Orthopaedic Journal of Sports Medicine最新文献

Background: Shoulder and elbow injuries (SEIs) remain prevalent among high school (HS) baseball players. Pitching restriction (PR) policies were mandated by the National Federation of State High School Associations (NFHS) in 2016 as an injury prevention strategy to set workload limits and reduce overuse injuries. The effect of PR policies on HS baseball SEIs remains unknown.

Hypotheses: (1) SEI rates in HS baseball players would be lower in the 3 seasons after PR policy implementation when compared with the 3 seasons before PR policy implementation and (2) specific components of PR policies would be associated with statistically significant decreases in SEI rates.

Study design: Descriptive epidemiological study.

Methods: NFHS member state PR policies were obtained from publicly available websites, and components of each policy were analyzed for similarities and differences. SEI/exposure data for US HS baseball players were obtained from High School Reporting Information Online, a sports injury surveillance system. Athletic trainers reported practice and competition injury and athlete-exposure (AE) data from a national school sample during the 2013-2014 through 2018-2019 academic years.

Results: During the study period, 295 (164 shoulder, 131 elbow) injuries occurred during 1,554,708 AEs. No statistically significant changes were found in SEI rates, shoulder-specific rates, or elbow-specific injury rates after PR policy mandates were implemented. When analyzing injury rates for practices and competitions collectively, consecutive pitching day rest rules (incidence rate ratio [IRR], 0.32; 95% CI, 0.22-0.46), ≤105 pitch daily maximum (IRR, 0.40; 95% CI, 0.31-0.51), different PR policy rules for regular versus postseason (IRR, 0.43; 95% CI, 0.27-0.65), varsity versus subvarsity pitch count maximums (IRR, 0.46; 95% CI, 0.35-0.59), and ≥4 days' rest if >105 pitch count (IRR, 0.53; 95% CI, 0.42-0.68) provided protective effects against SEIs compared with PR policies without these components.

Conclusion: Specific components of PR policies rather than a national PR policy mandate were associated with significant reduction in SEI rates in HS baseball players. The presence of a consecutive pitching day rest rule and daily maximum pitch count of ≤105 pitches were associated with significant reductions in SEIs based on total (practice and competition) exposures, practice exposures, and competition exposures.

Background: Distal biceps tendon ruptures often require surgical repair to restore elbow flexion and forearm supination. However, the reinsertion procedure may be complicated by postoperative posterior interosseous nerve palsy caused by iatrogenic injury to the deep branch of the radial nerve (DBRN). While safe drilling trajectories for distal biceps tendon repair have been extensively studied, the potential influence of a bony gap between the insertion sites of the supinator muscle layers, referred to as the bare area of the proximal radius, has not been adequately addressed.

Purpose: To determine the frequency, morphometrics, and topography of the bare area and to propose a safe bicortical drilling trajectory for single-incision distal biceps tendon repair that minimizes the risk of injury to the DBRN in the context of the bare area.

Study design: Descriptive laboratory study.

Methods: A cadaveric dissection of 100 formalin-fixed upper limbs was conducted. Additionally, 1000 dry radii were examined for an osseous groove corresponding to the bare area. Furthermore, 10 fresh-frozen elbows were used for assessment of safe bicortical drilling trajectories in the presence of the bare area.

Results: The bare area was present in 56.0% of cases, with no significant side or sex predominance. The bare area was 13.7 ± 5.2 mm long and 5.1 ± 1.6 mm wide, and occupied an area of 58.7 ± 33.8 mm². Direct contact between the DBRN and the periosteum of the radius was noted in 28.6% of specimens. The extent of an osseous groove corresponding to the bare area overlapped with the radial tuberosity in 28.5% of the cases. Experimentally, bicortical drilling directed 30° ulnarly and 45° proximally ensured a safe distance from both the DBRN and the bare area.

Conclusion: The frequent occurrence of the bare area should be a critical consideration during bicortical drilling for distal biceps tendon repair. Drilling angles directed ulnarly and proximally are recommended to minimize the risk of neural injury.

Clinical relevance: This study highlights the increased risk of DBRN injury during distal biceps tendon repair in individuals with the bare area and provides safe drilling trajectories to guide surgeons in reducing the likelihood of this neural injury.

Background: Body mass index (BMI) has been commonly studied in relation to hip and knee procedures, but the effect on shoulder instability procedures is less understood. This study aims to analyze BMI's relationship to clinical outcomes and recurrence rates after shoulder instability surgery.

