The American Journal of Sports Medicine

Recent literature has shown that inferior Hill-Sachs extension for on-track shoulders is predictive of recurrent instability after arthroscopic Bankart repair alone. Specifically, there is a high risk for recurrent instability when the lesion extends below the humeral equator on sagittal magnetic resonance imaging. This worrisome inferior extension has been termed “critical humeral bone loss (CHBL).” Remplissage has yet to be explored as a potential useful augmentation in patients with CHBL.

The addition of remplissage would decrease recurrence rates for Hill-Sachs lesions with inferior extension or CHBL compared with arthroscopic Bankart repair alone in patients with on-track Hill-Sachs lesions.

Case series; Level of evidence, 4

Retrospective analysis was performed on the records of patients who underwent primary arthroscopic Bankart repair with or without the addition of remplissage from 2007 to 2021. Off-track shoulders, revision stabilization, glenoid bone loss (GBL) >20%, and those with follow-up <2 years or incomplete medical data were excluded. The primary outcome was recurrent instability, defined as either postoperative dislocation or subluxation. The Hill-Sachs position was measured relative to the humeral axis on sagittal magnetic resonance imaging as previously described. Univariate and multivariate logistic regression analyses were implemented to determine the protective effect of remplissage.

A total of 219 patients were included for analysis with a mean age of 21.1 years (range, 12.9-40.5 years) and mean follow-up of 7.0 years (range, 2-14.4 years); 44 patients (20%) underwent remplissage in addition to arthroscopic Bankart. In multivariate analysis, remplissage significantly reduced the risk of recurrent instability (OR, 0.06; P = .002) and CHBL was a significant predictor of recurrent instability (OR, 3.0; P = .029) while adjusting for age, multiple preoperative dislocations, contact athlete status, and percent GBL. When stratified by CHBL, remplissage remained protective (OR, 0.013; P = .007) against recurrent instability.

The addition of a remplissage for CHBL in patients with subcritical GBL and on-track Hill-Sachs lesions reduces the risk of recurrent instability in patients undergoing arthroscopic Bankart repair.

Mesenchymal stromal cell (MSC) techniques represent a promising method to enhance the surgical repair of rotator cuff tears. To eliminate the resource-intensive process of cell isolation and culture expansion, a method to recruit endogenous MSCs was investigated in an established rat model of rotator cuff repair.

MSCs can be pharmacologically mobilized from the peripheral blood and recruited to the operative rotator cuff to enhance tendon-bone healing.

Controlled laboratory study.

The rat model of supraspinatus tendon detachment and acute surgical repair was used to compare the ability of 3 different chemokines (SDF-1β, MIP-3α, and MCP-1) to recruit optically labeled MSCs to the operative shoulder from circulation. Additional experimentation was undertaken to assess the effects of pharmacological MSC mobilization using a combination of a β₃ adrenoreceptor agonist (BRL37344) and a CXCR4 antagonist (AMD3100) on chemokine-directed recruitment to the shoulder. Finally, the effects of this therapeutic strategy on tendon-bone healing were assessed.

MCP-1–loaded hydrogels recruited the greatest number of MSCs from circulation. MCP-1–driven MSC recruitment was significantly enhanced by a regimen of subcutaneous BRL37344 and AMD3100. Postmortem micro–computed tomography imaging performed at a 6-week endpoint revealed that local MCP-1 delivery was associated with significant reductions in trabecular spacing and apparent mineral density, and a significant increase in trabecular number, while pharmacological MSC mobilization had no significant effects. MCP-1 delivery was associated with a lower tendon cross-sectional area and a significant increase in percent relaxation (P = .006). Pharmacological MSC mobilization was associated with significantly increased peak stress (P = .039), significantly increased elastic modulus (P = .037), and a nonsignificant increase in both equilibrium stress (P = .057) and ultimate stress (P = .058). Local MCP-1 delivery was associated with significant improvements in tenocyte morphology.

Endogenous MSCs can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1. This therapeutic strategy was associated with improvements in the static and dynamic mechanical properties of the tendon-bone interface.

The healing of rotator cuff repairs represents an ongoing clinical challenge in orthopaedic surgery. This study demonstrates a method to use endogenous MSCs to enhance healing of the rotator cuff.

Whether the use of platelet-rich plasma (PRP) as an adjuvant to extensor carpi radialis brevis (ECRB) repair in recalcitrant lateral epicondylitis (RLE) promotes tendon healing and improves clinical outcomes remains unclear.

To evaluate the tendon healing and clinical outcomes of arthroscopic ECRB repair combined with PRP injection and compared with arthroscopic ECRB repair alone at early-term follow-up in patients with RLE.

Randomized controlled trial; Level of evidence, 1.

A consecutive series of 80 patients with RLE were enrolled and randomized to the PRP group (arthroscopic ECRB repair followed by 1 PRP injection; n = 40) and the control group (arthroscopic ECRB repair alone; n = 40). Magnetic resonance imaging was performed to assess tendon healing at 3, 6, and 12 months. The visual analog scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, range of motion, and muscle strength were evaluated at preoperative and follow-up points. The time to return to work was also compared between the 2 groups. Patients and assessors were blinded to the intervention.

A total of 80 patients who met the inclusion criteria were enrolled between July 2020 and July 2023, and 73 patients completed follow-up. The PRP group contained 35 patients, 11 men and 24 women, with a mean age of 47.8 ± 8.8 years. The control group contained 38 patients, 13 men and 25 women, with a mean age of 44.5 ± 5.8 years. No significant differences were found in magnetic resonance imaging classification and functional scores between groups at preoperative and follow-up periods. VAS, MEPS, DASH, and PRTEE scores and muscle strength showed significant improvement at 12 months in both groups (P < .001). However, the PRP group showed a significant improvement in grip and wrist extension muscle strength at 6 weeks postoperatively (P = .008 and P < .001, respectively), whereas the control group did not (P = .583 and .056). No complications were associated with PRP injection.

PRP used as an adjuvant to ECRB repair did not show a difference in tendon healing and functional outcomes compared with ECRB repair alone for RLE at 12-month follow-up. However, PRP treatment showed a difference in muscle strength at 6-week follow-up compared with ECRB repair alone.

NCT04556825 (ClinicalTrials.gov).

Major League Baseball (MLB) recently instituted a combine for their prospective players.

The purpose of this study was to report initial epidemiological findings for both physical examination and imaging findings for the MLB Combine. It was hypothesized that most players would have no significant abnormal physical examination findings, but most would have abnormal findings on their shoulder and elbow magnetic resonance imaging (MRI) scans.

Descriptive epidemiology study.

All players who attended the 2023 MLB Combine were included. History was taken and physical examination was performed by an MLB team physician, and MRI of the shoulder, elbow, cervical spine, and lumbar spine was performed on all players and read by 1 of 2 musculoskeletal radiologists. Physical examination notes and imaging reports were reviewed by the authors and recorded. Data were analyzed separately for pitchers and position players.

