Person: Figueroa, Francisco
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Figueroa
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Francisco
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Publication Return to sports in female athletes after anterior cruciate ligament reconstruction: A systematic review and metanalysis(2024) Figueroa, David; Figueroa, María; Figueroa, FranciscoImportance: Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes. Objective: The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS. Evidence review: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted. Findings: Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]. Conclusions: This systematic review demonstrates that a majority of female athletes (69 %) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play. Level of evidence: III.Publication 4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad(2024) Figueroa, David; Guiloff, Rodrigo; Figueroa, Francisco; Stocker, Esteban; Rocha, SergioAntecedentes y objetivo: Las medidas de resultado reportadas por el paciente (PROM) son herramientas de interés creciente en la población deportiva. El propósito de este estudio fue realizar la adaptación transcultural y análisis de confiabilidad del 4-Domain Sports Patient-Reported Outcome Measure (4DSP) al español. Métodos: Se ejecutó un protocolo de adaptación transcultural en seis etapas para obtener la versión en español del 4DSP (S-4DSP). Posteriormente, se aplicó el cuestionario a una población de 108 deportistas posoperados de reconstrucción de ligamento cruzado anterior (RLCA). Se aplicó nuevamente el cuestionario luego de 30 días. Se evaluó la aceptabilidad, efecto piso y techo, consistencia interna (alfa de Cronbach) y reproducibilidad (correlación intraclase). Resultados: La S-4DSP fue respondida completamente por 108 participantes (edad media 34 ± 10,75, 26% mujeres) alcanzando una aceptabilidad de 100%. No se detectó efecto piso. El análisis estadístico entregó un alfa de Cronbach global para el cuestionario de 0,65, y desagregado por dominios de 0,88, 0,72, 0,27, 0,68 para el primer, segundo, tercer y cuarto dominio, respectivamente. El estudio de correlación intraclase alcanzó un máximo de 0,94 y un mínimo de 0,48 en la primera y quinta preguntas, respectivamente. Conclusión:El S-4DSP es una herramienta confiable y útil para evaluar deportistas de habla hispana posterior a una RLCA. Abstract Background: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. Methods: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. Results: The S-4DSP was fully completed by 108 participants (mean age 34 ± 10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. Conclusions: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.Publication Specific considerations in female patients with patellar instability: current concepts(2024) Figueroa, Francisco; Guiloff, Rodrigo; Bolton, Sarah; Figueroa, David; Tapasvi, Sachin; Stocker, EstebanPrior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years, worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.Publication Orthopedic Residency Programs: What are Our Current Goals? An International Society of Orthopedic Centers (ISOC) Delphi Consensus(2025) Figueroa, David; Moya, Luis; Arteaga, José; Alex Vaisman; Bostrom, Mathias; Acuña, Carolina; Alesi, Domenico; Radice, Fernando; Figueroa, Francisco; Toro, Felipe; Liebergall , Meir; Stegeman, Mark; Tagil, Magnus; Lenza, Mario; Sancheti, Parag; Ranawat, Amar; Calvo, Rafael; Guiloff, Rodrigo; Robbins, Laura; Irarrazaval, Sebastian; Zaffagnini, Stefano; Jung, Tobias; Winkler, TobiasThis article presents an international consensus reached by the International Society of Orthopaedic Centers (ISOC) to establish recommendations on postgraduate orthopedic education. Using the Delphi technique, expert opinions from different regions of the world were collected and analyzed. Twenty statements were evaluated, of which 16 achieved strong consensus, 2 moderate consensus, and 2 did not reach consensus. Key recommendations include the implementation of objective metrics to assess competencies, the integration of ethical and professional standards into the curriculum, the use of high-fidelity simulations and advanced technologies such as virtual reality and telemedicine, the promotion of inclusive and non-discriminatory environments, and the establishment of quotas to ensure sufficient hands-on surgical training. The importance of balancing clinical demands with the mental health needs of residents and fostering interdisciplinary collaboration was also emphasized. The consensus aims to provide a framework for improving orthopedic residency programs, adapting them to current challenges and promoting innovation and better patient outcomes. Limitations