Orthopaedic Journal of Sports Medicine最新文献

Background: Anterior cruciate ligament (ACL) injuries are among the most debilitating injuries in professional soccer, often leading to extended recovery times and performance impacts. While much is known about ACL injury outcomes in European leagues, data specific to the Major League Soccer (MLS) remains limited.

Purpose/hypothesis: This study aimed to assess the return to play (RTP) times, RTP rates, and performance outcomes after ACL reconstruction in MLS athletes. It was hypothesized that RTP times would improve over the study period and that player performance would stabilize by the third post-injury season, consistent with findings from other professional soccer leagues.

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

Methods: The MLS Injury Surveillance database was queried for ACL injuries from 2010 to 2021. Player characteristics, injury characteristics, and performance metrics were collected for 132 players with ACL injuries and compared with 396 uninjured controls matched by age, position, and seasons played. The injured cohort was divided into 2 groups: 2010-2015 and 2016-2021 to compare changes in RTP times, performance outcomes, and trends over time. RTP was defined as participation in at least 1 MLS match after injury. Statistical analyses, including the chi-square and t tests, were performed to evaluate differences between the 2 time periods and matched controls, with significance set at P < .05.

Results: RTP time decreased significantly from 269.6 days (2009-2015) to 219 days (2016-2021) (P = .044). Forwards experienced significant performance declines starting in the third post-injury year, with reductions in goals scored, minutes played, and offsides (P < .05). Midfielders showed improved performance in goals scored by the third post-injury year, while defenders exhibited recovery by the second year, with no significant long-term performance deficits.

Conclusion: Our study demonstrated that while overall RTP times have improved, position-specific performance outcomes vary significantly, with forwards exhibiting long-term deficits compared with midfielders and defenders. These findings suggest that position-specific rehabilitation protocols may be beneficial for athlete education in RTP and for potential prevention strategies.

Background: Individuals with unilateral chronic ankle instability (CAI) exhibit bilateral sensorimotor deficits, but whether these deficits contribute to bilateral biomechanical abnormalities remains unclear.

Purpose: To evaluate bilateral ankle biomechanics in individuals with CAI during unanticipated jumps.

Study design: Controlled laboratory study.

Methods: Eighteen individuals with unilateral CAI and 18 healthy controls were recruited to perform unanticipated jumps. Kinematic and kinetic data from both ankles during unanticipated jumps were simultaneously collected using an infrared high-speed motion capture system (T40, 200 Hz; Vicon) and 3-dimensional force platforms (1000 Hz; Kistler). The interactions and main effects were analyzed by statistical parametric mapping with 2-way repeated measures analysis of variance.

Results: The injured side of CAI exhibited greater ankle plantarflexion (9.5%-36.7%; P = .01) and inversion (0%-8.7%; P = .033) angles, vertical ground-reaction force (0%-2.8% [P = .045]; 18.6%-30% [P = .013]), and smaller eversion moment (93.4%-100%; P = .035). Additionally, the uninjured side of CAI showed lower ankle dorsiflexion (41.8%-100%; P = .01) and eversion (56%-70%; P = .025) angles and moment (3.6%-40% [P = .002]; 92.1%-100% [P = .044]) but higher vertical ground-reaction force (0%-1.8%; P = .049).

Conclusions: The study showed that the injured and uninjured sides of CAI demonstrate biomechanical characteristics associated with increased risk of ankle sprain, suggesting that management strategies should target both ankles. These findings may help in understanding and preventing ankle sprains. Further studies are needed to identify these risks.

Clinical relevance: Unilateral CAI may elevate the risk of ankle sprains bilaterally.

Background: Anterior cruciate ligament (ACL) injuries are prevalent among elite athletes, particularly in high-impact sports. While ACL reconstruction (ACLR) is the gold-standard treatment, graft failure rates can exceed 30% in high-risk populations. Moreover, associated meniscal injuries often necessitate secondary surgical interventions. Implementing a systematic surgical approach, including advanced meniscal repair techniques and lateral extra-articular procedures, may enhance outcomes and reduce reoperation rates.

Purpose/hypothesis: This study aimed to assess the effect of a systematic approach to ACLR on secondary surgery rates and ACL graft survival among professional athletes. It was hypothesized that this approach would significantly reduce secondary surgeries and ACL graft failures.

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

Methods: A retrospective analysis of data from the SANTI database, focusing on professional athletes who underwent primary ACLR performed by a single senior surgeon between 2003 and 2020, was performed. Patients were categorized into 2 groups: those before October 2012 and those treated after the introduction of a systematic surgical approach. Primary outcomes included ACL graft rupture rates and secondary surgery rates (meniscectomy and revision ACLR). Cox proportional hazards models were used to evaluate risk factors.

