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Keywords = arthroscopic surgery

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12 pages, 1519 KiB  
Article
Arthroscopic Repair Versus Conservative Treatment in Degenerative Cuff Tears: Midterm Results
by Maria Rosario Camacho-Sanchez, Irene Calzado-Alvarez, Jose Carlos Minarro, Diana Maria Dussan-Arango, Clementina López-Medina and Alberto Izquierdo-Fernandez
Life 2025, 15(8), 1254; https://doi.org/10.3390/life15081254 (registering DOI) - 7 Aug 2025
Abstract
(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for [...] Read more.
(1) Background and aim: The benefit of surgical treatment compared to conservative management is unclear in degenerative cuff tears, and there is limited evidence regarding midterm functional outcomes. This study sought to compare the midterm functional outcomes of surgical versus conservative treatment for rotator cuff tears. (2) Methods: All patients on the waiting list for arthroscopy of cuff tears in a single center between 2013 and 2015 were analyzed. They were divided into two groups: those who underwent surgery (arthroscopy group) and those who declined the procedure (orthopedic group). The primary endpoint was shoulder functionality, evaluated with the CMS, SST, and SPADI-SP questionnaires. Inverse probability of treatment weighting (IPTW) was used to account for differences between the groups. (3) Results: Of 57 patients (67 (62–71) years old, 47% women), 32 were in the arthroscopy group and 25 in the orthopedic group. Functionality was assessed at a median of 7 (7–8) years after diagnosis. The patients in the arthroscopy group were younger (p = 0.023) and more frequently women (p = 0.074). No significant differences were observed in the type of tear (p = 0.205) or laterality (p = 0.164). Functional outcome analysis showed more favorable scores in the surgical group: constant (74.5 ± 16.6 vs. 58.4 ± 23, p = 0.016), SST (7.3 ± 3.1 vs. 4.9 ± 4.2, p = 0.016), and SPADI-SP (35.7 ± 26.6 vs. 56.1 ± 30.4, p = 0.006). (4) Conclusions: In this cohort of patients with cuff tears, arthroscopic repair was associated with better clinical and functional midterm results compared to conservative treatment, although the benefit was less evident in older patients and those with complete tears. Full article
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8 pages, 824 KiB  
Systematic Review
Early Rotator Cuff Repair Yields Lower Retear Rates and Superior Functional Outcomes: A Systematic Review and Meta-Analysis
by Alexander Baur, Wesley Lemons, Omar Protzuk and Jonathan Brett Goodloe
J. Clin. Med. 2025, 14(15), 5552; https://doi.org/10.3390/jcm14155552 - 6 Aug 2025
Abstract
Background: Optimal timing for surgery following acute rotator cuff tears remains unclear. This study examines how the timing of arthroscopic rotator cuff repair (RCR) affects retear rates and functional outcomes. Methods: This PROSPERO-registered review (CRD42024528249) followed PRISMA guidelines and included randomized trials, and [...] Read more.
Background: Optimal timing for surgery following acute rotator cuff tears remains unclear. This study examines how the timing of arthroscopic rotator cuff repair (RCR) affects retear rates and functional outcomes. Methods: This PROSPERO-registered review (CRD42024528249) followed PRISMA guidelines and included randomized trials, and cohort, studies on adults with imaging-confirmed full-thickness rotator cuff tears. Studies lacking timing data or key outcomes were excluded. Risk of bias was assessed using ROBINS-I. Meta-analysis of retear rates was performed comparing surgical timing. Qualitative analysis was conducted classifying results as early-beneficial, delayed-detrimental, or neutral. Results: Our review included 13 studies and 871 patients with an average age of 57.9. Meta-analysis of eight studies comparing retear rates between early and delayed RCR demonstrated a significant benefit associated with early intervention risk ratio 0.60 (95% CI: 0.38–0.96). Functional outcomes also favored early intervention with four studies demonstrating significantly greater postoperative functional improvements in the early intervention group. Conclusions: Early arthroscopic RCR decreased the rate of retear and improved functional outcomes. No study found early intervention to be detrimental or delayed intervention to be superior. These findings support consideration of early repair when clinically appropriate. Future studies should determine more finite timing guidelines. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Arthroscopic Shoulder Surgery)
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12 pages, 617 KiB  
Article
Increased Posterior Tibial Slope Is Associated with Isolated Meniscal Injuries: A Case-Control Study
by Kai von Schwarzenberg, Tamara Babasiz, Jan P. Hockmann, Peer Eysel and Jörgen Hoffmann
Medicina 2025, 61(8), 1368; https://doi.org/10.3390/medicina61081368 - 29 Jul 2025
Viewed by 211
Abstract
Background and Objectives: The relationship between posterior tibial slope (PTS) and isolated meniscal injuries remains a topic of debate. This study aimed to investigate whether an increased PTS was associated with a higher risk of isolated meniscal tears, using a case-control design with [...] Read more.
