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Anterior tibial translation versus rotational instability in ACL reconstruction: Defining the problem before choosing the procedure
(Wiley, 2026) Pineda, Tomás; Dejour, David H.; Musahi, Volker; Seil, Romain; Zaffagnini, Stefano; Ollivier, Matthieu
The expanding use of lateral extra‐articular procedures (LEAPs) and tibial deflexion osteotomy (TDO)—also referred to as slope‐reducing anterior closing wedge high tibial osteotomy—in anterior cruciate ligament (ACL) reconstruction reflects meaningful progress in our understanding of mechanisms of graft failure. However, as their use expands, an important distinction just be maintained: they do not address the same problem.
Association between posterior tibial slope and graft survival in high-risk anterior cruciate ligament reconstruction with lateral extra-articular tenodesis
(SAGE Publications, 2026) Pineda, Tomás; Mazy, Davis; Ramos-Rojas, José; Cance, Nicolás; Dan, Michael J.; Demey, Guillaume; Dejour, David H.
Background: Posterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure.Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized. Purpose: To determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR 1 LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities. Results: PTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5 to 9, below which the risk of failure plateaued. In contrast, PTS values exceeding 11 to 12 were associated with high failure probabilities in both groups. Conclusion: PTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.
Preoperative dynamic anterior tibial translation is not predictive of graft rupture after anterior cruciate ligament reconstruction
(Wiley, 2026) Pineda, Tomás; Mazy, David; Cance, Nicolas; Lucia Angelelli; Pineda, Tomás; Dan, Michel James; Dejour, David Henri
Purpose: This study aimed to determine whether higher preoperative dynamic anterior tibial translation (DATT) using laximetry is a risk factor for graft rupture after anterior cruciate ligament reconstruction (ACLR). Methods: This retrospective study included all patients who underwent primary ACLR with hamstring autograft between January 2014 and December 2017. Demographic data, absolute DATT on the injured side and ΔDATT (side‐to‐side difference), posterior tibial slope (PTS), static anterior tibial translation (SATT), concomitant lateral extra‐articular tenodesis (LET) and meniscal tears were collected. Subgroup analysis was performed using a ΔDATT threshold of 6 mm. Univariate and multivariable logistic regression analyses were conducted to identify independent risk factors for ACL graft rupture. Results: Among the 680 patients included with a minimum follow‐up of 6 years, 41 (6%) experienced graft rupture at a mean of 45 ± 30 months postoperatively. The median DATT on the injured side was 9 mm [interquartile range, IQR, 5], and the median ΔDATT was 6 mm [IQR, 4]. Graft rupture occurred in 5.8% for patients with ΔDATT < 6 mm and in 6.3% for patients with ΔDATT ≥ 6 mm (p = 0.787). Patients with ΔDATT ≥ 6 mm demonstrated a higher prevalence of medial meniscal tears (31% vs. 24%, p = 0.026). Independent risk factors for graft rupture included PTS ≥ 12° (odds ratio [OR] 3.1; 95% confidence interval [CI], 1.6–6.3; p < 0.001) and SATT ≥ 5 mm (OR 2.6; 95% CI, 1.2–5.5; p = 0.027), whereas neither ΔDATT nor absolute DATT was significantly associated with graft rupture. Conclusion: Preoperative DATT is not predictive of graft rupture following ACLR using hamstring autograft. PTS and SATT remain stronger predictors and should be prioritised for preoperative risk stratification.
