What’s New in Sports Medicine

Advances within the field of sports medicine continue to refine approaches to injury management in athletic and active patients. This review synthesizes research findings within the last year, highlighting key developments in the latest evidence across a range of treatment modalities and patient profiles, with a focus on surgical techniques and outcomes, injury prevention, physical therapy, and nonoperative treatment modalities. Through a structured analysis of 40 studies, the aim of this review is to serve as a guide with insights to enhance and implement evidence-based practice regarding the knee, shoulder, hip, and elbow. Knee Anterior Cruciate Ligament (ACL) Reconstruction ACL injury continues to be a main topic of research, with current literature focusing on optimizing techniques, graft choice, and therapy and their effects on return to sport and rate of failure. Lateral augmentation in ACL reconstruction (ACLR) has become a prominent focus in sports medicine research, with various techniques proposed to address persistent rotatory laxity. The addition of lateral extra-articular tenodesis (LET) to ACLR has been shown to add rotational stability and reduce graft rupture. In a multicenter randomized controlled trial (RCT) studying the highest-risk patient profile, the STABILITY Study Group compared hamstring tendon ACLR in isolation and hamstring tendon ACLR with LET in 618 patients with pivot shift grade 2 or higher and generalized ligamentous laxity who participated in high-risk or pivoting sports. At 24 months postoperatively, there were similar rates of return to sport between groups; patients who had undergone ACLR with LET had a lower rerupture rate (11.2% compared with 4.1%; p = 0.004)1. Similarly, a systematic review and meta-analysis of 14 clinical trials with 1,830 patients compared ACLR in isolation and ACLR combined with either LET or anterolateral ligament reconstruction (ALLR). Lateral augmentation was superior to isolated ACLR in terms of improved pivot shift, graft failure, and patient-reported outcome measures (PROMs). Patients who underwent ACLR with LET or ALLR had a lower graft failure rate (range, 3% to 5%) compared with patients who underwent ACLR alone (range, 9% to 12%), with a pooled risk ratio (RR) of 0.42 (95% confidence interval [CI], 0.28 to 0.62; p < 0.001), indicating a 58% lower risk of graft failure. The Lysholm Score (p < 0.05), Tegner Activity Scale score (p < 0.05), and International Knee Documentation Committee (IKDC) Subjective Score (p = 0.03) were all significantly improved with ACLR with LET or ALLR2. For revision cases, a systematic review and meta-analysis compared revision ACLR in isolation and revision ACLR with lateral augmentation. In 8 clinical trials, 334 patients were treated with isolated revision ACLR and 342 patients were treated with combined revision ACLR with LET or ALLR. Revision ACLR with LET or ALLR had a lower failure rate (5.6%) than revision ACLR in isolation (11.7%), with a relative risk reduction of 54% (p = 0.004). Additionally, revision ACLR with LET or ALLR had a lower residual positive pivot shift rate (20.1% compared with 39.2%; RR, 0.50; p = 0.0001) and a lower high-grade (grades 2 to 3) pivot shift rate (3.3% compared with 11.1%; RR, 0.32; p = 0.003) when compared with revision ACLR in isolation3. Both systematic reviews and meta-analyses found no significant differences among the different lateral extra-articular procedures. A topic that is often at the forefront of research related to ACLR is graft choice. Compared with hamstring and patellar tendon autografts, quadriceps tendon autograft is a newer option, with literature now showing equivalent outcomes with no difference in failure rates between quadriceps tendon and patellar tendon autografts at up to 4 years. However, less is known about the long-term sequelae of the quadriceps tendon autograft, such as anterior knee pain and weakness. In a cross-sectional study, 104 patients who had received quadriceps tendon autografts were matched to 104 patients with hamstring autografts and 104 patients with patellar tendon autografts to assess differences in quadriceps strength. At a mean of 7 months postoperatively, patients with quadriceps tendon autografts had the most impaired strength as measured by the limb symmetry index, ranging