Pub Date : 2026-01-11DOI: 10.1177/03635465251400313
Edward J Testa,Ryan T Fallon,Rohit Badida,Michael J Kutschke,Jonathan Liu,Stephen E Marcaccio,John D Milner,Brett D Owens
BACKGROUNDPosterior glenoid reconstruction for shoulder instability is commonly performed with distal tibia allograft (DTA), but with variable results. Recent evidence shows that distal radius allograft (DRA) has a radius of curvature (ROC) that more closely matches that of the glenoid.HYPOTHESISDRA would more closely match the posterior glenoid than DTA in ROC and bone mineral density (BMD), and DRA would have superior biomechanical characteristics in a posterior instability model.STUDY DESIGNControlled laboratory study.METHODSTen cadaveric shoulders, ankles, and wrists underwent computed tomography scans. ROC and BMD for the glenoid, DRA, and DTA were measured. Biomechanical analysis was performed for each shoulder by translating the humerus 10 mm posterior-inferiorly relative to the glenoid and recording the maximum force (N) required and lateral displacement (mm) of the humeral head. Five conditions were tested for each shoulder: intact, posterior capsulolabral tear, 30% glenoid bone loss, DRA, and DTA.RESULTSTen shoulders were tested (mean age, 58.1 years [SD, 5.9 years]). The mean anterior-posterior ROC was 31.1 mm (SD, 6.9 mm) for the glenoid, compared to 14.0 mm (SD, 1.9 mm; P < .0001) for DRA, and 68.2 mm (SD, 29.1 mm; P < .0001) for DTA. The mean superior-inferior ROC was 30.2 mm (SD, 3.7 mm) for the glenoid, compared to 30.7 mm (SD, 3.2 mm; P = .901) for DRA, and 23.5 mm (SD, 5.4 mm, P < .001) for DTA. For biomechanical testing, DRA demonstrated increased resistance to force compared with the instability and bone loss states (42.1 N [SD, 14.3 N] vs capsulolabral tear 21.5 N [SD, 17.9 N; P = .002] and bone loss 14.3 N [SD, 7.8 N; P < .001], respectively). However, DRA showed no significant difference in force resistance when compared with DTA (36.3 N [SD, 9.3 N]; P = .362).CONCLUSIONThe native glenoid ROC and BMD are more comparable with DRA than DTA. The DRA restores posterior forces comparable to those of the native glenoid and did not result in significantly greater resistance forces when compared with DTA.CLINICAL RELEVANCEThese anatomic data support DRA use in posterior glenoid reconstruction.
背景：肩关节不稳定的后盂重建通常采用胫骨远端同种异体移植（DTA），但结果不一。最近的证据表明，远端桡骨异体移植物（DRA）的曲率半径（ROC）更接近于关节盂的曲率半径。假设在ROC和骨密度（BMD）方面，DRA比DTA更接近后盂关节，并且在后路不稳定模型中，DRA具有更优越的生物力学特征。研究设计：对照实验室研究。方法对尸体肩部、踝关节和手腕进行计算机断层扫描。测量关节盂、DRA和DTA的ROC和BMD。通过将肱骨相对于关节盂向后下方平移10mm，记录所需的最大力(N)和肱骨头的侧向位移（mm），对每个肩部进行生物力学分析。对每个肩膀进行了五种情况的测试：完整，后囊撕裂，30%盂骨丢失，DRA和DTA。结果10例肩部检查（平均年龄58.1岁[SD， 5.9岁]）。肩关节的平均前后ROC为31.1 mm (SD, 6.9 mm)，而DRA为14.0 mm (SD, 1.9 mm, P < 0.0001)， DTA为68.2 mm （SD, 29.1 mm, P < 0.0001）。关节盂的平均优劣ROC为30.2 mm (SD, 3.7 mm)，而DRA为30.7 mm (SD, 3.2 mm, P = 0.901)， DTA为23.5 mm （SD, 5.4 mm, P < 0.001）。在生物力学测试中，与不稳定和骨质流失状态相比，DRA表现出更大的抗力能力（分别为42.1 N [SD， 14.3 N]和21.5 N [SD, 17.9 N; P = 0.002]和骨质流失14.3 N [SD, 7.8 N; P < 0.001]）。然而，与DTA相比，DRA在抗力方面没有显著差异（36.3 N [SD, 9.3 N]; P = .362）。结论与DRA相比，膝关节骨密度和关节关节ROC值更具可比性。与DTA相比，DRA恢复的后侧力量与原有的关节盂相当，并且不会产生明显更大的阻力。临床意义：这些解剖学数据支持DRA在肩关节后路重建中的应用。
{"title":"Distal Radius Allograft for Posterior Glenoid Bone Loss: A Cadaveric Graft Matching Study and Biomechanical Study.","authors":"Edward J Testa,Ryan T Fallon,Rohit Badida,Michael J Kutschke,Jonathan Liu,Stephen E Marcaccio,John D Milner,Brett D Owens","doi":"10.1177/03635465251400313","DOIUrl":"https://doi.org/10.1177/03635465251400313","url":null,"abstract":"BACKGROUNDPosterior glenoid reconstruction for shoulder instability is commonly performed with distal tibia allograft (DTA), but with variable results. Recent evidence shows that distal radius allograft (DRA) has a radius of curvature (ROC) that more closely matches that of the glenoid.HYPOTHESISDRA would more closely match the posterior glenoid than DTA in ROC and bone mineral density (BMD), and DRA would have superior biomechanical characteristics in a posterior instability model.STUDY DESIGNControlled laboratory study.METHODSTen cadaveric shoulders, ankles, and wrists underwent computed tomography scans. ROC and BMD for the glenoid, DRA, and DTA were measured. Biomechanical analysis was performed for each shoulder by translating the humerus 10 mm posterior-inferiorly relative to the glenoid and recording the maximum force (N) required and lateral displacement (mm) of the humeral head. Five conditions were tested for each shoulder: intact, posterior capsulolabral tear, 30% glenoid bone loss, DRA, and DTA.RESULTSTen shoulders were tested (mean age, 58.1 years [SD, 5.9 years]). The mean anterior-posterior ROC was 31.1 mm (SD, 6.9 mm) for the glenoid, compared to 14.0 mm (SD, 1.9 mm; P < .0001) for DRA, and 68.2 mm (SD, 29.1 mm; P < .0001) for DTA. The mean superior-inferior ROC was 30.2 mm (SD, 3.7 mm) for the glenoid, compared to 30.7 mm (SD, 3.2 mm; P = .901) for DRA, and 23.5 mm (SD, 5.4 mm, P < .001) for DTA. For biomechanical testing, DRA demonstrated increased resistance to force compared with the instability and bone loss states (42.1 N [SD, 14.3 N] vs capsulolabral tear 21.5 N [SD, 17.9 N; P = .002] and bone loss 14.3 N [SD, 7.8 N; P < .001], respectively). However, DRA showed no significant difference in force resistance when compared with DTA (36.3 N [SD, 9.3 N]; P = .362).CONCLUSIONThe native glenoid ROC and BMD are more comparable with DRA than DTA. The DRA restores posterior forces comparable to those of the native glenoid and did not result in significantly greater resistance forces when compared with DTA.CLINICAL RELEVANCEThese anatomic data support DRA use in posterior glenoid reconstruction.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"48 1","pages":"3635465251400313"},"PeriodicalIF":0.0,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949672","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 : 2026-01-11DOI: 10.1177/03635465251399165
Ivan Wong,Marco Adriani,Sarah Remedios,Phob Ganokroj,Nate J Dickinson,Annalise M Peebles,Ryan J Whalen,Stephanie K Eble,Justin W Arner,Toufic R Jildeh,Liam A Peebles,Anthony A Romeo,Matthew T Provencher
BACKGROUNDThe distal tibial allograft (DTA) procedure has been described as an effective treatment option for reconstruction of glenoid bone deficiency in the setting of recurrent anterior shoulder instability; however, no comparative data between an arthroscopic or open DTA approach are available.PURPOSETo compare the clinical and radiographic outcomes of patients who underwent open fresh versus arthroscopic frozen DTA stabilization procedures.STUDY DESIGNCohort study; Level of evidence, 4.METHODSA retrospective review was performed of consecutive patients with a minimum of 5% anterior glenoid bone loss (GBL) associated with recurrent anterior shoulder instability who underwent stabilization with either open fresh or arthroscopic frozen DTA glenoid reconstruction and had a minimum 2-year follow-up. Consecutive patients undergoing arthroscopic frozen DTA were matched in a 1-to-1 format to patients undergoing open fresh DTA by age, body mass index, and number of previous shoulder operations. Patients were evaluated postoperatively in terms of the Western Ontario Shoulder Instability Index (WOSI) score, pain relief, and episodes