Citations

Since Tanzer’s seminal work introducing costal cartilage for ear reconstruction, subsequent advances by Brent, Nagata, and Firmin have refined surgical techniques and aesthetic outcomes. However, fundamental aspects of the procedure—such as planning incisions, achieving accurate ear positioning, and guiding chest wall incisions for rib harvest—have seen limited innovation. The current standard practice of using projection paper or transparent templates to replicate the contralateral ear position remains imprecise. Similarly, autologous cartilage harvest can be particularly challenging in patients with higher BMI, due to difficulty in accurate rib palpation and visualization. Misplaced chest wall incisions can result in suboptimal rib harvest, longer operative times, and increased morbidity. In this study, we introduce patient-specific, three-dimensional (3D) printed masks, termed hEARo masks, as a novel and user-friendly tool for ear framework positioning. Furthermore, we present the integration of augmented reality (AR) technology to enhance preoperative planning and intraoperative guidance during microtia repair, enabling more precise incision placement for rib harvest. The combined use of 3D printing and AR facilitates complex ear reconstruction, offering increased surgical precision, reduced operative time, and potentially improved patient outcomes. These innovations represent a significant advancement in the personalization and accuracy of auricular reconstruction.

Introduction: Renal accessory arteries originate at the aorta and deliver renal blood flow independent of the main renal artery, while renal artery branches originate from and their flow depends on the main renal artery. However, the clinical significance of accessory arteries remains unclear. We tested the hypothesis that characteristics of renal accessory and/or branching arteries morphology are linked to resistant hypertension (RH). Methods: In a case-control study we compared the presence and characteristics of renal accessory and branching arteries (exposures) in individuals with RH (cases) vs. healthy kidney donors (normotensive controls) (Figure 1). Using MR angiography we calculated the length, diameter, tortuosity, and resistance (8*Length*blood viscosity)/(πr 4 )) of each artery (Figure 2). In separate logistic regression analyses we compared cases and controls for each of the following accessory or branching artery parameters: number of vessels, smallest diameter, length of longest vessel, greatest tortuosity, and greatest resistance. Results: We compared 89 unique RH cases to 248 unique normotensive controls (Table 1). For accessory arteries, their number was inversely related with RH (OR 0.38, 95% CI: 0.21 to 0.69, p<0.01), while length was mildly associated with RH (OR 1.06, 95% CI 1.00 to 1.13, p=0.04). Diameter and tortuosity were not associated in either direction. For branching arteries, RH was strongly associated with their diameter (OR 12.86, 95% CI 2.89 to 57.13, p<0.01), but more mildly and inversely with their resistance (OR 0.99, 95% CI: 0.97 to 1.00, p=0.01). The number and length of branching arteries were not associated in either direction. Conclusion: RH is strongly associated with a reduced number of accessory renal arteries and wider branching arteries, both being novel findings. Future longitudinal studies should determine if these changes are causally related to development of hypertension. Elucidation of this relationship may open new avenues for management of RH.

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain in female athletes. There are limited data on midterm outcomes for female athletes undergoing hip arthroscopic surgery. Purpose: To evaluate return-to-sport rates and clinical outcomes in female athletes with FAI after primary hip arthroscopic surgery with labral repair and femoral osteochondroplasty. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of a single institution’s database was performed to identify female athletes who underwent primary hip arthroscopic surgery with labral repair and femoral osteochondroplasty from July 2011 to October 2019 with a minimum 5-year follow-up. Preoperative radiographs were evaluated for the lateral center-edge angle, Tonnis angle, Tonnis grade, and alpha angle. Patient-reported outcome measure (PROM) scores, including those for the modified Harris Hip Score, Hip Outcome Score, Tegner Activity Scale, and visual analog scale for pain, as well as patient satisfaction with surgery were analyzed postoperatively. Results: A total of 63 hips (27 left, 36 right) in 56 female patients (mean age, 21.6 ± 8.0 years; mean body mass index, 24.7 ± 4.8 kg/m 2 ) were included and followed for a mean of 8.4 ± 2.1 years (range, 5.0-13.2 years). Preoperatively, patients participated in basketball (n = 18), dance (n = 21), hockey (n = 8), and soccer (n = 12). Of the 56 patients, 41 attempted to return to sport. There were 28 (68%) female athletes who successfully returned to their preoperative sport. Of the total cohort, 21 (38%) patients cited non–hip-related factors for discontinuing their sport. All postoperative PROM scores improved significantly compared with preoperatively ( P ≤ .002) for patients with available preoperative data. Those who returned to sport had significantly improved Hip Outcome Score values compared with those who did not return to sport ( P ≤ .010). Conclusion: Female athletes who underwent primary hip arthroscopic surgery for FAI had significant improvements in PROM scores and moderate return-to-sport rates at a minimum 5-year follow-up. Most athletes discontinued sports because of non–hip-related factors, although hip-related issues were also cited. Our analysis highlights the need for thorough perioperative counseling and establishing appropriate patient expectations for female athletes before hip arthroscopic surgery.