Hypothesis: Shoulder instability surgery in patients with elevated BMI will produce similar postoperative functional outcomes and recurrence rates to those with normal BMI.

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

Methods: This is a single-institution, retrospective study of patients who underwent operative treatment for shoulder instability and had 6 months of clinical follow-up between 2009 and 2023. Primary procedures included Bankart repair, Latarjet, distal tibial allograft, Hill-Sachs bone grafting, and remplissage. Patients were stratified into 3 cohorts by BMI: underweight or normal weight (U/NW; BMI, ≤25 kg/m²), overweight (OW; BMI, >25 to ≤30 kg/m²), and obese (BMI, >30 kg/m²). Data collected from electronic medical records included patient demographics, clinical outcomes, and functional markers.

Results: A total of 509 patients (391 male, 118 female) underwent surgery for recurrent shoulder instability. Of the total, 210 patients were normal or underweight (23 kg/m² [range, 21-24 kg/m²]), 184 patients were overweight (27 kg/m² [range, 26-28 kg/m²]), and 115 patients were obese (34 kg/m² [range, 32-38 kg/m²]). Age statistically differed across BMI cohorts at time of surgery (U/NW vs OW vs obese, 21 years [range, 18-27 years]; 24 years [range, 20-33 years]; 28 years [range, 20-35 years]; P < .001). Obese individuals had a greater depression rate, 36%, compared with 19% and 21% for U/NW and OW, respectively (P = .001). Preoperatively, the 3 cohorts statistically differed in terms of external rotation, forward elevation, and internal rotation range of motion. Obese patients had significantly lower postoperative internal rotation (T12) compared with the other cohorts (T10) (P < .001). Obese patients had an overall instability recurrence rate of 27%, compared with 16% in U/NW and 13% in OW patients (P = .33).

Conclusion: Our cohort demonstrated no significant association between obesity and outcomes of shoulder instability surgery. While the range of motion differences between the groups were statistically significant, these differences were not clinically significant and may be attributed to body habitus. Our findings suggest that shoulder instability surgery is a safe and effective procedure regardless of BMI.

Background: The implementation of the Major League Baseball (MLB) pitch clock in 2023 aimed to shorten game durations and enhance pace of play. However, concerns have been raised regarding its potential effect on pitcher health, particularly related to musculoskeletal and elbow-specific injuries.

Purpose: To determine if recent MLB pitch clock rule changes have affected total pitch counts, time to first injury, total injury time, pitches per inning, total batters faced, or total musculoskeletal injuries for the 200 highest-volume pitchers across 2 full seasons postimplementation (2023 and 2024) as compared with 2 seasons before the change (2021 and 2022).

Study design: Descriptive epidemiology study.

Methods: Pitching and injury data were collected from the MLB official website for the 2021-2024 seasons. A total of 800 high-volume pitcher-specific seasons were evaluated, representing 290 individual pitchers over the 4 seasons. The 200 highest-volume pitchers by pitch count per season were included. Outcomes included total pitches, batters faced, time to first injury, total injuries, and injury type. Statistical comparisons were made between the preimplementation (2021-2022) and postimplementation (2023-2024) periods via t tests, chi-square tests, and Cox proportional hazards modeling. An injury was defined as a musculoskeletal injury resulting in a player being placed on the injured list or missing at least 15 consecutive days of game time.

Results: The total number of injuries decreased significantly, from 50.4% in the preimplementation period to 39.3% in the postimplementation period (P = .003), and mean time to first injury increased from 142.8 days to 160.9 days (P < .001). While the number of batters faced rose significantly from 525 to 575 (P < .001), total pitches and pitches per inning remained stable. Although elbow injuries increased in 2024 after declining in 2022 and 2023, the overall rate did not significantly differ from 2021 to 2022.

Conclusion: The current study shows that after the implementation of the MLB pitch clock, injury rates among high-volume pitchers decreased and time to first injury increased, with no significant rise in elbow injuries. These findings suggest that the pitch clock has not increased short-term injury risk, although ongoing research is needed to assess its long-term effects.

Background: Osteochondral allograft (OCA) transplantation is an established surgical intervention for full-thickness chondral defects. Standard preservation (SP) protocols currently allow for OCAs to be stored for a maximum of 28 days after procurement before significant chondrocyte death. An alternative protocol, the Missouri Osteochondral Allograft Preservation System (MOPS), has been shown to allow for grafts to be stored for twice the maximum time allotment as SP.

