Pub Date : 2026-02-12DOI: 10.1177/03635465251408091
Alessandro Carrozzo, Valerio Nasso, Alessandro Annibaldi, Susanna Maria Pagnotta, Silvia Cardarelli, Pierfrancesco Orlandi, Gianluca Ciccarelli, Andrea Ferretti, Edoardo Monaco
Background: Lateral extra-articular tenodesis (LET) combined with anterior cruciate ligament reconstruction (ACLR) has been shown to reduce graft failure. While the benefits of techniques such as the modified Lemaire procedure and anterolateral ligament reconstruction are well documented, the literature on other LET techniques is more limited. Purpose: To evaluate the clinical outcomes and risk factors for failure in patients undergoing ACLR combined with LET using the Coker-Arnold modification of the MacIntosh technique. Study Design: Case series; Level of evidence, 4. Methods: This retrospective case series included patients who underwent primary ACLR using a hamstring tendon autograft along with concurrent LET at a single institution between 2013 and 2022. Clinical evaluations included subjective outcome measures (International Knee Documentation Committee [IKDC] score, Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm score, and Tegner score) and objective KT-1000 arthrometer testing. Risk factors for graft failure were identified using multivariate logistic regression. Results: The final study cohort consisted of 328 patients. At a mean follow-up of 72.4 ± 30.3 months, 11 patients (3.4%) experienced graft failure. The mean side-to-side difference according to the KT-1000 arthrometer was 1.45 ± 1.04 mm. Patients showed excellent outcomes, with 91.5% achieving the patient acceptable symptom state (PASS) for the IKDC score and >90.0% achieving the PASS for all KOOS subscales, except for the Activities of Daily Living subscale (79.6%). High Tegner scores (≥8) and the presence of chondral lesions were independently associated with graft failure (odds ratio, 6.82 and 5.89, respectively; P < .01). Age, sex, pivot-shift grade, meniscal status, and timing of surgery were not predictive of failure. Conclusion: Combined ACLR and LET using the Coker-Arnold modification of the MacIntosh technique led to a 3.4% failure rate at a mean follow-up of >5 years. Higher Tegner scores and the presence of chondral lesions were found to be independently associated with reruptures.
{"title":"Clinical Outcomes of Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-articular Tenodesis Using the Coker-Arnold Technique: A Retrospective Case Series of 328 Patients With a 72-Month Follow-up","authors":"Alessandro Carrozzo, Valerio Nasso, Alessandro Annibaldi, Susanna Maria Pagnotta, Silvia Cardarelli, Pierfrancesco Orlandi, Gianluca Ciccarelli, Andrea Ferretti, Edoardo Monaco","doi":"10.1177/03635465251408091","DOIUrl":"https://doi.org/10.1177/03635465251408091","url":null,"abstract":"Background: Lateral extra-articular tenodesis (LET) combined with anterior cruciate ligament reconstruction (ACLR) has been shown to reduce graft failure. While the benefits of techniques such as the modified Lemaire procedure and anterolateral ligament reconstruction are well documented, the literature on other LET techniques is more limited. Purpose: To evaluate the clinical outcomes and risk factors for failure in patients undergoing ACLR combined with LET using the Coker-Arnold modification of the MacIntosh technique. Study Design: Case series; Level of evidence, 4. Methods: This retrospective case series included patients who underwent primary ACLR using a hamstring tendon autograft along with concurrent LET at a single institution between 2013 and 2022. Clinical evaluations included subjective outcome measures (International Knee Documentation Committee [IKDC] score, Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm score, and Tegner score) and objective KT-1000 arthrometer testing. Risk factors for graft failure were identified using multivariate logistic regression. Results: The final study cohort consisted of 328 patients. At a mean follow-up of 72.4 ± 30.3 months, 11 patients (3.4%) experienced graft failure. The mean side-to-side difference according to the KT-1000 arthrometer was 1.45 ± 1.04 mm. Patients showed excellent outcomes, with 91.5% achieving the patient acceptable symptom state (PASS) for the IKDC score and >90.0% achieving the PASS for all KOOS subscales, except for the Activities of Daily Living subscale (79.6%). High Tegner scores (≥8) and the presence of chondral lesions were independently associated with graft failure (odds ratio, 6.82 and 5.89, respectively; <jats:italic toggle=\"yes\">P</jats:italic> < .01). Age, sex, pivot-shift grade, meniscal status, and timing of surgery were not predictive of failure. Conclusion: Combined ACLR and LET using the Coker-Arnold modification of the MacIntosh technique led to a 3.4% failure rate at a mean follow-up of >5 years. Higher Tegner scores and the presence of chondral lesions were found to be independently associated with reruptures.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160403","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}
Pub Date : 2026-02-12DOI: 10.1177/03635465251411932
Armin Runer, Svenja A. Höger, Joshua Frantz, Benjamin Moyer, Emre Anil Özbek, Camila Grandberg, Monica A. Linde, Michael P. Smolinski, Mark C. Miller, Volker Musahl, Sachin Tapasvi, Patrick J. Smolinski
Background: The resistance to gap development under repetitive loading influences the probability of meniscal healing after meniscal repair. The optimal meniscal suture interval spacing for repairing longitudinal meniscal tears is poorly understood. This study aimed to investigate the effect of varying suture interval spacings on the biomechanical properties of vertical meniscal repairs. Hypothesis: There is a critical meniscal suture interval spacing beyond which the gap development during cycling loading increases and the stiffness of the construct decreases. Study Design: Controlled laboratory study. Methods: In 50 bovine menisci, complete vertical circumferential meniscal tears were created. All lesions were repaired using two 2-0 braided sutures with the vertical mattress inside-out technique. Five suture spacings (3, 5, 7, 9, and 11 mm) with 10 samples each were tested. Each sample underwent 1000 loading cycles between 5 and 20 N (combined load) at a 75-mm/min crosshead speed and subsequent load-to-failure testing. The tear opening gap between the 2 meniscal sutures was measured using the Digital Image Correlation system with 2 high-speed cameras after 10, 100, 500, and 1000 cycles. Gap formation, cyclic stiffness, and failure modes were measured. A 1-way analysis of variance with post hoc t testing with Bonferroni correction for significant pairwise analysis of all outcome variables was performed. Statistical significance was set at a P value <.05. Results: Meniscal repairs with suture interval spacings of 3 mm, 5 mm, and 7 mm demonstrated statistically significantly smaller gap formation—a mean of 36% less—compared with spacings of 9 mm and 11 mm. There were no significant differences in gap formation between the suture interval spacings of 3 mm, 5 mm, and 7 mm. Construct stiffness was significantly higher with a suture interval spacing of 7 mm and less compared with ≥9 mm (all P < .05). No significant differences in construct stiffness were observed among the 3-mm, 5-mm, and 7-mm suture intervals. Suture breakage occurred in 76% of cases (38/50), suture cut-through in 22% (11/50), and a combination of both in 2% (1/50). Failure mode did not correlate with suture distance. Conclusion: Meniscal repair with a suture interval spacing of ≤7 mm demonstrates significantly lower gap formation and higher construct stiffness during cyclic loading than interval spacings of >7 mm. Based on these biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears. Clinical Relevance: On the basis of this biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears.
