Pub Date : 2026-01-21DOI: 10.1177/03635465251405731
Dean K Matsuda,Andrew B Wolff,Shane Nho,John J Christoforetti,John P Salvo,RobRoy L Martin,Ryan McGovern,Richard J Silk,Allysa Ishimoto,Brandon Ko,Dominic Carreira
BACKGROUNDSome studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts.PURPOSE/HYPOTHESISThe purpose of this study was to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. It was hypothesized that patients with acetabular cysts would demonstrate inferior outcomes at minimum 2-year follow-up compared with patients without acetabular cysts.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA multicenter matched-pair study was performed across 6 medical centers with data from a large prospectively collected database. Inclusion criteria were adult patients who had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging. A control group was matched on age; sex; body mass index (BMI); lateral center-edge angle (LCEA); alpha angle; arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (ie, repair, reconstruction, or debridement); Beck chondral grade; and minimum 2-year outcomes using visual analog scale (VAS) for pain, International Hip Outcome Tool-12 (iHOT-12), minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS).RESULTSThe study included 82 patients, of whom 41 composed the study group and 41 served as matched control patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m2. Mean LCEA was 33.55°± 6.30°, and mean alpha angle was 70.22°± 9.71°. Mean Beck chondral grade was 2.59 ± 1.27 in the study group and 2.70 ± 0.95 in the matched control group (P = .72). Two-year mean postoperative iHOT-12 scores for the study and control groups were 69.49 ± 24.51 and 73.24 ± 25.16, respectively (P = .38), whereas mean postoperative VAS scores for pain were 18.84 ± 18.17 and 20.74 ± 21.39, respectively (P = .70). The study group reached MCID in 82.93%, SCB in 58.54%, and PASS in 65.85% and were similar to those of the control group.CONCLUSIONPatients undergoing arthroscopic surgery for FAIS with acetabular cysts had similarly successful outcomes as patients without acetabular cysts. Acetabular subchondral cysts may not be a contraindication to hip arthroscopy in patients with FAIS who would otherwise be indicated for this surgery.
{"title":"Outcomes of Hip Arthroscopy in Patients With Acetabular Cysts: A Multicenter Matched Controlled Study From the MASH Study Group.","authors":"Dean K Matsuda,Andrew B Wolff,Shane Nho,John J Christoforetti,John P Salvo,RobRoy L Martin,Ryan McGovern,Richard J Silk,Allysa Ishimoto,Brandon Ko,Dominic Carreira","doi":"10.1177/03635465251405731","DOIUrl":"https://doi.org/10.1177/03635465251405731","url":null,"abstract":"BACKGROUNDSome studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts.PURPOSE/HYPOTHESISThe purpose of this study was to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. It was hypothesized that patients with acetabular cysts would demonstrate inferior outcomes at minimum 2-year follow-up compared with patients without acetabular cysts.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA multicenter matched-pair study was performed across 6 medical centers with data from a large prospectively collected database. Inclusion criteria were adult patients who had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging. A control group was matched on age; sex; body mass index (BMI); lateral center-edge angle (LCEA); alpha angle; arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (ie, repair, reconstruction, or debridement); Beck chondral grade; and minimum 2-year outcomes using visual analog scale (VAS) for pain, International Hip Outcome Tool-12 (iHOT-12), minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS).RESULTSThe study included 82 patients, of whom 41 composed the study group and 41 served as matched control patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m2. Mean LCEA was 33.55°± 6.30°, and mean alpha angle was 70.22°± 9.71°. Mean Beck chondral grade was 2.59 ± 1.27 in the study group and 2.70 ± 0.95 in the matched control group (P = .72). Two-year mean postoperative iHOT-12 scores for the study and control groups were 69.49 ± 24.51 and 73.24 ± 25.16, respectively (P = .38), whereas mean postoperative VAS scores for pain were 18.84 ± 18.17 and 20.74 ± 21.39, respectively (P = .70). The study group reached MCID in 82.93%, SCB in 58.54%, and PASS in 65.85% and were similar to those of the control group.CONCLUSIONPatients undergoing arthroscopic surgery for FAIS with acetabular cysts had similarly successful outcomes as patients without acetabular cysts. Acetabular subchondral cysts may not be a contraindication to hip arthroscopy in patients with FAIS who would otherwise be indicated for this surgery.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"123 1","pages":"3635465251405731"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005265","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 : 2026-01-21DOI: 10.1177/03635465251401561
Ali Asma,Samir Sharrak,Marcus A Shelby,Matthew Veerkamp,Shital N Parikh
BACKGROUNDAbout 10% to 16% of patients with patellar instability have bilateral involvement. The risk factors for future contralateral patellar instability in patients who have ipsilateral patellar instability are not known. Knowledge related to the possibility of future contralateral patellar instability would be helpful, as previous studies have shown suboptimal outcomes and increased complication rates in patients with bilateral patellar instability.PURPOSEThe purpose of the current study was to identify the risk factors for future contralateral patellar instability and develop a prediction model for contralateral patellar instability.STUDY DESIGNCase series; Level of evidence, 4.METHODSUsing a hospital-based surgery database from 2012 to 2022, all patients who underwent medial patellofemoral ligament (MPFL) reconstruction were identified. Age, sex, skeletal maturity, body mass index, generalized joint hypermobility (defined as a Beighton score ≥5), and first-time versus recurrent ipsilateral patellar dislocation were noted. There were 4 anatomic risk factors-trochlear depth, Caton-Deschamps index, tibial tubercle-trochlear groove distance, and patellar tilt-assessed on magnetic resonance imaging of the ipsilateral knee. Multivariable backward conditional logistic regression analysis was performed to identify the risk factors for contralateral patellar instability. A simplified prediction model for contralateral patellar instability was developed based on the number of risk factors.RESULTSDuring the study period, 380 knees in 293 patients underwent MPFL reconstruction and formed the study cohort. The mean age at surgery was 14.7 ± 2.7 years. 243 ipsilateral knees (63.9%) were female, and 168 (44.2%) were skeletally immature. 83 knees (21.8%) had a first-time dislocation, while 297 (78.2%) had a recurrent dislocation. Of these 380 knees, 130 (34.2%) had future contralateral patellar instability. On multivariable regression analysis, skeletal immaturity (odds ratio [OR], 1.90 [95% CI, 1.20-3.00]), generalized joint hypermobility (OR, 2.80 [95% CI, 1.50-5.10]), recurrent patellar instability in the ipsilateral knee (OR, 2.00 [95% CI, 1.10-3.70]), trochlear dysplasia in the ipsilateral knee (OR, 1.90 [95% CI, 1.05-3.40]), and patella alta in the ipsilateral knee (OR, 1.80 [95% CI, 0.96-3.30]) comprised the final model to predict contralateral patellar instability. As per the prediction model, the risk of future contralateral patellar instability was 9.2% if there was no risk factor present and 77.8% if all 5 risk factors were present.CONCLUSIONSkeletal immaturity, recurrent patellar instability in the involved knee, generalized joint hypermobility (Beighton score ≥5), trochlear dysplasia in the involved knee, and patella alta in the involved knee could help to predict contralateral patellar instability.
