The American Journal of Sports Medicine

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results.

To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement.

Cohort study; Level of evidence, 3.

Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes.

A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures.

Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

There may be an association between repetitive stress on the elbow and capitellar osteochondritis dissecans (COCD). The influence of activity on the characteristics or specific location of the lesion within a capitellar zone of propensity remains unclear.

The purpose of this study was to evaluate COCD in gymnasts and baseball players compared with a non–upper extremity (non-UE) sport COCD cohort. It was hypothesized that activity would influence presentation and lesion location and characteristics.

Cross-sectional study, Level of evidence, 3.

Consecutive patients presenting with COCD treated in a tertiary sports medicine practice between March 2006 and March 2021 were reviewed. Demographic and imaging lesion characteristics were recorded. The sagittal inclination angle position of the lesion center relative to the humeral shaft was recorded. Intra- and interrater reliability was confirmed (intraclass correlation coefficient, 0.808; intraclass correlation coefficient, 0.824, respectively). Participants were analyzed by activity.

A total of 126 elbows were identified: 68 in gymnasts, 31 in baseball players, and 27 in patients with no history of UE sports. The mean age of the participants was 12.5 years (range, 8-18 years). All (100%) unilateral cases of osteochondritis dissecans (OCD) in baseball players occurred in the dominant throwing arm, compared with less hand-dominance correlation in gymnasts (64%) and non-UE athletes (67%). Significantly, 14 of the 20 (70%) patients with bilateral OCD were gymnasts (P = .036). In non-UE athletes, lesions occurred at a mean sagittal inclination angle of 52.7° (±13.8°), with a mean lateral containment of 4.7 (±2.1) mm. In gymnasts, lesions occurred more posteriorly at 41.2° (±14.9°), with a lateral containment of 3.6 (±1.9) mm. In baseball players, COCDs occurred at 55.1° (±11.9°), with a lateral containment of 2.5 (±1.6) mm. These more posterior lesion positions in gymnasts (P = .001) and lesser lesion containment noted in gymnasts (P = .015) and baseball players (P < .001) were significant.

Compared with COCD lesions in adolescents with no history of UE sports, gymnastics participation (impact weightbearing) correlated with a higher rate of bilateral lesion formation and a more posterior (extended) lesion position. Baseball participation (resulting in valgus shear forces in the elbow) resulted in a sagittal position similar to non-UE lesions, but more lateral and with less containment.

Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy.

The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively.

Case series; Level of evidence, 4.

A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study.

Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively (P = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery (P = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively (P < .001).

Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.

The open Latarjet procedure yields excellent results as a treatment for anterior shoulder instability. The position of the bony fragment and the insertion angle of the screw (the alpha angle) are critical factors for a successful procedure. The alpha angle is considered overangulated at >25°, which is associated with poor bone fixation and healing.

To assess preoperative patient anatomic factors that affect the alpha angle in the Latarjet procedure for anterior shoulder instability.

Case-control study; Level of evidence, 3.

In this retrospective study, 76 patients who underwent the open Latarjet procedure between October 2009 and December 2023 were included. Postoperative computed tomography scans were reviewed for the alpha angle, and patients were classified into 2 groups: group 1 (alpha angle ≥25°) and group 2 (alpha angle <25°). Preoperative patient characteristics and radiological parameters obtained from preoperative computed tomography scans were analyzed and compared between groups 1 and 2. We developed a novel method to measure the depth of the chest and the angle between the deltopectoral interval and the plane of screw insertion. We also measured the thickness of the pectoralis major and subscapularis muscles.

Of the 76 patients in this study, 41 and 35 patients were included in groups 1 and 2, respectively. The mean alpha angles of groups 1 and 2 were 36° and 12°, respectively, and the body mass index was significantly higher in group 1 (P < .001). In addition, group 1 had a significantly longer distance from the anterior edge of the glenoid to the skin margin of the deltopectoral interval (P < .001). The angle between the deltopectoral interval and the plane of screw insertion (traction angle) was significantly larger in group 1 (P < .001), and the pectoralis major and subscapularis muscles were thicker in group 1 (P = .017 and P = .032, respectively).

The alpha angle after the Latarjet procedure was strongly related to the patient's weight, body mass index, depth of the chest, and the angle between the deltopectoral interval and the plane of screw insertion. To our knowledge, this is the first study in which the preoperative factors that facilitate proper screw fixation in the Latarjet procedure are reported.

Although there has been some amount of research into the use of platelet-rich plasma (PRP) after arthroscopic rotator cuff repair, most studies have not fully demonstrated its benefits. In addition, PRP formulations containing different concentrations of leukocytes have not been directly compared for rotator cuff repair.

