Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

{"title":"Predicted healing rates do not correlate with patient outcomes following rotator cuff repair—A minimum 2-year follow-up","authors":"Jonathan Chan BSc, MBChB,&nbsp;Ritwik Kejriwal BHB, MBChB, FRACS PGDipSportsMed","doi":"10.1016/j.jisako.2025.101026","DOIUrl":"10.1016/j.jisako.2025.101026","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>The Rotator Cuff Healing Index (RoHI) predicts healing rates following rotator cuff repair based on patient- and tear-specific risk factors and has subsequently been suggested as a means of predicting which high-risk patients might benefit from the use of repair augmentation. However, the correlation between predicted healing rates and functional outcomes is unclear. The aim of this study was to evaluate the relationship between predicted healing rates based on the RoHI and patient-reported outcomes (PROMs) at minimum 2-years following rotator cuff repair.</div></div><div><h3>Methods</h3><div>Patients undergoing superior rotator cuff repair, supraspinatus with or without concurrent infraspinatus repair, by a single surgeon between 2019 and 2022 with a minimum 2-year follow-up were included. Modified RoHI scores were retrospectively calculated using preoperative imaging. Patients were divided into four groups based on RoHI scores (≤4, 5–6, 7–9, and ≥10) and into two groups for further analysis (RoHI &lt;7 and RoHI ≥7). PROMs [the American Shoulder and Elbow Surgeons score (ASES) and the University of California Los Angeles (UCLA) score] were compared preoperatively and at 2 years postoperatively. Statistical significance was set at p ​&lt; ​0.05.</div></div><div><h3>Results</h3><div>A total of 94 patients met the inclusion criteria. All groups demonstrated significant improvements in the ASES and the UCLA scores from preoperative to 2-year follow-up, RoHI &lt;4 group ASES 33.58 to 87.88 (p ​&lt; ​0.0001), UCLA score 15.45 to 32.26 (p ​&lt; ​0.0001); RoHI 5–6 group ASES 45.88 to 93.29 (p ​&lt; ​0.0001), UCLA score 16.06 to 22.12 (p ​&lt; ​0.0001); RoHI 7–9 group ASES score 34.00 to 87.00 (p ​&lt; ​0.0001), UCLA score 15.277 to 31.53 (p ​&lt; ​0.0001); RoHI ≥10 group ASES score 41.00 to 90.00 (p ​= ​0.0014), UCLA score 13.50 to 33.17 (p ​= ​0.0004). Mean 2-year PROMs were not statistically different across all RoHI groups. Likewise, patients in the RoHI &lt;7 and RoHI ≥7 groups demonstrated no statistical difference in outcomes at 2 years (ASES, p ​= ​0.68; UCLA, p ​= ​0.56).</div></div><div><h3>Conclusion</h3><div>Patients achieve similar and significant improvements in PROMs at 2 years following rotator cuff repair without augmentation regardless of predicted healing rates.</div></div><div><h3>Level of evidence</h3><div>Retrospective series; level of evidence, 4.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101026"},"PeriodicalIF":3.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432450","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":"Acceptable outcomes for isolated medial patellofemoral ligament reconstruction despite using higher thresholds for patella alta and regardless the value of tibial tubercle-trochlear groove distance and the degree of trochlear dysplasia—An international multicenter study","authors":"Julian A. Feller ,&nbsp;Robert A. Magnussen ,&nbsp;Petri Sillanpää ,&nbsp;Ryosuke Kuroda ,&nbsp;Marc A. Tompkins ,&nbsp;Raimundo Vial ,&nbsp;Julie Agel ,&nbsp;Elizabeth A. Arendt","doi":"10.1016/j.jisako.2025.101028","DOIUrl":"10.1016/j.jisako.2025.101028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;When planning surgery for treatment of recurrent patellar instability, one of the questions of interest is how far the indications for an isolated medial patellofemoral ligament (MPFL) reconstruction can be extended. This international multicenter study followed the outcomes of patients undergoing isolated MPFL reconstruction using higher thresholds for patella alta and tibial tubercle-trochlear groove (TT-TG) distance imaging measurements than in the current literature and in common practice algorithms.