Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"Pickleball-Related Geriatric Fractures and Pediatric Equipment-Related Injuries Are Increasing in Emergency Departments Across the United States","authors":"Philip M. Lee B.S. ,&nbsp;Ryan Nishi B.S. ,&nbsp;Kyle K. Obana M.D. ,&nbsp;Sean M. Chan M.D. ,&nbsp;Jae K. You M.D. ,&nbsp;Jennifer M. Weiss M.D. ,&nbsp;William N. Levine M.D. ,&nbsp;David P. Trofa M.D.","doi":"10.1016/j.asmr.2025.101228","DOIUrl":"10.1016/j.asmr.2025.101228","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the epidemiology, prevalence, and mechanism of injury of pickleball-related injuries in patients presenting to emergency departments in the United States.</div></div><div><h3>Methods</h3><div>Data between 2004 and 2023 from the National Electronic Injury Surveillance System were analyzed for racquetball-related injuries. The data set was screened for pickleball-related injuries using keywords. Data included body part, diagnosis, mechanism of injury, and disposition. Calculations used corresponding hospital sample weights for national estimates (NEs). Patients were divided into the following age groups: pediatric (&lt;18 years), 19 to 39 years, 40 to 59 years, and 60 years or older.</div></div><div><h3>Results</h3><div>A total of 1,714 injuries (NE, 99,816 [98.8%]) were included. The most commonly injured body locations were the upper trunk (n = 232) (NE, 14,884 [13.5%]), head (n = 226) (NE, 12,990 [13.2%]), and knee (n = 188) (NE, 10,700 [10.9%]). The most identified final diagnoses were fracture (n = 493) (NE, 27,493 [28.7%]), sprain/strain (n = 423) (NE, 25,237 [24.7%]), internal organ damage (n = 168) (NE, 10,050 [9.8%]), and contusion (n = 163) (NE, 9,573 [9.5%]). The most identified mechanisms of injury were impact with the floor (n = 856) (NE, 50,797 [49.9%]), exertional cardiovascular event (n = 244) (NE, 15,796 [14.2%]), and non-contact movement (n = 222) (NE, 12,936 [13.0%]). Pediatric patients had the highest proportion of head injuries (NE, 222 [16.9%]) and injuries from equipment (NE, 634 [32.2%]). The group aged 60 years or older had the highest proportion of wrist injuries (NE, 10,302 [13.0%]), fractures (NE, 17,802 [32.8%]), and injuries cause by impact with the floor (NE, 43,592 [56.1%]). Additionally, this group had the highest proportion of upper trunk injuries (NE, 12,947 [15.4%]) and exertional chest pain (NE, 13,789 [16.2%]).</div></div><div><h3>Conclusions</h3><div>Pickleball injuries most frequently involved the upper trunk, head, and knee, with fractures and sprains/strains being the most common diagnoses. Nearly half of all pickleball injuries resulted from impacts with the floor. Pediatric patients had a higher proportion of head injuries and equipment-related trauma, whereas older adults (≥60 years) were more prone to wrist and upper trunk injuries, fractures, and exertional chest pain.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective epidemiologic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101228"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Classification Systems for Knee Ligament Injuries Are Limited to Ligament Involvement and Do Not Consider Injury Mechanism or Sequence of Injury: A Scoping Review","authors":"Jelle P. van der List M.D., Ph.D., M.B.A. ,&nbsp;Roy A.G. Hoogeslag M.D., Ph.D.","doi":"10.1016/j.asmr.2025.101207","DOIUrl":"10.1016/j.asmr.2025.101207","url":null,"abstract":"<div><h3>Purpose</h3><div>To systematically assess published classification systems for knee ligament injuries and to propose a comprehensive, multiplanar, sequential knee ligament classification system that improves upon those in the published literature.</div></div><div><h3>Methods</h3><div>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed, Embase, and Cochrane were searched from inception to January 2025 for studies reporting knee classification systems. Inclusion criteria consisted of studies reporting knee classification systems and English language. Exclusion criteria consisted of classifications only describing specific type of knee injuries (e.g., only anterior cruciate ligament injuries). The characteristics of each classification system were recorded and analyzed descriptively. A classification system was proposed that addresses the weaknesses of the existing systems.