between 67.5% and 75.1%, compared with patellar tendon autografts (74.4% to 81.5%) and hamstring tendon autografts (84.0% to 89.0%)4. An RCT of 57 patients receiving quadriceps tendon autografts compared with 55 patients receiving hamstring tendon autografts found significantly better ACL RTS (Return to Sport) after Injury (ACL-RSI) scores in the hamstring tendon autograft group at 3 months (p = 0.008), 6 months (p = 0.010), and 12 months (p = 0.014). The hamstring tendon autograft group had better quadriceps strength at 6 and 12 months, whereas the quadriceps tendon autograft group had better hamstring strength at 6, 12, and 24 months5. One side effect of obtaining a hamstring tendon autograft is pain from harvesting both the semitendinosus and gracilis tendons and resultant knee flexion deficits. In the tendon-sparing, all-inside technique, a quadrupled semitendinosus graft is used. An RCT of 98 patients, with 89 patients completing 2-year follow-up (45 all-inside and 44 traditional), showed no significant difference in mean IKDC scores (80.5 ± 14.4 for the all-inside group and 79.2 ± 15.6 for the traditional group; p = 0.51), but the all-inside group had a higher number of revision surgeries (5 compared with 2) and more patients with 1+ and 2+ pivot shift values than the traditional group6. Blood flow restriction rehabilitation is thought to improve recovery and prevent atrophy. A systematic review of 5 studies comparing blood flow restriction training and standard rehabilitation methods for ACL injuries showed mixed results. Two studies showed greater strength gains and greater muscle size with blood flow restriction training, whereas 2 other studies favored standard rehabilitation. The fifth study was the only study that measured PROMs, which showed a significant improvement in the blood flow restriction group, related to physical function7. Meniscus Several studies with regard to the cost-effectiveness of different meniscal tear treatment strategies were published recently. A multicenter RCT from the STARR study group evaluated the cost-effectiveness of arthroscopic partial meniscectomy (APM) compared with physical therapy plus optional delayed surgery. Across 100 patients, higher cost was associated with APM when compared with physical therapy with optional delayed surgery, as measured by health-care costs (€3,645 compared with €2,881) and societal costs (€6,037 compared with €5,778), with no significant difference in quality of life, suggesting that physical therapy should be prioritized as a first-line treatment8. Another multicenter RCT from the FIDELITY Trial compared APM with placebo surgery (diagnostic arthroscopy with simulated partial meniscectomy) in 146 adults with degenerative meniscal tears and no osteoarthritis. The investigators found that APM had increased costs (€7,441 compared with €6,780), in an analysis in which the cost of surgery was standardized, due to productivity loss, medication, and additional health-care visits and associated travel. Additionally, there was no difference in quality of life, leading Kalske et al. to recommend against APM in this population9. A systematic review on the management of meniscal root tears evaluated differences among repair, APM, and nonoperative treatment, with PROMs, radiographic measures, and the rate of conversion to total knee arthroplasty (TKA) as outcome measures. Across 56 studies and 3,191 patients, meniscal root repair had lower rates of conversion to TKA (event rate, 0.00 to 0.22) compared with nonoperative treatment (0.27 to 0.35) and meniscectomy (0.35 to 0.60). Root repair also showed a smaller decrease in joint space width (−0.9 to −0.1 mm) compared with meniscectomy (−2.4 to −0.6 mm) and less medial meniscal extrusion (−0.6 to 6.5 mm) compared with meniscectomy (0.2 to 4.2 mm)10. Anterior Knee Patellofemoral pain is one of the most common symptoms in the adolescent patient and, despite physical therapy, can often be refractory. To assess whether psychological therapy in addition to physical therapy could improve function, a double-blinded RCT assigned 68 adolescent patients with patellofemoral pain to watch videos either on fear-avoidance beliefs, kinesiophobia, and pain catastrophizing or on knee anatomy, biomechanics, and exercise (control). The authors found that the psychologically informed group had