Orthopaedic Journal of Sports Medicine最新文献

Background: Acromiohumeral interval (AHI) reversibility is used to evaluate whether superior humeral migration is fixed or flexible in patients with massive rotator cuff tears (MRCTs). AHI reversibility is measured as the difference in the AHI observed between standard and stress radiography. However, factors affecting AHI reversibility have not been studied in the existing literature.

Purpose: To investigate potential factors affecting AHI reversibility in patients with MRCTs.

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

Methods: A retrospective analysis was conducted on 58 patients with MRCTs, who had undergone magnetic resonance imaging, computed tomography, and stress radiography of the same shoulder. Potential factors affecting AHI reversibility were evaluated by stepwise regression analysis.

Results: A total of 58 patients (26 male, 32 female) were included in this study. The mean age of the patients was 66.4 ± 8.3 years. There were 33 patients classified as having a reversible AHI and 25 patients classified as having an irreversible AHI. Age, time from symptom onset, anteroposterior tear size, critical shoulder angle (CSA), acromial index, and subscapularis Goutallier grade were associated with AHI reversibility in univariate analysis. Multivariate linear regression analysis showed that a longer time from symptom onset and a bigger CSA were significantly associated with lower AHI reversibility. No significant association was found between AHI reversibility and sex; body mass index; activity level; tear retraction; biceps condition; deltoid cross-sectional area; and Goutallier grade of the supraspinatus, infraspinatus, and teres minor muscles. The cutoff values to predict AHI reversibility for time from symptom onset and CSA were found to be 5.5 years and 38°, respectively.

Conclusion: Time from symptom onset (>5.5 years) and CSA (>38°) were significant independent factors of AHI reversibility. These factors should be considered for the decision-making process in patients with MRCTs.

Background: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and statins may be able to modulate postoperative stiffness, a major cause of morbidity after arthroscopic rotator cuff repair (aRCR).

Purpose: To determine whether there is an association between ACEi, ARB, or statin usage and stiffness after aRCR.

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

Methods: Patients who underwent primary aRCR between January 2016 and December 2019 were categorized into 4 groups depending on the usage of ACEi (n = 45), ARB (n = 27), statins (n = 53), or none of these medications (controls; n = 113). Range of motion in flexion, abduction, internal rotation (IR), and external rotation (ER) was recorded preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Functional outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST) preoperatively and at 1 and 2 years postoperatively. The groups were compared using t test or Mann-Whitney U test for continuous data and chi-square or Fisher exact test for categorical data.

Results: Preoperatively, compared with controls, the ACEi group had decreased flexion (P = .038), abduction (P = .001), ER (P = .009), and IR (P = .015); the ARB group had decreased abduction (P = .012) and IR (P = .019); and the statins group had decreased abduction (P = .015), ER (P = .008), and IR (P = .011). Postoperatively, compared with controls, the ACEi group had decreased 6-month abduction (P = .034) that resolved by 12 months and 3-month ER (P = .004) that persisted into 6 months, the ARB group had greater ER at 12 months (P = .006), and the statins group had increased 6-week abduction (P = .017) that normalized by 3 months. Patients taking ACEi had lower postoperative ASES (30 vs 58.6; P = .001) and SANE scores (28.4 vs 52.3; P = .002) at 1 year and lower SST scores at 2 years (74.7 vs 85.5; P = .002) versus controls.

Conclusion: Patients who used ACEi showed an increased risk of stiffness 6 months postoperatively and had worse SST scores at 2 years after aRCR, while those who used ARB demonstrated improved postoperative ER and IR, with no changes in functional outcomes at longer-term follow-ups.

Background: The Shoulder Pain and Disability Index (SPADI) is a widely used 13-item shoulder-specific patient-reported outcome measure for shoulder pain disorders. The English version of SPADI is easy to use and demonstrates excellent measurement properties for clinical and research settings.

Purpose: To translate and culturally adapt an Indonesian version of SPADI (SPADI-IDN) and then validate its use in Indonesian patients.

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

Methods: Through a forward and a backward translation process, the validity of the questionnaire was investigated. The study population was 100 patients with shoulder pain who were treated in a hospital in Indonesia. The patients were asked to fill out the SPADI-IDN during their visit. To evaluate the validity of SPADI-IDN, the patients were also asked to fill out the Medical Outcomes Study 12-Item Short-Form Health Survey and the Oxford Shoulder Score. To assess the test-retest reliability, the same patients were asked to fill out the SPADI-IDN questionnaire again 1 week later. The assessment of construct validity, test-retest reliability, internal consistency, floor and ceiling effect, and measurement of error followed the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) guidelines. The Bland-Altman method was used to explore absolute agreement.

