Orthopaedic Journal of Sports Medicine最新文献

Background: The tibial tuberosity-trochlear groove (TT-TG) distance is a key measurement in guiding surgical management of patellofemoral instability. A TT-TG of 20 mm is often used as the threshold for supplementing soft tissue procedures with tuberosity medialization, although this remains an active area of investigation.

Purpose: To identify the relationship between TT-TG distance and the force required to cause lateral translation of the patella in a cadaveric model at 30º of flexion.

Study design: Descriptive laboratory study.

Methods: Eight fresh-frozen human cadaveric knee specimens were acquired, and computed tomography scans were obtained to measure anatomic features of patellar instability. A flat tibial tuberosity osteotomy was performed. Specimens were mounted on an Instron ElectroPuls E10000 in 30° of flexion. The force (N) required to produce 10 mm of lateral patellar translation over a 1-second interval was measured under the following tibial tuberosity translation conditions: (1) native; (2) predetermined translation (+5, 10, and 15 mm from native); and (3) predetermined TT-TG values (10 to 25 mm by 5 mm increments).

Results: For TT-TG values ≤20 mm, there was a significant negative linear relationship between the TT-TG distance and the force required for lateral patellar translation (-1.63 N/mm [95% CI, -1.637 to -1.629]; P < .001); 1 mm of TT-TG increase resulted in a 1.63 N decrease in the required force. With TT-TG testing conditions >20 mm, this linear relationship was no longer present (slope, -0.5 N/mm [95% CI, -1.36 to 0.36]; P = 0.25).

Conclusion: The force required to translate the patella laterally decreased linearly as the TT-TG distance increased up to 20 mm. However, for TT-TG distances >20 mm, our model showed variability in the relationship between force and TT-TG distance.

Clinical relevance: The linear relationship identified between translational force and anatomic alignment, with TT-TG distances <20 mm, suggests a predictable biomechanical response to tibial tuberosity translation. The disruption of this relationship >20 mm confirms a threshold at which patellofemoral biomechanics are altered.

Background: Exercise therapy is recommended for the initial treatment of individuals with rotator cuff tears but fails in 25% to 50% of cases. Determining the baseline factors associated with patient-reported outcomes and tear propagation immediately following exercise therapy may improve treatment decision-making.

Purpose: To prospectively identify factors associated with tear propagation and patient-reported outcomes immediately following a 12-week personalized exercise therapy program in individuals with symptomatic isolated supraspinatus tears.

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

Methods: In total, 109 individuals were recruited for this prognostic prospective longitudinal cross-sectional study and underwent a 12-week personalized exercise therapy program for the treatment of rotator cuff tears. Individuals underwent assessments of passive glenohumeral range of motion (ROM), isometric muscle strength (internal and external rotation and abduction), and glenohumeral arthrokinematics during scapular plane abduction immediately before the initiation of exercise therapy. Immediately before and after the exercise therapy program, tear size was quantified using ultrasound (propagation defined as tear size change ≥4.6 mm), and individuals completed the Western Ontario Rotator Cuff (WORC) Index score. Logistic and multiple linear regression were used to determine if baseline glenohumeral contact path length, tear size, passive glenohumeral ROM, and isometric strength were predictors of tear propagation and patient-reported outcomes immediately following exercise therapy.

Results: Overall, 7 individuals (8.5%) experienced tear propagation immediately following exercise therapy. Logistic regression analysis indicated that baseline tear size was the only predictor associated with tear propagation immediately following exercise therapy. There was a 29.0% decrease in the odds of tear propagation for each 1.0-mm increase in baseline tear size (odds ratio, 0.71; 95% CI, 0.51-0.99; P = .04). Higher baseline isometric internal rotation strength predicted higher WORC scores (P = .044).

Conclusion: Immediately following a 12-week personalized exercise therapy program, the percentage of individuals who experienced tear propagation was low, and baseline tear size and higher internal rotation strength were associated with tear propagation and WORC scores, respectively. Thus, the current study identified factors immediately before exercise therapy that affect tear propagation and WORC scores following an exercise therapy program.

Background: Throwing is a fundamental skill in many sports that requires intricate biomechanical coordination to achieve maximum performance and minimize injury. Baseball pitchers and football quarterbacks have distinct throwing motions that involve unique demands on the upper extremity, which ultimately contribute to injury, especially in cases of overuse.

Purpose: To compare the throwing biomechanics, incidence, and types of injuries sustained and their respective treatments between baseball pitchers and football quarterbacks.

