Pub Date : 2026-01-12DOI: 10.1177/03635465251376649
Anirudh Sharma,Muaaz Tahir,Osama Aweid,Tarek Boutefnouchet,Tamer Sweed,Amit Meena,Darren L de Sa,Rachel M Frank,Peter D'Alessandro,Shahbaz S Malik
BACKGROUNDThe use of a quadriceps tendon (QT) autograft has gained popularity in recent years, and it has been called the "graft of the future." However, there is limited evidence of its sex-specific outcomes in female patients.PURPOSETo assess the outcomes of anterior cruciate ligament reconstruction (ACLR) with a QT autograft specifically in female patients and to elucidate any differences in sex-specific outcomes compared with male patients.STUDY DESIGNSystematic review; Level of evidence, 2.METHODSThis systematic review was conducted in accordance with PRISMA guidelines using 4 online databases for a review of the literature. Studies using a QT autograft for ACLR but not reporting female-specific outcomes were excluded. Outcomes assessed included patient-reported outcomes, objective functional outcomes, and complications. A meta-analysis was performed in which data allowed for a comparison of outcomes with male patients.RESULTSThere were 9 studies included in this review, with a total of 714 female knees (mean age, 23.0 years) that underwent ACLR with a QT autograft. No difference was observed in the pooled graft failure rate between male and female patients at ≥24 months (8.8% vs 7.4%, respectively; P = .50). Female patients had lower Tegner scores at 24 months (P = .0007) and a lower quadriceps strength limb symmetry index at 6 months (P < .0001). No significant difference was seen in the side-to-side difference in instrumented laxity measurements at 6 months (P = .44) or in Lysholm scores at 24 months (P = .52). The mean extension loss in female patients was 0.07° (range, -0.22° to 0.58°) at 24 months. The return-to-sport rate in female patients ranged from 71.4% to 82.7%.CONCLUSIONEvidence from currently available literature suggests that there is no difference in graft failure rates between the sexes after ACLR with a QT autograft. Additionally, female patients have lower activity scores and slower quadriceps recovery compared with male patients.
{"title":"Anterior Cruciate Ligament Reconstruction With a Quadriceps Tendon Autograft in Female Patients Shows Equivalent Graft Failure But Lower Activity Scores and Slower Quadriceps Strength Recovery Compared With Male Patients: A Systematic Review and Meta-analysis.","authors":"Anirudh Sharma,Muaaz Tahir,Osama Aweid,Tarek Boutefnouchet,Tamer Sweed,Amit Meena,Darren L de Sa,Rachel M Frank,Peter D'Alessandro,Shahbaz S Malik","doi":"10.1177/03635465251376649","DOIUrl":"https://doi.org/10.1177/03635465251376649","url":null,"abstract":"BACKGROUNDThe use of a quadriceps tendon (QT) autograft has gained popularity in recent years, and it has been called the \"graft of the future.\" However, there is limited evidence of its sex-specific outcomes in female patients.PURPOSETo assess the outcomes of anterior cruciate ligament reconstruction (ACLR) with a QT autograft specifically in female patients and to elucidate any differences in sex-specific outcomes compared with male patients.STUDY DESIGNSystematic review; Level of evidence, 2.METHODSThis systematic review was conducted in accordance with PRISMA guidelines using 4 online databases for a review of the literature. Studies using a QT autograft for ACLR but not reporting female-specific outcomes were excluded. Outcomes assessed included patient-reported outcomes, objective functional outcomes, and complications. A meta-analysis was performed in which data allowed for a comparison of outcomes