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To examine the association between systemic Janus kinase (JAK) inhibitor use and the incidence of newly diagnosed dry eye disease (DED) in patients with rheumatoid arthritis (RA). This multi-institutional retrospective cohort study used de-identified electronic health records from the United States Collaborative Network. Adults aged 18 years or older with RA were categorized according to systemic JAK inhibitor use or non-use. A secondary active-comparator analysis compared JAK inhibitor users with rituximab-treated patients. Propensity score matching was performed to balance demographic characteristics, comorbidities, medication history, ocular conditions, and healthcare utilization. The primary outcome was newly diagnosed DED. Time-to-event analyses were conducted using Kaplan-Meier methods and Cox proportional hazards models. A total of 25,149 JAK inhibitor users and 150,250 non-users with RA were identified. After matching, each cohort contained 23,343 patients with balanced baseline characteristics. JAK inhibitor use was associated with a lower incidence of newly diagnosed DED compared with non-use within 1 year of follow-up (hazard ratio [HR], 0.633; 95% CI, 0.545-0.736). In the secondary active-comparator analysis, 6,637 JAK inhibitor users were matched to 6,637 rituximab-treated patients, and JAK inhibitor use remained associated with a lower incidence of newly diagnosed DED (HR, 0.613; 95% CI, 0.476-0.791). Individual-agent analyses showed directionally consistent associations for tofacitinib and upadacitinib. Findings were consistent across sensitivity analyses using varying follow-up durations and landmark definitions. In this large real-world cohort study, JAK inhibitor use was associated with a lower incidence of newly diagnosed DED among patients with RA, with similar findings in a rituximab active-comparator analysis. However, the observational design, residual confounding, and coding-based outcome definition preclude causal inference. Prospective studies incorporating standardized ocular surface assessments and direct RA disease activity measures are needed to clarify the clinical relationship between systemic JAK inhibition and DED.

Recent evidence suggests that meniscotibial ligament disruption with progressive extrusion often precedes medial meniscus posterior root tears, clarifying the limited efficacy of isolated root repair. Accordingly, combined root repair and centralization yield more favorable biomechanical restoration and clinical outcomes. This technical note describes an arthroscopic root repair reinforced by dual centralization to enhance stability and recovery.

Significant meniscal injuries lead to pain and possible early osteoarthritis development. Fibrin clot augmentation represents an effective, cost-efficient method for improving healing rates in poorly vascularized meniscal tears. This arthroscopic technique shows fibrin clot augmentation combined with horizontal and vertical mattress sutures in a "ripstop" configuration for radial midbody medial meniscus tears. Thirty milliliters of autologous blood is collected and processed to form a fibrin clot, which is introduced inside-out through an endotracheal tube to optimize surface contact within the tear. The clot is secured with braided sutures while meniscal repair is performed using 2-0 polydioxanone sutures in a ripstop configuration. A similar technique may be used for any repair requiring biological augmentation. Rehabilitation protocols include 4 weeks of nonweight-bearing, followed by graduated weight-bearing to achieve full weight-bearing by 8 weeks. Range-of-motion restrictions vary by tear location. This technique provides a cost-effective, low-complexity technique for biological augmentation of repair of high-risk meniscus tears, potentially improving healing probability.

Abnormal femoral torsion is associated with labral and chondral tears, hip pain, and early onset arthritis. Derotational femoral osteotomy (DFO) is the surgical treatment of choice to correct femoral torsional deformity, restore normal hip joint mechanics, and improve clinical outcomes. DFO is often performed in conjunction with hip arthroscopy to address intra-articular pathology, which requires hip joint distraction for visualization. In these cases, the same setup can be carried out seamlessly, allowing for an easy transition between procedures, thus increasing operative efficiency. Traditionally, this combined approach was performed using perineal post traction beds, which carry risks of groin complications and pudendal nerve injury, occasionally resulting in severe consequences. To avoid these complications, postless traction beds were developed to provide safe and reliable distraction without the morbidity associated with perineal posts. This technical note describes the operative management of dual hip arthroscopy and DFO with a postless traction bed offering a safe, reproducible, and efficient surgical technique for managing patients requiring concurrent hip arthroscopy and DFO. Additionally, this paper describes the advantages of the postless traction bed for DFO surgery, even if arthroscopy is not performed concurrently.

