Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

{"title":"FAILED SHOULDER INSTABILITY SURGERY: STATE OF THE ART.","authors":"Gonzalo Luengo-Alonso, Raffy Mirzayan, Joo Han Oh, Deepak Bhatia, Emilio Calvo","doi":"10.1016/j.jisako.2025.101011","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.101011","url":null,"abstract":"<p><p>Recurrent shoulder instability after failed surgical stabilization is a disabling and complex condition. Over time, clinical research has reshaped traditional approaches, emphasizing the importance of understanding patient-specific factors, accurate diagnosis, and anatomical reconstruction. A comprehensive evaluation is essential to identify failure causes, which typically include patient-related factors (such as young age, male sex, multiple dislocations, and delayed surgery), missed diagnoses (including glenoid bone loss, engaging Hill-Sachs lesions, and capsular laxity), and technical errors (such as malpositioned anchors or insufficient fixation). High-quality imaging with computed tomography (CT) and magnetic resonance imaging (MRI) arthrograms is critical for assessing glenoid and humeral bone defects, soft tissue integrity, and associated lesions. While the Latarjet procedure remains the most widely used technique for glenoid bone reconstruction, free bone grafts from the iliac crest or allografts like distal tibia are increasingly utilized. Arthroscopic revision capsulolabral repair with or without the remplissage procedure has shown promising outcomes in selected patients with subcritical bone loss and preserved soft tissue quality. However, the definition of subcritical bone loss varies widely, complicating treatment algorithms. Special populations, such as elderly patients, those with epilepsy, or high-demand athletes, pose additional challenges and require individualized strategies. Reverse shoulder arthroplasty has emerged as a salvage option in older patients with combined instability and cuff deficiency. In athletes, bone block procedures often provide more reliable outcomes than soft tissue repairs alone. Despite advances in surgical techniques, implants, and imaging, several issues remain unresolved. There is a lack of consensus on optimal treatment for subcritical bone loss, limited high-level evidence comparing techniques, and variability in outcome definitions. Future research should aim to standardize shoulder instability treatment to create a more reproducible series supported by long-term data.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101011"},"PeriodicalIF":3.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226109","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":"Immune Rejection of Orthopedic Tissue Allograft Scoping Review: Are we missing a cause of graft/procedural failure?: current concepts.","authors":"Grady H Hofmann, Reem Sarsour, Willemijn van Deursen, Amin Alayleh, Nneoma Duru, Evans Whitaker, Kevin Shea","doi":"10.1016/j.jisako.2025.101002","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.101002","url":null,"abstract":"<p><p>Allograft transplants are commonly used in orthopedics. Unlike other transplanted tissues, orthopaedic tissue allografts are not HLA-matched. The clinical impact of immune response to allografts is poorly understood. Recent experience with allograft failures and reactions to ACL, MPFL, osteochondral, and meniscus transplants raises concern. This scoping review examines the literature on immunologic rejection of orthopedic tissue allograft using PubMed, Embase, Web of Science, and Scopus for studies describing immune rejection of orthopedic tissue allografts in humans and animals. Four reviewers independently screened titles/abstracts based on these criteria. Full texts were screened independently by two reviewers for inclusion. Variables of interest included the species, graft type, and graft treatment. Our literature search yielded 1625 articles, with 78 meeting the inclusion criteria. Of these studies, 30 (38.5%) were in humans, 16 (20.5%) in rats, and 11 (14.1%) in dogs. The remaining 21 studies were in a combination of rabbit, primate, mice, sheep, and cat subjects. The orthopedic tissues in these studies included 23 osteochondral (29.5%), 16 bone (20.5%), 13 cartilage (16.7%), 6 bone-tendon-bone (7.7%), and 12 tendon/ligaments (15.4%) with 8 (10.2%) of the studies specifically in menisci. Methods used to reduce immune response include freezing, irrigation, and immunosuppressant administration. Recorded histological evidence of immune response included cell apoptosis, type II collagen increase, IL secretion, and increased lymphocytes/plasma cells in the synovial fluid. The pathways proposed were mismatched in cell surface proteins