Abstract Graft tear is the primary mode of failure after superior capsule reconstruction, and graft tear correlates with clinical outcome. Thicker fascia lata autografts (6‐8 mm) are associated with lower tear rates, but the fascia lata is not always thick enough to allow such a harvest. Incorporating a reinforced polyester patch between 2 thin fascia lata layers can more than double time‐zero ultimate load and raise stiffness to levels comparable to a thick graft. However, the biologic implications of a thin patch‐augmented graft require further study.
Purpose To identify complications in patients who undergo tibial tubercle osteotomy (TTO) for patellar instability and secondarily to summarize patient‐reported outcomes across patients who underwent TTO. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, PubMed, Embase, and Cochrane Library databases were searched in November 2025 for studies published in the past 20 years. Studies were included if they met these criteria: evaluated complications after primary TTO and were written in English. Data was pooled for analysis using inverse‐variance random‐effects models. Results The initial screen identified 5619 studies, 12 of which were included in this systematic review and meta‐analysis. A total of 1110 patients were included in this study, with 866 (78.0%) female patients. Mean age across studies ranged from 15.8 to 27.7 years. Mean follow‐up times across studies ranged from 15.0 to 81.6 months. Demographics were similar across studies, and each study had a low risk of bias per Methodological Index for Non‐Randomized Studies criteria. Favorable postoperative clinical outcomes were observed, with mean Kujala scores of 78.1 to 96.0, International Knee Documentation Committee scores of 83.0 to 88.4, and Lysholm scores of 76.7 to 94.0. Overall, 149 complications were reported from the 1110 patients analyzed (13.4%). Reoperation to remove painful hardware was observed in up to 38.9% (range 0%‐38.9%), rates of arthrofibrosis ranged from 0% to 12.5%, postoperative infection rates ranged from 0% to 5.6%, and bony complication rates, including malunion/nonunion and fracture, ranged from 0% to 1% reoperation. The failure‐associated reoperation rate ranged from 0% to 25% across studies. Conclusions TTO performed for the treatment of patellofemoral instability has low associated bony and soft‐tissue complication risk, but it can potentially require reoperation to address hardware‐related discomfort, postoperative stiffness, or failure. Level of Evidence Level III, systematic review and meta‐analysis of Level II and III studies.
Purpose To compare clinical outcomes and complications after primary anterior cruciate ligament reconstruction with all‐soft tissue quadriceps tendon (ST‐QT) versus quadriceps tendon‐bone (QT–B) autograft. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines by searching PubMed, Embase, and Cochrane Library to identify studies directly comparing outcomes of primary anterior cruciate ligament reconstruction with ST‐QT versus QT–B autograft. Outcomes included rates of graft failure and other complications, patient‐reported outcomes, return to sport, anteroposterior knee laxity, pivot shift testing, and the Objective International Knee Documentation Committee score. Results Five studies (1 Level II, 4 Level III) met the inclusion criteria, including a total of 996 knees undergoing anterior cruciate ligament reconstruction with ST‐QT autograft and 1279 with QT–B autograft. Mean age at surgery ranged from 20.3 to 31.7 years. Minimum follow‐up time ranged from 12.0 to 24.0 months. The overall percentage of men ranged from 48.8% to 84.6%. Graft failure ranged from 2.4% to 7.6% of patients in the ST‐QT autograft group and 3.3% to 6.4% in the QT–B autograft group. No study found a significant difference in graft failure rates between the 2 groups. Intraoperative patellar fracture occurred in 2 cases overall, both in the QT–B group. No studies found a significant difference in return to sport between groups. One study found significantly better Knee Injury and Osteoarthritis Outcome Score subscale scores in the ST‐QT group. One study found a significantly greater proportion of ST‐QT patients showing a positive pivot shift postoperatively. No other significant differences were found for the remaining patient‐reported outcomes between groups. Conclusions Current comparative evidence suggests ST‐QT and QT–B autografts for primary anterior cruciate ligament reconstruction yield similar short‐ to midterm outcomes, though limited studies and follow‐up warrant cautious interpretation. Patellar fracture remains an uncommon QT–B risk. Level of Evidence Level III, systematic review of Level II and III studies.
Abstract The number of artificial intelligence (AI) use cases relevant to health care has continued to increase substantially because technology has evolved. For orthopaedic surgeons and musculoskeletal providers, the onus has expanded beyond learning about these tools conceptually and shifted toward understanding how to use them in everyday clinical workflows. There is a perceived opportunity cost from ignoring these use cases and, similarly, an operational cost from excessively implementing AI tools without thoughtful consideration of how they may impact patient care. This infographic shows how orthopaedic surgeons may leverage various AI solutions to create a digital ecosystem that portends efficiency and value. Before a patient formally establishes care with a physician, AI solutions leveraging agentic frameworks may assist with scheduling appointments based on screening criteria, informing patients of outstanding laboratory or imaging requests, and curating physicians’ schedules. During appointments, physicians can leverage ambient scribes, which listen to patient‐physician encounters and automatically synthesize clinical notes, to make visits more efficient. Furthermore, more recent iterations of scribes automatically codify diagnoses and treatments using International Classification of Diseases, 10th Revision and Current Procedural Terminology and prepopulate orders. The Hospital for Special Surgery, Cleveland Clinic, and Kaiser Permanente, among many others, have used these pipelines to reduce administrative burden and allow more time for direct patient interactions. Multimodal models trained on vast amounts of imaging data may allow for intelligent diagnosis of musculoskeletal pathologies; however, several advanced solutions allow physicians to create “digital twins” and model patient‐specific pathology to guide surgical techniques and predict optimal placement of grafts, implants, and/or tunnels. Postoperatively, physicians can leverage practice‐specific guidelines to create asynchronous chat agents to increase adherence to rehabilitation guidelines. Wearable devices allow real‐time transmission of motion data to help physicians understand recovery trajectory and progress against milestones. Important ethical questions remain. Patient privacy is paramount, requiring enterprise agreements with AI vendors to ensure data remains Health Insurance Portability and Accountability Act‐compliant. Furthermore, systems need to implement governing boards, regular audits, and safety guardrails to ensure data safety and appropriate model performance. Significant literacy gaps remain among patients in underserved communities, so physicians must consider equitable AI implementation. As models progress in capability and speed and become less costly, physicians have exciting avenues to optimize clinical workflows and free more time for empathetic, patient‐guided care.
