To assess the ability of artificial intelligence (AI) to identify common sports-related pathologies using radiologic imaging and to compare ChatGPT 4.0 with 2 competitors, Grok 2 and Claude 3.5 Sonnet. ChatGPT 4.0, Grok 2, and Claude 3.5 Sonnet were used. Five common orthopaedic sports pathologies were chosen: anterior cruciate ligament tears, posterior cruciate ligament tears, meniscal tears, chondral pathologies, and rotator cuff tears. Fifty images representing each pathology were collected from a radiologic imaging database when possible, which included radiographic images, computed tomography, and magnetic resonance imaging. Normal images were collected that corresponded to each diagnostic category. Receiver operator characteristic curves and area under the curve values were calculated to assess the accuracy of each AI platform. ChatGPT 4.0, Grok 2, and Claude 3.5 Sonnet accurately identified the pathology in 23.6%, 15.7%, and 17.1% of diseased images, respectively. ChatGPT and Grok were most accurate at identifying meniscus pathologies (ChatGPT: 48%, Grok: 42%), whereas Claude Sonnet was most accurate at identifying anterior cruciate ligament pathologies (30%). The area under the curve for ChatGPT, Grok, and Claude Sonnet was 0.21, 0.16, and 0.15, respectively (ChatGPT 4.0 vs Grok 2, P = .30; ChatGPT 4.0 vs Claude 3.5 Sonnet, P = .24; Grok 2 vs Claude 3.5 Sonnet, P > .99). There were no differences in performance between the 3 platforms overall or within any of the diagnostic categories. ChatGPT 4.0, Grok 2, and Claude 3.5 Sonnet correctly identified the pathology in less than 25% of images of common sports-related pathologies and showed area under the curve values well below 0.5, indicating poor accuracy. Based on these findings, we do not recommend the current use of these generative AI models for image-based diagnosis in orthopaedics. As the use of AI becomes more popular within the general public, it becomes increasingly important to make aware the capabilities and limitations of popular AI platforms in regard to their current image-based diagnostic capabilities.
Irreparable posterosuperior massive rotator cuff tears represent a common and challenging condition in shoulder surgery. Reconstruction procedures can effectively restore the anatomical structure and function of the shoulder joint and, as an important joint-preserving treatment option for irreparable posterosuperior massive rotator cuff tears, have garnered increasing attention and application among shoulder surgeons. However, a lack of consensus currently exists regarding its definition, diagnostic criteria, and treatment strategies, leading to inconveniences in clinical decision-making and academic communication. To standardize the indications, surgical option selection, and postoperative rehabilitation strategies for the reconstruction of irreparable posterosuperior massive rotator cuff tears, the Shoulder Joint Study Group of the Fifth Committee of the Chinese Society of Sports Medicine of Chinese Medical Association organized experts in the relevant field to develop a consensus using a modified Delphi method, which involved two rounds of questionnaire surveys and one online expert meeting. After reviewing domestic and foreign literature, the consensus drafting group compiled the initial draft and questionnaire items. Suitable topics were selected via the first round of expert voting, and the recognition level of responses to each consensus question was determined in the second round. Online expert discussions were subsequently held to refine wording and reconcile divergent views, yielding the final consensus. A consensus is confirmed with an approval rate of no less than 85%. It is classified into three tiers: high consensus (95.0%-100%), general consensus (90.0%-94.9%), and basic consensus (85.0%-89.9%). This consensus ultimately formulated 10 recommendations focusing on core issues, including the definition and diagnosis of irreparable posterosuperior massive rotator cuff tears, the indications and timing of reconstruction surgery, the selection and application principles of commonly used reconstruction techniques, perioperative management and phased rehabilitation protocols, and the prevention and treatment of postoperative complications. This consensus aims to provide a clinical decision-making reference for orthopedic surgeons, sports medicine physicians, and rehabilitation specialists, thereby promoting the standardization and individualization of reconstruction treatment for irreparable massive rotator cuff tears and improving patient functional outcomes. 后上不可修复巨大肩袖撕裂是肩关节外科领域的治疗难点。重建术式作为重要的保肩治疗手段，其临床应用日益广泛，但目前尚缺乏统一的定义、诊断标准及重建治疗规范。为提供系统性临床指导，推动诊疗策略的规范化与个体化，由中华医学会运动医疗分会第五届委员会肩关节学组发起，组织国内相关领域专家，严格遵循改良Delphi法，通过2轮问卷调查及1轮线上专家论证会议，系统梳理并整合循证医学证据与专家临床经验制定本共识。共识起草小组在参阅国内外相关文献后，拟定共识初稿及问卷条目，经第1轮专家投票筛选合适题目，第2轮专家投票明确各共识问题的认可程度；随后组织线上专家讨论，进一步优化条款表述、统一分歧意见，最终形成本共识。共识认定标准为赞成率≥85%，并根据赞成率高低分为3级：高度共识（95.0%～100%）、普遍共识（90.0%～94.9%）、基本共识（85.0%～89.9%）。本共识围绕后上不可修复巨大肩袖撕裂的定义与诊断、重建手术的适应证与时机、常用重建技术的选择与应用要点、围术期管理与阶段性康复方案，以及术后并发症的防治等核心问题，共形成推荐意见10条。本共识基于当前最佳证据和专家意见，为骨科、运动医学科及康复科医师在重建治疗后上不可修复巨大肩袖撕裂的临床决策中提供重要参考。遵循共识建议，有望规范重建技术的应用，优化围术期管理，从而改善患者肩关节功能与生活质量。.
