Orthopaedic Journal of Sports Medicine最新文献

Background: Artificial intelligence (AI) chatbots are increasingly used for medical information provision. However, systematic evaluations of their accuracy and reliability in orthopaedic surgery, particularly in total knee replacement (TKR), remain limited.

Purpose: To systematically compare and evaluate performances of various AI chatbots, focusing on their ability to provide accurate and reliable information related to TKR.

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

Methods: A total of 43 clinically relevant TKR-related frequently asked questions (FAQs) were selected based on Google search trends and expert consultation. Questions were categorized into 6 key domains: (1) general/procedure-related information, (2) indications and outcomes, (3) risks and complications, (4) pain and postoperative recovery, (5) specific activities after surgery, and (6) alternatives and variations. Each question was submitted to 5 different chatbot models (GPT-3.5, GPT-4, GPT-4 Omni, Gemini Advanced, and Gemini 1.5) for response generation. Two independent orthopaedic surgeons assessed the chatbot's responses for both accuracy and relevance using a 5-point Likert scale. Responses were anonymized, blinding evaluators to the chatbot identities to prevent bias. Accuracy differences among the chatbot models were analyzed by analysis of variance, and relevance was compared using the Kruskal-Wallis test.

Results: GPT-3.5 (4.8 ± 0.5), GPT-4 (4.9 ± 0.4), GPT-4 Omni (4.9 ± 0.3), and Gemini 1.5 (4.8 ± 0.4) demonstrated high accuracy, whereas Gemini Advanced scored significantly lower (4.1 ± 1.4) (P < .001). However, general/procedure-related information, risks and complications, pain and recovery, and postoperative activities showed no significant differences among chatbots. Gemini Advanced underperformed in indications and outcomes (P = .04) and alternatives and variations (P = .002). Regarding relevance, all chatbots except Gemini Advanced (36/43; 83.7%) achieved a 100% relevance rate (P < .001).

Conclusion: This study demonstrates that GPT-3.5, GPT-4, GPT-4 Omni, and Gemini 1.5 can provide highly accurate and relevant responses to TKR-related queries, while Gemini Advanced underperforms.

Background: The effectiveness of matrix-associated autologous chondrocyte implantation (MACI) in patients with lower limb malalignment remains debatable.

Hypothesis: Performing MACI in patients with lower limb alignment abnormalities would result in worse postoperative outcomes than in those without alignment abnormalities.

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

Methods: Patients who underwent MACI using autologous cultured cartilage for traumatic chondral defects and osteochondritis dissecans across 3 institutions between February 2014 and August 2022 were reviewed. Osteotomy was recommended for patients with mechanical alignment (MA) <40% and performed on consenting patients. Evaluation included demographic and clinical variables, Lysholm Knee Score (LKS), Knee injury and Osteoarthritis Outcome Score (KOOS), International Cartilage Regeneration & Joint Preservation Society (ICRS) grade from second-look arthroscopy, and postoperative complications.

Results: Of 96 cases, 39 showed normal alignment and did not require osteotomy, 44 showed varus alignment and underwent corrective osteotomy, and 13 showed varus alignment but declined osteotomy. All groups showed significant improvement in the LKS and KOOS at 2 years (all P < .05). At 1 year, the normal alignment group showed superior LKS (P = .01) and KOOS Activities of Daily Living (ADL) subscale (P = .04) compared with the varus group without osteotomy. The varus group with osteotomy had significantly better LKS (P = .02) and KOOS ADL (P = .04) than the varus group without osteotomy. ICRS grade-based assessments of medial femoral condylar graft sites showed no significant difference between the normal alignment group and varus group with osteotomy (mean, 10.2 vs 10.0; P = .70). However, significantly worse graft-site repair was noted in patients with MA ≥60% (P = .004), although clinical outcomes were not significantly different. Eight complications were reported in the normal alignment group, with 4 each in the varus groups with and without osteotomy.

Conclusion: In patients with varus alignment, MACI outcomes were improved when osteotomy was performed to shift alignment toward valgus. The corrected varus group demonstrated cartilage repair status and clinical outcomes comparable with those of the normal alignment group.

Background: Patient-reported outcome measures (PROMs) are widely used to capture patients' perspectives when evaluating outcomes after arthroscopic knee surgery. To aid in the interpretation of PROM scores at the individual level, the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) are used. These metrics provide patient-centered thresholds for what constitutes a meaningful improvement and satisfactory state postoperatively.

Purpose: To summarize available literature on MCID and PASS values for all PROMs across common primary arthroscopic knee sports surgeries.