Background and Objectives: The relationship between posterior tibial slope (PTS) and isolated meniscal injuries remains a topic of debate. This study aimed to investigate whether an increased PTS was associated with a higher risk of isolated meniscal tears, using a case-control design with propensity score matching to minimize confounding factors. Materials and Methods: A retrospective case-control study was conducted at a University Hospital. A total of 294 patients who underwent arthroscopic surgery for meniscal injuries were compared to a matched control group without documented knee pathology. Two independent observers measured PTS on standardized lateral knee radiographs and assessed inter- and intra-rater reliability. Propensity score matching was performed to control for potential confounders. Statistical analysis included logistic regression to evaluate the association between PTS and isolated meniscal injuries. Results: A significantly increased mean PTS was observed in patients with isolated meniscal injuries compared to controls (p < 0.05). However, PTS was not significantly associated with the specific location of meniscal tears. Inter- and intra-rater reliability for PTS measurements was excellent (intraclass correlation coefficient > 0.75). Conclusions: An increased posterior tibial slope was associated with a higher risk of meniscal injury, even in the absence of ACL rupture. However, no significant association was found between PTS and specific tear patterns or locations. These findings support the role of posterior tibial slope as an independent anatomical risk factor for meniscal damage and underscore the importance of its early identification in clinical risk assessment and prevention strategies. Full article
(This article belongs to the Special Issue Sports Injuries: Prevention, Treatment and Rehabilitation)
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14 pages, 561 KiB  
Review
Current Evidence and Surgical Strategies in the Management of Greater Tuberosity Fracture–Dislocations: A Narrative Review
by Gabriele Colò, Federico Fusini, Luca Faoro, Giacomo Popolizio, Sergio Ferraro, Giorgio Ippolito, Massimiliano Leigheb and Michele Francesco Surace
J. Clin. Med. 2025, 14(14), 5159; https://doi.org/10.3390/jcm14145159 - 21 Jul 2025
Viewed by 425
Abstract
Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, [...] Read more.
Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article
(This article belongs to the Special Issue Orthopedic Trauma Surgery: Current Challenges and Future Perspectives)
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13 pages, 1082 KiB  
Article
Telerehabilitation After Anterior Cruciate Ligament Reconstruction Is Effective in Early Phases of the Recovery Programme
by Bruno Turchetta, Giovanna Brancaleoni, Alessandro D’Alesio, Sara Tosoni, Marianna Citro, Matteo Turchetta, Lorenzo Polo, Ivan Pinna, Guglielmo Torre and Pier Paolo Mariani
J. Clin. Med. 2025, 14(14), 4843; https://doi.org/10.3390/jcm14144843 - 8 Jul 2025
Viewed by 360
Abstract
Background/Objectives: In recent years, scientific literature has illustrated the growing interest in telerehabilitation after ACL reconstruction. The aim of this study is to compare the effectiveness of remotely supervised rehabilitation with traditional supervised rehabilitation after ACLR, focusing on objective postoperative functional assessment [...] Read more.
