Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献_第9页

Increased rate of surgery for loss of motion following anterior cruciate ligament reconstruction during COVID-19 在 COVID-19 期间，前十字韧带重建术后活动度丧失的手术率增加。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-24 DOI: 10.1016/j.jisako.2024.100314

Joseph D. Giusto , Gillian M. Ahrendt , Ariana Lott , Kathleen M. Poploski , Janina Kaarre , Camila Grandberg , Jonathan D. Hughes , James J. Irrgang , Volker Musahl

Objectives

To investigate the incidence and risk factors associated with loss of motion after anterior cruciate ligament reconstruction (ACLR) during the coronavirus disease 2019 pandemic (COVID-19).

Methods

A retrospective review of patients undergoing primary ACLR between March 2017 and November 2022 by a senior high-volume orthopaedic surgeon was performed. Exclusion criteria included revision ACLR, multiligamentous knee surgery, and age <14 years. The COVID-19 group was categorized according to the United States Centers for Disease Control Public Health Emergency declaration dates (January 31, 2020–May 11, 2023). To minimize confounding variables associated with the early stages of COVID-19, patients who underwent ACLR between December 1, 2019 and February 29, 2020 were excluded. Loss of motion was defined using the International Knee Documentation Committee criteria for loss of motion of the knee (i.e. an extension deficit >5° or flexion deficit >15° compared to the contralateral knee) 3–12 months after ACLR or as requiring surgery to restore motion within 12 months of ACLR.

Results

A total of 336 individuals who underwent 352 primary ACLRs (164 pre-COVID-19, 188 during COVID-19) were included (mean age: 25.2 ± 10.6 years, 44% female). The overall rate of postoperative loss of motion was 15% (n = 53), and 9% (n = 31) required surgery to restore motion within 12 months of ACLR. More patients underwent surgery for loss of motion during COVID-19 compared to pre-COVID-19, which was statistically significant (12% (n = 23) vs 5% (n = 8), respectively, P = 0.02). However, a statistically significant difference in the rate of loss of motion was not detected (18% (n = 33) vs 12% (n = 20), respectively, P = 0.16). A statistically significant increased median time from injury to ACLR was observed during COVID-19 compared to pre-COVID-19 (55 vs 37 days, P <0.01). More patients were unable to achieve terminal extension (0°) at minimum 9 months postoperatively during COVID-19 compared to pre-COVID-19 (10% vs 3%, P = 0.04) and motion was worse at this interval (0°–136° vs −2°–138°, P <0.01).

Conclusion

Surgery for loss of motion following ACLR was more common during COVID-19. Decreased access to elective medical care, changed activity level, psychological effects, or COVID-19 itself may explain the increased rate of surgery for loss of motion during COVID-19.

Level of evidence

Case series; level IV.

目的研究2019年冠状病毒病大流行（COVID-19）期间前交叉韧带重建术（ACLR）后运动功能丧失的发生率和相关风险因素：方法：对2017年3月至2022年11月期间接受初级前交叉韧带重建术的患者进行回顾性审查，该手术由一名资深的高容量骨科外科医生进行。排除标准包括前交叉韧带置换术（ACLR）翻修、膝关节多韧带手术、前交叉韧带置换术后3-12个月内年龄达到5°或与对侧膝关节相比屈曲缺损>15°，或在前交叉韧带置换术后12个月内接受恢复运动的手术：共有 336 人接受了 352 次初级 ACLR（164 人在 COVID-19 前接受，188 人在 COVID-19 期间接受）（平均年龄为 25.2 ± 10.6 岁，44% 为女性）。术后运动功能丧失的总比例为 15%（53 人），9%（31 人）的患者需要在 ACLR 术后 12 个月内接受手术来恢复运动功能。与COVID-19前相比，COVID-19期间因活动度丧失而接受手术的患者更多，这在统计学上有显著意义（分别为12%（n=23） vs 5%（n=8），P=0.02）。不过，在运动功能丧失率方面未发现有统计学意义的差异（分别为 18% (n=33) vs 12% (n=20)，P=0.16）。与 COVID-19 前相比，COVID-19 期间观察到从受伤到 ACLR 的中位时间有明显的统计学差异（55 天 vs 37 天，P=0.16）：在 COVID-19 期间，前交叉韧带损伤后因运动功能丧失而进行手术的情况更为普遍。获得选择性医疗护理的机会减少、活动水平改变、心理影响或COVID-19本身可能是COVID-19期间因活动能力丧失而进行手术的比例增加的原因：病例系列；IV 级。

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引用次数: 0

Development and validation of a novel method for assessing physical activity profiles after anterior cruciate ligament reconstruction: The Sports and Physical Activity scale 开发和验证一种新方法，用于评估前十字韧带重建后的体力活动情况：运动和体育活动量表。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-23 DOI: 10.1016/j.jisako.2024.100312

Haydn J. Klemm , Kate E. Webster , Brian M. Devitt , Cameron J. Norsworthy , Timothy S. Whitehead , Julian A. Feller

Objectives

To describe and evaluate the preliminary validity of a novel scoring system for assessing the physical activity of patients after anterior cruciate ligament (ACL) reconstruction.

