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

{"title":"Editorial Commentary: Maintaining the Ideal Balance in Complex Orthopaedic Surgical Procedures.","authors":"Alexandros Lykos, Athina Zacharoula Ditsiou, Nikolaos K Paschos","doi":"10.1002/arj.70662","DOIUrl":"https://doi.org/10.1002/arj.70662","url":null,"abstract":"<p><p>The management of patellofemoral instability can be extremely challenging and occasionally requires complex interventions that can be associated with high complication risk. Tibial tubercle osteotomy has a high complication rate and, in the attempt to decrease the risk of hardware irritation, can sometimes lead to unintended consequences, resulting in worse overall outcomes or additional complications. In orthopaedics, it is extremely common that the surgical decision is a careful balancing act between potential benefits and risks and sometimes questions even the necessity of a complex intervention.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Failure Rate of Anterior Cruciate Ligament Reconstruction Using All-Inside 4-Stranded Semitendinosus Autograft Is 20.5.","authors":"Maxime Wolf, Rabih Kortbawi, Benoit De Saint-Vincent, Mattéo Luisetto, Romain Letartre","doi":"10.1002/arj.70646","DOIUrl":"https://doi.org/10.1002/arj.70646","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate outcomes (graft failure, Patient-Reported Outcome Measures, and knee stability) after primary isolated anterior cruciate ligament (ACL) reconstruction using the all-inside technique with 4-stranded semitendinosus autograft fixed between 2 adjustable-loop cortical suspension devices, with a minimum follow-up of 10 years.</p><p><strong>Methods: </strong>Patients who underwent primary isolated ACL reconstruction using the all-inside 4-stranded semitendinosus between January 2011 and January 2013, with a minimum of 10-year follow-up, were included. Patients completed a standardized questionnaire and were offered a follow-up consultation. The questionnaire included the Tegner, ACL-Return to Sport after Injury, Subjective Knee Value, subjective International Knee Documentation Committee, and assessment of graft failure. Clinical evaluations and laxity measurements were conducted during follow-up consultations.</p><p><strong>Results: </strong>At a mean follow-up of 138 months (range: 122-159), 156 patients completed the questionnaire, and 111 were clinically evaluated. The mean age was 39.6 ± 9.7 years (range: 15-62). Graft failure occurred in 20.5% of cases (32/156). The mean decrease in Tegner was 1.03 ± 1.23 points, and 51% returned to their preinjury sport level. The median preoperative Tegner was 7.0 (interquartile range: 6.0-7.0). A higher preoperative Tegner was associated with an increased risk of graft failure (P = .016). Graft failure occurred in 23% of males and 16.6% of females (P = .461). Patients with grafts sized ≤8 mm (n = 85) had a failure rate of 17.5%, compared with 23.9% for grafts >8 mm (P = .441). The mean subjective International Knee Documentation Committee was 85.6 ± 13.5, Subjective Knee Value 79.2 ± 22.1, and ACL-Return to Sport after Injury 69.5 ± 26.5. Among patients without reported graft failure, 16.5% exhibited >3 mm differential anterior laxity, and 28% had a pivot-shift score ≥2.</p><p><strong>Conclusions: </strong>At a minimum 10-year follow-up, primary isolated ACL reconstruction using an all-inside 4-stranded semitendinosus autograft showed a 20.5% graft failure rate, despite favorable patient-reported outcomes. A higher preoperative Tegner showed a trend toward increased graft failure.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: Many Ramp Lesions Appear to Heal Prior to Anterior Cruciate Ligament Reconstruction.","authors":"George C Balazs","doi":"10.1002/arj.70690","DOIUrl":"https://doi.org/10.1002/arj.70690","url":null,"abstract":"<p><p>Medial meniscus ramp lesions disrupt meniscocapsular and/or meniscotibial interconnections, exacerbating translational and rotational instability in the anterior cruciate ligament-deficient knee. The difficulty in directly visualizing this region of the meniscus has led some to advocate for routine viewing through the intercondylar notch and probing/debridement of the posterior horn through a posteromedial portal. A growing number of studies show that far more ramp lesions are seen on preoperative magnetic resonance imaging than are found at the time of arthroscopy, and clinical studies show equivalent clinical outcomes to repair when stable tears are left unrepaired. It seems likely that many ramp lesions heal and that stability of the tear dictates the need for intercondylar notch viewing and establishment of a posteromedial portal.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: A Root Repair Is Only as Good as Its Healing: Proceed Cautiously With Early Weight-Bearing.","authors":"Aaron J Krych, Adam J Tagliero","doi":"10.1002/arj.70702","DOIUrl":"https://doi.org/10.1002/arj.70702","url":null,"abstract":"<p><p>The clinical value of medial meniscus posterior root repair depends on biologic healing sufficient to restore hoop-stress transmission. Recent systematic review studying early partial weight-bearing (≤4 weeks) was associated with incomplete or absent healing in over 30% of patients, progression of osteoarthritis in all included studies, persistent meniscal extrusion, variable patient-reported outcome improvement, and reoperation rates of up to 8.8% at short-term follow-up. These findings do not establish causation, particularly because partial weight-bearing protocols were heterogeneous, poorly quantified, and incompletely controlled. However, they raise an important clinical concern: in the absence of stronger comparative evidence, routine early partial weight-bearing after medial meniscus posterior root repair should be approached with caution.