Orthopaedic Journal of Sports Medicine最新文献

Background: A critical component of conducting systematic reviews or meta-analyses is assessing the methodological quality and bias of included studies. Several methodological quality assessment tools have been developed; however, these tools may not be relevant to observational sports medicine research, which carries numerous unique nuances and biases.

Purpose: To develop the Sport Publication Observational Research Tool (SPORT), which evaluates and scores the methodological quality of observational sports medicine research.

Study design: Consensus statement.

Methods: SPORT was developed through a modified Delphi approach involving members from the Herodicus Society and The FORUM. All active members were invited to participate in the process aimed at building consensus on SPORT content and scoring. After finalizing SPORT, a power analysis led to the independent selection of 55 observational clinical sports medicine studies, which were scored twice by 4 reviewers of varying training levels. Interrater and intrarater reliability for SPORT was assessed using intraclass correlation coefficients (ICCs). The distribution and percentiles for total SPORT score across the 55 studies were calculated. SPORT was also compared with the methodological index for non-randomized studies (MINORS), a commonly utilized quality assessment tool.

Results: A total of 51 members participated and achieved 100%, 100%, 98.0%, and 98.0% completion rates for rounds 1 through 4, respectively. The final SPORT included 19 subscores related to methodological quality and bias and achieved 94% consensus approval. Mean SPORT completion time was 6 minutes and 19 seconds per study, which varied significantly by reviewer training level. The subscore "peer review" demonstrated unacceptable reliability and was removed. The remaining 18 subscores exhibited ICC ranges of 0.599 to 0.955 for interrater reliability and 0.530 to 0.936 for intrarater reliability. Total SPORT score demonstrated excellent agreement, for interrater (ICC, 0.967) and intrarater reliability (ICC, 0.966). Median SPORT score across the 55 studies was 20.0 and skewed toward lower scores. There was a moderate significant correlation between SPORT and MINORS (r[53] = 0.575; P < .001).

Conclusion: An objective tool to assess the methodologic quality of observational sports medicine research (SPORT) was successfully developed through a modified Delphi approach with numerous content experts in the field. This tool may be useful in assessing the methodological quality of primary observational sports medicine studies included in systematic reviews and meta-analyses.

Background: Microfracture offers a joint-preserving treatment for glenohumeral osteochondral defects, although its application to bipolar defects remains understudied, especially among an active-duty servicemember (ADSM) population.

Purpose: To evaluate outcomes after microfracture of bipolar glenoid and humeral head lesions in ADSM aged <55 years.

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

Methods: ADSM aged <55 years were eligible for inclusion if they underwent microfracture for Outerbridge grade IV bipolar glenohumeral cartilage lesions identified on diagnostic arthroscopy at various locations within the joint and had >5 years of postoperative follow-up. All patients underwent concomitant arthroscopic subacromial debridement and other procedures that did not necessitate extended postoperative immobilization, while those with concomitant rotator cuff or labral repair were excluded. Outcomes included patient-reported outcome measures-specifically, pain on visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons standardized assessment-and range of motion, return to duty, and arthroplasty-free survivorship.

Results: In total, 31 patients were eligible for inclusion (mean ± SD age, 45.7 ± 8.1 years; male, 90.3%; mean follow-up, 8.0 ± 1.9 years). On average, glenoid and humeral head lesions measured 247 ± 155 and 201 ± 137 mm², respectively. All patient-reported outcome measures demonstrated significant improvements postoperatively independent of lesional size (visual analog scale, 8.2 ± 1.8 to 1.7 ± 1.8; Single Assessment Numeric Evaluation, 51.0 ± 18.8 to 80.5 ± 14.9; American Shoulder and Elbow Surgeons, 47.0 ± 11.7 to 85.2 ± 12.5; P < .0001 for all). Internal rotation improved slightly (T10.5 ± 2.4 to T9.1 ± 2.5; P = .0109); otherwise, range of motion remained stable. At final follow-up, 71% (n = 22) returned to full duty and 65% (n = 20) to preinjury level of sport. Two patients (6.5%) experienced symptom progression and underwent total shoulder arthroplasty at 6 and 8 years postoperatively at ages 52 and 62 years, respectively.

