A 39-year-old woman presented with catching, pain during deep knee flexion, and intermittent locking. Magnetic resonance imaging showed no definite meniscal tear, and diagnostic arthroscopy was performed. Arthroscopy revealed hypermobility of the posterior horn of the lateral meniscus with no tear identified. This hypermobility was considered the source of the patient's mechanical symptoms and was stabilized with three all-inside sutures. In addition, systematic inspection of the medial compartment incidentally identified a smooth, well-demarcated valley-like concavity at the meniscocapsular junction, predominantly involving the midbody of the medial meniscus and extending to the anterior segment. The peripheral rim appeared cliff-like, and the capsule was continuous beyond the concavity, which created a separation-like appearance. However, probing and dynamic assessment did not reproduce gapping, abnormal translation, or impingement, and there were no corresponding medial symptoms. Therefore, the concavity was left untreated. At 24 months postoperatively, symptoms had not recurred, and the Knee injury and Osteoarthritis Outcome Score was 100 in all subscales, with no complications or reoperation. A stable valley-like concavity at the medial meniscocapsular junction can mimic meniscocapsular separation but may remain asymptomatic and dynamically stable. Repair decisions should be guided by symptom correlation and arthroscopic dynamic stability rather than morphology alone.
Background Superior humeral head migration is a feature of advanced rotator cuff tears, but conventional radiographic measurements such as the acromiohumeral interval (AHI) have limitations. Evidence predicting massive tears like Collin type B or C remains scarce. This study aimed to develop and validate the acromion-humeral angle (AHA) as a novel parameter for assessing superior humeral head migration and compare its diagnostic value with the AHI. Methods The study involved a retrospective review of 65 patients with confirmed rotator cuff tears, diagnosed between 2012 and 2016, after conservative treatment had failed. Patients underwent preoperative radiographic evaluations, and surgeries were performed by a senior surgeon. Three radiological parameters were measured: the AHI; acromion-humeral angle (AHA); and its subcomponents (A1, A2). Reliability was assessed using ICC, and statistical analyses, including logistic regression and ROC curve(Receiver operating characteristic curve) analysis, were conducted to evaluate diagnostic accuracy. Results The study involved an analysis of 65 participants (32 men, 33 women; mean age, 59.2 years) with 68 shoulders diagnosed with rotator cuff tears. Collin type B/C tears were observed in 27 shoulders (49.3%). Interobserver reliability for A1, A2, and AHI measurements showed excellent agreement (ICC > 0.75). Radiological evaluations and simple logistic regression indicated that the A1-A2 ratio provided the highest accuracy for detecting Collin B/C tears (AUC = 0.80, likelihood ratio = 18.06, p < 0.001. An AHI < 7.9 mm (odds ratio = 9, p < 0.001) and A1-A2 ratio > 1.52 significantly increased the likelihood of Collin B/C tears (odds ratio = 6.28, p = 0.002). Conclusion The A1–A2 ratio is a reliable radiographic parameter for predicting Collin type B or C massive rotator cuff tears, with diagnostic performance comparable to the AHI. It serves as a useful alternative or complementary measure for assessing superior humeral migration. An A1–A2 ratio greater than 1.52 is associated with an approximately 6.3-fold increased risk of Collin type B or C massive rotator cuff tears. Level of evidence III, Cohort study
Medial meniscus (MM) posterior root tears (PRTs) disrupt hoop stress transmission and accelerate the progression of medial compartment osteoarthritis. High tibial osteotomy (HTO) combined with transtibial pullout repair is indicated in selected patients with a high body mass index, severe varus malalignment, or high functional demands. Although medial open-wedge HTO (MOWHTO) is widely performed, correction angles exceeding approximately 12° may compromise mechanical stability and increase the risk of lateral hinge fracture and delayed union. In patients with predominantly tibial-based deformity and a predicted postoperative medial proximal tibial angle (MPTA) of less than 95°, double-level osteotomy is generally unnecessary; in such circumstances, a closing-wedge strategy is biomechanically appropriate. However, conventional lateral closing-wedge or hybrid closing-wedge HTO techniques reduce medial proximal tibial bone stock, leaving insufficient cortical bone to safely accommodate transtibial pullout repair for MMPRTs. Therefore, when HTO is performed in conjunction with MMPRT repair, preservation of adequate medial bone stock is essential. To our knowledge, no previous studies have described a technique specifically designed to address this structural requirement. This technical note describes a surgical technique combining transtibial pullout repair for MMPRTs with inverted V-shaped HTO (iV-HTO), a closing-wedge-based osteotomy that preserves medial cortical bone stock while permitting substantial angular correction. The medial approach required for pullout repair provides two additional advantages: independent tibial tunnel placement with reduced risk of interference from lateral plate screws second straightforward augmentation with an additional medial plate when indicated. The supplementary medial plate reinforces the weakened medial cortex, enhances construct stability, and may facilitate earlier weight-bearing while promoting reliable osseous union. The indications, surgical technique, technical considerations, and potential advantages of combining iV-HTO with transtibial pullout repair for MMPRTs in patients with severe tibial varus deformity are also presented.