Overall, 219 players (112 pitchers [51%], 107 position players [49%]) were included. The mean age was 20.4 ± 1.5 years. The majority of players (95%) had no current pain or limitations; 54 players (25%) had a history of previous surgery. For pitchers, 18% underwent previous elbow surgery. With regard to MRI, >80% of pitchers had some abnormality within their ulnar collateral ligament (UCL), the majority of which was UCL scarring/remodeling. 70% of pitchers and 60% of position players had evidence of an olecranon osteophyte. Increased signal within the ulnar nerve was common in pitchers (40%) but rare in position players (4%). For the shoulder, 95% of pitchers and 93% of position players had some rotator cuff abnormality (often tendinosis within the supraspinatus and infraspinatus muscles). Also, 75% of pitchers had MRI evidence of a superior labrum anterior to posterior (SLAP) tear, while 24% of position players demonstrated this. Lumbar spine MRI showed that 47% of position players had a disk protrusion and 46% had a previous pars fracture.

Most baseball players who participated in the 2023 MLB Combine had MRI evidence of rotator cuff abnormalities, and many showed evidence of an olecranon osteophyte. Eighteen percent of pitchers had a previous history of elbow surgery. The majority of pitchers had some abnormality within their UCL and evidence of a SLAP tear on MRI scans.

Osteochondral allograft transplant and autograft transplant for femoral head defects have emerged as promising treatments for concomitant cartilage and subchondral bone injuries in young patients.

To evaluate the clinical and radiological outcomes of patients who underwent osteochondral allograft or autograft transplant for femoral head defects and identify any risk factors that may lead to conversion to total hip arthroplasty (THA).

Case series; Level of evidence, 4.

All patients who underwent osteochondral allograft or autograft transplant for femoral head defects across 2 institutions were analyzed. Clinical outcomes were assessed at final follow-up with the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-12). Complications and reoperations were recorded. Patients were assessed radiographically preoperatively and at final follow-up for osteoarthritis using Tönnis grading.

A total of 27 patients were included in this study (19 osteochondral allograft transplant, 8 osteochondral autograft transplant). The mean follow-up for the allograft and autograft cohorts was 2.8 and 9.5 years, respectively. The mean defect size for patients who underwent allograft and autograft transplant was 2.8 × 2.1 cm and 1.6 × 1.0 cm, respectively. The mean mHHS, HOS-ADL, HOS-SSS, and iHOT-12 for the allograft cohort were 86.7, 92.8, 81.4, and 79.0, respectively, and for the autograft cohort were 87.6, 92.7, 83.1, and 82.0, respectively. No significant difference in outcomes was noted for patients who underwent femoral head allograft versus nonorthotopic femoral condyle allograft transplant. For the allograft cohort, 4 patients (21.1%) underwent conversion to THA at a mean of 1.9 years. Of the remaining 15 allograft patients, only 1 patient (6.7%) had radiographic osteoarthritis progression. None of the patients in the autograft cohort underwent conversion to THA.

Osteochondral allograft and autograft transplant for femoral head defects demonstrated overall favorable clinical outcomes and rates of conversion to THA. Additionally, nonorthotopic femoral condyle allografts demonstrated similar outcomes to femoral head allografts. Both osteochondral allograft and autograft transplant should be considered for patients with focal femoral head defects.

While both short- and long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been reported, the predictive relationship between the two has yet to be established.

To determine whether the degree of improvement in patient-reported outcomes observed at 1 year postoperatively predicts long-term outcomes at 10 years after primary hip arthroscopy for FAIS.

Cohort study; Level of evidence, 3

Patients who underwent primary hip arthroscopy for FAIS by a single surgeon at a single institution with 10-year follow-up were identified. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at baseline and 1, 2, 5, and 10 years postoperatively. Patients were classified as either high improvement (HI) or low improvement (LI) based on if they achieved the median 1-year change in mHHS from baseline. Chart review was performed to collect surgical details such as operative procedures, complications, and revision surgery. Outcomes were compared between groups over time using repeated-measures analysis of variance. Failure rates were determined using Kaplan-Meier and Mantel-Cox log-rank analyses.

A total of 129 patients with a mean age of 41.0 ± 13.5 years and mean body mass index of 25.0 ± 4.3 kg/m² were included. Both the HI and LI groups demonstrated significant improvement in mHHS and NAHS from baseline at all follow-up time points (P < .001). The HI group had significantly higher outcome scores at all time points up to 10 years after arthroscopy compared with the LI group (P = .018). Additionally, a greater proportion of patients in the HI group achieved the Patient Acceptable Symptom State and minimal clinically important difference compared with the LI group at the 10-year follow-up (P = .018). Rates of overall complications, revision arthroscopy, and conversion to total hip arthroscopy were significantly higher in the LI group (P = .013, P = .009, and P = .004, respectively). The mean hip survival time after the index operation was shorter for the LI group (11.9 ± 0.5 years) than for the HI group (13.2 ± 0.2 years) (P = .002).

Patients who experienced greater improvement in the first year after hip arthroscopy had superior 10-year outcome scores, fewer complications, and lower rates of reoperation compared with those who experienced minimal improvement in the same period.

Central acetabular stenosis (CAS), defined as an osteophyte within the acetabular fossa, is associated with higher rates of femoral head chondral damage and, when left untreated, inferior short-term outcomes after hip arthroscopic surgery. Central acetabular decompression (CAD) is an arthroscopic technique to resect the osteophyte and resurface the acetabular fossa to improve contact mechanics of the femoral head.

The primary aim was to provide the 5-year hip preservation rate and patient-reported outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) concomitantly with CAD for CAS. A secondary aim was to compare outcomes in patients treated with CAD for CAS to a propensity score–matched control group of patients without CAS.

Cohort study; Level of evidence, 3.

A surgical registry with prospectively collected data was reviewed for patients who underwent CAD for CAS identified during primary hip arthroscopic surgery for FAI. The primary outcome for the study was conversion to arthroplasty within 5 years postoperatively. Secondary outcomes included revision arthroscopic surgery and patient-reported outcome scores. Multivariate regression analysis was performed to evaluate the risk factors for progression to arthroplasty. A propensity score–matched control group based on preoperative age, sex, body mass index, and Tönnis grade was formed of patients undergoing hip arthroscopic surgery for FAI without CAS to evaluate the differences in outcomes between the 2 groups.

There were 155 of 189 eligible patients (82.0%) who had a minimum 5-year follow-up. Within this cohort, the mean age was 45.9 ± 10.8 years, with 90 female patients (58.1%). At the 5-year time point, the arthroplasty-free survivorship rate was 80.6% (125/155). For patients not requiring arthroplasty, significant postoperative improvements were durable (P < .001), with high satisfaction. On multivariate analysis, severe acetabular chondral defects were most predictive of conversion to arthroplasty. The control group of patients with FAI without CAS demonstrated lower rates of chondral damage and higher rates of arthroplasty-free survivorship (P < .01). For patients not requiring arthroplasty, postoperative outcome scores, rates of achieving clinically relevant outcome thresholds, and satisfaction with surgery were comparable between the CAD and control groups.