Methods

The Sports and Physical Activity (SPA) scale consists of thirty options of sports and physical activities, followed by four frequency options for each option selected. Factors used to develop the scoring system were frequency of participation and intensity of the sports or physical activities. Possible scores ranged from a low of 0 to a high of 24. The scale was assessed for validity and responsiveness.

Results

The study cohort included 418 primary ACL reconstructed patients 2 years after surgery, and a subgroup of 183 patient 5 years after surgery. The mean and median SPA scores for the cohort were 12.35 ( ± 6.95) and 12, respectively. There was no statistically significant difference between the scores of men and women (U = 21,541.0, p = 0.921). The SPA scale had a small but statistically significant inverse correlation with age (r_s = −0.2, p = <0.001), indicating divergent validity. Patients who had returned to sport had a statistically significantly higher score (U = 21593.5, p = <0.001), and there was a statistically significant difference between scores of the three current sports status groups (H = 19.99, p value = <0.001) indicating convergent validity. Construct validity was indicated with a statistically significant correlation with the Marx scale (r_s = 0.422, p value= <0.001). In a subgroup (n = 183) of the patient sample, comparison between scores at 2-years (13.27 ± 7.02) and 5-years (12.11 ± 7.88) found a statistically significant decline (p= <0.001). However, this decline was smaller than the decline seen in the Marx score between 2 and 5 years (11.11 ± 4.07 and 9.30 ± 4.52 p= <0.001).

Conclusion

Preliminary validity was found for the SPA scale. Women and men were found to be participating in a similar amount of activity 2 years post ACL reconstruction, despite return to sport differences between men and women being well documented. The scores of the SPA scale showed a statistically significant decrease over time with a negligible effect size.

Level of evidence

III.

目的描述并评估用于评估前交叉韧带（ACL）重建术后患者体育活动的新型评分系统的初步有效性：运动和体力活动（SPA）量表由 30 个运动和体力活动选项组成，每个选项有 4 个频率选项。制定评分系统的因素包括运动或体育活动的参与频率和强度。评分范围从最低的 0 分到最高的 24 分不等。对量表的有效性和响应性进行了评估：研究队列包括 418 名术后 2 年的前交叉韧带初次重建患者，以及 183 名术后 5 年的亚组患者。组群的 SPA 评分平均值和中位数分别为 12.35（+/- 6.95）和 12。男性和女性的得分没有明显的统计学差异（U= 21541.0，P= 0.921）。SPA 量表与年龄呈微小但有统计学意义的反向相关（r=-0.2，p = 结论）：SPA量表具有初步有效性。尽管男女在恢复运动方面存在差异，但在前交叉韧带重建后两年，女性和男性参加的活动量相似。随着时间的推移，SPA量表的得分出现了统计学意义上的显著下降，其影响大小可忽略不计：证据等级：III。

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引用次数: 0

Transcultural adaptation and validation of the 4-Domain Sports PROM into Italian 跨文化改编和验证意大利语的 4 域运动促进项目。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-23 DOI: 10.1016/j.jisako.2024.100305

S.R. Piedade , G.L. Canata , N. Maffulli

Objectives

This work aims to evaluate and validate the process of cross-cultural adaptation and validation of the 4-Domain Sports PROM (4-DSP) into Italian, assessing its understandability and reproducibility in all questionnaire domains for Italian-speaking patients.

Methods

Cross-sectional study, level of evidence II. The questionnaire was self-administered by 100 patients (80 males and 20 females) who had undergone anterior cruciate ligament (ACL) reconstruction and had a one-year minimum follow-up. The mean age and standard deviation (SD) was 31.20 ± 12.65 years. According to their level of sports participation, 51% were recreational, 31% were regional, 12% were national, and 6% were international athletes. All patients filled in the 4-DSP questionnaire without direct supervision of their trainer/coach or researcher. All data were collected and processed anonymously. The translation and cultural adaptation of the 4-DSP involved six phases: (1) translation, (2) synthesis, (3) back-translation, (4) pre-test, (5) expert committee review and (6) final version approval by the author of the original version for publication.

Results

The cross-cultural validation of the questionnaire 4-DSP into Italian presented a global Cronbach's alpha of 0.65, Conceptual equivalence to translation and relevance were 99.09% and 99.81%, respectively, and the percentage of agreement was 99.09%.

Conclusion

The cross-culturally validated version of the 4-DSP into Italian proved to be adequately understandable and reproducible in all questionnaire domains and can be safely and reliably used in Italian-speaking patients.

Level of evidence

Study level II.

