Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

Objective: There is paucity of literature on the impact of patients' gender on recovery and treatment success after arthroscopic rotator cuff repair. This study investigates the effect of gender on patient-reported outcomes preoperatively and postoperatively (minimum 2 years), and to determine if gender affects the attainment of patient-acceptable symptomatic state (PASS) thresholds.

Methods: 266 patients (117 males, 149 females), who underwent primary arthroscopic rotator cuff repair for atraumatic, full-thickness tears, were included. Functional outcomes and pain scores were collected preoperatively and postoperatively. Percentage of attainment of PASS for the various outcome scores was calculated and compared between males and females.

Results: Women had statistically significantly poorer functional outcome and pain scores preoperatively and at 1 and 2 years postoperatively (P ​< ​0.01). They also experienced less improvement in outcome scores throughout the postoperative period. Women had statistically significantly lower rates of PASS attainment at 2 years postoperatively.

Conclusion: Women experience greater pain and poorer shoulder function compared with men preoperatively, and up to 2 years postoperatively. Women are less likely to achieve PASS thresholds postoperatively, compared to their male counterparts.

Study design: Retrospective Cohort Study.

Level of evidence: III.

Objectives: The purpose of this study was to assess the educational reliability and quality of videos shared on YouTube regarding medial collateral ligament (MCL) injuries of the knee.

Methods: Using the search keywords "medial collateral ligament" on YouTube, the first 50 videos were evaluated by two independent reviewers. Video characteristics were extracted, and each video was categorized by upload source and content type. Three scoring systems were used to evaluate the videos: the Journal of the American Medical Association (JAMA) Benchmark Score to assess a video's reliability; the Global Quality Score (GQS) to assess educational quality; the novel MCL Specific Score (MCL-SS) to assess MCL-specific content quality. Linear regression analyses were conducted to explore relationships between video characteristics and scores.

Results: Collectively, the videos were viewed 5,759,427 times with a mean number of views per video of 115,189 ​± ​177,861. The mean JAMA score was 1.8, GQS was 2.1, and MCL-SS was 5.6, indicating both poor reliability and quality. Only videos uploaded by physicians showed a statistically significantly higher mean MCL-SS (P ​= ​0.032) but were still of low quality with a mean MCL-SS of 9.2 ​± ​5.9. Multivariate linear regression revealed that videos uploaded by physicians were statistically significant predictors of greater MCL-SS (β ​= ​4.108; P ​= ​0.029). Longer video durations were statistically significant predictors of greater GQS (β ​= ​0.001; P ​= ​0.002) and MCL-SS (β ​= ​0.007; P ​< ​0.001).

Conclusions: YouTube videos regarding MCL injuries, despite their popularity, were found to be on average having poor overall reliability and quality as measured by JAMA, GQS and MCL-SS.

Level of evidence: III.

Study design: Cross-sectional Study.

This is the case of an 18-year-old male professional soccer player, an attacking midfielder, who presented acute-onset pain in his right thigh during a training match but continued playing and training until the end of the session. Two weeks after the initial symptoms, the athlete's pain increased after kicking the ball and stopping training. He came for consultation a week later with tenderness in his right thigh and impaired gait. A 3 ​cm gap in his right mid-quadriceps muscle and tenderness during resisted knee extension and leg raises with no hip or knee range of motion limitations were observed on physical examination. He was scheduled for magnetic resonance imaging (MRI) after the consultation, revealing an acute-on-chronic type 2A lateral muscle tear of the distal rectus femoris. A 2 ​ml seroma aspiration was performed five weeks after the initial injury with a subsequent intra-lesional 1 ​ml liquid leukocyte-rich platelet-rich plasma (LR-PRP) injection using intermittent ultrasound guidance within 5 ​min after preparation. The LR-PRP preparation was classified as 3 14-1 3-0 0 according to the Universal Coding System (UCS) by Kon et al. Nine physiotherapy sessions, including an initial assessment, were conducted over five weeks. The rehabilitation started with pulley exercises with hip flexion, tension arch, leg extension, and squatting with supporting exercises for core and hip strength, with a gradual increase in loading. As the player's symptoms improved, he started doing eccentric exercises such as the reverse Nordics and leg extension. He also followed a running program, gradually increasing speed to a full sprint without pain or irritation. The return-to-sports clearance consultation was conducted seven weeks after the injury, previously confirming satisfactory healing on an MRI. The patient was cleared after passing the Rehabilitation Department battery tests and physical examination. The patient was asymptomatic and had no complaints despite his right quadriceps gap, returning to competition nine weeks after injury. After a one-year follow-up, the patient remains playing at a competitive level, asymptomatic, with no reported reinjury. Adequate reporting of rehabilitation programs and PRP injection characterization is crucial for future research quality improvement and reproducibility.

