Hamid Rahmatullah Bin Abd Razak

Purpose: To evaluate the rate of return to sport (RTS) and improvement in patient‐reported outcomes after labral reconstruction in patients with labral tear. Methods: Major databases such as PubMed, Embase, Cumulative Index to Nursing and Allied Health, Scopus, and Cochrane Library were searched from inception to May 2025. Case series or cohort studies assessing outcomes and RTS rates after labral reconstruction were included. Literature retrieval and data extraction were conducted by 2 independent reviewers. Inclusion criteria were published prospective/retrospective studies or case series on patients diagnosed with hip labral tear undergoing labral reconstruction. Exclusion criteria were studies on patients who did not undergo labral reconstruction of the hip and non‐English studies. Data analysis of modified Harris Hip Score, Non‐Arthritic Hip Score, Hip Outcome Score, and Visual Analog Scale was conducted. RTS rates were analyzed. Results: Eight studies (2 case series, 6 cohort studies) involving 262 patients were included. The mean population age was 33 years, ranging from 10 to 40. Studies had RTS rates ranging from 64% to 88%. Four of these studies reported patients returning to sport at the same or an even higher level of play. Patient‐reported outcomes improved postoperatively. Visual Analog Scale at the latest follow‐up showed an improvement ranging from 2.60 to 4.50, with at least 70% of patients in 2 included studies achieving minimal clinically important difference and substantial clinical benefit. The modified Harris Hip Score improvement at the latest follow‐up ranged from 18.00 to 24.30, with at least 60% of patients in included studies achieving minimal clinically important difference. Non‐Arthritic Hip Score improvement at the latest follow‐up ranged from 15.50 to 25.70, with 70% of participants in 1 study achieving minimal clinically important difference. Hip Outcome Score improvement at the latest follow‐up ranged from 25.10 to 35.50. Three studies reported revision surgery rates ranging from 3.4% to 10%. Conclusions: Current evidence suggests that labral reconstruction for the treatment of hip labral tears is an effective option producing good RTS rates ranging from 60% to 80% and improvements in patient‐reported outcomes. Level of Evidence: Level IV, systematic review of Level III and IV studies.

Objective: Allogenic platelet-rich plasma(PRP) has emerged as a promising alternative to autologous PRP for treating joint pathologies, offering potential advantages in consistency, cost, and applicability across patient demographics. This scoping review aims to firstly, examine the basic science of allogenic PRP and secondly, assess its clinical outcomes in joint diseases. Design: A scoping review was conducted following PRISMA-ScR guidelines, encompassing studies from 2010 to 2025, across databases such as Embase, PubMed, and SCOPUS. The selection criteria included controlled laboratory studies, cohort studies, and randomised controlled trials focusing on the basic science, safety profile, and clinical outcomes of allogenic PRP. Results: A total of 20 studies were included. In vivo and in vitro, allogenic PRP demonstrates anti-inflammatory and pro-regenerative properties. Clinically, it showed consistent patient-reported outcome improvements in the short term up to 6 months, significantly reducing VAS pain scores by up to 25% and improving joint function scores such as WOMAC, IKDC in knees and DASH and SPADI in shoulders. However, there is a lack of long-term superiority data. Clinician-reported outcomes, such as range of motion and imaging, were similarly improved; ultrasonography-detected effusion in knee OA improved and measured femoral cartilage thickness by 22%. The safety profile was generally favourable, with mild, transient adverse events and no severe complications reported. Conclusions: Current literature supports allogenic PRP as potentially effective and safe investigational therapy, but not as an established clinical treatment given the lack of standardisation and long-term superiority data.

Background: Knee osteoarthritis (KOA) is a prevalent cause of disability. Current intra-articular injections (hyaluronic acid [HA] and corticosteroids) fall short in maintaining long-term effects and repeated usage may result in deleterious effects on the knee. The development of hydrogels offers a potentially safe and longer-lasting alternative. Purpose: To assess current literature and analyse the clinical outcomes of intra-articular hydrogel in patients with KOA. Methods: A systematic search on 4 databases was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta‑Analyses. Quantitative findings were complemented by narrative synthesis. Study quality was assessed using the Cochrane Risk of Bias (RoB) 2.0 tool and Methodological Index for Non-Randomized Studies guidelines. Results: Twelve studies comprising 1,413 patients were included. Most reported improvements in clinical outcomes above the minimal clinically important difference. Average follow-up was 11 months. Quality assessment revealed high risk of bias for randomized controlled trials (RCTs) ( n = 4) and low to moderate risk of bias non-randomized studies ( n = 8). Conclusion: Intra-articular hydrogel injections for KOA represent an area of ongoing investigation. Current literature is heterogeneous and limited by methodological shortcomings. Adequately powered RCTs with standardized outcome reporting are needed to clarify their role in routine clinical practice. Level of evidence: Level II

