Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"Biointegrative Nail Raftering Improves Pain and Function in Patients With Subchondral Insufficiency of the Knee","authors":"Alexander C. Weissman M.S.,&nbsp;Allen A. Yazdi B.S.,&nbsp;Jared P. Sachs M.S.,&nbsp;Sarah A. Muth B.A.,&nbsp;Andrew S. Bi M.D.,&nbsp;Ron Gilat M.D.,&nbsp;Brian J. Cole M.D., M.B.A.","doi":"10.1016/j.asmr.2025.101105","DOIUrl":"10.1016/j.asmr.2025.101105","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the utility of implanting biointegrative cannulated nails in a rafter arrangement within the tibial plateau or femoral condyle for treatment of subchondral insufficiency of the knee.</div></div><div><h3>Methods</h3><div>Patients were followed for 12 months after surgical intervention for subchondral insufficiency using biointegrative, fiber-reinforced fixation nails. Patients (ages 18-75 years) had moderate knee pain for at least 6 months, unicompartmental Kellgren-Lawrence grade 2-3 and bone marrow lesions confirmed on magnetic resonance imaging (MRI). Comparison of baseline and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure. Other patient-reported outcome measures included International Knee Documentation Committee (IKDC) and Patient-reported Outcomes Measurement Information System (PROMIS). Minimal clinically important difference was calculated for each PRO. Calculated bone marrow lesion volumes measured on MRI were compared from baseline to 12 months postoperative.</div></div><div><h3>Results</h3><div>Nine patients were included, with follow-up of 12 ± 1 months. Significant improvements were seen in KOOS, IKDC, PROMIS, and Veterans RAND 12-Item Health Survey (VR-12). The average change in patient-reported outcome measures at 12 months were KOOS (19.68, <em>P</em> = .008), IKDC (28.99, <em>P</em> = .004), PROMIS Pain Interference (10.35, <em>P</em> = .008), PROMIS Physical Function (11.06, <em>P</em> = .008), and VR-12 Physical (16.14, <em>P</em> = .008). Minimal clinically important difference was achieved in 89% of patients for KOOS, 100% for IKDC, 87.5% for PROMIS Pain Interference and Physical Function, and 62.5% for VR-12 Physical. The average decrease in subchondral lesion size measured on MRI did not reach statistical significance (<em>P</em> = .064). All patients reported successful return to sport, with no reoperations or implant failures.</div></div><div><h3>Conclusions</h3><div>Biointegrative fixation nail raftering for treatment of subchondral insufficiency of the knee resulted in improved patient-reported pain and functionality at 12-month follow-up in the setting of early-to-moderate osteoarthritis.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101105"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481238","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}

{"title":"TikTok Videos Related to the Posterior Cruciate Ligament Have Low Educational Value","authors":"Riccardo D’Ambrosi M.D. ,&nbsp;Pietro Maria Marchetti M.D. ,&nbsp;Domenico Albano M.D. ,&nbsp;Chiara Ursino M.D. ,&nbsp;Matteo Formica M.D. ,&nbsp;Nicola Ursino M.D. ,&nbsp;Timothy E. Hewett Ph.D.","doi":"10.1016/j.asmr.2025.101102","DOIUrl":"10.1016/j.asmr.2025.101102","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the validity and informational value of the material about the posterior cruciate ligament (PCL) provided on TikTok.</div></div><div><h3>Methods</h3><div>The terms “posterior cruciate ligament” and “PCL” were used as keywords for an extensive search of the video content on the TikTok video platform. The video duration and the numbers of likes, shares, saves, and views were recorded for each video. The quality and reliability assessments of the video content were conducted via the DISCERN instrument, <em>Journal of the American Medical Association</em> benchmark criteria, and Global Quality Score.