Orthopaedic Journal of Sports Medicine最新文献

Background: Research on surgical strategies to minimize tunnel collisions in combined anterior cruciate ligament (ACL) reconstruction (ACLR) using the modified transtibial technique (MTT) and anterolateral augmentation is limited, unlike with independent tunnel drilling techniques.

Purpose: To analyze the optimal drill orientations for the anterolateral ligament (ALL) femoral tunnel to minimize tunnel collisions and reduce damage to surrounding structures during combined ACLR with MTT and anterolateral augmentation procedures, accounting for far-cortex drilling (FCD) of the ALL femoral tunnel required for graft fixation.

Study design: Descriptive laboratory study.

Methods: Three-dimensional reconstructed femoral models of patients who underwent ACLR with MTT between 2015 and 2018 were used. Geometric factors of femoral models were analyzed, and virtual ALL femoral tunnels were simulated to evaluate 45 drilling combinations. To assess potential damage to surrounding structures associated with ALL femoral tunnel drilling, femoral cortical violation caused by the ALL femoral tunnel itself was assessed under each drilling condition, whereas tunnel trajectories were analyzed to classify drilling conditions according to FCD. In addition, the minimum distance between the ACL and ALL femoral tunnels (MDBT) and the tunnel collision rate were evaluated.

Results: A total of 27 patients were analyzed. In scenarios where FCD was not required for ALL graft femoral fixation, the optimal drill orientation for the ALL femoral tunnel was within the range of coronal -40° to -20°, eliminating cortex violation and tunnel collisions (mean MDBT, 9 ± 4.1 mm; collision rate 0%). When FCD was required for ALL graft femoral fixation, the optimal drill orientation was axial 40° and coronal 10°, resulting in the longest MDBT without the risk of femoral cortex violation (MDBT, 4.9 ± 3.5 mm; collision rate, 7.4%).

Conclusion: During the combined surgeries for ACLR using MTT and anterolateral augmentation procedures, the optimal drill orientation of the ALL femoral tunnel was within the range of coronal -40° to -20° for techniques not requiring FCD and axial 40° and coronal 10° for those requiring FCD.

Clinical relevance: This study provides practical surgical guidance for optimizing ALL femoral tunnel orientation during combined ACLR using MTT and anterolateral augmentation. By accounting for whether FCD is required for ALL graft femoral fixation, the findings may help surgeons minimize tunnel collision and reduce the risk of femoral cortical violation, thereby potentially decreasing procedure-related complications.

Background: All-suture anchors (ASAs) significantly reduced gap formation and increased strength compared with traditional fixation in a transosseous cadaveric quadriceps tendon repair model. However, the biomechanical performance of ASAs for unicortical quadriceps tendon repair has not been evaluated.

Hypothesis: ASAs would reduce gap formation and exhibit comparable stiffness, yield load, and ultimate load to knotless hard-body suture anchors (SAs) for unicortical quadriceps tendon repair.

Study design: Controlled laboratory study.

Methods: Eight matched pairs of male cadaveric knees were used to compare ASA and SA control repairs. Distal quadriceps tendons were prepared with 2 Krackow sutures using 1.3-mm suture tape. Sutures were fixed unicortically with 2 anchors using 2.6-mm ASAs or 4.75-mm SAs. Knees were actuated from 5° to 90° of flexion via the quadriceps tendon for 10 native preconditioning cycles and 250 cycles after repair at 0.1 Hz, with a peak force of 150 N per cycle. Repairs were loaded to failure at 50 mm/min. Gap formation (mm) during cyclic loading and stiffness (N/mm), yield load (N), and ultimate load (N) during load to failure were statistically compared between groups using paired t tests.

Results: The ASA repair had significantly less gap formation at cycle 250 compared with the control repair (Δ = 4.2 mm [95% CI, 2.9 to 5.3 mm]; P < .001) and survived greater cycles before reaching a critical gap threshold of 5 mm (200 vs 50 cycles). No significant differences in stiffness or ultimate load were found between repairs. The yield load was significantly greater in the control group than the ASA group (Δ = 55 N [95% CI = 27-82 N]; P = .002).

Conclusion: Unicortical quadriceps tendon repair with ASAs reduced gap formation by 43% compared with hard-body SAs. No significant differences in stiffness or ultimate load were observed, although a significantly greater yield load was found for the SA controls.

Clinical relevance: ASAs are a biomechanically viable alternative to hard-body SAs for unicortical quadriceps tendon repair, potentially resulting in less gap formation.

Background: Platelet-rich plasma (PRP) has gained widespread use an adjunct to orthopaedic procedures, yet clinical studies have reported conflicting efficacy. The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines were published in 2017 to standardize reporting of PRP preparation, characterization, and delivery, which may explain the heterogeneity of clinical outcomes in studies evaluating PRP for anterior cruciate ligament reconstruction (ACLR).

