Orthopaedic Journal of Sports Medicine最新文献

Background: Partial-thickness subscapularis (SSC) tears are frequently underdiagnosed due to subtle clinical presentation and the limited sensitivity of routine imaging modalities, particularly magnetic resonance imaging (MRI). Dynamic ultrasonography (USG) and structured test combinations may improve early detection.

Purpose/hypothesis: The purpose of this study is to compare the diagnostic accuracy of individual SSC-specific clinical tests, systematic 3-test combinations, USG, and MRI in detecting partial-thickness SSC tears, using arthroscopy as the reference standard. It was hypothesized that structured 3-test combinations and dynamic USG would outperform MRI in detecting partial SSC tears.

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

Methods: A total of 46 patients undergoing arthroscopy for rotator cuff pathology were prospectively assessed using 6 SSC-specific clinical tests, dynamic USG, and standardized MRI sequences. Two independent, blinded observers evaluated all diagnostic modalities. All clinically relevant 3-test combinations were systematically analyzed and considered positive when ≥2 tests were positive. Diagnostic performance metrics-including sensitivity, specificity, accuracy, area under the curve (AUC), and interobserver agreement-were compared with arthroscopic findings.

Results: The triads of Bear Hug + Napoleon + internal rotation lag sign and Bear Hug + Belly Press + Napoleon demonstrated the highest clinical diagnostic accuracy (sensitivity, 83.9% [95% CI, 67.4-92.9]; specificity, 100% [95% CI, 79.6-100.0]; AUC, 0.92 [95% CI, 0.85-0.98]). USG outperformed MRI across all diagnostic metrics (sensitivity, ≤96.8% [95% CI, 83.8-99.4]; AUC, 0.92 [95% CI, 0.83-1.00]), whereas MRI showed limited sensitivity (ranging from 61.3% [95% CI, 43.8-76.3] to 67.7% [95% CI, 50.1-81.4]). Interobserver agreement was almost perfect for MRI (κ≈ 0.91) and substantial for USG (κ≈ 0.68). Diagnostic accuracy was higher for Lafosse type 2 tears, although USG and the top-performing clinical triad remained effective across both tear subtypes.

Conclusion: Dynamic USG and structured SSC-specific clinical test combinations offer superior diagnostic accuracy compared with MRI for partial SSC tears.

Background: Tibial spine fractures (TSFs) are uncommon injuries in pediatric patients, often requiring operative fixation. While complications such as arthrofibrosis and anterior cruciate ligament (ACL) insufficiency have been previously reported, the risk factors associated with unplanned reoperation remain incompletely understood.

Purpose: To identify the most common complications leading to reoperation and to evaluate associated risk factors, using a multicenter quality improvement registry.

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

Methods: A multicenter registry of operatively treated pediatric TSFs was retrospectively reviewed from July 2018 to March 2025 across 27 institutions. Grade 3 complications were defined as complications resulting in reoperation, unplanned hospitalization, or interventional radiologic procedures. Complication types, patient and injury characteristics, fixation methods, and intraoperative findings were analyzed. Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors for Clavien-Dindo grade 3 complications.

Results: A total of 532 patients were included (mean age, 12.1 years; 73.4% men). Overall, 56 patients (10.5%) underwent reoperation. The most common reasons for reoperation were stiffness (4.9%) and ACL insufficiency (3.6%). Screw fixation of TSFs was associated with a 4.5-fold increased risk of grade 3 complications compared with suture fixation (P = .009). Both suture and anchor fixation (P = .045) and longer operative times (P = .020) were also associated with higher complication rates. Meniscal or intermeniscal ligament entrapment was significantly associated with increased stiffness-related reoperation (P = .045). Patients who underwent delayed ACL reconstruction (ACLR) were older (P = .041) and more likely to have concomitant meniscal tears (P = .011) at the time of their TSF.

Conclusion: Stiffness and ACL insufficiency represented the most frequent indications for reoperation after TSF fixation. Screw fixation, meniscal entrapment, and prolonged operative time were significant predictors of reoperation. Older age and concomitant meniscal injuries increased the risk of delayed ACLR.

Background: Circumferential labral tears are characterized by complete detachment of the labrum from the glenoid rim, and studies have reported significant improvements in patient-reported outcome measures (PROMs) after arthroscopic repair. However, patients' perspectives on the meaningfulness of these outcomes remain unknown, and debate continues regarding whether circumferential tears can occur after a single instability event.

Purpose: To investigate the number of preoperative instability events in patients with circumferential tears and evaluate their clinical outcomes after arthroscopic repair according to the minimal clinically important difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) parameters.

