Abstract Purpose This study aimed to evaluate histomorphological changes associated with residual foreign material in failed anterior cruciate ligament (ACL) autografts. We hypothesised that retained suture material is associated with histopathological regression phenomena in ligamentous and osseous compartments following ACL reconstruction failure. Methods In this prospective study, 43 consecutive patients (mean age 29.7 ± 9.0 years; 20.9% female) undergoing revision surgery after failed autologous ACL reconstruction were included and analysed. A total of 76 bone‐graft specimens were obtained by over‐reaming femoral and tibial drill tunnels to retrieve the periarticular tunnel segment. Specimens were processed using Hematoxylin–Eosin, Masson–Goldner and Elastika–van Gieson staining. Morphological alterations related to foreign material were assessed qualitatively and semi‐quantitatively using a four‐point grading system under light microscopy. Evaluations were performed independently by two observers (a pathology professor and a trained investigator), with consensus in case of disagreement. Results Foreign material residues were identified in 92.6% of specimens. Polarised light microscopy revealed birefringent suture remnants frequently associated with histiocytic inflammatory reactions and multinucleated giant cells. Observed regression phenomena included inflammatory reactions (IR), capillary proliferation (CP), osteonecrosis (ON), fissural splitting (FS) and intraligamentous cyst formation. Severe tissue destruction of the autograft or bony compartment was present in approximately 20% of femoral and tibial samples. Descriptive contingency analysis indicated that regression phenomena predominantly occurred in association with adjacent foreign body reactions, whereas isolated regression changes without detectable foreign material were rare. Conclusion Residual suture material in failed ACL reconstructions is frequently associated with inflammatory and degenerative histomorphological changes in both tendon graft and bone tunnel compartments. Although causality cannot be established, these findings suggest that foreign body reactions may contribute to local tissue degradation. Further studies are needed to clarify the clinical and biomechanical relevance of these observations. Level of Evidence N/A.

Minimalinvasive Verfahren haben die operative Therapie von Kleinzehenfehlstellungen wesentlich verändert und stellen heute bei vielen Deformitäten ein etabliertes Vorgehen dar. Ziel ist eine gewebeschonende, funktionell und kosmetisch günstige Korrektur bei geringer Invasivität. Die Indikationsstellung basiert auf einer präzisen klinischen Analyse der Fehlstellung im MTP-, PIP- und DIP-Gelenk, der betroffenen Fehlstellungsebene sowie der Flexibilität oder Rigidität der Deformität. Das operative Konzept folgt einem sequenziellen Vorgehen mit weichteiligen und knöchernen Techniken, die regelhaft kombiniert werden. Neben perkutanen Tenotomien und Kapsulotomien ermöglichen insbesondere minimalinvasive Osteotomien der Phalangen, PIP- und DIP-Arthrodesen, Exostosen- und Kondylenabtragungen sowie distale minimalinvasive metatarsale Osteotomien Korrekturen in verschiedenen Ebenen. Eine interne Osteosynthese ist meist nicht erforderlich, da die Korrektur durch redressierende Tape-Verbände gesichert wird. Minimalinvasive Kleinzehenkorrekturen ermöglichen eine effektive Korrektur mit niedriger Komplikationsrate und frühfunktioneller Nachbehandlung. Bei schweren, kontrakten oder luxierten Fehlstellungen können weiterhin offene Verfahren oder die Kombination aus minimalinvasiven und offenen Verfahren erforderlich sein.