Partial-thickness articular-sided gluteus medius and minimus tears-referred to as gluteal undersurface concealed crescent injury lesions-can cause debilitating pain. Persistent symptoms despite nonoperative care indicate operative management. Conventional endoscopic repair techniques for partial-thickness gluteal tears have commonly involved a transtendinous approach, which involves tendon splitting, anchor placement, and knot tying. Despite satisfactory outcomes, several characteristics of conventional techniques may perpetuate pain and irritation postoperatively and result in prolonged operative and recovery times. This technical note describes a tissue-sparing gluteal undersurface concealed crescent injury tear repair using all-suture knotless anchors in an "X-linked" compressive configuration (GUCCI-X).

To identify maternal and intrapartum risk factors associated with obstetric anal sphincter injury (OASIS) among Asian women who underwent singleton term vaginal delivery at a tertiary perinatal center in Japan. We conducted a retrospective cohort study including 2334 Asian women who underwent singleton term vaginal delivery at Kitasato University Hospital between January 2020 and December 2024. Maternal characteristics and intrapartum variables were extracted from the institutional perinatal database and electronic medical records. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors for OASIS. Among 2334 singleton term vaginal deliveries, OASIS occurred in 101 women (4.3%). Multivariable logistic regression analysis demonstrated that nulliparity (adjusted odds ratio [aOR] 4.86, 95% confidence interval [CI] 2.47-9.58), instrumental delivery (aOR 4.02, 95% CI 2.19-7.37), and abnormal cardiotocography (CTG) findings (aOR 2.17, 95% CI 1.39-3.37) were independently associated with OASIS. Abnormal CTG findings may represent a potentially novel risk factor for OASIS among Asian women, while nulliparity and instrumental delivery were confirmed as established risk factors. Increased attention to perineal protection may be warranted in women with these risk factors during vaginal delivery.

Increasing evidence suggests that autoimmune responses are involved in the pathogenesis of age-related macular degeneration (AMD). This study aimed to characterize changes in serum autoantibody-captured retinal antigens in patients with different AMD subtypes, in order to gain further insight into the immunological mechanisms associated with AMD progression. Serum samples were collected from healthy controls (CTRL, n = 15) and patients with early AMD (n = 15), intermediate AMD (Int. AMD, n = 15), late AMD (n = 15), neovascular AMD with type 1 macular neovascularization (nAMD type 1, n = 10), and neovascular AMD with type 2 macular neovascularization (nAMD type 2, n = 10). Serum antibodies were isolated using Protein G magnetic beads and incubated with porcine retinal lysates to capture antigen-antibody complexes. After elution, the captured retinal antigens were subjected to proteomic analysis. Mass spectrometry identified 91 differentially captured retinal antigen targets across AMD subtypes. Compared with controls, 11, 9, 11, 18, and 22 retinal antigen targets were significantly increased in serum samples from patients with early AMD, intermediate AMD, late AMD, nAMD type 1, and nAMD type 2, respectively. Conversely, 14, 11, 9, 10, and 20 retinal antigen targets were decreased in the corresponding AMD subtypes, respectively (FDR < 0.05; p < 0.05). Selected mass spectrometryderived retinal antigen targets were further evaluated in serum and tear samples using antigen microarray analysis. Consistent with the proteomics results, anti-ATP5A1, anti-HIST2H2AA3, and anti-PFKM autoantibody levels were significantly increased in tears from patients with nAMD type 2 (p = 0.03, p = 0.01, and p = 0.04, respectively). In addition, anti-FTH1 autoantibody levels were decreased in serum from patients with nAMD type 1. Comprehensive screening of serum autoantibody-captured retinal antigens across AMD stages, together with pathway enrichment and STRING network analyses, revealed subtype-specific immune alterations. These findings provide new insights into the immunopathological features of AMD.

Hypermobile lateral meniscus refers to abnormal mobility of an otherwise morphologically normal meniscus without obvious tears, causing lateral knee pain due to catching or locking of the lateral meniscus during flexion. The most common cause is rupture or elongation of the popliteomeniscal fascicles (PMFs), which connect the lateral meniscus to the joint capsule around the popliteus tendon. Hypermobile lateral meniscus is most commonly managed with simple, minimally invasive all-inside meniscal repair techniques or inside-out suture techniques. However, nonanatomic suturing not only results in unphysiologic repair but may also compromise popliteus tendon function. We describe a simple all-inside technique using a standard all-inside meniscal fixation device to anatomically repair the anteroinferior and posterosuperior PMFs. This approach reproduces the native fascicular anatomy while avoiding perforation of the popliteus tendon. The technique restores lateral meniscal stability, minimizes the risk of iatrogenic popliteus tendon injury, and does not require additional posterior portals or graft harvesting, allowing it to be performed with commonly available devices.

Antibiotic prescribing in simple hand trauma is variable, and poor documentation may undermine antimicrobial stewardship. This study combined a closed-loop audit with a literature review to evaluate prescribing practices and current evidence regarding prophylactic antibiotic use in hand trauma. A retrospective closed-loop audit of adult patients presenting with simple hand trauma to a tertiary plastic surgery trauma clinic was performed over two 2-week cycles. Uncomplicated lacerations and nail bed injuries were included, while bite wounds, crush injuries, and open fractures were excluded. Data collected included wound characteristics, antibiotic prescribing practices, and documentation quality. Following cycle one, a departmental teaching session on antimicrobial stewardship and a revised trauma clinic proforma with mandatory prescribing prompts were introduced prior to re-audit. A literature review of PubMed, Scopus, and Google Scholar was also conducted. Twenty-two patients were included in cycle one and 15 in cycle two. In cycle one, antibiotics were prescribed in 72% (15/22) of cases, with poor documentation of indication (6.7%), wound status (6.7%), antibiotic choice and route (40%), and duration (20%). Following intervention, prescribing reduced to 60% (9/15; p=0.099). Documentation of indication, wound status, duration, and appropriate antibiotic choice improved to 100%. The literature review demonstrated substantial variation in prescribing practices and limited evidence supporting routine prophylactic antibiotics in uncomplicated hand trauma. Antibiotic prescribing and documentation in simple hand trauma were suboptimal at baseline. Targeted education and redesign of the trauma proforma improved documentation quality and adherence to antimicrobial stewardship principles, highlighting the value of simple, low-cost interventions in supporting evidence-based prescribing.

Pelvic health physiotherapy (PHPT) is a recommended, evidence-based approach in the management of pregnancy- and childbirth-related pelvic health conditions. However, it remains unclear how many women can access these services. Therefore, the aim of this study was to examine access to PHPT during pregnancy and after childbirth. A cross-sectional study was conducted using an online survey. Women who had given birth in the past 4 years and resided in the province of Quebec (Canada) were eligible to participate. The survey included questions on obstetric history, pelvic health conditions, and access to services. Data were analyzed using descriptive statistics and logistic regression. Data from 3,822 women were included in the analysis. More than 95% of them reported at least one pelvic health condition that lasted for more than 3 months during pregnancy and/or in the postpartum period. Physiotherapists were the most frequently consulted specialists, with one-half of the women with pelvic health conditions (50.4%) seeking their services. Among the remaining one-half, the main reasons for not consulting PHPT included perceiving the issues as normal and self-resolving, a lack of awareness that PHPT could help, and the absence of a referral or recommendation. Accessing PHTP was most strongly associated with higher income and university education, third- or fourth-degree perineal tears, and experiencing diastasis recti or pelvic organ prolapse, with each of these factors associated with more than double the odds of consulting PHPT. The results reveal poor access in a population with a high need for PHPT services, largely due to insufficient knowledge about pelvic health conditions and a lack of awareness of the relevance of PHPT.

Supraspinatus tendon tears are a common cause of shoulder pain and dysfunction. Although magnetic resonance imaging and computed tomography arthrography are still considered the gold standard, ultrasound offers a reliable, accessible, and radiation-free alternative. However, identifying tears can be challenging, particularly for less experienced operators. This technical note describes a simple dynamic ultrasound maneuver employing a Pilates elastic band. With the patient in a modified Crass position, the band is secured around the pelvis to provide controlled resistance during active lateral elevation of the shoulder. This loading mobilizes joint fluid and applies physiological stress to the tendon, thereby enhancing visualization of tears through gapping or altered gliding. This simple, well-tolerated technique could improve diagnostic accuracy, as well as guiding rehabilitation and surgical decisions.

Recent literature showing equivalent outcomes for surgical and nonoperative management of Achilles tendon ruptures emphasizes the importance of proper indications for surgical repair. Various techniques for tendon repair via reapproximation of the torn ends have been described, such as open, mini-open, and minimally invasive, each with their own advantages and disadvantages. This technique note describes a modified double transverse mini-open repair procedure for proximal Achilles tendon tears that addresses the limited mobility of the distal stump seen with proximal tears, allowing for reapproximation and high healing rate. Advantages of this technique include simplicity, high reproducibility, and limited disruption of the posterior watershed region of the superficial skin and soft tissue overlying the tendon. This decreases the risk of wound complications that can lead to surgical site infections and skin-tendon adhesion.

This technique describes a tensionable knotless tendon-sparing biceps rerouting for superior capsular reconstruction using the long head of the biceps in irreparable supraspinatus tears. The long head of the biceps is arthroscopically released from the bicipital groove, rerouted over the greater tuberosity footprint, and secured with 2 self-punching, double-loaded knotless all-suture anchors, creating tensionable loops that stabilize both the long head of the biceps and infraspinatus or anterior cuff remnants. Medial side-to-side sutures further enhance reduction and stability. This technique preserves the tendon, avoids perforation of the tendon tissue, and eliminates the need for graft harvesting or bone tunnels. The approach is reproducible, minimally invasive, and suitable for degenerative or inflamed tendons, providing biomechanical stability and improved functional outcomes. Diligent patient selection remains critical for optimal results.

The deep layer of the triangular fibrocartilage complex (distal radioulnar ligament) serves as the primary stabilizer of the distal radioulnar joint. Historically, the deep triangular fibrocartilage complex was reattached to the ulnar fovea using bone tunnel or suture anchor techniques to achieve isometric repair. However, with advances in anatomical research, a more refined approach has emerged, using suture anchors for anatomic repair of the deep triangular fibrocartilage complex on the radial wall of the ulnar fovea. Additionally, the introduction of ligament remnant preservation techniques has enhanced ligament-to-bone healing.

The long head of the biceps tendon is a valuable autologous tissue for biologic augmentation in rotator cuff repair. Redirecting the long head of the biceps tendon can enhance its role as a humeral head depressor, limiting superior humeral head migration, and improving rotator cuff force couple and shoulder biomechanics. Incorporating the long head of the biceps tendon into the rotator cuff repair construct can enhance the repair by acting as a biologic internal brace, promoting load sharing and improving structural integrity. This technique may improve healing, repair durability, and functional outcomes, especially in large or revision tears with poor tissue quality.

Anterior cruciate ligament (ACL) ruptures can cause knee instability, potentially leading to meniscal and chondral injury if left untreated. Recent guidance suggests listing ACL reconstruction as lower priority without meniscal pathology. This study examines the risk of subsequent meniscal tears with delayed surgery. We conducted a retrospective cohort study (January 2018-March 2024) of consecutive patients who underwent ACL reconstruction. Patients were categorised by preoperative magnetic resonance imaging (MRI) findings of meniscal tears, and time from listing to surgery. Intraoperative findings of meniscal tears were recorded. Nonparametric testing and binary logistic regression determined risk factors for meniscal pathology with delayed surgery. Among 272 patients, 15.1% had new meniscal tears identified intraoperatively that were absent on initial MRI scan, with a male-to-female ratio of 3:1. Additionally, 5% had MRI-detected pathology not confirmed surgically. Median time to diagnosis was 21 days, and median time to surgery was 140 days. Age and time to diagnosis did not affect outcomes (p>0.05). Body mass index (BMI) differences were not significant overall but became significant when outliers (BMI>43) were excluded (p=0.038). Logistic regression, adjusting for sex and BMI, showed a 0.3% increase in meniscal tear risk per waiting day (p=0.013). This study highlights the risk factors and progression of meniscal tears following delayed ACL reconstruction. Patient BMI and waiting list duration are important factors for risk reduction. With a delay of a month to surgery, the likelihood of developing a meniscal tear increases by nearly 10%. These findings emphasise the importance of early intervention, and potential re-evaluation of the current guidance.

Degenerative tendon tears are common, but mechanisms behind initiation and progression are not fully understood. There is a clear need to be able to track microstructural changes during progressive biological degradation to better understand degenerative tendon pathophysiology. The aim of this study was to evaluate the sensitivity of a snapshot Stokes polarimetry technique, quantitative polarized light imaging (QPLI), in monitoring the severity and progression of biologically mediated degeneration in tendon. Leveraging a collagenase mediated in vitro tendon digestion model, we assessed the effect of enzyme degradation on polarimetric outcomes from reflectance and transmission modes of QPLI, second harmonic generation (SHG) imaging, histology, and mechanical testing. Changes observed in reflectance mode QPLI (rQPLI) allowed for characterization of progression of degeneration at all digestion severities tested, whereas data acquired from transmission mode QPLI was only able to discern changes at the most severe digestion level. Outcomes from this study establish rQPLI as a powerful tool in the microstructural evaluation of musculoskeletal soft tissues, particularly in the context of monitoring progressive degradation. The findings from this study also highlight the potential multiscale nature of biological degeneration in tendon and emphasize the importance of better understanding these processes to inform regeneration and repair strategies.

There is a paucity of literature comparing the midterm outcomes of arthroscopic labral reconstruction and arthroscopic labral repair in the revision setting. To evaluate the minimum 5-year patient-reported outcomes (PROs) of patients who underwent revision hip arthroscopy, comparing labral reconstruction with labral repair. Cohort study; Level of evidence, 3. A retrospective analysis was performed for patients who underwent revision hip arthroscopy, either labral repair or labral reconstruction, to treat femoroacetabular impingement and labral tears between 2008 and 2019. Patients who underwent reconstruction were matched 1:1 to patients who underwent repair. Included patients had complete preoperative and minimum 5-year follow-up scores for at least one of the following PRO measures: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, patient satisfaction, and visual analog scale for pain. Rates of achieving the minimal clinically important difference and patient acceptable symptom state as well as secondary surgery rates were compared between groups. A total of 68 patients were included, with 34 patients who underwent labral reconstruction successfully matched to 34 patients who underwent labral repair, controlling for age, body mass index, sex, acetabular Outerbridge grade, and capsular treatment. The reconstruction group had a significantly higher incidence of Seldes type 1 and 2 labral tears (n = 21 [61.8%]) compared to the repair group, which had a higher proportion of Seldes type 1 tears (n = 11 [32.4%]) (both P < .05). Both groups demonstrated a significant improvement in scores from preoperatively to postoperatively (all P < .01) and achieved the minimal clinically important difference and patient acceptable symptom state at similar rates across all PRO measures. There were no significant differences between groups in the rates of revision arthroscopy or conversion to arthroplasty. Patients undergoing revision hip arthroscopy with adequate labral treatment, either labral reconstruction or labral repair, can expect favorable and comparable outcomes, reaching clinically relevant thresholds at similar rates, with a low complication rate, at midterm follow-up.

To evaluate the clinical outcomes and survivorship of hip arthroscopy with simultaneous labral and ligamentum teres (LT) reconstruction for the treatment of irreparable labral and LT tears, with a minimum follow-up of 2 years. Prospectively collected data were retrospectively reviewed for patients who underwent combined arthroscopic labral and LT reconstruction between 2017 and 2021. Inclusion criteria required completion of preoperative and 2-year postoperative patient-reported outcomes, including the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, International Hip Outcome Tool, and visual analog scale. Clinically relevant thresholds-minimal clinically important difference and patient acceptable symptom state-were included in the analysis. Survivorship was defined as the absence of revision surgery or conversion to total hip arthroplasty. Seven patients underwent hip arthroscopy with concomitant LT and labral reconstruction, all with 2-year follow-up. Six patients (85.7%) underwent the procedure as revision surgery. Statistically significant improvements were observed across all evaluated patient reported outcomes measures, with a mean patient satisfaction score of 7.4. All patients (100%) met the minimal clinically important difference for modified Harris Hip Score, Non-Arthritic Hip Score, and visual analog scale. Additionally, 6 patients (85.7%) achieved minimal clinically important difference for International Hip Outcome Tool and Hip Outcome Score-Sports-Specific Subscale. Five patients (71.4%) answered positively to the patient acceptable symptom state anchor question. A 100% arthroplasty-free survivorship at 2 years was observed; subsequently, at 38 months, 1 patient underwent conversion to total hip arthroplasty. Hip arthroscopy with simultaneous labral and LT reconstruction for irreparable tears resulted in significant improvements in functional outcomes and high patient satisfaction. A high proportion of patients achieved clinically meaningful thresholds at a minimum 2-year follow-up. Notably, a high arthroplasty-free survivorship rate was observed at short-term follow-up. Level IV, therapeutic retrospective case series.