Orthopaedic Journal of Sports Medicine最新文献

Background: Accurate coronal alignment is crucial in medial open wedge high tibial osteotomy (MOWHTO). Postoperative changes in the joint line convergence angle (JLCA) can cause coronal alignment errors. A preemptive JLCA compensation method has been proposed to address this; however, its clinical value remains unclear.

Purpose: To assess the accuracy of the preemptive JLCA compensation method for correction angle calculation in MOWHTO.

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

Methods: Patients who underwent MOWHTO for varus osteoarthritis alignment between 2010 and 2024 were reviewed. The patients were classified into 2 groups based on whether the preemptive JLCA compensation method was applied (group 1: the conventional Miniaci method, group 2: the preemptive JLCA compensation method). After propensity score matching for sex, body mass index, hip-knee-ankle (HKA) angle, Kellgren-Lawrence grade, and correction angle on standing radiography, we conducted a comparative analysis of radiologic outcomes (weightbearing ratio) and functional outcomes (Lysholm score and International Knee Documentation Committee [IKDC] scores). Acceptable alignment was defined as a postoperative weightbearing line ratio between 55% and 70%.

Results: After propensity score matching, 20 patients were included in each group. The mean preoperative HKA angle was varus 6.2°± 2.2° and 6.3°± 2.2° (P = .922), while the correction angle measured by the Miniaci method was 10.0°± 2.1° and 10.3°± 1.7° for the conventional and preemptive JLCA compensation method group, respectively (P = .855). The mean postoperative weightbearing line ratio at 1 year postoperatively was 64.1 ± 7.4 and 62.5 ± 4.7 for the conventional and preemptive JLCA compensation methods, respectively, with no significant difference. However, 95.0% of patients in the JCLA modification group achieved acceptable target alignment, compared with 60.0% (12/20) in the conventional group (P = .014). Despite the significant difference in coronal alignment accuracy, functional outcomes showed no significant difference between the 2 groups.

Conclusion: The preemptive JLCA compensation method significantly improved correction accuracy, with 95.0% of patients achieving acceptable target alignment, compared with 60.0% with the conventional Miniaci method, although no significant differences in clinical scores were found in the short-term follow-up period.

Background: The COVID-19 pandemic significantly disrupted elective orthopaedic sports procedures, including anterior cruciate ligament (ACL) reconstructions, meniscal surgeries, and rotator cuff repairs. These disruptions also extended into athletics, likely resulting in reduced injury rates in athletes leading to decreased surgical volumes.

Hypothesis: It was hypothesized that the COVID-19 pandemic led to an initial decline in ACL reconstructions, meniscal surgeries, and rotator cuff repairs, with a gradual recovery in surgical volumes during the later pandemic years.

Study design: Descriptive epidemiology study.

Methods: A retrospective analysis of the American College of Surgeons' National Surgical Quality Improvement Program database was conducted from 2015 to 2022. Patients undergoing ACL reconstruction, knee meniscectomy or repair, knee foreign body removal, and rotator cuff repair were identified using Current Procedural Terminology codes. Surgical volumes and demographics from 2015 to 2019 served as a baseline for comparison with 2020 to 2022 data. Primary outcome was surgical volume change; secondary outcomes included patient demographics and operative-related factors. Chi-square tests were used for categorical variables and Student t tests for numerical variables, with nonparametric corrections and substitutions as needed. Significance was set at P < .05.

Results: Overall, a total of 200,511 cases (N = 200,511 patients) were identified in our database search. From 2019 to 2020, surgical volume decreased by 25.48%, followed by a 10.32% rebound in 2021 and a 2.17% decrease in 2022. All 2022 volume remained below 2019 levels, except for knee meniscal repair. Postpandemic data showed a 5.66% increase in diabetic patients (P < .001), 14.64% increase in total operative time (P < .001), 71.43% increase in pneumonia incidence (P = .02), and 48.48% increase in inpatient surgeries (P < .001). There was a 21.38% decrease in current smokers (P < .001) and 5.12% decrease in patients with insulin-dependent diabetes (P < .001). No change in hospital length of stay was observed (P = .52).