Purpose: To compare clinical outcomes in patients who have undergone OCA transplantation utilizing the extended storage capabilities of the MOPS versus SP protocols.

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

Methods: Patients who underwent OCA transplantation from 2012 to 2018 were retrospectively identified. Patients without appropriate follow-up, postoperative outcomes, or necessary preoperative imaging were excluded. All patients had at least 2 years of follow-up data. Patient characteristics, outcomes, and graft information were compared between patients who received grafts preserved by MOPS versus SP as previously defined.

Results: In total, 64 patients were included: 25 were in the MOPS group and 39 in the SP group. Members of the MOPS group were significantly younger at the time of surgery than those in the SP group (28.6 ± 10.7 years vs 36.7 ± 10.9 years; P = .005). In total, 78 grafts were analyzed with 39 grafts in the MOPS group and 39 in the SP group. Grafts in the MOPS group had significantly longer (mean, 50.03 days) storage duration than grafts in the SP group (mean, 23.18 days) (P < .001). Preoperative patient-reported outcomes showed no statistically significant differences between the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) values, International Knee Documentation Committee (IKDC) scores, Physical Component Summary (PCS-12) scores, and Mental Component Summary (MCS-12) scores. Two-year outcome between groups showed no statistically significant differences in mean KOOS, JR values (81.4 ± 14.1 in the MOPS group vs 78.5 ± 16.2 in the SP group; P = .467), IKDC scores (74.3 ± 19.8 in the MOPS group vs 66.4 ± 18.4 in the SP group; P = .128), PCS-12 scores (48.7 ± 9.94 in the MOPS group vs 48.0 ± 9.83 in the SP group; P = .683), and MCS-12 scores (53.4 ± 8.92 in the MOPS group vs 50.6 ± 11.8 in the SP group; P = .583). There were no statistically significant differences in failure rates (20% in the MOPS group vs 17.95% in the SP group; P = .838) or complication rates (8% in the MOPS group vs 5.13% in the SP group; P = .643).

Conclusion: OCAs preserved using the MOPS can be stored at greater than twice the storage duration of grafts preserved with SP techniques without a significant difference in postoperative outcomes.

Background: There exist multiple radiographic measurements to assess patellar instability and maltracking. While originally described as a measurement predictive of patellar instability, patellar tendon-lateral trochlear ridge distance (PT-LTR) has not yet been explored as an indicative measurement of patellar maltracking in the setting of instability.

Purpose: To assess PT-LTR in patients with instability with and without concomitant malalignment to determine whether PT-LTR may be a significant measurement in patients who exhibit patellar maltracking in addition to patellar instability, as well as to explore the relationship between patellar height and tibial tubercle-trochlear groove distance (TT-TG) to PT-LTR.

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

Methods: Three groups were studied, with 30 patients included in each group: (1) patients with an anterior cruciate ligament (ACL) tear without a history of patellar instability who underwent ACL reconstruction (ACLR) (control group or ACLR group), (2) patients who underwent isolated medial patellofemoral ligament reconstruction (MPFLR) for patellofemoral instability (MPFLR group), and (3) patients who underwent combined MPFLR and tibial tubercle transfer (TTT) for patellofemoral instability (MPFLR+TTT group). Intraclass correlation coefficients (ICCs) were generated to determine level of agreement in PT-LTR measurement between raters. Appropriate statistical tests were utilized for analysis.

Results: The ICC was 0.93 for the cohort. The groups differed significantly by incidence of patella alta (Caton-Deschamps Index >1.2), in all TT-TG groupings, patella alta with TT-TG >15 mm, and patella alta with TT-TG >20 mm. The mean PT-LTR differed significantly between groups (P < .0001). Measurements for the ACLR, isolated MPFLR, and MPFLR+TTT groups were 1.15 ± 3.71 mm, 6.60 ± 6.58 mm, 12.72 ± 8.43 mm, respectively. When comparing all patients, those with patella alta, an elevated TT-TG, and a combination of both had higher PT-LTR than patients without patella alta or elevated TT-TG.