{"title":"Prediction of Contralateral Patellar Instability After Ipsilateral Medial Patellofemoral Ligament Reconstruction.","authors":"Ali Asma,Samir Sharrak,Marcus A Shelby,Matthew Veerkamp,Shital N Parikh","doi":"10.1177/03635465251401561","DOIUrl":"https://doi.org/10.1177/03635465251401561","url":null,"abstract":"BACKGROUNDAbout 10% to 16% of patients with patellar instability have bilateral involvement. The risk factors for future contralateral patellar instability in patients who have ipsilateral patellar instability are not known. Knowledge related to the possibility of future contralateral patellar instability would be helpful, as previous studies have shown suboptimal outcomes and increased complication rates in patients with bilateral patellar instability.PURPOSEThe purpose of the current study was to identify the risk factors for future contralateral patellar instability and develop a prediction model for contralateral patellar instability.STUDY DESIGNCase series; Level of evidence, 4.METHODSUsing a hospital-based surgery database from 2012 to 2022, all patients who underwent medial patellofemoral ligament (MPFL) reconstruction were identified. Age, sex, skeletal maturity, body mass index, generalized joint hypermobility (defined as a Beighton score ≥5), and first-time versus recurrent ipsilateral patellar dislocation were noted. There were 4 anatomic risk factors-trochlear depth, Caton-Deschamps index, tibial tubercle-trochlear groove distance, and patellar tilt-assessed on magnetic resonance imaging of the ipsilateral knee. Multivariable backward conditional logistic regression analysis was performed to identify the risk factors for contralateral patellar instability. A simplified prediction model for contralateral patellar instability was developed based on the number of risk factors.RESULTSDuring the study period, 380 knees in 293 patients underwent MPFL reconstruction and formed the study cohort. The mean age at surgery was 14.7 ± 2.7 years. 243 ipsilateral knees (63.9%) were female, and 168 (44.2%) were skeletally immature. 83 knees (21.8%) had a first-time dislocation, while 297 (78.2%) had a recurrent dislocation. Of these 380 knees, 130 (34.2%) had future contralateral patellar instability. On multivariable regression analysis, skeletal immaturity (odds ratio [OR], 1.90 [95% CI, 1.20-3.00]), generalized joint hypermobility (OR, 2.80 [95% CI, 1.50-5.10]), recurrent patellar instability in the ipsilateral knee (OR, 2.00 [95% CI, 1.10-3.70]), trochlear dysplasia in the ipsilateral knee (OR, 1.90 [95% CI, 1.05-3.40]), and patella alta in the ipsilateral knee (OR, 1.80 [95% CI, 0.96-3.30]) comprised the final model to predict contralateral patellar instability. As per the prediction model, the risk of future contralateral patellar instability was 9.2% if there was no risk factor present and 77.8% if all 5 risk factors were present.CONCLUSIONSkeletal immaturity, recurrent patellar instability in the involved knee, generalized joint hypermobility (Beighton score ≥5), trochlear dysplasia in the involved knee, and patella alta in the involved knee could help to predict contralateral patellar instability.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"48 1","pages":"3635465251401561"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005267","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 : 2026-01-21DOI: 10.1177/03635465251407113
Corinna C Franklin,Emily Nice,Kevin Moran, , ,Eric Heidel,Jeremy Bauer
BACKGROUNDAthletes can be profoundly impacted by their environment and support system. For young, injured athletes, parents may wield significant influence over their treatment and recovery, yet may hold divergent perceptions of the athletes' condition.HYPOTHESISWhen using the Patient-Reported Outcomes Measurement Information System (PROMIS) metrics, parents and athletes will have differing perceptions about how the athletes are affected by their injury.STUDY DESIGNCohort study; Level of evidence, 3.METHODSThis study was approved by our institutional review board. In our clinics, each child (age, 8-17 years) routinely takes a series of PROMIS questionnaires. For study purposes, at 1 sports clinic visit per child, we had an accompanying parent independently complete the same PROMIS metrics on the child's behalf. We then formed dyads from each athlete/parent response and used these dyads for analysis to quantify differences in their understanding. Generalized estimating equations were used to analyze differences between members of the dyads (correlated data).RESULTSThe total number of dyads examined was 387. There were 201 female athletes, 186 male athletes, 302 female parents, and 85 male parents. The mean age of both male and female athletes was 14 years. Across all dyads, parents rated pain interference as worse than patients did, by a mean of 5 points (mean score, 50.03 vs 45.46, respectively; P < .001). Significant differences were also noted in peer relationships, mobility, and upper-extremity PROMIS domains. In all domains, parents rated the patients as doing worse than the athletes did themselves. When examined by sport, parents of athletes in football, soccer, gymnastics, and basketball rated pain interference as worse. Parents of athletes treated both operatively and nonoperatively rated pain interference as higher, and parents of both sexes rated pain interference as higher.CONCLUSIONParents of injured athletes perceive their children to be more affected by pain than the athletes themselves. Parents also perceive injured athletes to have worse function across all domains than the athletes themselves do.