of recurrent instability. All patients also underwent postoperative imaging evaluation with computed tomography (CT) in which graft incorporation and allograft angle were measured.RESULTSA total of 100 patients (50 open fresh DTA, 50 arthroscopic frozen DTA) with a median ± IQR age of 32.0 ± 6.7 and 27.9 ± 15.9 years, respectively, were analyzed at minimum 2-year follow-up. The open fresh DTA group had significantly more male patients than the arthroscopic frozen DTA group (98% vs 70%, respectively; P < .01), and patients in the open fresh DTA group had significantly greater GBL defects (25% ± 6% vs 21% ± 11%, respectively; P < .01). Both groups demonstrated significantly improved WOSI scores (P < .05) and had similar clinical outcomes regarding improvement postoperatively (P = .61), pain relief (P = .09), and recurrence rates (P = .31). Only 1 case of recurrent instability was noted, which occurred in the open fresh DTA cohort. Analysis of CT data at a mean of 15 months postoperatively showed no significant difference between open fresh versus arthroscopic frozen DTA groups.CONCLUSIONOpen fresh and arthroscopic frozen DTA for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability resulted in a clinically stable joint with comparable outcomes and excellent healing rates. Additional long-term studies are needed to determine whether the surgical technique and type of allograft used influence clinical outcomes and whether these results are maintained over time.
{"title":"Surgical Stabilization for Recurrent Shoulder Instability Using Distal Tibial Allograft: Open Technique With Fresh Allograft Versus Arthroscopic Technique With Frozen Allograft, a Cohort Study.","authors":"Ivan Wong,Marco Adriani,Sarah Remedios,Phob Ganokroj,Nate J Dickinson,Annalise M Peebles,Ryan J Whalen,Stephanie K Eble,Justin W Arner,Toufic R Jildeh,Liam A Peebles,Anthony A Romeo,Matthew T Provencher","doi":"10.1177/03635465251399165","DOIUrl":"https://doi.org/10.1177/03635465251399165","url":null,"abstract":"BACKGROUNDThe distal tibial allograft (DTA) procedure has been described as an effective treatment option for reconstruction of glenoid bone deficiency in the setting of recurrent anterior shoulder instability; however, no comparative data between an arthroscopic or open DTA approach are available.PURPOSETo compare the clinical and radiographic outcomes of patients who underwent open fresh versus arthroscopic frozen DTA stabilization procedures.STUDY DESIGNCohort study; Level of evidence, 4.METHODSA retrospective review was performed of consecutive patients with a minimum of 5% anterior glenoid bone loss (GBL) associated with recurrent anterior shoulder instability who underwent stabilization with either open fresh or arthroscopic frozen DTA glenoid reconstruction and had a minimum 2-year follow-up. Consecutive patients undergoing arthroscopic frozen DTA were matched in a 1-to-1 format to patients undergoing open fresh DTA by age, body mass index, and number of previous shoulder operations. Patients were evaluated postoperatively in terms of the Western Ontario Shoulder Instability Index (WOSI) score, pain relief, and episodes of recurrent instability. All patients also underwent postoperative imaging evaluation with computed tomography (CT) in which graft incorporation and allograft angle were measured.RESULTSA total of 100 patients (50 open fresh DTA, 50 arthroscopic frozen DTA) with a median ± IQR age of 32.0 ± 6.7 and 27.9 ± 15.9 years, respectively, were analyzed at minimum 2-year follow-up. The open fresh DTA group had significantly more male patients than the arthroscopic frozen DTA group (98% vs 70%, respectively; P < .01), and patients in the open fresh DTA group had significantly greater GBL defects (25% ± 6% vs 21% ± 11%, respectively; P < .01). Both groups demonstrated significantly improved WOSI scores (P < .05) and had similar clinical outcomes regarding improvement postoperatively (P = .61), pain relief (P = .09), and recurrence rates (P = .31). Only 1 case of recurrent instability was noted, which occurred in the open fresh DTA cohort. Analysis of CT data at a mean of 15 months postoperatively showed no significant difference between open fresh versus arthroscopic frozen DTA groups.CONCLUSIONOpen fresh and arthroscopic frozen DTA for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability resulted in a clinically stable joint with comparable outcomes and excellent healing rates. Additional long-term studies are needed to determine whether the surgical technique and type of allograft used influence clinical outcomes and whether these results are maintained over time.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":"3635465251399165"},"PeriodicalIF":0.0,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949671","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 literature suggests that both arthroscopic posterior Bankart repair (APB) and posterior bone block (PBB) are effective procedures in the short to medium term, although recurrence and revision rates do not appear to be negligible. However, fewer studies, especially comparative ones, are available regarding the long-term outcomes of these procedures.PURPOSE/HYPOTHESISThe purpose was to compare the long-term outcomes of APB and PBB procedures. It was hypothesized that at long-term follow-up, APB would have the same recurrence rate as PBB but lower complication and revision rates, with both techniques providing good or excellent functional outcomes and high satisfaction and return-to-sport (RTS) rates.STUDY DESIGNCohort study; Level of evidence, 3.METHODSFrom January 2007 to December 2024, 86 patients underwent surgery for posterior shoulder instability. Exclusion criteria included a single episode of posterior instability (Moroder types A1 and A2), nontraumatic instability, static instability (Moroder type C1s and C2), functional or voluntary and reproducible instability (Moroder type B1), multidirectional instability, posterior unstable painful shoulder, posterior Bankart lesion with paraglenoid cysts, and patients with <2 years of follow-up. Of the initial 52 patients who met the inclusion criteria, 46 were available for follow-up and were divided into 2 groups: 28 underwent APB, and 18 underwent PBB.RESULTSAt a mean follow-up of 8 years, APB and PBB showed no difference in recurrence rates (3.6% and 5.9%, respectively; P > .999). However, APB had lower revision rates (3.6% vs 33.3%; P < .01) and lower complication rates (3.6% vs 50%; P < .001) compared with PBB. Both groups achieved good or excellent clinical and functional outcomes, along with high satisfaction and RTS rates. There were no statistically significant differences in scores, except for the Western Ontario Shoulder Instability Index score, which favored PBB (122.1 vs 282.4 for APB; P = .026). Time to return to work was longer for the APB group, with 70.4% taking >2 months, compared with 29.4% of the PBB group (P = .009).CONCLUSIONAt a mean follow-up of 5 years for APB and 12 years for PBB, the APB group had a similar recurrence rate but fewer complications and revisions compared with the PBB group. Both techniques resulted in good to excellent clinical and functional outcomes, as well as high satisfaction and RTS rates.