Purpose: To evaluate adherence to MIBO guidelines in studies evaluating PRP-augmented ACLR and to assess whether reporting adherence improved after the publication of the 2017 guidelines.

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

Methods: A systematic literature search was conducted using the PubMed/MEDLINE, Embase, and Web of Science databases in March 2025 to identify studies evaluating PRP-augmented ACLR. Included studies were randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies published in the English language. Two independent reviewers extracted data on study characteristics and assessed adherence to all 23 MIBO checklist items.

Results: A total of 26 studies (14 RCTs, 12 observational studies) involving 1319 patients were included. The mean MIBO adherence was 40.1% (9.2/23 items) for pre-MIBO studies and 50.1% (11.5/23 items) for post-MIBO studies, with no statistically significant improvement (P = .115). The range of adherence was 17.4% to 82.6%. The most poorly reported items included CONSORT (Consolidated Standards of Reporting Trials)/STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) compliance, anti-inflammatory medication use, platelet recovery rate, PRP storage conditions, and final PRP analysis. No significant differences in MIBO adherence were found between RCTs and observational studies (P = .578). Half of the included studies reported positive outcomes with PRP augmentation, while half reported neutral outcomes.

Conclusion: Adherence to the 2017 MIBO guidelines in studies evaluating PRP-augmented ACLR remains poor, with no significant improvement after guideline publication. Critical information regarding PRP preparation, characterization, and platelet recovery rate continues to be inadequately reported, limiting study reproducibility and the ability to determine true PRP efficacy.

Background: Medial elbow joint instability is a critical concern among young baseball players and is associated with throwing-related injuries. Greater medial elbow joint space (MEJS) gapping has been proposed as a key indicator of valgus instability. However, age-specific differences remain unclear, particularly in elementary school-age pitchers.

Hypothesis/purpose: This study aimed to clarify age-related differences in MEJS gapping by comparing joint space changes between resting and gravity stress conditions among young baseball players. It was hypothesized that 12-year-old players would show greater changes in MEJS compared with younger players.

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

Methods: This study included 190 young baseball players (mean age, 11 ± 0.6 years) from 22 teams. Ultrasonographic assessment of the MEJS was performed during a resting and a gravity-induced valgus stress test. The change in MEJS was defined as the distance between the medial humeral epicondyle and the sublime tubercle of the ulna measured under each condition. The Kruskal-Wallis test was used to compare changes in MEJS among 3 age groups (10, 11, and 12 years), and the Wilcoxon rank-sum test was used to assess differences between the throwing and nonthrowing sides. Multiple regression analysis was performed to identify factors associated with the change in MEJS on the throwing side.

Results: Significant age-related differences in MEJS changes were observed (P = .03). Post hoc analysis revealed that 10-year-old players (median, 0.75 mm [interquartile range [IQR], 0.34-1.27]) exhibited significantly greater changes in MEJS on the throwing side compared with 12-year-old players (median, 0.47 mm [IQR, 0.25-0.70]; P = .03). The change in MEJS on the throwing side was significantly greater than that on the nonthrowing side across all age groups (P < .01). Change in MEJS on the nonthrowing side (β = 0.56; P < .01) and age (β = -0.14; P = .03) were associated with the change in MEJS on the throwing side (R ² = 0.38; P < .01).

Conclusion: Our study demonstrated that 10-year-old players showed greater MEJS changes than 12-year-old players, highlighting the need for age-specific interpretation. These changes may reflect physiological joint laxity related to growth rather than pathological instability, with implications for ultrasonographic interpretation and injury risk.

Background: Heterotopic ossification (HO) frequently occurs after treatments for acute acromioclavicular (AC) joint dislocations, and is often considered a complication.

Hypothesis/purpose: This study aimed to evaluate and compare HO severity and configuration after single-suture button (SSB) and double-suture button (DSB) stabilization, and nonoperative treatment. It was hypothesized that the extent of HO after Rockwood (RW) type V injuries is associated with increased vertical stability, without substantially impairing clinical results.

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

Methods: Patients with acute RW type V dislocations treated with SSB (group 1), DSB (group 2), or nonoperatively (group 3) were analyzed with a 2-year follow-up. The exclusion criteria were previous shoulder surgery or concomitant fractures. HO was evaluated on anteroposterior stress radiographs in the conoid ligament area (CLA) and trapezoid ligament area (TLA), graded by severity and configuration. Radiographic parameters (coracoclavicular difference, RW classification, DPT, and osteoarthritis) and clinical outcomes (Constant Score, Subjective Shoulder Value, Taft score (TF), and Acromioclavicular Joint Instability score were assessed. Group differences were tested using the Kruskal-Wallis test, and associations between HO severity and outcomes were assessed using linear regression.