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;One hundred ninety-nine patients from five countries (USA, Australia, Finland, Japan and Chile) were enrolled. All underwent an isolated MPFL reconstruction. The decision to perform additional stabilization surgery such as a tibial tubercle osteotomy was left to the discretion of the individual surgeon. Patients having additional bony surgery were not included. The guiding principle was a TT-TG distance up to 24 ​mm on magnetic resonance imaging (MRI) and a Caton–Deschamps index (CDI) or Insall–Salvati index (ISI) up to 1.4 were not considered to be an automatic indication for a tibial tubercle osteotomy. Patient-reported outcome measures (PROMs; Norwich Patellar Instability, Marx Activity, and the Knee injury and Osteoarthritis Outcome Score (KOOS) uality of ife scores) were recorded preoperatively and the same PROMS and reinjury (patellar re-dislocation) were recorded at 1 and 2 years, postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Sixty-six percent of patients were female and the mean age at surgery was 21 (standard deviation [SD]: 7.4) years. The CDI ranged from 0.7 to 1.7 with a mean of 1.1 (SD: 0.15); 7 ​% patients had a CDI of 1.4 or more. The ISI ranged from 0.7 to 1.9 with a mean of 1.3 (SD: 0.21); 44 ​% patients had an ISI ≥1.4. The TT-TG distance ranged from 4.0 to 29.0 ​mm (mean: 15 ​mm, SD: 4.4 ​mm); 3 ​% patients had a TT-TG distance ≥24 ​mm. Fourteen percent had no trochlear dysplasia, while 51 ​% had Dejour type A dysplasia; the remaining 35 ​% had types B to D dysplasia. Fourteen percent of patients had a J-sign on the affected side. The re-dislocation rate was 2 ​% at 2 years. There were more re-dislocations when the CDI was ≥1.4 compared to when it was &lt;1.4 (p ​= ​0.04). There were no differences in re-dislocation rates based on an ISI threshold of ≥1.4, a TT-TG distance threshold of ≥24 ​mm, or on the grade of trochlear dysplasia (Dejour B, C, or D).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Based on the data of this case series, isolated MPFL reconstruction in the setting of increased thresholds for patella alta height and regardless of the value of TT-TG distance and the degree of trochlear dysplasia resulted in a low overall rate of patellar re-dislocation. This finding supports the concept of using higher threshold values for patella alta and TT-TG distance than previously suggested when deciding what surgical intervention is appropriate for a pati","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101028"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427065","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":"Breaking down tibial tuberosity to trochlear groove distance into two components to enable patient-specific treatment strategies","authors":"Johannes M. Sieberer ,&nbsp;Nancy Park ,&nbsp;Shelby Desroches ,&nbsp;Kelsey Brennan ,&nbsp;Albert Rancu ,&nbsp;Brooke McGinley ,&nbsp;Armita R. Manafzadeh ,&nbsp;Neil A. Segal ,&nbsp;David Felson ,&nbsp;Steven M. Tommasini ,&nbsp;Daniel H. Wiznia ,&nbsp;John P. Fulkerson","doi":"10.1016/j.jisako.2025.101025","DOIUrl":"10.1016/j.jisako.2025.101025","url":null,"abstract":"<div><h3>Objective</h3><div>Tibial tuberosity to trochlear groove (TT-TG) distance serves as one of the main metrics for patellofemoral instability (PFI) surgical decision-making. The purpose of this study is to split TT-TG into translational (caused by bony morphology) and rotational (external tibiofemoral rotation) components, elucidate how those two components relate to each other, and determine how the components differ between recurrent PFI patients and controls.</div></div><div><h3>Methods</h3><div>Computed tomography (CT) scans of PFI patients with at least two reported dislocation events, seen by our institution's orthopedic department, were retrospectively acquired. Control CT scans were acquired from the Multicenter Osteoarthritis Study (MOST). Three-dimensional (3D) landmarks were placed on the distal femora and the proximal tibias. TT-TG, its rotational and translational components, and tibiofemoral rotation were algorithmically calculated from these landmarks. The two cohorts' means were compared using Mann–Whitney U-tests. Pearson coefficients were used to evaluate the correlation between the TT-TG components. The reliability of the measurements was evaluated with intraclass correlation coefficients (ICCs). The minimal sample size for a power level of 0.80 was calculated with an <em>a priori</em> sample size calculation.