with male patients.RESULTSThere were 9 studies included in this review, with a total of 714 female knees (mean age, 23.0 years) that underwent ACLR with a QT autograft. No difference was observed in the pooled graft failure rate between male and female patients at ≥24 months (8.8% vs 7.4%, respectively; P = .50). Female patients had lower Tegner scores at 24 months (P = .0007) and a lower quadriceps strength limb symmetry index at 6 months (P < .0001). No significant difference was seen in the side-to-side difference in instrumented laxity measurements at 6 months (P = .44) or in Lysholm scores at 24 months (P = .52). The mean extension loss in female patients was 0.07° (range, -0.22° to 0.58°) at 24 months. The return-to-sport rate in female patients ranged from 71.4% to 82.7%.CONCLUSIONEvidence from currently available literature suggests that there is no difference in graft failure rates between the sexes after ACLR with a QT autograft. Additionally, female patients have lower activity scores and slower quadriceps recovery compared with male patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"24 1","pages":"3635465251376649"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949669","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 : 2026-01-12DOI: 10.1177/03635465251380285
Lei Zhang,Tianhao Xu,Qianjiang Xiong,Yunan Hu,Lei Fan,Weili Fu
BACKGROUNDThe incidence of knee osteoarthritis (KOA) after anterior cruciate ligament (ACL) reconstruction (ACLR) is high, posing significant challenges to long-term joint health and overall quality of life. Identifying and understanding the risk factors associated with postoperative KOA are crucial for improving surgical outcomes and guiding preventive strategies.PURPOSETo perform a systematic review and meta-analysis to investigate the risk factors for KOA after ACLR.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review with meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 3 databases (PubMed, Embase, and Web of Science) searched from inception to September 2024. All prospective and retrospective studies investigating the risk factors for KOA after ACLR were considered. The odds ratio (OR) or weighted mean difference (WMD) was calculated for potential risk factors if ≥2 studies assessed the same risk factor. Variables that could not be subjected to a meta-analysis were qualitatively analyzed.RESULTSA total of 39 studies met the inclusion criteria, with a combined sample size of 46,545, and 35 studies were subjected to a meta-analysis. The incidence of KOA after ACLR ranged from 2.34% to 100.00%, with a mean incidence of 8.29%. Overall, 9 factors were associated with an increase in the risk of KOA after ACLR: older age (WMD, 3.30 [95% CI, 2.33-4.28]), male sex (OR, 1.41 [95% CI, 1.14-1.74]), a higher body mass index (WMD, 1.31 [95% CI, 0.34-2.27]), bone-patellar tendon-bone autografts (OR, 1.66 [95% CI, 1.11-2.50]), a longer interval between ACL injury and surgery (WMD, 1.09 [95% CI, 0.55-1.63]), meniscectomy (OR, 2.42 [95% CI, 2.01-2.91]), meniscal injuries (OR, 3.35 [95% CI, 2.06-5.45]), additional injuries (OR, 3.65 [95% CI, 1.74-7.68]), and chondral lesions at the time of ACLR (OR, 2.15 [95% CI, 1.43-3.24]).CONCLUSIONOlder age, male sex, a higher body mass index, bone-patellar tendon-bone autografts, meniscectomy, a longer interval between ACL injury and surgery, and concomitant other injuries (meniscal or chondral) may increase the risk of KOA after ACLR. An increased awareness of relevant risk factors and targeted preventive strategies for modifiable risk factors can effectively reduce the incidence of KOA after ACLR.