{"title":"Perception of Pain and Function Among Athletes and Parents: A PROMIS Dyad Study.","authors":"Corinna C Franklin,Emily Nice,Kevin Moran, , ,Eric Heidel,Jeremy Bauer","doi":"10.1177/03635465251407113","DOIUrl":"https://doi.org/10.1177/03635465251407113","url":null,"abstract":"BACKGROUNDAthletes can be profoundly impacted by their environment and support system. For young, injured athletes, parents may wield significant influence over their treatment and recovery, yet may hold divergent perceptions of the athletes' condition.HYPOTHESISWhen using the Patient-Reported Outcomes Measurement Information System (PROMIS) metrics, parents and athletes will have differing perceptions about how the athletes are affected by their injury.STUDY DESIGNCohort study; Level of evidence, 3.METHODSThis study was approved by our institutional review board. In our clinics, each child (age, 8-17 years) routinely takes a series of PROMIS questionnaires. For study purposes, at 1 sports clinic visit per child, we had an accompanying parent independently complete the same PROMIS metrics on the child's behalf. We then formed dyads from each athlete/parent response and used these dyads for analysis to quantify differences in their understanding. Generalized estimating equations were used to analyze differences between members of the dyads (correlated data).RESULTSThe total number of dyads examined was 387. There were 201 female athletes, 186 male athletes, 302 female parents, and 85 male parents. The mean age of both male and female athletes was 14 years. Across all dyads, parents rated pain interference as worse than patients did, by a mean of 5 points (mean score, 50.03 vs 45.46, respectively; P < .001). Significant differences were also noted in peer relationships, mobility, and upper-extremity PROMIS domains. In all domains, parents rated the patients as doing worse than the athletes did themselves. When examined by sport, parents of athletes in football, soccer, gymnastics, and basketball rated pain interference as worse. Parents of athletes treated both operatively and nonoperatively rated pain interference as higher, and parents of both sexes rated pain interference as higher.CONCLUSIONParents of injured athletes perceive their children to be more affected by pain than the athletes themselves. Parents also perceive injured athletes to have worse function across all domains than the athletes themselves do.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"29 1","pages":"3635465251407113"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005263","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 : 2026-01-21DOI: 10.1177/03635465251400346
Rodrigo Bernstein Conde,André Richard da Silva Oliveira Filho,Elcio Machinski,Vinícius Furtado da Cruz,Bruno Butturi Varone,Riccardo Gomes Gobbi,Camilo Partezani Helito,Andre Giardino Moreira da Silva,Daniel Peixoto Leal
BACKGROUNDAnterior cruciate ligament reconstruction with suture augmentation (ACLR-SA) has been explored for its potential to provide additional graft protection.PURPOSETo compare failure rates, complications, patient-reported outcomes, and return to sport between ACLR-SA and nonaugmented ACLR.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 2.METHODSRandomized controlled trials and quasi-experimental studies were included if they provided data on population (patients with anterior cruciate ligament tear), intervention (ACLR-SA regardless of SA material and graft type), comparator (nonaugmented ACLR), and outcomes (failure, arthrofibrosis and cyclops, subsequent meniscal surgery, hardware removal, Lysholm and International Knee Documentation Committee scores, and/or return to sport).RESULTSEleven articles (1179 patients) were included. ACLR performed with hamstring autograft augmented with FiberTape reduced failure rates as compared with nonaugmented ACLR (3.1% vs 8.5%; odds ratio [OR], 2.86; 95% CI, 1.03-7.90; P = .043; I2 = 0%). In addition, the 2 techniques showed no differences in arthrofibrosis/cyclops (OR, 0.94; 95% CI, 0.26-3.33; P = .919; I2 = 0%), subsequent meniscal surgery (OR, 1.05; 95% CI, 0.32-3.44; P = .942; I2 = 0%), International Knee Documentation Committee score (mean difference, -1.20; 95% CI, -3.06 to 0.06; P = .206; I2 = 0%), and Lysholm score (mean difference, -0.96; 95% CI, -4.53 to 2.61; P = .597; I2 = 65%). When the FiberWire was utilized for hamstring autograft suture augmentation, no significant differences in failure rates were observed between groups. The pooled synthesis for all graft and augmentation combinations showed that ACLR-SA was associated with an increased return to preinjury activity level (72.5% vs 54.0%; OR, 0.44; 95% CI, 0.21-0.91; P = .027; I2 = 0%).CONCLUSIONAvailable evidence supports the use of suture tape augmentation in ACLRs performed with hamstring autografts, as it reduces failure rates while maintaining equivalent complication rates and patient-reported outcomes as compared with nonaugmented ACLR.