{"title":"Suture Interval Spacing in Meniscal Repair— Aim for ≤7 mm: A Biomechanical Study: ISAKOS Albert Trillat Award 2025","authors":"Armin Runer, Svenja A. Höger, Joshua Frantz, Benjamin Moyer, Emre Anil Özbek, Camila Grandberg, Monica A. Linde, Michael P. Smolinski, Mark C. Miller, Volker Musahl, Sachin Tapasvi, Patrick J. Smolinski","doi":"10.1177/03635465251411932","DOIUrl":"https://doi.org/10.1177/03635465251411932","url":null,"abstract":"Background: The resistance to gap development under repetitive loading influences the probability of meniscal healing after meniscal repair. The optimal meniscal suture interval spacing for repairing longitudinal meniscal tears is poorly understood. This study aimed to investigate the effect of varying suture interval spacings on the biomechanical properties of vertical meniscal repairs. Hypothesis: There is a critical meniscal suture interval spacing beyond which the gap development during cycling loading increases and the stiffness of the construct decreases. Study Design: Controlled laboratory study. Methods: In 50 bovine menisci, complete vertical circumferential meniscal tears were created. All lesions were repaired using two 2-0 braided sutures with the vertical mattress inside-out technique. Five suture spacings (3, 5, 7, 9, and 11 mm) with 10 samples each were tested. Each sample underwent 1000 loading cycles between 5 and 20 N (combined load) at a 75-mm/min crosshead speed and subsequent load-to-failure testing. The tear opening gap between the 2 meniscal sutures was measured using the Digital Image Correlation system with 2 high-speed cameras after 10, 100, 500, and 1000 cycles. Gap formation, cyclic stiffness, and failure modes were measured. A 1-way analysis of variance with post hoc <jats:italic toggle=\"yes\">t</jats:italic> testing with Bonferroni correction for significant pairwise analysis of all outcome variables was performed. Statistical significance was set at a <jats:italic toggle=\"yes\">P</jats:italic> value <.05. Results: Meniscal repairs with suture interval spacings of 3 mm, 5 mm, and 7 mm demonstrated statistically significantly smaller gap formation—a mean of 36% less—compared with spacings of 9 mm and 11 mm. There were no significant differences in gap formation between the suture interval spacings of 3 mm, 5 mm, and 7 mm. Construct stiffness was significantly higher with a suture interval spacing of 7 mm and less compared with ≥9 mm (all <jats:italic toggle=\"yes\">P</jats:italic> < .05). No significant differences in construct stiffness were observed among the 3-mm, 5-mm, and 7-mm suture intervals. Suture breakage occurred in 76% of cases (38/50), suture cut-through in 22% (11/50), and a combination of both in 2% (1/50). Failure mode did not correlate with suture distance. Conclusion: Meniscal repair with a suture interval spacing of ≤7 mm demonstrates significantly lower gap formation and higher construct stiffness during cyclic loading than interval spacings of >7 mm. Based on these biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears. Clinical Relevance: On the basis of this biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160404","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}
Pub Date : 2026-02-12DOI: 10.1177/03635465261415837
Van S. Krueger, Roslyn M. Kackman, Jordan K. Penn, Julie C. McCauley, William D. Bugbee, Tim Wang
Background: There are few studies reporting the midterm outcomes of osteochondral allograft (OCA) transplantation for chondral lesions in the patellofemoral joint, particularly in patients who are not receiving a high rate of concomitant realignment procedures. Purpose: To report clinical outcomes among patients undergoing OCA transplantation of the patellofemoral joint, and compare differences between patellar, trochlear, and bipolar (patellar and trochlear) grafts. Study Design: Case series; Level of evidence, 4. Methods: The authors identified 127 knees that underwent OCA transplantation in the patellofemoral compartment (51 patella, 47 trochlea, 29 bipolar patella and trochlea). A concomitant tibial tubercle osteotomy was performed in 5 knees (4%). Reoperations were documented, and OCA failure was defined as any reoperation that involved removal of the allograft. International Knee Documentation Committee (IKDC) subjective knee score, Knee injury and Osteoarthritis Outcome Score (KOOS), and satisfaction were assessed preoperatively and postoperatively with a minimum 2-year follow-up. Results: Reoperations occurred in 49 knees (39%) at a median time to first reoperation of 1.9 years, and did not differ among patellar (47%), trochlear (30%), and bipolar (38%) grafts ( P = .214). OCA failures occurred in 20 knees (16%) at a median of 4.4 years postoperatively. The failure rates for trochlear (9%), patellar (20%), and bipolar grafts (21%) did not differ ( P = .227). Graft survivorship rates at 5 and 10 years were 91% and 82%, respectively (85% and 78% for patellar grafts, 100% and 93% for trochlear grafts, and 87% and 68% for bipolar grafts ( P = .120). Among grafts in situ, the mean follow-up duration was 7.5 years (range, 2-19 years). Patients had significant improvements in IKDC and KOOS values at the latest follow-up (all P < .05), with no statistically significant differences among groups. Overall, 77% of cases reported being satisfied with the OCA transplantation (80% in the patellar group, 78% in the trochlear group, and 68% in the patellar and trochlear group; P = .555). Conclusion: Patients undergoing patellofemoral OCA transplantation exhibited high survival rates at 5 and 10 years, along with improved patient-reported outcomes when performed without concomitant tibial tubercle osteotomy. Trochlear grafts had greater survivorship than isolated patellar or bipolar grafts, and outcomes were comparable to those of OCA transplantation performed in the femoral condyles.