Stress fractures, a common overuse injury in physically active individuals, present a significant challenge for athletes and military personnel. Patients who sustain stress fractures have demanding training regimes where periods of rest and immobilisation have unacceptable negative consequences on sports goals and finances. Aside from being an overuse injury, there are various contributing risk factors that put certain individuals at risk of a stress fracture. The main two being nutritional deficiencies and hormonal variations, which have significant effects on bone metabolism and turnover. Historically, treatment of stress fractures focused on conservative strategies such as rest and immobilisation. Calcium and vitamin D deficiencies have been closely linked to stress fractures and so over time supplementation has also played a role in treatment. With the introduction of biologics into orthopaedics, newer treatment strategies have been applied to accelerate fracture healing and perhaps improve fracture callus quality. If such therapies can reduce time spent away from sport and activity, it would be ideal for treating stress fractures. This article aims to offer insights into the evolving landscape of stress fracture management. It investigates the pre-clinical evidence and available published clinical applications. Though fracture healing is well understood, the role of biologics for fracture healing is still indeterminate. Available literature for the use of biologic therapies in stress fractures are restricted and most reports have used biologics as a supplement to surgical fixation in subjects in studies that lack control groups. Randomised control trials have been proposed and registered by a few groups, with results awaited. Assessing individuals for risk factors, addressing hormonal imbalances and nutritional deficiencies seems like an effective approach to addressing the burden of stress fractures. We await better designed trials and studies to accurately determine the clinical benefit of adding biologics to the management of these injuries.

Objectives: Sleep is an important determinant of quality of life. Sleep disturbance is concomitant with end-stage knee osteoarthritis for which total knee arthroplasty (TKA) is the most commonly done procedure. However, literature on this topic is lacking in terms of the impact of sleep quality on patient satisfaction after arthroplasty, especially the adverse associations of surgery on sleep quality. Improvement in sleep quality may be a necessary prerequisite for any effective rehabilitation program. In our study we aim to assess the changes in sleep quality after TKA, and how it affects patient satisfaction of TKA and other quality-of-life indicators, postoperatively.

Methods: Over a period of two years, 104 patients undergoing primary total knee arthroplasty were assessed prospectively using the Pittsburgh Sleep Quality Index (PSQI), Knee Society Score (KSS), Oxford Knee Score (OKS); preoperatively and postoperatively at 3 months, 6 months, and 1 year. Obesity and diabetes status were also included in the analyses.

Results: Preoperatively, most patients exhibited poor sleep quality (mean PSQI score 9.23 (Standard deviation (SD) ​= ​3.03), which subsequently improved after surgery. Immediately after surgery, there was an initial worsening in the PSQI scores until 6 weeks (12.58 (SD ​= ​3.59)). However, at 1 year, there was a statistically significant improvement to a mean of 5.69 (SD ​= ​1.91). The mean Visual Analogue Scale (VAS) score showed a statistically significant decrease from 7.26 (SD ​= ​1.90) pre-operatively to 1.80 (SD ​= ​1.37) at 1 year postoperatively (p ​< ​0.001). The mean OKS showed a statistically significant increase from preoperative 18.15 to 33.81 at 1 year and the composite KSS increased from 36.22 preoperative to 87.09 at 1 year (p ​< ​0.001). Improvement in sleep was observed for 61% of non-obese patients while obese patients did not observe any improvement in sleep. Only 8% of diabetics showed improved sleep compared to 55% of non-diabetics.