背景：前交叉韧带重建与缝线增强（ACLR-SA）已被探索其潜在的提供额外的移植物保护。目的比较ACLR- sa和非增强型ACLR的失败率、并发症、患者报告的结果和重返运动。研究设计：系统评价和荟萃分析；证据等级2。方法随机对照试验和准实验研究纳入，如果它们提供了人群（前交叉韧带撕裂患者）、干预（ACLR-SA，无论SA材料和移植物类型）、比较（非增强ACLR）和结果（失败、关节纤维化和cyclops、随后的半月板手术、硬件移除、Lysholm和国际膝关节文献委员会评分和/或恢复运动）的数据。结果纳入文献7篇（1179例）。与未增强的ACLR相比，FiberTape增强的腿筋自体移植物行ACLR降低了失败率（3.1% vs 8.5%；比值比[OR]， 2.86; 95% CI, 1.03-7.90; P = 0.043; I2 = 0%）。此外，两种技术在关节纤维化/独眼症（OR, 0.94; 95% CI, 0.26-3.33; P = 0.919; I2 = 0%）、随后的半月板手术（OR, 1.05; 95% CI, 0.32-3.44; P = 0.942; I2 = 0%）、国际膝关节文献委员会评分（平均差值，-1.20;95% CI, -3.06 - 0.06; P = 0.206; I2 = 0%）和Lysholm评分（平均差值，-0.96;95% CI, -4.53 - 2.61; P = 0.597; I2 = 65%）方面均无差异。当FiberWire用于腘绳肌腱自体缝合增强时，两组间的失败率无显著差异。所有移植物和增强物组合的综合分析显示，ACLR-SA与损伤前活动水平的恢复增加相关（72.5% vs 54.0%； OR, 0.44; 95% CI, 0.21-0.91; P = 0.027; I2 = 0%）。结论现有证据支持在自体腘绳肌腱移植的ACLR中使用缝合带增强，因为与未增强的ACLR相比，它降低了失败率，同时保持了相同的并发症发生率和患者报告的结果。
{"title":"Anterior Cruciate Ligament Reconstruction With Hamstring Autografts and Suture Tape Augmentation Results in Lower Failure Rates While Maintaining Functional Outcomes and Complication Rates Similar to Nonaugmented Techniques: A Systematic Review and Meta-analysis.","authors":"Rodrigo Bernstein Conde,André Richard da Silva Oliveira Filho,Elcio Machinski,Vinícius Furtado da Cruz,Bruno Butturi Varone,Riccardo Gomes Gobbi,Camilo Partezani Helito,Andre Giardino Moreira da Silva,Daniel Peixoto Leal","doi":"10.1177/03635465251400346","DOIUrl":"https://doi.org/10.1177/03635465251400346","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament reconstruction with suture augmentation (ACLR-SA) has been explored for its potential to provide additional graft protection.PURPOSETo compare failure rates, complications, patient-reported outcomes, and return to sport between ACLR-SA and nonaugmented ACLR.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 2.METHODSRandomized controlled trials and quasi-experimental studies were included if they provided data on population (patients with anterior cruciate ligament tear), intervention (ACLR-SA regardless of SA material and graft type), comparator (nonaugmented ACLR), and outcomes (failure, arthrofibrosis and cyclops, subsequent meniscal surgery, hardware removal, Lysholm and International Knee Documentation Committee scores, and/or return to sport).RESULTSEleven articles (1179 patients) were included. ACLR performed with hamstring autograft augmented with FiberTape reduced failure rates as compared with nonaugmented ACLR (3.1% vs 8.5%; odds ratio [OR], 2.86; 95% CI, 1.03-7.90; P = .043; I2 = 0%). In addition, the 2 techniques showed no differences in arthrofibrosis/cyclops (OR, 0.94; 95% CI, 0.26-3.33; P = .919; I2 = 0%), subsequent meniscal surgery (OR, 1.05; 95% CI, 0.32-3.44; P = .942; I2 = 0%), International Knee Documentation Committee score (mean difference, -1.20; 95% CI, -3.06 to 0.06; P = .206; I2 = 0%), and Lysholm score (mean difference, -0.96; 95% CI, -4.53 to 2.61; P = .597; I2 = 65%). When the FiberWire was utilized for hamstring autograft suture augmentation, no significant differences in failure rates were observed between groups. The pooled synthesis for all graft and augmentation combinations showed that ACLR-SA was associated with an increased return to preinjury activity level (72.5% vs 54.0%; OR, 0.44; 95% CI, 0.21-0.91; P = .027; I2 = 0%).CONCLUSIONAvailable evidence supports the use of suture tape augmentation in ACLRs performed with hamstring autografts, as it reduces failure rates while maintaining equivalent complication rates and patient-reported outcomes as compared with nonaugmented ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"101 1","pages":"3635465251400346"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005264","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}
BACKGROUNDOsteochondral injuries, involving damage to both cartilage and subchondral bone, require a biphasic regenerative approach. A previous study demonstrated that a biphasic implant, composed of a hydroxyapatite (HA) block for the bone layer and a scaffold-free synovial mesenchymal stem cell-derived tissue-engineered construct (TEC) for the cartilage layer, successfully repaired osteochondral defects in a rabbit model. To facilitate less invasive surgical application, the authors investigated alternative HA forms including granules and paste for use in the subchondral component for the biphasic implant.HYPOTHESISBiphasic implants composed of TEC combined with either HA granules or HA paste would potentially achieve successful osteochondral repair, comparable to that of a conventional HA block-based implant.STUDY DESIGNControlled laboratory study.METHODSBilateral osteochondral defects (5 mm in diameter and 6 mm in depth) were created in the femoral grooves of rabbits and treated with a TEC combined with 1 of 3 HA forms: block, granules, or paste. Histological and biomechanical analyses were performed at 4, 8, and 24 weeks postimplantation (5 per group per time point).RESULTSThe TEC/HA block group achieved complete osteochondral repair with stable maturation, and the repaired tissue demonstrated biomechanical properties comparable to native tissue at 24 weeks postimplantation. In contrast, the TEC/HA granule group showed early signs of repair that progressively deteriorated, resulting in significantly inferior structural and mechanical properties. The TEC/HA paste group supported subchondral bone repair but resulted in incomplete cartilage formation at 24 weeks postimplantation.CONCLUSIONThe TEC/HA block implant showed superior histological and biomechanical outcomes compared with other HA forms. Therefore, further optimization of granular or paste formulation is required to possibly enhance the potential for arthroscopic or minimally invasive delivery of a biphasic implant.CLINICAL RELEVANCEThis study highlights the potential of biphasic implants combining clinically available TEC and HA artificial bone for osteochondral repair. The biphasic implant can be easily prepared intraoperatively without specialized fabrication. Long-term observations revealed distinct repair patterns for each HA form, which may assist surgeons in selecting the optimal HA artificial bone form for effective and durable subchondral bone repair in osteochondral regeneration.
