Orthopaedic Journal of Sports Medicine最新文献

Background: Ulnar collateral ligament reconstruction (UCLR) is a common elbow procedure in baseball pitchers. Previous studies of Major League Baseball pitchers identified the weather as a potential risk factor, as warmer climates enable more annual playing time and increase overuse injury risks.

Purpose: To determine whether weather conditions play a role in UCLR rates and timing for National Collegiate Athletic Association (NCAA) Division I (D1) collegiate pitchers in the United States.

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

Methods: A total of 320 NCAA D1 college baseball pitchers who underwent UCLR surgery between July 1, 2015, and June 30, 2022, were analyzed. Pitcher college climates were categorized as warm or cold based on their location relative to the 33rd parallel line in North America. A 2-sample independent t test was used to compare the mean UCLR rate for pitchers in warm versus cold climates. The incidence rate difference and incidence rate ratios by state and pitcher year were calculated and evaluated. The chi-square test and Poisson Regression were used to evaluate associations between pitcher year and high school pitching climate.

Results: Among 320 total UCLRs, warm-state pitchers had a higher mean UCLR rate compared with cold-state pitchers (P = .0001). The highest number of UCLRs in warm states occurred during the sophomore year (n = 57), while the highest number of UCLRs in cold states occurred during the junior year (n = 63). Freshmen, sophomore, and senior warm state pitchers had significantly higher (incidence rate ratios [IRR] and incidence rate difference [IRD]) rates and likelihood of UCLR than their cold state counterparts (freshmen P _IRD = .0025, P _IRR = .0032; sophomore: P _IRD = .0002, P _IRR = .0003, senior: P _IRD = .0123, P _IRR = .0159). Underclassmen (freshmen and sophomores) pitchers who threw in warm high school climates had a 1.4 times higher rate of UCLRs than underclassmen pitchers from cold high school climates (P = .041).

Conclusion: NCAA D1 college baseball pitchers who play in warm climates undergo UCLR surgery significantly more often and significantly earlier in their collegiate careers than pitchers playing in cold climates.

Background: Acetabular subchondral cysts are commonly identified signs of joint degeneration and arthritis. This pathology is generally considered a relative contraindication for hip preservation surgery.

Purpose: To investigate the effect of arthroscopic bone grafting for the treatment of acetabular subchondral cysts.

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

Methods: We completed a retrospective analysis of hip arthroscopies performed by the senior author between 2013 and 2021. Patients with radiologic evidence of acetabular cysts who underwent arthroscopic bone grafting, with or without subsequent periacetabular osteotomy (PAO) and/or derotational femoral osteotomy with a minimum of 2-year follow-up, were included in the analysis. Patients undergoing surgical treatment for diagnoses of slipped capital femoral epiphysis, Legg-Calves-Perthe disease, osteochondromatosis, or postdislocation syndrome, as well as patients who refused to participate in the study, were excluded. We compared the patient-reported outcomes (PROs) for patients who underwent arthroscopic bone grafting with a case-matched control group without acetabular cysts with the same surgical route (hip arthroscopy or hip arthroscopy followed by PAO). An "inside-out" arthroscopic bone grafting technique was utilized, which allowed for precise access to the cystic cavity through the articular side. We analyzed postoperative PROs at a minimum of 2 years postoperatively using the international Hip Outcome Tool (iHOT-12) and Nonarthritic Hip Score (NAHS).

Results: In total, there were 44 hips in the experimental group and 78 hips in the control group. The mean PRO interval in the experimental group was 3.4 years (range, 2-5 years postoperatively), with 20 patients reaching PROs 5 years postoperatively. The experimental group reported significant improvement of iHOT-12 and NAHS scores postoperatively (both P < .001). Postoperative iHOT-12 and NAHS scores did not significantly differ between groups over a 5-year follow-up interval (P = .26 and .17, respectively). Radiographic evidence of cyst healing was achieved in all 7 patients who underwent postoperative magnetic resonance imaging, with 3 cases of complete resolution.

