Orthopaedic Journal of Sports Medicine最新文献

Background: The optimal position and number of anchors that need to be implanted in Hill-Sachs lesions (HSLs) during remplissage with Bankart repair (RMBR) to correct anterior glenohumeral instability remain unclear. Previous studies have mainly focused on anchor placement in the central, medial, and peripheral regions, as well as the superior and inferior poles of the HSL, but anchor placement in the upper or lower regions of the HSL has not been investigated.

Purpose: To assess, using finite element analysis, the effect of placing 2 anchors in the superior or inferior regions of the HSL during RMBR on humeral head displacement and postoperative joint stability.

Study design: Controlled laboratory study.

Methods: Finite element models of the glenohumeral joint in the abduction external rotation position were created, including normal models and models with 2 anchors placed in the superior, inferior, or central regions of the HSL. Models with Bankart lesions and HSLs were established based on the normal glenohumeral joint model. Humeral head displacement was calculated by applying anterior dislocation forces and muscle contractions from the infraspinatus and teres minor muscles.

Results: Models with 2 anchors placed in the superior (1.92 ± 0.00 mm) region of the HSL showed less anterior humeral head displacement than those with anchors in the lower (1.95 ± 0.00 mm) or central (1.95 ± 0.00 mm) regions under anterior dislocation load. However, posterior displacement was greater (2.05 ± 0.00 mm vs 1.90 ± 0.00 mm and 1.87 ± 0.00 mm) with anchors placed in the superior region under muscle contraction.

Conclusion: The placement of 2 anchors in the upper portion of the HSL more effectively (P < .001) reduced anterior humeral head displacement than did the placement of anchors in the lower or central regions of the HSL. In clinical practice, external forces on the shoulder joint comparable with those causing dislocation may amplify this displacement difference, rendering it more prominent and clinically relevant. This provides a more refined reference for determining the position and number of anchors that need to be implanted into the HSL during RMBR surgery.

Clinical relevance: The placement of 2 anchors in the upper region of the HSL effectively reduces anterior displacement under simulated dislocation loads, while increasing posterior displacement under muscle contraction. This may enhance postoperative glenohumeral stability and reduce the risk of recurrent dislocations, offering valuable insights for clinical practice.

Background: A novel retropatellar tendon implant (LIFT) that is fixed deep to the patellar tendon proximal to the tibial tubercle may provide patellofemoral offloading benefits.

Purpose/hypothesis: The purpose of this study was to analyze the patellofemoral contact pressures from 0° to 60° of knee flexion in 3 states: (1) intact knee, (2) knee with the implantation of a retropatellar tendon implant, and (3) knee with a 45° anteromedialization tibial tubercle osteotomy (TTO). It was hypothesized that the implant would significantly reduce the contact pressure between the patella and trochlea compared with the intact state and produce a similar offloading effect as an anteromedializing TTO.

Study design: Controlled laboratory study.

Methods: Trochlear pressure sensors were placed in 7 cadaveric knees (6 donors). Patellofemoral contact area, contact pressure, peak force, and center of force were measured using a model for native quadriceps force on the patella. On each specimen, measurements were taken in an intact state, after implantation of a novel retropatellar tendon implant, and after a 45° anteromedializing TTO. Force data were collected from 0° to 60° of flexion in 15° increments and normalized to each specimen's intact state.

Results: Compared with the intact and implant groups, the TTO reduced the contact area at 30°, 45°, and 60° of flexion. TTO reduced contact pressure compared with intact from 15° to 60° of flexion, and reduced contact pressure at 15° when compared with the implant. The implant reduced the contact pressure compared with the intact state at 30° and 45° of flexion. For peak force, TTO reduced the force seen in 15° to 60° of flexion compared with the intact condition, while outperforming the implant at 15° of flexion. The implant reduced the peak force compared with the intact condition at 30° of flexion. Center of force analysis revealed that the implant medialized the center of force at 45° and 60° of flexion.

Conclusion: The main finding from our biomechanical cadaveric study was that the novel retropatellar tendon implant did not reduce patellofemoral contact area, contact pressure, and peak force as much as a 45° anteromedializing TTO. The implant does reduce peak and contact pressures in early degrees of knee flexion compared with native states.