</div></div><div><h3>Results</h3><div>A total of 6 classification systems were identified in 8 studies in the literature and were published between 1975 and 2009. Existing classification systems were strong in correlating type of injuries with rotatory ligamentous laxity and physical examination findings but were lacking assessment of knee position during injury, discussion of sequence of injuries, involvement of bone marrow edema (except one study), and lack of correlation with knee dislocations. No clinical validation was performed. A knee classification system was created that included sequence of injuries, correlation with knee dislocation and injury mechanism, and bone marrow edema.</div></div><div><h3>Conclusions</h3><div>Knee injury classification systems lack comprehensive consideration of injury mechanism, sequence of injury, bone marrow edema, meniscus and chondral damage, involved ligaments, rotatory instability, and correlation with knee dislocation. The sequence of injury to these structures could be relevant to understanding injury mechanism and treatment, but requires validation.</div></div><div><h3>Level of Evidence</h3><div>Level V, systematic review of level IV-V studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101207"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Hip Arthroscopy Is Associated With Improved Outcomes of Core Decompression for Osteonecrosis of the Femoral Head: A Systematic Review","authors":"Ady H. Kahana-Rojkind M.D. ,&nbsp;Paras P. Shah B.A. ,&nbsp;Krishi Rana B.A. ,&nbsp;Nils Becker M.D. ,&nbsp;Roger Quesada-Jimenez M.D. ,&nbsp;Benjamin G. Domb M.D.","doi":"10.1016/j.asmr.2025.101225","DOIUrl":"10.1016/j.asmr.2025.101225","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effectiveness of core decompression (CD) with concomitant arthroscopic treatment of intra-articular pathologies for improving outcomes for patients with osteonecrosis of the femoral head (ONFH) and intra-articular pathology and to compare results with patients undergoing isolated CD.</div></div><div><h3>Methods</h3><div>A systematic literature review was conducted using PubMed, MEDLINE, and Cochrane Library databases through July 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing CD with and without hip arthroscopy (HA) were included, provided they reported patient-reported outcomes (PROs), survivorship, or total hip arthroplasty (THA) conversion rates. Studies were excluded if HA was solely diagnostic. Quality was assessed using Methodological Index for Non-Randomized Studies and Risk Of Bias In Non-randomised Studies - of Interventions. Data extracted included demographics, surgical techniques, PROs, and THA-free survivorship.</div></div><div><h3>Results</h3><div>Six studies (4 Level III, 2 Level IV) met the inclusion criteria, comprising 632 hips with mean ages ranging from 35.5 to 41.1 years. All studies reported pre- and postoperative Harris Hip Score, and one included visual analog scale pain scores. Patients undergoing CD with HA had significantly greater postoperative Harris Hip Score (71.41-93.33) and improved THA-free survivorship compared with CD alone. Three of four comparative studies showed significantly lower THA conversion rates and femoral head collapse in the HA group. However, no study directly showed that HA improved bone healing.</div></div><div><h3>Conclusions</h3><div>CD with HA results in better PROs and femoral head survivorship compared with CD alone, likely because of intra-articular pathology treatment and improved joint function. Core decompression with concomitant hip arthroscopy to address intra-articular pathology should be considered for pre-collapse ONFH.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III and IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101225"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral Neck Impingement Cysts Treated With Biocomposite Implants in the Setting of Femoroacetabular Impingement Show Improvement in Patient-Reported Outcomes at a Minimum 2-Year Follow-Up","authors":"Tyler Uppstrom M.D. ,&nbsp;Nicholas A. Felan B.A. ,&nbsp;Kent C. Doan M.D. ,&nbsp;Hannah K. Day M.S. ,&nbsp;Spencer M. Comfort B.S. ,&nbsp;Trevor J. Shelton M.D. ,&nbsp;Grant J. Dornan M.S. ,&nbsp;Alyson Speshock M.P.H. ,&nbsp;Marc J. Philippon M.D.","doi":"10.1016/j.asmr.2025.101221","DOIUrl":"10.1016/j.asmr.2025.101221","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess minimum 2-year outcomes in patients treated with biocomposite anchors for impingement cysts of the femoral neck during hip arthroscopy for femoroacetabular impingement.