Orthopaedic Journal of Sports Medicine最新文献

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) is an uncommon clinical condition with a reported prevalence of <0.5%. There is a paucity of histopathological descriptions in the literature, which limits our understanding of the underlying pathophysiology.

Purpose: To define the histopathology and gene expression patterns of ACL mucoid degeneration to guide future biological and surgical management options.

Study design: Case series; Level of evidence 4.

Methods: Ten patients with ACL mucoid degeneration between 2002 and 2023 were included. Plain radiograph and magnetic resonance imaging were reviewed to obtain multiple anatomic and morphometric measurements. Tissue samples were obtained from all patients during arthroscopic partial debridement of the ACL, and ACL tissue from 3 normal cadaveric knees was sampled for comparison. Formalin-fixed and paraffin-embedded tissues were prepared for histopathologic examination of microstructure and composition and for multiplex gene expression analysis using the NanoString nCounter Human Fibrosis V2 Panel.

Results: All 10 patients reported pain and limited knee flexion. Radiological evaluation exhibited a bulbous appearance, an increased posterior tibial slope, a narrow notch width index, and increased signal intensity of the ACL. Early degenerative changes were common in the medial compartment. Histopathological analysis revealed significant differences in tissue architecture compared with normal ACL controls, including a disorganized collagen matrix and increased glycosaminoglycan content. NanoString multiplex gene expression analysis revealed 155 differentially expressed genes (DEGs) between the mucoid degeneration and control groups. The 5 most upregulated DEGs identified were Fibronectin 1, COL5A1, COL6A3, COL3A1, and COL1A2. Significant differences were observed in the pathway scores for epithelial-to-mesenchymal transition, extracellular matrix degradation/synthesis, collagen biosynthesis, focal adhesion kinase, platelet-derived growth factor signaling, and PI3K-Akt.

Conclusion: Histological findings demonstrated distinct abnormalities in ACL structure and composition. We hypothesized that repetitive microtrauma of the ACL would lead to cumulative damage that ultimately would result in mucoid degeneration. Also, we hypothesized that increased PTS and a narrow notch width index would contribute to cumulative ligament loading and subsequent mucoid degeneration.

Background: Knee injuries are among the most common injuries in female basketball players. Despite the growing popularity of professional women's basketball, particularly the Women's National Basketball Association (WNBA), there are limited recent data evaluating the incidence of and risk factors for knee injuries in WNBA athletes.

Hypothesis: Older age, minutes played per game, number of games played, and player usage rate would be significantly associated with having a knee injury in WNBA players from the 2017 to 2022 seasons.

Study design: Descriptive epidemiology study.

Methods: Publicly available data on the injury history and player records of active WNBA players between the 2017 and 2022 seasons were reviewed to identify players with a knee injury resulting in ≥1 games missed. The primary outcome was the incidence of knee injuries reported per 1000 minutes-exposures (MEs). Player demographics, statistics, and injury characteristics were recorded. Secondary analysis was conducted using bivariate and multivariable logistic regression to investigate risk factors associated with having a knee injury.

Results: A total of 87 players (10.8% of all players) sustained a combined 104 knee injuries between the 2017 and 2022 seasons, indicating a rate of 6.03 knee injuries per 1000 MEs. Accounting for potential confounders, having a knee injury was significantly associated with older age (OR, 1.11; 95% CI, 1.05-1.18; P = .0002) and higher usage rate (OR, 1.06; 95% CI, 1.02-1.11; P = .02).

Conclusion: This study showed that knee injuries occurred in 10.8% of players, with an overall rate of 6.03 injuries per 1000 MEs. The most significant risk factors associated with having a knee injury in WNBA athletes were older age and higher player usage rate. Implementing targeted load management strategies for players with higher usage rates or advanced age may help reduce the incidence of knee injuries among female basketball athletes.

Background: Platelet-rich plasma (PRP) treatment for chronic lateral elbow tendinopathy (LET) has increased because of its potential for prolonged symptom relief and improved function. Limited studies have definitively documented long-term benefits.

Purpose: To assess the efficacy of a single intratendinous PRP injection compared to a corticosteroid injection for the treatment of LET.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: In total, 48 participants (n = 50 elbows), aged 18 to 65 years, were randomly assigned to ultrasound-guided PRP (n = 26) or corticosteroid (control, n = 24) injection. Patient-Rated Tennis Elbow Evaluation (PRTEE) and Quick version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) were compared at baseline and 4, 8, 12, 16, 26, and 52 weeks. Secondary outcomes were assessed via grip strength, visual analog scale (VAS) scores, and overall satisfaction with treatment. Wilcoxon rank-sum tests and longitudinal analysis of covariance models were used to assess outcomes over time.