To evaluate patient-reported outcome measures (PROMs), clinically significant outcome (CSO) achievement rates, and return to sport (RTS), and military duty (RMD) rates at a minimum of 10 years following arthroscopic posterior labral repair in active-duty military service members (ADSM). Consecutive ADSM undergoing arthroscopic posterior labral repair between January 2010 and December 2013 at a single institution with a minimum 10-year follow-up were retrospectively evaluated. PROMs assessed included visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Rowe instability score. CSOs, return to sport, and return to military duty were also collected and assessed. A total of 39 patients met inclusion criteria with an average 140 months (11.7 years, range: 120-165) of follow-up. VAS, ASES, SANE, and Rowe scores all improved significantly postoperatively (VAS: 7.9 to 1.7, ASES: 46.7 to 87.8, SANE: 48.1 to 89.1, Rowe: 35.6 to 91.3; P < .0001 for all) at latest follow-up. All patients achieved the minimal clinically important difference, and the majority (62%-85%) achieved the patient acceptable symptomatic state for all PROMs. Achievement of substantial clinical benefit varied more considerably than the other measures (31%-69%). Across all clinical thresholds, a majority of patients (62%-100%) showed clinically significant improvements in pain as compared to preoperatively. In total, 92.3% (n = 36) of patients showed full return to military duty. Similarly, 87.2% (n = 34) reported return to sport including pushups at final follow-up. Following arthroscopic posterior labral repair of the shoulder, high-demand active-duty military patients sustain significant improvement in PROMs and high CSOs achievement rates at a minimum 10-year follow-up, alongside high rates of return to military duty and sports at 92.3% and 87.2%. Level IV, retrospective case series.
To evaluate medieval and postmedieval Dutch skeletal collections for signs of cam impingent. The medieval collections from Alkmaar Paardenmarkt and Klaaskinderkerke and the postmedieval period from Middenbeemster were studied. Standard osteological methods for sex and age estimation were used. From digital photographs of the femora, the apparent neck shaft angle, true neck shaft angle, angles of version and inclination, and the α and β angles of Nötzli were measured with ImageJ software. The time spans were ~1448 to 1573 for Alkmaar Paardenmarkt, ~1286 to 1573 for Klaaskinderkerke, and 1615 to 1866 for Middenbeemster. Femora exhibiting signs of trauma, disease, or poor preservation were excluded. There were 116 individuals (186 femora) available for study: 21 individuals (35 femora) from Alkmaar Paardenmarkt, 38 individuals (52 femora) from Klaaskinderkerke, and 57 individuals (99 femora) from Middenbeemster. There were 104 male and 68 female femora (sex not known in 14). Using an α angle of ≥50°, ≥55°, and ≥60°, the prevalence of cam deformity was 25%, 16%, and 10%, respectively. The cam deformity prevalence (α ≥ 50°) was higher in the medieval group (39%) than the postmedieval group (13%) (P < .001) and in male individuals (35%) compared with females (9%) (P < .001). The prevalence of cam deformity was 46% in Klaaskinderkerke, 29% in the Alkmaar Paardenmarkt, and 13% in the Middenbeemster collection (P < .001). There were no differences by laterality, paired/unpaired femora, or individual/comingled burials. The prevalence of cam deformity correlated with the physical activities of the individuals. The highest prevalence was in the Klaaskinderkerke (46%) collection and soldiers (62%) from the Alkmaar Paardenmarkt collection. With increasing urbanization and a concomitant decrease in self-sufficiency, the prevalence dropped to 13% in the Middenbeemster collection. Cam deformities that correlate with physical activity levels were found in historical Dutch skeletal specimens. Cam deformity is considered an adaptive response to modern athletic activity. Evaluation of historical specimens will provide a fuller understanding of this condition by revealing whether cam deformity was present in historical skeletal specimens.
To identify whether there is a gender-based disparity in salary among sports medicine fellowship-trained academic orthopaedic surgeons. Deidentified faculty compensation data were obtained from the Association of American Medical Colleges, which are compiled after distributing surveys to 157 Liaison Committee on Medical Education-accredited medical schools through a deidentified internet-based survey application. Mean and median data for the 2023 calendar year was extracted from this dataset for male and female sports medicine fellowship-trained orthopaedic surgeons and stratified in a cross-sectional fashion by position, including assistant professor, associate professor, and professor. Independent sample t-tests and Cohen's d test were performed with Python and shown through a bar graph. A total of 312 orthopaedic surgeons were included in this analysis, with 268 (85.9%) male and 44 (14.1%) female surgeons. Sports medicine fellowship-trained female surgeons earn significantly lower salaries than their male counterparts at the positions of assistant professor ($504,994 vs $654,697; P < .001), associate professor ($617,612 vs 776,754; P < .001), and professor ($486,303 vs $820,406; P < .001). The effect size of the difference between male and female salaries is greatest at the position of professor (d = 7.5), although there is a large difference in means between male and female assistant professors (d = 4.2) and associate professors (d = 3.4). Female sports medicine fellowship-trained academic orthopaedic surgeons earn significantly lower salaries at the assistant professor, associate professor, and professor levels. However, data were not able to be stratified based on additional variables that may influence salary among orthopaedic surgeons such as age, years in practice, geographic location, practice focus, and surgical volume. This study shows that gender-based disparities exist in compensation among sports medicine fellowship-trained academic orthopaedic surgeons.
