Orthogate Subspecialty Journal Scan: Sports Medicine & Arthroscopy

Curated critical appraisals of recent high-impact trials and clinical evidence across knee ligament and meniscus reconstruction, evaluating isolated hamstring autograft failure in high-risk patients from the New Zealand ACL Registry, complication profiles and motion protocols in 600 youth meniscus repairs, and sex disparities in return-to-sport rates across 25 studies.

Featured Sports Medicine Studies This Edition (October 2026)
Sports Medicine

1. Isolated Hamstring Tendon Autograft Should Be Avoided in High-Risk Patients Undergoing Anterior Cruciate Ligament Reconstruction: A New Zealand ACL Registry Study

Authors: Rahardja R, Love H, Clatworthy M, Young S | Journal: The Bone & Joint Journal (May 2026) | View Source / DOI

Situation

Adolescent and young adult athletes undergoing primary anterior cruciate ligament reconstruction (ACLR) represent a population at heightened risk of secondary graft rupture. This nationwide prospective registry study evaluated revision risk differences between hamstring tendon autografts (HTA) and bone-patellar tendon-bone (BTB) autografts in high-risk patients.

Background

While quadrupled hamstring autografts remain the most commonly utilized graft construct globally due to low anterior kneeling pain, biological concerns persist regarding graft elongation, delayed tunnel incorporation, and higher rerupture rates in younger patients participating in high-demand pivoting sports with high-grade rotational laxity.

Assessment & Findings
  • Study Design & Cohort: Prospective multicenter cohort study analyzing the New Zealand ACL Registry encompassing 3,482 high-risk primary ACL reconstructions (age 14 to 25 years, sporting injury mechanism, surgery within 12 months, grade 2 pivot shift, and preinjury Marx activity score of 8 or higher) with a minimum 2-year follow-up.
  • Comparative Revision Rates: The revision ACL reconstruction rate was 11.4% (238 of 2,091) in the hamstring autograft cohort compared with 4.3% (60 of 1,391) in the BTB autograft cohort (P < 0.001).
  • Survival Analysis & Hazard Ratio: Multivariable Cox regression demonstrated that isolated hamstring autografts carried a 2.5-fold higher risk of revision compared with BTB autografts (adjusted hazard ratio [HR] 2.5; 95% CI, 1.9 to 3.3; P < 0.001). The number needed to treat (NNT) with a BTB autograft to prevent one revision procedure was 14 patients.
  • Extra-Articular Augmentation: Among 175 patients who received an adjunct lateral extra-articular procedure, zero graft revisions occurred during the entire registry surveillance window.
Recommendation & Practice Takeaway

Clinical Pearl: Isolated hamstring tendon autografts should be avoided in high-risk adolescent and young adult athletes (aged 14 to 25 years) with high-grade rotational laxity (Grade 2+ pivot shift). In this high-demand cohort, surgeons should counsel patients toward bone-patellar tendon-bone autografts with rigid aperture bone-to-bone fixation, or ensure the addition of an adjunct lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction if soft-tissue hamstring or quadriceps autografts are selected.

Sports Medicine

2. Isolated Meniscus Repairs in Youth Have a 19% Complication Rate and 9% Failure Rate With Variations by Tear Type, Location, Range of Motion Protocol, and Sex at 8 Months

Authors: Agonias K, Knell G, Pacicca D, Heyworth B, Wilson P et al. | Journal: Arthroscopy: The Journal of Arthroscopic and Related Surgery (Oct 2026) | View Source / DOI

Situation

Preservation of native meniscal tissue via arthroscopic repair is paramount in pediatric and adolescent patients to avoid early osteoarthritic progression. This prospective multicenter registry investigation evaluated early postoperative complications, repair failures, and modifiable surgical risk factors using the modified Clavien-Dindo-Sink classification.

Background

While meniscal preservation is the established gold standard in youth, failure rates and adverse event profiles across diverse tear morphologies, repair techniques, and postoperative motion regimens remain inconsistently reported in multicenter collaborative settings.

