Orthopaedic Journal of Sports Medicine最新文献

Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games.

Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games.

Study design: Descriptive epidemiology study.

Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes.

Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90).

Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.

Background: The modified Balance Error Scoring System (mBESS) incorporates nondominant leg stance for a ceiling effect, but that may not be the worse balancing leg. Updated recommendations call for single- and dual-task tandem gait, but limited research has explored these effects on the mBESS.

Purposes: To compare mBESS performance between dominant and nondominant legs during single and dual tasks and to determine 1-week test-retest reliability.

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

Methods: A total of 119 intercollegiate, collegiate club, and high school athletes were administered a baseline mBESS battery consisting of performance on both legs and during single and dual task at 2 time points, 1 week apart. Measures consisted of mBESS errors and sway index during counterbalanced single- and dual-task conditions on dominant and nondominant legs. Wilcoxon signed-rank tests were conducted to determine differences in errors and sway index between dominant and nondominant legs and single- and dual-task performance. Spearman correlations were used to measure reliability at 1 week ± 2 days.

Results: No differences were observed between nondominant and dominant single-leg errors (P = .79) and sway index (P = .98), nor tandem stance errors (P = .95) and sway index (P = .86). Greater errors were committed during dual-task single-leg stance (P = .05) but not on sway index (P = .69). No differences existed between single and dual tasks on tandem errors (P = .63) and sway index (P = .53). Test-retest coefficients were weak to moderate (r_s = -0.009 to 0.368) for normal mBESS errors and fair for sway index (r_s = 0.389 to 0.442) at a 1-week interval.

Conclusion: Our study demonstrated that leg dominance does not appear to affect mBESS errors or sway index, indicating that either leg may be used, in the absence of lower extremity injury history or instability. Incorporation of a dual task provides little clinical utility and may not be specific enough to elicit postural control changes on the mBESS, further indicating the use of optional foam conditions or single- and dual-task tandem gait. Caution is needed when using mBESS after a 1-week time point.

Background: Hip abductor tendon tears have been identified as a common cause of greater trochanteric pain syndrome. While abductor tendon tears are often managed surgically, the optimal tendon attachment technique remains controversial.

Purpose: To compare the outcomes of hip abductor tendon repair between the suture anchor (SA) and transosseous suture (TS) techniques.

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

Methods: A literature search was performed in June 2023 in Embase, PubMed, and Web of Science databases. Studies reporting pre- and postoperative clinical outcomes of hip abductor repairs using SA or TS fixation with a minimum follow-up of 12 months were included in our analysis. From 608 studies initially identified, 21 studies (14 SA and 7 TS) with a total of 680 patients met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction, and the quality of the studies was assessed using the methodological index for non-randomized studies checklist. The results were presented as a narrative summary using descriptive statistics such as ranges and agreement statistics.

Results: Significant pre- to postoperative improvement in pain scores and functional outcomes were reported on all included studies. The mean improvement on the Harris Hip Score/modified Harris Hip Score was 32.5 (95% CI, 28.4-36.7) for the SA technique versus 21.9 (95% CI, 6.7-37.0) for the TS technique, while mean improvement in pain according to the visual analog scale was 5.1 ± 2.3 for SA and 4.8 ± 2.2 for TS (P = .9). There was a trend toward statistical significance regarding retear rates, with higher rates for SA (6.7% ± 7.6%) versus TS (1.3% ± 4.7%) (t[13.9] = 2.0; P = .06).

Conclusion: We observed no significant difference between SA and TS regarding improvements in patient-reported hip outcome and pain scores. However, SA trended toward a higher retear rate. Future research should propose a classification scheme that considers tear size and morphology, the extent of associated muscle degeneration, and the distance of tendon retraction to provide more context for the understanding of expected functional outcomes.

Background: The effects of the erector spinae plane (ESP) block and interscalene nerve block (ISNB) on arthroscopic rotator cuff repair (RCR) have been investigated separately.

Purpose: To evaluate whether additional catheterization for the ESP block can decrease acute postoperative pain and opioid consumption above the ISNB and multimodal oral analgesics in patients after arthroscopic RCR.

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

Methods: Included were patients who underwent primary arthroscopic RCR between January 1 and December 31, 2021, and received either ISNB (ISNB group) or additional ESP block catheterization (ESP block group) as part of their pain management. Patients who underwent concomitant shoulder procedures were excluded. Patient characteristics, surgical details, pre- and postoperative numerical pain rating scale (NPRS) scores, rescue analgesic use, and possible opioid-related side effects were recorded. The primary outcome was the NPRS score immediately after surgery; secondary outcomes included rescue opioid use and opioid-related side effects until patients were discharged the next day. The Mann-Whitney U test or the chi-square test was used for between-group comparisons. Multiple linear regression analysis was conducted to examine predictors for total opioid consumption.

