Orthopaedic Journal of Sports Medicine最新文献

Background: It has been demonstrated that an athlete's psychological readiness contributes to one's ability to successfully return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction. However, the effect of graft choice on psychological readiness is not yet understood.

Purpose/hypothesis: The purpose of this study was to evaluate the association between graft choice and an athlete's psychological readiness to RTS. It was hypothesized that similar ACL-Return to Sport after Injury (ACL-RSI) scores would be achieved among patients who underwent ACL reconstruction with quadriceps autograft (QA), hamstring tendon autograft (HA), and bone-patellar tendon-bone (BTB) autograft.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent primary ACL reconstruction at a single institution between January 2017 and December 2018 were placed into separate cohorts depending on graft type (HA, BTB, or QA; n = 30 patients in each group), and the ACL-RSI, International Knee Documentation Committee subjective form, and Lysholm scores were compared between the different graft cohorts at 6 months postoperatively, at RTS, and at 2 years postoperatively. Also, the rate of patients who achieved an ACL-RSI score of ≥65 (predictive of return to preinjury sport at 2 years postoperatively) was calculated, as was the RTS rate and time.

Results: The QA group demonstrated significantly higher ACL-RSI scores than both the HA and BTB groups at 6 months postoperatively (P < .0001) and RTS (P = .011). The QA group also had a higher rate of achieving ≥65 on ACL-RSI than the other groups at 6 months postoperatively (P = .002) and RTS (P = .024). There was no significant difference in the RTS rate between the 3 groups, although the QA group demonstrated a significantly quicker return (QA, 8.1 months; BTB, 9.6 months; HA, 10.5 months; P < .001).

Conclusion: Athletes undergoing primary ACL reconstruction with QA achieved a higher mean ACL-RSI score and more often achieved a score of ≥65 at the 6-month and RTS time points compared with the HA and BTB groups. QA may afford an advantage over other grafts in terms of improved psychological readiness to RTS.

Background: Distal tibial deformities are not assessed using the proximal anatomical axis (PAA) to determine the posterior tibial slope (PTS). Therefore, it seems advantageous to measure PTS on full-length lateral tibial radiographs using the mechanical axis (MA).

Purposes: To (1) compare the PTS measurements using the MA and the PAA and (2) determine whether using the PAA fails to detect a certain number of significantly elevated PTS values compared with using the MA.

Study design: Cohort study (Diagnosis); Level of evidence, 3.

Methods: Full-length lateral tibial radiographs of 218 consecutive cases were reviewed. Radiographs were checked for malrotation. Therefore, the distance between the posterior tibial condyles was measured in millimeters. Patients with a difference of ≥7 mm between the posterior tibial condyles were excluded, leaving 196 cases for the final statistical analysis. The PTS was measured using the MA and the PAA. Differences between these 2 techniques were analyzed. The sensitivity and specificity of the PAA as a screening method for pathological PTS were calculated, with the MA as the standard for comparison. Four subgroups were formed, all with PAA <12° and different lower limits for the MA: group 1, MA ≥10°; group 2, MA ≥10.5°; group 3, MA ≥11°; and group 4, MA ≥11.5°.

Results: Radiographs with ≥7 mm between the posterior tibial condyles showed an increased inconsistency between the PTS measurement with the MA and the PAA. In the group with a distance of <7 mm between the posterior tibial condyles (n = 196), the mean PTS measured with the MA was 9.4°± 3.8° (range, 0.4° to 21.9°), and the mean PTS was 10.5°± 3.5° (range, 1.7° to 20.9°) according to the PAA. The mean difference in PTS between the PAA and the MA was 1.1°± 1.2° (range, -2.4° to 4.1°; P < .001). Group 1 had a sensitivity of 73% and specificity of 98%; group 2, sensitivity of 84% and specificity of 97%; group 3, sensitivity of 87% and specificity of 93%; and group 4, sensitivity of 95% and specificity of 89%.

Conclusion: Measuring the PTS using the MA was advantageous, as the measurement with the PAA did not correctly identify all cases with sagittal alignment changes. The proportion of patients with pathologically increased PTS not identified with the proximal anatomical measurement, reflected by the sensitivity, depended on the threshold value defined for the MA. Lateral radiographs, showing an increased distance between the posterior tibial condyles, indicated malrotation of the tibia leading to measurement inaccuracy.

