Pub Date : 2026-01-29DOI: 10.1177/03635465251400357
Rui W Soares,Ignacio Pasqualini,Khaled A Elmenawi,Shujaa T Khan,Turan Oguz,Cole R Johnson,Matthew E Deren,Michael J Scarcella,Nicolas S Piuzzi
BACKGROUNDTotal knee arthroplasty (TKA) provides pain relief and functional improvement for end-stage knee osteoarthritis patients. As TKA use increases in younger patients, return to sports (RTS) has become a key outcome measure. While RTS rates after TKA are generally high, they vary significantly across studies due to differences in study design, patient populations, and RTS definitions.PURPOSETo determine RTS rates, evaluate return to preoperative sport levels, quantify time to RTS, and identify factors affecting RTS after TKA.STUDY DESIGNCohort study; Level of evidence, 2.METHODSWe analyzed 21,466 primary TKAs performed between 2016 and 2022. Of these, 1782 patients (8.3%) were athletes at baseline, with 1464 (82.2%) completing 1-year follow-up. We recorded demographic characteristics, comorbidities, baseline and 1-year RTS status, time to RTS, athlete type, and patient-reported outcomes. Analysis included descriptive statistics, Cox regression for time to RTS, and logistic regression for RTS-associated factors.RESULTSOf 1464 patients, 782 (53.4%) achieved RTS, while 676 (46.6%) did not; both contact and noncontact sports were included. Among those who returned, 62% resumed their previous sport at the same level, 34.5% at a reduced intensity, and 3.4% switched to a different sport. The median RTS time was 12 weeks, with 90% returning within 27 weeks. Medicaid patients had a delayed RTS compared with those with commercial insurance (hazard ratio [HR], 0.51). Overweight patients returned sooner than normal-weight patients (HR, 1.41). Female patients (odds ratio [OR], 0.76) and Black patients (OR, 2.34) had lower RTS odds, while recreational (OR, 0.06) and competitive athletes (OR, 0.10) had higher RTS odds versus those not participating in athletic activities.CONCLUSIONOver half of athletes returned to sports within 1 year of TKA, most within 27 weeks. RTS rates varied by preoperative competitive level, sex, race, body mass index, and comorbidity burden. These findings can guide patient expectations and shared decision-making regarding post-TKA sports participation. Future research should focus on improving RTS rates in high-risk groups, standardizing RTS criteria, and stratifying outcomes by sport type and impact level to enable more individualized patient recommendations.
{"title":"Return to Sports After Primary Total Knee Arthroplasty: A Prospective Cohort Study of 1782 Patients.","authors":"Rui W Soares,Ignacio Pasqualini,Khaled A Elmenawi,Shujaa T Khan,Turan Oguz,Cole R Johnson,Matthew E Deren,Michael J Scarcella,Nicolas S Piuzzi","doi":"10.1177/03635465251400357","DOIUrl":"https://doi.org/10.1177/03635465251400357","url":null,"abstract":"BACKGROUNDTotal knee arthroplasty (TKA) provides pain relief and functional improvement for end-stage knee osteoarthritis patients. As TKA use increases in younger patients, return to sports (RTS) has become a key outcome measure. While RTS rates after TKA are generally high, they vary significantly across studies due to differences in study design, patient populations, and RTS definitions.PURPOSETo determine RTS rates, evaluate return to preoperative sport levels, quantify time to RTS, and identify factors affecting RTS after TKA.STUDY DESIGNCohort study; Level of evidence, 2.METHODSWe analyzed 21,466 primary TKAs performed between 2016 and 2022. Of these, 1782 patients (8.3%) were athletes at baseline, with 1464 (82.2%) completing 1-year follow-up. We recorded demographic characteristics, comorbidities, baseline and 1-year RTS status, time to RTS, athlete type, and patient-reported outcomes. Analysis included descriptive statistics, Cox regression for time to RTS, and logistic regression for RTS-associated factors.RESULTSOf 1464 patients, 782 (53.4%) achieved RTS, while 676 (46.6%) did not; both contact and noncontact sports were included. Among those who returned, 62% resumed their previous sport at the same level, 34.5% at a reduced intensity, and 3.4% switched to a different sport. The median RTS time was 12 weeks, with 90% returning within 27 weeks. Medicaid patients had a delayed RTS compared with those with commercial insurance (hazard ratio [HR], 0.51). Overweight patients returned sooner than normal-weight patients (HR, 1.41). Female patients (odds ratio [OR], 0.76) and Black patients (OR, 2.34) had lower RTS odds, while recreational (OR, 0.06) and competitive athletes (OR, 0.10) had higher RTS odds versus those not participating in athletic activities.CONCLUSIONOver half of athletes returned to sports within 1 year of TKA, most within 27 weeks. RTS rates varied by preoperative competitive level, sex, race, body mass index, and comorbidity burden. These findings can guide patient expectations and shared decision-making regarding post-TKA sports participation. Future research should focus on improving RTS rates in high-risk groups, standardizing RTS criteria, and stratifying outcomes by sport type and impact level to enable more individualized patient recommendations.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"88 1","pages":"3635465251400357"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069960","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 : 2026-01-29DOI: 10.1177/03635465251408832
Mark Kurapatti,Matthew Yuro,Brian S Tao,Matthew D Ramey,Srivatsan Swaminathan,Auston R Locke,Niklas H Koehne,Robert L Parisien
BACKGROUNDThere is currently no consensus regarding the superiority of allografts or autografts in labral hip reconstruction.PURPOSETo compare patient outcomes after arthroscopic labral reconstruction using autografts versus allografts.STUDY DESIGNMeta-analysis; Level of evidence, 4.METHODSA systematic review and meta-analysis were conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Scopus databases were queried on February 2, 2025. Original outcome studies on arthroscopic hip labral reconstruction with clearly delineated graft type and a mean follow-up of at least 1 year were included. Studies with a mean follow-up <1 year, nonarthroscopic labral reconstruction, or unclear graft-specific outcomes were excluded. Data were extracted from 30 studies (1968 hips: 1071 autograft, 897 allograft). A random-effects meta-analysis was performed using RStudio to assess patient-reported outcomes, revision surgery, and complication rates.RESULTSThere were no significant differences in most patient-reported outcomes: Harris Hip Score (allograft: 27.5 vs autograft: 24.6; P = .17), Hip Outcome Score (HOS) Activities of Daily Living (20.9 vs 22.8; P = .59), HOS Sports (33.2 vs 34.0; P = .65), SF-12 Physical score (10.0 vs 7.0; P = .19), and visual analog scale pain score (-3.5 vs -4.2; P = .34). The SF-12 Mental score improvement was significantly higher in the allograft group (5.2 vs 0.0; P = .03), although sample size was limited. Complication rates approached significance favoring allografts (<1% vs 3%; P = .06). No significant differences were observed in revision arthroscopy (1% allograft vs 5% autograft; P = .07) or conversion to total hip arthroplasty (3% vs 7%; P = .20). Considerable heterogeneity existed in surgical technique and concomitant procedures.CONCLUSIONLabral reconstruction using autograft or allograft tissue produces comparable improvements in most functional and pain outcomes. Use of allograft was associated with significantly higher mental health improvements, and further investigation is warranted to understand if it may carry a lower complication burden.