Abstract Purpose Evaluating knee joint function, activity level, and osteoarthritis severity in patients at least 8 years after post‐operative knee septic arthritis (SA) following anterior cruciate ligament reconstruction (ACLR). Methods From May 2010 to January 2012, 39 patients at our institution were treated for knee SA following ACLR using graft‐retaining treatment protocols. Follow‐up examinations after a minimum of 8 years included clinical examination, measurement of anterior tibial translation (rolimeter), International Knee Documentation Committee Subjective Knee Form (IKDC), 12‐Item Short Form Health Survey (SF‐12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx and Tegner scores. Osteoarthritis severity was described on radiographs using the Kellgren–Lawrence scale. Synovial fluid was aspirated from patients with persistent infection signs and evaluated using multiplex polymerase chain reaction (PCR). Based on ACLR graft, sex and preoperative Tegner score (±1), a 1:1 propensity score matched control group including patients with ACLR without knee SA signs was assembled. Results Matching resulted in 17 patients per group. While the patient‐reported outcome measures (PROMs) (IKDC, Tegner, Marx and SF‐12) showed no significant differences between the groups (p > 0.05), the WOMAC score was significantly worse in the infection group (p = 0.016). Range of motion deficits were more frequent in the infection group (65% vs. 18%; p = 0.005). The infection group also had higher Kellgren–Lawrence grades (2 [1–2.75] vs. 0 [0–1], p < 0.001). Multiplex PCR detected no persistent infection. Two patients (10%) in the infection group required graft removal. No correlation was found between the number of lavages and long‐term outcomes. Conclusions SA after ACLR, when treated with a standardized graft‐retaining protocol, results in higher OA severity, worse WOMAC scores and persistent range of motion limitations at long‐term follow‐up, while other PROMs and activity level remained comparable to those of non‐infected cases. Level of Evidence Level III.

Anterior cruciate ligament (ACL) rupture is the most serious injury in judo. However, little is known about the outcome of treatment and its impact on subsequent athletic development. This study aimed to evaluate (1) ACL re-injury rates, injury-related time loss, and (2) regained level of performance in judoka after conservatively and surgically treated ACL ruptures.Five hundred judoka who had suffered an ACL rupture were included in the study via an online survey. Re-injury rates, persistent symptoms, time loss, and reduction in athletic performance were assessed according to performance level and treatment approach (surgical vs. conservative).Eighty-six percent of athletes underwent surgery. The overall re-injury rate was 27.6%. In the highest performance level group, 41.4% sustained a re-injury. No significant difference was observed with regard to persistent pain, swelling, and episodes of instability (surgical vs. conservative: pain 40.1% vs. 35.2%, p=0.436; swelling 21.7% vs. 12.7%, p=0.081; instability 14.0% vs. 15.5% p=0.736) Among conservatively treated patients, 70.4% returned to sport after 6 months, whereas among surgically treatment patients, 35.9% returned within 6-9 months and 33.6% after more than 9 months . There was no significant difference in post-injury performance level between treatment groups (same performance level: surgical 32% vs. conservative 35%).Judo athletes show high re-injury rates after ACL ruptures, especially in high performance classes. The proportion of persistent symptoms after surgical therapy is high and differs only slightly from those treated conservatively. In rare cases, pre-injury performance levels may be regained even after conservative therapy.

BACKGROUND:Minimally invasive techniques have substantially changed the surgical management of lesser toe deformities. The therapeutic objective is a tissue-sparing correction that restores function, improves alignment, and achieves a favorable cosmetic result with minimal surgical morbidity. Indication for surgery requires a detailed clinical assessment of the deformity at the metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, including the affected plane, severity, and degree of flexibility or rigidity. OPERATIVE STRATEGY:The operative strategy is based on a sequential concept combining soft-tissue and osseous procedures as required. Percutaneous tenotomies and capsulotomies may be supplemented by minimally invasive phalangeal osteotomies, proximal and distal interphalangeal joint arthrodeses, exostosis and condylar resections, and distal minimally invasive metatarsal osteotomies, allowing multiplanar correction. Internal fixation is usually not required, as postoperative alignment is maintained by corrective taping. RESULTS:Minimally invasive correction of lesser toe deformities provides effective realignment with low complication rates and allows early functional postoperative management. In severe, rigid, or dislocated deformities, combined open procedures may remain necessary.

