In 2026, we are sending probes to Mars, mining metals from asteroids, and debating whether artificial intelligence should write our operative notes, yet we are still arguing about which tendon to use for anterior cruciate ligament reconstruction. Amid the noise, the quadriceps tendon has quietly re-emerged as the pragmatic choice in a field long dominated by graft dogma. With its broad cross-sectional area, favorable collagen alignment, and lower donor-site morbidity, it offers an appealing balance between biomechanics and biology. Recent evidence shows comparable stability and superior patient comfort compared with bone-patellar tendon-bone and hamstring grafts, particularly in athletes and revision cases. The quadriceps graft combines strength, predictability, and humility-it performs without demanding worship. As we move toward precision surgery and personalized orthopedics, perhaps the real question is no longer which graft is superior, but whether our reasoning has evolved as fast as our technology.

To investigate the functional outcomes of patients over 40 years of age who underwent isolated rotator cuff (RC) repair (RCR) for full-thickness RC tears resulting from a primary traumatic anteroinferior shoulder dislocation and to compare these outcomes with a control group of patients who underwent RCR for instability-independent RC tears, with a minimum follow-up of two years. Patients aged 40 years and older were included for RCR following primary traumatic anteroinferior shoulder dislocation between 01/2012 and 06/2020 with a minimum follow-up of two years. Patients were excluded if they received an additional labral repair or capsular shift. Outcomes were compared to a control group of patients who underwent RCR without history of previous dislocations. Primary outcome measures included passive range of motion (ROM) as well as patient reported outcomes comprising the Western Ontario Shoulder Instability Index (WOSI) and Rowe score. Rates of re-dislocation were evaluated as secondary outcomes. Thirty-six patients were enrolled and divided into 2 groups (n = 18, respectively). Demographic characteristics did not significantly differ (p > 0.05). At final follow-up, patients affected by instability-related RC tears showed comparable functional outcomes in terms of WOSI (427.2 ± 238.9instability group (IG) vs. 431.1 ± 252.1control group (CG); p = 0.962) and Rowe (87.5 ± 12.0IG vs. 91.1 ± 10.2CG; p = 0.339) scores as well as in terms of passive ROM (abduction: 88.1 ± 4.6°IG vs. 86.7 ± 11.5°CG; p = 0.637, forward elevation: 87.8 ± 6.2°IG vs. 88.3 ± 5.1°CG; p = 0.772, external rotation: 55.3 ± 10.5°IG vs. 50.8 ± 15.3°CG; p = 0.312, internal rotation: 65.3 ± 8.5IG vs. 68.8 ± 4.9CG, p = 0.388). No patient experienced a re-dislocation. Patients ≥ 40 years who underwent isolated RCR without labral repair or capsular shift for a concurrent RC tear after experiencing a primary traumatic anteroinferior shoulder dislocation, achieved favorable functional outcomes along with absence of re-dislocations. Retrospective case series; Level of Evidence IV.

PURPOSE:To examine ChatGPT's effectiveness in responding to common patient questions related to meniscus surgery, including procedures such as meniscus repair and meniscectomy. METHODS:We identified 20 frequently asked questions (FAQs) about meniscus surgery from major orthopedic institutions recommended by ChatGPT, which were then refined by two authors into 10 questions commonly encountered in the outpatient setting. These questions were posted to ChatGPT. Answers were evaluated using a scoring system to assess accuracy and clarity and were rated as "excellent answer requires no clarification," "satisfactory requires minimal clarification," "satisfactory requires moderate clarification," or "unsatisfactory requires substantial clarification." RESULTS:Four responses were excellent, requiring no clarification, four responses were satisfactory, requiring minimal clarification, two were satisfactory, requiring moderate clarification, none of the answers were unsatisfactory. CONCLUSION:As hypothesized, ChatGPT provides satisfactory and reliable information for frequently asked questions about meniscus surgery.