Results: The final cohort comprised 342 patients, with 130 treated before October 2012 and 212 after the introduction of a systematic protocol. Athletes treated after October 2012 exhibited a significantly lower rate of secondary surgery (30.0% before vs 16.5% after, P = .0174) and reduced ACL graft rupture rates (13.1% before vs 6.6% after, P = .0039). The 7-year graft survival rate improved from 86.9% before October 2012 to 93.3% after that month. Notably, younger athletes (<21 years) had an elevated risk of reoperation (hazard ratio, 2.090) and graft failure (hazard ratio, 2.224). The systematic approach also led to a significant reduction in the rate of secondary medial meniscectomy (10.8% vs 3.3%, P = .0052).

Conclusion: A systematic approach to ACLR significantly reduced secondary surgeries and graft failure rates in elite athletes. These findings support the routine use of advanced meniscal repair techniques and lateral extra-articular procedures to enhance long-term outcomes.

Background: Multiple prospective cohort studies have consistently shown a strong association between cam morphology and the development of hip osteoarthritis. However, associated factors of primary cam morphology (PCM) in the general adolescent population remain largely unexplored.

Purpose: To investigate associated factors of the presence of PCM and increased alpha angle in early adolescents from the general population.

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

Methods: The authors included 4477 participants with high-resolution dual-energy x-ray absorptiometry scans of the right hip from the population-based Generation R cohort in Rotterdam, the Netherlands. The alpha angle was automatically measured using validated methods. PCM was defined as an alpha angle ≥60°. The authors used multivariable logistic and linear regression models to investigate factors (demographic, anthropometric, and lifestyle factors and proximal femoral physis status) associated with PCM and increased alpha angle, respectively.

Results: Of the included participants (median age, 13.5 years [2.5th-97.5th percentile, 13.2-14.6]; 51.6% female, 73.7% European), 151 (3.4%) had PCM. Male sex (adjusted odds ratio [aOR], 2.56; 95% CI, 1.62-4.04) and closed proximal femoral physis (aOR 3.28; 95% CI, 2.05-5.24) were associated with higher odds of PCM, whereas underweight (aOR 0.42; 95% CI, 0.18-0.97) was associated with lower odds of PCM. Factors associated with increased alpha angle included male sex (β coefficient, 2.99; 95% CI, 2.40-3.58), closed proximal femoral physis (β coefficient, 1.22; 95% CI, 0.61-1.82), cutting sport type (β coefficient, 1.07; 95% CI, 0.30-1.85), overweight (β coefficient, 0.89; 95% CI, 0.22-1.55), and obesity (β coefficient, 1.81; 95% CI, 0.57-3.04). Ethnicity and physical activity frequency were not associated with PCM or increased alpha angle.

Conclusion: Among Dutch early adolescents, male sex and proximal femoral physis closure were associated factors of PCM and increased alpha angle, while cutting sport type, overweight, and obesity were modifiable factors of increased alpha angle. These findings could inform potential primary prevention strategies for PCM.

Background: Hip arthroscopy is a common surgical treatment method for femoroacetabular impingement syndrome (FAIS) and typically involves labral repair. Suture limbs can either be placed around (circumferential repair technique) or through (labral base refixation [LBR] technique) the labrum; however, there remains a lack of consensus regarding the superiority of either technique.

Purpose: To evaluate and narratively synthesize the available evidence on patient-reported outcome measure (PROM) scores of LBR and circumferential repair in patients undergoing hip arthroscopy and labral repair for FAIS.

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

Methods: A systematic electronic search of MEDLINE, Embase, and the Cochrane Library was carried out on July 21, 2024. All English-language randomized controlled trials, comparative studies, and case series on adults with symptomatic FAIS were eligible for inclusion.

Results: A total of 12 studies with 1488 patients were included in the analysis. Overall, 9 cohorts with 1035 patients and a mean age of 33.1 years were included in the circumferential repair group, and 6 cohorts with 453 patients and a mean age of 32.3 years were included in the LBR group.Both the circumferential repair and LBR techniques were associated with significant improvements on PROMs, including the mHHS (modified Harris Hip Score), HOS-ADL (Hip Outcome Score-Activities of Daily Living), HOS-SSS (Hip Outcome Score-Sports-Specific Subscale), NAHS (Non-Arthritic Hip Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and VAS (visual analog scale). Postoperative scores were commonly >80 points across measures, with mean improvements of 20 to 30 points in function and 2 to 4 points in pain. Reported rates of revision surgery and conversion to total hip arthroplasty were low across both techniques, generally <10%, although some variability existed between studies.

Conclusion: Both techniques led to improved PROM scores after hip arthroscopy for the management of FAIS. Given the heterogeneity and predominance of lower level evidence, future high-quality comparative studies are warranted.