Osteomyelitis continues to pose significant challenges in clinical management, with no universally accepted treatment guidelines at either national or international level as of 2025. Amoxicillin/clavulanic acid (AMC) is a widely used β-lactam antibiotic known for its safety, tolerability, and broad-spectrum activity against common osteomyelitis pathogens. This work seeks to determine whether oral AMC could serve as a viable and effective option in the management of osteomyelitis based on the current treatment landscape of osteomyelitis. Preferred Reporting Items for Systematic Reviews (PRISMA) were applied during the preparation of the article. For the structured search in PubMed®, The Cochrane Library, and UpToDate®, key research questions were defined and translated into specific search terms. Inclusion and exclusion criteria were defined using the population-intervention-comparison-outcome-study design strategy. All relevant publications available from 1981 to March 2025 were considered. A total of 1,321 publications were identified. After applying in- and exclusion criteria - supported by automation tools − 104 publications were analysed. The number of primary studies specifically investigating AMC for osteomyelitis is limited. However, available data suggest that AMC is effective and demonstrates non-inferiority compared to standard reference antibiotics. Pharmacokinetic data indicate that prolonged and repeated dosing may enhance distribution into deeper compartments, including bone tissue. Reported adverse effects of AMC are generally mild to moderate, in contrast to alternative agents. The analysis of the included publications and theoretical considerations on the treatment of osteomyelitis show that surgical debridement followed by long-term administration of AMC can be an effective option for empirical therapy.

BACKGROUND:Surgical site infections are a clinically relevant complication in orthopedic surgery, and administration of perioperative antibiotic prophylaxis has been shown to reduce infection rates. This study aimed to identify influencing factors on the concentration of unbound cefazolin in shoulder synovial fluid, following the perioperative antibiotic prophylaxis administration of 2 g of cefazolin during shoulder surgery. METHODS:Patients who underwent arthroscopic or open shoulder surgery within 5 months were prospectively included. The exclusion criteria were patient age under 18 years, shoulder joint infection, beta-lactam allergy, and creatinine clearance below 30 ml/min. All patients received 2 g of cefazolin pre-operatively via intravenous short infusion. The infusion duration, sampling time, patient age, body weight, body mass index, American Society of Anesthesiologists score, smoking status and diabetes status were documented. Unbound cefazolin concentrations in the synovial fluid were determined using ultrafiltration and ultra-high-performance liquid chromatography coupled to tandem mass spectrometry. Multiple linear regression analysis with backward elimination (significance level P < .05) was used to analyze influencing factors on unbound cefazolin concentration. RESULT:A total of 62 patients (35 men (56.5%), age 57.1 ± 15.4 years, body weight 88.2 ± 18.5 kg) were included in the final evaluation. The unbound cefazolin concentration was 20.2 ± 8.6 μg/mL. Increasing body weight and current smoking independently negatively influenced the unbound cefazolin concentration (B = -.217, P = < .001 and B = -6.631, P = .002, respectively). No significant correlation was found with age, sex, body mass index, American Society of Anesthesiologists score, diabetic status, creatinine clearance and the time interval between perioperative antibiotic prophylaxis administration and sample collection. Sufficient drug concentrations were detected in all cases against Cutibacterium acnes (2 μg/mL). The fourfold epidemiologic cut-off value for Staphylococcus aureus (8 μg/mL) was achieved in 58 patients (93.5%). In 55 patients (88.7%), the unbound drug concentrations were below 4 times the epidemiologic cut-off value for coagulase-negative staphylococci (32 μg/mL). CONCLUSIONS:Higher body weight and current smoking are associated with lower unbound cefazolin concentrations in shoulder synovial fluid. Patient-specific adjustment of cefazolin dosing may be considered to optimize perioperative antibiotic prophylaxis.