Background: Understanding the factors associated with poor recovery over time after anterior cruciate ligament reconstruction (ACLR) helps clinicians identify patients who are at risk and targets for an intervention.

Purpose: To determine the factors associated with improvement in subjective knee function from 6 to 12 months after ACLR.

Study design: Case-control study; Level of evidence, 3.

Methods: A total of 91 patients undergoing primary unilateral ACLR were included. Subjective knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at 6 and 12 months postoperatively. Isokinetic knee strength (quadriceps and hamstring) and Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale scores were also assessed. Patients were included in the poor recovery group if their improvement in the IKDC-SKF score from 6 to 12 months was <15.5 points (minimal detectable change) and their IKDC-SKF score at 12 months was <90 points (maximum, 100 points). The IKDC-SKF score, knee strength, and the ACL-RSI score were compared between the poor recovery and good recovery groups with and without propensity score matching. Matched variables included age, sex, and IKDC-SKF score at 6 months after ACLR. In addition, logistic regression analysis was performed to identify factors that discriminated between the poor recovery and good recovery groups.

Results: There were 32 participants (35%) allocated to the poor recovery group. Before propensity score matching, the poor recovery group had a significantly older age, lower IKDC-SKF scores at 6 and 12 months, and a lower limb symmetry index (LSI) for quadriceps strength at 6 months. After propensity score matching, the LSI for quadriceps strength at 6 months was significantly different between the poor recovery and good recovery groups (73.0 ± 17.4 vs 83.3 ± 18.2, respectively; P = .039). Logistic regression analysis showed that a lower LSI for quadriceps strength at 6 months was significantly associated with poor recovery of the IKDC-SKF score (odds ratio, 0.96 [95% CI, 0.93-0.98]), and receiver operating characteristic curve analysis identified 80.9% as a cutoff value of the LSI for quadriceps strength with 75.0% sensitivity and 61.0% specificity.

Conclusion: A lower LSI for quadriceps strength at 6 months postoperatively was associated with poor recovery of the IKDC-SKF score from 6 to 12 months after ACLR, even after adjusting for confounders.

Background: There has been increased interest in lateral extra-articular procedures, such as anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), to reduce anterolateral rotation instability of the knee after anterior cruciate ligament reconstruction (ACLR). Despite promising surgical outcomes with these techniques, their impact on knee strength recovery is unknown.

Hypothesis: Patients undergoing lateral extra-articular procedures at the time of ACLR would have impaired thigh muscle strength at 6 to 9 months after surgery.

Study design: Cohort study; Level of evidence, 3.

Methods: Adolescent patients who had undergone primary unilateral ACLR with lateral extra-articular augmentation between 2017 and 2023 were identified. Patients were included if they were aged between 12 and 20 years at the time of surgery and had completed an isokinetic strength assessment at 6 to 9 months after surgery. A total of 104 participants (mean age, 16.5 ± 1.7 years; 63 female) were included in this analysis: 25 who underwent ACLR+ALLR, 17 who underwent ACLR+LET, and 62 who underwent isolated ACLR. Isokinetic knee extension and flexion strength normalized to body weight, as well as the bilateral limb symmetry index (LSI), were assessed. One-way analysis of variance and analysis of covariance were used to compare differences between surgical techniques.

Results: After adjusting for age, graft type, and time since surgery, the ACLR+LET (1.36 ± 0.52 N·m/kg) and ACLR+ALLR (1.61 ± 0.53 N·m/kg) groups had significantly less involved limb knee extension strength (P = .025), uninvolved limb knee extension strength (P = .046), and LSI for knee extension strength (P = .040) compared to the isolated ACLR group. There were no differences between the 3 groups regarding involved limb knee flexion strength (P = .222) or uninvolved limb knee flexion strength (P = .984), but the isolated ACLR group displayed a greater LSI for knee flexion strength (96.6% ± 17.8%; P = .012).