Conclusion: The study showed that orthopaedic sports surgery volumes declined in 2020 because of the COVID-19 pandemic and had not fully returned to prepandemic levels by 2022. Surgeries postpandemic were more commonly inpatient, required longer operative times, and involved patients with shifting demographic and comorbidity profiles. Understanding and reporting changes in surgical volume, setting, and patient profiles postpandemic may better prepare surgeons and health care institutions for future resource disruptions or impaired elective surgical capabilities.

Background: Previous research has shown that tendon graft soaking in vancomycin or tobramycin solution has no negative effects on graft mechanical properties, but there are no studies that have investigated graft mechanical properties after soaking grafts in gentamicin. Additionally, nearly all published biomechanical studies are based on data collected from a mechanical load frame or strain gauge, which does not provide insight on local graft strains compared with 3-dimensional digital image correlation (3D-DIC).

Purpose/hypothesis: The purpose of this study was to use 3D-DIC to investigate the effects of vancomycin, tobramycin, and gentamicin soaking on tendon graft mechanical properties. It was hypothesized that (1) no significant difference in mechanical properties exists between the saline control, vancomycin, tobramycin, and gentamicin groups and (2) local graft strain at the graft failure location will be greater than global strain spanning the entire graft length.

Study design: Controlled laboratory study.

Methods: Human tibialis anterior, peroneus longus, and tibialis posterior tendon grafts were prepared and evenly separated into 4 groups: control, vancomycin (5.0 mg/mL), tobramycin (1.0 mg/mL), and gentamicin (0.8 mg/mL). Grafts were soaked in antibiotic solution for 10 minutes, then removed and painted via airbrush with water-based black paint. Uniaxial tension testing was then completed at a strain rate of 10 mm/min. Data collected were used to calculate Young modulus (YM), elasticity limit (EL), ultimate tensile strength (UTS), and failure strain (FS).

Results: There were no significant differences in YM (P = .49), EL (P = .62), UTS (P = .98), and FS (P = .14) between control, vancomycin, tobramycin, and gentamicin, respectively. Additionally, local strain at graft failure location was larger than global strain across the length of the graft.

Conclusion: Soaking tendon grafts in vancomycin, tobramycin, or gentamicin does not alter the mechanical properties of grafts under uniaxial loading.

Clinical relevance: If vancomycin use is not possible or is contraindicated for certain patients, surgeons can soak grafts in tobramycin or gentamicin to achieve similarly effective infection mitigation without weakening the graft.

Background: The medial meniscus posterior root tear (MMPRT) is a contributing factor to osteoarthritis (OA). The Coronal Plane Alignment of the Knee (CPAK) classification is a method for characterizing knee alignment phenotypes by incorporating the arithmetic hip-knee-ankle (aHKA) and the joint line obliquity (JLO).

Purpose: To evaluate the CPAK type in patients with MMPRT while comparing the radiographic parameters between the MMPRT knees and the unaffected knees.

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

Methods: A total of 74 patients with MMPRT, including 87 knees, were confirmed using magnetic resonance imaging. Radiographic parameters of long-leg radiographs were measured separately by 2 reviewers at 2 different time points to classify the CPAK phenotypes, where the neutral aHKA was determined by 0°± 2° and neutral JLO by 180°± 3°.

Results: Patients with MMPRT were predominantly women (72.97%), with a mean age of 55.1 ± 9.3 years and a body mass index of 27.7 kg/m². Among 74 patients, 13 had bilateral MMPRT. According to a mean aHKA of -2°± 3.4° and JLO of 173.9°± 4.2°, a total of 87 MMPRT knees tended to demonstrate varus (41.4%) to neutral (49.4%) alignment, and apex distal JLO (73.4%). The CPAK distribution of MMPRT was type 2 (39.1%), type 1 (28.7%), type 4 (11.5%), type 5 (10.3%), type 3 (5.6%), type 6 (3.5%), and type 7 (1.2%); types 8 and 9 were not found. There was no difference in CPAK distribution between the MMPRT knees and the non-affected knees. The intra- (0.74) and interrater (0.80) reliability of the CPAK classification were in substantial agreement. The intrarater reliability for the lateral distal femoral angle (LDFA) and the medial proximal tibial angle (MPTA) was good (intraclass correlation coefficient [ICC] = 0.89). Interrater reliability was excellent for the LDFA (ICC = 0.91) and MPTA (ICC = 0.93).