Purpose: This scoping review aims to map and evaluate the current body of literature on the use of extended reality (XR), including virtual reality (VR), augmented reality (AR) and mixed reality (MR), in the field of knee arthroplasty. There is a high global prevalence of knee osteoarthritis, and the frequency of knee replacement surgeries is increasing. The integration of XR technologies with surgery has the potential to improve patient care, surgical precision and medical education. This review seeks to understand the current landscape of XR applications in knee arthroplasty and identify gaps in knowledge to guide future research and clinical innovation. Methods: A systematic search of four databases—PubMed, Cochrane Central Register for Controlled Trials, National University of Singapore Libraries and Google Scholar—was conducted in December 2023 and updated in April 2024. Only English‐language articles published from 2004 onwards were included. Editorials, case reports and articles not related to the knee joint were excluded. Eligible studies involved the use of XR/VR/AR/MR technologies specifically in the context of knee arthroplasty. Included articles were categorised under three major themes: (1) Clinical Practice (encompassing surgery, anaesthesia and rehabilitation), (2) Education (targeting both surgeons and nursing staff) and (3) Research (including applications in artificial intelligence and robotic‐assisted surgery). Data from each study were extracted and summarised in a thematic table. Results: Out of 236 articles retrieved from databases and 5 identified through reference screening, 54 articles met the inclusion criteria. VR was the most commonly studied modality ( n  = 42), followed by AR ( n  = 21), MR ( n  = 5), and XR ( n  = 2), with some overlap ( n  = 9) across technologies. Most articles focused on clinical practice ( n  = 45), while fewer addressed educational uses ( n  = 9) and research applications ( n  = 2). Two studies were classified under multiple themes. XR technologies were applied across preoperative training, intraoperative surgical navigation, anaesthesia techniques and postoperative rehabilitation. Conclusions: XR technologies in knee arthroplasty are diverse and show promising applications across clinical, education and research domains. While surgery, anaesthesia and education‐related applications appear practical and beneficial, rehabilitation‐related studies report mixed outcomes. Further high‐quality research is needed to evaluate effectiveness and support broader clinical implementation across all identified subthemes. Level of Evidence: Level V.

Medial opening wedge high tibial osteotomy (MOWHTO) has gained popularity for treating patients with medial knee osteoarthritis. Bicortical screw fixation is conventionally preferred, but its mechanical advantage over monocortical fixation remains elusive clinically, and may have additional symptomatic hardware risks. Our study aimed to quantify mechanical differences between monocortical and bicortical distal screws construct in MOWHTO. Twenty artificial composite tibiae were used, with 10 specimens per arm. The first arm underwent MOWHTO with bicortical screw fixation throughout; the second arm incorporated two monocortical distal locking screws. Mechanical properties of specimens were evaluated with static compressive load-bearing till failure and cyclic fatigue strength testing. For quasi-static compression testing, monocortical specimens had a median ultimate load of 2.60 [interquartile range (IQR)=0.12] kN [mean ± standard deviation (SD) =2.59±0.15 kN], comparable to the bicortical group [median (IQR) =2.64 (0.46) kN, mean ± SD =2.56±0.33 kN]. Cyclic fatigue strength testing also demonstrated comparable maximal loads tolerated by both monocortical [median (IQR) =1.28 (0.08) kN, mean ± SD =1.33±0.12 kN] and bicortical [median (IQR) =1.28 (0.00) kN, mean ± SD =1.28±0.06 kN] specimens, as well as median number of cycles attained before failure. Mann-Whitney-U tests showed no statistically significant difference for all measured outcomes between monocortical and bicortical groups (P>0.05). Our study found monocortical fixation of the two distal-most screws in MOWHTO mechanically non-inferior to bicortical fixation. This supports monocortical fixation as an alternative technique for distal screw placement in MOWHTO.

