Orthopaedic Journal of Sports Medicine最新文献

Background: Platelet-rich plasma (PRP) is frequently used in sports medicine to treat muscle injuries; however, the clinical evidence remains inconsistent and fragmented.

Purpose: To assess whether PRP therapy improves clinical outcomes, particularly return to sport (RTS) and reinjury rate, compared with conventional treatments for acute muscle injuries.

Study design: Systematic review and meta-analysis; Level of evidence, 2.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search of PubMed, Embase, BVS, and Scopus was conducted through April 2025 for systematic reviews, with or without meta-analysis, to evaluate PRP for acute muscle injuries in athletes. A total of 1464 manuscripts were identified through the initial search. Main outcomes included RTS, reinjury rate, pain, and complications. Methodological quality was assessed using the Risk of Bias in Systematic Reviews (ROBIS) tool, and the certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Meta-analyses were performed using random-effects models with Hartung-Knapp-Sidik-Jonkman adjustments.

Results: Eight systematic reviews were included. PRP significantly reduced reinjury risk compared with controls (risk ratio, 0.84 [95% CI, 0.76 to 0.92]; I² = 0%), with high-certainty evidence. A reduction in RTS time favored PRP (mean difference, -4.43 days [95% CI, -9.28 to 0.42); however, it did not reach statistical significance (low-certainty evidence). Narrative synthesis suggested inconsistent short-term pain relief and low complication rates, but evidence certainty was rated very low to low due to methodological and reporting limitations.

Conclusion: Our review study demonstrated that PRP may reduce muscular reinjury rates and potentially accelerate RTS, although benefits on pain and safety remain uncertain. Current evidence supports the selective use of PRP in sports settings; however, standardization in protocols and outcomes is needed. These findings may assist clinicians in individualizing treatment strategies involving PRP for acute muscle injuries, particularly in high-performance athletes at risk of recurrence.Registration: CRD42021279300.

Background: Chronic Achilles tendon ruptures with large defects present a considerable challenge in treatment.

Purpose: This study evaluated the midterm outcomes of fresh-frozen large-caliber allograft reconstruction for chronic Achilles tendon ruptures.

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

Methods: A total of 32 patients (18 women and 14 men), with a mean age of 57.6 years (range, 21-81 years), were enrolled between 2007 and 2021. Of 32 ankles, 21 and 11 defects involved Achilles tendon ruptures at the middle and distal sections, respectively. The mean ruptured gap was 5.8 cm (range, 5-10 cm), and the mean follow-up period was 8.4 years (range, 3-16.9 years). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score, and Achilles Tendon Total Rupture Score (ATRS) were used to evaluate the outcomes.

Results: The patients' AOFAS ankle-hindfoot score increased from 64.8 ± 10.8 to 95.4 ± 4.2 (P < .001), their mean VAS score decreased from 6.3 ± 0.9 to 1.7 ± 0.5 (P < .001), and their mean ATRS increased from 49.9 ± 12.6 to 97.9 ± 5.7 (P < .001). Three complications, comprising 2 superficial infections and 1 partial retear, were reported. No complete rerupture, revision reconstruction, or non-tendon healing was reported. At the final follow-up, no patient required an assistive device for ambulation, and good tissue incorporation was observed.

Conclusion: Our midterm results revealed that fresh-frozen large-caliber tendon allografts represent a reasonable option for treating chronic Achilles tendon ruptures with large defects, achieving acceptable outcomes.

Background: Arthroscopic surgical takedown and repair of symptomatic partial-thickness rotator cuff tears are commonly undertaken. An alternative approach is the use of a bioinductive collagen implant to augment the rotator cuff tear.

Purpose: To investigate early function and rotator cuff tendon integrity in patients undergoing arthroscopic bioinductive collagen implant augmentation (REG group) versus rotator cuff takedown and repair (RCR group) for high-grade partial-thickness rotator cuff tears.

Study design: Randomized controlled clinical trial; Level of evidence, 2.