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meniscal Allograft Transplantation Fixation Technique Type Does Not Meaningfully Impact Patient-Reported Outcomes: A Systematic Review of Clinical Outcomes.","authors":"Benjamin Miltenberg, Gaston Davis, Harrison S Fellheimer, Paul Tjoumakaris, William L Johns, Cooper Roslund, Kevin B Freedman","doi":"10.1002/arj.70667","DOIUrl":"https://doi.org/10.1002/arj.70667","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the current literature and investigate whether there are any significant differences in outcome between fixation techniques for medial or lateral meniscal allograft transplantation (MAT).</p><p><strong>Methods: </strong>A systematic search was conducted of PubMed, Scopus, and Embase. Reported data on demographics, location of MAT, graft fixation techniques, meniscal extrusion, graft failure, and postoperative patient-reported outcomes (PROs) were extracted and tabulated. The results were analyzed, and subgroup analysis was performed to isolate the results of medial and lateral MAT.</p><p><strong>Results: </strong>Twenty-seven articles met inclusion criteria without meeting exclusion criteria. In total, there were 1622 individual cases of MAT with 1125 lateral MATs, 80 medial MATs, and 417 MATs where compartment was not specified. MAT was associated with improved PROs regardless of fixation technique. Few studies directly compare different fixation techniques for MAT, but, based on the available data, there is no clear advantage of any fixation technique for medial or lateral MAT with regard to PROs or graft failure. However, meniscal extrusion appears to be greater for soft-tissue only fixation.</p><p><strong>Conclusions: </strong>With regard to PROs and failure rates, there is no clear advantage of any fixation technique for medial or lateral MAT; however, high-quality comparative studies are limited. Therefore, surgeons can weigh other options such as concomitant procedures and technical familiarity when determining the fixation method for medial or lateral MAT.</p><p><strong>Level of evidence: </strong>Level III, systematic review of Level II and III studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Delivery of Particulated Juvenile Articular Cartilage Allografts Provides Durable Outcomes for Full-Thickness Chondral Lesions of the Knee.","authors":"Jason L Dragoo, Evangelia P Constantine, Kaitlyn E Whitney, Carolynn M McCartney, Jake N Dragoo, Kyle G Williams","doi":"10.1002/arj.70629","DOIUrl":"https://doi.org/10.1002/arj.70629","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate patient outcomes after arthroscopic particulated juvenile articular cartilage implantation for full-thickness cartilage lesions in the knee with a minimum 24-month follow-up.</p><p><strong>Methods: </strong>This was a retrospective case series of patients aged ≥15 years with International Cartilage Repair Society grade IV chondral lesions with exposed subchondral bone treated with primary arthroscopic particulated juvenile articular cartilage implantation between 2016 and 2023. All included patients had a minimum of 24 month follow-up. Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index subscales were compared between baseline and a minimum of 24 months postoperatively using Wilcoxon signed-rank tests. Linear mixed-effects models with random intercepts for patients were constructed a priori to evaluate longitudinal associations between outcomes and prespecified covariates (age, sex, body mass index [BMI], smoking exposure, lesion area and compartment, and common concomitant procedures).</p><p><strong>Results: </strong>Thirty-four patients (16 women, 18 men; mean age 43.5 ± 10.2 years; mean BMI 27.9 ± 5.2) with mean lesion area of 2.98 ± 1.50 cm² were included. Mean follow-up was 3.9 years (range: 2.1-9.5). All outcome subscales improved significantly from baseline to 24 months (all P < .003), with 71% to 82% of patients achieving clinically meaningful improvements (54% for Western Ontario and McMaster Universities Osteoarthritis Index Stiffness). In mixed-effects models, higher BMI was the only covariate associated with worse outcomes, with approximately 1.2-point lower Knee Injury and Osteoarthritis Outcome Score scores for each 1 increase in BMI. No acute graft displacements occurred, and 1 patient (2.9% of the cohort) experienced late graft delamination requiring revision 2.3 years postoperatively.</p><p><strong>Conclusions: </strong>Arthroscopic particulated juvenile articular cartilage transplantation provided significant 24-month improvements across all outcome domains for high-grade knee lesions. Outcomes were not associated with lesion size, location, or demographics, though higher BMI was associated with worse results. No acute graft complications occurred.