{"title":"Midterm Outcomes of Patellofemoral Osteochondral Allograft Transplantation: A Comparison of Patellar, Trochlear, and Bipolar Grafts","authors":"Van S. Krueger, Roslyn M. Kackman, Jordan K. Penn, Julie C. McCauley, William D. Bugbee, Tim Wang","doi":"10.1177/03635465261415837","DOIUrl":"https://doi.org/10.1177/03635465261415837","url":null,"abstract":"Background: There are few studies reporting the midterm outcomes of osteochondral allograft (OCA) transplantation for chondral lesions in the patellofemoral joint, particularly in patients who are not receiving a high rate of concomitant realignment procedures. Purpose: To report clinical outcomes among patients undergoing OCA transplantation of the patellofemoral joint, and compare differences between patellar, trochlear, and bipolar (patellar and trochlear) grafts. Study Design: Case series; Level of evidence, 4. Methods: The authors identified 127 knees that underwent OCA transplantation in the patellofemoral compartment (51 patella, 47 trochlea, 29 bipolar patella and trochlea). A concomitant tibial tubercle osteotomy was performed in 5 knees (4%). Reoperations were documented, and OCA failure was defined as any reoperation that involved removal of the allograft. International Knee Documentation Committee (IKDC) subjective knee score, Knee injury and Osteoarthritis Outcome Score (KOOS), and satisfaction were assessed preoperatively and postoperatively with a minimum 2-year follow-up. Results: Reoperations occurred in 49 knees (39%) at a median time to first reoperation of 1.9 years, and did not differ among patellar (47%), trochlear (30%), and bipolar (38%) grafts ( <jats:italic toggle=\"yes\">P</jats:italic> = .214). OCA failures occurred in 20 knees (16%) at a median of 4.4 years postoperatively. The failure rates for trochlear (9%), patellar (20%), and bipolar grafts (21%) did not differ ( <jats:italic toggle=\"yes\">P</jats:italic> = .227). Graft survivorship rates at 5 and 10 years were 91% and 82%, respectively (85% and 78% for patellar grafts, 100% and 93% for trochlear grafts, and 87% and 68% for bipolar grafts ( <jats:italic toggle=\"yes\">P</jats:italic> = .120). Among grafts in situ, the mean follow-up duration was 7.5 years (range, 2-19 years). Patients had significant improvements in IKDC and KOOS values at the latest follow-up (all <jats:italic toggle=\"yes\">P</jats:italic> < .05), with no statistically significant differences among groups. Overall, 77% of cases reported being satisfied with the OCA transplantation (80% in the patellar group, 78% in the trochlear group, and 68% in the patellar and trochlear group; <jats:italic toggle=\"yes\">P</jats:italic> = .555). Conclusion: Patients undergoing patellofemoral OCA transplantation exhibited high survival rates at 5 and 10 years, along with improved patient-reported outcomes when performed without concomitant tibial tubercle osteotomy. Trochlear grafts had greater survivorship than isolated patellar or bipolar grafts, and outcomes were comparable to those of OCA transplantation performed in the femoral condyles.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160439","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}
Pub Date : 2026-02-12DOI: 10.1177/03635465251411806
Paul R. Allegra, John F. Korzelius, Douglas J. Matijakovich, Ian J. Kremenic, Karl F. Orishimo, Susan Y. Kwiecien, Stephen J. Nicholas
Background: Meniscus root tears, if untreated, can lead to rapid osteoarthritic changes. Effective repairs are essential to maintain meniscal function and prevent degeneration. Hypothesis/Purpose: This study aimed to evaluate the integrity of medial meniscus (MM) root repairs performed using an inlay transosseous single-tunnel repair technique. It was hypothesized that such repairs could withstand physiological cyclic weightbearing in full extension. Study Design: Controlled laboratory study. Methods: Fifteen fresh-frozen cadaveric knee specimens (mean age, 67 ± 14 years) with intact collateral ligaments, cruciate ligaments, and meniscocapsular attachments were used. Diagnostic arthroscopy confirmed MM integrity in 11 specimens, which then underwent root detachment and repair using a transosseous single-tunnel technique. Metallic tracers were placed into the medial tibial spines and posterior horns of the medial menisci. Specimens were loaded in full extension using a tensile testing machine under 4 conditions: intact, cut, repaired, and repaired after cyclic loading (1700 N for 250 cycles). Fluoroscopic imaging, performed with standardized, reproducible positioning, documented meniscal displacement with known resolution. ImageJ software was used to calculate displacement normalized to tibial plateau width. Repair integrity after cyclic loading was assessed by arthroscopic inspection. Results: All specimens showed intact MM root repairs after cyclic loading. Significant meniscal displacement was observed between intact and cut states ( P = .044), intact and repaired states ( P = .020), and intact and repaired-cycled states ( P = .036). No significant difference was found between repaired and cut or between repaired and repaired-cycled states ( P > .05). Repairs did not catastrophically fail but demonstrated significant plastic deformation. Conclusion: MM root repairs using the transosseous single-tunnel technique do not withstand simulated physiological weightbearing in full extension and demonstrate meniscal displacement similar to that of the unrepaired (cut) state in a cadaveric model. Clinical Relevance: This study suggests that MM root repairs with this technique allow unacceptable displacement under physiological loads. These results provide insight into the biomechanical performance of meniscus root repairs and underscore the importance of establishing appropriate postoperative weightbearing protocols.
