BackgroundThe optimal approach to fixation techniques in cartilage repair of the ankle remains unclear due to the predominance of low-quality evidence and limited high-level studies. To address this gap, an international group of experts convened to establish consensus-based recommendations grounded in the best available evidence, formulated during the 2017 International Congress on Cartilage Repair of the Ankle.MethodsSeventy-five multidisciplinary experts from 25 countries and 1 territory participated in a structured Delphi-based consensus process. Eleven working groups were tasked with reviewing specific topics within cartilage repair of the ankle, conducting systematic literature reviews, and grading evidence to support each statement. Statements lacking full agreement were further discussed and refined before final voting. Consensus strength was defined as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%).ResultsFifteen consensus statements related to fixation techniques were developed and all achieved strong consensus, with a minimum agreement level of 82%. These statements provide standardized guidance on indications, technical considerations, and expected outcomes for fixation procedures in osteochondral lesions of the talus.ConclusionThis synthesis of the international expert consensus statements offers unified recommendations to guide the use of fixation techniques in the management of osteochondral lesions of the talus, fostering greater consistency in clinical practice, research methodology, and future guideline development.

This review aims to evaluate the current landscape of outpatient reverse total shoulder arthroplasty, as well as summarize protocols to facilitate safe and effective patient selection and implementation. It also aims to demystify cost and reimbursement concerns surrounding this topic.

A 7-year-old Warmblood mare used for show jumping was evaluated for progressive left hindlimb lameness of 5 weeks' duration, localized clinically to the metatarsophalangeal region. Radiography revealed ill-defined osteolysis of the axial apical regions of both proximal sesamoid bones (PSBs). Due to rapid clinical deterioration, low-field magnetic resonance imaging was performed and demonstrated aggressive axial osteomyelitis of both PSBs, partial rupture of the intersesamoidean ligament and proximal scutum with herniation of synovium of the plantar joint recess, and an occult penetrating tract. Endoscopic surgical exploration confirmed the imaging findings. Following surgical treatment, the horse returned to full athletic function.

As endoscopic techniques for the management of proximal hamstring injuries have evolved, new challenges have emerged. Tendon-to-bone healing remains the ultimate goal, but a strong time-zero fixation construct is necessary to resist tension and facilitate healing. The constraints of an endoscopic environment limit the surgeon's ability to pass suture and create constructs that are relatively straightforward in an open procedure. Biomechanical studies have shown that suture configurations that distribute tension and maximize suture purchase achieve higher ultimate load to failure. Locking constructs, such as the Krackow or modified Mason-Allen stitch, have shown the best biomechanical performance, nearly doubling the load to failure of a simple suture. However, these configurations are technically more challenging to perform endoscopically. Horizontal mattress configurations have a load-to-failure profile similar to that of locking constructs but are technically more comparable to a simple suture. In our practice, we have found that Krackow sutures are well suited for retracted proximal hamstring tears, particularly those with macerated tissue and dissociation from the tendon sheath. In contrast, locking constructs may be unnecessary for partial tears. For these tears, we typically use a horizontal mattress configuration as it provides comparable strength while being technically simpler. Suture configuration matters when repairing these tendons, as the repair construct is subjected to substantial tension during the early postoperative period. Thus, fixation strength must be optimized while maintaining technical efficiency in an endoscopic setting. Although several biomechanical studies show the superiority of mattress and locking constructs, the next step is evaluating how these different configurations translate to clinical outcomes.

Perineal complications-including nerve injury (eg, pudendal neurapraxia), soft tissue injury and sexual or urinary dysfunction-are well-documented adverse effects of conventional hip arthroscopy using a perineal post. Postless hip arthroscopy avoids direct perineal pressure, but high-quality randomised evidence is lacking.