{"title":"Risk Factors for Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.","authors":"Lei Zhang,Tianhao Xu,Qianjiang Xiong,Yunan Hu,Lei Fan,Weili Fu","doi":"10.1177/03635465251380285","DOIUrl":"https://doi.org/10.1177/03635465251380285","url":null,"abstract":"BACKGROUNDThe incidence of knee osteoarthritis (KOA) after anterior cruciate ligament (ACL) reconstruction (ACLR) is high, posing significant challenges to long-term joint health and overall quality of life. Identifying and understanding the risk factors associated with postoperative KOA are crucial for improving surgical outcomes and guiding preventive strategies.PURPOSETo perform a systematic review and meta-analysis to investigate the risk factors for KOA after ACLR.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSA systematic review with meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 3 databases (PubMed, Embase, and Web of Science) searched from inception to September 2024. All prospective and retrospective studies investigating the risk factors for KOA after ACLR were considered. The odds ratio (OR) or weighted mean difference (WMD) was calculated for potential risk factors if ≥2 studies assessed the same risk factor. Variables that could not be subjected to a meta-analysis were qualitatively analyzed.RESULTSA total of 39 studies met the inclusion criteria, with a combined sample size of 46,545, and 35 studies were subjected to a meta-analysis. The incidence of KOA after ACLR ranged from 2.34% to 100.00%, with a mean incidence of 8.29%. Overall, 9 factors were associated with an increase in the risk of KOA after ACLR: older age (WMD, 3.30 [95% CI, 2.33-4.28]), male sex (OR, 1.41 [95% CI, 1.14-1.74]), a higher body mass index (WMD, 1.31 [95% CI, 0.34-2.27]), bone-patellar tendon-bone autografts (OR, 1.66 [95% CI, 1.11-2.50]), a longer interval between ACL injury and surgery (WMD, 1.09 [95% CI, 0.55-1.63]), meniscectomy (OR, 2.42 [95% CI, 2.01-2.91]), meniscal injuries (OR, 3.35 [95% CI, 2.06-5.45]), additional injuries (OR, 3.65 [95% CI, 1.74-7.68]), and chondral lesions at the time of ACLR (OR, 2.15 [95% CI, 1.43-3.24]).CONCLUSIONOlder age, male sex, a higher body mass index, bone-patellar tendon-bone autografts, meniscectomy, a longer interval between ACL injury and surgery, and concomitant other injuries (meniscal or chondral) may increase the risk of KOA after ACLR. An increased awareness of relevant risk factors and targeted preventive strategies for modifiable risk factors can effectively reduce the incidence of KOA after ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"94 1","pages":"3635465251380285"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949667","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 : 2026-01-12DOI: 10.1177/03635465251392196
Benjamin G. Domb, Drashti Sikligar, Andrew R. Schab, Roger Quesada-Jimenez, Tyler R. McCarroll, Ady H. Kahana-Rojkind
Background: Labral reconstruction demonstrates promising short- and midterm benefits for irreparable labral tears, but long-term outcomes remain understudied. Purpose: To evaluate minimum 10-year patient-reported outcomes (PROs) of primary arthroscopic labral reconstruction compared with a propensity-matched control group. Study Design: Cohort study; Level of evidence, 2. Methods: Data were prospectively collected for all patients who underwent primary arthroscopic labral reconstruction with allograft as treatment for femoroacetabular impingement and labral tears. Patients included had preoperative and 10-year minimum postoperative data for PROs. Patients were propensity-matched to a control group that had undergone primary labral repair in a 1:3 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics and PROs were reported and compared between the groups. Rates of meeting clinically relevant thresholds, secondary arthroscopy, and survivorship were also compared. Results: A total of 22 hips (22 patients) of 27 eligible hips (81%) that underwent primary labral reconstruction (RECON) were matched to 66 hips (63 patients) that underwent primary repair (REPAIR). Both groups had similar preoperative and postoperative scores for all PROs ( P > .05). The RECON group met the substantial clinical benefit for the Non-Arthritic Hip Score at a lower rate than the REPAIR group ( P < .05). The RECON group underwent secondary arthroscopy at similar rates to the REPAIR group (13.6% vs 10.6%; P > .05) and had similar rates of survivorship (90.9% vs 81.8%; P > .05). Conclusion: Primary labral reconstruction demonstrated favorable outcomes at a minimum 10-year follow-up. When compared with a propensity-matched control group that underwent primary labral repair, both groups achieved similar postoperative PRO scores. Additionally, they met clinically meaningful thresholds and underwent secondary procedures at comparable rates.