Conclusion: Acetabular subchondral cysts treated with an inside-out method of arthroscopic bone grafting in the setting of hip preservation surgery with or without PAO was associated with a significant improvement in midterm PROs, comparable with a control group of patients without acetabular cysts who did not undergo bone grafting. Our results support the use of arthroscopic grafting in appropriately selected patients and suggest that hip preservation is not contraindicated in patients with acetabular subchondral cysts.

Background: Magnetic resonance imaging (MRI) measurement parameters-the standard noninvasive diagnostic method for rotator cuff tears (RCTs)-have been used to compare groups with and without RCTs. Arthroscopy is used in definitive diagnosis and treatment.

Purposes: To evaluate the association between RCT and shoulder angles and distances on MRI in patients with and without arthroscopically validated RCT and to determine whether the degree of rotator cuff fatty degeneration affects the MRI measurements.

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

Methods: Shoulder measurements on MRI were compared between patients with and without RCT as confirmed by shoulder arthroscopy performed by a single surgeon between 2019 and 2024, and non-RCT patients without arthroscopic confirmation. Interobserver reliability (Fleiss kappa coefficient) was calculated for the measurements. The groups were compared using the independent t test or the Mann-Whitney U test. The RCT group was further divided according to the level of fatty degeneration (Goutallier types 0-1-2 vs types 3-4) for subanalysis.

Results: In addition to the 368 RCT and 55 non-RCT patients with arthroscopic confirmation, there were 92 non-RCT patients without arthroscopic confirmation. The sagittal acromiohumeral interval (AHI) (8.32 vs 9.24 mm), coronal AHI (7.87 vs 8.96 mm), and coronal AHI/glenoid height ratio (22.63% vs 24.88%) were significantly lower in the patients with RCT (P < .001, P < .001, and P = .001, respectively). In contrast, the critical shoulder angle (CSA) (33.17° vs 31.92°) and the glenoid width/humeral head coverage ratio (57.52% vs 55.7%) were significantly higher in the patients with RCT (P = .037 and P = .017, respectively). Higher rotator cuff fatty degeneration levels (Goutallier types 3-4) further increased these differences within the patients with RCT (P < .001 for all). When the arthroscopically validated and nonvalidated non-RCT patients were compared, coronal AHI and AHI/glenoid height ratio values were found to be significantly lower in the nonvalidated group (P = .034 and P = .047, respectively).

Conclusion: In this study, RCT was associated with decreased sagittal AHI, coronal AHI, and coronal AHI/glenoid height ratios and increased CSA and glenoid width/humeral head coverage ratios.

Background: While glenoid bone loss (GBL) after anterior shoulder instability correlates with poor functional outcomes, the specific effects of GBL in posterior and combined-type shoulder instability remain poorly characterized, especially in a high-risk military population.

Purpose/hypothesis: The purpose of this study was to compare GBL between unidirectional anterior or posterior instability versus combined-type instability in active-duty servicemembers. It was hypothesized that total GBL and GBL in the direction of instability would be greater in those with combined-type instability compared with unidirectional instability.

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

Methods: Active-duty servicemembers who underwent shoulder stabilization surgery between January 2010 and December 2019 were eligible for inclusion. Patients with multidirectional instability, concomitant rotator cuff tears, osteochondritis dissecans of the glenoid or humeral head, superior labral anterior-posterior tears, biceps pathologies, and humeral avulsion of the glenohumeral ligament were excluded. Patients were grouped according to direction of instability (anterior, posterior, or combined), and patient characteristics, instability characteristics, suture anchor use, and GBL were compared between the 3 cohorts.

Results: In total, 117 patients met the study inclusion criteria. The mean patient age was 29 years, 89.7% were male, the dominant extremity was involved in 63.2%, 65.8% attributed their injuries to a singular traumatic event, and the mean follow-up was 7.9 years. There was no significant difference regarding patient characteristics, injury mechanism, or follow-up time between the 3 cohorts. As compared with the combined-type instability cohort, mean anterior GBL was greater in the anterior instability cohort (8.00% ± 4.40% vs 4.98% ± 5.26% for combined; P = .012), while mean posterior GBL was greater in the posterior instability cohort (7.44% ± 4.54% vs 4.86% ± 5.69% for combined; P = .024). There was no significant difference in mean total GBL between the combined-type (9.84% ± 7.82%) and either of the unidirectional cohorts (anterior: 8.00% ± 4.40% [P = .231]; posterior: 7.44% ± 4.54% [P = .082]).

