Gelenkpunkt

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potential complication following anterior cruciate ligament reconstruction (ACLR). The necessity and efficacy of routine thromboprophylaxis following ACL reconstruction remain controversial. To determine the efficacy and safety of thromboprophylaxis in preventing symptomatic venous thromboembolism (VTE) following ACLR. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Electronic searches of MEDLINE, EMBASE, PubMed, and the Cochrane Library were performed from inception to January 2026. Included studies compared any form of VTE prophylaxis (pharmacologic, mechanical, or combination approaches) to a control group (no prophylaxis) in patients undergoing isolated ACLR, reporting on symptomatic VTE as a primary outcome. Symptomatic VTE events were pooled and compared using a random-effects model, calculating the pooled odds ratio (OR) with 95% confidence intervals (CI). Thirteen studies, comprising 29,186 patients, were included (1 randomized controlled trial [RCT], 12 observational studies). The mean age of the overall patient cohort ranged from 26.5 to 34.2 years, with predominantly male patients (approximately 59.3%). The pooled incidence of symptomatic VTE across all studies was 0.41% (120/29,186 patients). Comparative analysis showed 51 symptomatic events in the prophylaxis group (n = 10,984, 0.46%), and 69 events in the no prophylaxis group (n = 18,202, 0.38%). Meta-analysis of eligible studies showed no statistically significant impact of thromboprophylaxis on the risk of symptomatic VTE occurrence (risk difference [RD], 0.00; 95% CI, -0.00 to 0.00; p = 0.795). The overall complication rate was notably higher among those who received prophylaxis (n = 122, 1.11%) compared to those who did not (n = 6, 0.03%), primarily due to minor bleeding events and hemarthrosis. Routine thromboprophylaxis following isolated ACLR does not yield a statistically significant reduction in the incidence of symptomatic VTE in the general patient population, which already has a very low intrinsic risk (0.41%). Given the very low baseline risk and potential for complications, routine prophylaxis is not recommended for all patients undergoing isolated ACLR. A risk-stratified approach using validated assessment tools should be employed to identify high-risk individuals who may benefit from prophylaxis. III.

Anterior cruciate ligament (ACL) injuries are common in competitive alpine skiing and pose significant challenges for return-to-performance (RTP) pathways. The aim of this scoping review was to map the current state of research, identify key factors for recovery, highlight knowledge gaps and synthesize evidence- and expert-informed practice recommendations for RTP after ACL injury. A search was conducted in four electronic databases using a set of pre-defined search terms. Studies that examined relevant aspects of RTP in competitive alpine skiers (not competitive para alpine skiers or recreational alpine skiers) who had suffered an ACL injury were included. Two assessors independently screened titles, abstracts and full-text sources to determine eligibility. Of the 622 double-removed hits from the literature search and the two studies added manually, 35 studies were included in this scoping review based on the eligibility criteria. The entities extracted included study characteristics such as general descriptors, injury patterns, surgical details, rehabilitation/training activities, testing/monitoring metrics, and key outcomes. The extracted data were then narratively/descriptively synthesized across several key domains. Most studies identified focus on epidemiology, secondary risks and early rehabilitation, with limited research on later recovery phases, such as returning to competition and returning to performance. There is also little evidence regarding the psychological and social factors that influence RTP. While further research is needed to fill these knowledge gaps, we propose a sport-specific, criteria-based and multi-domain RTP framework with stepwise progression on snow. Finally, we provide insights into practical implementation and present a comprehensive and jointly created RTP protocol for competitive alpine skiers to serve as a guideline for evidence- and expert-informed practice.

