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

{"title":"Editorial Commentary: Focus on Magnetic Resonance Imaging-Defined Tear Location of Acute Posterior Cruciate Ligament Injuries-Certain Clinical Predictors and Tear Site Are Associated.","authors":"Matthias Brockmeyer","doi":"10.1002/arj.70701","DOIUrl":"https://doi.org/10.1002/arj.70701","url":null,"abstract":"<p><p>The treatment strategy for posterior cruciate ligament (PCL) tears, particularly in multiligament knee injuries, is demanding. In this context, the specific tear location is crucial to guide treatment decision-making. Recent literature introduces a magnetic resonance imaging-based tear location classification system for PCL injuries, aiming to enhance consistent diagnostic accuracy and achieve more tailored, evidence-based treatment approaches. Additionally, there is an analysis of the epidemiology of PCL tear locations and determination of clinicodemographic and injury-related predictors confirming the predominance of midsubstance tears and anterior tibial bone bruising as the most common pattern. Independent predictors of proximal PCL tears were multiligament injury, hyperextension-type bone bruise pattern, medial meniscus tear, and younger age. Midsubstance tears showed inverse associations, whereas no predictors were found for distal tears.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290081","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 Coffee's Worth of Time: Artificial Intelligence May Accelerate, Not Replace, Preoperative Planning for High Tibial Osteotomy.","authors":"Marco-Christopher Rupp, Julius Watrinet, Sebastian Siebenlist","doi":"10.1002/arj.70689","DOIUrl":"https://doi.org/10.1002/arj.70689","url":null,"abstract":"<p><p>Artificial intelligence is advancing quickly in orthopaedic imaging, yet remarkably, few tools have entered daily surgical practice. The most convincing near-term use cases for orthopaedic surgeons are tasks that are repetitive, time-consuming, and prone to error; automated landmark detection with subsequent coronal-plane planning for high tibial osteotomy fits that description. Deep learning can localize the anatomical landmarks required for lower-limb alignment analysis and compute a correction angle in seconds, with reproducibility that approaches experienced readers, standardizing measurement and, at scale, letting surgeons iterate across large radiographic datasets and simulate osteotomies for research and training. Two limitations deserve equal attention. One is inherent to planning itself: a coronal, angle-based model cannot represent the 3-dimensional consequences of a posterosuperiorly ascending osteotomy on the axial or sagittal plane nor the intra-articular and ligamentous contributions to deformity. The other is specific to the tool: a system trained on selected, high-quality radiographs should be able to recognize when it should not analyze an image, for example, under insufficient radiographic quality because of malrotation or with retained hardware. Systems may still have a way to go prior to routine use; the distance from a promising prototype to a dependable instrument runs through increasing robustness in clinical reality, independent validation, and an awareness of what 2-dimensional planning cannot capture. Ultimately, the greatest potential will lie in translation from plan to execution, which is where artificial intelligence working with 3-dimensional data may lift osteotomy care to the next level. Until then, the efficiency gains reported in the present study may accelerate planning for high tibial osteotomy by roughly the time it takes to drink a coffee.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289913","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":"Anteromedial Gap Opening and Osteotomy Sufficiency Are Associated With Multiplanar Correction Errors in Open-Wedge High Tibial Osteotomy: A Computed Tomography-Based Study.","authors":"Yugo Morita, Shinichi Kuriyama, Yusuke Yamawaki, Kohei Nishitani, Shinichiro Nakamura, Hiromu Ito, Shuichi Matsuda","doi":"10.1002/arj.70697","DOIUrl":"https://doi.org/10.1002/arj.70697","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate 3-dimensional correction errors in the coronal, sagittal, and axial planes using computed tomography and identify surgical and anatomical factors associated with multiplanar correction errors after open-wedge high tibial osteotomy.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent biplanar open-wedge high tibial osteotomy between September 2014 and October 2022. The opening-angle error, posterior tibial slope (PTS) change, and axial rotation were measured using preoperative and 1- to 2-week postoperative computed tomography images; hinge angle and osteotomy sufficiency were evaluated. Analysis involved mixed-effects models adjusted for age, sex, and body mass index.