Purpose: Recommendations regarding the surgical modification of the medial posterior tibial slope (mPTS) in medial unicompartmental knee arthroplasty (UKA) vary. Given the high preoperative variability, this often results in a significant change in the patient's mPTS through UKA. However, it is unclear whether this change in mPTS impacts the coronal alignment, specifically the medial proximal tibial angle (MPTA). Therefore, the purpose of this study was to report on the preoperative to post‐operative changes in mPTS and MPTA and their potential correlation in UKA.Methods: Pre‐ and post‐operative radiographs of 96 consecutive patients undergoing conventional medial UKA were analyzed. Pre‐ and post‐operative mPTS and MPTA were measured on radiographs by two observers and reported. Their differences, as well as the difference from the target value of 7°, were analyzed. Cases were grouped regarding their mPTS change into cases with <3° and cases with ≥3° mPTS change, and the correlation between changes in mPTS and changes in MPTA was reported.Results: The mean mPTS was reported at 9.27° (standard deviation [SD], 3.41°) preoperatively and 7.25° (SD, 2.23°) post‐operatively, with a mean change of −2.02° (SD, 3.84°; p < 0.001). Overall, 71.7% of cases had a post‐operative mPTS within ±2° of 7° without significant difference from the target value of 7° (p = 0.797). At a mean preoperative MPTA of 85.39° (SD, 2.34°) and a mean post‐operative MPTA of 84.12° (SD, 2.55°), UKA resulted in an average change of MPTA of −1.28° (SD, 2.55°; p < 0.001). Correlation coefficients revealed very weak correlations between the change in mPTS and the change in MPTA for all groups (r < −0.13 in all).Conclusions: Targeted mPTS modification can be achieved, which implies a significant change from preoperative mPTS values in patients undergoing UKA. However, the change in mPTS does not affect the change in MPTA.Level of Evidence: Level III.

Purpose: To compare medial posterior tibial slope (mPTS) measurements on abduction/adduction malpositioned versus properly positioned lateral knee radiographs within the same patients. We hypothesized that malpositioning would significantly alter mPTS values and potentially change surgical classification at the commonly used 12° threshold for slope‐correcting osteotomies. Methods: This retrospective analysis included patients with preoperative knee radiographs between October 2020 and March 2023 at a single academic institution. Patients were included if at least two lateral knee radiographs were available: one with abduction/adduction malalignment (proximal‐distal distance [PDD] ≥5 mm) and one properly aligned (PDD < 5 mm). Radiographs with insufficient tibial length, rotational malalignment, or prior osseous surgery or fractures were excluded. mPTS was measured using the method of Dejour & Bonnin. Inter‐ and intra‐rater reliability were assessed via intra‐class correlation coefficients (ICC > 0.9 for all comparisons). A t ‐test was used to compare mPTS values. Cases with a measurement difference of ≥2° were identified. Bland–Altman analysis was performed, and classification shifts across the 12° mPTS threshold for slope‐correcting osteotomies were reported. Results: Eighty‐eight lateral knee radiographs from 44 patients (57% female) were analyzed. The mean mPTS was 7 ± 3° in properly aligned radiographs and 9 ± 3° in malaligned radiographs ( p < 0.001), with a mean difference of 2°. In 59.1% of patients, mPTS differed by ≥2° between imaging conditions. Bland–Altman analysis showed 95% limits of agreement from –3.62° to 7.80°. In 15.9% of patients, classification relative to the 12° mPTS threshold changed. Conclusions: Abduction/adduction malalignment significantly alters mPTS measurements on lateral knee radiographs. A clinically relevant difference of ≥2° was observed in over half of patients, and 15.9% changed classification relative to the 12° surgical threshold. Lateral radiographs with a PDD ≥ 5 mm should not be used for surgical planning, and repeat imaging should be considered when mPTS values approach surgical decision thresholds. Level of Evidence: Level III diagnostic study.