The purpose of this article was to determine whether arthroscopic rotator cuff repair combined with PRP injection, either leukocyte-rich PRP (LR-PRP) or leukocyte-poor PRP (LP-PRP), is superior to the control. The null hypothesis was that the addition of any PRP formulation would not result in outcomes superior to the control group.

Randomized controlled trial; Level of evidence, 1.

Patients with full-thickness rotator cuff tears who underwent arthroscopic repair were assessed for eligibility. The included patients were randomized to 3 treatment groups: the LR-PRP, LP-PRP, and standard-care control groups. After the rotator cuff suture was fixed firmly, different groups of liquid PRP preparations prepared by centrifugation were injected into the tendon-to-bone interface. The functional outcomes were assessed using the University of California, Los Angeles (UCLA) score, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale for pain during sleep and activity, and active range of motion at 3, 6, and 12 months after surgery. In addition, the visual analog scale score was obtained at weeks 2 and 6. Postoperative structural integrity was assessed by magnetic resonance imaging at 12 months using the Sugaya classification. Type III was considered partial retear, and types IV and V were considered complete retears. The safety of surgery was compared by the incidence of complications. The main analyses were performed in accordance with the intention-to-treat principle.

Of 150 patients initially randomized, the functional outcomes in 142 (46 LR-PRP, 47 LP-PRP, 49 control) and the structural integrity in 133 (40 LR-PRP, 46 LP-PRP, 47 control) were analyzed. There was no significant difference in the primary outcome of the UCLA score among the 3 groups (P = .169). The trends in functional outcomes and range of motion were similar for the 3 groups, with no significant differences among the groups at 12 months. However, within 6 months after surgery, the ASES score was better in the LR-PRP group than in the control group (3 months: 85.8 ± 4.1 vs 81.6 ± 8.7; P = .011; 6 months: 90.0 ± 5.4 vs 86.2 ± 6.8; P = .003). At 12 months after surgery, the overall retear rate, including partial and complete retears, was 8%. There were no significant differences in the rates of overall retear (P = .755) or complete retear (P = .633) among the 3 groups. The only surgical complication was postoperative stiffness, which occurred in 3% of patients, and the incidence did not significantly differ among the groups (P = .790).

The study did not reveal that shoulders treated with the LR-PRP or LP-PRP formulations had any superior functional or structural outcomes at 12 months compared with those of the control group. However, LR-PRP may offer better ASES scores than the control group up to 6 months after surgery, and its clinical benefit remains to be proven.

ChiCTR2100045039 (Chinese Clinical Trial Register).

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results.

To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs).

Case series; Level of evidence, 4.

Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed.

A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm.

At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Repair of rotator cuff tear is not always feasible, depending on the severity. Although several studies have investigated factors related to reparability and various methods to predict it, inconsistent scoring methods and a lack of validation have hindered the utility of these methods.

To develop machine learning models to predict the reparability of rotator cuff tears, compare them with previous scoring systems, and provide an accessible online model.

Cohort study; Level of evidence, 3.

Arthroscopic rotator cuff repairs for tears with both anteroposterior and mediolateral diameters >1 cm on preoperative magnetic resonance imaging were included and divided into a training set (70%) and an internal validation set (30%). For external validation, rotator cuff repairs performed by 2 different surgeons were included in a test set. Machine learning models and a newly adjusted scoring system were developed using the training set. The performance of the models including the adjusted scoring system and 2 previous scoring systems were compared using the test set. The performance was assessed using metrics such as the area under the receiver operating characteristic curve (AUROC) and compared using the net reclassification improvement based on the adjusted scoring system.

A total of 429 patients were included for the training and internal validation set, and 112 patients were included for the test set. An elastic-net logistic regression demonstrated the best performance, with an AUROC of 0.847 and net reclassification improvement of 0.071, compared with the adjusted scoring system in the test set. The AUROC of the adjusted scoring system was 0.786, and the AUROCs of the previous scoring systems were 0.757 and 0.687. The elastic-net logistic regression was transformed into an accessible online model.

The performance of the machine learning model, which provides a probability estimation for rotator cuff reparability, is comparable with that of the adjusted scoring system. Nevertheless, when deploying prediction models beyond the original cohort, regardless of whether they rely on machine learning or scoring systems, clinicians should exercise caution and not rely solely on the output of the model.

The insufficient regeneration of fibrocartilage at the tendon enthesis is the primary cause of retearing after surgical reattachment of the rotator cuff. Exosomes derived from bone marrow–derived mesenchymal stem cells (BMSC-Exos) and kartogenin (KGN) have been demonstrated to induce fibrocartilage formation. Loading drugs into exosomes may lead to a synergistic effect, significantly enhancing the inherent activity of both components. However, further investigation is necessary to determine whether loading KGN into BMSC-Exos could yield superior efficacy in promoting tendon enthesis healing.

