Orthopaedic Journal of Sports Medicine最新文献

[This corrects the article DOI: 10.1177/23259671251380883.].

Background: Few reports have examined the relationship between anterolateral ligament (ALL) injury or deep medial collateral ligament (dMCL) and meniscal injury in an acute anterior cruciate ligament (ACL)-injured knee.

Purpose/hypothesis: The purpose of this study was to investigate the association between ALL or dMCL injury observed on magnetic resonance imaging (MRI) in acute ACL injury with meniscal ramp lesions and lateral meniscus (LM) oblique radial tears (LMORTs) or localization of bone marrow lesions (BML), preoperative anterior tibial translation (ATT), and rotational instability. It was hypothesized that ALL or dMCL injuries accompanying acute ACL-injured knees are linked to meniscal injuries, such as ramp lesions or LMORT, BML, and increased knee instability.

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

Methods: This study included 164 patients who underwent MRI ≤1 month after primary ACL injury. All participants underwent evaluation of the side-to-side difference in ATT on stress radiographs and manual pivot-shift test preoperatively. ALL or dMCL injury and BML localization were diagnosed using MRI, and meniscal injuries were diagnosed via arthroscopy during ACL reconstruction. The relationship between concomitant meniscal injuries, BML, and knee instability in the ALL-injured and -intact groups, as well as in the dMCL-injured and -intact groups, was evaluated.

Results: Overall, 89 of 164 (54.3%) knees had ALL injuries, 101 (61.6%) knees had dMCL injuries, and 64 (39.0%) knees had both ALL and dMCL injuries on MRI. ALL injuries were significantly correlated with ramp lesions, other LM injuries, and BML in both the lateral femoral condyle (LFC) and the lateral tibial plateau (LTP) (P < .05). dMCL injury was significantly correlated with LMORT, other LM injuries, BML in the LFC, and BML in the LTP (P < .05). ALL or dMCL injuries observed on MRI did not increase knee instability. Ramp lesions (odds ratio [OR], 3.70; P = .001), BML in LFC (OR, 2.17; P = .03), and BML in LTP (OR, 2.00; P = .04) were independent factors that increased the odds of finding associated ALL injury, whereas LMORT (OR, 3.01; P = .04) and BML in LTP (OR, 2.90; P = .002) independently increased the odds of dMCL injury.

Conclusion: In the acute phase of ACL injury, ramp lesions and BML in LFC, and BML in LTP were an independent factor that increased the odds of finding ALL injury, whereas LMORT and BML in LTP independently increased the odds of having associated dMCL injury.

Background: Acromioclavicular joint (ACJ) reconstruction has been widely studied; however, the methodological quality of its most cited research remains uncertain. Citation-based analyses have emphasized the influence of frequently cited studies.

Purpose: To (1) identify the 50 most cited original studies on ACJ reconstruction and assess their methodological quality using established scoring systems, and (2) explore correlations between study quality, citation count, and citation density.

Study design: Cross-sectional study.

Methods: A Web of Science search (1946-August 2024) identified publications on ACJ reconstruction. The 50 most cited articles were analyzed for bibliographic details, citation metrics, and level of evidence (LOE). Clinical studies were assessed using the Modified Coleman Methodology Score (MCMS), Methodological Index for Non-Randomized Studies (MINORS), and Methodological Quality for Clinical Studies of Radiologic Examinations (MQCSRE). Cadaveric studies were evaluated using the Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT).

Results: The 50 most cited articles garnered 5918 citations, with a mean of 118 ± 62 citations per article. Most articles were published in the American Journal of Sports Medicine, accounting for 56% of the total (n = 28). Clinical studies accounted for 66% (n = 33) of the articles, while cadaveric studies comprised 34% (n = 17). The United States was the leading contributor (44%; n = 22), followed by Germany (22%; n = 11). Significant correlations were observed between citation counts and the MINORS (r = 0.37; P < .05) scores and LOE (r = -0.37; P < .05). No significant correlations were found between citation counts and the MCMS (r = 0.24; P > .05), MQCSRE (r = 0.20; P > .05) or BOBQAT (r = -0.22; P > .05). Analysis of citation density indicated that recent decades (2011-2020) showed increased values, showing trends in research activity.

Conclusion: Study quality was partially correlated with citation counts among highly cited clinical studies on ACJ reconstruction. The overall methodological quality was moderate, highlighting the need for higher-level evidence. This article serves as a reference for key literature.

Background: Lateral ankle sprains are the most common lower extremity injury in athletes, most often involving the anterior talofibular ligament (ATFL). Although ATFL repair outcomes are well studied, optimal management for patients with generalized ligamentous laxity (GLL) remains less understood.

Purpose: To (1) evaluate the radiographic findings, clinical measures, and complications in patients with GLL undergoing modified Broström-Gould repair and to (2) assess the role of suture augmentation in optimizing outcomes.

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

Methods: During July 2025, the PubMed, EMBASE, and Cochrane library databases were systematically searched to identify studies examining outcomes and complications in GLL patients who underwent modified Broström-Gould repair.