Conclusion: Microfracture of bipolar glenohumeral osteochondral lesions among ADSM yields significant improvements in pain and shoulder function; however, rates of return to unrestricted duty and former level of sport were limited, and 6.5% of patients ultimately underwent total shoulder arthroplasty 6 to 8 years postoperatively. While microfracture begets symptomatic relief for many young, active patients with bipolar osteochondral lesions and appears to offer several years of improved symptom management, return to full occupational and athletic function remains limited and warrants appropriate patient education and counseling.

Background: Adolescent baseball pitchers are vulnerable to upper-extremity injuries because of the repetitive, high-stress nature of throwing movements. While shoulder strength and range of motion (ROM) are commonly measured, they are often interpreted in isolation during injury prevention assessments.

Purpose: To determine the relationship between clinical measures (shoulder ROM and strength) and throwing arm joint kinetics in adolescent baseball pitchers.

Study design: Descriptive laboratory study.

Methods: This study was conducted in a laboratory setting. A total of 43 adolescent baseball pitchers (age, 15-18 years) were recruited through convenience sampling. Participants underwent clinical assessments of shoulder ROM and isokinetic concentric strength testing. Pitching biomechanics were analyzed to obtain elbow valgus torque, shoulder distraction force, shoulder internal rotational (IR) torque, and ball velocity. A stepwise linear regression analysis was performed to assess shoulder strength and ROM as predictors of pitching kinetics and ball velocity.

Results: A stepwise regression analysis showed that elbow valgus torque (92.1 ± 24.9 N·m) was positively associated with increased shoulder IR strength at 60 deg/sec and negatively associated with total arc ROM (IR strength, 68.3 ± 17.3 N·m; total arc, 172.8°± 19.2°; adjusted R ² = .258; P < .001). Peak shoulder distraction force (1238.9 ± 361.2 N) was positively associated with shoulder external rotation (ER) strength at 60 deg/sec (41.3 ± 10.8 N·m; β = .465; adjusted R ² = .197; P = .002). Peak shoulder IR torque (113.7 ± 37.4 N·m) was positively associated with shoulder IR strength (β = .421; adjusted R ² =.157; P = .005). Higher ball velocity (125.9 ± 8.7 km/h) was linked with higher shoulder IR strength (β = .390; adjusted R ² =.131; P = .010). There were moderate to strong positive relationships between ball velocity and pitching kinetics (Pearson's r value: valgus torque, 0.603; distraction force, 0.594; shoulder IR torque, 0.865; P < .001).

Conclusion/clinical relevance: Pitchers with greater shoulder IR strength and reduced total arc ROM demonstrated increased elbow valgus torque at maximal shoulder ER during pitching. Although IR strength is crucial for generating ball velocity, maintaining total arc ROM within an optimal range will help reduce elbow joint stress. In addition, shoulder ER was positively associated with peak shoulder distraction force. Monitoring ER strength may help identify potential fatigue or imbalance, allowing for timely clinical attention.

Background: Hip flexor tightness is common in ice hockey players because of postural demands. It remains unknown whether hip tightness plays a role in the occurrence of low back pain (LBP).

Hypothesis: It was hypothesized that ice hockey players with hip flexor tightness would be at increased risk of developing LBP.

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

Methods: Preseason hip flexor tightness was measured annually for 4 seasons in a boy's high school team, a college men's team, and a college women's team providing a total of 289 player-seasons. A digital level was placed on the anterior thigh during the Thomas test. "Tight" was defined as a Thomas test >5° above horizontal with the remaining players defined as normal. Game and practice injuries with associated time loss and diagnosis were recorded. LBP was defined as an injury in the lumbar region requiring the player to miss ≥1 game or >2 practices. Prevalence and incidence of LBP were compared between players with tight versus normal hip flexor flexibility, and relative risks were computed. Additionally, hip flexion abduction and adduction strength was assessed with a handheld dynamometer. Incidence and prevalence of LBP was compared between weak, average, and strong players within each team.

Results: There were 33 cases of LBP resulting in 97 missed games and 377 missed practices. The incidence of LBP was 1.02/1000 athlete-exposures (95% CI 0.72-1.43). Of 172 players with hip flexor tightness, 27 (15.7%) developed LBP compared with 6 of 117 (5.1%) with normal flexibility (P = .006). LBP incidence was higher for players with tight (1.42; 95% CI, 0.98-2.06) versus normal (0.55; 95% CI, 0.21-0.98) hip flexor flexibility (relative risk, 3.17; 95% CI, 1.31-7.67; P = .007). Players with hip flexor tightness missed 85 games and 318 practices because of LBP compared with 12 games and 59 practices for players with normal hip flexor flexibility (P < .001). LBP incidence was not different between teams (P = .91). Incidence of LBP was not different between players weak, average, or strong in hip flexion (P = .53), abduction (P = .48) or adduction (P = .35).