such as variability in resources and needs between institutions are acknowledged, and it is proposed to continue with future research and adaptations to maintain the relevance of the recommendations.Publication Rethinking the Schenck Classification for Multiligament Knee Injuries: Evaluating Whether the Schenck KD Grade Is Associated With the Presence of Vascular or Neurological Injuries in a Multicenter Study With 144 Patients(2025) Sanchez, Enrique; Lozano, Beatriz; Andrade, Renato; Valente, Cristina; Espregueira, João; Figueroa, Francisco; Figueroa, David; Vuylsteke, Kristien; Verdonk, Peter; Passarelli , Luís Eduardo; Janson Angelini, Fabio; Zijl, Jacco; Wolterbeek, Nienke; Maestro, AntonioBackground: Posterolateral corner (PLC) lesions and knee dislocations (KDs) have been recognized as risk factors for vascular and neurological injuries in patients with multiligament knee injury (MLKI), but an association between Schenck KD grade and neurovascular lesions has yet to be established. Hypothesis: The ligamentous injury pattern in MLKIs with high KD grades will be associated with a higher likelihood of vascular and neurological injuries. Study design: Cross-sectional study; Level of evidence, 3. Methods: Included were 144 patients from a multicenter database with surgically treated MLKI. All patients were skeletally mature, had MLKI lesion identified on magnetic resonance imaging and confirmed intraoperatively, and did not have any previous knee surgery or previous vascular or neurological lesions. Demographic data (sex, age), injury mechanism (high energy, sports injury, low energy), ligaments injured, and neurological and vascular lesions were recorded. A new classification for MLKI based on ligamentous injury pattern, and intended for all MLKIs (with and without KD) was developed, and all patients were categorized according to this classification. Associations were evaluated between the risk of vascular and neurological lesion and demographic data, injury mechanism, and new classification grade. Results: The mean patient age was 33.9 years (range, 15-64 years), and 72% were male. High-energy trauma was the most common injury mechanism (55.6%). Vascular injury was present in 5 patients (3.5%) and nerve injury in 17 (11.8%), with 1 patient (0.7%) having both. None of the analyzed variables were associated with the presence of vascular lesion. Univariate logistic regression showed that medial collateral ligament (MCL) lesion decreased the probability of neurological injury (odds ratio [OR], 0.29; 95% CI, 0.1-0.87; P = .03) while PLC injury increased that probability (OR, 12.66; 95% CI, 1.63-100; P = .02). Multivariate logistic regression showed that the proposed MLKI grade was significantly associated with the presence of neurological lesions, with a 2.5-fold increase in the odds of having a neurological injury for each increase in grade (OR, 2.47; 95% CI, 1.36-4.50; P = .003). Conclusion: PLC injuries increased the odds of neurological injury in MLKI, while MCL injuries decreased these odds. MLKI grade and presence of PLC injury was associated with the presence of neurological injury. MLKI grade was not associated with the presence of a vascular lesion.Publication Age influences the efficacy of osteochondral autograft transfer: Promising results for patients under 40(2024) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Stocker, Esteban; Itriago, Minerva; Nuñez, MarilauraBackground: Previous research using osteochondral autograft transfer (OAT) has shown poorer outcomes with increasing patient age. The aim of this article is to evaluate a cohort of patients that received an OAT and to correlate their clinical results with their age at procedure. Methods: Patients that underwent an OAT to treat an osteochondral (OC) lesion with a minimum 24-month follow-up were included. Patients were categorized into two groups based on their age at procedure (<40 years and ≥40 years). Postoperatively, each patient completed the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Lysholm scales. Results: 51 patients were included (35<40 years, 16≥40 years). Mean follow-up was 4.2 years (2-7). For patients<40 years, IKDC averaged 80.8 (SD 15.9) versus 71.2 (SD 19.4) in ≥40 years (p=0.03). For patients <40 years, Lysholm averaged 85.9 (SD 10.8) versus 77.0 (SD 21.6) in ≥40 years (p=0.02). For patients<40 years, KOOS averaged 78.3 (SD 11.8) versus 68.9 (SD 18.5) in ≥40 years (p=0.01). There was a 100% sensibility in identifying all the patients with a poor IKDC and Lysholm from 34 years old (AUC 0.76 and 0.8). Conclusions: OAT has better outcomes in patients younger than 40 years compared to patients older than 40 years. Based on the prognostic capacity of age, the ideal candidate for an OAT is a patient younger than 34 years old.