The aim of our study was to evaluate the potential role of Artificial Intelligence tools like ChatGPT in patient education. To do this, we assessed both the quality and readability of information provided by ChatGPT 3.5 and 4 in relation to Anterior Cruciate Ligament (ACL) injury and treatment. ChatGPT 3.5 and 4 were used to answer common patient queries relating to ACL injuries and treatment. The quality of the information was assessed using the DISCERN criteria. Readability was assessed with the use of seven readability formulae: the Flesch–Kincaid Reading Grade Level, the Flesch Reading Ease Score, the Raygor Estimate, the SMOG, the Fry, the FORCAST, and the Gunning Fog. The mean reading grade level (RGL) was compared with the recommended 8th-grade reading level, the mean RGL among adults in America. The perceived quality and mean RGL of answers given by both ChatGPT 3.5 and 4 was also compared. Both ChatGPT 3.5 and 4 yielded DISCERN scores suggesting “good” quality of information, with ChatGPT 4 slightly outperforming 3.5. However, readability levels for both versions significantly exceeded the average 8th-grade reading level for American patients. ChatGPT 3.5 had a mean RGL of 18.08, while the mean RGL of ChatGPT 4 was 17.9, exceeding the average American reading grade level by 10.08 grade levels and 9.09 grade levels, respectively. While ChatGPT can provide both reliable and good quality information on ACL injuries and treatment options, the readability of the content may limit its utility. Additionally, the consistent lack of source citation represents a significant area of concern for patients and clinicians alike. If AI is to play a role in patient education, it must reliably produce information which is accurate, easily comprehensible, and clearly sourced.

Purpose: During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used during the arthroscopic surgical processes show bacterial contamination over time during surgery remains unclear. The purpose of this study was to determine this contamination rate and to analyze its possible influence on postoperative infection.Materials and methods: In this study, 155 patients were included. Fifty‐eight underwent reconstruction of the anterior cruciate ligament (ACL), 63 meniscal surgery and 34 patients combined ACL reconstruction and meniscus repair. We collected pooled samples of irrigation fluid from the reservoir on the sterile drape every 15 min during the surgery. In addition, we evaluated suture material of ACL graft and meniscus repair for bacterial contamination. Samples were sent for microbiological analysis, incubation time was 14 days.All patients were seen in the outpatient department 6, 12 weeks and 12 months postoperatively and examined for clinical signs of infection.Results: A strong statistical correlation (R² = 0.81, p = 0.015) was found between an advanced duration of surgery and the number of positive microbiological findings in the accumulated fluid. Suture and fixation material showed a contamination rate of 28.4% (29 cases). Despite the high contamination rate, only one infection was found in the follow‐up examinations, caused by Staphylococcus lugdunensis.Conclusion: Since bacterial contamination of accumulated fluid increases over time the contact with the fluid reservoirs should be avoided.Level of evidence: IV.

Introduction: The radiographical assessment of patella height has historically been performed using X-Ray. The aim of this study was to evaluate a new method for the assessment of patella height using MRI and to assess the correlation with the X-Ray based assessment. Materials and methods: 159 patients who had both lateral radiographs and MRI images were included. Parameters measured included traditional radiographical CDI, MRI-based CDI, and TT-TG distance. On the basis of the TT-TG, the patients were divided into 2 groups. Two different methods were used to assess CDI using MRI: using a single slice image, and an alternative technique using two different cross-sectional images. The correlation of the two measurement methods was assessed using Pearson’s correlation coefficient. The intraclass correlation coefficient (ICC) was determined from the measurements of the two investigators. Results: The average TT-TG distance was 11.6 mm (± 4.6). In patients with a TT-TG < 15 mm, both measurement methods showed comparable correlation with measurements on X-Ray. In patients with a TT-TG of > 15 the the new cross-sectional imaging method showed higher correlation with traditional X-Ray assessment compared to CDI assessment using the traditional single slice method (r = 0.594, p < 0.001 vs. r = 0.302, p = 0.055). Conclusions: The assessment of CDI on MRI using a cross-sectional imaging method has a better correlation with traditional X-Ray assessment of CDI than single-slice assessment. This is particularly true in patients with elevated TT-TG and as such should be preferentially used in the assessment of Patellar height in this cohort.

Purpose: This study aimed to evaluate the clinical and functional outcomes of autologous bone grafting with spheroid‐based matrix‐induced autologous chondrocyte implantation (MABCI) for osteochondral defects of the knee by analysing pre‐ and postoperative patient‐reported outcome measures (PROMs). Postoperative gait analysis was conducted and compared with a matched healthy control group to investigate biomechanical deviations.Methods: A total of 35 patients (m: 21, f: 14; mean defect size: 4.2 ± 2.4 cm², localisation: femoral condyle: 31, patellofemoral: 5) were analysed. The mean follow‐up was 42.6 ± 22.8 months. International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), PROMIS 29 profile, and a questionnaire on patient perception of treatment success were assessed to evaluate PROMs. 3D‐instrumented gait analysis (GRAIL, Motek) was used to assess lower extremity kinematics, kinetics and vertical ground reaction forces, compared to sex‐, age‐ and body mass index‐matched healthy controls.Results: All clinical scores showed significant improvement compared to the preoperative condition (IKDC: 73.1 ± 10.1 vs. 56.6 ± 17.2, p < 0.01; KOOS subcategories: pain 82.0 [±12.7] vs. 70.7 [±16.7] [p < 0.01], symptoms 79.1 [±20.3] vs. 68.9 [±13.9] [p < 0.01], activities of daily living 90.1 [±11.2] vs. 80.5 [±15.6] [p < 0.01], sport and recreational function: 65.3 [±19.3] vs. 51.3 [±26.29] [p < 0.01], quality of life 52.2 [±18.6] vs. 42.6 [±18.6] [p < 0.01]; numeric pain rating scale: 2.7 ± 2.0 vs. 5.0 ± 2.5, p < 0.01). The analysed patients reported a high satisfaction rate (94.3%). Self‐selected walking speed was significantly lower than in healthy controls (1.17 ± 0.17 m/s vs. 0.98 ± 0.18 m/s, p < 0.01). Peak knee flexion angle (PKA) during loading response was significantly smaller (9.6° ± 7.0 vs. 17.7° ± 4.6, p < 0.01), and knee extension moment was significantly reduced (0.1 Nm/kg ± 0.2 vs. 0.4 Nm/kg ± 0.2, p < 0.01).Conclusion: MABCI is an effective treatment for osteochondral knee defects, showing significant improvements in all evaluated PROMs. Postoperative gait analysis revealed abnormal gait patterns, including reduced PKA and lower knee extension moment, suggesting a need for further rehabilitation to optimise functional recovery.Level of Evidence: Level III.

