BACKGROUND:Arthroscopic cortical surface tenodesis has been established as an effective technique for managing lesions of the long head of the biceps tendon (LHBT). However, traditional suture techniques frequently provide insufficient initial mechanical strength, which may contribute to tenodesis failure. To address this limitation, the Lark-Loop suture technique was developed. PURPOSE:To compare the biomechanical, histological, and radiological outcomes of Lasso-Loop, Lark-Loop, and Krackow suture techniques for cortical surface tenodesis of the LHBT in a rabbit model. STUDY DESIGN:Controlled laboratory study. METHODS:A total of 75 New Zealand White rabbits underwent bilateral proximal biceps tenodesis using a cortical surface fixation model. Animals were randomly assigned to 1 of 3 groups: (1) Lasso-Loop suture (control group; n = 25), (2) Lark-Loop suture (experimental group; n = 25), and (3) Krackow suture (positive control group; n = 25). At 4, 8, and 12 weeks postoperatively, 21 rabbits from each group (n = 63 total) were sacrificed for evaluation: 3 rabbits per group were used for magnetic resonance imaging and histological analysis, and 4 rabbits per group for micro-computed tomography and biomechanical testing. An additional 12 rabbits (4 per group) were used for initial biomechanical testing at week 0. One-way analysis of variance and Bonferroni post hoc correction were used to assess between-group differences. A P value <.05 was considered statistically significant. RESULTS:Macroscopically, complete healing at the tenodesis site was observed in all groups at 12 weeks. The Lark-Loop group demonstrated significantly improved signal-to-noise quotient values, mechanical strength, new bone formation, and histological tendon-bone integration compared with the Lasso-Loop group at all time points. No significant differences were observed between the Lark-Loop and Krackow groups. CONCLUSION:This study demonstrated that all 3 suture techniques achieved effective tendon-bone healing in a rabbit model. The Lark-Loop technique provided enhanced biomechanical properties and histological healing compared with the Lasso-Loop technique, and comparable outcomes to the Krackow stitch. CLINICAL RELEVANCE:The findings suggest that the Lark-Loop technique may serve as a viable arthroscopic alternative for LHBT tenodesis in clinical practice, potentially enhancing tendon-bone healing and reducing failure rates.
BACKGROUND:Bone-patellar tendon-bone (BTB) autografts have been considered the gold standard for anterior cruciate ligament reconstruction, although the popularity of quadriceps tendon (QT) autografts is increasing. HYPOTHESIS/PURPOSE:The purpose of this study was to compare the ultrasound-derived cross-sectional area (CSA) and biomechanical strength of BTB and QT grafts harvested with different techniques. The authors hypothesized that ultrasound CSA measurements would be reliable and that QT grafts would be larger and stronger than BTB grafts, without differences between QT harvest methods. STUDY DESIGN:Controlled laboratory study. METHODS:Thirty grafts from 15 cadaveric knees included 15 BTB grafts harvested with a 9-mm double-blade scalpel, 7 full-thickness QT grafts harvested with the same 9-mm double-blade scalpel (DB-QT), and 8 QT grafts harvested with a proprietary 9-mm cylindrical QT harvester (CH-QT). CSA was measured at 3 regions with ultrasound by 2 raters, followed by cyclic loading and pull-to-failure testing. Between-group differences were analyzed, and associations between CSA and biomechanical outcomes were assessed with linear regression. RESULTS:Ultrasound CSA demonstrated good to excellent reliability (ICC2,1 = 0.70-0.87; ICC2,k = 0.82-0.93). CSA differed between graft types (mean ± SD; BTB, 0.44 ± 0.08 cm2; CH-QT, 0.64 ± 0.10; DB-QT, 0.97 ± 0.22; all pairwise P < .01), with heterogeneous variance (Levene P = .002). DB-QT demonstrated greater CSA variability than BTB (P = .005) and no difference in variability when compared with CH-QT (P = .055). Maximum load and energy to maximum load differed significantly (both omnibus P < .001) with DB-QT > CH-QT > BTB, with significant post hoc differences. In paired-knee analyses, pooled QT grafts also demonstrated greater maximum displacement than BTB grafts from the same specimens. CH-QT demonstrated significantly greater variability in maximum load than BTB (P = .002) and DB-QT (P = .045). Mean displacement at maximum load and stiffness were similar, although variance differed. Cyclic elongation differed among grafts (omnibus P = .011), with DB-QT < CH-QT < BTB, while other cyclic measures did not differ. When grafts were pooled, CSA correlated positively with maximum load and energy to maximum load; however, within-graft type regressions were not significant. After normalization to CSA, stress and strain were similar across graft types. CONCLUSION:QT grafts were significantly larger and stronger than BTB, with full-thickness double-blade harvest producing the greatest CSA and load to failure. Ultrasound was a reliable tool to measure CSA, which correlated with graft strength. CLINICAL RELEVANCE:QT grafts demonstrate greater structural capacity than BTB, and QT harvest technique influences graft size and strength, with double-blade harvest producing larger, stronger grafts.