To evaluate the ability of ChatGPT-4o to provide clinical assessments of mock photos of knees and shoulders that had undergone arthroscopic or open surgery and answer common questions related to anterior cruciate ligament reconstruction and rotator cuff repair. The authors created a series of mock postoperative knee and shoulder photos and common questions about anterior cruciate ligament reconstruction and rotator cuff repair. These clinical photos and questions were presented to GPT in isolated chat windows and without prior training, and its responses were graded by orthopaedic surgeons, physician assistants, and residents using a previously established 4-point grading system. When grading ChatGPT's assessments of mock clinical photos, raters gave 18.8% to 75.0% total excellent grades and 0% to 25.0% unsatisfactory grades. When grading ChatGPT question answers, raters gave 4.5% to 77.3% total excellent grades and 0% to 9.1% unsatisfactory grades. Mean grades ranged from excellent to satisfactory, requiring moderate clarification, depending on the photo or question. There was wide variability in rater grading agreement, with attendings being the most critical graders. ChatGPT-4o can provide some satisfactory assessments of simple postoperative clinical photos and responses to common questions after orthopaedic knee and shoulder surgery, as graded by orthopaedic surgeons, residents, and physician assistants. While this study highlights how ChatGPT could serve as a tool for generating draft responses to patient concerns after undergoing orthopaedic knee and shoulder surgery, it cannot yet provide reliable, independent clinical advice. As digital interactions in health care continue to expand, large language models could play a role in enhancing communication between patients and the orthopaedic care team, potentially improving patient engagement and access to information.
To perform a systematic review of postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction. A systematic review was conducted by searching PubMed, the Cochrane Library, and Embase databases for studies reporting postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction. Inclusion criteria were clinical studies detailing rehabilitation protocols after hip arthroscopy with primary labral reconstruction. Studies were excluded if they involved revision procedures, lacked rehabilitation protocols, or were nonclinical reports. The search terms used were: hip labral reconstruction. Extracted data included initial weight-bearing (WB) status, time to full WB, use of continuous passive motion (CPM), initial range of motion limitations, brace use and duration, physical therapy modalities, return-to-sports timing, patient-reported outcome measures, and reoperation rates, defined as the need for revision arthroscopy or conversion to total hip arthroplasty. Twenty studies, including 641 patients, met inclusion criteria. The mean patient age ranged from 32.0 to 43.7 years, with mean follow-up durations ranging from 0.6 years to 6.4 years. Four studies allowed WB as tolerated, one required non-WB, whereas 15 studies implemented protected WB (i.e., partial WB or touch-down WB) postoperatively, with all studies allowing full WB within 8 weeks. CPM was initiated within 12 to 24 hours postoperatively in 6 studies. Hip immobilization devices were used in 6 studies. Five studies reported range of motion restrictions, limiting hip flexion anywhere from 30° to 90°. Fourteen studies reported 11 unique patient-reported outcome measures and 55% of all studies reported reoperation rates. Among 5 studies that reported return-to-sport timelines, 4 (80%) permitted return by 6 months. Although most protocols discussed physical therapy and strength progression, considerable variability existed regarding exercise timing and initiation. This systematic review highlights the heterogeneity in postoperative rehabilitation protocols after hip arthroscopy with labral reconstruction, reflecting a lack of standardized, evidence-based guidelines. Level V, systematic review of Level II-V studies.
