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

{"title":"Posterior tibial slope measurement with the axis estimate method is not inferior to the established proximal anatomic axis method and both differ from cortical-based measurements.","authors":"Michael B DiCosmo, Alyssa M DiCosmo, Michael J DeSarno, Matthew G Geeslin, Andrew G Geeslin","doi":"10.1016/j.arthro.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.036","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether simpler alternative methods, using a tangential line along the (1) posterior tibial cortex (Posterior cortical reference, PCR), (2) anterior tibial cortex (Anterior cortical reference, ACR), (3) axis estimate (AE) can yield PTS measurements comparable in reliability and reproducibility to the proximal anatomic axis (PAA) method.</p><p><strong>Methods: </strong>Retrospective review of patients aged 18-40 with lateral knee radiographs and MRI within 30 days for pain and suspected internal derangement (January 2018 to January 2022), lateral radiograph with ≥ 10 cm of tibia distal to the joint line, and an MRI demonstrating no cruciate ligament tear (NT), ACL tear (ACLT) or PCL tear (PCLT). Each measurement was performed by two independent raters. Inter-method, inter- and intra-rater reliability were assessed using intraclass correlation (ICC).</p><p><strong>Results: </strong>155 patients met study criteria: 73 NT, 70 ACLT, and 12 PCLT. Compared to the PAA, the AE showed no difference (10.3°, p = 0.09), while the ACR (11.7°, p < 0.0001) and PCR (7.5°, p < 0.0001) differed significantly from the PAA. All methods had moderate reliability (ICCs 0.5-0.74). Intermethod ICC was excellent for the AE and PAA (ICC = 0.87), lowest for the PAA and PCR (ICC = 0.47).</p><p><strong>Conclusion: </strong>The reliability of the AE method was not significantly different from the established standard PAA method, and may serve as a suitable substitute in the clinical setting. The ACR and PCR methods were significantly different from the PAA. While the PAA and PCR method had similar inter-rater reliability it may underestimate the PTS and therefore may not be interchangeable with the PAA method.</p><p><strong>Clinical relevance: </strong>The PAA requires several steps to measure the PTS which can be time-consuming and prone to variability. A simpler and equally reliable method like the AE may increase utilization and maintain performance.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602326","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":"Epinephrine Solution in arthroscopic irrigation fluid is Marginally Superior to IV Tranexamic Acid, but should we focus instead on using Ringer's Lactate Instead of Normal Saline for Arthroscopic Clarity?","authors":"Mark G Siegel","doi":"10.1016/j.arthro.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.035","url":null,"abstract":"<p><p>Utilizing a double blinded randomized technique, a matched cohort of shoulder arthroscopic surgeries is compared and evaluated for visual clarity of the surgical field. Epinephrine in a 0.9% saline irrigation solution is marginally superior to an intravenous infusion of tranexamic acid. It is unknown whether 0.9% saline is inferior to a solution of Ringer's lactate irrigation when evaluating loss of clarity due to intraoperative arthroscopic bleeding.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568147","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":"Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy For Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review.","authors":"Benjamin D Kuhns, Nils Becker, Dharma Patel, Paras P Shah, Benjamin G Domb","doi":"10.1016/j.arthro.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.030","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review is to report preoperative and intraoperative variables as well as patient-reported outcome measures (PROMs) of patients receiving either isolated periacetabular osteotomy (PAO) or combined hip arthroscopy with PAO (PAOHS) for the surgical management of acetabular dysplasia.</p><p><strong>Methods: </strong>A review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was conducted to identify studies published between January 2014 and March 2025 that reported PROMs for combined arthroscopic hip surgery with PAO (PAOHS) or isolated PAO. Patient demographics, radiographic variables, surgical data, as well as postoperative PROMs and complications were recorded. Forest plots were used to identify heterogeneity using the I² statistic.