目标：本研究旨在评估和验证意大利语 4-DSP（4-Domain Sports PROM）的跨文化改编和验证过程，评估意大利语患者对所有问卷领域的可理解性和可重复性：横断面研究，证据等级 II。100名接受过前交叉韧带（ACL）重建术的患者（80名男性和20名女性）自行填写了调查问卷，并进行了至少一年的随访。平均年龄（31.20±12.65）岁，标准差（SD）为 31.20±12.65。根据他们的运动参与水平，51%为休闲运动员，31%为地区运动员，12%为国家运动员，6%为国际运动员。所有患者都在没有教练或研究人员直接监督的情况下填写了 4-DSP 问卷。所有数据均以匿名方式收集和处理。4-DSP 的翻译和文化调整包括六个阶段：(1) 翻译，(2) 综合，(3) 反译，(4) 预测试，(5) 专家委员会审查，(6) 最终版本由原版作者批准出版：4-DSP 意大利语问卷的跨文化验证结果显示，总体 Cronbach's ALPHA 值为 0.65，翻译概念等同性和相关性分别为 99.09% 和 99.81%，一致率为 99.09%：经跨文化验证的意大利语版 4-DSP 被证明在所有问卷领域都具有充分的可理解性和可重复性，可安全可靠地用于讲意大利语的患者：研究等级 II。

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引用次数: 0

Vascular complications after a multiligament knee reconstruction: A case report highlighting the role of preoperative imaging 多韧带膝关节重建术后的血管并发症：强调术前成像作用的病例报告。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-22 DOI: 10.1016/j.jisako.2024.100313

Simon Martel , KC Herne , Saud M. Alfayez , Mark Burman , Paul A. Martineau

Vascular injuries are serious complications of multiligament knee injuries and can result in catastrophic outcomes. These injuries can range from intimal flaps with no compromise of the distal perfusion to a complete occlusion or transection requiring emergent vascular intervention. Several diagnostic tests, including the measurement of the ankle-brachial index (ABI), conventional angiography, and computed tomography angiography (CTA), are commonly used as diagnostic tools to identify vascular injuries in the context of a multiligament knee injury. In this report, the authors discuss the case of a patient with a normal ABI and palpable distal pulses on physical examination who developed limb ischemia after a multiligament knee reconstruction under tourniquet. The patient underwent emergent embolectomy and had a favorable postoperative outcome. During vascular exploration, there was no evidence of injury to the popliteal artery. The two working diagnoses were that either the patient had an intimal flap complicated by the development of a thrombus during surgery or that the initial vascular injury was not detected by ABI and clinical examination. Therefore, intimal flaps in multiligament knee injuries can lead to limb threatening ischemia in the context of reconstructive knee surgery and are likely underdiagnosed with ABI assessment. The utilization of preoperative CTA may help identify these injuries in patients indicated for reconstructive surgeries.

血管损伤是膝关节多韧带损伤的严重并发症，可导致灾难性后果。这些损伤的范围从远端灌注不受影响的内膜瓣到需要紧急血管干预的完全闭塞或横断。包括测量踝肱指数（ABI）、传统血管造影术和计算机断层扫描血管造影术（CTA）在内的几种诊断测试通常被用作诊断工具，以识别膝关节多韧带损伤中的血管损伤。在本报告中，作者讨论了一例 ABI 正常且体检时可触及远端搏动的患者在止血带下进行多韧带膝关节重建术后出现肢体缺血的病例。患者接受了紧急栓子切除术，术后效果良好。在血管探查过程中，没有发现腘动脉损伤的迹象。因此，两个可行的诊断是：患者的内膜瓣在手术过程中因血栓形成而并发，或者 ABI 和临床检查未发现最初的血管损伤。因此，膝关节多韧带损伤中的内膜瓣可能会在膝关节重建手术中导致威胁肢体的缺血，而 ABI 评估很可能对此诊断不足。利用术前 CTA 可能有助于在有重建手术指征的患者中识别这些损伤。

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引用次数: 0

Osteochondroplasty with or without labral repair is more cost-effective than arthroscopic lavage with or without labral repair for treatment of young adults with femoroacetabular impingement: A cost-utility analysis based on data from a randomized controlled trial 在治疗患有股骨髋臼撞击症的年轻成年人时，带或不带髋臼唇修补术的骨软骨成形术比带或不带髋臼唇修补术的关节镜灌洗术更具成本效益：基于随机对照试验数据的成本效用分析。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-22 DOI: 10.1016/j.jisako.2024.100307

Jiajun Yan , Brittany Humphries , Zhenyan Bo , Ling Dai , Nicole Simunovic , Feng Xie , Olufemi R. Ayeni

Objectives

The objective of this study was to conduct a cost–utility analysis of osteochondroplasty with or without labral repair compared to arthroscopic lavage with or without labral repair for femoroacetabular impingement (FAI) from a Canadian public payer perspective.

Methods

A Markov model was constructed to compare the lifetime quality-adjusted life years (QALYs) and costs of the two treatment strategies. The target population was surgical FAI patients aged 36 years. The primary data source was patient-level data from the Femoroacetabular Impingement Randomised Controlled Trial, which evaluated the efficacy of the surgical correction of FAI via arthroscopic osteochondroplasty with or without labral repair compared to arthroscopic lavage with or without labral repair in Canada. Long-term data were extrapolated using a generalized gamma model. The primary outcome was the incremental cost-effectiveness ratio, calculated by dividing the difference in costs by the difference in QALYs between osteochondroplasty and lavage, with or without labral repair. Probabilistic sensitivity analyses and one-way sensitivity analyses were used to characterize uncertainty of model parameters and assumptions.

