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Background: Primary repair of the anterior cruciate ligament (ACL) confers an alternative to ACL reconstruction in appropriately selected patients. Purpose: To prospectively assess survivorship and to define the clinically meaningful outcomes after ACL repair. Study Design: Case series; Level of evidence, 4. Methods: Included were consecutive patients with Sherman grade 1-2 tears who underwent primary ACL repair with or without suture augmentation between 2017 and 2019. Patient-reported outcomes (Lysholm, Tegner, International Knee Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Osteoarthritis Outcome Score [KOOS] subscales) were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. The minimal clinically important difference (MCID) was calculated using a distribution-based method, whereas the Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were calculated using an anchor-based method. Plain radiographs and magnetic resonance imaging (MRI) were obtained at 6 months, 1 year, and 2 years postoperatively. Results: A total of 120 patients were included. The overall failure rate was 11.3% at 2 years postoperatively. Changes in outcome scores required to achieve the MCID ranged between 5.1 and 14.3 at 6 months, 4.6 and 8.4 at 1 year, and 4.7 and 11.9 at 2 years postoperatively. Thresholds for PASS achievement ranged between 62.5 and 89 at 6 months, 75 and 89 at 1 year, and 78.6 and 93.2 at 2 years postoperatively. Threshold scores (absolute/change based) for achieving the SCB ranged between 82.8 and 96.4/17.7 and 40.1 at 6 months, between 94.7 and 100/23 and 45 at 1 year, and between 95.3 and 100/29.4 and 45 at 2 years. More patients achieved the MCID and PASS at 1 year compared with 6 months and 2 years. For SCB, this trend was also observed for non-KOOS outcomes, while for KOOS subdomains, more patients achieved the SCB at 2 years. High-intensity signal of the ACL repair (odds ratio [OR], 31.7 [95% CI, 1.5-73.4]; P = .030) and bone contusions on MRI (OR, 4.2 [95% CI, 1.7-25.2]; P = .041) at 1 year postoperatively were independently associated with increased risk of ACL repair failure. Conclusion: The rate of clinically meaningful outcome improvement was high early after ACL repair, with the greatest proportion of patients achieving the MCID, PASS, and SCB at 1 year postoperatively. Bone contusions involving the posterolateral tibia and lateral femoral condyle as well as high repair signal intensity at 1 year postoperatively were independent predictors of failure at 2 years postoperatively.

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CASE: A 62-year-old male patient suffered an irreducible posterolateral knee dislocation after a horse fell on him. The left knee was slightly flexed with a medial dimple sign present. The medial retinaculum, medial patellofemoral ligament, posteromedial corner structures, and vastus medialis obliquus (VMO) muscle were incarcerated in the medial joint. An open reduction and the medial retinaculum and VMO gap were repaired, and the knee was stabilized in an external fixator for 4 weeks. At 32-month follow-up, the patient had almost full knee motion and good subjective outcomes with moderate residual joint laxity. CONCLUSION: Early clinical diagnosis of irreducible knee dislocations and emergent open reduction should be performed to reduce the risk of soft-tissue compromise.

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Introducción: el objetivo del trabajo es evaluar y comparar resultados funcionales en pacientes que fueron sometidos a una reparación primaria del LCA y aquellos en quienes se efectuó reparación asociada con aumentación con cinta de polietileno. Materiales y métodos: se realizó un estudio comparativo en el que se analizaron ochenta y siete pacientes intervenidos quirúrgicamente por lesión proximal del LCA entre 2017 y 2019. El grupo 1, con lesión Sherman I, fue tratado con reparación primaria (cincuenta y seis pacientes). En el grupo 2, con lesiones Sherman II, se efectuó reparación más aumentación (treinta y un pacientes). Se evaluaron el IKDC (Lysholm, Tegner, International Knee Documentation Committee), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), y KOOS (Knee Injury and Osteoarthritis Score), preoperatorio y a los seis, doce y veinticuatro meses postoperatorios. Se consideraron significativas aquellas pruebas con p <0.001 (IC 95%). Los análisis estadísticos fueron llevados a cabo en el software estadístico R (R Core Team, 2022).Resultados: el índice de falla fue de 10.4% y 7.6% para los grupos 1 y 2, respectivamente, a los dos años del postoperatorio. Todos los scores mejoraron en el postoperatorio y fue estadísticamente significativa la diferencia con el preoperatorio a los seis y a los veinticuatro meses (p <0.001). El tipo de cirugía no tiene un efecto estadísticamente significativo en los scores clínicos. Conclusión: la reparación en una lesión proximal de LCA (Sherman I o II) es una buena alternativa quirúrgica que permite una mejoría rápida de los scores clínicos, buenos resultados y con bajo índice de complicaciones. Nivel de Evidencia: IV