Purpose:To investigate static tibial subluxation on magnetic resonance imaging (MRI) as a potential method to quantify rotatory knee instability and differentiate between complete anterior cruciate ligament (ACL) injuries, partial ACL injuries, and intact ACL. Methods:Consecutive patients who underwent knee arthroscopy between 2016 and 2021 were retrospectively reviewed and divided into two groups according to arthroscopically verified ACL status: partial (p-ACL-I) or complete ACL injury (c-ACL-I). Patients with p-ACL-I required ACL-augmentation. The control group with an intraoperatively confirmed intact ACL (i-ACL) and a meniscus injury was 1:1 matched to p-ACL-I considering age, sex and body mass index (BMI). Static tibial subluxation in the medial (MC) and lateral compartment (LC) was measured on preoperative MRI. Intraclass correlation coefficients (ICC) were calculated for inter- and intrarater reliability. Pairwise t-test and multivariate logistic regression were used to identify differences with significance set at p < 0.05. Results:The final analysis included 136 patients, 30 patients with p-ACL-I (8 female, 28 ± 10 years, BMI 27 ± 5 kg/m2), 24 patients with an i-ACL (6 female, 34 ± 11 years, BMI 28 ± 5 kg/m2) and 82 patients with c-ACL-I (26 female, 27 ± 11 years, BMI 26 ± 5 kg/m2). The static tibial subluxation was found to be greater in c-ACL-I (MC: 2.5 mm, LC: 6.8 mm) compared with the p-ACL-I (MC: -0.6 mm, LC: 1.7 mm) both in the MC and LC (p < 0.001). The static anterior tibial subluxation was greater in p-ACL-I (-1.1 mm) compared with i-ACL (-4.1 mm) in the MC (p = 0.01). However, no significant difference between p-ACL-I (1.6 mm) and i-ACL (0.9 mm) was found in the LC (p = 0.90). Intra- and interrater reliability analysis showed good to excellent agreement (ICC = 0.75-0.90). Conclusion:Residual fibres in p-ACL-I stabilized static anterior tibial translation. Preoperative static MRI subluxation measurement may help to differentiate between c-ACL-I and p-ACL-I who require surgical intervention, as an adjunct to the decisive dynamic examination of knee instability. Level of Evidence:Level III.

Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA.

Background: In most cases osteoarthritis of the ankle is of posttraumatic origin. Younger people are more frequently affected, which makes treatment a particular challenge. In addition to conservative treatment numerous surgical procedures are available for the treatment of advanced arthrosis. The aim of this nationwide survey was to document the current status of the diagnostics and treatment of ankle arthritis in Germany. Material and methods: Members of the German Society for Orthopedics and Trauma Surgery (DGOU) were invited to participate in an anonymous online survey on the treatment of ankle joint osteoarthritis. The survey included 69 questions on the person, on the diagnostic and treatment approaches as well as 3 clinical and radiological patient cases. The evaluation of the results of the survey included differences in the subgroups of participants based on the discipline, the location of activity, position and certification. Results: From November 2019 to February 2020 a total of 343 members participated in the survey. For the diagnostics 96% requested conventional radiographs in a standing position and in 2 levels. Other native radiographs were considered necessary by less than half of respondents. Less than one third of participants sometimes (n = 87) or always (n = 18) use an outcome score. The therapeutic repertoire included supramalleolar osteotomy (n = 106), ankle arthroplasty (n = 100) and arthrodesis (n = 248). Open arthrodesis using screws through an anterior approach was the most frequently used surgical procedure. Conclusion: Diagnostic standards were regularly used in the treatment of ankle arthrosis. With respect to the surgical treatment there was a wide heterogeneity due to the pathological anatomy and preferences of the participants. Open arthrodesis was the most frequently selected procedure.

There is broad consensus that Rockwood type II injuries are treated conservatively. However, several studies have shown that some of these patients have persistent mid- to long-term symptoms, partly due to horizontal instability.Patients with a side-to-side difference of up to 25% in the coracoclavicular distance on bilateral stress radiographs were included in this case series if they had either a posterior subluxation of the distal clavicle on axial radiographs and/or on MRI (in 8 patients), or if they showed dynamic posterior instability both clinically and radiologically. Injuries other than Rockwood type II or Rockwood type II injuries without horizontal instability were excluded.During the period from 2015 to 2022, 13 patients with an average age of 30.7 years (range 21-48 years) fulfilled the inclusion criteria. The mean time from trauma to final diagnosis was 32.4 days (range 7-67 days). Eight patients had an additional static posterior dislocation of the distal clavicle consistent with a Rockwood type IV injury. Five patients had dynamic posterior instability. All patients had initially been classified as having Rockwood type II injuries based on the findings of bilateral stress radiographs at the referring institution.The diagnosis of a Rockwood type II injury should not be based solely on bilateral stress radiographs but should instead be made only after horizontal instability has been ruled out with appropriate imaging modalities. Otherwise, Rockwood type IV injuries or Rockwood type II injuries with concomitant horizontal instability may be overlooked.