{"title":"Weightbearing After Medial Meniscus Root Repair: A Cadaveric Study Analyzing the Integrity of Meniscus Root Repairs Subjected to Physiological Cyclic Loading","authors":"Paul R. Allegra, John F. Korzelius, Douglas J. Matijakovich, Ian J. Kremenic, Karl F. Orishimo, Susan Y. Kwiecien, Stephen J. Nicholas","doi":"10.1177/03635465251411806","DOIUrl":"https://doi.org/10.1177/03635465251411806","url":null,"abstract":"Background: Meniscus root tears, if untreated, can lead to rapid osteoarthritic changes. Effective repairs are essential to maintain meniscal function and prevent degeneration. Hypothesis/Purpose: This study aimed to evaluate the integrity of medial meniscus (MM) root repairs performed using an inlay transosseous single-tunnel repair technique. It was hypothesized that such repairs could withstand physiological cyclic weightbearing in full extension. Study Design: Controlled laboratory study. Methods: Fifteen fresh-frozen cadaveric knee specimens (mean age, 67 ± 14 years) with intact collateral ligaments, cruciate ligaments, and meniscocapsular attachments were used. Diagnostic arthroscopy confirmed MM integrity in 11 specimens, which then underwent root detachment and repair using a transosseous single-tunnel technique. Metallic tracers were placed into the medial tibial spines and posterior horns of the medial menisci. Specimens were loaded in full extension using a tensile testing machine under 4 conditions: intact, cut, repaired, and repaired after cyclic loading (1700 N for 250 cycles). Fluoroscopic imaging, performed with standardized, reproducible positioning, documented meniscal displacement with known resolution. ImageJ software was used to calculate displacement normalized to tibial plateau width. Repair integrity after cyclic loading was assessed by arthroscopic inspection. Results: All specimens showed intact MM root repairs after cyclic loading. Significant meniscal displacement was observed between intact and cut states ( <jats:italic toggle=\"yes\">P</jats:italic> = .044), intact and repaired states ( <jats:italic toggle=\"yes\">P</jats:italic> = .020), and intact and repaired-cycled states ( <jats:italic toggle=\"yes\">P</jats:italic> = .036). No significant difference was found between repaired and cut or between repaired and repaired-cycled states ( <jats:italic toggle=\"yes\">P</jats:italic> > .05). Repairs did not catastrophically fail but demonstrated significant plastic deformation. Conclusion: MM root repairs using the transosseous single-tunnel technique do not withstand simulated physiological weightbearing in full extension and demonstrate meniscal displacement similar to that of the unrepaired (cut) state in a cadaveric model. Clinical Relevance: This study suggests that MM root repairs with this technique allow unacceptable displacement under physiological loads. These results provide insight into the biomechanical performance of meniscus root repairs and underscore the importance of establishing appropriate postoperative weightbearing protocols.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160441","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}
Pub Date : 2026-02-12DOI: 10.1177/03635465251411751
Daniel W. Green, Patrick P. Nian, Shae K. Simpson, Marco Crippa, Giulia Beltrame, Samuel A. Beber, Sarah Lu, Ariana I. Matarangas, Diego Jaramillo, Joshua T. Bram
Background: Trochlear dysplasia is the primary anatomic risk factor for patellofemoral instability (PFI), but current classification systems rely on qualitative observations and are limited in their reproducibility. The Dejour Version 3.0 (2025) classification was established on quantitative magnetic resonance imaging (MRI)–based measurements in adults, but its validity in the pediatric population has yet to be evaluated. Purpose: To (1) assess the accuracy of the Dejour MRI-based classification of trochlear dysplasia in the diagnosis of PFI in children and adolescents and (2) derive pediatrics-specific thresholds of MRI-based measurements of dysplasia and additional risk factors to optimally predict PFI. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 144 knees (127 patients) with objective PFI were age- and sex-matched to 144 controls. Four raters had excellent agreement on 7 measures of patellofemoral morphology: cartilaginous sulcus angle, lateral trochlear inclination, patellar tilt, lateral patellofemoral angle (LPFA), tibial tubercle–trochlear groove distance, sagittal central bump size, and Caton-Deschamps Index. Dejour Version 3.0 was assessed for sensitivity, specificity, and diagnostic accuracy, as defined by the area under the curve (AUC) for the respective receiver operating characteristic curves, within this study’s pediatric sample. Regression tree analysis with recursive partitioning was utilized to identify pediatrics-specific threshold values on MRI. Resulting combinations were assessed for their sensitivity, specificity, and diagnostic accuracy. The AUCs for the 2 options with the highest sensitivity were compared using a random forest (RF) model to evaluate optimal diagnostic accuracy. Results: Application of the 4 previously established adult cutoff combinations resulted in low/moderate sensitivity and fair/good diagnostic accuracy (range of AUCs, 0.79-0.87) in the study’s pediatric cohort. Regression tree analysis yielded 5 cutoff combinations, of which 2 achieved a sensitivity >90%. The first cutoff was a singular cartilaginous sulcus angle measurement ≥151° (sensitivity: 93% [95% CI, 87.6%-96.6%]; specificity: 87% [95% CI, 80.2%-91.9%]; AUC, 0.94); the second cutoff combination incorporated an LPFA cutoff <0.45° if the cartilaginous sulcus angle was <151° (sensitivity: 98% [95% CI, 94.0%-99.6%]; specificity: 85% [95% CI, 78.6%-90.7%]; AUC, 0.97). The AUC for the second cutoff combination was noninferior to the AUC (RF) by a prespecified ΔAUC of 0.03 ( <jats:italic toggle="yes">P</jats:italic> = .33). Conclusion: Application of the Dejour classification of trochlear dysplasia utilizing adult-specific thresholds yielded only moderate accuracy in the diagnosis of PFI in pediatric patients. The authors present an MRI-based classification system utilizing objective measurements of trochlear and patellofemoral morphology, emphasizing a 2-measurement combination of sulcus angle and LPFA that y