Initiated by the Knee Group of the Chinese Society of Sports Medicine and the Arthroscopy Group of the Chinese Association of Orthopaedic Surgeons, domestic experts in the field were organized to develop a Chinese expert consensus on anterior cruciate ligament (ACL) reconstruction using the over-the-top (OTT) technique, based on the latest clinical practices and research advancements. This consensus aims to standardize and promote the application of this technique in ACL reconstruction. The consensus was reached using the modified Delphi method and was completed through two rounds of online questionnaire surveys and one round of face-to-face expert meeting discussions. The consensus was jointly formulated by 43 sports medicine experts from grade Ⅲ class A hospitals across 20 provinces, autonomous regions and municipalities of China. Among them, 7 experts served as guiding experts. The consensus drafting team drafted the first draft of the consensus based on evidence-based evidence and transformed it into questionnaire items. The second draft was revised according to the feedback from the first round of questionnaires and discussed, revised and voted on item by item in face-to-face meetings. Items with an approval rate of ≥85% were recognized as having reached a consensus. The consensus terms were categorized as "strong" (approval rate: 95.0%-100%), "moderate" (approval rate: 90.0%-94.9%), and "basic" (approval rate: 85.0%-89.9%). All 43 experts completed the entire process and participated in the face-to-face meeting. Ultimately, 9 consensus statements were agreed upon, including 8 highly-consensus items and 1 general consensus item, covering surgical indications, technical key points, and postoperative rehabilitation. The ACL OTT reconstruction technique does not require the establishment of a femoral tunnel and demonstrates favorable outcomes in adolescent ACL reconstruction and adult ACL revision, making it a viable surgical option for such patients. However, whether OTT reconstruction should be routinely recommended for primary ACL reconstruction in adults requires further clinical research to confirm its standardized application and ensure clinical efficacy. 由中华医学会运动医疗分会膝关节学组与中国医师协会骨科医师分会关节镜学组牵头，组织国内相关领域专家，基于最新临床实践与科研进展，制定关于膝关节前交叉韧带（anterior cruciate ligament，ACL）过顶位（over-the-top，OTT）重建技术的中国专家共识，旨在规范并推广该术式在ACL重建中的应用。. 共识采用改良Delphi方法，经过2轮在线问卷调查及1轮面对面专家会议讨论完成。共识邀请了43位来自全国20个省、自治区、直辖市三甲医院的运动医学专家共同制定，其中7位专家作为指导专家。共识起草小组根据循证依据拟定共识初稿并转化为问卷条目，根据第1轮问卷反馈意见修订形成二稿，并在面对面会议中逐条讨论、修改与投票，赞成率≥85%的条目认定为达成共识。共识条款分高度共识（赞成率95.0%～100%）、普遍共识（赞成率90.0%～94.9%）、基本共识（赞成率85.0%～89.9%）3级。. 43位专家完成二轮线上问卷投票流程并参与面对面专家会议讨论。最终共9项共识条目达成一致，包括8项高度共识条目和1项普遍共识条目，涵盖手术适应证、技术要点与术后康复等方面。. ACL OTT重建技术无需建立股骨隧道，在青少年ACL重建和成人ACL翻修术中疗效良好，可作为该类患者的术式选择；OTT重建技术是否可被推荐常规应用于成人ACL初次重建需要更多临床研究予以进一步证实。.
To systematically assess published classification systems for knee ligament injuries and to propose a comprehensive, multiplanar, sequential knee ligament classification system that improves upon those in the published literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed, Embase, and Cochrane were searched from inception to January 2025 for studies reporting knee classification systems. Inclusion criteria consisted of studies reporting knee classification systems and English language. Exclusion criteria consisted of classifications only describing specific type of knee injuries (e.g., only anterior cruciate ligament injuries). The characteristics of each classification system were recorded and analyzed descriptively. A classification system was proposed that addresses the weaknesses of the existing systems. A total of 6 classification systems were identified in 8 studies in the literature and were published between 1975 and 2009. Existing classification systems were strong in correlating type of injuries with rotatory ligamentous laxity and physical examination findings but were lacking assessment of knee position during injury, discussion of sequence of injuries, involvement of bone marrow edema (except one study), and lack of correlation with knee dislocations. No clinical validation was performed. A knee classification system was created that included sequence of injuries, correlation with knee dislocation and injury mechanism, and bone marrow edema. Knee injury classification systems lack comprehensive consideration of injury mechanism, sequence of injury, bone marrow edema, meniscus and chondral damage, involved ligaments, rotatory instability, and correlation with knee dislocation. The sequence of injury to these structures could be relevant to understanding injury mechanism and treatment, but requires validation. Level V, systematic review of level IV-V studies.
To evaluate the epidemiology, prevalence, and mechanism of injury of pickleball-related injuries in patients presenting to emergency departments in the United States. Data between 2004 and 2023 from the National Electronic Injury Surveillance System were analyzed for racquetball-related injuries. The data set was screened for pickleball-related injuries using keywords. Data included body part, diagnosis, mechanism of injury, and disposition. Calculations used corresponding hospital sample weights for national estimates (NEs). Patients were divided into the following age groups: pediatric (<18 years), 19 to 39 years, 40 to 59 years, and 60 years or older. A total of 1,714 injuries (NE, 99,816 [98.8%]) were included. The most commonly injured body locations were the upper trunk (n = 232) (NE, 14,884 [13.5%]), head (n = 226) (NE, 12,990 [13.2%]), and knee (n = 188) (NE, 10,700 [10.9%]). The most identified final diagnoses were fracture (n = 493) (NE, 27,493 [28.7%]), sprain/strain (n = 423) (NE, 25,237 [24.7%]), internal organ damage (n = 168) (NE, 10,050 [9.8%]), and contusion (n = 163) (NE, 9,573 [9.5%]). The most identified mechanisms of injury were impact with the floor (n = 856) (NE, 50,797 [49.9%]), exertional cardiovascular event (n = 244) (NE, 15,796 [14.2%]), and non-contact movement (n = 222) (NE, 12,936 [13.0%]). Pediatric patients had the highest proportion of head injuries (NE, 222 [16.9%]) and injuries from equipment (NE, 634 [32.2%]). The group aged 60 years or older had the highest proportion of wrist injuries (NE, 10,302 [13.0%]), fractures (NE, 17,802 [32.8%]), and injuries cause by impact with the floor (NE, 43,592 [56.1%]). Additionally, this group had the highest proportion of upper trunk injuries (NE, 12,947 [15.4%]) and exertional chest pain (NE, 13,789 [16.2%]). Pickleball injuries most frequently involved the upper trunk, head, and knee, with fractures and sprains/strains being the most common diagnoses. Nearly half of all pickleball injuries resulted from impacts with the floor. Pediatric patients had a higher proportion of head injuries and equipment-related trauma, whereas older adults (≥60 years) were more prone to wrist and upper trunk injuries, fractures, and exertional chest pain. Level IV, retrospective epidemiologic case series.
