Background Suture anchors (SAs) made of human allogenic mineralized cortical bone matrix are among the newest developments in orthopaedic and trauma surgery. Biomechanical properties of an allogenic mineralized suture anchor (AMSA) are not investigated until now. The primary objective was the biomechanical investigation of AMSA and comparing it to a metallic suture anchor (MSA) and a bioabsorbable suture anchor (BSA) placed at the greater tuberosity of the humeral head of cadaver humeri. Additionally, we assessed the biomechanical properties of the SAs with bone microarchitecture parameters. Methods First, bone microarchitecture of 12 fresh frozen human cadaver humeri from six donors was analyzed by high-resolution peripheral quantitative computed tomography. In total, 18 AMSAs, 9 MSAs, and 9 BSAs were implanted at a 60 degrees angle. All three SA systems were systematically implanted alternating in three positions within the greater tuberosity (position 1: anterior, position 2: central, position 3: posterior) with a distance of 15 mm to each other. Biomechanical load to failure was measured in a uniaxial direction at 135 degrees. Results Mean age of all specimens was 53.6 +/- 9.1 years. For all bone microarchitecture measurements, linear regression slope estimates were negative which implies decreasing values with increasing age of specimens. Positioning of all three SA systems at the greater tuberosity was equally distributed (p = 0.827). Mean load to failure rates were higher for AMSA compared to MSA and BSA without reaching statistical significance between the groups (p = 0.427). Anchor displacement was comparable for all three SA systems, while there were significant differences regarding failure mode between all three SA systems (p < 0.001). Maximum load to failure was reached in all cases for AMSA, in 44.4% for MSA, and in 55.6% for BSA. Suture tear was observed in 55.6% for MSA and in 22.2% for BSA. Anchor breakage was solely seen for BSA (22.2%). No correlations were observed between bone microarchitecture parameters and load to failure rates of all three suture anchor systems. Conclusions The AMSA showed promising biomechanical properties for initial fixation strength for RCR. Since reduced BMD is an important issue for patients with chronic rotator cuff lesions, the AMSA is an interesting alternative to MSA and BSA. Also, the AMSA could improve healing of the enthesis.

Anterior cruciate ligament reconstruction (ACLR) in patients over 50 years has traditionally been considered controversial due to concerns about graft failure, limited healing potential, and the risk of degenerative progression. However, with increasing life expectancy and higher physical activity in older adults, the demand for ACLR in this population has grown, and the role of graft selection remains unclear. The aim of this study was to evaluate the influence of graft choice on clinical outcomes, graft survival, and re-rupture rates after ACLR in patients aged 50 years and older. It was hypothesized that (1) ACLR in this population would result in low re-rupture rates and satisfactory functional outcomes, and (2) no significant differences would be observed among different graft types. A systematic literature search of PubMed, Embase, and the Cochrane Library was performed from database inception to July 20, 2025, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included skeletally mature patients ≥50 years undergoing primary ACLR with different grafts (hamstring tendon [HT], bone-patellar tendon-bone [BPTB], quadriceps tendon [QT], allograft, or synthetic). Outcomes of interest included graft re-rupture, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score. Random-effects meta-analyses were conducted to pool results, and subgroup analyses were performed by graft type. Twenty-one studies including a total of 1093 patients were analyzed. The overall weighted mean age at surgery was 55.88 years (95% confidence interval [CI], 54.6-57.2). The majority of patients underwent HT reconstruction (n = 744-68.1%), followed by QT (n = 142-12.9%), BPTB (n = 81-7.4%), allograft (n = 110-10.1%), and synthetic grafts (ligament augmentation and reconstruction system [LARS]; n = 16-1.5%). The overall re-rupture rate was 0.3% (95% CI, 0.0-1.4), with no statistically significant differences among graft types (p > 0.05), ranging from 0.0% for BPTB/QT to 1.8% for allograft/LARS. The pooled mean Lysholm score was 91.2 (95% CI, 89.5-92.9), and the pooled mean IKDC score was 81.4 (95% CI, 77.9-84.9), showing no statistically significant graft-related differences. Odds ratio analysis confirmed no increased risk of re-rupture across graft types. ACL reconstruction in patients aged 50 years and older is associated with excellent functional outcomes and very low re-rupture rates. No statistically significant differences were observed among graft types. These findings should be interpreted with caution due to limited data for some graft categories and the heterogeneity of the available evidence. Graft selection should be individualized based on patient characteristics and surgeon expertise rather than chronological age. Systematic review and meta-analysis; level of evidence, III.