{"title":"Modification of Objective Dejour Criteria Yields Excellent Diagnostic Accuracy for Pediatric Patellofemoral Instability","authors":"Daniel W. Green, Patrick P. Nian, Shae K. Simpson, Marco Crippa, Giulia Beltrame, Samuel A. Beber, Sarah Lu, Ariana I. Matarangas, Diego Jaramillo, Joshua T. Bram","doi":"10.1177/03635465251411751","DOIUrl":"https://doi.org/10.1177/03635465251411751","url":null,"abstract":"Background: Trochlear dysplasia is the primary anatomic risk factor for patellofemoral instability (PFI), but current classification systems rely on qualitative observations and are limited in their reproducibility. The Dejour Version 3.0 (2025) classification was established on quantitative magnetic resonance imaging (MRI)–based measurements in adults, but its validity in the pediatric population has yet to be evaluated. Purpose: To (1) assess the accuracy of the Dejour MRI-based classification of trochlear dysplasia in the diagnosis of PFI in children and adolescents and (2) derive pediatrics-specific thresholds of MRI-based measurements of dysplasia and additional risk factors to optimally predict PFI. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 144 knees (127 patients) with objective PFI were age- and sex-matched to 144 controls. Four raters had excellent agreement on 7 measures of patellofemoral morphology: cartilaginous sulcus angle, lateral trochlear inclination, patellar tilt, lateral patellofemoral angle (LPFA), tibial tubercle–trochlear groove distance, sagittal central bump size, and Caton-Deschamps Index. Dejour Version 3.0 was assessed for sensitivity, specificity, and diagnostic accuracy, as defined by the area under the curve (AUC) for the respective receiver operating characteristic curves, within this study’s pediatric sample. Regression tree analysis with recursive partitioning was utilized to identify pediatrics-specific threshold values on MRI. Resulting combinations were assessed for their sensitivity, specificity, and diagnostic accuracy. The AUCs for the 2 options with the highest sensitivity were compared using a random forest (RF) model to evaluate optimal diagnostic accuracy. Results: Application of the 4 previously established adult cutoff combinations resulted in low/moderate sensitivity and fair/good diagnostic accuracy (range of AUCs, 0.79-0.87) in the study’s pediatric cohort. Regression tree analysis yielded 5 cutoff combinations, of which 2 achieved a sensitivity >90%. The first cutoff was a singular cartilaginous sulcus angle measurement ≥151° (sensitivity: 93% [95% CI, 87.6%-96.6%]; specificity: 87% [95% CI, 80.2%-91.9%]; AUC, 0.94); the second cutoff combination incorporated an LPFA cutoff <0.45° if the cartilaginous sulcus angle was <151° (sensitivity: 98% [95% CI, 94.0%-99.6%]; specificity: 85% [95% CI, 78.6%-90.7%]; AUC, 0.97). The AUC for the second cutoff combination was noninferior to the AUC (RF) by a prespecified ΔAUC of 0.03 ( <jats:italic toggle=\"yes\">P</jats:italic> = .33). Conclusion: Application of the Dejour classification of trochlear dysplasia utilizing adult-specific thresholds yielded only moderate accuracy in the diagnosis of PFI in pediatric patients. The authors present an MRI-based classification system utilizing objective measurements of trochlear and patellofemoral morphology, emphasizing a 2-measurement combination of sulcus angle and LPFA that y","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160440","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}
Pub Date : 2026-02-12DOI: 10.1177/03635465251410956
Corinne Maurice, Yoan Bourgeault-Gagnon, Joshua A.J. Keogh, Isabelle Keng, João Dinis, Manraj Nijjar, Etienne L. Belzile, Olufemi R. Ayeni
Background: Femoroacetabular impingement (FAI) morphology is common in asymptomatic adults. Spinopelvic alignment modulates hip mechanics and influences hip range of motion. Specific spinopelvic parameters, such as pelvic incidence and dynamic parameters, have been inconsistently associated with FAI. Yet, their specific influence on FAI morphology and symptomatology remains uncertain. Purpose: To determine how morphologic, postural, and dynamic spinopelvic parameters differ according to FAI morphology (cam, pincer) and symptomatology. Study Design: Meta-analysis; Level of evidence, 3. Methods: PubMed, EMBASE, and Scopus were searched from inception to December 23, 2024. Studies reporting spinopelvic parameters in symptomatic or asymptomatic FAI compared with controls were included. Two reviewers independently screened, extracted data, and rated methodological quality (Newcastle-Ottawa Scale [NOS]). Fixed- or random-effects meta-analyses of mean differences were stratified by parameter, FAI type, and concept (morphology vs symptomatology). Results: A total of 41 studies (n = 3750; 1343 symptomatic, 821 asymptomatic FAI; 1586 controls; median NOS 6/9) were included. Symptomatic cam hips had higher pelvic incidence (PI) than asymptomatic cam hips (mean difference [MD], 4.94° [95% CI, −0.10 to 9.98]; P = .05). Pincer morphology was linked to lower PI versus controls (MD, −5.13° [95% CI, −8.70 to −1.57]; P < .01). No significant differences emerged for pelvic tilt or sacral slope. Cam FAI exhibited reduced posterior pelvic excursion in late-phase squat (MD, −5.23° [95% CI, −7.17 to −3.30]; P < .01) and a modest global excursion increase during gait (MD, 0.38° [95% CI, 0.05 to 0.72]; P = .03). Conclusion: Low PI was linked to pincer morphology, suggesting a primary prevention target during development. Cam hips with higher PI were predisposed to symptoms. Symptomatic cam FAI also showed diminished pelvic rollback and increased anterior pelvic tilt, identifying kinematic targets for conservative management. Finally, dynamic spinopelvic characteristics more consistently demonstrated significant differences than static ones and may be more clinically pertinent in FAI research.