Abstract The acetabular labrum is a fibrocartilaginous structure that deepens the acetabular socket and helps maintain a suction seal. In patients with hip dysplasia, a distinct labral tear pattern called an inside‐out labral tear is often seen. This tear pattern is particularly challenging to correct via conventional techniques since the labrum can potentially remain everted and insufficiently restore the native hip labral suction seal after repair. An inverted hip labral repair technique is performed for this pathology at our institution and focuses on achieving optimal labral orientation to enhance the suction seal and joint stability, particularly in dysplastic hips. This Technical Note aims to describe the key surgical principles and clinical considerations of inverted hip labral repair. Technique Video video See video under supplementary data.

ABSTRACT Introduction Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas. Methods This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two‐round survey. Sixty‐two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025. Results A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case‐by‐case basis. Conclusion Sinonasal sarcomas require a histology‐driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.

Objectives: To evaluate return-to-sport (RTS) rates and patient reported outcome measures (PROMs) following hip arthroscopy for femoroacetabular impingement (FAI) in active football players with a minimum of 5-years follow-up. Methods: All active football players who underwent hip arthroscopy for FAI from 2010-2019 were identified. Preoperative radiographic measures including lateral center edge angle, Tönnis angle, alpha angle, and acetabular depth were obtained. Patients were evaluated for post-operative RTS and revision surgery data at final follow-up. Modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), HOS Activities of Daily Living (HOS-ADL), HOS Sports Specific Subscale (HOS-Sports), Tegner Activity Scores, Visual Analogue Scale (VAS) for pain, and surgery satisfaction were collected at a minimum 5-year follow-up. Descriptive and comparative statistical analysis was performed using R software (version 4.4.1). Results: Sixty-six hips from 53 male patients were included. The mean age was 20.4 ± 6.4 years and mean BMI was 27.3 ± 6.6 kg/m² (Table 1). Mean follow-up was 8.7 ± 2.8 years. The majority (60%) were high school players and 19% were college players. Figure 1 displays the most commonly affected positions which included wide receiver (32%), defensive lineman (26%), and tight end or offensive lineman (16%). There were 11 bilateral cases and 2 revisions. The mean lateral center edge angle was 31.6º ± 6.4, the mean Tönnis angle was 5.0º ± 5, and the mean alpha angle was 63.2º ± 12.7. There was significant improvement in all PROMs from baseline to a minimum 5-year follow-up (p<0.04). Fifty-four percent of athletes returned to football postoperatively and the average overall surgery satisfaction rating was 8.1/10. Among those who didn’t return, 14% cited hip-related reasons, while 67% cited non-hip related reasons such as priorities changing or graduating (Figure 2). Athletes who returned to football had significantly higher mean HOS-ADL (p=0.049), HOS-Sport (p=0.042), and Tegner level before surgery (p=0.023) compared to those who did not return (Table 2). Conclusions: Football players undergoing hip arthroscopy for FAI demonstrate significant improvements in outcome scores at a minimum 5-year follow-up with a moderate return-to-sport rate. Athletes who are able to return to football report higher patient reported outcomes compared to those who do not. Player position may also influence incidence and outcomes. Although football players demonstrate significant improvements following hip arthroscopy, the moderate RTS rates highlights the demanding nature of the sport and need for improved perioperative counseling.