Clinical relevance: An implant that allows for offloading patellofemoral contact pressures without the morbidity, complication profile, or postoperative rehabilitation associated with a TTO may aid in the treatment of patellofemoral chondral lesions and retropatellar knee pain.

Background: The anterior cruciate ligament (ACL) is one of the most frequently injured structures in different sports, particularly football (soccer). Numerous studies have investigated the mechanisms and risk factors leading to ACL ruptures in this sport; however, most analyses have focused on individual leagues.

Hypothesis: It was hypothesized that pooling data from different football leagues would show that (1) most ACL ruptures occur in noncontact situations, predominantly during the defensive phase and within the initial minutes of play; (2) the number and incidence rate of injuries differ significantly across leagues; and (3) the number of injuries correlates with the team market value.

Study design: Descriptive epidemiology study.

Methods: An online database was accessed to collect data on ACL ruptures and player characteristics in the top 5 European football leagues between the 2018-2019 and 2023-2024 seasons. Player age, player position, moment of injury during the season and during the match (if applicable), and team market value were initially collected. Then, the video of the moment of injury of those players injured during official matches was searched to classify the injury mechanism.

Results: A total of 272 ACL ruptures were identified, 44.5% involving defenders. Most occurred within the first 15 minutes of play. The mean age of injured players was 25.8 ± 3.9 years. Among the 135 injuries for which video analysis was available, 84 (62.2%) occurred during defensive actions, 66 (48.9%) were classified as noncontact injuries, and 35 (33.3%) happened while pressing an opponent. Differences in the number of injuries (P = .066) and injury rate (P = .225) between leagues, as well as the correlation between team market value and number of injuries (P = .922), were not statistically significant.

Conclusion: Most ACL ruptures occurred through noncontact mechanisms, typically during defensive actions, particularly while pressing an opponent. Most injuries affected defenders and took place within the first minutes of play, with a mean player age of 25.8 years. No significant differences were found in the number or rate of injuries between leagues, nor was any correlation observed between team market value and the number of injuries.

Background: It has been demonstrated that exogenous testosterone can lead to higher rates of tendinous rupture and that injectable testosterone replacement therapy (TRT) is associated with more systemic complications. While this is the case, there are few studies exploring associations between injectable TRT and complications after anterior cruciate ligament reconstruction (ACLR) surgery.

Purpose/hypothesis: The purpose of this study is to evaluate the association between preoperative injectable TRT and ACLR revision surgery. It was hypothesize that ACLR revision surgery rates will be higher in patients undergoing TRT preoperatively compared with a matched cohort.

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

Methods: A retrospective cohort of patients who underwent ACLR between 2015 and 2022 was obtained through the PearlDiver Database (Mariner). Patients with a history of ACLR, 2 years of follow-up, and injectable TRT use before ACLR were identified using International Classification of Diseases, 10th Revision, and Current Procedural Terminology codes. Three TRT usage intervals were analyzed to evaluate ACLR revision rates in those with usage of injectable TRT compared with those with propensity score-matched demographics and Charlson Comorbidity Index with no history of injectable TRT use who underwent ACLR. Cohorts were via univariate analysis, chi-square tests, Student t tests, and log-rank tests.

Results: TRT use ≤1 year before primary ACLR surgery demonstrated a 17.05% (66/387; mean age, 40.3) ACLR revision rate compared with 5.17% (20/387; mean age, 40.8) in the matched cohort control group (P < .001), yielding a relative risk of revision surgery of 3.30 (95% CI, 2.04-5.33). Statistical analysis for distant TRT use >1 year before surgery (n = 160) was underpowered but supported trends toward increased revision risk with TRT exposure with a 14.38% revision rate (n = 23). TRT users with any exposure before or after surgery (n = 2614) had similar revision rates (n = 168; 6.36%) compared with the control group (n = 164; 6.21%); the difference was not significant (P = .82).