Background/Objectives: In recent years, scientific literature has illustrated the growing interest in telerehabilitation after ACL reconstruction. The aim of this study is to compare the effectiveness of remotely supervised rehabilitation with traditional supervised rehabilitation after ACLR, focusing on objective postoperative functional assessment outcomes. Methods: A retrospective analysis of prospectively collected data was carried out, selecting patients that underwent arthroscopic ACLR by a single surgeon. Functional assessments of the patients were carried out at 1 and 2 weeks and 1, 2 and 3 months after surgery, including range of motion (ROM), maximal voluntary isometric contractions (MVICs) of extensor and flexor muscles, the sit-to-stand test and the countermovement jump. Intergroup statistics were carried out using a non-inferiority hypothesis. Results: A total of 251 patients were included in this study (supervised rehabilitation n = 165; remotely supervised rehabilitation n = 86). Functional assessment improved over time in both groups. The extension ROM deficit decreased to 0 difference 30 days after surgery. The median flexion ROM ILD at 60 days was significantly different among the groups, with a residual 10° ILD in the Group R compared with 0° ILD in group S (p = 0.01). All other assessments did not achieve statistical significance. Conclusions: The results support the integration of a digital rehabilitation tool in post-ACLR recovery programs. The results suggest that remotely supervised rehabilitation can be a viable alternative to traditional supervised rehabilitation for early-stage recovery. However, more research is needed to optimize protocols and to identify patients who may benefit most from this approach. Full article
(This article belongs to the Special Issue Orthopedic Surgery: Latest Advances and Future Prospects)
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18 pages, 1827 KiB  
Article
Exploring the Impact of Extraplatelet Content on Fibrin-Based Scaffold Performance for Regenerative Therapies
by Daniel Marijuán-Pinel, Jon Mercader-Ruiz, Maider Beitia, Pello Sánchez, Leonor López de Dicastillo, Sergio Gonzalez, João Espregueira-Mendes, Beatriz Aizpurua, Jaime Oraá, Diego Delgado and Mikel Sánchez
Int. J. Mol. Sci. 2025, 26(13), 5967; https://doi.org/10.3390/ijms26135967 - 21 Jun 2025
Viewed by 361
Abstract
This study investigated the impact of increased extraplatelet content on the tissue regenerative capacity of platelet-rich plasma (PRP)-derived fibrin scaffolds. Comparative analyses were performed between a “balanced protein-concentrate plasma” (BPCP) and a standard PRP (sPRP), focusing on platelet and fibrinogen content, scaffold microstructure, [...] Read more.
This study investigated the impact of increased extraplatelet content on the tissue regenerative capacity of platelet-rich plasma (PRP)-derived fibrin scaffolds. Comparative analyses were performed between a “balanced protein-concentrate plasma” (BPCP) and a standard PRP (sPRP), focusing on platelet and fibrinogen content, scaffold microstructure, and functional performance. Growth factor (GF) release kinetics from the scaffolds were quantified via ELISA over 10 days, while scaffold biomechanics were evaluated through rheological testing, indentation, energy dissipation, adhesion, and assessments of coagulation dynamics, biodegradation, swelling, and retraction. Microstructural analysis was conducted using scanning electron microscopy (SEM), with fiber diameter and porosity measurements. The results demonstrated that BPCP scaffolds released significantly higher amounts of GFs and total protein, especially beyond 24 h (* p < 0.05). Despite a delayed coagulation process (** p < 0.01), BPCP scaffolds exhibited superior structural integrity and cushioning behavior (* p < 0.05). SEM revealed thicker fibers in BPCP scaffolds (**** p < 0.0001), while adhesion and biodegradation remained unaffected. Notably, BPCP scaffolds showed reduced retraction after 24 h and maintained their shape stability over two weeks without significant swelling. These findings indicate that enhancing the extraplatelet content in PRP formulations can optimize fibrin scaffold performance. Further preclinical and clinical studies are warranted to evaluate the therapeutic efficacy of BPCP-derived scaffolds in regenerative medicine. Full article
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Graphical abstract

18 pages, 7422 KiB  
Review
Atypically Displaced Meniscal Tears: An Educational Review with Focus on MRI and Arthroscopy
by Paolo Spinnato, Paola Franceschi, Giuseppe Martinese, Anna Parmeggiani, Valerio D’Agostino, Silvia Ferraro, George R. Matcuk, Stefano Zaffagnini and Alberto Grassi
Clin. Pract. 2025, 15(6), 109; https://doi.org/10.3390/clinpract15060109 - 12 Jun 2025
Viewed by 493
Abstract
This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to [...] Read more.