Patients with CAS undergoing CAD during primary hip arthroscopic surgery for FAI had durable postoperative improvements and high satisfaction with surgery at a minimum 5-year follow-up. As expected, intraoperative chondral damage rates were significantly greater, and arthroplasty-free survivorship rates were lower, in the CAD group compared with the control group. Nonetheless, 81% of patients undergoing CAD who did not require arthroplasty had significant improvements that were comparable with the control group. We conclude that, with appropriate expectations, patients with FAI and CAS may be treated successfully with advanced arthroscopic techniques.

Multiple 2-dimensional magnetic resonance imaging (MRI) studies have indicated that the size of the labrum adjusts in response to altered joint loading. In patients with hip dysplasia, it tends to increase as a compensatory mechanism for inadequate acetabular coverage.

To determine the differences in labral contribution to the joint surface among different hip deformities as well as which radiographic parameters influence labral contribution to the joint surface using a deep learning–based approach for automatic 3-dimensional (3D) segmentation of MRI.

Cross-sectional study; Level of evidence, 4.

This retrospective study was approved by the local ethics committee with waiver for informed consent. A total of 98 patients (100 hips) with symptomatic hip deformities undergoing direct hip magnetic resonance arthrography (3 T) between January 2020 and October 2021 were consecutively selected (mean age, 30 ± 9 years; 64% female). The standard imaging protocol included proton density–weighted turbo spin echo images and an axial-oblique 3D T1-weighted MP2RAGE sequence. According to acetabular morphology, hips were divided into subgroups: dysplasia (lateral center-edge [LCE] angle, <23°), normal coverage (LCE, 23°-33°), overcoverage (LCE, 33°-39°), severe overcoverage (LCE, >39°), and retroversion (retroversion index >10% and all 3 retroversion signs positive). A previously validated deep learning approach for automatic segmentation and software for calculation of the joint surface were used. The labral contribution to the joint surface was defined as follows: labrum surface area/(labrum surface area + cartilage surface area). One-way analysis of variance with Tukey correction for multiple comparison and linear regression analysis was performed.

The mean labral contribution of the joint surface of dysplastic hips was 26% ± 5% (95% CI, 24%-28%) and higher compared with all other hip deformities (P value range, .001-.036). Linear regression analysis identified LCE angle (β = −.002; P < .001) and femoral torsion (β = .001; P = .008) as independent predictors for labral contribution to the joint surface with a goodness-of-fit R² value of 0.35.

The labral contribution to the joint surface differs among hip deformities and is influenced by lateral acetabular coverage and femoral torsion. This study paves the way for a more in-depth understanding of the underlying pathomechanism and a reliable 3D analysis of the hip joint that can be indicative for surgical decision-making in patients with hip deformities.

Amid mounting pressure to reduce health care spending, strategies for identifying and eliminating unwarranted variation in costs have garnered significant attention. Previous studies have characterized intersurgeon variation in costs for common orthopaedic procedures, but such variation remains unexplored in the context of hip arthroscopic surgery.

To (1) characterize variation in the cost of hip arthroscopic surgery between surgeons using time-driven activity-based costing (TDABC) and (2) identify patient characteristics, intraoperative findings, and operative procedures underlying such intersurgeon variation in costs.

Cohort study; Level of evidence, 3.

Employing TDABC, the authors determined the intraoperative cost of 890 outpatient hip arthroscopic surgery cases performed by 5 surgeons at 4 surgery centers from 2015 to 2022. All costs were calculated in United States dollars. Costs were normalized to protect the confidentiality of internal hospital cost data. Surgeon-specific mean costs were calculated with and without adjustment for patient characteristics, surgical personnel, operative factors, and surgery center. Finally, to elucidate the sources of surgeon-driven cost variation, the authors estimated the proportion of variation attributable to different cost subcategories, including labor, implant/allograft, and other supply costs.

The intraoperative cost per patient ranged from 38.2 to 212.8 normalized cost units (mean, 100.0 ± 26.5), with a 1.6-fold variation in the mean cost between the highest and lowest cost surgeons. Operating surgeon alone explained 53.4% of the observed variation in costs. Controlling for case-specific features significantly improved the explanatory power to 91.8% (P < .001), but the adjusted variation in costs between surgeons remained essentially unchanged (decreased by <3%). Each of the 5 surgeons generated costs that deviated significantly from those predicted based on case-specific factors, with mean surgeon deviations ranging from −5.0% to 21.8% (P < .001 for all). Drivers of cost variation differed substantially between surgeons but generally stemmed from labor or other supply costs rather than implant/allograft costs.

The cost of outpatient hip arthroscopic surgery varied widely between surgeons; the cause of this deviation was multifactorial and surgeon specific. While within-surgeon cost variation was effectively explained by patient and operative characteristics, most between-surgeon variability remained unexplained by observable factors. These insights may support individual surgeons in cost reduction efforts and, more importantly, may enable the alignment of reimbursement rates with costs.

The outcomes of surgical repair for traumatic avulsions of the pyramidalis, anterior pubic ligament, adductor longus complex (PLAC) remain unknown.

To report how surgical repair for PLAC injuries in professional athletes affected return to preinjury level of sporting activity, injury recurrence, patient satisfaction, functional performance, and complications.

Case series; Level of evidence, 4.

This retrospective, single-surgeon study included 62 professional athletes. Inclusion criteria for study participation were professional athletes, primary injury within 28 days of surgical intervention, magnetic resonance imaging scan confirming complete avulsion of the proximal adductor longus tendon fibrocartilaginous entheses, patient symptomatic with groin pain and adductor weakness, and surgical intervention undertaken by the senior author. Exclusion criteria were chronic and recurrent adductor injuries; concomitant chronic conditions including osteoarthritis, inguinal hernia, and chronic groin pain; and patient living abroad or not available for follow-up. All study participants underwent surgical repair with suture anchor fixation. A standard rehabilitation protocol was followed postoperatively. The Lower Extremity Functional Scale (LEFS), Marx Activity Rating Scale (MARS), patient satisfaction levels, and time to return to previous level of sport were the primary outcome measures used in this study.