背景：目前对于同种异体移植和自体移植在唇侧髋关节重建中的优势还没有达成共识。目的比较关节镜下自体移植物与同种异体移植物重建患者的结果。研究DESIGNMeta-analysis;证据等级，4级。方法根据PRISMA（首选系统评价和荟萃分析报告项目）指南进行系统评价和荟萃分析。在2025年2月2日查询了PubMed、Embase和Scopus数据库。纳入了关节镜下髋关节唇部重建的原始结果研究，明确描述了移植物类型，平均随访至少1年。排除了平均随访<1年、非关节镜下唇部重建或移植物特异性结果不明确的研究。数据来自30项研究（1968年髋关节：1071例自体移植物，897例异体移植物）。使用RStudio进行随机效应荟萃分析，以评估患者报告的结果、翻修手术和并发症发生率。结果：Harris髋关节评分（同种异体移植：27.5 vs自体移植：24.6;P = 0.17）、髋关节结局评分（HOS）日常生活活动（20.9 vs 22.8; P = 0.59）、HOS运动（33.2 vs 34.0; P = 0.65）、SF-12身体评分（10.0 vs 7.0; P = 0.19）和视觉模拟量表疼痛评分（-3.5 vs -4.2; P = 0.34）均无显著差异。同种异体移植组的SF-12心理评分改善明显更高（5.2 vs 0.0; P = .03），尽管样本量有限。同种异体移植的并发症发生率接近显著性（<1% vs 3%; P = 0.06）。在翻修性关节镜检查（1%异体移植物vs 5%自体移植物，P = 0.07）或全髋关节置换术（3% vs 7%, P = 0.20）中未观察到显著差异。在手术技术和伴随手术中存在相当大的异质性。结论采用自体或同种异体组织进行下唇重建在大多数功能和疼痛预后方面都有相当的改善。同种异体移植物的使用显著提高了心理健康的改善，需要进一步的研究来了解它是否会降低并发症的负担。
{"title":"Comparative Outcomes of Autograft and Allograft in Hip Labral Reconstruction: A Systematic Review and Meta-analysis.","authors":"Mark Kurapatti,Matthew Yuro,Brian S Tao,Matthew D Ramey,Srivatsan Swaminathan,Auston R Locke,Niklas H Koehne,Robert L Parisien","doi":"10.1177/03635465251408832","DOIUrl":"https://doi.org/10.1177/03635465251408832","url":null,"abstract":"BACKGROUNDThere is currently no consensus regarding the superiority of allografts or autografts in labral hip reconstruction.PURPOSETo compare patient outcomes after arthroscopic labral reconstruction using autografts versus allografts.STUDY DESIGNMeta-analysis; Level of evidence, 4.METHODSA systematic review and meta-analysis were conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Scopus databases were queried on February 2, 2025. Original outcome studies on arthroscopic hip labral reconstruction with clearly delineated graft type and a mean follow-up of at least 1 year were included. Studies with a mean follow-up <1 year, nonarthroscopic labral reconstruction, or unclear graft-specific outcomes were excluded. Data were extracted from 30 studies (1968 hips: 1071 autograft, 897 allograft). A random-effects meta-analysis was performed using RStudio to assess patient-reported outcomes, revision surgery, and complication rates.RESULTSThere were no significant differences in most patient-reported outcomes: Harris Hip Score (allograft: 27.5 vs autograft: 24.6; P = .17), Hip Outcome Score (HOS) Activities of Daily Living (20.9 vs 22.8; P = .59), HOS Sports (33.2 vs 34.0; P = .65), SF-12 Physical score (10.0 vs 7.0; P = .19), and visual analog scale pain score (-3.5 vs -4.2; P = .34). The SF-12 Mental score improvement was significantly higher in the allograft group (5.2 vs 0.0; P = .03), although sample size was limited. Complication rates approached significance favoring allografts (<1% vs 3%; P = .06). No significant differences were observed in revision arthroscopy (1% allograft vs 5% autograft; P = .07) or conversion to total hip arthroplasty (3% vs 7%; P = .20). Considerable heterogeneity existed in surgical technique and concomitant procedures.CONCLUSIONLabral reconstruction using autograft or allograft tissue produces comparable improvements in most functional and pain outcomes. Use of allograft was associated with significantly higher mental health improvements, and further investigation is warranted to understand if it may carry a lower complication burden.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"296 1","pages":"3635465251408832"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070007","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}
BACKGROUNDAnterior cruciate ligament reconstruction (ACLR) is the preferred treatment for ACL rupture. Medial hamstring (HS) tendons are the most common autografts. An abnormal mediolateral HS muscle activation pattern after ACLR with an HS autograft could influence return to sport (RTS).PURPOSETo evaluate patients who underwent ACLR with concurrent isokinetic tests and surface electromyography (sEMG) of the medial versus lateral HS compared with a group of healthy controls to identify potential abnormal patterns at RTS.STUDY DESIGNComparative study; Level of evidence, 3.METHODSThe mean medial versus lateral HS sEMG amplitude and timing were measured during isokinetic tests at 60, 180, and 300 deg/sec in 92 participants: 46 patients who underwent primary HS-grafted ACLRs (ACLR group) and 46 healthy controls matched for age (18-45 years), sex, and level of physical activity (Tegner, 4-9) (control group). After the 8th postoperative month, the ACLR group were evaluated with an isokinetic test combined with sEMG of the medial and lateral HS. The control group were tested with the same procedure. sEMG data were included only if the minimum criteria for RTS were met according to the published literature (HS/quadriceps ratio ≥60% and quadriceps and HS interlimb peak torque difference at 60, 180, and 300 deg/sec ≤10%).RESULTSThere was no difference in isokinetic peak torque normalized to body mass between ACLRs and controls at any tested angular velocity. The mean sEMG amplitude for both the medial and lateral HS showed no between-group difference at 60, 180, and 300 deg/sec. No intergroup differences emerged for the mediolateral HS ratio during all tests. Instead, the mean sEMG time-to-peak for the medial HS was consistently faster in the ACLR group (P = .02 at 60 deg/sec; P = .01 at 180 deg/sec; P = .04 at 300 deg/sec), with no intergroup difference for the lateral HS at 60, 180, 300 deg/sec.CONCLUSIONThe grafted medial HS showed consistently faster sEMG time-to-peak in the ACLR group than in the control group at all tested velocities. No differences emerged on sEMG amplitude for the medial HS and on both sEMG amplitude and timing for the lateral HS. Those who underwent HS-grafted ACLR showed a higher neuromuscular demand on the grafted medial HS at RTS. This altered overall HS muscle coordination could affect lower limb biomechanics during active movements, potentially increasing the risk of ACL reinjury.