To evaluate the current practices, techniques, and opinions regarding the use of the quadriceps tendon (QT) in anterior cruciate ligament reconstruction (ACLR) among knee surgeons worldwide. A 25-question web-based, anonymous survey was conducted between July 1 and August 15, 2025, and distributed electronically to members of the ACL Study Group, Herodicus Society, and Magellan Society. The questionnaire explored demographics, graft choice, surgical technique, fixation methods, postoperative management, and perceived complications related to QT use. Data were analyzed descriptively. A total of 137 surgeons completed the survey (response rate: 16%), representing more than 30 countries. Respondents had a mean age of 55 ± 11 years (range: 36-88) and reported performing an average of 160 ± 170 ACL reconstructions per year (range: 0-1500). The QT was reported to be used in 27% of primary ACL reconstructions, with an average usage of 42% in revision cases. Over the past five years, QT use increased by approximately 15%. The most commonly reported reasons for selecting QT included its use in revision settings, reduced donor site morbidity, and limitations related to prior grafts. Partial-thickness harvest was preferred by 62% of respondents, and 63% used a soft-tissue-only graft. Adjustable buttons and interference screws were the most frequent methods for femoral and tibial fixation, respectively. Most surgeons (83%) did not alter rehabilitation protocols when using QT, and 71% did not perceive an increased risk of cyclops lesions. This international survey provides valuable insights into current practices and evolving approaches regarding quadriceps tendon use in ACL reconstruction among knee surgeons. While QT usage has increased and is commonly employed in revision settings, there remains variability in harvesting technique, fixation strategy, and perceived indications. These findings underscore the need for further comparative clinical studies and efforts toward standardization of QT-based ACL reconstruction techniques. International Survey, Level IV.

Background: Early mobilization without muscle activation is important after arthroscopic rotator cuff repair (RCR). Motor-driven continuous passive motion (CPM) devices may support rehabilitation, but it is unclear whether motion remains passive or setup errors could push joint motion beyond ROM limits. Purpose: To assess whether patients can relax shoulder musculature and avoid evasive movements during CPM, and to quantify how altered device setup affects joint motion and muscle activity. Methods: Shoulder kinematics and bilateral surface EMG of four shoulder muscles were recorded during CPM-guided abduction/adduction and internal/external rotation using 3D motion capture. Patients completed 10 min in the “optimal” setup, followed by four suboptimal positioning conditions (2 min each). Patients then used the CPM device at home for 4 weeks and reported pain, comfort, compliance, and satisfaction. Results: Thirteen patients (56.9±6.6 years) were assessed 12.9±2.8 days after arthroscopic RCR. Actual ROM differed from device-guided ROM (p<0.001), but discrepancies were similar between sides (p>0.05) and remained below approved limits (50-90° abduction and 0-30° external rotation). Suboptimal positioning showed a main effect on ROM (p<0.015); post-hoc differences occurred only for abduction (p=0.002) and remained within safe limits. Muscle activity stayed low and below activation thresholds; deltoid and upper trapezius activation remained within acceptable limits. Pain and discomfort were low (≤0.72±0.96 and ≤0.87±0.91; 0–10 scales), abduction ROM improved from 37±16° to 46±19°, and satisfaction was high (reuse willingness 9.1±1.58/10). Conclusion: Early after RCR, the CPM device provides safe passive shoulder mobilization with very low muscle activation, limited sensitivity to setup errors, low pain/discomfort, and high acceptance.

To assess the safety, effectiveness, and postoperative outcomes of medial collateral ligament (MCL) pie-crusting (PC) in arthroscopic meniscus surgery. This systematic review was conducted in accordance with PRISMA guidelines. Three databases (PubMed, EMBASE and MEDLINE) were searched from inception to 21 January 2025, for studies evaluating the use of MCL PC during arthroscopic meniscus or anterior cruciate ligament (ACL) surgery. Data on patient demographics, medial joint space measurements, postoperative instability, patient reported outcome measures (PROMs), and complications were extracted. Fifteen studies comprising 1009 patients were included, with 723 undergoing PC. PC significantly increased medial joint space width by a mean of 5.7 mm intraoperatively (p < 0.05), with no residual laxity reported at mean final follow-up of 16.5 months. The most common complications of PC were transient medial knee pain (12.7%) and ecchymosis (12.9%). There were five reports of saphenous nerve irritation (0.8%), all resolved by final follow-up of 31.6 months. In contrast, iatrogenic chondral injury was reported in 9.0% of patients undergoing meniscal repair without PC. MCL PC is a safe and effective technique to improve visualisation and outcomes in arthroscopic meniscus surgery. It is associated with improved joint access and low complication rates without long-term instability. While current evidence supports its use, further high-quality, long-term comparative studies are needed to validate its safety and efficacy, as this study primarily used retrospective data without long-term follow-up. Level IV.