Purpose:The aim of this study was to identify morphological alterations that occur in graft failure following anterior cruciate ligament (ACL) reconstruction. It was hypothesised that multiple morphological regression phenomena are present at the time of revision surgery. Methods:In this prospective study, 43 consecutive patients undergoing revision surgery due to graft failure after autologous ACL reconstruction were analysed. Specimens were redrilled with a hollow reamer to obtain the entire drill channel and ACL remnants, which were examined histopathologically using haematoxylin and eosin (HE), Masson-Goldner, Elastika-Gieson and CD68+ stains to characterise ligamentous and osseous changes qualitatively and quantitatively under light microscopy. Results:A total of 76 bone blocks were obtained from 43 patients (mean age 29.67 ± 9.02 years; range 18-58). The cohort included 9 women (20.9%) and 34 men (79.1%). The mean time from graft failure to revision surgery was 53.4 months (range 0.23-84). Femoral fixation in the primary surgery used extracortical button fixation in 87.5% and the All-Press-Fit technique in 12.5%, while tibial fixation most commonly involved interference screws (86.4%). Spontaneous trauma was rare (2.5%), with inadequate trauma in 7.5%; 90% of failures followed adequate trauma. Histomorphologic analysis revealed various influential regression phenomena, predominantly central within the autograft. Findings included chronic histiocytic inflammation with associated capillary proliferation, fissure defects and osteonecrosis. Residual suture material emerged as a potential pathological factor contributing to severe regression and destructive changes. Occasionally, degenerative cysts, chondral metaplasia, myxoid degeneration, osteoporotic changes and ectopic ossifications were observed. Conclusion:Several histomorphological changes have been identified, each with the potential to contribute to graft failure following ACL reconstruction. The most prevalent were fissure defects, inflammatory reactions, osteonecrosis, capillary proliferation and foreign body reactions. Less common are myxoid degenerations, cystic alterations, ectopic ossifications, chondral metaplasia and osteoporotic changes. Their collective impact on graft stability and long-term clinical outcomes warrants further investigation. Level of Evidence:Level III, cohort study.

Die Arthrose des oberen Sprunggelenks (OSG) betrifft häufig jüngere Menschen, weshalb die Behandlung eine besondere Herausforderung darstellt. Zur Versorgung fortgeschrittener Arthrosen stehen neben konservativen zahlreiche operative Verfahren zur Verfügung. Ziel unserer bundesweiten Umfrage war es, die aktuellen Versorgungsstrategien in Deutschland zu erfassen. Die Mitglieder der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie e. V. (DGOU) wurden zur Teilnahme an einer Onlineumfrage zur Behandlung der OSG-Arthrose eingeladen. Diese umfasste insgesamt 69 Fragen zur Person, zu diagnostischem und therapeutischem Vorgehen sowie 3 klinisch-radiologische Patientenfälle. Hierbei sollten die Teilnehmenden ihr Vorgehen bei fiktiven Patienten darlegen. Bei der Auswertung der Umfrageergebnisse werden Differenzen in den Untergruppen der Befragten anhand ihrer Fachrichtung, Tätigkeitsstätte, Position und Zertifizierung eruiert. Von November 2019 bis Februar 2020 nahmen 343 DGOU-Mitglieder an der Umfrage teil. Diagnostisch wird von 96

