Biological augmentation in revision surgery: effect of a bioinductive collagen patch (REGENETEN) in patients with rotator cuff retear and a previous arthroscopic rotator cuff repair.

Machine learning-based prediction and quantification of OCD surgery and pedigree effects on racehorse performance.

Comparison of clinical efficacy between all-inside technique and traditional technique in anterior cruciate ligament reconstruction under knee arthroscopy.

Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are often associated with higher failure rates after arthroscopic repair compared with non-ALPSA lesions. The purpose of this study was to compare failure rates after arthroscopic ALPSA repair versus non-ALPSA (Bankart/Perthes) repair, with the effect of the Hill-Sachs lesions (HSLs) controlled by performing concomitant remplissage in all patients. It was hypothesized that addressing the Hill-Sachs defect would result in similar failure rates for both ALPSA and non-ALPSA repairs. Cohort study; Level of evidence, 2. A prospective cohort study included 198 patients who underwent arthroscopic anterior labral repair with concomitant remplissage for anterior shoulder instability with an HSL. Patients were classified as ALPSA or non-ALPSA, and functional outcomes were analyzed in a matched cohort (N = 153), with a minimum 2-year follow-up. ALPSA lesions were subclassified intraoperatively based on repaired tissue quality and soft tissue bumper restoration into 3 types (A, B, and C). The primary outcome was the failure rate at 2-year follow-up. Secondary outcomes included Rowe scores, Western Ontario Shoulder Instability Index (WOSI) scores, and range of motion. Failure rates were comparable between ALPSA (5.3%) and non-ALPSA (5.6%) groups (P = .94). Both groups achieved significant improvements in Rowe and WOSI scores (P < .001); however, patients with ALPSA had lower rates of achieving Patient Acceptable Symptom State (PASS) for WOSI (76.5% vs 92.2%; P = .007). Type C ALPSA repairs demonstrated inferior outcomes (WOSI PASS: 23.1% vs 100% for types A/B; P < .001). ALPSA repairs resulted in greater external rotation deficits (19° vs 14°; P < 01), particularly in type B repairs (23° deficit). Remplissage for concomitant HSL yields similarly low redislocation rates after both ALPSA and non-ALPSA repairs. Additionally, soft tissue bumper restoration is associated with improved functional outcomes at 2-year follow-up.

This randomized trial compared ultrasound-guided interscalene block (ISB) and combined infraclavicular (ICB)-anterior suprascapular nerve block (SSNB) for arthroscopic shoulder surgery. We hypothesized that combined ICB-anterior SSNB provides equivalent analgesia to ISB 30 min after surgery. Fifty subjects were randomized to ISB or combined ICB-anterior SSNB. Twenty mL of bupivacaine 0.5% with epinephrine 5 µg/mL was used for ISB. For ICB and anterior SSNB, we administered 20 mL and 3 mL of bupivacaine 0.5% with epinephrine 5 µg/mL, respectively. Subsequently, all patients underwent general anesthesia.The primary outcome was the pain score at 30 min in the post-anesthesia care unit. Secondary outcomes included the rate of complete sensorimotor blockade (assessed after the performance of the blocks using a 14-point composite scale), postoperative pain scores at 0.5, 1, 3, 6, 12, 24, 36, and 48 hours, the presence of hemidiaphragmatic paralysis at 30 min after the performance of the blocks and in the post-anesthesia care unit, consumption of intraoperative and postoperative narcotics, opioid-related side effects, and patient satisfaction at 24 hours. No intergroup differences were found in postoperative pain scores, proportion of patients with complete sensorimotor blockade, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours. Compared with combined ICB-SSNB, ISB resulted in a higher incidence of hemidiaphragmatic paralysis 30 min after the block and in the post-anesthesia care unit (68% vs 0%; and 88% vs 0%, respectively; both p<0.001). Compared with ISB, combined ICB-anterior SSNB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate whether combined ICB- anterior SSNB can provide surgical anesthesia for shoulder surgery. NCT05444517.