Conclusion: Hip flexor tightness was associated with increased risk of LBP. Hip flexor stretching and postural training is indicated for players with hip flexor tightness.

Background: Anterior shoulder dislocation is a common and functionally limiting injury in professional martial arts (MA) athletes. While arthroscopic Bankart repair is widely performed, data on long-term functional and sport-specific outcomes in elite-level MA athletes after a first-time dislocation remain scarce.

Purpose: To evaluate the 5-year clinical and functional outcomes of arthroscopic Bankart repair using bioabsorbable suture anchors in elite MA athletes who sustained a first-time traumatic anterior shoulder dislocation without bony Bankart lesions.

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

Methods: A total of 27 elite international-level MA athletes who experienced a first-time anterior shoulder dislocation and underwent arthroscopic Bankart repair with bioabsorbable suture anchors were included. All surgeries were performed within 3 weeks after the injury. Patients with bony Bankart lesions and those who had undergone either remplissage for large Hill-Sachs lesion or previous shoulder surgery were excluded. Functional evaluation included pre- and postoperative assessments using Rowe, Athletic Shoulder Outcome Scoring System, Shoulder Sport Activity Score, forward flexion, and external rotation in adduction. Return to sport and return to preinjury competitive level were also recorded. Postoperative magnetic resonance imaging (MRI) at 6 months assessed anchor position, stability, and cartilage or bony lesions. Outcomes were compared between athletes who returned to their previous competition level and those who did not.

Results: The mean age was 24.3 years and the mean follow-up was 63.0 ± 2.5 months (range, 54-69 months). All athletes returned to sports, with 85.2% (n = 23) resuming competition at their preinjury level. Significant improvements were observed in all functional scores (P < .001 for all), while a slight postoperative decrease in range of motion parameters was noted. No significant differences were found in clinical scores between those who returned to their preinjury level and those who did not. Recurrent dislocation occurred in 2 athletes (7.4%) during competition. Radiological follow-up with postoperative MRI was available for all 27 athletes. At 6 months, all patients demonstrated proper anchor position and stability, with no evidence of displacement or loosening. No cartilaginous or bony lesions were detected.

Conclusion: Arthroscopic Bankart repair with bioabsorbable suture anchors is a safe and effective treatment for first-time anterior shoulder dislocation in elite MA athletes. This approach results in excellent long-term functional outcomes and a high rate of return to elite-level competition, with a low risk of recurrence when patients are properly selected.

Background: All-suture anchors (ASAs) are increasingly used in biceps tenodesis (BT), and their fixation strength may vary with cortical bone and surgical position. Defining the influence of bone mineral density (BMD) on ASA pullout strength and failure mode across the high bicipital groove (HG), low bicipital groove suprapectoral position (SUP), and subpectoral (SUB) positions may allow for optimal anchor placement.

Hypothesis: ASA biomechanical characteristics at each region of the bicipital groove would improve with increasing regional BMD.

Study design: Controlled laboratory study.

Methods: ASAs measuring 2.6 mm were inserted into the HG, SUP, and SUB positions of the bicipital groove of 12 cadaveric specimens. Local measures of bone quality around each anchor were evaluated using micro-computed tomography. Afterward, each ASA was biomechanically loaded to failure to determine the ultimate pullout strength and mode of failure. Repeated-measures correlations were calculated to determine the relationship between measures of bone quality and pullout strength.

Results: Mean load to failure of ASAs placed in the HG, SUP, and SUB positions were 370.7 ± 111.2 N (95% CI, 300.0-441.3 N), 600.5 ± 120.8 N (95% CI, 523.8-677.3 N), and 668.1 ± 117.2 N (95% CI, 593.6-742.5 N), respectively. Mean load to failure of ASAs placed in the SUP and SUB positions was significantly greater than in the HG position (P < .01). There was no significant difference in mean pullout force between the SUP and SUB positions. The most common mode of failure was anchor pullout in the HG (100%) and suture breakage in the SUP (58%) and SUB (75%) positions. Mean BMD and cortical BMD were significantly greater in the SUP and SUB positions compared to the HG position (P < .05). Pullout force measured throughout the bicipital groove was significantly correlated to cortex mean bone density, cortex volume, mean BMD, and bone volume (P < .01).