To study the effect and mechanism of KGN-loaded BMSC-Exos (Kl-BMSC-Exos) on tendon enthesis repair and biomechanical properties in a rat rotator cuff injury (RCI) model.

Controlled laboratory study.

The characteristics and in vivo retention of exosomes were demonstrated using nanoflow cytometry, transmission electron microscopy, and in vivo imaging of a small animal. The differentiation markers of BMSCs were assessed through quantitative polymerase chain reaction and immunofluorescence assays. Unilateral supraspinatus tenotomy and repair were performed in rats to establish the RCI model. Gelatin sponges were utilized to contain and deliver exosomes. In total, 44 rats were randomly assigned to 4 groups: sham, RCI, BMSC-Exos, and Kl-BMSC-Exos. Tendon enthesis regeneration and biomechanical properties were evaluated 8 weeks after surgery. RNA sequencing of BMSCs was performed to elucidate the underlying mechanism through which Kl-BMSC-Exos enhance tendon enthesis healing.

No discernible disparities in fundamental characteristics were evident between BMSC-Exos and Kl-BMSC-Exos. Incorporating exosomes into a gelatin sponge extended the in vivo retention time from 7 to 14 days. Kl-BMSC-Exos were more effective in inducing differentiation markers of BMSCs, improving fibrocartilage regeneration, organizing collagen fiber arrangement, and enhancing the biomechanical properties of tendon enthesis. Furthermore, transcriptomics suggested that Mospd1 was involved in Kl-BMSC-Exos–mediated tendon enthesis healing by enhancing fibrocartilage regeneration.

The incorporation of exosomes into a gelatin sponge significantly enhances their in vivo retention time. Kl-BMSC-Exos can expedite the healing of RCI by enhancing chondrogenesis and fibrocartilage regeneration, providing more organized collagen fiber arrangement and superior biomechanical properties of the rotator cuff enthesis. The promotion of rotator cuff enthesis regeneration may contribute to enhancing the chondrogenic potential in BMSCs through Kl-BMSC-Exos–mediated upregulation of Mospd1.

As a cell-free therapeutic approach, Kl-BMSC-Exos displayed a better therapeutic effect on tendon enthesis healing than BMSC-Exos did, and these can be used as a biologic augmentation to enhance the healing of rotator cuff enthesis.

Paralabral cysts at the spinoglenoid notch are rare disorders that can potentially lead to compressive suprascapular neuropathy. Given their infrequency, a standard treatment protocol has not yet been established.

This study aimed to assess changes in the infraspinatus muscle using magnetic resonance imaging (MRI) and to compare the outcomes of 2 different surgical methods. It was hypothesized that surgical intervention could alleviate compressive neuropathy, with comparable outcomes between the 2 surgical approaches.

Cohort study; Level of evidence, 3.

This retrospective review encompassed 43 patients undergoing arthroscopic labral repair for a paralabral cyst at the spinoglenoid notch, with cyst decompression (27 patients; labral repair with cyst decompression [LRCD] group) or without cyst decompression (16 patients; labral repair only [LRO] group). Preoperative MRI focused on evaluating the condition of the infraspinatus and teres minor muscles. Electromyography (EMG) was conducted on 36 patients (21 in LRCD and 15 in LRO) to assess suprascapular nerve function. Postoperative evaluations were performed in 35 patients at postoperative 1 year, excluding those lost to follow-up. Postoperative MRI findings (24 patients in LRCD and 11 patients in LRO) and functional outcome scores including recovery of external rotation power were compared with preoperative status in both groups.

Preoperative MRI revealed denervation changes or atrophy of the infraspinatus in 26 of the 43 patients (60.4%). Among the 36 patients who underwent preoperative EMG, 21 patients (58.3%; 13 patients in LRCD and 8 patients in LRO) showed evidence of suprascapular neuropathy. A discrepancy between EMG and MRI findings was noted in 10 patients, with 5 patients showing suprascapular neuropathy according to EMG despite normal muscle status on MRI scans, and the remaining 5 vice versa. Notable atrophy of the infraspinatus was seen in 6 patients and teres minor hypertrophy in 5 patients, all of whom exhibited concurrent infraspinatus atrophy. Postoperatively, cyst disappearance was observed in all cases in both LRCD (24 patients) and LRO (11 patients) groups. Denervation changes in the infraspinatus were resolved in all patients. In patients with infraspinatus atrophy, some improvement was noted. Teres minor hypertrophy persisted in 2 of 4 patients. Improvements were similar in both groups (all P > .05). External rotation power improved postoperatively in both groups (from 39.1 ± 18.6 to 50.6 ± 17.7 N in LRCD, P < .001; from 45.1 ± 16.0 to 54.2 ± 10.7 N in LRO, P = .025).