Outcomes of arthroscopic meniscal repair versus partial meniscectomy on knee function and quality of life in middle-aged and elderly patients: a retrospective control study of 80 cases.

Arthroscopic treatment of TFCC lesions and stabilization of the DRUJ offer a differentiated range of findings-oriented procedures. Theses include central smoothing/partial resection via peripheral capsular sutures to foveal refixation and, in cases of irrepairable damage, anatomical reconstruction of the DRUJ-stabilizing radioulnar ligaments. The Palmer and Atzei classifications are widely used in everyday clinical practice and offer a structured approach to diagnosis and indication, with foveal integrity being the central criterion for DRUJ stability. Medical history, clinical examination, imaging and, in particular, diagnostic arthroscopy ensure precise classification, while standardized follow-up treatment concepts and realistic expectations ensure functional results. The choice of the specific procedure should be injury-specific, patient-related and experience-based.

Arthroscopic knee surgery (AKS) is a widely performed day procedure used for both the diagnosis and treatment of various knee-related conditions. Although this surgical approach is less invasive compared to traditional methods, it still necessitates effective anesthesia management. Conventional anesthetic techniques, such as spinal anesthesia and peripheral nerve blocks, often fall short in facilitating rapid recovery after day surgery, primarily due to prolonged postanesthesia recovery times and the potential for associated complications. In contrast, general anesthesia that preserves spontaneous respiration may present a more advantageous alternative, as it avoids the complications associated with tracheal intubation. This study aims to evaluate the effects of inhalation anesthesia in comparison to total intravenous anesthesia, both with preserved spontaneous respiration, on intraoperative adverse respiratory events and postoperative recovery. To prevent leakage of volatile anesthetics, we will utilize a headgear device designed for fully enclosed inhalation anesthesia that enables patients to maintain spontaneous respiration throughout the procedure. The findings of this research are intended to provide reliable evidence to support the broader clinical application of this anesthesia technique in the context of arthroscopic knee surgery. This study is designed as a randomized clinical trial conducted at a single center. A total of 96 participants will be randomly assigned to one of two groups: the sevoflurane group or the propofol group, with a 1:1 allocation ratio. In the sevoflurane group, sevoflurane will be utilized for the induction and maintenance of anesthesia, administered through our patented equipment. The propofol group will receive propofol via intravenous target-controlled infusion for both the induction and maintenance of anesthesia. The primary outcome measure is the incidence of intraoperative respiratory depression. Secondary outcome measures include the incidence of intraoperative hypotension, bradycardia, somatic responses, and coughing, as well as the occurrence of postoperative headache and agitation within 24h following surgery. Additionally, we will evaluate the severity of postoperative pain, nausea, and vomiting using a numerical rating scale (NRS) at the same postoperative interval. And the quality of recovery will be measured with the Quality of Recovery-15 score (QoR-15) at 24h post-surgery. The length of hospital stay and associated hospitalization costs will also be documented. The objective of our study is to assess the potential benefits of our fully enclosed inhalational anesthesia system in patients undergoing AKS. We will specifically examine the effects of inhalational anesthesia compared to total intravenous anesthesia on intraoperative spontaneous respiration and postoperative recovery. Our aim is also to determine which anesthesia modality offers greater safety and comfort for surgical patients. China Clinical Trial Register ChiCTR2200057229. Registered on 4 March 2022.