{"title":"Comparison of 3 Forms of Clinically Available Hydroxyapatite Artificial Bone for Use in Biphasic Implants With Synovial Mesenchymal Stem Cell-Derived Tissue-Engineered Constructs for Osteochondral Repair.","authors":"Kazunori Shimomura,Seido Yarimitsu,George Jacob,Taro Akimori,Masato Nakamura,Wataru Ando,David A Hart,Hiromichi Fujie,Seiji Okada,Norimasa Nakamura","doi":"10.1177/03635465251407260","DOIUrl":"https://doi.org/10.1177/03635465251407260","url":null,"abstract":"BACKGROUNDOsteochondral injuries, involving damage to both cartilage and subchondral bone, require a biphasic regenerative approach. A previous study demonstrated that a biphasic implant, composed of a hydroxyapatite (HA) block for the bone layer and a scaffold-free synovial mesenchymal stem cell-derived tissue-engineered construct (TEC) for the cartilage layer, successfully repaired osteochondral defects in a rabbit model. To facilitate less invasive surgical application, the authors investigated alternative HA forms including granules and paste for use in the subchondral component for the biphasic implant.HYPOTHESISBiphasic implants composed of TEC combined with either HA granules or HA paste would potentially achieve successful osteochondral repair, comparable to that of a conventional HA block-based implant.STUDY DESIGNControlled laboratory study.METHODSBilateral osteochondral defects (5 mm in diameter and 6 mm in depth) were created in the femoral grooves of rabbits and treated with a TEC combined with 1 of 3 HA forms: block, granules, or paste. Histological and biomechanical analyses were performed at 4, 8, and 24 weeks postimplantation (5 per group per time point).RESULTSThe TEC/HA block group achieved complete osteochondral repair with stable maturation, and the repaired tissue demonstrated biomechanical properties comparable to native tissue at 24 weeks postimplantation. In contrast, the TEC/HA granule group showed early signs of repair that progressively deteriorated, resulting in significantly inferior structural and mechanical properties. The TEC/HA paste group supported subchondral bone repair but resulted in incomplete cartilage formation at 24 weeks postimplantation.CONCLUSIONThe TEC/HA block implant showed superior histological and biomechanical outcomes compared with other HA forms. Therefore, further optimization of granular or paste formulation is required to possibly enhance the potential for arthroscopic or minimally invasive delivery of a biphasic implant.CLINICAL RELEVANCEThis study highlights the potential of biphasic implants combining clinically available TEC and HA artificial bone for osteochondral repair. The biphasic implant can be easily prepared intraoperatively without specialized fabrication. Long-term observations revealed distinct repair patterns for each HA form, which may assist surgeons in selecting the optimal HA artificial bone form for effective and durable subchondral bone repair in osteochondral regeneration.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"275 1","pages":"3635465251407260"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005268","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 : 2026-01-21DOI: 10.1177/03635465251409347
Napatpong Thamrongskulsiri,Jacob T Morgan,Felipe Casanova,Tomas F Vega,Alireza Mirahmadi,Jorge Chahla
BACKGROUNDFemoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data.PURPOSETo compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome.STUDY DESIGNSystematic review and Meta-analysis; Level of evidence, 3.METHODSA systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA).RESULTSNine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature.CONCLUSIONSimultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile.REGISTRATIONPROSPERO (CRD420251039957).
{"title":"Outcomes of Simultaneous Bilateral, Staged Bilateral, and Unilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis.","authors":"Napatpong Thamrongskulsiri,Jacob T Morgan,Felipe Casanova,Tomas F Vega,Alireza Mirahmadi,Jorge Chahla","doi":"10.1177/03635465251409347","DOIUrl":"https://doi.org/10.1177/03635465251409347","url":null,"abstract":"BACKGROUNDFemoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data.PURPOSETo compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome.STUDY DESIGNSystematic review and Meta-analysis; Level of evidence, 3.METHODSA systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA).RESULTSNine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature.CONCLUSIONSimultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile.REGISTRATIONPROSPERO (CRD420251039957).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"194 1","pages":"3635465251409347"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005312","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 : 2026-01-21DOI: 10.1177/03635465251403499
Valeria Vismara,Pascal Boileau
BACKGROUNDThe high rates of failures and reoperations (up to 50%) after arthroscopic posterior Bankart repair (APBR) remain a concern.PURPOSETo evaluate mid- to long-term follow-up outcomes of APBR in patients with unidirectional, recurrent posterior shoulder instability and to identify risk factors for failure.STUDY DESIGNCase series; Level of evidence, 4.METHODSA single-center, retrospective study was conducted that included all consecutive athletes with unidirectional recurrent posterior shoulder instability operated on between 2006 and 2022. Patients with voluntary instability or previous failed instability repair were excluded. The posterior labrum was reattached using a minimum of 4 suture anchors, and a posteroinferior capsular shift was systematically performed. The mean follow-up was 11 years (range, 2-18 years). At final follow-up, the investigators evaluated persistent pain, apprehension, recurrence of instability (recurrent episode of either true dislocation or subluxation), range of motion, return to sport, and satisfaction. Revision surgeries and reoperations were also recorded.RESULTSThe study included 44 athletes (45 shoulders). Patients were predominantly males (96%) and had a mean age of 28 years at surgery, and half (51%) practiced a contact or collision sport. Recurrence of posterior instability occurred in 22% (10/45): 2 patients sustained frank posterior dislocations, 6 reported recurrent subluxations, and 2 had a single episode of subluxation. Of the 10 patients with recurrence of instability, only 2 were reoperated (revision rate 4%); the 8 remaining patients declined any additional surgery. The presence of posterior glenoid bone erosion (9 patients) was associated with a higher risk of postoperative recurrent dislocation or subluxation (P = .024). By contrast, the presence of a posterior glenoid fracture (6 patients) was not a risk factor for postoperative recurrence of instability. Other potential prognostic factors (young age, contact sport, voluntary instability that became involuntary, or reproducible instability) were not found to be significant in the present series. At 1-year follow-up, 75% returned to the same level of sports.CONCLUSIONIn patients with recurrent posterior instability, the presence of posterior glenoid erosion was the main risk factor for failure after APBR. By contrast, a posterior bony Bankart lesion did not represent a contraindication to arthroscopic stabilization using suture anchor fixation.