</div></div><div><h3>Methods</h3><div>Patients aged 18 to 65 years who underwent treatment of a femoral neck impingement cyst with placement of a suture anchor by the senior surgeon between January 1, 2007, and December 1, 2019, and were eligible for a minimum 2-year follow-up were identified. Demographic, surgical, and patient-reported outcomes—including Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport (HOS-SSS), modified Harris Hip Score (mHHS), patient satisfaction, and Tegner Activity Scale—were retrospectively reviewed from the senior surgeon’s prospectively collected database. Complications, including femoral neck fracture, need for revision, or conversion to total hip arthroplasty, were assessed from patient charts and postoperative follow-up surveys. Postoperative magnetic resonance images were assessed for suture anchor integration and presence of a residual cyst.</div></div><div><h3>Results</h3><div>Fifty patients (50 hips) met inclusion criteria, with a median age at surgery of 45 (range, 19-63) years. Minimum 2-year follow-up was obtained for 43 of 50 (86%) patients, with a mean follow-up time of 3.4 ± 1.4 years. One patient reported conversion to total hip arthroplasty, and no additional patients reported revision surgery or postoperative femoral neck fractures. HOS-ADL, HOS-SSS, mHHS, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form 12 Physical Component Summary scores significantly improved after hip arthroscopy (<em>P</em> &lt; .001), with most patients attaining minimum clinically significant difference and patient acceptable symptom state for HOS-ADL, HOS-SSS, and mHHS. Notably, the median postoperative patient satisfaction score was 9.0 of 10 (range, 1-10).</div></div><div><h3>Conclusions</h3><div>Hips with femoral neck impingement cysts treated with biocomposite suture anchors showed excellent patient-reported outcomes and high survivorship at a minimum 2-year follow-up, with most patients achieving mHHS minimum clinically significant difference and patient acceptable symptom state.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101221"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial Analysis of Hamstring Autograft With Vancomycin Presoaking in Primary Anterior Cruciate Ligament Reconstruction Shows High Incidence of Colonization Without Early Clinical Infection","authors":"Maximiliano Scheu M.D. ,&nbsp;Raimundo Bosselin M.D. ,&nbsp;Rafael Araos M.D. ,&nbsp;Juan Ugalde M.D. ,&nbsp;María Jesús Tuca M.D. ,&nbsp;Gonzalo Espinoza M.D.","doi":"10.1016/j.asmr.2025.101231","DOIUrl":"10.1016/j.asmr.2025.101231","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the incidence of autograft bacterial colonization (BC) in anterior cruciate ligament reconstruction (ACLR) and to identify any bacteria type at the genus level.</div></div><div><h3>Methods</h3><div>This prospective descriptive study included patients aged 18 years or older undergoing ACLR with hamstring autograft. Thirty-one patients (21 male and 10 female patients), with a mean age of 32.2 years, were included, with a mean follow-up period of 150 days (range, 90-208 days). Three samples were taken from every surgical procedure: a sample from the graft at the time it was obtained, a sample from the graft after tibial fixation, and a sample from the saline solution receptacle on the instrument table (control). All grafts underwent vancomycin presoaking. Bacterial composition was determined by next-generation sequencing of the 16S ribosomal RNA coding gene. Descriptive statistics were used to summarize data. The Fisher exact test was used to compare group samples (with <em>P</em> &lt; .05 considered significant).</div></div><div><h3>Results</h3><div>BC was detected in 11 of 31 patients (35.4%). BC was found in the first sample (sample from the graft at the time it was obtained) in 1 patient and in the third sample (control) in another. All 11 patients showed BC in the second sample (sample from the graft after tibial fixation), with statistical significance (<em>P</em> = .003). In these samples with BC, 47 types of gram-negative bacteria (GNB) were identified, averaging 6.8 bacteria per sample, with 3.97% relative abundance per bacterium. <em>Pseudomonas</em> was present in 5 of 11 samples, with 6.76% relative abundance. Additionally, 33 types of gram-positive bacteria (GPB) were found, averaging 6 bacteria per sample, with 9.62% relative abundance per bacterium; <em>Streptococcus</em> was present in 8 of 11 samples, with 26.23% relative abundance. All colonized samples exhibited both GPB and GNB.</div></div><div><h3>Conclusions</h3><div>Bacterial contamination during ACLR is frequent, with the presence of both GNB and GPB. Although such colonization was common, no early clinical infections were noted in our patient cohort.