Introduction: the objective of this study is to compare clinical and functional results in patients who underwent primary ACL repair and primary repair associated with augmentation with polyethylene tape. Materials and methods: eighty-seven patients who underwent surgery for proximal ACL injury between 2017 and 2019 were analyzed. The group 1, with Sherman I injury was treated with primary repair (fifty-six patients). In the group 2, with Sherman II lesions, repair plus augmentation was performed (thirty-one patients). IKDC (Lysholm, Tegner, International Knee Documentation Committee), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and KOOS (Knee Injury and Osteoarthritis Score) were evaluated preoperatively and at six, twelve, and twenty-four months postoperatively. Those tests with p <0.001 (95% CI) were considered significant. Statistical analyzes were carried out in the statistical software R (R Core Team, 2022). Results: the failure rate was 10.4% and 7.6% for groups 1 and 2, respectively, at two years after surgery. All the scores improved in the postoperative period, with significant difference respect to the preoperative period at six and at twenty-four months (p <0.001). Type of surgery does not have a significant effect on clinical scores.Conclusion: repairing a proximal ACL injury (Sherman I or II) is a good surgical alternative, which allows fast improvement of clinical scores, good results and a low rate of complications. Level of Evidence: IV

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Background: The movement of the arm relative to the trunk results from 3-dimensional (3D) coordinated movements of the glenohumeral (GH) and scapulothoracic (ST) joints and dictates the scapulohumeral rhythm (SHR). Alterations in SHR increase joint overload and may lead to low functional scores, pain, and failures in patients undergoing reverse total shoulder arthroplasty (RSA). The goal of this systematic review and meta-analysis was to examine 3D SHR kinematics after RSA and compare it to that of asymptomatic shoulders. Methods: A systematic review and meta-analysis of articles in English were performed using PubMed, Embase, Cochrane Library, and SciELO. Additional studies were identified by searching bibliographies. Search terms included "Reverse shoulder arthroplasty", "3D", and "scapula". It was selected cross-sectional studies that reported SHR with 3D motion analysis systems in patients who underwent RSA and asymptomatic controls. Two authors independently performed the extraction of articles using predefined data fields, including study quality indicators. Results: Data from four studies were included in quantitative analysis, totaling 48 shoulders with RSA and 63 asymptomatic shoulders. Pooled analyses were based on random-effects model (DerSimonian-Laird). A statistically smaller SHR ratio was observed in the RSA group than that in the control group (P < .00001), meaning a greater contribution of ST joint in relation to GH joint for arm elevation. The standardized mean difference was -1.16 (95% confidence interval: -1.64, -0.67). A sensitivity analysis with three more studies that had imputed data on control group did not change the direction of the effect. The standardized mean difference on sensitivity analysis was -0.60 (P = .03; 95% confidence interval: -1.13, -0.06). It was detected as "not important heterogeneity" within the comparison (I2: 22%). Chi-square was not statistically significant (Chi2: 3.85), and I2 was 22%. Tau2 was not zero (Tau2: 0.05). Sensitivity analysis showed an I2 of 74%, which might represent substantial heterogeneity, Chi-square was not statistically significant (Chi2: 23.01), and Tau2 was not zero (Tau2: 0.37). Conclusion: This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. More movement in ST joint in proportion to GH joint increases GH joint contact forces, which could lead to component loosening or other complications. Further studies should address the clinical implications of this kinematic finding.

