Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

Nearly two decades ago, the posterolateral corner (PLC) was commonly referred to as the "dark side" of the knee due to our limited anatomical understanding, no anatomic-based reconstruction techniques, and high rates of clinical failures. During this time, non-anatomic PLC reconstruction techniques, or "fibular slings", gained popularity early on due to ease of the procedure; however, clinical studies demonstrated residual varus gapping and external rotation laxity associated with these non-anatomic techniques that only reconstructed the fibular (lateral) collateral ligament (FCL). The term "anatomic" PLC reconstruction generally refers to a procedure that aims to restore the entirety of the 3 main PLC static stabilizers. Currently, the most commonly utilized PLC reconstruction techniques have evolved to be either a complete anatomic reconstruction with a tibiofibular-based (LaPrade and Engebretsen) approach or a partial anatomic reconstruction through a fibular-based (Levy/Marx, Arciero) technique. Both reconstruction approaches incorporate the use of a second femoral tunnel for improved restoration of the femoral attachments of the FCL and popliteus tendon (PLT) and are biomechanically superior compared to the historic non-anatomic techniques. As such, these improved PLC reconstruction techniques, whether tibiofibular-based or fibular-based, are strongly recommended over non-anatomic reconstruction techniques. Compared to the fibular-based approach, an anatomic tibiofibular-based PLC reconstruction more closely recreates the native architecture of the PLC with recreation of the PFL and use of a tibial tunnel to restore the static function of the PLT. In addition, certain conditions, such as concurrent proximal tibiofibular joint instability and asymmetric knee hyperextension are contraindications to using fibular-based reconstructions and should always utilize a tibial tunnel.

Purpose: The purpose of this study was to identify the return-to-sport (RTS) rate in athletes undergoing a Latarjet procedure, while outlining the specific reasons for failure to RTS.

Methods: An electronic literature search was conducted (PubMed/MEDLINE, Scopus, Web of Science). Studies in peer-reviewed journals with Latarjet procedures performed on athletes that reported rates and reasons for failure to RTS were included. Excluded studies were those that reported solely on non-athletes, non-Latarjet surgery, and missing rates of and reasons for failure to RTS. Study heterogeneity was assessed using the I² statistic and quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results: After review of 3617 articles, a total of 18 studies with 1,066 patients met the inclusion criteria. The level of evidence for included studies ranged from LOE II to LOE IV. Rates of not returning to sports (NRTS) ranged from 3.4-35.3%. More studies cited shoulder-unrelated reasons than shoulder-related reasons for why athletes failed to RTS. Ten (55.5%) studies, making up 656 (61.5%) patients reported that shoulder-unrelated reasons were accountable for more than 50% of NRTS. Only 3 (16.7%) studies reported 100% NRTS due to shoulder-related reasons, which include fear of reinjury and psychological factors. Study heterogeneity was found to be moderate (I² = 73.4%; 95% CI: 57.5-83.3; p < 0.001) and study quality was found to be satisfactory (Mean MINORS score 12.1 for non-comparative and 20.5 for comparative studies).

Conclusion: According to this systematic review, the rate of NRTS after Latarjet ranged from 3.4-35.3% across 18 studies, with the majority of studies citing non-shoulder related reasons such as fear or reinjury or psychological factors as the major deterrent for returning to sports.

Level of evidence: IV Systematic Review of Case Series.

With sincere appreciation to the Arthroscopy Association of North America Education Foundation for their support, we present Arthroscopy's 2025 Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, Systematic Review, and Podcast published in 2024, as well as the Most Downloaded and Most Cited papers published 5 years ago in Arthroscopy, and the Most Downloaded Arthroscopy Techniques article. In addition, as of January 1, 2025, we have updated our Editor-in-chief, Assistant Editor, and Deputy and Associate Editors disclosures of potential conflicts of interest as well as our journal masthead.

The advent of higher-quality imaging has brought increased attention to the understanding and implications of commonly observed hip morphology and pathology. Many patients and even physicians like to focus on the presence of an acetabular labral tear when one is present on magnetic resonance imaging (MRI), despite the limitations of MRI in identifying labral tears. Furthermore, recent studies have demonstrated normal variations of the acetabular labrum, as well as a high prevalence of labral tears in both symptomatic and asymptomatic individuals. For patients electing surgical treatment of a labral tear, addressing the underlying pathology is imperative. Ignoring the primary pathology (e.g. femoroacetabular impingement [FAI] or hip dysplasia) risks the formation of a new labral tear following initial surgical management. This comprehensive approach ensures that the primary cause of the labral tear is treated, thereby reducing the likelihood of recurrence and improving patient outcomes. Although the labrum is highly innervated, making labral tears a direct cause of hip pain in affected patients, we should not be setting our focus on the labral tear itself. Focusing solely on the labral pathology may set up our patients for failure by overlooking the underlying anatomical issues that precipitate these tears. Addressing the root cause, such as correcting FAI and/or hip dysplasia, is crucial for effective treatment. By correcting these anatomical factors, we can prevent future labral damage and provide more comprehensive and lasting relief for the patient. Ignoring the primary anatomical issues risks recurrent tears and ongoing pain, highlighting the need for a holistic approach to treatment.