Results

Over a lifetime horizon, osteochondroplasty, with or without labral repair, had a greater expected benefit (0.63 QALYs gained per patient) and lower costs ($955.89 saved per patient), as compared with lavage with or without labral repair. Probabilistic sensitivity analyses demonstrated that the probability of osteochondroplasty, with or without labral repair, being cost-effective was 90.5% at a commonly used willingness-to-pay threshold of $50,000/QALY in Canada. Across all one-way sensitivity analyses, osteochondroplasty with or without labral repair remained a cost-effective option.

Conclusion

Over a lifetime time horizon, osteochondroplasty, with or without labral repair, is a cost-effective treatment strategy for young adults with FAI. Future research involving real-word data is needed to further validate these findings.

Level of evidence

III.

研究目的从加拿大公共支付方的角度，对股骨髋臼撞击症（FAI）进行骨软骨置换术（带或不带髋臼唇修补术）与关节镜灌洗（带或不带髋臼唇修补术）的成本效用分析：方法：建立马尔可夫模型，比较两种治疗策略的终生质量调整生命年（QALY）和成本。目标人群为 36 岁的 FAI 手术患者。该试验评估了在加拿大通过关节镜骨软骨成形术（带或不带唇瓣修复）与关节镜灌洗（带或不带唇瓣修复）手术矫正FAI的疗效比较。长期数据采用广义伽马模型进行推断。主要结果是增量成本效益比（ICER），计算方法是将骨软骨成形术与灌洗术之间的成本差异除以质量调整生命年（QALYs）差异（无论是否进行了唇瓣修复）。概率敏感性分析和单向敏感性分析用于描述模型参数和假设的不确定性：在终生范围内，与进行或不进行唇瓣修复的灌洗术相比，进行或不进行唇瓣修复的骨软骨成形术具有更大的预期收益（每位患者获得 0.63 QALYs）和更低的成本（每位患者节省 955.89 美元）。概率敏感性分析表明，在加拿大常用的支付意愿阈值为 50,000 美元/QALY 时，无论是否进行唇缘修复，骨软骨成形术具有成本效益的概率为 90.5%。在所有单向敏感性分析中，无论是否进行唇缘修复，骨软骨置换术仍是一种具有成本效益的选择：结论：在一生的时间跨度内，对于患有FAI的年轻成年人来说，无论是否进行唇缘修复，骨软骨成形术都是一种具有成本效益的治疗策略。未来的研究需要真实数据来进一步验证这些发现：证据等级：III。

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引用次数: 0

Management of patellar and trochlear cartilage lesions with matrix-induced autologous chondrocyte implantation in conjunction with patellofemoral realignment procedures improves patient-reported outcomes and magnetic resonance image appearance 髌骨和趾骨软骨病变的基质诱导自体软骨细胞植入治疗与髌股关节复位手术相结合，可改善患者报告的疗效和磁共振成像外观。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-21 DOI: 10.1016/j.jisako.2024.100311

Julia S. Retzky , E. Grant Carey , Ryan S. Selley , Connor Fletcher , Matthew J. Hartwell , Alissa J. Burge , Andreas Gomoll , Sabrina Strickland

Objectives

The aim of this study is to evaluate the relationship between the achievement of clinically significant improvement in patient-reported outcome measures (PROMs) and the postoperative magnetic resonance image (MRI) appearance of matrix-associated chondrocyte implantation (MACI), in conjunction with patellofemoral realignment procedures, for the treatment of grade-IV chondral defects about the patellofemoral joint.

Methods

A retrospective review of patients undergoing MACI for grade-IV chondral defects of the patella or trochlea by a single sports-medicine-fellowship-trained surgeon from 2017 to 2020 was performed. Concomitant realignment procedures, including tibial tubercle osteotomy and medial patellofemoral ligament reconstruction, were also performed as needed. Patients with preoperative and minimum 1-year postoperative PROMs and postoperative knee MRI were included. MRI scans were obtained at 6.3 (interquartile range: 5.8, 7.5) months postoperatively. A fellowship-trained musculoskeletal radiologist assigned a Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (range: 0–100, with 100 equating to complete graft healing) to each MRI. Achievement of the minimal clinically important difference (MCID) for International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Score—Quality of Life, and Kujala scores were determined for each patient. Paired t-tests or Wilcoxon rank-sum tests were used to evaluate for an association between achievement of the MCID for each PROM and MOCART score. The average follow-up time and time from surgery to PROMs were 2.7 ± 1.5 years and 1.7 ± 0.66 years, respectively.

Results

Thirty patients were included. There was a significant improvement in all PROMs from preoperative to postoperative (p < 0.001). More than two-thirds of patients achieved the MCID for each PROM. Patients who achieved the MCID for IKDC had significantly higher MOCART scores (66.5 ± 16.2) than those who did not meet the MCID for IKDC (50.6 ± 23.6, p = 0.043).

Conclusion

MACI for the treatment of patellofemoral chondral injuries is associated with clinically significant improvement in PROMs at short-term follow-up. Clinically significant improvements in IKDC scores are associated with a more mature MRI appearance of the autologous chondrocyte implantation graft on postoperative MRI, as indicated by higher MOCART scores.

Level of evidence

IV—Case Series.