This review article on atypically displaced meniscal tears serves as a critical reminder for radiologists and orthopedic surgeons. It highlights and details uncommon lesions that may be overlooked during MRI evaluation and/or arthroscopic exploration. The knowledge of their existence can enable radiologists to critically assess any meniscal abnormality, keeping in mind its possible arthroscopic presentation. This is essential for assisting the surgeon in making an accurate preoperative diagnosis. In fact, these atypical lesions pose great challenges to surgeons in terms of the technical aspects of their treatment. Often, they could require additional arthroscopic portals for their identification or the need for special devices or instrumentations for the repair. Knowing these challenges in advance is thus imperative for properly planning a proficient surgery. The correct diagnosis and description of tear patterns, including extent and location, allow optimal pre-operative planning with the choice of the indicated approach. Radiologists should know how to recognize menisci tears, even with atypical dislocation patterns. Particularly, in the case of ‘minus’ detection or thickness reduction in a meniscus, the possible displaced fragment should be carefully searched for, even in atypical sites. Full article
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14 pages, 500 KiB  
Systematic Review
Arthroscopic Management of Medial or Rotational Ankle Instability: A Comprehensive Review of Current Evidence
by Chiara Barbieri, Guido Bocchino, Daniele Grassa, Doriana Di Costa, Elena Gabrielli, Fabrizio Forconi, Giulio Maccauro and Raffaele Vitiello
Healthcare 2025, 13(12), 1398; https://doi.org/10.3390/healthcare13121398 - 11 Jun 2025
Viewed by 784
Abstract
Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic [...] Read more.
Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article
(This article belongs to the Special Issue Sports Trauma: From Prevention to Surgery and Return to Sport)
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11 pages, 2884 KiB  
Systematic Review
Leukocyte-Rich Platelet-Rich Plasma’s Clinical Effectiveness in Arthroscopic Rotator Cuff Repair: A Meta-Analysis of Randomized Controlled Trials
by Peiyuan Tang, Meihui Huang, Wenfeng Xiao, Ting Wen, Pavel Volotovsky, Mikhail Gerasimenko, Shiyao Chu, Shuguang Liu, Kai Zhang and Yusheng Li
Bioengineering 2025, 12(6), 617; https://doi.org/10.3390/bioengineering12060617 - 5 Jun 2025
Viewed by 794
Abstract
Background: Arthroscopic rotator cuff repair faces high retear risks in multi-tendon injuries due to insufficient biological healing; leukocyte-rich PRP may enhance tendon–bone integration through inflammatory modulation and growth factor release. Methods: Four databases including PubMed, Embase, Cochrane Library, and Web of [...] Read more.
Background: Arthroscopic rotator cuff repair faces high retear risks in multi-tendon injuries due to insufficient biological healing; leukocyte-rich PRP may enhance tendon–bone integration through inflammatory modulation and growth factor release. Methods: Four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched until March 2025. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. GRADE was used to grade the strength of the evidence and the results. Results: The main finding of this study was that leukocyte-rich platelet-rich plasma combined with arthroscopic surgery for rotator cuff injuries can improve the Constant Score (MD = 1.13, 95% CI: 0.19, 2.07, p = 0.02, I2 = 47%), American Shoulder and Elbow Surgeons score (MD = 6.02, 95% CI: 4.67, 7.36, p < 0.01, I2 = 0%), and University of California, Los Angeles score (MD = 1.20, 95% CI: 0.34, 2.06, p < 0.01, I2 = 0%) of patients with rotator cuff tear after treatment, and reduce the postoperative Visual Analog Scale score (MD = −0.62, 95% CI: −1.16, −0.08, p = 0.02, I2 = 83%) of patients. However, there were no statistical differences regarding the Simple Shoulder Test (MD = 0.08, 95% CI: −0.23, 0.39, p = 0.61, I2 = 5%). Conclusions: Based on current evidence, the use of LR-PRP in arthroscopic rotator cuff repair could lessen postoperative pain and improve postoperative functional scores in individuals with rotator cuff injuries. Full article
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13 pages, 3930 KiB  
Article
Isolation and Characterization of Articular Cartilage-Derived Cells Obtained by Arthroscopic Cartilage Biopsy from Non-Osteoarthritic Patients
by Pedro Nogueira Giglio, Débora Levy, Phelipe Oliveira Favaron, Lucas da Ponte Melo, Cadiele Oliana Reichert, Fábio Alessandro de Freitas, Juliana Sampaio Silva, Walcy Paganelli Rosolia Teodoro, Sérgio Paulo Bydlowski and Marco Kawamura Demange
Cells 2025, 14(11), 830; https://doi.org/10.3390/cells14110830 - 3 Jun 2025
Viewed by 693
Abstract
Cartilage-derived migratory cells show great potential for autologous use in cartilage repair surgery. However, their collection through arthroscopic biopsy has not been previously reported in individuals without osteoarthritis. This study aimed to characterize migratory cartilage cells isolated from arthroscopic biopsies of volunteers without [...] Read more.