</p><p><strong>Results: </strong>29 studies (10 PAOHS; 19 PAO) with 3,809 patients were included in the review. Rates of intra-articular pathology for the PAOHS studies ranged from 68%-100%. Level of evidence ranged from I-IV. The most common PROMs used by both the PAO and PAOHS studies were the modified Harris Hip Score (mHHS: 53% vs. 70%) and the International Hip Outcome Tool-12 (iHOT-12; 26% vs. 40%), while other outcome scores were utilized more infrequently between the two groups. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the mHHS (I²=0.95) and iHOT-12 (I²=0.97). Five studies in the PAOHS group reported clinically relevant outcomes including the Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) with MCID rates ranging 75.9-93.3% and PASS rates ranging from 56.4%-91%. No studies in the isolated PAO group reported on the MCID or PASS.</p><p><strong>Conclusion: </strong>While there was sustained PROM improvement for both the PAO and PAOHS, there was significant heterogeneity and little comparability between the two groups of studies limiting potential conclusions regarding the efficacy of intra-articular intervention despite high levels of intra-articular pathology identified in the PAOHS studies.</p><p><strong>Level of evidence: </strong>Systematic review of Level I to IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568150","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":"Patient-Specific Cutting Guides Provide Consistent Planned Correction and Preserved Joint Line Obliquity for Double-Level Knee Osteotomy.","authors":"Xinlong Ma, Zhihu Zhao, Haohao Bai, Songqing Ye, Bin Zhao, Wei Luo","doi":"10.1016/j.arthro.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.032","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate clinical outcomes, accuracy of patient-specific cutting guides (PSCGs) in double-level knee osteotomy (DLO) patients over a minimum 24-month follow-up.</p><p><strong>Methods: </strong>This single-center retrospective case series included consecutive patients who underwent DLO using PSCGs from December 2016 to May 2022. Inclusion criteria comprised symptomatic knee osteoarthritis with varus/valgus malalignment, planned double-level correction, and a minimum follow-up of 24 months. Primary outcomes were functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores) and complications; secondary outcomes included alignment accuracy (hip-knee-ankle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), joint line obliquity (JLO), joint line convergence angle (JLCA)) and patient satisfaction. The WOMAC scores and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis. Statistical analysis used the Mann-Whitney U test for alignment accuracy and paired t-tests for functional outcomes.</p><p><strong>Results: </strong>Among 31 patients (35 knees), the mean follow-up was 36.2 months (range, 24 to 91 months). Patients' average age was 59.3 ± 5.14 years with a BMI of 22.1 ± 1.8 kg/m². HKA improved from 163.9° to 181.1°, MPTA from 83.9° to 91.5°, LDFA from 94.7° to 85.7° and JLCA from 5.6° to 2.4° (all preoperative to postoperative P<0.05). Postoperative values showed no significant difference versus planned values (all P>0.05). Preoperative JLO (4.71°±2.12°) significantly improved to 2.31°±2.02° postoperatively (P=0.019), with no significant difference from the target (2.10°±1.53°, P=0.526). WOMAC total scores decreased from 41.6 to 22.4 (P < 0.001), with 100% achieving the minimal clinically important difference (MCID). Patient acceptable symptom state (PASS) rates varied: WOMAC pain (85.3%), stiffness (67.6%), physical function (94.1%), and total (79.4%). Complications included 2 femoral and 1 tibial hinge fractures, plus 6 venous thromboses (all resolved with rivaroxaban). Patient satisfaction was high (26/31 highly satisfied).</p><p><strong>Conclusion: </strong>DLO with PSCGs achieved consistent alignment with preoperative plans, preserved physiological joint line orientation, and sustained functional improvements over 36.2 months. All patients met MCID for WOMAC total scores, with 79.4% attaining PASS.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568148","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":"Platelet-Rich Plasma and Its Analogues Does Not Clinically Improve Functional Outcomes One Year After ACL Reconstruction: A Meta-Analysis of Randomized Controlled Trials.","authors":"Paulo Vitor Pereira Pinho, Maria L R Defante, Gustavo Miranda Oliveira, Joaquim Fernandes Fagundes Júnior","doi":"10.1016/j.arthro.