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.
{"title":"Intra-articular Delivery of Recombinant Interleukin-1 Receptor Antagonist Protein (Anakinra) Enhances Graft Function in a Porcine Model of Osteochondral Repair.","authors":"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","doi":"10.1177/03635465251401225","DOIUrl":"https://doi.org/10.1177/03635465251401225","url":null,"abstract":"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.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 1","pages":"3635465251401225"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005266","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: 10.1177/03635465251407118
Andrew R Schab,Tyler R McCarroll,Elizabeth G Walsh,Ady H Kahana-Rojkind,Roger Quesada-Jimenez,Benjamin G Domb
BACKGROUNDMaster athletes (MAs), or athletes older than age 40 years, make up a patient population whose midterm outcomes after primary hip arthroscopy are largely unstudied.PURPOSETo report minimum 5-year outcomes of MAs after primary hip arthroscopy and compare their results to a matched nonathlete (NA) control group.STUDY DESIGNCohort study; Level of evidence, 3.METHODSData were collected between February 2008 and April 2019 and reviewed for all patients who underwent primary hip arthroscopy. Patients were excluded if they were younger than age 40 years and had previous ipsilateral hip pathology, dysplasia (lateral center-edge angle <18°), Tönnis grade >1, or workers' compensation claims. Patients included in the MA cohort reported participation in sports within 1 year before surgery and had a 5-year minimum follow-up. MAs were matched to NAs in a 1:1 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics, radiographic measurements, intraoperative findings, surgical procedures performed, and patient-reported outcomes (PROs) were compared between the groups. Additionally, rates of meeting clinically relevant thresholds and secondary procedures were compared.RESULTSA total of 118 hips were included in the study, with 59 hips per group. The groups showed comparable demographics, intraoperative findings, and labral procedures. The MA group had higher preoperative and postoperative values for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) (P < .05). MAs met the Patient Acceptable Symptom State and maximum outcome improvement for all evaluated PROs at higher rates. Additionally, the study group met the minimal clinical important difference for the mHHS and HOS-SSS at higher rates when compared with the control group (P < .05). MAs underwent secondary arthroscopy at similar rates to the NAs (1.59% vs 5.08%; P > .05) and had higher arthroplasty-free survivorship (94.92% vs 71.19%; P < .01).CONCLUSIONWhen compared with a propensity-matched control group of NA patients, MAs had better preoperative and postoperative PRO scores. However, the magnitudes of improvement in PROs were comparable between the groups. Furthermore, MAs met clinically meaningful thresholds at higher rates and had higher arthroplasty-free survivorship when compared with the NA group.
背景：运动员大师（MAs），或年龄大于40岁的运动员，构成了一个患者群体，其原发性髋关节镜检查后的中期结果在很大程度上未被研究。目的报告原发性髋关节镜术后MAs患者的最低5年预后，并将其结果与匹配的非运动员（NA）对照组进行比较。研究设计：队列研究；证据水平，3。方法收集2008年2月至2019年4月期间的数据，并对所有接受原发性髋关节镜检查的患者进行回顾。年龄小于40岁且既往有同侧髋关节病变、发育不良（外侧中心边缘角1）或工人索赔的患者被排除在外。纳入MA队列的患者报告在手术前1年内参加体育运动，并进行了至少5年的随访。根据年龄、性别、体重指数和髋臼外桥分级，MAs与NAs按1:1的比例匹配。比较两组之间的患者特征、x线测量、术中发现、手术过程和患者报告的结果（PROs）。此外，还比较了符合临床相关阈值和二次手术的比率。结果共纳入118例髋关节，每组59例。两组的人口统计学、术中发现和手术程序具有可比性。MA组术前和术后改良Harris髋关节评分（mHHS）、非关节炎髋关节评分和髋关节结局评分运动特异性亚量表（HOS-SSS）的评分均较高（P < 0.05）。ma达到了患者可接受的症状状态，所有评估的pro的最大预后改善率较高。此外，与对照组相比，研究组在mHHS和HOS-SSS方面达到最小临床重要差异的比例更高（P < 0.05）。MAs接受二次关节镜检查的比例与NAs相似（1.59% vs 5.08%; P < 0.05），无关节成形术生存率更高（94.92% vs 71.19%; P < 0.01）。结论与NA患者倾向匹配对照组相比，MAs患者术前和术后PRO评分较高。然而，两组之间pro的改善程度是相当的。此外，与NA组相比，MAs组达到临床意义阈值的比例更高，无关节置换术生存率更高。