Cartilage-derived migratory cells show great potential for autologous use in cartilage repair surgery. However, their collection through arthroscopic biopsy has not been previously reported in individuals without osteoarthritis. This study aimed to characterize migratory cartilage cells isolated from arthroscopic biopsies of volunteers without osteoarthritis and compare them with cells obtained by enzymatic digestion. Cell cultures were successfully established using both methods—enzymatic digestion and cell migration—from cartilage explants, with no significant differences observed in stem cell markers or plasticity between the cell lines. Cells derived from both procedures exhibited characteristics of mesenchymal stem cell, including fibroblast-like morphology, expression of CD29, CD90, and CD105 markers, absence of hematopoietic and endothelial cell markers, and the ability to differentiate into adipocytes, chondrocytes, and osteoblasts under appropriate conditions. Cells obtained by migration showed lower expression of collagen I and II, along with reduce collagen II/collagen I ratio, both positively associated with chondral matrix production, as well as lower RUNX2 expression. However, no differences were found in the levels of SOX9, essential for chondrogenic differentiation, or in the expression of perlecan gene. Syndecan-1 expression was lower in cells obtained by migration. In conclusion, this study demonstrates that cartilage-derived migratory cells can be successfully obtained from arthroscopic biopsies of individuals without osteoarthritis, presenting comparable dedifferentiation and plasticity profiles. Furthermore, these cells express essential chondrogenic markers and proteins. Although further in vivo studies are needed to determine their effective regenerative potential, cartilage-derived migratory cells represent a promising avenue for cartilage repair strategies. Full article
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14 pages, 517 KiB  
Article
Quantification and Predictors of Hemoglobin Drop, Hidden Blood Loss and Irrigation Fluid Retention in Shoulder Arthroscopy
by Nikola Matejcic, Nikola Grzalja, Karlo Tudor, Andrica Lekic, Filip Stefanac, Ana Matejcic and Lana Ruzic
J. Clin. Med. 2025, 14(11), 3875; https://doi.org/10.3390/jcm14113875 - 30 May 2025
Viewed by 524
Abstract
Background: Shoulder arthroscopy is a common, minimally invasive surgery, but the resulting postoperative blood loss remains poorly understood. In this study, we quantified the intraoperative and postoperative blood loss, the hemoglobin (Hb) drop, and the effects of irrigation fluid retention, as well [...] Read more.