Conclusion: ASA pullout strength was correlated with local cortical BMD. ASA fixation strength and BMD were robust in all tested regions of the bicipital groove but were greatest in the SUP and SUB positions.

Clinical relevance: ASAs can effectively be placed throughout the bicipital groove. ASAs in all 3 tested positions can withstand not only the force reportedly placed on the anchor by the native biceps but also the force previously reported to cause failure at the suture-biceps tendon interface. These biomechanical findings add to the growing clinical and basic science evidence supporting the use of ASA for BT.

Background: Rotator cuff tears occur with increased prevalence and worse outcomes in patients with diabetes mellitus. Glucagon-like peptide-1 receptor agonists (GLP-1RA) have demonstrated efficacy in improving glycemic control and reducing body weight, and early studies have examined their perioperative use in total shoulder arthroplasty.

Purpose: To investigate the association between GLP-1RA use and postoperative outcomes following arthroscopic rotator cuff repair (RCR).

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

Methods: A retrospective cohort study utilizing the TriNetX database identified patients undergoing arthroscopic RCR from 2000 to 2024. Patients prescribed GLP-1RA within 6 months preoperatively were compared with a propensity-matched cohort without GLP-1RA exposure. Primary outcomes included 90-day postoperative medical complications and 2-year surgical outcomes. Outcomes between cohorts were compared using odds ratios (ORs) with 95% CIs.

Results: After propensity score matching, 3066 patients were included in each cohort. The GLP-1RA cohort had a significantly lower risk of hospital readmission within 90 days (2.7% vs 3.6%; OR, 0.741; 95% CI, 0.555-0.989; P = .04) and reduced likelihood of subsequent RCR within 2 years (4.5% vs. 5.7%; OR, 0.768; 95% CI, 0.611-0.966; P = .02). No significant differences were observed in surgical-site infection, pneumonia, thromboembolic events, or emergency department visits within 90 days postoperatively. Likewise, no differences were found in other surgical outcomes, including shoulder arthroplasty, lysis of adhesions, or adhesive capsulitis at the 2-year follow-up.

Conclusion: Preoperative GLP-1RA use for patients undergoing arthroscopic RCR was associated with a decreased risk of both hospital readmission at 90 days and subsequent RCR at 2 years postoperatively. There was no difference in the risk of shoulder arthroplasty, adhesive capsulitis, lysis of adhesions, or 90-day medical complications between groups. These findings suggest that GLP-1RA use appears safe in the perioperative period for patients undergoing arthroscopic RCR, providing reassurance for clinicians managing patients already prescribed these medications.

Background: Reverse shoulder arthroplasty (RSA) requires deliberate preoperative planning and evaluation of glenoid deformity. The shoulder β and RSA angles, as described by Mauer and Boileau, respectively, are of value for preoperative planning for RSA.

Purposes: To evaluate differences in relevant glenoid markers, such as the β and RSA angles, between plain radiographs and computed tomography (CT) scans and to further introduce and evaluate a novel measurement, the inferior glenoid bony resection depth (BRD), which is the resection distance required for placement of a baseplate in 0° of superior inclination.

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

Methods: Patients with both plain radiographs and CT scans of the shoulder performed at the same institution within 3 months were reviewed. The shoulder β and RSA angles and BRD were assessed using radiographs and 2-dimensional CT scans. All radiographic measures were compared based on imaging modality (radiographs vs 2-dimensional CT scan). A subgroup analysis was conducted to evaluate differences between male and female patients.

Results: In total, 41 patients were included. The mean β angle on radiographs was greater than when measured using CT (78.8° vs 76.9°, P = .02). The average resection depth was higher on radiographs as well (7.32 mm vs 5.86 mm, P < .001). Furthermore, men had a higher average β angle than women (81.6° vs 75.8°, P = .001).

Conclusion: Plain radiographs may overestimate shoulder β angle and inferior glenoid resection. In addition, inferior glenoid resection depth necessary to achieve a neutral baseplate, as measured on both radiograph and CT, would lead to overresection of the glenoid, putting patients at risk for implant subsidence. We further found that there may be differences in glenoid inclination based on patient sex.