Results: At 4 weeks, mean PRTEE scores were 47.6 ± 3.7 in the PRP group compared to 14.8 ± 3.9 in the CSI group (P < .001). At 8 weeks, PRTEE scores were 32.1 ± 3.7 for PRP and 15.2 ± 4.0 for CSI (P = .003). At 12 weeks, scores were 26.3 ± 3.9 for PRP versus 16.0 ± 4.1 for CSI (P = .07). By 26 weeks, mean scores favored PRP (17.7 ± 6.5 vs 35.3 ± 6.8; P = .07), and by 52 weeks, PRP scores remained lower (14.4 ± 6.3 vs 29.6 ± 6.3; P = .10). At 4 weeks, mean QuickDASH scores were 22.4 ± 1.1 in the PRP group versus 15.5 ± 1.1 in the CSI group (P < .001). At 8 weeks, PRP scores were 19.3 ± 1.1 compared to 15.8 ± 1.2 for CSI (P = .04). No significant differences were observed at 12 weeks (17.7 ± 1.1 vs 16.6 ± 1.2; P = .49) or 16 weeks (16.8 ± 1.1 vs 18.4 ± 1.2; P = .35). At 26 weeks, QuickDASH scores favored PRP (15.7 ± 1.6 vs 20.3 ± 1.7; P = .05), and this difference persisted at 52 weeks (14.0 ± 1.6 vs 18.6 ± 1.6; P = .05). However, VAS scores were on average 1.5 points lower in the PRP group across all time points.

Conclusion: Our study demonstrated that corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. PRP was associated with lower average VAS scores over time.

Background: Hamstring injuries are common in sports involving rapid acceleration and directional changes. Despite extensive research, management remains primarily dependent on clinical judgment, owing to the absence of standardized, evidence-based protocols.

Purpose: To compare the outcomes of operative versus nonoperative treatments, focusing on patient satisfaction, muscle strength, range of motion (ROM), activity level, and return to sport.

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

Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a systematic search of the PubMed, Google Scholar, Web of Science, and ScienceDigest databases from January 2000 to May 2024. Reported outcomes measured were muscle strength, ROM, functional activity, pain levels, return to preinjury activity levels, and patient satisfaction. Additionally, any complications related to the intervention were documented. The authors identified 13 eligible studies involving adults with acute hamstring injuries, including 526 patients. Eleven studies specifically investigated operative treatment, 1 examined nonoperative management, and 1 directly compared both approaches.

Result: Surgical intervention was consistently associated with superior outcomes across multiple domains. Postoperatively, the Lower Extremity Functional Scale score often exceeded 74, and strength recovery commonly approached 90.0% of the contralateral limb. ROM was preserved after surgery but was not evaluated in nonoperative cohorts. Functional activity was generally higher after operative treatment (mean Tegner Activity Scale [TAS] scores: 4.7 ± 0.8, 6.0 ± 1.47, 5.1, and 8.5 ± 2.4; Marx Activity Rating Scale scores: 3.5 ± 4.3 and 4.4 ± 4.4), whereas nonoperative treatment showed a decline in TAS score (6.9 ± 1.7 to 6.1 ± 1.9; P = .030). Pain levels were low overall (visual analog scale score: 0.7 ± 0.9 to 4.0 ± 4.0). Complications were more frequent after surgery (4.2%-36.6%, including hematomas, neurapraxia, and superficial infections), although mostly minor. Nonoperative complications were limited to ecchymosis.

Conclusion: This study demonstrated that operative treatment was associated with good functional recovery, muscle strength, and high return-to-sport rates. Complications rates within the operative group were mostly minor and not statistically significant when compared to nonoperative management, which yielded good outcomes in the limited available data. Further prospective studies using standardized outcome measures and clear subtype definitions are required to determine which patients benefit most from operative versus nonoperative management.

Background: Weightlifting improves physical fitness; however, injuries can lead to impaired functionality and long-term complications. Data on weightlifting-related injuries are limited.

Purpose: To evaluate the epidemiologic trends of weightlifting-associated upper extremity injuries, further stratified by age.

Study design: Descriptive epidemiologic study.

Methods: This analysis used the National Electronic Injury Surveillance System (NEISS) database, including all patients presenting to the emergency department (ED) with a primary upper extremity weightlifting injury between 2021 and 2024. Outcomes included patient demographic characteristics, final diagnosis, primary body region injured, and mechanism of injury (MOI). Patients were stratified into 4 age groups: pediatric (<18 years), young adult (18-39 years), middle-age (40-64 years), and geriatric (≥65 years). Chi-square tests and post hoc comparisons were used to evaluate categorical variables. Linear and logistic regression analyses were used to evaluate associations between age groups. Statistical significance was predetermined at <.05.

