Search Results (461)

Tibial spine avulsion injuries represent a distinct pattern of anterior cruciate ligament (ACL) injury in children and adolescents, reflecting the unique anatomical and biomechanical properties of the skeletally immature knee. Unlike midsubstance ACL ruptures, these injuries involve avulsion of the tibial insertion and pose specific diagnostic and therapeutic challenges. Management strategies remain heterogeneous, particularly for partially displaced fractures, with variation in surgical indications, fixation techniques, and rehabilitation protocols. This narrative review provides a structured synthesis of current evidence on the anatomy, biomechanics, clinical presentation, and management of pediatric tibial spine avulsion injuries. Nonoperative and operative approaches are compared, with attention to fixation strategies, complications, physeal considerations, and rehabilitation principles. Return-to-sport (RTS) outcomes are examined, with available evidence suggesting that RTS rates may be comparable between operative and nonoperative management in selected patients, although interpretation is limited by heterogeneous and predominantly retrospective data. Early mobilization appears important for reducing arthrofibrosis risk, while rehabilitation should be individualized. RTS decision-making remains inconsistent, with commonly used criteria largely extrapolated from ACL reconstruction literature and lacking validation in pediatric populations. Multifactorial assessment incorporating functional testing and patient-reported outcomes is increasingly advocated, although evidence for psychological readiness remains limited. Overall, the current literature is characterized by methodological heterogeneity and limited comparative data, restricting definitive conclusions. This review provides a clinically oriented synthesis while highlighting key uncertainties and priorities for future research. Full article

Background/Objectives: In patients with femoroacetabular impingement syndrome (FAI), the efficacy and safety of platelet-rich plasma (PRP) as an auxiliary treatment for femoroacetabular impingement syndrome (FAI) remain controversial. The study aimed to evaluate the safety and clinical effectiveness of arthroscopy combined with PRP compared with arthroscopy alone for the treatment of patients with FAI. Methods: In this retrospective study, patients who underwent hip arthroscopy for the treatment of FAI between January 2019 and January 2022 were included and divided into two groups: (1) arthroscopy group (A) and (2) arthroscopy combined with PRP group (AP). During the 2-year follow-up, Visual Analog Scale (VAS) pain scores, modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific (HOS-SSS), 12-Item Short Form Physical Composite Summary and Mental Composite Summary (SF-12 PCS and MCS), medical related expenses were recorded. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) comparison for mHHS, HOS-ADL, and HOS-SSS scores between the two groups. VAS, mHHS, iHOT-12, HOS-ADL, HOS-SSS score, and changing trends were described pre-operation and one month, six months, one year, and two years after the operation. Results: A total of 107 FAI patients were included; 55 patients were in Group A, 52 patients in Group AP. The overall mean ± SD was 39.1 ± 12.6 years (arthroscopy group, (A): 18 females, arthroscopy combined with PRP group, (AP): 13 females). There were no significant differences in the general data between the two groups (p > 0.05). Except for the auxiliary tools subscale of the mHHS (p > 0.05), both groups showed statistically significant improvements at one year (p < 0.01) and two years (p < 0.01) after surgery than pre-operation in VAS, mHHS, iHOT-12, HOS-ADL, and HOS-SSS. The scores after two years of treatment were further improved compared with one year (p < 0.01). There were no differences between the two groups at one year and two years postoperatively in VAS, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores (p > 0.05). No differences in the achievement of MCID and PASS for mHHS, HOS-ADL, and HOS-SSS (p > 0.05). A significant difference in SF-12 PCS and MCS was observed between the two groups preoperatively and two years after the operation (p < 0.01). The Group AP had significantly higher scores at two years (p < 0.01) after surgery than the Group A in the SF-12 MCS. There was no significant difference in SF-12 MCS distribution (>46.5, 36–46.5, ≤36) (χ² = 0.198, p > 0.01). The AP group had significantly higher indirect and absenteeism expenses in the year of surgery than Group A (p < 0.01). Conclusions: For patients with FAI, compared with arthroscopy alone, arthroscopy combined with PRP can significantly improve SF-12 MCS two years after therapy; however, there was no significant improvement in clinical results, and indirect treatment costs were higher. Arthroscopy combined with PRP has no obvious advantage and cannot be recommended as the first choice. Full article