Conclusion: GBL in the direction of instability was found to be significantly greater in the unidirectional versus combined-type instability cohorts.

Background: Functional recovery and return to sports after fixation of osteochondritis dissecans (OCD) lesions of the knee with osteochondral autologous transplantation (OAT) have not been well investigated.

Purpose: To retrospectively evaluate the functional recovery and clinical outcomes after internal fixation with OAT for knee OCD.

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

Methods: A consecutive series of patients who underwent OAT for OCD lesions between 2010 and 2020 were initially enrolled in the study. Patients with adult-onset OCD and those who underwent fragment removal and/or mosaicplasty were excluded. Lysholm score, Tegner activity scale, return-to-sports rate (at the practice/training and preinjury levels), and time to return were evaluated. Clinical factors influencing postoperative functional recovery were analyzed.

Results: Included were 24 patients (26 knees); there were 23 male and 1 female patients, with a mean age of 14.7 years. The mean follow-up period was 27.6 months. A total of 17 lesions were located in the medial femoral condyle and 9 in the lateral femoral condyle. The mean Tegner score was 7.0 preoperatively and 6.5 postoperatively, with no significant difference. The return-to-sports rate was 96.2% at the practice/training level and 84.6% at the preinjury level, with an average return time of 5.1 months and 9.6 months, respectively. In a subgroup analysis of knees that returned to preinjury level (n = 22) by lesion location, there was a significant difference between knees with lesions in the lateral femoral condyle (12.9 months) versus the medial femoral condyle (8.1 months) (P = .02). The rate of return to preinjury level after primary surgery was significantly higher than after revision surgery after failed drilling (P = .02).

Conclusion: Return-to-sports rates and clinical outcomes were favorable after fixation with OAT in patients with knee OCD. A shorter time to return to sports was observed in knees with medial lesions compared with lateral lesions. Furthermore, the rate of return to sports at the preinjury level was significantly higher after primary surgery than after revision surgery after drilling.

Background: Running-related overuse injuries are common among recreational runners; however, there is currently little prospective research investigating the role of running characteristics on overuse injury development.

Purpose: To investigate the relationship between running characteristics and lower extremity musculoskeletal injury (MSKI).

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

Methods: The study included 827 incoming cadets of the class of 2020 at the United States Military Academy. Before cadet basic training, running spatiotemporal parameters (stride length, ground contact time, and cadence) were recorded for each participant, and foot-strike pattern was analyzed. Demographic data were recorded and analyzed as potential covariates. Lower extremity MSKIs sustained over the 9 weeks of cadet basic training were documented. Kaplan-Meier survival curves were estimated, with time to incident lower extremity MSKI as the primary outcome, by level of the independent predictor variables. Risk factors or potential covariates were carried forward into multivariate Cox proportional hazards regression models.

Results: Approximately 18.1% of participants incurred a lower extremity MSKI resulting in ≥3 days of activity limitation during cadet basic training. Univariate analysis indicated that participants with the shortest stride length (<133.0 cm) were 39% more likely to incur any lower extremity MSKI and 45% more likely to incur an overuse MSKI than those with the longest stride length (>158.5 cm), and that participants with the longest ground contact time (>0.42 seconds) were twice as likely to incur any MSKI than those with the shortest contact time (<0.28 seconds). After adjusting for sex, weekly distance running 3 months before cadet basic training, and history of injury, multivariate regression analysis indicated that participants with the longest contact times were significantly more likely to incur overuse lower extremity MSKI than those with the shortest contact times (hazard ratio, 2.15; 95% CI, 1.06-4.37). There was no significant difference in risk of MSKI associated with foot-strike pattern or cadence.

Conclusion: Study participants running with the longest ground contact times were 2.15 times more likely to incur an overuse lower extremity MSKI during cadet basic training than those with the shortest contact times. Also, study participants with the shortest stride length were 45% more likely to incur an overuse MSKI than those with the longest stride length.