Both LRCD and LRO surgical approaches appear to be effective for paralabral cysts at the spinoglenoid notch. Suprascapular neuropathy can be successfully addressed by both methods. However, conditions with severe infraspinatus atrophy and teres minor hypertrophy warrant further investigation in larger series.

Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage. Treatment options focused on preventing premature osteoarthritis vary depending on multiple patient and lesion characteristics, including lesion mobility.

To differentiate lesion mobility before arthroscopy using a multivariable model that includes patient demographic characteristics and physical examination findings.

Cohort study (Diagnosis); Level of evidence, 2.

Demographic, preoperative physical examination, and radiographic data were collected from a multicenter national prospective cohort of patients with OCD of the knee. Inclusion criteria included patients <19 years of age and patients with arthroscopically confirmed mobility status based on the Research on Osteochondritis Dissecans of the Knee arthroscopy classification. Multivariable logistic regression analysis using stepwise model selection was used to determine factors associated with the likelihood of a mobile versus an immobile lesion. A 75% partition of the data was used for model training, and 25% was used as a validation cohort. Quantitative model fit statistics were computed using the holdout data, including sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC), along with the corresponding 95% CI.

A total of 407 patients in the prospective cohort met inclusion criteria, and 62% were male. The mean ± SD age was 13.7 ± 2.2 years, height 161.8 ± 5.3 cm, and weight 59.2 ± 42.2 kg. Arthroscopic evaluation yielded 235 immobile and 172 mobile lesions. Multivariable analysis determined that the best model to predict lesion mobility included chronologic age ≥14 years (P < .001), effusion on physical examination (P < .001), and any loss of range of motion on physical examination (P = .07), while controlling for male sex (P = .38) and weight >54.4 kg (P = .12). In the 25% holdout validation sample (n = 102), a sensitivity of 83%, a specificity of 82%, and an AUC of 0.89 (95% CI, 0.82-0.95) were achieved with these predictive factors.

Age, effusion, and loss of motion can predict knee OCD lesion mobility at the time of arthroscopy. Education about lesion mobility can help with surgical planning and patient and family counseling.

The microvasculature of the human meniscus has been previously described by Arnoczky and Warren. However, to date, the qualitative and quantitative extra-articular vascular anatomy of the medial meniscus has not been characterized.

To perform a qualitative and quantitative anatomic study of the extra-articular medial meniscal vasculature and to introduce the novel “medial meniscal artery” (MMA), potentially providing future guidelines for the treatment of meniscal abnormalities.

Descriptive laboratory study.

A total of 33 unpaired, frozen human cadaveric knees were dissected. The femoral artery was identified and cannulated using an angiocatheter. The arteries were perfused with a red acrylic paint solution, allowing for improved visualization. Artery dimensions and distances were measured using a digital caliper. Perfused specimens were imaged using computed tomography and segmented using 3D reconstruction software to identify vessels and repeat artery measurements digitally.

The MMA was consistently identified in all specimens. In 27 (82%) of 33 specimens, the MMA branched directly from the popliteal artery; in 5 (15%), the MMA shared a common trunk with the inferior medial genicular artery; and in 1 specimen (3%), the MMA shared a common branch with the inferior lateral genicular artery. The MMA was easily distinguishable from the superior, inferior, and middle genicular arteries, given its direct course to the medial joint line with terminal branches to the posterior horn of the medial meniscus and deep to the semimembranosus tendon. The MMA exhibited a consistently smaller vessel diameter relative to the genicular arteries.

This is the first study to identify and quantitatively describe the MMA in the human knee. The MMA can be identified consistently on gross anatomic dissection in cadaveric donors of varying demographics. Further research is needed to identify and characterize the artery in vivo and to determine the MMA’s role in meniscus preservation surgery.

The findings of this study will provide future avenues of research toward understanding medial meniscus vascularization and the genesis of potential degenerative changes when vascularization is poor. This will help to further refine diagnostic and treatment options for meniscus revascularization and compartment preservation. Additionally, this study may help define safe zones in the knee during posterior approaches and expand the base of knowledge for emerging vascular procedures such as genicular artery embolization.

One-step cell-based techniques of cartilage repair that lead to restoration of durable chondral tissue and long-term maintenance of joint function are cost-effective and ideal for routine use.

