Objectives
: Arthroscopic distal clavicular autograft (DCA) is an effective alternative to coracoid or iliac autograft in shoulder instability with glenoid bone loss. This study aims to report the outcomes of arthroscopic anterior bone block glenohumeral stabilisation with distal end clavicle autograft.

Design and Methods: 
This is a single-centre retrospective, observational study of anterior bone block stabilisation with lateral clavicle
 bone graft done by a single surgeon (TB). Data were collected on patient demographics, post-operative PROMs (Oxford
Instability Score OIS) and complications. Post-operative CT scans were analysed to assess the position of bone graft and
union.



Results
: 23 patients with a mean age of 32 years (±8), who presented with recurrent shoulder instability underwent stabilisation with 
this technique and had a minimum follow-up of 6 months. 9 (50%) patients had medium to large Hill-Sachs defects and 6
 patients had previously failed soft tissue stabilisation. Average glenoid bone loss was 10%. The average pre-operative OIS was 21 (±7). The mean follow-up period was 10 (±3) months. The average post-operative OIS at the last follow-up was 36 (±8). 21 patients had a union of the graft confirmed by post-operative CT. 2 patients had
partial-union of graft although had remained stable thus far. No cases
 experienced donor site morbidity (ACJ pain or instability).



Conclusion: 
The lateral clavicle provides an excellent alternative bone graft to previously established options with no donor site morbidity
 and cost-effective than allografts. Healing is equivalent to other techniques and early clinical results are reassuring.

Objective: To investigate the effect of arthroscopic superior capsular reconstruction (ASCR) of irreparablemassive rotator cuff tears (IRCTs) using the autogenous peroneus longus tendon graft. Methods: The patients with irreparable massive RCTs who underwent ASCR by using autogenous peroneus longus tendon graft (APLT) evaluated between December 2019 and October 2021. All cases were followed up more than 2 years. The pain and function of the shoulder were evaluated by visual analogue scale (VAS), active forward elevation (aFE), American Shoulder & Elbow
Surgeons score (ASES), University of California Los Angeles(UCLA) score, and Constant⁃Murley score. The acromiohumeral distance (AHD) and healing were assessed by X⁃ray and MRI scan.
Results: 36 patients were enrolled for final analysis. The average age was 66.0±5.88 years. The average length of follow⁃up was 35.3±7.20 months. At the last follow⁃up, the aFE of the surgical shoulder significantly higher than before the surgery. The ASES score was 92.92±9.08, UCLA score was 31.62±3.93, and Constant⁃Murley score was 85.8±8.44, which were higher than those before the operation. The VAS was significantly lower than that of before operation. At the last follow⁃up, MRI showed that the AHD increased from 3.31±1.57mm to 6.94±1.76 mm significantly. Radiological outcomes were evaluated according to MRI, the total healing rate was 89.7%. There were two cases of complete tears, which including one case of infection and 1 partial tears.
Conclusion: ASCR of IRCTs using APLT graft showed the high healing rate in the short⁃term follow⁃up. It is an effective method for the treatment of IRCTs.

Purpose: In Asian populations, increased prevalence of hip dysplasia as well as activities of daily living which require increased hip range of motion (such as squatting) may impact outcomes of arthroscopic surgery for femoroacetabular impingement (FAI) when compared to their Western counterparts. Thus, we aimed to conduct the first systematic review and meta-analysis that examines outcomes of arthroscopic intervention in Asian patients with FAI. Methods: Major databases such as PubMed, Embase, CINAHL, SCOPUS and Cochrane Library were reviewed. Case series or cohort studies assessing outcomes of arthroscopic intervention in FAI were included. Pooled analysis of modified Harris Hip Score (mHHS), Visual Analogue Scale (VAS) and adverse events were conducted. Rate of revision surgery and conversion to total hip arthroplasty (THA) were analysed. Results: Six studies (5 case series, 1 cohort study) of high methodological quality involving 498 patients were included. Age of patients ranged from 20s to 70s, with a balanced gender ratio. Pooled patient-reported outcomes improved significantly postoperatively. VAS at the last follow up mark improved by -4.28 (95% CI, -4.49 - -4.08, P < 0.00001) and VAS at the 12-month post-operation mark improved by -4.11 (95% CI, -4.34 - -3.88, P < 0.00001). The mHHS at the last follow up mark improved by 23.37 (95% CI, 20.29 - 26.45, P < 0.00001). Revision surgery rate was low at 2.8% and conversion to THA rate was 0.3%. Conclusions: Arthroscopic intervention in FAI provides favourable outcomes in the Asian population that is comparable with outcomes seen in the western population.