Posterior tibial slope and static anterior tibial translation are not associated with increased cyclops syndrome after anterior cruciate ligament reconstruction
(Wiley, 2026) Mazy, David; Cance, Nicolas; Angelelli, Lucia; Pineda, Tomás; Pintore, Andrea; Dejour, David Henri
Purpose: Posterior tibial slope (PTS) and static anterior tibial translation (SATT) are established risk factors for anterior cruciate ligament (ACL) graft rupture and may also be associated with cyclops syndrome. This study aimed to assess whether these anatomical parameters influence the prevalence of cyclops syndrome after ACL reconstruction (ACLR). The hypothesis of the present study was that increased PTS and SATT would facilitate the development of cyclops syndrome. Methods: Patients aged ≥14 years with a minimum follow-up of 6 years who underwent primary ACLR with hamstring autograft between January 2015 and December 2017 were included. Demographic data, PTS, SATT, concomitant lateral extra-articular tenodesis (LET) and reoperation for cyclops syndrome were recorded. Time from index surgery to arthrolysis was documented, with a minimum follow-up of 6 years. Subgroup analysis regarding PTS, SATT and gender was performed. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors. Results: Of 530 patients included for analysis, 18 (3.4%) developed cyclops syndrome at a mean of 14 ± 9 months postoperatively (range, 6–33 months). Patients with a PTS ≥ 12° had a 4.3% rate of cyclops syndrome compared with 3.2% in those with a PTS < 12° (p = 0.536). Patients with a SATT ≥ 5 mm had a 5.6% rate compared with 2.7% for SATT < 5 mm (p = 0.154). Female patients presented a statistically significant higher prevalence (5.9%) compared with males (1.8%, p = 0.024). Concomitant LET did not demonstrate a protective effect (p = 0.807). Female sex was the only independent predictor of cyclops syndrome (OR, 3.3; 95% CI, 1.2–9.1; p = 0.018). Conclusion: This study found no evidence that increased PTS or SATT predisposes to cyclops syndrome after ACLR with hamstring autograft. These preoperative parameters should not alert clinicians to an increased risk of postoperative cyclops syndrome.
No association detected between posterior tibial slope, static anterior tibial translation and medial meniscus repair failure after anterior cruciate ligament reconstruction
(Wiley, 2026) Mazy, David; Cance, Nicolas; Angelelli, Lucia; Pineda, Tomás; Dan, Michael James; Dejour, David Henri
Purpose: This study aimed to evaluate the influence of the posterior tibial slope (PTS) and static anterior tibial translation (SATT) on the success of medial meniscus (MM) repair performed concomitantly with anterior cruciate ligament reconstruction (ACLR). Methods: In this retrospective study, all patients who underwent primary ACLR using hamstring autograft combined with isolated MM repair between January 2014 and December 2017, and a minimum follow‐up of 6 years, were included. Patients who had undergone meniscectomy or lateral meniscus repair were excluded. Demographic data, PTS, SATT, dynamic anterior tibial translation (DATT), the need for reoperation (at the same location) for MM repair failure (MMRF), and time to failure were recorded. Comparative analyses were performed using thresholds of 12° for PTS and 5 mm for SATT. Univariate logistic regression analyses were used to identify independent risk factors for MMRF. Results: Among the 148 patients included, 14 (9.4%) experienced a MMRF at a mean of 24 ± 16 months post‐operatively (range 7–60 months). Twenty‐ eight percent of patients had undergone concomitant lateral extra‐articular tenodesis (LET). There were no significant differences between the MMRF and non‐failure groups in terms of age, sex, presence of LET, PTS, SATT or DATT. Patients with PTS ≥ 12° (odds ratio, 2.9; 95% confidence interval, 0.8–11.6; p = 0.11) or SATT ≥ 5 mm did not demonstrate a higher rate of MMRF. No variable from the univariate analysis met the criteria for inclusion in the multivariate analysis. Limited number of MMRF events increase potential risk of type II error. Conclusion: No statistically significant association was detected between PTS, SATT, DATT, age or the presence of LET and MMRF after hamstring ACLR. However, larger studies are needed, particularly in high‐slope subgroups. Increased PTS or SATT alone should not discourage MM repair in the setting of ACLRMedial meniscus