</div></div><div><h3>Level of Evidence</h3><div>Level III, prospective descriptive study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101231"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT Can Provide Satisfactory Answers to Assessments of Mock Clinical Photos Following Anterior Cruciate Ligament Reconstruction and Rotator Cuff Repair","authors":"Ian Hollyer M.D.,&nbsp;Grant G. Schroeder M.D.,&nbsp;Bill Young B.S.,&nbsp;Connor Sholtis M.D.,&nbsp;Anastasia Hunt M.D.,&nbsp;Jayme Koltsov Ph.D.,&nbsp;Seth L. Sherman M.D.,&nbsp;Marc R. Safran M.D.","doi":"10.1016/j.asmr.2025.101212","DOIUrl":"10.1016/j.asmr.2025.101212","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the ability of ChatGPT-4o to provide clinical assessments of mock photos of knees and shoulders that had undergone arthroscopic or open surgery and answer common questions related to anterior cruciate ligament reconstruction and rotator cuff repair.</div></div><div><h3>Methods</h3><div>The authors created a series of mock postoperative knee and shoulder photos and common questions about anterior cruciate ligament reconstruction and rotator cuff repair. These clinical photos and questions were presented to GPT in isolated chat windows and without prior training, and its responses were graded by orthopaedic surgeons, physician assistants, and residents using a previously established 4-point grading system.</div></div><div><h3>Results</h3><div>When grading ChatGPT’s assessments of mock clinical photos, raters gave 18.8% to 75.0% total excellent grades and 0% to 25.0% unsatisfactory grades. When grading ChatGPT question answers, raters gave 4.5% to 77.3% total excellent grades and 0% to 9.1% unsatisfactory grades. Mean grades ranged from excellent to satisfactory, requiring moderate clarification, depending on the photo or question. There was wide variability in rater grading agreement, with attendings being the most critical graders.</div></div><div><h3>Conclusions</h3><div>ChatGPT-4o can provide some satisfactory assessments of simple postoperative clinical photos and responses to common questions after orthopaedic knee and shoulder surgery, as graded by orthopaedic surgeons, residents, and physician assistants. While this study highlights how ChatGPT could serve as a tool for generating draft responses to patient concerns after undergoing orthopaedic knee and shoulder surgery, it cannot yet provide reliable, independent clinical advice.</div></div><div><h3>Clinical Relevance</h3><div>As digital interactions in health care continue to expand, large language models could play a role in enhancing communication between patients and the orthopaedic care team, potentially improving patient engagement and access to information.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101212"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protected Weight-Bearing and Early Passive Mobilization Are Common Components of Rehabilitation After Hip Arthroscopy With Labral Reconstruction","authors":"Kyle P. Messer D.O. ,&nbsp;Jaydeep Dhillon D.O. ,&nbsp;Matthew J. Kraeutler M.D.","doi":"10.1016/j.asmr.2025.101230","DOIUrl":"10.1016/j.asmr.2025.101230","url":null,"abstract":"<div><h3>Purpose</h3><div>To perform a systematic review of postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction.</div></div><div><h3>Methods</h3><div>A systematic review was conducted by searching PubMed, the Cochrane Library, and Embase databases for studies reporting postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction. Inclusion criteria were clinical studies detailing rehabilitation protocols after hip arthroscopy with primary labral reconstruction. Studies were excluded if they involved revision procedures, lacked rehabilitation protocols, or were nonclinical reports. The search terms used were: <em>hip labral reconstruction</em>. Extracted data included initial weight-bearing (WB) status, time to full WB, use of continuous passive motion (CPM), initial range of motion limitations, brace use and duration, physical therapy modalities, return-to-sports timing, patient-reported outcome measures, and reoperation rates, defined as the need for revision arthroscopy or conversion to total hip arthroplasty.</div></div><div><h3>Results</h3><div>Twenty studies, including 641 patients, met inclusion criteria. The mean patient age ranged from 32.0 to 43.7 years, with mean follow-up durations ranging from 0.6 years to 6.4 years. Four studies allowed WB as tolerated, one required non-WB, whereas 15 studies implemented protected WB (i.e., partial WB or touch-down WB) postoperatively, with all studies allowing full WB within 8 weeks. CPM was initiated within 12 to 24 hours postoperatively in 6 studies. Hip immobilization devices were used in 6 studies. Five studies reported range of motion restrictions, limiting hip flexion anywhere from 30° to 90°. Fourteen studies reported 11 unique patient-reported outcome measures and 55% of all studies reported reoperation rates. Among 5 studies that reported return-to-sport timelines, 4 (80%) permitted return by 6 months. Although most protocols discussed physical therapy and strength progression, considerable variability existed regarding exercise timing and initiation.