背景：对于无法修复的唇裂，唇部重建显示出有希望的短期和中期益处，但长期结果仍有待研究。目的：与倾向匹配的对照组比较，评估原发性关节镜下唇部重建的最低10年患者报告结果（PROs）。研究设计：队列研究；证据等级2。方法：前瞻性地收集所有接受首次关节镜下同种异体唇瓣重建术治疗股骨髋臼撞击和唇裂的患者的资料。纳入的患者术前和术后10年的最小PROs数据。根据年龄、性别、体重指数和髋臼外桥分级，将患者倾向匹配到接受初级唇部修复术的对照组，比例为1:3。报告两组患者的特征和PROs并进行比较。达到临床相关阈值的比率、二次关节镜检查和生存率也进行了比较。结果：27个符合条件的髋关节（81%）中，22个髋关节（22例患者）接受了初级唇部重建（RECON），与66个髋关节（63例患者）接受了初级修复（repair）。两组术前和术后所有PROs评分相似（P > 0.05）。RECON组在非关节炎髋关节评分方面达到实质性临床获益的比率低于REPAIR组（P < 0.05）。RECON组接受二次关节镜检查的比例与REPAIR组相似（13.6% vs 10.6%; P > 0.05），生存率相似（90.9% vs 81.8%; P > 0.05）。结论：在至少10年的随访中，初级唇部重建显示出良好的结果。与接受初次唇部修复的倾向匹配对照组相比，两组术后PRO评分相似。此外，他们达到了有临床意义的阈值，并以相当的比率接受了二次手术。
{"title":"Arthroscopic Primary Labral Reconstruction in the Hip: Minimum 10-Year Outcomes With a Nested Propensity-Matched Control","authors":"Benjamin G. Domb, Drashti Sikligar, Andrew R. Schab, Roger Quesada-Jimenez, Tyler R. McCarroll, Ady H. Kahana-Rojkind","doi":"10.1177/03635465251392196","DOIUrl":"https://doi.org/10.1177/03635465251392196","url":null,"abstract":"Background: Labral reconstruction demonstrates promising short- and midterm benefits for irreparable labral tears, but long-term outcomes remain understudied. Purpose: To evaluate minimum 10-year patient-reported outcomes (PROs) of primary arthroscopic labral reconstruction compared with a propensity-matched control group. Study Design: Cohort study; Level of evidence, 2. Methods: Data were prospectively collected for all patients who underwent primary arthroscopic labral reconstruction with allograft as treatment for femoroacetabular impingement and labral tears. Patients included had preoperative and 10-year minimum postoperative data for PROs. Patients were propensity-matched to a control group that had undergone primary labral repair in a 1:3 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics and PROs were reported and compared between the groups. Rates of meeting clinically relevant thresholds, secondary arthroscopy, and survivorship were also compared. Results: A total of 22 hips (22 patients) of 27 eligible hips (81%) that underwent primary labral reconstruction (RECON) were matched to 66 hips (63 patients) that underwent primary repair (REPAIR). Both groups had similar preoperative and postoperative scores for all PROs ( <jats:italic toggle=\"yes\">P</jats:italic> > .05). The RECON group met the substantial clinical benefit for the Non-Arthritic Hip Score at a lower rate than the REPAIR group ( <jats:italic toggle=\"yes\">P</jats:italic> < .05). The RECON group underwent secondary arthroscopy at similar rates to the REPAIR group (13.6% vs 10.6%; <jats:italic toggle=\"yes\">P</jats:italic> > .05) and had similar rates of survivorship (90.9% vs 81.8%; <jats:italic toggle=\"yes\">P</jats:italic> > .05). Conclusion: Primary labral reconstruction demonstrated favorable outcomes at a minimum 10-year follow-up. When compared with a propensity-matched control group that underwent primary labral repair, both groups achieved similar postoperative PRO scores. Additionally, they met clinically meaningful thresholds and underwent secondary procedures at comparable rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949866","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: 10.1177/03635465251400313
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。
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