Orthopaedic Journal of Sports Medicine最新文献

Background: With the increasing popularity of shoulder arthroplasty, indications and usage has expanded to younger more physically active patients. Limited knowledge exists on return to outdoorsman sports after shoulder arthroplasty.

Purpose: To determine return to outdoorsman sports, including fishing, shooting, archery, and rowing, after primary total shoulder arthroplasty at a minimum 2-year follow-up.

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

Methods: A retrospective study was performed on patients who underwent primary reverse or anatomic total shoulder arthroplasty between 2012 and 2022 who participated in outdoorsman sports, including fishing, shooting, archery, and rowing, with a minimum 2-year follow-up. Questionnaires were expanded to explore patients' preoperative and postoperative activity with regard to outdoorsman sports. Patient-reported outcomes (PROs), including visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value, as well as active range of motion including forward flexion, external rotation, internal rotation, were collected pre- and postoperatively.

Results: A total of 102 patients met study criteria and responded. Overall, 77% returned to outdoorsman sports, with 80%, 85%, 50%, and 68% returning to fishing, shooting, archery, and rowing, respectively. Of those who returned, 86% reported being mostly or completely satisfied with their performance postoperatively, with 77% reporting a return to at least the same level of activity. Among those who returned, 61% did so within 6 months postoperatively. Patients from all sports showed significant clinical improvement in forward flexion (P≤ .003), external rotation (P≤ .006), and PROs (P≤ .006) at a mean postoperative follow-up of 38 ± 12 months. Between sports, postoperative VAS (P = .04) and ASES (P = .03) values were significantly different, with shooting showing lower ASES (83) and higher VAS (1.5) scores, despite demonstrating the highest return rate (85%). When considering arm dominance, return rates were comparable between patients who had surgery on their dominant arm and those treated on their nondominant arm across each sport.

Conclusion: Participants had a 77% return to outdoorsman sports, such as fishing, shooting, archery, and rowing, with >50% doing so within 6 months of primary total shoulder arthroplasty. Respondents who participated in rowing and archery returned at lower rates compared with fishing and shooting, despite shooting's showing higher pain postoperatively. Activities entailing greater shoulder demands may hinder a patient's ability to return after arthroplasty.

Background: No biomechanical study has established the effect of different graft positions or bone block options on anterior glenohumeral joint stability.

Purpose/hypothesis: The purpose of this study was to compare graft choice (distal clavicular vs coracoid autograft for Latarjet) and position on stability of the bone block for anterior glenohumeral instability. It was hypothesized that both grafts would be comparable if flush with the glenoid but that the sling effect of the Latarjet procedure would lead to greater stability in case of graft medialization.

Study design: Controlled laboratory study.

Methods: Eight cadaveric shoulders were included. Defects stabilized using a distal clavicular graft and a coracoid graft were consecutively positioned at 0, 4, and 8 mm medially. The starting position was determined by the humeral head's being seated at its most medial position on the glenoid surface. Each experiment comprised maximal external rotation and glenohumeral abduction at 60° while applying a constant 50-N medial compressive force to the humerus under all conditions. The conjoint tendon was routed through a split in the subscapularis and loaded with a 5-N weight using a pulley system for all Latarjet trials to simulate the sling effect.

Results: Regarding the clavicular graft, the stability ratio significantly decreased versus the intact condition at all medial offsets (P = .007 for 0 mm, P < .001 for 4 mm, and P < .001 for 8 mm), and it was significantly lower in the 4-mm versus 0-mm position (P = .008), significantly higher in the 4-mm versus 8-mm position (P < .001), and significantly lower in the 8-mm versus 0-mm position (P < .001). Regarding the coracoid graft, the stability ratio was comparable with intact for the 0-mm position (P = .12), while it was significantly lower in the 4-mm and 8-mm positions (P < .001 for both). The distal clavicular graft at 0-mm offset was comparable with the coracoid graft at 0-mm offset.

