Chih-Hao Chiu

Objective: A high lateral tibial slope (LTS) has been associated with an increased risk of graft failure and inferior subjective outcomes following anterior cruciate ligament reconstruction (ACLR), but the impact of a flat LTS remains unclear. This study aimed to compare long-term subjective outcomes of single-bundle (SB) and double-bundle (DB) ACLR in patients with a flat LTS to determine the more favorable approach. Methods: The study comprised 136 patients with an LTS less than 7.4 degrees who underwent SB-ACLR (64 cases) or DB-ACLR (72 cases). Lateral tibial slope was measured on preoperative magnetic resonance imaging. Patient-reported outcomes, including the University of California Los Angeles (UCLA) Activity Score, the Lysholm Knee Score, and International Knee Documentation Committee (IKDC) Score, were collected and compared between those undergoing SB- and DB-ACLR at a mean follow-up of 14.06 ± 2.98 years. Categorical and continuous variables were analyzed using chi-square and independent-samples t-tests, respectively. A P-value less than .05 was considered statistically significant. Results: The mean LTS was similar between the SB and DB groups (4.76 ± 1.48 vs. 4.23 ± 1.82, P = .06). The DB group had significantly better postoperative UCLA (9.32 ± 0.95 vs. 8.55 ± 1.99, P < .01), Lysholm (94.26 ± 5.61 vs. 88.23 ± 13.45, P < .01), and IKDC score (82.99 ± 4.55 vs. 77.67 ± 11.21, P < .01). Specifically, among male patients, no significant differences were found between SB and DB groups, though trends favored DB-ACLR. Conclusion: In patients with a flat LTS, DB-ACLR was associated with higher long-term patient-reported outcome measures than SB-ACLR; however, the clinical relevance of these differences should be interpreted with caution. Cite this article as: Yao S, Lin K, Chan Y, et al. Comparison of subjective outcomes between single-bundle and double-bundle anterior cruciate ligament reconstruction in patients with flat lateral tibial slope. Acta Orthop Traumatol Turc., 2026; 60(5), 0795, doi: 10.5152/j.aott.2026.25795.

Background: Massive irreparable rotator cuff tears (MIRCTs) following failed rotator cuff-related surgery pose a significant challenge in shoulder surgery. Both lower trapezius tendon (LTT) transfer and reverse shoulder arthroplasty (RSA) offer potential solutions for patients without advanced glenohumeral arthritis. Objectives: The aim of this study was to compare surgical results, functional outcomes, and pain relief after RSA and LTT in patients with MIRCTs without advanced glenohumeral arthritis following failed rotator cuff-related surgery. Materials and Methods: This retrospective cohort study included 36 patients with MIRCTs and prior failed cuff-related surgeries treated between January 2018 and May 2022. Fourteen underwent arthroscopic-assisted LTT with an average follow-up of 24.9 ± 0.9 months, and 22 underwent RSA with an average follow-up of 25.0 ± 1.6 months. Pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) were assessed. Results: The LTT group was significantly younger than the RSA group (59.6 ± 4.8 vs. 71.3 ± 3.7 years, P < 0.001). Preoperative forward flexion (FF) was higher in the LTT group than in the RSA group (108.6° ± 53.0° vs. 50.5° ± 39.0°). Both LTT and RSA significantly improved ROM, pain, and function. LTT demonstrated greater improvement in external rotation (ER) compared with RSA (39.3° ± 19.8° vs. 10.5° ± 17.6°, P < 0.001). RSA demonstrated greater improvement in FF compared with LTT (76.8° ± 41.4° vs. 32.1° ± 36.2°, P = 0.002). Pain VAS, CS, ASES, and SSV improvements from the preoperative baseline were similar between groups. Conclusions: Both LTT and RSA are effective treatment options for MIRCTs after failed rotator cuff-related surgery in patients with preserved glenohumeral joint surfaces. LTT may be preferable for younger patients with preserved preoperative FF seeking greater ER recovery, whereas RSA may be more suitable for patients with severe preoperative FF limitation or those ineligible for LTT.

We describe a surgical technique repairing medium‐to‐large anterosuperior rotator cuff (RC) tear that combines long head of the biceps tendon (LHBT) augmentation with a dermal allograft patch using a knotless double‐row repair. LHBT augmentation is done using a triple‐loaded anchor placed 5 mm posterior to the bicipital groove at the bone‐cartilage junction. One suture strand creates a lasso‐loop, rip‐stop configuration to secure and posteriorly reroute the LHBT, improving anterior cable coverage. The remaining medial anchor sutures function as mattress sutures through the supraspinatus. Knots are tied, but the suture limbs are left uncut to secure the graft later to the cuff. A 3 × 3 cm, 2 × 2 mm thick dermal allograft is prepared. The uncut medial row sutures and a nonabsorbable tape suture (for lateral fixation) are passed through the graft. Using a custom cannula and traction sutures placed on the corners, the graft is shuttled and positioned on the bursal side of the repaired tendon. Once positioned, the medial sutures are secured. All remaining sutures (medial limbs, nonabsorbable tape suture, and traction sutures) are loaded into a lateral row anchor and impacted into the greater tuberosity. The final construct sandwiches the repaired tendon beneath the allograft, increasing construct thickness and ensuring complete footprint coverage.