Background: While ulnar collateral ligament (UCL) injuries have been widely studied, no investigations have characterized the kinematics of acutely presenting UCL injuries or examined the pitch-by-pitch sequence leading up to ligamentous failure.

Purpose: To use Statcast pitch-tracking metrics from Major League Baseball (MLB) games to identify potential warning signs for acute UCL injury.

Study design: Retrospective case-control; Level of evidence, 3.

Methods: Seven MLB pitchers who sustained acute UCL injuries on a single pitch between 2020 and 2025 were retrospectively identified. Statcast data from the injury game and 4 prior outings were analyzed for each player. Five pitch-tracking metrics (velocity, spin rate, release extension, arm angle, and acceleration magnitude) were extracted for each pitch. For each pitcher and pitch type, a principal component model was trained on control outings; Mahalanobis distance (MD) was calculated to quantify multivariate deviation from baseline. To assess short-term variability, MD values from the 5 fastballs before injury were summed and compared with control-derived thresholds. Pitch-to-pitch trends in MD and individual features were analyzed for progressive changes. Matched controls were selected according to age, handedness, starting versus relief pitcher, and season pitch count. The same process was then completed for a 5-game sample window of pitches for these matched controls. Outlier pitches and periods of elevated short-term variability were identified when MD values exceeded a 95th percentile threshold derived from each pitcher's control data; statistical significance for performance trends was set at P < .05.

Results: Principal component analysis and MD analysis revealed 3 principal findings: (1) every injury pitch was a mechanical outlier based on MD exceeding the 95th percentile of the control distribution (all P < .05), (2) velocity was suppressed by a mean of 2.1 SD and arm angle reduced by a mean of 1.5 SD at the injury pitch, and (3) 86% of pitchers (6 of 7) showed elevated cumulative deviation across the 5 fastballs preceding injury, compared with 7% of matched controls (1 of 14) (P < .001).

Conclusion: This study demonstrated that acute UCL injuries in MLB pitchers are often preceded by identifiable changes in key pitch-tracking metrics. Rather than a prolonged deterioration across outings, acute UCL failure may reflect a distinct biomechanical pattern marked by short-term variability and abrupt decompensation within the injury game. These findings provide the first pitch-level characterization of UCL failure and may support future in-game risk-monitoring strategies. However, future studies are needed to help understand these warning signs and prevent UCL injury.

Background: Elbow stiffness is a condition that causes mobility dysfunction and severe suffering in patients. Patients with posttraumatic elbow stiffness who undergo open elbow arthrolysis are at risk for poor postoperative flexion-extension outcome, which leads us to suspect that these patients possess a unique "elbow stiffness predisposition."

Purpose: To develop an innovative predictive model that combines clinical and laboratory indicators to forecast poor flexion-extension outcomes after open elbow arthrolysis, thereby interpreting the "elbow stiffness predisposition."

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

Methods: Patients who underwent open elbow arthrolysis between 2019 and 2022 were selected for model training and validation (n = 254), while those who underwent open elbow arthrolysis between 2016 and 2017 served as a test set (n = 35). The study assessed 19 clinical features and 58 laboratory parameters. A comparative analysis of several machine learning models-logistic regression, Naive Bayes, decision trees, random forest, gradient boosting, and XGBoost-was performed to identify the most effective approach. SHapley Additive exPlanations (SHAP) were employed to prioritize the key factors.

Results: Using univariate analysis and the least absolute shrinkage and selection operator (LASSO) regression, 14 key variables were selected for inclusion in the model. The XGBoost model demonstrated superior performance, reaching an area under the curve of 0.909 on the test dataset. The most important indicator identified by LASSO was alkaline phosphatase. Indicators ranked by SHAP were lipoprotein(a), alkaline phosphatase, visual analog scale score, serum calcium, basophil count, serum sodium, previous arthrolysis, alanine aminotransferase, blood glucose, preoperative elbow range of motion, Cystatin C, uric acid, tobacco use, and serum cholinesterase.

Conclusion: We have successfully developed a machine learning model using 14 key indicators to predict poor flexion-extension outcomes, which preliminarily explains the "elbow stiffness predisposition."

Background: Renewed interest in anterior cruciate ligament (ACL) preservation has led to increased focus on tear location within the knee joint in treatment decisions, with primary ACL repair reserved for proximal tears. Retrospective studies have reported varying tear locations in adults when assessed on magnetic resonance imaging (MRI), with few studies comparing tear location on MRI versus intraoperative findings.

Purpose: To prospectively determine the distribution of ACL tear location assessed on MRI versus intraoperative evaluation to test the hypothesis that <15% of ACL tears are proximal type avulsions.