Conclusion: Among patients with MMPRT, the most common CPAK phenotypes are types 2, 1, and 4, respectively. Most patients had an apex-distal JLO and varus-to-neutral alignment. These findings suggest that apex distal JLO may be a contributing factor for the development of MMPRT.

Background: Irreducible knee dislocation (IKD) is a rare but severe injury, accounting for approximately 4% of all knee dislocations and characterized by soft tissue incarceration that precludes closed reduction. Current management remains debated, particularly regarding the optimal timing of ligament reconstruction (single- vs. two-stage) and the choice of surgical approach.

Purpose: To investigate the short-term efficacy and outcomes of 1-stage arthroscopic reduction combined with reconstruction of knee stability for irreducible knee dislocation (IKD).

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

Methods: A total of 16 patients with IKD, treated with 1-stage arthroscopic surgery between June 2015 and July 2022, were included in this study. The surgery involved arthroscopic knee reduction and simultaneous multiligament reconstruction or repair. Side-to-side differences determined with a KT-1000 arthrometer and physical examinations-including the Lachman test, the pivot shift test, the drawer test, and the varus and valgus stress test-were performed for the evaluation of knee joint stability. Other assessments included the International Knee Documentation Committee (IKDC) score, the Lysholm score, pain scores, and satisfaction scores. A paired t test was used to determine the difference between the pre- and postoperative clinical outcomes.

Results: One patient experienced traumatic redislocation at 1 month due to noncompliance with bracing and was excluded from functional outcome analysis. The remaining 15 patients completed a 2-year follow-up. For all patients included in this study, the mean time from injury to surgery was 5.5 ± 1.4 days, and the mean follow-up time was 27.4 ± 2.6 months. At the last follow-up, all patients had normal or nearly normal Lachman, pivot shift, drawer, and varus and valgus stress tests. The IKDC score was 76.07 ± 2.84 (range, 70-82), the Lysholm score was 81.87 ± 4.22 (range, 74-87), and the pain score was 1±1 (range, 0-3). The satisfaction score was 8.53 ± 0.74 (range, 7-10), which significantly improved compared with the preoperative score (P < .05). No severe complications-including infection, compartment syndrome, neurovascular complications, graft ruptures, or deep vein thrombosis -were observed during follow-up.

Conclusion: One-stage arthroscopic reduction, combined with reconstruction of knee stability, can effectively restore knee stability and improve clinical outcomes in the treatment of IKD.

Background: The discoid lateral meniscus (DLM) is a common congenital abnormality of the meniscus. Tears are common, and initial treatment is often not definitive, leading to a spectrum of complications, including persistent symptoms, meniscal insufficiency, osteochondral defects, and recurrent tears potentially requiring reoperation.

Purpose: To determine demographic, injury, and perioperative risk factors that increase the likelihood of complications and reoperation after treatment in patients with DLM.

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

Methods: Patients surgically treated for DLM from 9 institutions between 2000 and 2020 were reviewed. Data on demographics, presenting symptoms and signs, surgical findings and treatments, complications, and reoperations were collected and analyzed using a 2-level generalized linear mixed model. The conditional probability of complications was predicted using logistic regressions. Odds ratios were calculated to identify findings associated with an increased likelihood of postoperative complications and reoperations.

Results: In total, 867 knees in 784 patients were surgically treated for DLM. There were 175 complications in 139 knees (16%); reoperations were performed in 110 knees (13%). Complication rates varied among institutions, ranging from 0% to 29%. The most common complication was retear of the meniscus (12%). Female patients were more likely to have complications and reoperations than male patients. Patients with a meniscus tear were 74% less likely to have a complication than those without tears, although patients with a complex meniscal tear were 3.4 times more likely to have a complication and 4.4 times more likely to have a reoperation than those without. Horizontal tears, as well as the open repair technique, had an increased risk of reoperation. Other tear types, tear locations, repair techniques, the presence of rim instability, age, and preoperative symptoms were not significantly associated with complications.

