SICOT-J, official journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT)

Artificial intelligence (AI) has rapidly emerged as a transformative force in musculoskeletal imaging and interventional radiology. This article explores how AI-based methods—including machine learning (ML) and deep learning (DL)—streamline diagnostic processes, guide interventions, and improve patient outcomes. Key applications discussed include ultrasound-guided procedures for joints, nerves, and tumor-targeted interventions, along with CT-guided biopsies and ablations, and fluoroscopy-guided facet joint and nerve block injections. AI-powered segmentation algorithms, real-time feedback systems, and dose-optimization protocols collectively enable greater precision, operator consistency, and patient safety. In rehabilitation, AI-driven wearables and predictive models facilitate personalized exercise programs that can accelerate recovery and enhance long-term function. While challenges persist—such as data standardization, regulatory hurdles, and clinical adoption—ongoing interdisciplinary collaboration, federated learning models, and the integration of genomic and environmental data hold promise for expanding AI’s capabilities. As personalized medicine continues to advance, AI is poised to refine risk stratification, reduce radiation exposure, and support minimally invasive, patient-specific interventions, ultimately reshaping musculoskeletal care from early detection and diagnosis to individualized treatment and rehabilitation.

Background: There remains controversy regarding the ideal graft choice for anterior cruciate ligament (ACL) reconstruction ¹ . Bone-patellar tendon-bone and hamstring autografts have been considered the gold standard for decades. Despite the good clinical outcomes, donor-site morbidity is a concern for both of these grafts ² . Peroneus longus tendon autograft has also been considered as a potential graft for many orthopaedic reconstructive procedures ³ . The biomechanical properties and thickness of such a graft permit its use for ACL reconstruction ^3,4 . The tensile strength of a peroneus longus tendon autograft is the same as that of a hamstring autograft and greater than that of a bone-patellar tendon-bone graft and a quadriceps tendon graft ^3,5 . We aimed to describe the steps to harvest the peroneus longus tendon autograft during single-bundle ACL reconstruction. Description: Identification of anatomical landmarks is performed, including the distal aspect of the fibula and the posterior border of the fibula, 2 cm above the tip of the bone. A longitudinal incision is made along the posterior border of the fibular bone, from 2cm above the tip of the fibula. Care is taken to identify the tendon sheath that covers the longus and brevis approximately 2 cm above the superior extensor retinaculum, and the peroneus longus is stitched to the peroneus brevis. The proximal aspect of the peroneus longus tendon is whipstitched, after which the peroneus longus tendon and surrounding soft tissues are incised. The peroneus longus tendon is then released with use of a closed stripper, and the graft is prepared. Alternatives: Alternative nonoperative treatment options include physical therapy, nonsteroidal anti-inflammatory drugs, rest, and limitation of sporting activities. Alternative surgical treatment options include arthroscopic debridement, ACL repair or reconstruction with bone-patellar tendon-bone or hamstring-tendon autograft, and ACL reconstruction with allograft. Rationale: Recent studies have shown that ACL reconstruction with use of a peroneus longus tendon autograft is safe and effective, with less donor-site morbidity compared with other tendon autografts ^4,6,7 . Expected Outcomes: The peroneus longus graft has been accepted for ligament reconstruction because of its strength, safety, and less donor-site morbidity ⁷ . The peroneus longus graft allows surgeons to harvest the autograft via a relatively small incision, resulting in fewer donor-site complications ⁴ . According to Rhatomy et al., the use of a peroneus longus graft provides good functional outcomes that are comparable with those of a hamstring autograft, but it has a larger graft diameter and its harvest results in less thigh hypotrophy ⁸ . Additionally, a case series of 10 patients who underwent ACL reconstruction with use of a peroneus longus autograft showed satisfactory Lysholm scores and low disability according to the Foot and Ankle Disability Index ⁹ . Important Tips: Examination under anesthesia and arthroscopic confirmation of the ACL tear are recommended prior to harvesting the peroneus longus tendon. Take care to identify the anatomical landmarks of the peroneus longus and brevis. Tenodesis of the peroneus longus to the brevis is performed first, followed by whipstitching of the peroneus longus proximal to the site of the tenodesis. Once the peroneus longus tendon is passed through the closed stripper, gently maintain traction on the sutures while pushing the stripper proximally until the tendon is freed. Care should be taken not to damage the superior peroneal retinaculum, which provides the primary restraint to tendon subluxation. Identification of the peroneus longus and brevis is important. The peroneus longus tendon is free of muscle attachment and more rounded in shape, while the peroneus brevis contains muscle fibers. Acronyms & Abbreviations: PL = peroneus longus CI = confidence interval IKDC = International Knee Documentation Committee

Introduction: Medical case notes are the only lasting interpretation of a patient-physician interaction and are important for good quality patient care. Accurate, legible and contemporaneous note-keeping is important however it can be substandard. This can lead to errors in handover of patients and to medicolegal vulnerability. We present a comprehensive auditing tool for Trauma & Orthopaedics medical case notes and our experience in using it over the last 12 months. Patients and Methods: The TONK score was developed from a pre-existing system with some additions for Trauma & Orthopaedic case notes, with the incorporation of a legibility scoring system. An initial audit was carried out evaluating the case notes for each team against the TONK score. In order to evaluate the reproducibility of this score, we employed the Cohen’s Kappa coefficient and noted substantial agreement. The individual team scores were analysed and the audit cycle completed four months later with the provision of feedback. Results: Our first audit revealed a mean of 81 with a range from 70 to 90. Subsequent audits over the next two quarters revealed mean scores in excess of 90. Significant improvement has been noted in all areas of documentation and it has been decided to conduct this audit every six months in our department. Conclusions: The TONK score is an easy, quick and reproducible tool, which aims to eliminate the weaknesses in Trauma & Orthopaedic medical note-keeping. It emphasises the medicolegal importance of accurate medical note-keeping to doctors at all levels of training.

Objectives: The purpose of this study is to evaluate the short term outcomes of isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor technique, in young and middle aged patients with post traumatic Anterior Shoulder Instability (ASI). Study Design: Prospective Observational Study. Setting: Sports Units of Hayatabad Medical Complex, Peshawar. Period: January 2018 to December 2020. Material & Methods: 32 patients were included in this study, all of them were male, and who had traumatic anterior shoulder dislocation and underwent Arthroscopic Bankart Repair (ABR), with at least 2 years follow-up and minimum of 4 months of physiotherapy postoperatively. Sample size was calculated through non-probability consecutive sampling technique. Recurrent instability, postoperative glenohumeral osteoarthritis, post-surgical complications and subjective scores (Simple Shoulder Test [SST], American Shoulder and Elbow Surgeon [ASES] and Rowe scores) were evaluated. Results: Among the 32 participants, five patients (15.6%) experienced at least one episode of redislocation, eight patients (25%) had moderate to severe glenohumeral-osteoarthritis. The overall satisfaction rate was 76% with ASES, SST and Rowe scores of 82%, 9% and 79% respectively. One patient (3.12%) had wound infection. Conclusion: Isolated Arthroscopic Bankart Repair (ABR) using knotless suture anchor fixation for anterior shoulder instability followed by physiotherapy has excellent short term outcome in term of low post-surgical complication rate, high patient satisfaction, ability to joint work back and improved subjective scores, although high rate of postoperative glenohum eral osteoarthritis is disappointing necessitating further studies on the matter.