The mean follow-up time was 4.2 years (range, 2.1-8.1 years) from the date of surgery. The study included 62 professional athletes (52 male, 10 female) with a mean age of 27.2 years (range, 18-36 years) with acute traumatic avulsions of the proximal adductor longus tendon involving the PLAC: type I, 28 patients (45.2%); type II, 24 patients (38.7%); type III, 2 patients (3.3%); type IV, 2 patients (3.3%); type V, 6 patients (9.7%); and type VI, 0 patients (0%). All 62 patients (100%) returned to their preinjury level of sporting activity. The specific level of each sport at which the individuals were performing was not recorded; however, all participants were professional athletes who returned to professional play. The mean time from surgical intervention to return to full sporting activity was 12.3 ± 2.2 weeks (range, 9-18 weeks) with no injury recurrence at 2 years after surgery. Overall, 46 patients (74.2%) were highly satisfied and 16 patients (25.8%) were satisfied with the outcomes of their surgery. Improvements were observed in the mean LEFS (from 49.7 ± 5.2 points preoperatively to 80.2 ± 4.2 points at 2-year follow-up; P < .001). In addition, 48 patients (77.4%) had a LEFS of 75 points, and 12 patients (19.4%) achieved the maximum LEFS score of 80 points at 2-year follow-up. Improvements were also seen in MARS scores (from 3.1 ± 1.2 points preoperatively to 12.8 ± 1.8 points at 2-year follow-up; P < .001). In total, 46 patients (74.2%) achieved a MARS score of 12 points, and 14 patients (22.6%) achieved the maximum MARS score of 16 points at 2-year follow-up. Four patients had postoperative wound complications, and 1 patient had postoperative neuroma-related pain.

Surgical repair of acute traumatic avulsions of the adductor longus fibrocartilaginous entheses involving the PLAC was associated with early return to preoperative level of sporting function in professional athletes, with no risk of injury recurrence, high levels of patient satisfaction, improvements in functional outcomes, and low risk of postoperative complications at short-term follow-up.

Operative repair of partial proximal hamstring avulsions has been shown to improve pain and function at short- and midterm follow-up. Long-term outcomes have not yet been reported. Furthermore, it is unknown whether greater tendon involvement (ie, tendon number) in partial tears affects clinical outcomes.

Hamstring function and patient satisfaction would remain stable over time at minimum 5-year and mean 10-year follow-up, with no differences in outcomes when comparing isolated and combined tendon involvement.

Case series; Level of evidence, 4.

Patients who underwent surgical repair of partial proximal hamstring avulsions refractory to nonoperative measures were included. Patient-reported outcome measures were completed and included the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS, custom Marx, and total proximal hamstring score. Patient satisfaction, return to play, current sport participation, subjective strength, and postoperative complications were also recorded. Long-term outcomes were compared with midterm outcomes. Outcomes of isolated (semimembranosus or conjoint tendon) versus combined (semimembranosus and conjoint tendon) tendon injuries were also compared.

A total of 53 patients (57 hamstrings) met the inclusion criteria at a mean follow-up of 10.1 years (range, 5.1-16.2 years). The mean Marx score was 8.0 (range, 0-16), the custom Marx score was 95% (range, 15%-100%), the LEFS and custom LEFS were 90% (range, 22%-100%) and 83% (range, 19%-100%), respectively, and total proximal hamstring score was 89% (range, 19%-100%). In total, 91% of patients were satisfied with surgery and 95% of patients returned to sport at a mean of 11 months after surgery. Current participation in sport was endorsed by 86% of patients. Hamstring strength >75% compared with the contralateral leg was reported in 88% of patients, with 58% of patients reporting equal strength (100%). No differences were found in comparing long-term (mean 10.7 years) to midterm (mean 6.2 years) follow-up with the exception of decreases in the Marx score from 12.0 to 8.5 and custom Marx score from 100% to 95%. One case (1.7%) required revision due to acute reinjury at 4 months postoperatively, with other complications including sitting pain, occasional posterior thigh cramping, and posterior thigh or foot paresthesia.

Surgical repair of partial proximal hamstring avulsions refractory to nonoperative measures led to successful outcomes and high rates of return to activities with low complications at mean 10.1-year follow-up, with no differences in outcomes comparing isolated versus combined tendon involvement.

Emerging evidence suggests that anterior cruciate ligament (ACL) ruptures can restore ACL fiber continuity. The relationship between ACL continuity on magnetic resonance imaging (MRI) (sign of ACL healing) and outcomes >5 years after an acute ACL rupture has not been investigated.

This study aimed to (1) describe clinical outcomes and radiographic osteoarthritis (ROA) at 11 years based on ACL continuity status at 5 years and (2) investigate the relationship between 5-year ACL continuity status and 11-year Knee Injury and Osteoarthritis Outcome Score (KOOS₄) scores.

Secondary analysis of KANON randomized controlled trial; Level of evidence, 3.

Overall, 105 of 121 (87%) active adults with acute ACL ruptures randomized to undergo initial exercise therapy and optional delayed ACL reconstruction (ACLR) or early ACLR and postoperative exercise therapy completed 11-year follow-up. MRI scans at 5 years were evaluated using the Anterior Cruciate Ligament OsteoArthritis Score (0-3), with grades 0 to 2 considered to represent “ACL continuity.” Patient-reported outcomes (KOOS₄, 36-Item Short Form Health Survey, Tegner Activity Scale, self-reported new knee injuries), knee laxity, and radiographic findings (tibiofemoral and/or patellofemoral ROA) were assessed at 11 years. The relationship between 5-year ACL continuity and 11-year KOOS₄ scores (0-100) was examined using linear regression, adjusted for age, sex, smoking, and baseline KOOS₄ scores.

Of patients managed nonsurgically, 58% (n = 14) had ACL continuity and 42% (n = 10) had ACL discontinuity at 5 years. Analyses suggest that ACL continuity was associated with worse 11-year KOOS₄ scores compared with delayed ACLR (adjusted mean difference, –20.2 [95% CI, –31.9 to −8.6]) and early ACLR (adjusted mean difference, –15.5 [95% CI, –26.4 to −4.7]) as well as similar or worse KOOS₄ scores compared with ACL discontinuity (adjusted mean difference, –11.4 [95% CI, –26.5 to 3.6]). The proportion of patients with tibiofemoral ROA ranged from 14% (ACL continuity) to 23% (delayed ACLR), and the proportion of patients with patellofemoral ROA ranged from 11% (ACL discontinuity) to 41% (early ACLR).

ACL continuity on 5-year MRI may be associated with worse patient-reported outcomes at 11 years after an ACL injury compared with early or delayed ACLR.

84752559 (ISRCTN)

Primary anterior cruciate ligament (ACL) repair (ACLPR) demonstrates promising short-term clinical outcomes in select patients; however, it remains poorly understood as to whether previously reported short-term outcomes are maintained at midterm follow-up.

To determine whether short-term (2-year) outcomes are maintained at 5 years after ACLPR, evaluate age-stratified failure and reoperation rates, and identify preoperative risk factors for failure.

Case series; Level of evidence, 4.

This prospective study included the first 113 consecutive patients with proximal (type I/II) ACL tears who underwent ACLPR between 2008 and 2017 with a minimum 5-year follow-up. Failure rates were recorded based on instrumented laxity (>3-mm anterior tibial translation side-to-side difference), pivot-shift grade (grade ≥2), and subjective instability. Patient Acceptable Symptom State thresholds were established based on collected patient-reported outcome measure scores. Logistic regression models were constructed to determine associations with independent risk factors for failure.