{"title":"Recurrence Rate, Complications and Revisions in Long-term Follow-up of Arthroscopic Posterior Bankart Repair Compared to Posterior Bone Block.","authors":"Angelo Mosca,Kuan Ting Wu,Matias Hoffman,Juan Cassinelli,Clément Horteur,Johannes Barth","doi":"10.1177/03635465251400359","DOIUrl":"https://doi.org/10.1177/03635465251400359","url":null,"abstract":"BACKGROUNDThe literature suggests that both arthroscopic posterior Bankart repair (APB) and posterior bone block (PBB) are effective procedures in the short to medium term, although recurrence and revision rates do not appear to be negligible. However, fewer studies, especially comparative ones, are available regarding the long-term outcomes of these procedures.PURPOSE/HYPOTHESISThe purpose was to compare the long-term outcomes of APB and PBB procedures. It was hypothesized that at long-term follow-up, APB would have the same recurrence rate as PBB but lower complication and revision rates, with both techniques providing good or excellent functional outcomes and high satisfaction and return-to-sport (RTS) rates.STUDY DESIGNCohort study; Level of evidence, 3.METHODSFrom January 2007 to December 2024, 86 patients underwent surgery for posterior shoulder instability. Exclusion criteria included a single episode of posterior instability (Moroder types A1 and A2), nontraumatic instability, static instability (Moroder type C1s and C2), functional or voluntary and reproducible instability (Moroder type B1), multidirectional instability, posterior unstable painful shoulder, posterior Bankart lesion with paraglenoid cysts, and patients with <2 years of follow-up. Of the initial 52 patients who met the inclusion criteria, 46 were available for follow-up and were divided into 2 groups: 28 underwent APB, and 18 underwent PBB.RESULTSAt a mean follow-up of 8 years, APB and PBB showed no difference in recurrence rates (3.6% and 5.9%, respectively; P > .999). However, APB had lower revision rates (3.6% vs 33.3%; P < .01) and lower complication rates (3.6% vs 50%; P < .001) compared with PBB. Both groups achieved good or excellent clinical and functional outcomes, along with high satisfaction and RTS rates. There were no statistically significant differences in scores, except for the Western Ontario Shoulder Instability Index score, which favored PBB (122.1 vs 282.4 for APB; P = .026). Time to return to work was longer for the APB group, with 70.4% taking >2 months, compared with 29.4% of the PBB group (P = .009).CONCLUSIONAt a mean follow-up of 5 years for APB and 12 years for PBB, the APB group had a similar recurrence rate but fewer complications and revisions compared with the PBB group. Both techniques resulted in good to excellent clinical and functional outcomes, as well as high satisfaction and RTS rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"14 1","pages":"3635465251400359"},"PeriodicalIF":0.0,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949670","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 : 2026-01-09DOI: 10.1177/03635465251383851
Jake M. Reed, Colby C. Wollenman, Breann K. Tisano, Kevin M. Dale, Lance E. LeClere
Background: Patellar dislocation in pediatric athletes often involve additional injuries not identified on plain films. Purpose: To identify the rate of medial patellofemoral ligament (MPFL) injury and adjunctive injury findings identified by magnetic resonance imaging (MRI) in first-time patellar dislocations in the pediatric population. Study Design: Systematic review; Level of evidence, 4. Methods: This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD: 42024559285). PubMed, EMBASE, and SPORTDiscus were searched for studies on MRI findings after first-time pediatric patellar dislocations. Abstracts and articles were screened using predefined inclusion and exclusion criteria. The inclusion criteria were (1) first-time patellar dislocation, (2) explicit documentation of MRI findings, (3) patients <18 years, and (4) written in English. The exclusion criteria were (1) abstract only, case reports, or review articles; (2) overlapping or repeated patient sets; in such cases, the article containing the more comprehensive variables was retained. Data were extracted regarding patient characteristics and MRI findings. Pooled rates were calculated using only the studies that reported the specific variable in question. Bias was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies, and the Joanna Briggs Institute Critical Appraisal tools for the cross-sectional studies and case series. Results: A total of 322 studies were initially identified. After screening by 2 independent reviewers, 12 articles were included in the data extraction. Findings include complete MPFL tears in 47% of cases, while partial MPFL tears were present in 41% of the time. Osteochondral (OC) injury was present in 50% of the MRIs. Among these, chondral lesions were reported in 75% of MRIs, OC lesions in 21%, and OC fractures in 37%. The location of these lesions was isolated to the medial patella facet 66% of the time, compared with the lateral femoral condyle, which was the location for 31% of the lesions. Additionally, loose bodies were found in 34% of MRIs. Conclusion: This study highlights the frequent occurrence of significant MRI findings in pediatric first-time acute patellar dislocations, showing that obtaining MRI after first-time patellofemoral instability events in the pediatric population should be standard of care.