</div></div><div><h3>Results</h3><div>A total of 26 PFI (sex parity; age: 24.6 ​± ​10.0 years) and 294 control knees (sex parity; age: 52.6 ​± ​7.0 years) were analyzed. Statistically significant differences for TT-TG (18.7 ​± ​4.8 vs. 12.0 ​± ​3.4 ​mm, p ​&lt; ​0.001), rotational (5.3 ​± ​2.5 vs. 1.0 ​± ​2.5 ​mm, p ​&lt; ​0.001) and translational (13.4 ​± ​3.7 vs. 11.0 ​± ​3.1 ​mm, p ​= ​0.002) components of TT-TG, and tibiofemoral rotation (10.7 ​± ​4.7 vs. 1.9 ​± ​4.7°, p ​&lt; ​0.001) were found. No significant correlation between the components of TT-TG was found (p ​= ​0.14, r² ​= ​0.29). Predictive ICCs for the four measurements ranged from 0.82 to 0.99.</div></div><div><h3>Conclusion</h3><div>TT-TG can be split into (1) a translational component, primarily dependent on bony morphology, and (2) a rotational component, caused by external tibiofemoral rotation, both of which can lead to an elevated TT-TG measurement independently of each other. The rotational component is the primary factor for differences observed between PFI patients and controls but might vary between consequential patient scans. Our findings emphasize the importance of personalized treatment strategies tailored to individual patient profiles in treating patellar instability and will aid in more accurately targeted selection of surgical methods addressing either or both translational or rotational components of TT-TG.</div></div><div><h3>Level of evidence</h3><div>III Case-Control study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"16 ","pages":"Article 101025"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423175","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":"Proximal graft size predicts anterior cruciate ligament re-tear after hamstring reconstruction: A minimum 2-year follow-up in a high-volume center","authors":"Fabio Mancino ,&nbsp;Simon L.E. Walgrave ,&nbsp;Sam C. Parker ,&nbsp;David A. Parker","doi":"10.1016/j.jisako.2025.101027","DOIUrl":"10.1016/j.jisako.2025.101027","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>This study aimed to investigate variables associated with increased odds of anterior cruciate ligament (ACL) re-tear and re-operation after anterior cruciate ligament reconstruction (ACLR) using hamstring autograft. We hypothesized that a proximal and/or distal graft diameter smaller than 8.5 ​mm would be associated with higher odds of re-tear.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent primary ACLR between 2019 and 2022 were prospectively followed and retrospectively analyzed. Patients were excluded in cases of multi-ligament knee injury, bilateral ACLR, or age under 18 years. ACL re-tear was assessed at a minimum follow-up of 24 months (mean: 42 months, range: 24–60 months). Baseline characteristics, as well as intraoperative and postoperative data, were collected. Clinical outcomes and knee laxity were assessed 12 months postoperatively. Univariate logistic regression was performed to identify associations with re-tear and re-operation. P values ​&lt;0.05 were considered statistically significant.</div></div><div><h3>Results</h3><div>Overall, 255 patients were included, with a mean age of 30.3 ​± ​10.6 years. A hamstring graft was used in all cases. Intraoperative meniscal treatment was performed in 47.1% of cases (121 knees) and lateral extra-articular tenodesis in 15% (37 of 255 knees). The re-tear rate was 7.1% (18 knees). A proximal graft size &lt;8.5 ​mm was statistically significantly associated with ACL re-tear (odds ratio [OR]: 3.1, p ​= ​0.023). Male gender and graft size showed a statistically significant interaction effect with ACL re-tear (p ​= ​0.016).</div><div>In total, 30 patients (12%) underwent re-operation at a mean follow-up of 42 months (range: 24–60 months). A medial meniscal (MM) tear was associated with increased odds of re-operation (OR: 2.8, p ​= ​0.010). The re-operation rate was higher in cases of MM repair (27%) than in cases of MM debridement (5%, p ​= ​0.040). Lateral meniscal tears were not associated with an increased re-operation rate (p ​= ​0.496).</div></div><div><h3>Conclusions</h3><div>A proximal graft diameter &lt;8.5 ​mm in hamstring autograft ACLR is associated with increased odds of re-tear, particularly in young, active male patients. Meniscal tears are associated with higher odds of subsequent surgery on the same knee, especially following MM repair.