Diagnostic accuracy of PCT, IL-6, and MR-ProADM for early identification of sepsis in the emergency department
(Sociedad Española de Quimioterapia, 2026-05-29) Tejada, Sofía; Clemente, Antonio; Socias, Antonia; Giglio, Andrés; Aranda, María; del Castillo, Alberto; Mena, Joana; Ribas, Joana María; Martín, Luisa; Llerena, Karla Milagritos; Arellano, María Magdalena; Agudo, Miguel; de la Rica, Roberto; Borges, Marcio
Objective: To evaluate the diagnostic accuracy of the biomarkers procalcitonin (PCT), interleukin-6 (IL-6), and mid-regional pro-adrenomedullin (MR-ProADM), individually and in combination, for early detection of sepsis and septic shock during emergency department (ED) triage. Materials and methods: A retrospective observational study was conducted in adults presenting to the ED with triage levels 2 and 3 between December 2021 and July 2023. Blood samples were collected at admission, prior to any therapeutic intervention. Plasma concentrations of PCT, IL-6, and MR-ProADM were measured using CMIA or ELISA. Diagnostic accuracy was assessed using ROC curves and AUC analysis. Results: A total of 248 patients were included (214 with sepsis and 34 non-septic controls). Simultaneous elevation of PCT, IL-6, and MR-ProADM was observed in 70% of septic patients compared with 3% of controls. Each biomarker showed high diagnostic accuracy for sepsis (AUROC >0.90). The combined assessment increased specificity and was strongly associated with sepsis and septic shock, with progressively higher odds as the number of elevated biomarkers increased. Higher biomarker burden was also associated with indicators of greater clinical severity, including higher SOFA scores and ICU admission. Conclusions: Combined measurement of PCT, IL-6, and MR-ProADM at ED triage, before therapeutic intervention, improves early identification of patients with sepsis and provides relevant information on initial disease severity. This multiplex platform approach may support clinical prioritization and protocol activation in the ED.
Risk of cervical metastasis in primary parotid gland malignancies: A Yo-IFOS multicenter retrospective longitudinal study: a Yo-IFOS multicenter retrospective longitudinal study
(Head & Neck, 2026-05-08) Kalfert, David; Palacios-Garcia, Jose; Tel, Alessandro; Vaira, Luigi Angelo; Maniaci, Antonino; Silva-Figueroa, Angelica; Boscolo-Rizzo, Paolo; Salzano, Giovanni; Consorti, Giuseppe; Enver, Necati; Dequanter, Didier; Melkane, Antoine; Cobanoglu, H. Bengu; Petrocelli, Marzia; Andueza-Guembe, Maider; Lentini, Mario; Toledo-Villegas, Karina; Tirelli, Giancarlo; Tramontano, Sara; Cirignaco, Giulio; Lechien, Jerome R.; İncaz, Sefa; De Riu, Giacomo
Background: Cervical lymph node metastasis is a major adverse prognostic factor in primary parotid gland malignancies. However, the incidence, level-specific distribution, and independent predictors of nodal metastasis remain incompletely defined in large contemporary multicenter cohorts. Methods: A retrospective longitudinal multicenter study was conducted across 17 tertiary referral centers. Adult patients with histopathologically confirmed primary parotid gland carcinoma who underwent parotidectomy with concurrent neck dissection were included. The primary outcome was pathologically confirmed cervical lymph node metastasis. Secondary outcomes included level-specific nodal distribution, identification of independent risk factors, overall survival (OS), and disease-specific survival (DSS). Results: A total of 380 patients were included. Pathological cervical lymph node metastasis was identified in 94 patients (24.7%). Metastases most frequently involved Level II (IIa 17.1%; IIb 11.1%). Salivary duct carcinoma demonstrated the highest rate of nodal metastasis (58.7%). On multivariate analysis, high histological grade and lymphovascular invasion (LVI) were independent predictors of nodal metastasis (p<0.05). Five-year OS for the entire cohort was 64.4%. Patients with nodal metastasis had significantly worse survival compared with node-negative patients (p<0.001). Conclusions: Cervical lymph node metastasis occurs in approximately one-quarter of surgically staged primary parotid gland malignancies and predominantly involves Levels II–III. High-grade histology and LVI independently predict nodal involvement. These findings support a risk-adapted approach to elective neck management ased on histological and pathological risk stratification.
