Background: Posterior medial meniscus root (PMMR) tears (PMMRTs) can be repaired using various techniques to promote healing. However, the biomechanical properties of suture-relay all-suture anchor (ASA) versus conventional suture anchor (CSA) and loop-locking transtibial pullout (TTP) have not been well established. Purpose: To compare the biomechanical properties of PMMR repairs using suture-relay ASA, CSA, and loop-locking TTP. Study Design: Controlled laboratory study. Methods: A total of 33 fresh-frozen porcine knee joints with intact medial menisci were randomly divided into 3 groups, with 11 specimens in each group: ASA, CSA, and TTP. The study involved cyclic loading, with displacement measurements taken after 100, 500, and 1000 cycles. Subsequently, the specimens were loaded until clinical failure (defined as 3-mm displacement) and then to ultimate failure of the construct, with data recorded for displacement after cyclic loading, load to 3-mm displacement, and ultimate load to failure. Results: After 1000 cyclic loadings, the suture-relay ASA group showed considerably less displacement than the loop-locking TTP group (1.8 ± 0.7 mm vs 2.9 ± 0.3 mm; P < .001), but the displacements did not differ considerably between the suture-relay ASA and CSA groups (2.2 ± 0.9 mm; P > .05). The mean loads to clinical failure were significantly greater in the suture-relay ASA and CSA groups (61.3 ± 6.5 and 57.5 ± 9.7 N, respectively) than in the loop-locking TTP group (38.3 ± 9.4 N; P < .05). The ultimate load to failure was significantly greater in the suture-relay ASA group than in the loop-locking TTP group (153 ± 55.1 N vs 102 ± 12.9 N; P < .05). All specimens in the loop-locking TTP group failed by suture elongation mode, whereas only 2 specimens (18%) in the suture-relay ASA group and 5 specimens (45%) in the CSA group failed by suture elongation. Nine specimens (82%) in the suture-relay ASA group and 6 specimens (55%) in the CSA group failed due to suture cutout through the meniscal tissue. Conclusion: The biomechanical properties after PMMR repair did not statistically differ between the suture-relay ASA and CSA groups. The suture-relay ASA technique had a higher load to failure than the loop-locking TTP technique. Clinical Relevance: The suture-relay ASA technique is a promising option for the repair of PMMRTs; its repairing strength is also comparable to that of the CSA technique. Notably, the suture-relay ASA technique can be utilized without establishing a posteromedial portal, resulting in decreased procedure time and mitigating challenges associated with working from the posterior aspect of the knee.

Split type of greater tuberosity fracture has variety of surgical treatment options. This study aimed to compare the biomechanics property of additional cuff suture and other fracture fixation techniques. Fifteen porcine humeri were categorized into three groups of fixation techniques those were proximal humeral internal locking system (PHILOS) plate with 2 cuff sutures, nonlocking (conventional, 3.5 mm) T-plate with 2 cuff sutures and T-plate with washer that had additional cuff suture (novel technique). Fracture was created by greater tuberosity osteotomy with 50˚ inclination to the line of surgical neck and then fixed with different prescribed techniques. Displacement of fracture site was measured with universal testing machine. The maximum forces to produce 3 mm, 5 mm of displacement and load to failure were recorded. The average loads to reach 3 mm, 5 mm displacement and failure were 30.8 N, 45.4 N and 161 N for nonlocking T-plate; 76.6 N, 99.2 N and 144 N for PHILOS plate; 95.8 N, 120 N and 197 N for novel technique. The differences among three groups were significant in load to displacement at 3 and 5 mm (but not significant in load to failure). For load to reach 3- and 5-mm displacement, PHILOS plate and novel technique were significantly stronger than nonlocking T-plate (P < 0.05). For load to reach 3 and 5 mm displacement, novel technique was stronger than PHILOS plate but not significant (P > 0.05). For load to failure, novel technique was stronger than nonlocking plate and PHILOS plate but not significant (P < 0.05). The important factors affecting the strength of fracture fixation are type of plate and numbers of suture augmentation that tie to the plate. Fixation with additional cuff suture showed the superior biomechanics of load to reach 3 mm, 5 mm displacement with better load to failure compared with PHILOS plate and conventional T-plate alone.

Bursal-side supraspinatus tendon tears are a common form of rotator cuff injury, often associated with acromial impingement and other extrinsic factors. Existing anatomical parameters, such as the lateral acromion angle, acromial index, and critical shoulder angle, have been studied in relation to rotator cuff tears; however, reliable indicators specific to the risk of bursal-side supraspinatus tears remain lacking. The acromioclavicular (AC) angle, which reflects the angular relationship between the acromion and clavicle, may offer a new predictive marker for this specific pathology. In this retrospective case-control study, patients presenting with shoulder pain between January 2016 and February 2020 were reviewed. Group 1 included patients with isolated bursal-side supraspinatus tendon tears confirmed by arthroscopy, while Group 2 consisted of age- and gender-matched controls without rotator cuff pathology. The AC angle was measured using both X-ray and MRI. Diagnostic performance was assessed through Receiver Operating Characteristic (ROC) curve analysis, identifying the optimal cut-point with Youden's index. Reliability was measured using the Intraclass Correlation Coefficient (ICC) for both intra- and inter-rater reliability. The ROC analysis determined an optimal AC angle cut-point of ≤160°. X-ray measurements showed moderate diagnostic value (AUC 0.60, sensitivity 67.2 %, specificity 51.7 %), while MRI measurements demonstrated good diagnostic performance (AUC 0.79, sensitivity 84.5 %, specificity 70.7 %). X-ray yielded high sensitivity but low specificity, suggesting its utility as an initial screening tool, whereas MRI provided improved diagnostic accuracy. Reliability assessments indicated high intra- and inter-rater reliability for AC angle measurements across both imaging modalities (ICC >0.80). The AC angle, particularly when measured on MRI, may serve as a valuable diagnostic marker for identifying isolated bursal-side supraspinatus tendon tears. While X-ray can be utilized as an accessible screening tool, combining it with clinical assessments and MRI is recommended for greater diagnostic precision. Further multi-center, prospective studies are warranted to confirm the clinical utility of the AC angle in predicting rotator cuff pathology.

To establish a standardized set of criteria for Return to Play (RTP) after Anterior Cruciate Ligament (ACL) reconstruction based on a consensus among international experts. An international group of ACL experts convened at the APKASS 2024 Consensus Meeting to address the variability in RTP criteria. Using a structured questionnaire, the experts evaluated six key areas: clinical assessment, functional testing, psychological factors, rehabilitation and reinjury prevention, surgery-related factors, and stakeholder insights. Data were analyzed using a predefined consensus threshold of 75% agreement. The consensus identified several key recommendations for RTP, emphasizing the avoidance of purely time-based decision-making in favour of a more comprehensive approach that incorporates functional and psychological assessments, and sport-specific demands. Notable findings included the endorsement of manual stability tests (Lachman and Pivot Shift) as important components of evaluating knee stability, the critical role of psychological readiness, and the importance of a multifaceted approach involving various stakeholders in the RTP decision-making process. The APKASS 2024 Consensus Statement provides a comprehensive, expert consensus-based framework for RTP after ACL reconstruction and may help promote greater consistency in clinical practice. It highlights the need for a personalized approach that considers the unique recovery progress of athletes. Future research is encouraged to refine RTP protocols further and explore the integration of novel diagnostic and therapeutic technologies. V (Expert opinion).