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101027"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427104","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":"Posterior capsulolabral reconstruction results in good clinical and return to sport outcomes in tennis players with microtraumatic posterior shoulder instability","authors":"Franziska Eckers ,&nbsp;Lyn Watson ,&nbsp;Simon Balster ,&nbsp;Sarah Warby ,&nbsp;Maike S. Müller ,&nbsp;Emma Hoy ,&nbsp;Paul Borbas ,&nbsp;Gregory Hoy","doi":"10.1016/j.jisako.2025.101015","DOIUrl":"10.1016/j.jisako.2025.101015","url":null,"abstract":"<div><h3>Introduction/objective</h3><div>Microtraumatic posterior shoulder instability (PSI) can affect tennis players due to the repetitive demands placed on the dominant shoulder during the preparation of backhands, backhand volleys, and the follow-through phase of forehands and serves. Treatment of microtraumatic PSI typically involves a trial of conservative management, and if this fails, surgical stabilization may be warranted. To date, the effect of shoulder stabilization surgery on PSI in tennis players has not been investigated. The objective of this paper is to retrospectively review return-to-sport success and patient-reported outcome measures (PROMs) in high-level tennis players who have undergone capsulolabral reconstruction for microtraumatic PSI.</div></div><div><h3>Methods</h3><div>A retrospective review of professional or semiprofessional tennis players who had undergone posterior capsulolabral reconstruction (PCR) for microtraumatic PSI was performed. The PROMs included the Western Ontario Shoulder Index (WOSI), Melbourne Instability Shoulder Score (MISS), and Subjective Shoulder Value (SSV), evaluated preoperatively and a mean of 12 months and 6 years postoperatively. Return to sport (RTS) (time to return and level) and any adverse events associated with surgery were reported. Data analysis for the WOSI, MISS, and SSV focused on detecting within-group treatment effects at 12 months and 6 years using linear mixed models.</div></div><div><h3>Results</h3><div>Fourteen tennis players (2 females, 12 males, mean age: 20.0 years) with microtraumatic PSI were included in the study. Post-surgery, participants showed statistically significant improvements at 12 months and 6 years for the WOSI, the MISS, and the SSV (p ​&lt; ​0.05).</div><div>Return-to-sport data were available for 12 athletes. Eleven players (91.6%) were able to return to tennis competitively at a median time of 12 months (range: 5-72 months) postoperatively. Six of the 11 players (54.5%) who returned to competition were able to return to the same or a higher level than preoperatively. For the whole cohort (n ​= ​14) there were five minor adverse events, primarily related to post-operative inflammation and/or ongoing stiffness. No recurrence of instability was reported.</div></div><div><h3>Conclusions</h3><div>PCR results in good clinical and return-to-sport outcomes in tennis players with microtraumatic PSI who have failed conservative management, though return to previous level of play is more variable.</div></div><div><h3>Level of evidence</h3><div>IV (Case Series).</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101015"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423198","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":"Favorable outcomes after all-inside repair of complete lateral meniscus oblique radial tears in patients undergoing anterior cruciate ligament reconstruction: A case-series study","authors":"Periklis Giannakis ,&nbsp;Blake C. Meza MD ,&nbsp;Sophia T. Zhuang BA ,&nbsp;Robert G. Marx MD","doi":"10.1016/j.jisako.2025.101024","DOIUrl":"10.1016/j.jisako.2025.101024","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the outcomes of repairing lateral meniscus oblique radial tears of the posterior horn (LMORT) that are complete and originate &gt;1 ​cm from the posterior root (type 4), during anterior cruciate ligament reconstruction (ACLR) at a minimum of 2 years of follow-up.