To examine the long-term clinical outcomes, after a mean follow-up duration of 14 years, of cartilage repair in the knee using a hyaluronic acid–based scaffold in association with bone marrow aspirate concentrate (HA-BMAC) and to evaluate the effect of age, lesion characteristics, and associated treatments on the outcome of this cartilage repair method.

Case series; Level of evidence, 4.

Patients were followed prospectively for a mean duration of 14.0 years after undergoing treatment of knee full-thickness articular cartilage injury using HA-BMAC. Clinical evaluation consisted of the patient-reported scoring tools of the visual analog scale and the Knee injury and Osteoarthritis Outcome Score, which were completed preoperatively and at the time of final follow-up.

A total of 26 patients with a mean age of 48.3 years (17 male, 9 female) and median chondral lesion size of 6.6 cm² (range, 1-27 cm²) were followed prospectively. There were 3 treatment failures, and 1 patient who underwent medial compartment unicompartmental arthroplasty 12 years after HA-BMAC treatment of patellar chondral injury. Of the 22 remaining patients, after a mean final follow-up duration of 14.0 years (range, 12-16 years), the median visual analog scale score of 0.6 was significantly decreased from the preoperative median score of 5.0 (P < .001). The median Knee injury and Osteoarthritis Outcome Score Pain (92), Symptoms (86), Activities of Daily Living (96), Sports (85), and Quality of Life (88) subscale values were all increased compared with the preoperative scores (P≤ .001). There was no correlation of clinical outcome score and body mass index.

One-step cartilage repair of full-thickness chondral defects in the knee using an HA-BMAC led to successful long-term clinical outcomes and maintenance of joint junction after a mean follow-up duration of 14 years. Long-term clinical success in active, nonobese patients has been uniformly demonstrated across a wide range of patient ages and lesion types, including cases of multicompartment involvement, treatment of associated conditions, and large or bipolar chondral lesions.

The utilization of lateral extra-articular tenodesis (LET) augmentation for anterior cruciate ligament reconstruction has increased. Various fixation points have been recommended based on tactile and anatomic landmarks; however, there is limited reporting of the accuracy or precision of these techniques in clinical practice.

The purpose of this study was to evaluate whether LET fixation points identified using anatomic landmarks and tactile techniques would fall within a predefined radiographic zone. It was hypothesized that the majority of LET fixation points would be inside the radiographic zone.

Cross-sectional study; Level of evidence, 4.

Postoperative lateral knee radiographs of patients who underwent anterior cruciate ligament reconstruction with LET using a landmark-based technique without fluoroscopy between January 2018 and September 2023 were reviewed. Fixation points were measured by 2 raters based on their distance from an extension of the posterior femoral cortex line (PFCL) distally and a line perpendicular to the PFCL at the posterior condylar flare (PCF). Patients were excluded if the tunnel position could not be identified or if postoperative radiographs were malrotated. The mean LET position and percentage of points within the radiographic isometric zone, defined as 4 ± 4 mm posterior and 4 ± 3 mm anterior to the PFCL and 6 ± 4 mm distal and 20 ± 5 mm proximal to the PCF were calculated.

Complete data sets were obtained for 47 cases. The mean LET position was 6.4 ± 7.1 mm (range, –9 to 27.3 mm) anterior to the PFCL and 1.8 ± 7.6 mm (range, –16.7 to 12.6 mm) proximal to the PCF. Overall, 53% of LET fixation points were within the predefined radiographic zone. Of the malpositioned tunnels (n = 22), their locations relative to the radiographic zone were anterior (n = 18), posterior (n = 2), proximal (n = 1), and anterior and distal (n = 1).

This study found large variation in the location of LET fixation points, and almost half of fixation points were outside the predefined radiographic zone. Accurate and precise tunnel placement is one of multiple factors that may be important to minimize the risk of lateral compartment overconstraint, anterior cruciate ligament graft failure, and anisometry leading to LET graft loosening.

If an increased posterior tibial slope (PTS) and concomitant unicompartmental osteoarthritis are present, a simultaneous sagittal (slope) and coronal correcting high tibial osteotomy has been recommended. However, no study has investigated the accuracy of such combined high tibial slope correction osteotomies.

(1) To report the accuracy of navigated high tibial slope correction osteotomies using patient-specific instruments (PSI) and (2) to analyze the influence of an open wedge osteotomy (OWO) versus a closed wedge osteotomy (CWO) and the hinge axis angle (HAA) on the accuracy of the PTS correction.

Cohort study; Level of evidence, 3.