BACKGROUND:Tibial plateau fractures (TPF) have significantly increased over the last decade, with a notable proportion being bicondylar fractures. The necessity of a temporary external fixator (tEF) as an initial treatment for bicondylar TPF remains controversial, with limited data available regarding associated complications. AIM OF THE STUDY:The aim of this study is to investigate the complication rates between patients with and without initial treatment using tEF in patients with bicondylar TPF. MATERIAL AND METHODS:This monocentric retrospective study analyzed the complication rates of bicondylar TPF from January 2011 to December 2020 at a university national trauma center. The bicondylar TPFs were divided into two groups based on the respective initial treatment: temporary external fixator (tEF, n = 67) and primary immobilization in brace/cast (iBC, n = 82). The complication rate was determined using univariate regression analysis. RESULTS:Overall, there was no significantly increased relative risk of complications between tEF and iBC (odds ratio, OR 1.97, 95% confidence interval, CI 0.90-4.37, p = 0.069). The specific complication of a postinterventional infection, however, was significantly more frequent with the use of tEF (OR 5.11, 95% CI 1.27-29.88, p = 0.01) but the use of tEF was not associated with an impaired range of motion (ROM). DISCUSSION:The overall postoperative complication rate for tibial plateau fractures is not influenced by the initial treatment with a temporary external fixator or a brace/cast. The decision for a tEF should be made individually and based on clear indications. The higher infection rate in patients with tEF represents a risk that must be considered in the context of potential bias related to more complex soft tissue and bone injuries as well as multiple injuries. Further studies are needed to validate these findings and provide further analysis to improve clinical decision making.

This case report presents the clinical findings and management of a 32-year-old male recreational athlete who presented with ongoing knee pain for 4 months, without a history of trauma. The patient experienced intermittent pain during walking, particularly after prolonged periods of sitting, and exhibited positive findings on meniscus tests. However, he was able to participate in sports activities without pain. Magnetic resonance imaging (MRI) revealed a partial tear of the medial gastrocnemius head, confirming the diagnosis. Conservative treatment, including rest, physical therapy, and a gradual return to sports activities, led to significant symptom improvement. This case highlights the importance of considering rare injuries, such as isolated tears of the medial gastrocnemius head, in patients with persistent knee pain and meniscal symptoms, even in the absence of traumatic events. Previous reports on this specific injury are sparse, indicating its rarity and underscoring the need for further understanding and documentation.

Tibiakopffrakturen (TKF) verzeichnen in den letzten 10 Jahren einen signifikanten Inzidenzanstieg. Häufig handelt es sich hierbei um bikondyläre Frakturen. Die initiale Versorgung dieser Frakturen mittels Fixateur externe (tEF) wird kontrovers diskutiert, und es gibt nur wenige Daten über Komplikationen bei temporär angelegtem tEF. Das Ziel dieser Studie ist, die Komplikationsraten zwischen Patienten mit und ohne initiale tEF-Anlage in einem ähnlichen Patientenkollektiv zu untersuchen. Diese monozentrische retrospektive Studie analysiert die Komplikationsraten von bikondylären Tibiakopffrakturen von Januar 2011 bis Dezember 2020 an einem universitären überregionalen Traumazentrum. Die Frakturen wurden nach der jeweiligen initialen Therapie in 2 Gruppen eingeteilt (temporärer Fixateur externe (tEF)) und primäre Immobilisierung in Gips/Orthese (iGO). Das Komplikationsrisiko wurde mithilfe einer univariaten Regressionsanalyse ermittelt. Insgesamt zeigte sich kein signifikant erhöhtes relatives Risiko für Komplikationen zwischen tEF und iGO (Odds Ratio (OR) 1,97, 95