</div></div><div><h3>Methods</h3><div>In this case series (March 2018–March 2023), we included adults undergoing primary ACLR with type 4 LMORT all-inside repair and complete ≥2-year postoperative complication data. We assessed change from baseline and minimal clinically important difference (MCID) rate for the Patient Reported Outcome Measures Information System Pain Interference (PROMIS-PI) and Mobility (PROMIS-MO), International Knee Documentation Committee Subjective Knee Form (IKDC), Activity Rating Scale (ARS) and Single Assessment Numeric Evaluation (SANE). Return-to-sport (RTS), same-level RTS and complication (retear of lateral meniscus, reoperation, ACLR graft failure, infection, contralateral knee surgery) rates were reported. When available, we evaluated second-look arthroscopy and postoperative magnetic resonance imaging (MRI) findings.</div></div><div><h3>Results</h3><div>In 16 cases (median follow-up; 37.3 [29.1–65.3] months), improvement was noted in median PROMIS-PI (60.3 [57.7–65.8] vs 43.0 [39.0–48.9]; p ​&lt; ​0.001), PROMIS-MO (38.5 [33.5–40.8] vs 61.1 [54.0–66.8]; p ​&lt; ​0.001), IKDC (42.0 [23.5–48.0] vs 91.4 [82.8–96.6]; p ​&lt; ​0.001) and SANE (25.0 [10.0–38.3] vs 89.0 [80.0–95.0]; p ​= ​0.002). No statistically significant differences were observed for ARS (16.0 [13.0–16.0] vs 12.0 [8.0–14.5] p ​= ​0.099). MCID rates were 85.7 ​%, 92.9 ​%, 100 ​%, 57.1 ​% and 78.6 ​% for PROMIS-PI, PROMIS-MO, IKDC, ARS and SANE, respectively. RTS and same-level RTS rates were 12/14 (85.7 ​%) and 8/14 (57.1 ​%), respectively. Three (18.8 ​%) patients underwent ipsilateral knee reoperations; none for lateral meniscus retears. There was one (6.3 ​%) contralateral knee operation. Complete LMORT repair healing was observed on available second-look arthroscopies and MRIs.</div></div><div><h3>Conclusions</h3><div>Our study of patients with type 4 LMORT repair during ACLR supports the limited existing evidence by demonstrating statistically significant improvement in patient-reported outcome measures, low complication rates and satisfactory healing patterns. Our findings should further encourage all-inside repair of type 4 LMORTs during ACLR, as it results in high RTS and substantial same-level RTS.</div></div><div><h3>Level of evidence</h3><div>IV. Case-series. Clinical study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101024"},"PeriodicalIF":3.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525719","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":"Anterior cruciate ligament surgeons frequently modify their approach when treating patients with knee hyperextension or ligamentous hyperlaxity: Results from an international survey of ISAKOS members","authors":"Camilo Partezani Helito MD, PhD ,&nbsp;Andre Giardino Moreira da Silva MD ,&nbsp;Seth Lawrence Sherman MD ,&nbsp;Brett A. Fritsch MBBS BSc(Med), FRACS, FAOrthA ,&nbsp;Riccardo Cristiani MD, PhD ,&nbsp;Juan Miguel Del Castillo MD ,&nbsp;Adnan Saithna MD, FAANA ,&nbsp;ISAKOS Young Professionals Task Force","doi":"10.1016/j.jisako.2025.101021","DOIUrl":"10.1016/j.jisako.2025.101021","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with ligamentous hyperlaxity or knee hyperextension seem to be at a higher risk of failure following anterior cruciate ligament (ACL) reconstruction. The objective of this study was to better understand global practices for the treatment of ACL injuries in patients with knee hyperextension and ligamentous hyperlaxity among knee and sports medicine surgeons worldwide.</div></div><div><h3>Methods</h3><div>A survey invitation was sent to members of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) who were identified as knee and sports surgeons. The survey consisted of a total of 25 questions, covering topics related to preoperative assessment, surgical technique, and postoperative management of patients with knee hyperextension. Survey responses were tabulated and reported using descriptive statistics.</div></div><div><h3>Results</h3><div>In total, 427 responses to the survey were obtained from ISAKOS members. All continents participated, with the largest number of responses coming from Latin America (36.8 ​%). 75.4 ​% of respondents believe that patients with knee hyperextension tend to have more ACL tears, and 90.4 ​% believe that those who undergo ACL reconstruction have higher rates of reconstruction failure. Regarding surgical technique and graft type, 66.7 ​% of respondents modify their approach when treating patients with knee hyperextension. 