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

Methods: This study was retrospective review of a consecutive series of patients who underwent shoulder arthroscopy for instability between February 2015 and July 2023. Patients with primary circumferential tears repaired using arthroscopic suture anchors, glenoid bone defects <13.5%, and a minimum 24-month follow-up were included. Analysis was conducted of patient demographics, clinical characteristics, and PROMs, including American Shoulder and Elbow Surgeons (ASES), Western Ontario Shoulder Instability Index (WOSI), and visual analog scale (VAS) scores. Patients who achieved the MCID, SCB, and PASS thresholds for these scores were determined.

Results: Circumferential tears were identified in 3.6% (n = 41) of 1147 patients undergoing arthroscopic procedures for shoulder instability. Of these, 31 patients (mean age, 29.5 ± 9.3 years; 90% male; mean instability events, 5.5 ± 6.9; mean follow-up, 60.4 ± 30.1 months) meeting the inclusion criteria were analyzed. Overall, 39% (n = 12) had a single instability event, with 6 participating in contact sports and 4 in overhead or throwing sports, 9 of them at a competitive level. The proportions of patients who achieved MCID, PASS, and SCB thresholds were as follows: ASES (100, 80.6, and 80.6, respectively), WOSI total (100, 90.3, and 80.6, respectively), and VAS (90.3, 87.1, and 80.6, respectively).

Conclusion: Circumferential labral tears are rare. One-third of them may occur even after a single instability event and, therefore, should be considered during clinical evaluation, regardless of the number of prior instability events. Reassuringly, most patients who underwent arthroscopic repair of circumferential tears using suture anchors achieved successful clinically meaningful outcomes at a mean follow-up of approximately 5 years.

Background: Wrestling is a high-impact sport characterized by rapid, forceful movements, posing a considerable injury risk to athletes who are often evaluated in emergency departments (EDs) across the United States. This study examines the principal mechanics, distributions, and epidemiological trends of wrestling-related injuries.

Hypothesis: (1) Upper extremity injuries would be the most common, (2) young men would be the most affected group, and (3) sprains/strains would be the most frequent diagnosis.

Study design: Descriptive epidemiology study.

Methods: Patients evaluated at US EDs for wrestling-related injuries between January 1, 2015, and December 31, 2024, were identified using the National Electronic Injury Surveillance System database. Patient characteristics, injury location, diagnosis, disposition, and mechanisms of injury were recorded. Data analysis was calculated using national estimates (NEs) and linear regression to assess trends and associations.

Results: From 2015 to 2024, US EDs reported approximately 10,508 cases (NE, 370,089) of wrestling-related visits. Of these, 88.4% involved males (NE, 326,985). Pediatric patients (≤18 years of age) accounted for the majority of injuries, accounting for 84.9% of all cases (NE, 314,166), with a mean age of 15.9 ± 6.2 years for the entire cohort. The lowest number of wrestling-related injuries occurred in 2020 (NE, 20,270), while the highest number was reported in 2024 (NE, 57,026). The most commonly injured body regions were the shoulder (15.2%; NE, 56,150) and head (13.1%; NE, 48,619). Sprains and strains represented the most frequent injury type at 27.6% (NE, 102,253).

Conclusion: This study showed that males constituted the predominant majority of ED visits from wrestling injuries, with shoulder and neck strains being the most prevalent. The significant rise in injuries from 2020 to 2024 highlights the necessity for preventative measures and heightened awareness of wrestling safety, especially in recreational environments, where occurrences are notably elevated.

Background: Insufficient tendon-bone healing remains a major cause of rotator cuff repair failure. The inability to reestablish a native-like enthesis results in scar formation and inferior mechanics. From a biomechanical standpoint, maximizing footprint contact and minimizing micromotion are critical determinants of early repair stability. Current greater tuberosity preparation techniques are primarily directed toward smoothing the footprint surface and exposing marrow elements to enhance biologic integration; however, the biomechanical consequences of deliberately controlled surface geometry on tendon fixation strength remain undefined.

Hypothesis: Controlled decortication channels, termed biogrooves, would reduce supraspinatus (SSP) tendon displacement and improve footprint contact area compared with standard double-row repair with a smooth surface.

Study design: Controlled laboratory study.

Methods: Six fresh-frozen cadaveric shoulders were acquired. The SSP of all specimens was sharply dissected from the humeral origin. Each specimen underwent a standard double-row repair on PCF-25 Sawbone blocks. Biogrooves that were 6-mm in width and isosceles cross-section were created with a high-speed conical rotary tool and were sequentially tested across 5 conditions: (1) no biogrooves, (2) one 2 mm-deep biogroove, (3) two 2 mm-deep biogrooves, (4) two 3 mm-deep biogrooves, and (5) one 3 mm-deep biogroove. Constructs were mounted on a servohydraulic testing machine and ramped to a single load of 70 N over 30 seconds. Tendon displacement was measured under tension, and ultrasound imaging assessed footprint infill. Repeated-measures analysis of variance with Bonferroni correction was used for comparisons.