Conclusion: In shoulders with anterior glenoid bone loss, the coracoid and distal clavicular autografts were biomechanically comparable when placed flush with the glenoid. The distal clavicle at 0-mm offset did not restore stability compared with the intact specimen, but the Latarjet at 0-mm offset was not significantly different from the intact condition.

Clinical relevance: The Latarjet procedure provides higher stability compared with distal clavicular autograft when medialized.

Background: Various medial patellofemoral ligament (MPFL) reconstruction techniques have been developed to minimize risks to the physis in skeletally immature patients.

Purpose: To examine outcomes of MPFL reconstruction (MPFLR) based on fixation technique in skeletally immature patients.

Study design: Systematic review; Level of evidence, 4.

Methods: PubMed, Scopus, Ovid, Cochrane Library, and CINAHL databases were searched for the literature on outcomes of MPFLR in the pediatric population, utilizing various anatomic and nonanatomic techniques. Primary outcomes were postoperative redislocation rates, return-to-sports (RTS) rates, and patient-reported outcomes (PROs). Moreover, outcomes involving sequela of growth plate disturbance were collected.

Results: The final analysis included 17 studies-2 using sling-based techniques, 3 using surface-based techniques, 5 using soft tissue realignments, and 7 utilizing transosseous femoral fixations. Higher rates of postoperative redislocation were found in the sling-based (14.8%) and distal soft tissue realignment using semitendinosus tenodesis (38%) techniques, while lower rates were noted with surface-based (1.3%) and transosseous (3.4%) techniques. For PROs, there were large amounts of heterogeneity among studies, but all reported postoperative improvements, with more positive PROs generally seen in anatomic reconstructions. The RTS rate was 100% for surface-based techniques, 79.4% for distal soft tissue realignments, 79.5% for soft tissue realignment techniques, and 83.2% for transosseous techniques. No negative outcomes as a sequela of growth plate disturbance were reported.

Conclusion: Nonanatomic techniques-such as sling-based and distal soft tissue realignment techniques-have higher rates of redislocation and lower RTS rates in skeletally immature patients undergoing MPFLR. Surface-based and transosseous tunnel-based techniques were shown to have lower redislocation and higher RTS rates.

Clinical relevance: This review provides insight into the most appropriate surgical management of patellar instability in patients with open growth plates.

Background: Medial patellofemoral ligament reconstruction (MPFLR) using the quadriceps tendon can avoid complications related to the fixation of other graft types to the patella. However, there is concern about postoperative loss of knee extensor muscle strength because of harvesting a portion of the quadriceps tendon.

Hypothesis: Knee extensor muscle strength after superficial slip of the quadriceps tendon MPFLR (SQ-MPFLR) decreases postoperatively, and there are specific factors that effect knee extensor muscle strength recovery.

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

Methods: A total of 26 patients who underwent unilateral primary SQ-MPFLR were enrolled. Clinical and functional outcomes were evaluated using the Kujala score and Tegner activity score preoperatively and 12 months postoperatively. Knee extensor muscle strength was examined preoperatively and 6 and 12 months postoperatively using the Biodex dynamometer. The knee muscle strength of the operated leg was compared with that of the contralateral leg using the limb symmetry index (LSI). The associations of sex, body mass index, and daily sports activity level with knee extensor muscle strengths at 6 and 12 months postoperatively were investigated and compared between the 2 groups.

Results: The preoperative mean Kujala score was 65.0 and significantly improved to 94.7 at 12 months after surgery (P < .001). The preoperative Tegner activity score was 5.6, and the 12-month postoperative score was 5.8. The knee extensor LSI increased from 69.2% preoperatively to 82.0% at 12 months postoperatively. The patient group with a high sports activity level had a significant higher knee extensor muscle LSI (mean, 87.8%) than the group with a low sports activity level at 12 months postoperatively (P = .003).

