Article
Functional Differences in the Affected Limbs Between CPAK Type I and Type II Patients Undergoing Unilateral Total Knee Arthroplasty
by Ju Won Bae, Seung Ik Cho, Dhong Won Lee, Byung Sun Park, Yu Bin Lee, Wonjun Chang and Joon Kyu Lee
Medicina 2026, 62(2), 259; https://doi.org/10.3390/medicina62020259 - 26 Jan 2026
Viewed by 665
Abstract
Background and Objectives: This study compared functional performance, gait performance, and dynamic balance between Coronal Plane Alignment of the Knee (CPAK) Type I and Type II patients undergoing unilateral total knee arthroplasty (TKA). Materials and Methods: We included 162 consecutive patients scheduled for [...] Read more.
Background and Objectives: This study compared functional performance, gait performance, and dynamic balance between Coronal Plane Alignment of the Knee (CPAK) Type I and Type II patients undergoing unilateral total knee arthroplasty (TKA). Materials and Methods: We included 162 consecutive patients scheduled for unilateral TKA between January 2022 and August 2025. Patients were classified according to CPAK type; 42 were Type I and 33 were Type II. Preoperative assessments included demographic data, Korean Knee Score, and WOMAC. Functional performance was evaluated using the Timed Up and Go (TUG) test and the 4 m walk test. Isokinetic knee extensor and flexor strength (60°/s), hip abductor strength, and bilateral thigh circumferences measured 5 cm and 15 cm proximal to the patella were assessed. Dynamic balance asymmetry was evaluated using the POSTUROMED device. Inter-limb differences were calculated by comparing the operated and non-operated limbs. Results: No significant between-group differences were observed in clinical scores, knee extensor, or flexor strength deficits, hip abductor strength deficits, or thigh circumference differences. However, CPAK Type II patients demonstrated significantly better functional performance, with faster TUG (p = 0.014) and 4 m walk test times (p = 0.022). Dynamic balance outcomes were also significantly better in the Type II group (p = 0.042). Conclusions: Despite similar patient-reported clinical scores and muscle strength, patients with the CPAK Type II phenotype exhibited superior gait performance and dynamic balance compared with those with Type I following unilateral TKA. Full article
(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)
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12 pages, 8211 KB  
Article
Novel Visual Grade and Hounsfield Unit Predict Adequate Bone Strength for Cementless Total Knee Arthroplasty
by Dong Hwan Lee, Dai-Soon Kwak, Sheen-Woo Lee, Yong Deok Kim, Nicole Cho and In Jun Koh
Medicina 2025, 61(11), 2018; https://doi.org/10.3390/medicina61112018 - 12 Nov 2025
Cited by 1 | Viewed by 844
Abstract
Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, [...] Read more.
Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, and intraoperative evaluation is subjective. This study aimed to establish objective assessment methods by analyzing the correlations between a novel visual grading system, CT Hounsfield units (HU), and actual bone strength. Materials and Methods: This prospective study included 131 patients undergoing posterior-stabilized TKA. We developed a novel visual grading system (Excellent, Good, Fair, Poor) based on femoral cutting surface characteristics. CT HUs were measured preoperatively by an assisting surgeon in the box bone area. Femoral box specimens underwent indentation testing to determine their actual bone strength. Minimum Required Strength (MRS) was defined at 2.5-fold the patient’s body weight, and Estimated Withstanding Strength (EWS) was determined by scaling first failure load using area ratios. Patients were classified as “cementless suitable” (EWS > MRS) or “cemented mandatory” (EWS < MRS). Correlations were assessed using Spearman’s rank correlation for visual grade and Pearson correlation for Hounsfield units. ROC curve analysis determined diagnostic accuracy. Results: Visual grade exhibited an exceptionally robust relationship to bone strength (Spearman ρ = 0.903, p < 0.01), whereas HU showed substantial correlation (Pearson r = 0.660, p < 0.01, R2 = 0.435). Visual grading achieved excellent diagnostic accuracy (AUC = 0.974, sensitivity 95.1%, specificity 95.9%) using “Good” grade as cutoff. HU demonstrated AUC of 0.938 with 92.7% sensitivity and 81.6% specificity at a cutoff value of 65.2. Conclusions: Our novel visual grading system and CT HU demonstrated excellent correlations with actual distal femoral bone strength and outstanding diagnostic performance for identifying cementless TKA candidates. Unlike traditional subjective intraoperative assessments such as the “thumb test”, this system provides objective visual criteria directly correlated with actual bone strength. Preoperative HU screening with intraoperative visual grading can help prevent early failure. Full article
(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)
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Review

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22 pages, 7137 KB  
Review
Evolving Philosophies of Alignment in TKA: From Mechanical Uniformity to Personalised Harmony
by Hong Yeol Yang, Jong-Keun Seon and Khairul Anwar Ayob
Medicina 2026, 62(2), 307; https://doi.org/10.3390/medicina62020307 - 2 Feb 2026
Viewed by 935
Abstract
Background and Objectives: Mechanical alignment (MA) has long been the gold standard in total knee arthroplasty (TKA), aiming for neutral hip–knee–ankle alignment with proven long-term survivorship. However, up to 20% of patients remain dissatisfied, often due to neglect of individual constitutional limb [...] Read more.
Background and Objectives: Mechanical alignment (MA) has long been the gold standard in total knee arthroplasty (TKA), aiming for neutral hip–knee–ankle alignment with proven long-term survivorship. However, up to 20% of patients remain dissatisfied, often due to neglect of individual constitutional limb variation and subsequent soft tissue imbalance. This has driven the development of alternative alignment philosophies. This current concepts review aims to determine the various evolving alignment strategies, elucidate their underlying principles, and demonstrate the available clinical outcomes data. Materials and Methods: This review examines MA and the paradigm shift towards personalized alignment techniques, including Kinematic Alignment (KA), restricted Kinematic Alignment (rKA), inverse Kinematic Alignment (iKA), adjusted mechanical alignment (aMA), and the most recent evolution, Functional Alignment (FA). Results: Kinematic alignment and its derivatives (rKA, iKA) seek to better replicate native joint morphology and tension, often reducing the need for soft tissue releases and improving functional outcomes compared to MA. rKA and iKA introduce protective boundaries to avoid extreme phenotypes and possible instability. FA leverages robotic platforms and integrates these principles with real-time gap balancing, demonstrating promise for consistent, personalized outcomes. Some reports, however, advise caution with adjusted Mechanical Alignment (aMA), particularly those that result in phenotypes such as Coronal Plane Alignment of the Knee (CPAK) VII or VIII, which may increase the risk of revision. Conclusions: The philosophy of TKA has evolved from a uniform mechanical target (MA) to a more nuanced, patient-specific strategy. While promising mid- to long-term outcomes and comparable survival data support the viability of KA and its derivatives, critical needs remain, including standardizing nomenclature (especially for FA) and conducting high-quality comparative trials. Future directions involve leveraging high-volume intraoperative data and Artificial Intelligence (AI) to refine decision-making and further personalize alignment strategies, without compromising long-term implant survivorship. Full article
(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)
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