Results: A total of 54 patients were included-21 in the ISNB group and 33 in the ESP block group. The ESP block group exhibited significantly lower postoperative NPRS scores (2 ± 0.3 vs 3 ± 1.6 for ISNB; P = .003), reduced opioid consumption during hospitalization (0.5 ± 1.3 vs 6.1 ± 8.3 morphine milligram equivalent [MME] for ISNB; P < .001), and fewer opioid-related side effects (0 vs 3 for ISNB; P = .022). Multiple linear regression analysis indicated that the analgesic protocol (β = 5.750; P < .001) and the number of anchors used (β = 1.609; P = .022) were independently correlated with higher opioid consumption. Subgroup analysis revealed that additional ESP block significantly reduced opioid consumption during repairs involving ≥2 tendons (7.6 ± 9 vs 0.5 ± 1.4 MME; P < .001).

Conclusion: The study findings indicated that additional catheterization for the ESP block reduced postoperative pain, opioid consumption, and opioid-related side effects during the acute postoperative period of arthroscopic RCR when the ISNB and multimodal oral analgesics had already been administered. Future studies are needed to evaluate this treatment protocol.

Background: Atrophy and fatty infiltration of the supraspinatus (SS) muscle are prognostic indicators of poor functional outcomes and higher retear rates after rotator cuff repair. While older patients, female patients, and those with massive and retracted rotator cuff tears are at a higher risk for these indicators, it is unclear whether tear characteristics, acromion morphology, and acromioclavicular (AC) joint arthritis affect SS atrophy in older patients with chronic shoulder pain.

Purpose: To investigate the multifactorial influences associated with SS atrophy in rotator cuff tears.

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

Methods: A review was conducted on 391 patients with atraumatic shoulder pain (mean age, 60.88 ± 8 years; range, 50-93 years; 200 men and 191 women) who underwent magnetic resonance imaging between May 2019 and April 2020. SS atrophy was calculated using the occupation ratio. Logistic regression was performed to evaluate the association of SS atrophy with patient age and sex, rotator cuff tear type (partial- vs full-thickness), anteroposterior (AP) tear size, AC and glenohumeral (GH) joint arthritis, and acromion shape. A subgroup analysis was performed in patients without tears to investigate whether SS atrophy and fatty infiltration were independent phenomena.

Results: Overall, 91 patients had full-thickness tears without retraction, 131 had partial-thickness tears, and 169 had no tears. The prevalence of SS atrophy was associated with patient age and was more prevalent in women (67.6%), full-thickness tears (91.1%), an AP tear size of >15 mm (92.6%), and GH joint arthritis (100%) (P < .001 for all). The severity of atrophy (indicated by a decrease in the occupation ratio) increased with older age. In the patients without tears, SS atrophy prevalence was 33.1%. Logistic regression analysis showed significant independent associations of SS atrophy with age (P < .001), female sex (P < .001), nonretracted full-thickness tears (P < .001), an AP tear size of >15 mm (P < .001), and hook-shaped acromion (P = .007). A subgroup analysis of the nontear group revealed a significant association of SS atrophy with fatty infiltration (P < .001).

Conclusion: This study identified significant associations between SS atrophy and older age, female sex, full-thickness tear without retraction, an AP tear size of >15 mm, and hook-shaped acromion. Notably, partial-thickness tears were not significantly associated with SS atrophy.

Background: Postoperative knee arthrofibrosis after arthroscopic ligament reconstruction is a serious complication. Among adolescents, risk factors for postoperative arthrofibrosis are not well characterized and the effectiveness of early manipulation under anesthesia (MUA) is not well established.

Purposes: To identify risk factors for arthrofibrosis after arthroscopic knee ligament reconstruction in adolescent patients and to evaluate the safety and effectiveness of early MUA.

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

Methods: The charts of all adolescent patients (<19 years of age) who underwent early MUA (<3 months) for knee stiffness after anterior cruciate ligament (ACL) or medial patellofemoral ligament (MPFL) reconstructions between 2008 and 2021 were retrospectively reviewed. Patients were matched 2:1 with patients without MUA from the same study period. The primary outcome was the final range of motion (ROM) after MUA. Logistic regression analysis was performed to identify predictors of MUA.