BACKGROUND:Tibial plateau fractures (TPFs) are complex injuries associated with significant postoperative complications including infection, deformity and wound healing disorders. Limited data exist on risk factors for complications following surgical treatment, particularly in large multicenter cohorts. METHODS:This retrospective study analyzed 1027 patients with intra-articular TPFs treated surgically at two level-I trauma centers in Germany (2011-2020). Preoperative CT imaging and follow-up data were required for inclusion. Complications were categorized into seven groups (infection, deformity, wound healing disorders, postoperative compartment syndrome, range of motion deficit and others). Statistical analyses assessed associations with fracture type (Schatzker classification), surgical approach, duration, and patient factors (BMI, age, smoking). RESULTS:Nineteen percent of patients required surgical revision, with deformity (5.7 %), infection (5.4 %), and wound healing disorders (3.3 %) being the most common complications. Complex fractures (Schatzker V-VI) and prolonged or multi-approach surgeries were associated with higher complication rates. Elevated BMI increased overall complication risk, while smoking was linked to wound healing disorders. CONCLUSION:The 19 % revision rate highlights the challenges of managing TPFs. Surgical factors, including operative duration and approach, play a critical role in the occurrence of complications, emphasizing the need for tailored strategies based on fracture complexity and surgical considerations.

This case report presents the clinical findings and management of a 32-year-old male recreational athlete who presented with ongoing knee pain for 4 months, without a history of trauma. The patient experienced intermittent pain during walking, particularly after prolonged periods of sitting, and exhibited positive findings on meniscus tests. However, he was able to participate in sports activities without pain. Magnetic resonance imaging (MRI) revealed a partial tear of the medial gastrocnemius head, confirming the diagnosis. Conservative treatment, including rest, physical therapy, and a gradual return to sports activities, led to significant symptom improvement. This case highlights the importance of considering rare injuries, such as isolated tears of the medial gastrocnemius head, in patients with persistent knee pain and meniscal symptoms, even in the absence of traumatic events. Previous reports on this specific injury are sparse, indicating its rarity and underscoring the need for further understanding and documentation.

OBJECTIVE:The goal of this systematic review is to determine the prevalence of these testing systems in the current rotator cuff literature, determine the most common outcome measurements evaluated with each of these systems, and discuss the benefits and limitations of each of these modalities. MATERIALS AND METHODS:A PubMed search was conducted to identify studies utilizing either dynamic or static whole shoulder models to assess rotator cuff pathology with or without subsequent repair. For each study, the repair method, the outcomes measured, and the loading forces used were collected. These were then compared between studies using either a dynamic or static model. RESULTS:A total of 44 studies (34 static, 10 dynamic) were included for analysis. The most common repairs evaluated were superior capsular reconstruction (SCR; static: 35%; dynamic: 40%), no repair (static: 24%; dynamic: 30%), and suture anchor repair (static: 15%; dynamic: 30%). The most common outcome measures for static studies were superior humeral head migration (65%) and glenohumeral contact force (21%), while the most common outcomes in dynamic studies were maximum abduction (50%) and deltoid force at maximum abduction (40%). CONCLUSION:Currently, a majority of this research utilizes static models. Understanding the benefits and limitations of these systems is important for researchers hoping to employ these models in their future work.

Background: Tibial plateau fractures (TPF) have significantly increased over the last decade, with a notable proportion being bicondylar fractures. The necessity of a temporary external fixator (tEF) as an initial treatment for bicondylar TPF remains controversial, with limited data available regarding associated complications. Aim of the study: The aim of this study is to investigate the complication rates between patients with and without initial treatment using tEF in patients with bicondylar TPF. Material and methods: This monocentric retrospective study analyzed the complication rates of bicondylar TPF from January 2011 to December 2020 at a university national trauma center. The bicondylar TPFs were divided into two groups based on the respective initial treatment: temporary external fixator (tEF, n = 67) and primary immobilization in brace/cast (iBC, n = 82). The complication rate was determined using univariate regression analysis. Results: Overall, there was no significantly increased relative risk of complications between tEF and iBC (odds ratio, OR 1.97, 95% confidence interval, CI 0.90-4.37, p = 0.069). The specific complication of a postinterventional infection, however, was significantly more frequent with the use of tEF (OR 5.11, 95% CI 1.27-29.88, p = 0.01) but the use of tEF was not associated with an impaired range of motion (ROM). Discussion: The overall postoperative complication rate for tibial plateau fractures is not influenced by the initial treatment with a temporary external fixator or a brace/cast. The decision for a tEF should be made individually and based on clear indications. The higher infection rate in patients with tEF represents a risk that must be considered in the context of potential bias related to more complex soft tissue and bone injuries as well as multiple injuries. Further studies are needed to validate these findings and provide further analysis to improve clinical decision making.