Background/Objectives: Structural retear after rotator cuff repair does not always correspond to poor clinical outcomes. Functional factors may help explain this discrepancy and may have rehabilitation relevance in patients with postoperative retear. This study aimed to evaluate the association of preoperative external-to-internal rotation strength ratio for postoperative pain and functional outcomes in patients with retear after arthroscopic rotator cuff repair. Methods: This retrospective cohort study included 72 patients who underwent arthroscopic rotator cuff repair at a tertiary referral center between January 2015 and December 2019 and whose magnetic resonance imaging performed 5–6 months after surgery revealed postoperative retear. Patients were classified according to the preoperative external-to-internal rotation strength ratio into a normal group (NG; ratio, 60–80%; n = 34) and an abnormal group (AG; n = 38). Postoperative outcomes were assessed at 1 year and 2 years using functional and pain visual analog scale (FVAS and PVAS), the American Shoulder and Elbow Surgeons (ASES) score, and Constant score. Two-way repeated measures analysis of variance (ANOVA) was used to assess group and time effects and group × time interaction. Results: No significant between-group differences were observed at baseline for PVAS and FVAS scores, ASES score, or Constant score. During follow-up, NG showed significantly lower PVAS values at 1 year (p = 0.007) and 2 years (p = 0.009), significantly higher FVAS scores at 1 year (p = 0.002) and 2 years (p = 0.007), significantly higher Constant scores at 1 year (p = 0.019) and 2 years (p = 0.020), and significantly higher ASES scores at 2 years than the AG (p = 0.041). Repeated-measures ANOVA demonstrated significant time effects for all outcome measures (all p < 0.001) and significant group effects for PVAS (p = 0.007) and FVAS scores (p = 0.002) and ASES (p = 0.016) and Constant scores (p = 0.012). No significant group × time interaction was observed for any outcome measure. Conclusions: A normal preoperative external-to-internal rotation strength ratio was associated with better pain and functional outcomes in patients with structurally confirmed postoperative retear after arthroscopic rotator cuff repair. These findings suggest that preoperative rotator cuff strength balance may provide clinically useful information for postoperative functional stratification. Full article

Background/Objectives: Previous studies have measured a limited number of biomechanical parameters during medical rehabilitation of an anterior cruciate ligament (ACL) rupture. This study aimed to quantitatively assess changes in gait biomechanics, knee function, and lower-extremity muscle activity during after ACL reconstruction. Methods: The study included 32 patients after arthroscopic ACL reconstruction. The patients were divided into three groups based on postoperative time points: 0.5 year (12 men), 1 year (7), and over 1 year (9). Gait analysis at both self-selected and fast speeds was performed using an inertial system. Statistical analysis was performed using rank models and full-factorial orthogonal designs. Results: After 0.5 year, the timing of the gait cycle at self-selected speed was within the control group’s range and showed no significant asymmetry. With increasing speed, a decrease in knee joint range of motion was observed in the 0.5 year and 1-year groups, without achieving a full physiological increase in range of motion at long-term follow-up. Multivariate analysis revealed the greatest biomechanical imbalance during fast walking at one year and a phase-dependent effect of time after surgery, speed, and limb status on kinematics and EMG, particularly in the quadriceps. Conclusions: Basic temporal gait parameters during self-selected walking were within the control range by 0.5 year, but load-dependent knee kinematic and EMG abnormalities persisted. The knee joint’s response to increased loads remained impaired for at least one year. The persistence of phase-specific compensatory changes in kinematics and muscle activity at later stages can be assessed using exercise testing. Full article