Background: Shoulder arthroscopy is a common, minimally invasive surgery, but the resulting postoperative blood loss remains poorly understood. In this study, we quantified the intraoperative and postoperative blood loss, the hemoglobin (Hb) drop, and the effects of irrigation fluid retention, as well as the influence of solutions administered through infusions. Methods: A prospective observational study of 49 patients undergoing arthroscopic rotator cuff tear (RCT) repair was conducted. Their preoperative and postoperative Hb levels were measured, along with the intraoperative and postoperative blood loss. Irrigation fluid retention was analyzed, and multiple regression was used to assess the factors contributing to Hb drops. Results: The intraoperative blood loss amounted to 36.46 ± 20.34 mL, while the total blood loss reached 791.17 ± 280.96 mL, with 94.64% occurring postoperatively. The postoperative Hb drop (2.06 ± 0.74 g/dL) was significantly greater than the intraoperative Hb drop (0.11 ± 0.06 g/dL) (p < 0.001). An older age (p = 0.02) and male sex (p = 0.025) significantly predicted the postoperative Hb drop, while irrigation fluid retention and administration of crystalloids and colloids had no notable effects. Capsulotomy was associated with a small but significant increase in intraoperative blood loss (p < 0.01). Increased intraoperative blood loss correlated with greater irrigation fluid retention (r = 0.41, adjusted R2 = 0.152, p < 0.001). Conclusions: In shoulder arthroscopy, the postoperative blood loss and Hb drop are significantly greater than the intraoperative blood loss and Hb drop, as well as the fluid gain, emphasizing the need for careful monitoring, especially in high-risk patients. Future studies should investigate the potential impacts of low-molecular-weight heparin on postoperative bleeding after shoulder arthroscopy. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 3820 KiB  
Article
Analysis of the Correlation Between Postoperative MRI Findings, Patient-Reported Outcome Measures, and Residual Pain After Arthroscopic TFCC Repair—A Pilot Study
by Francesca von Matthey, Franziska Hampel, Georg Feuerriegel, Klaus Woertler, Alexandra Gersing and Helen Abel
J. Clin. Med. 2025, 14(11), 3729; https://doi.org/10.3390/jcm14113729 - 26 May 2025
Viewed by 501
Abstract
Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after [...] Read more.
Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after surgery. Post-operative MR imaging can reveal potential pathologies but it needs to be assessed whether depicted changes are normal or whether these findings have a clinical significance. Therefore, the purpose of this study was to evaluate postoperative MR imaging and the function of the patients’ wrists in order to assess which postoperative changes are correlated with pain. Patients and Methods: All patients with a TFCC lesion who were treated arthroscopically at our hospital between January 2012 and December 2016 were retrospectively enrolled. Seventeen patients with complete data sets were enrolled. Post-operative MRI examinations needed to be performed within 24 months after arthroscopy. The mean magnet resonance imaging (MRI) follow-up was 22 months. The average clinical follow-up was 27.3 months. Age, gender, pain level, PROM scores (Munich Wrist Questionnaire, MWQ), follow-up interval, and TFCC classification (Palmer) were documented. The patients underwent a clinical examination and MR imaging. Results: Ten patients (59%) had scar tissue at the triangular fibrocartilaginous complex (TFCC) and nine (53%) had an effusion in the ulnar recess. These findings were not necessarily associated with pain, as six patients without pain and four with pain had scar tissue at the TFCC and six patients without pain and three with pain showed an effusion in the ulnar recessus. Bone marrow edema could be found in the lunate of five patients (29%) (three with pain, two without pain) and in the distal radial ulnar joint (DRUJ) of one patient (6%) with pain. However, typical degenerative changes were not necessarily associated with pain. Conclusions: This present study is the first study correlating postoperative MRI findings after arthroscopic assisted TFCC surgery with both pain and function. Bone edema seems to be associated with pain, whereas scarring at the TFCC is visible on MRI but is not necessarily associated with pain. Full article
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22 pages, 646 KiB  
Article
Saving the Meniscus: A Retrospective Observational Study of the Incidence, Treatment, and Failure Rate of the Main Meniscal Tear Types at 24-Month Follow-Up
by Daniele Screpis, Fjorela Qordja, Luca De Berardinis, Gianluca Piovan, Stefano Magnanelli, Andrea Amarossi, Antonio Pompilio Gigante and Claudio Zorzi
J. Clin. Med. 2025, 14(10), 3350; https://doi.org/10.3390/jcm14103350 - 12 May 2025
Viewed by 1135
Abstract
Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex [...] Read more.