研究目的本研究旨在评估基质相关软骨细胞植入术（MACI）与髌骨复位术联合治疗髌股关节IV级软骨缺损时，患者报告结果指标（PROMs）的临床显著改善与术后磁共振成像（MRI）外观之间的关系：对2017-2020年期间接受MACI治疗髌骨或踝关节IV级软骨缺损的患者进行回顾性研究，该研究由一名接受过运动医学研究培训的外科医生负责。根据需要，还进行了包括胫骨结节截骨术和髌股关节内侧韧带重建术在内的配套调整手术。患者术前、术后至少 1 年的 PROM 和术后膝关节 MRI 均被纳入其中。磁共振成像在术后6.3个月[四分位间距（IQR）：5.8，7.5]时采集。一位受过研究员培训的肌肉骨骼放射科医生对每张磁共振成像进行了软骨修复组织磁共振观察（MOCART）评分（范围：0-100，100 分代表移植物完全愈合）。确定每位患者的国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎生活质量评分（KOOS-QoL）和库亚拉评分的最小临床重要差异（MCID）。采用配对t检验或Wilcoxon秩和检验来评估每个PROM的MCID和MOCART评分之间的关联。平均随访时间和从手术到PROM的时间分别为2.7±1.5年和1.7±0.66年：结果：共纳入 30 例患者。从术前到术后，所有 PROMs 均有明显改善（p 结论：MACI 治疗髌骨损伤的疗效显著：治疗髌骨软骨损伤的 MACI 与短期随访时 PROMs 的临床显著改善有关。IKDC评分的临床明显改善与ACI移植物在术后磁共振成像上更成熟的磁共振成像外观有关，这体现在MOCART评分更高：IV - 病例系列。

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引用次数: 0

Quadriceps tendon size does not affect postoperative strength recovery following quadriceps tendon anterior cruciate ligament reconstruction 股四头肌腱的大小不会影响股四头肌腱前交叉韧带重建术后的力量恢复。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-21 DOI: 10.1016/j.jisako.2024.100308

Jumpei Inoue , M Enes Kayaalp , Joseph D. Giusto , Koji Nukuto , Bryson P. Lesniak , Andrew L. Sprague , James J. Irrgang , Volker Musahl

Objective

The influence of quadriceps tendon (QT) size on postoperative quadriceps strength following QT anterior cruciate ligament reconstruction (ACLR) is unclear. Therefore, this study aimed to determine the relationship between QT morphology and postoperative quadriceps strength recovery following primary ACLR using a QT autograft.

Methods

Patients who underwent primary ACLR using QT autograft from 2014 to 2022 followed by a postoperative isometric strength measurement between 5 and 8 months were retrospectively reviewed. Using preoperative magnetic resonance imaging findings, the anterior–posterior (A-P) thickness, medial–lateral (M-L) width, and cross-sectional area (CSA) of the QT were measured. Postoperative residual CSA of QT was estimated based on the graft-harvest diameter. The quadriceps index (QI) was also calculated, which was determined by dividing the maximum isometric quadriceps torque on the involved side by the maximum quadriceps torque on the uninvolved side. Associations between the QI and QT morphology were assessed. Furthermore, multivariable logistic regression analysis with the addition of sex as a covariate was performed with the addition of each individual measure of QT morphology to determine the association with a QI ≥80%.

Results

A total of 84 patients (mean age: 21.9 ± 7.3 years; 46 female) were included. Residual CSA showed a statistically significant positive correlation with the QI (r = 0.221, p = 0.043). There were no statistically significant correlations between QI and CSA, A-P thickness, or M-L width. Multivariable logistic analysis adjusting for sex demonstrated that each individual measure of QT morphology was not statistically significantly associated with a QI ≥80%.

Conclusion

A statistically significant correlation between measures of preoperative QT size and postoperative quadriceps strength were not detected in patients undergoing primary QT autograft ACLR. A smaller residual QT CSA based on QT harvest diameter was weakly associated with decreased quadriceps strength 5–8 months postoperatively, but this association was not independent of sex. Future studies examining the impact of QT morphology on quadriceps strength at longer follow-up intervals are needed.

Level of evidence

IV.

目的：QT前交叉韧带重建术（ACLR）后，股四头肌肌腱（QT）大小对术后股四头肌力量的影响尚不明确。因此，本研究旨在确定使用 QT 自体移植物进行初级 ACLR 后 QT 形态与术后股四头肌力量恢复之间的关系：方法：回顾性研究了2014年至2022年期间使用QT自体移植物进行初级前交叉韧带置换术的患者，术后5至8个月进行了等长力量测量。利用术前磁共振成像（MRI）结果，测量了 QT 的前后（A-P）厚度、内侧-外侧（M-L）宽度和横截面积（CSA）。术后 QT 的残余 CSA 是根据移植物采集直径估算的。此外，还计算了股四头肌指数（QI），其计算方法是将受累侧股四头肌最大等长扭力除以未受累侧股四头肌最大扭力。评估了 QI 与 QT 形态之间的关联。此外，还进行了以性别为协变量的多变量逻辑回归分析，并加入了 QT 形态学的各项指标，以确定 QI ≥80% 与 QT 形态学之间的关联：共纳入 84 名患者（平均年龄为 21.9 ± 7.3 岁；46 名女性）。残留 CSA 与 QI 呈统计学意义上的显著正相关（r = 0.221，p = 0.043）。QI 与 CSA、A-P 厚度或 M-L 宽度之间没有明显的统计学相关性。调整性别后进行的多变量逻辑分析表明，QT 形态的每种测量值与 QI ≥80% 均无统计学意义上的明显相关性：结论：在接受初级QT自体移植前交叉韧带重建术的患者中，未发现术前QT大小与术后股四头肌力量之间有统计学意义的相关性。根据QT切口直径计算的较小残留QT CSA与术后5-8个月股四头肌力量下降有微弱关联，但这种关联与性别无关。未来需要进行更多研究，在更长的随访间隔内检查QT形态对股四头肌力量的影响：证据等级：IV。