Results: After application of inclusion and exclusion criteria, 3189 upper extremity weightlifting injuries (national estimate [NE] = 127,667) were analyzed. Across all ages, sprain/strain (NE = 36,054; 26.2%), fracture/crush/avulsion (NE = 22,388; 15.8%), and laceration/puncture (NE = 9020; 7.2%) were the most common diagnoses. Injuries most frequently involved the shoulder (NE = 45,825; 33.8%), finger (NE = 32,398; 28.1%), and upper arm (NE = 7827; 8.8%). The most common MOIs were drop/crush injuries (NE = 34,757; 30.1%), pulling movements (NE = 14,232; 10.5%), and overhead movements (NE = 11,110; 8.3%). Pediatric patients were 2.5 times more likely to sustain finger injuries (odds ratio [OR], 2.536; 95% CI, 2.191-2.935; P < .001) and injuries from drop/crush mechanisms (OR, 2.484; 95% CI, 2.166-2.849; P < .001) compared with all other age groups. The geriatric age group was 2 times more likely to sustain injuries from pushing movements (OR, 2.037; 95% CI, 1.326-3.130; P < .001) compared with all other age groups.

Conclusion: Sprain/strain and fracture/crush/avulsion were frequent upper extremity weightlifting injuries, often secondary to drop/crush injuries and overhead movements. Pediatric athletes were more likely to sustain finger and drop/crush injuries, whereas shoulder injuries affected all adult age groups. The low proportion of geriatric weightlifters suggests there may be underuse of a sport effective in combating osteoporosis. These insights into overall and age-specific injury patterns can help shape evidence-based recommendations to reduce the overall injury burden and promote safe resistance training.

Background: Lumbar spondylolysis (LS) has distinct pathologic stages, and worsening LS can cause poor bone union and low back pain. However, the risk factors involved in LS pathogenesis remain unclear.

Purpose: To identify risk factors associated with the pathologic progression of LS at the L5 in adolescent male soccer players.

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

Methods: A total of 189 male adolescent soccer players aged 12 to 14 years were recruited. We used lumbar magnetic resonance imaging (MRI) to examine adolescent soccer players' lumbar lordosis (LL), sacral slope (SS), sacral rotation angle, maturity stage of the lumbar vertebral bodies, and bone marrow edema (BMO) at L5. In addition, whole-body dual-energy x-ray scans measured bone mineral density and content as well as trunk lean body mass. Moreover, we tested the flexibility of the iliopsoas, hamstrings, and quadriceps, as well as evaluated the range of motion (ROM) of the hip in both external and internal rotation. LS stages were determined using computed tomography (CT)-like and short-tau inversion recovery (STIR) modes. The change over the 6-month period was the main outcome; participants were classified as "worsened,""improved," or "no change." The worsened group was defined by a pathological progression on CT-like mode or new BMO appearance on STIR mode without CT-like change. Multiple logistic regression analysis was then performed to identify risk factors for the pathologic progression of LS.

Results: Of the 163 players analyzed, 47 (28.5%) showed LS progression. BMO (odds ratio [OR], 5.54; 95% CI, 2.23-13.76), SS relative to LL (OR, 5.58; 95% CI, 2.32-13.51), sacral rotation angle ≤-1.5 or ≥1.5 (OR, 5.74; 95% CI, 2.36-13.96), and hip external rotation ROM (OR, 4.30; 95% CI, 1.67-11.06) were significantly associated with the pathologic progression of LS.

Conclusion: Our study demonstrated that the risk factors for LS progression in male adolescent soccer players include BMO, sacral anteversion relative to LL, sacral rotation, and restricted hip external rotation ROM. Early BMO detection and sacral malalignment improvement may prevent pathologic LS progression in male adolescent soccer players.

Background: Spondylolysis is commonly seen in adolescent athletes with lumbar pain after acute or repetitive low back hyperextension. Nonoperative management and rest often lead to symptom resolution and return to sport in acute injuries. However, follow-up imaging confirming radiographic healing is rarely utilized.

Purpose/hypothesis: The purpose of this study was to investigate the relationship between age, sex, and radiographic healing in pediatric athletic patients with spondylolysis after nonoperative treatment. It was hypothesized that younger athletes would have better healing rates as older patients are closer to the end of bony growth.

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

Methods: A retrospective review was conducted of adolescent cases of spondylolysis treated by a single physician between September 1, 2022, and May 1, 2024. Patients included were <19 years of age, had a diagnosis of spondylosis as confirmed by magnetic resonance imaging with limited computed tomography (CT) imaging, and had a 3-month follow-up limited CT study. Patients diagnosed with chronic spondylosis or spondylolisthesis or treated surgically were excluded. Data collection included sex, date of birth, sports participation, date of injury and initial visit, fracture Hollenberg grade, fracture laterality, and fracture spinal level. Initial and 3-month follow-up limited CT imaging reports were also reviewed to evaluate healing status.