Methods: Patients 35 to 75 years of age with symptoms >3 months and unresponsive to nonoperative treatment, with high-grade partial-thickness rotator cuff tears confirmed on 3-T magnetic resonance imaging (MRI), were randomly allocated to RCR or REG groups. Exclusion criteria included previous ipsilateral shoulder surgery, multitendon tears/pathology, and concomitant surgery including labral repair, long head of biceps tenodesis, or chondroplasty/microfracture. Patients were assessed preoperatively and at 6 weeks as well as 3, 6, and 12 months postoperatively. The primary study outcome was the Western Ontario Rotator Cuff Index (WORC) at 3 months after surgery. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and Constant scores, and the time taken to return to work and activities of daily living (ADLs). MRI-based rotator cuff repair integrity was assessed using the Sugaya grading system.

Results: This study recruited 41 patients (REG n = 21; RCR n = 20). No group differences (P > .05) were observed in mean age (REG 57.1 years; RCR 57.8 years), preoperative duration of symptoms, and previous nonoperative treatments. The REG group reported superior outcomes for the WORC at 6 weeks (P = .001) and 3 months (P = .026) as well as the ASES at 6 weeks (P < .001) and WORC Work, Sport, and Emotions domains at 6 weeks and 3 months (P < .05). There were no group-based differences (P > .05) in patient-reported outcomes at 6 or 12 months after surgery. The REG group was faster (P < .05) to permanently remove the sling, drive a motor vehicle, and return to office duties and moderate-intensity chores. No MRI-based differences were observed, with 19 (90%) and 17 (85%) REG and RCR patients, respectively, graded Sugaya 1 to 2 at 12 months.

Conclusion: For symptomatic high-grade partial-thickness rotator cuff tears, bioinductive collagen implant augmentation versus standard rotator cuff repair demonstrated improved early function with equivalent MRI-based healing rates.

Registration: Australian New Zealand Clinical Trials Register (ACTRN12620000926932p).

Background: Multiligament knee reconstruction is a technically demanding procedure with a steep learning curve and carries the potential for significant complications if technical accuracy is not achieved. Although optimal tunnel trajectories to prevent convergence have been described, it remains unclear how accurately these theoretical trajectories are executed in practice and whether patient-specific guides can improve precision and reduce tunnel convergence.

Purpose: To evaluate the effectiveness of patient-specific guides in preventing tunnel convergence and improving surgical accuracy in multiligament knee reconstruction.

Study design: Controlled laboratory study.

Methods: Computed tomography scans from a single case were used to create accurate 3-dimensionally printed femur models. Each of the 8 participating orthopaedic surgeons performed tunnel placement on 2 models: 1 using the freehand technique and 1 using a custom-designed guide. Tunnels of the anterior cruciate ligament (single bundle) and posterior cruciate ligament (double bundle consisting of the anterolateral and posteromedial bundles) were constant. Surgeons created femoral tunnels for posterolateral structures (fibular collateral ligament, popliteus tendon) and posteromedial structures (medial collateral ligament, posterior oblique ligament). Postprocedure computed tomography was used to assess tunnel convergence, intertunnel distances (>2 mm defined as safe), and tunnel entry accuracy.

Results: Lateral tunnel convergence occurred in 11 of 16 tunnels via freehand-primarily between the popliteus tendon and anterior cruciate ligament (7/8)-and none of the patient-specific guide models (0/16; P = .001). Medial convergence was reduced from 10 of 16 via freehand to 2 of 16 via the guide (P = .001), most commonly between the posterior oblique ligament and posterior cruciate ligament-posteromedial bundle. Mean intertunnel distances were significantly greater via the guide. Tunnel entry accuracy was 100% with the guide.

Conclusion: The use of patient-specific guides significantly reduces tunnel convergence and improves tunnel entry point precision in multiligament reconstruction simulation. Freehand tunneling highlights the prominent influence of human error.

Clinical relevance: Surgical success in multiligament reconstruction relies on anatomic graft function, yet tunnel convergence may jeopardize graft integrity and lead to failure. Therefore, avoiding tunnel convergence is of utmost importance for a successful reconstruction.

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) using quadriceps tendon (QT) autograft is associated with lower rates of graft rupture and favorable functional outcomes compared with hamstring (HS) autograft in adolescents. The ACL-deficient knee is at increased risk of injury to secondary stabilizers of the knee, including the menisci, although studies have not reported differences in rates of subsequent meniscal tear between HS and QT groups.

Purpose: The goal of this study was to compare rates of graft rupture and subsequent meniscal tear after adolescent ACLR using HS or QT autograft.