{"title":"The Effect of Sagittal Spinopelvic Parameters and Kinematics on the Morphology and Symptomatology of Femoroacetabular Impingement: A Systematic Review and Meta-analysis","authors":"Corinne Maurice, Yoan Bourgeault-Gagnon, Joshua A.J. Keogh, Isabelle Keng, João Dinis, Manraj Nijjar, Etienne L. Belzile, Olufemi R. Ayeni","doi":"10.1177/03635465251410956","DOIUrl":"https://doi.org/10.1177/03635465251410956","url":null,"abstract":"Background: Femoroacetabular impingement (FAI) morphology is common in asymptomatic adults. Spinopelvic alignment modulates hip mechanics and influences hip range of motion. Specific spinopelvic parameters, such as pelvic incidence and dynamic parameters, have been inconsistently associated with FAI. Yet, their specific influence on FAI morphology and symptomatology remains uncertain. Purpose: To determine how morphologic, postural, and dynamic spinopelvic parameters differ according to FAI morphology (cam, pincer) and symptomatology. Study Design: Meta-analysis; Level of evidence, 3. Methods: PubMed, EMBASE, and Scopus were searched from inception to December 23, 2024. Studies reporting spinopelvic parameters in symptomatic or asymptomatic FAI compared with controls were included. Two reviewers independently screened, extracted data, and rated methodological quality (Newcastle-Ottawa Scale [NOS]). Fixed- or random-effects meta-analyses of mean differences were stratified by parameter, FAI type, and concept (morphology vs symptomatology). Results: A total of 41 studies (n = 3750; 1343 symptomatic, 821 asymptomatic FAI; 1586 controls; median NOS 6/9) were included. Symptomatic cam hips had higher pelvic incidence (PI) than asymptomatic cam hips (mean difference [MD], 4.94° [95% CI, −0.10 to 9.98]; <jats:italic toggle=\"yes\">P</jats:italic> = .05). Pincer morphology was linked to lower PI versus controls (MD, −5.13° [95% CI, −8.70 to −1.57]; <jats:italic toggle=\"yes\">P</jats:italic> < .01). No significant differences emerged for pelvic tilt or sacral slope. Cam FAI exhibited reduced posterior pelvic excursion in late-phase squat (MD, −5.23° [95% CI, −7.17 to −3.30]; <jats:italic toggle=\"yes\">P</jats:italic> < .01) and a modest global excursion increase during gait (MD, 0.38° [95% CI, 0.05 to 0.72]; <jats:italic toggle=\"yes\">P</jats:italic> = .03). Conclusion: Low PI was linked to pincer morphology, suggesting a primary prevention target during development. Cam hips with higher PI were predisposed to symptoms. Symptomatic cam FAI also showed diminished pelvic rollback and increased anterior pelvic tilt, identifying kinematic targets for conservative management. Finally, dynamic spinopelvic characteristics more consistently demonstrated significant differences than static ones and may be more clinically pertinent in FAI research.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160442","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}
Pub Date : 2026-02-08DOI: 10.1177/03635465261416931
Truls Martin Straume-Næsheim, Per-Henrik Randsborg, Tina Løkken Nilsgård, Asbjørn Årøen
Background: Medial patellofemoral ligament reconstruction (MPFL-R) is the primary surgical intervention for recurrent lateral patellar dislocation (LPD). Isolated MPFL-R is recommended for patients without anatomic high-risk factors that predispose to further dislocations. Purpose: To compare instability recurrence in patients with recurrent LPD without underlying anatomic risk factors treated with MPFL-R versus active rehabilitation. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Patients aged 12 to 30 years with recurrent LPD and no underlying anatomic high-risk factors for further dislocations—specifically, no severe trochlear dysplasia (Dejour D) and a tibial tuberosity–trochlear groove distance ≤20 mm on computed tomography—were randomized to receive knee arthroscopy with isolated MPFL-R followed by active rehabilitation (MPFL group) or knee arthroscopy without reconstruction followed by active rehabilitation (control group). The primary outcome was subjective persistent patellar instability at 3 years. Knee function at baseline and 1 and 3 years was assessed by the following patient-reported outcome measure (PROM) scores: Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala Knee Score, Cincinnati Knee Rating System, and Noyes Sports Activity Rating Scale. Results: Between 2010 and 2019, 61 patients (72.1% female) were included in the study and randomized, with 30 assigned to the MPFL group and 31 to the control group. At 3-year follow-up, subjective persistent patellar instability was reported by 5 patients in the MPFL group (16.7%) versus 15 patients in the control group (53.6%), corresponding to an odds ratio of 5.8 (95% CI, 1.7-19.4; P = .003). Both groups reported significant improvements in all PROM scores from baseline to 3 years. However, no significant differences in PROM scores were observed between the groups at any follow-up time point. Conclusion: Isolated MPFL-R was more effective than active rehabilitation alone in preventing patellar instability after 3 years. Trial Registration: ClinicalTrials.org (NCT02263807).