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OBJECTIVE: To synthesize available evidence about diagnostic accuracy of clinical tests and imaging examinations for femoroacetabular impingement (FAI) syndrome. DESIGN: Umbrella review. SETTING: N/A. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Systematic reviews (SR) indexed in Embase, LIVIVO, PubMed, SCOPUS, the Cochrane Library, and Web of Science were searched in a 2-phase process. SR assessing diagnostic accuracy were considered eligible. RESULTS: From 1520 studies, 6 SR were included, which evaluated 24 primary studies related to FAI syndrome. Of these, 5 SR assessed clinical tests, and a substantial heterogeneity was found concerning reference standards adopted across primary studies, which included arthroscopy, clinical examination (associated or not with imaging exams), intra-articular injections, and open surgery. Most clinical tests presented higher values of sensitivity compared with specificity, although evidence was considered limited because the same primary studies were often included across SR. Nonetheless, evidence around the flexion adduction internal rotation (FADIR) test was considered stronger and its use as a screening tool was consistently supported. Only one SR assessed the accuracy of imaging examinations, which adopted open surgery as the sole reference standard. Most imaging exams presented considerably high values of sensitivity, although specificity values were notably lower. CONCLUSIONS: No robust recommendations can be provided for most clinical tests, although the FADIR test, in particular, was consistently supported as a screening tool. Moreover, although imaging examinations showed considerably high sensitivity values, evidence was considered sparse and further research is strongly recommended to validate its use as reference standards for diagnostic accuracy data.

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Anterior cruciate ligament (ACL) tears are routinely treated with an ACL reconstruction. This is based on historical literature reporting high failure rates after ACL repairs in addition to the limited healing potential of the ACL. Recently, improved understanding of pathophysiology of ligamentous healing has led to increasing interest in treating proximal avulsions with excellent tissue quality in the acute setting, as this technique allows for ACL healing. Potential advantages of ACL repair include preservation of native proprioceptive and kinematics of the knee, avoidance of graft harvesting morbidity and the possibility to perform a primary ACL reconstruction in case of failure. As a consequence, several techniques for ACL repair have been proposed that can be performed in isolation or with suture augmentation. The primary aim of this technical note is to describe step-by-step the ACL repair technique with and without suture augmentation. The secondary aim of the current study is to review the indications, patient selection and advantages of the technique.

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ABSTRACT BACKGROUND AND OBJECTIVES: This study aimed to identify the association between hip muscle strength and the scores from subjective functional and psychological evaluation questionnaires in patients with chronic hip pain. METHODS: Fifty-fivepatients with painful hip injuries (30 males) performed isometric peak strength tests of the abductors, extensors, and internal and external rotators of the hips with a hand-held dynamometer. The degree of functionality was measured by the Hip Outcome Score (HOS) and Lower Extremity Functional Score (LEFS), pain was estimated by the Visual Analog Scale (VAS) and kinesiophobia was calculated using the Tampa questionnaire. The Pearson correlation coefficient was used (alfa=5%) to test the associations between the muscle strength and the scores from the questionnaires. RESULTS: There were significant correlations between the strength of all four hip muscles and the HOS (r>0.29). Only the hip external rotators showed a significant correlation with pain (r=-0.30). No significant correlations were found for LEFS (r<0.24) and Tampa questionnaires (r¬0.15). CONCLUSION: The reduction in peak strength of the hip extensors, abductors and external rotators was associated with a reduction in the level of hip functionality but did not correlate with neither the level of overall functionality of the lower limbs nor the degree of kinesiophobia. Also, a reduction of hip external rotators strength was related to an increase in the intensity of pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Este estudo teve como objetivo identificar a associação entre a força muscular do quadril e os escores de questionários subjetivos de avaliação funcional e psicológica em pacientes com dor crônica no quadril. MÉTODOS: Cinquenta e cinco pacientes com lesões dolorosas no quadril (30 homens) realizaram testes isométricos do pico de força de abdutores, extensores e rotadores internos e externos do quadril com um dinamômetro portátil. O grau de funcionalidade foi medido pelo Hip Outcome Score (HOS) e Lower Extremity Functional Score (LEFS), a dor foi avaliada pela escala analógica visual (EAV) e a cinesiofobia foi calculada pelo questionário de Tampa. O coeficiente de correlação de Pearson foi utilizado (alfa=5%) para testar as associações entre a força muscular e os escores dos questionários. RESULTADOS: Houve correlações significativas entre a força de todos os quatro músculos do quadril e o HOS (r>0,29). Apenas os rotadores externos do quadril apresentaram correlação significativa com a intensidade da dor (r=-0,30). Nenhuma correlação significativa foi encontrada para LEFS (r<0,24) e questionário de Tampa (r¬0,15). CONCLUSÃO: A redução no pico de força dos extensores, abdutores e rotadores externos do quadril foi associada à redução no nível de funcionalidade do quadril, mas não se correlacionou com o nível de funcionalidade geral dos membros inferiores ou com o grau de cinesiofobia. Além disso, uma redução da força dos rotadores externos do quadril foi relacionada a aumento na intensidade da dor.