Vacunación profiláctica contra el VPH en adultos: inmunogenicidad, eficacia y prevención de lesiones orofaríngeas. Revisión estructurada y recomendaciones basadas en evidencia. Parte I
(Sociedad de Cirujanos de Chile, 2026-04-30) Silva-Figueroa, Angelica; Carvajal-Villarroel, Felipe; Correa-Vega, Francisca; Gallego-Cifuentes, Alejandra; Leon-Ramirez, Augusto; Veloso-Olivares, Marcelo
Antecedentes: Esta recomendación técnica en dos partes evalúa la vacunación profiláctica contra el VPH y su posible impacto en enfermedad de cabeza y cuello en adultos, mediante revisión estructurada y calificación de certeza con GRADE. Parte 1 (alcance): métodos; lesiones orales/orofaríngeas benignas y ADN-VPH oral; esquemas de dosis (una vs dos/tres); grupos especiales (p. ej., PVVIH, trasplante, inmunomodulación). Parte 2 (alcance): prevención de carcinoma escamoso orofaríngeo VPH-positivo (CEOF); vacunación posdiagnóstico en CEOF; proyecciones a largo plazo de modelos de transmisión/eficiencia; recomendaciones y prioridades de investigación. Métodos: Búsquedas (2009-2025) en MEDLINE y bases complementarias; criterios predefinidos; tamizaje/extracción por duplicado; síntesis narrativa y tabular por eje; evaluación de sesgo y GRADE. Hallazgos: No existe evidencia comparativa directa que la vacunación reduzca incidencia o recurrencia de lesiones orales/orofaríngeas benignas en adultos; las señales de menor prevalencia de ADN-VPH oral son indirectas e imprecisas (certeza muy baja). La monodosis muestra inmunogenicidad duradera y protección frente a infección anogenital persistente; su extrapolación a desenlaces orales en adultos es indirecta (certeza baja). En inmunosuprimidos, la vacuna es inmunógena y segura; la evidencia para desenlaces orales es muy limitada (baja–muy baja). Aún no hay cohortes con estado vacunal individual y confirmación tumoral por VPH que demuestren menor incidencia de CEOF en adultos; los modelos predicen beneficio poblacional a largo plazo con programas tempranos, neutros en género y de alta cobertura (baja certeza para modelos). No hay evidencia de beneficio oncológico posdiagnóstico en CEOF. Recomendaciones: Preferir esquemas de dos–tres dosis; considerar monodosis según contexto programático. Vacunar a inmunosuprimidos y a pacientes con CEOF incompletamente vacunados por beneficio preventivo. Mantener programas de alta cobertura y priorizar cohortes enlazadas vacuna–cáncer con ≥ 10 años y confirmación tumoral por VPH.
Weight management interventions before IVF in overweight and obese women: a scoping review
(Springer Nature, 2026-05-11) Arancibia, Constanza; Giglio, Andres; Camus, Adela; Mondion, Mauricio; Jesam, Cristian
Background: Overweight and obesity are associated with reduced fertility outcomes in assisted reproduction. This scoping review maps available evidence on pre-IVF weight management interventions. Methods: We searched PubMed/MEDLINE (2008–2025) for studies evaluating weight management interventions (dietary, exercise, pharmacological, surgical) before or during IVF in women with BMI ≥ 25 kg/m². We included randomized controlled trials, quasi-xperimental studies, and cohorts with interventions. Two reviewers independently screened records and extracted data on interventions and outcomes. Supplementary searches included reference screening and citation tracking. Results: From 230 records, 19 studies met inclusion criteria: 17 evaluating IVF-specific outcomes — lifestyle or dietary interventions (n = 10), pharmacological therapies (n = 3), and bariatric surgery (n = 4) — and 2 examining preconception interventions before other ART modalities included exclusively to inform implementation challenges. Weight loss was achieved across intervention categories, though the magnitude varied substantially. Improvements in reproductive outcomes were inconsistent. Some studies reported improved pregnancy rates following lifestyle interventions, while well-designed trials showed no significant differences despite weight reduction. Orlistat showed no reproductive benefit; GLP-1 agonist combination therapy showed preliminary promise in PCOS. Bariatric surgery produced substantial weight loss but inconsistent live birth outcomes. High attrition rates (> 20%), treatment delays, and variable adherence were common challenges. Conclusions: Pre-IVF weight management interventions demonstrate substantial outcome heterogeneity. While weight loss is achievable, reproductive benefits are inconsistent. Evidence does not support rigid BMI cutoffs. Clinical decisions should be individualized. Future research should identify predictive factors and optimize intervention protocols.