{"title":"Frequency of Adjunctive MRI Findings on First-Time Patellar Dislocations in Pediatric Patients: A Systematic Review","authors":"Jake M. Reed, Colby C. Wollenman, Breann K. Tisano, Kevin M. Dale, Lance E. LeClere","doi":"10.1177/03635465251383851","DOIUrl":"https://doi.org/10.1177/03635465251383851","url":null,"abstract":"Background: Patellar dislocation in pediatric athletes often involve additional injuries not identified on plain films. Purpose: To identify the rate of medial patellofemoral ligament (MPFL) injury and adjunctive injury findings identified by magnetic resonance imaging (MRI) in first-time patellar dislocations in the pediatric population. Study Design: Systematic review; Level of evidence, 4. Methods: This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD: 42024559285). PubMed, EMBASE, and SPORTDiscus were searched for studies on MRI findings after first-time pediatric patellar dislocations. Abstracts and articles were screened using predefined inclusion and exclusion criteria. The inclusion criteria were (1) first-time patellar dislocation, (2) explicit documentation of MRI findings, (3) patients <18 years, and (4) written in English. The exclusion criteria were (1) abstract only, case reports, or review articles; (2) overlapping or repeated patient sets; in such cases, the article containing the more comprehensive variables was retained. Data were extracted regarding patient characteristics and MRI findings. Pooled rates were calculated using only the studies that reported the specific variable in question. Bias was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies, and the Joanna Briggs Institute Critical Appraisal tools for the cross-sectional studies and case series. Results: A total of 322 studies were initially identified. After screening by 2 independent reviewers, 12 articles were included in the data extraction. Findings include complete MPFL tears in 47% of cases, while partial MPFL tears were present in 41% of the time. Osteochondral (OC) injury was present in 50% of the MRIs. Among these, chondral lesions were reported in 75% of MRIs, OC lesions in 21%, and OC fractures in 37%. The location of these lesions was isolated to the medial patella facet 66% of the time, compared with the lateral femoral condyle, which was the location for 31% of the lesions. Additionally, loose bodies were found in 34% of MRIs. Conclusion: This study highlights the frequent occurrence of significant MRI findings in pediatric first-time acute patellar dislocations, showing that obtaining MRI after first-time patellofemoral instability events in the pediatric population should be standard of care.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920233","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 : 2026-01-09DOI: 10.1177/03635465251383039
César Romero Antunes Júnior, Ramon Sampaio Souza Santos, Eduardo Silva Reis Barreto, Guilherme Neves Azevedo, Ewerton Borges de Souza Lima, Paulo Henrique Schmidt Lara, Alberto de Castro Pochini, Carlos Vicente Andreoli, Benno Ejnisman, Paulo Santoro Belangero
Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial. Purpose: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs; Level of evidence: 1. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs). Results: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, –0.17 to 0.34; P = .526), 8 to 12 weeks (SMD, –0.36; 95% CI, –0.99 to 0.27; P = .263), or 24 to 26 weeks (MD, –1.58; 95% CI, –4.74 to 1.58; P = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, –0.18 to 0.37; P = .518), 12 weeks (SMD, –0.09; 95% CI, –0.39 to 0.21; P = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, –0.18 to 0.43; P = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; P = .287). Conclusion: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.
{"title":"Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials","authors":"César Romero Antunes Júnior, Ramon Sampaio Souza Santos, Eduardo Silva Reis Barreto, Guilherme Neves Azevedo, Ewerton Borges de Souza Lima, Paulo Henrique Schmidt Lara, Alberto de Castro Pochini, Carlos Vicente Andreoli, Benno Ejnisman, Paulo Santoro Belangero","doi":"10.1177/03635465251383039","DOIUrl":"https://doi.org/10.1177/03635465251383039","url":null,"abstract":"Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial. Purpose: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs; Level of evidence: 1. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs). Results: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, –0.17 to 0.34; <jats:italic toggle=\"yes\">P</jats:italic> = .526), 8 to 12 weeks (SMD, –0.36; 95% CI, –0.99 to 0.27; <jats:italic toggle=\"yes\">P</jats:italic> = .263), or 24 to 26 weeks (MD, –1.58; 95% CI, –4.74 to 1.58; <jats:italic toggle=\"yes\">P</jats:italic> = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, –0.18 to 0.37; <jats:italic toggle=\"yes\">P</jats:italic> = .518), 12 weeks (SMD, –0.09; 95% CI, –0.39 to 0.21; <jats:italic toggle=\"yes\">P</jats:italic> = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, –0.18 to 0.43; <jats:italic toggle=\"yes\">P</jats:italic> = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; <jats:italic toggle=\"yes\">P</jats:italic> = .287). Conclusion: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920197","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 : 2026-01-09DOI: 10.1177/03635465251376655
Riccardo D’Ambrosi, Alessandro Carrozzo, Edoardo Monaco, Luca Maria Sconfienza, Elmar Herbst, Mirco Herbort, Elisabeth Abermann, Christian Fink
Background: Lateral extra-articular procedures (LEAPs) have gained increasing attention as an adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in individuals at high risk for reinjury. When combined with ACLR, LEAPs contribute to the restoration of normal knee kinematics and provide a significant reduction in residual anterior laxity compared with isolated ACLR. This added stability provides a protective effect on the intra-articular graft, promoting improved healing and integration while reducing mechanical stress on the reconstructed anterior cruciate ligament (ACL). As a result, these techniques have been demonstrated to result in improved performance after ACLR, higher graft survival, and lower revision rates, even in elite athletes who are at significant risk for reinjury. Purpose/Hypothesis: The aim of this study was to systematically compare the existing evidence on ACL rerupture rates by performing a meta-analysis comparing combined ACLR and LEAP versus isolated ACLR in elite athletes. The primary hypothesis of this systematic review and meta-analysis was that the addition of LEAP would reduce the rate of revision ACLR in elite athletes. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The method followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed rerupture rate in elite athletes after isolated ACLR versus ACLR plus LEAP. The MINORS (Methodological Index for Non-Randomized Studies) score was used for quality assessment. The main outcome measure was ipsilateral ACL rerupture. Results: A total of 586 elite athletes received an isolated ACLR, whereas 417 athletes received combined ACLR plus LEAP. Rerupture was reported by 9.3% (95% CI, 5.5%-14.0%) of athletes. In the ACLR group, 14.0% (95% CI, 7.9%-21.5%) reported a rerupture, whereas in the ACLR plus LEAP group, the reinjury rate was 5.0% (95% CI, 1.2%-10.8%), with a statistically significant difference between the 2 groups ( P = .042). Pooled odds ratio (OR) showed a 65% reduced risk of a new rupture episode in the ACLR plus LEAP group compared with the ACLR group, with an OR of 0.35 (95% CI, 0.20-0.59; P < .001). Conclusion: In elite athletes, adding an anterolateral procedure during ACLR significantly reduced the rerupture rate and reduced the risk of rerupture by >60%. Despite the few studies considered, our study seems to indicate that surgeons should carefully consider LEAP when treating an elite athlete in order to significantly reduce the risk of rerupture. Registration: PROSPERO: CRD42025637843.