Background:The evaluation in pelvic-lower limb alignment compared to both open wedge distal tuberosity osteotomy (OWDTO) and total knee arthroplasty (TKA) using the EOS imaging system remain unclear. The primary objective of this study is to evaluate the pelvic-lower limb alignment after OWDTO and TKA using the EOS imaging system. The secondary objective is to investigate the relationship between coronal and sagittal alignment parameters. Patients and methods:A total of 102 patients, including 51 who underwent OWDTO and 51 who underwent TKA, were included. Radiographic evaluations were performed using the EOS imaging system pre-operatively and at 12 months post-operatively. Coronal alignment parameters (medial proximal tibial angle (MPTA), coronal hip-knee-ankle angle (c-HKA), pelvic obliquity (PO), and sagittal alignment including sagittal HKA (s-HKA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS)) were assessed. Changes (Δ) and their correlations were analyzed. To account for potential confounding by age, sex, and Kellgren-Lawrence grade, partial correlation analysis adjusting for these variables was additionally performed. Results:TKA resulted in significant improvements in coronal and sagittal alignment parameters except PT (p < 0.001). OWDTO showed significant changes in coronal parameters except PO (p < 0.001), with no significant changes observed in sagittal alignment. Δs-HKA was weakly and moderate negatively correlated with Δc-HKA, ΔSS and ΔPO (r = -0.20, -0.22 and -0.33, 95%CI: -0.38 to -0.01, -0.40 to -0.03 and -0.49 to -0.14, p = 0.04, 0.03 and 0.001). ΔSS was weakly negatively correlated with the change in ΔMPTA (r = -0.24, 95%CI: -0.44 to -0.05, p = 0.02). ΔPI was strongly positively correlated with the change in ΔPT (r = 0.77, 95%CI: 0.67 to 0.83, p < 0.001). After adjusting for age, sex, and K-L grade, the correlations between changes in coronal and sagittal alignment parameters remained largely consistent with the unadjusted results. Conclusion:TKA resulted in greater improvements in both coronal and sagittal alignment parameters compared to OWDTO. Among sagittal parameters, the change in s-HKA showed the strongest, although modest, correlation with coronal alignment changes. The EOS imaging system may serve as a useful tool for simultaneously and reproducibly assessing coronal and sagittal alignment in patients undergoing OWDTO and TKA.
Background Proprioception dysfunction, including deficits in joint position sense (JPS) and kinesthesia, is a common sequela following anterior cruciate ligament (ACL) injury. While previous studies have compared proprioceptive outcomes in ACL-injured patients undergoing different types of surgical reconstruction or repair, their findings have been inconsistent, and a systematic review is lacking. Objective To summarize and evaluate proprioceptive deficits (in JPS and kinesthesia) across different postoperative time points and joint angles in patients undergoing different types of ACL reconstruction or repair, compared to healthy controls. Literature survey A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases using terms related to ACL injury, reconstruction or repair, and proprioception, covering all records through November 2025. Method ology: The following information was extracted from the included articles: demographic data, sample size, selection criteria, methodology, test indicators (e.g., time points and joint angles), proprioceptive test results, and other relevant variables. Network meta-analyses were conducted to synthesize proprioceptive outcomes. Results Nineteen studies were included in the network meta-analysis. No statistically significant differences were found in intermediate-angle JPS or kinesthesia among various ACL reconstruction and repair techniques when assessed beyond six months postoperatively. Notably, our analysis revealed that hamstring tendon autografts (SMD = 1.9, 95% CI = 0.3, 3.5) and tibialis anterior allografts (SMD = 1.7, 95% CI = 0.1, 3.5) were associated with inferior small-angle position perception outcomes at the six-month follow-up compared to control. Conclusion The results indicate that, in small-angle position at six-month follow-up, ACL repair may yield similar or even better proprioceptive recovery compared to hamstring tendon autografts and tibialis anterior allografts. However, different types of reconstructive grafts or repairs do not show significant differences in proprioceptive recovery from most angles. These findings suggest that ACL repair demonstrates proprioceptive outcomes similar to those of ACL reconstruction, and different graft selections for ACL reconstruction may produce similar proprioceptive outcomes, allowing graft choice to be guided by specific clinical needs.