significantly greater improvements in the mean Anterior Knee Pain Scale scores at 6 weeks (mean difference, 8.0; p = 0.01) and 3 months (mean difference, 6.2; p = 0.01) and 76% of the psychologically informed group achieved clinically meaningful improvements compared with 52% in the control group (p = 0.03)11. Other common anterior knee pathologies are patellar instability and dislocation. Postoperative rehabilitation protocols for medial patellofemoral ligament reconstruction with tibial tubercle osteotomy have varied widely over the years. An RCT of 50 patients with recurrent patellar instability who underwent medial patellofemoral ligament reconstruction with tibial tubercle osteotomy sought to compare short-term, postoperative outcomes of early rapid rehabilitation versus standard rehabilitation protocols. The early rapid rehabilitation group started weight-bearing at 3 weeks instead of 6 weeks, progressed to 120° range of motion by 6 weeks instead of 9 weeks, and started strength and proprioception training earlier. The rapid rehabilitation group demonstrated higher Tegner scores at 6 weeks and 3 months, higher Lysholm scores at 3 and 6 months, and higher IKDC scores at 6 weeks, 3 months, and 12 months (p < 0.05 for all)12. Shoulder Rotator Cuff Several recent studies have investigated tranexamic acid (TXA) as an adjunct to improve visualization during arthroscopy. In a systematic review and meta-analysis evaluating the use of TXA in arthroscopic rotator cuff repair, 7 studies including 537 patients showed improved surgeon-reported visual clarity (mean difference, +9.10%; p = 0.0004), decreased operative time (mean difference, −11.24 minutes; p = 0.01), and no reported adverse events with TXA use13. A double-blinded RCT of 128 patients involving 5 upper-extremity fellowship-trained surgeons compared placebo saline solution irrigation fluid, epinephrine (0.33 mL of 1:1,000/L) mixed in irrigation fluid (EPI), 1 g intravenous TXA, and TXA and EPI combined. The mean visual clarity (and standard deviation) was 2.0 ± 0.6 for the placebo group, 2.0 ± 0.6 for the TXA group, 2.6 ± 0.5 for the EPI group, and 2.7 ± 0.5 for the TXA and EPI combined group (p < 0.001), suggesting that epinephrine is the most effective adjunct for visualization, with TXA providing no additional benefit14. The retear rates in rotator cuff repair remain high, prompting new research into strategies such as patch augmentation, platelet-rich plasma, and bone marrow stimulation to improve outcomes. In a systematic review evaluating the utilization of patch augmentation in rotator cuff repair, 6 studies with 381 patients were identified, with follow-up ranging from 14.0 to 68.4 months. Four studies indicated retear rates, which were significantly reduced in patients who underwent rotator cuff repair with patch augmentation in 3 studies, ranging from 9% to 53%, compared with patients who underwent rotator cuff repair alone, ranging from 34% to 65%15. To assess biologic adjuvants, a double-blinded RCT aimed to assess whether the retear rate in rotator cuff repair could be reduced by leukocyte-poor platelet-rich plasma. In 96 patients randomized into 2 groups, the retear rate was significantly lower in the leukocyte-poor platelet-rich plasma group (15.2%) when compared with the control group (34.1%), with a mean follow-up of 12 months. There were no significant functional differences between groups at 6 and 12 months. However, in a systematic review and meta-analysis evaluating the use of platelet-rich plasma in rotator cuff repair, 9 studies with 537 patients with follow-up ranging between 6 and 60 months showed a nonsignificantly lower retear rate for rotator cuff repair with platelet-rich plasma compared with rotator cuff repair controls (relative risk, 0.63; p = 0.08). Furthermore, there were no significant differences in visual analog scale (VAS) pain scores, functional improvement, or complications, suggesting that the use of platelet-rich plasma remains controversial16. Bone marrow stimulation is a similar adjunctive therapy that was recently assessed via a meta-analysis of 7 RCTs that included 576 patients with follow-up ranging from 6 to 24 months, which also found no significant difference in retear rates between the bone marrow stimulation group (18.8%) and the control group (21.0%), with an RR of 0.88 (95% CI, 0.55 