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Background: Hamstring tendon (HT) autografts have become a popular choice for anterior cruciate ligament (ACL) reconstruction. However, small-diameter grafts are inevitably encountered during surgery, which have poor biomechanical properties. Hybrid grafts (HGs) using an allograft combined with small diameter HT are gaining interest from surgeons. Hypothesis: There would be no difference between the HT autograft and HG in terms of failure, knee stability, and patient-reported outcomes. Study design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed, Embase, web of science and Cochrane databases were systematically searched from their inception until July 1, 2022. Clinical trials that compared HG and HT autografts were included. The quality of the included studies was assessed with the Cochrane Collaboration's risk of bias tool and the modified Newcastle-Ottawa Scale. Extracted data were pooled with fixed or random effects depending on the detected heterogeneity. Results: A total of 14 eligible studies involving 1411 patients (HT: 863; HG: 548) were included in the quantitative meta-analysis. The mean age of the patients involved ranged from 14.6 to 40.4 years. Compared to patients who received HT autografts, patients receiving HGs had similar postoperative failure rate (OR, 0.99; P = 0.97; I2 = 41%), side-to-side difference (MD, -0.16; P = 0.13; I2 = 41%), Subjective IKDC (MD, 0.51; P = 0.58; I2 = 69%), Lysholm (MD, 2.79; P = 0.1; I2 = 79%), Tegner (MD, -0.88; P = 0.56; I2 = 0%). When the available data for failure rate were analyzed by the dose of irradiation, patient age, and mean diameter of the HT, the results of subgroup analyses did not change substantially. Conclusion: This review found no significant differences in failure rates, knee stability, or patient-reported outcomes between autologous HT and HG in ACLR. Surgeons should prioritize autografts of adequate size through optimized techniques and consider hybrid grafts as a last resort, considering the risks associated with allografts. [ABSTRACT FROM AUTHOR]

Background: There have been emerging clinical trials investigating the efficacy of synthetic-graft-augmented autografts in anterior cruciate ligament reconstruction (ACLR) in recent years. Hamstring tendon and Ligament Augmentation and Reconstruction System (LARS) are both widely discussed graft choices for ACLR. Purpose: To compare the clinical efficacy of hamstring tendon grafts with LARS-augmented hamstring tendon grafts in ACLR. Study Design: Systematic review and meta-analysis. Method: A systematic literature search was performed in PubMed, Embase and the Cochrane Library to identify primary evidence related to the comparison of ACLR with a hamstring tendon (HT) versus a hamstring tendon with LARS (HT + LARS). Quality assessment of the included studies was conducted using Newcastle–Ottawa Scale for non-RCTs. Quantitative analysis was conducted with Reviewer Manager 5.4. The primary outcomes compared were the Lysholm scale, Tegnar activity scale, International Knee Documentation Committee (IKDC) evaluation, KT-1000-based laxity, complication/retear rate and rate of return-to-sports. The secondary outcomes were the Knee Injury and Osteoarthritis Outcomes Score (KOOS), Global Rating of Change (GRC) scale, hop tests, isokinetic knee strength tests and radiographic and arthroscopic evaluations. Results: Six cohort studies with 710 participants were included in this study. Compared with the HT group, the HT + LARS group had better Lysholm scores at the 1-year follow-up (P = 0.0007) and at the final follow-up (P = 0.04). HT + LARS group had better IKDC scores at the 1-year follow-up (P = 0.003). The HT + LARS group had a better return-to-sports rate in short term. No significant difference in complications or re-surgery was observed. The secondary results revealed superior or non-inferior outcomes in the HT + LARS group. Conclusions: As grafts for ACLR, the use of hamstring tendons with LARS augmentation, compared with the use of hamstring tendons alone, in the short term, has significantly superior overall functional results and better early sports participation and non-inferior results in other comparisons. In the long term, the use of hamstring tendon with LARS augmentation demonstrated non-inferior results in terms of functional scores, knee stability, knee strength, complications and re-tear rate, etc. [ABSTRACT FROM AUTHOR]

Background: Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication. Purpose: To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted. Results: A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery. Conclusion: This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication. [ABSTRACT FROM AUTHOR]