Background and Objectives: Conventional supramalleolar osteotomy (SMO) often involves a concomitant fibular osteotomy (FO), which carries risks, such as nonunion and nerve injury. We evaluated the clinical and radiological outcomes of a fibula-preserving SMO (FP-SMO) combined with arthroscopic modified Broström operation (MBO) in patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. Materials and methods: We retrospectively reviewed 22 patients who underwent medial opening wedge FP-SMO and arthroscopic MBO between 2014 and 2019. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and Foot and Ankle Outcome Score (FAOS). Radiological evaluation included the anterior drawer test (ADT), talar tilt angle, tibiotalar surface (TTS) angle, medial distal tibial angle (MDTA), tibial lateral surface (TLS) angle, Takakura stage, and International Cartilage Regeneration and Joint Preservation Society (ICRS) grade assessed during second-look arthroscopy. Results: At a mean follow-up of 17.22 months, the mean VAS, AOFAS, and FAOS scores improved significantly (p< 0.001). Radiologically, the mean ADT decreased from 5.98 mm to 4.70 mm (p = 0.015), and the mean talar tilt angle decreased from 9.85° to 6.09° (p< 0.001). The mean TTS angle increased from 80.46° to 84.86° (p = 0.021), and the mean MDTA increased from 85.03° to 91.26° (p< 0.001). The TLS angle showed no significant change from 81.17° to 81.54° (p = 0.238). Takakura stage and ICRS grade improved or remained stable in all patients. No major complications, including nonunion, were observed. Conclusions: FP-SMO combined with arthroscopic MBO demonstrated favorable short-term clinical and radiological outcomes in selected patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. This combined approach may be a feasible joint-preserving option that addresses coronal malalignment and lateral ankle instability without requiring FO; however, longer-term comparative studies are needed to confirm its durability and clinical utility. Full article

Background: Osteoarthritis involves the degeneration of cartilage, subchondral bone, and the synovial membrane, often associated with rotator cuff (RC) tears, causing pain and functional limitations. While non-surgical treatments can provide relief, surgery is sometimes necessary. Autologous adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in tissue repair. Objective: This study compared clinical outcomes between patients treated with arthroscopic RCR alone and those treated with RCR combined with intra-articular AdMSC injection. Methods: This retrospective study included 61 patients. Group A (n = 30) underwent standard RCR, while Group B (n = 31) received RCR combined with intra-articular ADMSC injections. Participants had comparable baseline age, BMI, height, CMS, and VAS scores. Shoulder function was assessed using the Constant–Murley Score, and pain intensity was assessed using the visual analog scale at baseline, 3, 6, and 12 months. Statistical significance was set at p < 0.05. Results: At 3 months, Group B showed lower VAS scores than Group A (13.09 ± 8.34 vs. 25.14 ± 13.57, p < 0.001), while CMSs did not differ significantly (70.55 ± 23.46 vs. 63.01 ± 24.33, p = 0.223). At 6 months, Group B showed better VAS and CMSs than Group A (VAS: 5.31 ± 4.38 vs. 23.74 ± 15.72, p < 0.001; CMS: 83.29 ± 18.98 vs. 65.66 ± 11.58, p < 0.001). At 12 months, Group B maintained better VAS and CMSs than Group A (VAS: 4.45 ± 5.67 vs. 18.34 ± 12.65, p < 0.001; CMS: 85.55 ± 13.12 vs. 66.36 ± 9.38, p < 0.001). Conclusions: In this preliminary retrospective non-randomized cohort, AdMSC use as an adjunct to arthroscopic rotator cuff repair was associated with better pain and functional scores over 12 months. Because of the retrospective design and lack of imaging follow-up, these findings should be interpreted as clinical associations and require confirmation in randomized studies. Full article