as many studies conducted MHC class I matching, which reduced the immune response. Despite histological evidence, including HLA sensitization after transplant signaling an immune response, clinical significance was not observed. Recent clinical experience of increased MRI signal response to orthopedic allografts, along with patient symptoms, has raised questions about rejection. Clinical rejection reports are limited in this review. This immune response to orthopedic allografts must be considered and additional studies are needed to explore the relationship between rejection and clinical outcomes. This scoping review informs that there is a range of human and animal studies demonstrating various immunologic response presentations and severities with different orthopedic tissue allografts.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101002"},"PeriodicalIF":3.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151163","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":"Use of Custom Three-Dimensionally Printed Models Improves Cam Resection Quality in Arthroscopic Treatment of Femoral Acetabular Impingement Syndrome.","authors":"Malik Ali, Johnny Rayes, Maude Joannette-Bourquignon, Sara Sparavalo, Jie Ma, Ivan Wong","doi":"10.1016/j.jisako.2025.101003","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.101003","url":null,"abstract":"<p><strong>Introduction: </strong>/Objectives: To investigate whether the use of a three-dimensionally (3D) printed model, compared to conventional imaging, resulted in better corrections of osseous deformities following femoral acetabular impingement syndrome (FAIS) hip arthroscopy by comparing radiographic outcomes.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent hip arthroscopy for FAIS between 2015 and 2019 was performed. Patients were sequentially allocated into the conventional or 3D model group. Radiographic plain films pre- and postoperatively assessed bony resection quality, measuring alpha angles and head neck offset (HNO) ratios using 45° Dunn, frog-leg lateral, and anteroposterior (AP) views. Good resection was defined as an alpha angle <55°, and poor resection as an alpha angle ≥55°.</p><p><strong>Results: </strong>One-hundred forty-eight patients were included (n=86 in the conventional group, n=62 in the 3D model group). Compared to conventional imaging, the 3D model group had statistically significantly lower post-operative alpha angles on 45° Dunn (p=0.002) and frog-leg lateral views (p<0.001). The change (pre- to postoperative) in alpha angle was statistically significantly larger for the 3D model group, compared to conventional imaging, in 45° Dunn (p=0.003) and frog-leg lateral views (p=0.041). Compared to the conventional imaging group, the postoperative HNO ratio was statistically significantly higher in the 3D model group on 45° Dunn (p=0.001) and frog-leg lateral views (p<0.001) and change in HNO ratio was statistically significantly larger for the 3D model group in both 45° Dunn (p=0.001) and frog-leg lateral views (p=0.026). When considering the good and poor resections separately for all three radiographic views, the 3D model group showed a statistically significantly higher number of good resections than the conventional imaging group (p<0.001).</p><p><strong>Conclusions: </strong>Arthroscopic FAIS treatment shows adequate resection using conventional surgical planning. The use of a 3D model facilitated better cam resection and permitted more patients to return to within normal radiological values as measured by alpha angle and HNO ratios.</p><p><strong>Level of evidence: </strong>III. (Retrospective Cohort).</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101003"},"PeriodicalIF":3.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151137","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":"Bony Bankart Lesions Exceeding 20% of Glenoid Width Are Common and Show Gender-Based Anatomical Differences: A Radiological study of 239 Patients.","authors":"Vladislavs Gordins, Mikael Sansone, Louise Karlsson, Nicklas Olsson, Neel Desai","doi":"10.1016/j.jisako.2025.101001","DOIUrl":"https://doi.org/10.1016/j.jisako.2025.101001","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Bony Bankart lesions are anterior glenoid rim fractures associated with anterior shoulder dislocation and can increase the risk of recurrent instability, particularly in cases of fragment resorption or malpositioned healing . Despite their clinical significance, few large-scale radiological studies have detailed the fragment characteristics, displacement patterns, and associated bipolar lesions. The objective of this study was to describe fragment morphology, displacement, and related shoulder parameters using CT imaging.