Background Revision anterior cruciate ligament reconstruction (ACLR) is a complex procedure with varying diagnostic, surgical, and rehabilitation approaches. This study aimed to develop a consensus among surgeons from APKASS on key aspects of revision ACLR to improve clinical outcomes. Methods A total of 23 expert surgeons from eight member countries participated in the survey. Topics included diagnostics, surgical indications, techniques, graft selection, rehabilitation protocols, and return-to-play (RTP) considerations for revision ACLR. Responses were analyzed in comparison with the current literature to identify areas of agreement and divergence. Results A consensus was reached on the importance of clinical and imaging criteria, including the pivot shift test, KT-2000 measurements, and MRI for identifying ACL failure. CT was preferred for evaluating tunnel placement. Poor tunnel placement was identified as the leading cause of ACL failure. One-stage revision surgeries were favoured unless significant tunnel enlargement required a two-stage approach. Bone-patellar tendon-bone (BTB) autografts were the preferred graft choice, while quadriceps tendon (QT) autografts emerged as a viable alternative. Revision ACLR was deemed critical for active patients engaged in high-impact sports, while older age and established osteoarthritis were considered relative contraindications. Additional procedures, such as lateral extra-articular tenodesis (LET), were selectively indicated based on individual patient factors. Conservative, patient-specific rehabilitation protocols were recommended, with an emphasis on addressing psychological factors. RTP rates varied widely, highlighting the importance of tailored recovery plans to optimize outcomes. Conclusion This consensus emphasizes the importance of individualized and evidence-based approaches in revision ACLR, from diagnostics and surgical techniques to rehabilitation and RTP. Standardized criteria and further research are essential to refine strategies and improve outcomes in this patient population. Level of evidence V (Expert opinion).
Introduction:As trunk rotation is essential for sports requiring spinal mobility, accurate assessment is important for identifying functional deficits and evaluating performance. This study compared trunk rotation angles and left-right asymmetry between bar-holding and crossed-arms positions. Materials and methods:Twenty-four athletes performed seated trunk rotation under two conditions: (1) a bar-holding position (bar resting on shoulders), which allows shoulder girdle contribution, and (2) a crossed-arms position, which minimizes it. A ceiling-mounted camera captured overhead images. Markers attached to the acromion and posterior superior iliac spines were used to track trunk and pelvic movement, respectively. Rotation angles were calculated relative to the horizontal reference line. Each angle was measured three times per condition and averaged for analysis. Results:Trunk rotation angles were significantly greater in the bar-holding condition than in the crossed-arms condition (right: 58.0 ± 12.9° vs. 49.2 ± 10.1°; left: 55.9 ± 12.3° vs. 47.5 ± 9.6°; p < 0.01). High positive correlations were found between conditions for both right (r = 0.82, p < 0.01) and left rotation angles (r = 0.65, p < 0.01). Asymmetry patterns were also positively correlated between conditions (r = 0.64, p < 0.01). Discussion:The larger angles in the bar-holding condition confirm that shoulder girdle motion contributes substantially to the measured trunk rotation. However, the consistent asymmetry patterns suggest that either posture is valid for identifying side-to-side imbalances. Conclusion:This study highlights that the choice of upper limb position substantially influences the measured range of trunk rotation. Collectively, these findings emphasize that clinicians should select the specific test position based on the evaluation purpose-whether to isolate thoracic motion or to assess coordinated trunk-shoulder movement.