Objectives: Periacetabular osteotomy (PAO) is utilized for the treatment of hip dysplasia, with a growing trend towards hip arthroscopy at the time of PAO or in a planned, staged manner prior to PAO in order to address intra-articular pathology such as labral tears. For patients with persistent or new pain following isolated PAO, a subset undergo unplanned, primary hip arthroscopy. To date, there is a paucity of available evidence regarding the risk factors for and outcomes of unplanned hip arthroscopy for persistent or new pain after PAO. The purpose of this study was to determine demographic and radiographic characteristics of patients undergoing hip arthroscopy for persistent pain after PAO and also to compare radiographic parameters, surgical characteristics, and postoperative PROMs between patients that underwent hip arthroscopy following PAO and a demographically similar group of controls without acetabular dysplasia that underwent primary hip arthroscopy. Methods: An institutional database of 3014 hip arthroscopies performed between 1988 and 2022 was reviewed for patients having undergone unplanned (i.e. non-staged) first-time hip arthroscopy after PAO. These patients were propensity-matched on a 1:2 ratio with demographically similar, non-dysplastic patients undergoing primary hip arthroscopy with labral repair. All patients were contacted at final-follow-up to collect outcomes including subsequent procedures, progression to THA, and patient-reported outcome measures (PROMs), including modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT), Tegner Activity Scores, Visual Analogue Scale (VAS) for pain, and surgery satisfaction. Demographics, radiographic characteristics, and postoperative outcomes were compared. All statistical analysis and Kaplan-Meier survival curve analysis was performed using R software (version 4.4.1). Results: We identified 22 hips in 21 patients (17 female, 4 male; age: 24.6 ± 8.5 years; BMI: 29.3 ± 7.4 kg/m²) who underwent first-time arthroscopy after ipsilateral PAO and were followed for a mean of 7.2 ± 2.8 years (Table 1). The median post-PAO LCEA was 28° (IQR: 24.6 – 31.7) and the mean Tönnis angle was 4.2° ± 5.9. The median time from the date of PAO to date of subsequent hip arthroscopy was 1.6 years (IQR: 1.1 - 3.4). Compared to the control group, there was a significantly lower rate of femoral osteochondroplasty (50% vs, 86%, p < 0.01), as well as trends towards lower rate of labral repair (77% vs. 95% p = 0.11), and higher rate of capsular repair (64% vs. 75%, p = 0.34). No differences were found between the PAO and control groups in any of the postoperative PROMs (Table 2). Among the PAO patients, 3 (20%) progressed to total hip arthroplasty (THA) compared to 1 (9%) in the control group (p=0.62). Conclusions: Hip arthroscopy after prior PAO was associated with postoperative improvements in pain and moderate rates of conversion to THA. When patients undergoing hip arthroscopy following PAO were compared to a demographically similar matched cohort of nondysplastic hips who underwent primary hip arthroscopy without a prior PAO, similar postoperative outcome scores were observed. This data provides valuable counselling information for clinicians discussing hip arthroscopy in the setting of patients with persistent pain following PAO.

Objectives: Historically, horizontal cleavage meniscus tears have been debrided with single leaflet preservation, but more recently this has been challenged by repair of these tear types. While circumferential meniscus repair with all-inside and inside-out instrumentation has been described, there remains a paucity of literature regarding the clinical outcomes of this technique. Our purpose was to assess clinical outcomes and reoperation rates of circumferential meniscus repair for horizontal cleavage tears at minimum 2-year follow-up. Methods: Patients with isolated horizontal cleavage tears of the meniscus (Fig. 1a) undergoing primary circumferential meniscus repair (Fig. 1b), including both inside-out and all-inside suturing techniques, at a single institution between 2015 and 2022 were eligible for inclusion and analyzed retrospectively. Arthroscopic images and operative notes were examined to confirm circumferential meniscal repair. Patient demographics, surgery details, and clinical findings were extracted from the institutional electronic medical records. Exclusion criteria consisted of patients not consenting for research, less than 2-years of clinical follow-up, and concurrent ipsilateral repair of a non-horizontal cleavage tear. Patients were not excluded if they had a concomitant anterior cruciate ligament reconstruction (ACLR). Thirty-seven patients met the criteria for inclusion in this study. Knees were analyzed for laterality, number of sutures, suturing technique, concurrent injuries, concurrent procedures, and surgical history. Visual Analogue Scale (VAS) for pain, Tegner, and International Knee Documentation Committee (IKDC) scores were collected at minimum 2-year follow-up and analyzed. Return to sport (RTS) and revision surgery were analyzed. Results: Thirty-seven patients (25 male, 12 female; mean age, 29.4 ± 12.4 years) who underwent circumferential meniscal repair of a horizontal cleavage tear were included in the study and followed for a mean of 6.2 years (range, 2.2-9.3 years, Table 1). There was a total of 38 knees (23 right, 15 left). One patient (3%) had bilateral circumferential meniscal repair surgeries done at separate times. Three (16%) patients failed primary repair and had secondary partial meniscectomy. Similar numbers of circumferential meniscal repairs were performed on lateral and medial menisci, 21 (55%) and 17 (45%), respectively. An average number of 3 ± 2 sutures were used at the time or repair with one of 38 menisci (3%) having a hybrid combination of both all-inside and inside-out suture technique, 24 menisci (63%) had all-inside technique, and 13 menisci (34%) had inside-out technique. Concurrent procedures included 4 ACL reconstructions (3 autograft, 1 allograft), and 8 chondroplasties (4 patella, 2 trochlea, 1 medial femoral condyle, and 1 unspecified, Table 2). At the time of final follow-up, patients reported mean Tegner activity scores of 6.2 ± 2.3, VAS pain with rest of 1.0 ± 2.0, VAS pain with use of 2.5 ± 2.7, and IKDC of 81.6 ± 18.6. When asked, using a VAS Five Point scale, how their knee is currently compared to before their surgery, 14 (74%) feel much better than before surgery, 2 (11%) feel slightly better than before surgery, 1 (5%) feels no change when compared to before their surgery, 2 (11%) feel slightly worse than before surgery, and no one felt much worse than before surgery. Sixteen patients were involved in sports before their surgery. Of those that played sports before their surgery, 14 (88%) returned to sport (Table 3). The most common sports played were hockey (19%), volleyball (19%), tennis (13%), and football (13%). Levels of sport played before surgery included 7 (44%) recreational, 6 (38%) high school, 2 (13%) college, and 1 (6%) club. Levels of sport played after surgery for those who returned to sport included 6 (43%) recreational, 2 (14%) high school, 5 (36%) college, and 1 (7%) club with a significant increase in levels of sport played after surgery ( p ≤ 0.006) compared to before surgery. Conclusions: At an average of 6-years of follow up, there was an 84% success rate of circumferential meniscal repair for horizontal cleavage tears. Most patients who play sports, return to sport and do so at the same or higher level and report successful PROMs. Circumferential meniscal repairs should be considered for patients with horizontal cleavage tears.