82.7 ​% of respondents do not change the position of the bone tunnels, while 12.9 ​% reported placing the tibial tunnel more posteriorly. The most used grafts are hamstrings (38.4 ​%) and bone-patellar tendon-bone (BTB) (37.2 ​%). Allografts are preferred by only 5.9 ​% of respondents, and 75.9 ​% of surgeons are not concerned about using autografts, even in cases of suspected collagen disorders. 89.5 ​% of respondents believe adding an extra-articular procedure could minimize failure risk. The most used extra-articular procedure is lateral extra-articular tenodesis (LET) (63.9 ​%).</div></div><div><h3>Conclusion</h3><div>ACL surgeons across diverse regions, demographics, experience levels, and surgical volumes tend to modify their approach for patients with knee hyperextension or ligamentous hyperlaxity. Hamstring and BTB grafts are most commonly used, with the vast majority not changing tunnel positioning. Most fix the graft at 20–30° of knee flexion and believe that lateral augmentations reduce failure rates in this population, with LET being the preferred technique.</div></div><div><h3>Level of evidence</h3><div>Level V, expert opinion study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101021"},"PeriodicalIF":3.3,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370425","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":"Anterior cruciate ligament injury is rarely the last dance for professional basketball players: High return to play with longer recovery times. A systematic review and meta-analysis","authors":"Riccardo D'Ambrosi MD ,&nbsp;Derya Akbaba MD ,&nbsp;Alessandro Carrozzo MD ,&nbsp;Lorenzo Tagliabue MD ,&nbsp;Luca M. Sconfienza MD ,&nbsp;Elmar Herbst MD PhD ,&nbsp;Elisabeth Abermann MD ,&nbsp;Christian Fink MD","doi":"10.1016/j.jisako.2025.101023","DOIUrl":"10.1016/j.jisako.2025.101023","url":null,"abstract":"<div><h3>Importance</h3><div>Anterior cruciate ligament (ACL) injuries are considered one of the most serious setbacks for professional basketball players. While return to play (RTP) is commonly achieved in other sports, the impact of ACL reconstruction (ACLR) on RTP rate, timing, and re-rupture in elite basketball remains unclear.</div></div><div><h3>Aim</h3><div>To evaluate the rate, timing, and level of RTP, as well as re-rupture rates, in professional basketball players following ACL reconstruction, and to assess whether these outcomes have changed over time. We hypothesized that while overall RTP rates would remain high, time to RTP may have increased over the past decade, reflecting evolving rehabilitation protocols and return to sport criteria.</div></div><div><h3>Evidence review</h3><div>A comprehensive search of PubMed, Embase, and Cochrane Library was performed (last updated July 2025) following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies were included if they reported RTP outcomes in skeletally mature professional basketball players after primary ACLR. Four distinct outcome measures were extracted and documented: RTP, time to RTP, level of RTP, and ACL re-rupture. Meta-regression was performed based on the publication period (before 2016, 2016-2020, after 2020).</div></div><div><h3>Findings</h3><div>Eight studies were included. The pooled RTP rate was 86.8% (95% confidence interval [CI], 79.5-92.8%), with 97.2% (95% CI, 86.9-100.0%) of players returning to their pre-injury level. The mean time to RTP was 367 days (95% CI, 357-376), increasing significantly in recent years (p ​= ​0.012). The overall ACL re-rupture rate was 1.8% (95% CI, 0.2-4.6%). No significant differences were observed in RTP or re-rupture rates across time periods, but a progressive increase in time to RTP was noted.</div></div><div><h3>Conclusion</h3><div>Professional basketball players achieve high rates of RTP after ACLR, with most returning to their pre-injury level. Re-rupture rates are low; however, time to RTP has increased in recent years, likely reflecting more conservative, criteria-based rehabilitation strategies. ACL injury is no longer a career-ending event in elite basketball but a longer and more complex recovery may be required.</div></div><div><h3>Level of Evidence</h3><div>Level IV.</div></div><div><h3>Registration</h3><div>PROSPERO Registry (CRD420251113289).