Background:Lateral ankle sprains and subsequent chronic ankle instability (CAI) are common among dancers, often presenting with impaired static and dynamic balance. Ankle taping is a conservative treatment option, but its effectiveness remains controversial. Dancers, who often exhibit greater generalized ligamentous laxity compared to other athletes, may respond differently to ankle taping, yet research specific to this population is limited. Hence, this study aimed to investigate the acute effects of taping on ankle stability and subjective functional outcomes in dancers with CAI, as well as to compare any outcome differences between CAI and non-CAI dancers. Methods:This was a randomized crossover study in which eligible dancers were recruited in local dance institutions on a voluntary basis. Dancers underwent 4 ankle functional tests (single-leg stance, Y balance, side hop, figure-of-8 test) with and without ankle taping, clinical screening for ankle instability and generalized ligamentous laxity, as well as a questionnaire on their subjective ankle functional outcome (i.e., Cumberland Ankle Instability Tool/CAIT) and their perception of ankle taping. The primary outcome measure was single-leg stance result parameters, while secondary outcome measures included results from the remaining three ankle functional tests and the CAIT score. CAI in this study was defined as dancers with at least one ankle sprain and CAIT ≤24, the recommended cutoff by the International Ankle Consortium (IAC). Control group was defined as dancers with no ankle sprain or CAIT >24. Results:Eighty-nine eligible dancers from local dance institutions were recruited, with 85 (170 ankles) completing the study. 74.1% reported at least one ankle sprain, and 64.7% met the criteria for CAI. Ankle taping significantly improved static balance in dancers with non-structural instability (i.e., functional CAI or non-hypermobile dancers), but not for those with structural instability (i.e., mechanical CAI or hypermobile dancers). No significant improvements were observed in dynamic balance or other functional tests across all dancers. Conclusion:While this study showed evidence that ankle taping can improve static balance in CAI dancers with non-structural instability (e.g., functional CAI, non-hypermobile), the effectiveness of reducing reinjury risks in dancers with CAI remained uncertain. These findings provided some support for the use of ankle taping as an adjunct for dancers with CAI. There is a need to explore alternative conservative treatments tailored to this population.
Purpose:Shoulder instability affects quality of life and function. The Western Ontario Shoulder Instability Index (WOSI) is widely used; however, a validated Thai version is not available. This study aimed to translate, culturally adapt, and validate the Thai WOSI. Methods:The WOSI was cross-culturally adapted to the Thai version (Thai WOSI) following guidelines. Sixty-two patients comprising 2 women and 60 men, with unilateral shoulder instability, were recruited for this study. All patients completed Thai WOSI and Thai QuickDASH for internal consistency and validity.Additionally, all patients repeated the Thai WOSI two weeks after the initial examination to assess test-retest reproducibility. Results:Sixty-two subjects, with a mean age of 28.76 years (SD, 9.7), were included in the study. Internal consistency (Cronbach's α = 0.956) and test-retest reliability (ICC = 0.97) were excellent. A strong correlation was observed between the Thai WOSI and the Thai QuickDASH (Pearson's r = 0.963), supporting good criterion validity. Conclusions:The results of this study demonstrate that the Thai version of the Western Ontario Shoulder Instability Index (WOSI) is a valid and reliable instrument for assessing shoulder-related function and quality of life in Thai-speaking patients with shoulder instability. Following linguistic translation and cultural adaptation, the Thai WOSI can be confidently used in both clinical practice and research settings to evaluate patients with shoulder instability in the Thai population.
Background:The aim of this study was to evaluate the clinical outcomes of arthroscopic rotator cuff repair (ARCR) in which intratendinous tears (ITTs) were converted to full-thickness tears and repaired via the suture-bridge technique. Methods:Partial-thickness ITTs that were refractory for more than 6 months to conservative treatment were surgically treated using a radiofrequency device to convert the ITTs into full-thickness tears, which were subsequently repaired via the suture-bridge technique. The evaluation parameters included shoulder range of motion (forward elevation and external rotation), Japanese Orthopaedic Association (JOA) scores, Constant-Murley scores, University of California at Los Angeles (UCLA) scores, American Shoulder and Elbow Surgeons (ASES) scores, and retear rates (Sugaya classifications IV and V). Results:Twenty-one patients (8 males, 13 females; mean age: 55.3 ± 14.7 years) out of 25 diagnosed with isolated ITT completed at least 12 months of follow-up after surgery. Significant improvements were observed in the shoulder range of motion (139.5 ± 31.4° preoperatively to 164.5 ± 12.8° postoperatively), external rotation (45.8 ± 15.1° to 54.1 ± 14.7°), and clinical scores including the JOA score (64.4 ± 15.0 to 91.9 ± 7.2), Constant-Murley score (49.1 ± 18.7 to 81.9 ± 16.6), UCLA score (18.1 ± 5.2 to 30.4 ± 6.1), and ASES score (46.9 ± 28.8 to 91.3 ± 9.8). No re-tears were observed (0%). Conclusions:There is no consensus on the optimal surgical approach for ITT. This study demonstrated the favorable clinical outcomes of ARCR via the suture-bridge technique after conversion of ITT to full-thickness tears. Level of evidence:Level Ⅳ, retrospective cohort study.