Conclusion: Our study demonstrated that injectable TRT use within 1 year of primary ACLR is associated with a >3-fold increase in ACLR revision rates with 2 years of follow-up. Physicians should consider incorporating this increased risk into patient counseling during shared decision-making discussions, as this correlation may influence clinical and surgical decision making for patients with previous ACLR.

Background: Lateral meniscal posterior root tears (LMPRTs) affect knee stability and load distribution. LMPRT repair with anterior cruciate ligament reconstruction (ACLR) demonstrated favorable functional outcomes and a high meniscal healing rate. However, most studies have reported only short-term follow-up results.

Purpose: To evaluate the long-term clinical and radiologic outcomes of LMPRT repairs with ACLR.

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

Methods: Inclusion criteria consisted of patients who underwent LMPRT repair and hamstring ACLR from 2005 to 2019. Exclusion criteria were patients without postoperative magnetic resonance imaging (MRI), patients followed for <4 years, and patients who had reinjury. Healing of the repaired LMPRT was evaluated, and extrusion of the midbody of the lateral meniscus was measured by MRI. Joint space width (JSW) of the lateral compartment on the Rosenberg view was measured and compared preoperatively and at follow-up. Lysholm score and Tegner activity scale were compared between preoperative and follow-up periods.

Results: Thirty-four patients were included, with a mean follow-up period of 96.8 ± 45.9 months (range, 48-200 months). Tear patterns of the LMPRT were classified into oblique (n = 22) and complex (n = 12) types. Follow-up MRI showed complete healing in 27, partial in 4, and none in 3. Follow-up extrusion was not significantly different from preoperative extrusion (1.31 ± 1.35 mm vs 1.46 ± 1.41 mm, P = .646). Preoperative lateral JSW did not show a significant decrease compared to follow-up lateral JSW (6.2 ± 1.1 mm vs 5.9 ± 0.8 mm, P = .18). Preoperative Lysholm score and Tegner activity scale improved significantly at follow-up (P < .001 and P < .001, respectively).

Conclusion: At a mean 8-year follow-up, LMPRT repair with ACLR led to significant functional improvement and 91.1% complete or partial healing.

Background: The tibial tubercle-trochlear groove (TT-TG) distance is a known risk factor for patellar instability, but its role in anterior cruciate ligament (ACL) deficiency is unclear. Previous studies found an increased TT-TG distance in patients with noncontact ACL tears compared with patients with intact ACLs.

Hypothesis: The authors hypothesize that there will be a significantly increased TT-TG distance in patients with ACL injury compared with patients without ACL injury.

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

Methods: All patients aged 18 to 50 years who had noncontact ACL tears between 2020 and 2021 were included in this study. Patients with ACL tears were compared with a similar cohort of patients with meniscal tears, matched for age and sex, between 2020 and 2021. Patients were excluded if preoperative magnetic resonance imaging (MRI) was unavailable. One author reviewed axial images to measure TT-TG distance. An independent 1-tailed t test was used to assess for a difference in TT-TG distance between patients with and without ACL injury.

Results: The TT-TG distance was measured for 299 patients, of whom 159 had an ACL injury and 140 patients had intact ACLs. Patients with an ACL injury had a mean TT-TG distance of 11.3 ± 4.10 mm, and patients without ACL injury had a mean TT-TG distance of 11.9 ± 4.62 mm. There was no significant difference in TT-TG distance between the 2 groups (P = .246). The sample of patients in both groups had no significant differences in age, sex, or laterality of injury.

Conclusion: No statistically significant difference in TT-TG distance was found between patients with and without ACL injury. The findings of this study do not support an association between TT-TG distance and ACL deficiency. Instead, TT-TG distance may vary as a result of ACL injury due to increased laxity in tibial external rotation.

Background: Medial patellofemoral ligament reconstruction (MPFLR) is widely used for treating recurrent lateral patellar instability, with advancements such as artificial tapes and anchor fixation aiming to improve biomechanical stability and recovery outcomes compared with traditional autograft techniques. However, limited research exists on the outcomes of simultaneous bilateral MPFLR.

Hypothesis: The time to return to sports (RTS) is longer for bilateral MPFLR than for unilateral MPFLR.

