Annals of Joint最新文献

Background and objective: The integration of artificial intelligence (AI) into medical education is reshaping traditional learning paradigms. In orthopaedic surgery, AI applications such as virtual reality (VR) and augmented reality (AR) simulations and intelligent tutoring systems are being utilized to enhance training. This review aims to explore the current applications, benefits, challenges, and future directions of AI in orthopaedic education, while also addressing relevant ethical and logistical considerations.

Methods: A targeted literature review was conducted using PubMed, prioritizing studies published in 2024 and including relevant articles from 2023. Search terms included "artificial intelligence", "orthopaedic education", "surgical simulation", and related keywords. Studies were selected based on relevance to orthopaedic surgery education, with a particular focus on surgical skill acquisition, diagnostic training, and curriculum development. Both peer-reviewed and selected non-peer-reviewed sources were analyzed to synthesize current trends and emerging practices. Relevant articles were also identified using manual reference searching.

Key content and findings: The review highlights a positive shift in attitudes toward AI among educators and learners, particularly for its ability to simulate surgical environments safely and personalize learning. Current applications include AI-powered VR/AR platforms for realistic procedural training, intelligent tutoring systems that tailor feedback to individual learning gaps, and tools for enhancing diagnostic reasoning. Despite these advances, challenges remain, including concerns about overreliance on technology, institutional readiness, and the need for adjustments to the curriculum.

Conclusions: AI presents a transformative opportunity for orthopaedic education by enabling safer, more personalized, and more efficient learning. While current applications show promising results in improving both knowledge and technical skill, ongoing evaluation, thoughtful integration, and structured implementation are necessary to maximize educational value while addressing limitations and ethical concerns.

Background: A clear synthesis of anterior cruciate ligament (ACL) injuries across various sports is lacking. This review aimed to explore the ACL injury across various sports, with focus on the injury mechanism, situational patterns and the circumstances of the ACL injury in articles using video analyses on American football, Australian football, basketball, football (soccer), handball, and rugby.

Methods: A systematic literature search in four databases was conducted in October 2023. English-language articles that analyzed the injury mechanism and situational patterns of ACL injuries through video analysis in American football, Australian football, basketball, football (soccer), handball, and rugby, were considered for inclusion. Data of the injury mechanism, offensive and defensive play, when the injury occurred during the game, the player position, and the horizontal velocity of which the injury occurred were summarized using weighted averages with standard deviation for all, and for respective sports.

Results: Twenty-eight articles were included in this scoping review with 1,274 professional athletes, of whom 1,055 (83%) were men. The most common ACL injury mechanism across all sports was non-contact with 43.7%±12.0% of ACL injuries. With regard to game play, the distribution of ACL injuries during offensive versus defensive play was relatively even across all sports (47.2%±20.6% offensive vs. 49.1%±20.9% defensive). Most ACL injuries occurred during the first half across all sports (57.5%±8.9%). The most frequent horizontal velocity at the time of the ACL injury was medium (46.0%±9.9%), corresponding to running, and high to very high velocities (43.4%±18.3%) across all sports.

Conclusions: This scoping review provides an overview of the ACL injury mechanisms, situational patterns, and injury circumstances associated with ACL injuries across multiple sports. By examining the role of contact, type of game play, timing, player position, and horizontal velocity in injury occurrence, this review offers valuable insights for both injury prevention and future research. To understand these factors can inform more effective prevention strategies and help reduce the incidence of ACL injuries in athletes.