</div></div><div><h3>Conclusions</h3><div>This systematic review highlights the heterogeneity in postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction, reflecting a lack of standardized, evidence-based guidelines.</div></div><div><h3>Level of Evidence</h3><div>Level V, systematic review of Level II-V studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101230"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture-Button Repair Improves Outcomes in Arthroscopically Diagnosed Chronic Syndesmotic Injury Despite Low Imaging Sensitivity","authors":"Tarjei Vinje M.D. ,&nbsp;Eivind Inderhaug M.D., Ph.D. ,&nbsp;Jon Jarning M.D. ,&nbsp;Randi M. Hole M.D., Ph.D. ,&nbsp;Nils Vetti M.D., Ph.D ,&nbsp;Merete A. Malt P.T. ,&nbsp;Kjell Matre M.D., Ph.D.","doi":"10.1016/j.asmr.2025.101227","DOIUrl":"10.1016/j.asmr.2025.101227","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate patient-reported outcomes after arthroscopic suture-button repair of chronic isolated syndesmotic injuries and to compare the diagnostic sensitivity of standard imaging with arthroscopy.</div></div><div><h3>Methods</h3><div>Patients with chronic (≥3 months) syndesmotic injuries confirmed by arthroscopy (≥2 mm widening) who underwent suture-button repair between 2017 and 2021 were included. Exclusion criteria were ankle fractures, previous major surgery, or significant arthritis. Foot Function Index and Foot-and-Ankle Ability Measure scores were recorded preoperatively as part of routine clinical assessment and at final follow-up. The minimal clinically important difference was defined as 75% of preoperative standard deviation.</div></div><div><h3>Results</h3><div>Forty-one patients (43 ankles) were analyzed. Median age was 32 years (15-57 years), 63% were female, and time from injury to surgery was 1.7 years (0.25-25). Fifteen ankles (35%) received concomitant lateral suture-tape stabilization. Arthroscopic syndesmotic widening was 2-3 mm in 5%, 3-4 mm in 10%, &gt;4 mm in 46%, and posterior in 38%. All 6 Foot Function Index and Foot-and-Ankle Ability Measure subscores improved significantly (<em>P</em> &lt; .001), with 79% to 93% achieving minimal clinically important difference at a median 2.3-year follow-up (1.0-4.8). Sensitivity for syndesmotic pathology was 5% for radiographs and stress fluoroscopy, 22% for computed tomography, and 26% for magnetic resonance imaging.</div></div><div><h3>Conclusions</h3><div>Arthroscopic suture-button repair led to significant improvements in patient-reported outcomes for chronic isolated syndesmotic injuries. Standard imaging had low sensitivity, and a posterior-predominant syndesmotic widening pattern was commonly observed arthroscopically. These findings suggest that chronic syndesmotic instability is underdiagnosed, highlight the role of arthroscopic evaluation for accurate diagnosis, and support the use of suture-button stabilization as an effective treatment.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101227"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Margin Convergence Yields Comparable Clinical Outcomes With Repair Using the Interval Slide Technique in Patients Who Had Undergone Complete Repair of Large-to-Massive Rotator Cuff Tears","authors":"W.P. Yau M.B.B.S., F.R.C.S.Ed., F.R.C.S.Ed. (Ortho.), F.H.K.C.O.S., F.H.K.A.M. (Orthopaedic Surgery)","doi":"10.1016/j.asmr.2025.101214","DOIUrl":"10.1016/j.asmr.2025.101214","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the outcomes of complete repairs for large-to-massive rotator cuff tears between patients who underwent the margin convergence (MC) or interval slide technique (IS).</div></div><div><h3>Methods</h3><div>A retrospective study was conducted. The inclusion criteria included patients who received primary repairs using either MC or IS to address a large-to-massive rotator cuff tear between 2007 and 2020. Clinical outcomes, including visual analog scale score, American Shoulder and Elbow Surgeons score, and active shoulder forward flexion (FF), were assessed at the 2-year follow-up. Minimal clinically important difference (MCID) was calculated. Magnetic resonance imaging (MRI) was performed at the 2-year follow-up.