{"title":"Medial Hamstrings Used as Autograft for ACL Reconstruction Show an Abnormal Neuromuscular Pattern at the Time of Return to Sport.","authors":"Sebastiano Nutarelli,Alessandro Sangiorgio,Thomas Legrand,Federico Monzoni,Luca Deabate,Marco Delcogliano,Eamonn Delahunt,Giuseppe Filardo","doi":"10.1177/03635465251404915","DOIUrl":"https://doi.org/10.1177/03635465251404915","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament reconstruction (ACLR) is the preferred treatment for ACL rupture. Medial hamstring (HS) tendons are the most common autografts. An abnormal mediolateral HS muscle activation pattern after ACLR with an HS autograft could influence return to sport (RTS).PURPOSETo evaluate patients who underwent ACLR with concurrent isokinetic tests and surface electromyography (sEMG) of the medial versus lateral HS compared with a group of healthy controls to identify potential abnormal patterns at RTS.STUDY DESIGNComparative study; Level of evidence, 3.METHODSThe mean medial versus lateral HS sEMG amplitude and timing were measured during isokinetic tests at 60, 180, and 300 deg/sec in 92 participants: 46 patients who underwent primary HS-grafted ACLRs (ACLR group) and 46 healthy controls matched for age (18-45 years), sex, and level of physical activity (Tegner, 4-9) (control group). After the 8th postoperative month, the ACLR group were evaluated with an isokinetic test combined with sEMG of the medial and lateral HS. The control group were tested with the same procedure. sEMG data were included only if the minimum criteria for RTS were met according to the published literature (HS/quadriceps ratio ≥60% and quadriceps and HS interlimb peak torque difference at 60, 180, and 300 deg/sec ≤10%).RESULTSThere was no difference in isokinetic peak torque normalized to body mass between ACLRs and controls at any tested angular velocity. The mean sEMG amplitude for both the medial and lateral HS showed no between-group difference at 60, 180, and 300 deg/sec. No intergroup differences emerged for the mediolateral HS ratio during all tests. Instead, the mean sEMG time-to-peak for the medial HS was consistently faster in the ACLR group (P = .02 at 60 deg/sec; P = .01 at 180 deg/sec; P = .04 at 300 deg/sec), with no intergroup difference for the lateral HS at 60, 180, 300 deg/sec.CONCLUSIONThe grafted medial HS showed consistently faster sEMG time-to-peak in the ACLR group than in the control group at all tested velocities. No differences emerged on sEMG amplitude for the medial HS and on both sEMG amplitude and timing for the lateral HS. Those who underwent HS-grafted ACLR showed a higher neuromuscular demand on the grafted medial HS at RTS. This altered overall HS muscle coordination could affect lower limb biomechanics during active movements, potentially increasing the risk of ACL reinjury.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"71 1","pages":"3635465251404915"},"PeriodicalIF":0.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070075","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 : 2026-01-27DOI: 10.1177/03635465251404911
Young Tak Cho, Jang Whan Bai, Younghoon Yang, Yu-Seok Kim, Joon Ho Wang
Background: In combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) using hamstring autografts, a femoral in-tunnel graft length (FTGL) of at least 15 mm has traditionally been recommended. However, achieving this length is not always feasible. Purpose: To evaluate graft healing and clinical outcomes in patients with an intraoperative FTGL target of 10 to 15 mm, and to investigate whether shorter postoperative magnetic resonance imaging (MRI)–measured FTGL (mFTGL) within this cohort affected outcomes through subgroup analysis. Study Design: Case series; Level of evidence: 4 Methods: The records of patients who underwent primary single-bundle ACLR using a quadrupled semitendinosus autograft and ALLR using a gracilis autograft, with a minimum 2-year follow-up, were retrospectively reviewed. During surgery, the FTGL was intentionally set to fall within the 10- to 15-mm range. Postoperatively, the graft length within the femoral tunnel was measured on postoperative day 2 MRI (mFTGL) and used for analyses. Graft healing was evaluated using 6-month MRI scans: (1) graft incorporation, assessed by the signal-to-noise quotient (SNQ) at the tunnel (SNQ_tunnel), signal intensity at the graft-bone interface, and tunnel widening; and (2) graft ligamentization, assessed by the SNQ of the graft (SNQ_graft) and Howell grade. Clinical outcomes were also assessed. For subgroup analysis, patients were classified into group 1 (mFTGL ≤12.6 mm) and group 2 (mFTGL >12.6 mm). Results: A total of 180 knees were consecutively enrolled; 169 completed the 6-month MRI evaluation. The graft failure rate was 3.9%. The mean mFTGL was 12.6 ± 2.6 mm. In subgroup analysis, the femoral SNQ_tunnel difference between the tunnel aperture and proximal site was 0.9 ± 3.3 for group 1 and 2.3 ± 3.9 for group 2 ( P = .014). Femoral tunnel widening was 60.1% ± 30.7% for group 1 and 74.3% ± 37.2% for group 2 ( P = .008). In multiple regression analysis, mFTGL (β = 3.28; P < .001) and graft diameter (β = −23.86; P < .001) were independently associated with femoral tunnel widening. Conclusion: In combined ACLR and ALLR, an intraoperative FTGL target of 10 to 15 mm was clinically acceptable regarding graft failure, graft healing, and clinical outcomes. The subgroup with shorter FTGL showed less femoral tunnel widening.