to 1.42; p = 0.61)17. Shoulder Instability The management of first-time anterior shoulder dislocations is trending toward surgical management. A meta-analysis of 34 studies with 2,220 patients and a mean follow-up of 59.4 months found that arthroscopic stabilization, compared with immobilization, significantly reduced redislocation rates (6.8% compared with 48.6%; odds ratio [OR], 0.09; p < 0.001), cumulative instability (11.2% compared with 67.7%; OR, 0.05; p < 0.001), and subsequent stabilization surgery (6.3% compared with 33.7%; OR, 0.08; p < 0.001). Arthroscopic stabilization also improved return-to-sport rates (OR, 3.87; p < 0.001) and Rowe scores (p = 0.03), favoring early surgical intervention over nonoperative management18. Arthroscopic Bankart repair with remplissage has superior outcomes over Bankart repair alone in the treatment of anterior shoulder instability. A medium-term follow-up of a multicenter RCT comparing these techniques in patients with Hill-Sachs lesions and subcritical glenoid bone loss found significantly lower rates of recurrent instability (9.6% compared with 30%; p = 0.008) and treatment failure (7.7% compared with 22%; p = 0.036) in the remplissage group at a mean follow-up of 4 years. High-risk patients and contact sport athletes also benefited significantly from remplissage, with lower rates of treatment failure and revision surgery19. This finding is also supported by a systematic review and meta-analysis of 12 studies with 897 patients, which found that remplissage significantly reduced postoperative instability recurrence (OR, 9.36; p < 0.001) and instability-related revision (OR, 3.46; p = 0.01). The rates of return to sport were also 2.85 times higher with remplissage, along with a higher Rowe score (+6.5 points; p = 0.01) and American Shoulder and Elbow Surgeons score (+2.2 points; p = 0.04), although the improvements in PROMs were not clinically important20. Further supporting evidence from another systematic review and meta-analysis of 7 studies (837 patients) demonstrated that remplissage resulted in a 9-fold reduction in the recurrence of instability in patients with engaging Hill-Sachs lesions compared with patients who had undergone isolated Bankart repair (OR, 0.11; p < 0.001). The addition of remplissage improved forward flexion slightly (mean difference, +1.97°; p < 0.001) while minimally limiting external rotation in adduction (mean difference, –1.43°; p = 0.004), with no clinically important impact on range of motion, and PROMs were comparable between groups21. Collectively, these findings highlight remplissage as an effective addition to Bankart repair for improving shoulder stability in patients with anterior shoulder instability, particularly those with engaging Hill-Sachs lesions or high-risk profiles, while preserving function and range of motion. There has been conflicting evidence with regard to the efficacy of the Latarjet procedure as a revision surgery rather than a primary surgery for shoulder instability. A systematic review and meta-analysis of 11 comparative studies found no significant differences between primary and revision Latarjet procedures in VAS pain scores, Rowe scores, return to sport, or range of motion. Complication rates were also similar, with no significant differences in overall complications, recurrent dislocation, or reoperations. However, revision Latarjet procedures were associated with a higher infection rate (2.6% compared with 1.2%; p = 0.039) and a nonsignificant trend toward increased subjective feelings of instability (20.9% compared with 12.6%; p = 0.085)22. Hip Capsular and Labral Management There remains debate around the need for capsular closure following hip arthroscopy and subsequent capsulotomy. In a single-surgeon RCT of 90 hips in patients who were 14 to 60 years of age and had cam or mixed-type femoroacetabular impingement, no differences in the net changes in the International Hip Outcome Tool (iHOT-12), modified Harris hip score (mHHS), or the symptoms, pain, daily living, sports and recreational activities, participation in physical activities, and quality-of-life subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS) were observed between the capsular closure group and the no-closure group at a minimum follow-up of 2 years. The majority of patients reported being satisfied or very