Discoid lateral meniscus (DLM) is a congenital anomaly associated with increased risk of tearing and peripheral rim instability due to abnormal morphology and deficient capsular attachments. While total meniscectomy was historically performed, long-term complications have prompted a shift toward arthroscopic saucerization with or without repair. Though midterm outcomes are favorable, long-term data remain limited. This study aimed to evaluate long-term clinical outcomes following arthroscopic preservation surgery for symptomatic DLM and compare results between saucerization alone and saucerization with repair. We performed a retrospective cohort study of patients <21 years who underwent arthroscopic treatment for symptomatic DLM at a single academic pediatric center (2012 to 2022) with a minimum of 5 years of follow-up. Treatment was determined intraoperatively: stable menisci underwent saucerization alone, whereas menisci with PRI and/or meniscocapsular disruption underwent saucerization with repair. PROs included Tegner-Lysholm, Pedi-International Knee Documentation Committee (Pedi-IKDC), and KOOS-Child. Return to full activity and reoperation were assessed via chart review and follow-up documentation. Thirty-six patients met the inclusion criteria (mean age, 13.3±3.8y) with a median follow-up of 8.08 years. PROs at ≥5 years were available for 24 patients (66.7%). Median PROs were favorable in both groups, including Pedi-IKDC (88.5 saucerization-only vs. 94.0 saucerization+repair), Tegner-Lysholm (86.0 vs. 98.0), and KOOS-Child Quality of Life (70.8 vs. 87.8), with no statistically significant differences between groups. Return to full activity was achieved by 35/36 patients (97.2%). Three patients (8.3%) underwent reoperation, with no difference between groups. Arthroscopic meniscal preservation for symptomatic DLM in pediatric and adolescent patients is associated with favorable long-term outcomes, high return to full activity, and low reoperation rates. Outcomes were favorable for both stable and unstable DLM treated with saucerization with or without repair.

Risk of infection after knee arthroscopy and after intra-articular steroid injections (IASI) following total knee arthroplasty (TKA).

Acute traumatic patellar dislocations may cause intra-articular derangements of the knee in the setting of acute and chronic instability which may not always be appropriately identified on magnetic resonance imaging (MRI). To determine the rates of coexisting intra-articular pathology in patients with patellar instability requiring medial patellofemoral ligament (MPFL) reconstruction and to report discrepancies between preoperative magnetic resonance imaging (MRI) findings and diagnostic arthroscopy results. Cohort study (Diagnosis); Level of evidence, 3. Patients who underwent MPFL reconstruction at a single institution between 2010 and 2023 were identified. Operative reports and preoperative MRIs were reviewed. Records without full MRI reports as read by a radiologist or cases in which a diagnostic arthroscopy was not conducted were excluded. Intra-articular pathologies noted on MRI and confirmed by arthroscopy were documented. MRI findings were considered to be discordant from arthroscopic findings if a lesion was identified on diagnostic arthroscopy that was not present in the full MRI report and that lesion resulted in additional surgical procedures. There were 331 arthroscopic procedures conducted within the study population of 508 patients who underwent diagnostic arthroscopy at the time of their patellar stabilization procedures. These procedures included 180 loose body removals, 95 osteochondral lesions treated via a variety of interventions including open reduction and internal fixation (26 cases), particulated allograft chondral grafting (30 cases), osteochondral allograft transplantation (9 cases), and microfracture (30 cases), and 39 meniscal tears resulting in 33 partial meniscectomies and 6 meniscal repairs. Among these 508 patients, 105 (21%) demonstrated discordance of preoperative MRI and arthroscopic findings that necessitated additional procedures. This discordance was responsible for a total of 109 (33%) of the 331 arthroscopic procedures. These included 75 loose body removals, 2 osteochondral fracture fixation procedures, 2 microfractures for full-thickness cartilage loss, 16 partial meniscectomies, and 2 meniscal repairs, among others. Among patients undergoing patellar stabilization, 21% had intra-articular lesions not identified on preoperative MRI detected at the time of diagnostic arthroscopy that resulted in surgical intervention. This study, representing the largest cohort to date of patellar stabilization surgeries with both MRI and arthroscopy findings, underscores the importance of diagnostic arthroscopy for improving diagnostic accuracy and addressing associated intra-articular pathology.