Results: All biogroove conditions significantly reduced tendon displacement compared with the no-biogroove condition (P < .05). Mean displacement decreased by 19.5% with one 2-mm biogroove (P = .010), 25.4% with two 2-mm biogrooves (P = .021), 31.1% with two 3-mm biogrooves (P = .001), and 31.8% with one 3-mm biogroove (P = .005). The single 3-mm biogroove demonstrated a 14.3% reduction in displacement compared with the 2-mm biogroove (P = .0459). Ultrasound confirmed complete tendon infill across all groove conditions.

Conclusion: Biogrooves reduced SSP tendon displacement and improved footprint conformity compared with standard double-row repair in this laboratory model. Groove depth was more influential than groove number, with a single 3-mm biogroove providing as much improvement as two 3-mm biogrooves.

Clinical relevance: Biogrooves enhance the mechanical environment for biologic healing.

Background: Gymnasts, due to repetitive upper extremity weightbearing, are prone to capitellar osteochondritis dissecans (OCD) lesions, which often require surgery and result in time away from sport. Ultrasound has shown promise for detecting early, often asymptomatic, capitellar osteochondral lesions in baseball players; however, it has not been applied to young, healthy gymnasts.

Purpose: To determine the prevalence and characteristics of capitellar osteochondral abnormalities in young, high-level gymnasts.

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

Methods: This institutional review board-approved study recruited healthy gymnasts aged 10 to 19 years from local gymnastics clubs. The exclusion criteria included treatment for an upper extremity injury within the past 6 months or previous elbow surgery. Participants completed questionnaires to capture sports history and upper extremity function through patient-reported outcomes (PROs). Physical examination assessed elbow extension, valgus alignment, and ultrasound assessed humeral retrotorsion angles. Ultrasound evaluation of the medial elbow and radiocapitellar joint was performed. Comparisons were made between gymnasts with and without capitellar osteochondral abnormalities.

Results: A total of 62 elbows were evaluated in 31 gymnasts (13.7 ± 2.9 years; 80.6% women). They trained at levels 6 to elite (median, 8.57), with 8.9 ± 3.7 years of gymnastics participation. A total of 15 (24.2%) elbows (9 gymnasts) had radiocapitellar joint abnormalities. Also, 66.7% (n = 6) of gymnasts with radiocapitellar joint abnormalities had bilateral abnormalities. Visualized capitellar changes included 7 concavities of the subchondral plate (11.3%), 6 with subchondral flattening (9.7%), and 2 with division of the subchondral plate (3.2%). Capitellar changes were associated with pain with palpation of the radiocapitellar joint (P < .01) and dominant arm Single Assessment Numeric Evaluation Elbow Score (P = .02). Capitellar changes were not associated with other PROs (P > .05), gymnast level (P = .80), years in sport (P = .90), elbow extension (right, P = .45; left, P = .68), or valgus differences (right, P = .39; left, P = .22).

Conclusion: One in 4 high-level youth gymnasts demonstrated capitellar osteochondral abnormalities, often bilateral and associated with pain to palpation over the radiocapitellar joint but unrelated to function. Prospective studies are needed, but ultrasound screening may allow earlier detection of capitellar OCDs in youth gymnasts.

Background: The Major League Baseball (MLB) Health and Injury Tracking System (HITS), created in 2010 with the MLB Players Association, was designed to overcome limitations of injured list-based reporting. It serves as a longitudinal injury surveillance platform and electronic medical record across major and minor league players.

Purpose: To evaluate all publications related to the HITS database to provide an overview of epidemiology, treatment outcomes, and return-to-play (RTP) rates in professional baseball, guiding player safety and performance strategies.

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

Methods: All peer-reviewed publications utilizing the HITS database (2010-2023) were reviewed under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting epidemiology, surgical versus nonoperative management, and RTP outcomes across upper extremity, lower extremity, spine, and other injuries were synthesized.

Results: From 2011 to 2016, HITS recorded 49,955 injuries, resulting in 722,176 missed days of play. Pitchers accounted for 39% of injuries, with the upper extremity most affected (39%). Ulnar collateral ligament (UCL) injuries, while the sixth most common, represented the leading cause of surgery (46%) and season-ending injuries (60%). RTP following UCL reconstruction ranged from 73% to 84%, though outcomes declined with revision procedures. Shoulder injuries were also prevalent: labral repairs showed moderate RTP rates (74%-82%), whereas rotator cuff repair yielded poor outcomes (14%-42%), leading to preference for nonoperative care. Lower extremity injuries included hamstring strains, hip/groin injuries, and meniscal pathology, with variable RTP timelines. Core injuries, lumbar spine disorders, and concussions also contributed significantly to time lost. Overall, HITS has informed >40 publications, highlighting variable outcomes by injury type, treatment, and player position.