Background: Additional anterolateral ligament (ALL) reconstruction has been associated with improved clinical outcomes and reduced failure rates in anterior cruciate ligament (ACL) reconstruction. Despite the excellent clinical results reported, there is still a heated debate about its indications. Currently, the indications are mainly based on the patient's clinical criteria and not the imaging diagnosis of the injury of this ligament.

Purpose: To compare the clinical outcomes of patients undergoing isolated ACL reconstruction and combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion.

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

Methods: A retrospective analysis of prospectively collected data was performed. Patients undergoing primary ACL reconstruction between January 2017 and January 2022 were included. Patients were excluded if they had a previous history of ipsilateral knee surgery or if they underwent other concomitant procedures, including multiligament reconstruction surgery or osteotomy. The decision to perform an ALL reconstruction in addition to isolated ACL reconstruction was based on ultrasound diagnosis of this lesion. At the end of the study period, further knee injury and any other reoperations or complications were recorded and compared between patients who had isolated ACL reconstruction (no-ALLR group) and combined ACL and ALL. Propensity score matching was performed between groups. A multivariable analysis using the penalized Cox model was performed to explore the relationship between the graft rupture, surgical procedure type, and potential explanatory variables.

Results: A total of 339 patients met the predefined eligibility criteria; 146 ACL reconstructions were performed in an isolated manner (no-ALLR group) and 193 were combined with ALL (ALLR group). After matching, 130 patients were allocated to each group. The mean follow-up was 36.7 months. The overall graft failure rate was 4.6% (6.9% in the no-ALLR group and 2.3% in the ALLR group; P = .076). The adjusted Cox regression showed that graft failure rate was nonsignificantly different between the groups (adjusted hazard ratio [HR], 0.36 [95% CI, 0.096-1.364]; P = .133). Younger age (≤20 years) was associated with graft failure (adjusted HR, 0.29 [95% CI, 0.121-0.719]; P = .007).

Conclusion: Combined ACL and ALL reconstruction conditioned to intraoperative ultrasound-guided diagnosis of the ALL lesion has an equivalent ACL graft failure rate to isolated ACL. Intraoperative ultrasound diagnosis of an ALL injury may be an indication for the addition of an ALL reconstruction.

Background: Graft selection is an important part of preoperative planning for anterior cruciate ligament reconstruction (ACLR). In addition, ACLR with the remnant preservation technique has recently gained attention due to potential benefit in bone-tendon healing, graft revascularization, and proprioceptive nerve remodeling. However, the ideal graft choice remains controversial, and there is limited research comparing autograft and allograft in ACLR with remnant preservation.

Purpose: To compare knee muscle strength, neuromuscular control, and patient-reported outcomes between hamstring (HS) tendon autografts and tibialis anterior (TA) allografts in patients undergoing ACLR with remnant preservation through posterior transseptal portal for >1 year.

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

Methods: A total of 70 patients who underwent ACLR with remnant preservation between 2018 and 2021 using HS tendon autograft (n = 35) or TA allograft (n = 35) were analyzed at 3 different time points (preoperative, 6 months, and 12 months). Quadriceps and HS muscle strengths were measured with an isokinetic device. Proprioception was evaluated with reproduction of passive positioning for joint position sense and overall stability index (OSI) for dynamic postural stability. Patient-reported outcomes included the Lysholm score and the International Knee Documentation Committee score.

Results: There were no significant differences in demographic information including age, body mass index, concomitant meniscal injuries, and sports activities (P > .05) between HS tendon autograft and TA allograft groups. Quadriceps and HS strength in both groups, HS strength in deep knee flexion in both groups, and OSI in the HS tendon autograft group significantly improved at 12 months (P < .05). Repeated-measures analysis of variance revealed significant interactions between time and grafts for OSI (F[2, 136] = 5.08; P = .007). The subsequent independent t test demonstrated that the OSI was significantly higher in the TA allograft group (2.7 ± 1.0) than that of the HS tendon autograft group (2.1 ± 0.8) at 12 months (P = .009), indicating better dynamic postural stability in the HS tendon autograft group.

Conclusion: No significant differences were found in knee muscle strength or patient-reported outcomes between HS tendon autograft and TA allograft after ACLR with remnant preservation for up to 1 year except for dynamic postural stability favoring HS tendon autograft.