The medial meniscus posterior root (MMPR) provides biomechanical support to the medial compartment of the knee. An MMPR tear confers significantly increased peak contact pressures in the medial compartment. MMPR tears (MMPRTs), when unrecognized or when treated nonoperatively, often result in rapid progression of osteoarthritis. Once described as a silent epidemic, awareness of the clinical presentation and common imaging findings associated with MMPRTs has improved recognition of MMPRTs by orthopedic surgeons. The majority of patients with MMPRTs are candidates for repair of the MMPR whenever possible. In patients with early osteoarthritis, coronal knee malalignment, advanced age, or irreparable tear patterns, the indications for management are not well defined. Various techniques for repair for the repair of MMPR have been described, including the arthroscopic approach, suture configurations, and different implant properties. In addition to the repair of the MMPR, a novel technique aiming to centralize the meniscus can decrease meniscal extrusion, which is often not reliably addressed with MMPR repair alone. While MMPRTs remain a challenging injury for patients, increased recognition of these tears allows for improved decision-making regarding management of these injuries. Surgical management techniques continue to be refined and are aimed at restoring native anatomy of the medial meniscus to the extent possible, with the ultimate goal of prolonging the life of the native knee and facilitating a return to satisfactory function.

Background and objective: Multiligament knee injuries (MLKIs), although rare in athletes, can present distinct challenges beyond the high-energy trauma commonly seen in the general population. The combination of anterior cruciate ligament (ACL) injury with other major knee stabilizers creates substantial treatment challenges as most athletes experience pressure to return to top-level sports quickly, while maintaining joint stability over a long career. This narrative review summarizes the epidemiology and biomechanics of common injury patterns, classification systems, surgical decision-making and rehabilitation strategies for managing multiple ligament knee injuries in athletes.

Methods: A narrative literature review was conducted using PubMed and MEDLINE databases, targeting English-language studies from 2000 to 2024. Relevant studies were identified through keyword searches including "multiligament knee injury", "ACL reconstruction", "athlete", "return to play", and "concomitant ligament injury". Studies focused on biomechanics, surgical technique, rehabilitation, biologic augmentation, and performance outcomes were included.

Key content and findings: MLKIs are recognized with an increasing incidence in athletes; however, they are not well studied in the literature outside of traumatic, typically high energy settings. In athletes, management becomes more complex as surgical intervention must be considered in tandem with return-to-play (RTP) necessitating individualized planning. Underlying knee biomechanics can help identify potential risk for specific injury patterns. Surgical reconstruction with autograft in a single staged procedure is preferred due to possible lower risk for re-rupture and potentially quicker return to sport; however, graft selection based on number of ligaments involved and timing of surgery remain points of controversy. Importantly, avoiding tunnel collision during MLKI reconstruction adds a unique challenge and requires thoughtful surgical preoperative planning. Appropriate rehabilitation is critical as well to allow RTP at the same level. Generally, early range of motion with progressive weight bearing is recommended with an additive potential for standardized testing to evaluate for RTP. As MLKI research continues to progress, identifying optimal graft selection, timing of reconstruction, and rehabilitation protocols with a potential role for biologics will improve athletes' successful RTP.

Conclusions: MLKIs in athletes present unique challenges that extend beyond those seen in high-energy trauma cases. Coordinating surgical management with RTP goals requires individualized planning and thoughtful rehabilitation. Ongoing research is needed to refine graft selection, surgical timing, and recovery protocols. In this narrative review, we aim to review the literature, highlight treatment gaps and future areas of research, and provide

Background and objective: Cartilage lesions of the knee occur frequently and can cause debilitating symptoms such as pain, swelling, locking, clicking, or catching. In some lesions, both the cartilage and underlying subchondral bone are affected, which may require treatment of both the osseous and cartilaginous units. The objective of this review was to assess the available evidence of advanced treatments for osteochondral lesions in the knee.

Methods: A literature search was conducted in the electronic databases of PubMed, Embase and Cochrane Library for a narrative review on studies reporting outcomes of osteochondral knee treatments. Studies were included if they reported outcomes at minimum 1-year follow-up and had minimum 5 patients, and biomechanical, translational and basic science studies were excluded.