Background: Although numerous clinical studies have compared transtibial (TT) and anteromedial portal (AMP) drilling of femoral tunnels during anterior cruciate ligament reconstruction (ACLR), there is no high-quality, evidence-based consensus regarding which technique affords the best outcome. Hypothesis: There would be no difference between the TT and AMP techniques in terms of knee stability, patient-reported outcomes, incidence of revision, and radiological results. Study Design: Meta-analysis; Level of evidence, 2. Methods: The PubMed and EMBASE databases were searched from inception to February 1, 2021. Level 1 and 2 clinical trials that compared TT and AM techniques were included. Data were meta-analyzed for the outcome measures of knee stability, patient-reported functional outcomes, incidence of revision, and radiological results. Dichotomous variables were presented as odds ratios (ORs), and continuous variables were presented as mean differences (MDs) and standard mean differences (SMDs). Results: The meta-analysis included 18 clinical studies, level of evidence 1 or 2, that involved 53,888 patients. Pooled data showed that the AMP group had a lower side-to-side difference (SMD, 0.22; 95% CI, 0.06 to 0.39; P =.009), a lower incidence of pivot-shift phenomenon (OR, 3.69; 95% CI, 1.26 to 10.79; P =.02), and a higher postoperative Lysholm score (SMD, −0.26; 95% CI, −0.44 to −0.08; P =.005) than the TT group. However, no statistically significant differences were seen in other outcomes, including subjective International Knee Documentation Committee scores (SMD, –0.11; 95% CI, –0.30 to 0.09; P =.30) or grades (OR, 0.93; 95% CI, 0.35 to 2.49; P =.89), postoperative activity level (MD, –0.14; 95% CI, –0.42 to 0.15; P =.35), and incidence of revision ACLR (OR, 1.04; 95% CI, 0.93 to 1.16; P =.45). The TT technique was more likely to create longer (SMD, 1.05; 95% CI, 0.05 to 2.06; P =.04) and more oblique (SMD, 0.81; 95% CI, 0.51 to 1.11; P <.001) femoral tunnels than the AMP technique, and a higher height ratio of the aperture position was detected with the TT technique (SMD, −3.51; 95% CI, −5.54 to −1.49; P <.001). Conclusion: The AMP technique for ACLR may be more likely to produce better knee stability and improved clinical outcomes than the TT technique, but no difference was found in the incidence of revision between the 2 groups. [ABSTRACT FROM AUTHOR]

Background: Superior capsular reconstruction (SCR) is an option for patients with massive or irreparable rotator cuff tears. Purpose: To describe the literature on rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the introduction of motion. Study Design: Scoping review; Level of evidence, 4. Methods: We conducted a scoping review of articles published on PubMed, Ovid, Embase, and the Cochrane Library from inception to October 2020. The methodological index for non-randomized studies (MINORS) was used to assess the individual studies. For each article, we summarized the study characteristics, patient demographics, and rehabilitation protocols after SCR: duration of immobilization, initiation of passive range of motion (ROM), active-assisted ROM, active ROM, strengthening, and return to activities. In a subgroup narrative analysis, rehabilitation protocols were stratified by graft type: autograft versus nonautograft (xenograft, allograft, and synthetic). Results: A total of 21 studies met the search criteria. Six studies had level 3 evidence and 15 had level 4 evidence; 16 studies were considered high quality according to the MINORS score. After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks. Of the 21 studies, 7 (33%) started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for patients with nonautograft versus autograft (χ2 = 225; P <.001). There was a high level of heterogeneity in the rehabilitation protocols after SCR. Conclusion: The majority of published protocols were descriptive. At present, there is little agreement on the published rehabilitation guidelines after SCR, precluding specific clinical best practice suggestions. Although there was a tendency of recommending early motion in nonautograft cases, the optimal protocols based on graft healing and functional outcomes require further verification based on the clinical outcomes from high-quality studies. [ABSTRACT FROM AUTHOR]

Purpose: FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical outcome between arthroscopic surgery (AT) and conservative treatment (CT). Method: The six studies were selected from PubMed, Embase and OVID database. The data were extracted and analyzed by RevMan5.3. Mean differences and 95% confidence intervals were calculated. RevMan5.3 was used to assess the risk of bias. Result: Six observational studies were assessed. The methodological quality of the trials indicated five of six studies had a low risk of bias and one article had a high risk of bias. The differences were statistically significant between AT and CT for HOS (follow-up for 6 months), iHOT-33 (follow-up for 6 months) improvement, iHOT-33 (follow-up for 12 months) improvement, iHOT-33 (follow-up for 12 months), EQ-5D-5L index score (follow-up for 12 months) and AT showed higher benefits than CT. Meanwhile no statistically significant were found in iHOT-33 (follow-up for 6 months), EQ-5D-5L index score (follow-up for 6 months), EQ5D-VAS (follow-up for 6 months) and EQ5D-VAS (follow-up for 12 months). Conclusion: AT and CT both can have clinical effects when facing FAI. In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder (FS) is a common progressive disorder that causes restricted motion and refractory pain undermining quality of life. Intra-articular hyaluronic acid (HA) injection is a widely adopted conservative therapy relieving symptomatic FS, whereas the effect of which were contradictory and unclear in current literatures. The aim of the present study is to investigate whether intra-articular HA administration facilitates symptomatic pain relief and functional improvements in patients diagnosed with shoulder FS. Methods: The PubMed, Embase, Cochrane Library electronic databases and Google scholar were searched, from inception to 15th Jan 2022. Randomized controlled trials (RCTs) comparing intra-articular HA administration with any other non-surgical treatment in patients with FS were included. Risk of bias was evaluated using the Cochrane risk-of-bias tool and meta-analyses were undertaken to pool the data of visual analog scale for pain, range of motion (ROM) in external rotation, abduction, and flexion, as well as Shoulder Pain and Disability Index (SPADI), Constant score and American Shoulder and Elbow Surgeons (ASES). Results: The present study included 7 RCTs involving 504 patients. The results provided no support for superior pain control in patients undergoing HA injection compared with any other treatment (p = 0.75). Furthermore, HA group failed to exert superior improvements to other treatments in ROM concerning abduction (p = 0.69) and flexion (p = 0.33). However, HA injection was observed to facilitate functional recovery in external rotation (p = 0.003). In addition, the pooled data showed a significant higher SPADI score in control group than in HA group (p = 0.01), while no statistical significance between two groups was observed in Constant score (p = 0.36) and ASES (p = 0.76). Conclusions: The current meta-analysis suggested that HA is a beneficial treatment procedure in improving the ROM of the shoulder for patients with FS, whereas the effect in relieving pain may be equal to the existing therapy. In conclusion, Intra-articular HA injection is recommended for FS patients. [ABSTRACT FROM AUTHOR]