BACKGROUND:The medial collateral ligament (MCL) is the most frequently injured knee ligament. MCL repair is a surgical technique intended to acutely reduce medial side laxity that can be performed in isolation or combined with suture augmentation (SA). PURPOSE:To assess the effect of MCL repair with and without SA on (1) valgus laxity and anteromedial rotational laxity and (2) force carried by the anterior cruciate ligament (ACL) and (3) to quantify load-sharing between the MCL repair and SA components. STUDY DESIGN:Controlled laboratory study. METHODS:Seven cadaveric knees were tested using a 6 degrees of freedom robotic manipulator in 4 states: (1) intact, (2) MCL cut, (3) isolated MCL repair, and (4) MCL repair combined with SA. Valgus laxity and anteromedial rotational laxity were measured at 0°, 15°, 30°, and 90° of flexion. In situ ACL force and forces carried by the MCL repair components were assessed at peak valgus moment using principle of superposition. RESULTS:Valgus laxity after isolated MCL repair was greater than the intact state at all flexion angles >0° (P≤ .01). The addition of SA to MCL repair significantly reduced valgus laxity at 15° and 30° of flexion only (P≤ .02). Anteromedial rotational laxity after both MCL repairs was greater than the intact state at 90° of flexion (P < .01), whereas no differences were detected at 0° and 30°. For both MCL repairs, ACL force was less than in the MCL cut state and did not differ from the intact state. In situ forces carried by the repair and SA components did not differ for the MCL repair combined with SA. CONCLUSION:Both MCL repair with and without SA reduced ACL force relative to the MCL cut state. Addition of SA to MCL repair resulted in less residual valgus laxity but not less anteromedial rotational laxity. CLINICAL RELEVANCE:These findings suggest that MCL repair may reduce medial side laxity and partially offload the ACL relative to the MCL cut state. This is particularly important for treatment of combined ACL and MCL injuries, where the protection of the ACL graft or repair is most important immediately after surgery.
BACKGROUND:The Latarjet procedure is widely used for recurrent anterior shoulder instability with glenoid bone loss. Arthroscopic techniques are increasing; however, there is limited evidence for mid- to long-term outcomes. PURPOSE:To evaluate clinical outcomes, recurrence rates, and quality of life at a minimum of 5 years' follow-up after undergoing the arthroscopic Latarjet procedure. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Patients who underwent the arthroscopic Latarjet procedure using double-screw fixation at Oslo University Hospital between 2014 and 2019 were prospectively registered. Descriptive data and Western Ontario Shoulder Instability Index (WOSI) scores were recorded preoperatively and at 1 and 5 years postoperatively. At 5 years, complications and health-related quality of life (HRQoL; EQ-5D-5L) were assessed. RESULTS:Of 107 patients who underwent the arthroscopic Latarjet procedure, 93 cases met the inclusion criteria. After loss to follow-up, 85 cases were included. The median follow-up time was 5.2 years (range, 5.1-9.4 years). The median age at surgery was 27.8 years (range, 15.6-49.8 years), and 78 of 85 (92%) cases were male. Of the 85 cases, 56 (66%) had >10 dislocations before surgery, and 36 (42%) were revision procedures. At the 5-year follow-up, 2 of 85 patients experienced recurrent dislocations, and 8 of 85 reported subluxations. The median WOSI score improved significantly from 51% (IQR, 29.1%-62.4%) preoperatively to 79% (IQR, 62.9%-91.4%) at 5 years (P < .001). The median WOSI score at 1 year was 80% (IQR, 67%-88.4%), with no significant difference between the 1-year and 5-year scores (P = .69). The mean EQ-5D-5L index scores at 5 years were 0.889 ± 0.169 compared to 0.896 ± 0.177 for general population norms, with no significant difference (P = .77). Overall, 87% of patients reported satisfaction with the surgical outcome. Ten patients underwent reoperation due to complications. CONCLUSION:At a minimum 5-year follow-up, the arthroscopic Latarjet procedure resulted in significant improvement in WOSI score, low rates of recurrent dislocation, and high patient satisfaction. The WOSI score remained stable over 1 to 5 years. HRQoL, assessed using the EQ-5D-5L index, was comparable to age- and sex-matched general population norms at 5 years, supporting a satisfactory long-term impact on HRQoL.