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引用次数: 0

Sagittal computed tomography evaluation of osteochondritis dissecans of the capitellum correlates with clinical outcomes of arthroscopic debridement in adolescent baseball players 髌骨骨软骨软化症的矢状面计算机断层扫描评估与青少年棒球运动员关节镜清创术的临床效果相关。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-20 DOI: 10.1016/j.jisako.2024.07.009

Kenji Yokoyama , Tetsuya Matsuura , Joji Iwase , Toshiyuki Iwame , Koichi Sairyo

Objectives

To investigate the relationship between the size and location of osteochondral defects in capitellar osteochondritis dissecans (OCD) measured on coronal and sagittal reconstructed computed tomography (CT) images and the clinical outcomes of arthroscopic debridement in adolescent baseball players.

Methods

This retrospective study investigated the clinical outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players with ≥24 months of follow-up after surgery between 2008 and 2020. On preoperative coronal CT images, medial and lateral distance (%) were used to evaluate the location of the defect. Defect size (%) was also evaluated. On preoperative sagittal CT images, superior and inferior angles (deg) were used to evaluate the location of the defect. The size of the defect was evaluated using the defect angle (deg). Outcome measures were determined using the Timmerman–Andrews score at the latest follow-up. Spearman’s rank correlation coefficient was used to examine relationships between these parameters and the Timmerman–Andrews score. Statistical significance was set at p < 0.05.

Results

Thirty players [mean age, 14 (range, 11–16) years] underwent arthroscopic debridement: 5 were pitchers, 7 were catchers, 13 were infielders, and 5 were outfielders. Mean follow-up duration was 26 (range, 24–66) months. The median Timmerman–Andrews score at the latest follow-up was 193 [interquartile range (IQR), 181–200] points. Inferior angle showed statistically significant positive correlations with Timmerman–Andrews score (r_s = 0.520, p < 0.01), pain (r_s = 0.478, p < 0.01), and sagittal arc of motion (r_s = 0.409, p = 0.025). Defect angle showed statistically significant negative correlations with Timmerman–Andrews score (r_s = −0.462, p = 0.010) and flexion contracture (r_s = -0.424, p = 0.020). Medial distance, lateral distance, defect size, and superior angle were not correlated with the Timmerman–Andrews score or any of its subscores.

Conclusion

Posterior or large osteochondral defects of the humeral capitellum on preoperative sagittal CT images affected the outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players.

Level of evidence

Level V, case series.

研究目的研究冠状位和矢状位重建计算机断层扫描（CT）图像上测量的帽状腱膜骨软骨松解症（OCD）骨软骨缺损的大小和位置与青少年棒球运动员关节镜清创术临床疗效之间的关系：这项回顾性研究调查了 2008 年至 2020 年间手术后随访时间≥ 24 个月的青少年棒球运动员关节镜清创治疗帽状腱膜 OCD 的临床效果。在术前冠状 CT 图像上，内侧和外侧距离（%）用于评估缺损位置。同时还评估了缺损大小（%）。在术前的矢状 CT 图像上，上角和下角（度）用于评估缺损的位置。用缺损角度（度）评估缺损大小。在最近一次随访时，采用 Timmerman-Andrews 评分来确定结果。斯皮尔曼等级相关系数用于检验这些参数与 Timmerman-Andrews 评分之间的关系。统计显著性以 p < 0.05 为标准：30名球员（平均年龄14岁[11-16岁]）接受了关节镜清创术：其中投手 5 人，接球手 7 人，内野手 13 人，外野手 5 人。平均随访时间为 26 个月（24-66 个月）。最近一次随访的 Timmerman-Andrews 评分中位数为 193 分（IQR，181-200 分）。下角与 Timmerman-Andrews 评分（rs = 0.520，p < 0.01）、疼痛（rs = 0.478，p < 0.01）和矢状运动弧（rs = 0.409，p = 0.025）呈显著正相关。缺损角度与 Timmerman-Andrews 评分（rs = -0.462，p = 0.010）和屈曲挛缩（rs =-0.424，p = 0.020）呈统计学意义上的显著负相关。内侧距离、外侧距离、缺损大小和上角与 Timmerman-Andrews 评分或其任何子评分均无相关性：结论：术前矢状CT图像显示的肱骨髌骨后方或大块骨软骨缺损会影响青少年棒球运动员髌骨OCD关节镜清创术的效果：证据级别：V级，病例系列。