A total of 107 patients (median age, 35.5 years [interquartile range, 22.4-43.1 years]) were available at final follow-up (median, 6.0 years [interquartile range, 5.3-7.0 years]). No significant differences were reported in failure rates between 2- and 5-year follow-up: overall non–age-differentiated: 11.5% versus 15.9%, respectively (P = .34); ≤21 years: 37.0% versus 38.5%, respectively (P = .92); and >21 years: 3.5% versus 8.6%, respectively (P = .16). No failures occurred in patients aged ≤21 years, while 4 failures occurred in patients aged >21 years. Additionally, no significant differences were observed in overall non–age-differentiated reoperation rates (6.2% vs 7.5%, respectively; P = .71) and contralateral ACL injury rates (3.5% vs 4.7%, respectively; P = .67). Clinical outcomes and patient-reported outcome measure scores did not significantly differ between time points, and most patients met Patient Acceptable Symptom State thresholds (88% for International Knee Documentation Committee form, 91% for Lysholm scale, 93% for Forgotten Joint Score–12, and 84% for ACL–Return to Sport after Injury scale; all P < .001). Preoperative risk factor analysis only revealed younger age as negatively impacting ipsilateral ACL failure, as the odds decreased by 12.5% for each year of increasing age (P = .002).

Sustained clinical and functional outcomes for ACLPR were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively. Although younger age was an important risk factor for ipsilateral ACL failure, with a high failure rate of 37.0% in patients aged ≤21 years at short-term follow-up, no additional failures were observed at midterm follow-up. In contrast, patients aged >21 years experienced modest failure rates, increasing from 3.5% at short-term follow-up to 8.6% at midterm follow-up, with no significant change.

Anterior cruciate ligament (ACL) reconstruction (ACLR) in the presence of excessive posterior tibial slope (PTS) is a well-established risk factor for increased ACL graft forces and a heightened risk of graft failure.

The primary aim of this study was to evaluate whether lateral extra-articular tenodesis (LET) could mitigate the adverse effects of increased PTS on knee kinematics and ACL graft forces, achieving results comparable to those of slope-reducing osteotomy (SRO). It was hypothesized that LET would provide similar improvements in knee stability and graft force reduction to SRO in the presence of increased PTS. A secondary aim was to determine if an ALC injury exacerbates the effect of increased PTS on ACL graft forces and overall knee stability. It was hypothesized that ALC injury would amplify the negative effects of increased PTS.

Controlled laboratory study.

Eight fresh-frozen cadaveric specimens were prepared, excluding those with previous surgery or significant knee pathology. ACLR was performed using a quadrupled hamstring tendon autograft. The effects of LET and SRO were tested at various degrees of PTS (0°, 10°, and 20°). A simulated pivot-shift maneuver was used to measure ACL graft loads, anterior tibial translation (ATT), and internal rotation (IR). Mixed-effects models were utilized to analyze the data.

Increasing PTS resulted in significant increases in ACL graft forces (P < .001), ATT (P < .001), and IR (P < .001). LET reduced ACL graft loads by 22.1% at 10° and 36.6% at 20° of PTS. In contrast, a 10° SRO showed only a 2.6% reduction at 10° and 23.9% at 20° of PTS. There were no significant differences in graft forces between the postosteotomy states and LET augmentation states at both 10° and 20° of tibial slope, suggesting equivalent efficacy in reducing graft loads. Additionally, LET significantly decreased graft forces compared with the ALC-sectioned state (P = .019). Finally, ALC sectioning did not significantly increase ACL graft load compared with the ACLR-only condition (P = .320), nor did it exacerbate the effects of increased PTS on ATT and IR.

LET effectively reduces ACL graft forces and improves knee stability in the presence of increased PTS, performing comparably to or better than SRO under simulated pivot-shift conditions.

These findings suggest that LET is a viable alternative to SRO, particularly for patients with high PTS undergoing ACLR.

Anteromedial rotatory instability (AMRI) can result from combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) complex (superficial and deep [sMCL and dMCL]).

Adding an oblique anteromedial (AM) limb to an sMCL reconstruction improves the control of AMRI.

Controlled laboratory study.

A 6 degrees of freedom robotic setup simulated clinical laxity in 9 unpaired knees under the following tests: 5-N·m external rotation (ER), 8-N·m valgus rotation (VR), and AM drawer (combined 89-N anterior tibial translation and 5-N·m ER). Knees were tested intact after cutting the sMCL and dMCL and after 5 different reconstructions: modified Lind, short sMCL, and sMCL with the addition of an AM graft limb with 3 different obliquities.

After short sMCL reconstruction, AM drawer and ER laxity were not significantly different from either the MCL-deficient state or the intact state. VR was reduced from the MCL-deficient state between 0° and 60° of flexion but not at 90°. For combined sMCL + AM reconstructions, VR was reduced as compared with the MCL-deficient state at all flexion angles. AM drawer laxity and ER laxity were also reduced, similar to the intact state, except at 30° where, for the more oblique T1 and T2 AM reconstructions, laxity was less than in the intact state. The modified Lind reconstruction reduced AM drawer and ER laxity from the MCL-deficient state to values similar to the intact state at all flexion angles. VR laxity was also reduced at all flexion angles, similar to the intact knee at 0° to 30°. However, it was not as good at restraining AM drawer and ER when compared with the sMCL reconstructions with more oblique AM limbs.

AMRI appears to be better restrained by adding an oblique AM graft limb to an sMCL reconstruction, replicating the function of the sMCL and dMCL in a cadaveric model. The tibial attachment of the AM limb should be anterior to the sMCL, but its precise attachment on the tibia is less important. This offers surgical flexibility, which may be helpful in avoiding anterior cruciate ligament tibial tunnel coalition. The femoral attachment on the posterior medial epicondyle is critical to optimize graft isometry.

Adding an AM limb to a medial reconstruction optimizes the control of AMRI at time zero. The tibial attachment site is less critical, offering surgical flexibility.

Patients with recurrent instability underwent isolated medial patellofemoral ligament (MPFL) reconstruction regardless of anatomic risk factors within the confines of strict exclusion criteria. Previous publications from this cohort have been limited in the ability to identify risk factors for failure of isolated MPFL reconstruction when recurrent instability was defined as the only mode of failure, likely because of the small patient numbers who experienced this outcome.

To investigate whether persistence of postoperative apprehension and J-sign indicate suboptimal outcomes after isolated MPFL reconstruction and to determine if they may help identify patients who need bony realignment in addition to a soft tissue stabilization.