{"title":"Short Femoral In-Tunnel Graft Length Does Not Compromise Graft Healing and Clinical Outcomes After Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using Hamstring Autograft","authors":"Young Tak Cho, Jang Whan Bai, Younghoon Yang, Yu-Seok Kim, Joon Ho Wang","doi":"10.1177/03635465251404911","DOIUrl":"https://doi.org/10.1177/03635465251404911","url":null,"abstract":"Background: In combined anterior cruciate ligament reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) using hamstring autografts, a femoral in-tunnel graft length (FTGL) of at least 15 mm has traditionally been recommended. However, achieving this length is not always feasible. Purpose: To evaluate graft healing and clinical outcomes in patients with an intraoperative FTGL target of 10 to 15 mm, and to investigate whether shorter postoperative magnetic resonance imaging (MRI)–measured FTGL (mFTGL) within this cohort affected outcomes through subgroup analysis. Study Design: Case series; Level of evidence: 4 Methods: The records of patients who underwent primary single-bundle ACLR using a quadrupled semitendinosus autograft and ALLR using a gracilis autograft, with a minimum 2-year follow-up, were retrospectively reviewed. During surgery, the FTGL was intentionally set to fall within the 10- to 15-mm range. Postoperatively, the graft length within the femoral tunnel was measured on postoperative day 2 MRI (mFTGL) and used for analyses. Graft healing was evaluated using 6-month MRI scans: (1) graft incorporation, assessed by the signal-to-noise quotient (SNQ) at the tunnel (SNQ_tunnel), signal intensity at the graft-bone interface, and tunnel widening; and (2) graft ligamentization, assessed by the SNQ of the graft (SNQ_graft) and Howell grade. Clinical outcomes were also assessed. For subgroup analysis, patients were classified into group 1 (mFTGL ≤12.6 mm) and group 2 (mFTGL >12.6 mm). Results: A total of 180 knees were consecutively enrolled; 169 completed the 6-month MRI evaluation. The graft failure rate was 3.9%. The mean mFTGL was 12.6 ± 2.6 mm. In subgroup analysis, the femoral SNQ_tunnel difference between the tunnel aperture and proximal site was 0.9 ± 3.3 for group 1 and 2.3 ± 3.9 for group 2 ( <jats:italic toggle=\"yes\">P</jats:italic> = .014). Femoral tunnel widening was 60.1% ± 30.7% for group 1 and 74.3% ± 37.2% for group 2 ( <jats:italic toggle=\"yes\">P</jats:italic> = .008). In multiple regression analysis, mFTGL (β = 3.28; <jats:italic toggle=\"yes\">P</jats:italic> < .001) and graft diameter (β = −23.86; <jats:italic toggle=\"yes\">P</jats:italic> < .001) were independently associated with femoral tunnel widening. Conclusion: In combined ACLR and ALLR, an intraoperative FTGL target of 10 to 15 mm was clinically acceptable regarding graft failure, graft healing, and clinical outcomes. The subgroup with shorter FTGL showed less femoral tunnel widening.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056185","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 : 2026-01-27DOI: 10.1177/03635465251407119
Nobutake Ozeki,Tomomasa Nakamura,Yusuke Nakagawa,Takashi Hoshino,Masaki Amemiya,Ichiro Sekiya,Hideyuki Koga
BACKGROUNDMedial meniscal extrusion (MME) contributes to knee osteoarthritis and is often caused by a medial meniscal posterior root tear (MMPRT). Although early surgical repair of MMPRT improves outcomes, MME often persists. Centralization techniques aim to reduce meniscal extrusion by anchoring the capsule to the tibial plateau; however, their clinical effectiveness when combined with MMPRT repair remains uncertain.PURPOSETo evaluate the efficacy of centralization combined with MMPRT repair in reducing MME using intraoperative ultrasound.STUDY DESIGNCase series; Level of evidence, 4.METHODSThe study included 26 patients who underwent MMPRT repair with a pullout technique and centralization with three knotless anchors. Of these, 22 patients also underwent additional high tibial osteotomy. Initial tensions of 0 to 40 N were applied to the pullout repair sutures at 60° of knee flexion, and MME was measured by intraoperative ultrasound. MME was also measured at 0°, 30°, 60°, 90°, and 120° of knee flexion, as well as at internally and externally rotated positions (IR and ER) at 30° and 90° of knee flexion, before MMPRT repair, after repair, and after centralization. A total of 22 patients underwent additional high tibial osteotomy after MMPRT repair and centralization.RESULTSWhen tension of 0 to 40 N was applied to the pullout repair sutures at 60°, the median MME decreased with increasing tension, with a significant reduction observed at 30 and 40 N compared with lower tension levels. Moreover, at tensions ≥30 N, the median MME remained <3 mm after centralization. MME was subsequently measured with 30 N tension applied to the pullout repair sutures. The median MME (mm) before MMPRT repair, after repair, and after centralization ranged from 7.6, 3.9, and 3 at 0° to 4.4, 3.5, and 2.6 at 120°, respectively. At 0°, MME was significantly smaller after centralization than before repair (P < .001) and also smaller than after repair (P < .006). At 120°, MME after centralization was significantly smaller than before repair (P < .001), and the difference among the 3 conditions was also significant (P = .03). Centralization resulted in the smallest MME at both flexion angles. The median MME before MMPRT repair, after repair, and after centralization at 30° were all smaller in the MME in the ER position. Conversely, the ER-IR differences were slight at 90°.CONCLUSIONIntraoperative ultrasound demonstrated that MMPRT repair reduced MME compared with the preoperative condition, and the addition of centralization further enhanced this reduction, yielding greater improvement than MMPRT repair alone.
{"title":"Effect of Additional Centralization Procedure on Intraoperative Ultrasound-Assessed Medial Meniscal Extrusion Compared With Medial Meniscal Posterior Root Repair Alone.","authors":"Nobutake Ozeki,Tomomasa Nakamura,Yusuke Nakagawa,Takashi Hoshino,Masaki Amemiya,Ichiro Sekiya,Hideyuki Koga","doi":"10.1177/03635465251407119","DOIUrl":"https://doi.org/10.1177/03635465251407119","url":null,"abstract":"BACKGROUNDMedial meniscal extrusion (MME) contributes to knee osteoarthritis and is often caused by a medial meniscal posterior root tear (MMPRT). Although early surgical repair of MMPRT improves outcomes, MME often persists. Centralization techniques aim to reduce meniscal extrusion by anchoring the capsule to the tibial plateau; however, their clinical effectiveness when combined with MMPRT repair remains uncertain.PURPOSETo evaluate the efficacy of centralization combined with MMPRT repair in reducing MME using intraoperative ultrasound.STUDY DESIGNCase series; Level of evidence, 4.METHODSThe study included 26 patients who underwent MMPRT repair with a pullout technique and centralization with three knotless anchors. Of these, 22 patients also underwent additional high tibial osteotomy. Initial tensions of 0 to 40 N were applied to the pullout repair sutures at 60° of knee flexion, and MME was measured by intraoperative ultrasound. MME was also measured at 0°, 30°, 60°, 90°, and 120° of knee flexion, as well as at internally and externally rotated positions (IR and ER) at 30° and 90° of knee flexion, before MMPRT repair, after repair, and after centralization. A total of 22 patients underwent additional high tibial osteotomy after MMPRT repair and centralization.RESULTSWhen tension of 0 to 40 N was applied to the pullout repair sutures at 60°, the median MME decreased with increasing tension, with a significant reduction observed at 30 and 40 N compared with lower tension levels. Moreover, at tensions ≥30 N, the median MME remained <3 mm after centralization. MME was subsequently measured with 30 N tension applied to the pullout repair sutures. The median MME (mm) before MMPRT repair, after repair, and after centralization ranged from 7.6, 3.9, and 3 at 0° to 4.4, 3.5, and 2.6 at 120°, respectively. At 0°, MME was significantly smaller after centralization than before repair (P < .001) and also smaller than after repair (P < .006). At 120°, MME after centralization was significantly smaller than before repair (P < .001), and the difference among the 3 conditions was also significant (P = .03). Centralization resulted in the smallest MME at both flexion angles. The median MME before MMPRT repair, after repair, and after centralization at 30° were all smaller in the MME in the ER position. Conversely, the ER-IR differences were slight at 90°.CONCLUSIONIntraoperative ultrasound demonstrated that MMPRT repair reduced MME compared with the preoperative condition, and the addition of centralization further enhanced this reduction, yielding greater improvement than MMPRT repair alone.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465251407119"},"PeriodicalIF":0.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056776","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}
BACKGROUNDThe clinical impact of coracoid graft resorption after the Latarjet procedure has been controversial and likely underestimated.PURPOSETo (1) develop and validate a refined classification system-coracoid graft resorption based on degree and location (CRDL); and (2) correlate clinical and radiological outcomes with the CRDL classification system.STUDY DESIGNCohort study; Level of evidence, 3.METHODSBetween January 2015 and December 2018, 63 patients who underwent the arthroscopic Latarjet procedure were evaluated with computed tomography imaging preoperatively, immediately postoperatively, and at a minimum 5-year follow-up. According to the resorption location, the coracoid graft resorption was classified as grade 0 (no resorption), grade 1 (resorption on the proximal-medial and/or distal-medial part), grade 2 (resorption on the proximal-lateral part with no resorption on the distal-lateral part), and grade 3 (resorption on the distal-lateral part). Resorption severity was categorized as mild (grades 0 and 1) and severe (grades 2 and 3). The incidence, classification, and location of graft resorption were described. Intrarater and interrater reliability were calculated. Correlations between the classification and clinical and radiological outcomes were analyzed.RESULTSAfter a mean follow-up of 85.3 months, coracoid graft resorption was observed in 84.1% of cases: grade 0 in 15.9%, grade 1 in 47.6%, grade 2 in 30.2%, and grade 3 in 6.3%. Mild and severe resorption were found in 63.5% and 36.5% of patients, respectively. Resorption mainly occurred on the proximal-medial part of the graft. Intra- and interrater reliability of the classification system were both almost perfect (κ = 0.865 and 0.822, respectively). Significant differences were found in the postoperative American Shoulder and Elbow Surgeons (ASES) and visual analog scale for pain (VAS) scores among different grades and between mild and severe resorption. Correlation and multivariable regression analyses identified higher-grade graft resorption as a risk factor for worse postoperative ASES and VAS scores.CONCLUSIONCRDL classification is a reliable and clinically relevant classification system for coracoid graft resorption evaluation. Application of the CRDL system reveals that while high-grade resorption is a significant risk factor for postoperative shoulder pain, it has no major impact on shoulder function or stability.
