Orthopaedic Journal of Sports Medicine最新文献

Background: The role of magnetic resonance imaging (MRI) in the treatment protocol of lateral epicondylitis is controversial.

Purpose: To explore the relationship between the radiohumeral synovial plica (RHSP) and surrounding anatomic landmarks through cadaveric studies, perform a precise and detailed morphometric parametric analysis of RHSP using MRI in patients with lateral epicondylitis, and assess the predictive power of RHSP syndrome on the failure of nonoperative treatment.

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

Methods: There were a total of 8 elbow specimens in this study. The MRI findings were compared with those in anatomic sections and histological preparations. A total of 459 patients with lateral epicondylitis from 3 hospitals were included and divided into a nonoperative treatment failure group (n = 138) and a nonoperative treatment success group (n = 321). The prognostic prediction model for nonoperative treatment was developed using the logistic regression method. Model 1 was based on logistic regression results, and model 2 was model 1 with the parameter of RHSP syndrome removed.

Results: The RHSP is contiguous with the radiohumeral articular capsule and subtly mingles with the lateral collateral ligament (LCL) complex and common extensor tendon (CET), forming an enthesis. Furthermore, the authors found that patients in the nonoperative treatment failure group had greater RHSP dimensions and a higher prevalence of RHSP syndrome (all P < .05). In addition, sex, RHSP syndrome, size of CET tear, grade of LCL complex abnormality, and muscle edema were independent predictors of failure for nonoperative treatment. The AUC of model 1 (0.839; 95% CI, 0.796-0.881) was significantly higher than that of model 2 (0.805; 95% CI, 0.760-0.851) (P = .024).

Conclusion: The authors developed a model to predict the failure of nonoperative treatment in patients with lateral epicondylitis. Additionally, RHSP syndrome significantly improves the model's predictive capacity.

Background: Ulnar collateral ligament (UCL) reconstruction (UCLR) is commonly performed in Major League Baseball (MLB) pitchers, and there remain limited data on off-speed pitch performance in those that return to play after reconstruction.

Purpose/hypothesis: The purpose of this study was to evaluate the effect of primary UCLR on curveball (CB) and change-up (CU) pitch performance in terms of velocity along with novel pitching metrics including spin rate, hard-hit rate, and whiff rate. It was hypothesized that post-UCLR off-speed pitch spin rates, velocity, and whiff rate would decrease significantly compared with pre-UCLR levels, while hard-hit rates would increase.

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

Methods: Pitchers who underwent UCLR and returned to MLB level of play were identified from public records from 2016 to 2019. The Statcast system was used to collect spin rate, velocity, hard-hit, and whiff rate data for CB and CU pitches for preinjury seasons, as well as the first 2 seasons after return from UCLR. A matched-pair analysis was performed by matching each pitcher to an uninjured healthy pitcher from the same draft class and round.

Results: A total of 29 pitchers met inclusion criteria and threw the pitches of interest. There were no statistically significant changes in CB or CU mean spin rate, pitch velocity, hard-hit rate, or whiff rate when comparing preinjury levels with the first and second seasons played after reconstruction. There were no significant differences in any pitching metrics when comparing the UCLR cohort with the healthy matched-pair cohort. The mean total number of CU pitches significantly decreased in the first season after UCLR (154.0 vs 67.9; P = .04) and compared with the matched-pair cohort at 1 year (67.9 vs 233.2; P = .001). Pitchers also threw fewer total pitches in the first season after returning from UCLR compared with preinjury baselines and healthy matched pairs.

Conclusion: The results of this study demonstrate that pitchers who undergo UCLR and return to the MLB level can expect similar off-speed pitch performance in comparison with their preinjury levels and with pitchers without UCL injury.

Background: Sports injuries are a leading cause of pediatric emergency department (ED) visits in the United States (US), accounting for approximately 20% of all injury-related visits, with 41% requiring operation. Football, basketball, baseball, soccer, and ice hockey are the 5 most popular US sports by viewership and participation, and pose a high risk of lower-extremity orthopedic injury. Despite increasing youth participation, previous studies have focused on a single sport or diagnosis, leaving limited population-level data to compare injury patterns across sports and sexes.

Purpose: This study used nationally representative ED data to characterize the epidemiology, anatomical distribution, and temporal trends of pediatric lower extremity injuries from 2015 to 2024 across the 5 most popular US sports.