Case series; Level of evidence, 4

Patients with recurrent patellar instability were prospectively enrolled from March 2014 to December 2019 and underwent primary, unilateral MPFL reconstruction by the senior author within the confines of strict exclusion criteria. Imaging measurements were obtained at baseline. Patient-reported outcome measures (PROMs) were collected at baseline and annually. Recurrent instability events (patellar dislocations or subluxations), return-to-sport (RTS) rates, presence of postoperative apprehension, and J-sign were collected at 1- and 2-year follow-ups.

A total of 138 knees (72% female; mean age, 20.1 ± 6.1 years) underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean Beighton score was 5.3 ± 3.0, and knee hyperextension beyond 0° was 5.4° ± 2.8°. Of the knees evaluated, 95 (81%) had a preoperative J-sign and 89 (65%) had preoperative knee hyperextension. At 2 years, recurrent instability was reported in 6 knees (5%), postoperative apprehension in 9 knees (8%), and a postoperative J-sign in 44 knees (37%). No patients with postoperative apprehension reported recurrent instability. At 2 years, 89% of patients were able to RTS. Patients with both preoperative knee hyperextension and postoperative apprehension had worse RTS rates compared with patients without either (P = .034). Patients with postoperative J-signs had a significantly worse International Knee Documentation Committee score (P = .022), Knee injury and Osteoarthritis Outcome Score Physical Function Short Form score (P = .011), and Kujala score (P = .035) at the 2-year follow-up. For patients with recurrent instability or postoperative apprehension, the Kujala score was statistically significantly lower at 1 year compared with those without (84.9 vs 91.7; P = .019).

In this prospective study of knees undergoing isolated MPFL reconstruction for recurrent patellofemoral instability, patients with postoperative J-signs showed worse PROMs at 2 years, a higher percentage of patients with preoperative knee hyperextension and postoperative apprehension did not RTS, and patients with postoperative apprehension did not experience recurrent instability. These findings support the need to further investigate if postoperative J-sign and apprehension may be important markers of suboptimal outcomes after isolated MPFL reconstruction for recurrent instability, which in turn may help identify patients who may benefit from concomitant bony realignment procedures at the time of their index procedure.

Medial closing wedge distal femoral osteotomy (CWDFO) is used to correct valgus deformities and manage lateral osteoarthritis (OA) and patellar dislocation (PD). However, its effect on the tibial tuberosity–trochlear groove (TT-TG) distance remains debated, with limited studies evaluating contributing factors.

To determine whether TT-TG distance changes after CWDFO differ by the underlying diagnosis prompting the procedure and to identify preoperative factors influencing the extent of TT-TG distance changes.

Case series; Level of evidence, 4.

This study analyzed 43 knees of 34 patients with valgus deformity who underwent CWDFO, categorized into the lateral OA (n = 14) and PD (n = 29) groups. Radiographic parameters, including the TT-TG distance, were assessed preoperatively and at least 1 year postoperatively. Regression analyses were conducted to identify the factors influencing TT-TG distance changes. A predictive model with 95% confidence intervals determined the thresholds for deviations from the expected values.

The TT-TG distance significantly decreased from 14.7 ± 5.1 to 11.5 ± 4.7 mm after CWDFO (P < .001). On average, the TT-TG distance decreased by 21.8% after CWDFO. Changes in the TT-TG distance did not significantly differ by diagnosis (lateral OA: −3.0 ± 2.3 mm; PD: −3.3 ± 4.5 mm; P = .771). The preoperative TT-TG distance and osteotomy type significantly influenced TT-TG distance changes. A higher preoperative TT-TG distance was correlated with a greater reduction (odds ratio, −0.375; P = .001), and biplanar osteotomy showed a more pronounced effect than uniplanar osteotomy (odds ratio, −3.083; P = .013). Patients with preoperative TT-TG distances >23.5 mm demonstrated greater variability in TT-TG distance changes in the predictive model.

CWDFO effectively reduced the TT-TG distance regardless of the diagnosis. Preoperative TT-TG distance and osteotomy type were key determinants of this reduction. In cases with preoperative TT-TG distances >23.5 mm, TT-TG distance changes demonstrated greater variability, suggesting that radiographic outcomes may deviate from expected values. These findings highlight the need for careful postoperative assessments and consideration of additional procedures in select cases.

Meniscal injuries trigger a local inflammatory response mediated by intra-articular mediators. Proinflammatory cytokines and chemokines can lead to cartilage degradation and subchondral bone changes, contributing to posttraumatic osteoarthritis. The role that age plays in this inflammatory response is unclear.

To investigate age-dependent variation in cytokine types and concentrations in knee synovial fluid after meniscal injury.

Cohort study; Level of evidence, 3.

Patients undergoing arthroscopic knee surgery for isolated meniscal injury were prospectively enrolled between July 2011 and April 2024. Synovial fluid was aspirated from the operative knee, and concentrations of 10 biomarkers were measured. Patients at least 9 years after surgery were invited to complete patient-reported outcome (PRO) surveys. Multivariable linear regression assessed pairwise relationships between age at surgery, log-normalized biomarker concentrations, and PROs, while adjusting for relevant covariates. Conditional process analysis was used to explore age-biomarker relationships, with symptom duration as a moderator and baseline Outerbridge grade as a mediator.

The study included 160 patients for biomarker analysis with a mean ± SD age of 50.2 ± 12.5 years. Forty-seven patients who reached a minimum 9 years of follow-up completed PRO surveys. Mean follow-up was 10.2 ± 1.3 years. Regression analysis revealed positive associations between age and log-normalized concentration of preoperative IL-6. Moderator analysis found age to be positively associated with IL-6, VEG-F, and IL-1Ra in chronic meniscal injuries. Mediator analysis found an indirect positive relationship between age and MIP-B, VEGF, and MMP-3 and an indirect negative relationship between age and TIMP-1 and TIMP-2. Preoperative TIMP-1 was positively associated with 10-year Knee injury and Osteoarthritis Outcome Score–Physical Function Short Form score and elevated in treatment responders.

Age at surgery was associated with higher concentrations of proinflammatory biomarkers and lower concentrations of anti-inflammatory biomarkers in the synovial fluid before meniscal surgery. Anti-inflammatory markers were associated with improved long-term PROs. These findings suggest an age-related intensification of the proinflammatory response and inhibition of the anti-inflammatory response that may contribute to long-term functional decline in older patients after meniscal surgery. There is potential for age-specific immunomodulatory therapeutic strategies to manage inflammation and mitigate the progression toward posttraumatic osteoarthritis in older patients.

Synovial fluid (SF) biomarkers demonstrate time-dependent variation after acute knee injury, and it is postulated that persistently elevated inflammatory markers may mediate worse long-term outcomes.

This study investigated the relationship between biomarkers in SF at the time of meniscectomy and long-term patient-reported outcomes in patients with acute versus chronic meniscal injuries.

Cohort study; Level of evidence, 3.