Objectives: There remains considerable debate regarding the optimal management of anterior cruciate ligament (ACL) injuries in skeletally immature patients. This study aims to evaluate the clinical outcomes of transphyseal ACL reconstruction in patients with open growth plates. Methods: This retrospective study included skeletally immature patients with full-thickness ACL tears and confirmed open physis. ACL reconstructions were performed using a four-strand semitendinosus autograft, with an additional gracilis tendon graft if needed. The surgical technique emphasized tibial and femoral physeal-sparing tunnel placement to minimize disruption of the growth plates. Clinical assessment included measurements for limb length discrepancy, knee stability, and growth disturbances. Functional outcomes were evaluated using IKDC 2000, Lysholm, and KOOS scores, while ligament stability was assessed with KT-1000 arthrometer measurements at routine follow-up. Results: A total of 31 consecutive patients (15 females, 16 males; mean age 13.6 ± 1.8 years, range 9–16 years) were included. Mean follow-up was 49 ± 26 months (range 18–93 months). The mean time to return to sports was 8.8 ± 4.4 months. Eight patients (26%) experienced ACL graft rupture and underwent revision ACL reconstruction. One additional patient required partial meniscectomy. The overall revision rate was 29%. The mean subjective IKDC score was 91.8 ± 7.2, with Lysholm and KOOS scores of 96.6 ± 7.9 and 94.2 ± 5.3, respectively. No significant growth disturbances were noted. The mean side-to-side difference in KT-1000 testing was 2.2 ± 1.5 mm. Patients who underwent revision ACL reconstruction showed significantly greater length growth compared with those with intact ACL reconstruction (p = 0.02). Spearman correlation revealed a significant association between length growth and anterior tibial translation (p = 0.02, r = 0.46). Conclusions: Transphyseal ACL reconstruction in skeletally immature patients provides favorable clinical and radiological outcomes, with minimal risk of growth disturbance. Most patients returned to pre-injury levels of athletic activity. However, the high revision rate emphasizes the complexity of managing ACL injuries in this population.

Zusammenfassung: Hintergrund: Ziel der Studie war es, den Einfluss der COVID-19-Pandemie auf die physiotherapeutische und ärztliche Nachsorge nach Rekonstruktion des vorderen Kreuzbandes (VKB) zu untersuchen. Methoden: Insgesamt wurden 116 Patienten (72 Männer und 44 Frauen) eingeschlossen, die zwischen September 2019 und Dezember 2020 eine Rekonstruktion des VKB erhalten hatten. Die Patienten wurden in eine 2019 vor der COVID-19(„coronavirus disease“ 2019)-Pandemie operierte Patientengruppe sowie eine 2020 operierte, von der COVID-19-Pandemie unmittelbar betroffene Patientengruppe eingeteilt. Anhand eines standardisierten Fragebogens wurden die Auswirkungen der Pandemie auf die ärztliche und physiotherapeutische Nachsorge sowie auf die Dauer der postoperativen Arbeitsunfähigkeit erhoben. Ergänzend erfolgte eine Auswertung des Bewegungsumfanges des operierten Knies 3 Monate postoperativ. Ergebnisse: Es zeigte sich bei den 2020 operierten Patienten eine deutliche Tendenz zu einem höheren Anteil an Streckdefiziten ≥ 5° (18,8 % vs. 4,3 %, p = 0,097) oder einer maximalen Beugefähigkeit von < 120° (23,3 % vs. 10 %, p = 0,197) 3 Monate postoperativ, die allerdings nicht signifikant war. In der physiotherapeutischen und ärztlichen Nachsorge berichteten die 2020 operierten Patienten von signifikant längeren Wartezeiten auf Termine, späteren Zeitpunkten des ersten postoperativen Termins, einer höheren Anzahl vergeblicher Terminanfragen sowie einer höheren Anzahl abgesagter Termine. 34,9 % der 2020 operierten Patienten gaben an, die Dauer ihrer postoperativen Arbeitsunfähigkeit durch die Möglichkeiten zur Arbeit im Homeoffice verkürzt haben zu können. Pandemiebedingte alternative Behandlungsangebote wurden den Patienten von 13,3 % der Physiotherapeuten sowie 12,2 % der Ärzte angeboten. Schlussfolgerung: Obwohl die physiotherapeutische und ärztliche Behandlung von keinem „Lockdown“ betroffen war, kam es aufgrund der Pandemie zu signifikanten Einschränkungen, welche sich auch in einer deutlichen Tendenz zu schlechteren klinischen Ergebnissen niederschlagen. Es besteht daher Bedarf an einem weiteren Ausbau alternativer Therapieoptionen, die bislang nur von 12–13 % der Praxen zur Verfügung gestellt werden und mutmaßlich auch für andere Erkrankungen von ähnlicher Bedeutung sind.