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

Methods: MEDLINE, Embase, and Cochrane databases were queried from inception through January 13, 2025, to identify studies that calculated MCID or PASS values of PROMs after primary knee arthroscopic surgeries of the anterior cruciate ligament (ACL), meniscus, or cartilage. Study characteristics, MCID and PASS thresholds, and threshold calculation methods were extracted. MCID and PASS thresholds were aggregated by PROM, surgical treatment, and calculation method and then summarized using a range.

Results: In total, 59 studies met the inclusion criteria; 52 studies calculated MCID thresholds, with 15 studies using anchor-based methods and 39 studies using distribution-based methods. A total of 21 studies calculated PASS thresholds; 35 studies calculated thresholds for ACL procedures, 15 studies for meniscus procedures, and 8 studies for cartilage procedures. ACL reconstruction was the most reported procedure (n = 32 studies). Thresholds were calculated for 18 different PROMs, with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) being the most frequently reported instrument (n = 34 studies). The range of MCID thresholds for the IKDC after ACL reconstruction was 7.1 to 16.2 using anchor-based methods and 7.6 to 10.5 using distribution-based methods, while PASS thresholds ranged from 66.7 to 80.5.

Conclusion: The heterogeneity observed in reported MCID and PASS values suggests that these metrics should be viewed as context-specific. While most studies in this review used distribution-based calculations to derive MCID values, anchor-based calculations should be prioritized in future studies as they better reflect the patient's perception of improvement. Overall, this study will allow investigators to use appropriate clinically relevant thresholds for designing randomized controlled trials, comparing the proportion of patients achieving a meaningful improvement and satisfactory state across different treatment arms, and establishing patient expectations for recovery.

Background: Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, accounting for about half of all knee injuries, and most athletes opt to undergo ACL reconstruction (ACLR). The quadriceps tendon (QT) ACLR has only recently been gaining popularity, and therefore few studies exist for evaluating the healing, or ligamentization, timeline of the QT autograft.

Purpose: To evaluate the signal intensity (SI) ratio of the tendon QT autograft after ACLR during the first postoperative year.

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

Methods: A prospective case series of 19 athletes (mean age = 15.63 years) with ACL rupture who underwent ACLR with a QT autograft underwent knee magnetic resonance imaging (MRI) at 4 time points: presurgery (PRE), 3 months postoperative (3M), 6 months postoperative (6M), and 12 months postoperative (12M). SI ratio was calculated across different anatomic landmarks, specifically the intra-articular tissue of the native ACL of the contralateral knee from the PRE time point; the QT graft in the intra-articular space at 3M, 6M, and 12M time points; and the posterior cruciate ligament at each visit, to be used as a reference value and account for visit-to-visit variations in the MRI signal. Means of the SI ratio were calculated at the full graft level, as well as segmented into either 4 or 24 segments for analysis.

Results: At the full-graft level, there was a significantly higher SI ratio in the QT graft at 3M and 6M compared with the native contralateral ACL. By 12M, the full graft was most like the native contralateral ACL. Similarly at the 4 subsegment level, all regions except the distal segment had significantly higher SI ratios at 3M and 6M as compared with the native contralateral ACL. By 12M, all subsections of the graft were not significantly different from the native contralateral ACL.

Conclusion: The SI ratio of QT graft was increased at 3M and 6M after surgery and then returned close to that of the native ACL by 12M after surgery, which is largely consistent with the published maturational timeline of patellar tendon and hamstring tendon autografts.

Background: The surgical indications for reverse shoulder arthroplasty (RSA) have continued to expand as it continues to be effective in restoring functionality in older, less active populations. The effect of RSA on return to sport (RTS) in the athletic population has been sparsely studied.

Purpose: To systematically review the RTS rate after primary RSA.

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

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the PubMed, Embase, and Web of Science online databases was conducted and included articles published from database inception until December 22, 2024. Inclusion criteria consisted of studies reporting on RTS after primary RSA. Rates of RTS or activity were collected. Patient-reported outcome measures (PROMs) and range of motion (ROM) data were collected when available. Delta values, the change from preoperative to postoperative values, were calculated for each PROM and ROM when available. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results: Overall, 15 studies reporting on a total of 937 patients (954 shoulders) were included in this review. Mean patient age was 72.7 years (range, 68.0-76.5 years), and 58.1% were female. Mean follow-up was 40.5 months (range, 31.6-57.6 months). The RTS for the studies ranged from 48% to 100%. Swimming (n = 188 athletes) was the most reported sport, followed by golf (n = 151 athletes). Sport-specific RTS rates ranged from 50% to 100% for golf and 64% to 67% for swimming. Patients returned to a higher level of performance 11% to 74% of the time. Postoperative delta values ranged from -7 to -2.1 for the visual analog scale for pain (VAS Pain) during sport, -6.1 to -3 for VAS Pain, 24.4 to 59 for the American Shoulder and Elbow Surgeons score, and 3.8 to 8 for the Simple Shoulder Test. The mean MINORS score of the included studies was 16.8 (range, 16-19) for comparative studies and 10.0 (range, 9-11) for noncomparative studies.