{"title":"Midterm Outcomes of Primary Hip Arthroscopy in Athletes Older Than Age 40: A Propensity-Matched Controlled Study.","authors":"Andrew R Schab,Tyler R McCarroll,Elizabeth G Walsh,Ady H Kahana-Rojkind,Roger Quesada-Jimenez,Benjamin G Domb","doi":"10.1177/03635465251407118","DOIUrl":"https://doi.org/10.1177/03635465251407118","url":null,"abstract":"BACKGROUNDMaster athletes (MAs), or athletes older than age 40 years, make up a patient population whose midterm outcomes after primary hip arthroscopy are largely unstudied.PURPOSETo report minimum 5-year outcomes of MAs after primary hip arthroscopy and compare their results to a matched nonathlete (NA) control group.STUDY DESIGNCohort study; Level of evidence, 3.METHODSData were collected between February 2008 and April 2019 and reviewed for all patients who underwent primary hip arthroscopy. Patients were excluded if they were younger than age 40 years and had previous ipsilateral hip pathology, dysplasia (lateral center-edge angle <18°), Tönnis grade >1, or workers' compensation claims. Patients included in the MA cohort reported participation in sports within 1 year before surgery and had a 5-year minimum follow-up. MAs were matched to NAs in a 1:1 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics, radiographic measurements, intraoperative findings, surgical procedures performed, and patient-reported outcomes (PROs) were compared between the groups. Additionally, rates of meeting clinically relevant thresholds and secondary procedures were compared.RESULTSA total of 118 hips were included in the study, with 59 hips per group. The groups showed comparable demographics, intraoperative findings, and labral procedures. The MA group had higher preoperative and postoperative values for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) (P < .05). MAs met the Patient Acceptable Symptom State and maximum outcome improvement for all evaluated PROs at higher rates. Additionally, the study group met the minimal clinical important difference for the mHHS and HOS-SSS at higher rates when compared with the control group (P < .05). MAs underwent secondary arthroscopy at similar rates to the NAs (1.59% vs 5.08%; P > .05) and had higher arthroplasty-free survivorship (94.92% vs 71.19%; P < .01).CONCLUSIONWhen compared with a propensity-matched control group of NA patients, MAs had better preoperative and postoperative PRO scores. However, the magnitudes of improvement in PROs were comparable between the groups. Furthermore, MAs met clinically meaningful thresholds at higher rates and had higher arthroplasty-free survivorship when compared with the NA group.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"183 1","pages":"3635465251407118"},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005321","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 : 2026-01-19DOI: 10.1177/03635465251390546
Joseph E Nassar,Lama A Ammar,Mohammad Daher,Trevor L Toavs,Manjot Singh,Michael J Farias,Bassel G Diebo,Alan H Daniels
BACKGROUNDReturn to sport (RTS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a critical patient-centered outcome, yet evidence-based guidelines remain limited. This systematic review synthesizes existing literature on RTS after PSF treatment in AIS to inform clinical practice.PURPOSETo evaluate the timing, rates of RTS, and factors influencing RTS outcomes after PSF for AIS and provide recommendations for clinical practice.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Embase, Cochrane Library, and Google Scholar databases from inception to February 24, 2025. Studies evaluating RTS after PSF for AIS were included. Data extracted included patient characteristics, curve characteristics, surgical details, RTS outcomes, and patient-reported outcome measures.RESULTSOf 1569 identified articles, 11 studies (722 patients) were included. The mean age of patients was 15.2 ± 2.8 years, and the mean maximum Cobb angle was 58.3°± 14.8°. Patients generally resumed sports between 8 and 12 months postoperatively. RTS delays were frequently associated with older patient age, greater curve severity, longer spinal fusions, more distal fusion levels, and psychosocial factors including fear of injury, anxiety, physical deconditioning, and reduced spinal flexibility. Additionally, some patients transitioned from competitive or contact sports to noncompetitive or noncontact sports postoperatively due to these factors or conservative surgeon recommendations.CONCLUSIONMost patients with AIS successfully returned to sport within 1 year after PSF, although timing and performance levels varied significantly based on individual patient characteristics. Age, spinal curve severity, surgical extent, and psychological readiness considerably influenced RTS outcomes. Clear and individualized clinical guidelines addressing these factors are necessary to optimize RTS outcomes for patients with AIS undergoing PSF. Based on this systematic review, specific phased recommendations have been proposed to guide clinical practice and rehabilitation protocols for athletes with AIS.