satisfied (80% compared with 82.2%; p = 0.408) postoperatively, and an iHOT-12 score reaching the patient acceptable symptom state (PASS) was achieved in 78% of hips in both groups (p = 1). There was no significant difference in complication rates (4.08% compared with 1.96%; p = 0.614) in the capsular closure group (1 algodystrophy, 1 tendinopathy) compared with the no-closure group (1 tendinopathy)23. Hip arthroscopy for generalized joint hypermobility has been shown to produce favorable functional and clinical outcomes, and evidence has suggested that capsular repair reduces instability and dislocation risks in this group of patients with a thinner hip capsule. A systematic review including 10 studies evaluated PROMs, return to sport, and clinical complications in patients over 18 years of age with generalized joint hypermobility undergoing hip arthroscopy. Most of the included studies described high rates of labral repair and capsular closure or plications in patients with generalized joint hypermobility (5 studies had a 100% capsular plication rate). In the 8 studies showing PROMs, the mHHS ranged from 71.8 to 90, and the VAS pain score ranged from 1.6 to 3.6. With effective labral repair and capsular closure, no significant differences in PROMs or minimal clinically important difference (MCID) or PASS achievement were found between patients with and without generalized joint hypermobility in 5 comparative studies24. Elbow Ulnar Collateral Ligament (UCL) Repair Elbow UCL repair with suture augmentation has become a popular alternative to UCL reconstruction. A systematic review of 8 biomechanical and 9 clinical studies compared repair and reconstruction with or without suture augmentation. The biomechanical studies testing 140 elbows (70 UCL repairs with suture augmentation compared with 70 reconstructions) observed that suture-augmented UCL repair demonstrated equivalent or superior torsional stiffness and torque at treatment failure, with significantly less gap formation and restored valgus stability. Five of 7 studies found no significant difference in terms of failure load, whereas 2 studies demonstrated lower failure load in the suture repair group. Although no clinical studies directly comparing suture-augmented repair with UCL reconstruction were identified, the systematic review showed high rates of return to the previous level of play for both UCL repair with suture augmentation (93% across 201 athletes; time to return, 3.8 to 7.4 months) and without suture augmentation (92% across 102 athletes; time to return, 2.5 to 6 months)25. Perioperative Analgesia Reducing Opioid Consumption There has been a movement toward pain management strategies to reduce opioid consumption and minimize its associated risks and adverse effects. A double-blinded RCT of 50 patients undergoing elective hip arthroscopy found that perioperative intravenous dexamethasone in addition to a standardized multimodal pain regimen reduced postoperative opioid consumption by 40% compared with placebo (32 compared with 51.4 morphine milligram equivalents; p = 0.014), without any reported complications. Patients in the dexamethasone group had lower pain scores on postoperative day 2 and significantly lower rates of postoperative pruritus, fatigue, and vomiting26. Postoperative opioid consumption is also influenced by the doses prescribed by physicians. A prospective RCT of 180 patients undergoing primary ACLR compared postoperative opioid use and patient-reported outcomes in 3 groups of patients randomized to 15, 25, or 35 tablets of 5-mg oxycodone in addition to a standardized multimodal analgesic regimen. There were no significant differences in VAS pain levels, opioid consumption, IKDC scores, or patient satisfaction across groups, with 72% of opioids consumed within the first 3 days. Patients prescribed 15 tablets were more likely to report that they thought that the prescribed amount was appropriate. This suggests that smaller prescriptions can meet pain management needs while reducing overprescription27. Suprascapular Nerve Blocks The suprascapular nerve block (SSNB) has been reported to be an alternative regional analgesic to the standard interscalene block, offering pain control while avoiding the risk of hemidiaphragmatic paresis in arthroscopic shoulder surgery. In a single-center RCT, a continuous