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Reply to \"Regarding 'Systemic Hormonal Contraceptive Use Is Associated With Greater Odds of Rotator Cuff Tears, Shoulder Instability, Dislocation, and Other Shoulder Pathologies: A Propensity Matched Epidemiological Study'\".","authors":"Argen Omurzakov, Arsen M Omurzakov, Robert J Burkhart, Aakash K Shah, Rayyan Abid, James E Voos, Jacob G Calcei, John M Apostolakos","doi":"10.1002/arj.70683","DOIUrl":"https://doi.org/10.1002/arj.70683","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"Systemic Hormonal Contraceptive Use Is Associated With Greater Odds of Rotator Cuff Tears, Shoulder Instability, Dislocation, and Other Shoulder Pathologies: A Propensity Matched Epidemiological Study\".","authors":"Ahmet Yiğitbay","doi":"10.1002/arj.70686","DOIUrl":"https://doi.org/10.1002/arj.70686","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Commentary: Manually Contoured Femoral Head and Neck Allograft Is a Versatile and Cost-Conscious Option for Tunnel Bone Grafting During 2-Stage Revision Anterior Cruciate Ligament Reconstruction; Radiographic Tunnel Filling Remains a Surrogate Rather Than a Clinical Endpoint.","authors":"Jay Moran, Jorge Chahla","doi":"10.1002/arj.70699","DOIUrl":"https://doi.org/10.1002/arj.70699","url":null,"abstract":"<p><p>Tunnel malposition is among the most common technical causes of failure after anterior cruciate ligament reconstruction, and tunnel osteolysis can further complicate revision by limiting anatomic tunnel placement and secure graft fixation. When existing tunnels cannot be safely incorporated into a single-stage revision, first-stage tunnel bone grafting remains an important consideration. Multiple graft sources are available, including iliac crest autograft, reamer-irrigator-aspirator-harvested autograft, allograft bone dowels and chips, and synthetic substitutes; however, comparative evidence remains heterogeneous, and no option has shown clear superiority. Manually contoured femoral head and neck allograft is an appealing option because multiple structural dowels can be fashioned from a single graft and tailored to irregular or combined femoral and tibial tunnel defects. Recent computed tomography-based evidence has shown high mean filling of reamed tibial tunnels, lower filling of femoral tunnels, significantly greater tibial than femoral filling across all measurements, no perioperative or postoperative complications, and lower modeled graft-material costs than prefabricated allograft dowels. Although radiographic percent filling is a promising metric, future investigation will need to further define which tunnel defects truly require staging and correlate quantitative computed tomography findings with fixation quality, patient-reported outcomes, and subsequent graft survival.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging Findings and Demographics Predict Surgical Versus Nonoperative Management of Rotator Cuff Injuries: A Natural Language Processing Analysis.","authors":"Timothy S Keeley, Ryan T Halvorson, Kian Niknam, Katharina Ziegeler, Brian T Feeley, Thomas Link, Sharmila Majumdar, Drew A Lansdown","doi":"10.1002/arj.70612","DOIUrl":"https://doi.org/10.1002/arj.70612","url":null,"abstract":"<p><strong>Purpose: </strong>To identify pathologic and demographic predictors of treatment selection and timing in patients with rotator cuff injuries using natural language processing of magnetic resonance imaging (MRI) reports.</p><p><strong>Methods: </strong>Data were retrospectively reviewed in our institution's Information Commons database. Adult patients who underwent shoulder MRI within 30 days of rotator cuff injury diagnosis (1996-2023) were identified using International Classification of Diseases codes and categorized by treatment. A Generative Pre-Transformer-4 model analyzed MRI reports using a reference list of shoulder pathologies, with validation against a human reference for 50 reports. χ² tests evaluated differences in shoulder pathology across treatment groups. Logistic regressions identified predictors of surgery-overall, as initial treatment, and after an initial trial of conservative management-while controlling for age, sex, insurance, race, and other imaging findings.</p><p><strong>Results: </strong>A total of 3555 patients were identified, of whom 1139 underwent surgery. Natural language processing achieved 93.9% sensitivity and 99.3% specificity. Full-thickness supraspinatus tears predicted surgery overall (odds ratio [OR] 3.25; 95% confidence interval [CI], 2.54-4.17, P < .001) and after an initial trial of conservative management (OR 3.14; 95% CI, 2.23-4.41, P < .001). Full-thickness subscapularis tears also predicted surgery overall (OR 1.74; 95% CI, 1.14-2.66, P = .011). Female sex decreased the odds of surgery (OR 0.76; 95% CI 0.64-0.90, P = .001). No differences in surgical likelihood were observed by race (P = .272-.986) or between Medicare and private insurance (P = .735).</p><p><strong>Conclusions: </strong>MRI findings and demographics were associated with treatment selection and timing for patients with rotator cuff injuries. Natural language processing analysis of MRI reports enabled the identification of pathologic treatment predictors.</p><p><strong>Level of evidence: </strong>Level III, retrospective prognostic cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}