Tibial slope in ACL reconstruction: When should it be corrected?
(Elsevier, 2026) Pineda, Tomás; Dejour, D. H.
The tibial slope has been identified as a key anatomical factor influencing anteroposterior knee stability. Increased slope values have been linked to greater anterior tibial translation, higher stress on the anterior cruciate ligament and an elevated risk of graft failure following reconstruction. This review aims to examine the current evidence and ongoing controversies regarding the clinical relevance of tibial slope, measurement methods, and surgical correction indications.
Extracorporeal membrane oxygenation in pediatric septic shock: A single-center experience in Chile
(SAGE Publications, 2026-01) Godoy, Loreto; Yunge, Mauricio; Rufs, Jorge; Gatica, Alejandra; Muñoz, Carlos; Valverde, Cristian
Background: Refractory septic shock (RSS) in children carries high mortality despite advances in critical care. Extracorporeal membrane oxygenation (ECMO) is a rescue therapy when conventional management fails. Evidence from Latin America remains limited, with no detailed reports from Chile. Methods: We conducted a retrospective single-center study (2009–2024) in a Chilean Pediatric ICU. Patients aged 1 month to 17 years with septic shock unresponsive to maximal conventional therapy were included. We analyzed demographics, illness severity, ECMO modality, complications, and outcomes. Primary endpoint was survival to hospital discharge. Results: Nine patients received ECMO (median age=6.3 years). All had RSS, frequently associated with severe ARDS. Configurations included venoarterial (VA; n=4), venovenous (VV; n=4), and venoarteriovenous (VAV; n=1), all via peripheral cannulation. Pre-ECMO median vasoactive-inotropic score was 117, and 78% required renal replacement therapy during ECMO. Overall survival was 55% (5/9). Survivors had longer ECMO runs (median 11 days vs 3 days) and ICU stays (median 63 days vs 5 days). Hemorrhage was the most frequent complication (intracranial n=3; gastrointestinal n=1). One survivor developed hemiparesis; no cognitive impairment was observed at 1-year follow-up. Conclusions: ECMO can be an effective rescue therapy for pediatric RSS, even without central cannulation capability. Distinguishing cardiogenic from vasoplegic phenotypes and identifying severe ARDS guided configuration selection (VA vs VV). These findings highlight the feasibility of peripheral ECMO in carefully selected patients within resource-limited settings, achieving survival comparable to international reports.
Enhancing medical training through 360-degree evaliation: A review and Proposal for ICU training
(Elservier, 22-03-26) Giglio, Andrés; Ferre, Andrés; Pedreros, César; Vuletin, Valentina; Armijo-Rivera, Soledad
La formación de médicos residentes requiere estrategias educativas que desarrollen competencias clínicas, comunicacionales y profesionales de manera integral. En este contexto, las evaluaciones de 360 grados han emerido como una alternativa a los métodos tradicionales, al permitir una valoración más completa del desempeño. Esta revisión narrativa tuvo como objeto analizar su implementación, efectividad, desafíos y resultados a largo plazo en la educación médica. Se realizó una búsqueda exhaustiva utilizando términos relacionados con "evaluación de 360°", "retroalimentación multisource" y educación en salud", seleccionándose 34 estudios en distintos entornos formativos. Los hallazgos indican que las evaluaciones de 360 grados ofrecen una perspectiva holística al integrar opiniones de múltiples actores, incluyendo pares, supervisores, pacientes y la autoevaluación. Su aplicación se asocia con mejoras en competencias clínicas, habilidades de comunicación, profesionalismo y desempeño global. Además, la retroalimentación continua favorece la práctica reflexiva y el desarrollo profesional sostenido, con impacto positivo en la calidad de la atención y la satisfacción de los pacientes. No obstante, su implementación enfrenta desafíos relevantes, como el sesgo de los evaluadores, las dificultades loigísticas y la integración efectiva de los resultados en los programas formativos. Las estrategias más eficaces incluyen la capacitación estructurada de evaluadores, el uso de instrumentos estandarizados, la realización de sesiones peródicas de retroalimentación y el soporte institucional mediante plataformas tecnológicas adecuadas.