</p><p><strong>Results: </strong>Of 110 included knees (94 patients), the mean opening-angle error, PTS increase, and internal rotation were -0.1°, 2.6°, and 2.7°, respectively. Planned opening angle was associated with coronal undercorrection (β = 0.230, P = .001) and internal rotation (β = 0.321, P = .001); hinge angle with coronal undercorrection (β = 0.023, P = .039) and PTS increase (β = 0.045, P = .044); and osteotomy sufficiency was associated with a smaller PTS increase (β = -0.039, P = .005) but greater internal rotation (β = 0.046, P < .001). Sex-stratified analyses identified factors associated with correction errors: planned opening angle in both sexes; hinge angle, biplanar and sagittal osteotomy angles, and osteotomy sufficiency in women; and entry height and osteotomy sufficiency in men. Each degree of internal rotation was associated with a 1.6-point lower 1-year Lysholm score (β = -1.572, P = .018). Lateral hinge fractures occurred in 23.6% of knees. Type I fractures exhibited greater internal rotation, and type III fractures showed greater PTS increases and reduced postoperative flexion.</p><p><strong>Conclusions: </strong>Anteromedial gap opening was associated with coronal undercorrection and increased PTS during open-wedge high tibial osteotomy. Greater osteotomy sufficiency was associated with a reduced PTS increase but greater distal tibial internal rotation. Greater internal rotation was associated with lower 1-year Lysholm scores.</p><p><strong>Level of evidence: </strong>Level III, retrospective case-control study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149289916","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: Arthroscopic Bony Bankart Fixation Stands the Test of Time-Preserve Native Glenoid Anatomy When You Can!","authors":"Allison M Morgan, Peter J Millett","doi":"10.1002/arj.70731","DOIUrl":"https://doi.org/10.1002/arj.70731","url":null,"abstract":"<p><p>Bony Bankart lesions provide an opportunity to restore native glenoid anatomy through direct fragment fixation. Arthroscopic bony Bankart repair can provide long-term shoulder stability, high patient satisfaction, and sustained participation in sport. Although we prefer double-row bridge fixation for its broad compression across the fracture bed, rotational control, and biomechanically stronger fixation, a properly indicated and well-executed single-row repair can achieve excellent results. Latarjet and other glenoid bone-augmentation procedures remain important options for patients with attritional or irreparable bone loss and high-risk bipolar lesions. However, increasing enthusiasm for these procedures should not displace anatomic repair when a viable bony Bankart fragment can be mobilized, anatomically reduced, and securely fixed. When native glenoid anatomy can be reliably restored, arthroscopic bony Bankart fixation is an effective and durable treatment.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290000","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: Successful Adolescent Medial Patellofemoral Ligament Reconstruction Depends on More Than Graft Choice.","authors":"Jonathan C Spaan, Felipe Casanova, Jorge Chahla","doi":"10.1002/arj.70700","DOIUrl":"https://doi.org/10.1002/arj.70700","url":null,"abstract":"<p><p>Medial patellofemoral ligament reconstruction is an effective treatment for recurrent patellar instability in adolescent patients; however, the optimal graft choice remains debated. Current evidence shows favorable patient-reported outcomes and overlapping ranges of reported failure rates with both autograft and allograft reconstruction. Although autograft may offer theoretical biologic advantages and potentially lower complication rates, substantial heterogeneity among existing studies and a paucity of direct comparative investigations preclude conclusions regarding graft superiority. Importantly, successful treatment of patellar instability depends on more than graft selection. Recognition and correction of underlying pathoanatomy, appropriate surgical indications, and technical execution are critical to optimizing outcomes. In our practice, semitendinosus allograft is favored because it avoids donor-site morbidity while providing reliable graft characteristics; however, graft choice remains secondary to appropriate patient selection, anatomic assessment, and correction of the pathoanatomic factors responsible for recurrent instability. Ultimately, successful treatment of adolescent patellar instability depends less on choosing between an autograft and an allograft than on performing the right reconstruction for the right patient.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290104","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":"Femoral Head Osteochondral Lesions Predict Lower Survivorship but Not Inferior Patient-Reported Outcomes After Hip Arthroscopy at a Minimum 10-Year Follow-Up.","authors":"Itay Perets, Roger Quesada-Jimenez, Shahar R Barda, Wonjin Ko, Andrés Maldonado-Rosales, Benjamin G Domb","doi":"10.1002/arj.70627","DOIUrl":"https://doi.org/10.1002/arj.70627","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the long-term outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome and labral tears who were found to have femoral head (FH) cartilage lesions and to compare these results to a matched control group of patients without FH cartilage damage.