</p><p><strong>Methods: </strong>This retrospective cohort study included 239 patients with isolated bony Bankart injuries identified via the Swedish Fracture Register between 2012 and 2019. All patients underwent CT imaging. Standardized linear measurement techniques were used to assess fragment size, displacement (inferior migration, diastasis, and step-off), Hill-Sachs lesion characteristics, glenoid version, and glenohumeral subluxation index.</p><p><strong>Results: </strong>The mean bony Bankart fragment size was 6.5 mm, representing 21.8% of the glenoid width. While absolute fragment size was similar between sexes, it accounted for a significantly larger portion of the glenoid surface in females (p=0.008). Fragment displacement parameters showed no sex-based differences. Hill-Sachs lesions were present in 61% of patients and were significantly larger in males (p=0.007), though relative to humeral head diameter, differences were not significant. A consistent ratio of glenoid-to-humeral head diameter (∼66-67%) was observed across sexes.</p><p><strong>Conclusion: </strong>Bony Bankart lesions frequently involve more than 20% of the anterior glenoid, particularly in female patients due to anatomical size differences. CT-based linear measurements provide valuable data for analyzing clinically significant critical bone loss in cases of bony Bankart injuries. The consistent glenoid-to-humeral head diameter ratio may aid surgical planning in shoulder reconstructive procedures.</p><p><strong>Level of evidence: </strong>Level IV, diagnostic study.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101001"},"PeriodicalIF":3.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132106","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":"Thai version of the Marx Activity Rating Scale: Cross-cultural adaptation and validation in patients with anterior cruciate ligament injury.","authors":"Pakorn Chawanpaiboon, Kongpob Reosanguanwong, Wacharapol Tepa, Suchitphon Chanchoo, Pisit Lertwanich","doi":"10.1016/j.jisako.2025.101000","DOIUrl":"10.1016/j.jisako.2025.101000","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>The Marx Activity Rating Scale (MARS) is a validated patient-reported outcome measure quantifying high-demand knee activity frequency in anterior cruciate ligament (ACL)-injured populations. The instrument consists of 4 domains: running, cutting, decelerating, and pivoting. This prospective validation study aimed to translate and cross-culturally adapt the MARS into Thai and evaluate its psychometric properties among ACL-injured patients.</p><p><strong>Methods: </strong>Cross-cultural adaptation followed Beaton's established guidelines, including translation, synthesis, backward translation, expert committee review, and pretesting. Validation of the Thai version of the MARS used dual recall timeframes: MARS with a 1-year recall period (MARS_yr) and MARS with a 1-month recall period (MARS_mo). A total of 110 ACL-injured patients, aged 18-50 years with pre-injury Tegner Activity Scale (TAS) scores ≥4, completed questionnaires at the baseline and 2-week follow-up. Psychometric evaluation encompassed construct validity, internal consistency, test-retest reliability, measurement error, and floor/ceiling effects.</p><p><strong>Results: </strong>Cross-cultural adaptation of the Thai version of the MARS was successfully completed. Construct validity of the instrument was demonstrated by correlations between the MARS and the TAS with corresponding timeframes (Spearman's correlation coefficient of 0.51-0.61). Internal consistency was excellent with Cronbach's α coefficients of 0.87 (MARS_yr) and 0.93 (MARS_mo). Test-retest reliability showed excellent intraclass correlation coefficients of 0.93 (MARS_yr) and 0.94 (MARS_mo). Notable floor effects (33.6% for MARS_mo) and ceiling effects (26.4% for MARS_yr) were observed.</p><p><strong>Conclusion: </strong>The MARS was successfully cross-culturally adapted into the Thai version. It exhibits acceptable psychometric properties for quantifying physical activity in ACL-injured populations. Floor/ceiling effects necessitate complementary outcome measures for comprehensive functional assessment.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":" ","pages":"101000"},"PeriodicalIF":3.