Infecciones respiratorias agudas graves en niños: desafíos actuales en un panorama epidemiológico en evolución
(Sociedad Chilena de Pediatría, 2026-03-01) Díaz, Franco
Este editorial aborda la elevada carga de enfermedad y mortalidad infantil por infecciones respiratorias agudas graves (IRAG) a nivel global, destacando su desproporcionado impacto en países de bajos ingresos debido a determinantes estructurales. Se analiza el cambio en el patrón epidemiológico de las IRAG pediátricas en Chile durante 2024, con una significativa reducción del 14% en hospitalizaciones y un 54% en menores de un año, atribuido a programas de inmunización como el implementado contra el VRS. El documento enfatiza la necesidad de una agenda de investigación pediátrica que aborde desafíos clínicos, de salud pública y sociales, promoviendo la colaboración internacional y la equidad en el acceso a intervenciones preventivas y terapéuticas. Se proponen líneas de investigación emergentes, incluyendo desenlaces centrados en el paciente, seguridad asistencial, medicina de precisión y el impacto de los determinantes sociales
Prognostic Value of International Normalized Ratio and Thrombocytopenia in Early Risk Stratification of Septic Patients
(MDPI, 2026-04-07) Tejada, Sofia; Giglio, Andres; Aranda, Maria; Socias, Antonia; del Castillo, Alberto; Mena, Joana; Franco, Sara; Ortega, Maria; Nieto, Yasmina; Borges-Sa, Marcio
Background/Objective: Coagulopathy is a hallmark of sepsis, associated with poor outcomes. Although platelet count has commonly been used for risk stratification, its prognostic value has remained limited. This study compared the ability of the International Normalized Ratio (INR) and platelet count to predict in-hospital mortality in septic patients. Methods: A retrospective study was conducted including adult patients diagnosed with sepsis and admitted to Hospital Universitario Son Llàtzer (Spain) between 2006 and 2022. The INR and platelet count at diagnosis were categorized using clinical thresholds. The primary outcome was in-hospital mortality. Results: Among 6433 patients (60.6% females), mortality was 8.8%. Mortality increased from 6.3% (INR ≤ 1.2) to 20.2% (INR 2.0–3.0), slightly decreasing at INR > 3.0 (10.8%). The platelet count showed a weaker association, with the highest mortality observed at <50 × 109/L (24.6%). The combined markers identified a high-risk subgroup with 50% mortality (INR > 3.0 and platelet count < 50 × 109/L). In the full cohort, multivariable analysis confirmed the INR as an independent predictor of mortality (OR 2.183, p = 0.0002), whereas the platelet count was not significant. The model including the INR achieved an AUC 0.746, while adding the platelet count did not improve performance. Conclusions: the INR at diagnosis was a strong and independent predictor of in-hospital mortality, outperforming the platelet count. These findings could support the consideration of the INR in early risk stratification frameworks and highlight the need for prospective validation before integration into sepsis guidelines.
Response to Letter to the Editor: Reliable pain and function outcomes after high tibial osteotomy for medial osteoarthritis in the grey area between osteotomy and unicompartmental replacement
(Wiley, 2026) Pineda, Tomás
Los autores aclaran que su estudio sobre osteotomía tibial alta (HTO) se centra en el alivio del dolor y la mejora funcional en pacientes con osteoartritis de zona gris (AKUMA), no en el retorno al deporte. Reconocen limitaciones del estudio y destacan la relevancia de factores psicológicos, manteniendo que sus resultados ofrecen orientación clínica válida.