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Las lesiones de la raíz meniscal se definen como desgarros radiales ubicados dentro del centímetro de la inserción del menisco, o como una avulsión de la raíz ósea. Esta lesión es biomecánicamente comparable a una meniscectomía total, lo que lleva a una disminución del área de contacto tibiofemoral y un aumento perjudicial de las cargas para el cartílago articular y, en última instancia, conducen al desarrollo de una artrosis precoz.La reparación quirúrgica es el tratamiento de elección en pacientes sin artrosis significativa (grados 3 o 4 de Outerbridge). Las reparaciones de raíz mejoran los resultados clínicos, disminuyen la extrusión meniscal y enlentecen la aparición de cambios degenerativos. Aquí describimos la anatomía, biomecánica, evaluación clínica, métodos de tratamiento y resultados para los desgarros de las raíces meniscales posteriores. Nivel de Evidencia: IV

Meniscal root tears either are defined as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion. Untreated meniscal root tears have been reported to result in altered joint biomechanics and accelerated articular cartilage degeneration. In this regard, the "recently" recognized pathology of meniscal root tears have been reported to precipitously worsen articular cartilage degeneration, cause painful bone edema, and lead to progressive osteoarthritis if left untreated.Meniscal root repair has been demonstrated to have high satisfaction rates and superior outcomes than arthroscopic meniscectomy for root tears. Early referral of these patients for surgery had been demonstrated to significantly decrease the progression of knee osteoarthritis and the requirement for a TKA at mid-term follow-up. Level of Evidence: IV

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Introducción: El síndrome de fricción femoroacetabular (SFFA) es frecuentemente diagnosticado en atletas que participan en deportes con súbitos cambios de dirección como fútbol, básquet, tenis y en otras actividades con rangos suprafisiológicos de movimiento, como el ballet o yoga. El objetivo del presente estudio es evaluar el retorno al deporte de los pacientes a los que se les realizó una artroscopía de cadera como tratamiento del SFFA. Materiales y métodos: se incluyeron pacientes que realizaban deportes antes de la cirugía y que fueron tratados mediante una artroscopía de cadera por diagnóstico de SFFA, con un seguimiento mínimo de dos años. Todos fueron evaluados mediante una encuesta escrita acerca del deporte que realizaban, el tiempo de retorno a la práctica, en qué nivel competitivo la llevaban a cabo y la satisfacción con la cirugía. Se evaluaron los scores mediante Harris Hip Score modificado (mHHS) y la escala de Tegner antes y después de la cirugía. Resultados: se evaluaron ciento cuatro artroscopías de cadera, con seguimiento promedio de 29.4 meses (rango 24 ­ 46), en cuarenta y cinco (43.3%) mujeres y cincuenta y nueve (56.7%) hombres. Observamos que noventa y seis (92.3%) pacientes fueron capaces de retornar a su actividad deportiva con una media de 4.7 meses (rango 2-9). Ocho (7.7%) pacientes no pudieron retornar al deporte luego de la cirugía. Del total de la muestra, el 95.2% refirió estar conforme con la cirugía. Las puntuaciones del mHHS mostraron un incremento estadísticamente significativo (69.2 ± 4.8 versus 87.5 ± 4.4; p <0.05). No hubo diferencias estadísticamente significativas con los puntajes observados en la escala de actividad de Tegner (6.6 ± 0.9 versus 6.3 ± 1; p >0.05). Discusión: previamente se ha documentado en la literatura que la mayoría de los pacientes que realizan actividad deportiva recreacional, y que fueron sometidos a una artroscopía de cadera por presentar SFFA, pueden retornar a su actividad deportiva previa y presentan un alto índice de satisfacción postoperatoria. Nuestros resultados se condicen con la bibliografía.Conclusión: el tratamiento artroscópico del SFFA, en pacientes que realizan deportes de forma recreacional, brinda una tasa elevada (>90%) de satisfacción, de retorno a la práctica y a un nivel similar al que presentaban antes de la cirugía

