British medical bulletin最新文献

{"title":"Current concepts and management of insertional Achilles tendinopathy and calcific insertional Achilles tendinopathy.","authors":"Nicola Maffulli, Ciaran Padhiar, Nat Padhiar, Otto Chan, Francesco Oliva, Filippo Spiezia","doi":"10.1093/bmb/ldag031","DOIUrl":"10.1093/bmb/ldag031","url":null,"abstract":"<p><strong>Background: </strong>Insertional Achilles tendinopathy (IAT) accounts for ~20%-25% of all Achilles tendinopathy presentations. Diagnosis is primarily clinical, supported by weight-bearing radiographs, ultrasound, and magnetic resonance image. At the molecular level, activation of the mammalian target of rapamycin (mTOR) pathway, reactive oxygen species (ROS), nuclear factor kappa B (NF-κB)-mediated inflammation, and aberrant tenocyte differentiation drives entheseal degeneration, and, in calcific insertional Achilles tendinopathy (CIAT), dystrophic calcification. Genetic susceptibility modulates individual risk.</p><p><strong>Sources of data: </strong>A narrative literature review was conducted, searching PubMed, Embase, and the Cochrane Library for studies addressing the epidemiology, clinical presentation, imaging, pathophysiology, genetics, and treatment of IAT and CIAT, prioritizing randomized controlled trials, systematic reviews, and meta-analyses, to March 2026.</p><p><strong>Areas of agreement: </strong>Insertional and calcific Achilles tendinopathy markedly impair athletic performance and quality of life. Modified eccentric loading and extracorporeal shock wave therapy have better evidence-based outcomes. There is genetic susceptibility.</p><p><strong>Areas of controversy: </strong>Management of IAT and CIAT requires a structured, staged approach. There is a lack of high-level evidence base for operative management.</p><p><strong>Growing points: </strong>mTOR pathway activation drives chondral metaplasia and dystrophic calcification in CIAT; oxidative stress Nicotinamide adenine dinucleotide phosphateoxidase/mitochondrial reactive oxygen species (ROS) and NF-κB signalling are parallel, interacting mechanisms that are targetable pharmacologically. The modified Zadek calcaneal osteotomy is effective for appropriately selected CIAT patients, even without excision of intratendinous calcific deposits.</p><p><strong>Areas timely for developing research: </strong>High-quality comparative trials across all treatment domains are a priority. Tissue engineering strategies for enthesis regeneration represent a promising direction for the future.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"159 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back squat and deadlift fatiguing protocols elicit distinct countermovement jump profiles: phase-specific predictors and soreness responses.","authors":"Marco Gervasi, Eugenio Formiglio, Johnny Padulo, Giacomo Belmonte, Antonino Patti, Eneko Fernández-Peña","doi":"10.1093/bmb/ldag013","DOIUrl":"10.1093/bmb/ldag013","url":null,"abstract":"<p><strong>Introduction or background: </strong>Residual fatigue following resistance exercise can impair neuromuscular performance. The back squat (BSQ) and deadlift (DL) are key lower-limb exercises but may differ in their fatigue and recovery profiles. Identifying phase-specific markers during the countermovement jump (CMJ) may improve monitoring and guide recovery strategies.</p><p><strong>Sources of data: </strong>Fifty-four resistance-trained adults (≥1 year experience) were randomly assigned to BSQ, DL, or control (CON) groups. After one-repetition maximum (1RM) estimation, BSQ and DL completed a fatiguing protocol (3 × 12 repetitions at 70% 1RM). CMJ performance was assessed at baseline, immediately, 30 min, and 24 h post-exercise using a force platform. Phase-specific force-time variables and the modified reactive strength index (RSImod) were calculated; muscle soreness was recorded at 24 and 48 h.</p><p><strong>Areas of agreement: </strong>Both BSQ and DL caused significant decrements in CMJ-derived metrics, as indicated by a linear mixed-effects model, and greater soreness than control, according to a two-way mixed analysis of variance (ANOVA). BSQ produced larger and earlier impairments across force, displacement, and work variables, whereas DL showed smaller but more persistent reductions in braking rate of force development (RFD) and RSImod.</p><p><strong>Areas of controversy: </strong>Despite similar soreness, recovery patterns differed, indicating distinct neuromuscular demands and time courses between exercises.</p><p><strong>Growing points: </strong>Phase-specific CMJ metrics particularly braking and unloading RFD, eccentric/concentric work, and RSImod are sensitive indicators of residual fatigue.