Results: A total of 25 patients (10 with ACL reconstruction and 15 with MPFL reconstruction) with a mean age of 14.8 ± 2.6 years were included for analysis. Overall, 44% were skeletally immature. Patients underwent MUA at a mean of 63.3 ± 19.5 days after the index surgery. The mean ROM improved significantly from 96.3°± 20.5° to 135°± 9.7° after MUA after a median follow-up of 8.1 months (interquartile range, 5.4-15.0 months). There were no complications associated with MUA, but 2 patients (8.0%) had MUA treatment failure. There were no differences in body mass index, type and frequency of associated procedures, or patellar height on lateral radiographs between the cohorts. The MUA cohort had statistically significant increased operative time, decreased preoperative motion, decreased ROM at 6 weeks postoperatively, and increased pain at 6 weeks postoperatively when compared with the non-MUA cohort. Regression analysis demonstrated that ROM at 6 weeks (OR: 0.83, 95% CI, 0.69-0.98, p = .034) was significantly associated with the need for MUA.

Conclusion: The findings of this study suggest that early (<3 months) MUA is safe and effective in treating knee arthrofibrosis in adolescent patients. MUA is a treatment alternative for patients with restricted ROM at 6 weeks that may help them recover full ROM.

Background: A new "terrible triad" has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known.

Purpose: To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs.

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

Methods: An initial cohort of 1228 patients with ACLRs were retrospectively identified between April 2016 and November 2021. A total of 41 patients with isolated ACLR (isolated cohort) were age and sex matched to 41 patients who had an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Patients in the triad cohort were identified consecutively by date of surgery. Preoperative and ≥2-year postoperative PROs were evaluated to compare the isolated cohort with the triad cohort. Statistical analysis was performed with unpaired t tests and chi-square tests.

Results: Both the isolated cohort and triad cohort demonstrated significant differences between preoperative and postoperative PROs in all questionnaire categories assessed. Postoperative scores for the International Knee Documentation Committee (isolated, 88.8; triad, 86.2; P = .392), Cincinnati (isolated, 91.1; triad, 88.1; P = .295), and Lysholm (isolated, 92.1; triad, 90.1; P = .472) PROs demonstrated no significant differences between the cohorts. No significant difference was found between the isolated and triad cohorts for all preoperative questionnaire categories. Additionally, no significant difference was found in revision or reoperation rates between isolated and triad patients (P = .733).

Conclusion: No significant differences in PROs were found at minimum follow-up of 2 years postoperatively between the patients who underwent isolated ACLR (isolated cohort) and those who underwent ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Inferior outcomes were not observed in the triad cohort when revision rates, reoperation rates, and postoperative PROs were compared. Given the optimistic short-term outcomes for isolated versus triad ACLR patients and the known biomechanical consequences of these untreated meniscal injuries, medial meniscus ramp and lateral meniscus root repairs should be performed when encountered concurrently with an ACL tear when possible.

Background: Approximately 20% of acute ankle sprains progress to chronic lateral ankle instability (CLAI), requiring surgical intervention. When only the anterior talofibular ligament (ATFL) is ruptured, it is controversial whether to perform arthroscopic inferior extensor retinacular (IER) reinforcement.

Purpose: To assess the postoperative outcomes of IER reinforcement versus nonreinforcement in arthroscopic treatment of CLAI with ATFL-only injury.

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

Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, Cochrane Library, Embase, and Web of Science databases were searched for publications on arthroscopic ATFL repair with versus without IER reinforcement. The final search date was July 7, 2023. Through a comprehensive meta-analysis, functional outcomes (American Orthopaedic Foot & Ankle Society Ankle-Hindfoot [AOFAS], Karlsson-Peterson [K-P], and Foot and Ankle Outcome Score [FAOS] scores), radiological outcomes (talar anterior translation and talar tilt), and complication rates (superficial peroneal nerve injury, knot irritation, and total complications) were evaluated. The mean difference (MD) was compared for continuous outcomes, and the odds ratios (ORs) were compared for categorical outcomes between the patients with versus without IER reinforcement.