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries worldwide. Primary ACL reconstruction (PACLR) is the standard treatment, but graft failure may necessitate revision ACLR (RACLR). Even though RACLR restores knee stability, outcomes such as return to sport (RTS) and patient-reported measures are thought to be inferior compared with PACLR. While RACLR is widely recognized as resulting in inferior clinical outcomes compared with PACLR, there remains a need for an updated, head-to-head meta-analysis to precisely quantify the magnitude of these disparities in terms of RTS and specific patient-reported outcomes (PROs) across larger patient populations. Purpose/Hypothesis: This study aimed to compare RTS and PROs between PACLR and RACLR. It was hypothesized that RACLR would result in significantly lower RTS rates and inferior PROs compared with PACLR. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic search was conducted in PubMed and Cochrane Library (August 26, 2025) using terms related to “primary,”“revision,”“anterior cruciate ligament,”“reconstruction,” and “outcome.” Inclusion criteria included (1) comparative studies between PACLR and RACLR, (2) reporting of RTS or PROs through outcome measures (subjective International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, and Tegner), and (3) randomized controlled trials, cohort, cross-sectional, or case-control studies. Exclusion criteria comprised duplicates, reviews, case reports, abstracts, or letters. Two independent reviewers performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist. Data on RTS (categorical) were analyzed using risk difference (RD) and PROs (continuous) using mean difference (MD). Random- or fixed-effects models were applied based on heterogeneity. Analyses were conducted with RevMan Web. Results: A total of 22 studies were included, comprising a total of 24,773 patients (22,767 PACLR and 2006 RACLR). While no significant difference was observed between groups in overall RTS rates (RD, 0.09; 95% CI, –0.02 to 0.19; P = .11), the PACLR group demonstrated significantly higher rates of returning to the same level of sports (RTS-S) compared with the RACLR group (RD, 0.17; 95% CI, 0.08 to 0.27; P = .0002). Regarding PROs, PACLR was found to be superior in all assessed metrics, including the IKDC (MD, 5.21; 95% CI, 2.41 to 8.00; P = .0003), Lysholm (MD, 4.62; 95% CI, 3.58 to 5.66; P < .00001), and Tegner activity scores (MD, 0.30; 95% CI, 0.13 to 0.48; P = .0005). Furthermore, PACLR showed significantly better results across all 5 domains of the KOOS, with the most pronounced disparities observed in the Sport and Recreation and Quality of Life subscales. Conclusion: Compared with PACLR, RACLR demonstrated similar overall RTS rates but significantly lower RTS-S and consistently worse PROs. While revision surgery can restore function for daily living, substantial limitations remain in sports performance and quality of life.

Pre-operative imaging evaluation is critical in determining the correct surgical indication and healing rate of rotator cuff repairs. While factors like su

Background: Anterior cruciate ligament reconstruction (ACLR) is a critical surgical intervention for NBA players. While return-to-play (RTP) rates are documented to be high, the long-term impact of ACLR on specific performance metrics and on-court play style remains poorly understood. Questions/Purposes: The purpose of this study was to (1) evaluate changes in performance and play style in NBA players post-ACLR compared to matched controls and (2) determine if durability or skill loss is the primary limiting factor following surgery. Methods: This matched case-control study analyzed 38 NBA players who underwent ACLR between 2000 and 2022. Cases were matched 1:2 with 76 control players based on position, experience, and pre-injury performance. Metrics analyzed included minutes per game (MPG), usage rate (USG%), shooting distribution, and optical tracking data. Results: Post-ACLR players exhibited significant declines in MPG, USG%, and dunk attempt frequency ( p < .05) compared to controls, suggesting a reduction in physical explosiveness and offensive involvement. Conversely, no significant differences were observed in average shot distance, shooting distribution, or player tracking data. Notably, players who reached minimum post-surgery participation thresholds maintained pre-injury performance levels relative to controls. Conclusion: ACLR in NBA players is associated with a reduction in offensive workload and explosiveness; however, skill-based performance remains preserved in those who successfully return to sustained competition. These findings suggest that durability—rather than skill loss—is the primary challenge. Rehabilitation should emphasize workload management and neuromuscular conditioning to optimize career sustainability.

Objective: Methods: Results: Conclusion: Level of evidence: Systematic review, level 4.