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Background: Animal research suggests that repeated heat exposures may stimulate skeletal muscle protein synthesis and downregulate protein degradation., Hypothesis: Repeated heat exposures during ankle immobilization and rehabilitation would preserve human muscle strength and mass., Study Design: Controlled laboratory study., Methods: A total of 20 male participants (age, 33.6 ± 2.8 years; weight, 83.8 ± 9.2 kg; height, 182 ± 6 cm) underwent 4 weeks of supervised training, 2 weeks of single-lower leg immobilization, and 2 weeks of supervised rehabilitation before return to sports (RTS). Participants were split into 2 groups: (1) whole-body heat therapy (HEAT) and (2) sham treatment (SHAM) throughout the immobilization and rehabilitation periods. Measures of muscle strength (isometric and isokinetic), volume (magnetic resonance imaging and ultrasound), and muscle biopsies were obtained preimmobilization, postimmobilization, and at RTS., Results: Maximal isometric strength of the plantarflexors was lower at RTS compared with preimmobilization in SHAM ( P = .027) but not HEAT ( P = .301). Isokinetic strength during a fatigue test was higher at RTS compared with preimmobilization in HEAT ( P = .039) but not SHAM ( P = .245). Pennation angle and muscle thickness were lower at postimmobilization compared with preimmobilization only in SHAM ( P ≤ .027). Muscle cross-sectional area decreased in soleus and both gastrocnemius medialis and lateralis (all P ≤ .035) in SHAM, but only in gastrocnemius medialis in HEAT. There was a large ( d = 0.91) but not significant ( P = .054) decrease in the ratio of phosphorylated/total nuclear factor-kappa B (NFκB) from preimmobilization to postimmobilization in HEAT only. There was an increase in phosphorylated fork head box O proteins (FoxO) only in HEAT ( P = .034), suggesting a decrease in FoxO activity. Caspase 3 expression increased from preimmobilization to postimmobilization in SHAM only ( P = .004)., Conclusion: These results indicate that using heat therapy throughout immobilization and rehabilitation reduces skeletal muscle atrophy and maintains plantarflexor strength in healthy humans. Moreover, heat therapy may lead to the inactivation of the FoxO and NFκB signaling pathways involved in atrophy., Clinical Relevance: Repeated heat exposures should be considered a novel therapeutic intervention to counteract muscle atrophy during immobilization., Competing Interests: The authors declare that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Visual AbstractThis is a visual representation of the abstract., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online., (© The Author(s) 2024.)

Background: Anterior cruciate ligament (ACL) injuries are commonly assessed using clinical examination and magnetic resonance imaging, but these methods have limitations in reproducibility and quantification. Instrumented laxity measurements using devices, like the DYNEELAX®, offer an alternative approach. However, to date, there is no human data on the DYNEELAX® and the reliability of these devices remains a subject of debate, and there is no consensus on appropriate knee tightening levels for testing. We hypothesized that the DYNEELAX®, with standardized knee tightening, would provide reliable measurements of knee laxity in adult volunteers., Methods: This prospective cohort study involved 48 pain-free adult volunteers. Laxity measurements were taken using a robotic-type motorized instrument (DYNEELAX®) on two separate occasions, at least 1 h and no more than 8 h apart, with knee tightening forces of 90 N ± 5 N. Metrics of anterior tibial translation and internal/external tibial axial rotations were recorded., Results: The device displayed excellent intrarater reliability for all the metrics, with intraclass correlation coefficients ranging from 0.91 to 0.96. Anterior translation exhibited the highest reliability (intraclass correlation coefficient = 0.96), with a minimum detectable change of 0.83 mm., Conclusions: DYNEELAX® is reliable in measuring knee laxity in adult volunteers when using standardized stabilizing knee tightening forces of 90 ± 5 N. The most sensitive measurement parameters (in terms of minimum detectable change as a proportion of the observed range) were anterior translation (in mm) at 150 N and secondary compliance., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2024 Nuno Nascimento et al.)

Background: Meniscus root tears represent significant pathology that, historically, has been underdiagnosed and undertreated. However, the recognition of their clinical and functional significance has recently surged, mainly due to their frequent association with anterior cruciate ligament injuries., Aim: This comprehensive review discusses various aspects of meniscal root tears, including their epidemiology, biomechanics, etiology, clinical and radiological findings, classification, management and surgical techniques., (© 2024. The Author(s).)