</p><p><strong>Methods: </strong>Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and labral tears between February 2008 and April 2014. Patients were included if they had completed preoperative questionnaires, with follow-up defined as having minimum 10-year postoperative patient-reported outcomes or a documented endpoint. Patients with Tönnis grade >1 were excluded. Patients with FH osteochondral lesions (Outerbridge grade ≥2) were propensity matched 1:1 to controls without FH damage based on age, sex, body mass index, lateral center-edge angle, labral treatment, capsular management, acetabular Outerbridge, and follow-up time. Clinically relevant thresholds, survivorship, and predictors of conversion to arthroplasty were included in the analysis.</p><p><strong>Results: </strong>A total of 188 patients (94 per group) were included. The FH group showed comparable improvements in all evaluated patient-reported outcomes compared with the control group at the latest follow-up (P < .01), with both groups achieving the minimal clinically important thresholds at similar rates. The FH lesion group had a significantly higher rate of conversion to total hip arthroplasty (23.4% vs 11.7%, P = .03). Multivariable Cox proportional hazards regression identified increasing FH damage severity as an independent predictor of conversion (hazard ratio 3.9, 95% confidence interval 1.73-9.13, P = .001).</p><p><strong>Conclusions: </strong>Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome and labral tears with concomitant FH osteochondral lesions showed significant functional improvements comparable to those of a matched control group at long-term follow-up. However, their higher conversion rate to arthroplasty supported by regression analysis highlights FH damage as a key determinant of long-term survivorship after hip arthroscopy.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290064","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: High Failure Rate of All-Inside Hamstring Anterior Cruciate Ligament Reconstruction at Long-Term Follow-Up: It's the Graft Not the Construct, but the Future Keeps Complicating the Past.","authors":"Collin Laporte, Brian B Gilmer","doi":"10.1002/arj.70715","DOIUrl":"https://doi.org/10.1002/arj.70715","url":null,"abstract":"<p><p>Recent reports of high failure rates after all-inside hamstring autograft anterior cruciate ligament reconstruction have renewed an old debate: is the problem the graft, the construct, or both? Interpretation is difficult because hamstring anterior cruciate ligament reconstruction has evolved alongside changes in graft configuration, socket drilling, and adjustable-loop cortical fixation. Potential contributors include graft elongation, unequal strand loading, adjustable-loop lengthening, and the longer working length of cortical fixation. Yet higher revision rates with hamstring autografts were identified before widespread adoption of the modern all-inside technique, suggesting that fixation alone does not explain the signal. Meanwhile, all-inside techniques have increasingly been paired with quadriceps tendon autograft without the same apparent failure concern. The literature remains messy, but the simplest explanation may still be the correct one: hamstring autograft itself appears less forgiving in higher-risk patients. For those patients, quadriceps or patellar tendon autograft remains the more reliable choice.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290110","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: Concomitant Anterior Closing Wedge High Tibial Osteotomy Should Be Considered to Protect the Graft After Primary Anterior Cruciate Ligament Reconstruction for Patients With a Posterior Tibial Slope More Than 12° and Anterior Tibial Translation More Than 5 mm.","authors":"Nam-Hong Choi","doi":"10.1002/arj.70722","DOIUrl":"https://doi.org/10.1002/arj.70722","url":null,"abstract":"<p><p>A posterior tibial slope ≥12° at the time of primary anterior cruciate ligament reconstruction is a challenging situation, especially when combined with a static anterior tibial translation >5 mm. Either the use of a bone-patellar tendon-bone graft or the addition of a lateral extra-articular tenodesis at the time of primary anterior cruciate ligament reconstruction may provide insufficient protection for the graft in patients with an increased posterior tibial slope. Anterior closing wedge high tibial osteotomy may be considered to protect the graft after primary anterior cruciate ligament reconstruction for patients with a posterior tibial slope ≥12°. However, further evidence is required to determine whether concomitant anterior closing wedge high tibial osteotomy significantly reduces the graft failure rate.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149290075","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: 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}