Introduction: The aim of this study was to assess return to sport of patients after hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAI). Materials and Methods: patients with sports activity prior to surgery and who underwent hip arthroscopy due to FAI syndrome, with minimum follow-up of two years were included. All patients had to complete a written survey about type of sports they performed, sports return, competition level and satisfaction with surgery. Modified Harris Hip Score (mHHS) was assessed, and level of sport activity was registered, according to Tegner's Activity Scale.Results: one hundred and four hip arthroscopies were available for full analysis with minimum follow-up of 29.4 (24 ­ 46) months. We observed ninety-six (92.3%) patients were able to return to same prior sports activity at a mean of 4.7 (range 2 ­ 9) months. Eight (7.7%) patients were unable to return to sports after surgery. 95.2% reported agreement with hip surgery. mHHS score showed an statistically significant increase after surgery (69.2 ± 4.8 versus 87.5 ± 4.4; p <0.05). There was no significant difference in Tegner's Activity Scale. Discussion: several authors sustain that patients with recreational sports activity who underwent hip arthroscopy for FAI syndrome, achieve excellent outcomes, and able to return to their prior level of competition with a high rate of satisfaction. Our results are similar, according with literature. Conclusion: FAI treatment with arthroscopy achieves high rates of satisfaction and sports return, with similar competition level before surgery

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Background: The acetabular labrum plays a major role in hip function and stability. The gold standard treatment for labral tears is labral repair, but in cases where tissue is not amenable to repair, reconstruction has been demonstrated to provide superior outcomes compared to debridement. Many types of grafts have been used for reconstruction with good to excellent outcomes. Autograft options include iliotibial band (ITB), semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Questions/Purposes: As allografts are not always readily available and have some inherent disadvantages, the aims of this systematic review were to assess (1) indications for labral reconstruction and (2) summarize outcomes, complications, and reoperation rates after arthroscopic labral reconstruction with autografts. Methods: A systematic review of the literature was performed using six databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar) to identify studies reporting outcomes for arthroscopic labral reconstruction utilizing autografts, with a minimum follow-up of 1 year. Study design, patient demographics, autograft choice, complications, donor site morbidity, reoperation rates, conversion to arthroplasty, and patient reported outcomes were extracted and reported. Results: Seven studies were identified for inclusion with a total of 402 patients (173 females, age range 16-72, follow-up range 12-120 months). The most commonly reported functional outcome score was the modified Harris Hip Score (mHHS), which was reported in six of seven studies. Preoperative mHHS ranged from 56 to 67.3 and improved postoperatively to a range of 81.4-97.8. Conversion to total hip arthroplasty and reoperation rates ranged from 0 to 13.2% and 0 to 11%, respectively. The most common indication for labral reconstruction was an irreparable labrum. Autografts utilized included ITB, hamstring tendons, indirect head of rectus femoris, and capsular tissue. Conclusions: Arthroscopic autograft reconstruction of the acetabular labrum results in significant improvement in the short- and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury.