Purpose To evaluate sequential changes in angiogenesis after superior capsule reconstruction using fascia lata autograft with power Doppler ultrasound and to investigate the relation between angiogenesis‐related findings and clinical outcomes. Methods Thirty patients with irreparable rotator cuff tears who underwent superior capsule reconstruction using a fascia lata autograft were prospectively enrolled. Angiogenesis and blood flow volume in the superficial layered tissue in contact with the bursal side of the graft (perigraft) and within the graft on the greater tuberosity and humeral head were evaluated using Fealy's scoring system with power Doppler ultrasound at 6 weeks and 3, 6, and 12 months postoperatively. Visual analog scale (VAS) score for shoulder pain, Neer and Hawkins tests, and American Shoulder and Elbow Surgeons (ASES) score were evaluated preoperatively and postoperatively. Minimal clinically important difference achievement rates for VAS and ASES scores were also evaluated. Results All grafts (100%) showed angiogenesis within the 6‐month postoperative period. In the perigraft, the rate of cases with angiogenesis and blood flow scores was highest at 6 weeks and then significantly decreased at 12 months (90%‐47%, P = .0003; 1.2‐0.6 points, P = .04). Angiogenesis within the graft on the greater tuberosity significantly increased at 3 months (43%‐77%, P = .004), with blood flow scores peaking at 6 months (0.3‐1.3 points, P = .02). No significant correlations were observed between blood flow and VAS or ASES scores ( P = .16‐.99) or between angiogenesis and impingement tests ( P = .09‐>.99). Minimal clinically important difference achievement rates were 93.3% for VAS and 100% for ASES scores. Conclusions Overall, the minimal clinically important difference achievement rates were 93.3% for the VAS and 100% for the ASES scores after superior capsule reconstruction. Postoperatively, all grafts displayed progressive angiogenesis and pulsatile blood flow, with volume peaking at 6 months. Notably, these sequential changes in vascularization may represent a physiological graft healing and remodeling process rather than pain‐related inflammation. Level of Evidence Level II, prospective cohort study.
Purpose To determine maximal outcome improvement (MOI) thresholds for patient‐reported outcome measures and identify predictors of achieving them after autologous osteoperiosteal transplantation (AOPT) for cystic osteochondral lesions of the talus. Methods Patients with Hepple V cystic osteochondral lesions of the talus who underwent AOPT from January 2010 to January 2023 and had a minimum follow‐up of 24 months were retrospectively included. An anchor question was queried regarding satisfaction with current ankle status. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), Ankle Activity Score (AAS), and Foot and Ankle Outcome Score (FAOS) were evaluated pre‐ and postoperatively. The minimal clinically important difference and patient acceptable symptom state were calculated using a distribution‐ and anchor‐based method, respectively. MOI was defined as a patient‐specific percentage of improvement normalized by the maximal possible improvement. MOI threshold for predicting patient satisfaction was determined by the optimal cutoff using receiver operating characteristic curve analysis. Predictors of achieving these thresholds were identified through multivariable logistic regression analysis. Results In total, 124 patients were included, with a mean follow‐up of 71.3 ± 36.9 months (range, 24.4‐173.5 months). Among them, 101 (81.5%) were satisfied with current ankle status. Significant differences were observed in postoperative patient‐reported outcome measures and improvements ( P < .01) between the satisfied and dissatisfied groups, except for AOFAS improvement ( P = .237). The proportions of patients exceeding the minimal clinically important difference were 97.6%, 100%, 90.3%, and 96.0% for AOFAS, VAS, AAS, and FAOS, whereas the proportions exceeding the patient acceptable symptom state were 70.2%, 49.2%, 56.5%, and 94.0%, respectively. MOI thresholds were 81.4%, 73.2%, 11.8%, and 64.0% for the AOFAS, VAS, AAS, and FAOS scores, respectively. MOIs for FAOS showed the highest predictive capacity for satisfaction with an area under the curve of 0.858. Increased body mass index (odds ratio = 0.884, P = .031) and double plugs (odds ratio = 3.512, P = .017) were associated with lower odds of achieving the MOI threshold for FAOS. Sex showed an insignificant correlation (odds ratio = 0.982, P = .306). Conclusions After primary AOPT for cystic osteochondral lesions of the talus, the MOI thresholds were 81.4%, 73.2%, 11.8%, and 64.0% for the AOFAS, VAS, AAS, and FAOS scores, respectively, with MOIs for FAOS showing the highest predictive capacity of predicting satisfaction. Increased body mass index and double plugs in AOPT were associated with reduced odds of achieving the MOI threshold for FAOS. Level of Evidence Level IV, retrospective case series.
Purpose To determine the reliability and diagnostic accuracy of fluoroscopic parameters for diagnosis and staging of scapholunate (SL) instability in distal radius fractures. Methods Between May 2021 and March 2024, intraoperative fluoroscopic assessments were performed after fixation of unstable distal radius fractures. Imaging included anteroposterior, clenched‐fist anteroposterior‐ulnar deviation, true lateral, and modified scaphoid shift views. Wrist arthroscopy served as the reference standard, with staging according to Geissler (GI‐GIV) and European Wrist Arthroscopy Society (EI‐EV) classifications. Fluoroscopic parameters—SL gap, SL‐ulnar deviation gap, SL translation, scaphoradius (SR) translation, SL angle, delta‐SL angle, and delta‐SR angle—were analyzed for intra‐ and interobserver reliability and diagnostic accuracy. Results Eighty‐eight wrists (38 men, 50 women) were included. Fluoroscopic parameters differed significantly across SL instability stages. A staging algorithm was developed using parameters with high intra‐ and interobserver reliability (intraclass correlation coefficient > 0.89) and good diagnostic accuracy (area under the receiver‐operating characteristic [AUC], 0.71‐1.00). The SL angle differentiated G0‐II, GIII, and GIV instability, with cutoff values of 60° (AUC 0.74) and 74° (AUC 0.97). An SL angle < 60° or delta‐SL angle ≤ 4°, combined with delta‐SR angle > 11° (AUC 0.71), indicated non‐SL instability (G0/E0), whereas delta‐SR angle ≤ 11° indicated GI‐II/EI‐II instability. A delta‐SL angle > 4° differentiated EIIIA from G0‐II/E0‐II (AUC 0.82) and EIIIB‐C (AUC 0.88). Delta‐SR angle ≤ 5° differentiated EIIIB‐C from EIIIA (AUC 1.00). SL‐ulnar deviation gap ≥ 2.9 mm, SL translation ≥ 1.8 mm, or SR translation ≥ 2.5 mm differentiated EIIIC from EIIIB (AUC 0.89‐1.00). Advanced instability (GIV/EIV/V) was indicated by SL gap ≥ 2.5 mm, SL‐ulnar deviation gap ≥ 3.2 mm, or SL translation ≥ 2.4 mm (AUC 0.86‐0.95). Conclusions Fluoroscopic parameters identified in this study show high reliability and good diagnostic accuracy for diagnosis and staging of SL instability in distal radius fractures. Level of Evidence Level II, diagnostic study of consecutive patients.
Purpose To evaluate bone–patellar tendon–bone autograft anterior cruciate ligament reconstruction patellar defect dimensions over time and associate these with patient‐reported outcomes. Methods Patients undergoing bone–patellar tendon–bone autograft autograft anterior cruciate ligament reconstruction by 1 of 7 surgeons between June 2020 and June 2023 were recruited to obtain knee magnetic resonance imaging at 6 weeks and 1 year postoperatively and complete a knee injury and osteoarthritis outcome score (KOOS) survey at 1 year postoperatively. Patellar bony defect dimensions relative to the entire patellar dimensions were measured on magnetic resonance imaging and associated with KOOSs at 1 year. Results For the 23 patients (15 men) with a mean ± standard deviation age 25.5 ± 5.2 analyzed, shorter relative patellar defect length at 6 weeks postoperatively was associated with better 1‐year KOOS activities of daily living ( R 2 = 0.481, P = .002) and function in sports and recreation ( R 2 = 0.436, P = .002), and showed trends for associating with better pain ( R 2 = 0.196, P = .078) and knee‐related quality of life ( R 2 = 0.222, P = .054). Participants with longer relative defects were more likely to report difficulty with kneeling ( R 2 = 0.278, P = .020). These associations were not altered by considering patient age or sex. The average relative patellar defect width and depth decreased from 6 weeks to 1 year ( P < .001), whereas relative defect length was unchanged. Intraobserver reliability was good to excellent for all measurements at 6 weeks and 1 year. Relative defect width and depth, at both 6 weeks and 1 year, had no significant associations with KOOSs at 1 year. Conclusions Shorter relative patellar defect length after bone–patellar tendon–bone autograft autograft anterior cruciate ligament reconstruction is associated with better patient‐reported outcome measures at 1 year, and thus, individual patient patellar size should be a consideration during graft harvest. Level of Evidence Level IV, retrospective case series.
Abstract A hypermobile lateral meniscus remains an important and underappreciated cause of lateral compartment knee pain despite increasing understanding of the complex anatomy surrounding the popliteal hiatus. Recent anatomic and histologic studies continue to refine knowledge of the meniscofibular ligament and the popliteomeniscal fascicle, but microscopic anatomy alone should not dictate surgical decision‐making. Histologic evidence of ligamentous tissue does not establish biomechanical function nor validate tear repair techniques. The priority in symptomatic lateral meniscus instability should remain restoration of native meniscal anatomy through anatomic repair, regardless of which individual fascicle or ligament is involved in the tear pattern. Equally important is recognition of the normal mobility of the popliteal hiatus to avoid iatrogenic overconstraint during repair. As our understanding of this region evolves, the clinical message remains straightforward. If the lateral meniscus is hypermobile, repair it, preserve it, and avoid meniscectomy wherever possible.