背景Latarjet手术后喙骨移植物吸收的临床影响一直存在争议，并且可能被低估。目的(1)建立并验证一种基于程度和位置（CRDL）的喙骨移植物吸收精细分类系统；(2)将临床和影像学结果与CRDL分类系统联系起来。研究设计：队列研究；证据水平，3。方法：在2015年1月至2018年12月期间，63例接受关节镜Latarjet手术的患者术前、术后立即和至少5年随访时进行计算机断层成像评估。根据吸收部位分为0级（无吸收）、1级（近内侧和/或远内侧部分吸收）、2级（近外侧部分吸收，远外侧部分无吸收）和3级（远外侧部分吸收）。吸收严重程度分为轻度（0级和1级）和重度（2级和3级）。描述了移植物吸收的发生率、分类和部位。计算了内部信度和内部信度。分析其分型与临床及影像学结果的相关性。结果平均随访85.3个月后，84.1%的患者出现喙骨移植吸收，其中0级15.9%，1级47.6%，2级30.2%，3级6.3%。轻度吸收占63.5%，重度吸收占36.5%。吸收主要发生在移植物的近内侧部分。分类系统的组内信度和组间信度均接近完美（κ分别为0.865和0.822）。术后美国肩肘外科医生（American Shoulder and肘surgeons， ASES）和视觉模拟疼痛量表（visual analogue scale for pain， VAS）评分在不同分级之间、轻度和重度吸收之间存在显著差异。相关分析和多变量回归分析表明，较高程度的移植物吸收是术后较差的as和VAS评分的危险因素。结论crdl分型是一种可靠的、与临床相关的喙骨移植骨吸收评价分型系统。CRDL系统的应用表明，虽然高度吸收是术后肩关节疼痛的重要危险因素，但它对肩关节功能或稳定性没有重大影响。
{"title":"Impact of Significant Coracoid Graft Resorption on Clinical Outcomes After Arthroscopic Latarjet Procedure: Development and Validation of a Refined Classification System for Coracoid Bone Graft Resorption.","authors":"Qihuang Qin,Pinxue Li,Dan Zhang,Jianhao Xie,Zeyu Wang,Haoyue Li,Siyi Guo,Chunyan Jiang,Yiming Zhu","doi":"10.1177/03635465251408095","DOIUrl":"https://doi.org/10.1177/03635465251408095","url":null,"abstract":"BACKGROUNDThe clinical impact of coracoid graft resorption after the Latarjet procedure has been controversial and likely underestimated.PURPOSETo (1) develop and validate a refined classification system-coracoid graft resorption based on degree and location (CRDL); and (2) correlate clinical and radiological outcomes with the CRDL classification system.STUDY DESIGNCohort study; Level of evidence, 3.METHODSBetween January 2015 and December 2018, 63 patients who underwent the arthroscopic Latarjet procedure were evaluated with computed tomography imaging preoperatively, immediately postoperatively, and at a minimum 5-year follow-up. According to the resorption location, the coracoid graft resorption was classified as grade 0 (no resorption), grade 1 (resorption on the proximal-medial and/or distal-medial part), grade 2 (resorption on the proximal-lateral part with no resorption on the distal-lateral part), and grade 3 (resorption on the distal-lateral part). Resorption severity was categorized as mild (grades 0 and 1) and severe (grades 2 and 3). The incidence, classification, and location of graft resorption were described. Intrarater and interrater reliability were calculated. Correlations between the classification and clinical and radiological outcomes were analyzed.RESULTSAfter a mean follow-up of 85.3 months, coracoid graft resorption was observed in 84.1% of cases: grade 0 in 15.9%, grade 1 in 47.6%, grade 2 in 30.2%, and grade 3 in 6.3%. Mild and severe resorption were found in 63.5% and 36.5% of patients, respectively. Resorption mainly occurred on the proximal-medial part of the graft. Intra- and interrater reliability of the classification system were both almost perfect (κ = 0.865 and 0.822, respectively). Significant differences were found in the postoperative American Shoulder and Elbow Surgeons (ASES) and visual analog scale for pain (VAS) scores among different grades and between mild and severe resorption. Correlation and multivariable regression analyses identified higher-grade graft resorption as a risk factor for worse postoperative ASES and VAS scores.CONCLUSIONCRDL classification is a reliable and clinically relevant classification system for coracoid graft resorption evaluation. Application of the CRDL system reveals that while high-grade resorption is a significant risk factor for postoperative shoulder pain, it has no major impact on shoulder function or stability.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"35 1","pages":"3635465251408095"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021630","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 : 2026-01-23DOI: 10.1177/03635465251407324
Utsav Kapoor,Kevin J Khoo,Jason E Hsu,Frederick A Matsen,Corey J Schiffman
BACKGROUNDChronic sternoclavicular (SC) joint instability is a relatively rare orthopaedic pathology that is treated with surgical reconstruction when symptoms persist despite adequate nonsurgical treatment. There are a variety of surgical techniques; however, the literature on the topic is limited to small case series.PURPOSETo provide a comprehensive systematic review of the surgical variables, clinical outcomes, and complications after SC joint reconstruction.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review of the literature was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and MEDLINE were searched using a comprehensive search strategy for articles involving SC joint reconstructions. A descriptive and critical analysis of the results was performed.RESULTSTwelve studies comprising 164 patients (169 SC joint reconstructions) were identified. Bicortical reconstruction was the most frequently used technique overall (63% of cases) and was used more often in the setting of posterior instability (87%). All studies demonstrated significant improvements in patient-reported outcome measures (PROMs) regardless of graft type, technique, or direction of instability. Complication rates were similar between techniques (9% bicortical vs 15% unicortical; P = .23), although there was a trend toward a higher rate of recurrent instability when utilizing unicortical reconstruction techniques (3% bicortical vs 10% unicortical; P = .06). Allograft and autograft reconstructions also had a similar overall complication (12% autograft vs 10% allograft; P = .68) and revision rates (4% autograft vs 4% allograft; P = .83). All techniques allowed a high rate of return to sport or work (83%), although limitations were noted in some cases (35%).CONCLUSIONThis review found that SC joint reconstruction leads to significant improvements in PROMs and return to activity, with a low complication rate, regardless of technique type, including unicortical versus bicortical and allograft versus autograft reconstruction. This study supports the need for further comparative and biomechanical studies to validate findings and refine surgical recommendations.