Conclusion: The knee extensor LSI of patients who underwent SQ-MPFLR increased from 69.2% preoperatively to 82.0% postoperatively at 12 months. The patient group with a high sports activity level had a significantly higher knee extensor LSI than the group with a low sports activity level at 12 months after SQ-MPFLR surgery.

Background: The abnormal morphology of complete discoid lateral meniscus (CDLM) is associated with a greater propensity for tears. The magnetic resonance imaging (MRI) morphology of CDLM is most often described in the coronal plane, with few morphological studies in the sagittal position.

Hypothesis: The sagittal anteroposterior diameter of CDLM is smaller than that of normal meniscus and is increased after tear in adults.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: The authors searched the radiology records at our institution from June 2018 to December 2023 for patients aged from 18 to 55 years with knee pain. According to inclusion and exclusion criteria, 70 knees (66 patients) with torn CDLM were enrolled as group A, 36 knees (31 patients) with intact CDLM were enrolled as group B, and 48 knees (32 patients) with normal lateral meniscus (LM) were enrolled as group C. The coronal view passing through the middle point of the lateral tibial plateau (LTP) were identified the referrence coronal view, then the sagittal view passing through the middle point of the LTP on the referrence coronal view were selected for the measurements, the anterior distance, posterior distance, and anteroposterior diameter of the LM, sagittal tibial diameter (TD) were measured. The 4 measurements and the ratios were compared among the groups by independent sample t test.

Results: The reliability of all measurements was excellent, except that posterior distance was classified as good in group B. The anteroposterior diameter and TD were smaller in group A than in group C (both P < .001) and smaller in group B than in group C (P < .001 and P = .007). anteroposterior diameter and anteroposterior diameter/TD in group A were larger than in group B (P = .003 and P < .001), while anteroposterior diameter/TD in group A and group C were similar (P > .05). The anterior distance and anterior distance/TD were smaller in group A than in group B (P = .02 and P = .03) and smaller in group A than in group C (P < .001 and P = .008). Posterior distance, posterior distance/anteroposterior diameter, and posterior distance/TD were larger in group A than in group C (P < .001, P < .001, and P < .001) and larger in group B than in group C (P < .001, P < .001, and P < .001).

Conclusion: Our study demonstrates that in adults, the meniscal anteroposterior diameter and the TD are smaller in CDLM than in normal LM, and the anteroposterior diameter of torn CDLM is larger than intact CDLM.

Background: The Athlete Fear-Avoidance Questionnaire (AFAQ) is a validated instrument that measures athletes' fear and avoidance behaviors after an injury, particularly regarding their sporting activities.

Purpose: This study aimed to adapt and validate the AFAQ for Arabic-speaking recreational players (AFAQ-Arabic) after anterior cruciate ligament reconstruction (ACLR).

Study design: Cohort study; level of evidence: 3.

Methods: The AFAQ underwent translation and cross-cultural adaptation according to the Beaton guidelines. A total of 104 male recreational players who had undergone ACLR completed the AFAQ-Arabic, the Fear-Avoidance Belief Questionnaire (FABQ), and the Numerical Pain Scale (NPS). To assess test-retest reliability, a subset of 38 recreational players were asked to complete the AFAQ-Arabic twice, 1 week apart. Statistical tests were conducted to test the internal consistency, reliability, and convergent validity of the AFAQ-Arabic.

Results: The AFAQ-Arabic demonstrated high internal consistency (Cronbach alpha, 0.854) and excellent test-retest reliability (intraclass correlation coefficient, 0.885) (95% CI, 0.784-0.942; P < .001). Minimal floor (4.8% scoring the minimum) and ceiling effects (1% scoring the maximum) were observed. Convergent validity showed significant positive weak correlations between the AFAQ-Arabic and (1) the FABQ-Physical Activity (r = 0.340; P < .01), (2) the FABQ-Work (r = 0.272; P < .01), and (3) the NPS (r = 0.383; P < .01). Cross-cultural adaptation of the AFAQ-Arabic revealed linguistic and cultural relevance.