Study design: Descriptive epidemiology study.

Methods: Pediatric lower extremity injuries from January 1, 2015, to December 31, 2024, in football, baseball, basketball, ice hockey, and soccer were queried using the National Electronic Injury Surveillance System (NEISS). Descriptive data, injury site, diagnosis, and product codes were recorded for patients aged between 0 and 18 years. National estimates (NEs) were calculated using NEISS sample weighting, and injury trends were evaluated using linear regression modeling.

Results: A total of 77,654 cases representing an estimated 2,308,476 national injuries were identified, with a mean age of 13.74 ± 2.85 years. The injury distribution by sport was as follows: basketball (41.9%); football (27.7%); soccer (24.7%); baseball (4.8%); and ice hockey (0.9%). The most injured body parts were the ankle (42.9%) and the knee (29.3%). Sprains/strains accounted for 50.6%, followed by fractures (13.6%) and contusions (10.2%). Injuries occurred most frequently in boys, accounting for 78.7% of cases; however, girls experienced disproportionately higher rates of sprains/strains, ankle, and knee injuries. Injury levels peaked in 2015, with a 53.5% decline between 2019 and 2020 during the coronavirus disease 2019 pandemic. By 2024, injury frequencies rebounded to 94.9% of prepandemic levels.

Conclusion: Despite a temporary pandemic-related decline, pediatric lower-extremity injuries remain prevalent and have nearly returned to prepandemic levels. While injury rates were highest among boys, girls experienced disproportionately high rates of noncontact injuries in soccer and basketball. Targeted prevention efforts should address sport- and sex-specific risks to improve youth athlete safety.

Background: Anterior cruciate ligament (ACL) injuries of the knee in skeletally immature patients are increasingly prevalent, yet limited data exist regarding the mechanical properties of pediatric knee ligaments.

Purpose: To evaluate and compare the biomechanical properties of the ACL, posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and iliotibial band (ITB) in pediatric cadaveric knee specimens.

Study design: Controlled laboratory study.

Methods: Eighteen fresh-frozen pediatric knee specimens (aged 8-12 years) underwent dissection and uniaxial tensile testing to failure. Mechanical parameters, including maximum load, stiffness, linear modulus, tensile strain, and tensile strength, were calculated. Results were analyzed using linear mixed-effects models with Tukey-adjusted P values.

Results: The ITB demonstrated comparable mechanical properties to the ACL and MCL. The ITB also exhibited lower stiffness than the PCL (P = .004) and a higher maximum load than the LCL (P = .001).

Conclusion: The ITB shows biomechanical properties similar to the ACL and MCL, supporting its use as a graft in pediatric knee ligament reconstruction. These findings enhance the understanding of pediatric ligament mechanics and inform graft selection in surgical planning.

Clinical relevance: The study highlights the ITB's biomechanical similarity to the ACL, informing graft selection for ACL reconstruction in pediatric patients.

Background: Upper extremity neurovascular injuries (UENVIs) are a significant yet understudied aspect of sports medicine. Although distinct UENVIs have been independently studied, no report describes the incidence of UENVIs across all collegiate sports.

Purpose: To analyze the occurrence, demographics, treatment modalities, and outcomes associated with UENVIs across various sports in collegiate athletes using data from the Pac-12 Health Analytics Program database.

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

Methods: The Pac-12 Health Analytics Program database was queried for brachial plexus injuries and sports-related UENVIs over a 7-year period (2016-2022). UENVIs were subdivided into neurologic neck injury, transient brachial plexus injury, and thoracic outlet syndrome. Statistical analysis consisted of the chi-square test for categorical variables and analysis of variance for continuous variables. Significance was defined as P < .05.

Results: In total, 15,609 athletes with injuries across 21 sports were identified, of whom 213 experienced UENVIs. Of the athletes, 155 (72.8%) were male and 58 (27.2%) were female. Football players comprised the largest number of UENVI cases. When football players were excluded from the analysis, female athletes had a higher incidence of UENVIs at 61.7% compared to males at 38.3%. Most players were White (50.8%) or Black (23%). Among all athletes in each sport, the highest rates of UENVIs were observed in wrestling (3.9%), football (3.6%), and tennis (2.6%). Of the athletes, 95.5% with UENVIs returned to their previous level of activity or reported no interference with their sport from the injury.