Purpose: This study aimed to investigate the effect of previously failed rotator cuff repair (RCR) on surgical outcomes of superior capsular reconstruction (SCR) with a fascia lata autograft. Methods: A total of 79 patients with irreparable massive rotator cuff tears who underwent SCR between 2018 and 2023 were included. Of these, thirteen patients were found to have previously failed RCR. Clinical outcomes were collected and evaluated, including the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion. Radiological outcomes were evaluated using radiographs and MRIs, including acromiohumeral distance, rotator cuff tear arthropathy, and graft integrity.
Results: Patients undergoing primary SCR showed significantly improved outcomes in all functional scores and AHD (all P < 0.001). However, patients undergoing SCR after failed RCR only showed significant improvements in the VAS and ASES scores after surgery. Furthermore, patients undergoing SCR after failed RCR showed worse VAS, ASES, Constan and graft integrity scores than those undergoing primary SCR. Only the difference in Constant scores exceeded the MCID threshold. For patients who underwent SCR after failed RCR, those with intact grafts showed significant improvements in VAS score and AHD compared with those with torn grafts. Patients undergoing SCR after failed RCR showed significantly worse VAS and Constant scores. Conclusion: The results indicated that SCR using fascia lata autograft contributed to improvements in surgical outcomes regardless of previously failed RCR. However, SCR after failed RCR showed a significantly worse outcome and higher graft tear rate compared to primary SCR.

Background: Arthroscopic rotator cuff repair (RCR) with long head biceps (LHB) tenodesis become a common combined procedure in shoulder surgeries.
Methods: This is a prospective cohort study aimed to compare the functional outcome of patients who underwent RCR with or without LHB tenodesis in King Abdullah Medical City in Makkah from January 2017 until March 2023 using ASES and UCLA scoring questionnaire at 3, 6,9, 12-month period post-surgery.
Results: Cohort of 102 patients, 66 had rotator cuff repair with biceps tenodesis and 36 without biceps tenodesis. The mean age (SD) was 54.5 (9.8) years. Mean BMI was 30.36 (5.1%). The mean (SD) at the baseline 3-month period for RCR with versus without LHB tenodesis for ASES score and UCLA score revealed no statistically significant deference between the two groups, P value 0.67. Paired t-test used to compare the progress in scores, arthroscopic RCR with and without LHB tenodesis both demonstrated no statistically significant deference in mean enhancement in both outcome measures: ASES (mean, 41.32 vs 39.96; P= .000; 95% CI, 36.59, 44.32), and UCLA (mean, 12.35 vs 11.59; P = .000; 95% CI, 10.77, 12.96) at 1-year follow-up. By using the ANOVA test there was no statistical difference in ASES, UCLA score mean (SD) in each time period at 3,6,9, 12 months period between both groups (p>0.05).
Conclusion: Adding LHB tenodesis to the arthroscopic RCR has no statistically significant improvement in the functional outcome as reported by patient using ASES, UCLA score systems.

Background: There is a paucity of literature regarding the age-related changes in PTS. This study aims to identify the trend in the variation of PTS with age and its role in the incidence of ACL injury. Methods: Data for 312 patients (423 knees) were assessed, of which there were 189 males (232 knees) and 123 females (191 knees). Medial Posterior tibial slope (MPTS) and Lateral Posterior tibial slope (LPTS) were measured using digital software on the true lateral view radiographs of patients. Patients were then grouped into various age groups- up to third decade (18-30 years), fourth decade (31-40 years), fifth decade (41-50 years), and sixth decade (51-60 years). Results: The MPTS varied between 5.30°-21.60° (mean=12.437°±2.79°) while the LPTS varied between 3.00° and 18.10° (mean=9.527°±2.65°). MPTS demonstrated a trend of first increasing and then decreasing with aging, while LPTS demonstrated a trend of decreasing with aging. There was no significant gender-based variation of PTS across age groups. MPTS and LPTS variation were independently associated with ACL injury in the age group 18 to 40 years (p<0.05) and 18 to 30 years (p=0.01), respectively. The slope values (MPTS and LPTS) were higher in subjects with ACL injury. Conclusions: Posterior tibial slope is a dynamic entity, and its value is different across age groups. Lateral radiographs of the knee are feasible and cheap, enabling large sample sizes for assessing PTS in a population. These trends need to be taken into account while analyzing risk factors, treatment planning, and surgical techniques.

Background: Studies suggest poorer long-term function and decreased return to sports in anterior cruciate ligament reconstruction (ACLR) patients with kinesiophobia. However, we postulate that in our Asian, generally less athletic population, preoperative kinesiophobia does not have a significant impact on postoperative patient reported functional scores at short-term follow-ups. Methods: We prospectively recruited 168 ACLR patients and followed them at 6 months and 1 year postoperatively. We documented Tampa Scale of Kinesiophobia (TSP-17), International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome (KOOS) scores. We compared differences in preoperative and postoperative 6 months and 1 year IKDC and KOOS scores between patients with higher TSP-17 scores and those with lower TSP-17 scores. Results: Median TSK-17 score was 46. Mean TSK-17 score decreased by 3.4 points at 6 months postoperatively (P <0.001) and by 5.2 points at 1 year postoperatively (P<0.001). Comparing patients with TSK-17 score above median (≥47,n=70) with those below median (≤ 46,n=93), there were no statistically significant differences in changes in KOOS-symptom, KOOS-Sports, KOOS-pain and KOOS-QoL at 6 months as compared to preoperative baseline. At 1 year postoperatively, there were no significant difference in KOOS and IKDC between the high TSK-17 group (≥47, n= 52) and the low TSK-17 group (≤ 46, n =72) as compared to preoperative baseline. Conclusion: In our Asian, non-athletic population, TSO-17 decreases significantly at 6 months and 1 year postoperatively. Increased TSP-17 score is not associated with worse IKDC and KOOS scores at short-term follow-ups of 6 months and 1 year postoperatively.