</div></div><div><h3>Results</h3><div>A total of 48 videos were included in the analysis, of which 18 (37.5%) were posted by physiotherapists; 14 (29.2%), by private users; and 16 (33.3%), by medical doctors/doctors of osteopathic medicine. Most of the information concerned clinical examination (12-25%) or patient experience (12-25%). Video content was focused on education in 26 videos (54.2%), patient experience in 11 (22.9%), and rehabilitation in 11 (22.9%). Most of the videos used music as the background audio (29-60.4%). The mean length of the videos was 29.29 ± 26.95 seconds. The mean number of views was 565,863.02 ± 2,686,462.45, whereas the mean numbers of likes, comments, shares, and saves were 15,533.58 ± 73,143.51, 127.85 ± 671.49, 661.38 ± 3,049.96, and 1,473.90 ± 7,523.37, respectively. The mean DISCERN score, <em>Journal of the American Medical Association</em> score, and Global Quality Score were 16.15 ± 2.53, 0.15 ± 0.36, and 1.08 ± 0.28, respectively, indicating the poorest quality for all 3 indices.</div></div><div><h3>Conclusions</h3><div>Videos about the PCL on the TikTok platform are not comprehensive and have low educational value.</div></div><div><h3>Clinical Relevance</h3><div>Given the growing number of patients using social media to seek information about their medical concerns, it is crucial for orthopaedic health care practitioners to recognize the constraints of TikTok videos that focus on the PCL as possible sources of information for their patients.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101102"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480285","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}

{"title":"Disagreement Persists on Optimal Rehabilitation Goals and Timelines for Weight-Bearing Restriction, Knee Brace Use, and Return to Sports After Posterolateral Corner Reconstruction","authors":"Ilan Y. Mitchnik M.D. ,&nbsp;Tomer Mimouni M.Sc. ,&nbsp;Loren S. Haichin M.Sc. ,&nbsp;Suzana Bayyouk B.P.T. ,&nbsp;Gilbert Moatshe M.D. ,&nbsp;Dror Lindner M.D. ,&nbsp;Jorge Chahla M.D., Ph.D. ,&nbsp;Yiftah Beer M.D. ,&nbsp;Ron Gilat M.D.","doi":"10.1016/j.asmr.2025.101142","DOIUrl":"10.1016/j.asmr.2025.101142","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the variability of rehabilitation protocols for both isolated posterolateral corner (PLC) reconstructions and those with a concomitant anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL) reconstruction, to construct uniform rehabilitative protocol recommendations, and to propose rehabilitative outcome measures for future PLC-related clinical studies.</div></div><div><h3>Methods</h3><div>A Google search was conducted for online PLC reconstruction rehabilitation protocols, categorizing them into isolated PLC reconstructions or PLC with concomitant ACL/PCL reconstructions. Rehabilitative goals and timelines were described and agreement rates among protocols were calculated. Comparisons were made between groups and before/after 2019, when a global consensus was published. Common rehabilitative goals with high agreement rates were used to form a recommended protocol.</div></div><div><h3>Results</h3><div>Thirty-seven protocols were analyzed (19 isolated PLC, 9 PLC + PCL, and 9 PLC + ACL). Overall, 31% of rehabilitative goals and timelines had good-to-excellent agreement rates. Post-2019 consensus, adherence to a stepwise rehabilitative approach significantly improved, especially for initiating strength exercises after muscular endurance exercises (<em>P</em> = .009) and initiating power exercises after strength exercises (<em>P</em> = . 031). However, there was no significant change in overall agreement rates (<em>P</em> = . 735). Most disagreements involved postoperative weight-bearing restrictions, with one half of protocols recommending non−weight-bearing and one half partial-weight-bearing; the period of time a knee brace is required after 6 weeks; and return to sports timing, which differed with concomitant ACL (later return) and PCL (earlier return) reconstructions.</div></div><div><h3>Conclusions</h3><div>There is disagreement about optimal rehabilitative goals and timelines for weight-bearing restriction, knee brace use, and return to sports after PLC reconstructions. Rehabilitative outcomes that warrant further research were identified, and a suggested rehabilitation protocol was constructed.</div></div><div><h3>Clinical Relevance</h3><div>Rehabilitation after PLC reconstruction lacks standardization, with significant variation in key milestones such as weight-bearing, knee bracing, and return-to-sport timelines. This study provides an analysis of current rehabilitation protocol inconsistencies and offers a structured recommendation that may assist clinicians and physiotherapists in patient counseling and protocol development.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101142"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480290","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}