</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101023"},"PeriodicalIF":3.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356403","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":"Treatment of multiple chondral/osteochondral lesions in the knee of a juvenile athlete: A case report with literature review","authors":"Daniel P. Leal MD ,&nbsp;Victor Mores MD ,&nbsp;Bruno B. Varone MD ,&nbsp;Riccardo G. Gobbi MD, PhD ,&nbsp;Luís E.P. Tirico MD, PhD","doi":"10.1016/j.jisako.2025.100928","DOIUrl":"10.1016/j.jisako.2025.100928","url":null,"abstract":"<div><div>Chondral and osteochondral lesions in the knee, particularly in juvenile athletes, pose significant challenges due to their impact on joint functionality and the complexity of treatment. This case report describes the management of a 14-year-old soccer athlete with osteochondritis dissecans of the lateral femoral condyle and a subsequent grade IV chondral lesion in the femoral trochlea. The initial treatment with fresh osteochondral transplantation resulted in osteointegration, pain resolution, and restored functionality. During rehabilitation, a secondary trochlear lesion developed and was treated with a combination of micro-fragmented autologous adipose tissue and a collagen membrane. The patient showed significant improvements in functional scores (Internation Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala, and Lysholm) and magnetic resonance imaging–confirmed cartilage regeneration and returned to sports-specific training. These findings highlight the potential of regenerative techniques for cartilage repair in young athletes. Further research is needed to validate these results in larger cohorts with extended follow-ups.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 100928"},"PeriodicalIF":3.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330244","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":"Biomechanical evaluation of four biceps tenodesis locations: A comparative study of ultimate failure load and tendon displacement","authors":"Supanat Vaivoothpinyo M.D,&nbsp;Prakasit Sanguanjit M.D,&nbsp;Adinun Apivatgaroon M.D,&nbsp;Punnawit Pinitchanon,&nbsp;Seksan Kukreja","doi":"10.1016/j.jisako.2025.101018","DOIUrl":"10.1016/j.jisako.2025.101018","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>Biceps tenodesis is a widely accepted treatment for patients with long-head biceps tendinopathy, particularly in younger, high-demand individuals. Despite its efficacy, the biomechanically optimal location for biceps tenodesis remains a subject of ongoing debate. This biomechanical study aims to compare the ultimate failure load and tendon displacement across four distinct biceps tenodesis locations in fresh-frozen human humeri to determine the strongest and most stable fixation site.</div></div><div><h3>Methods</h3><div>Fresh-frozen porcine tendons were fixed using interference screws at four biceps tenodesis sites (intra-articular, biceps groove, suprapectoral, and subpectoral) on six fresh-frozen human humeri. Each construct was subjected to cyclic loading (50 ​N–100 ​N for 5000 cycles), followed by continuous load increments until failure occurred. The ultimate failure load and tendon displacement were recorded. A linear mixed model was applied to account for the multilevel model testing.</div></div><div><h3>Results</h3><div>The mean ultimate failure loads for each group were as follows: intra-articular, 261.2 ​± ​78 ​N; biceps groove, 305 ​± ​113 ​N; suprapectoral, 337 ​± ​64 ​N; and subpectoral, 274.3 ​± ​108 ​N. Statistical analysis demonstrated a significant difference between the intra-articular and suprapectoral groups (p value ​= ​0.03). No other pairwise comparisons in the subgroup analysis revealed significant differences.</div></div><div><h3>Conclusions</h3><div>The suprapectoral location demonstrated the highest ultimate failure load, with statistically significant differences compared with the intra-articular group (p value ​= ​0.03) but not with the biceps groove and subpectoral groups. However, the results are specific to the interference screw fixation technique.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 101018"},"PeriodicalIF":3.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330332","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}