To compare clinical outcomes between augmented subchondral drilling (aSCD) and nonsubchondral drilling (NoSCD) techniques, both using a cartilage scaffold, in the treatment of isolated patellar cartilage lesions. A retrospective cohort study was conducted on patients who underwent surgical treatment for isolated patellar cartilage using either an aSCD technique (a subchondral drilling augmented with a particulated cartilage allograft scaffold or a flexible osteochondral allograft scaffold) or a NoSCD technique (a particulated juvenile articular cartilage scaffold or a flexible osteochondral allograft scaffold implanted without performing a subchondral drilling). Patients were included if they had a minimum 2-year follow-up and excluded if they underwent concomitant meniscal or ligamentous procedures. While tibial tubercle osteotomy (TTO) was commonly performed, it was not a strict inclusion criterion. All procedures were performed through arthrotomy with a standardized postoperative rehabilitation protocol. Clinical outcomes included International Knee Documentation Committee (IKDC) and Lysholm scores, reoperation rates, conversion to total knee arthroplasty, and complications. A total of 65 knees were included: 31 in the aSCD group and 34 in the NoSCD group, with a mean follow-up of 50.4 months (range, 24-88 months). In the aSCD group, particulated allograft cartilage hydrated with platelet-rich plasma was used in 80.7% of cases and flexible osteochondral allograft in 19.3%, while the NoSCD group was treated with Cartiform (Arthrex) in 70.6% and particulated juvenile articular cartilage in 29.4% of cases. TTO was performed in 87.0% of aSCD and 91.2% of NoSCD cases. Average defect sizes were 3.7 cm2 (aSCD) and 4.0 cm2 (NoSCD). At final follow-up, the NoSCD group had significantly better outcomes, with higher median IKDC scores (81.0 vs 74.0; P < .001) and median Lysholm scores (83.0 vs 77.0; P < .001). A significantly greater proportion of NoSCD patients exceeded the minimal clinically important difference for IKDC (100% vs 80.6%; P = .024) but not for Lysholm (97.1% vs 93.5%; P = .935) at final follow-up. In multivariable regression adjusting for scaffold type, TTO, and defect size, aSCD remained a significant independent predictor of lower final IKDC (β = -8.97; P = .001) and Lysholm (β = -12.71; P < .001) scores. The aSCD group had a significantly higher rate of repeat surgery (45.2% vs 14.7%; P = .015). There was no significant difference in conversion to total knee arthroplasty between groups (P = .432). For the treatment of isolated patellar cartilage lesions, a nonsubchondral drilling technique with scaffolding was associated with improved patient-reported outcomes and fewer complications compared to a subchondral drilling technique with scaffolding, although there was no difference in the rate of conversion to total knee arthroplasty. Level III, retrospective comparative study.
Scapular dyskinesis is frequently observed with various types of shoulder instability, but whether scapular dyskinesis could contribute to shoulder instability is still unclear. The purpose of this study was to determine the effects of scapular orientation on anterior and posterior glenohumeral translation using a cadaveric model of anterior and posterior labral tears. Twenty fresh-frozen cadaveric shoulders were divided into 2 groups: the anterior lesion (n = 10) and posterior lesion (n = 10) groups. The humeral head was translated anteriorly or posteriorly with a constant 30 N force in the anterior or posterior tear groups, respectively. Humeral head displacement was measured at neutral scapula orientation for the intact labrum and following anterior or posterior labral tears. Following a labral tear, humeral head displacement was also measured at 6 additional scapular orientations (±10° increments from neutral), including downward rotation, upward rotation, posterior tilt, anterior tilt, internal rotation, and external rotation. The humerus was held at 0° of horizontal abduction and 40° of horizontal abduction (the apprehension test position) or 40° of horizontal adduction (the jerk test position) in the anterior lesion or posterior lesion groups, respectively. The presence of isolated labral tears generally increased anterior and posterior translations on the order of 1-2 mm in the neutral scapular orientation (P ≤ .021). Anterior humeral head translation in 0° humeral abduction further increased by approximately 1 mm in the mean upward scapular rotation orientation (P ≤ .021). In the apprehension test, anterior translation increased from posterior to anterior scapular tilt (1.3 mm, P = .017), and from internal to external scapular rotation (1.8 mm, P ≤ .006). Posterior humeral translation in 0° humeral abduction showed trends increasing from downward to upward scapular rotation (1.2 mm, P ≤ .027) and posterior to anterior scapular tilt (2.8 mm, P ≤ .007), while slightly decreasing from internal to external scapular rotation (0.6 mm, P = .014). Posterior translation in the jerk test increased from downward to upward scapular rotation (0.8 mm, P ≤ .012) and posterior to anterior scapular tilt (0.9 mm, P ≤ .043), but slightly decreased from internal to external scapular rotation (0.6 mm, P = .001). Increased scapular upward rotation, anterior tilt, and external rotation were associated with increased anterior translation of the humeral head in shoulders with anterior labral lesions. In shoulders with posterior labral lesions, increased scapular upward rotation, anterior tilt, and internal rotation were associated with increased posterior translation of the humeral head. These findings suggest that scapular dyskinesis could contribute to instability recurrence.