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

Methods: This was a retrospective review of adolescent patients (age, 10-19 years) who underwent ACLR with either HS or QT autograft between 2009 and 2023 at an urban tertiary care pediatric hospital. Patients with ≥2 years of clinical follow-up were included. Patient characteristics, surgical details, and reinjury rates were calculated and compared between the 2 subgroups. Multivariable logistic regression was performed to evaluate the relationship between graft failure and relevant variables.

Results: A total of 467 patients (52.0% female) with mean age 14.6 ± 1.9 years and median follow-up of 3.1 (range, 2.0-13.4) years were included. The QT subgroup more commonly underwent concomitant anterolateral ligament reconstruction/lateral extra-articular tenodesis at the time of primary ACLR (P < .001), were slightly older (P = .04), had higher baseline body mass index (P = .01), had a shorter period of follow-up (P < .001), and more commonly had concomitant medial meniscal tear compared with the HS group (P = .047). Graft rupture was lower among patients treated with QT versus HS (7.2% vs 23.2%; P < .001). The rate of subsequent meniscal tear was not statistically significantly different among patients treated with QT versus HS (4.6% vs 9.2%, respectively; P = .08). Regression analysis showed that graft type was associated with risk of graft failure (QT vs HS: odds ratio, 0.29; P < .001) but was not clearly associated with subsequent meniscal tear (QT vs HS: odds ratio, 0.47; P = .09).

Conclusion: Adolescent patients undergoing ACLR with QT autograft have significantly lower risk of graft rupture compared with those treated with HS autograft. There was no statistically significant difference in rate of subsequent meniscal tear between the QT and HS groups.

Background: Osgood-Schlatter Disease (OSD) is an overuse injury causing pain and inflammation at the tibial tubercle, usually in skeletally immature patients. Various treatments are available, including surgical and nonsurgical approaches.

Purpose: To review the literature focusing on the clinical outcomes of different treatments for OSD.

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

Methods: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was performed in June 2024 with PubMed, Embase, and Cochrane Trials, totaling 349 initial articles. Data were collected on patient demographics, treatments, clinical outcomes, and complication rates. Bias was assessed using the methodological index for non-randomized studies and risk of bias 2.0 tools.

Results: Fifteen studies encompassing 712 patients were included and categorized into nonoperative (n = 7), injection-based (n = 4), and surgical (n = 6) treatment groups. Among injection studies, full recovery rates ranged from 31.8% to 84.3%, with the Knee injury and Osteoarthritis Outcome Score and Tegner Activity Scale (TAS) scores as high as 94.3 and 6.3, respectively, after treatment. Dextrose and platelet-rich plasma injections demonstrated no reported complications. Nonoperative treatments, including physical therapy, immobilization, and supportive care, showed full recovery of activities of daily living (ADL) in 14.3% to 100% of cases. Complication rates for nonoperative treatments ranged from 0% to 66.7%, most commonly involving quadriceps atrophy and skin irritation. Surgical treatments were typically reserved for refractory cases and achieved return to ADL in 79% to 100% of patients. Postoperative Lysholm scores ranged from 96.9 to 99.0, and TAS scores ranged from 6.2 to 8.5. However, complications were reported in 5 of 6 surgical studies, with rates ranging from 0% to 75.8%, including infections, hypertrophic scarring, and residual pain.

Conclusion: Our systematic review showed that nonoperative treatments are effective for managing OSD. Surgery, while rare, seems reserved for patients with closed growth plates who have persistent symptoms. This review highlights the need for additional studies to better identify the best nonsurgical treatment.

Background: Studies on the coronal plane alignment of the knee (CPAK) classification after high tibial osteotomy (HTO) are scarce.

Purpose: To (1) clarify the distribution of the CPAK phenotype in patients who underwent HTO and (2) compare the clinical results according to the CPAK phenotypes.

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

Methods: Overall, 171 knees of patients with HTO were retrospectively evaluated. The primary outcome was to investigate the serial changes in the CPAK preoperatively and 2 years postoperatively. The secondary outcome was to assess the subcategories of the knee injury and osteoarthritis outcome score (KOOS) and postoperative change of KOOS according to the CPAK.