Study design: Narrative review.

Methods: Comprehensive literature review examining biomechanical differences between baseball pitching and football quarterback throwing motions, analyzing injury patterns and prevalence in both sports, and evaluating current treatment approaches for throwing-related upper extremity injuries. Multiple databases (Google Scholar and PubMed) were queried for peer-reviewed publications related to baseball/football throwing biomechanics (biomechanics, kinematics, kinetics, electromyography, throwing phases, arm slot, external rotation, varus torque, kinetic chain), injury entities (ulnar collateral ligament [UCL], rotator cuff, superior labrum anterior-posterior/labral, acromioclavicular joint, biceps tendinopathy, ulnar neuritis, posteromedial impingement, flexor-pronator, latissimus dorsi/teres major), and management (rehabilitation/physical therapy, arthroscopy, UCL reconstruction/repair/internal brace, return to play); pediatric/adolescent studies and nonoverhand sports were excluded. Studies were screened for inclusion by 2 reviewers and synthesized qualitatively due to heterogeneity.

Results: Significant differences in timing, velocity, and arm angles were observed between baseball and football throwing motions, which affected injury prevalence and nature. Baseball pitchers demonstrated higher rates of both elbow and shoulder injuries compared to football quarterbacks, with elbow injuries being particularly prevalent due to the high volume of repetitive throwing motions. Treatment options ranged from nonoperative approaches, including physical therapy, to operative interventions such as UCL reconstruction.

Conclusion: The biomechanics of throwing in baseball and football differ significantly, leading to distinct injury patterns between sports. Baseball pitchers experience more shoulder and elbow injuries due to repetitive high-velocity throwing, while quarterbacks typically sustain trauma-related injuries rather than overuse injuries.

Background: There has been increased interest in the biologic augmentation of osteochondral allografts (OCAs), specifically the use of autologous bone marrow, to decrease failure rates. The iliac crest is a common donor site, but its use is associated with increased pain separate from the primary surgical site and increased complexity in the operating room setup and draping. Local bone marrow aspirate (BMA) from the proximal tibia or femoral condyle addresses these limitations, but the quality of the aspirate may be lower. It has not been determined whether this difference in aspirate quality influences the postoperative imaging appearance of OCA grafts.

Purpose: To determine whether bone marrow aspirate augmentation from the iliac crest versus the proximal tibia affected 6-month postoperative magnetic resonance imaging (MRI) appearance of OCA grafts.

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

Methods: Patients undergoing OCA transplantation for grade IV chondral defects of the distal femur from January 2018 to June 2021, with 6-month (±2 months) postoperative knee MRI, were included in the study. Patients without knee postoperative MRI, patients with multiple plugs on different surfaces of the knee, and patients with patellar OCA plugs were excluded. Osteochondral Allograft Magnetic Resonance Imaging Scoring System (OCAMRISS) scores were calculated and compared for patients undergoing OCA with either ipsilateral iliac crest BMA augmentation or ipsilateral proximal tibia BMA augmentation.

Results: Of 56 patients (62 knees) who met the inclusion criteria, 33 had tibial BMA augmentation and 29 had iliac crest BMA augmentation. The mean age was 34.9 ± 10.4 years, the median [IQR] body mass index was 25.5 kg/m² [23.6-28.3 kg/m²], and the mean time from surgery to MRI was 6.2 ± 0.9 months. Most lesions involved the medial femoral condyle (29 lesions, 47%). The mean OCAMRISS score was 6.9 ± 2.8. There were no differences in the proximal tibia and iliac crest BMA groups with respect to demographic factors, lesion location, or OCAMRISS score on 6-month postoperative MRI (P > .05 for all).

Conclusion: BMA augmentation does not affect the 6-month postoperative MRI appearance of OCA grafts.

Background: Heterotopic ossification (HO) is a common complication after hip arthroscopy that has historically been prophylactically treated with postoperative radiation. Newer prophylactic treatments use nonsteroidal anti-inflammatory drugs (NSAIDs) in place of radiation.

Purpose: To examine the incidence of HO after hip arthroscopy with and without the use of chemoprophylactic agents.

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

Methods: PubMed and Scopus electronic databases were queried for all studies published between January 2000 and July 2025 that evaluated HO after hip arthroscopy. Information on study design, the use of exclusive NSAID chemical prophylaxis and regimen, presence of HO, and length of follow-up were collected from all studies. The Brooker classification was used for determining severity of HO. Matched-cohort studies were combined for meta-analysis and analyzed using the DerSimonian and Laird method of random-effects meta-analysis.