Conclusions: We observed an overall improvement in sleep quality after total knee arthroplasty. However, there was an initial stage of sleep disturbance immediately postoperatively. Obesity and diabetes may lower the chances of achieving optimal improvements in both functional and sleep outcomes.

Level of evidence: Level III.

Objectives: The purposes of this study were to (1) prospectively evaluate clinical and functional outcomes of athletes following anterior cruciate ligament (ACL) reconstruction up to 12 months after surgery, (2) to identify the correlations between functional and subjective tests, and (3) to determine which factors influence patients' capability to resume sports at pre-injury level.

Methods: Patients who underwent ACL reconstruction using doubled autologous hamstring graft were prospectively assessed pre-operatively, 6, and 12 months after surgery using International Knee Documentation Committee (IKDC) Subjective Knee Form, Tegner activity level, and ACL-Return to Sport after Injury (ACL-RSI) scale. Jumping ability was instrumentally assessed using a test battery including bipodalic squat jump (SJ), bipodalic countermovement jump (CMJ), monopodalic CMJ, and monopodalic side-hop test.

Results: Thirty-three patients were available for clinical evaluation at 12-months follow-up. Average age was 34.0 years (SD 11.5, range 19-50). Male/female ratio was 31:2. Mean overall IKDC, and ACL-RSI scores increased from 52.5 to 47.1 preoperatively, to 89.9 (SD: 12.2, range 36.8-100) and 81.3 (SD 21.7, range 10-98.3), respectively at last follow-up (p ​< ​0.001). Monopodalic jump tests showed improvements at 12-month evaluation compared to 6-month follow-up (p ​< ​0.01). No statistically significant correlation was reported for ACL-RSI and jump limb symmetry index (LSI) (p ​= ​0.08 vs. CMJ; p ​= ​0.07 vs. side-hop test). No differences were observed in terms of jump LSI between patients who returned to pre-injury activity level and those who did not (p ​= ​0.11 for CMJ, p ​= ​0.09 for side-hop test). A significantly higher IKDC score at 6 months was observed in patients who did not return to pre-injury levels (p ​= ​0.009). Patients who did not return to pre-injury activity reported lower ACL-RSI scores at 12-months follow-up (p ​= ​0.007).

Conclusions: One year after ACL reconstruction, an improvement in jumping ability was observed, while a persistence of lower limbs asymmetries when performing jump tests was noted at 6-months follow-up. The ability to perform vertical jumps was not influenced by psychological outcomes 12 months following surgery. Higher values of subjective knee score and psychological readiness weakly correlated to return to sport at preinjury level, while no correlation was reported concerning jumping performance.

Objectives: This study aims to evaluate the outcomes of patients following surgery diagnosed with femoroacetabular impingement syndrome (FAIS) who also experience low back and other joint pain compared to those with isolated hip pain.

Methods: This is a retrospective cohort study of patients diagnosed with FAIS, with or without other joint pain, treated with hip arthroscopy from 2016 to 2020. Excluded cases were patients who had significant arthritis, irreparable labral tear requiring reconstruction, or were lost follow-up. Analysis was carried out in two ways, the first was according to the musculoskeletal morbidity (MSKM) scheme where patients were stratified into four different groups, and the second was according to the presence of any other joint or back pain (MSKM 2-4) compared to hip pain only (MSKM 1). Demographic data was analyzed between the groups. International Hip Outcome Tool 33 (iHOT-33) and Hip Outcome Score (HOS) were used as the primary and secondary outcome measures pre-operatively and a minimum of two years postoperatively.

