Michele Malavolta

This Editor's Note considers how three‐dimensional trochlear morphology, extensor mechanism alignment, patellar reconstruction and implant geometry interact in kinematically aligned total knee arthroplasty (TKA). Imaging studies suggest that personalised alignment may reproduce selected native trochlear parameters more closely than systematic mechanical alignment, although rotational and implant‐related mismatch persists. Improved anatomical reconstruction has not consistently translated into less anterior knee pain or better patient‐reported outcomes. Native‐like trochlear restoration remains a plausible biomechanical target, but its clinical benefit has not been established consistently across phenotypes and implant designs.

Purpose: Meniscal extrusion alters joint biomechanics and accelerates cartilage degeneration, contributing to the progression of knee osteoarthritis (OA). Meniscal centralization techniques aim to reposition the meniscus, addressing extrusion and restoring load distribution. This systematic review aims to evaluate meniscal centralization's clinical and radiological outcomes, hypothesizing its efficacy in treating symptomatic meniscal extrusion with minimal complications.Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and was registered with PROSPERO (CRD42023484353). Literature searches were conducted in PubMed, Science Direct and Scopus. Studies reporting clinical and/or radiological outcomes of meniscal centralization with ≥24 months of follow‐up were included. Data on demographics, surgical techniques, patient‐reported outcome measures (PROMs), imaging findings and complications were extracted. Methodological quality was assessed using the ROBINS‐I tool, and heterogeneity was evaluated via the I² statistic.Results: Four studies (113 patients, mean follow‐up: 24–35 months) met inclusion criteria. Arthroscopic meniscal centralization with suture anchors significantly improved PROMs, including International Knee Documentation Committee (IKDC), Lysholm and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores, demonstrating symptom relief and functional recovery. Lysholm scores improved from 46.0 to 96.5, KOOS pain from 47.4 to 88.9, and IKDC from 51.8 to 75.8 (p < 0.05 for all). Imaging showed reduced meniscal extrusion and improved joint space width. Complications were minimal, though one study reported a 26.9% failure rate due to incomplete healing and OA progression. Rehabilitation protocols allowed return to full activity within 4–6 months.Conclusions: Meniscal centralization effectively reduces extrusion, improves clinical outcomes, and restores knee function with minimal complications. However, further long‐term and comparative studies are needed to validate these findings and refine surgical indications.Level of Evidence: Level IV.