{"title":"Clinical Outcomes and Complications After Sternoclavicular Joint Reconstruction for Chronic Instability: A Systematic Review.","authors":"Utsav Kapoor,Kevin J Khoo,Jason E Hsu,Frederick A Matsen,Corey J Schiffman","doi":"10.1177/03635465251407324","DOIUrl":"https://doi.org/10.1177/03635465251407324","url":null,"abstract":"BACKGROUNDChronic sternoclavicular (SC) joint instability is a relatively rare orthopaedic pathology that is treated with surgical reconstruction when symptoms persist despite adequate nonsurgical treatment. There are a variety of surgical techniques; however, the literature on the topic is limited to small case series.PURPOSETo provide a comprehensive systematic review of the surgical variables, clinical outcomes, and complications after SC joint reconstruction.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review of the literature was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and MEDLINE were searched using a comprehensive search strategy for articles involving SC joint reconstructions. A descriptive and critical analysis of the results was performed.RESULTSTwelve studies comprising 164 patients (169 SC joint reconstructions) were identified. Bicortical reconstruction was the most frequently used technique overall (63% of cases) and was used more often in the setting of posterior instability (87%). All studies demonstrated significant improvements in patient-reported outcome measures (PROMs) regardless of graft type, technique, or direction of instability. Complication rates were similar between techniques (9% bicortical vs 15% unicortical; P = .23), although there was a trend toward a higher rate of recurrent instability when utilizing unicortical reconstruction techniques (3% bicortical vs 10% unicortical; P = .06). Allograft and autograft reconstructions also had a similar overall complication (12% autograft vs 10% allograft; P = .68) and revision rates (4% autograft vs 4% allograft; P = .83). All techniques allowed a high rate of return to sport or work (83%), although limitations were noted in some cases (35%).CONCLUSIONThis review found that SC joint reconstruction leads to significant improvements in PROMs and return to activity, with a low complication rate, regardless of technique type, including unicortical versus bicortical and allograft versus autograft reconstruction. This study supports the need for further comparative and biomechanical studies to validate findings and refine surgical recommendations.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"45 1","pages":"3635465251407324"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021629","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 : 2026-01-23DOI: 10.1177/03635465251405493
Varun Gopinatth,Daniel C Touhey,Edward M Barksdale,Derrick M Knapik
BACKGROUNDRevision anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established procedure to restore knee stability and improve function after a failed primary ACLR. In active individuals, patient, injury, and operative variables influencing successful return to sport (RTS) after revision ACLR remain poorly understood.PURPOSETo evaluate RTS outcomes in patients undergoing revision ACLR.STUDY DESIGNMeta-analysis, Level of evidence, 4Methods:A systematic review was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was conducted by querying 5 databases from inception through January 2025 to identify studies reporting on RTS outcomes in athletes undergoing revision ACLR. Meta-analysis was performed using random-effects models at 95% confidence intervals, with odds ratios used for comparative studies.RESULTSA total of 52 studies, consisting of 3814 patients, met inclusion criteria. The mean patient age was 27.6 ± 8.4 years, with 66.3% (2340/3532) of the patients being male. Soccer was the most commonly reported sport (24.6%; 390/1584), followed by basketball (17.6%; 278/1584) and football (7.8%; 124/1584). The overall pooled RTS rate was 77.8% (95% CI, 0.732-0.824), with the RTS rate to the previous level of competition being 48.2% (95% CI, 0.410-0.553). The weighted mean time to RTS was 9.3 ± 2.7 months. Patients undergoing revision ACLR with the addition of a lateral extra-articular procedure (LEAP) had a significantly higher RTS rate (90.6% vs 74.9%; P < .00001), while greater articular cartilage damage was associated with less successful RTS (OR, 0.214; 95% CI, 0.078-0.584). The mean postoperative Anterior Cruciate Ligament Return to Sport after Injury score was 61.2 ± 24.1 (n = 535). The most commonly reported reason for failure to RTS or RTS at a lower competition level was fear of reinjury (28.0%; 142/508), followed by knee pain (12.0%; 61/508) and persistent instability (7.3%; 37/508).CONCLUSIONThe overall RTS rate after revision ACLR was 77.8%, with 48.2% returning to the previous level of competition. The addition of a LEAP led to improved RTS rates. Fear of reinjury was reported as the most commonly reported barrier to successful RTS.