{"title":"Combined Latissimus Dorsi/Teres Major Transfer and Superior Capsular Reconstruction Using Autogenous Biceps Tendon Effectively Relieves Pain and Improves Shoulder Function for Posterosuperior Irreparable Rotator Cuff Tears","authors":"Luis Alfredo Miranda M.D. ,&nbsp;Bo Taek Kim M.D. ,&nbsp;Paulo J. Llinás M.D. ,&nbsp;Chang Hee Baek M.D. ,&nbsp;Jean-David Werthel M.D. ,&nbsp;Jean Kany M.D.","doi":"10.1016/j.asmr.2025.101147","DOIUrl":"10.1016/j.asmr.2025.101147","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical outcomes of fully arthroscopic latissimus dorsi (LD) and teres major (TM) transfer combined with superior capsular reconstruction (SCR) using long head of biceps (LHB) tendon in patients with posterior-superior irreparable cuff tears (PSIRCTs).</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients who underwent fully arthroscopic LDTM transfer with SCR using LHB tendon for PSIRCT between January 2021 and November 2023. The inclusion criteria were failure of conservative treatments, PSIRCTs with intact LHB, no or minimal glenohumeral arthritis, and minimum of one year follow-up. Patients were excluded if loss to follow-up, or follow-up of less than 1 year. Clinical assessments included the visual analog scale for pain, Simple Shoulder Test, Subjective Shoulder Value, and American Shoulder and Elbow Surgeons scores, and range of motion (ROM). Using 0.5 standard deviation distribution-based method, the percentage of the minimal clinically important difference was evaluated.</div></div><div><h3>Results</h3><div>A total of 17 patients were included (10 male and 7 female), with a mean follow-up period of 16.3 ± 5.9 months (range, 12-27 moths). Significant improvements were observed across all outcome measures, including the visual analog scale (6.3 ± 2.0 to 2.0 ± 2.2), Simple Shoulder Test (3.3 ± 2.6 to 7.6 ± 2.9), Subjective Shoulder Value (34.1 ± 16.7 to 71.7 ± 13.8), Activities of Daily Living requiring active External Rotation (18.3 ± 8.3 to 26.2 ± 5.2), and American Shoulder and Elbow Surgeons (37.7 ± 21.8 to 77.3 ± 16.8) scores (all <em>P</em> &lt; .001). The percentage of the minimal clinically important difference achieved for each score was 94.1%, 82.3%, 100%, 76.5%, and 82.3%, Shoulder ROM improvements were as follows: forward elevation increased from 123° ± 28° to 155° ± 30°, abduction improved from 87° ± 31° to 142° ± 31°, and external rotation increased from 21° ± 20° to 40° ± 10°. At the final follow-up, no patients experienced retears of transferred tendon, infection, progression of arthritis, or axillary nerve palsy.</div></div><div><h3>Conclusions</h3><div>Fully arthroscopic LDTM with SCR using LHB tendon effectively alleviated pain and improved shoulder function in patients with PSIRCTs at short term follow-up. Significant improvements were observed in pain, patient-reported outcome measures, and ROM, with no progression of glenohumeral arthritis and no significant complications reported.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101147"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480384","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}