{"title":"Return to Sport After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic Review and Clinical Recommendations.","authors":"Joseph E Nassar,Lama A Ammar,Mohammad Daher,Trevor L Toavs,Manjot Singh,Michael J Farias,Bassel G Diebo,Alan H Daniels","doi":"10.1177/03635465251390546","DOIUrl":"https://doi.org/10.1177/03635465251390546","url":null,"abstract":"BACKGROUNDReturn to sport (RTS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is a critical patient-centered outcome, yet evidence-based guidelines remain limited. This systematic review synthesizes existing literature on RTS after PSF treatment in AIS to inform clinical practice.PURPOSETo evaluate the timing, rates of RTS, and factors influencing RTS outcomes after PSF for AIS and provide recommendations for clinical practice.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, Embase, Cochrane Library, and Google Scholar databases from inception to February 24, 2025. Studies evaluating RTS after PSF for AIS were included. Data extracted included patient characteristics, curve characteristics, surgical details, RTS outcomes, and patient-reported outcome measures.RESULTSOf 1569 identified articles, 11 studies (722 patients) were included. The mean age of patients was 15.2 ± 2.8 years, and the mean maximum Cobb angle was 58.3°± 14.8°. Patients generally resumed sports between 8 and 12 months postoperatively. RTS delays were frequently associated with older patient age, greater curve severity, longer spinal fusions, more distal fusion levels, and psychosocial factors including fear of injury, anxiety, physical deconditioning, and reduced spinal flexibility. Additionally, some patients transitioned from competitive or contact sports to noncompetitive or noncontact sports postoperatively due to these factors or conservative surgeon recommendations.CONCLUSIONMost patients with AIS successfully returned to sport within 1 year after PSF, although timing and performance levels varied significantly based on individual patient characteristics. Age, spinal curve severity, surgical extent, and psychological readiness considerably influenced RTS outcomes. Clear and individualized clinical guidelines addressing these factors are necessary to optimize RTS outcomes for patients with AIS undergoing PSF. Based on this systematic review, specific phased recommendations have been proposed to guide clinical practice and rehabilitation protocols for athletes with AIS.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"38 1","pages":"3635465251390546"},"PeriodicalIF":0.0,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994835","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 : 2026-01-18DOI: 10.1177/03635465251399167
Jakob E Schanda,Roman Ullrich,Sandra Boesmueller,Rainer Mittermayr,Thomas Bruell,Michael Hexel,Philipp R Heuberer,Gebhard Woisetschlaeger,Ortrun M Neuper,Heinz Redl,Johannes Grillari,Christian Fialka
BACKGROUNDDespite technical innovations and surgical improvements, retear rates after arthroscopic rotator cuff (RC) repair remain high. Preclinical studies demonstrated improved outcomes using bisphosphonates after RC repair.PURPOSE/HYPOTHESISThe purpose of this monocentric, prospective, randomized, placebo-controlled, triple-blinded phase II trial was to investigate retears in patients without osteoporosis undergoing arthroscopic RC repair with a systemic single-dose zoledronic acid. It was hypothesized that zoledronic acid would reduce retears after RC repair.STUDY DESIGNRandomized controlled trial; Level of evidence, 1.METHODSA total of 80 patients were intraoperatively randomized to the zoledronic acid group (n = 40) or the control group (n = 40). All patients underwent magnetic resonance imaging 6 months after surgery. Range of motion, abduction strength, Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) for pain were assessed preoperatively as well as 3 and 6 months after arthroscopic RC repair.RESULTSAt 6 months, retears were significantly lower (P = .001) in the zoledronic acid group (n = 6; 15%) compared with the control group (n = 14; 35%). The risk of a RC retear with an additional zoledronic acid treatment (RR, 0.43 [95% CI, 0.16; 0.98]) was significantly lower compared with that of the control group (OR, 0.328; 95% CI, 0.111-0.969; P = .044). Postoperative fatty muscle infiltration of the supraspinatus was significantly lower in the zoledronic acid group compared with the control group (P < .001). Clinical and functional outcomes significantly improved in the 2 study groups 3 and 6 months postoperatively, with better outcomes for abduction (P = .002), forward flexion (P = .002), external rotation (P = .001), CMS (P < .001), ASES score (P < .001), SSV (P < .001), and VAS for pain (P < .001) in the zoledronic acid group at the final follow-up.CONCLUSIONAn intraoperative systemic single-dose zoledronic acid reduced retears after arthroscopic RC repair. Zoledronic acid is a safe, easy-to-apply, and cost-effective augmentation technique for patients undergoing arthroscopic RC repair.REGISTRATIONNCT05677152 (ClinicalTrials.gov identifier).