</p><p><strong>Areas timely for developing research: </strong>Future studies should integrate electromyographic and biochemical markers and extend observation beyond 48 h to describe full recovery trajectories.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"158 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle herniae in exercise-induced leg pain: diagnostic pitfalls and the 'repair paradox'.","authors":"Corrado Antonetti, Nat Padhiar, Otto Chan, Nicola Maffulli","doi":"10.1093/bmb/ldag015","DOIUrl":"10.1093/bmb/ldag015","url":null,"abstract":"<p><strong>Background: </strong>Muscle herniae are an uncommon distinct clinical entity within the broad spectrum of exercise-induced leg pain (EILP). Given the symptomatic overlap with other prevalent conditions and physicians' lack of familiarity, muscle herniae are frequently misdiagnosed, leading to ineffective therapeutic strategies.</p><p><strong>Sources of data: </strong>We conducted a comprehensive review of the literature to analyze the pathophysiological mechanisms, diagnostic pitfalls, and therapeutic paradigms associated with muscle herniation in athletes.</p><p><strong>Areas of agreement: </strong>Standard static magnetic resonance imaging yields a high rate of false negatives. Dynamic ultrasonography is the diagnostic gold standard, allowing for real-time visualization of the fascial defect under load.</p><p><strong>Areas of controversy: </strong>A 'surgical paradox' exists regarding surgical management: direct repair (closure) of the fascial defect increases intracompartmental pressure and risks to precipitate acute compartment syndrome, whereas surgeons historically debated the morbidity of open decompression.</p><p><strong>Growing points: </strong>Decompression fasciotomy, especially minimally invasive fasciotomy, have emerged as the safest and most effective solution for symptomatic patients, prioritizing functional decompression over anatomical restoration.</p><p><strong>Areas timely for developing research: </strong>Current guidelines rely predominantly on Level IV-V evidence. Future prospective comparative studies are needed to further standardize surgical indications and long-term outcomes.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"158 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaffolds and platelet concentrates in bone regenerative medicine: applications, mechanisms, and future approaches.","authors":"Ahmad Oryan, Seyed Ali Afzali, Amin Bigham-Sadegh, Nicola Maffulli, Hassan Sharifiyazdi","doi":"10.1093/bmb/ldag014","DOIUrl":"10.1093/bmb/ldag014","url":null,"abstract":"<p><strong>Introduction: </strong>Scaffolds are being increasingly employed to enhance tissue regeneration, after the development of scaffold fabrication methods and utilization of different biomaterials in the manufacturing process. Blood derivatives are used to enhance tissue regeneration. We summarize recent advances in the field of biomaterials, fabrication methods of scaffolds, and platelet concentrates (PCs) as a source of regenerative blood compounds. We also evaluate the separate and combined use of biomaterials and PCs, and address the challenges of their future use.</p><p><strong>Source of data: </strong>PubMed, Scopus, and Google Scholar.</p><p><strong>Areas of agreement: </strong>The role of scaffolds and their development to enhance bone regeneration is well researched. Also, the cellular and macromolecular contents of PCs promote bone regenerative processes.</p><p><strong>Areas of controversy: </strong>Lack of a universal preparation protocol for the production of first-generation PCs, contradictory results of animal studies for the second generation of PCs, and conflicting results of the effectiveness of some types of the third PCs generation on tissue regeneration.</p><p><strong>Growing points: </strong>More advanced techniques of scaffold fabrication, exploration of scaffold biomaterials to increase therapeutic characterization and to minimize unwanted effects, development of new PCs should promote bone regeneration in vivo and in vitro. The effects of combined use of scaffolds and PCs on bone regeneration should be investigated.</p><p><strong>Areas timely for developing research: </strong>Advanced generations of scaffold biomaterials and PCs are important to stimulate bone regeneration and minimize unwanted negative effects. Further research is needed in the production of scaffold biomaterials and PCs development, as well as their combined use.