{"title":"Sagittal computed tomography evaluation of osteochondritis dissecans of the capitellum correlates with clinical outcomes of arthroscopic debridement in adolescent baseball players","authors":"Kenji Yokoyama , Tetsuya Matsuura , Joji Iwase , Toshiyuki Iwame , Koichi Sairyo","doi":"10.1016/j.jisako.2024.07.009","DOIUrl":"10.1016/j.jisako.2024.07.009","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the relationship between the size and location of osteochondral defects in capitellar osteochondritis dissecans (OCD) measured on coronal and sagittal reconstructed computed tomography (CT) images and the clinical outcomes of arthroscopic debridement in adolescent baseball players.</div></div><div><h3>Methods</h3><div>This retrospective study investigated the clinical outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players with ≥24 months of follow-up after surgery between 2008 and 2020. On preoperative coronal CT images, medial and lateral distance (%) were used to evaluate the location of the defect. Defect size (%) was also evaluated. On preoperative sagittal CT images, superior and inferior angles (deg) were used to evaluate the location of the defect. The size of the defect was evaluated using the defect angle (deg). Outcome measures were determined using the Timmerman–Andrews score at the latest follow-up. Spearman’s rank correlation coefficient was used to examine relationships between these parameters and the Timmerman–Andrews score. Statistical significance was set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Thirty players [mean age, 14 (range, 11–16) years] underwent arthroscopic debridement: 5 were pitchers, 7 were catchers, 13 were infielders, and 5 were outfielders. Mean follow-up duration was 26 (range, 24–66) months. The median Timmerman–Andrews score at the latest follow-up was 193 [interquartile range (IQR), 181–200] points. Inferior angle showed statistically significant positive correlations with Timmerman–Andrews score (r<sub>s</sub> = 0.520, <em>p</em> < 0.01), pain (r<sub>s</sub> = 0.478, <em>p</em> < 0.01), and sagittal arc of motion (r<sub>s</sub> = 0.409, <em>p</em> = 0.025). Defect angle showed statistically significant negative correlations with Timmerman–Andrews score (r<sub>s</sub> = −0.462, <em>p</em> = 0.010) and flexion contracture (r<sub>s</sub> = -0.424, <em>p</em> = 0.020). Medial distance, lateral distance, defect size, and superior angle were not correlated with the Timmerman–Andrews score or any of its subscores.</div></div><div><h3>Conclusion</h3><div>Posterior or large osteochondral defects of the humeral capitellum on preoperative sagittal CT images affected the outcomes of arthroscopic debridement for capitellar OCD in adolescent baseball players.</div></div><div><h3>Level of evidence</h3><div>Level V, case series.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100301"},"PeriodicalIF":2.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

In the medium term, more than half of males report kinesiophobia after anterior cruciate ligament reconstruction 从中期来看，半数以上的男性在前十字韧带重建术后会出现运动恐惧。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-17 DOI: 10.1016/j.jisako.2024.100309

Leho Rips , Tauno Koovit , Mihkel Luik , Helena Saar , Rein Kuik , Jüri-Toomas Kartus , Madis Rahu

Objectives

Anterior cruciate ligament rupture is a serious trauma with long-term consequences for the patient. Psychological and physiological factors may negatively affect patient recovery after anterior cruciate ligament reconstruction (ACLR), and development of kinesiophobia is possible. The aim of this study was to examine the presence of kinesiophobia and lower-leg muscle strength recovery in both sexes after ACLR.

Methods

140 ACLR patients agreed to participate in the study. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). The Knee injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS) and Tegner Activity Scale (TAS) were used for patient-related outcome measurements. In both legs quadriceps and hamstring muscle strength at 60°/s and 180°/s were measured with an isokinetic dynamometer. For dynamic balance and leg function, the Y-balance test and single-leg hop test were used.

Results

100 (71%) males and 40 (29%) females—mean age 32.5 (±8.3)—were examined 5.5 (±1.25) years after ACLR. 68/140 patients (48.6%) reported a TSK kinesiophobia score equal to or higher than 37 points: 54/100 (54%) males and 14/40 (35%) females (p = 0.04). Patients with kinesiophobia had significantly lower KOOS values (p < 0.001). In terms of the TAS no significant differences were found between those with or without kinesiophobia. Knee strength deficiency at 180°/sec and 60°/sec was significantly higher in the kinesiophobia group in knee extension in males (p = 0.009) and knee flexion in females (p = 0.001). Normalized body weight isokinetic average peak torque strength tests were significantly better in males compared to females in both groups (p < 0.001).

Conclusion

Both sexes reported high rates of kinesiophobia, but males are at higher risk of developing kinesiophobia than females in the medium term after ACLR. Furthermore, patients with kinesiophobia have significantly lower total KOOS scores, and females were significantly weaker than males in knee flexion and extension according to normalized body weight muscle strength tests. Also, a longer time from injury to surgery increases the risk of kinesiophobia in females.

Level of evidence

Level IV.

Type of study

Retrospective case series study.

Clinical trial registration

Trial registration in ClinicalTrials.gov. Identifier: NCT05762809.