{"title":"Most TikTok Videos Regarding the Anterolateral Ligament of the Knee Are Posted by Patients and Have Little Educational Value","authors":"Riccardo D’Ambrosi M.D. ,&nbsp;Thais Dutra Vieira M.D. ,&nbsp;Bertrand Sonnery-Cottet M.D., Ph.D.","doi":"10.1016/j.asmr.2025.101101","DOIUrl":"10.1016/j.asmr.2025.101101","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the validity and informational value of TikTok content related to the anterolateral ligament (ALL) of the knee.</div></div><div><h3>Methods</h3><div>The terms “anterolateral ligament of the knee,” “ALL reconstruction,” “LET,” “lateral extra-articular tenodesis,” “Lemaire,” and “Segond fracture” were used as keywords for an extensive search of video content on the TikTok video platform in August 2024. The video duration and the numbers of likes, shares, saves, and views were recorded for each video. The quality and reliability assessments of the video content were conducted via the DISCERN instrument, <em>Journal of the American Medical Association</em> benchmark criteria, and Global Quality Score.</div></div><div><h3>Results</h3><div>A total of 55 videos were included in the analysis, of which 4 (7.3%) were posted by physiotherapists; 7 (12.7%), doctors of osteopathic medicine; 38 (69.1%), patients; and 6 (10.9%), medical doctors. Most of the information concerned patient experience (36%-65.5%). The mean length of the videos was 39.56 ± 49.31 seconds. The mean number of views was 16,444.44 ± 49,509.91, whereas the mean number of likes was 739.05 ± 2,558.24; comments, 9.40 ± 20.06; shares, 10.47 ± 33.59; and saves, 44.02 ± 113.35. The mean DISCERN score, <em>Journal of the American Medical Association</em> score, and Global Quality Score were 15.45 ± 1.56, 0.04 ± 0.19, and 1.07 ± 0.26, respectively, indicating the poorest quality for all 3 indices.</div></div><div><h3>Conclusions</h3><div>Most of the videos on TikTok about the ALL of the knee are posted by patients. Videos created by health professionals are significantly more valid and reliable than those created by patients, but all the videos have low educational value.</div></div><div><h3>Clinical Relevance</h3><div>In light of the increasing number of patients who use social media for medical information, it is imperative for orthopaedic health care professionals to acknowledge the limitations of TikTok videos concerning the ALL as potential informational resources for their patients.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101101"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481239","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}

{"title":"Conservative Treatment for Frozen Shoulder Is Effective Regardless of the Severity of Symptoms","authors":"Chanont Kanokvaleewong M.D. ,&nbsp;Takashi Inoue M.D. ,&nbsp;Morihito Tokai M.D. ,&nbsp;Hiroyuki Sugaya M.D.","doi":"10.1016/j.asmr.2025.101149","DOIUrl":"10.1016/j.asmr.2025.101149","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze the recovery duration of pain and functional activity after conservative treatment, including oral medication, injections, and rehabilitation, for frozen shoulder among patients based on the severity of their symptoms.</div></div><div><h3>Methods</h3><div>The study involved patients with new reports of shoulder night pain considered more severe than daytime pain and limited range of motion between January 2021 and December 2021 at the Tokyo Sports and Orthopaedic Clinic. Patients with recent shoulder treatment, a history of shoulder injury, rotator cuff tears, arthritic changes, or shoulder trauma were excluded. After dividing patients into 3 groups by severity of stiffness (group 1, severe; group 2, moderate; and group 3, mild), we recorded retrospective data on range of motion and details of conservative treatment, such as oral medication, injection frequency, and physical therapy, each time the patient visited.</div></div><div><h3>Results</h3><div>The study included 113 shoulders from 106 patients (39 men and 67 women), with a mean age of 54 years (range, 43-75 years). For night pain treatment, median recovery time was 1, 1, and 0.5 months for groups 1, 2, and 3, respectively, with no significant difference. Group 1 used oral medication and injections significantly more than groups 2 and 3 (<em>P</em> &lt; .004). No significant differences were found in the number of rehabilitation sessions among the 3 groups, which had averages of 17.5, 12, and 16 sessions in groups 1, 2, and 3, respectively. Median recovery times for range of motion were 10, 9, and 12 months in groups 1, 2, and 3, with no significant differences. Similar results were observed for oral medication duration, injection frequency, and rehabilitation sessions. Group 1 had median durations of 1 month for oral medication, 3 injections, and 17.5 rehabilitation sessions; group 2 had durations of 1 month, 2 injections, and 12 sessions; group 3 had durations of 1, 1.5, and 16 months for oral medication, injections, and rehabilitation sessions, respectively.