Conclusion: Our study showed that primary RSA allows for variable rates of RTS ranging from 48% to 100%, with 50% to 100% of patients returning to golf and 64% to 67% returning to swimming. Overall, patients reported improved postoperative outcomes scores and range of motion.

Background: Sulcus-deepening trochleoplasty is an effective surgical treatment for high-grade trochlear dysplasia in patients with recurrent patellofemoral instability. However, concerns remain regarding the potential development of patellofemoral osteoarthritis (OA) over time and its effect on clinical outcomes.

Purpose: To determine whether the presence of radiographic grade ≤2 OA after trochleoplasty is associated with inferior functional outcomes or patient satisfaction.

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

Methods: A retrospective study was conducted on 42 patients (47 knees) who underwent thick-flap sulcus-deepening trochleoplasty. After applying inclusion and exclusion criteria, 27 patients (33 knees) with a minimum follow-up of 10 years were included. Patients were categorized into OA and non-OA groups based on radiographic assessment (Iwano classification) at final follow-up. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Kujala scores, while patient satisfaction was assessed on a 10-point scale. Group comparisons were performed using Mann-Whitney U and chi-square tests.

Results: At a mean follow-up of 14.97 years (range, 10.4-19 years), 20 knees (60.6%) demonstrated radiographic OA (Iwano grades 1-2), while 13 knees (39.4%) showed no OA. Patients in the OA group were older (37.5 ± 6.7 vs 30.5 ± 3.0 years, P < .001) and had a longer follow-up duration (15.8 vs 13.0 years, P = .037). No significant differences were observed in other baseline characteristics. All patients underwent concomitant medial patellofemoral ligament reconstruction, and 14 additionally received a tibial tubercle osteotomy. Functional outcomes did not significantly differ between groups (IKDC: 79.06 ± 14.72 vs 78.04 ± 15.11, P = .726; Kujala: 80.45 ± 12.5 vs 80.07 ± 13.88, P = .462). Range of motion was comparable between groups, and overall patient satisfaction remained high (8.4 ± 1.65).

Conclusion: Low-grade patellofemoral OA (Iwano ≤2) was observed in 60% of knees at a mean follow-up of 15 years, but its presence did not negatively affect long-term functional outcomes or patient satisfaction. Importantly, no patient developed grade 3 or 4 OA, and radiographic changes were more frequent in older patients and those with longer follow-up, supporting trochleoplasty as a reliable surgical option for patients with high-grade trochlear dysplasia.

Background: Relative humeral retrotorsion (rHRT) is an osseous adaptation in overhead athletes garnered from repetitive overhead throwing. Accurate measurement of anatomic humeral retrotorsion (aHRT) is important as it aids in the determination of rHRT, which influences glenohumeral range of motion profiles. While computed tomography scans are the gold standard for assessing aHRT, their limited clinical utility has driven interest in accessible alternatives, such as diagnostic ultrasound.

Purpose/hypothesis: The purpose of this study was to validate a handheld ultrasound device (HH-US) as a clinically accessible tool to measure aHRT in baseball and softball athletes. It was hypothesized that a HH-US device will be reliable and valid when quantifying aHRT compared with an established benchmark, diagnostic musculoskeletal ultrasound (MSK-US).

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

Methods: Data were collected from collegiate baseball and softball athletes at 2 local universities. Participants were uninjured at the time of testing and over 17 years old. Anatomic HRT was measured bilaterally using both MSK-US (GE Venue Go) and handheld ultrasound (GE Vscan Air) using previously established methods. The intraclass correlation coefficient, standard error of measure, and minimal detectable change, as well as Bland-Altman plots, were used to assess reliability and agreement between devices, respectively.

Results: A total of 93 athletes were included in this study. HH-US had excellent intrarater reliability (ICC₂,₁ = 0.98; 95% CI, 0.94-0.97; SEM₉₀ = 1.77°; and MDC₉₀ = 4.12°). There was acceptable agreement between the HH-US and MSK-US. The mean difference between devices was -0.63° and 0.48° for the throwing and nonthrowing arms, respectively. Analysis of Bland-Altman plots demonstrated no significant bias across the range of measurements. HH-US measurements were completed in <2 minutes.