目的：前交叉韧带断裂是一种严重创伤，会对患者造成长期影响。心理和生理因素可能会对患者在前交叉韧带重建术（ACLR）后的恢复产生负面影响，并有可能导致运动恐惧。本研究旨在探讨前交叉韧带重建术后男女患者是否存在运动恐惧以及小腿肌肉力量的恢复情况。采用坦帕运动恐惧量表（TSK）对运动恐惧进行评估。膝关节损伤和骨关节炎结果评分（KOOS）、牛津膝关节评分（OKS）和泰格纳活动评分（TAS）用于患者相关结果的测量。双腿股四头肌和腘绳肌的肌力分别以 60˚/s 和 180˚/s 的速度通过等速测力计进行测量。在动态平衡和腿部功能方面，采用了 Y 型平衡测试和单腿跳跃测试：100 名男性（71%）和 40 名女性（29%）--平均年龄为 32.5（±8.3）岁--在前交叉韧带置换术后 5.5（±1.25）年接受了检查。68/140（48.6%）名患者的 TSK 运动恐惧评分等于或高于 37 分：男性为 54/100（54%），女性为 14/40（35%）（P=0.04）。运动恐怖症患者的 KOOS 值明显较低（p 结论：男女患者的运动恐怖症发生率都很高：男女患者的运动恐惧发生率都很高，但在前交叉韧带置换术后的中期，男性比女性患运动恐惧的风险更高。此外，运动恐惧患者的 KOOS 总分明显较低，根据正常化体重肌力测试，女性膝关节屈伸能力明显弱于男性。此外，从受伤到手术的时间越长，女性患运动恐惧的风险就越大：回顾性病例系列研究。IV 级临床试验注册：在 ClinicalTrials.gov 进行试验注册。标识符：NCT05762809：NCT05762809。

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引用次数: 0

Shoulder girdle muscle abscess: Potential routes of spread and surgical management by a dual anterior approach 肩腰肌脓肿：潜在的扩散途径和双前路手术疗法。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine

Pub Date : 2024-08-17 DOI: 10.1016/j.jisako.2024.100310

Narendran Pushpasekaran , Sivaranjinie Selvakkalanjiyam , Monish Kumar Rajesh , Muthukannan Hari Sivanandan , Kandasamy Meenakshi Sundaram

Background

Spontaneous infections involving muscles in the shoulder girdle are uncommon conditions rarely reported in the literature. The large musculature of shoulder girdle, complex communicating spaces into the periscapular region, and late glenohumeral joint involvement can cause delay in diagnosis of infections involving muscular portion of rotator cuff. The method of surgical drainage with involvement of scapulothoracic and subscapular spaces and prognosis can be challenging.

Methodology

In this descriptive study, we included patients with shoulder girdle muscle abscess and analyzed the spread in the shoulder girdle and arm through various pathways radiologically. Debridement of the abscess in the subscapular muscle and adnexa was done through the dual approach, one with deltopectoral approach for the shoulder girdle and another incision anterior to the latissimus dorsi muscle for inferior subscapular spaces and gravity-dependent drainage of collection.

Results

The causative organism Staphylococcus aureus was isolated only in two patients out of four cases. In repeated collections, axillary and suprascapular nerve palsies were commonly encountered. Adequate debridement, antibiotic cover with vancomycin and clindamycin for six weeks, and rehabilitation restored normal functions of the shoulder in three patients.

Conclusion

Unsuspecting nature of the subscapular abscess and similarities with common shoulder conditions at initial presentation often led to extensive shoulder girdle involvement via subscapular space, subcoracoid recess, and scapulothoracic space to adjacent areas. The dual approach provides adequate access to drain the collections in subscapularis muscle, subscapular spaces, and shoulder girdle.

Level of study

V.

背景：涉及肩部肌肉的自发性感染并不常见，文献中鲜有报道。肩部肌肉组织庞大，肩胛周围的沟通空间复杂，盂肱关节受累较晚，这些因素都可能导致肩袖肌肉部分感染的诊断延迟。肩胛胸椎和肩胛下间隙受累时的手术引流方法和预后可能具有挑战性：在这项描述性研究中，我们纳入了肩腰肌脓肿患者，并通过放射学方法分析了脓肿在肩腰和手臂的扩散情况。肩胛下肌肉和附件脓肿的清创是通过双途径进行的，其中一个途径是肩腰部的胸骨下切口，另一个切口在背阔肌前方，用于肩胛下间隙和依靠重力引流的集脓：结果：在四例患者中，只有两名患者分离出致病菌金黄色葡萄球菌。反复积液、腋神经和肩胛上神经麻痹是常见症状。经过适当的清创、使用万古霉素和林可霉素进行为期六周的抗生素治疗以及康复治疗后，三名患者的肩部功能恢复正常：结论：肩胛下脓肿的不可预见性以及与常见肩部疾病的相似性往往导致肩胛下间隙、胸骨下凹陷和肩胛胸间隙邻近空间广泛受累。双重方法为肩胛下肌、肩胛下间隙和肩腰部的积液引流提供了充分的通道：V.

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引用次数: 0