Conclusion: The mean PT-LTR was significantly higher in patients who underwent MPFLR+TTT compared with that in ACLR controls and patients who underwent isolated MPFLR. This may reflect its role as a measurement of patellar maltracking in the setting of patellar instability. PT-LTR may be a useful tool in predicting which patients with instability may benefit from a concomitant bony realignment procedure in addition to a soft tissue stabilization procedure.

Background: Quantifying glenoid bone loss (GBL) in patients with shoulder instability is essential for guiding surgical management and determining the need for bone augmentation procedures.

Purpose/hypothesis: The purpose of this study was to evaluate the diagnostic agreement and cost-effectiveness of 3-dimensional (3D) zero echo time (ZTE) magnetic resonance imaging (MRI) compared with 3D computed tomography (CT) for assessing GBL. It was hypothesized that ZTE MRI would demonstrate strong concordance with CT and serve as a cost-effective, radiation-free alternative.

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

Methods: Patients undergoing MRI with both 3D ZTE and 2-dimensional proton density fat-saturated (PD FS) sequences, as well as 3D CT of the ipsilateral shoulder, were retrospectively reviewed. Patients with recurrent instability between imaging studies were excluded. GBL was measured independently by 2 raters using the perfect-circle linear method. Interrater and intrarater reliability were assessed using intraclass correlation coefficients (ICCs). Concordance with CT was evaluated using concordance correlation coefficients (CCCs). Cost-effectiveness was preliminarily assessed using institutional imaging charges and diagnostic agreement.

Results: Eleven patients were included; 81.8% had ≥3 instability episodes. Mean GBL was 13.2% ± 9.3% (PD FS), 12.8% ± 8.9% (ZTE), and 12.7% ± 8.9% (CT). Inter- and intrarater reliability were excellent (ICC > 0.9). ZTE (CCC, 0.999; 95% CI, 0.997-0.999) and PD FS (CCC, 0.988; 95% CI, 0.974-0.994) demonstrated excellent agreement with CT. Estimated patient-billed costs were $1652 for CT + MRI, versus $1019 for either ZTE MRI or PD FS MRI alone. Corresponding institutional costs were $593 for CT + MRI and $329 for either ZTE or PD FS MRI.

Conclusion: 3D ZTE MRI is a reliable and reproducible alternative to CT for quantifying GBL in shoulder instability. With excellent diagnostic agreement, elimination of ionizing radiation, and reduced costs, ZTE MRI may serve as a single-modality solution for preoperative evaluation in select patients.

Background: Baseball players are vulnerable to stress-related injuries due to the biomechanics required to perform successfully, and stress fractures can occur via overuse. Baseball players can also sustain traumatic fractures via collision. Rib fractures are among the most common injuries of the chest in professional baseball players, yet literature is lacking regarding the characteristics of these injuries and the subsequent missed time and effect on performance.

Purpose: To evaluate in professional baseball players (1) the epidemiologic characteristics of rib fractures, (2) the differences between traumatic and stress rib fractures, (3) the effect of rib fracture on performance, and (4) the return-to-sport (RTS) time and rate after rib fracture.

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

Methods: The Major League Baseball Health and Injury Tracking System database was utilized to obtain fracture data between 2011 and 2022. The authors analyzed differences in stress and traumatic fractures across position groups and compared time missed and performance data for each fracture type.

Results: A total of 121 fractures (54 stress, 57 traumatic, and 10 not specified) were identified: 42 MLB players and 79 Minor League Baseball players. The mean time missed for rib stress fractures was significantly higher at 98.13 ± 11.19 days compared with traumatic fractures (47.44 ± 6.23 days) (P < .001). Pitchers missed more time (99.93 ± 84.94 days) than infielders (42.83 ± 41.71 days) (P < .001). When assessing the effect of rib fractures on performance, position players had lower on-base percentage (P = .008) upon RTS as compared with before injury. In pitchers, a longer RTS time correlated with fewer innings pitched upon RTS .

Conclusion: Professional baseball players who sustain rib stress fractures have a longer RTS time than those who sustain traumatic injuries. Athletes needed approximately 14 and 7 weeks to RTS after stress and traumatic fractures, respectively. Pitchers who sustained stress fractures had the longest RTS time at 17.6 weeks. Position players experienced significant decline in 1 out of 15 performance metrics indicating a minimal decline in performance upon return.