Key content and findings: In addition to chondroplasty and microfracture, four major advanced osteochondral restoration procedures aimed at treating injuries to the osteochondral unit were identified in the literature, which consisted of surgical internal fixation of either acute osteochondral fragments or osteochondritis dissecans (OCD) lesions, osteochondral autograft transplantation (OAT), osteochondral allograft (OCA) transplantation and biphasic scaffold implantation. Internal fixation of acute osteochondral patellofemoral fractures has been found to have superior outcomes compared to fragment removal, but does require concomitant patellar stabilization. Fixation of OCD also leads to good outcomes without superiority for fixation method. Osteochondral autograft is an excellent treatment option for smaller defects and has a high rate of return to sport. OCA outcomes are excellent with good survival rates although reoperations can frequently occur. Finally, biphasic scaffolds are relatively recent and can be used in both more acute as well as more degenerative settings and the short-term outcomes are promising.

Conclusions: Osteochondral injury in the knee requires unique treatment options as both the underlying bone and cartilage need to be treated, due to their poor healing capacity and significant cause of morbidity. Several treatment options exist and the overall outcomes of these treatments are satisfactory in improving patient-reported outcomes, and most patients can return to activities.

Posterior shoulder instability should be increasingly recognized in patients with acute shoulder dislocations or instability, while also warranting a high index of suspicion in contact athletes with insidious onset of shoulder pain. Athletes often present with vague symptoms, typically including deep-seated joint pain and frequently without a described acute traumatic event. The contact athlete will often complain of pain with push-ups and bench press, particularly provoked during blocking motions relevant to football linemen and linebackers. In addition to a patulous posterior capsule, bony morphology can contribute to increased risk of posterior shoulder instability, such as a reverse Hill-Sachs lesion, glenoid dysplasia, glenoid retroversion and posterior acromial height. Posterior bone defects occur in a predictable pattern within the posteroinferior quadrant of the glenoid face and 15% of posterior glenoid bone loss can lead to a 25 times higher failure rate of arthroscopic posterior shoulder stabilization alone. While arthroscopic posterior shoulder stabilization is the gold standard in the absence of substantial posterior glenoid bone loss, posterior bone block stabilization may be necessitated in patients with significant posterior glenoid bone loss or retroversion, or who have failed a previous arthroscopic soft tissue procedure. Free bone block augmentation for posterior glenoid reconstruction has demonstrated compelling short-term results, yet there are no long-term outcome data or comparative studies reporting on the outcomes of these relatively new techniques. Overall, arthroscopic posterior shoulder stabilization leads to high patient satisfaction and excellent clinical outcomes. Contact athletes generally demonstrate similar patient-reported and functional outcomes when compared to overhead throwing athletes. However, contact athletes generally return to sport and previous level of play at a higher rate compared to overhead throwing athletes, potentially due to the lower dynamic stressor applied across the glenohumeral joint, typically at mid-range of motion, compared to the overhead throwing athlete. Findings suggest that comprehensive evaluation and individualized treatment strategies are necessary for optimizing patient outcomes and return to sport among contact athletes.

Patellofemoral instability (PFI) is a relatively common injury in the young, athletic population and remains a significant source of knee pain and functional limitation. It most frequently affects athletes who participate in sports that involve repetitive jumping, cutting, and pivoting motions, such as basketball, soccer, and volleyball. During the competitive season, managing this condition becomes particularly challenging. Athletes are often eager to return to play, while clinicians must weigh the risks of early return against the need for sufficient recovery to prevent re-injury. As a result, in-season management continues to be a topic of ongoing discussion and debate. This review explores the comprehensive evaluation and treatment of PFI, with a focus on both non-surgical and surgical options. Non-surgical management, including rehabilitation and activity modification, is typically favored for first-time dislocations or in the absence of significant anatomical abnormalities. Surgical intervention is considered in cases of recurrent instability or when structural issues are identified. In addition to physical treatment, rehabilitation plays a central role in restoring strength, stability, and neuromuscular control. Equally important is psychological readiness, which is increasingly recognized as a critical factor in safely returning athletes to sport. A well-rounded approach that addresses both physical and mental recovery is essential for optimal outcomes.