Purpose: To evaluate the accuracy of two-dimensional (2D) digital templating in primary total knee arthroplasty (TKA) and assess whether surgical training level affects templating accuracy. Methods: A total of 424 patients who underwent primary TKA with preoperative 2D digital templating using the Attune system were retrospectively analyzed. Templating was performed in TraumaCad (Brainlab AG) by junior residents (< 3 years of training), senior residents (≥ 3 years), or board-certified orthopaedic surgeons. Planned and implanted component sizes were compared, and accuracy was assessed as exact matches and deviations of ± 1, ± 2, and ± 3 sizes. Pearson correlation analysis was used to assess the association between planned and implanted sizes. One-way ANOVA was used to compare mean absolute deviation across training levels. Additionally, the proportion of cases with a deviation greater than ± 1 size was calculated for both components across experience levels and compared using chi-square tests. Results: A total of 424 patients (61% female) were included. The median planned component sizes were 6 (IQR, 5–7) for the femoral and 6 (IQR, 5–7) for the tibial component; the median implanted sizes were 6 (IQR, 5–7) and 6 (IQR, 4–7), respectively. Planned and implanted sizes were very strongly correlated for both femoral ( r = 0.864; P < 0.001) and tibial components ( r = 0.841; P < 0.001). Templating accuracy was high, with 92.7% of femoral and 88.7% of tibial components within ± 1 size. No significant differences in correlation strength or mean absolute deviation were observed across training levels ( P > 0.05). The proportion of cases with > ± 1 size deviation was low across all groups and did not differ significantly between training levels for either component (femoral: P = 0.874; tibial: P = 0.791). Conclusion: 2D digital templating for primary TKA demonstrated high accuracy, with reliable prediction within a ± 1 size range and no significant influence of surgical training level. These findings support its continued clinical use and confirm that templating can be reliably performed by residents at all stages of training. Level of evidence: Level III, diagnostic study.

Background: The posterior tibial slope (PTS) is a key determinant of knee biomechanics, with increased PTS values identified as a risk factor for anterior cruciate ligament (ACL) injuries and ACL graft failure. While the relationship between PTS and passive anterior tibial translation (ATT) is well-documented, its influence on dynamic ATT during gait remains unclear. Purpose: To evaluate the in vivo association between medial and lateral PTS (MPTS and LPTS, respectively), as well as lateral-medial PTS difference (ΔPTS), with dynamic and passive ATT in ACL-deficient knees compared with contralateral ACL-intact knees. Study Design: Descriptive laboratory study. Methods: A total of 13 patients with unilateral ACL tears undergoing ACL reconstruction at the authors’ orthopaedic sports medicine center were included in the analysis. Dynamic ATT was assessed using a motion capture–based gait analysis system during walking, while passive ATT was measured using a KT-1000 arthrometer. The contralateral ACL-sufficient knees of the participants were used as paired controls. PTS values (MPTS, LPTS, ΔPTS [LPTS minus MPTS]) were measured from computed tomography. Correlation analyses were performed to evaluate the relationships between PTS parameters and ATT during gait, as well as during passive assessment. Results: MPTS, LPTS, or ΔPTS values did not differ significantly between ACL-injured and healthy knees ( P > .05). No significant correlations were identified in healthy knees or between MPTS/LPTS and ATT in either group.A strong inverse correlation was observed between ΔPTS and dynamic ATT in ACL-injured knees ( r = −0.692; P = .014), particularly during the stance ( r = −0.708; P = .015) and swing phases ( r = −0.775; P = .005). Conclusion: The results suggest that lateral-medial asymmetry of the PTS (ΔPTS) may influence dynamic ATT in ACL-injured knees during gait. A greater LPTS relative to MPTS was associated with reduced dynamic ATT, whereas a lower LPTS relative to MPTS correlated with increased ATT. This directional relationship indicates that slope asymmetry could act as a restraint, potentially limiting anterior tibial shift during dynamic loading. The observed inverse correlation between ΔPTS and dynamic ATT indicates that this asymmetry could act as a restraint, potentially limiting anterior tibial shift. No significant correlations were identified between MPTS or LPTS individually and dynamic or passive ATT. Further studies are needed to validate these findings. Clinical Relevance: Considering the potential influence of lateral-medial tibial slope asymmetry on dynamic knee stability, these findings provide insight into the biomechanical function of the ACL-injured knee during gait.