Assessment & Findings
  • Study Design & Cohort: Prospective multicenter quality improvement study from the Sports Cohort Outcomes Registry (SCOR) across 16 institutions and 26 orthopaedic sports surgeons, analyzing 600 isolated meniscus repairs in patients aged 19 years or younger (mean age 15.1 years; 40% female) with minimum 8-month follow-up.
  • Overall Complication Profile: The overall complication rate was 19.2% (Grade II: 7.2%; Grade III: 12.0%), with a definitive structural repair failure rate of 9.2% (approximately 1 in 11 patients).
  • Anatomical & Demographic Predictors: Postoperative complications occurred significantly more frequently in female patients (P = 0.009), medial tears involving the posterior horn and body (P = 0.001), and lateral complex or oblique/parrot-beak tears (P = 0.001).
  • Rehabilitation Regimen Impact: Range of motion protocols characterized by extremes (either rigid immobilization locked in full extension or completely unrestricted motion) demonstrated significantly elevated complication rates compared with structured partial protected motion (P = 0.03).
Recommendation & Practice Takeaway

Clinical Pearl: Pediatric and adolescent isolated meniscus repair carries an early adverse event risk approaching 20%. Surgeons should exercise heightened vigilance in complex tear patterns (medial posterior horn, lateral parrot-beak) and avoid extreme postoperative rehabilitation strategies. Implement a structured hinged knee brace protocol permitting protected range of motion (0 to 90 degrees) with delayed deep flexion loading beyond 90 degrees to optimize fibrocartilage healing without inducing arthrofibrosis.

Sports Medicine

3. Are There Sex Disparities in Return to Sport After Anterior Cruciate Ligament Reconstruction? A Systematic Review and Exploratory Meta-Analysis

Authors: Elliott D, Gill S, Gupte C | Journal: The American Journal of Sports Medicine (Oct 2026) | View Source / DOI

Situation

Anterior cruciate ligament injury rates are disproportionately high in female athletes. This systematic review and exploratory random-effects meta-analysis evaluated whether sex disparities exist in return-to-sport (RTS) rates and competitive play resumption at 12 months following primary ACL reconstruction.

Background

While anatomical reconstruction and objective laxity restoration have progressed substantially, whether biological, neuromuscular, and psychosocial differences between sexes translate into disparate RTS trajectories has remained an unresolved clinical dilemma.

Assessment & Findings
  • Study Design & Cohort: Systematic review and random-effects meta-analysis adhering to PRISMA guidelines querying PubMed, MEDLINE, Embase, Scopus, and Web of Science through September 2025, synthesizing 25 comparative studies encompassing 7,183 athletes (2,892 females, 4,291 males) with minimum 12-month follow-up.
  • Return-to-Sport Disparities: Female athletes demonstrated significantly lower odds of returning to sport at 12 months compared with male counterparts (odds ratio [OR] 0.76; 95% CI, 0.62 to 0.92; P = 0.006).
  • Return to Preinjury Competitive Level: Female athletes experienced a 32% lower likelihood of returning to their preinjury competitive performance level compared to males (OR 0.68; 95% CI, 0.54 to 0.85; P < 0.001).
  • Psychosocial Readiness: Kinesiophobia, fear of reinjury, and decreased psychological readiness (lower ACL-Return to Sport after Injury [ACL-RSI] scores) were disproportionately prevalent among female athletes despite comparable physical knee stability measurements.
Recommendation & Practice Takeaway

Clinical Pearl: Successful anatomical graft stability does not equate to successful athletic resumption, especially for female athletes who face a 24% reduction in overall RTS and 32% reduction in preinjury level participation. Surgeons and rehabilitation teams must integrate routine psychological readiness testing (ACL-RSI) alongside physical testing (limb symmetry index, jump-landing mechanics) and implement sex-tailored neuromuscular conditioning to address apprehension and enhance safe return-to-play rates.

Orthogate Weekly Journal Scan is curated and synthesized by ORION (Orthopaedic Research, Intelligence & Operations Navigator) for orthopaedic surgeons, fellows, and residents. Evidence synthesized under the clinical direction of Christian Veillette, MD, MSc, FRCSC.