Background: Superior labrum anterior-posterior (SLAP) lesions are common shoulder injuries. The 10-type classification system has been widely used to diagnose SLAP lesions since it was proposed. However, growing evidence from arthroscopic studies indicates the existence of many SLAP lesions, especially those associated with superior glenoid humeral ligament (SGHL) injuries, that were not included in the initial classification.

Purpose: To introduce a SLAP classification associated with SGHL injury based on arthroscopic views and discuss the injury mechanism and corresponding treatment options.

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

Methods: Patients with SLAP lesions who underwent shoulder arthroscopic surgical treatment between June 2011 and January 2017 in 6 level 1 centers were evaluated in this study. Preoperative radiographs and magnetic resonance imaging scans were used to diagnose SLAP lesions, and arthroscopic views from the standard posterior portal were recorded. The traditional 10-type classification system for SLAP was used to classify these cases. A classification method for SLAP lesions associated with SGHL injury was introduced. This classification system was investigated by 4 observers to evaluate inter- and intraobserver reliability (kappa coefficient [κ]).

Results: A total of 828 patients were included in this analysis; 61 patients (7.4%) could not be classified by the 10-type traditional classification, and 44 patients (5.3%) had SGHL lesions. A novel classification for 3 subtypes of SLAP with SGHL lesions was introduced. The mean κ value of the interobserver reliability for the classification approach was 0.796 (range, 0.678-0.854), indicating substantial agreement. The mean κ value for the intraobserver reliability was 0.883 (range, 0.779-0.964), indicating excellent agreement.

Conclusion: This study demonstrated a novel classification system for SLAP lesions associated with SGHL injury by introducing a series of cases with characteristics that showed high inter- and intraobserver reliability. Such cases have not been reported before, and the classification correlates with surgical treatment. This classification may be used as a supplement to the traditional 10-type classification.

Background: Previous studies have demonstrated that lateral meniscal allograft transplantation (MAT) through medial arthrotomy showed less extrusion than that of the lateral arthrotomy. However, there is a paucity of literature reporting clinical and radiological outcomes after lateral MAT through the medial arthrotomy.

Hypothesis: Lateral MAT through a medial arthrotomy would show significantly improved clinical scores and minimal joint space narrowing compared with preoperative status.

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

Methods: Between 2001 and 2019, a retrospective chart review was conducted for all patients who underwent lateral MAT using the bony bridge technique through medial arthrotomy. Inclusion criteria were patients who underwent lateral MAT after subtotal or total meniscectomy of the lateral meniscus. A total of 27 patients who were not followed up for >4 years or had follow-up magnetic resonance imaging after surgery were excluded. At final follow-up, Lysholm scores and Tegner activity scale scores were collected. Graft extrusion, trough angle, and position of the bony bridge were measured by magnetic resonance imaging at 6 months after MAT. Joint space width (JSW) of the lateral compartment on Rosenberg view was measured and compared preoperatively and at follow-up.

Results: A total of 28 patients were included in this study. Their mean age was 29.8 years (range, 15-48 years) with a mean follow-up of 11.4 years. Preoperative Lysholm scores and Tegner activity scale scores (66.5 ± 16.6 and 3.1 ± 1.9, respectively) significantly improved at follow-up (84.8 ± 11.1 [P < .001] and 4.4 ± 1.5 [P = .008], respectively). The JSW decreased from 6.2 ± 1.6 mm to 5.7 ± 1.4 mm (P = .014). Extrusion was 2.2 ± 1.5 mm, and trough angle was 1.5°± 8.9°. The bony bridge was positioned at 43.9% ± 4.3% from the lateral edge on the entire tibial plateau. Nine patients (32.1%) underwent subsequent procedures. Partial meniscectomies were performed in 2 patients, meniscal repairs in 2, manipulation under anesthesia in 1, and lateral capsular plication in 1. Three patients who underwent total meniscectomy or revision surgery were regarded as having a failure; therefore, 89.3% grafts survived.

Conclusion: Lateral MAT through the medial arthrotomy demonstrated satisfactory clinical and radiological outcomes at long-term follow-up.