To evaluate the effects of tranexamic acid (TXA) on postoperative blood loss, operation time, pain control, and complications in arthroscopic rotator cuff repair and to investigate its impact on intraoperative visualization clarity, hemoglobin, and mean arterial pressure. Randomized controlled trials up to February 2025 were comprehensively searched in databases such as PubMed, Embase, and the Cochrane Library. Literature was screened according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The quality of included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis of postoperative blood loss, operation time, Visual Analog Scale for pain, and complication rates was conducted using RevMan 5.4 software. A total of 9 randomized controlled trials (691 patients) were included. The results showed that compared with the control group, the TXA group significantly reduced surgical blood loss (mean difference = -6.40 mL, 95% confidence interval (CI): -12.44 to -0.36, P = .04, I2 = 62%), shortened operation time (mean difference = -8.60 min, 95% CI: -12.83 to -4.37, P < .00001, I2 = 59%), and decreased Visual Analog Scale pain scores at 24 hours postoperatively (mean difference = -0.65, 95% CI: -0.97 to -0.34, P < .0001, I2 = 41%), but the minimal clinically important difference was not reached. There was no statistically significant difference at both 24 and 48 hours. TXA lowered the overall complication rate (odds ratio = 0.23, 95% CI: 0.08 to 0.69, P = .009, I2 = 0). However, TXA did not have a significant effect on intraoperative visualization clarity, postoperative hemoglobin levels, or mean arterial pressure. TXA reduces postoperative bleeding, shortens operation time, alleviates early pain (within 24 hours), where no significant differences were observed at 48 or 72 hours postoperatively, and lowers the incidence of complications in arthroscopic rotator cuff repair, with a favorable safety profile. Level III, systematic review of Level I and III studies.
To determine the diagnostic performance and inter-rater agreement for magnetic resonance imaging (MRI) signs of long head biceps tendon (LHBT) instability and overall, using conventional MRI for the diagnosis of biceps pulley lesions. In this retrospective analysis, conventional MRIs were reviewed by 5 assessors for the presence or absence of biceps pulley lesions and 6 specific MRI signs. Diagnostic performance of pulley lesion and sign detection using MRI was tested using arthroscopy as the reference standard. Interobserver agreement was measured with Kappa statistics and diagnostic performance with sensitivity, specificity, negative and positive predictive values overall and for radiologists and surgeons. A total of 60 MRIs, 30 with biceps pully lesions and 30 without, were included. Overall, diagnostic performance metrics for MRI included a sensitivity of 81%, specificity of 79%, positive predictive value of 80%, and negative predictive value of 80%. Interobserver reliability analysis revealed moderate agreement overall, with a global kappa value of 0.59. LHBT angle showed the highest sensitivity (84%) and LHBT-groove distance showed the greatest specificity (98%). Both radiologists and surgeons reported similar diagnostic accuracy through MRI. Overall, conventional MRI had an acceptable diagnostic performance, with sensitivity, specificity, and predictive values of approximately 80%. Among the evaluated signs, the LHBT angle had the highest sensitivity, whereas the LHBT-groove distance showed the greatest specificity. Interobserver reliability was moderate overall, though some observer pairs achieved substantial agreement. However, there was variability across diagnostic signs. Level III, retrospective comparative study.