All PSI PTS-reducing osteotomies performed at 1 institution between 2019 and 2022 were reviewed. Three-dimensional (3D) accuracy was defined as the mean absolute 3D angular difference between the planned and achieved surgical correction (in degrees) in 3D models of computed tomography data. The influence of OWO versus CWO and the HAA on the reported accuracy was analyzed and a cutoff defined using receiver operating characteristic curve analysis.

Eighteen patients who underwent a slope-reducing CWO (n = 9) or OWO (n = 9) were included. The 3D accuracy for PTS was 2.3°± 1.1° (mean ± SD), with CWO being more accurate than OWO (1.4°± 0.9° vs 3.1°± 0.6°; P < .01). Accuracy strongly correlated with the HAA (r = 0.788; P < .01). An HAA >38.9° predicted a PTS error >2° (odds ratio, 1.12 [95% CI, 1.04-1.20; P = .004]; area under the curve, 0.95 [95% CI, 0.89-1.00; P < .001]) corresponding to a coronal/sagittal correction of 0.8:1.

Slope-reducing osteotomy can accurately be achieved using PSI. CWO demonstrated an increased accuracy when compared with OWO, which strongly depended on the HAA. With an aim of combined PTS and coronal correction, CWO should be considered the primary choice for accurate slope reduction with a coronal/sagittal correction cutoff of 0.8:1 (HAA, 38.9°).

There is concern that physiologic knee hyperextension may be associated with inferior outcomes after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts.

To assess whether there is an association between contralateral passive preoperative knee hyperextension (≤−5°) and postoperative anterior knee laxity, subjective knee function, or revision surgery after ACLR using HT autografts.

Cohort study; Level of evidence, 3.

Patients without concomitant ligament injuries who underwent primary ACLR using an HT autograft at Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, were identified. The cohort was dichotomized into the hyperextension group (≤−5°) and the no hyperextension group (>–5°) depending on preoperative contralateral passive knee extension degree. Anterior knee laxity (KT-1000 arthrometer; 134 N) was assessed preoperatively and at 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent revision ACLR at any institution in Sweden within 5 years of the primary surgery were identified in the Swedish National Knee Ligament Registry.

A total of 6104 patients (53.5% male) for whom knee range of motion measurements were available were identified (hyperextension group [≤−5°]: 2350 [38.5%]; mean extension, −6.1°± 2.3° [range, −20° to −5°]; no hyperextension group [>−5°]: 3754 [61.5%]; mean extension, 0°± 1.4° [range, −4° to 15°]). There were no intergroup differences in anterior knee laxity preoperatively (hyperextension group, 3.6 ± 2.8 mm; no hyperextension group, 3.7 ± 2.7 mm; P = .24) or postoperatively (hyperextension group, 1.8 ± 2.3 mm; no hyperextension group, 1.8 ± 2.2 mm; P = .41). The only significant but nonclinically relevant intergroup differences were seen in the KOOS Symptoms subscale at the 1-year follow-up (hyperextension group, 81.4 ± 16.0; no hyperextension group, 80.3 ± 16.5; P = .03) and in the Sport and Recreation subscale at the 5-year follow-up (hyperextension group, 73.0 ± 25.6; no hyperextension group, 75.7 ± 24.3; P = .02). No other significant intergroup differences were noted preoperatively or at 1, 2, or 5 years postoperatively in any of the KOOS subscales. The overall revision ACLR rate at ≤5 years after the primary surgery was 4.9% (302 of 6104 patients). The hazard for revision ACLR in the no hyperextension group (4.5%; 170 of 3754 patients) was not significantly different from that in the hyperextension group (5.6%; 132 of 2350 patients) (hazard ratio, 0.89; 95% CI, 0.71 to −1.12; P = .34). A subsequent subanalysis showed that the hazard of revision ACLR in patients with no hyperextension was not significantly different from that of patients with ≤−10° of extension (5.8%; 27 of 467 patients) (hazard ratio, 0.91; 95% CI, 0.61 to 1.36; P = .65).

Preoperative passive contralateral knee hyperextension (≤−5°) was not associated with postoperative anterior knee laxity, subjective knee function, or revision surgery ≤5 years after ACLR using HT autografts. Therefore, the presence of knee hyperextension alone should not be considered a contraindication per se for the use of HT autografts in ACLR.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR.

To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR.

Cohort study; Level of evidence, 3.

Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.²³

A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14).

Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.

Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively.

The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position.

Cohort study (Diagnosis); Level of evidence, 2.

This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated.

This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion (P = .003 and P < .001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P < .001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases (P < .05); however, no significant differences were observed in the chronic cases.

The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position.

The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique.

(1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force.

Controlled laboratory study.

Eight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance (P < .05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state.

Peak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact (P < .001), moderate-tension CLR (P = .016), and high-tension CLR (P = .002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration (P < .05).

CLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces.

These findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration.

Previous studies have revealed that early postoperative rehabilitation of chronic lateral ankle instability is just as crucial as surgical intervention. Immediate weightbearing has yielded good clinical results; however, randomized controlled studies have been limited.

To compare the clinical outcomes of patients with immediate weightbearing after lateral ankle ligament repair with those with delayed weightbearing after 2 weeks in a prospective randomized controlled study.

Randomized controlled clinical trial; Level of evidence, 1.

Patients who underwent arthroscopic anterior talofibular ligament repair between August 2021 and December 2022 were randomized into 2 groups—immediate weightbearing with a hard ankle brace and nonweightbearing casting for 2 weeks followed by cast removal and weightbearing. Primary outcomes were the ankle function scores as assessed using the visual analog scale at rest and during activities, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Karlsson Ankle Functional Score (Karlsson score). Secondary outcomes were the time to return to unsupported walking, jogging, work, and exercise and change in the ankle range of motion (ROM) at 3-, 6-, and 12-month follow-ups.

A total of 88 participants were included, consisting of 58 men and 30 women, with a mean age of 30.26 years. Computerized randomization resulted in 44 patients per group. These 2 groups displayed no difference in the AOFAS score, Karlsson score, and ankle ROM at all follow-ups. Patients who underwent immediate weightbearing had a significantly shorter time of returning to unsupported walking (P < .001). No differences were observed in the time of returning to work, jogging, and sports exercise.

For patients with chronic ankle instability after arthroscopic anterior talofibular ligament repair, immediate weightbearing allowed patients to return to unsupported walking more quickly and had no negative effects on the AOFAS score, Karlsson score, times of returning to normal life, jogging, sports exercise, and ankle ROM at 3-, 6-, and 12-month follow-ups compared with cast fixation.

ChiCTR2100049612 (Chinese Clinical Trial Registry; https://www.chictr.org.cn/).

Microfracture is one surgical treatment strategy for osteochondral lesions of the talus (OLTs) but results in fibrocartilage repair tissue, which has inferior mechanical properties to native hyaline cartilage. Biological regulation of microfracture has been suggested to improve the quality of cartilage repair in patients.

To determine if administration of losartan, fisetin, or losartan and fisetin combined can enhance microfracture-mediated cartilage repair of OLTs in a rabbit model.

Controlled laboratory study.

Four-month-old female rabbits were divided into the following groups (8 rabbits per group): microfracture only (microfracture), microfracture plus losartan (losartan), microfracture plus fisetin (fisetin), and microfracture plus losartan and fisetin (losartan+fisetin). A 2.7-mm osteochondral defect and 4 microfracture holes were created in the talar dome cartilage. The rabbits were administered losartan (10 mg/kg/day), fisetin (20 mg/kg/day), or losartan and fisetin orally until euthanized 12 weeks after surgery. Gross evaluation, micro–computed tomography, histology, and immunohistochemistry evaluations of the osteochondral defects were performed as well as quantitative polymerase chain reaction of capsule tissue and enzyme-linked immunosorbent assay of serum.

The losartan and fisetin groups had increased International Cartilage Regeneration & Joint Preservation Society macroscopic scores with improved cartilage repair and enhanced subchondral bone healing compared with the microfracture group. However, the losartan+fisetin group did not show a synergistic effect. O’Driscoll histology scores were higher in the losartan and fisetin groups compared with the microfracture group, while the losartan+fisetin group had a lower score than the losartan, fisetin, and microfracture groups. Collagen type 2 staining revealed organized chondrocytes in the losartan and fisetin groups, but the losartan+fisetin group did not show improvement when compared with other groups. Fisetin treatment decreased catalase and transforming growth factor-β1–activated kinase 1 expression in capsular tissue.

Concomitant microfracture and biological regulation, using oral administration of either losartan or fisetin, may improve cartilage healing of OLTs; however, losartan and fisetin combined in the current drug administration regimen does not appear to provide synergistic effects.

Oral intake of losartan or fisetin may result in beneficial effects on microfracture-mediated cartilage repair of OLTs.

Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation.

To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t.

Systematic review. Level of evidence, 3.

A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared.

The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size.

BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation.

Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in sports medicine, and undesirable outcomes still may range from 3-18%. One technique that has been explored to improve outcomes is preservation of the ACL remnant tibial stump, as opposed to stump debridement, at the time of reconstruction.

To review current high-level evidence and compare remnant-preserving anterior cruciate ligament reconstruction (ACLR) versus standard ACLR in terms of clinical outcomes and measures of knee stability.

ACLR with remnant preservation would result in improved clinical outcomes and knee stability measures.