Conclusion: Of the patients, 17% (16% of knees) had postoperative complications after DLM treatment, of whom 17% had more than 1 complication. Additionally, 13% underwent reoperation. Complications were less likely in those treated for their DLM who had a meniscus tear and more likely in female patients and those with complex meniscus tears. Reoperation was more likely in female patients, those with a horizontal or complex tear, and those who had an open meniscus repair.

Background: The patient-specific instrumentation (PSI) used during corrective high tibial osteotomies and distal femoral osteotomies is based on 3-dimensional computed tomography (3D CT). Plain radiographs are typically used preoperatively to determine the need for an osteotomy; however, it is unclear how well measurements on plain radiographs correlate with 3D CT.

Purpose/hypothesis: The purpose of this study was to evaluate the correlation between coronal and sagittal alignment measurements on plain radiographs and 3D CT. It was hypothesized that there would be high agreement in the measurement of the mechanical medial tibial width ratio (mMTWr) and the medial posterior tibial slope (PTS) between both modalities.

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

Methods: Patients who underwent hip-to-ankle CT as part of the preoperative workup before a corrective osteotomy from October 2020 to November 2023 were reviewed. Coronal (mMTWr) and sagittal alignment (medial PTS) were evaluated preoperatively by 2 raters on standing whole-leg radiographs and a lateral radiograph of the knee, respectively, and by semi-automated PSI software on 3D CT. Intraclass correlation coefficients (ICC) were calculated to assess interrater reliability for each measurement and to evaluate agreement between raters and the PSI software.

Results: Complete data sets were obtained for 91 cases. The ICC between raters for preoperative mMTWR was 0.99. The ICC between the raters' measurements and the PSI software measurements of mMTWr was 0.99. The ICC between raters for preoperative PTS was 0.82. The ICC between the raters' measurements and the PSI software's PTS measurements was 0.63.

Conclusion: This study found that coronal measurements performed on whole-leg radiographs and 3D CT were highly correlated, with near-perfect agreement, and that medial PTS measurements showed moderate agreement between modalities. These data suggest that measurements on plain radiographs are reproducible and accurate for evaluating coronal alignment and PTS preoperatively. Surgeons can confidently use plain radiographs to assess whether or not a patient is a candidate for a knee osteotomy.

Background: Heterotopic ossification (HO) may occur after multiligament knee injuries (MLKIs), with the potential to cause significant functional deficits. However, risk factors for HO after MLKI are not well understood.

Purpose: To identify the incidence and risk factors for HO after MLKI.

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

Methods: Patients were included if they had undergone treatment for an MLKI by a single surgeon at a level 1 trauma center between 2001 and 2023, with radiographs at the time of injury and at a minimum 6-month follow-up. All data were obtained from electronic medical records. Two senior musculoskeletal radiologists reviewed all cases for the presence of HO in the most recent radiographs, using the initial radiographs obtained at the time of injury for comparison. Patients were grouped by whether they had developed HO after MLKI. Univariable analyses were performed to compare patient, injury, and treatment characteristics between groups. Odds ratios (ORs) for HO were assessed by multivariable logistic regression, adjusted for ligament injury classification, mechanism of injury, documented dislocation, central nervous system (CNS) trauma, and knee-spanning external fixation (KSEF).

Results: The studied cohort included 128 patients, of whom 28 were excluded due to insufficient follow-up. Of the remainder, 35 (35%) developed HO, with a mean follow-up of 35.17 months. In the univariable analysis, the HO group had significantly higher rates of documented dislocation, CNS trauma, and KSEF. In the multivariable analysis, KSEF (OR, 8.51; 95% CI, 21.81-31.717; P = .001) and CNS trauma (OR, 6.63; 95% CI, 1.507-29.209; P = .012) remained independent predictors of HO after MLKI.

Conclusion: The incidence of HO after MLKI was 35%. KSEF and CNS trauma were independently associated with HO. Recognition of these risk factors may help identify at-risk patients for closer monitoring and consideration of HO prophylaxis and should therefore be included in the decision-making strategy for KSEF versus early surgical treatment after MLKI.

Background: Although bone marrow stimulation (BMS) is believed to promote rotator cuff healing, there is no comparison of clinical outcomes and structural integrity between different BMS techniques in patients undergoing arthroscopic rotator cuff repair (ARCR).