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

Methods: Patients were divided into bilateral and unilateral MPFLR groups. RTS rates, time to RTS, and postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed.

Results: A total of 45 knees were analyzed, including 21 in the unilateral group and 24 in the bilateral group. Their mean ages were 15.2 ± 1.9 years and 15.2 ± 2.1 years, respectively, with a minimum 2-year follow-up including evaluations at 1, 2, 3, 6, 12, and 24 months postoperatively. Both groups demonstrated favorable postoperative KOOS values across all subscales, with no significant differences between them (pain: 92.3 ± 7.9 vs 89.2 ± 10.3; symptoms: 92.3 ± 8.7 vs 87.4 ± 11.9; activities of daily living: 88.9 ± 15.3 vs 94.2 ± 8.5; sports: 98.2 ± 3.2 vs 85.4 ± 15.5; quality of life: 91.6 ± 12.3 vs 81.4 ± 16.9; all P > .05). RTS rates were 92% for the bilateral group and 76% for the unilateral group, whereas the mean times to RTS were 6.1 ± 2.6 and 5.3 ± 2.4 months, respectively, showing no significant differences. Factors preventing RTS included knee pain, loss of interest, and lifestyle changes such as retirement to pursue higher education.

Conclusion: Bilateral MPFLR achieved comparable functional outcomes, recovery time, and RTS rates to unilateral procedures. This study suggests that bilateral MPFLR with FiberTape and knotless SwiveLock anchors is an effective treatment for young athletes, offering excellent postoperative knee function and a high RTS likelihood. Further prospective studies with larger cohorts are recommended to validate these results and assess long-term outcomes.

Background: Knee injuries are common in volleyball athletes, often resulting from the sport's unique movement requirements. Among these, anterior cruciate ligament (ACL) tears are particularly prevalent, and while the existing literature has examined risk factors such as biomechanical asymmetries and landing mechanics, there is limited research on the relationship between hand dominance and the side of injury.

Purpose: To examine the relationship between hand dominance and ACL tear laterality in competitive volleyball players diagnosed with first-time unilateral ACL tears.

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

Methods: After a medical record review of 1529 consecutive patients, 149 met the inclusion criteria, resulting in a study population of 124 females and 25 males. Data on sex, age, body mass index, handedness, and ACL tear laterality were collected from the medical records. A Fisher exact test was used to assess the association between handedness and ACL tear laterality, while binomial tests evaluated differences in ACL tear laterality within each handedness group.

Results: Among the 136 right-handed players, 81.62% tore their left ACL, while 18.38% tore their right ACL. Among the 13 left-handed players, 84.62% tore their right ACL, while 15.38% tore their left ACL. A statistically significant association was found between hand dominance and ACL tear laterality (P < .001). Additionally, statistical significance was found between right-handed players tearing their left ACL (P < .001) and left-handed players tearing their right ACL (P < .05).

Conclusion: This study suggests a significant relationship between hand dominance and ACL tear laterality in competitive volleyball players. Right-handed volleyball players were significantly more likely to tear their left ACL, whereas left-handed players predominantly tore their right ACL. These findings suggest a biomechanical or sports-specific risk factor contributing to ACL injury patterns in volleyball players.

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain in young, active athletes. American football players place high demands on the hip due to the sport's requirements for pivoting, cutting, and loading in deep flexion. Although arthroscopic treatment of FAI in professional National Football League (NFL) players has shown favorable outcomes, football-specific outcomes in non-NFL athletes remain limited.

Purpose: To report the return-to-sport (RTS) rates and functional outcomes at a minimum 2-year follow-up for active American football players competing at multiple levels after primary hip arthroscopy for FAI.

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

Methods: An institutional database was queried to identify all active American football players who underwent primary hip arthroscopy with labral repair between 2010 and 2023. Demographic characteristics, radiographic parameters, procedure details, complications, and reoperations were collected. Follow-up was completed at a minimum of 2 years to obtain updated patient-reported outcome measures (PROMs) as well as football-specific data, including current participation and RTS status. PROMs were reported as mean ± standard deviation, and categorical variables, including RTS, were reported as frequencies. Pre- versus postoperative PROMs were compared using t tests or Mann-Whitney U tests to assess outcomes.