{"title":"Arthroscopic Posterior Bankart Repair: Risk Factors for Recurrence of Instability.","authors":"Valeria Vismara,Pascal Boileau","doi":"10.1177/03635465251403499","DOIUrl":"https://doi.org/10.1177/03635465251403499","url":null,"abstract":"BACKGROUNDThe high rates of failures and reoperations (up to 50%) after arthroscopic posterior Bankart repair (APBR) remain a concern.PURPOSETo evaluate mid- to long-term follow-up outcomes of APBR in patients with unidirectional, recurrent posterior shoulder instability and to identify risk factors for failure.STUDY DESIGNCase series; Level of evidence, 4.METHODSA single-center, retrospective study was conducted that included all consecutive athletes with unidirectional recurrent posterior shoulder instability operated on between 2006 and 2022. Patients with voluntary instability or previous failed instability repair were excluded. The posterior labrum was reattached using a minimum of 4 suture anchors, and a posteroinferior capsular shift was systematically performed. The mean follow-up was 11 years (range, 2-18 years). At final follow-up, the investigators evaluated persistent pain, apprehension, recurrence of instability (recurrent episode of either true dislocation or subluxation), range of motion, return to sport, and satisfaction. Revision surgeries and reoperations were also recorded.RESULTSThe study included 44 athletes (45 shoulders). Patients were predominantly males (96%) and had a mean age of 28 years at surgery, and half (51%) practiced a contact or collision sport. Recurrence of posterior instability occurred in 22% (10/45): 2 patients sustained frank posterior dislocations, 6 reported recurrent subluxations, and 2 had a single episode of subluxation. Of the 10 patients with recurrence of instability, only 2 were reoperated (revision rate 4%); the 8 remaining patients declined any additional surgery. The presence of posterior glenoid bone erosion (9 patients) was associated with a higher risk of postoperative recurrent dislocation or subluxation (P = .024). By contrast, the presence of a posterior glenoid fracture (6 patients) was not a risk factor for postoperative recurrence of instability. Other potential prognostic factors (young age, contact sport, voluntary instability that became involuntary, or reproducible instability) were not found to be significant in the present series. At 1-year follow-up, 75% returned to the same level of sports.CONCLUSIONIn patients with recurrent posterior instability, the presence of posterior glenoid erosion was the main risk factor for failure after APBR. By contrast, a posterior bony Bankart lesion did not represent a contraindication to arthroscopic stabilization using suture anchor fixation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"87 1","pages":"3635465251403499"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005216","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 : 2026-01-21DOI: 10.1177/03635465251400355
Thomas E Moran,Eric Y Hu,Jesus E Cervantes,Shane J Nho
BACKGROUNDLong-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been promising, but no studies to date have examined the effect of body mass index (BMI) on 10-year outcome scores and reoperation rates.PURPOSETo compare outcome scores and reoperation rates between normal-weight, overweight, and obese patients undergoing hip arthroscopy for FAIS at 10-year follow-up.STUDY DESIGNCohort study; Level of evidence, 3.METHODSPreoperative, 2-year, 5-year, and 10-year scores for patient-reported outcome measures (PROMs) in patients undergoing surgery between January 2012 and June 2014 were collected. These included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Clinically significant outcomes were also collected including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Patients were stratified into the normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2) group and matched in a 1:1:1 ratio, controlling for age and sex. Reoperation-free survivorship was determined.RESULTSA total of 168 patients, with a mean follow-up time of 10.3 ± 0.4 years, who underwent hip arthroscopy for FAIS were included in the study: 56 normal weight, 56 overweight, and 56 obese. While all groups had similar significant improvements in PROM scores by 10-year follow-up (all P < .001), multivariable analysis revealed significant differences in HOS-ADL scores preoperatively (P < .001) and at 2 years (P = .008), 5 years (P = .005), and 10 years (P = .023). The groups differed in mHHS scores at 2-year (P = .006), 5-year (P = .041), and 10-year follow-up (P = .027). All patients, regardless of BMI, had similar achievement rates of the MCID and PASS for all PROMs. Obese and overweight patients had significantly worse rates of total hip arthroplasty (THA)-free survivorship compared with normal-weight patients (80.4% vs 85.7% vs 96.4%, respectively; P = .026).CONCLUSIONThere were significant improvements in all outcome scores across all BMI groups by 10 years after the arthroscopic treatment of FAIS. Obese patients tended to have worse PROM scores at most follow-up time points but similar magnitudes of improvement from preoperatively. Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients.