Reliable pain and function outcomes but limited sport performance after high tibial osteotomy for medial knee osteoarthritis in the grey zone between osteotomy and unicompartmental replacement
(Wiley, 2026) Pineda, Tomás; Pierecchi, Antoine; Jacquet, Christophe; Gaggero, Nicolás; Kley, Kristian; Ollivier, Matthieu
Purpose: To evaluate mid-term outcomes of high tibial osteotomy (HTO) in patients with medial knee osteoarthritis presenting borderline indication between osteotomy and unicompartmental knee arthroplasty (UKA) and to identify clinical and radiographic factors associated with success in pain, function and sport. Methods: Retrospective multicentre cohort of consecutive HTOs performed between 2005 and 2015 with ≥2 years of follow-up, including patients classified within the grey zone according to the AKUMA framework. Preoperative and postoperative long-leg radiographs were obtained to measure hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA). Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner and modified Weiss (mW) scores; secondary outcomes included satisfaction, sports relevance, symptom-free return to sport and forgotten-knee. Success thresholds were WOMAC ≥ 80, Tegner ≥5 and mW ≥6. Univariate analyses compared successes versus non-successes, and multivariable logistic regression was performed for WOMAC. Results: Eighty-four patients were analysed with a mean follow-up 8.0 ± 3.2 (2.0-14.3) years. Success rates were 72.0% for WOMAC, 6.8% for Tegner and 7.5% for mW. Postoperative MPTA was higher in WOMAC successes than in non-successes. In multivariable analysis, Ahlbäck Grade 3 lowered the odds of achieving WOMAC ≥ 80 (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.94). Tegner success was associated with greater LDFA and with rating sport as very important. mW success was associated with lower preoperative MPTA, lower LDFA, higher tibial extra-articular deformity (TEAD) and very high sport priority. Higher Ahlbäck and Kellgren-Lawrence (KL) grades were linked to worse satisfaction; the forgotten-knee endpoint showed no significant associations. Conclusion: In medial OA knees within the AKUMA grey zone, HTO provides reliable pain relief and functional improvement, while sport success remains limited. Osteoarthritis burden reduces the probability of high pain and function-related scores, while sport-oriented outcomes depend more on coronal alignment features and the patient's sport priority.
Rectus femoris tendon: An emerging option in ACL reconstruction
(Wiley, 2026) Pineda, Tomás
Over the past decades, the search for the 'ideal' graft in anterior cruciate ligament (ACL) reconstruction has remained one of orthopaedic surgery's most enduring pursuits. Each generation of surgeons has witnessed new grafts and techniques emerge - only for most to find their rightful place somewhere between innovation and pragmatism. The sheer number of available options - bone-patellar tendon-bone, hamstring autografts, quadriceps tendon, peroneus longus and the many forms of allografts - is itself a reminder that no single graft is perfect. Each carries its own strengths and limitations, underscoring that no option fully satisfies the balance between biomechanical performance, donor-site morbidity, graft survival and functional recovery. This ongoing search for improvement keeps the door open for exploring new alternatives. In this context, a new and unexpected contender has quietly entered the scene.
The rectus femoris tendon demonstrates comparable ultimate stress to the patellar tendon: A paired biomechanical study
(Wiley, 2025) Pineda, Tomás; Sewpaul, Yash; Morin, Vincent; Jacquet, Christophe; Horteur, Clement; Ollivier, Matthieu
Purpose: The objective of this study was to compare the ultimate tissue strength of the rectus femoris (RF) and patellar tendons using paired soft‐tissue grafts obtained from fresh organ donors, simulating clinical graft preparation. Methods: Fourteen paired RF and patellar tendon (PT) grafts were harvested from seven organ donors and tested within 12 h postmortem. The RF was folded and mounted as a double‐stranded graft to simulate its clinical use. All grafts underwent uniaxial tensile testing using a standardised protocol. Primary outcomes included ultimate stress (MPa), load to failure (N) and elongation at failure (%). Data distribution was assessed with the Shapiro–Wilk test, and paired t‐tests or Wilcoxon signed‐rank tests were applied accordingly. A post hoc power analysis was conducted to determine the minimum detectable difference in stress with the given sample size. Results: Ultimate stress did not diﬀer significantly between RF and PT grafts (46.4 ± 10.5 MPa vs. 52.9 ± 9.7 MPa, p = 0.184). RF grafts showed significantly lower load to failure (885.9 ± 52.3 N vs. 1278.7 ± 207.5 N, p < 0.001) and greater elongation (1.2 ± 0.2% vs. 0.2 ± 0.1%, p < 0.001). Conclusion: This study found that the double‐stranded RF tendon exhibits ultimate tissue strength comparable to the patellar tendon, despite diﬀerences in load to failure and elongation. These results highlight the RF as a biomechanically viable graft option that merits further investigation. Given its consistent dimensions and soft‐tissue‐only harvest, the RF tendon represents a reproducible and potentially less invasive alternative for knee ligament reconstruction.