This retrospective analysis included patients who underwent knee SF aspiration on the day of arthroscopic meniscectomy between October 2011 and October 2020 with minimum 4-year follow-up. SF aspirated from the operative knee was analyzed for 10 pro- and anti-inflammatory biomarkers. Patients completed the visual analog scale for pain, Lysholm Knee Questionnaire, Tegner Activity Scale, and Knee injury and Osteoarthritis Outcome Score–Physical Function Short-form (KOOS-PS) before surgery and at follow-up. Patients were categorized as having acute (<6 weeks) or chronic (>1 year) symptoms. K-means clustering analysis was performed using biomarker levels to group patients into distinct cohorts.

Of 85 patients meeting inclusion criteria, 55 had chronic and 30 had acute meniscal pathology, with 62 (72.9%) completing patient-reported outcome surveys at a mean follow-up of 8.66 years (SD, 2.27). K-means clustering identified 2 distinct biomarker profiles: a high-inflammation cluster and a low-inflammation cluster. The high-inflammation cluster had higher levels of 7 proinflammatory biomarkers as compared with the low-inflammation cluster (P = .015). The low-inflammation cluster predominantly comprised chronic meniscal injuries (89.2%), whereas the high-inflammation cluster was divided between acute and chronic cases. There were no differences in postoperative outcomes between clusters in the overall cohort. However, within the chronic cohort, the high-inflammation cluster exhibited worse postoperative scores on the visual analog scale for pain (P = .035), Lysholm questionnaire (P = .007), KOOS-PS (P = .038), and Tegner scale (P = .049) and had a higher rate of postoperative injections (P = .020) than the low-inflammation cohort.

In patients with chronic meniscal injury, those with a more proinflammatory SF biomarker profile at the time of meniscectomy had worse outcomes than those who had a low inflammatory profile. In acute meniscal injuries, most patients demonstrate a high inflammatory profile, which was not associated with a difference in long-term outcomes.

Partial meniscectomy provides short-term symptom relief but may accelerate the development of knee arthritis due to meniscal deficiency and altered joint biomechanics. While meniscal allograft transplantation (MAT) addresses complete meniscal loss, segmental meniscal transplantation may be an option for segmental loss.

To evaluate the biomechanical effect of segmental posterior medial meniscal transplantation on knee joint loading characteristics and compare it with the states of both intact meniscus and full MAT.

Controlled laboratory study.

Ten fresh-frozen human cadaveric knees (mean age, 54.3 years) were tested under 4 conditions: intact meniscus, segmental medial meniscal loss, segmental posterior horn MAT, and full MAT. The knees were subjected to a 500-N compressive load at 0°, 30°, 60°, and 90° of knee flexion. Medial meniscal extrusion, contact area, mean contact pressure, and peak contact pressure were measured. Statistical analyses included 2-way repeated measures analysis of variance to assess the effects of meniscal state and knee flexion on biomechanical outcomes.

Segmental medial meniscal deficiency significantly increased extrusion (+1.32 mm at 0°; +1.45 mm at 30°; +1.42 mm at 60°; and +1.67 mm at 90°) and mean pressure compared with the intact meniscus across all flexion angles. Both segmental transplantation and full transplantation restored extrusion to intact levels, with full transplantation demonstrating superior improvement in peak pressure at flexion angles >60° compared with segmental transplantation. Both segmental and full transplantation restored peak pressure to levels comparable with the intact meniscus at flexion angles ≥30°.

Both segmental and full meniscal transplantation tested at the time of surgery restored meniscal extrusion and contact pressure to the intact state.

Segmental transplantation may offer a promising approach for managing posterior medial meniscal deficiencies by restoring knee joint function and reducing meniscal extrusion.

Anabolic-androgenic steroids (AASs) are synthetic derivatives of testosterone that are abused by athletes to enhance their physical appearance and performance. AAS abusers have an increased risk of tendon ruptures compared with nonusers, and it has been proposed that AASs damage tendon tissue. Only a few human studies have investigated the effect of AASs on tendon tissue, and to our knowledge, there are no data on female sex.

The purpose was to investigate the effect of current and former abuse of AASs on the patellar tendon (PT). It was hypothesized that AASs would not affect tendon tissue.

Cross-sectional study; Level of evidence, 3.

This study included recreational athletes with current (female: n = 4; male: n = 18; total: n = 22) or former (female: n = 5; male: n = 7; total: n = 12) AAS abuse and nonusers (female: n = 5; male: n = 9; total: n = 14). The authors investigated the proportion of tendon injuries, PT cross-sectional area by magnetic resonance imaging, mechanical properties by ultrasound, gene expression levels of connective tissue proteins, and cell density by histological staining from tendon biopsy samples.

The combined AAS group (both current and former abusers) reported a higher proportion of upper body tendon injuries compared with nonusers (79.4% vs 28.6%, respectively; P = .002). There was no difference in PT cross-sectional area (P = .918) or cell density (fascicular matrix: P = .413; interfascicular matrix: P = .982) between current AAS abusers, former AAS abusers, and nonusers. There was a greater expression of IGF-1 mRNA in current AAS abusers compared with nonusers (P = .043), but there were no group differences in other mRNA targets. Former AAS abusers had significantly higher tendon deformation (P = .030) and strain (P = .026) at common force compared with nonusers. There were no significant differences between male and female participants in the effect of AASs on tendon tissue.

These data show that the PT itself was not severely affected by AAS abuse.

Turf toe is a plantar plate injury of the first metatarsophalangeal joint that commonly occurs in athletes participating in outdoor cutting sports. However, there is a lack of evidence-based consensus on treatment guidelines and surgical outcomes in the current literature.

The purpose of this study was to report on postoperative clinical outcomes and return to sport for athletic patients treated for both acute and chronic grade 3 turf toe injuries at the authors’ institution. It was hypothesized that patients would have significant improvement in pre- to postoperative clinical outcomes and quickly return to sport after surgical repair.

Case series; Level of evidence, 4.

The records of patients who received plantar plate repair at the first metatarsophalangeal joint between February 2016 to July 2022 by 3 fellowship-trained foot and ankle orthopaedic surgeons were reviewed. Inclusion criteria included athletes of at least high school–level competition who underwent plantar plate repair for a primary diagnosis of turf toe injury. Excluded were patients with histories of ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. In total, 28 patients were identified and screened for inclusion. Patient-reported outcomes via Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at least 1 year postoperatively for all patients. Return-to-sport data were collected via telephone call. Bilateral preoperative and postoperative radiographs were analyzed to measure preoperative and postoperative sesamoid diastasis.

The improvement in pre- to postoperative PROMIS scores was found to be significant for Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. A total of 21 return-to-sport surveys were completed from the patient cohort. Nineteen of 21 (90.5%) of patients were able to return to preinjury levels of physical competition. The mean time to return to sport was 20.4 weeks (range, 12-32 weeks). Both medial and lateral sesamoids demonstrated a significant pre- to postoperative improvement in sesamoid diastasis. No difference in outcomes was observed between acute and chronic injuries.