髋关节镜治疗股髋臼撞击综合征（FAIS）后的长期预后很有希望，但迄今为止还没有研究检查体重指数（BMI）对10年预后评分和再手术率的影响。目的比较正常体重、超重和肥胖患者在10年随访期间接受髋关节镜治疗FAIS的结局评分和再手术率。研究设计：队列研究；证据水平，3。方法收集2012年1月至2014年6月接受手术的患者的术前、2年、5年和10年预后指标（PROMs）评分。这些包括髋关节结局评分-日常生活活动（HOS-ADL）、髋关节结局评分-运动子量表（HOS-SS）、改良Harris髋关节评分（mHHS）、12项国际髋关节结局工具（iHOT-12）、疼痛视觉模拟量表（VAS）和满意度VAS。收集临床显著性结果，包括最小临床重要差异（MCID）和患者可接受症状状态（PASS）。患者被分为正常体重组（18.5-24.9 kg/m2）、超重组（25.0-29.9 kg/m2）和肥胖组（≥30.0 kg/m2），在控制年龄和性别的情况下，按1:1:1的比例进行匹配。确定无再手术生存率。结果共纳入168例因FAIS接受髋关节镜检查的患者，平均随访时间为10.3±0.4年，其中体重正常56例，超重56例，肥胖56例。虽然随访10年各组PROM评分均有相似的显著改善（P < 0.001），但多变量分析显示术前、2年（P = 0.008）、5年（P = 0.005）和10年（P = 0.023）的HOS-ADL评分差异均有统计学意义（P < 0.001）。两组在随访2年（P = 0.006）、5年（P = 0.041）和10年（P = 0.027）时mHHS评分存在差异。所有患者，无论BMI如何，所有PROMs的MCID和PASS的成活率相似。与正常体重患者相比，肥胖和超重患者的全髋关节置换术（THA）无生存率明显较差（分别为80.4% vs 85.7% vs 96.4%; P = 0.026）。结论：关节镜治疗FAIS后10年，所有BMI组的所有结局评分均有显著改善。肥胖患者在大多数随访时间点的PROM评分较差，但与术前相比有相似程度的改善。与正常体重的患者相比，肥胖和超重患者转化为THA的比例明显更高。
{"title":"The Effect of Body Mass Index on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Matched Analysis With 10-Year Follow-up.","authors":"Thomas E Moran,Eric Y Hu,Jesus E Cervantes,Shane J Nho","doi":"10.1177/03635465251400355","DOIUrl":"https://doi.org/10.1177/03635465251400355","url":null,"abstract":"BACKGROUNDLong-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been promising, but no studies to date have examined the effect of body mass index (BMI) on 10-year outcome scores and reoperation rates.PURPOSETo compare outcome scores and reoperation rates between normal-weight, overweight, and obese patients undergoing hip arthroscopy for FAIS at 10-year follow-up.STUDY DESIGNCohort study; Level of evidence, 3.METHODSPreoperative, 2-year, 5-year, and 10-year scores for patient-reported outcome measures (PROMs) in patients undergoing surgery between January 2012 and June 2014 were collected. These included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Clinically significant outcomes were also collected including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Patients were stratified into the normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2) group and matched in a 1:1:1 ratio, controlling for age and sex. Reoperation-free survivorship was determined.RESULTSA total of 168 patients, with a mean follow-up time of 10.3 ± 0.4 years, who underwent hip arthroscopy for FAIS were included in the study: 56 normal weight, 56 overweight, and 56 obese. While all groups had similar significant improvements in PROM scores by 10-year follow-up (all P < .001), multivariable analysis revealed significant differences in HOS-ADL scores preoperatively (P < .001) and at 2 years (P = .008), 5 years (P = .005), and 10 years (P = .023). The groups differed in mHHS scores at 2-year (P = .006), 5-year (P = .041), and 10-year follow-up (P = .027). All patients, regardless of BMI, had similar achievement rates of the MCID and PASS for all PROMs. Obese and overweight patients had significantly worse rates of total hip arthroplasty (THA)-free survivorship compared with normal-weight patients (80.4% vs 85.7% vs 96.4%, respectively; P = .026).CONCLUSIONThere were significant improvements in all outcome scores across all BMI groups by 10 years after the arthroscopic treatment of FAIS. Obese patients tended to have worse PROM scores at most follow-up time points but similar magnitudes of improvement from preoperatively. Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"49 1","pages":"3635465251400355"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005218","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 : 2026-01-21DOI: 10.1177/03635465251407326
Satyavenkata Kotipalli,Thomas Haidl,Prushoth Vivekanantha,Darren de Sa,Jeffrey Kay
BACKGROUNDLateral extra-articular tenodesis (LET), alongside anterior cruciate ligament reconstruction (ACLR), has been shown to improve rerupture and rotational laxity in patients <25 years. However, safety and efficacy in both general pediatric (<18 years) and skeletally immature patients are important to identify.PURPOSETo assess clinical outcomes and complications after the LET procedure with ACLR in the pediatric and skeletally immature population.STUDY DESIGNMeta-analysis; Level of evidence, 4.METHODSThree databases were searched on December 5, 2024. Data were collected on study characteristics, demographics, surgical details, LET indications, patient-reported outcome measures, return to sport (RTS), rerupture rates, and complications. A meta-analysis of graft rerupture and RTS was performed using a Mantel-Haenszel and fixed-effects model (pooled effect measure: odds ratio [OR] with 95% CI).RESULTSNine studies comprising 317 patients (318 knees) were included, of whom 204 patients (205 knees) were skeletally immature. The mean age of all patients and skeletally immature patients was 14.6 years (range, 8-18 years) and 13.6 years (range, 8-16.1 years), respectively. Common indications for LET included a grade 2+ pivot shift and intention to return to a high level of sport. The pooled RTS rate of ACLR+LET was 96% (92%-99%; I2 = 48%) and 98% (94%-100%; I2 = 39%) in general pediatric and skeletally immature patients, respectively. The rerupture rate after ACLR+LET was 1.6% and 2.4% in general pediatric and skeletally immature patients, respectively. Pooled data consisting of 119 patients who underwent ACLR+LET and 87 patients with isolated ACLR found ACLR+LET to have a significantly lower rate of ACLR graft reruptures compared with isolated ACLR of 0.8% and 12.6%, respectively (I2 = 0%; OR = 0.12; 95% CI, 0.03-0.53; P = .0036). ACLR+LET was also found to have a significantly higher RTS rate compared with isolated ACLR (92.4% vs 80.5%, respectively) (I2 = 0%; OR, 3.06; 95% CI, 1.3-7.18; P = .0104). There were 2 reports of growth disturbances (0.63%), with 1 case being corrected by surgical epiphysiodesis and another being clinically asymptomatic.CONCLUSIONThe LET procedure, as an adjunct to ACLR in pediatric and adolescent patients, has been shown to be safe with low complication rates-including physeal disturbance. Pooled data from the literature to date demonstrate that ACLR combined with an LET has a lower rate of graft rerupture while maintaining previously described high rates of RTS in pediatric patients compared with isolated ACLR.