Results: Of the 100 eligible patients, all were used to assess construct validity, and 87 patients (87%) were used to assess test-retest reliability. Almost every established hypothesis about the correlations between SPADI-IDN and other questionnaires could be confirmed, implying good construct validity. No floor or ceiling effects were found. The intraclass correlation value was 0.99, indicating strong test-retest reliability. A Cronbach α was 0.95, indicating a good internal consistency. The Bland-Altman analysis did not reveal any bias. The standard error of measurement and the minimal detectable change at the individual and group levels were 2.65, 7.3, and 0.7, respectively.

Conclusion: The SPADI-IDN represents a valid and reliable tool for measuring pain and disability in patients with shoulder pain disorders.

Background: Coexisting symptoms can confound outcomes after arthroscopic correction of femoroacetabular impingement (FAI). Symptom burden (SB) represents the cumulative load of patient-reported symptoms.

Purpose: To quantify the prevalence of symptoms in athletes before and after arthroscopic correction of FAI and evaluate the impact of independent and cumulative SB resolution on outcomes.

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

Methods: Included were 509 hips of 386 athletes (89% men; age, 26.4 ± 6.1 years) who underwent primary hip arthroscopy for FAI between 2011 and 2020. Symptom prevalence was assessed preoperatively and 1 year postoperatively using a 15-item SB survey, with the total number of symptoms reported as the SB score. Minimal clinically important difference (MCID-SB) and substantial clinical benefit (SCB-SB) thresholds according to the proportional pre- to postoperative resolution of SB were calculated, and 1- and 2-year postoperative patient-reported outcome measures (PROMs)-including the modified Harris Hip Score and 36-Item Short Form Survey-were compared relative to MCID-SB and SCB-SB achievement. Multivariable stepwise regression was used to evaluate the ability of individual symptom resolution for MCID and SCB achievements on PROMs.

Results: The SB score was 6 ± 2.9 preoperatively, improving to 2.8 ± 2.7 at 1 year postoperatively (P < .001). A proportional reduction in symptoms by 48.5% and 70.3% defined the MCID-SB and SCB-SB, respectively; this was achieved by 63.6% and 43.8% of the hips, respectively. Postoperatively, PROMs were superior where clinically meaningful SB resolution thresholds were achieved (P < .001). A significantly higher proportion of these cases returned to their main sport (79.4% vs 63.1% achieved MCID-SB; 83.8% vs 65.2% achieved SCB-SB) (P < .001). Odds ratios for symptoms associated with achieving the MCID on PROMs included resolution of groin pain (2.6-5.5), side hip pain (3.4), pain during (3.1) and after (2.6-3.5) activity, hamstring tightness (2.6), and limping after activity (2.6). Symptom resolution associated with achieving SCB included groin pain (3.0-3.1), pain during (3.3) and after (2.7-4.2) activity, and limping after activity (3-6.8).

Conclusion: Achieving thresholds of clinically important SB resolution was associated with superior postoperative PROM scores and higher rates of return to sports for this athletic cohort. Resolution of groin pain, pain during/after activity, hamstring tightness, and limping after activity increased the odds of achieving clinically important improvement on PROMs.

Background: Tibiofemoral rotation is an emerging parameter, especially in assessing patellofemoral instability. However, reference values in the literature are inconsistent regarding the used imaging modality and do not consider the effect of knee flexion during image acquisition.

Purpose: To analyze the differences in tibiofemoral rotation measurements between computed tomography (CT) and magnetic resonance imaging (MRI).

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

Methods: A total of 78 knees in 72 patients were included. All patients underwent surgery for patellofemoral instability at our institution and preoperative CT and MRI were available. Tibiofemoral rotation was measured on axial CT and MRI, whereas the respective knee flexion angle (KFA) was measured on sagittal images. Tibiofemoral rotation values in which the tibia was externally rotated to the femur were handled as positive values. Differences between CT and MRI measurements were calculated and the association between KFA and tibiofemoral rotation was evaluated using Pearson correlation and the Mann-Whitney U test.

Results: The mean tibiofemoral rotation was 8.7°± 5.5° in CT and 4.2°± 6.7° in MRI (P < .001). The mean KFA was 2.4°± 3.1° in CT and 14.9°± 6.4° in MRI (P < .001). The difference in the KFA between CT and MRI moderately correlated with the difference in tibiofemoral rotation between imaging modalities (r = 0.529; P < .001).