Background: Osteochondral lesions of the talus (OLT) remain a challenging condition due to the limited regenerative potential of articular cartilage. Conventional bone marrow stimulation (BMS) techniques often result in fibrocartilage formation with inferior biomechanical properties. This study aimed to evaluate the safety and preliminary clinical efficacy of an arthroscopically assisted, single-stage injection of a heparin-conjugated fibrin hydrogel (HCFH) for OLT treatment. Methods: Twelve patients with symptomatic OLT underwent arthroscopic debridement, microfracturing, and HCFH injection containing autologous mesenchymal stromal cells (MSCs) and growth factors. Safety was assessed through systematic monitoring of adverse events (graded according to Common Terminology Criteria for Adverse Events criteria), wound healing, and serial laboratory inflammatory markers (leukocytes, erythrocyte sedimentation rate, C-reactive protein) during early and late follow-up. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) preoperatively and at 6 and 12 months. Morphological assessment was performed using magnetic resonance imaging (MRI) with the modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system, evaluated independently by two blinded musculoskeletal radiologists. Results: No serious adverse events (Grade III–IV) were observed during the 12-month follow-up. All adverse events were mild (Grade I) and self-limited. A transient postoperative elevation in inflammatory markers was observed, returning to clinically acceptable levels by day 14. Significant improvements were noted in pain (VAS decreased from 6.0 to 2.0) and ankle function (AOFAS increased from 70.0 to 90.6) (p < 0.001). MRI demonstrated progressive morphological improvement, with the MOCART score increasing from 34.16 ± 17.1 at 6 months to 75 ± 5.43 at 12 months (p < 0.001). This increase corresponded with imaging features consistent with tissue maturation over time. The favorable MOCART outcomes observed in this study may be explained by the regenerative properties of heparin-conjugated fibrin hydrogels; however, larger randomized controlled trials with longer follow-up are needed to confirm the durability of the regenerated tissue. Interobserver agreement was substantial to almost perfect for MOCART scoring (κ = 0.68–0.84), with perfect agreement observed for surface assessment, bony defect/overgrowth, and cysts. Conclusions: Within the limitations of this study, single-stage HCFH injection demonstrated an acceptable safety profile and favorable preliminary clinical and radiological outcomes at 12 months. These findings suggest potential regenerative capability; however, controlled studies with larger cohorts and longer follow-up are required to determine comparative efficacy and long-term durability. Full article

Purpose: We evaluate the relationship between preoperative anxiety, as measured by the Surgical Fear Questionnaire (SFQ), and postoperative pain intensity during the first three days following arthroscopic ankle ligament reconstruction. A secondary objective was to determine whether preoperative anxiety levels are associated with failure to reach the Patient Acceptable Symptom State (PASS) threshold for pain by postoperative day 3. Methods: A prospective cohort of 68 patients undergoing anatomic arthroscopic ankle lateral ligament reconstruction between January 2023 and March 2025 was assessed. Patients were categorized into high- and low-anxiety groups based on a tertile distribution of SFQ scores, with a threshold of 45. Pain intensity was measured using the Visual Analog Scale (VAS) on days 0, 1, 2, and 3 postoperatively. The proportion of patients with unacceptable pain (VAS > 3) according to the patient’s acceptable symptom state was compared between groups. A receiver operating characteristic (ROC) curve identified the optimal SFQ threshold for discriminating PASS achievement on day 3. Odds ratios were calculated using logistic regression. Results: A total of 68 patients were included (34 in each group). The mean age was 32.9 ± 10.5 years in the high-anxiety group and 33.1 ± 9.9 years in the low-anxiety group (p = 0.747). The mean SFQ score was 58.9 ± 11.9 in the high-anxiety group and 28.0 ± 10.8 in the low-anxiety group (p < 0.001). There were no significant differences between groups in demographic characteristics. Patients in the high-anxiety group reported significantly higher VAS scores at all postoperative time points. The proportion failing to achieve PASS on day 3 was also significantly greater in the high-anxiety group (67.6% vs. 35.3%, p = 0.015). An SFQ threshold of 46 discriminated PASS status with an AUC of 0.70. Patients with SFQ ≥ 46 had more than triple the odds of not achieving PASS (OR = 3.39; 95% CI: 1.26–9.59, p = 0.017). Conclusions: Preoperative anxiety is significantly associated with early postoperative pain and pain acceptability following arthroscopic ankle ligament reconstruction. Identifying and managing high-anxiety patients preoperatively may improve pain outcomes and patient satisfaction. Full article