</div></div><div><h3>Results</h3><div>The number of patients operated on with IS and MC technique was 59 and 24, respectively, including 42 male and 41 female patients, with an average age of 62.5 ± 10 years. The 2-year follow-up rate was 91%. Postoperative MRIs were performed at 17.8 ± 7.3 months. The rates of full-thickness retear were 88% for MC and 27% for IS. One patient (4%) who was operated on with MC, compared with 2 patients who underwent IS (3%), received revision surgeries. There were no differences between the 2 repair techniques in terms of visual analog scale score, American Shoulder and Elbow Surgeons Score, and FF at the 2-year follow-up. However, more patients in the IS group achieved MCID for ASES (93% and 67%, respectively; <em>P</em> = .006) and FF (62% and 30%, respectively; <em>P</em> = .016), compared with those who underwent MC. The odds ratio were 7.2 (95% confidence interval 1.6-33) and 3.7 (95% confidence interval 1.2-11.3), respectively.</div></div><div><h3>Conclusions</h3><div>Both margin convergence and interval slide techniques are effective methods for improving clinical outcomes in patients with large-to-massive rotator cuff tears, despite a 3-fold greater full-thickness retear rate observed on postoperative MRI and a lower likelihood of achieving MCID for ASES and FF in the MC group.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101214"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145479355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous Peripheral Blood Stem Cells With Adjuvant Hyaluronic Acid Enhance Cartilage Repair After Subchondral Drilling in a Sheep Model","authors":"Caroline Siew Yoke Jee B.Eng. (Hons.), Ph.D. ,&nbsp;Alisha Ramlan B.Sc. ,&nbsp;Razana Mohd Ali M.B.B.S. (U.T.A.S.), M.P.A.T.H. (U.K.M.), A.M. (M.A.L.). ,&nbsp;Nurul Hayah Khairuddin D.A.H.P. (U.P.M.), D.V.M. (U.P.M.), Ph.D. (U.K.) ,&nbsp;Hui Cheng Chen D.V.M., MV.M., D.V.Sc. ,&nbsp;Amal Dawam M.Sc. ,&nbsp;Yan-Chang Saw M.B. Ch.B. ,&nbsp;Khay-Yong Saw M.Ch.Orth., F.R.C.S.(Edin).","doi":"10.1016/j.asmr.2025.101217","DOIUrl":"10.1016/j.asmr.2025.101217","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine histologically whether intra-articular injections of autologous peripheral blood stem cells (PBSC) and adjuvant hyaluronic acid (HA) after subchondral drilling result in better articular cartilage repair.</div></div><div><h3>Methods</h3><div>Fifteen sheep (aged 12-36 months) were included in this study. An 8-mm full-thickness cartilage defect was created. There were 3 groups: group A, which comprised 5 control (subchondral drilling only); group B, which comprised 5 subchondral drilling + HA (3 injections); and group C, which comprised 5 subchondral drilling + PBSC + HA (3 injections). Each injection was given intra-articularly at 7 days apart. Animals were killed humanely at 6 months after operation. The left stifle joint was examined macroscopically as well as histologically (hematoxylin and eosin, safranin-O, collagen type 1 and 2, International Cartilage Regeneration &amp; Joint Preservation Society [ICRS] II scale).</div></div><div><h3>Results</h3><div>All the animals survived the duration of the study. Macroscopic evaluation showed the presence of repair tissues in all groups, although the chondral defects were not completely filled with repair cartilage. Greater ICRS II scores indicate better chondrogenesis. Group C (902 ± 229) showed significantly greater ICRS II scores compared with group A (536 ± 81) and group B (563 ± 83), with <em>P</em> values of .014 and .016, respectively. However, the scores for group C were lower to those of normal cartilage (1266 ± 35), with a <em>P</em> of .014.</div></div><div><h3>Conclusions</h3><div>In this sheep model, postoperative intra-articular injections of autologous PBSCs with HA were associated with better histologic cartilage repair after subchondral drilling when compared with HA alone, as assessed using the ICRS II scoring system.</div></div><div><h3>Clinical Relevance</h3><div>This large animal study shows that intra-articular injections of autologous PBSC combined with HA are associated with improved histologic features of cartilage repair after subchondral drilling, supporting further investigation of this approach in preclinical models and the findings may have relevance in guiding future treatment strategies for cartilage defects in humans.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 5","pages":"Article 101217"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145478852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}