Results: A total of 100 patients were included in the final analysis. The mean age at the time of injury was 15.0 years (range, 9-18 years). The most common spondylosis fracture grade seen was grade 2 (64%) across all age groups. After 3 months of nonoperative treatment, 93 fractures demonstrated partial or complete healing on follow-up imaging, whereas 7 fractures demonstrated no healing. No differences in healing rates were observed between the age groups or sexes. Notably, all the nonhealed fractures were bilateral, compared with 33 (35.5%) of the healed fractures (P = .001).

Conclusion: The vast majority (93%) of acute adolescent spondylosis cases demonstrated radiographic healing after 3 months of nonoperative treatment.

Background: Adolescent gymnasts are at increased risk for wrist pathology due to repetitive high-impact wrist loading during the midgrowth spurt.

Purpose: To conduct a comprehensive systematic review on the epidemiology and risk factors for wrist pain and injury in adolescent artistic gymnasts.

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

Methods: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched MEDLINE, EMBASE, CINAHL, Cochrane, and SPORTDiscus from inception to January 2025. We included observational studies of adolescent artistic gymnasts that reported prevalence, incidence, and/or risk factors for wrist pain, acute injuries, chronic injuries (causing physeal stress or not attributable to a specific acute event), or positive ulnar variance (PUV). Where applicable, meta-analyses were conducted to estimate the pooled prevalence and proportion of new cases for each outcome using common- or random-effect models. Results from studies that were not possible to pool were also reported.

Results: Of the 3650 records identified, 25 studies (185,107 gymnasts) were included for analysis. All evidence was deemed low to very low certainty. Nine studies suggested a pooled wrist pain prevalence of 53% (95% CI, 39%-66%), with 1 study reporting the proportion of new wrist pain cases to be 2% over 1 year. The prevalence of acute wrist injuries reported in 1 study was 34%, and the pooled proportion of new cases was 4% (n = 2 studies; 95% CI, 2%-7%) over a 2-year period. The pooled prevalence of chronic wrist injury was 36% (n = 6 studies; 95% CI, 12%-71%), and the pooled proportion of new chronic wrist injury cases was 5% (n = 2 studies; 95% CI, 3%-10%) over a 2-year period. Two studies suggested a pooled PUV prevalence of 4% (95% CI, 1%-14%), with 1 study reporting the proportion of new PUV cases to be 16% over an 18-month period in preteen gymnasts (mean ± SD age, 10 ± 2 years). Wrist pain was significantly associated with age between 10 and 14 years, increased age at training onset, training intensity, body mass index, years training, and weekly training hours.

Conclusion: Our review demonstrated that adolescent artistic gymnasts demonstrate an alarmingly high prevalence of acute and chronic wrist pain and wrist injury. Further research on training intensity thresholds and risk reduction strategies is imperative for informing and implementing guidelines that protect the health of this vulnerable population.

Background: Hip arthroscopy is an effective treatment for femoroacetabular impingement and labral tears, with improvements in patient-reported outcomes (PROs). Whether anatomic and management differences between sexes translate into divergent outcomes remains uncertain.

Purpose: To systematically review sex-based differences in radiographic findings, intraoperative pathology, surgical management, and postoperative outcomes after hip arthroscopy.

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

Methods: A literature search of the PubMed, CENTRAL, and Scopus databases was performed on February 27, 2025, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were included if they reported sex-specific preoperative and postoperative PROs in individuals undergoing hip arthroscopy for femoroacetabular impingement or labral pathology, were published in the English language, and had a minimum 2-year follow-up. Data on patient demographics, radiographic parameters, intraoperative findings, surgical management, and outcomes were extracted. The methodological quality of each study was independently evaluated using the methodological index for non-randomized studies.

Results: Six studies including 3914 hips (2260 female, 1654 male) met inclusion criteria. Four studies were level 3 and 2 were level 4 evidence, all with moderate methodological quality. All studies demonstrated significant postoperative improvements in PROs (p < .05). Of 4 studies reporting alpha angles, all of them found significantly greater values in male patients (p < .05). Of 6 studies, 1 identified significantly higher Non-Arthritic Hip Score and modified Harris Hip Score totals in men within the 30- to 44-year age subgroup (p = .008; p = .015), and 1 reported significantly higher Hip Sports Activity Scale scores in men (p = .01). One study found that a greater proportion of female patients achieved Patient Acceptable Symptom State thresholds for the 12-item International Hip Outcome Tool (p = .0008). No sex-based differences were observed in minimal clinically important difference achievement, revision arthroscopy, or conversion to total hip arthroplasty (p > .05).

Conclusion: Male and female patients demonstrated comparable improvements in PROs, achievement of clinically meaningful thresholds, revision rates, and rates of conversion to total hip arthroplasty after hip arthroscopy. Although men exhibited larger alpha angles and more advanced chondral damage, and women more frequently underwent capsular repair, these sex-based differences did not translate into clinically significant disparities in postoperative outcomes.