Anterior cruciate ligament (ACL) graft failure following ACL reconstruction (ACLR) remains a persistent challenge, especially in the high-level athlete. This review aims to provide a comprehensive overview of the key considerations in revision ACLR, with a particular focus on the high-level athlete. ACL graft failure is multifactorial in origin, with the most common technical error being femoral tunnel malposition. Preoperative evaluation should include a thorough history, physical examination, and advanced imaging such as magnetic resonance imaging and three-dimensional (3D) computed tomography (CT) to assess tunnel position, osteolysis, and associated intra-articular pathology. Concomitant injuries, including meniscal tears and collateral ligament insufficiencies, must be identified and appropriately addressed during revision surgery. Surgical planning must consider prior ACL graft choice, ACL tunnel position, and the potential need for a staged procedure. ACL graft selection should be individualized, though autografts, particularly bone-patellar tendon-bone (BPTB) and quadriceps tendon (QT), are preferred over hamstring tendon (HT) or allograft due to superior outcomes. The decision to perform a single-stage versus two-stage revision is influenced by tunnel placement and tunnel lysis, with a CT scan aiding in preoperative planning. Adjunctive procedures such as a lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction may be considered when certain high-risk characteristics are present, such as young age, knee hyperextension >5 degrees, high-grade pivot shift, multiple revisions, and increased posterior tibial slope (PTS) not meeting criteria for slope-correcting osteotomy. Additionally, slope-reducing or coronal alignment-correcting osteotomies may be necessary in select cases to optimize knee biomechanics and prevent further failure, but literature regarding return to high-level sport following these procedures is limited. Return to sport (RTS) following revision ACLR should be approached as a continuum, incorporating strength, neuromuscular control, and psychological readiness, with emphasis on individualized, criteria-based protocols. Delaying RTS to at least 9 months postoperatively has been associated with reduced ACL graft failure risk. Overall, revision ACLR in the high-level athlete is a complex and nuanced procedure that requires a meticulous, multifactorial approach. By tailoring surgical strategies and postoperative rehabilitation, surgeons can optimize outcomes and facilitate a safe return to competitive sport.

Background and objective: Anterior cruciate ligament (ACL) reconstructions remain a prominent surgery performed in the United States. Despite continuous efforts from surgeons and rehabilitation specialists, the return to previous levels of sports participation remains low and the reinjury rates remain high. The purpose of this narrative review is to summarize the progression of post-operative rehabilitation following ACL reconstruction in elite and professional athletes.

Methods: A literature review was conducted in 2025, searching for the most up-to-date evidence on criterion-based rehabilitation programs and rehabilitation strategies in the English language.

Key content and findings: For the purpose of this narrative, the rehabilitation progression begins when the athlete is cleared to begin a jogging progression and highlights the inclusion of all members of the sports medicine and sports performance teams within the rehabilitation process. The narrative review highlights the three elements of the return to sport (RTS) continuum: returning to participation, sport, and performance. In each element, the athlete's goals are defined and how the rehabilitation and performance teams work together to address them. In order for the athlete to progress within their rehabilitation program, they must demonstrate mastery of simple, controlled tasks and movements before performing complex, chaotic ones. This principle also applies to their reintroduction and progression in sports participation. In using these principles, we outline a progression that uses a criterion-based progression, coinciding with time after surgery, to minimize risk of reinjury and restore performance metrics during the rehabilitation and RTS and performance processes. This method also allows the rehabilitation and performance teams to assess, track, and improve upon key performance indicators throughout the rehabilitation process. Examples include, but are not limited to, objective strength testing, jump testing using force plates, volume ran and maximum velocity during rehabilitation and practice sessions, and psychological readiness.

Conclusions: This review demonstrates how the principles of the Control-Chaos Continuum, Return to Sport Continuum and Return to Sport Clearance Continuum help to navigate the sport-specific progression of rehabilitation. The review can be generalized to all sports, but there is a specific focus on basketball, football, soccer, and skiing.