BACKGROUND:Hip arthroscopy effectively treats femoroacetabular impingement syndrome (FAIS), but persistent pain may be related to concomitant extra-articular pathology such as subspine impingement syndrome (SSI). Standard diagnosis of SSI often relies on 3-dimensional computed tomography (3D-CT) morphology (Hetsroni type II/III), although this morphology is common in individuals who are asymptomatic and correlates poorly with symptoms. PURPOSE:To compare minimum 2-year clinical outcomes after arthroscopic subspine decompression in patients with concurrent FAIS and type II/III anterior inferior iliac spine (AIIS) morphology, stratified by diagnostic method: 3D-CT morphology alone versus 3D-CT morphology plus a positive ultrasound-guided diagnostic injection. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:This study included patients aged 18 to 55 years with type II/III AIIS morphology who underwent primary hip arthroscopy for FAIS and SSI between January 2021 and November 2023 and had minimum 2-year follow-up. Patients diagnosed by CT morphology alone (CT classification group) were propensity score matched 1:1 to patients with a positive ultrasound-guided AIIS injection (injection group), with 57 patients per group. Matching variables were age, sex, body mass index, lateral center-edge angle, alpha angle, Tönnis grade, and Beighton score. All patients underwent arthroscopic subspine decompression. Patient-reported outcomes and rates of achieving the minimal clinically important difference, Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) were compared. RESULTS:Preoperative patient-reported outcome scores were similar between groups (all P > .05). At minimum 2-year follow-up, the injection group had significantly better scores on the modified Harris Hip Score (90.8 vs 84.2), Hip Outcome Score-Activities of Daily Living (88.4 vs 82.4), Hip Outcome Score-Sports Subscale (71.9 vs 64.1), 12-item International Hip Outcome Tool (83.9 vs 76.1), and visual analog scale for pain (1.2 vs 2.0) (all P < .001). Minimal clinically important difference rates were high in both groups, with higher rates in the injection group for modified Harris Hip Score (93% vs 77%; P = .033) and Hip Outcome Score-Activities of Daily Living (91% vs 75%; P = .042). PASS and SCB rates were significantly higher in the injection group across all patient-reported outcome measures (all P < .05). Revision and complication rates were low and did not differ significantly between groups. CONCLUSION:Both groups improved significantly after arthroscopic subspine decompression. However, patients with a positive ultrasound-guided diagnostic AIIS injection achieved higher PASS and SCB rates than those selected by CT morphology alone, suggesting that injection-confirmed SSI may improve patient selection for subspine decompression.