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.031","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate with a meta-analysis of randomized controlled trials (RCT) of at least 12 months the current controversy if platelet-rich plasma (PRP) improves postoperative functional outcomes in anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Methods: </strong>The MEDLINE, EMBASE and COCHRANE databases were evaluated for studies involving the use of PRP or its analogues in ACLR. Only RCTs with a follow-up of 12 months or more and that presented only PRP as an intervention were selected. Statistical analysis was performed using R software (Version 4.4.1) and heterogeneity was assessed using I².</p><p><strong>Results: </strong>We included 502 patients from 9 studies submitted to ACLR, with 251 treated with PRP. The mean age varied from 27.7 to 34.5 years, and the studies reported the participation of 109 females The use of PRP in ACL reconstruction resulted in a statistically significant improvement in the International Knee Documentation Committee (IKDC) score after 12 months (MD = 2.05; 95% CI = 0.25 - 3.85; p = 0.03; I² = 27%). However, based on the Minimal Clinically Important Difference (MCID), there was no statistical significance. No statistically significant difference was found for the Tegner and Lysholm score at 12 months.</p><p><strong>Conclusion: </strong>This meta-analysis evaluated the effects of PRP and its analogues in ACLR . Functional outcomes were compared after 12 months in both PRP enhanced group and inactive control. While the IKDC score demonstrated a statistically significant improvement (p < 0.05), the Lysholm and Tegner scores did not show significant differences. The statistical difference, however, did not translate into clinically significant differences based on the MCID. These findings suggest that although some functional benefits may be observed within the first year post-surgery, overall recovery remains variable.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568149","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: Are we checking our bias in patients with fibromyalgia that need hip arthroscopy?","authors":"Sailesh V Tummala, Kostas J Economopolous","doi":"10.1016/j.arthro.2025.06.034","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.034","url":null,"abstract":"<p><p>Like all diagnoses and co-morbidities, patients with hip pain should be managed with individualized treatment plans. Patients with fibromyalgia undergoing hip arthroscopy are no different. Even if their absolute scores remain lower than those without fibromyalgia, these patients can achieve clinically meaningful improvements in patient-reported outcomes after treatment of femoroacetabular impingement. As orthopedic providers we should be aware of potential bias against patients with chronic musculoskeletal pain and critically evaluate the literature that supports clinically relevant improvement after surgical intervention. Fibromyalgia should not be viewed as a condition that excludes or increases the threshold for hip arthroscopy, but rather as a factor requiring nuanced, multidisciplinary perioperative care and realistic goal-setting.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568105","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":"Combined Hip Arthroscopy and PAO Performed Under the Same Anesthesia Event Results in Significant Improvement in Outcomes at Short-and-Medium-Term Follow-Up with Low Rates of Complications and Conversion to Total Hip Arthroplasty.","authors":"Spencer M Comfort, Nicholas A Felan, Mitchell S Mologne, Marc J Philippon, Marc J Philippon, Joseph J Ruzbarsky","doi":"10.1016/j.arthro.2025.06.027","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.027","url":null,"abstract":"<p><strong>Purpose: </strong>To summarize and evaluate the surgical technique, patient reported outcomes (PROs) and complications of combined periacetabular osteotomy (PAO) and hip arthroscopy for the treatment of hip dysplasia and intra- and extra-articular hip pathology, respectively.