Medial open wedge high tibial osteotomy (MOW-HTO) is a standard treatment for medial compartment osteoarthritis (OA) of the knee. Its success relies on precise preoperative planning, typically using full-leg standing radiographs (FLSR) for coronal alignment assessment. However, factors like knee flexion and rotation can influence alignment measurements. The Rosenberg view (RB), commonly used for OA assessment, may offer additional value in preoperative planning. This study investigates whether the medial proximal tibial angle (MPTA) measurements differ between RB and FLSR, hypothesizing that both methods yield comparable measurements. This retrospective cohort study included 60 patients diagnosed with medial compartment osteoarthritis scheduled for MOW-HTO. MPTA was measured on both RB and FLSR radiographs by two observers. Interrater reliability was assessed using intraclass correlation coefficients, while Pearson correlation and Student's t-test were used to compare MPTA means between the two measurement techniques. The percentage of measurements exceeding a clinically acceptable threshold of 3° was reported. A Bland-Altman plot was generated to evaluate agreement. The mean MPTA was 86.0° ​± ​1.8° (95% CI: [85.55; 86.46]) on RB and 85.1° ​± ​1.6° (95% CI: [84.70; 85.50]) on FLSR, with a mean difference of 0.9° ​± ​2.41° (95% CI: [0.29; 1.51]), showing a statistically significant difference between the two modalities (p ​< ​0.001; Cohen's d ​= ​0.53). In 51 of 60 cases (85%), the difference remained within the threshold of 3°, while 9 cases (15%) exceeded this threshold. Pearson correlation analysis demonstrated a strong positive correlation between MPTA measurements on RB and FLSR (r ​= ​0.53, p ​< ​0.001). Bland-Altman analysis revealed 95% limits of agreement ranging from -3.61° to +5.41°. This study found a small, statistically significant difference of <1.0° between MPTA measurements from RB and FLSR, which was not clinically relevant as 85% of cases were within the threshold of 3°. A strong correlation and good agreement on Bland-Altman analysis support the comparability of both methods. RB may therefore serve as a viable alternative for both diagnosis and preoperative planning in MOW-HTO, potentially reducing the need for additional FLSR in resource-limited settings while also minimizing radiation exposure. Level III, cohort study.

Purpose: To evaluate the quality, reliability, and educational value of TikTok videos on cartilage surgery. It was hypothesized that overall quality would be low but higher in videos by healthcare professionals (HCP) and those with educational content. Methods: TikTok was searched (September 22–25, 2025) using terms related to cartilage surgery and repair. Of 800 retrieved videos, 108 met inclusion criteria. Video metrics, uploader type, and content type were recorded. Quality and reliability were assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmark criteria, and Global Quality Score (GQS). Associations between video metrics and quality scores were analyzed using Spearman rank correlation, and Mann–Whitney U tests compared scores by uploader and content type. Results: Most videos were posted by private users (61.1%) and focused on patient experiences (58.3%). Duration, shares, and views correlated positively with all quality metrics ( P < 0.001). HCP videos achieved significantly higher DISCERN (47.5 vs. 26.0), JAMA (2.9 vs. 0.9), and GQS (3.2 vs. 1.8) scores but lower engagement (all P < 0.001). Educational videos outperformed patient experience videos across all quality metrics (all P < 0.01). Conclusion: TikTok videos on cartilage surgery demonstrated low overall quality and reliability. Greater professional engagement is needed to enhance the accuracy and credibility of cartilage-related information on social media.