</div></div><div><h3>Conclusions</h3><div>Conservative treatment is effective for the treatment of frozen shoulder. In this study, it improved night pain within a month and enhanced range of motion significantly within a year.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101149"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480277","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}

{"title":"Perioperative Arthroscopic Tourniquet Usage: Practices and Trends of the AANA Membership Are Varied","authors":"Brian Day M.B., M.Sc., F.R.C.P.(Lon), F.R.C.S.(Eng and C)","doi":"10.1016/j.asmr.2025.101106","DOIUrl":"10.1016/j.asmr.2025.101106","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate current practices for tourniquet use, including tourniquet times, indications, and other perioperative applications, among Arthroscopy Association of North America (AANA) members and to determine whether recommendations can be made for safer tourniquet use.</div></div><div><h3>Methods</h3><div>Participants in this study were AANA members who responded to our survey in the AANA DocMatter Community. The survey was developed based on discussion prompts in DocMatter. The survey consisted of 28 questions on 4 core themes, including demographic characteristics, general understanding of tourniquet safety, applied tourniquet use in arthroscopy, and tourniquet technology in perioperative applications. The survey was open for responses for 7 weeks from September to November 2023. Multiple-choice responses were counted, and short-form responses were reviewed and aggregated based on keywords. Qualitative analysis was used to understand the data.</div></div><div><h3>Results</h3><div>A total of 59 AANA DocMatter Community Members participated in the survey. Eighty percent of respondents had been in practice for more than 10 years, whereas 20% had been in practice for between 3 and 10 years. Tourniquet usage in arthroscopy was varied, although some patterns were detected. For example, 91% of responders applied tourniquets for all limb procedures, but many inflated them only as needed, and some preferred not to use a tourniquet. When tourniquet times were minimized by selectively inflating cuffs, tourniquet times averaged between 15 and 20 minutes compared with 20 to 60 minutes for continuous inflation. However, 76% of participants reported encountering venous congestion when a tourniquet was applied but not inflated. Perioperative tourniquet uses were also varied. Almost half of respondents used tourniquets for blood flow restriction therapy in their care protocols. In a separate possible trend, a majority of respondents were interested in using tourniquet-related technology to help resolve postsurgical lymphedema.</div></div><div><h3>Conclusions</h3><div>Despite large reported variation in the indications for tourniquet use and the control of key tourniquet parameters, use is evolving through a focus on optimizing tourniquet times through selective inflation for specific aspects of arthroscopic procedures.</div></div><div><h3>Clinical Relevance</h3><div>Standardized approaches to the safe use of tourniquets and their evolving applications are important areas of investigation.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101106"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480291","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}