Conclusion: The addition of lateral extra-articular procedures at the time of ACLR was associated with decreased quadriceps strength at 6 to 9 months after ACLR. While lateral extra-articular procedures may enhance knee rotary stability after ACLR, prolonged rehabilitation may be needed to re-establish adequate quadriceps strength before return to sports.

Background: Pickleball is one of the fastest-growing sports in the United States. It is popular among seniors but has recently grown across all age groups. As pickleball has gained interest, its corresponding injury burden has also increased.

Purpose/hypothesis: The purpose of this study was to identify pickleball-related injury trends and underlying mechanisms across different age groups presenting to US emergency departments. It was hypothesized that (1) pickleball-related injuries would increase significantly between 2013 and 2022, (2) older age groups would have the greatest frequency of injury, and (3) falls would be the most common mechanism of injury.

Study design: Descriptive epidemiology study.

Methods: The National Electronic Injury Surveillance System (NEISS) was queried for pickleball injuries between January 1, 2013, and December 31, 2022. The demographic information, injury site, and diagnosis were recorded, and case narratives were reviewed to identify the injury mechanism. The statistical sample weight assigned for NEISS cases by hospital was used to calculate national estimates (NEs). Injury trends over time were evaluated by linear regression.

Results: A total of 1110 NEISS cases representing 66,350 nationally estimated pickleball-related injuries were included. The mean age was 64 ± 14.7 years (range, 4-93 years). Most injuries occurred in those aged 65 to 80 years (NEISS cases = 643; NE = 40,507 [61.1%]), followed by those aged 35 to 64 years (NEISS cases = 349; NE = 20,785 [31.3%]). Falls were the most common injury mechanism overall (NEISS cases = 699; NE = 43,434 [65.5%]). However, being hit with a paddle and a twist/inversion were the most common mechanisms for ages 0 to 17 and 18 to 34 years, respectively. Fractures were the most common diagnosis (NEISS cases = 363; NE = 21,703 [32.7%]), followed by strains/sprains (NEISS cases = 327; NE = 20,419 [30.8%]). Also, 69.1% of all fractures occurred in female players. The wrist was the most injured, accounting for 12.7% of all injuries. Significant increases in pickleball injuries were seen over time (P < .001) and across all age groups (P < .05).

Conclusion: There was a significant increase in pickleball-related injuries presenting between 2013 and 2022, with most injuries arising from a fall. Notably, injuries decreased by 14% between 2019 and 2020 but rose again by 41% between 2020 and 2021 during the coronavirus 2019 pandemic. Older players disproportionately presented to the emergency department with pickleball-related injuries. Increased awareness and comprehensive injury prevention initiatives may be warranted to address the considerable prevalence of fractures and overuse/strain injuries.

Background: The factors contributing to osteoarthritis progression after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) are not fully understood. Quantitative magnetic resonance imaging (MRI) offers a noninvasive way to evaluate cartilage biochemical composition using T1ρ mapping, thereby detecting early cartilage degeneration. The specific impact of preoperative quantitative MRI on long-term outcomes after ACLR remains underreported.

Purpose/hypothesis: The purpose of this study was to investigate the effects of various factors, including preoperative cartilage T1ρ values, on the 10-year outcomes after ACLR. It was hypothesized that individual differences in baseline cartilage degeneration would influence osteoarthritis progression at 10 years postoperatively.

Study design: Case series; Level of evidence, 4.

Methods: This case series involved 13 patients with primary ACL injury who underwent anatomical double-bundle ACLR using hamstring tendon autograft between April 2012 and August 2013. All patients underwent preoperative quantitative MRI using a 3.0-T scanner with an 8-channel knee coil. Cartilage was divided into 18 compartments for compositional analysis, and average T1ρ values were calculated for each compartment. At the 10-year follow-up, 9 of the patients were available for patient-reported outcome (PRO) measures and radiographs.

Results: The 9 patients (6 female, 3 male) had a mean age of 26.4 years and a mean body mass index of 23.3 at surgery. All patients exhibited favorable PRO scores at the 10-year follow-up, but 5 patients showed osteoarthritis progression according to Kellgren-Lawrence (KL) grade. Although preoperative T1ρ values did not significantly correlate with PRO scores, patients with KL grade progression had significantly higher preoperative T1ρ values in the posterolateral tibial cartilage than those without progression (P = .04).