Background: Groin pain syndrome (GPS) is a complex pathology of the pubic joint resulting from excessive torque on the pubic symphysis and surrounding structures. Although broadly recognized as a sports-related injury, GPS also affects nonathletes due to physical demands common in occupational labor or routine physical activity. Surgical management has demonstrated favorable outcomes in athletes, but its role in the general population remains uncertain.

Purpose: (1) To compare surgical and nonsurgical outcomes in athletes versus nonathletes with GPS and (2) to compare outcomes between different surgical techniques for GPS.

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

Methods: Patients treated for GPS between December 2013 and August 2024 were included. All patients were diagnosed clinically by physical examination and treated using a standardized diagnostic-therapeutic algorithm. Complete symptom resolution and residual pain on physical examination were compared between athletes and nonathletes for surgical and nonsurgical treatment. All patients were followed until complete resolution or treatment completion and assessed for long-term complications.

Results: A total of 250 patients with GPS were evaluated, including 75 athletes and 175 nonathletes, with a median symptom duration of 13 months. Overall, 202 patients (80.8%) were treated surgically, and 247 patients (98.8%) achieved either complete (n = 154, 61.6%) or partial (n = 93, 37.2%) resolution of symptoms. Athletes demonstrated lower odds of residual pain than nonathletes (odds ratio [OR], 0.276; 95% CI, 0.098-0.778; P = .015). Surgery demonstrated lower odds of residual pain than no surgery (OR, 0.248; 95% CI, 0.100-0.614; P = .003), which remained significant only in the nonathlete subgroup analysis (OR, 0.164; 95% CI, 0.058-0.464; P < .001). Furthermore, the effect of surgery on residual pain was significantly modified by athletic status (P = .034). Robotic transabdominal preperitoneal (TAPP) mesh repair demonstrated higher odds of complete resolution (OR, 5.413; 95% CI, 1.837-15.949; P = .002) and lower odds of residual pain (OR, 0.152; 95% CI, 0.053-0.439; P < .001) than no surgery. Combined mesh repair and adductor tenotomy demonstrated higher odds of complete resolution (OR, 8.435; 95% CI, 1.648-43.181; P = .010) than no surgery.

Conclusion: Under a standardized diagnostic-therapeutic algorithm, both athletes and nonathletes with GPS demonstrated significant improvement. Surgery, particularly robotic TAPP mesh repair, significantly improved outcomes in nonathletes. These findings extend GPS management beyond the elite, young, male athlete.

Background: While midterm outcomes of donor-recipient sex-mismatch have been reported after knee osteochondral allograft procedures, no studies have been conducted to report on all available literature.

Purpose: To investigate whether sex-mismatch between donor and recipient influences graft survival in studies evaluating knee OCA surgery.

Study design: Systematic review; Level of evidence, 3.

Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases (PubMed, Embase, and Cochrane) were searched for published studies evaluating donor sex-specific outcomes in human subjects. Studies were included regardless of the level of evidence. All studies were manually screened, followed by a full-text review and data extraction. All outcome measures reported in studies were recorded. The extracted data were reported as descriptive statistics. A risk-of-bias assessment was also conducted for each identified study.

Results: Of 140 full-text articles screened, 4 articles were included in this analysis. Of these, 1 study concluded that a donor-recipient sex mismatch is a negative predictor of outcomes, while 3 studies (75%) found no difference in postoperative outcomes between donor-recipient pairs. Two studies analyzed individual sex pairings (eg, female-to-male pairing), and 1 found lower survival in male-to-female grafts. A failure rate of 14% OCA was observed across 973 knees-including 514 male recipients (53%) and 459 female recipients (47%). At baseline, concomitant tibial tubercle osteotomy was more common in sex-mismatched pairing (14% compared with 8%), and concomitant high tibial osteotomy in sex-matched pairing (9% compared with 4%). Other adjuvant procedures and patient characteristics were comparable. Failure rate for donor-recipient sex-matched and sex-mismatched cohorts was 15% and 13%, respectively.

Conclusion: This study assessed the current literature to determine the role of donor-recipient sex pairing in the outcomes of OCA transplantation. Only 1 study (25%) concluded a significant difference in graft failure among sex-matched and mismatched cohorts. A principal concern of this review is that only 4 studies report data on donor-recipient sex pairings. Only one-fifth of all patients received a female donor graft, limiting the ability to draw conclusions about subgroups. Graft failure across all studies was comparable between sex-matched and sex-mismatched cohorts. This study supports current graft-matching practices, primarily based on size and anatomy, without sex matching.