</p><p><strong>Methods: </strong>Clinical studies evaluating outcomes of simultaneous combined hip arthroscopy and PAO procedures performed under the same anesthesia event were identified in PubMed, Embase, The Cochrane Library per the PRISMA guidelines up to October 10, 2024. PROs, complications, intraoperative procedures, radiographic parameters, and demographic factors were assessed. Study quality and bias were assessed using the Modified Coleman Score and Methodological index for non-randomized studies (MINORS). Studies assessing hip arthroscopy and PAO not performed under the same anesthesia event were excluded.</p><p><strong>Results: </strong>Twelve studies with 730 hips (612 female and 118 male) were included with average follow-up time ranging from 1.7 to 12.8 years. Eleven studies reported PROs and all studies that compared postoperative and baseline outcomes reported a statistically significant improvement in modified Harris Hip Score (mHHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), Hip Outcome Score - Sport (HOS-Sport), and Visual Analog Scale - Pain (VAS-Pain) postoperatively compared to baseline. mHHS, VAS-Pain, and NAHS ranged from 55-72 preoperatively to 82-90 postoperatively, 5.1-6 preoperatively to 1.9-3 postoperatively, and 57-61 preoperatively to 80-90 postoperatively, respectively. MCID was reported in 4 studies and PASS in 2 studies. Thirty-three hips (4.5%) experienced complications, and 8 hips (1%) converted to total hip arthroplasty. The median MCMS and MINSORS were 59 (Range: 43 - 65), and the median MINORS score was 12 (Range: 11-14) for non-comparative studies and 20.5 (Range: 19-22) for comparative studies.</p><p><strong>Conclusion: </strong>Combined hip arthroscopy and PAO results in statistically significant improvement in PROs, low complication rates, and low conversion to arthroplasty at short to medium-term follow-up.</p><p><strong>Level of evidence: </strong>IV (Range: III to IV); Systematic Review.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565531","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":"International Delphi Consensus on Medial Meniscal Root Tears Shows High Agreement on Diagnosis, Treatment, and Rehabilitation, but Lack of Agreement on Treatment of Asymptomatic Tears.","authors":"Jorge Chahla, Jose Rafael Garcia, Luke Tollefson, Lika Dzidzishvili, Felicitas Allende, Cameron Gerhold, Aaron J Krych, Robert F LaPrade","doi":"10.1016/j.arthro.2025.06.028","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.028","url":null,"abstract":"<p><strong>Purpose: </strong>To develop an expert consensus statement on the diagnosis, management, and rehabilitation of MMRTs using a modified Delphi technique.</p><p><strong>Methods: </strong>A working group developed statements on MMRT diagnosis, nonoperative management, surgical indications, surgical management, alignment, and rehabilitation using modified Delphi techniques. Fifty-six experts were surveyed over three rounds to reach consensus, with agreement measured on a 5-point Likert scale. Statements were included, revised, or excluded based on predefined thresholds (≥75% agreement, <20% disagreement). Experts suggested revisions or new statements in the first two rounds, and final consensus statements were included.</p><p><strong>Results: </strong>All 56 experts completed three survey rounds. Experts agreed that root tears may occur with no known history of trauma, typically in older patients, and that it should be diagnosed with an MRI. In symptomatic patients with MMRTs without advanced osteoarthritis should be repaired using an anatomic transtibial pull-out technique (performing a pie crusting technique can be helpful for visualization). Nonoperative management is advised for patients with advanced osteoarthritis. High tibial osteotomy may be considered for significant varus malalignment during MMRT repair. The only statement without consensus was the management of asymptomatic MMRTs with mild medial compartment cartilage wear, indicating ongoing debate.</p><p><strong>Conclusion: </strong>Overall, 98% of statements reached consensus. There is agreement that MRI is the gold standard for diagnosis. Symptomatic MMRTs without advanced osteoarthritis should be repaired early using an anatomic transtibial pull-out technique. End-stage knee osteoarthritis warrants nonoperative management of MMRTs, and a structured postoperative protocol with limited weightbearing and range of motion is essential after repair. No agreement was reached on managing asymptomatic MMRTs in patients without significant medial compartment degeneration. Meniscal centralization sutures may help in cases of substantial extrusion, but their routine use is debated.