BACKGROUND:The high incidence of posttraumatic osteoarthritis after anterior cruciate ligament (ACL) injury and reconstruction suggests that biological mechanisms beyond joint instability contribute to disease progression. After injury, ACL-resident cells are exposed to inflammatory mediators within the joint and may influence the local inflammatory microenvironment; however, their global transcriptomic responses to inflammatory stimuli remain underexplored. HYPOTHESIS:Interleukin-1 beta (IL-1β) induces inflammatory transcriptomic responses in ACL remnant-derived (ACLr) fibroblasts, and transforming growth factor beta 1 (TGF-β1) attenuates these responses. STUDY DESIGN:Descriptive laboratory study. METHODS:Primary ACLr fibroblasts were isolated from ACL remnants (n = 10) collected at the time of knee surgery. Near-confluent cultures were treated with IL-1β (10 ng/mL) for 24 hours to model an inflammatory joint environment. Genome-wide transcriptional changes were assessed by RNA sequencing using an Illumina NovaSeq-6000, with selected targets confirmed by microfluidic digital polymerase chain reaction (PCR). To evaluate the effects of TGF-β1, ACLr fibroblasts pretreated with IL-1β were exposed to TGF-β1 (10 ng/mL) for 48 hours, and chemokine transcript levels were assessed using digital PCR. RESULTS:IL-1β induced broad inflammatory transcriptional responses characterized by upregulation of chemokines (CXCL6, CXCL8, CXCL5, CCL20, CXCL1, and CXCL3), cytokines (IL33, IL1B, and IL6), and matrix-degrading enzymes (MMP3 and MMP12), while suppressing extracellular matrix-associated genes (KRT14, COL21A1, POSTN, COL1A1, and COL6A3). Functional enrichment analysis demonstrated activation of immune and inflammatory responses, cytokine and chemokine signaling, and cell activation. TGF-β1 reduced the expression of all assessed IL-1β-induced chemokines, with reduction of up to 50%, with statistically significant suppression observed for 13 of the 16 chemokines. Concomitantly, TGF-β1 treatment reduced expression of CEBPB, NFKBIA, and NFKBIZ, transcripts implicated in inflammatory gene regulation. CONCLUSION:ACLr fibroblasts mounted a robust inflammatory transcriptomic response to IL-1β, characterized by marked induction of chemokines and inflammatory pathways. TGF-β1 attenuated many of these responses, supporting its role as a regulator of inflammatory signaling in ACL-resident cells. CLINICAL RELEVANCE:ACL-resident cells respond to injury and may contribute to the post-injury inflammatory microenvironment. Therapeutic modulation of inflammatory signaling in these cells could represent a strategy to mitigate early molecular events associated with post-traumatic osteoarthritis following ACL tear.
Background: Sex-based disparities in the anterior cruciate ligament (ACL) injury risk may be partly explained by cyclic variations in sex hormones that drive systemic shifts in tissue osmoregulation. Ultrashort echo time (UTE) T2 * magnetic resonance imaging provides a noninvasive, quantitative means of evaluating the water content and collagen orientation in tissue. Hypothesis: Eumenorrheic female participants will exhibit significant ACL T2 * changes across the cycle, while anovulatory control participants will demonstrate no significant changes over time. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 25 women with no prior knee injuries were enrolled: 10 premenopausal, eumenorrheic participants and 15 anovulatory control participants (6 postmenopausal and 9 premenopausal using oral contraceptives). Bilateral knee magnetic resonance imaging was performed at 4 time points evenly spaced over 1 month, with the first visit within 24 hours of menses onset. Ovulation status was confirmed using commercially available ovulation predictor kits. Three-dimensional UTE sequences (11 echoes; 0.03-25 ms) were acquired to evaluate bicomponent ACL T2 * metrics. Linear mixed-effects models assessed temporal differences in long and short T2 * values, and the Cohen d quantified effect size. Results: Eumenorrheic participants demonstrated significantly shorter preovulatory long T2 * values compared with postovulatory values (mean difference, 1.0 ms [95% CI, 0.2-1.9 ms]; P = .015; Cohen d = 0.51). No significant temporal differences were observed for any T2 * metric in anovulatory controls. Conclusion: Eumenorrheic female participants exhibited significant preovulatory to postovulatory changes in ACL T2 * metrics, while anovulatory controls demonstrated no significant changes over time. These findings suggest that ACL T2 * metrics are sensitive to cyclic fluctuations in female sex hormones across the menstrual cycle.