{"title":"Lateral Extra-articular Procedures Reduce the Risk of Revision of Anterior Cruciate Ligament Reconstruction in Elite Athletes: A Systematic Review and Meta-analysis of Comparative Studies","authors":"Riccardo D’Ambrosi, Alessandro Carrozzo, Edoardo Monaco, Luca Maria Sconfienza, Elmar Herbst, Mirco Herbort, Elisabeth Abermann, Christian Fink","doi":"10.1177/03635465251376655","DOIUrl":"https://doi.org/10.1177/03635465251376655","url":null,"abstract":"Background: Lateral extra-articular procedures (LEAPs) have gained increasing attention as an adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in individuals at high risk for reinjury. When combined with ACLR, LEAPs contribute to the restoration of normal knee kinematics and provide a significant reduction in residual anterior laxity compared with isolated ACLR. This added stability provides a protective effect on the intra-articular graft, promoting improved healing and integration while reducing mechanical stress on the reconstructed anterior cruciate ligament (ACL). As a result, these techniques have been demonstrated to result in improved performance after ACLR, higher graft survival, and lower revision rates, even in elite athletes who are at significant risk for reinjury. Purpose/Hypothesis: The aim of this study was to systematically compare the existing evidence on ACL rerupture rates by performing a meta-analysis comparing combined ACLR and LEAP versus isolated ACLR in elite athletes. The primary hypothesis of this systematic review and meta-analysis was that the addition of LEAP would reduce the rate of revision ACLR in elite athletes. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The method followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed rerupture rate in elite athletes after isolated ACLR versus ACLR plus LEAP. The MINORS (Methodological Index for Non-Randomized Studies) score was used for quality assessment. The main outcome measure was ipsilateral ACL rerupture. Results: A total of 586 elite athletes received an isolated ACLR, whereas 417 athletes received combined ACLR plus LEAP. Rerupture was reported by 9.3% (95% CI, 5.5%-14.0%) of athletes. In the ACLR group, 14.0% (95% CI, 7.9%-21.5%) reported a rerupture, whereas in the ACLR plus LEAP group, the reinjury rate was 5.0% (95% CI, 1.2%-10.8%), with a statistically significant difference between the 2 groups ( <jats:italic toggle=\"yes\">P</jats:italic> = .042). Pooled odds ratio (OR) showed a 65% reduced risk of a new rupture episode in the ACLR plus LEAP group compared with the ACLR group, with an OR of 0.35 (95% CI, 0.20-0.59; <jats:italic toggle=\"yes\">P</jats:italic> < .001). Conclusion: In elite athletes, adding an anterolateral procedure during ACLR significantly reduced the rerupture rate and reduced the risk of rerupture by >60%. Despite the few studies considered, our study seems to indicate that surgeons should carefully consider LEAP when treating an elite athlete in order to significantly reduce the risk of rerupture. Registration: PROSPERO: CRD42025637843.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920501","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 : 2026-01-06DOI: 10.1177/03635465251380278
Shiv Patel,Omkar S Anaspure,Anthony N Baumann,Troy M Manz,R Justin Mistovich
BACKGROUNDThe medial patellofemoral ligament (MPFL) serves as a major stabilizer in the knee, providing restraint against lateral patellar translation. The optimal approach for treating patients with first-time MPFL injuries remains uncertain, as the choice between operative and nonoperative treatment depends on the risks and variability associated with individual patient anatomy, activity, and presentation.PURPOSETo evaluate high-level literature on outcomes after operative and nonoperative treatment of MPFL injuries to guide decision-making.STUDY DESIGNMeta-analysis; Level of evidence, 1.METHODSThis systematic review and meta-analysis utilized PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus through November 25, 2024, to find randomized controlled trials that assess the outcomes associated with operative versus nonoperative treatment for MPFL tears. The primary outcomes were rates of recurrent dislocation and patient-reported outcomes. Statistical analysis included relative risk (RR) with 95% confidence intervals (95% CIs) along with trial sequential analysis (TSA) and assessment of fragility index.RESULTSA total of 306 patients (55.9% female) had a frequency-weighted mean ± SD age of 19.68 ± 4.24 years (range, 9-40) and follow-up time of 21.61 ± 5.34 months and underwent nonoperative (n = 147) or operative (n = 159) treatment. When compared with nonoperative treatment, operative treatment had a significantly lower rate of recurrent instability (10.69% vs 29.93%; RR, 2.49; 95% CI, 1.34-4.61; P = .004) with robust evidence (fragility index, 7 patients) but no difference in Kujala scores (79.02 ± 10.71 vs 88.78 ± 2.91; overall mean difference, -9.32; 95% CI, -19.45 to 0.81; P = .071). Subgroup analysis showed that repair had a significantly lower rate of recurrent instability as compared with nonoperative treatment (15.74% vs 35.42%; RR, 1.87; 95% CI, 1.11-3.17; P = .019). Similarly, reconstruction showed a significantly lower rate of recurrent instability as compared with nonoperative treatment (3.92% vs 33.33%; RR, 6.80; 95% CI, 1.93-23.95; P = .003). TSA for all primary outcomes demonstrated that the Z curve did not cross the required information size, suggesting that the current volume of data is not sufficient to draw definitive conclusions for each comparison.CONCLUSIONOperative treatment of MPFL injuries resulted in a robust and significantly lower rate of recurrent instability when compared with nonoperative treatment, although there was no difference in Kujala scores. Given the current evidence, operative treatment appears to be the more ideal approach to treating first-time patellar dislocations. However, the key to these findings is the need for further studies, as TSA showed that the current level of evidence is insufficient to draw definitive conclusions.