Results: A total of 44 studies including a total of 32,603 patients were included. The incidence of HO in patients who received chemoprophylaxis after hip arthroscopy was 15.3 per 1000 patients per year compared with 80.1 per 1000 patients per year in those who did not receive chemoprophylaxis (P = .01). Patients who received chemoprophylaxis had a higher portion of Brooker 1 grade HO (73.6%) compared with patients who did not receive chemoprophylaxis (63.1%) (X ² = 8.6558; P = .03). Meta-analysis of 6 studies comparing chemoprophylaxis with no chemoprophylaxis had an odds ratio of 0.10 (95% CI, 0.03-0.35; P < .001).

Conclusion: Postoperative NSAIDs were effective in reducing the incidence and severity of HO after hip arthroscopy. Meta-analysis of matched-cohort studies estimated a 10-fold decrease in the incidence.

Background: The D.H. Dejour classification (Version 2 [V2]) expanded upon the H. Dejour radiographic classification of trochlear dysplasia by adding computed tomography (CT) scans to the evaluation. Magnetic resonance imaging (MRI) then became the main investigation of choice.

Purpose: To report the reliability of the Dejour V2 using a combination of radiographs and MRI instead of CT scan as per the original classification and to explore differences in the assessment of trochlear dysplasia between assessors to better understand limitations to the classification.

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

Methods: This is a retrospective comparative study, conducted by reviewing a prospectively maintained institutional database, between 2 groups of patients: those with recurrent patellar dislocation, termed objective patellar instability (OPI), and control patients with no patellofemoral symptoms. Inclusion criteria were available preoperative imaging including both knee MRI and a true lateral view radiograph of the knee at 20° of flexion and no history of previous knee surgery. Imaging evaluation was performed independently by 2 orthopaedic surgeons, and each trochlea was classified according to the Dejour V2 classification. To classify, all reviewers initially used the lateral radiograph, then confirmed with MRI slice imaging.

Results: A total of 200 patients were included in the statistical analysis (OPI, n = 123; control, n = 77). In the control group, 13% of patients presented with trochlear dysplasia type A, whereas 87% of patients had a normal trochlea. The kappa coefficient was 0.77 for intrarater reliability and 0.75 for interrater reliability, representing a substantial level of agreement. In the OPI group, 97% of patients presented a trochlear dysplasia. The kappa coefficient was 0.92 for intrarater reliability and 0.86 for interrater reliability, representing an excellent correlation between reviewers. When simplified from 4 types to 2 types of trochlear dysplasia, high-grade (supratrochlear spur present) versus low-grade (no supratrochlear spur present), the intrarater reliability and interrater reliability improved to 0.95 and 0.93, respectively, and there was a 97.8% sensitivity and 96.4% specificity for diagnosing high-grade trochlear dysplasia.

Conclusion: Utilizing radiographs and MRI for the Dejour V2 classification of trochlear dysplasia, we demonstrated only moderate sensitivity in diagnosing low-grade trochlear dysplasia utilizing the 4 types of trochlear dysplasia. The sensitivity for diagnosing low-grade trochlear dysplasia, along with the overall intra- and interrater reliability was improved by simplifying the classification from 4 types of dysplasia to 2 grades, low versus high grade, based on the presence of a supratrochlear spur.

Background: Acetabular labral tears are frequently treated with arthroscopic repair using suture anchors. Iatrogenic chondral injury may occur during predrilling for suture anchors owing to factors such as portal location and drill guide type.

Purpose/hypothesis: The purpose of this study was to evaluate the effect of portal location and use of straight versus curved drill guides on drill perforation rates of the acetabular subchondral bone and outer cortex. It was hypothesized that curved guides and distal portals would minimize these perforation rates.

Study design: Controlled laboratory study.

Methods: Nine cadaveric acetabula were marked at specific clockface positions (3:00 to 11:00) and drilled through anterior, anterolateral, and distal anterolateral accessory (DALA) portals using straight and curved guides. Ninety drill holes were analyzed for subchondral and cortical perforations. Statistical analysis included Fisher exact test and regression modeling.