Results: The most common pre- and postoperative CPAK phenotype types were I (62%), II (22.8%), IV (8.8%), VI (36.7%), V (18.9%), and IX (13%). The distribution of preoperative CPAK significantly changed after HTO. KOOS subscales showed no significant differences according to the CPAK phenotypes.

Conclusion: The most common pre- and postoperative CPAK phenotypes were I and VI. No significant differences in the KOOS subscales were observed according to CPAK phenotypes following HTO.

Background: Posterior humeral avulsion of glenohumeral ligament (PHAGL) lesions involves detachment of the posterior band of the inferior glenohumeral ligament from the humeral neck. Although uncommon, these lesions have been associated with recurrent instability.

Purpose: To compare clinical outcomes and recurrence rates of patients with PHAGL lesions undergoing surgical repair for posterior shoulder instability versus a pair-matched control group without PHAGL lesions undergoing isolated arthroscopic posterior labral repair.

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

Methods: This was a retrospective study of patients diagnosed with PHAGL lesions and posterior shoulder instability who underwent primary arthroscopic repair between 2010 and 2019. These patients were matched 1:3 with a cohort of patients with isolated posterior labral tears (PLTs). Demographics, surgical data, and pre- and postoperative clinical outcomes scores (American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Survey Physical Component Summary, and short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) were collected. Return-to-sport rates and satisfaction were also evaluated. Failure was defined as recurrent instability or progression to arthroplasty.

Results: Nine patients diagnosed with PHAGL lesions who underwent primary arthroscopic repair were included. These 9 patients (PHAGL group) were age-matched to a cohort of 26 patients with PLTs who underwent repair (PLT group). The mean follow-up was 5.8 years (range, 2.0-14.2). No significant differences were found between the PHAGL and PLT groups regarding shoulder function, physical health, or patient satisfaction. The median satisfaction score for the PHAGL group was 8.5 of 10, compared to 10 of 10 for the PLT group (P = .144). One patient with PHAGL lesions experienced recurrent instability compared with 0 in the PLT group.

Conclusion: This study shows that patients with PHAGL lesions who undergo arthroscopic stabilization can attain comparable mid-term functional outcomes to those with isolated PLTs. Failure rates are similar between the PLT group and those with PHAGL lesions, and surgical management remains an effective treatment option for both groups. Further studies are needed to optimize surgical techniques and refine patient selection criteria for improved long-term success.

Background: Despite surgical reconstruction, some patients develop persistent residual rotatory laxity following anterior cruciate ligament (ACL) reconstruction (ACLR). Lateral extra-articular tenodesis (LET) has been shown to be a successful adjunctive procedure to address anterolateral instability in high-risk patients with ACL tears. It is often performed during ACLR; however, there is growing interest in understanding possible indications for the LET as an isolated procedure.

Purpose: To consolidate the current evidence on isolated LET (iLET) following ACLR, explore its indications, and evaluate outcomes such as laxity, patient-reported outcome (PRO) measures (PROMs), and complication rates.

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

Methods: This systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive literature search was performed across Ovid MEDLINE, Embase, EBM Reviews, and Emcare from inception to April 2025. Studies were eligible if they reported outcomes in patients undergoing iLET for residual laxity following ACLR with evidence of an intact ACL graft. Biomechanical, cadaveric, and non-English studies were excluded. Two reviewers independently screened studies, extracted data, and assessed methodological quality. A narrative synthesis was conducted, with descriptive statistics (frequencies, percentages, or weighted means with measures of variability) reported where appropriate.

Results: Four studies (N = 69 patients, 70 knees) were included, with a mean ± SD patient age of 25.3 ± 2.9) and follow-up period of 26.3 ± 3.6 months. Patients demonstrated significant reductions in rotatory laxity following iLET, with only 6 patients reporting positive postoperative pivot shift (grade ≥1). Reported PROMs improved across all studies. Complication rates ranged from 15.8% to 36.8% while failure rates ranged from 0% to 10.5%.

Conclusion: This review demonstrated that iLET may provide favorable PROs, reduction in laxity, and low failure rates in patients with residual laxity following ACLR. These findings suggest that the use of iLET may be a viable option for residual laxity following ACLR with evidence of an intact ACL graft; however, a limited number of reporting studies and small sample size require these results to be interpreted with caution.