Background: Despite advances in repair techniques, the failure rates of meniscal surgery are still high. The seven most common tear types—horizontal cleavage tears (HCTs), radial tears (RTs), meniscal ramp lesions (MRLs), meniscal root tears (MRTs), longitudinal tears (LTs), bucket-handle tears (BHMTs), and complex meniscal tears (CMTs)—were reviewed. The present retrospective observational study aimed to analyze their characteristics, incidence, treatment approach and failure rates of a consecutive cohort of patients undergoing meniscal arthroscopic repair. Methods: The database of a high-volume meniscal suture center was examined for lesions managed by all-inside, inside-out, outside-in, or transtibial pull-out techniques from January 2018 to September 2022. Demographic (gender, age at surgery, laterality of the affected knee) and intraoperative data (tear type/site, repair technique, and suture number/combination) were collected in order to calculate the failure rates of the cohort and of each tear type and suture technique. Results: Altogether, 636 procedures met our criteria of having at least a 2-year follow-up. The overall failure rate was 1.98%. The most frequent lesions were HCTs (41.98%), with most injuries being in the body/posterior horn (88.52%) of the right knee (56.92%). Treatment predominantly (92.50%) included all-inside sutures. All-inside repair had the highest failure rate (2.98%), followed by inside-out (1.56%) repair (p = 1.0), whereas outside-in and pull-out techniques never failed. Failure rates by lesion included BHMTs (7.27%), HCTs (2.25%), CMTs (1.49%), and LTs (1.25%); RMT, RML, and MRT repair were always successful. Conclusions: Findings at two years suggest that 1–3 all-inside sutures minimize MRL failure, whereas three or more all-inside sutures or combined techniques seem to be effective for HCTs, LTs, and RTs but not BHMTs. Pull-out repair worked best for complete tears/avulsion types of MRTs, whereas all-inside sutures effectively managed partial lesions. Results for CMTs were inconclusive. Full article
(This article belongs to the Special Issue Advances in Arthroscopic Surgery for Meniscus and Cartilage Repair)
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17 pages, 4232 KiB  
Article
No Short-Term Effects of Acromioclavicular Joint Augmentation in Acute Acromioclavicular Joint Stabilization Surgery: A Randomized Controlled Clinical Trial on 70 Patients
by Miha Ambrožič, Matej Cimerman, Kristjan Omahen, Martina Jaklič, Veronika Kralj-Iglič and Ladislav Kovačič
J. Clin. Med. 2025, 14(9), 3161; https://doi.org/10.3390/jcm14093161 - 2 May 2025
Viewed by 482
Abstract
Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. [...] Read more.
Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant–Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation. Full article
(This article belongs to the Special Issue Current Trends and Innovations in Arthroscopic Shoulder Surgery)
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19 pages, 12128 KiB  
Article
Marker-Less Navigation System for Anterior Cruciate Ligament Reconstruction with 3D Femoral Analysis and Arthroscopic Guidance
by Shuo Wang, Weili Shi, Shuai Yang, Jiahao Cui and Qinwei Guo
Bioengineering 2025, 12(5), 464; https://doi.org/10.3390/bioengineering12050464 - 27 Apr 2025
Viewed by 558
Abstract
Accurate femoral tunnel positioning is crucial for successful anterior cruciate ligament reconstruction (ACLR), yet traditional arthroscopic techniques face significant challenges in spatial orientation and precise anatomical localization. This study presents a novel marker-less computer-assisted navigation system that integrates three-dimensional femoral modeling with real-time [...] Read more.
Accurate femoral tunnel positioning is crucial for successful anterior cruciate ligament reconstruction (ACLR), yet traditional arthroscopic techniques face significant challenges in spatial orientation and precise anatomical localization. This study presents a novel marker-less computer-assisted navigation system that integrates three-dimensional femoral modeling with real-time arthroscopic guidance. The system employs advanced image processing techniques for accurate condyle segmentation and implements the Bernard and Hertel (BH) grid system for standardized positioning. A curvature-based feature extraction approach precisely identifies the capsular line reference (CLR) on the lateral condyle surface, forming the foundation for establishing the BH reference grid. The system’s two-stage registration framework, combining SIFT-ICP algorithms, achieves accurate alignment between preoperative models and arthroscopic views. Validation results from expert surgeons demonstrated high precision, with 71.5% of test groups achieving acceptable or excellent performance standards (mean deviation distances: 1.12–1.86 mm). Unlike existing navigation solutions, our system maintains standard surgical workflow without requiring additional surgical instruments or markers, offering an efficient and minimally invasive approach to enhance ACLR precision. This innovation bridges the gap between preoperative planning and intraoperative execution, potentially improving surgical outcomes through standardized tunnel positioning. Full article
(This article belongs to the Special Issue Advances in Medical 3D Vision: Voxels and Beyond)
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