Background/objective:Although many studies have reported the clinical outcomes of pullout repair for medial meniscus posterior root tears (MMPRTs) or microfractures for focal cartilage lesions alone, no study has specifically reported the clinical outcomes in patients with MMPRT combined with cartilage lesions. Therefore, we investigated the effectiveness of bone marrow stimulation via microfracture for treating focal cartilage lesions associated with MMPRT and compared the clinical outcomes between patients who underwent microfracture and those who did not. We hypothesised that favourable clinical outcomes could be achieved after transtibial pullout repair combined with microfracture for MMPRTs with focal cartilage lesions and that these outcomes would be comparable to those after transtibial pullout repair alone for MMPRTs without cartilage lesions. Methods:Ten patients who underwent transtibial pullout repair and microfracture for MMPRT with cartilage lesions (Group MF) and 37 patients who underwent only pullout repair for MMPRT without cartilage lesions (Group P) using the same pullout technique (two simple stitches) as Group MF between November 2016 and September 2023 were retrospectively evaluated. The age at the time of surgery, sex, height, weight, body mass index, duration from injury to surgery, and KL grade were recorded for each patient. The presence, location, and area of cartilage lesions were evaluated. Clinical outcomes were assessed, and all included patients underwent a second-look arthroscopy. Results:The mean follow-up period, patient age, body mass index, femorotibial angle, and percentage of the mechanical axis in Group MF were 3.2 years, 60.2 years, 26.1 kg/m2, 176.3°, and 42.4%, respectively. All postoperative clinical outcomes at one and three years showed significant improvement compared with preoperative outcomes, including the KOOS and IKDC, Tegner, Lysholm, and pain VAS scores. Second-look arthroscopy confirmed good meniscal healing. No significant differences in demographic data, radiological parameters, clinical outcomes, or meniscal healing were observed between Groups MF and P, both preoperatively and at the three-year postoperative follow-up. Conclusion:The clinical outcomes of transtibial pullout repair combined with microfracture were favourable in patients with MMPRT and focal cartilage lesions in well-aligned knees. Moreover, no significant differences in clinical outcomes were detected between patients who underwent pullout repair combined with microfracture and those who underwent pullout repair alone. MMPRTs with focal cartilage lesions may be effectively treated with pullout repair combined with microfracture, provided that strict patient selection criteria are applied.
Background:The greater training load and early specialization in youth sports has led to an alarming increase in knee injuries, particularly anterior cruciate ligament (ACL) injuries among children and adolescents. This study aimed to develop a consensus among surgeons and experts from the Asia-Pacific Knee, Arthroscopy and Sports Medicine Society (APKASS) on key aspects of paediatric ACL injury management to enhance clinical outcomes. Methods:Twenty-three expert surgeons from 8 countries participated in the consensus meeting, which focused on nine crucial domains: prevention, diagnosis, management, surgical techniques, post-operative care, management of associated injuries, rehabilitation, outcome evaluation, and future directions. A predefined agreement threshold of 75% was used to determine consensus. Responses were analysed alongside current literature to pinpoint areas of agreement and divergence. Results:The consensus project revealed strong agreement on several key aspects of paediatric ACL injury management, particularly the implementation of injury prevention programmes for high-risk sports (85%) and the importance of assessing concomitant meniscal or chondral injuries for surgical intervention (91.3%). However, significant variability was observed in areas such as diagnostic challenges, treatment timing, and rehabilitation protocols. There was no consensus on optimal surgical techniques for skeletally immature patients or the ideal graft diameter for reconstruction. Individualized treatment approaches were emphasized, with 78.3% of surgeons advocating for case-by-case decision-making, reflecting the need to consider factors like skeletal maturity, activity level, and family preferences. There was also a strong consensus on the need for routine monitoring of growth disturbances post-surgery and a comprehensive multi-criteria approach for return-to-sport assessments, underscoring the complexity of managing paediatric ACL injuries. Conclusion:This expert consensus, developed from an Asia-Pacific perspective, showed both agreement and variation in managing paediatric ACL injuries. While strong consensus was achieved on diagnostic and immediate post-injury care, differences remained in surgical timing, graft selection, and rehabilitation. These findings highlight the need for region specific and paediatric focused guidelines to optimise long term outcomes and establish standardised evaluation criteria for this unique population. Level of evidence:V (Expert opinion).