Results: A total of 4 studies (n = 271 patients; 157 male, 114 female; 141 patients with IER reinforcement, 130 without IER reinforcement) were included in the final analysis. There were no significant differences between the patients with versus without reinforcement regarding AOFAS score (MD = 0.72 [95% CI, -2.17 to 3.61]; P = .63; I ² = 0%), any of the FAOS subscores, talar anterior translation (MD = 0.10 [95% CI, -0.53 to 0.73]; P = .76; I ² = 0%), talar tilt (MD = 0.14 [95% CI, -0.86 to 1.13]; P = .79; I ² = 0%), or total complications (OR = 2.29 [95% CI, 0.92 to 5.71]; P = .07; I ² = 24%). However, the IER reinforcement group showed superior postoperative K-P scores compared with the nonreinforcement group (MD = 6.22 [95% CI, 2.17 to 10.26]; P = .003; I ² = 0%).

Conclusion: The results of the meta-analysis suggest that IER reinforcement may not be necessary for achieving satisfactory postoperative outcomes in CLAI with ATFL-only injury. Further research is required to investigate the impact of ligament injury severity, body weight, and concomitant calcaneofibular ligament injuries on the results.

Registration: CRD42023447669 (PROSPERO).

Background: Injury to the posterior vasculature is a potential complication in orthopaedic knee surgery that may be associated with variations in its anatomy, such as the type II-A2 variant, which places the anterior tibial artery (ATA) in closer proximity to the tibia. However, how close surgical instrumentation comes to injuring the ATA is not well described.

Purpose: To determine how the type II-A2 variant of the popliteal vasculature affects proximity of the ATA to instrumentation for orthopaedic knee procedures.

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

Methods: A total of 222 knee magnetic resonance imaging (MRI) scans from a single academic tertiary referral center were evaluated, and ATA branching patterns were characterized. The distances from the ATA to simulated instrumentation of high tibial osteotomy (HTO), posterolateral corner anatomic reconstruction, posterior cruciate ligament (PCL) reconstruction, lateral meniscus posterior horn repair, and lateral meniscus posterior root repair on axial plane MRI scans were measured by 2 authors independently using imaging software. Intrarater and interrater reliability of the measurements was calculated using the intraclass correlation coefficient.

Results: ATAs with the type II-A2 pattern passed anterior to the popliteus on 3.15% (n = 7) of the 222 MRI scans. The distance between the ATA and the simulated instrumentation was significantly closer in type II-A2 compared with normal (type I) knees for the lateral meniscus posterior root repair tunnel (11.1 vs 15.7 mm; P = .014), HTO cuts (0.6 vs 8.2 mm; P < .001), and PCL reconstruction tunnel (4.1 vs 11.7 mm; P < .001). Interrater reliability was good to excellent for all measurements, and intrarater reliability ranged from moderate to excellent.

Conclusion: HTO cut, PCL reconstruction tunnel, and lateral meniscus posterior root tunnel instrumentation were significantly closer to the ATA in knees with type II-A2 anatomy compared with normal (type I) anatomy. Careful analysis of vasculature using MRI may be of utility for select surgery about the knee to guide surgical technique.

Background: Young athletes who undergo surgery for a rotator cuff tear (RCT) are expected to return to sports (RTS) at the preinjury level.

Purpose: To determine the rate and level of RTS and associated factors after RCT surgery in young athletes.

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

Methods: A literature search was performed in PubMed, Embase, and Cochrane Library the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were studies in English evaluating RTS after surgical treatment of RCTs in athletes <40 years. Study quality was evaluated according to the Methodological Index for Nonrandomized Studies scores. Fixed-effects and random-effects meta-analyses were conducted to investigate the overall RTS rate and the ability to RTS at the preinjury level and explore the heterogeneity of the studies.

Results: Of 168 studies initially identified, 13 studies (332 athletes; 270 competitive and 62 recreational) were included. The mean age of the athletes was 26.1 years (range, 13.2-39 years). Eleven studies (289 athletes) reported the type of sports; the most common sports were baseball (n = 195), football (n = 47), and tennis (n = 13). A total of 25 athletes were lost to follow-up, leaving 307 athletes with postoperative RTS data for meta-analysis. The combined rate of RTS according to the fixed-effects model was 84% (95% CI, 80%-88%). The level of RTS was evaluated in 11 studies (251 athletes), and according to the random-effects models, the combined rate of RTS at the preinjury level was 63% (95% CI, 49%-77%). In a subgroup analysis, the rate of RTS at the preinjury level was significantly different between competitive athletes (61% [95% CI, 46%-76%]) and recreational athletes (89% [95% CI, 78%-99%]) (P = .004).

Conclusion: Results of this review indicated that most young athletes were able to RTS after RCT surgery, and more than half were able to RTS at the preinjury level. Compared with competitive athletes, a higher proportion of recreational athletes were able to RTS at the preinjury level after surgery.