Results: Eight studies including 301 GLL patients (309 ankles) and 367 patients (370 ankles) without ligamentous laxity were analyzed. Both cohorts demonstrated postoperative clinical improvement. A significant difference in postoperative talar tilt angle existed only between GLL patients who underwent modified Broström-Gould repair without suture augmentation and patients without ligamentous laxity (mean difference, 2.18°; 95% CI, 0.57°-3.79°; P = .008). GLL patients experienced 53 (17.2%) failures and were 4.79 times more likely to develop recurrent mechanical instability than patients without ligamentous laxity (risk ratio [RR], 4.79; 95% CI, 1.70-13.5; P = .003). Among GLL patients, the absence of suture augmentation was associated with a 2.95-fold higher complication risk compared with patients without ligamentous laxity (RR, 2.95; 95% CI, 1.08-8.01; P = .03). When suture augmentation was performed, no significant difference in complication rates existed between cohorts.

Conclusion: Patients with GLL experienced significantly higher rates of complication and failure following modified Broström-Gould repair compared with patients without ligamentous laxity. Suture augmentation may lower complication rates in GLL patients, but its effect on failure rates remains undetermined, as no studies directly compared augmented and nonaugmented GLL patients. Importantly, both GLL patients and patients without ligamentous laxity experienced clinical improvements from the modified Broström-Gould repair. While GLL increases the risk of mechanical complications, it should not be considered a contraindication to undergoing the modified Broström-Gould procedure. However, suture augmentation may be beneficial for GLL patients to reduce the risk of complications after undergoing ATFL repair.

Registration: CRD420251182303 (PROSPERO identifier).

Background: Persistent instability and altered scapular mechanics after acromioclavicular joint (ACJ) reconstruction may stem from inadequate replication of native coracoclavicular (CC) ligament function. However, in vivo data on postoperative CC ligament behavior during dynamic shoulder motion remain lacking.

Purpose: To assess in vivo functional distance and timing characteristics of the conoid and trapezoid ligaments during active shoulder elevation after ACJ reconstruction, using dynamic stereo x-ray (DSX) imaging and patient-specific 3-dimensional (3D) models.

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

Methods: Twelve participants (10 men and 2 women, mean age 39 ± 10 years, mean body mass 92 ± 17 kg) who had sustained an acute unilateral ACJ disruption (Rockwood classification of 3-5) and undergone anatomic ACJ reconstruction were recruited within 1 to 3 years after surgery. Participants underwent 3D computed tomography (CT) and DSX imaging to capture abduction, scaption, and flexion movements. Patient-specific bone models with digitized CC insertion points were then aligned within each frame of the biplanar radiograph images. From this, the peak functional distance, time at peak, and displacement were measured and compared with the uninjured limb.

Results: Compared with uninjured limbs, the reconstructed limb demonstrated increased conoid and trapezoid peak distances of 23% and 17% between insertion points, respectively, across abduction, flexion, and scaption. Additionally, the conoid and trapezoid reached these peak distances at later stages of the movement cycle, and experienced increased displacement by 2.7 and 1.8 mm, respectively, in the reconstructed limb.

Conclusion: This investigation established the methodological feasibility of using DSX combined with patient-specific CT models to quantify in vivo ligament behavior during functional shoulder motion. It further identified significant asymmetries in the functional distance between conoid and trapezoid ligament insertion points when comparing reconstructed and uninjured limbs across multiple shoulder elevation movements.

Background: Rotator cuff repair aims to optimize stability and healing. While double-row (DR) techniques have shown biomechanical advantages, retear rates remain high, especially in the anterior supraspinatus (SSP). This region experiences greater gap formation and strain than the posterior SSP, making it more prone to retears.

Purpose: To assess the biomechanical properties of a novel double-double-row (DDR) repair compared with a DR repair.

Hypothesis: The DDR repair will exhibit superior biomechanical outcomes than the standard DR repair.

Study design: Controlled laboratory study.

Methods: Twelve pairs of fresh-frozen human cadaveric shoulders were mounted to a 6-degree-of-freedom robot. With the humerus at 30° of abduction and external rotation, the SSP line of action was marked. The SSP muscle was dissected, and native tendon stiffness was measured. Each specimen was then repaired with either a DR or a DDR repair. The DR repair used a 6-strand, self-reinforcing construct with three medial and two lateral anchors. The DDR repair added an anterior row to the standard repair. A pressure sensor was placed beneath the repair. The tendon was then cyclically loaded from 25 to 100 N for 3000 cycles and pulled to failure. Repair footprint contacts and failure outcomes were compared.

Results: The DDR repair group exhibited a 54% increase in overall contact area (DR, 172 ± 27 mm²; DDR, 266 ± 42 mm²; P < .001), a 92% increase in mean contact pressure (DR, 0.08 ± 0.03 MPa; DDR, 0.16 ± 0.4 MPa; P = .015), a 57% improvement in gapping (DR, 0.7 ± 0.2 mm; DDR, 0.4 ± 0.1 mm; P = .001), and a 57% increase in failure load (DR, 332 ± 119 N; DDR, 520 ± 184 N; P = .025) compared with the DR repair group.

Conclusion: Addressing the anterior portion of the SSP in a DDR repair versus a DR rotator cuff repair yields significant increases in contact area and mean contact pressure at the tendon-bone interface, stronger fixation, and reduced gap formation under cyclic loading.

Clinical relevance: DDR repair may enhance healing potential and reduce retear risk, particularly in patients with anteriorly based tears or those at elevated risk due to tissue quality or tear morphology.