Conclusion: Ten years after anatomical double-bundle ACLR, most patients reported favorable outcomes. Preoperative T1ρ values were not directly correlated with PROs, although the presence of a patient subset with progressive KL grades suggests that preoperative posterolateral tibial cartilage condition may influence long-term osteoarthritis progression.

Background: Inconsistencies in the workup of labral tears in the hip have been shown to result in a delay in treatment and an increased cost to the medical system.

Purpose: To establish consensus statements among Canadian nonoperative/operative sports medicine physicians via a modified Delphi process on the diagnosis, nonoperative and operative management, and rehabilitation and return to play (RTP) of those with labral tears in the hip.

Study design: A consensus statement.

Methods: A total of 40 sports medicine physicians (50% orthopaedic surgeons) were selected for participation based on their level of expertise in the field. Experts were assigned to 1 of 4 balanced working groups defined by specific subtopics of interest. Consensus, strong consensus, and unanimous consensus were defined as achieving 80% to 89%, 90% to 99%, and 100% agreement with a proposed statement, respectively.

Results: There was a unanimous consensus that several prognostic factors-including age, pain severity, dysplasia, and degenerative changes-should be taken into consideration with regard to the likelihood of surgical success. There was strong agreement that the cluster of symptoms of anterior groin pain, pain in hyperflexion, and sharp catching pain with rotation make a diagnosis of a labral tear more likely, that radiographs-including a minimum of a standing anteroposterior pelvis and 45° Dunn view-should be obtained in all patients presenting with a suspected labral tear, that a diagnostic injection should be performed if there is uncertainty that the pain is intra-articular in origin, and that a minimum of 6 months should elapse after surgical treatment before reinvestigation for persistent symptoms.

Conclusion: Overall, 76% of statements reached a unanimous/strong consensus, thus indicating a high level of agreement between nonoperative sports medicine physicians and orthopaedic surgeons on the management of labral tears in the hip. The statements that achieved unanimous consensus included the timing of RTP after surgery, prognostic factors affecting surgical success, and the timing to begin sport-specific training after nonoperative management. There was no consensus on the use of orthobiologics for nonoperative management, indications for bilateral surgery, whether the postoperative range of motion and weightbearing restrictions should be employed, and whether postoperative hip brace usage is required.

Background: Femoroacetabular impingement syndrome (FAIS) is frequently treated arthroscopically with osteoplasty and labral repair. Surgical preferences vary in terms of equipment, technique, and postoperative protocol. Patient-reported outcome measures (PROMs) are valuable tools to assess outcomes across different institutions.

Purpose: To compare PROMs after FAIS arthroscopy and evaluate the impact on postoperative outcomes with independent surgeons utilizing different surgical techniques and postoperative protocols.

Study design: Cohort study; Level of evidence, 2.

Methods: Prospective data were collected from patients with a 2-year follow-up after arthroscopic FAIS treatment by 2 orthopaedic surgeons from different states, each attending different sports medicine fellowships. Patients were matched according to age, sex, and body mass index. Data included patient characteristics, surgical findings, and the Hip disability and Osteoarthritis Outcome Score (HOOS) preoperatively and 2 years postoperatively. Patients with revision surgery, concomitant procedures, or incomplete pre- and postoperative data were excluded. Surgeon A utilized interportal capsulotomy, capsular repair, all-suture anchors, and a postoperative hip brace. Surgeon B employed periportal capsulotomy without repair, polyether ether ketone suture anchors, and no brace. The 2 high-volume arthroscopists (>100 hips/year) performed osteoplasty and labral repair and used a large perineal post. Cohorts were analyzed with appropriate t tests, with significance set at P < .05. The percentage of patients achieving minimal clinically important difference (MCID) was calculated using Pearson chi-square tests.

Results: A total of 176 hips (100 women, 76 men) were included, with 88 matched patients from each institution. The mean age was 33.7 years and the body mass index was 26.3 kg/m². Both cohorts significantly improved in all 5 HOOS subscales 2 years after surgery. When comparing the mean change in PROMs and the percentage of patients achieving the MCID, differences were only observed in the HOOS-Sports subscale (cohort A: 25.3 ± 29.7 vs cohort B: 34.3 ± 29.7; P = .048; MCID achieved in 57% of patients vs 76%; P = .01).