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087630","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":"Deep lateral femoral notch sign is associated with superficial medial collateral ligament tear in patients with anterior cruciate ligament injury","authors":"Jumpei Inoue MD ,&nbsp;Koji Nukuto MD, PhD ,&nbsp;Yunseo L. Park BS ,&nbsp;Kohei Kamada MD, PhD ,&nbsp;Karina Dias MD ,&nbsp;Ting Cong MD ,&nbsp;Volker Musahl MD","doi":"10.1016/j.jisako.2025.100999","DOIUrl":"10.1016/j.jisako.2025.100999","url":null,"abstract":"<div><h3>Objectives</h3><div>The deep lateral femoral notch sign, observed in some anterior cruciate ligament (ACL) injuries, may result from valgus-compressive forces and anterior tibial translation. Since combined ACL and medial collateral ligament (MCL) injuries often involve high valgus torque, we hypothesized an association between MCL tears and the presence of a deep lateral femoral notch sign.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of skeletally mature patients (≥14 years) who underwent primary ACL reconstruction (ACLR) and had preoperative MRIs within 3 weeks of injury. Patients were grouped by the presence of a deep lateral femoral notch sign (≥2 ​mm depth). Superficial and deep MCL tears were graded via MRI. Demographics and meniscus surgery data were collected. Univariable and multivariable analyses were used to identify factors associated with the deep lateral femoral notch sign (P ​&lt; ​.050).</div></div><div><h3>Results</h3><div>Among 590 included patients, 104 (17.6%) had a deep lateral femoral notch sign. Intra- and inter-observer reliability for notch depth and MCL grading showed near-perfect agreement (κ ​&gt; ​0.8). Multivariable analysis identified superficial MCL tear, younger age, and medial posterior tibial bone bruise as independent predictors of a deep lateral femoral notch sign (P ​&lt; ​.001 for all). When stratifying superficial MCL tears, 12.6% of grade 0/I cases and 34.6% of grade II/III cases had deep lateral femoral notch signs. The sign showed 34.6% sensitivity, 87.4% specificity, and an odds ratio of 3.68 (95% CI, 2.35–5.77) for predicting grade II/III superficial MCL tears.</div></div><div><h3>Conclusion</h3><div>In acute ACL injuries, the deep lateral femoral notch sign is associated with grade II/III superficial MCL tears, showing high specificity and a 3.7-fold increased risk. Its presence should prompt careful assessment of MCL-related instability to optimize patient outcomes.</div></div><div><h3>Level of evidence</h3><div>Level IV, retrospective cohort study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 100999"},"PeriodicalIF":3.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034393","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":"Surgical reconstruction techniques for irreparable subscapularis tears provide functional improvement but variable failure rates: A systematic review","authors":"Marc Daniel Bouchard MD ,&nbsp;Justin Gilbert MD ,&nbsp;Omar Haque MD ,&nbsp;Colin Kruse MD, MSc ,&nbsp;Bianca Giovanna Vescio MB BCh BAO ,&nbsp;Darshil Shah MBBS ,&nbsp;Moin Khan MD, MSc, FRCSC ,&nbsp;Bashar Alolabi MD, MSc, FRCSC","doi":"10.1016/j.jisako.2025.100998","DOIUrl":"10.1016/j.jisako.2025.100998","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>Irreparable subscapularis tears can cause severe functional impairment and present significant clinical challenges. Current treatment options include tendon transfers (TTs), anterior capsular reconstruction, and reverse shoulder arthroplasty. Each approach has distinct biomechanical advantages and limitations, but there remains no consensus regarding the optimal treatment. This systematic review aimed to evaluate and compare clinical outcomes, failure rates, and complication profiles of surgical reconstruction techniques for irreparable subscapularis tears.</div></div><div><h3>Methods</h3><div>This systematic review followed PRISMA guidelines. A comprehensive search was conducted in Embase, OVID Medline, and Emcare databases. Eligible studies included adults with irreparable subscapularis tears treated with surgical reconstruction (e.g., tendon transfers, graft augmentation, or anterior capsular reconstruction) and reporting clinical outcomes. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) score. A narrative synthesis was performed with descriptive statistics (frequencies, percentages, or weighted means with variability).</div></div><div><h3>Results</h3><div>Fourteen studies comprising 351 patients (355 shoulders) were included, with a mean age of 58.1 years (SD 9.5) and mean follow-up of 44.7 months (SD 54.4). Studied procedures included latissimus dorsi (LD) TT (6 studies, n ​= ​164), pectoralis major (PM) TT (5 studies, n ​= ​94), pectoralis minor (Pm) TT (1 study, n ​= ​74), and anterior capsular reconstruction (ACR; 2 studies, n ​= ​25). PM TT had the highest failure rate (13.0 ​%), followed by ACR (12.0 ​%), LD transfer (11.0 ​%), and Pm TT (1.4 ​%). Postoperative complications were most frequent after PM TT (12.8 ​%), while LD TT had a complication rate of 9.8 ​%. Patient-reported outcome measures improved across all groups, with the greatest Constant-Murley Score (CMS) improvement following LD TT (+33.0), the greatest Subjective Shoulder Value (SSV) improvement after PM TT (+38.6), and the largest Visual Analogue Scale (VAS) pain reduction following ACR (−5.0) and Pm transfer (−5.1).