Purpose: The present study aims to assess the impact of the local language on the view count of patient-oriented educational Sports Medicine videos in an Orthopaedic and Sports Medicine Hospital in the Middle East and North Africa., Methods: An observational study on English and Arabic versions of Aspetar's YouTube channel patient-oriented educational video series was conducted in February 2023, comparing the view count and viewer characteristics. Included videos were posted either simultaneously or in English version first, in both languages, and shared on the same media platforms. Collected data of interest included video title, view count in each language, age and sex of the viewers, location, and traffic source., Results: Eleven videos of the patient-oriented educational video series were included in the present study. Except for one, the view count was significantly higher in the Arabic version of all 11 videos (minimum sevenfold, P = 0.03). Viewers were predominantly males (73.9%) and between 18 and 44 years old (81.1%). Eleven out of 19 countries of the Middle East and North Africa region [11] were among the viewers' top 20 countries. Traffic sources included YouTube search (45.9%), YouTube suggested videos (17%), external sources (14.4%), YouTube browse features (8.5%), and YouTube advertising (6%)., Conclusion: Patient-oriented educational Sports Medicine videos in Arabic yield higher view counts than their English version in young adult viewers from 11 countries in the Middle East and Africa among the top 20. Content creation on languages with limited online representation could effectively reach the targeted population by breaking language barriers., (© 2023. The Author(s).)

Purpose: This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction., Methods: A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity., Results: A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups., Conclusion: ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed., (© 2023. The Author(s).)

Restoring the joint line level is one of the surgical challenges during revision of total knee arthroplasty. The position of the tibial surface is commonly estimated by its distance to the apex of fibular head, but no study evaluating this distance accurately has been published yet. The purpose of this work was to study the distance between the knee joint line and the apex of the fibular head and the proximal tibia, particularly the tibial tuberosity. Variability with clinical data and relations with other local measurements have been evaluated on knee radiographs (an antero-posterior view, a medio-lateral view and an anteroposterior full length view) of 100 subjects (125 knees). Results showed no correlation between the joint line-fibular head apex distance and any clinical data of the patients, or any other performed measurements. Relations between tibial measurements and the sexe or the height of the subjects were noted. Besides, the review of the 25 bilateral cases did not show statistically significant side difference but the descriptive analysis showed too large discrepancies for the joint line-fibular head apex distance to be used as a landmark. We conclude that the fibular head apex cannot be used as a morphologic landmark to determine the knee joint line position. Its interest in clinical and surgical practice must be discussed.

The authors report their results after arthrodesis of the first metatarsophalangeal joint (MP) performed in 50 cases including 18 rheumatoid feet, 18 major hallux valgus deformities and 14 recurrent deformities. Preparation of the bone ends for arthrodesis was achieved using convex and concave drills and fixation was done with an axial screw. The patients were evaluated after an average of 12 months, using Kitaoka's score. Eighty per cent were very satisfied, 16% were satisfied and 4% were dissatisfied. Ninety six percent reported no pain over the MP joint of the hallux, and none complained of metatarsalgia. Return to activities was normal in 80% of cases. Radiographs showed non-union in six cases; they did not show interphalangeal osteoarthritis in any instance.

Long-term stable osseointegration of porous-coated acetabular cups depends on bony ingrowth within their porous surface. For ingrowth to take place, one must ensure rigid initial fixation of the implant, by means of screws or by impaction or using a threaded ring. Primary stability is a prerequisite for long term stability through bony ingrowth. We tested several cups commonly used in our department to assess their primary stability. The study was done using synthetic EP-Dur polyurethane resin blocks (Bayer, Leverkusen, Germany). The blocks were fixed at a 45 degrees angle to the horizontal. They were subsequently reamed using the appropriate reamers and the cups tested were impacted into the resin blocks. Eleven 52-mm cups were tested. The pull out force necessary to extract each cup was measured. The pull-out strength ranged from 7.63 to 55.46 Nm. We noted that the closer the cup was to a hemisphere, the better was the initial stability. The contact zone was at the periphery, and the greater the contact was with the resin, the better was the stability. Micromovements exceeding 150 microns prevent any bony ingrowth in vivo. Solid osseointegration can thus only be achieved if movements between implant and bone can be prevented. Our study indicated that initial fixation is essentially peripheral and that those cups that demonstrated the highest pull-out values also had the best peripheral contact. Our observations suggest that the geometry of the cup is more important than its surface macrostructure in terms of primary stability. To achieve stable fixation, we recommend using an oversized cup with a flattened dome to allow maximum peripheral contact.