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"158 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human health in relation to visible, functional, and accessible green space: a systematic review and narrative synthesis of the 3 + 30 + 300 guideline.","authors":"Melissa K Lee, Hendrik Willems, Valerie Dewaelheyns, Eva Beele, Eline Rega, Raf Aerts, Ben Somers","doi":"10.1093/bmb/ldag016","DOIUrl":"10.1093/bmb/ldag016","url":null,"abstract":"<p><strong>Background: </strong>Residential greenness has been associated with health, but exposure to visible, functional, and accessible green may be associated with different health outcomes.</p><p><strong>Sources of data: </strong>We searched Web of Science, PubMed, Scopus, and Embase for quantitative studies evaluating health in relation to specific green space exposures.</p><p><strong>Areas of agreement: </strong>There is evidence for associations between visible, functional, and accessible green space exposures and health, but most evidence is derived from observational studies.</p><p><strong>Areas of controversy: </strong>High heterogeneity was found across studies with the possibility of publication bias. Some studies suggest stronger associations in low socioeconomic status and urban neighborhoods, but the evidence is inconclusive.</p><p><strong>Growing points: </strong>Quantitative and clinical evidence for health impacts of interventions focusing on improving visible, functional, and accessible green space exposure is limited and therefore causal relationships can usually not be inferred.</p><p><strong>Areas timely for developing research: </strong>Further research should include randomized controlled trials and consider different green space types, private green, spatial configuration, street network distances, and quality and use.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"158 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing bone healing through osteogenic medium components: biological roles, mechanisms, and clinical applications.","authors":"Amir Mohammad Jannesar, Amin Bigham-Sadegh, Ahmad Oryan, Nicola Maffulli","doi":"10.1093/bmb/ldag012","DOIUrl":"10.1093/bmb/ldag012","url":null,"abstract":"<p><strong>Introduction: </strong>Bone healing is a multifaceted, true regenerative process that involves a dynamic interplay of molecular signals, cellular responses, and extracellular matrix remodeling. This review explores the critical roles of osteogenic culture medium components-including glutamine, β-glycerophosphate, L-ascorbic acid, pyruvate, and dexamethasone-to enhance osteogenesis. These components contribute to cell metabolism, differentiation, mineralization, and modulation of inflammation, making them essential for both in vitro bone tissue engineering and in vivo regeneration.</p><p><strong>Source of data: </strong>PubMed, Scopus, and Google Scholar.</p><p><strong>Areas of agreement: </strong>Recent studies have highlighted the superior osteoinductive potential of osteogenic medium over individual growth factors and its capability to stimulate endogenous repair when applied directly to fracture sites. Furthermore, we examine the molecular basis of bone healing and the translational significance of localized osteogenic medium delivery in critical-size bone defects. The synergistic interaction of these medium constituents not only facilitates stem cell differentiation and bone matrix formation but also promotes angiogenesis, mechanotransduction, and tissue remodeling.</p><p><strong>Areas of controversy: </strong>While several studies have investigated the effects of osteogenic medium on bone healing, no conclusive or consistently reported controversial outcomes have been documented to date.</p><p><strong>Growing points: </strong>This integrative review underscores the therapeutic potential of osteogenic medium in regenerative medicine and encourages further investigation into its clinical application as a cost-effective, targeted alternative to conventional treatments.</p><p><strong>Areas timely for developing research: </strong>Continued research into optimized delivery systems and scaffold combinations may pave the way for more effective and novel therapies in complex skeletal injuries and orthopedic surgery.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"158 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Walking on the Achilles tendons.","authors":"Nicola Maffulli, Filippo Spiezia, Filippo Migliorini, Gayle Maffulli, Francesco Oliva","doi":"10.1093/bmb/ldag009","DOIUrl":"10.1093/bmb/ldag009","url":null,"abstract":"<p><strong>Background: </strong>The 'walking Achilles tendon' technique can be safely adopted when the initial percutaneous repair fails to achieve sufficient grip in the proximal stump of the ruptured tendon. In such instances, two additional stab wounds are produced proximal to the initial most proximal ones to increase the tendon area available for suture grip.</p><p><strong>Sources of data: </strong>A total of 36 patients had who sustained Achilles tendon rupture were included in the present study, divided in two groups: 'the walking on the Achilles tendon group' and 'traditional repair' group.</p><p><strong>Areas of agreement: </strong>There was no difference in the mean Achilles Tendon Resting Angle (ATRA), Achilles Tendon Total Rupture Score (ATRS), calf circumference, isometric strength, time to return to sport, European Foot and Ankle Society Score (EFAS Score), and Patient-Reported Outcome Measures (PROMs) Piedade, between the patient group who underwent 'the walking on tendon technique' and the traditional suture.</p><p><strong>Areas of controversy: </strong>Percutaneous management Achilles tendon rupture remains challenging with mixed results reported in the literature.</p><p><strong>Growing points: </strong>The results of the present investigation show that these additional steps, resulting in a total of nine stab wounds, add some time to the actual procedure, but produce comparable results to the seven stab wounds technique.</p><p><strong>Areas timely for developing research: </strong>The 'walking on the Achilles tendon' technique allows to easily and effectively overcome the poor hold in the proximal stump of the torn Achilles tendon which surgeon may occasionally encounter and continue to perform minimally invasive percutaneous Achilles tendon repair without the need to shift to open procedures.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"157 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tissue engineering & nanocarriers: a game-changer in healing cartilage lesions.","authors":"Erwin Pavel Lamparelli, Giovanna Della Porta, Nicola Maffulli","doi":"10.1093/bmb/ldag001","DOIUrl":"10.1093/bmb/ldag001","url":null,"abstract":"<p><strong>Background: </strong>Despite significant advances in tissue engineering and regenerative medicine, articular cartilage repair remains a major clinical challenge. Conventional pharmacological and surgical interventions are largely ineffective in promoting durable tissue regeneration or halting progressive cartilage degradation.</p><p><strong>Sources of data: </strong>This review integrates evidence from recent peer-reviewed literature focusing on nanotechnology-based drug delivery, stem cell-based therapy, and biomimetic scaffold design for cartilage tissue engineering.</p><p><strong>Areas of agreement: </strong>There is a broad consensus that current standard treatments fail to restore native cartilage structure and function. The literature supports the view that integrating nanomedicine with tissue engineering strategies can enhance chondrogenic outcomes. In particular, nanocarriers enable targeted and controlled delivery of bioactive molecules, while synthetic extracellular matrix-mimicking scaffolds provide essential structural and biochemical cues for chondrogenesis.</p><p><strong>Areas of controversy: </strong>Key unresolved issues include identifying the optimal stem cell source, the long-term safety and biodegradability of nanomaterials, and the scalability of engineered constructs for clinical use. The immunogenicity of advanced biomaterials and the regulatory challenges associated with their clinical translation remain subjects of debate.</p><p><strong>Growing points: </strong>Recent studies demonstrate the feasibility of integrating nanocarriers within three-dimensional biomimetic scaffolds to better replicate the native cartilage microenvironment. Advances in biofabrication techniques and in situ delivery systems are enabling the development of more physiologically relevant and functional cartilage models.</p><p><strong>Areas timely for developing research: </strong>Future research should prioritize in vivo validation of bio-activated scaffolds, comprehensive assessment of long-term functional outcomes, and strategies to facilitate clinical translation of combined nanocarrier-scaffold platforms. Further investigation into both patient-specific and off-the-shelf regenerative approaches is essential to overcome current translational barriers.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"157 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based clinical practice guidelines on the surgical management of acute Achilles tendon rupture.","authors":"Shi-Ming Feng, Nicola Maffulli, Francesco Oliva, Christian Paul, Kai Fehske, Christian Plaass, Thomas Karius, Amol Saxena, Samuel Ka-Kin Ling, Ying-Hui Hua, Mingzhu Zhang, Kai-Hei Leung, Lu Bai, Shun-Hong Gao, Qi Li, Yue-Feng Hao, Zhi-Hong Xu, Ni-Rong Bao, Hong-Mou Zhao, Bo Jiang, Hong-Jun Liu, Jia-Ju Zhao, Yu Cheng, Ke Ren, Chuan Jiang, Huan Li, Hua Xu, Xiao-Fei Li, Gang Liu, Huang-He Song, Chen Zhao, Ya-Xin Han, Chong Xue, Zi-He Zhang, Wei Jiao, Jian-Hua Wu, You Yu, Run-Lai Song, YanJiang Feng, Liu Ouyang, Jun-Bo Pan, Fei Liu, Si-Yuan Guo, De-Sheng Chen, Xue-Ping Gu, Chao Ma","doi":"10.1093/bmb/ldaf026","DOIUrl":"10.1093/bmb/ldaf026","url":null,"abstract":"<p><strong>Background: </strong>Surgical intervention remains a cornerstone to restore function after acute Achilles tendon rupture (AATR), but evidence-based guidelines for surgical management are limited.</p><p><strong>Sources of data: </strong>A steering committee of 40 orthopedic surgeons identified nine key clinical questions on the surgical management of AATR. A systematic search of PubMed, MEDLINE, Web of Science, Cochrane Library, and EMBASE was conducted for studies published since 1980.</p><p><strong>Areas of agreement: </strong>Surgical management represents a reliable option to manage patients who suffered AATR. A well-designed operative strategy is essential to facilitate early recovery and achieve optimal functional outcomes.</p><p><strong>Areas of controversy: </strong>The surgical management of AATR remains challenging, particularly with respect to defining surgical indications, determining the optimal timing of intervention, selecting the most appropriate patient positioning, choosing between open and minimally invasive techniques, deciding on the role of primary augmentation, and establishing evidence-based postoperative rehabilitation protocols.</p><p><strong>Growing points: </strong>In the absence of established guidelines for the surgical management of AATR, this evidence-based clinical practice guideline provides nine key recommendations designed to address current controversies in the field.</p><p><strong>Areas timely for developing research: </strong>Further studies are warranted to evaluate emerging strategies such as nutraceuticals, biomaterials, cellular therapies, bioprinting, gene therapy, and anti-inflammatory agents, as no single approach has yet been validated as the optimal method to accelerate or enhance recovery following AATR.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"157 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-inside arthroscopic capsular plication shows favorable outcomes in patients with chronic lateral ankle instability and irreparable anterior talofibular ligament.","authors":"Shi-Ming Feng, Zi-He Zhang, Nicola Maffulli, Francesco Oliva, Chong Xue, Chao Ma","doi":"10.1093/bmb/ldaf012","DOIUrl":"10.1093/bmb/ldaf012","url":null,"abstract":"<p><strong>Background: </strong>In chronic lateral ankle instability (CLAI) and irreparable anterior talofibular ligament (ATFL), reconstruction procedures are commonly advocated. All-inside arthroscopic capsular plication may be a viable alternative for CLAI in patients with an unrepairable ATFL.</p><p><strong>Source of data: </strong>A retrospective study was conducted between 2016 and 2021 on 92 consecutive CLAI patients with arthroscopically confirmed unrepairable ATFL who underwent all-inside arthroscopic surgery. Patients were divided into two groups: in the reconstruction group (n = 40), an autologous gracilis tendon was used to reconstruct the lateral ligament complex; in the plication group (n = 52), the lateral ankle capsule was plicated using a double-loaded suture anchor.</p><p><strong>Areas of agreement: </strong>Restoring lateral ankle stability is the optimal goal in the management of CLAI.</p><p><strong>Areas of controversy: </strong>The reliability of all-inside arthroscopic capsular plication for CLAI with an irreparable ATFL compared with reconstruction procedures remains uncertain.</p><p><strong>Growing points: </strong>Over 2 years of follow-up, the plication group achieved superior American Orthopedic Foot and Ankle Society scores at 3 months and 1 year, and higher Karlsson Ankle Functional scores at 1 and 2 years, whereas the reconstruction group demonstrated better anterior talar translation scores; ankle joint position sense was comparable between groups.</p><p><strong>Areas timely for developing research: </strong>Biomechanical comparisons between the two procedures are urgently needed.</p>","PeriodicalId":9280,"journal":{"name":"British medical bulletin","volume":"157 1","pages":""},"PeriodicalIF":7.5,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}