{"title":"Double-Allograft Shoulder Stabilization for Multidirectional Instability Is Associated With Improved Function and Survivability After 2 Years","authors":"Felix H. Savoie III M.D. ,&nbsp;Matthew W. Cole M.D. ,&nbsp;Lacee K. Collins B.S. ,&nbsp;J. Heath Wilder M.D. ,&nbsp;Bailey J. Ross M.D. ,&nbsp;Michael J. O’Brien M.D. ,&nbsp;William F. Sherman M.D., M.B.A.","doi":"10.1016/j.asmr.2025.101120","DOIUrl":"10.1016/j.asmr.2025.101120","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe a double-allograft technique used for patients with severe, symptomatic multidirectional instability and hyperlaxity of the shoulder as well as to introduce a modification of the Beighton score that helps determine when this procedure should be utilized and report long-term outcomes of this procedure in the management of these patients.</div></div><div><h3>Methods</h3><div>A retrospective review of patients with multidirectional instability who were managed with the double-allograft technique after failure of extensive physical therapy was conducted. The final analysis included 43 patients (46 shoulders). Included patients had minimum 2 years of in-office follow-up with a Tulane modified Beighton score of 11 or greater and severe multidirectional instability/hyperlaxity of the shoulder. Preoperative and postoperative patient-reported outcome (PRO) measures were compared using 2-tailed paired <em>t</em> -tests. Subgroup analyses were performed using 2-tailed, independent <em>t</em><em>-</em>tests.</div></div><div><h3>Results</h3><div>Mean postoperative outcome scores were significantly improved compared with preoperative scores for all PRO measures evaluated from the 6-month postoperative visit on (all <em>P</em> &lt; .001). Subgroup analyses of gender, age, and patients with versus without genetically confirmed Ehlers-Danlos syndrome were equivalent with respect to postoperative improvements in PRO scores. The average Tulane modified Beighton score was 14, range 11 to 15. Among the 46 operative cases, there were a total of 7 (15.2%) complications and 5 recurrences requiring additional surgery. The 5 (10.9%) patients who underwent a subsequent revision procedure did so at a mean time of 5.36 ± 2.64 years.</div></div><div><h3>Conclusions</h3><div>The double allograft reconstruction technique appears to be a safe and effective method to restore shoulder stability in patients with severe ligamentous laxity.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101120"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480383","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}

{"title":"Preoperative Anteroposterior and Lateral Assessment of Sagittal Spinopelvic Parameters Show High Positional Correlation and Measurement Reliability Preceding Both Hip Preservation and Reconstruction Surgery","authors":"Benjamin D. Kuhns M.D., M.S. ,&nbsp;Tyler R. McCarroll M.D. ,&nbsp;Roger Quesada-Jimenez M.D. ,&nbsp;Ady H. Kahana-Rojkind M.D. ,&nbsp;Drashti Sikligar M.Eng. ,&nbsp;Meredith F. Cohen B.A. ,&nbsp;Benjamin G. Domb M.D.","doi":"10.1016/j.asmr.2025.101146","DOIUrl":"10.1016/j.asmr.2025.101146","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the reliability of sagittal radiographic variables across multiple positions and radiographic views and to correlate measures obtained on anteroposterior (AP) radiographs to lateral pelvis imaging.</div></div><div><h3>Methods</h3><div>Subjects undergoing hip surgery with complete AP and lateral pelvic imaging were included. Images were evaluated by 4 independent reviewers. Sagittal radiographic variables included the sacral slope, spinopelvic tilt (SPT), anterior pelvic plane (APP), pelvic inclination, and pelvic incidence. AP pelvic measures of sagittal pelvic position included the sacrococcygeal to pubis distance (SC distance) and the trans-teardrop to pubis ratio. Interobserver reliability for each measure was evaluated through the intraclass correlation coefficient (ICC). Bivariate linear correlations between AP and lateral standing, supine, and sitting images were obtained.</div></div><div><h3>Results</h3><div>In total, 60 subjects who underwent hip surgery with complete AP and lateral pelvic imaging were included. The sacral slope and SC distance showed excellent reliability (ICC &gt;0.90) across all positions. Additional parameters showed good reliability (ICC &gt;0.85) in standing and supine positions, with moderate-to-good reliability (ICC 0.76-0.79) for the APP, SPT, and pelvic inclination in the sitting position. Measures of pelvic tilt on AP radiographs had variable correlations to sagittal parameters, with the strongest correlation occurring between the SC distance and sacral slope in the supine and standing positions (r = 0.72 and 0.70, respectively; <em>P</em> &lt; .001 for both positions).