Background: Rotator cuff tears, a prevalent pathology with significant functional impact, primarily find their therapeutic approach in arthroscopic repair. The long-term success of this intervention is modulated by various factors, among which shoulder morphology stands out. In this context, the critical shoulder angle (CSA) has gained relevance as a potential predictor of postoperative prognosis. Objectives: To determine if the CSA influences the need for reoperation after retears and functional outcomes following the arthroscopic repair of chronic rotator cuff tears. Methods: A retrospective cohort study has been conducted, which includes 74 patients (between 47 and 86 years old, mean age of 58.85 ± 2.21 years) who underwent arthroscopic shoulder surgery for the repair of chronic rotator cuff tears by the traumatology service of a tertiary level hospital in the period between 2009 and 2022, to study variables such as the appearance of complications, reoperation, and functional outcomes. Results: Patients with a CSA greater than 40° represent 56.75% (n = 42). Functional improvement was achieved in 59.52%, in contrast to 40.48% of patients who did not obtain significant functional improvement (OR = 1.470; 95% CI = 1.009–2.141). The reoperation rate in this group was 21.4% (n = 9) (OR = 1.562; 95% CI = 1.085–2.249). Conclusions: This study provides statistically significant evidence that a high CSA (>40°) behaves as a risk factor for the reoperation rate and poorer functional outcomes after the arthroscopic repair of chronic rotator cuff tears. Full article

Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and functional limitation in young and physically active individuals. Although hip arthroscopy is an established treatment when conservative management fails, objective data on early postoperative changes in active hip range of motion (ROM) remain limited. This study aimed to evaluate changes in active hip ROM three months after arthroscopic treatment for FAIS using inertial measurement units (IMUs) and to investigate their relationship with patient-reported outcomes. Methods: A prospective cohort of forty-two patients (mean age 36 ± 9 years; 64% male) undergoing hip arthroscopy for FAIS was assessed preoperatively and at a three-month follow-up. Active hip ROM—including flexion, internal rotation, external rotation, and total rotation—was measured using IMU sensors, while subjective outcomes were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS). Results: Significant improvements were observed across all HOOS subscales at follow-up (all p < 0.001). The HOOS Total score increased from 57 ± 15 to 83 ± 11. Clinical recovery, defined by the Minimal Important Change (MIC), was achieved by 74% of patients for Symptoms, 81% for Pain, 81% for ADL, 83% for Sport, and 67% for Quality of Life (QOL). Active hip ROM in the operated hip increased significantly for internal rotation (19.6° ± 11.9° to 26° ± 8°), external rotation (37° ± 10° to 40° ± 8°), and total rotation (57° ± 15° to 67° ± 12°). Changes in hip flexion were not clinically meaningful (98° to 100°), and no changes were observed in the non-operated hip. Spearman’s analysis showed weak and inconsistent correlations between active ROM and HOOSs (r ranging from −0.34 to 0.31). Conclusions: Hip arthroscopy for FAIS leads to early improvements in both patient-reported outcomes and active hip mobility, particularly in rotational movements, although the relationship between ROM and subjective outcomes appears weak. Full article