Results: A total of 90 acetabular suture anchor drill holes were created using each combination of portal (anterior, anterolateral, DALA), drill guide (curved, straight), and clockface position on the acetabulum. Among 90 drillings, 7 (7.8%) perforated the subchondral bone, and 10 (11.1%) perforated the outer cortex. Out of 45 drillings performed with a straight drill guide, 6 (13.3%) perforated the subchondral surface, as opposed to 1 (2.2%) with a curved drill guide. Of 30 drillings conducted via the anterolateral portal, 5 (16.7%) perforated the subchondral surface, as compared with 1 (3.3%) drilled from the DALA or anterior portal. Multiple linear regression based on portal, drill guide, and clockface position did not predict subchondral perforation (R ² = 0.08; P = .35) or outer cortical perforation (R ² = 0.04; P = .35).

Conclusion: The use of anterior and DALA portals minimized subchondral perforation rates but was not statistically significant. Curved guides showed a trend toward reduced perforations when compared with straight guides. Articular surface penetration was most common at the 3:00 and 11:00 positions.

Clinical relevance: This study supports the use of curved guides and distal portals to enhance safety during arthroscopic acetabular labral repair, providing actionable insights for optimizing surgical techniques.

Background: Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. A recent study showed that AMI occurs in over half of patients with acute ACL injuries.

Purposes: To (1) determine the incidence of AMI within the 6 weeks after an anterior cruciate ligament reconstruction (ACLR) and (2) identify the risk factors associated with AMI after an ACLR.

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

Methods: Consecutive patients who sustained a primary ACLR between January and October 2023 were considered for study inclusion. Eligible patients underwent a standardized physical examination at 3 and 6 weeks postoperatively. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its clinical reversibility according to the Sonnery-Cottet classification.

Results: A total of 210 consecutive patients with a primary ACLR were prospectively enrolled in the study. Respectively, 48.6% of patients had AMI at 3 weeks and 24.3% at 6 weeks postoperatively. Among them, 79.4% and 72.5% demonstrated reversible types (grade 1A or 2A), respectively. Multivariate analysis revealed that patients who had a preoperative AMI (odds ratio [OR], 8.27 [95% CI, 4.177-17.138]; P < .001), experienced immediate postoperative pain exceeding 7 out of 10 on the visual analog scale (VAS) (OR, 4.689 [95% CI, 2.144-10.814]; P = .0002), or did not have preoperative physical therapy (OR, 2.303 [95% CI, 1.186- 4.530]; P = .0149) were associated with a significantly greater risk of AMI at 3 weeks postoperatively. No risk factors were found at 6 weeks postoperatively.

Conclusion: AMI occurs in 48.5% of patients at 3 weeks, and 24.2% at 6 weeks after an ACLR. Important risk factors identified for the presence of AMI at 3 weeks postoperatively included the presence of preoperative AMI, immediate postoperative VAS pain score of >7, and absence of preoperative physical therapy.

Background: Technical variations in elbow ulnar collateral ligament reconstruction (UCLR) include graft source, graft/tunnel configuration, and humeral and ulnar fixation. While the biomechanical performance of various constructs has been reported, these studies have small sample sizes and compare at most a few technical variations.

Purpose: To quantitatively synthesize the results of biomechanical investigations of UCLR and repair.

Study design: Systematic review.

Methods: A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses); included articles were published between 1998 and 2020. Biomechanical metrics were utilized to compute effect sizes (standardized mean difference [SMD]) for quantitative analysis when 2 studies reported the same metric for the same comparison. After our initial search, 1293 studies were identified. Summary effects were estimated in random-effects models, and mixed-effects models were constructed to evaluate the fixed effects of technical variations through meta-regression.

Results: A total of 24 eligible studies were included, of which 19 were included in the quantitative analysis. Compared with the intact ligament, UCLR had significantly lower ultimate strength (SMD, -1.411; P < .0001) and stiffness (N/mm) (SMD, -3.259; P = .0268), and significantly greater valgus opening at 70° of flexion (SMD, 1.638; P < .0001). Stiffness (N·m/deg), valgus opening angle at 30° and 90° of flexion, and gapping at failure were not significantly different from the intact UCL (all P > .05). There was no significant difference in ultimate strength between docking and Jobe reconstructions (P = .2889). There were no significant differences between repair and reconstruction in ultimate strength, stiffness (N·m/deg), or yield torque (all P > .05).

Conclusion: Our study demonstrates that, at time zero, UCLR has inferior biomechanical properties compared with the native intact ligament. Biomechanical performance of UCLR was either inferior to the intact UCL (ultimate strength, stiffness [N/mm], and valgus opening at 70° flexion) or not significantly different from it (stiffness [N⋅m/deg], valgus opening at 30° and 90° of flexion, and gapping at failure). There is no difference in biomechanical outcome measurements between docking and Jobe reconstructions, or between UCL repair and reconstruction.