{"title":"Lateral Extra-Articular Tenodesis With Anterior Cruciate Ligament Reconstruction in Pediatric and Skeletally Immature Patients: A Systematic Review and Meta-analysis.","authors":"Satyavenkata Kotipalli,Thomas Haidl,Prushoth Vivekanantha,Darren de Sa,Jeffrey Kay","doi":"10.1177/03635465251407326","DOIUrl":"https://doi.org/10.1177/03635465251407326","url":null,"abstract":"BACKGROUNDLateral extra-articular tenodesis (LET), alongside anterior cruciate ligament reconstruction (ACLR), has been shown to improve rerupture and rotational laxity in patients <25 years. However, safety and efficacy in both general pediatric (<18 years) and skeletally immature patients are important to identify.PURPOSETo assess clinical outcomes and complications after the LET procedure with ACLR in the pediatric and skeletally immature population.STUDY DESIGNMeta-analysis; Level of evidence, 4.METHODSThree databases were searched on December 5, 2024. Data were collected on study characteristics, demographics, surgical details, LET indications, patient-reported outcome measures, return to sport (RTS), rerupture rates, and complications. A meta-analysis of graft rerupture and RTS was performed using a Mantel-Haenszel and fixed-effects model (pooled effect measure: odds ratio [OR] with 95% CI).RESULTSNine studies comprising 317 patients (318 knees) were included, of whom 204 patients (205 knees) were skeletally immature. The mean age of all patients and skeletally immature patients was 14.6 years (range, 8-18 years) and 13.6 years (range, 8-16.1 years), respectively. Common indications for LET included a grade 2+ pivot shift and intention to return to a high level of sport. The pooled RTS rate of ACLR+LET was 96% (92%-99%; I2 = 48%) and 98% (94%-100%; I2 = 39%) in general pediatric and skeletally immature patients, respectively. The rerupture rate after ACLR+LET was 1.6% and 2.4% in general pediatric and skeletally immature patients, respectively. Pooled data consisting of 119 patients who underwent ACLR+LET and 87 patients with isolated ACLR found ACLR+LET to have a significantly lower rate of ACLR graft reruptures compared with isolated ACLR of 0.8% and 12.6%, respectively (I2 = 0%; OR = 0.12; 95% CI, 0.03-0.53; P = .0036). ACLR+LET was also found to have a significantly higher RTS rate compared with isolated ACLR (92.4% vs 80.5%, respectively) (I2 = 0%; OR, 3.06; 95% CI, 1.3-7.18; P = .0104). There were 2 reports of growth disturbances (0.63%), with 1 case being corrected by surgical epiphysiodesis and another being clinically asymptomatic.CONCLUSIONThe LET procedure, as an adjunct to ACLR in pediatric and adolescent patients, has been shown to be safe with low complication rates-including physeal disturbance. Pooled data from the literature to date demonstrate that ACLR combined with an LET has a lower rate of graft rerupture while maintaining previously described high rates of RTS in pediatric patients compared with isolated ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"63 1","pages":"3635465251407326"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005315","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 : 2026-01-21DOI: 10.1177/03635465251401225
Brendan D Stoeckl,Rachel A Flaugh,Akbar N Syed,Kendall M Masada,Elizabeth R Bernstein,Elisabeth A Lemmon,Austin C Jenk,Lorielle G Laforest,Natalie L Fogarty,Bijan Dehghani,Carla R Scanzello,James L Carey,David R Steinberg,Robert L Mauck
BACKGROUNDOsteochondral autografts may be subject to suboptimal healing and graft degeneration due to surgical insult and the inflammatory environment of an injured joint.PURPOSE/HYPOTHESISThe purpose of this study was to alleviate the negative effect of this inflammatory milieu on the healing of osteochondral grafts by treating operative joints with interleukin-1 receptor antagonist (IL-1ra; Anakinra) in a porcine model. It was hypothesized that such treatment would reduce markers of inflammation and lead to improved implant structural and functional outcomes.STUDY DESIGNControlled laboratory study.METHODSThe authors performed an osteochondral autograft transfer (OAT) procedure on the weightbearing surface of the medial femoral condyle of adult Yucatan minipigs. Beginning 1 week after surgery, a subset of animals received an intra-articular injection of 8 mg Anakinra in the operative stifle on a weekly basis for 4 weeks. At the 5-week endpoint, mechanical testing of the cartilage was performed, synovium and osteochondral specimens were analyzed histologically using semiquantitative scoring systems, and subchondral bone was analyzed via micro-computed tomography.RESULTSIL-1ra-treated joints showed significantly less histological evidence of synovial inflammation. Autografts from treated joints showed better retention of mechanical properties and better histological scores.CONCLUSIONResults indicate that intra-articular IL-1ra administration after surgery significantly improves graft structure and function and dramatically enhances healing.CLINICAL RELEVANCEThis study demonstrates that local provision of adjuvant anti-inflammatory therapeutics after OAT may enhance healing and protect graft integrity. This not only has implications for current clinical practice of osteochondral autograft (and allograft) procedures but also may allow expanded indications for advanced biological repair in a greater number of patients.
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