BACKGROUND:Secondary muscle degeneration after a rotator cuff tear (RCT) critically affects clinical outcomes. Vascular compromise after a tendon injury creates a complex microenvironment that may be associated with the degeneration of rotator cuff muscle. The role of hypoxia-inducible factor-1α (HIF-1α), a master regulator of cellular stress responses to hypoxia, in modulating muscle abnormalities after an RCT remains undefined. PURPOSE:To define the role of HIF-1α in stem cell differentiation and muscle degeneration after an RCT in a murine model. STUDY DESIGN:Controlled laboratory study. METHODS:A supraspinatus tendon transection and suprascapular nerve transection (TTDN) model was established in C57BL/6J, platelet-derived growth factor receptor α (PDGFRα)-green fluorescent protein (GFP) reporter, and inducible cell-specific HIF-1α knockout mice. Vascularity and HIF-1α colocalization with fibroadipogenic progenitor (FAP) cells and satellite cells were analyzed. Fibrosis, fatty infiltration, and myofiber cross-sectional area were assessed. In vitro, HIF-1α was modulated in isolated FAP cells via CRISPR-Cas9 or prolyl hydroxylase domain inhibitors to evaluate FAP cell differentiation. RESULTS:TTDN induced significant capillary density reduction (CD31+) at 1, 2, and 6 weeks after an injury. Global HIF-1α expression decreased after TTDN compared to the sham side (1 week: 0.78 ± 0.22 vs 1.40 ± 0.42, respectively [P = .019]; 2 weeks: 0.74 ± 0.51 vs 1.70 ± 0.48, respectively [P = .015]). The percentage of PDGFRα+ FAP cells increased at 6 weeks after TTDN compared to the sham side (15.69% ± 1.90% vs 12.76% ± 0.78%, respectively; P = .013). The percentage of HIF-1α+ FAP cells relative to total PDGFRα+ cells significantly decreased in the late stage (6 weeks) of an RCT compared to the sham side (2.78% ± 0.90% vs 7.38% ± 2.29%, respectively; P = .003). Knocking out HIF-1α in FAP cells in vivo resulted in increased fibrosis (Cre+: 4.43% ± 2.16% vs Cre-: 1.72% ± 0.39%; P = .047), decreased fatty infiltration (Cre+: 0.62% ± 0.42% vs Cre-: 1.55% ± 0.45%; P = .016), and reduced cross-sectional area (Cre+: 664.71 ± 354.45 vs Cre-: 1195.81 ± 338.66; P = .041). Neither satellite cell-specific nor myocyte-specific HIF-1α deletion resulted in significant phenotypic changes. The downregulation of HIF-1α led to a decrease in uncoupling protein 1 expression and an increase in α-smooth muscle actin expression in FAP cells. CONCLUSION:Although vascularity was reduced after TTDN, pronounced global tissue hypoxia was not directly evidenced. Decreased global HIF-1α expression may reflect denervation-induced reductions in metabolic demand. HIF-1α emerges as a key player in FAP cell differentiation within the injury microenvironment, promoting brown adipose tissue differentiation and inhibiting fibrogenesis. CLINICAL RELEVANCE:Targeting HIF-1α in FAP cells offers a novel therapeutic strategy to mitigate secondary muscle atrophy and fibrosis after an RCT.
BACKGROUND:Multiligament knee injuries (MLKIs) are serious and heterogeneous injuries that often lead to long-term functional limitations. There is limited literature regarding objective muscle strength and functional recovery after surgical treatment of MLKIs. PURPOSE:To investigate long-term quadriceps and hamstring muscle strength and functional recovery after surgical treatment of MLKI and to compare postoperative outcomes between single cruciate MLKI and bicruciate MLKIs. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:Patients surgically treated for an MLKI at a single level 1 trauma center between January 2013 and December 2020 were included. Isokinetic quadriceps and hamstring muscle strength were assessed using a Biodex dynamometer, and physical function was measured by single-leg hop, triple hop, crossover hop, and 6-m timed hop tests, with the limb symmetry index (LSI) calculated. RESULTS:Of 124 eligible patients, 90 (72%) participated at a mean follow-up time of 7 years (SD, 2.1) since surgery to evaluation. The median age at the time of testing was 49 years (range, 21-72) and 59% were male. In total, 54% of the patients had not regained full quadriceps strength (LSI <90%), and 46% had persistent hamstring deficits for peak torque/body weight (PT/BW) at 60 deg/s. Across the entire cohort, there was a significant difference between the uninvolved and involved sides for quadriceps and hamstrings for PT/BW (P = .01). The mean LSI for quadriceps PT/BW was 88% at 60 deg/s and 90% at 240 deg/s, while for the hamstrings, the mean LSI was 93% at 60 deg/s and 97% at 240 deg/s. Median LSIs for the hop tests ranged from 93% (range, 41%-187%) for single leg to 99% (42%-141%) for crossover; however, 44% of patients failed to reach the 90% threshold for the single-leg hop. The 6-m timed hop test and quadriceps muscle strength were significantly lower for patients with bicruciate injuries than those with single cruciate injuries (P < .05). CONCLUSION:Persistent deficits in quadriceps and hamstring muscle strength were observed 7 years after MLKI surgery, with a substantial proportion of patients failing to regain full functional symmetry in muscle strength and hop test performance. Patients with bicruciate injuries demonstrated significantly more pronounced deficits in muscle strength and hop test scores as compared with those with single cruciate injuries.