背景：前交叉韧带（ACLR）重建（ACLR）是一种成熟的手术，用于恢复膝关节稳定性和改善原发性ACLR失败后的功能。在运动个体中，患者、损伤和手术变量对ACLR修订后成功恢复运动（RTS）的影响仍然知之甚少。目的评价改良ACLR患者的RTS预后。研究设计：荟萃分析，证据水平，4方法：根据2020年PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。文献检索通过查询5个数据库从成立到2025年1月，以确定报道运动员进行修订ACLR的RTS结果的研究。meta分析采用随机效应模型，置信区间为95%，比值比用于比较研究。结果共有52项研究，3814例患者符合纳入标准。患者平均年龄27.6±8.4岁，男性占66.3%（2340/3532）。足球是最常见的运动（24.6%;390/1584），其次是篮球（17.6%;278/1584）和足球（7.8%;124/1584）。总体合并RTS率为77.8% (95% CI, 0.732-0.824)，与之前竞争水平的RTS率为48.2% （95% CI, 0.410-0.553）。加权平均RTS时间为9.3±2.7个月。接受改良ACLR并增加外侧关节外手术（LEAP）的患者的RTS成功率明显更高（90.6% vs 74.9%; P < 0.00001），而更大的关节软骨损伤与更低的RTS成功率相关（OR, 0.214; 95% CI, 0.078-0.584）。术后前交叉韧带损伤后恢复运动的平均评分为61.2±24.1 （n = 535）。最常见的RTS失败原因是害怕再次受伤（28.0%,142/508），其次是膝盖疼痛（12.0%,61/508）和持续不稳定（7.3%,37/508）。结论修改ACLR后的总体RTS率为77.8%，其中48.2%恢复到原来的竞争水平。LEAP的加入提高了RTS率。对再次受伤的恐惧是成功RTS游戏最常见的障碍。
{"title":"Return to Sport After Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.","authors":"Varun Gopinatth,Daniel C Touhey,Edward M Barksdale,Derrick M Knapik","doi":"10.1177/03635465251405493","DOIUrl":"https://doi.org/10.1177/03635465251405493","url":null,"abstract":"BACKGROUNDRevision anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-established procedure to restore knee stability and improve function after a failed primary ACLR. In active individuals, patient, injury, and operative variables influencing successful return to sport (RTS) after revision ACLR remain poorly understood.PURPOSETo evaluate RTS outcomes in patients undergoing revision ACLR.STUDY DESIGNMeta-analysis, Level of evidence, 4Methods:A systematic review was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was conducted by querying 5 databases from inception through January 2025 to identify studies reporting on RTS outcomes in athletes undergoing revision ACLR. Meta-analysis was performed using random-effects models at 95% confidence intervals, with odds ratios used for comparative studies.RESULTSA total of 52 studies, consisting of 3814 patients, met inclusion criteria. The mean patient age was 27.6 ± 8.4 years, with 66.3% (2340/3532) of the patients being male. Soccer was the most commonly reported sport (24.6%; 390/1584), followed by basketball (17.6%; 278/1584) and football (7.8%; 124/1584). The overall pooled RTS rate was 77.8% (95% CI, 0.732-0.824), with the RTS rate to the previous level of competition being 48.2% (95% CI, 0.410-0.553). The weighted mean time to RTS was 9.3 ± 2.7 months. Patients undergoing revision ACLR with the addition of a lateral extra-articular procedure (LEAP) had a significantly higher RTS rate (90.6% vs 74.9%; P < .00001), while greater articular cartilage damage was associated with less successful RTS (OR, 0.214; 95% CI, 0.078-0.584). The mean postoperative Anterior Cruciate Ligament Return to Sport after Injury score was 61.2 ± 24.1 (n = 535). The most commonly reported reason for failure to RTS or RTS at a lower competition level was fear of reinjury (28.0%; 142/508), followed by knee pain (12.0%; 61/508) and persistent instability (7.3%; 37/508).CONCLUSIONThe overall RTS rate after revision ACLR was 77.8%, with 48.2% returning to the previous level of competition. The addition of a LEAP led to improved RTS rates. Fear of reinjury was reported as the most commonly reported barrier to successful RTS.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"69 1","pages":"3635465251405493"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021673","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 : 2026-01-23DOI: 10.1177/03635465251405495
Matthew Charles Johnson,Ameer Tabbaa,Jesse Galina,Hardik Dabas,Orry Erez,Jorge Chahla,Andrew Pearle,Ron Gilat
BACKGROUNDAnterior cruciate ligament reconstruction augmented with modified-Lemaire lateral extra-articular tenodesis (ACLR+LET) improves rotational stability of the knee in patients with a moderate to high risk of graft failure. Early biomechanical data suggest divergent pullout strengths among various LET fixation methods, but their clinical significance remains to be determined.PURPOSETo evaluate graft rupture rates in ACLR+LET compared with ACLR alone, stratified by the method of LET femoral fixation.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 3.METHODSA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search was conducted across PubMed, Embase, Scopus, and CENTRAL for studies that referenced Lateral Extra-articular Tenodesis and Modified Lemaire. A meta-analysis was performed with a significance threshold of .05.RESULTSA total of 1199 studies were screened, and 17 met the final inclusion criteria. Across these studies, 2527 patients who underwent ACLR were analyzed; 1254 underwent ACLR with LET augmentation. LET augmentation significantly reduced graft rupture rates compared with ACLR alone (odds ratio [OR], 2.90 [95% CI, 1.89-4.46]). Among ACLR+LET subgroups, anchor fixation demonstrated the greatest reduction in graft failure (OR, 4.93; P < .001), followed by staple fixation (OR, 3.04; P < .001). Other fixation methods-including button, suture, and screw-showed potential benefit, but individual results were not statistically significant (P > .05). Further analysis revealed that LET significantly reduced graft failure in primary ACLR (OR, 3.44; P = .00). LET-specific hardware removal was rare (0.82% [95% CI, 0.07%-2.10%]), with the highest rates seen in staple fixation, followed by anchor, and no events reported in the button and screw groups (1.58% vs 1.10% vs 0% vs 0%; P = .702).CONCLUSIONACLR+LET significantly reduces the risk of primary graft failure compared with ACLR alone. Among LET femoral fixation methods, anchor and staple fixation demonstrate the lowest ACL graft failure rates, with similar hardware removal rates.
背景：改良lemaire外侧关节外肌腱固定术（ACLR+LET）增强前交叉韧带重建可改善中度至高风险移植失败患者膝关节旋转稳定性。早期的生物力学数据表明，不同的LET固定方法的拔出强度不同，但其临床意义仍有待确定。目的评价ACLR+LET与单纯ACLR相比较，采用LET股内固定分层。研究设计：系统评价和荟萃分析；证据水平，3。方法按照PRISMA（系统评价和荟萃分析首选报告项目）指南进行系统评价。我们对PubMed、Embase、Scopus和CENTRAL进行了全面的检索，以查找有关外侧关节外肌腱固定术和改良Lemaire的研究。进行meta分析，显著性阈值为0.05。结果共筛选1199项研究，其中17项符合最终纳入标准。在这些研究中，2527例接受ACLR的患者被分析；1254例行ACLR伴LET增强。与单纯ACLR相比，LET增强显著降低了移植物破裂率（优势比[OR]， 2.90 [95% CI, 1.89-4.46]）。在ACLR+LET亚组中，锚钉固定能最大程度地减少移植物失败（OR, 4.93; P < 0.001），其次是钉钉固定（OR, 3.04; P < 0.001）。其他固定方法（包括钮扣、缝线和螺钉）显示出潜在的益处，但个别结果无统计学意义（P < 0.05）。进一步分析显示，LET可显著降低原发性ACLR的移植物衰竭（OR, 3.44; P = .00）。let特异性内固定清除非常罕见（0.82% [95% CI, 0.07%-2.10%]），钉钉固定发生率最高，其次是锚钉，钮扣和螺钉组未报告发生此类事件（1.58% vs 1.10% vs 0% vs 0%; P = 0.702）。结论与单纯ACLR相比，ACLR+LET可显著降低原发性移植物衰竭的风险。在LET股骨固定方法中，锚钉和钉钉固定显示出最低的ACL移植物失败率，其内固定物移除率相似。