SSNB was found to have inferior analgesic efficacy compared with an ultrasound-guided continuous superior trunk block, with higher postoperative patient-controlled anesthesia and opioid consumption in the SSNB group. However, it significantly reduced the risk of hemidiaphragmatic paresis, making it a preferable option for patients at higher risk for respiratory complications28. Another RCT demonstrated that a preoperative SSNB combined with axillary nerve blocks and parecoxib improved immediate postoperative pain and pain scores at 2 weeks compared with parecoxib alone, although there was no difference at 24 hours. Postoperative morphine consumption and 6-month PROMs were comparable between groups29. Forearm Fasciotomy The optimal management of forearm chronic exertional compartment syndrome, highly prevalent among motorcyclists, remains a topic of debate. Surgical options include traditional open fasciotomy and newer techniques such as minimally invasive fasciotomy and endoscopically assisted fasciotomy. A systematic review of 38 studies found comparably high rates of return to sport across all methods, with 94.2% returning to sport at any level and 86.8% returning to their preinjury level or higher. The mean return-to-sport time was 5.1 weeks, consistent across methods, with comparable rates of returning to sport at any level for open (97.3%), minimally invasive (92.2%), and endoscopically assisted fasciotomy (98.5%). Minor complications, such as hematomas (8.8%) and scar issues (6.6%), were reported, with minimally invasive techniques showing a slightly higher minor complication rate (21.1%) compared with endoscopic methods (9.5%). Symptoms recurred in 2.4% of cases, with no significant differences between approaches30. Evidence-Based Orthopaedics The editorial staff of JBJS reviewed a large number of recently published studies related to the musculoskeletal system that received a higher Level of Evidence grade. In addition to articles cited already in this update, 11 other articles relevant to sports medicine surgery are appended to this review after the standard bibliography, with a brief commentary about each article to help guide your further reading, in an evidence-based fashion, in this subspecialty area. Evidence-Based Orthopaedics Akhtar M, Razick D, Aamer S, Baig O, Dhaliwal A, Kamran K, Asad S, Shelton T. 41 to 75% of patients achieve a patient acceptable symptomatic state after endoscopic repair of hip abductor tendon tears: a systematic review. Arthroscopy. 2024 Aug;40(8):2292-306. The endoscopic repair of hip abductor tendon tears demonstrates good-to-excellent outcomes with low complication, retear, and revision rates in both partial-thickness and full-thickness tears. A systematic review including 13 studies with 275 hips showed significant improvements in PROMs following repair. There was variability in suture fixation techniques across all studies, with double-row or transosseous-equivalent repair used for full-thickness tears and single-row, side-to-side, or suture staple repair used in partial-thickness tears. Complication rates were 0% in 11 studies, and retear rates were 0% in 10 studies, with the remaining retear rates ranging from 6.7% to 33.3%. The rates of achieving the MCID (50% to 93.3%) and PASS (40.7% to 75%) were highly variable, and indicated that not all patients experienced clinically meaningful improvements. Akhtar M, Razick D, Baig O, Aamer S, Asad S, Bernal C, Dhaliwal A, Shelton T. No difference in most reported outcome measures for allograft versus autograft for hip labral reconstruction: a systematic review of comparative studies. Arthroscopy. 2024 Nov;40(11):2745-56. Allograft compared with autograft has been a topic of interest in ligament reconstruction and labral repair, each with different advantages. The overall outcomes are similar for either technique. A systematic review evaluating a total of 277 patients in comparative studies of allograft (92 patients) and autograft (185 patients) for hip labral reconstruction or augmentation found no significant differences in PROMs between groups across all 3 included studies, although PROMs were numerically higher in patients who received allograft. The overall rates of revision (0% to 23.6% compared with 0% to 7.3%) were higher in the autograft group, although only 1 study showed significant differences in revision rates. There were no significant differences in the rates of conversion to total hip arthroplasty (0% to 20% compared with 0% to 6.7%) across all studies. DeClercq MG, Martin MD, Whalen RJ, Cote MP, Midtgaard KS, Peebles LA, Di Giacomo G, Provencher MT. Postoperative radiographic outcomes following primary open coracoid transfer (Bristow-Latarjet) vary in definition, classification, and imaging modality: a systematic review. Arthroscopy. 