This study aims to compare the duration of surgery and fluoroscopy exposure between the supine and beach-chair positions during antegrade intramedullary nailing (IMN) of humeral shaft fractures. A retrospective, single-center study was conducted at a German Level I Trauma Center from January 2021 to August 2024. Patients included were aged 18–95 with confirmed humeral shaft fractures diagnosed via radiographic imaging. Exclusion criteria comprised fractures older than two weeks, polytrauma cases, concomitant neurovascular injuries, and patients undergoing alternative osteosynthesis procedures during the same surgery. Surgery was performed in either the supine or beach-chair position, and comparisons were made regarding operative duration, fluoroscopy time, and radiation dose exposure. Furthermore, the influence of fracture complexity (A-,B- and C- fractures according to AO) on these three parameters was tested. Demographic data were also collected and analyzed. A total of 79 patients were initially considered, with 59 meeting the inclusion criteria after the exclusion of 20 polytrauma cases. The final cohort consisted of 25 males (42.4

Die inverse Schultertotalendoprothese („reverse shoulder arthroplasty“, RSA) hat sich zunehmend als Behandlungsmethode bei irreparablen Rotatorenmanschettenrupturen etabliert, die aufgrund ihrer hohen Häufigkeit und komplexen Pathophysiologie eine therapeutische Herausforderung darstellen. Sie kompensiert den Verlust der Rotatorenmanschette, indem sie die Funktion des Deltamuskels nutzt, was zu einer signifikanten Verbesserung der Schulterfunktion und einer Schmerzlinderung führt – besonders bei älteren Patienten mit eingeschränkter Heilungsfähigkeit. Zahlreiche Studien belegen signifikante funktionelle Verbesserungen und eine hohe Patientenzufriedenheit. Trotz potenzieller Risiken wie Notching oder Lockerung bietet die RSA bei geeigneter Patientenauswahl und chirurgischer Expertise eine zuverlässige Lösung. Fortschritte in der Technologie tragen weiterhin dazu bei, die Langzeitergebnisse und die Haltbarkeit der Implantate zu verbessern.

Background There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation. Methods This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. Results Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10–145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73–136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group. Discussion Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.

In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF. For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed. A total of 23 surgeons from 7 hospitals (Trauma center levels I–III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2

Background: In young patients with irreparable subscapularis deficiency (SSC-D) and absence of severe osteoarthritis, anterior latissimus dorsi transfer (aLDT) has been proposed as a treatment option to restore the anteroposterior muscular force couple to regain sufficient shoulder function. However, evidence regarding the biomechanical effect of an aLDT on glenohumeral kinematics remains sparse. Purpose/Hypothesis: The purpose of this study was to investigate the effects of an aLDT on range of glenohumeral abduction motion, superior migration of the humeral head (SM), and cumulative deltoid force (cDF) in a simulated SSC-D model using a dynamic shoulder model. It was hypothesized that an aLDT would restore native shoulder kinematics by reestablishing the insufficient anteroposterior force couple. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle (gAA), SM, and cDF were compared across 3 conditions: (1) native, (2) SSC-D, and (3) aLDT. gAA and SM were measured using 3-dimensional motion tracking, while cDF was recorded in real time during dynamic abduction motion by load cells connected to actuators. Results: The SSC-D significantly decreased gAA (Δ–9.8°; 95% CI, –14.1° to −5.5°; P < .001) and showed a significant increase in SM (Δ2.0 mm; 95% CI, 0.9 to 3.1 mm; P = .003), while cDF was similar (Δ7.8 N; 95% CI, –9.2 to 24.7 N; P = .586) when compared with the native state. Performing an aLDT resulted in a significantly increased gAA (Δ3.8°; 95% CI, 1.8° to 5.7°; P < .001), while cDF (Δ–36.1 N; 95% CI, –48.7 to −23.7 N; P < .001) was significantly reduced compared with the SSC-D. For the aLDT, no anterior subluxation was observed. However, the aLDT was not able to restore native gAA (Δ–6.1°; 95% CI, –8.9° to −3.2°; P < .001). Conclusion: In this cadaveric study, performing an aLDT for an irreparable subscapularis insufficiency restored the anteroposterior force couple and prevented superior and anterior humeral head migration, thus improving glenohumeral kinematics. Furthermore, compensatory deltoid forces were reduced by performing an aLDT. Clinical Relevance: Given the favorable effect of the aLDT on shoulder kinematics in this dynamic shoulder model, performing an aLDT may be considered as a treatment option in patients with irreparable SSC-D.