{"title":"Medial Patellofemoral Ligament Reconstruction vs Nonoperative Treatment for Recurrent Lateral Patellar Dislocation: Three-Year Results From a Randomized Controlled Trial","authors":"Truls Martin Straume-Næsheim, Per-Henrik Randsborg, Tina Løkken Nilsgård, Asbjørn Årøen","doi":"10.1177/03635465261416931","DOIUrl":"https://doi.org/10.1177/03635465261416931","url":null,"abstract":"Background: Medial patellofemoral ligament reconstruction (MPFL-R) is the primary surgical intervention for recurrent lateral patellar dislocation (LPD). Isolated MPFL-R is recommended for patients without anatomic high-risk factors that predispose to further dislocations. Purpose: To compare instability recurrence in patients with recurrent LPD without underlying anatomic risk factors treated with MPFL-R versus active rehabilitation. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Patients aged 12 to 30 years with recurrent LPD and no underlying anatomic high-risk factors for further dislocations—specifically, no severe trochlear dysplasia (Dejour D) and a tibial tuberosity–trochlear groove distance ≤20 mm on computed tomography—were randomized to receive knee arthroscopy with isolated MPFL-R followed by active rehabilitation (MPFL group) or knee arthroscopy without reconstruction followed by active rehabilitation (control group). The primary outcome was subjective persistent patellar instability at 3 years. Knee function at baseline and 1 and 3 years was assessed by the following patient-reported outcome measure (PROM) scores: Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala Knee Score, Cincinnati Knee Rating System, and Noyes Sports Activity Rating Scale. Results: Between 2010 and 2019, 61 patients (72.1% female) were included in the study and randomized, with 30 assigned to the MPFL group and 31 to the control group. At 3-year follow-up, subjective persistent patellar instability was reported by 5 patients in the MPFL group (16.7%) versus 15 patients in the control group (53.6%), corresponding to an odds ratio of 5.8 (95% CI, 1.7-19.4; <jats:italic toggle=\"yes\">P</jats:italic> = .003). Both groups reported significant improvements in all PROM scores from baseline to 3 years. However, no significant differences in PROM scores were observed between the groups at any follow-up time point. Conclusion: Isolated MPFL-R was more effective than active rehabilitation alone in preventing patellar instability after 3 years. Trial Registration: ClinicalTrials.org (NCT02263807).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138285","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}
Pub Date : 2026-02-08DOI: 10.1177/03635465261415825
Antonio Cusano, Amirhossein Jahandar, Alexander E. White, Andreas Kontaxis, Benji Basseri, Lawrence V. Gulotta, David M. Dines, Joshua S. Dines, Michael C. Fu, Theodore A. Blaine, Samuel A. Taylor
Background: Multiple grafts have been described for glenoid resurfacing in the setting of anterior shoulder instability with glenoid bone loss. The medial tibial plateau has been shown to have a similar radius of curvature to the glenoid and may be an appropriate anatomic match for glenoid resurfacing. Purpose: To evaluate restoration of glenoid concavity and anterior glenohumeral stability among the distal tibial allograft (DTA), distal clavicle autograft (DCA), and medial tibial plateau allograft (MTPA). Study Design: Controlled laboratory study. Methods: Nine sets of fresh-frozen unpaired shoulder, knee, and ankle cadaveric specimens were obtained (mean specimen age, 58.7 years; range, 51-63). Specimens underwent preoperative computed tomography to assess glenoid depth and radius to define the bony shoulder stability ratio (BSSR; glenoid depth over radius). A Kuka robot was used to assess shoulder stability with forces loaded through the rotator cuff and the shoulder in 90° of abduction and neutral rotation. Glenoid bone loss was created via a 10-mm cut, with each graft restoring 100% of the native glenoid width. The following conditions were tested: intact state followed by reconstructions with the DTA, MTPA, and DCA. Posttest computed tomography scans were obtained to calculate the reconstructed BSSR, and motion detectors were used to calculate maximum anterior humeral translation. Results: The BSSR was similar between the intact state (mean ± SD, 0.39 ± 0.11) and 3 reconstructed glenoid grafts (DCA, 0.46 ± 0.11 [ P = .10]; MTPA, 0.43 ± 0.07 [ P = .45]; DTA, 0.39 ± 0.11 [ P = .21]). Maximum anterior translation did not differ between the 3 grafts (DCA, 6.4 ± 3.0 mm [ P = .29]; MTPA, 8.4 ± 5.3 mm [ P = .11]; DTA, 6.7 ± 3.6 mm [ P = .21]) and the intact state (6.0 ± 2.8). Conclusion: By way of a cadaveric analysis, the DCA, MTPA, and DTA restored glenoid concavity to a point similar to the intact state. Future investigations with larger sample sizes are warranted to confirm these biomechanical trends and determine clinical significance. Clinical Relevance: Restoration of glenoid concavity is essential for achieving stability in patients with anterior shoulder instability and critical glenoid bone loss. This biomechanical study demonstrates that distal clavicle autograft, distal tibia allograft, and medial tibial plateau allograft each restore native glenoid concavity comparable to the intact state, supporting their use as reliable free bone block options for anatomic glenoid reconstruction. Future clinical studies are warranted to determine whether these biomechanical findings translate to improved clinical outcomes.