BACKGROUND:Meniscal tears are frequently associated with anterior cruciate ligament (ACL) injuries. Evaluating longitudinal changes in meniscal integrity using quantitative magnetic resonance imaging after ACL surgery may provide valuable insight into joint recovery and subsequent reinjury risk. HYPOTHESES:(1) The cross-sectional area (CSA) and normalized signal intensity (SI) profiles of the lateral and medial menisci for the surgical knees would be greater than those of the contralateral uninjured knees observed at 6, 12, and 24 months after surgery. (2) The CSA and Constructive Interference in Steady State (CISS) SI profiles obtained at 24 months would be closer to those of the contralateral limb when compared with those of the 6- and 12-month time points. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Deidentified postsurgical CISS magnetic resonance imaging scans of patients (n = 82; median age 17.6 years; 42 females and 40 males; 57 ACL restoration and 25 ACL reconstruction) were analyzed. CSA and normalized CISS SI values were extracted from the lateral and medial menisci to create morphological profiles. Statistical parametric mapping was used to compare the CSA and normalized CISS SI profiles between the surgical and contralateral limbs to identify specific regions that were different among the menisci at 6, 12, and 24 months. RESULTS:The CSA and normalized CISS SI profiles of the anterior region of the medial menisci and lateral menisci for the surgical knees were greater than those of the contralateral uninjured knees, observed at 6, 12, and 24 months after surgery, whereas the posterior region CSA of the medial menisci was smaller. The lateral meniscus on the operated limb had a larger CSA and higher normalized CISS SI values than the lateral meniscus in the contralateral limb. The CSA and CISS SI profiles obtained at 24 months did not approach those of the contralateral limb. CONCLUSION:Significant changes occurred in both menisci after ACL surgery that did not return to baseline levels within 2 years. It is important to account for anatomic location when evaluating meniscal morphology in surgical knees and when evaluating the effects of ACL injuries on the surrounding tissues.
BACKGROUND:The peptide supplement market has experienced rapid growth due to marketing claims of enhanced performance and accelerated recovery from musculoskeletal injury. These peptides are increasingly popular with patients and athletes and are often perceived as low risk, despite the absence of efficacy or safety data for many emerging peptides. PURPOSE:To summarize existing peer-reviewed data on 6 emerging peptides (BPC-157, thymosin beta-4 or TB-500, CJC-1295, MK-677, ipamorelin, and GHK-Cu [copper peptide]) for musculoskeletal recovery and enhancement in animal and human models. STUDY DESIGN:Scoping review. METHODS:Three independent reviewers searched the PubMed database using permutations of peptide search terms (BPC-157, TB-500, CJC-1295, MK-677 [ibutamoren], ipamorelin, and GHK-Cu) combined with musculoskeletal tissue search terms (bone, fracture, muscle, tendon, ligament, meniscus, and cartilage) following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Papers were independently screened by 2 reviewers, with a third serving as a tiebreaker. Papers examining these peptides for musculoskeletal treatment, tissue recovery, or performance in animal or human models were included. RESULTS:Overall, 67% of identified publications utilized preclinical animal models. In animal models, most commonly rats, each compound demonstrated unique mechanisms with promising but variable effects on tendon, muscle, bone, and ligament healing. Human clinical studies were limited to a handful of investigations, most lacking robust controls or rigorous study designs. Human data were heterogeneous and revealed modest improvements at best for metabolic bone health and degenerative knee pain. Some peptides such as MK-677 were associated with significant risks including congestive heart failure, and significant heterogeneity existed in dosing and route of administration. CONCLUSION:Despite promising findings in animal studies, the claimed benefits of emerging peptide supplements for musculoskeletal recovery and performance remain unsubstantiated by current human trials. Documented risks include cardiovascular complications and metabolic dysfunction such as insulin resistance. Because of the lack of robust efficacy and safety data, peptide supplements should not currently be recommended as a replacement or adjunct for existing orthopaedic standard of care.