背景：髌股内侧韧带（MPFL）是膝关节的主要稳定物，可抑制髌骨外侧移位。治疗首次MPFL损伤患者的最佳方法仍然不确定，因为手术和非手术治疗的选择取决于个体患者解剖、活动和表现的风险和可变性。目的评价高水平的MPFL损伤手术和非手术治疗的预后，以指导决策。研究DESIGNMeta-analysis;证据等级：1。方法：本系统综述和荟萃分析利用PubMed、CINAHL、MEDLINE、Web of Science和SPORTDiscus，截至2024年11月25日，寻找随机对照试验，评估手术与非手术治疗MPFL撕裂的相关结果。主要结局是脱位复发率和患者报告的结局。统计分析包括95%置信区间的相对危险度（RR）、试验序贯分析（TSA）和脆弱性指数评估。结果306例患者（女性55.9%），频率加权平均±SD年龄19.68±4.24岁（范围9-40岁），随访时间21.61±5.34个月，分别接受了非手术治疗（n = 147）和手术治疗（n = 159）。与非手术治疗相比，手术治疗的复发不稳定率明显低于非手术治疗（10.69% vs 29.93%； RR, 2.49; 95% CI, 1.34-4.61; P = 0.004），证据可靠（脆弱性指数，7例），但Kujala评分无差异（79.02±10.71 vs 88.78±2.91；总平均差为-9.32;95% CI, -19.45 ~ 0.81; P = 0.071）。亚组分析显示，与非手术治疗相比，修复组的复发不稳定率明显降低（15.74% vs 35.42%； RR, 1.87; 95% CI, 1.11-3.17; P = 0.019）。同样，与非手术治疗相比，重建显示复发不稳定的发生率明显降低（3.92% vs 33.33%； RR, 6.80; 95% CI, 1.93-23.95; P = 0.003）。所有主要结果的TSA显示，Z曲线没有超过所需的信息大小，这表明当前的数据量不足以为每次比较得出明确的结论。结论与非手术治疗相比，手术治疗MPFL损伤的复发不稳定率明显降低，但Kujala评分无差异。鉴于目前的证据，手术治疗似乎是治疗首次髌骨脱位的更理想的方法。然而，这些发现的关键是需要进一步的研究，因为运输安全管理局表明，目前的证据水平不足以得出明确的结论。
{"title":"Operative Versus Nonoperative Treatment of Medial Patellofemoral Ligament Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.","authors":"Shiv Patel,Omkar S Anaspure,Anthony N Baumann,Troy M Manz,R Justin Mistovich","doi":"10.1177/03635465251380278","DOIUrl":"https://doi.org/10.1177/03635465251380278","url":null,"abstract":"BACKGROUNDThe medial patellofemoral ligament (MPFL) serves as a major stabilizer in the knee, providing restraint against lateral patellar translation. The optimal approach for treating patients with first-time MPFL injuries remains uncertain, as the choice between operative and nonoperative treatment depends on the risks and variability associated with individual patient anatomy, activity, and presentation.PURPOSETo evaluate high-level literature on outcomes after operative and nonoperative treatment of MPFL injuries to guide decision-making.STUDY DESIGNMeta-analysis; Level of evidence, 1.METHODSThis systematic review and meta-analysis utilized PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus through November 25, 2024, to find randomized controlled trials that assess the outcomes associated with operative versus nonoperative treatment for MPFL tears. The primary outcomes were rates of recurrent dislocation and patient-reported outcomes. Statistical analysis included relative risk (RR) with 95% confidence intervals (95% CIs) along with trial sequential analysis (TSA) and assessment of fragility index.RESULTSA total of 306 patients (55.9% female) had a frequency-weighted mean ± SD age of 19.68 ± 4.24 years (range, 9-40) and follow-up time of 21.61 ± 5.34 months and underwent nonoperative (n = 147) or operative (n = 159) treatment. When compared with nonoperative treatment, operative treatment had a significantly lower rate of recurrent instability (10.69% vs 29.93%; RR, 2.49; 95% CI, 1.34-4.61; P = .004) with robust evidence (fragility index, 7 patients) but no difference in Kujala scores (79.02 ± 10.71 vs 88.78 ± 2.91; overall mean difference, -9.32; 95% CI, -19.45 to 0.81; P = .071). Subgroup analysis showed that repair had a significantly lower rate of recurrent instability as compared with nonoperative treatment (15.74% vs 35.42%; RR, 1.87; 95% CI, 1.11-3.17; P = .019). Similarly, reconstruction showed a significantly lower rate of recurrent instability as compared with nonoperative treatment (3.92% vs 33.33%; RR, 6.80; 95% CI, 1.93-23.95; P = .003). TSA for all primary outcomes demonstrated that the Z curve did not cross the required information size, suggesting that the current volume of data is not sufficient to draw definitive conclusions for each comparison.CONCLUSIONOperative treatment of MPFL injuries resulted in a robust and significantly lower rate of recurrent instability when compared with nonoperative treatment, although there was no difference in Kujala scores. Given the current evidence, operative treatment appears to be the more ideal approach to treating first-time patellar dislocations. However, the key to these findings is the need for further studies, as TSA showed that the current level of evidence is insufficient to draw definitive conclusions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"12 1","pages":"3635465251380278"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907719","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 : 2026-01-06DOI: 10.1177/03635465251360229
Udit Dave,Jared Rubin,Alexander Mamonov,Andrew S Bi,Myles Atkins,Johnathon R McCormick,Fernando Gómez-Verdejo,Jorge Chahla,Nikhil N Verma
BACKGROUNDThere are multiple techniques for femoral tunnel creation for anterior cruciate ligament (ACL) reconstruction, with most modern techniques revolving around retrograde drilling or anteromedial (AM) portal drilling.PURPOSETo compile and quantify patient-reported outcomes and complication rates in patients who undergo hamstring ACL reconstruction with femoral tunnel creation via AM portal drilling versus retrograde drilling techniques.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 1.METHODSIn accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they (1) were level 1 randomized controlled trials, (2) comprised patients who underwent primary ACL reconstruction utilizing hamstring tendon autograft, and (3) compared femoral tunnels created via AM portal antegrade drilling versus retrograde drilling techniques. Studies that were not written in English or did not directly compare patients being treated with either femoral tunnel technique were excluded. Data were pooled with a DerSimonian-Laird random effects model, and risk of bias was assessed with the Cochrane RoB 2 tool.RESULTSThe initial search identified 1003 studies, of which 5 randomized controlled trials were included in this study with a total of 557 patients: 280 in the AM portal cohort and 277 in the retrograde drilling cohort. Mean ages across the cohorts ranged from 26.4 to 34.2 years. All patients had a minimum 6 months of follow-up. Descriptive data were similar between graft cohorts, and studies had low risk of bias and low heterogeneity. The mean difference in International Knee Documentation Committee score for the retrograde drilling versus AM portal cohorts was 1.0 (95% CI, -0.3 to 2.3). The odds ratios (ORs) for retrograde drilling versus AM portal showed no significant differences for revision ACL (OR, 2.1; 95% CI, -0.5 to 8.9), overall reoperation (OR, 1.1; 95% CI, 0.5-2.4), and total complications (OR, 1.0; 95% CI, 0.5-2.0).CONCLUSIONPrimary ACL reconstruction has no significant differences in patient-reported outcomes, complications, or revision ACL rates when femoral tunnels are created via AM portal antegrade drilling versus retrograde drilling techniques. Decisions regarding ACL reconstruction technique should be tailored to individual patient needs and surgeon preference.