Conclusion: Most UENVIs in collegiate athletes are transient and self-limited. This is the first study to report on sex and race distribution for UENVIs. Many athletes return to sport at a similar or higher level.

Background: Although several studies report the incidence of musculoskeletal injuries in ballet dancers, few studies evaluate return to dance (RTD) after surgery.

Purpose: To describe characteristics of professional ballet dancers who underwent surgery for musculoskeletal injuries/pathologies and to report their RTD, physical health, and mental health.

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

Methods: The records of all professional ballet dancers registered at the Opéra de Paris in September 2024 were reviewed to identify dancers who had undergone surgeries (excluding infiltrations and injections) to treat musculoskeletal injuries/pathologies. A questionnaire was completed, including RTD data, pain at the operated site, satisfaction with surgery, University of California-Los Angeles activity score, and 12-item Short-Form Health Survey (SF-12). Descriptive statistics were used to summarize the data.

Results: Of 165 registered professional ballet dancers, 18 had undergone at least 1 surgery during their professional career, and all 18 responded to the questionnaire. The cohort comprised 11 women and 7 men who had undergone a total of 31 surgeries (only 1 unrelated to dance), with a mean age at time of surgery of 30.7 ± 6.2 years (range, 18-42 years). There were 13 knee procedures, 8 foot/ankle procedures, 5 hip procedures, 3 hand/wrist procedures, and 2 thoracolumbar procedures. All 18 dancers eventually returned to dance (100%) at 7 ± 4 months (range, 1-17 months). At 83 ± 67 months (range, 11-305 months) after surgery, pain at the operated site was 1.6 ± 2.4 (range, 0-8), satisfaction with surgery was 8.3 ± 3.4 (range, 0-10), UCLA activity score was 9.1 ± 1.5 (range, 6-10), SF-12 physical component was 88.1 ± 12.5 (range, 45-100), and SF-12 mental component was 65.3 ± 19.2 (range, 25-100).

Conclusion: Our study demonstrated that, of the 165 professional ballet dancers registered at the Opéra de Paris in September 2024, 18 dancers (11%) had undergone 31 surgeries to treat musculoskeletal injuries and/or pathologies during their professional career. After surgery, the RTD rate was 100%, with dancers reporting little to no pain and excellent physical health, but satisfactory mental scores. High rates of return to dance and good clinical scores are possible in professional ballet dancers who undergo surgeries for musculoskeletal injuries.

Background: There is a paucity of literature on the effects of labral tear size on long-term patient-reported outcomes (PROs) and conversion to total hip arthroplasty (THA) after hip arthroscopy.

Purpose: To understand the differences in hip arthroscopy survivorship and outcomes between patients with large labral tears (LLTs) and small labral tears (SLTs).

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

Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to femoroacetabular impingement by a single surgeon from 2001 to 2013; they completed surveys for such PRO measures (PROMs) as the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific, 33-item International Hip Outcome Tool (iHOT-33), and pain relief. Patients ≤18 years of age, hip dysplasia LCEA <20°, and Tönnis grade ≥2 were excluded. Included patients were stratified into 2 cohorts: SLT (≤60°) and LLT (>60°).

Results: In this study of 154 patients (48.7% female; mean ± SD age, 38 ± 10.8), there was a mean ± SD follow-up of 11.0 ± 2.4 years and body mass index of 26.1 ± 4.3 kg/m². Women experienced a higher frequency of SLT than men (59.8% vs 40.2%; P = .003). Student t tests demonstrated that the SLT cohort experienced significantly better outcomes than the LLT cohort for mHHS, HOS-ADL, and iHOT-33. Multivariate linear regression analyses adjusting for demographic, radiographic, and intraoperative findings indicated that LLT size can predict worse long-term outcomes after hip arthroscopy for mHHS and HOS-ADL (P < .05). Kaplan-Meier estimates and weighted Cox regression demonstrated that the conversion rate to THA for LLT was significantly greater than that for SLT (hazard ratio, 7.92; 95% CI, 2.96-21.2; P < .0001).

Conclusion: Those in the LLT cohort experienced a significantly greater conversion rate to THA than did the SLT cohort. Also, SLT size can independently predict better long-term outcomes on certain PROMs after primary hip arthroscopy.