Background:Chronic ankle instability (CAI) is characterized by persistent ankle pain, instability, and recurrent sprains. Previous studies have investigated functional impairments and cartilage degeneration separately, but the relationship between them in CAI remains unclear and unexplored. Objective:This study aimed to compare the outcomes of functional impairments and cartilage composition between individuals with CAI and healthy controls to develop targeted interventions to improve joint health and prevent cartilage degeneration in patients with CAI. Methods:This case-control study enrolled 20 individuals with CAI and 25 healthy controls. Dynamic balance measured using the Y-Balance Test (YBT) and static postural control was quantified by analyzing the trajectory of the center of pressure (CoP). T2 mapping of the talocrural joint was conducted using a 3-T magnetic resonance imaging scanner to assess ankle cartilage composition. Clinical questionnaire such as the Cumberland Ankle Instability Tool (CAIT) was used to evaluate the self-reported functional instability. Results:The T2 values were significantly higher in medial center (MC), medial posterior (MP), and lateral posterior (LP) (P < .05) subregions of the talar cartilage in the CAI group compared with the control group, indicating greater cartilage degeneration. Higher T2 values in the MC subregion were correlated with poorer CAIT scores (r = -0.484, P=.031) and YBT reach distances on the injury side (r ranged from -0.721 to -0.557, P < .05). The T2 elevations were also associated with reduced YBT reach distances on the healthy side and increased CoP excursions during eyes-closed postural control testing (eyes open: r = -0.585, P=.001; eyes closed: r = -0.469, P=.037). Conclusions:This study provides evidence of functional impairments and cartilage degeneration in individuals with CAI. The observed biomechanical compensations and increased cartilage T2 values may contribute to the development of CAI and potentially increase the risk of long-term joint degeneration. These valuable insights into the pathophysiology of CAI may aid in developing targeted interventions to mitigate long-term joint degeneration.
Objective:Deep venous thrombosis (DVT) has the potential to develop into life-threatening pulmonary embolism which is a serious complication after anterior cruciate ligament reconstruction (ACLR). Advanced age (≥40 years) is a known risk factor for DVT. Anticoagulation is an effective pharmacological prophylaxis for DVT, but its indications after ACLR have not been established. This study aimed to investigate the incidence of DVT after ACLR when postoperative anticoagulation is administered to patients ≥40 years of age. Methods:Anticoagulation group comprised 75 consecutive patients who underwent ACLR (including 5 revision surgeries) at our hospital between November 2021 and April 2024. Among those patients, patients ≥40 years old in Anticoagulation group received edoxaban at 30 mg/day on postoperative days 3-7 as pharmacologic prophylaxis for DVT. The historical control group not administered anticoagulation (No anticoagulation group) comprised 56 patients with 56 ACLRs (including 10 revision surgeries) performed at our hospital between April 2017 and September 2018. Propensity score matching was performed for age, and 48 patients were selected from each group and enrolled in this study. There were 16 patients in Anticoagulation group and 17 in No anticoagulation group who were ≥40 years old. DVT was diagnosed using ultrasonography of both legs performed at 1 week postoperatively. Complications associated with anticoagulation and hemoglobin (Hb) levels in patients ≥40 years old were investigated. Results:After ACLR, DVT was detected in 2 patients (4.2%) in Anticoagulation group and 9 patients (18.8%) in No anticoagulation group. The incidence of DVT was thus significantly lower in Anticoagulation group (P = 0.025). All patients with DVT were asymptomatic. With regard to Hb levels in patients ≥40 years old, no significant difference was evident between groups. No complications associated with anticoagulation therapy, such as bleeding, were observed. Conclusion:Anticoagulation administered to patients ≥40 years of age significantly reduced the incidence of DVT after ACLR without obvious adverse events. A limited indication of postoperative anticoagulation based on age may be beneficial in preventing DVT after ACLR.