Physiological dissociation between ventilatory ratio and ventilatory efficiency in patients with ARDS
(Springer Nature, 2026-03-19) Benites, Martín Hernán; Suarez-Sipmann, Fernando; Santos, Arnoldo; Retamal, Jaime
Background: The ventilatory ratio (VR) is frequently used as a surrogate marker of ventilatory efficiency in patients with ARDS. However, its ability to reflect changes in alveolar ventilation (V̇Talv/VT) when respiratory mechanics are modified remains unknown. This study aimed to evaluate the relationship between VR and V̇Talv/VT during sequential changes in respiratory mechanics=, tidal volume (VT), and minute ventilation (V̇E) in patients with ARDS. Methods: This was a secondary analysis of a quasi-experimental, repeated-measures study conducted in a single-center adult ICU. Twenty-two patients with ARDS were evaluated across three sequential 60 min controlled periods, during which trunk inclination was adjusted to induce changes in VT. At the end of each period, VR was calculated, and V̇Talv/VT was measured using volumetric capnography. A total of 66 paired measurements were analyzed in this study. Results: By design, VT increased from Time 1 to Time 2 by + 62 mL and decreased from Time 2 to Time 3 by − 68 mL. These changes in VT were associated with the following: VR was not significantly different between Time 1 and Time 2 [− 0.23 (95% CI: − 0.44 to − 0.02; p = 0.071)] or between Time 2 and Time 3 [+ 0.17 (95% CI: − 0.04 to + 0.38; p = 0.086)]. The alveolar ventilation ratio (V̇Talv/VT) increased significantly from Time 1 to Time 2 by + 0.080 (95% CI: + 0.039 to + 0.121; p < 0.001), and decreased from Time 2 to Time 3 by − 0.060 (95% CI: − 0.101 to − 0.019; p < 0.001). Association between VR and V̇Talv/VT: no significant relationship was found (β = − 0.056, marginal R2 = 0.052, conditional R2 = 0.205, p = 0.111). Conclusions In this cohort of patients with ARDS, VR did not correlate with V̇Talv/VT following controlled modifications of respiratory mechanics. These findings suggest that VR may not reliably represent ventilatory efficiency under changing ventilatory conditions, and its use as a surrogate variable should be approached with caution.
Editorial: Insuficiencia Cardíaca
(Elsevier, 2025-09-01) Giordanino, Elian
La insuficiencia cardíaca constituye una de las principales causas de hospitalización en adultos mayores y afecta a más de 65 millones de personas en el mundo. Los avances recientes en diagnóstico, terapéutica y comprensión fisiopatológica han transformado su manejo clínico, aunque también lo han vuelto más complejo. Este número especial aborda la insuficiencia cardíaca desde múltiples perspectivas, incluyendo el diagnóstico de la fracción de eyección preservada, el uso apropiado de técnicas de imagen y las indicaciones actuales de dispositivos de asistencia. Asimismo, se revisan los progresos en el abordaje de miocardiopatías como la hipertrófica y la amiloidosis, así como el creciente desafío que representan los pacientes adultos con cardiopatías congénitas. Se incluyen también análisis actualizados sobre patologías de etiología diversa, como la insuficiencia tricuspídea y la pericarditis constrictiva, junto con una revisión del manejo crítico del shock cardiogénico y de los dispositivos de asistencia circulatoria mecánica. La edición ofrece una visión integral y actualizada de los retos clínicos que plantea la insuficiencia cardíaca en la práctica cardiológica contemporánea.

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