To compare the scientific rigor of Beighton Scoring System (BSS) use in generalized joint hypermobility (JH) studies (healthy subject injury risk/rate, physiological or kinesiological function determination) and joint-specific or arthroscopy JH studies; to identify the most commonly used BSS score thresholds; and to describe ways to improve BSS score use for improved surgical and clinical decision-making. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, the PubMed, EBSCO Host, and Web of Science databases were searched using "Beighton score" and "sports injury outcome" terms. Study purpose, publication year, female or male subject number, age and group type, measurement tools, BSS criteria, results, and conclusions data were extracted. Twenty-eight generalized JH studies (43.8%, 28/64) involving 12,138 subjects (6512 females) and 36 joint-specific or arthroscopy JH studies (56.3%, 36/64) involving 7351 subjects (3441 females) were identified. Overall, most studies reported that BSS scores influenced most/all (54.7%, n = 35/64) or some (26.6%, 17/64) study outcomes and most were Evidence Level II (57.8%, n = 37/64) or III (35.9%, n = 23/64). Most generalized JH studies used a BSS score ≥4 (n = 13, 46.4%) or BSS ≥5 (n = 7, 25%) while most joint-specific or arthroscopy JH studies used a BSS score ≥4 (n = 17, 47.2%), a BSS score ≥5 (n = 9, 25%), or the full BSS score scale (n = 7, 19.4%). Joint-specific and arthroscopy JH studies were more recently published (2020.2 ± 3.5 vs 2014.2 ± 6.8, P < .001). Generalized JH studies more frequently reported separate subject sex and age data (53.6%, n = 15/28) while joint-specific or arthroscopy JH studies more often combined this information (92.7%, 33/36) (P = .001). Most generalized JH studies were Evidence Level II (85.7%, 24/28) while most joint-specific or arthroscopy JH studies were Evidence Level III (52.8%, 19/36) (P < .001). Group study quality and bias risk was comparable; however, generalized JH studies had more prospective research designs (96.4%, 27/28 vs 58.3%, 21/36 (P < .001). Generalized JH studies had more prospective research designs, had higher evidence levels, and more frequently reported separate subject age and sex details. Greater use of these characteristics in joint-specific or arthroscopy JH studies may strengthen surgical and clinical decision-making and patient outcome prediction validity. Level IV, narrative review of Level I to IV studies.
To quantitatively determine the attachment location for lateral extra-articular procedures (LEAP) relative to the lateral physes using magnetic resonance imaging (MRI) to guide implant placement and physeal avoidance. This study included a consecutive series of skeletally immature patients who underwent a knee MRI between 2000 and 2023. The LEAP attachment locations relative to the femoral and tibial physes were determined using MRI in skeletally immature knees without evidence of knee injury. Five hundred ninety-nine individual knee MRI studies met the inclusion criteria (285 males, 314 females). Chronological and bone age for both males (r = .92, P = .0001) and females (r = .89, P = .0001) were strongly correlated; mean chronologic age was 14.4 years (SD 2.8) for males and 14.1 years (SD 2.6) for females. Mean distance from femoral LEAP attachment to the physis was 8.7 mm (SD .1) in males and 7.1 mm (SD .1) in females, increased with increasing age for males (P = .0001). Mean distance from the tibial ALL attachment to the physis was 11.0 mm (SD .1) in males and 9.4 mm (SD .1) in females, increased with increasing age (P = .0001). Mean lateral-femoral physeal obliquity was 28.5° (SD .4) in males and 30.0° (SD .4) in females (P = .0001). Mean tibial physeal obliquity 29.2° (SD .4) in males and 33.1° (SD .4) in females (P = .0004). The proximity of femoral surface attachment was closer to the physis than the tibial attachment across all patients, 7.8 mm vs 10.1 mm (P = .0001). The lateral femoral and tibial physes are close to surface attachment points for LEAP performed in conjunction with anterior cruciate ligament reconstruction in skeletally immature patients. The femoral LEAP surface attachment was significantly closer to the physis compared to the tibial attachment. LEAP are performed more frequently with anterior cruciate ligament reconstruction in skeletally immature patients and avoidance of physeal injury is important.
To perform a systematic review to evaluate the reported proportions of labral repair and reconstruction performed during primary hip arthroscopy. A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify studies, published from 2015 to October 2024, on primary hip arthroscopy reporting a number of hips undergoing labral repair versus reconstruction. When labral debridement was performed, these numbers were included as well. The search phrase used was: hip AND arthroscopy AND labral AND repair AND reconstruction. Outcomes reported were the numbers of labral repairs, reconstructions, and debridements in each study. Seven studies (all Level III) met the inclusion criteria with a total of 4,134 hips undergoing primary hip arthroscopy. Mean patient age ranged from 28.4 to 43.7 years, and the overall percentage of male patients ranged from 11.8% to 52.8% across studies. Procedures were carried out by a total of 13 surgeons. The proportion of cases in which labral repair was performed ranged from 25.7% to 86.9% across studies. Overall, 3,184 labral repairs, 902 labral reconstructions, and 48 selective labral debridements were performed. These procedures represented 25.6% to 86.9%, 13.1% to 21.8%, and 0.0% to 5.5% of procedures, respectively. Among studies reporting labral repair and reconstruction during primary hip arthroscopy, the proportion of each procedure performed varies widely. These findings highlight the procedural heterogeneity across surgeons performing hip arthroscopy. Level III, systematic review of level III studies.