Conclusion: Our study demonstrated that the AFAQ-Arabic was a reliable and valid tool for assessing fear avoidance in Arabic-speaking recreational players after ACLR. Future studies are needed to measure athlete fear-avoidance in injured Arabic-speaking athletes to understand its psychological aspects in rehabilitation and potentially aid in tailored interventions for improving outcomes.

Background: A preoperative high-grade pivot-shift phenomenon (2+ and 3+) is often a predictor of inferior knee rotational stability and excessive anterior tibial translation of the lateral compartment (L-ATT) after an anterior cruciate ligament (ACL) injury. Lateral extra-articular tenodesis (LET) has been reported to reduce failure rates and improve knee stability in patients with an ACL injury. However, the effect of LET on knee rotational stability and L-ATT is still not entirely clear in patients with an ACL injury and a high-grade pivot-shift phenomenon.

Purpose: To explore the effect of LET on knee rotational stability and L-ATT in patients with an ACL injury and a high-grade pivot-shift phenomenon.

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

Methods: A total of 254 patients who underwent ACL reconstruction (ACLR) between January 2019 and December 2020 were retrospectively reviewed, and 71 patients (43 male and 28 female) with a preoperative high-grade pivot-shift phenomenon were included. Of these, 24 patients who underwent ACLR combined with LET and 47 patients who underwent ACLR alone were categorized as the study and control groups, respectively. Knee stability was evaluated by the KT-1000 arthrometer side-to-side difference and the pivot-shift test, and L-ATT was measured on magnetic resonance imaging. Baseline patient characteristics, preoperative and postoperative knee stability, and preoperative and postoperative L-ATT were compared between the 2 groups. Moreover, the relative risk of a residual pivot-shift phenomenon after ACLR combined with LET versus ACLR alone was calculated.

Results: The mean time from injury to surgery in the study group was significantly longer than that in the control group (29.9 ± 54.7 vs 10.1 ± 23.1 months, respectively; P = .035). Other baseline patient characteristics, preoperative knee stability, and preoperative L-ATT showed no significant differences between the groups. At the final follow-up (26.4 ± 4.7 and 28.1 ± 11.0 months for study and control groups, respectively), knee rotational stability (residual pivot-shift phenomenon: 2/24 vs 16/47, respectively; P = .018) and L-ATT (4.6 ± 2.6 vs 6.3 ± 2.6 mm, respectively; P = .010) were superior in the study group compared with the control group. Furthermore, the relative risk of a residual pivot-shift phenomenon was significantly lower in the study group (0.176 [95% CI, 0.037-0.845]; P = .030).

Conclusion: ACLR combined with LET was an effective treatment strategy for ACL injuries with a high-grade pivot-shift phenomenon, associated with satisfactory clinical outcomes, significantly improved rotational stability, and reduced L-ATT.

Background: Hip arthroscopy (HA) for the surgical management of femoroacetabular impingement syndrome (FAIS) provides reliable improvements in pain and function; however, debate remains regarding the impact of HA on the progression of osteoarthritis (OA).

Purpose: To determine whether HA for FAIS reduces the progression of OA and the risk of conversion to total hip arthroplasty (THA).

Study design: Systematic review; level of evidence, 4.

Methods: A systematic electronic search of articles in Medline, Embase, and ClinicalTrials.gov databases was performed under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with 5046 articles remaining after duplicates were removed. All papers addressing HA for FAIS that reported radiographic progression of hip OA with a follow-up of ≥2 years were eligible for inclusion. Studies assessing labral reconstruction, revision HA, case reports, studies with <10 patients, and patients with hip dysplasia or rheumatoid arthritis were excluded. A total of 322 studies progressed to full text, and 16 studies were ultimately included in this review. Studies were divided based on short-term (ST) (2 to <5 years), mid-term (MT) (5 to <10 years), and long-term (LT) (>10 years) follow-ups. A meta-analysis of homogenous studies and outcomes was performed, otherwise, descriptive statistics were presented.