Purpose/hypothesis: The purpose of this study was to compare the clinical outcomes and structural integrity between BMS inside the rotator cuff footprint area ("greenhouse" technique) and BMS outside the rotator cuff footprint area ("crimson duvet" technique). It was hypothesized that the new "greenhouse" technique would provide better clinical outcomes and structural integrity at short-term follow-up.

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

Methods: This study included 60 patients who underwent ARCR using the "greenhouse" technique or "crimson duvet" technique (n = 30 per group). Functional outcomes at 24 months postoperatively were assessed including the ASES (American Shoulder and Elbow Surgeons) score, CMS (Constant-Murley score), UCLA (University of California, Los Angeles) score, SST (Simple Shoulder Test), VAS (visual analog scale) for pain, and range of motion consisting of forward elevation, external rotation, and internal rotation. The minimal clinically important difference, patient acceptable symptom state, substantial clinical benefit, and maximum outcome improvement were also compared between the 2 groups. Structural integrity was evaluated by magnetic resonance imaging at 2 years postoperatively and compared between the 2 groups.

Results: All functional outcomes improved significantly compared with preoperatively in both groups at the last follow-up (all P < .001). However, there were no significant differences between the 2 groups postoperatively. Overall, 52 patients (86.7%) achieved the minimal clinically important difference, 44 patients (73.3%) achieved the patient acceptable symptom state, 45 patients (75.0%) achieved the substantial clinical benefit, and 31 patients (51.7%) achieved the maximum outcome improvement, without significant differences between the 2 groups. The retear rate after ARCR in the "greenhouse" group was 6.7% and 10.0% in the "crimson duvet" group, which was not significantly different.

Conclusion: In ARCR, both the "greenhouse" and "crimson duvet" techniques exhibited significant functional improvement in patients with rotator cuff tears. The new "greenhouse" technique provided comparable clinical outcomes and structural integrity compared with the traditional "crimson duvet" technique at short-term follow-up.

Registration: NCT04686968 (ClinicalTrials.gov).

Background: Patient interest in orthobiologic injections continues to grow. While modern patients are increasingly reliant on artificial intelligence (AI) large language models (LLMs) for health information, it remains unclear whether AI-generated responses regarding orthobiologics are both accurate and written at a reading level suitable for patient education.

Purpose: To assess the accuracy and readability of responses to common patient questions regarding orthobiologic injections from 3 popular AI LLMs (ChatGPT, Gemini, and Grok).

Study design: Cross-sectional Study.

Methods: Responses to 20 common patient questions regarding orthobiologic injections were recorded from ChatGPT 4o, Gemini 2.5 Flash, and Grok 3 in July 2025. Four independent reviewers (2 fellowship-trained sports medicine orthopaedic surgeons and 2 fellowship-trained nonoperative sports medicine physicians) assessed AI responses for accuracy using the ChatGPT Response Rating System (CRRS) and the AI Response Metric (AIRM). Readability of responses was assessed using the Flesch-Kincaid Grade Level (FKGL).

Results: Interrater reliability was strong for all accuracy ratings (ICCs >0.70; P < .05). While response accuracy was generally acceptable, 50% (10/20) of ChatGPT, 25% (5/20) of Gemini, and 30% (6/20) of Grok responses were deemed as requiring more than minimal clarification (CRRS >2). One-way matched analysis of variance (ANOVA) revealed a significant effect of AI model on both CRRS (P = .02) and AIRM scores (P = .02), with Gemini displaying improved accuracy compared with ChatGPT (CRRS, P = .04; AIRM, P = .03). Regarding readability, the mean FKGL of all 3 models was at a collegiate level or higher, and all responses exceeded the American Medical Association and National Institutes of Health-recommended 6th-grade reading level for patient education. One-way matched ANOVA revealed a significant effect of AI model on FKGL (P = .02), with Gemini displaying reduced readability compared with ChatGPT (P = .03).

Conclusion: In this study, ChatGPT, Gemini, and Grok provided generally accurate information on orthobiologics but failed to produce responses at a patient-appropriate readability level. Gemini outperformed ChatGPT in accuracy, although all 3 models demonstrated significant limitations in clarity. Until these issues are resolved, AI-generated responses should serve only as supplemental resources, with final patient education directed by physicians.