</div></div><div><h3>Conclusions</h3><div>Surgical reconstruction techniques for irreparable subscapularis tears provide improvements in pain and function, though failure and complication rates vary by procedure and appear worse with concomitant rotator cuff pathology. Further high-quality comparative studies are needed to refine patient selection and optimize surgical decision-making.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"14 ","pages":"Article 100998"},"PeriodicalIF":3.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016347","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":"How much improvement in patient reported outcomes after isolated medial patellofemoral ligament reconstruction is associated with surgeon-defined satisfactory outcomes? A JUPITER study","authors":"Saral Patel MD ,&nbsp;Matthew W. Veerkamp BA ,&nbsp;Eric J. Wall MD ,&nbsp;Philip L. Wilson MD ,&nbsp;Daniel W. Green MD, MS, FAAP, FACS ,&nbsp;Benton E. Heyworth MD ,&nbsp;Natalie K. Pahapill BS ,&nbsp;Beth E. Shubin Stein MD ,&nbsp;Shital N. Parikh MD, FACS","doi":"10.1016/j.jisako.2025.100997","DOIUrl":"10.1016/j.jisako.2025.100997","url":null,"abstract":"<div><h3>Introduction</h3><div>The extent of change in Patient Reported Outcome Measures (PROMs) required to meet surgeon-defined satisfactory outcomes after isolated medial patellofemoral ligament reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROMs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PROM in predicting these outcomes and to evaluate the factors associated with it.</div></div><div><h3>Methods</h3><div>This is a retrospective review of prospectively collected data as part of the JUPITER multi-center study. Receiver operating characteristic curves were calculated to determine threshold values for MOI for 4 commonly used PROMs - Banff Patella Instability Instrument (BPII 2.0), Pediatric International Knee Documentation Committee (Pedi-IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala score - associated with surgeon-defined satisfactory outcomes. Multivariate analyses were performed to determine preoperative, intraoperative, and radiographic factors associated with satisfactory outcomes.</div></div><div><h3>Results</h3><div>284 patients were included in the analysis. 183 (66.9 ​%) patients achieved surgeon-defined satisfactory outcomes. For MOI, achieving an improvement in BPII 2.0 score greater than 65.86 ​% (Area under the curve (AUC): 0.75; CI: 068–0.80; p ​&lt; ​0.0001) and in the Kujala score greater than 85.18 ​% (AUC: 0.69; CI: 0.62–0.75; p ​&lt; ​0.0001) was associated with a satisfactory outcome. BPII 2.0 had the highest AUC while Kujala had the least AUC (p ​= ​0.04). Multiple logistic regression analysis showed that first-time dislocation or having 10 or more dislocations prior to surgery significantly decreased the odds of achieving satisfactory postoperative outcomes (OR 0.12, p ​= ​0.002). None of the radiographic parameters were associated with outcomes.</div></div><div><h3>Conclusion</h3><div>MOI serves as an important measure to gauge clinical success after isolated MPFL-R. The study sets MOI thresholds for four commonly used PROMs, thus correlating patient- and surgeon-defined satisfactory outcomes after isolated MPFL-R. BPII 2.0 had good discriminative ability while Kujala had the least. The study identifies that isolated MPFL-R after first-time dislocation or after 10 or more dislocations are associated with decreased odds of satisfactory outcomes.</div></div><div><h3>Level of evidence</h3><div>Level 4 retrospective review of prospectively collected data.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"15 ","pages":"Article 100997"},"PeriodicalIF":3.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008479","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":"Single stage anatomic posterolateral corner reconstruction with modified LaPrade technique, combined with arthroscopic posterior cruciate ligament reconstruction with tibia nail in situ—A current technique","authors":"N. Nizaj DNB(Ortho), MRCS (Glasgow) ,&nbsp;Jimmy Joseph Meleppuram MS (Ortho), FAASM ,&nbsp;Hamdi Nizar Ahamed MS (Ortho), FAASM ,&nbsp;T. Ajayakumar D'Ortho, MS (Ortho) ,&nbsp;Ayyappan V. Nair D'Ortho, DNB(Ortho) ,&nbsp;Azad Sait D'Ortho, MS (Ortho) ,&nbsp;Prince Shanavas Khan D'Ortho, MS (Ortho)","doi":"10.1016/j.jisako.2025.100996","DOIUrl":"10.1016/j.jisako.2025.100996","url":null,"abstract":"<div><div>The posterolateral corner (PLC) of the knee is a key anatomical structure which provides varus and rotational stability to the knee joint. Injuries to the PLC pose a great challenge for orthopedic surgeons due to their complex nature. PLC injuries rarely occur in isolation, with up to 95% being associated with ligament tears. Surgical reconstruction is indicated in Grade III injuries, defined clinically as &gt;10 ​mm lateral opening on varus stress and &gt;10° external rotation on the dial test, supported by MRI magnetic resonance imaging findings.