Knee rotational stability is crucial for anterior cruciate ligament (ACL) procedures, yet, current clinical assessments are subjective and lack precision. This study evaluates the accuracy and repeatability of the GATOR system, developed by PreciX Pte Ltd. and integrating ultrasound with inertial measurement units (IMUs), against a reference IMU (Xsens DOTS) for measuring knee flexion and rotation in six cadaveric specimens secured in an Oxford Knee Jig. Two experiments were conducted: (A) knee flexion from 0° to 120°, and (B) internal/external rotation at 0°, 30°, 60°, 90°, and 120° flexion. Analysis using Bland–Altman plots, root mean square error (RMSE: 3.93° for internal rotation, 6.90° for external rotation), mean biases, and paired t-tests (Bonferroni corrected) revealed that GATOR recorded lower peak flexion angles (91.49–114.65°) compared to the reference (110.31–118.49°). For rotation, internal rotation showed narrower limits of agreement than external rotation (biases: 1.91–6.88°). Over 60% of trials had errors < 5°, and 80% < 10°, indicating good agreement. Despite no isolated comparison of GATOR’s ultrasound component, findings suggest reduced soft tissue artifact due to bone-referenced sensor alignment. With optimal placement (10–15 cm from the knee center), GATOR shows promise in ACL assessment and remote rehabilitation.

Purpose: Implantation of mesenchymal stem cells (MSCs) is a potential non‐surgical option for cartilage repair. Currently, its clinical use largely focuses on focal cartilage defect repair and intra‐articular injections in knee osteoarthritis (OA). Most studies have looked at the efficacy of MSCs from autologous sources, which can be limited by inter‐patient variability of age, diseases, sites and methods of harvest. This systematic review aims to evaluate studies that focus on allogeneic MSCs implantation versus placebo in patients with knee OA to summarise the efficacy and safety of allogeneic MSCs in knee OA. Methods: A systematic search following PRISMA guidelines was performed in PubMed, Scopus and EMBASE. Original studies investigating the outcomes of allogeneic MSC implantations in patients with knee OA were included. Data on clinical outcomes, such as subjective scores such as VAS and WOMAC, radiological outcomes, such as cartilage thickness, and histological outcomes, such as ICRSII score, were extracted. Results: Seven studies were included in this review. There was 30.4 points improvement in Visual Analogue Scale scores and 40.0 points of improvement in Western Ontario and McMaster Universities Osteoarthritis Index scores at 12 months. Improved cartilage thickness and decreased poor cartilage quality as measured by T2 relaxation. Measurements at the lesion site were observed in three studies as assessed by postoperative magnetic resonance imaging and this was correlated clinically. One study also showed histological improvement with overall ICRSII scores significantly improving from 32.0 ± 21.6 at baseline to 55.9 ± 23.2 at 6 months ( p < 0.05). No major complications or tumorigenesis occurred. Conclusion: Allogeneic MSC implantation in patients with knee osteoarthritis provides sustained clinical improvement and satisfactory cartilage restoration, up to 12 months follow‐up. These results are supported by both imaging and histological studies. The safety profile of allogeneic MSCs is excellent, with minimal adverse events mainly limited to local reaction to injection and no long‐term adverse effects. Level of Evidence: Level II.

Purpose Midpole patellar fractures are traditionally fixed with an "11-8" metal tension band construct. However, this technique is rife with implant-related complications. This study aims to evaluate the radiographic and functional outcomes following "all-suture" fixation of mid-pole patellar fractures as compared to resorbable screw-augmented suture fixation. Methods We retrospectively studied a consecutive series of 18 patients, 9 each with mid-pole patellar fractures treated with all-suture fixation or suture fixation augmented with bioabsorbable cancellous screws in our institution. The hybrid fixation cohort was significantly older (p2 mm) at around four to six weeks postoperatively, for which all except one case from the hybrid fixation cohort achieved union thereafter. One patient from the hybrid fixation cohort had fibrous non-union and further fracture displacement. There was another case of mild fracture gapping and screw breakage on review of postoperative radiographs at three months from the hybrid fixation cohort. These patients recovered without surgical revision or implant removal. Conclusions Both non-metal fixation methods for mid-pole transverse patellar fractures proved to be radiographically and functionally comparable.