Systematic review; Level of evidence, 2.

A systematic review of randomized controlled trials (RCTs) and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of 2 was performed. Extracted data were summarized as general information, surgical characteristics, postoperative clinical outcomes, knee stability, graft evaluation, tunnel assessment, and postoperative complications. When feasible, a meta-analysis was performed.

Seven RCTs and 5 cohort studies met the inclusion criteria. In total, 518 patients underwent remnant-preserving ACLR and 604 patients underwent standard ACLR. Ten studies performed the reconstruction with hamstring tendon (HT) autografts, 1 study with HT and bone–patellar tendon–bone autografts, and 1 study with HT and tibialis anterior allografts. On meta-analysis, remnant-preserving ACLR provided comparable outcomes with respect to International Knee Documentation Committee grades or Tegner scores. Even though there was a significant improvement in Lysholm scores (mean difference, −1.9; 95% CI, −2.89 to −0.91; P = .0002) with the remnant-preserving technique, this did not exceed previously reported minimal clinically important difference values. Remnant-preserving ACLR demonstrated superior knee stability in terms of patients achieving negative pivot shift when compared with the control group (88.89% vs 79.92%; P = .006). Although there was a significant improvement in the side-to-side difference in anterior tibial translation favoring remnant preservation (P = .004), the mean difference was 0.51 mm.

Remnant-preserving ACLR, primarily with HT autografts, results in comparable clinical outcome scores and significantly improved knee stability relative to standard ACLR without remnant preservation without increasing the complication rate. Further studies will help clarify if remnant-preserving ACLR also has benefits in terms of enhancing graft integration and maturation, improving proprioception, limiting tunnel enlargement, and reducing complications.

Cutibacterium acnes (C acnes) is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common pathogenic organism in prosthetic joint infections after shoulder arthroplasty. Because of its low virulence, its diagnosis remains difficult.

To evaluate the relative effects of topical preparations in reducing C acnes in shoulder surgery.

Meta-analysis; Level of evidence, 1.

We searched the MEDLINE, Embase, PsychINFO, and Cochrane Library databases in March 2022. Randomized controlled trials (RCTs) comparing any form of topical preparation in arthroscopic or open shoulder surgery were included. The primary outcome was a reduction in the number of positive C acnes cultures. Secondary outcomes were adverse events related to the application of topical preparations. We performed a network meta-analysis to facilitate simultaneous comparisons between multiple preparations across studies. We calculated differences between preparations using odds ratios and their 95% CIs. The risk of bias was assessed using the Cochrane risk-of-bias tool.

The search yielded 17 RCTs (1350 patients), of which 9 were suitable for the network meta-analysis (775 patients). Overall, 2 RCTs were deemed as having a low risk of bias, and 15 raised “some concerns” of bias. Preparations included benzoyl peroxide (BPO), BPO combined with clindamycin, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, and water with soap. Only BPO resulted in significantly lower odds of a positive C acnes culture compared with placebo or soap and water (odds ratio, 0.12 [95% CI, 0.04-0.36]). There was no statistically significant difference with all other topical preparations. The only adverse events were skin irritation from BPO and chlorhexidine gluconate in a small number of reported cases.

BPO was the most effective topical agent in reducing the prevalence of C acnes in shoulder surgery. These results were limited by a combination of indirect and direct data. Future studies should focus on establishing the optimal frequency and duration of preoperative BPO to further reduce the burden of C acnes.

CRD42022310312 (PROSPERO).

Several randomized controlled trials (RCTs) have been conducted to assess the use of tranexamic acid (TXA) in the setting of arthroscopic rotator cuff repair (ARCR). However, these studies have shown mixed results, with some showing improved intraoperative visualization, subsequent operative times, and pain levels, and others finding no difference.

To perform a systematic review of the RCTs in the literature to evaluate the use of TXA on ARCR.

Meta-analysis; Level of evidence, 1.

Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing TXA with a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures, and shoulder swelling were evaluated. A P value < .05 was deemed statistically significant.

Six RCTs with 450 patients were included in this review. Overall, 5 studies evaluated intraoperative visualization, with 3 studies finding a significant difference in favor of TXA. With TXA, patients had a lower mean postoperative visual analog scale (VAS) score of 3.3, and with the control, patients had a mean VAS score of 4.1, which was statistically significant (P = .001). With TXA, the mean weighted operation time was 79.3 minutes, and with the control, the mean operation time was 88.8 minutes, which was statistically significant (P = .001). No study found any difference in intraoperative pump pressures or swelling.

TXA improved visualization, operative time, and subsequent postoperative pain levels in patients undergoing ARCR.