Results: A total of 131 patients were included in the study with 37 ​% males and 63 ​% females. Age (years) and body mass index (kg/m²) were similar between groups, whereas a statistically greater number of male participants were seen in the hip pain only group (MSKM 1). Pre-operatively, patients with isolated hip pain (MSKM 1), had a higher iHOT-33 scores (p ​< ​0.05), but no statistically significant differences were observed postoperatively between the groups. All groups demonstrated a statistically significant improvement in iHOT-33 and HOS scores postoperatively compared to pre-operatively (p ​< ​0.05), with 76 ​% meeting the threshold for minimum clinically important difference.

Conclusion: Patient-reported outcomes following hip arthroscopy for FAIS were significantly greater postoperatively for all patients, despite the presence of other joint or back pain. This study can assist in driving patient expectations following hip arthroscopy for FAIS.

Level of evidence: IV.

Introduction: Anterior cruciate ligament (ACL) injuries and ACL reconstruction (ACLR) surgery are very common. Patients increasingly use social media platforms like YouTube to find healthcare information to help them make medical decisions. The purpose of this study was to evaluate the quality of YouTube videos providing information about ACL injuries and ACL surgery.

Methods: The most-viewed YouTube videos for ACL-associated search terms were reviewed for inclusion and assessed by two authors using four video quality assessment tools: the Journal of American Medical Association benchmark (JAMA) (0-4), Global Quality Score (GQS) (1-5), modified DISCERN (mod-DISCERN) (0-5), and YouTube ACL Specific Score (the score) (0-25). Intraclass correlation coefficients (ICCs) were calculated to determine interrater reliability. Unpaired t-tests were used for comparisons between groups and linear regressions to identify associations.

Results: There were 45 videos that met the inclusion criteria. Overall, 31.1% of videos reported an academic affiliation, and 53.3% listed an MD as the lead author. The mean JAMA score was 2.8, GQS 3.2, mod-DISCERN 2.6, and overall the score 5.9. There was good interobserver agreement across all quality tools (ICC>0.75). Videos with an MD lead author had significantly higher JAMA (p ​< ​0.001) and GQS (p ​< ​0.01) scores than those led by non-physicians. Videos with academic affiliations had significantly higher JAMA (p ​< ​0.001), GQS (p ​< ​0.01), mod-DISCERN (p ​< ​0.01), and the score Management Domain (p ​= ​0.04) scores.

Conclusion: Among the most-viewed YouTube videos related to ACL injuries and ACL surgery, physician-led and academically affiliated videos provided higher quality educational information compared to other sources, however, the overall quality of content provided is low.

Level of evidence: Level IV.

Cartilage lesions around the knee are common injuries in the orthopedic practice. The spontaneous healing capacity of the articular cartilage is limited, and therefore surgical intervention may be necessary. The goal is to improve patients' symptoms, articular functionality, and potentially delay the progression of knee osteoarthritis. Extensive knowledge is available regarding the efficacy of cartilage restoration procedures for tibiofemoral chondral and osteochondral lesions; however, evidence on patellofemoral surgery remains more limited and controversial. The complex biomechanics and morphology of the patellofemoral joint represents a challenge in the setting of knee cartilage surgery and, as a result, inferior outcomes have been reported when compared to treatment of condylar lesions. Furthermore, patellofemoral cartilage restoration can be combined with procedures such as a tibial tuberosity osteotomy and/or other realigning osteotomies when pathological deformities are present. Finally, when the aforementioned strategies fail or when severe osteoarthritis develops, and preservation procedures are contraindicated, arthroplasty and other options can be considered. This State of the Art review aims to critically examine the current concepts of conservative and surgical treatment of patellofemoral cartilage lesions, reporting the latest clinical evidence and describing potential future perspectives in this field.