{"title":"Anterior Cruciate Ligament Reconstruction With Femoral Tunnel Anteromedial Portal Antegrade Drilling Versus Retrograde Drilling Techniques Using Hamstring Graft Has No Difference in Clinical Outcomes or Complications: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Udit Dave,Jared Rubin,Alexander Mamonov,Andrew S Bi,Myles Atkins,Johnathon R McCormick,Fernando Gómez-Verdejo,Jorge Chahla,Nikhil N Verma","doi":"10.1177/03635465251360229","DOIUrl":"https://doi.org/10.1177/03635465251360229","url":null,"abstract":"BACKGROUNDThere are multiple techniques for femoral tunnel creation for anterior cruciate ligament (ACL) reconstruction, with most modern techniques revolving around retrograde drilling or anteromedial (AM) portal drilling.PURPOSETo compile and quantify patient-reported outcomes and complication rates in patients who undergo hamstring ACL reconstruction with femoral tunnel creation via AM portal drilling versus retrograde drilling techniques.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 1.METHODSIn accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they (1) were level 1 randomized controlled trials, (2) comprised patients who underwent primary ACL reconstruction utilizing hamstring tendon autograft, and (3) compared femoral tunnels created via AM portal antegrade drilling versus retrograde drilling techniques. Studies that were not written in English or did not directly compare patients being treated with either femoral tunnel technique were excluded. Data were pooled with a DerSimonian-Laird random effects model, and risk of bias was assessed with the Cochrane RoB 2 tool.RESULTSThe initial search identified 1003 studies, of which 5 randomized controlled trials were included in this study with a total of 557 patients: 280 in the AM portal cohort and 277 in the retrograde drilling cohort. Mean ages across the cohorts ranged from 26.4 to 34.2 years. All patients had a minimum 6 months of follow-up. Descriptive data were similar between graft cohorts, and studies had low risk of bias and low heterogeneity. The mean difference in International Knee Documentation Committee score for the retrograde drilling versus AM portal cohorts was 1.0 (95% CI, -0.3 to 2.3). The odds ratios (ORs) for retrograde drilling versus AM portal showed no significant differences for revision ACL (OR, 2.1; 95% CI, -0.5 to 8.9), overall reoperation (OR, 1.1; 95% CI, 0.5-2.4), and total complications (OR, 1.0; 95% CI, 0.5-2.0).CONCLUSIONPrimary ACL reconstruction has no significant differences in patient-reported outcomes, complications, or revision ACL rates when femoral tunnels are created via AM portal antegrade drilling versus retrograde drilling techniques. Decisions regarding ACL reconstruction technique should be tailored to individual patient needs and surgeon preference.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"130 1","pages":"3635465251360229"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907659","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 : 2026-01-06DOI: 10.1177/03635465251371330
Jelle P van der List,Cory Meixner,Christopher C Kaeding,Robert A Magnussen,David C Flanigan
BACKGROUNDAnterior cruciate ligament (ACL) injuries are common, and ACL reconstruction (ACLR) restores stability and enables return to sport. To date, however, studies have failed to show that ACLR prevents long-term osteoarthritis, but the role of timing of ACLR in osteoarthritis has not been extensively examined in meta-analyses.PURPOSETo compare the risk of long-term osteoarthritis after early versus delayed ACLR in the literature.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 4.METHODSThe PubMed, Embase, and Cochrane Library databases were searched from 2000 to August 2024 for studies comparing osteoarthritis between early and delayed ACLR at a minimum 5-year follow-up. Outcomes are reported as risk reduction with 95% confidence interval for osteoarthritis incidence, and odds ratio with 95% confidence interval for difference in time from injury to surgery. Random-effects models were used.RESULTSSeventeen studies (3953 ACLRs) were included (mean age, 28.8 years; 67% male; mean follow-up, 13.3 years; 52% meniscectomy; 31% osteoarthritis incidence). The quality of the studies was rated as moderate, with a Methodological Index for Non-Randomized Studies score of 78% of maximum. Overall, earlier ACLR led to a 10% reduction in osteoarthritis compared with delayed ACLR (95% CI, 6%-14%; P < .001). Two studies (1474 patients) reported a 6% incidence reduction when ACLR was performed within versus after 1 month (95% CI, 2%-10%; P = .005). Similarly, 4 studies (349 patients) reported a 16% incidence reduction when ACLR was performed within versus after 6 months (95% CI, 5%-26%; P = .004), and 5 studies (2248 patients) showed a 13% osteoarthritis reduction with ACLR within versus after 12 months (95% CI, 6%-20%; P = .003). Six studies (685 patients) reported that patients without osteoarthritis were operated on a mean 15 months earlier than patients who developed osteoarthritis (95% CI, 2-29 months; P = .03).CONCLUSIONThis systematic review with a 5-year minimum follow-up demonstrates that shorter time from injury to ACLR was associated with a decreased incidence of long-term osteoarthritis. This reduced risk was already seen when surgery was performed within 1 month but most pronounced within 6 months and 12 months.
前交叉韧带（ACL）损伤是常见的，ACL重建（ACLR）可以恢复其稳定性并使其能够恢复运动。然而，迄今为止，研究未能表明ACLR可预防长期骨关节炎，但ACLR在骨关节炎中的作用尚未在荟萃分析中得到广泛研究。目的比较文献中早期与延迟ACLR术后长期骨关节炎的风险。研究设计：系统评价和荟萃分析；证据等级，4级。方法检索PubMed， Embase和Cochrane图书馆数据库，从2000年到2024年8月，在至少5年的随访中比较早期和延迟ACLR骨关节炎的研究。结果报告为骨关节炎发病率的风险降低（95%置信区间），以及从损伤到手术时间差异的比值比（95%置信区间）。采用随机效应模型。结果纳入17项研究（3953例ACLRs），平均年龄28.8岁，男性67%，平均随访13.3年，半月板切除术52%，骨关节炎发生率31%。这些研究的质量被评为中等，非随机研究的方法学指数得分为最高的78%。总体而言，与延迟ACLR相比，早期ACLR导致骨关节炎减少10% （95% CI, 6%-14%; P < 0.001）。两项研究（1474例患者）报告，ACLR在1个月内与1个月后相比，发生率降低了6% （95% CI, 2%-10%; P = 0.005）。同样，4项研究（349例患者）报告ACLR在6个月内比6个月后发生率降低16% (95% CI, 5%-26%; P = 0.004)， 5项研究（2248例患者）显示ACLR在12个月内比12个月后骨关节炎发生率降低13% （95% CI, 6%-20%; P = 0.003）。6项研究（685例患者）报道，无骨关节炎患者的手术时间比有骨关节炎患者平均早15个月（95% CI， 2-29个月；P = .03）。结论：这项为期5年的系统综述表明，从损伤到ACLR的时间缩短与长期骨关节炎的发病率降低有关。这种降低的风险在1个月内进行手术时已经看到，但在6个月和12个月内最为明显。
{"title":"Early Anterior Cruciate Ligament Reconstruction Is Associated With Decreased Risk of Osteoarthritis Compared With Delayed Reconstruction: A Systematic Review and Meta-analysis.","authors":"Jelle P van der List,Cory Meixner,Christopher C Kaeding,Robert A Magnussen,David C Flanigan","doi":"10.1177/03635465251371330","DOIUrl":"https://doi.org/10.1177/03635465251371330","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament (ACL) injuries are common, and ACL reconstruction (ACLR) restores stability and enables return to sport. To date, however, studies have failed to show that ACLR prevents long-term osteoarthritis, but the role of timing of ACLR in osteoarthritis has not been extensively examined in meta-analyses.PURPOSETo compare the risk of long-term osteoarthritis after early versus delayed ACLR in the literature.