2024 Apr;40(4):1311-1324.e1. A systematic review aiming to analyze the radiographic outcomes and complication rates by conventional radiography and computed tomography (CT) after open coracoid transfer (the Bristow-Latarjet procedure) included 33 studies with 1,456 shoulders. The mean follow-up was 7.84 years (range, 0.25 to 29 years). The pooled graft union rate was 75% to 100%, with CT-detected union rates lower than radiographic rates. The most commonly reported postoperative radiographic complications after open coracoid transfer were osteoarthritis, graft osteolysis, nonunion, a malpositioned graft, implant issues, and bone block fracture. The range of complication rates was 0% to 100% for osteoarthritis and graft osteolysis and 0% to 75% for a malpositioned graft. This study suggests that radiographic evaluation after open coracoid transfer varies greatly, and greater consistency in postoperative radiographic evaluation is required. Dhillon J, Tanguilig G, Keeter C, Borque KA, Heard WM, Kraeutler MJ. Insufficient evidence for anterior cruciate ligament reconstruction utilizing suture tape augmentation: a systematic review of clinical outcomes at minimum 1-year follow-up. Arthroscopy. 2024 Sep;40(9):2494-503. Suture tape to augment ACLR has increasingly been used in clinical practice and is a topic for debate. A systematic review on ACLR with and without suture tape augmentation included 5 studies with 528 patients (246 underwent ACLR with suture tape, and 282 underwent ACLR alone), with the mean follow-up ranging from 24 to 48.6 months. The graft failure rate for ACLR with suture tape ranged from 1.0% to 25.0%, which was not significantly different from that for ACLR alone, which was 8.0% to 20.0%. Only 1 study showed significantly lower graft failure rates in the group that underwent ACLR with suture tape (p = 0.02). There were no significant differences in return to sport, results of KT-1000 (MEDmetric) testing, or PROMs. Dunning J, Mourad F, Bliton P, Charlebois C, Gorby P, Zacharko N, Layson B, Maselli F, Young I, Fernández-de-Las-Peñas C. Percutaneous tendon dry needling and thrust manipulation as an adjunct to multimodal physical therapy in patients with lateral elbow tendinopathy: a multicenter randomized clinical trial. Clin Rehabil. 2024 Aug;38(8):1063-79. A multicenter RCT investigating the addition of electrical dry needling and thrust manipulation to a multimodal physical therapy program for lateral elbow tendinopathy found significantly greater improvements in pain, disability, and function compared with physical therapy alone. At 3 months, patients in the experimental group showed large effect sizes for reductions in pain (Numeric Pain Rating Scale, −2.0 [95% CI, −2.6 to −1.5]) and disability (Patient-Rated Tennis Elbow Evaluation, −15.0 [95% CI, −19.4 to −10.6]), as well as improvements in function (Tennis Elbow Function Scale, −6.5 [95% CI, −8.7 to −4.3]). Seventy-eight percent of the experimental group reported self-perceived improvement on the Global Rating of Change (GROC ≥ +5) compared with 36% in the control group (p < 0.001). The addition of dry needling and thrust manipulation to multimodal physical therapy may offer faster pain relief to patients with lateral epicondylitis. Kim H, Cho YS, Jung Y, Song HS. Effect of porcine-derived absorbable patch-type atelocollagen for arthroscopic rotator cuff repair: a prospective randomized controlled trial. Am J Sports Med. 2024 May;52(6):1439-48. An RCT investigating the efficacy of a porcine-derived absorbable patch-type atelocollagen as an adjunct during arthroscopic rotator cuff repair in 64 patients with medium or large full-thickness supraspinatus tendon tears was recently published. Fifty-five patients completed the study (29 in the atelocollagen group and 26 in the control group) at 12 months postoperatively, at which time the retear rate was significantly lower in the atelocollagen group (10.3% compared with 34.6%; p = 0.048). There were no significant differences between groups in PROMs. The addition of an atelocollagen patch augmentation to rotator cuff repair significantly decreases the rotator cuff retear rate. Lei M, Zhu Z, Hu X, Wu D, Huang W, Zhang Y, Chen H. Postoperative antiosteoporotic treatment with zoledronic acid improves rotator cuff healing but does not improve outcomes in female patients with postmenopausal osteoporosis: a prospective, single-blinded, randomized study. Arthroscopy. 