Background:This study aimed to compare two common radiographic axial imaging techniques, the skyline view (SV) and the merchant view (MV), and to reveal the variability of acquired images in patients with recurrent patellar dislocation (RPD). Methods:Thirty consecutive patients with 34 affected knees of RPD were included in this study (4 males, 26 females; mean age, 26.4 years). Both SV and MV were measured at 30°, and 45°of knee flexion in each patient. The congruence angle (CA) and the lateral patellofemoral angle (LPA) were evaluated for lateral shifts and patellar tilts in each view. Result:The axial alignment differed significantly between the SV and MV at both 30° and 45° of knee flexion. The MV had higher CA and lower LPA values than the SV. Intraclass correlation coefficient analysis demonstrated excellent-to-good intra- and inter-observer reliabilities. A discrepancy in acquired images between SV and MV was demonstrated, with SV underestimated patellar malalignment in both lateral tilt and shift in patients with RPD. Conclusion:Since axial patellar alignment varies significantly depending on the radiographic technique, MV imaging is preferable to prevent the underestimation of patellofemoral instability. Surgeons should be aware of the characteristics of each imaging method and choose the appropriate technique for accurate evaluation.
Objective To establish a standardized set of criteria for Return to Play (RTP) after Anterior Cruciate Ligament (ACL) reconstruction based on a consensus among international experts. Methods An international group of ACL experts convened at the APKASS 2024 Consensus Meeting to address the variability in RTP criteria. Using a structured questionnaire, the experts evaluated six key areas: clinical assessment, functional testing, psychological factors, rehabilitation and reinjury prevention, surgery-related factors, and stakeholder insights. Data were analyzed using a predefined consensus threshold of 75% agreement. Results The consensus identified several key recommendations for RTP, emphasizing the avoidance of purely time-based decision-making in favour of a more comprehensive approach that incorporates functional and psychological assessments, and sport-specific demands. Notable findings included the endorsement of manual stability tests (Lachman and Pivot Shift) as important components of evaluating knee stability, the critical role of psychological readiness, and the importance of a multifaceted approach involving various stakeholders in the RTP decision-making process. Conclusion The APKASS 2024 Consensus Statement provides a comprehensive, expert consensus-based framework for RTP after ACL reconstruction and may help promote greater consistency in clinical practice. It highlights the need for a personalized approach that considers the unique recovery progress of athletes. Future research is encouraged to refine RTP protocols further and explore the integration of novel diagnostic and therapeutic technologies. Level of evidence V (Expert opinion).
Purpose:Reconstruction of the anterior cruciate ligament (ACL) with a bone-patellar tendon-bone (BPTB) autograft leaves a central tendon defect, and whether this should be repaired remains debated. Conventional suturing techniques often show limited biomechanical benefit. This study evaluated the biomechanical efficacy of a novel Partial-Thickness Split and Bridging Repair (PTSBR) technique compared with non-repair in a cadaveric model. Methods:Twelve knees from six fresh-frozen human cadavers were randomized to repair or non-repair groups. In the repair group, PTSBR involved a longitudinal partial-thickness incision with superficial tendon bridging and interrupted vertical mattress sutures. All specimens were mounted and tested using an Instron universal testing machine. Primary outcomes included maximal load, maximal stress, stiffness, Young's modulus, tendon dimensions, and failure location. Statistical comparisons were performed using paired analyses with significance set at p < 0.05. Results:PTSBR demonstrated significantly higher Young's modulus [90.19 MPa (24.02-202.47) vs. 50.83 MPa (19.96-115.29), p = 0.028] and maximal stress [19.35 MPa (5.21-35.54) vs. 13.30 MPa (5.21-24.23), p = 0.046] compared with non-repair. No difference was observed in maximal load (p = 0.674) or stiffness. Tendon thickness was significantly reduced in the repair group (2.34 ± 0.20 mm vs. 2.69 ± 0.32 mm, p = 0.023). Failure occurred mainly at the tibial or patellar attachment, with no mid-substance ruptures. Conclusion:The PTSBR technique enhanced tensile stiffness and stress resistance compared with non-repair, likely due to improved tendon fiber alignment and load-sharing. These biomechanical advantages suggest that PTSBR may represent a clinically relevant advancement in managing patellar tendon defects after BPTB graft harvest.