Zusammenfassung: Dieser Artikel gibt einen Überblick über das Prinzip des „intention to treat“ (ITT; Patienten werden so ausgewertet, wie sie randomisiert wurden), „per protocol“ (PP; nicht protokollgemäß behandelte Patienten werden von der Analyse ausgeschlossen) und „as treated“ (AT; Patienten werden unter der Behandlung ausgewertet, die sie tatsächlich erhalten haben) für randomisierte klinische Studien in der Orthopädie. Eine ITT-Analyse soll die Aufrechterhaltung der Vorteile einer zufälligen Behandlungszuteilung zur Vergleichbarkeit der Behandlungsgruppen hinsichtlich bekannter und unbekannter Einflussfaktoren gewährleisten. Dabei kann es jedoch bei Protokollverletzungen zu einer Abschwächung des Behandlungseffekts kommen, sodass zusätzliche PP- bzw. AT-Analysen zur klareren Beurteilung des Behandlungseffekts sinnvoll sind. Vielmehr kann durch die Anwendung aller Prinzipien das Ergebnis einer randomisiert-kontrollierten Studie (RCT) auf Robustheit geprüft und so als Sensitivitätsanalyse genutzt werden.

Various nutritional supplements are available over the counter, yet few have been investigated in randomized controlled trials. The rationale for using the specific mix of nutritional substances including collagen type II, hyaluronic acid, n-acetyl-glucosamine, bamboo extract, L-lysine, and vitamin C is the assumption that combining naturally occurring ingredients of the intervertebral disc would maintain spine function. This double-blinded, placebo-controlled randomized trial aimed to evaluate the efficacy of a nutraceutical supplement mix in the management of lumbar osteochondrosis. Fifty patients were randomly assigned to either the supplement or placebo group in a 1:1 ratio. Patient-Reported Outcome Measures (PROMs) included the Oswestry Disability Index (ODI), the visual analogue scale for pain (pVAS), short form-12 (SF-12) physical and mental component summary subscale scores (PCS and MCS, respectively), and global physical activity questionnaire (GPAQ). Magnetic resonance imaging (MRI) was used to evaluate degenerative changes of intervertebral discs (IVD) including Pfirrmann grades as well as three-dimensional (3D) volume measurements. Data were collected at baseline and after the 3-month intervention. None of the PROMs were significantly different between the supplement and placebo groups. Disc degeneration according to Pfirrmann classifications remained stable during the 3-month intervention in both groups. Despite no significance regarding the distribution of Pfirrmann grade changes (improvement, no change, worsening; p = 0.259), in the supplement group, one patient achieved a three-grade improvement, and worsening of Pfirrmann grades were only detected in the placebo group (9.1%). Furthermore, in-depth evaluations of MRIs showed significantly higher 3D-measured volume changes (increase) in the supplement (+740.3 ± 796.1 mm³) compared to lower 3D-measured volume changes (decrease) in the placebo group (−417.2 ± 875.0 mm³; p < 0.001). In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs.

The aim of this study was to establish a consensus-based classification of postoperative events following anterior cruciate ligament reconstruction (ACLR), clearly distinguishing no complication/normal clinical course, minor complication, major complication, and failure, using a structured Delphi methodology among international experts in anterior cruciate ligament (ACL) surgery. A three-round modified Delphi process was conducted involving international high-volume ACL surgeons. An initial set of statements addressing potential postoperative events after ACLR was developed by a working group based on clinical expertise and contemporary literature. Panelists classified each statement as no complication/normal clinical course, minor complication, major complication, or failure. Consensus was predefined as ≥75% agreement within a single category. Statements reaching consensus were retained, whereas non-consensus statements were revised and re-evaluated in subsequent rounds. Thirty-nine experts completed the first and second Delphi rounds, and 30 (76.9%) completed the third round. The initial 52 statements were expanded to 67 in round two and refined to 46 in round three. Consensus was achieved for 14 statements (26.9%) in round one, 21 statements (31.3%) in round two, and 20 statements (43.5%) in round three. Overall, consensus was reached for 55 statements, forming the final classification framework. The panel clearly distinguished graft failure-defined as graft insufficiency or symptomatic instability-from major complications requiring surgical intervention or associated with substantial morbidity, and from minor complications or expected postoperative findings. Notably, traumatic graft rupture following a clearly documented new injury was not considered a postoperative complication. This international Delphi consensus establishes a standardized and clinically meaningful classification of postoperative events following ACLR. By clearly distinguishing no complication, minor complication, major complication, and failure, this framework provides a shared language that may improve consistency in outcome reporting, facilitate comparison across studies, and enhance the interpretability of clinical research and registry data. V, expert consensus.

Processing of research data is a crucial point in every scientific study. The basis of each statistical test is a clear research question and hypothesis. Then the scientist must consider which type of data are to be collected (nominal, ordinal, continuous). It is recommended that study-specific spreadsheets are developed before data collection, which consider the type of data being collected, how the data are to be analyzed, and which software will be used. Then, once the data have been gathered, tests for normality should be applied before proceeding with the specific statistical tests. This article provides a brief overview of common statistical tests based on fictional examples.