Patients who received plantar plate repair for a grade 3 turf toe injury demonstrated significant improvement in patient-reported outcomes and were able to quickly return to sport at a high rate.

Anterior cruciate ligament (ACL) tears are frequent injuries in athletes that often require surgical reconstruction so that patients may return to their previous levels of performance. While existing data on patient-reported outcomes are similar between bone–patellar tendon–bone (BTB) and hamstring tendon (HT) autografts, the literature regarding return to sport (RTS), return to previous levels of sport activity, and graft failure rate remains limited.

To compare rates of RTS, return to previous activity levels, and graft retears among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft.

Systematic review and meta-analysis; Level of evidence, 4.

The MEDLINE, Embase, and Cochrane Library databases were queried, and studies reporting on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Exclusion criteria included revision reconstruction, ACL repair, quadriceps tendon autografts, allografts, graft augmentation, or double-bundle autografts. Rates of RTS, return to previous levels of activity, and retears were extracted and analyzed across included studies.

A total of 33 articles met inclusion criteria, with a patient cohort of 4810 athletes. The overall RTS rate for all athletes was 80.4% (95% CI, 75.3%-84.6%) at a mean follow-up of 35.7 months, with 54.6% (95% CI, 48.5%-60.6%) returning to preinjury levels of activity. No significant difference was found between BTB and HT autografts with respect to rates of RTS, return to preinjury activity levels, or reruptures. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 83.3% (95% CI, 77.0%-88.2%), with 56.1% (95% CI, 49.3%-62.7%) returning to preinjury levels of activity. Conversely, the overall RTS rate in patients after primary ACL reconstruction with an HT autograft was 77.9% (95% CI, 70.3%-84.0%), with 53.5% (95% CI, 42.8%-63.9%) returning to preinjury levels of activity. The overall graft rerupture rate for the entire patient cohort was 3.6% (95% CI, 2.5%-5.1%), for patients with BTB grafts was 3.2% (95% CI, 1.9%-5.3%), and for patients with HT grafts was 4.4% (95% CI, 2.8%-6.8%).

Primary ACL reconstruction using BTB autografts demonstrated similar rates of RTS, return to previous activity levels, and reruptures compared with reconstruction using HT autografts.

Surgical options for septic arthritis include open arthrotomy or an arthroscopic procedure. The optimal surgical technique remains a matter of debate as acceptable results have been reported for both.

To evaluate the efficacy of arthroscopy versus arthrotomy for the treatment of septic arthritis in large and intermediate-sized joints.

Systematic review; Level of evidence, 3.

A literature search was performed of the PubMed and Cochrane online databases through September 2023 identifying articles comparing arthroscopy with arthrotomy for the treatment of septic arthritis. Eligible articles included retrospective or prospective comparative studies investigating reoperation, perioperative complications, or clinical outcomes after arthroscopic or open treatment for septic arthritis of the shoulder, elbow, wrist, hip, knee, or ankle in adults.

In total, 23 articles with 34,248 patients met the inclusion criteria comparing arthroscopy with arthrotomy. In 14 of the 20 (70%) studies that reported on reoperation rates, there was no significant difference in arthroscopic versus open surgical management for septic arthritis. Four (20%) studies reported lower reoperation rates when arthroscopy was utilized compared with open arthrotomy. One single-institution study found arthrotomy to be more effective for shoulder septic arthritis, and another favored open surgery only in the presence of erosions. In 11 of 23 (47.8%) studies, no difference in complications or clinical outcomes was found. However, 11 of 23 (47.8%) studies comprising the shoulder, wrist, hip, knee, and ankle reported a significant benefit to arthroscopy for improved outcomes.

Arthroscopic surgery for the treatment of septic arthritis involving the shoulder, wrist, hip, knee, and ankle appears to be safe and effective. Reoperation rates, short-term complications, and functional outcomes tend to be similar or in favor of arthroscopy when compared with arthrotomy.

The Latarjet and other bony augmentation procedures are commonly used to treat anterior shoulder instability in the setting of significant glenoid bone loss. Although several fixation strategies have been reported, the biomechanical strength of these techniques remains poorly understood.

To perform a systematic review of the biomechanical strength of glenoid bony augmentation procedures for anterior shoulder instability.

Systematic review; Level of evidence, 4.

A systematic search of the Medline, Embase, Web of Science, and Cochrane Library databases was performed to identify biomechanical studies evaluating various fixation strategies for coracoid and other bone transfer procedures for anterior shoulder instability. Biomechanical results included load to failure with both compression and traction forces, stiffness, and cyclic displacement. The quality of included articles was assessed based on the Quality Appraisal for Cadaveric Studies (QUACS) scale.

A total of 21 biomechanical studies comprising 486 specimens were included. The number of screws used and the addition of washers were found to significantly increase rigidity and load to failure. The comparison of fixation techniques demonstrated mixed results in load to failure between screw and alternative constructs including suture buttons and suture anchors. However, studies that tested graft displacement consistently found more graft displacement in buttons compared with screws. The median and mean of the QUACS scale were both 12, with a range of 10-13.

Biomechanical studies consistently demonstrated that when glenoid bone grafts were fixed with screws, the number of screws and use of washers significantly increased construct rigidity and load to failure. Different metal screw materials and sizes did not consistently demonstrate a significant difference in biomechanical strength. There are mixed results when comparing suture buttons to screw fixation. The evaluated studies revealed that all double metal screw constructs and the majority of suture button and anchor constructs were able to withstand the glenohumeral load reflective of activities of daily living using a 150-N threshold.

In 2014, Costello and colleagues published a sentinel paper spotlighting the large disparity of female versus male representation within sports science and sports medicine (SSSM) research.

To (1) revisit the method published by Costello et al a decade later to evaluate female representation and (2) ascertain whether study designs account for menstrual status.

Systematic Review; Level of evidence, 4.

All original and epidemiologic research of live human participants from the journals Medicine and Science in Sports and Exercise, British Journal of Sports Medicine, and the American Journal of Sports Medicine were included from January 2021 to August 2023. Number of male and female participants for each study was analyzed. A menstrual-status tiering system published by Smith et al was used to classify the consideration of female participants’ menstrual status in study design.

A total of 1441 studies and 40,152,860 participants were included in this analysis. This included 17,648,509 (43.95%) female participants. The mean proportion of female participants per study was 40.22%, and 103 (7.15%) studies included only female participants compared with 268 (18.6%) male-only studies. A total of 66 (5.6%) studies included menstrual-status considerations in their study design with 7.7 (0.7%) and 5.5 (0.5%) receiving a silver or gold classification, respectively, for design considerations.

Our investigation into the representation of female athletes in SSSM research found an increase in female participation from 39% to 43.95% of total participants over the past decade. While the overall number of female participants rose in the years 2021 to 2023, there remains a significant disparity in female representation in SSSM research compared with male participants. Additionally, we found that the inclusion of menstrual status in study designs has been limited, with few studies considering this crucial variable.