Results: Sixteen studies (2278 hips) with FAIS were included, in which 1196 hips underwent HA and 1082 hips were treated nonoperatively. There were 8 ST studies, 4 MT studies, and 4 LT studies. A meta-analysis of 2 comparative studies found 32% (P = .002) less risk of progression of radiographic OA (any increase in grading) with HA compared with nonoperative management. In addition, there was a nonsignificant 23% (P = .35) decreased risk of conversion to THA/hip resurfacing with HA. For all studies, there was a progression of hip OA ranging from 0% to 37.1% for ST studies, 11.5% to 23% for MT studies, and 4.3% to 28% for LT studies.

Conclusion: Our systematic review demonstrated that studies of patients undergoing HA for FAIS demonstrated increased radiographic progression of hip OA over time. Although significantly limited by only 2 retrospective cohort studies, subgroup analysis comparing operative versus nonoperative management demonstrated a 32% reduction in the radiographic progression of OA (any increase in grading) at the LT follow-up. However, there were no significant differences in the risk of THA/hip resurfacing. Future long-term, high-level controlled studies are needed to help further understand this important clinical question.

Background: Collision risks between femoral tunnels during combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction have been reported. However, studies on collision risks between tibial tunnels and optimal ALL tibial tunnel orientation are lacking.

Purpose: To analyze the optimal orientation of the ALL tibial tunnel to minimize collisions with the ACL tibial tunnel while preventing injury to the saphenous nerve in combined reconstruction.

Study design: Descriptive laboratory study.

Methods: Preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) images of patients who underwent primary ACL reconstruction using the anteromedial portal technique were analyzed. Only patients with preoperative MRI scans including thin-cut images (<1 mm) were included for 3-dimensional (3D) reconstruction. Patients who underwent ALL reconstruction or had poorly 3D-reconstructed essential structures were excluded to ensure accurate reproduction of bony attachments and landmarks associated with ALL. Bony structures of the knee joint, including the proximal tibia with the actual ACL tibial tunnel, were reconstructed from the postoperative CT scans. The greater saphenous vein (GSV), which runs together with the saphenous nerve, was reconstructed from the preoperative MRI and subsequently transferred to the CT model, maintaining the appropriate positional relationship. Twelve orientations of the ALL tunnel (at 10° intervals, ranging from 0° to 20° anteriorly and from 0° to 30° distally) were simulated with the final 3D model, starting from the ALL tibial footprint (midpoint between the Gerdy tubercle and the fibular head, 10 mm distal to the joint line), to measure the distances between the ALL tunnel trajectory and other structures (ACL tibial tunnel, GSV) by each orientation.

Results: A total of 35 out of 304 patients were included in this study. An anteriorly oriented ALL tunnel decreased the minimum distance to the ACL tibial tunnel (MD-ACL) and increased minimum distance to the GSV (MD-GSV) (all P < .001). A distally oriented ALL tunnel increased MD-ACL and decreased MD-GSV (all P < .001). Optimal ALL tunnel orientation was 10° anterior to 30° distal (MD-ACL, 14.6 ± 4.0 mm; MD-GSV, 27.8 ± 12.4 mm) and 20° anterior to 30° distal (MD-ACL, 11.5 ± 3.6 mm; MD-GSV 43.6 ± 12.9 mm), considering both collisions with the ACL tunnel and the potential risk of injury to the saphenous nerve.

Conclusion: The optimal orientations of the ALL tibial tunnel to avoid collision with the ACL tibial tunnel and prevent saphenous nerve injury are 10° anterior to 30° distal and 20° anterior to 30° distal for far-cortex drilling techniques, starting from the midpoint between the Gerdy tubercle and the fibular head, 10 mm distal to the joint line.