Conclusion: The HITS database provides the most comprehensive epidemiologic resource on injuries in professional baseball, identifying high-risk conditions and characterizing management outcomes. RTP success varies widely, with certain injuries such as UCL reconstruction yielding relatively favorable results, while others such as rotator cuff repair remain challenging.

Background: Acute traumatic patellar dislocations may cause intra-articular derangements of the knee in the setting of acute and chronic instability which may not always be appropriately identified on magnetic resonance imaging (MRI).

Purpose: To determine the rates of coexisting intra-articular pathology in patients with patellar instability requiring medial patellofemoral ligament (MPFL) reconstruction and to report discrepancies between preoperative magnetic resonance imaging (MRI) findings and diagnostic arthroscopy results.

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

Methods: Patients who underwent MPFL reconstruction at a single institution between 2010 and 2023 were identified. Operative reports and preoperative MRIs were reviewed. Records without full MRI reports as read by a radiologist or cases in which a diagnostic arthroscopy was not conducted were excluded. Intra-articular pathologies noted on MRI and confirmed by arthroscopy were documented. MRI findings were considered to be discordant from arthroscopic findings if a lesion was identified on diagnostic arthroscopy that was not present in the full MRI report and that lesion resulted in additional surgical procedures.

Results: There were 331 arthroscopic procedures conducted within the study population of 508 patients who underwent diagnostic arthroscopy at the time of their patellar stabilization procedures. These procedures included 180 loose body removals, 95 osteochondral lesions treated via a variety of interventions including open reduction and internal fixation (26 cases), particulated allograft chondral grafting (30 cases), osteochondral allograft transplantation (9 cases), and microfracture (30 cases), and 39 meniscal tears resulting in 33 partial meniscectomies and 6 meniscal repairs. Among these 508 patients, 105 (21%) demonstrated discordance of preoperative MRI and arthroscopic findings that necessitated additional procedures. This discordance was responsible for a total of 109 (33%) of the 331 arthroscopic procedures. These included 75 loose body removals, 2 osteochondral fracture fixation procedures, 2 microfractures for full-thickness cartilage loss, 16 partial meniscectomies, and 2 meniscal repairs, among others.

Conclusion: Among patients undergoing patellar stabilization, 21% had intra-articular lesions not identified on preoperative MRI detected at the time of diagnostic arthroscopy that resulted in surgical intervention. This study, representing the largest cohort to date of patellar stabilization surgeries with both MRI and arthroscopy findings, underscores the importance of diagnostic arthroscopy for improving diagnostic accuracy and addressing associated intra-articular pathology.

Background: Weight training contributes significantly to physical fitness but carries a high injury risk. Key contributors include high training frequency, insufficient recovery, and training through fatigue-often influenced by psychological factors such as exercise addiction, obsessive passion, athletic identity, and muscle dysmorphia.

Purpose/hypothesis: The purpose was to identify demographic, training, and psychological predictors of sports injuries-specifically exercise addiction, passion for exercise, athletic identity, and muscle dysmorphia-to guide injury prevention strategies among weight trainers. It was hypothesized that psychological factors such as obsessive passion, exercise addiction, athletic identity, and muscle dysmorphia are significant predictors of injury risk in weight trainers.

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

Methods: A total of 381 weight trainers (mean age 31.9 ± 8.6 years; 62.2% women) completed an online baseline survey assessing demographics, training patterns, injury history, coaching status, and psychological constructs, including obsessive passion, exercise addiction, athletic identity, and muscle dysmorphia. Sports injuries, defined as any musculoskeletal complaint from weight training or competition, were tracked biweekly from November 2023 to September 2024, and incidence was calculated per 1000 training hours. Logistic regression with backward selection was used to identify significant predictors.

Results: Over 9 months, 22.05% of participants reported 157 injuries, with an incidence rate of 1.86 injuries per 1000 training hours. Men had a slightly higher injury rate (23.61%) than women (21.9%). The most affected regions were the lower back (24.2%), shoulders/neck (20.38%), and knees (16.6%). A significant regression model (χ²(3, N = 381) = 27.4, P = .001) revealed that previous injuries increased the risk of future injury by 3.74 times. Obsessive passion and exercise addiction increased injury risk by 73% and 12%, respectively, while training with a partner reduced injury risk by 70%.

Conclusion: Our study showed that psychological factors, particularly obsessive passion and exercise addiction, significantly elevate injury risk in weight trainers. Training with a partner offers protective benefits. Injury prevention programs should incorporate psychological screening, promote rest and recovery, and encourage supportive training environments.