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of -2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes.

The significance of psychological factors in orthopaedic surgery has long been underestimated. High psychological resilience plays an important role in achieving a positive postoperative outcome in terms of mental health, pain, and functional outcomes. This underscores the need for a more holistic approach to patient care, one that considers not only the physical aspects of treatment but also the emotional and psychological well-being of patients. This may involve implementing strategies to enhance resilience, providing support resources for coping with the challenges of surgery and recovery, and fostering open communication between patients and healthcare providers. Patients who feel supported and empowered throughout their surgical journey are likely to experience improved overall satisfaction with their care. Patient emotional well-being is integral to achieving optimal recovery.

Background:Promising short- and midterm outcomes have been seen after anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint (ACJ) injuries. Purpose/Hypothesis:To evaluate long-term outcomes and shoulder-related athletic ability in patients after ACCR for chronic type 3 and 5 ACJ injuries. It was hypothesized that these patients would maintain significant functional improvement and sufficient shoulder-sport ability at a long-term follow-up. Study Design:Case series; Level of evidence, 4. Methods:Included were 19 patients (mean age, 45.9 ± 11.2 years) who underwent ACCR for type 3 or 5 ACJ injuries between January 2003 and August 2014. Functional outcome measures included the American Shoulder and Elbow Surgeons (ASES), Rowe, Constant-Murley, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores as well as the visual analog scale (VAS) for pain, which were collected preoperatively and at the final follow-up. Postoperative shoulder-dependent athletic ability was assessed using the Athletic Shoulder Outcome Scoring System (ASOSS). Shoulder activity level was evaluated using the Shoulder Activity Scale (SAS), while the Subjective Patient Outcome for Return to Sports (SPORTS) score was collected to assess the patients' ability to return to their preinjury sporting activity. Results:The mean follow-up time was 10.1 ± 3.8 years (range, 6.1-18.8 years). Patients achieved significant pre- to postoperative improvements on the ASES (from 54.2 ± 22.6 to 83.5 ± 23.1), Rowe (from 66.6 ± 18.1 to 85.3 ± 19), Constant-Murley (from 64.6 ± 20.9 to 80.2 ± 22.7), SST (from 7.2 ± 3.4 to 10.5 ± 2.7), SANE (from 30.1 ± 23.2 to 83.6 ± 26.3), and VAS pain scores (from 4.7 ± 2.7 to 1.8 ± 2.8) (P < .001 for all), with no significant differences between type 3 and 5 injuries. At the final follow-up, patients achieved an ASOSS of 80.6 ± 32, SAS level of 11.6 ± 5.1, and SPORTS score of 7.3 ± 4.1, with no significant differences between type 3 and 5 injuries. Four patients (21.1%) had postoperative complications. Conclusion:Patients undergoing ACCR using free tendon allografts for chronic type 3 and 5 ACJ injuries maintained significant improvements in functional outcomes at the long-term follow-up and achieved favorable postoperative shoulder-sport ability, activity, and return to preinjury sports participation.