Background: Sugaya type III rotator cuff re-tears are characterized by preserved tendon continuity with reduced thickness and are often associated with persistent pain and functional impairment. Bioinductive collagen implants may enhance tendon healing, but clinical evidence in this population remains limited. This study aimed to evaluate the clinical and radiologic outcomes of arthroscopic repair with bioinductive collagen implant augmentation in patients with Sugaya type III re-tears. Methods: This retrospective case series (Level IV) included 15 patients (mean age 61.7 years) with MRI-confirmed Sugaya type III re-tears. An a priori power analysis based on a large effect size (Cohen’s d = 0.80) indicated that a sample size of 15 would provide 80% power to detect clinically meaningful changes in the primary endpoint. Clinical outcomes were assessed preoperatively and at 6 and 12 months postoperatively using VAS, ASES, SANE, and WORC scores. MRI was used to evaluate changes in supraspinatus tendon thickness. Non-parametric statistical analysis with Bonferroni correction was applied. Results: The median VAS pain score improved from 6.5 (IQR, 6.0–7.0) preoperatively to 2.8 (IQR, 2.0–3.5) at 6 months and to 2.1 (IQR, 1.5–2.8) at 12 months (adjusted p < 0.001). The median ASES score increased from 45.0 (IQR, 39.0–51.0) to 78.0 (IQR, 72.0–85.0), with a median improvement of 33 points. SANE and WORC scores also showed significant improvements. Supraspinatus tendon thickness increased from 4.8 mm (IQR, 3.7–5.7) to 6.9 mm (IQR, 5.4–8.3) at 12 months (adjusted p < 0.001). No graft failure was observed on follow-up MRI. Conclusions: Arthroscopic repair with bioinductive collagen implant augmentation may be associated with short-term improvements in pain, function, and tendon thickness in patients with Sugaya type III re-tears. Given the small sample size and lack of a control group, these findings should be interpreted cautiously, and further prospective comparative studies are needed. Full article

Background/Objectives: Accurate tibial tunnel placement is critical for successful posterior cruciate ligament reconstruction (PCLR), yet remains technically demanding due to limited visualization and anatomic variability. This study aimed to demonstrate the feasibility of an arthroscopic technique for remnant-preserving PCLR using the champagne-glass drop-off and lateral cartilage point as consistently identifiable arthroscopic anatomic bony landmarks, and to evaluate the success rate of tibial tunnel placement in targeted position using postoperative magnetic resonance imaging (MRI). Methods: A retrospective review was performed of patients who underwent arthroscopic remnant-preserving PCLR using a trans-septal approach with the described dual-landmark technique between March 2020 and October 2022. Of 31 eligible patients, 20 with complete clinical follow-up and postoperative 1-year MRI were included for analysis. Tibial tunnel position was assessed on MRI to determine success rate of placement in the targeted inferior–lateral tibial footprint based on anatomic reference. Clinical outcomes, including knee range of motion and posterior laxity, were also evaluated. Results: MRI evaluation demonstrated tibial tunnel consistent placement with the predefined targeted zone in all patients (20/20). At a median follow-up of 745 days, the mean knee range of motion was 140.0 ± 12.7 degrees. Posterior stability assessment showed grade 0 laxity in 75% of patients and grade 1 laxity in 25%. No graft failures, neurovascular complications, infections, or revision PCLR procedures were observed. Conclusions: This retrospective case series suggests that the dual-landmark technique (champagne-glass drop-off and lateral cartilage point) may facilitate consistent tibial tunnel placement in remnant-preserving PCLR. Level of Evidence: IV (Retrospective case series). Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries are common in sports; they can be seen with an arthroscope in more than half of instances of acute traumatic hemarthrosis and are frequently associated with meniscal tears. By reducing soft tissue injury and enabling faster recovery while attaining comparable long-term outcomes, the switch from open surgery to arthroscopic ACL repair (ACLR) has transformed treatment. However, maintaining efficient intra-articular visualization is essential for both patient safety and surgical precision. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted across major medical databases, including PubMed, Web of Science, and ScienceDirect. The search strategy incorporated key terms such as epinephrine, irrigation fluid, and ACL reconstruction to identify relevant studies. The study focused on English-language clinical studies within the last 10 years that clearly assessed the safety and efficacy of epinephrine-added irrigation in ACL repair. The study design, patient demographics, specific outcomes (visualization, operation time, hemodynamics), and statistical findings were all carefully retrieved. The results were combined to determine the intervention’s safety profile and clinical value. Results: The pooled analysis demonstrated that the intervention group significantly decreased operating time (SMD = −0.51, 95% CI: −0.90 to −0.12, p = 0.01; I² = 24%). However, postoperative knee function showed no statistically significant difference between groups (OR = 1.80, 95% CI: 0.61 to 5.30, p = 0.29; I² = 0%). Postoperative pain levels also did not differ significantly between groups (SMD = −0.27, 95% CI: −0.63 to 0.09, p = 0.14; I² = 0%). Heterogeneity was low across all analyses (I² = 0–24%). Conclusions: Low-dose epinephrine in irrigation fluid significantly reduces operative time during arthroscopic ACL reconstruction, suggesting improved surgical efficiency. However, it does not significantly improve postoperative knee function or reduce pain compared to control irrigation. The intervention appears to be a reasonable alternative to tourniquets without major systemic cardiovascular effects. Nevertheless, preclinical data indicate potential chondrotoxicity. Therefore, while epinephrine can be considered to improve operating efficiency and reduce tourniquet-related problems, surgeons should weigh its use cautiously, especially in younger patients or those with susceptible cartilage. Full article