Background:Circumferential labral tears are characterized by complete detachment of the labrum from the glenoid rim, and studies have reported significant improvements in patient-reported outcome measures (PROMs) after arthroscopic repair. However, patients’ perspectives on the meaningfulness of these outcomes remain unknown, and debate continues regarding whether circumferential tears can occur after a single instability event.Purpose:To investigate the number of preoperative instability events in patients with circumferential tears and evaluate their clinical outcomes after arthroscopic repair according to the minimal clinically important difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) parameters.Study Design:Case series; Level of evidence, 4.Methods:This study was retrospective review of a consecutive series of patients who underwent shoulder arthroscopy for instability between February 2015 and July 2023. Patients with primary circumferential tears repaired using arthroscopic suture anchors, glenoid bone defects <13.5%, and a minimum 24-month follow-up were included. Analysis was conducted of patient demographics, clinical characteristics, and PROMs, including American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale (VAS) scores. Patients who achieved the MCID, SCB, and PASS thresholds for these scores were determined.Results:Circumferential tears were identified in 3.6% (n = 41) of 1147 patients undergoing arthroscopic procedures for shoulder instability. Of these, 31 patients (mean age, 29.5 ± 9.3 years; 90% male; mean instability events, 5.5 ± 6.9; mean follow-up, 60.4 ± 30.1 months) meeting the inclusion criteria were analyzed. Overall, 39% (n = 12) had a single instability event, with 6 participating in contact sports and 4 in overhead or throwing sports, 9 of them at a competitive level. The proportions of patients who achieved MCID, PASS, and SCB thresholds were as follows: ASES (100, 80.6, and 80.6, respectively), WOSI total (100, 90.3, and 80.6, respectively), and VAS (90.3, 87.1, and 80.6, respectively).Conclusion:Circumferential labral tears are rare. One-third of them may occur even after a single instability event and, therefore, should be considered during clinical evaluation, regardless of the number of prior instability events. Reassuringly, most patients who underwent arthroscopic repair of circumferential tears using suture anchors achieved successful clinically meaningful outcomes at a mean follow-up of approximately 5 years.

To compare the incidence and severity of patellofemoral chondromalacia and its correlation with anterior knee pain following suprapatellar (SP) versus infrapatellar (IP) approaches for tibial intramedullary nailing. Prospective, randomized controlled trial. Single-center study at a Level I Trauma Center. Patients aged between 18 and 45 years who presented with OTA/AO type 42 fractures from September 2020 to March 2024 were randomized into SP and IP groups. Magnetic resonance imaging (MRI) at 6 months post-surgery assessed cartilage damage using the Modified Outerbridge Classification. Diagnostic knee arthroscopy was offered for further evaluation. The primary outcome was frequency and severity of chondromalacia assessed through MRI (Modified Outerbridge Classification) and diagnostic knee arthroscopy at 6 months. Secondary outcomes were the correlation of MRI findings with knee pain (VAS (Visual Analogue Scale) score) and the comparison of the time taken for nail insertion with cartilage damage in the SP group. Both groups had 30 patients each. In the SP group, the mean age was 33.7 years (range 18-45 years) and 83.3% were men, while the IP group had a mean age of 29.3 years (range 18-45 years) and 83.3% were men. Overall, 57 underwent MRI knee (SP: 28, IP: 29) and 16 underwent diagnostic knee arthroscopy (SP: 9, IP: 7). MRI detected chondromalacia in 46.4% in the SP group and 44.8% patients in the IP group; there was no significant difference ( P -value 0.9). Arthroscopy revealed chondromalacia in all 9 (100%) patients who underwent diagnostic arthroscopy in the SP group as compared with 2 of 7 (28.6%) patients in the IP group ( P -value 0.003). Correlation between chondromalacia grading on MRI and VAS scores at 6 months follow-up was significant (r = 0.4, P -value 0.006). Time taken for nail insertion weakly correlated with the presence of chondromalacia on MRI in the SP group but was not statistically significant (r = 0.2, P -value 0.5). No differences were found in the occurrence of patellofemoral chondromalacia observed on MRI between the SP and IP nailing techniques. The SP approach demonstrated a higher frequency of patellofemoral chondromalacia on arthroscopic evaluation. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Posterior humeral avulsion of glenohumeral ligament (PHAGL) lesions involves detachment of the posterior band of the inferior glenohumeral ligament from the humeral neck. Although uncommon, these lesions have been associated with recurrent instability. To compare clinical outcomes and recurrence rates of patients with PHAGL lesions undergoing surgical repair for posterior shoulder instability versus a pair-matched control group without PHAGL lesions undergoing isolated arthroscopic posterior labral repair. Cohort study; Level of evidence, 3. This was a retrospective study of patients diagnosed with PHAGL lesions and posterior shoulder instability who underwent primary arthroscopic repair between 2010 and 2019. These patients were matched 1:3 with a cohort of patients with isolated posterior labral tears (PLTs). Demographics, surgical data, and pre- and postoperative clinical outcomes scores (American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Survey Physical Component Summary, and short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) were collected. Return-to-sport rates and satisfaction were also evaluated. Failure was defined as recurrent instability or progression to arthroplasty. Nine patients diagnosed with PHAGL lesions who underwent primary arthroscopic repair were included. These 9 patients (PHAGL group) were age-matched to a cohort of 26 patients with PLTs who underwent repair (PLT group). The mean follow-up was 5.8 years (range, 2.0-14.2). No significant differences were found between the PHAGL and PLT groups regarding shoulder function, physical health, or patient satisfaction. The median satisfaction score for the PHAGL group was 8.5 of 10, compared to 10 of 10 for the PLT group (P = .144). One patient with PHAGL lesions experienced recurrent instability compared with 0 in the PLT group. This study shows that patients with PHAGL lesions who undergo arthroscopic stabilization can attain comparable mid-term functional outcomes to those with isolated PLTs. Failure rates are similar between the PLT group and those with PHAGL lesions, and surgical management remains an effective treatment option for both groups. Further studies are needed to optimize surgical techniques and refine patient selection criteria for improved long-term success.

Arthroscopic surgical takedown and repair of symptomatic partial-thickness rotator cuff tears are commonly undertaken. An alternative approach is the use of a bioinductive collagen implant to augment the rotator cuff tear. To investigate early function and rotator cuff tendon integrity in patients undergoing arthroscopic bioinductive collagen implant augmentation (REG group) versus rotator cuff takedown and repair (RCR group) for high-grade partial-thickness rotator cuff tears. Randomized controlled clinical trial; Level of evidence, 2. Patients 35 to 75 years of age with symptoms >3 months and unresponsive to nonoperative treatment, with high-grade partial-thickness rotator cuff tears confirmed on 3-T magnetic resonance imaging (MRI), were randomly allocated to RCR or REG groups. Exclusion criteria included previous ipsilateral shoulder surgery, multitendon tears/pathology, and concomitant surgery including labral repair, long head of biceps tenodesis, or chondroplasty/microfracture. Patients were assessed preoperatively and at 6 weeks as well as 3, 6, and 12 months postoperatively. The primary study outcome was the Western Ontario Rotator Cuff Index (WORC) at 3 months after surgery. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and Constant scores, and the time taken to return to work and activities of daily living (ADLs). MRI-based rotator cuff repair integrity was assessed using the Sugaya grading system. This study recruited 41 patients (REG n = 21; RCR n = 20). No group differences (P > .05) were observed in mean age (REG 57.1 years; RCR 57.8 years), preoperative duration of symptoms, and previous nonoperative treatments. The REG group reported superior outcomes for the WORC at 6 weeks (P = .001) and 3 months (P = .026) as well as the ASES at 6 weeks (P < .001) and WORC Work, Sport, and Emotions domains at 6 weeks and 3 months (P < .05). There were no group-based differences (P > .05) in patient-reported outcomes at 6 or 12 months after surgery. The REG group was faster (P < .05) to permanently remove the sling, drive a motor vehicle, and return to office duties and moderate-intensity chores. No MRI-based differences were observed, with 19 (90%) and 17 (85%) REG and RCR patients, respectively, graded Sugaya 1 to 2 at 12 months. For symptomatic high-grade partial-thickness rotator cuff tears, bioinductive collagen implant augmentation versus standard rotator cuff repair demonstrated improved early function with equivalent MRI-based healing rates. Australian New Zealand Clinical Trials Register (ACTRN12620000926932p).

Current reliance on the expedited 510(k) approval pathway has driven rapid commercial availability of novel arthroscopic devices. Despite the low complication rates of arthroscopic procedures, products from this pathway are suspected to increase the rate of recalls and device malfunctions. This study aimed to characterize arthroscopic device recalls, analyze trends in recall incidence, and identify predictors of time to recall. A 20-year, retrospective, cross-sectional study was conducted using the Food and Drug Administration (FDA) Recalls database. Recalled devices approved under the FDA 510(k) pathway were identified and categorized by type, manufacturer, recall class, and cause. Statistical analyses included Poisson regression for trends and Cox proportional hazards modeling for predictors of time to recall. A total of 124 recalls were initiated during the study period (average 6.2 recalls/year), with packaging and process control issues accounting for 50.7% of recalls. Recall incidence remained stable over time, although nearly half occurred in 2008, 2010, 2012, and 2019. Mean recall time was 491 days (95% confidence interval [CI], 444 to 539). Devices recalled due to material/implant contamination had markedly shorter times (HR: 3.73 [95% CI, 1.78 to 7.82]), whereas process control issues prolonged recall times (HR: 0.56 [95% CI, 0.31 to 1.00]). Manufacturer was another predictor of time to recall, with one manufacturer exhibiting substantially extended recall times (HR: 0.45 [95% CI, 0.22 to 0.92]). Arthroscopic device recalls are largely caused by packaging and process control issues, emphasizing the need for stricter quality assurance during manufacturing. Although recall incidence remained stable over the past two decades, variability in recall times highlights opportunities for improved manufacturer accountability and FDA oversight. Increasing procurement scrutiny, enhancing FDA audit practices, and integrating recall data with clinical outcomes can minimize disruptions in arthroscopic surgery. Level III Therapeutic Study.

Comparative analysis of early versus delayed rehabilitation protocols following rotator cuff repair: A randomized controlled trial.

Anterior cruciate ligament anatomy of Vietnamese adults and applications in arthroscopic anterior cruciate ligament reconstruction surgery with all-inside single-bundle technique.

Hip distraction is essential for hip arthroscopy and other orthopaedic surgeries, but high traction forces often lead to complications like nerve injury and soft tissue impairment. Patients with total knee arthroplasties (TKAs) may face increased risk due to altered joint mechanics; however, the impact of specific TKA configurations on knee behavior during distraction is poorly understood. A validated finite element model of the pelvis and lower extremity was developed from patient CT and MRI data. Three configurations were modeled: bi-cruciate retaining (BCR), posterior-cruciate retaining (PCR; lacking ACL), and posterior-stabilized (PS; lacking both cruciates). Hip distraction was simulated with axial traction forces (100-500N) applied to the distal tibia/fibula with the pelvis fixed proximally. Knee and hip joint displacement and ligament strains were evaluated. The BCR model demonstrated the highest knee stiffness. ACL removal (PCR) reduced stiffness more compared to PCL removal. While the amount of hip distraction was consistent across models, PCR and PS knees experienced excessive knee distraction (>12mm) and ligament strains exceeding 20% before achieving 10mm of hip distraction. Conversely, the BCR model remained under 10mm of knee distraction and 15% strain at equivalent hip distraction levels. Finite element analysis revealed that PCR and PS configurations exhibit knee instability, exceeding soft tissue injury thresholds (>20% strain) within standard clinical traction ranges (250-350N). The ACL contributed greater to knee complex stiffness in axial traction compared to the PCL. Standard traction forces may pose an iatrogenic risk to PCR and PS patients, suggesting a need for TKA-specific distraction protocols to prevent soft tissue failure.

Meniscal vascular contact loss ratio (MVCLR): A novel MRI index for predicting meniscal irreparability.