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}
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。
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