Abstract Research Question: Early shoulder mobilization without muscle activation is crucial for recovery after rotator cuff surgery (Altintas et al., 2019). Motor driven continuous passive motion (CPM) devices, like the ARTROMOT-S3, could support the mobilization process, but there are concerns if patients can fully relax their muscles during use (Wang et al., 2015), and concerns about the sensitivity of the optimal device positioning and the corresponding range of shoulder movement. Therefore, the goal of this study was to assess patients' ability to relax shoulder muscles and resist unintended movements during continuous passive motion (CPM), as well as to evaluate the impact of suboptimal setup positions on these factors. Methods Thirteen patients (56.9 ± 6.6 years; 4 males, 9 females) were evaluated during passive shoulder mobilization using a CPM device (ARTROMOT-S3) 12.9 ± 2.8 days post arthroscopic rotator cuff repair surgery. A 3D motion capture system (Qualisys) and surface electromyography (EMG, Noraxon Ultium System) recorded shoulder movements and muscle activity of the healthy and injured side. Patients used the CPM device for 10 minutes in the optimal setup position, followed by four suboptimal positioning conditions recorded for 2 minutes each. EMG activity of four shoulder muscles (injured and non-injured sides) was normalized to resting values. Range of motion (RoM), joint displacement, and muscle activity during passive shoulder abduction, adduction, and rotation were analysed. Subsequently, patients used the CPM device at home for four weeks, reporting pain, compliance, and comfort via a questionnaire. Statistical analyses used paired t-tests and repeated measures ANOVAs with post-hoc evaluation using Bonferroni-Holm correction (p &lt; 0.05). Results There were significant differences noted between RoM of the device and actual shoulder movement (p &lt; 0.001). However, the discrepancies (difference between RoM of the CPM device and the shoulder RoM) were similar between the injured and healthy sides during abduction and rotation (p &gt; 0.05) and RoM values of the shoulder remained within the safe RoM settings specified for the device. Suboptimal positions revealed a significant main effect (p &lt; 0.015) on shoulder RoM. However, only abduction RoM showed a significant post hoc difference (p = 0.002), which remained smaller than the device’s full range. Muscle activity was low, with values not reaching activation threshold levels, supporting passive mobilization. Minimal activation of the deltoid and upper trapezius remained within acceptable limits. Pain scores were low (all means &lt; 0.72 ± 0.96 out of 10 on the VAS Scale), comfort ratings were high (all means &lt; 0.87 ± 0.91 out of 10), and RoM in abduction improved over four weeks (37° ± 16° to 46° ± 19°). Patient satisfaction was high (willingness to reuse: 9.1 ± 1.58 out of 10). Conclusion The ARTROMOT-S3 CPM device ensures effective and safe passive mobilization post-surgery, with low pain and high compliance, supporting early recovery after rotator cuff repair.

ACL injury in skeletally immature patients remains a debatable topic in terms of its management, surgical choices and rehabilitation. The treatment preferences vary across the globe. Children are not little adults in terms of their physiology and anatomy. Hence, contemporary treatment inferred from the adult population does not give the same outcomes in pediatric patients. An in-depth study of specific challenges and difficulties is warranted to optimize the treatment strategies to cater to this group of patients. There is a paucity of literature giving long-term follow-up of ACLR in skeletally immature patients and no standardized guidelines are present for managing this group of patients. The authors have tried to summarize the current concepts for managing ACL injuries in skeletally immature patients through this article. Multiple lacunae and controversies exist in the knowledge regarding the optimum treatment of pediatric patients with ACL injuries who are comparatively more prone to ACL tears than their adult counterparts. Identifying the best mode of management of ACL tears in these skeletally immature patients is necessary. Level of evidence: Level IV.