Conclusion: This prospective cohort study on arthroscopic FAIS treatment indicates that matched patient cohorts from different institutions show similarly improved PROMs at 2 years. This study suggests consistent patient outcomes across sites despite geography, surgeon, training, surgical technique, implants, and postoperative protocol.

Background: Ice hockey players have a high rate of hip pathology, which can lead to hip arthroscopy. Previous studies have not utilized team-based advanced performance statistics in the setting of hip arthroscopy in National Hockey League (NHL) players.

Purpose/hypothesis: The purpose of this study was to use team-based advanced performance statistics to evaluate postoperative performance after hip arthroscopy in NHL players in comparison with their preoperative performance and matched controls of uninjured skaters. It was hypothesized that there would be no significant difference between preoperative and postoperative performance after hip arthroscopy in NHL players, as well as no difference when compared with matched controls of uninjured players.

Study design: Descriptive epidemiology study.

Methods: There were 56 eligible NHL players found through public records who underwent hip arthroscopy over 12 seasons. Team-based advanced performance statistics including icetime, Corsi, Fenwick, goal, and expected goal percentages were recorded for the preinjury season, index season, and first 2 years after return to play (RTP). Relative percentages of each statistic were collected to allow for intrateam comparisons. A control group of NHL players without injury was collected and matched 1:2 by age, years of play, and draft round.

Results: The RTP rate after hip arthroscopy at the NHL level was 89% for 1 season and 70% for 2 seasons. There were no significant decreases in performance in any advanced statistics after RTP after hip arthroscopy in comparison with the preinjury season or versus a matched control group of uninjured players. There was a significant decrease in games played in the injury season and the first year after RTP versus the preinjury season and versus a matched control group without differences thereafter.

Conclusion: The RTP rate after hip arthroscopy at the NHL level was 89% for 1 season and 70% for 2 seasons. There were no significant decreases in team-based advanced performance statistics after RTP from hip arthroscopy for NHL players versus their preinjury levels or versus a matched control group of uninjured players. This indicates that NHL players who RTP at the NHL level are likely able to return to their previous level of performance, albeit playing in fewer games the first season after surgery.

Background: The importance of monitoring both physical and mental health in athletes across different levels of sport is increasingly acknowledged due to potential injury risks. However, for the Chinese-speaking population, there has not yet been an appropriate assessment tool available.

Purpose: To translate, culturally adapt, and assess the validity and reliability of the Chinese versions of the updated Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2) and the Health Problems Questionnaire (OSTRC-H2) among Taiwanese collegiate athletes.

Study design: Cohort study (diagnosis); Level of evidence: 3.

Methods: The OSTRC-O2 and OSTRC-H2 questionnaires were translated from English to Chinese following international guidelines. Subsequently, 80 and 84 collegiate athletes, respectively, were invited to complete these questionnaires on a weekly basis for 8 weeks. Internal consistency was evaluated using Cronbach alpha coefficient, while test-retest reliability was assessed with the intraclass correlation coefficient (ICC). Severity scores from the questionnaires were also documented.

Results: High response rates of 90% (n = 72/80) and 90.5% (n = 76/84) were achieved in the OSTRC-O2.CH and OSTRC-H2.CH groups, respectively, demonstrating strong acceptance among athletes, with no significant issues in back-translation. High content validity was observed across the different body parts in the translated OSTRC-O2, with Cronbach alpha values of .82, .83, .82, and .83 for the knee, shoulder, elbow, and lower back, respectively. The translated OSTRC-H2 also showed excellent internal consistency, with a Cronbach alpha of .95. The ICC values for test-retest reliability were 0.88, 0.82, 0.92, and 0.92 for the knee, shoulder, elbow, and lower back in the OSTRC-O2, and the ICC for the OSTRC-H2 was 0.90, indicating very good reliability for both questionnaires.

Conclusion: The Chinese versions of the OSTRC questionnaires were found to be valid and reliable for monitoring overuse injuries and health issues among Chinese-speaking collegiate athletes.