Aim: ACL reconstruction (ACL-R) fails in upto a third of patients. High re-rupture rates, variable outcomes and an improved understanding of the modes of failure has led to an evolution in strategies to augment ACL reconstruction. This study sought to compare the outcomes ACL augmentation techniques. Methods: All skeletally mature patients under 30 undergoing ACL-R with a minimum 12 month follow up were included. 3 cohorts were analysed to indicate the efficacy of each iteration of augmentation. Group 1 = first generation internal bracing, group 2 = Second Generation Internal bracing and group 3 underwent internal bracing and Lateral extraarticular tenodesis (LET). The primary outcome measure was clinical recurrence of symptoms, secondary outcome measures included tegner scores and secondary injury to the knee. Results:A total of 614 cases met the inclusion criteria. The main outcome measure was met in 23 / 280 (8.4%) patients in group 1, 12 / 237 (5.06%) patients in Group 2 and 0 / 97 patients in Group 3. Secondary injury was noted to be 9, 10 and 4 in the three groups respectively. Statistically fewer patients in group 3 achieved the primary end point than those in group 1 (fisher's exact p=0.0011) The tegner activity scale demonstrated clinically significant improvement in function in patients undergoing internal bracing and LET when compared to those undergoing generation 1 internal bracing p<0.05 (ANOVA). Conclusion. The addition of second generation internal bracing and an LET to augment ACL-R has led to clinically significant improvement in outcomes.

Introduction: One of the most prevalent knee disorders these days is anterior cruciate ligament (ACL) injury. There is ongoing debate over the connections between the anatomical structures and ACL injuries. The purpose of this study was to use magnetic resonance imaging (MRI) of the knee to discover the anatomical risk factors of ACL injury. Method: A retrospective analysis of MRI of patients who were clinically and radiologically diagnosed as ACL injured (non-contact injury) was conducted. As controls, there were additional individuals who had no biological injuries to their knee joints. The intercondylar notch's width and notch index, intercondylar roof angle and the medial and lateral tibial plateau slope were assessed in MRI images and compared. All the statistical analysis was done using SPSS. Results: A total of 100 patients (50 ACL injured and 50 normal) were included in the study. The ACL injured group of patients had significantly ( P<0.05, CI95%) smaller notch width (1.54 +/- 0.19 compared to 1.66+/- 0.22), smaller notch width index (0.22 +/- 0.02 compared to 0.24 +/- 0.02 ), smaller intercondylar roof angle (34.9 +/- 2.4 compared to 39.56 +/- 1.99) and larger medial (6.71 +/- 1.94 compared to 4.88 +/- 1.51) and lateral (6.74 +/- 2.21 compared to 4.56 +/- 1.41) posterior tibial slope as compared to the normal group. Conclusion: In summary, the chance of an ACL injury can be predicted in patient with smaller intercondylar notch and index, smaller intercondylar notch angle and greater posterior tibial slopes.

The study aimed to compare patient-reported outcomes and radiographic data between patients undergoing arthroscopic superior capsule reconstruction (ASCR) with and without long head of biceps tendon (LHBT) augmentation. Forty-three patients who underwent ASCR between 2016 and 2020 were included, with 27 in the augmentation group and 16 in the nonaugmentation group. Patient-reported outcome measurements (PROMs) and radiographic data were collected and compared between the two groups, including satisfaction, functional scores (ASES, Constant score, SANE, VAS), and radiographic findings (MRI, plain radiographs).

Results showed significant differences in functional scores favoring satisfied and improved patients in both groups, except for VAS scores. However, there was no significant difference in the percentage of patients achieving clinically significant outcome (CSO) thresholds between the groups for most functional scores, except for the maximal outcome improvement (MOI) for ASES score, where the augmented group had a higher percentage.

Furthermore, the mean acromiohumeral distance (AHD) was slightly greater in the augmentation group, but the graft tear rate did not differ significantly. The study concluded that while there were no significant differences in PROMs and CSO thresholds between the two groups, a higher percentage of patients achieved maximal outcome improvement in the augmented group. However, further evaluation is needed to determine any long-term benefits of LHBT augmentation in superior capsule reconstruction.