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565532","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: Transtibial Centralization Is Biomechanically Better Than Knotless Anchor Centralization When Repairing a Medial Meniscal Posterior Root Tear-But Only Just.","authors":"Chris Servant","doi":"10.1016/j.arthro.2025.06.025","DOIUrl":"10.1016/j.arthro.2025.06.025","url":null,"abstract":"<p><p>Medial meniscal posterior root tears are associated with medial meniscal extrusion, a decrease in tibiofemoral contact area, an increase in contact pressures, an acceleration of cartilage degeneration, and a high rate of progression to total knee arthroplasty. Although a medial meniscal posterior root repair may help slow the degenerative process, meniscal extrusion can persist after a repair. Strategies to reduce residual meniscal extrusion include ensuring that the repair is anatomical, using suture tape to minimize suture cut-out, performing an adequate capsular release, and restricting weight-bearing for 4 to 6 weeks postoperatively. The addition of a centralization suture also may help reduce meniscal extrusion by anchoring the meniscal body to the rim of the tibial plateau prior to root fixation. This can be achieved by inserting a further transtibial suture or suture anchors, with the transtibial tunnel or suture anchors located just central to the rim at the apex of the posteromedial aspect of the medial tibial plateau.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562079","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":"Interference screw and suture anchor fixation for lateral extra-articular tenodesis yield no significant differences in load to failure, while staple fixation lags behind: A Cadaveric Biomechanical Study.","authors":"Ron Gilat, Zeeshan A Khan, Juan Bernardo Villareal-Espinosa, Andrew S Bi, Harkirat S Jawanda, Garrett R Jackson, Safa Gursoy, Enzo S Mameri, Elizabeth F Shewman, Daniel J Kaplan, Pablo E Gelber, Jorge Chahla","doi":"10.1016/j.arthro.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.029","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the biomechanical properties and failure mechanisms of lateral extra-articular tenodesis (LET) performed using onlay staple, inlay interference screw, and onlay all-suture anchor fixation techniques.</p><p><strong>Methods: </strong>Twenty-four non-matched pairs of human cadaveric knees were randomized to receive either a cortical staple (n=8), interference screw (n=8), or all-suture anchor (n=8). A modified Lemaire LET technique was performed for all knees using their respective fixation technique. Biomechanical testing was performed using a tensile-testing apparatus (MTS Systems). All knees were subjected to an axially directed pre-load cycle and subsequently assessed for cyclic and load-to-failure outcomes. Results were analyzed via analysis of variance (ANOVA), Kruskal-Wallis, and post-hoc Tukey´s tests.</p><p><strong>Results: </strong>Three staple-fixated LETs failed during the cyclic loading and were excluded from analysis. Average elongation after cyclic loading was 2.89 millimeters (mm) (staple), 2.06 mm (screw), and 3.51 mm (anchor) (p = 0.134). Average maximum load to failure was 174.1 N (staple), 250.8 N (screw), and 199.2 N (anchor) with a significant between-group difference on ANOVA testing (p = 0.023). Post-hoc analysis revealed staple fixation had a significantly lower maximum load than interference screw fixation (p=0.026). Displacement at maximum load was significantly higher in the anchor group (22.2 mm) compared to the staple (11.3 mm) (p=0.05).</p><p><strong>Conclusion: </strong>While staple fixation resulted in early failure (174 N), both interference screw and anchor fixations (250 N and 199 N, respectively) are viable options for LET, with suture anchors offering less rigidity under high loads when compared with either fixation strategy. However, no differences were observed in elongation during cyclic loading.</p><p><strong>Clinical relevance: </strong>Emerging literature has revealed a 70% tunnel convergence rate when utilizing an interference screw for femoral fixation of a LET. The results of the present time-zero cadaveric study explores the role of surface-based fixation methods, given that it may mitigate convergence risk.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562080","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}