ABSTRACT
BACKGROUND: Injuries to the posterolateral corner of the knee are commonly reported in athletes, although the prevalence of isolated injuries to the popliteus in athletes is largely unknown. PURPOSE: To systematically review the literature to better understand the prevalence, mechanisms, sporting activities, tear characteristics, management, outcomes, and return-to-sport rate and timing in athletes who have sustained isolated popliteus injuries. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched the PubMed, OVID, MEDLINE, Biosis Previews, SPORTDiscus, PEDRO, and EMBASE databases for studies from January 1988 to August 2021 on athletes who sustained isolated popliteus injuries during sporting activities. RESULTS: A total of 19 studies consisting of 27 athletes with isolated popliteus injuries sustained during sport were identified. The mean athlete age was 19.9 ± 10.5 years, while 89% (n = 24/27) were male. Traumatic/contact mechanisms were reported in 67% (n = 18/27) of injuries, with American football and soccer being the most common sports. Lateral-sided knee pain was the most frequent complaint, with 85% (n = 23/27) of athletes reporting swelling. Avulsion injuries off the lateral condyle were present in 67% (n = 18/27) of cases. Nonoperative management was performed in 52% (n = 14/27) of athletes. Operative treatment consisted primarily of arthroscopic or open fixation of the osseous fragment. When reported, all athletes successfully returned to sport at a mean of 10.8 ± 8.2 weeks after injury. CONCLUSION: Isolated injuries to the popliteus remain rarely reported in athletes, and athletes are typically evaluated after they experience forced external rotation of the tibia relative to the femur, present with lateral-sided knee pain and effusion, and undergo a stable ligamentous examination. Injuries occurred primarily in male athletes and were the result of traumatic/contact mechanisms, most commonly involving avulsion injuries off the lateral femoral condyle.
ABSTRACT
BACKGROUND: Knot tying is a crucial component of successful arthroscopic shoulder surgery. It is currently unknown whether sliding or nonsliding techniques result in superior clinical outcomes. PURPOSE: To assess the clinical outcomes of arthroscopic sliding knot (SK)- versus nonsliding knot (NSK)-tying techniques during arthroscopic shoulder surgery, including rotator cuff repair, Bankart repair, and superior labral anterior-posterior (SLAP) repair. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search of the PubMed, Embase, and Cochrane Library databases was performed using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. All English-language literature published between 2000 and 2018 reporting clinical outcomes utilizing SK- or NSK-tying techniques during rotator cuff repair, Bankart repair, and SLAP repair with a minimum 24-month follow-up was reviewed by 2 independent reviewers. Information on type of surgery, knot used, failure rate, patient satisfaction, and patient-reported outcomes was collected. Patient-reported outcome measures included the Constant-Murley score, Rowe score, and visual analog scale for pain. Study quality was evaluated using the modified Coleman Methodology Score. RESULTS: Overall, 9 studies (6 level 3 and 3 level 4) with a total of 671 patients (mean age, 52.8 years [range, 16-86 years]; 65.7% male; 206 SK and 465 NSK) were included. There were 4 studies that reported on Bankart repair in 148 patients (63 SK and 85 NSK), 3 on SLAP repair in 59 patients (59 SK), and 2 on rotator cuff repair in 464 patients (84 SK and 380 NSK). Also, 6 studies compared knot-tying with knotless techniques (3 Bankart repair studies and 3 SLAP repair studies), while the studies reporting the outcomes of SLAP repair evaluated SK-tying techniques only. The failure rate for Bankart repair was 3.2% (2/63) for SKs and 4.7% (4/85) for NSKs. The failure rate for rotator cuff repair was 2.4% (2/84) for SKs and 6.3% (24/380) for NSKs. The failure rate for SLAP repair was 11.9% (7/59). Because of inconsistencies in outcomes and procedures, no quantitative analysis was possible. The mean modified Coleman Methodology Score for all studies was 65.1 ± 8.77, indicating adequate methodology. CONCLUSION: The literature on clinical outcomes using SKs or NSKs for shoulder procedures is limited to level 4 evidence. Future studies should be prospective and focus on comparing the use of SKs and NSKs for shoulder procedures to elucidate which arthroscopic knot results in superior clinical outcomes.