Conclusion: Tibiofemoral rotation measurements significantly differed between CT and MRI, with larger values observed in CT. The difference between imaging modalities correlated with the degree of knee flexion during image acquisition. This observation should be considered when assessing tibiofemoral rotation, as current reference values in the literature are inconsistent regarding the used imaging modality.

Background: The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1-RAs) for weight loss could significantly impact joint preservation and arthroplasty. While this will in part be driven by the association between obesity, osteoarthritis (OA), and total joint arthroplasty (TJA), recent evidence also indicates that GLP-1-RAs may have direct joint-protective, anti-inflammatory effects.

Purpose: To evaluate the association between GLP-1-RA use and the onset and progression of hip and knee OA in an obese population.

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

Methods: A national health network was queried for patients with an index visit between June 1, 2021, and January 1, 2023, and a body mass index (BMI) ≥30. Patients were stratified into groups without (n = 1,092,225) and with(n = 237,043) preexisting hip and/or knee OA. One-to-one propensity score matching was used to balance GLP-1-RA use based on age, sex, race, BMI, and comorbid type 2 diabetes mellitus. Primary outcomes were incidence of hip OA, knee OA, major joint injections, total hip arthroplasty (THA), and total knee arthroplasty (TKA) within 1 year. Cox proportional hazards models were used to estimate hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs.

Results: In patients with preexisting OA, GLP-1-RA use correlated with reduced odds of conversion to THA (1.1% vs 2.2%; HR, 0.6; 95% CI, 0.5 to 0.8) and TKA (1.4% vs 2.1%; HR, 0.8; 95% CI, 0.6 to 0.9) within 1 year. In patients without preexisting OA, GLP-1-RA use was associated with an increased incidence of hip OA (0.9% vs 0.7%; HR, 1.4; 95% CI, 1.2 to 1.6), knee OA (2.1% vs 1.9%; HR, 1.3; 95% CI, 1.2 to 3.1), major joint injections (2.2% vs 1.8%; HR, 1.4; 95% CI, 1.3 to 1.5), and TKA (0.09% vs 0.04%; HR, 2.6; 95% CI, 1.6 to 4.3). Comparing cohorts without prior OA, patients who were prescribed a GLP-1-RA demonstrated slightly greater decreases in BMI (-1.00; 95% CI, -1.06 to -0.96) at 1-year after the index visit compared with patients not prescribed a GLP-1-RA (-0.90; 95% CI, -0.94 to -0.84). However, in patients with a prior diagnosis of hip or knee OA, there was no difference noted in BMI change.

Conclusion: GLP-1-RAs may provide direct disease-modifying behaviors in patients with preexisting OA diagnosis, per a reduced risk of conversion to TJA not attributable to weight loss. Further investigation is also needed to elucidate the association between GLP-1-RA use and the increased incidence of OA diagnosis and conversion to TKA in patients with no preexisting OA diagnosis.

Background: Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile after trochleoplasty for the management of patellofemoral instability (PFI). In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts.

Purpose: To assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of PFI among surgeons who perform this procedure.

Study design: Cross-sectional study.

Methods: A 21-item cross-sectional survey was developed to evaluate trochleoplasty in its current practice among surgeons around the world. The survey was distributed between December 2021 and April 2022 to the orthopaedic surgeon membership of multiple national and international knee, arthroscopy, and sports medicine societies to identify any surgeon with experience performing the trochleoplasty procedure in practice for the management of PFI. Descriptive statistics of survey responses were performed to address study aims, and univariate analyses were performed to compare differences between high- and low-volume trochleoplasty surgeons.

Results: Survey distribution identified 32 orthopaedic surgeons with experience performing the trochleoplasty procedure. Procedural indications were most commonly felt to be met with Dejour classification of B or D on magnetic resonance imaging. Trochleoplasty was felt by most to be appropriate as a primary surgical intervention for PFI. A majority of surgeons utilized a Bereiter (thin-flap) trochleoplasty technique with suture-based fixation and performed concurrent medial patellofemoral ligament reconstruction, but other concomitant procedures varied. Range-of-motion precautions and bracing practices varied among respondents, and arthrofibrosis was the most frequently cited observed complication. High- and low-volume trochleoplasty surgeons differed in their radiographic and age-based indications for the procedure.