Background/objective:The Simple Knee Value (SKV) is a knee-specific adaptation of the Single Assessment Numeric Evaluation (SANE), serving as a single-item patient-reported outcome measure for knee function. Although the SKV has been translated into Thai, its measurement properties have not yet been evaluated in patients with anterior cruciate ligament (ACL) injury. Therefore, this study aimed to evaluate the measurement properties of the Thai version of the SKV in this population. Methods:This prospective study included patients aged 18 to 50 years with ACL injury scheduled for surgery. Participants completed the Thai version of the SKV at three time points: preoperatively at baseline and 2 weeks later (for test-retest reliability), and 3 months postoperatively (for responsiveness). Three additional patient-reported outcome measures including the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the European Quality of Life 5-Dimension 5-Level were administered at baseline and 3 months. Results:Ninety patients completed assessments at all time points. The Thai SKV demonstrated acceptable psychometric properties. Construct validity was supported by positive correlations with comparator patient-reported outcome measures (Spearman rank correlation coefficients = 0.20 - 0.37). Test-retest reliability was excellent (intraclass correlation coefficient = 0.92; 95% confidence interval 0.88 - 0.95). The SKV showed large responsiveness to change (effect size = 0.96, standardized response mean = 0.92) and good external responsiveness through moderate correlations with change scores of other instruments (Spearman rank correlation coefficients = 0.33 - 0.49). No floor or ceiling effects were observed. The minimal clinically important difference was 10.0 points (sensitivity 82.0%, specificity 100.0%). Conclusion:The Thai version of the SKV is a valid and reliable tool for evaluating knee function in patients with ACL injury. Responsiveness of the instrument was demonstrated in the early postoperative phase. This single-item measure offers a practical screening and monitoring tool for clinical practice where time-efficient assessment is required. For comprehensive patient evaluation, it should be used alongside detailed questionnaires such as IKDC-SKF or KOOS.
Introduction Meniscal surgery is one of the most common procedures in orthopedic surgery. Although several studies suggest an increased risk of osteoarthritis following meniscectomy compared to meniscus repair, surgical decision should consider individual patient's factor, such as tear pattern, age and activity level. Recent national trends in arthroscopic meniscal surgery in Japan remain unclear. This study aimed to analyze the number of meniscal surgeries, and the proportion of meniscal repairs performed between 2014 and 2023. Materials and methods The Excel files ‘Number of calculations by division, sex, and age group'under the ‘operation (code K)’ from 2014 to 2023 were downloaded from the National Databaseof Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data. Thearthroscopic data meniscectomy (code K068-2) and arthroscopic meniscus repair (code K069-3) were analyzed according to demographic characteristics (sex, age). The trend in the number of meniscal surgeries from 2014 to 2023 was examined. The number of surgical procedures performed per year and the incidence of both surgical procedures, calculated as the number performed per 100,000 population per year, were evaluated. Results The total number of arthroscopic meniscus surgeries increased from 35,100 cases in 2014 to 49,165 cases in 2023. The total number of arthroscopic meniscus repairs increased from 6652 cases in 2014 to 26,274 cases in 2023. The incidence per 100,000 person-years of arthroscopic meniscus repair also increased from 5.2 in 2014 to 21.1 in 2023. In contrast, the total number of arthroscopic meniscectomy decreased from 28,448 cases in 2014 to 22,891 cases in 2023. The incidence per 100,000 person-years of arthroscopic meniscectomy also decreased from 22.4 in 2014 to 18.4 in 2023. Ratio of arthroscopic meniscus repair significantly increased from 19.0 % in 2014 to 53.4 % in 2023 (p < 0.001). This trend was consistent in both sexes and across age groups. The rate of meniscus repair increased across all age groups (p < 0.001). Conclusions From 2014 to 2023 in Japan, the total number of arthroscopic meniscus surgeries increased with a marked rise in the proportion of arthroscopic meniscus repair. This trend was observed across age groups, including in patient over 40. Level of evidence Level Ⅳ