</div></div><div><h3>Conclusions</h3><div>Spinopelvic radiographic parameters are reliable in the supine and standing positions. The APP, SPT, and pelvic inclination had lower reliability when compared with the sacral slope in the sitting position. There were significant correlations between multiple spinopelvic parameters on the AP and lateral radiographs, the strongest of which were between the SC distance and sacral slope. These findings support the routine evaluation of positional spinopelvic parameters before both hip-preservation and reconstruction surgery.</div></div><div><h3>Clinical Relevance</h3><div>Evaluation of spinopelvic parameters across multiple functional positions will increase the understanding of dynamic hip motion as it relates to the lumbar spine and pelvis.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101146"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480284","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}

{"title":"Anterior Peripheral Rim Instability Is Prevalent in Young, Skeletally Immature Patients With Discoid Lateral Meniscus and Has Favorable Postoperative Outcomes","authors":"Steven Maxwell Henick M.D.,&nbsp;Zachariah Samuel B.S.,&nbsp;Joseph Nicholas Charla B.S.,&nbsp;Emily Ferreri B.S.,&nbsp;Emmanuel Mbamalu B.S.,&nbsp;Edina Gjonbalaj B.S.,&nbsp;Leila Mehraban Alvandi Ph.D.,&nbsp;Jacob Foster Schulz M.D.,&nbsp;Eric Daniel Fornari F.A.O.A., M.D.,&nbsp;Mauricio Drummond Jr. M.D.","doi":"10.1016/j.asmr.2025.101119","DOIUrl":"10.1016/j.asmr.2025.101119","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the prevalence and patient characteristics of anterior peripheral rim instability (PRI) in patients &lt;21 years of age with symptomatic discoid lateral meniscus (DLM) requiring operative intervention and to compare preoperative magnetic resonance imaging (MRI) with arthroscopic findings and patient-reported outcomes (PROs) after arthroscopic treatment of anterior compared with nonanterior PRI.</div></div><div><h3>Methods</h3><div>A retrospective review was performed at a single academic institution between 2012 and 2022. Patients were &lt;21 years old and underwent operative DLM management with a minimum follow-up period of 2 years. Patients were divided into 2 groups: anterior PRI (isolated anterior PRI and anterior combined with posterior PRI) and nonanterior PRI (nonanterior PRI designated as isolated posterior or no PRI). Data collection included demographics, clinical presentation, MRI results, arthroscopic findings, reoperation rates, complications, and PROs.</div></div><div><h3>Results</h3><div>Forty-four patients were included, 22 in the anterior PRI group and 22 in the nonanterior PRI group. Anterior PRI prevalence was 50% in this cohort. Patients in the anterior PRI group were younger (10.77 ± 3.07 vs 13.002 ± 3.39; <em>P</em> = .028) and more likely skeletally immature (16 vs 8; <em>P</em> = .034). Extension deficit (<em>P</em> = .486) did not differ significantly between the groups. MRI was less sensitive for detecting anterior PRI compared with posterior PRI (72.2% vs 95.0%; <em>P</em> = .140). Patients with anterior PRI showed significant improvements in postoperative PROs (Pedi- International Knee Documentation Committee 54.23 vs 89.65; <em>P</em> = .0006) after 6.1 years of average follow-up, achieving good-to-excellent scores that did not significantly differ between groups.</div></div><div><h3>Conclusions</h3><div>The prevalence of anterior PRI in symptomatic DLM is 50% in our cohort and is more likely to cause symptoms in skeletally immature and younger patients. It more commonly presents with posterior PRI (59%) than as an isolated entity (41%). Arthroscopic outside-in repair yields good-to-excellent PROs and low complication and reoperation rates after mean 6.1 years of follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level III, therapeutic retrospective, cohort study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 3","pages":"Article 101119"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480288","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}