The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS) secondary to hematomas is seldom reported. Here we present a case of a 51‐year‐old patient with history of a non‐Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis.

Background/Objectives: This international multicenter study aimed to assess the effectiveness of the Pivot-Shift Meter (PSM) mobile application in diagnosing and classifying anterior cruciate ligament (ACL) injuries, emphasizing the need for standardization to improve diagnostic precision and treatment outcomes. Methods: ACL evaluations were conducted by eight experienced orthopedic surgeons across five Latin American countries (Bolivia, Chile, Colombia, Ecuador, and Mexico). The PSM app utilized smartphone gyroscopes and accelerometers to standardize the pivot-shift test. Data analysis from 224 control tests and 399 standardized tests included non-parametric statistical methods, such as the Mann–Whitney U test for group comparisons and chi-square tests for categorical associations, alongside neural network modeling for injury grade classification. Results: Statistical analysis demonstrated significant differences between standardized and control tests, confirming the effectiveness of the standardization. The neural network model achieved high classification accuracy (94.7%), with precision, recall, and F1 scores exceeding 90%. Receiver Operating Characteristic (ROC) analysis yielded an area under the curve of 0.80, indicating reliable diagnostic accuracy. Conclusions: The PSM mobile application, combined with standardized pivot-shift techniques, is a reliable tool for diagnosing and classifying ACL injuries. Its high performance in predicting injury grades makes it a valuable addition to clinical practice for enhancing diagnostic precision and informing treatment planning.

Tips & Techniques Edmundo Berumen-Nafarrate, MD; Carlos Leal-Contreras, MD Double-bundle anterior cruciate ligament (ACL) reconstruction can be demanding and time consuming and requires twice as many implants, increasing both costs and possible complications. In this article, we present a new approach to double bundle ACL reconstruction: a biological fixation of the tibial side by means of a double tunnel and a U-shape passage of an anterior tibialis allograft, fixed into a double tunnel on the femoral condyle with 2 interference bioabsorbable screws. The technique is designed to combine 2 known procedures for the regular knee surgeon: the mono-tunnel technique and the medial-portal approach. Dr Berumen-Nafarrate is from the Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, Chihuahua, and Dr Leal-Contreras is from Bosque University Orthopedics, Knee Surgery and Sports Medicine Program, Universidad El Bosque, Bogota, Columbia. Drs Berumen-Nafarrate and Leal-Contreras have no relevant financial relationships to disclose. Correspondence should be addressed to: Edmundo Berumen-Nafarrate, MD, Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, Calle De La Llave #1419, Interior # 9, Colonia Santa Rita, Chihuahua, Mexico 31020 (edmundo.berumen@gmail.com). Anterior cruciate ligament (ACL) reconstruction has been a challenge for the orthopedic surgeon. Nowadays, we understand the consequences of the anteromedial and rotational instability that follow the absence of a functional ACL. Arthroscopic surgery offered not only a better scope of the anatomy and reconstruction possibilities, but also the best therapeutic tool available for solid biomechanical and anatomical reconstructions. History has shown many different therapeutic approaches to ACL reconstructions, most of them with good results in anteromedial stability. However, many recent studies have emphasized the role of rotational stability as a major variable in the final success of ACL reconstructions, specifically on the development of meniscal and articular cartilage damage. The use of autologous graft tissue in ACL reconstructions has been a sound strategy used worldwide with good results. The use of patellar tendon–bone grafts, hamstrings, or other similar tissues has the advantage of good and rapid integration at low cost. However, taking tissues from healthy sites has a toll. Patellofemoral pain in bone-tendon-bone grafts has been well described and decreased knee flexion power with high risk of muscle sprains in hamstring grafts has also been frequently reported in athletes. Donor sites can be painful, and sometimes even more symptomatic than the surgery itself. Other problems may arise such as hematomas or neurovascular injuries. Neuropathic pain is associated equally on the surgical portals and on the donor site in many reports. The development of tissue banks in the past 2 decades has opened a new window for ligament reconstructions. Taking the autograft off the table is an attractive option that potentially means less time, less morbidity, and faster recovery. Integration of the bank graft is similar to autografts. Biomechanical properties of tendon allografts have shown similar behavior at long follow-ups. Risk of bacterial or viral cross infections is low, but remains a concern. Modern tissue banks must follow strict protocols for harvesting, sterilization, packaging, and delivery. Demand is high and donors are scarce, especially in underdeveloped countries. Bone-tendon-bone and hamstring allografts are commonly used, as they do not require changing the original surgical technique. However, sometimes more demand exists than available tissue, so surgeons have been exploring other tendon allografts suitable for ACL reconstructions. The anterior tibialis tendon can be considered a good allograft for knee ligament reconstructions. It is a long tough tendon that can easily measure up to 20-cm long and 10-mm wide. It is biomechanically strong enough to take the knee forces, and long enough to play with different anatomical or biomechanical reconstruction techniques in ACL or posterior cruciate ligament reconstructions. Most of the complications related to ACL reconstructions are related to graft placement than to fixation or tissue choice. At the end of the past century, we saw a research boom on fixation devices, showing different possible advantages, more in terms of easiness than in biomechanical fixation properties. In the past decade, we witnessed the arrival of poor graft placement complications resulting in early meniscus and cartilage damage in many patients. Some studies highlighted the relevance of associated injuries, especially posterolateral instability and residual rotational deficits. The use of anatomical landmarks for better graft placement was followed by the introduction of the double-bundle technique that biomechanically replaces the posterolateral and anteromedial anatomical bands of the native ACL. We believe a double-bundle graft provides a better anatomical and biomechanical approach to ACL reconstruction. It has been clearly shown that on the tibial and femoral insertions, footprints exist of these 2 bundles. The biomechanical studies of Freddie Fu have shown the function of each bundle on the flexion and extension of the loaded knee joint.^1–5 They play a crucial role in the rotational degrees of freedom of knee motion and provide better flexion-extension and anteroposterior (AP) gliding moments. Anatomically and biomechanically speaking, it is logical to use double-bundle reconstruction. However, it involves designing new techniques that will require a learning curve, some complications due to these new techniques may arise, and many surgeons with good experience do not have a clear reason to switch techniques because of the good results of previous methods. All the in-vitro studies favor the...