The present meta-analysis aims to determine the outcomes and failure rates for medial meniscus repairs in patients with stable knees. A literature search was conducted using PubMed and Scopus with the terms '(medial meniscus OR medial meniscal) AND (repair)'. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included 93 articles assessed for eligibility. The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analyses and case reports. In total, 10 studies with 595 patients were included. Degenerative tears or studies reporting meniscus repair outcomes on root repairs, revision or primary anterior cruciate ligament reconstruction, discoid menisci or ramp lesions were excluded. All studies included revision surgery and/or clinical symptoms as failure definitions. The overall medial meniscal repair failure rate was 26% with a 95% confidence interval (CI) [15%-37%]. The mean time to failure from isolated medial meniscus repair surgery was 27.7 months with 95% CI [18.5-36.9 months]. The postoperative Lysholm and IKDC scores were reported in three articles. At the final follow-up, the mean postoperative Lysholm and IKDC scores were 92.3 with 95% CI [84.5-100] and 88.6 with 95% CI [83.5-93.8], respectively. The current meta-analysis revealed an overall failure rate of 26% in the case of medial meniscus repair in a stable knee. For these reasons, the patient should be aware of the substantial risk of revision surgery (one out of four cases). Medial meniscus repair in a stable knee yielded good clinical results. Level II.

Background:Anterior cruciate ligament rupture represents a career-threatening injury for professional soccer players.Purpose:To analyze the pattern of injury, return to play (RTP), and performance of a consecutive series of elite professional soccer players after anterior cruciate ligament reconstruction (ACLR).Study Design:Case series; Level of evidence, 4.Methods:We evaluated the medical records of 40 consecutive elite soccer players who underwent ACLR by a single surgeon between September 2018 and May 2022. Patient age, height, weight, body mass index, position, injury history, affected side, RTP time, minutes played per season (MPS), and MPS as a percentage of playable minutes before and after ACLR were retrieved from medical records and from publicly available media-based platforms.Results:Included were 27 male patients (mean ± SD age at surgery, 23.2 ± 4.3 years; range, 18-34 years). The injury occurred during matches in 24 players (88.9%), with a noncontact mechanism in 22 (91.7%). Meniscal pathology was found in 21 patients (77.8%). Lateral meniscectomy and meniscal repair were performed in 2 (7.4%) and 14 (51.9%) patients, respectively, and medial meniscectomy and meniscal repair were performed in 3 (11.1%) and 13 (48.1%) patients, respectively. A total of 17 players (63.0%) underwent ACLR with bone–patellar tendon–bone autograft and 10 (37.0%) with soft tissue quadriceps tendon. Lateral extra-articular tenodesis was added in 5 patients (18.5%). The overall RTP rate was 92.6% (25 of 27). Two athletes moved to a lower league after surgery. The mean MPS% during the last preinjury season was 56.69% ± 21.71%; this decreased significantly to 29.18% ± 20.6% (P < .001) in the first postoperative season and then increased to 57.76% ± 22.89% and 55.89% ± 25.8% in the second and third postoperative seasons. Two (7.4%) reruptures and 2 (7.4%) failed meniscal repairs were reported.Conclusion:ACLR in elite UEFA soccer players was associated with a 92.6% rate of RTP and 7.4% rate of reinjury within 6 months after primary surgery. Moreover, 7.4% of soccer players moved to a lower league during the first season after surgery. Age, graft selection, concomitant treatments, and lateral extra-articular tenodesis were not significantly associated with prolonged RTP.