Results: A total of 85 patients were included (group 1, n = 36; group 2, n = 28; and group 3, n = 21), with a mean age of 39.3 ± 11 and a mean follow-up of 44 ± 21.5 months. HO occurred in 71.3% of cases (CLA) and 58.7% of cases (TLA), with no group differences (P = .390). Severity was predominantly mild across all groups, and the configuration was mostly clavicular. Severity showed no group difference (CLA, P = .703; TLA, P = .132). Configuration differed for the TLA (P = .042), but not for the CLA (P = .178). Severity of HO in the CLA correlated with higher TF scores (B = 0.902; P = .003), whereas TLA severity correlated negatively (B = -0.823; P = .034).

Conclusion: When present, HO was mostly mild and clavicular, without relevant radiographic or clinical effects. Severity in the CLA correlated with a higher TF, whereas severity in the TLA correlated negatively. Given that the other radiographic and clinical parameters are unaffected, the term complication should be used with caution.

Background: Femoral trochlear dysplasia (FTD) is a major factor affecting the stability of the knee joint. Congenital patellar dislocation (CPD) is usually accompanied by distal FTD. Few studies have investigated trochlear development following surgery in skeletally immature patients.

Purpose: To observe trochlear remodeling following surgical extensor realignment and stabilization in children with CPD and to analyze the factors associated with this remodeling.

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

Methods: A retrospective analysis was conducted on surgical cases of CPD treated at 2 centers between January 2014 and June 2023. The recorded data comprised patient age, sex, side, presence of syndromic CPD, genetic testing results, and magnetic resonance imaging (MRI) findings, including the trochlear depth index (TDI), lateral trochlear inclination (LTI), and medial condylar trochlear offset (MCTO). Pre- and postoperative knee joint range of motion and Lysholm scores were also collected. The surgical procedure involved lateral retinacular release, resection of the redundant medial capsule, lengthening suture of the quadriceps femoris, and a Roux-Goldthwait procedure.

Results: In total, 58 cases (80 knees) of pediatric FTD (a modified MRI classification of FTD: 19 mild (type A), 28 moderate (type B), 4 severe (type C), 7 special type) with a mean ± SD age of 34.4 ± 3.68 months (range, 14-64 months) were followed up for 2.46 ± 0.73 years. A total of 40 cases (52 knees) were of the idiopathic type and 18 cases (28 knees) were of the syndromic type. Pre- and postoperative TDI, MCTO, and LTI improved significantly (all P < .0001). The patellar redislocation rate was 1.7%; all had full knee motion, with a mean Lysholm score of 96.

Conclusion: The dysplastic trochlea in CPD postoperation can remodel in skeletally immature patients.

Background: Medial patellofemoral ligament reconstruction (MPFLR) is a standard treatment for patellofemoral instability. Concomitant lateral retinacular release (LR) or lateral retinacular lengthening (LL) is considered for patients with a tight lateral retinaculum (as determined by examination under anesthesia); however, the literature is limited on the frequency of these procedures and the factors associated with their incidence.

Purpose: To investigate associations between demographic characteristics, physical examination findings, and radiologically measured patellofemoral parameters with LR/LL in patients undergoing primary MPFLR.

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

Methods: A prospective multicenter cohort study database was queried for patients who underwent primary MPFLR between January 2017 and July 2022. A total of 23 surgeons from academic centers across the United States performed the procedures. Radiologic parameters, concomitant procedures, and pre- and intraoperative physical examination findings were assessed between patients with and without LR/LL using the chi-square test, independent t test, or Mann-Whitney U test, as appropriate. Binary logistic regression was used to perform a multivariable analysis of factors associated with LR/LL.

Results: Of 428 patients (mean age, 16.7 ± 4.2 years, 64.5% women), 22.9% underwent LR (13.6%) or LL (9.3%). Those who underwent LR/LL were more frequently men (44% vs 23%; P = .049), had lower Beighton scores (2.6 ± 2.7 vs 3.8 ± 2.9; P < .001), and their surgeons were more likely to have completed a sports fellowship (82.7% vs 64.8%; P < .001) compared with those who did not undergo LR/LL. On preoperative examination, patients with LR/LL more often exhibited patellar apprehension (92.6% vs 81.2%; P = .008) and pathologic lateral patellar translation (62.2% vs 49.1%; P = .012). Intraoperatively, patients with LR/LL more often dislocated in extension during examination under anesthesia (70.4% vs 57%; P = .017) and underwent a tibial tubercle osteotomy (TTO) (35.7% vs 9.4%; P < .001). A total of 168 patients had preoperative imaging measurements available, and patients with LR/LL showed greater patellar tilt (24.1°± 7.7° vs 18.5°± 16.7°; P < .001).

Conclusion: Approximately 23% of patients who underwent MPLFR from a large multicenter cohort underwent LR/LL. The LR/LL appears to be associated with less ligamentous laxity, lateral patellar apprehension, surgeon completion of a sports fellowship, and concomitant TTO. These data may elucidate some of the relative factors associated with performing these procedures in patients undergoing primary MPFLR.