To evaluate clinical outcomes of augmenting an anterior cruciate ligament (ACL) allograft with an amnion matrix wrap and injecting bone marrow aspirate concentrate (BMAC). We enrolled 10 ACL reconstruction patients aged 22-60 years with hamstring allografts wrapped with an amnion collagen matrix and injected with BMAC in this prospective case series. Participants completed physical therapy and reported outcomes for 2 years. Postoperative magnetic resonance imaging scans were mapped/processed at 3, 6, 9, and 12 months, yielding mean transverse relations time constant (T2∗) and volume values for grafts and bone tunnel integration. We assessed the longitudinal outcomes of allograft augmentation using descriptive statistics and confidence intervals, showing significant increases in average Knee Injury and Osteoarthritis Outcome Score (KOOS5) and Single Assessment Numerical Evaluation (SANE) scores (KOOS5: Baseline-24 months [m] = 64.2-84.8, 95% confidence interval [CI] 9.14-32.56, SANE: Baseline-24m = 33.8-87.9, 95% CI 38.71-64.87). Average Veterans RAND 12 Item Health Survey (VR-12) Physical scores significantly increased from baseline to 24 months postoperation (Baseline-24m = 35.1-49.6, 95% CI 8.25-20.30). Average visual analog scale for pain scores significantly decreased from baseline at all time points except 2 weeks postoperation (baseline-2 weeks = 2.7-3.6, 95% CI -0.19 to 2.07) starting at 6 weeks postoperation (baseline-6 weeks = 2.7-1.3, 95% CI -2.52 to -0.26) and remained significantly lower than baseline to 24 months postoperation (baseline-24m = 2.7-0.6, 95% CI- 3.27 to -0.85). Average Max Activity Scale scores were significantly decreased from baseline starting at 12 months postoperation (baseline-12m = 6.3-2.7, 95% CI -6.32 to -0.88) but returned to baseline levels at 24-months postoperation (Baseline-24m = 6.3-5.8, 95% CI -4.45 to 1.45). There were no significant differences in VR-12 mental component scores or magnetic resonance imaging measures. No infections nor reconstruction failures occurred after 2 years. This case series demonstrated augmenting hamstring allograft ACL reconstruction with an amnion collagen matrix and injecting BMAC appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation. Level IV, therapeutic case series.
To analyze reporting bias in the form of spin present in systematic reviews and meta-analyses related to medial patellofemoral ligament reconstruction (MPFLR). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, systematic reviews were collected from PubMed, Web of Science, and Embase using the search "medial patellofemoral ligament reconstruction" or "MPFLR" AND "systematic review" OR "meta-analysis." Abstracts were assessed for 15 common spin types. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) was used to evaluate the quality of the studies. Characteristics such as Preferred Reporting Items for Systematic Reviews and Meta-Analyses adherence, publication year, and level of evidence were analyzed. Associations between these factors and spin presence or type were determined using statistical tests, including t tests, analysis of variance, Fisher tests, and Spearman rank coefficients. The initial database search identified 1,044 studies, of which a total of 57 studies were included. Spin was present in the abstract in 51 of 57 studies (89.5%). Each type of spin was observed in at least 1 study's abstract with the exceptions of spin types 1, 7, 13, and 15. The 3 most common types were type 5 (48/57, 84.2%), followed by type 3 (32/57, 56.1%) and type 9 (30/57, 52.6%). Of the included studies, 91.2% received a critically low AMSTAR 2 confidence rating, and only 5.3% reported a conflict of interest. There was a statistically significant negative correlation between the numerical AMSTAR 2 rating and the presence of spin (P < .01). Most systematic reviews on MPFLR received critically low AMSTAR 2 ratings, reflecting the poor quality of evidence in this area. Nearly 90% of abstracts exhibited at least 1 type of spin, with spin types 3, 5, and 9 being the most common, suggesting a tendency to overstate the efficacy of MPFLR for patellar instability. Level IV, systematic review of Level II-IV studies.
To evaluate clinical outcomes of anterior cruciate ligament reconstruction (ACLR) using a quadriceps tendon autograft (QTA) with adjunctive bone marrow aspirate concentrate, demineralized bone matrix, and suture tape augmentation. A retrospective review was conducted using a prospectively maintained registry of patients who underwent all-inside ACLR with QTA, adjunctive bone marrow aspirate concentrate, demineralized bone matrix, and suture tape augmentation between July 2018 and October 2022 at a single institution. Patients with less than a 2-year follow-up were excluded. A telephone survey assessed return to preinjury activity level, and patient-reported outcomes were collected, including the International Knee Documentation Committee subjective score, ACL Return to Sport after Injury score, and Visual Analog Scale for pain. Complications such as graft rerupture and total reoperations were also recorded. One hundred twenty patients (81%) received QTA ACLR, with 98 (81.7%) completing ≥2-year follow-up (37 female, 61 male; mean age 19.4 years, range 15-32). Mean follow-up was 3.4 years (range, 2.0-5.9). All patients were cleared for full activity at 6 months postoperatively. At the time of telephone follow-up, 90 patients (91.8%) reported they had returned to their preinjury activity levels. In all 98 patients, mean International Knee Documentation Committee and ACL Return to Sport after Injury scores were 84.0 ± 7.3 and 93.4 ± 17.2, respectively. There were 3 graft reruptures (3.1%) and 9 contralateral ACL tears (9.2%). All-inside ACLR with QTA, adjunctive bone marrow aspirate concentrate, demineralized bone matrix, and suture tape augmentation showed high rates of return to preinjury activity and low graft rerupture rates at a minimum of 2 years of follow-up. Level IV, retrospective therapeutic case series.