Conclusion: Study findings indicated that variation exists in the surgical indicators, technique, and postoperative rehabilitation practices of trochleoplasty surgeons, with specific differences noted between high- and low-volume trochleoplasty surgeons. The results of this survey identified areas of equipoise and treatment variation that should direct future research efforts in the study of the trochleoplasty procedure.

Background: Quadriceps weakness is a common barrier to effective rehabilitation after anterior cruciate ligament (ACL) surgery. Neuromuscular electrical stimulation (NMES)-the application of electrical currents to induce muscle contraction-has been used as part of the postoperative rehabilitation regimen.

Purpose: To investigate the effects of NMES on the recovery of quadriceps strength and knee function after ACL surgery.

Study design: Systematic review; Level of evidence, 1.

Methods: A search was conducted in the Web of Science, Embase, Cochrane Library, and PubMed databases between inception and August 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included were randomized controlled trials of patients undergoing NMES as postoperative rehabilitation after ACL reconstruction or repair, with standard physical therapy as the control intervention. The quality of the included studies was assessed according to the Cochrane Collaboration risk-of-bias tool. Lower limb function was assessed qualitatively, and standardized mean differences (SMDs) in muscle strength and Lysholm scores were analyzed quantitatively and pooled using a random-effects model.

Results: Eleven studies (N = 202 patients) met our inclusion criteria. The meta-analysis of muscle strength values, which included 9 studies, showed that patients who underwent physical rehabilitation with adjunctive NMES had better recovery and improvement in quadriceps muscle strength compared with standard physical therapy at both short- and long-term follow-ups (≤6 weeks: SMD, 0.53 [95% CI, 0.27-0.79] vs >6 weeks: SMD, 0.59 [95% CI, 0.18-0.99]; p < 0.001). Moreover, subgroup analyses showed that earlier physical rehabilitation with the assistance of NMES resulted in better muscle strength recovery (≤1 week: SMD, 1.48 [95% CI, 0.80-2.17] vs >1 week: SMD, 0.44 [95% CI, 0.21-0.67]; p < 0.001). The meta-analysis of Lysholm scores, which included 3 studies, did not indicate any significant differences between the assisted NMES and control groups.

Conclusion: Our study demonstrated that in both short- and long-term follow-up studies, postoperative rehabilitation with NMES after ACL surgery significantly increased quadriceps muscle strength compared with standard rehabilitation alone.

Background: Although previous studies have investigated the risk factors for rotator cuff syndrome (RCS), there remains controversy due to uncontrolled and uncertain confounding factors in their analyses.

Purpose: To perform Mendelian randomization (MR) analysis using single-nucleotide polymorphisms to investigate the causal relationship between RCS and 4 risk factors: type 2 diabetes mellitus (T2DM), high blood pressure (HBP), body mass index (BMI), and low high-density lipoprotein cholesterol (HDL-C).

Study design: Descriptive epidemiology study.

Methods: Genome-wide association study (GWAS) data for T2DM (ebi-a-GCST006867), BMI (ieu-b-40), HBP (finn-b-I9_HYPTENS), HDL-C (ieu-b-109), and RCS (ukb-b-50) were obtained from the IEU Open GWAS Project. The dataset of each risk factor was combined with the dataset of RCS, generating 4 datasets. Potential confounders and single-nucleotide polymorphisms related to RCS were excluded from these datasets. The causal relationships between the exposure factors and RCS were analyzed using 5 regression models: MR-Egger, weighted median estimate (WME), inverse-variance weighting (IVW), simple mode, and weighted mode. Heterogeneity in the causal effects was assessed using MR-Egger regression and IVW analyses. Sensitivity analyses were performed to determine the stability of the results.

Results: The MR-Egger regression intercepts for T2DM, BMI, HBP, and HDL-C showed no horizontal pleiotropic effects. The results of the Cochran Q test showed P values of .075 and .080 for BMI in the MR-Egger regression and IVW models, respectively, indicating the absence of heterogeneity between BMI and RCS. The results of the weighted median estimate and IVW regression analyses showed a significant causal association between BMI and RCS, with odds ratios of 1.002 (95% CI, 1-1.004; P = .038) and 1.003 (95% CI, 1.001-1.005; P = .0003), respectively. No significant associations were found for T2DM, HDL-C, or HBP.

Conclusion: In the present study, BMI was positively associated with the risk of developing RCS, while T2DM, HBP, and low HDL-C were not associated with RCS development.