{"title":"Intraoperative Zoledronic Acid for Arthroscopic Rotator Cuff Repair: Short-Term Results From a Prospective, Randomized, Placebo-Controlled Phase II Trial.","authors":"Jakob E Schanda,Roman Ullrich,Sandra Boesmueller,Rainer Mittermayr,Thomas Bruell,Michael Hexel,Philipp R Heuberer,Gebhard Woisetschlaeger,Ortrun M Neuper,Heinz Redl,Johannes Grillari,Christian Fialka","doi":"10.1177/03635465251399167","DOIUrl":"https://doi.org/10.1177/03635465251399167","url":null,"abstract":"BACKGROUNDDespite technical innovations and surgical improvements, retear rates after arthroscopic rotator cuff (RC) repair remain high. Preclinical studies demonstrated improved outcomes using bisphosphonates after RC repair.PURPOSE/HYPOTHESISThe purpose of this monocentric, prospective, randomized, placebo-controlled, triple-blinded phase II trial was to investigate retears in patients without osteoporosis undergoing arthroscopic RC repair with a systemic single-dose zoledronic acid. It was hypothesized that zoledronic acid would reduce retears after RC repair.STUDY DESIGNRandomized controlled trial; Level of evidence, 1.METHODSA total of 80 patients were intraoperatively randomized to the zoledronic acid group (n = 40) or the control group (n = 40). All patients underwent magnetic resonance imaging 6 months after surgery. Range of motion, abduction strength, Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) for pain were assessed preoperatively as well as 3 and 6 months after arthroscopic RC repair.RESULTSAt 6 months, retears were significantly lower (P = .001) in the zoledronic acid group (n = 6; 15%) compared with the control group (n = 14; 35%). The risk of a RC retear with an additional zoledronic acid treatment (RR, 0.43 [95% CI, 0.16; 0.98]) was significantly lower compared with that of the control group (OR, 0.328; 95% CI, 0.111-0.969; P = .044). Postoperative fatty muscle infiltration of the supraspinatus was significantly lower in the zoledronic acid group compared with the control group (P < .001). Clinical and functional outcomes significantly improved in the 2 study groups 3 and 6 months postoperatively, with better outcomes for abduction (P = .002), forward flexion (P = .002), external rotation (P = .001), CMS (P < .001), ASES score (P < .001), SSV (P < .001), and VAS for pain (P < .001) in the zoledronic acid group at the final follow-up.CONCLUSIONAn intraoperative systemic single-dose zoledronic acid reduced retears after arthroscopic RC repair. Zoledronic acid is a safe, easy-to-apply, and cost-effective augmentation technique for patients undergoing arthroscopic RC repair.REGISTRATIONNCT05677152 (ClinicalTrials.gov identifier).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"124 1","pages":"3635465251399167"},"PeriodicalIF":0.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994801","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 : 2026-01-18DOI: 10.1177/03635465251407328
James M Gregory,Ashley Z Smith,Payam Zandiyeh
BACKGROUNDRotator cuff repair (RCR) failure remains a persistent clinical challenge despite advances in surgical techniques. Although the subacromial bursa-historically excised during repair-is recognized for its regenerative potential due to its rich population of connective tissue progenitor cells, high-quality clinical evidence supporting its utility as an autologous biological adjunct remains lacking.HYPOTHESISSubacromial bursa augmentation during arthroscopic RCR improves patient-reported outcomes and magnetic resonance imaging (MRI)-based tendon healing compared with standard repair.STUDY DESIGNRandomized controlled trial; Level of evidence, 2.METHODSA total of 67 patients undergoing primary arthroscopic repair for full- or near-full-thickness supraspinatus tears were randomized to receive either standard repair (control; n = 34) or repair with minced subacromial bursa reimplantation (cases; n = 33). All patients underwent identical surgical repair constructs. Patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and PROMIS [Patient-Reported Outcomes Measurement Information System] Upper Extremity and Global scores) were collected at baseline and at multiple intervals up to 24 months. MRI was used to evaluate tendon integrity (Sugaya classification) and supraspinatus tendon thickness at a minimum of 6 months postoperatively. Generalized estimating equations and chi-square tests were used for longitudinal