Purpose Traumatic hip dislocation into the obturator foramen is poorly understood due to the rarity of the injury. The purpose of this study was to analyze the mechanism of trauma, associated injuries, treatment, and complications in patients who sustained obturator hip dislocation and to evaluate long-term outcomes, including patient-reported outcome measures (PROMs). Methods Patient demographics, trauma mechanisms, concomitant injuries, and the treatment of all consecutive patients who sustained an obturator hip dislocation at three level-one trauma centers from 2009 to 2024 were analyzed. At follow-up, the incidence of avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), further complications, return to work and sports, and PROMs, including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS), were recorded. Results A total of eight obturator hip dislocations were identified out of 201 traumatic hip dislocations. Associated knee injuries, particularly involving the posterior cruciate ligament (PCL), were observed in five of eight patients (62.5%). Computed tomography (CT) analysis revealed concomitant fractures of the femoral head (Pipkin Types I-IV) or acetabulum in six of eight cases (75%), with the femoral head involved in 50% of all cases. Five patients were followed up (mean 9.17 ± 4.79 years). All patients demonstrated a good or excellent mHHS (mean 85.44 ± 7.36), and the TAS slightly decreased compared to their pre-injury level (5.5 to 4.5). None of the patients had been diagnosed with PTOA or AVN or undergone total hip arthroplasty (THA). Conclusion Obturator hip dislocations most commonly result from a high-energy "dashboard injury" and are mainly associated with concomitant femoral head or anterior acetabular wall fractures. Long-term follow-up has shown only minor limitations in activities of daily living, sports, and return to work, with a low risk of femoral head AVN or PTOA.

Background/Objectives: Trochanteric femoral fractures pose significant surgical challenges, particularly in elderly patients. Intramedullary nailing (IMN) and plate fixation (PF) are the primary operative strategies, yet their comparative efficacy and safety remain debated. This meta-analysis synthesizes randomized controlled trials (RCTs) to evaluate clinical, functional, perioperative, and biomechanical outcomes of IMN versus PF specifically in trochanteric fractures. Methods: A systematic search of six databases was conducted up to 20 May 2024, to identify RCTs comparing IMN and PF in adult patients with trochanteric femoral fractures. Data extraction followed PRISMA guidelines, and outcomes were pooled using random-effects models. Subgroup analyses examined the influence of fracture stability, implant type, and patient age. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Fourteen RCTs (n = 4603 patients) were included. No significant differences were found in reoperation rates, union time, implant cut-out, or mortality. IMN was associated with significantly reduced operative time (MD = −5.18 min), fluoroscopy time (MD = −32.92 s), and perioperative blood loss (MD = −111.68 mL). It also had a lower risk of deep infection. Functional outcomes and anatomical results were comparable. Subgroup analyses revealed fracture stability and nail type significantly modified operative time, and compression screws were associated with higher reoperation rates than IMN. Conclusions: For trochanteric femoral fractures, IMN and PF yield comparable results for most clinical outcomes, with IMN offering some advantages in surgical efficiency and perioperative morbidity, though functional outcomes were comparable. Implant selection and fracture stability influence outcomes, supporting individualized surgical decision making.

BACKGROUND:Both EFAS and AOFAS are questionnaires used in evaluating postoperative outcome of foot and ankle surgeries. The EFAS is a Patient Reported Outcome Measure (PROM), whereas the AOFAS also contains a physician reported subset and is the most commonly used questionnaire worldwide. Our study compared psychometric properties of both scores in patients with foot or ankle surgery. METHODS:We compared validity and reliability of the EFAS and AOFAS questionnaires in 126 foot and ankle surgical patients. Internal consistency, test-retest reliability, floor and ceiling effects, construct validity, responsiveness and minimal important change were analyzed. RESULTS:The AOFAS and EFAS show similar psychometric properties overall with the EFAS showing better internal consistency than the AOFAS with a smaller standard error of the mean (SEM), while the AOFAS showed a higher sensitivity to change. CONCLUSIONS:Both the EFAS and the AOFAS show comparable psychometric properties. The EFAS performs better regarding SEM and internal consistency. Furthermore EFAS is a PROM without investigator bias and should therefore be preferred. LEVEL OF EVIDENCE:III.