{"title":"The Effect of Lateral Extra-articular Tenodesis Femoral Fixation Methods on Graft Failure Rates in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.","authors":"Matthew Charles Johnson,Ameer Tabbaa,Jesse Galina,Hardik Dabas,Orry Erez,Jorge Chahla,Andrew Pearle,Ron Gilat","doi":"10.1177/03635465251405495","DOIUrl":"https://doi.org/10.1177/03635465251405495","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament reconstruction augmented with modified-Lemaire lateral extra-articular tenodesis (ACLR+LET) improves rotational stability of the knee in patients with a moderate to high risk of graft failure. Early biomechanical data suggest divergent pullout strengths among various LET fixation methods, but their clinical significance remains to be determined.PURPOSETo evaluate graft rupture rates in ACLR+LET compared with ACLR alone, stratified by the method of LET femoral fixation.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 3.METHODSA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search was conducted across PubMed, Embase, Scopus, and CENTRAL for studies that referenced Lateral Extra-articular Tenodesis and Modified Lemaire. A meta-analysis was performed with a significance threshold of .05.RESULTSA total of 1199 studies were screened, and 17 met the final inclusion criteria. Across these studies, 2527 patients who underwent ACLR were analyzed; 1254 underwent ACLR with LET augmentation. LET augmentation significantly reduced graft rupture rates compared with ACLR alone (odds ratio [OR], 2.90 [95% CI, 1.89-4.46]). Among ACLR+LET subgroups, anchor fixation demonstrated the greatest reduction in graft failure (OR, 4.93; P < .001), followed by staple fixation (OR, 3.04; P < .001). Other fixation methods-including button, suture, and screw-showed potential benefit, but individual results were not statistically significant (P > .05). Further analysis revealed that LET significantly reduced graft failure in primary ACLR (OR, 3.44; P = .00). LET-specific hardware removal was rare (0.82% [95% CI, 0.07%-2.10%]), with the highest rates seen in staple fixation, followed by anchor, and no events reported in the button and screw groups (1.58% vs 1.10% vs 0% vs 0%; P = .702).CONCLUSIONACLR+LET significantly reduces the risk of primary graft failure compared with ACLR alone. Among LET femoral fixation methods, anchor and staple fixation demonstrate the lowest ACL graft failure rates, with similar hardware removal rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"86 1","pages":"3635465251405495"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021628","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 : 2026-01-23DOI: 10.1177/03635465251405438
Ajay Shah,Kosaran Gumarathas,Paul Marks,Robert G Marx,Alexander Kiss,David Wasserstein
BACKGROUNDDetermining the long-term risk of arthritis in patients with anterior cruciate ligament (ACL) injury treated nonoperatively versus those who undergo ACL reconstruction (ACLR) remains an important and unanswered question for patients and surgeons.PURPOSE(1) To define the cumulative arthritis rate and severity after nonsurgical management of ACL injury-the chronically ACL-deficient (ACLD) knee; (2) to compare rates and severity of arthritis in patients who have ACLD knee with similar patients who underwent ACLR; and (3) to identify clinically relevant risk factors for arthritis.STUDY DESIGNSystematic review; Level of evidence, 3.METHODSThree databases (Medline, Embase, PubMed) were searched for primary studies examining radiographic outcomes in patients with chronic ACL deficiency (>12 months of ACL deficiency). Studies with a matched ACLR control group were included. Quality assessment was performed with the MINORS (Methodological Index for Nonrandomized Studies) tool. Arthritis prevalence over time was plotted and modeled to best-fit using the Akaike information criterion. Data were extracted for meta-analysis for the primary outcome of osteoarthritis. The cumulative odds ratio of prognostic factors was calculated where appropriate.RESULTSNineteen full-text studies met inclusion criteria (11 matched cohort studies comparing ACLD and ACLR) including 1432 patients with a mean 11.1 years of follow-up after injury. The methodological quality of included studies was moderate. The pooled rate of radiographic arthritis in ACLD patients was 37.8%; the rate of moderate to severe arthritis was 18.1% (compared with 35.2% and 12.8% in patients with ACLR, respectively, and 5.0% in the nonoperated knee). An increase in the rate of arthritis was observed, accelerating sharply at 10 years after injury. ACLR and ACLD knees had similar prevalence of mild arthritis (P = .60), irrespective of activity level. Joint degeneration was significantly accelerated by meniscectomy in ACLD patients in most studies.CONCLUSIONPatients with a chronically ACLD knee may be at an increased predisposition for developing moderate to severe arthritis but not mild arthritis compared with matched patients who undergo ACLR. Meniscectomy is a key predictor of worsened severity of osteoarthritis.
{"title":"The Long-term Radiographic Fate of the Chronically ACL-Deficient Knee: A Systematic Review and Meta-analysis of Matched Cohort Studies.","authors":"Ajay Shah,Kosaran Gumarathas,Paul Marks,Robert G Marx,Alexander Kiss,David Wasserstein","doi":"10.1177/03635465251405438","DOIUrl":"https://doi.org/10.1177/03635465251405438","url":null,"abstract":"BACKGROUNDDetermining the long-term risk of arthritis in patients with anterior cruciate ligament (ACL) injury treated nonoperatively versus those who undergo ACL reconstruction (ACLR) remains an important and unanswered question for patients and surgeons.PURPOSE(1) To define the cumulative arthritis rate and severity after nonsurgical management of ACL injury-the chronically ACL-deficient (ACLD) knee; (2) to compare rates and severity of arthritis in patients who have ACLD knee with similar patients who underwent ACLR; and (3) to identify clinically relevant risk factors for arthritis.STUDY DESIGNSystematic review; Level of evidence, 3.METHODSThree databases (Medline, Embase, PubMed) were searched for primary studies examining radiographic outcomes in patients with chronic ACL deficiency (>12 months of ACL deficiency). Studies with a matched ACLR control group were included. Quality assessment was performed with the MINORS (Methodological Index for Nonrandomized Studies) tool. Arthritis prevalence over time was plotted and modeled to best-fit using the Akaike information criterion. Data were extracted for meta-analysis for the primary outcome of osteoarthritis. The cumulative odds ratio of prognostic factors was calculated where appropriate.RESULTSNineteen full-text studies met inclusion criteria (11 matched cohort studies comparing ACLD and ACLR) including 1432 patients with a mean 11.1 years of follow-up after injury. The methodological quality of included studies was moderate. The pooled rate of radiographic arthritis in ACLD patients was 37.8%; the rate of moderate to severe arthritis was 18.1% (compared with 35.2% and 12.8% in patients with ACLR, respectively, and 5.0% in the nonoperated knee). An increase in the rate of arthritis was observed, accelerating sharply at 10 years after injury. ACLR and ACLD knees had similar prevalence of mild arthritis (P = .60), irrespective of activity level. Joint degeneration was significantly accelerated by meniscectomy in ACLD patients in most studies.CONCLUSIONPatients with a chronically ACLD knee may be at an increased predisposition for developing moderate to severe arthritis but not mild arthritis compared with matched patients who undergo ACLR. Meniscectomy is a key predictor of worsened severity of osteoarthritis.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"47 1","pages":"3635465251405438"},"PeriodicalIF":0.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021679","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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