and categorical comparisons.RESULTSPatient-reported outcomes improved significantly over time in both the control and augmentation groups. While no statistically significant between-group differences were observed overall, the bursa augmentation group demonstrated a higher Global score at 6 months (P = .047). Across other time points, outcomes, including PROMIS, ASES, SST, and Global ratings, did not show significant differences. MRI analysis at 6 months reflected a similar pattern, and no significant differences were detected. A smaller proportion of patients in the augmentation group exhibited high-grade Sugaya types (3-5: 28% vs 39% in the control group), and retear dimensions were generally smaller.CONCLUSIONIn this randomized clinical trial, subacromial bursa augmentation did not improve tendon healing or clinical outcomes after arthroscopic RCR. These results clearly reject the initial hypothesis that bursal augmentation enhances the healing of repair. While the procedure appeared safe and feasible, the absence of measurable benefit indicates that its routine clinical use cannot be supported at this time.REGISTRATIONNCT04634084 (ClinicalTrials.gov identifier).
{"title":"Effect of Subacromial Bursa Augmentation on Self-Reported and Magnetic Resonance Imaging Outcomes in Arthroscopic Rotator Cuff Repair: A Prospective, Blinded Randomized Clinical Trial.","authors":"James M Gregory,Ashley Z Smith,Payam Zandiyeh","doi":"10.1177/03635465251407328","DOIUrl":"https://doi.org/10.1177/03635465251407328","url":null,"abstract":"BACKGROUNDRotator cuff repair (RCR) failure remains a persistent clinical challenge despite advances in surgical techniques. Although the subacromial bursa-historically excised during repair-is recognized for its regenerative potential due to its rich population of connective tissue progenitor cells, high-quality clinical evidence supporting its utility as an autologous biological adjunct remains lacking.HYPOTHESISSubacromial bursa augmentation during arthroscopic RCR improves patient-reported outcomes and magnetic resonance imaging (MRI)-based tendon healing compared with standard repair.STUDY DESIGNRandomized controlled trial; Level of evidence, 2.METHODSA total of 67 patients undergoing primary arthroscopic repair for full- or near-full-thickness supraspinatus tears were randomized to receive either standard repair (control; n = 34) or repair with minced subacromial bursa reimplantation (cases; n = 33). All patients underwent identical surgical repair constructs. Patient-reported outcomes (American Shoulder and Elbow Surgeons [ASES], Simple Shoulder Test [SST], and PROMIS [Patient-Reported Outcomes Measurement Information System] Upper Extremity and Global scores) were collected at baseline and at multiple intervals up to 24 months. MRI was used to evaluate tendon integrity (Sugaya classification) and supraspinatus tendon thickness at a minimum of 6 months postoperatively. Generalized estimating equations and chi-square tests were used for longitudinal and categorical comparisons.RESULTSPatient-reported outcomes improved significantly over time in both the control and augmentation groups. While no statistically significant between-group differences were observed overall, the bursa augmentation group demonstrated a higher Global score at 6 months (P = .047). Across other time points, outcomes, including PROMIS, ASES, SST, and Global ratings, did not show significant differences. MRI analysis at 6 months reflected a similar pattern, and no significant differences were detected. A smaller proportion of patients in the augmentation group exhibited high-grade Sugaya types (3-5: 28% vs 39% in the control group), and retear dimensions were generally smaller.CONCLUSIONIn this randomized clinical trial, subacromial bursa augmentation did not improve tendon healing or clinical outcomes after arthroscopic RCR. These results clearly reject the initial hypothesis that bursal augmentation enhances the healing of repair. While the procedure appeared safe and feasible, the absence of measurable benefit indicates that its routine clinical use cannot be supported at this time.REGISTRATIONNCT04634084 (ClinicalTrials.gov identifier).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"29 1","pages":"3635465251407328"},"PeriodicalIF":0.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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