Objectives: Traumatic lateral patellar dislocation is frequently associated with cartilage lesions, particularly of the patella and lateral femoral condyle (LFC). Multiple treatment options to address these chondral lesions including debridement, microfracture, cartilage restoration with allo- or autograft, and osteotomies can be utilized at the index patellar stabilization surgery, or in a staged fashion. However, these additional procedures are not without increased morbidity and long-term benefit has not been well elucidated. In patients with traumatic chondral lesions associated with patellofemoral instability (PFI), meniscal coverage of the lesion and intervention to eliminate further patellar instability may be all that is required for a successful outcome. Thus rendering the increased time, morbidity, and cost of chondral procedures unjustified in this setting. The purpose of this study was to assess outcomes of patients with LFC chondral lesions after traumatic patellar dislocations and whether meniscus coverage of the lesion on magnetic resonance imaging (MRI) has an impact on patient outcomes. Methods: A retrospective chart review was performed to compare outcomes for patients with LFC lesions following acute patellar dislocation treated surgically at a single institution. MRI, operative reports, and intraoperative imaging were reviewed to assess for LFC lesions. Size of the LFC lesion and evaluation of meniscus coverage was measured in the coronal plane on T2 MRI sequences (Figure 1). Patient charts were reviewed to follow postoperative rehabilitation and clinical course. Patient reported outcome measures (PROMs) were obtained using the International Knee Documentation Committee (IKDC) score, Lysholm Knee score, Visual Analog Scale (VAS), and Tegner Activity score. Results: A total of 228 patients underwent surgical stabilization for patellar instability from 2001 to 2022, 81 of which had an LFC lesion identified on MRI and confirmed intraoperatively. Seven of these patients underwent a concomitant cartilage restoration procedure (3 internal fixation of osteochondral fragment, 2 microfracture, 1 osteochondral allograft, and 1 MACI) and they were excluded from the study leaving 74 patients. In assessing meniscus coverage of the chondral lesion, 10 of these lesions had no meniscus coverage, 8 had 1-50% coverage, and 56 had 51-100% coverage. The average size of the chondral lesion was 7.1 ± 2.9 mm and the majority were in the anterior one-third of the LFC. Average follow up from the index surgery was 7.6 years (range, 2.2-15.2 years). During this time frame, 12 patients had subsequent knee surgeries, none of which were to address the LFC lesion (Table 2). Postoperatively, nearly all patients reported improvement in their pain with an average VAS pain decrease of 3.7 points. There were no significant differences in PROMs in patients with meniscus coverage versus those without (Table 2). At the time of final follow-up, four patients had radiographic evidence of knee osteoarthritis (OA) within the lateral compartment, and one underwent a total knee arthroplasty (TKA). The patient that underwent a TKA had no meniscal coverage of their chondral lesion at the time of their index procedure. Conclusions: Cartilage lesions secondary to traumatic lateral patellar dislocation are common; however, appropriate management of these lesions remains unclear. The present findings suggest that not surgically addressing chondral lesions in patients with overlying meniscus coverage can allow for high functional outcomes and minimal pain after patellar stabilization procedures. Although only four patients progressed to radiographic evidence of OA, long term data will be valuable to understand whether overlying meniscus coverage is also protective against the development of OA and progression to TKA.