Conclusion: Our study showed that HH-US provides a reliable and valid measurement of aHRT in comparison to MSK-US and may be an accessible option for clinicians evaluating overhead athletes. Given its strong agreement with established methods, HH-US offers an efficient and cost-effective alternative to MSK-US when measuring aHRT in baseball and softball athletes.

Background: Female runners have a higher risk of stress fractures compared with their male counterparts. However, the literature about best practices for preventing stress fractures in female long-distance runners is lacking.

Purpose: To identify which factors predict the risk of stress fractures within 6 months in highly trained female long-distance runners.

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

Methods: We measured bone mineral densities (whole body and lumbar spine) and body composition using dual-energy X-ray absorptiometry (DXA) in 21 highly trained female long-distance runners aged 18 to 37 years who belonged to a women's track team. Participants were followed prospectively for 6 months. Stress fractures were confirmed with bone scan, magnetic resonance imaging, and/or computed tomography findings. We employed univariate logistic regression and stepwise multivariate logistic regression, along with receiver operating characteristic curves, to examine the ability of bone mass and body composition parameters, alone or in combination, to predict the occurrence of a stress fracture.

Results: We performed 118 DXA measurements. Stress fractures (4 sacral, 3 tibial, 3 calcaneal, 2 pubic, 2 femoral neck, 1 rib, 1 cuboid, and 1 metatarsal) occurred in 9 runners within 6 months. Bone mineral densities (% of young adult mean [YAM]; whole body: odds ratio [OR], 0.923; lumbar spine: OR, 0.914), total bone mineral content (BMC) (OR, 0.019), lean body mass (OR, 0.807), and percentage total BMC relative to total body mass (OR, 0.197) were significantly associated with a stress fracture developing. The multivariate analysis showed that bone mineral density of the lumbar spine alone was the strongest predictive factor (OR, 0.914 [95% CI, 0.853-0.963]). A lumbar spine bone mineral density <81.1% of the YAM predicted a stress fracture within 6 months, with 88% sensitivity and 74% specificity (area under the curve, 0.818).

Conclusion: Our study demonstrated that highly trained female long-distance runners with lumbar spine bone mineral density <81.1% are at increased risk of a stress fracture within 6 months and should reduce their high-impact sports activities to avoid developing a stress fracture. The present study may provide meaningful information, suggesting that DXA measurements could be a useful screening tool in routine medical examinations to predict stress fractures in female long-distance runners, which may assist preventive programs or protocols.

Background: Multiple techniques exist to repair acute tears of the patellar tendon. Surgical repair is required to reestablish full function of the extensor mechanism of the knee, and optimal results typically occur when the tear is repaired acutely.

Purpose: To systematically review the literature to evaluate treatment outcomes and complication rates after acute surgical repair of patellar tendon ruptures using suture anchor repair, transosseous repair, and end-to-end repair.

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

Methods: A systematic review was performed to analyze outcomes after patellar tendon repair in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Potential studies were identified through searches of the Cochrane Central Register of Controlled Trials, PubMed, and Embase. Screening was completed independently by 2 authors, who sought to identify studies published from January 1980 to December 2024 that described the management of acute patellar tendon ruptures. Articles were excluded if they described chronic tears or included cases of patellar tendon ruptures in patients who previously underwent total knee arthroplasty. Clinical outcome data were recorded, including treatment outcomes and complications.

Results: Twenty studies analyzing 1161 patients met the inclusion criteria. The most reported repair techniques were suture anchor repair, transosseous repair, and end-to-end repair. Six studies analyzed transosseous repair and found positive postoperative functional outcomes, including mean postoperative Lysholm scores ranging from 84 to 98.08 (any, n = 3). Two studies reported using suture anchors, and each stated a postoperative flexion range of motion >130°, with no complications. Five studies analyzed end-to-end acute patellar tendon rupture repair and reported mean flexion >130° (n = 3), with the most reported complication being wound infections. Eight studies compared multiple techniques for acute patellar tendon rupture repair, and 6 studies showed statistically significant improvements in functional outcome scores when comparing pre- and postoperative scoring within cohorts. Additionally, 5 studies in this group reported complications, with the most common being rerupture, reoperation, skin infections, and deep vein thrombosis.

Conclusion: Surgical repair of acute patellar tendon rupture with suture anchor repair, transosseous repair, and end-to-end repair all achieved high healing rates. The majority of surgical options demonstrated good functional outcomes with a low risk of complications, the most common of which related to wound complications and infection.