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Study Type: Retrospective comparative cohort study

Key Question: Does first metatarsal head lowering during minimally invasive chevron Akin osteotomy (MICA) produce different patient outcomes compared to MICA with second distal metatarsal osteotomy when treating hallux valgus with intractable plantar keratosis?

Key Findings:

• Both techniques achieved similar intractable plantar keratosis resolution rates (87% vs 91%, OR 0.7, 95% CI 0.2-3.0)
• First metatarsal lowering produced superior FAAM sports scores (24% vs 21% improvement, mean difference 3%, 95% CI 2%-7%)
• Complication patterns differed: second DMMO caused new third metatarsal keratosis in 10% versus first metatarsal plantar discomfort in 17% with lowering technique

Clinical Relevance: UK foot and ankle surgeons managing hallux valgus with secondary keratosis can use this evidence to inform surgical planning, as both techniques offer comparable keratosis resolution but with distinct complication profiles.

Limitations: Retrospective design with potential selection bias, as technique choice was based on surgeon preference and patient factors rather than randomisation.

Study Type: Systematic review

Key Question: What is the relationship between patient-reported outcome measures (PROMs) and clinician-reported outcome measures (CROMs) across orthopaedic subspecialties?

Key Findings:

• Condition-specific PROMs showed stronger correlations with CROMs (Toronto Extremity Salvage Score r=0.75-0.81, AOFAS r=0.70) compared to general health measures (EQ-5D r=-0.29 to 0.13)
• PROMs correlated more strongly with "soft" CROMs (incorporating patient input) than "hard" CROMs (purely objective measures)
• Condition-specific PROMs demonstrated superior responsiveness to clinical change compared to CROMs, except in rehabilitation settings where hard CROMs were more responsive

Clinical Relevance: This evidence can guide NHS orthopaedic departments in selecting complementary PROM-CROM combinations for outcome assessment, with recommendations for pairing condition-specific PROMs with soft CROMs for benchmarking and including hard CROMs for rehabilitation monitoring.

Limitations: Most studies had incomplete paired PROM-CROM data and the review encompassed heterogeneous conditions with varying sample sizes (20-717 patients).

Study Type: Systematic review and meta-analysis

Key Question: How does preoperative Tönnis grade affect clinical outcomes, radiographic progression, and survivorship following hip arthroscopy for femoroacetabular impingement syndrome?

Key Findings:

• Clinical outcomes (mHHS, HOS scores) were similar between Tönnis grades 0, 1, and 2 at mean 68-month follow-up across 3,972 hips
• Conversion to total hip arthroplasty increased with higher Tönnis grades, though rates between Tönnis 2 and 3 were similar (OR 5.27, 95% CI 0.91-30.51)
• Revision arthroscopy rates were comparable across all Tönnis grades (OR 1.65, 95% CI 0.63-4.28)

Clinical Relevance: This evidence suggests UK orthopaedic surgeons can counsel patients that hip arthroscopy for FAIS in Tönnis grade 2 hips achieves similar symptomatic improvement to lower grades, but with higher risk of eventual joint replacement.

Limitations: High heterogeneity between studies (I² values up to 89%) and level 4 evidence quality limit confidence in pooled estimates.

Study Type: Retrospective cohort study

Key Question: Does AI assistance improve clinician accuracy and confidence when interpreting MRI and MRA for Bankart and reverse Bankart lesions?

Key Findings:

• AI assistance increased Bankart lesion detection sensitivity from 38% to 78.3% (p<0.001) and overall accuracy from 77.1% to 84% (p=0.002)
• For reverse Bankart lesions, sensitivity improved from 31.2% to 50% (p=0.049) with maintained high specificity
• AI corrected 51.1% of initially missed labral tears and increased diagnostic confidence by 0.8 points on non-contrast MRI

Clinical Relevance: This technology could significantly improve shoulder instability diagnosis in UK practice, potentially reducing missed labral tears and avoiding unnecessary MR arthrography procedures.

Limitations: Study used retrospective images with arthroscopic correlation, which may not reflect real-world clinical decision-making scenarios.

Study Type: Cohort study

Key Question: Do professional soccer and rugby players with combined ACL/MCL injuries have different career longevity compared to uninjured matched controls?

Key Findings:

• 90.4% of players returned to play at 11.6 months, similar to 91.5% of uninjured controls still competing at 11 months
• Career survival rates were equivalent between injured and control groups at 2 years (81.9% vs 81.3%) and 5 years (61.7% vs 62.8%)
• Median career length was comparable: 6.68 years for injured players versus 7.07 years for uninjured controls

Clinical Relevance: This evidence supports that appropriately managed combined ACL/MCL injuries do not significantly impact professional athletes' career longevity, informing prognosis discussions and return-to-sport counselling for elite athletes in the UK.

Limitations: Level 3 evidence with potential selection bias from the retrospective design and lack of detailed MCL injury grading or treatment protocols.

Study Type: Retrospective case series

Key Question: Do obese patients (BMI >30 kg/m²) have worse outcomes after multiligament knee reconstruction compared to non-obese patients?

Key Findings:

• Obese patients had significantly worse patient-reported outcomes: IKDC scores (67.9 vs 79.3, p=0.004), Lysholm scores (75.7 vs 85.1, p=0.007), and Tegner activity scores (4.4 vs 5.1, p=0.041)
• Complication rates were significantly higher in obese patients (p=0.028)
• No significant difference in reoperation rates or conversion to total knee arthroplasty between groups

Clinical Relevance: This evidence helps inform patient counselling and surgical decision-making for complex multiligament knee injuries in obese patients, particularly relevant given rising obesity rates in the UK population.

Limitations: Single-centre retrospective design with potential for selection bias and unmeasured confounding factors despite propensity matching.

Study Type: Retrospective case series

Key Question: Does preoperative joint line convergence angle (JLCA) predict clinical outcomes after isolated medial meniscus posterior root tear repair better than traditional hip-knee-ankle angle measurements?

Key Findings:

• Each 1° increase in preoperative JLCA corresponded to 5.45-point decrease in IKDC score and 4.35-point decrease in KOOS-short score at 24 months (both P < .01)
• JLCA remained independently predictive of outcomes when controlling for hip-knee-ankle angle, which showed no independent association
• JLCA demonstrated fair discrimination for achieving minimal clinically important difference (AUC = 0.60-0.69)

Clinical Relevance: This provides UK orthopaedic surgeons with a readily available radiographic parameter to better counsel patients about expected outcomes after meniscal root repair and identify those requiring additional interventions to optimise medial compartment biomechanics.

Limitations: Small sample size (n=62) from single surgeon limits generalisability of findings.

Study Type: Retrospective case series

Key Question: Do professional soccer and rugby players with combined ACL/MCL injuries have different return-to-play outcomes and career longevity compared to those with isolated ACL injuries?

Key Findings:

• Overall return-to-play rate was 95.4% with no significant difference between ACL-only (96.3%), ACL + non-operative MCL (40.8% of cohort), and ACL + MCL reconstruction groups (18.5% of cohort) (P = .06)
• Mean return-to-play time was similar across all groups at approximately 12 months (P = .88)
• Career longevity showed no difference between groups, with 79.8% still playing at 2 years and 67.7% at 5 years

Clinical Relevance: This evidence suggests that combined ACL/MCL injuries in elite athletes do not necessarily worsen prognosis compared to isolated ACL tears, potentially informing treatment decisions and patient counselling in UK sports medicine practice.

Limitations: Level 4 evidence from a retrospective case series with potential selection bias and limited generalisability beyond elite athletes.