</div><div>Several techniques have been described for PLC reconstruction; however, the classic anatomic reconstruction described by LaPrade remains the gold standard, traditionally performed using an Achilles tendon allograft. In this video technique, we describe a modified LaPrade technique using peroneus longus and hamstring tendon autografts for PLC and posterior cruciate ligament (PCL) reconstruction, respectively, in a patient having tibia nail in situ for Type IIIb open fracture shaft of tibia. The peroneus longus tendon is fashioned into a Y-shaped construct and must be at least 250 ​mm long to perform this technique. The graft passage and fixation sequence are the reverse of the LaPrade technique. This method ensures anatomic fixation, independent tensioning, and secure fixation of each segment, thereby restoring the normal biomechanics of the knee.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"14 ","pages":"Article 100996"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972656","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":"Complex knee injuries from bouldering: A case series","authors":"Jhulia Kawachi Cruz,&nbsp;Khim Yew Chew,&nbsp;Mok Ying Ren,&nbsp;Yee Han Dave Lee","doi":"10.1016/j.jisako.2025.100995","DOIUrl":"10.1016/j.jisako.2025.100995","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>Bouldering, a dynamic climbing discipline performed without ropes, is associated with high-energy ground falls. While most existing climbing injury literature has focused on the upper extremities, our data indicated an increasing number of complex knee injuries related to bouldering. This review was conducted to characterize the injury patterns sustained from ground falls during bouldering, and to compare the relative burden of these injuries with those sustained in other high-participation sports.</div></div><div><h3>Methods</h3><div>A retrospective case series was performed, including climbers who presented with knee injuries from ground falls during bouldering between March 2022 and October 2024. Patient demographics, injury mechanisms, ligamentous and meniscal pathology, as well as osseous or chondral damage were collected. The injuries were stratified by sex, age group, and injury complexity, including multiligament injury, meniscus tears, and osseous or chondral involvement. The bouldering-related injuries were then compared to institutional data from soccer and basketball, the two most common causes of sports-related knee injuries requiring surgery at the institution’s sports center.</div></div><div><h3>Results</h3><div>Nineteen patients were included, with a mean age of 27 ​± ​5.1 years. Of these, 15 (78.9 ​%) sustained combined anterior cruciate ligament and meniscus injuries. Surgical intervention was performed in 18 (94.7 ​%) patients. Multiligament knee injuries occurred in 4 (21.2 ​%) bouldering cases, accounting for 20 ​% of all multiligament knee injuries treated during the study period. Meniscus root tears were identified in 4 (21.1 ​%) bouldering cases, representing 22 ​% of all surgically treated meniscus root tears. Bone contusions consistent with pivot-shift patterns were observed in 52.6 ​% of patients, with cartilage fissuring and sulcus terminalis impaction in 10.5 ​% each. Compared to soccer and basketball, bouldering demonstrated a relatively higher proportion of complex knee injuries, despite lower participation volumes.</div></div><div><h3>Conclusion</h3><div>Ground falls during bouldering ground falls have been associated with a high proportion of complex knee injuries, including multiligament knee injuries, meniscus root tears, and injuries to both menisci. These injury patterns are believed to result from high-energy axial and rotational loading, and suggest the need for increased awareness, preventive strategies, and rehabilitation programs tailored to the sport.</div></div><div><h3>Level of evidence</h3><div>Level 4, Case series.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"14 ","pages":"Article 100995"},"PeriodicalIF":3.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972679","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}