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

Methods: A total of 174 patients with clinically confirmed full-thickness ACL tears between August 2022 and March 2024 were identified and enrolled. Patients with partial tears, chronic injuries, recurrent ACL tears, or multiligamentous injuries were excluded. ACL tear locations were classified on preoperative MRI and intraoperatively using the modified Sherman classification. Patient demographic characteristics, injury mechanism, and surgical details were recorded. Analysis of variance and chi-square and Fisher exact tests were used for analysis, with significance set at P < .05.

Results: ACL tear location based on MRI was as follows: 9.8% type I, 22.4% type II, 67.2% type III, and 0.60% type IV, with no type V tears. Arthroscopic tear location distribution was as follows: 26.4% type I (proximal avulsion), 44.8% type II (proximal), 25.8% type III (midsubstance), and 3.4% type IV (distal), with no type V tears. There was 43% agreement between arthroscopic and MRI evaluation overall, with 95.5% agreement when classifying type III tears. Type I tears were more common in older patients, whereas type III tears were more common in younger patients. No significant correlations were appreciated based on patient sex, body mass index, or injury mechanism.

Conclusion: Poor agreement was found between imaging and arthroscopic assessment of ACL tear location, as MRI predicted intraoperative ACL tear location in less than half of cases. However, very good agreement was noted when classifying type III tears. Tear pattern was associated with patient age, with more type I tears in older patients and more type III tears in younger patients.

Background: Meniscal replacement aims to restore function and delay joint degeneration in patients with symptomatic meniscus deficiency; nonetheless, comparative evidence among different implant options-meniscal allograft transplantation (MAT), collagen meniscus implant (CMI), and polyurethane scaffolds-remains limited.

Purpose: To systematically review and compare the clinical outcomes of MAT, CMI, and Actifit (polyurethane scaffold).

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

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a standardized search and review strategy was employed to identify clinical evidence of any designation examining clinical outcomes and implant-associated adverse events after meniscal replacement with specified implants. Effect sizes were calculated via standardized mean deviations and illustrated through forest plots to compare against the minimal clinically important difference (MCID) for relevant patient-reported outcome measures. The primary outcomes were clinically significant improvements in functional status and pain relief. Secondary outcomes included failure rates, reoperations, and other reported adverse events, as well as indirect evidence of chondroprotection.

Results: A total of 50 studies were included. All 3 implant types yielded statistically significant functional improvements (all reported P < .05), with scores such as the International Knee Documentation Committee and the Lysholm often exceeding the MCID. However, pain relief was inconsistent and frequently failed to achieve the MCID. Failure rates differed markedly among implants, with the mean failure rate being lowest for CMI (5.2%), highest for Actifit (15.9%), and intermediate for MAT (11.4%). Radiological evidence indicated a potential chondroprotective effect; nevertheless, it was not conclusive.

Conclusion: Meniscal replacement effectively improves patient function, but pain relief is unreliable, and failure risks vary by implant type. The current evidence is insufficient to definitively recommend one implant over another. Clinical decisions must be individualized, considering patient-specific factors, concomitant pathologies, and the unique risk profile of each implant. High-quality, head-to-head randomized controlled trials are urgently needed.

Background: The success of anterior cruciate ligament (ACL) reconstruction is influenced by precise anatomic knowledge, which may vary across populations. Despite extensive research on ACL anatomy, direct comparisons between Asian and Western populations remain unexplored.

Purpose/hypothesis: The purpose of this study is to systematically compare the footprint size and location of ACL and its individual bundles in Asian and Western populations. It was hypothesized that the ACL footprint size and location of the Asian population would differ from those in the Western population.

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

Methods: A systematic review and single-arm meta-analysis were conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies on ACL footprint anatomy were included and stratified into subgroups based on the origin of the data (Asian or Western regions). Meta-analyses were performed for femoral and tibial footprint locations of the entire ACL and its anteromedial and posterolateral bundles. The ACL femoral and tibial footprint areas were also compared. Statistical heterogeneity was assessed using a random-effects model.

Results: A total of 50 studies with 1652 knees were included in the meta-analysis, with 25 studies per subgroup.The center of the ACL femoral footprint was located at 35.2% and 27.3% from the posterior edge of the lateral femoral condyle in the Asian and Western subgroups, respectively (P < .001), and 39.4% and 33% from the Blumensaat line, respectively (P = .049). The Asian subgroup exhibited smaller femoral footprint areas (96.3 mm² [95% CI, 81.1-111.4] vs 126.8 mm² [95% CI, 103.5-150]; P = .03). No significant difference was found in the tibial footprint location or size.

Conclusion: This meta-analysis demonstrated that the ACL femoral footprint in the Asian population is located more anteriorly and distally than in the Western population, and the femoral footprint size is smaller. These findings provide valuable insights for population-specific surgical strategies in the future.