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 4.METHODSThe PubMed, Embase, and Cochrane Library databases were searched from 2000 to August 2024 for studies comparing osteoarthritis between early and delayed ACLR at a minimum 5-year follow-up. Outcomes are reported as risk reduction with 95% confidence interval for osteoarthritis incidence, and odds ratio with 95% confidence interval for difference in time from injury to surgery. Random-effects models were used.RESULTSSeventeen studies (3953 ACLRs) were included (mean age, 28.8 years; 67% male; mean follow-up, 13.3 years; 52% meniscectomy; 31% osteoarthritis incidence). The quality of the studies was rated as moderate, with a Methodological Index for Non-Randomized Studies score of 78% of maximum. Overall, earlier ACLR led to a 10% reduction in osteoarthritis compared with delayed ACLR (95% CI, 6%-14%; P < .001). Two studies (1474 patients) reported a 6% incidence reduction when ACLR was performed within versus after 1 month (95% CI, 2%-10%; P = .005). Similarly, 4 studies (349 patients) reported a 16% incidence reduction when ACLR was performed within versus after 6 months (95% CI, 5%-26%; P = .004), and 5 studies (2248 patients) showed a 13% osteoarthritis reduction with ACLR within versus after 12 months (95% CI, 6%-20%; P = .003). Six studies (685 patients) reported that patients without osteoarthritis were operated on a mean 15 months earlier than patients who developed osteoarthritis (95% CI, 2-29 months; P = .03).CONCLUSIONThis systematic review with a 5-year minimum follow-up demonstrates that shorter time from injury to ACLR was associated with a decreased incidence of long-term osteoarthritis. This reduced risk was already seen when surgery was performed within 1 month but most pronounced within 6 months and 12 months.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":"3635465251371330"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907720","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 : 2026-01-06DOI: 10.1177/03635465251357594
Eric Y. Hu, Thomas E. Moran, Jesus E. Cervantes, Kyleen Jan, Shane J. Nho
Background: The fragility index has been utilized in the literature to better characterize the limited categorical interpretation of the traditional P value in randomized controlled trials (RCTs). The reverse continuous fragility index (rCFI) aims to broaden this metric to include the analysis of nonsignificant, continuous outcome results, specifically on the topic of capsular closure versus nonclosure during hip arthroscopy. Purpose/Hypothesis: The purpose was to characterize the rCFI of statistically nonsignificant results in RCTs comparing capsular repair versus noncapsular repair in hip arthroscopy for the treatment of FAIS. It was hypothesized that (1) nonsignificant differences in clinical outcomes between the capsular closure and noncapsular closure groups would be statistically robust, as demonstrated by rCFI values exceeding the rate of loss to follow-up, and (2) rCFI would be greater than traditional rFI values and CFI values reported in the sports medicine literature. Study Design: Meta-analysis; Level of evidence, 2 Methods: The PubMed, Cochrane, and Embase databases were queried from inception to October 2024 with combinations of the following search terms: “hip arthroscopy,” “capsule, “capsular,” and “randomized controlled trials.” Studies were included if they were randomized trials that compared capsular closure with nonclosure and had at least 1 nonsignificant outcome reported. The rCFI calculation was performed on primary nonsignificant outcomes across all studies to obtain a mean rCFI. Multivariate linear regression was performed to determine study characteristics and variables associated with higher rCFI values. Results: Six studies with 416 patients were included in this analysis. A total of 136 outcomes with nonsignificant results were identified across 6 studies, with 6 of these outcomes representing each study’s primary outcome. The mean rCFI across all studies was 16.333 (SD, 6.121). A mean of 11.03% (SD, 5.79%) of patients were lost to follow-up. The rCFI exceeded the number of patients lost to follow-up for all analyzed studies. Multivariate regression showed that sample size was significantly predictive of high rCFI ( P = .018). Conclusion: Provisional assessment of rCFI suggests that the nonsignificant differences reported by RCTs comparing hip capsular closure versus nonclosure after interportal capsulotomies are relatively robust. Increased sample sizes in RCTs are associated with greater robustness of nonsignificant results.
{"title":"The Reverse Continuous Fragility Index of Randomized Controlled Trials Comparing Capsular Closure Versus Noncapsular Closure During Hip Arthroscopy","authors":"Eric Y. Hu, Thomas E. Moran, Jesus E. Cervantes, Kyleen Jan, Shane J. Nho","doi":"10.1177/03635465251357594","DOIUrl":"https://doi.org/10.1177/03635465251357594","url":null,"abstract":"Background: The fragility index has been utilized in the literature to better characterize the limited categorical interpretation of the traditional <jats:italic toggle=\"yes\">P</jats:italic> value in randomized controlled trials (RCTs). The reverse continuous fragility index (rCFI) aims to broaden this metric to include the analysis of nonsignificant, continuous outcome results, specifically on the topic of capsular closure versus nonclosure during hip arthroscopy. Purpose/Hypothesis: The purpose was to characterize the rCFI of statistically nonsignificant results in RCTs comparing capsular repair versus noncapsular repair in hip arthroscopy for the treatment of FAIS. It was hypothesized that (1) nonsignificant differences in clinical outcomes between the capsular closure and noncapsular closure groups would be statistically robust, as demonstrated by rCFI values exceeding the rate of loss to follow-up, and (2) rCFI would be greater than traditional rFI values and CFI values reported in the sports medicine literature. Study Design: Meta-analysis; Level of evidence, 2 Methods: The PubMed, Cochrane, and Embase databases were queried from inception to October 2024 with combinations of the following search terms: “hip arthroscopy,” “capsule, “capsular,” and “randomized controlled trials.” Studies were included if they were randomized trials that compared capsular closure with nonclosure and had at least 1 nonsignificant outcome reported. The rCFI calculation was performed on primary nonsignificant outcomes across all studies to obtain a mean rCFI. Multivariate linear regression was performed to determine study characteristics and variables associated with higher rCFI values. Results: Six studies with 416 patients were included in this analysis. A total of 136 outcomes with nonsignificant results were identified across 6 studies, with 6 of these outcomes representing each study’s primary outcome. The mean rCFI across all studies was 16.333 (SD, 6.121). A mean of 11.03% (SD, 5.79%) of patients were lost to follow-up. The rCFI exceeded the number of patients lost to follow-up for all analyzed studies. Multivariate regression showed that sample size was significantly predictive of high rCFI ( <jats:italic toggle=\"yes\">P</jats:italic> = .018). Conclusion: Provisional assessment of rCFI suggests that the nonsignificant differences reported by RCTs comparing hip capsular closure versus nonclosure after interportal capsulotomies are relatively robust. Increased sample sizes in RCTs are associated with greater robustness of nonsignificant results.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903680","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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