A 46-year-old woman presented with persistent right knee pain and swelling six months after a fall. MRI initially showed a lateral meniscus tear, leading to meniscus repair and later meniscectomy, but symptoms persisted. Retrospective review of the MRI revealed edema in the tibial plateau and distal femoral condyle. Arthroscopic debridement demonstrated severe synovitis, marked cartilage loss of the lateral femoral condyle with a loose body, and tibial plateau cartilage damage. Bone SPECT/CT showed bony destruction, cleft formation, and focal tracer uptake in the distal femur and proximal tibia. Femoral osteochondritis dissecans and a tibial osteochondral defect were diagnosed based on arthroscopic and imaging findings. Full article

Background/Objectives: Arthroscopic shoulder surgery is associated with postoperative pain and loss of function. Percutaneous electrical nerve stimulation (PENS) may serve as an effective adjunct to postoperative rehabilitation. This randomized clinical trial examined whether adding ultrasound-guided PENS to a multimodal rehabilitation program improves pain, disability, pressure pain sensitivity, shoulder range of motion, and muscle strength in individuals with postoperative pain following shoulder arthroscopy. Methods: A randomized, parallel-group clinical trial (registry: NCT06331871) was conducted. Seventy patients who had undergone shoulder arthroscopy were randomized to receive manual therapy/exercise alone (n = 35) or manual therapy/exercise/PENS (n = 35). All participants received the multimodal program including manual therapy and exercises four weeks after surgery for a duration of 12 weeks (five sessions/week). Those allocated to the PENS group also received two sessions (once per week) of ultrasound-guided PENS targeting the suprascapular and axillary nerves. Pain intensity (Numeric Pain Rating Scale (NPRS)) and disability (Disabilities of the Arm, Shoulder and Hand (DASH)) were the primary outcomes, whereas function (Shoulder Pain and Disability Index (SPADI)), pressure pain threshold (PPT), isometric strength, and shoulder range of motion (ROM) were secondary outcomes. Pain, PPT, strength, and ROM were assessed before and after treatment, and at 1 and 3 months. Disability and function were assessed at baseline and 3 months after treatment. Results: Patients receiving PENS showed greater improvements in shoulder pain (F_{2.72, 182.32} = 7.76, p = 0.007, η²p = 0.10), disability (F_{1, 68} = 5.63, p = 0.020, η²p = 0.08), function (F_{1, 68} = 4.15, p = 0.046, η²p = 0.02) and PPT over the infraspinatus muscle (F_{3.20, 217.28} = 2.93, p = 0.032, η²p = 0.04) than those receiving manual therapy/exercise alone. No between-group differences were observed for PPT at the deltoid or tibialis anterior muscles. The PENS group also showed greater improvements in some, but not all, measures of shoulder strength and range of motion; however, the effect sizes were small and the clinical relevance of these differences remains uncertain. Conclusions: Adding ultrasound-guided PENS targeting the suprascapular and axillary nerves to a multimodal physical therapy program resulted in greater improvements in pain, disability, and shoulder-specific function, with limited additional benefits for some measures of strength and range of motion, compared with physical therapy alone, in individuals with postoperative shoulder pain. However, many of the lower-bound estimates of the 95% confidence interval did not surpass the minimal clinically important difference. Therefore, the clinical relevance of the results should be considered with caution. Full article