BACKGROUND:While short- and midterm outcomes after meniscal allograft transplantation (MAT) are well documented, there is a paucity of data regarding long-term graft survival. PURPOSE:To assess mid- to long-term graft survivorship and patient-reported outcomes (PROs) after MAT. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:All patients who underwent MAT with bone block or soft tissue fixation between 1993 and 2020 at a single institution were identified. Individuals with <5 years of follow-up and untreated grade 4 cartilage lesions were excluded. Primary outcomes included graft survivorship and long-term PROs including International Knee Documentation Committee Subjective Knee Form (IKDC SKF) score, Knee injury and Osteoarthritis Outcome Score, and Marx Activity Scale score. Graft failure was defined as the need for meniscal allograft resection or repair, revision MAT, or conversion to total knee arthroplasty. Clinical failure was defined as an IKDC SKF score <56 at the final follow-up. Statistical analyses included chi-square/Fisher exact tests for categorical variables, the Mann Whitney U or t test for continuous variables, and Kaplan-Meier survival analysis with endpoints as graft failure. Statistical significance was defined as a P value <.05. RESULTS:This study included 160 patients (57% of the screened population; 46% female; median age at surgery, 28 years) with a median follow-up of 15 years (IQR, 10-21 years). A total of 43 graft failures occurred during follow-up, representing an 84% survival rate at 10 years, 76% at 15 years, 69% at 20 years, and 52% at 25 years. On univariable Cox regression, no patient or surgical factors, including age, sex, body mass index, tobacco use, fixation method, cartilage status, or concomitant osteotomy, were significantly associated with both graft and clinical failure (all P > .05). However, after adjusting for age and cartilage grade in the MAT compartment, female sex became a significant predictor for graft failure (P = .04). Clinical failures occurred in 32 patients (40%) and were not associated with graft failures (P = .20). PROs were not significantly different between male and female patients (P > .05). CONCLUSION:The MAT survival rate was 84% at 10 years, with a gradual decline to 76% at 15 years, 69% at 20 years, and 52% at 25 years. After adjusting for age and presence of cartilage lesion, female sex emerged as a predictor of graft failure. These findings highlight the importance of careful patient selection and counseling regarding long-term expectations after MAT.
BACKGROUND:Arthroscopic management of acetabular labral pathology in femoroacetabular impingement (FAI) has progressively shifted toward labrum preservation; however, the effectiveness of labral repair over debridement remains unsettled. PURPOSE:To compare arthroscopic labral repair versus debridement for FAI regarding patient-reported outcomes, pain, and risk of conversion to total hip arthroplasty (THA). STUDY DESIGN:Systematic review and meta-analysis; Level of evidence, 3. METHODS:The study protocol was registered on PROSPERO (CRD420251062063). A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed through October 21, 2025. Randomized controlled trials (RCTs) and comparative cohort studies evaluating arthroscopic labral repair versus arthroscopic labral debridement for FAI were included. Open procedures and labral reconstruction were excluded to minimize clinical heterogeneity. Outcomes included the Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) pain score, and conversion to THA. Random-effects models were applied, with prespecified subgroup analyses by study design and follow-up duration (<5 vs ≥5 years). RESULTS:Ten studies consisting of 2730 hips (1580 repairs, 1150 debridements) were included. No significant difference was observed in pooled mHHS (mean difference [MD], 1.92; 95% CI, -2.33 to 6.16). HOS outcomes varied by study design: observational cohorts demonstrated no significant between-group differences for HOS-ADL (MD, 0.69) or HOS-SSS (MD, 0.11), whereas the RCT demonstrated significantly higher scores favoring labral repair for both HOS-ADL (MD, 10.30) and HOS-SSS (MD, 12.40). VAS pain scores were comparable at short-term follow-up but favored repair at ≥5 years (MD, -1.37). Conversion to THA occurred in 3.5% of repaired hips versus 7.4% of debrided hips, with labral repair associated with a significantly lower risk of THA (risk ratio, 0.56; 95% CI, 0.37 to 0.84; P = .006), driven by long-term follow-up. CONCLUSION:Labral repair confers a significant protective benefit against conversion to THA and superior pain relief at mid- to long-term follow-up. While functional outcomes appear equivalent in observational cohorts, randomized evidence demonstrates superior activity-related scores favoring repair.
Background: Anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts faces persistent challenges of graft failure, especially in patients with high internal rotational tibial subluxation (IRTS). Hypothesis: Patients with high IRTS who undergo HT autograft ACLR with suture tape augmentation (STA) will have lower graft failure rates and superior clinical outcomes as compared with those without STA. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients with high IRTS—defined as lateral minus medial anterior tibial subluxation >5.8 mm based on prior studies—who underwent primary ACLR using HT autografts with STA and had a minimum follow-up of 3 years. Propensity score matching (1:1) was performed to identify a control group of patients with similarly high IRTS who underwent HT ACLR without STA. Postoperative outcomes were assessed by the International Knee Documentation Committee score, Lysholm score, and Tegner activity scale, as well as by return-to-sport status and graft failure. Clinically meaningful improvements were evaluated by the minimal clinically important difference, Patient Acceptable Symptom State, and substantial clinical benefit. Results: This study included 62 patients with high IRTS: 31 with STA and 31 matched controls. The mean IRTS was 6.6 mm (range, 5.9-8.9) in the STA group and 6.8 mm (range, 5.8-8.7) in the control group. The mean patient age was 32.9 years (range, 20-50), and the mean follow-up was 3.8 years (range, 3.1-5.0). At final follow-up, the STA group showed significantly higher proportions of patients achieving the minimal clinically important difference (93.5% vs 74.2%; P = .038), Patient Acceptable Symptom State (96.8% vs 74.2%; P = .012), and substantial clinical benefit (54.8% vs 25.8%; P = .020). The return-to-sport rate was also higher in the STA group (74.2% vs 48.4%; P = .037). Additionally, the STA group demonstrated a lower graft failure rate (0% vs 12.9%; P = .039). Conclusion: For patients with high IRTS, STA in ACLR with HT autografts is associated with improved clinical outcomes, a higher return-to-sport rate, and a lower risk of graft failure at midterm follow-up.
Background: Osteochondral autograft transplantation (OAT) is widely performed for capitellar osteochondritis dissecans (OCD). However, preoperative predictors of suboptimal postoperative outcomes remain unclear. Purpose/Hypothesis: The authors aimed to evaluate clinical outcomes after OAT for capitellar OCD and identify preoperative risk factors associated with suboptimal outcomes. They hypothesized that radiographic indicators of disease severity, including preoperative proximal migration of the radial head, lesion size, and lateral wall disruption, would be associated with suboptimal postoperative clinical outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: The records of adolescent athletes who underwent OAT for capitellar OCD with a minimum 2-year follow-up were retrospectively reviewed. Clinical outcomes included elbow range of motion (ROM) and Timmerman-Andrews (T-A) score. A suboptimal outcome was defined as a postoperative T-A score <160. Preoperative radiographs were used to measure proximal migration of the radial head relative to the coronoid process, hypertrophy of the radial head, OCD lesion area, and a 5-grade lateral wall disruption classification; measurement reliability was assessed. Multivariate logistic regression analysis was performed to identify independent predictors of a suboptimal outcome, and receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value for proximal migration. Results: A total of 69 elbows (mean age, 13.6 years; mean follow-up, 48 months) were included. ROM and T-A scores improved significantly after OAT, and all athletes returned to any sports. Of these, 50 elbows (72%) achieved good outcomes, whereas 19 (28%) had suboptimal outcomes. Preoperative proximal migration was significantly greater in the suboptimal outcome group compared with the good outcome group (mean, 2.1 ± 2.3 vs 0.5 ± 1.7 mm; P = .002), as were lesion area (mean, 70 ± 16 vs 58 ± 20 mm 2 ; P = .02) and lateral wall disruption grade (median, 5 vs 3; P = .01). On multivariate analysis, proximal migration of the radial head was the only independent predictor of a suboptimal outcome (adjusted OR, 1.47 per 1-mm increase; 95% CI, 1.03-2.09; P = .033). ROC analysis showed an area under the curve of 0.72 with an optimal cutoff of 2.2 mm (sensitivity, 56%; specificity, 84%). Conclusion: OAT resulted in significant clinical improvement in adolescents with capitellar OCD; however, 28% of patients were classified as having suboptimal outcomes. Preoperative proximal migration of the radial head is an independent predictor of a suboptimal postoperative outcome. A value >2.2 mm may indicate advanced radiocapitellar incongruity, a condition in which OAT may be less effective.