Bone regeneration demands biomaterials capable of supporting tissue integration and mimicking the native piezodynamic properties of bone. In this study, hydroxyapatite–barium titanate (HA-BT) composite coatings with varying BT content (10, 30, and 50 wt%) were developed to enhance the piezoelectric response and corrosion resistance of Ti6Al4V implants. The coatings were synthesized via high-energy ball milling and atmospheric plasma spraying (APS). XRD analysis with Rietveld refinement confirmed the presence of HA along with secondary phases (TTCP, β-TCP, CaO). Electrochemical tests revealed lower corrosion current densities for the coatings containing ≤30% BT, indicating improved stability in physiological environments. Cytotoxicity assays (MTT) demonstrated biocompatibility across all formulations. Piezoresponse force microscopy (DART-SS-PFM) confirmed enhanced d₃₃-eff values for the 50% BT coating (>15 pm/V); however, biological assays under low-intensity pulsed ultrasound (LIPUS) stimulation showed increased osteocalcin expression for ≤30% BT, while 50% BT induced cellular stress. Overall, HA-BT coatings with up to 30% BT exhibited optimal electrochemical stability, favorable piezoelectric performance, and enhanced biological response, underscoring their potential for orthopedic implant applications and regenerative tissue engineering.

This study aims to compare the clinical and radiographic outcomes of the tight-rope system versus internal fixation with a hook plate for treating grade III-VI acute acromioclavicular dislocation. Relevant studies were identified by searching PubMed, Cochrane, and Google Scholar, from January 2017 to December 2023. The primary focus of the study revolved around evaluating various factors such as the Constant Score, University of California Los Angeles (UCLA) Shoulder Score, Visual Analogue Scale (VAS), coracoclavicular distance (CCD), and incidences of complications. The analysis involved determining the weighted mean difference (WMD) along with its corresponding 95 % confidence intervals (95 % CIs), or risk ratios (RR) with 95 % CIs to quantify the collected data. Eight studies comprising 484 participants were included. Significant differences were observed in the Constant-Murley score between groups. However, no disparities were found in UCLA scores, VAS scores, or CCD improvement. Subgroup analyses also yielded consistent results. Both treatment modalities demonstrated similar clinical and radiographic efficacy in alleviating pain, enhancing acromioclavicular joint function, and correcting coracoclavicular distance. Nevertheless, the TightRope system exhibited additional advantages, including reduced reoperation rates and lower risk of subacromial distal clavicle osteolysis.