{"title":"The Effect of Concavity Restoration on Glenohumeral Stability in a Glenoid Bone Loss Model: Comparing Distal Tibial Allograft vs Medial Tibial Plateau Allograft vs Distal Clavicle Autograft","authors":"Antonio Cusano, Amirhossein Jahandar, Alexander E. White, Andreas Kontaxis, Benji Basseri, Lawrence V. Gulotta, David M. Dines, Joshua S. Dines, Michael C. Fu, Theodore A. Blaine, Samuel A. Taylor","doi":"10.1177/03635465261415825","DOIUrl":"https://doi.org/10.1177/03635465261415825","url":null,"abstract":"Background: Multiple grafts have been described for glenoid resurfacing in the setting of anterior shoulder instability with glenoid bone loss. The medial tibial plateau has been shown to have a similar radius of curvature to the glenoid and may be an appropriate anatomic match for glenoid resurfacing. Purpose: To evaluate restoration of glenoid concavity and anterior glenohumeral stability among the distal tibial allograft (DTA), distal clavicle autograft (DCA), and medial tibial plateau allograft (MTPA). Study Design: Controlled laboratory study. Methods: Nine sets of fresh-frozen unpaired shoulder, knee, and ankle cadaveric specimens were obtained (mean specimen age, 58.7 years; range, 51-63). Specimens underwent preoperative computed tomography to assess glenoid depth and radius to define the bony shoulder stability ratio (BSSR; glenoid depth over radius). A Kuka robot was used to assess shoulder stability with forces loaded through the rotator cuff and the shoulder in 90° of abduction and neutral rotation. Glenoid bone loss was created via a 10-mm cut, with each graft restoring 100% of the native glenoid width. The following conditions were tested: intact state followed by reconstructions with the DTA, MTPA, and DCA. Posttest computed tomography scans were obtained to calculate the reconstructed BSSR, and motion detectors were used to calculate maximum anterior humeral translation. Results: The BSSR was similar between the intact state (mean ± SD, 0.39 ± 0.11) and 3 reconstructed glenoid grafts (DCA, 0.46 ± 0.11 [ <jats:italic toggle=\"yes\">P</jats:italic> = .10]; MTPA, 0.43 ± 0.07 [ <jats:italic toggle=\"yes\">P</jats:italic> = .45]; DTA, 0.39 ± 0.11 [ <jats:italic toggle=\"yes\">P</jats:italic> = .21]). Maximum anterior translation did not differ between the 3 grafts (DCA, 6.4 ± 3.0 mm [ <jats:italic toggle=\"yes\">P</jats:italic> = .29]; MTPA, 8.4 ± 5.3 mm [ <jats:italic toggle=\"yes\">P</jats:italic> = .11]; DTA, 6.7 ± 3.6 mm [ <jats:italic toggle=\"yes\">P</jats:italic> = .21]) and the intact state (6.0 ± 2.8). Conclusion: By way of a cadaveric analysis, the DCA, MTPA, and DTA restored glenoid concavity to a point similar to the intact state. Future investigations with larger sample sizes are warranted to confirm these biomechanical trends and determine clinical significance. Clinical Relevance: Restoration of glenoid concavity is essential for achieving stability in patients with anterior shoulder instability and critical glenoid bone loss. This biomechanical study demonstrates that distal clavicle autograft, distal tibia allograft, and medial tibial plateau allograft each restore native glenoid concavity comparable to the intact state, supporting their use as reliable free bone block options for anatomic glenoid reconstruction. Future clinical studies are warranted to determine whether these biomechanical findings translate to improved clinical outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"295 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138333","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}
Pub Date : 2026-02-02DOI: 10.1177/03635465251401227
Kang Qin, Yichen Xu, Weiqiang Liang
{"title":"The Addition of Remplissage to Arthroscopic Bankart Repair and Effect on Recurrent Instability in Shoulders With Critical Humeral Bone Loss: Letter to the Editor","authors":"Kang Qin, Yichen Xu, Weiqiang Liang","doi":"10.1177/03635465251401227","DOIUrl":"https://doi.org/10.1177/03635465251401227","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101561","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}
Pub Date : 2026-02-02DOI: 10.1177/03635465251407255
Nicola Maffulli, Filippo Spiezia
{"title":"Outcomes of Revision Versus Primary Repair of Proximal Hamstring Avulsion Injury: Letter to the Editor","authors":"Nicola Maffulli, Filippo Spiezia","doi":"10.1177/03635465251407255","DOIUrl":"https://doi.org/10.1177/03635465251407255","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101563","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}
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