2024 Mar;40(3):714-22. To investigate the antiosteoporotic effects of zoledronic acid, a prospective, single-blinded RCT evaluated 124 women who were ≥55 years of age, had postmenopausal osteoporosis, and were undergoing rotator cuff repair. At 2 years, the zoledronic acid group (95%) had significantly higher tendon healing rates than the control group (79%) (p = 0.014), but no significant differences in PROMs. Masud S, Momtaz D, Betsch M, Migliorini F, Ghali A, Popa A, Gouveia K, Leroux T, Degen R, Khan M. A comprehensive comparison and evaluation of surgical techniques for anterior shoulder instability: a Bayesian network meta-analysis. J Shoulder Elbow Surg. 2023 Nov;32(11):e531-47. A Bayesian network meta-analysis was performed to evaluate surgical techniques for anterior shoulder instability. Fifty-two studies were included, involving 4,209 patients with a mean follow-up of 50.1 months, evaluating an open Latarjet procedure, arthroscopic Latarjet procedure, open Bankart repair, arthroscopic Bankart repair, and arthroscopic Bankart repair with remplissage, among others. The analysis found that the open Latarjet procedure had the lowest recurrence rates (log OR, 1.93), soft-tissue procedures such as arthroscopic Bankart repair showed higher recurrence rates but lower complication risks compared with osseous procedures, and complications and PROMs varied significantly. Okoroha KR, Tramer JS, Khalil LS, Jildeh TR, Abbas MJ, Buckley PJ, Lindell C, Moutzouros V. Effects of a perioperative blood flow restriction therapy program on early quadriceps strength and patient-reported outcomes after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2023 Nov 27;11(11):23259671231209694. A prospective RCT compared blood flow restriction therapy with standard therapy in patients undergoing ACLR, with 46 patients randomized into 2 groups (22 in the blood flow restriction group and 24 in the control group). Blood flow restriction therapy significantly increased quadriceps strength at 6 weeks (57% ± 24%) compared with the control group (40% ± 18%) (p = 0.029), but showed no long-term benefits at 3 or 6 months. Quinn M, Byrne RA, Albright JA, Testa E, Ahn B, Lemme N, Petit L, Blankenhorn B, Owens BD. Peroneus longus tendon autograft may present a viable alternative for anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. 2024 Apr;40(4):1366-1376.e1. A less commonly used ACLR tendon autograft is the peroneus longus tendon autograft. A systematic review evaluated the utilization of ACLR with peroneus longus tendon autograft compared with traditional grafts. Twelve studies were included (6 prospective and 6 retrospective), with 1,068 patients: 508 using peroneus longus tendon autograft and 560 using hamstring tendon or patellar tendon autograft. There were no significant differences in treatment failure rates or return to sport across studies (p > 0.05). The peroneus longus tendon autograft provided clinical outcomes comparable with traditional grafts, and donor site morbidity was mild and transient. Rungsinaporn V, Innarkgool S, Kongmalai P. Is ultrasound-guided or landmark-guided intra-articular lidocaine injection more effective for pain control in anterior shoulder dislocation reduction? A randomized controlled trial. Clin Orthop Relat Res. 2024 Jul 1;482(7):1201-7. An RCT of 28 patients with anterior shoulder dislocations randomized to receive landmark-guided or ultrasound-guided intra-articular lidocaine injections found no significant differences in pain reduction, emergency room length of stay, or complication rates between the 2 groups. Both techniques effectively reduced pain and achieved high patient satisfaction, suggesting that landmark-guided injections are a cost-effective and equally reliable alternative, particularly in resource-limited settings.