Background: Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior. Purpose: To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR). Study Design: Systematic review; Level of evidence, 1. Methods: The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data. Results: Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection. Conclusion: The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications. [ABSTRACT FROM AUTHOR]

Background: The combination of lateral extra-articular tenodesis (LET) with primary single-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) remains controversial. Purpose: To determine whether the combination of LET with single-bundle ACLR provides greater control of anterolateral rotatory instability and improved clinical outcomes compared with ACLR alone. Study Design: Systematic review; Level of evidence, 2. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched between inception and July 1, 2020. Level 1 or 2 randomized controlled trials that compared isolated single-bundle ACLR with combined LET with ACLR were included. Data were meta-analyzed for the primary outcome measure of knee stability and the secondary outcome measures of patient-reported outcome scores, return to sports, and graft failure. Dichotomous variables were presented as relative risks (RRs), and continuous variables were presented as mean differences (MDs) and standardized MDs (SMDs). Results: A total of 6 studies involving 1010 patients were included. Pooled data showed that the ACLR+LET group had a lower incidence of the pivot shift (RR, 0.56 [95% CI, 0.45 to 0.69]; P <.00001), a higher postoperative activity level (MD, 0.47 [95% CI, 0.15 to 0.78]; P =.004), and a lower risk of graft failure (RR, 0.35 [95% CI, 0.21 to 0.59]; P <.00001) than did the ACLR group. However, there were no statistically significant differences in primary outcomes including positive Lachman test findings (RR, 0.76 [95% CI, 0.48 to 1.21]; P =.26) or side-to-side differences (SMD, –0.43 [95% CI, –0.95 to 0.09]; P =.11) or in secondary outcomes including International Knee Documentation Committee scores (SMD, 0.25 [95% CI, –0.06 to 0.56]; P =.11) or Lysholm scores (SMD, 0.28 [95% CI, –0.06 to 0.62]; P =.11). Although the overall rate of return to sports was not significantly different between the groups (RR, 0.97 [95% CI, 0.90 to 1.03]; P =.33), the activity level was higher in the ACLR+LET group. Conclusion: The addition of LET to primary single-bundle ACLR produced greater knee stability, a higher activity level, and a lower incidence of graft failure than did ACLR alone. There may be a role for adding LET to ACLR for the treatment of ACL injuries. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a systematic review and meta-analysis comparing the surgical techniques, clinical outcomes, rates of revision and conversion to arthroplasty and complications between a repaired and unrepaired capsulotomy after hip arthroscopy. Methods: A search of the PubMed, Embase and Google Scholar databases was performed to identify comparative articles published prior to 10 July 2019 that reported the capsule management strategy and clinical outcomes after hip arthroscopy. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. Results: 12 comparative studies (n = 1185 hips) with an average (methodological index for non-randomized studies) MINORS score of 17.45 ± 2.02 were identified for analysis, of which 5 were included in the meta-analysis. The pre- to postoperative improvements in the modified Harris Hip Score (mHHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SS), and Hip Outcome Score–Activities of Daily Living (HOS-ADL) revealed no significant differences between the repaired and unrepaired groups (p = 0.40, 0.26 and 0.61, respectively). The risk ratio of the revision rate for the 2 groups was 0.66 (p = 0.21). Evaluation of the MRI scans and the rate of heterotopic ossification also showed no significant differences. The most preferred capsulotomy techniques were interportal and T-shape. No postoperative hip instability was reported in any of the 12 studies. Conclusion: The currently published evidence is still not strong enough to confirm the superiority of repairing the capsule after hip arthroscopy; hence, routine repair of the capsule during surgery cannot be suggested. [ABSTRACT FROM AUTHOR]

Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.003 , respectively). PSI reduced operative time (P = 0.03) and blood loss (P = 0.002) and improve the KSS (P = 0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems. [ABSTRACT FROM AUTHOR]