Results: In total, 49 hips in 38 male football players (age, 18.1 years; range, 14-26 years) were included. Most athletes played at the high school (74%) or college level (21%). A total of 51% played as linemen. Labral repair was performed in all cases. At a mean 7.6 years, mean modified Harris Hip Score was 90 ± 13, Hip Outcome Score-Activities of Daily Living was 95 ± 7, and Hip Outcome Score-Sport was 89 ± 17. Overall mean surgery satisfaction was 8.7 ± 1.7 (out of 10). Significant postoperative improvements were observed in all PROMs (P≤ .002). Twelve players (32%) did not attempt RTS due to other nonmedical factors and were excluded from return to sport analysis. A total of 23 (88%) players achieved RTS, and 3 players (12%) did not. Two players (8%) cited other injuries, and 1 player (4%) continued to have hip limitations. Four hips (8%) underwent reoperation at a mean 4.9 years postoperative.

Conclusion: Amateur American football players undergoing primary hip arthroscopy for FAI demonstrated excellent patient-reported outcomes and a high RTS rate of 88%, when excluding those who did not return for nonmedical reasons, at a mean 7.6-year follow-up. Notable positional differences were observed across multiple levels of play. Although outcomes were generally favorable, both medical and nonmedical factors could limit return to sport, particularly among high school and college athletes.

Background: Patient-reported outcome measures (PROMs) are essential for assessing knee function; however, their complexity can hinder efficiency. The subjective knee value (SKV) offers a simple alternative, but lacks distinction between daily activities and sports.

Purpose: We propose the SKV for daily activity (SKV-d) and sport (SKV-s). This study aimed to validate the SKV-d and SKV-s as simple and accurate tools for assessing knee function.

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

Methods: A total of 79 consecutive athletic patients (mean age, 39 years; 49% women) with knee-related issues were included and categorized into 4 groups between September and November 2024. PROMs were collected according to clinic standards: knee osteoarthritis (n = 21), Knee Society Clinical Rating System (KSS) (Knee Score and KSS Function), anterior cruciate ligament injury (n = 19), International Knee Documentation Committee subjective knee evaluation form (IKDC-S), patellar instability (n = 12), Kujala Anterior Knee Pain Scale (AKPS), and focal cartilage lesion or isolated meniscal tear (n = 27). Patients completed the SKV, SKV-d, and SKV-s, along with the validated scores mentioned above. Validity, reliability, floor/ceiling effects, and differences among the 3 single-item scores were assessed.

Results: The SKV-s correlated strongly with the AKPS (rs = 0.71), moderately with the IKDC-S (rs = 0.64) and the KSS Knee Score (rs = 0.45), and weakly with the KSS Function (rs = 0.28). The SKV-d correlated moderately with the IKDC-S (rs = 0.65) and the AKPS (rs = 0.50), and weakly with the KSS Knee Score (rs = 0.15) and the KSS Function (rs = 0.22). The SKV strongly correlated with the SKV-s (rs = 0.83) and the SKV-d (rs = 0.81). The SKV-s was significantly lower than the SKV (46.8 ± 27.8 vs 66 ± 20.7; P < .001) and the SKV-d (46.8 ± 27.8 vs 73.7 ± 23.3; P < .001). The SKV-d was higher than the SKV (73.7 ± 23.3 vs 66 ± 20.7; P < .001). Reliability was good for the SKV (intraclass correlation coefficient [ICC], 0.80), the SKV-s (ICC, 0.86), and the SKV-d (ICC, 0.81), with no significant floor/ceiling effects except for the SKV-d.

Conclusion: The SKV-d and SKV-s demonstrated acceptable validity with the SKV, the IKDC-S, and the AKPS, and were reliable, with significant differences between each other and the SKV. Both the SKV-d and the SKV-s may help distinguish between daily activities and sports and for assessing knee function in athletes; however, they should not replace commonly used PROMs.