Annals of Joint最新文献

Posterior shoulder instability should be increasingly recognized in patients with acute shoulder dislocations or instability, while also warranting a high index of suspicion in contact athletes with insidious onset of shoulder pain. Athletes often present with vague symptoms, typically including deep-seated joint pain and frequently without a described acute traumatic event. The contact athlete will often complain of pain with push-ups and bench press, particularly provoked during blocking motions relevant to football linemen and linebackers. In addition to a patulous posterior capsule, bony morphology can contribute to increased risk of posterior shoulder instability, such as a reverse Hill-Sachs lesion, glenoid dysplasia, glenoid retroversion and posterior acromial height. Posterior bone defects occur in a predictable pattern within the posteroinferior quadrant of the glenoid face and 15% of posterior glenoid bone loss can lead to a 25 times higher failure rate of arthroscopic posterior shoulder stabilization alone. While arthroscopic posterior shoulder stabilization is the gold standard in the absence of substantial posterior glenoid bone loss, posterior bone block stabilization may be necessitated in patients with significant posterior glenoid bone loss or retroversion, or who have failed a previous arthroscopic soft tissue procedure. Free bone block augmentation for posterior glenoid reconstruction has demonstrated compelling short-term results, yet there are no long-term outcome data or comparative studies reporting on the outcomes of these relatively new techniques. Overall, arthroscopic posterior shoulder stabilization leads to high patient satisfaction and excellent clinical outcomes. Contact athletes generally demonstrate similar patient-reported and functional outcomes when compared to overhead throwing athletes. However, contact athletes generally return to sport and previous level of play at a higher rate compared to overhead throwing athletes, potentially due to the lower dynamic stressor applied across the glenohumeral joint, typically at mid-range of motion, compared to the overhead throwing athlete. Findings suggest that comprehensive evaluation and individualized treatment strategies are necessary for optimizing patient outcomes and return to sport among contact athletes.

Patellofemoral instability (PFI) is a relatively common injury in the young, athletic population and remains a significant source of knee pain and functional limitation. It most frequently affects athletes who participate in sports that involve repetitive jumping, cutting, and pivoting motions, such as basketball, soccer, and volleyball. During the competitive season, managing this condition becomes particularly challenging. Athletes are often eager to return to play, while clinicians must weigh the risks of early return against the need for sufficient recovery to prevent re-injury. As a result, in-season management continues to be a topic of ongoing discussion and debate. This review explores the comprehensive evaluation and treatment of PFI, with a focus on both non-surgical and surgical options. Non-surgical management, including rehabilitation and activity modification, is typically favored for first-time dislocations or in the absence of significant anatomical abnormalities. Surgical intervention is considered in cases of recurrent instability or when structural issues are identified. In addition to physical treatment, rehabilitation plays a central role in restoring strength, stability, and neuromuscular control. Equally important is psychological readiness, which is increasingly recognized as a critical factor in safely returning athletes to sport. A well-rounded approach that addresses both physical and mental recovery is essential for optimal outcomes.

Anterior cruciate ligament (ACL) graft failure following ACL reconstruction (ACLR) remains a persistent challenge, especially in the high-level athlete. This review aims to provide a comprehensive overview of the key considerations in revision ACLR, with a particular focus on the high-level athlete. ACL graft failure is multifactorial in origin, with the most common technical error being femoral tunnel malposition. Preoperative evaluation should include a thorough history, physical examination, and advanced imaging such as magnetic resonance imaging and three-dimensional (3D) computed tomography (CT) to assess tunnel position, osteolysis, and associated intra-articular pathology. Concomitant injuries, including meniscal tears and collateral ligament insufficiencies, must be identified and appropriately addressed during revision surgery. Surgical planning must consider prior ACL graft choice, ACL tunnel position, and the potential need for a staged procedure. ACL graft selection should be individualized, though autografts, particularly bone-patellar tendon-bone (BPTB) and quadriceps tendon (QT), are preferred over hamstring tendon (HT) or allograft due to superior outcomes. The decision to perform a single-stage versus two-stage revision is influenced by tunnel placement and tunnel lysis, with a CT scan aiding in preoperative planning. Adjunctive procedures such as a lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction may be considered when certain high-risk characteristics are present, such as young age, knee hyperextension >5 degrees, high-grade pivot shift, multiple revisions, and increased posterior tibial slope (PTS) not meeting criteria for slope-correcting osteotomy. Additionally, slope-reducing or coronal alignment-correcting osteotomies may be necessary in select cases to optimize knee biomechanics and prevent further failure, but literature regarding return to high-level sport following these procedures is limited. Return to sport (RTS) following revision ACLR should be approached as a continuum, incorporating strength, neuromuscular control, and psychological readiness, with emphasis on individualized, criteria-based protocols. Delaying RTS to at least 9 months postoperatively has been associated with reduced ACL graft failure risk. Overall, revision ACLR in the high-level athlete is a complex and nuanced procedure that requires a meticulous, multifactorial approach. By tailoring surgical strategies and postoperative rehabilitation, surgeons can optimize outcomes and facilitate a safe return to competitive sport.

Background and objective: Anterior cruciate ligament (ACL) reconstructions remain a prominent surgery performed in the United States. Despite continuous efforts from surgeons and rehabilitation specialists, the return to previous levels of sports participation remains low and the reinjury rates remain high. The purpose of this narrative review is to summarize the progression of post-operative rehabilitation following ACL reconstruction in elite and professional athletes.

Methods: A literature review was conducted in 2025, searching for the most up-to-date evidence on criterion-based rehabilitation programs and rehabilitation strategies in the English language.

Key content and findings: For the purpose of this narrative, the rehabilitation progression begins when the athlete is cleared to begin a jogging progression and highlights the inclusion of all members of the sports medicine and sports performance teams within the rehabilitation process. The narrative review highlights the three elements of the return to sport (RTS) continuum: returning to participation, sport, and performance. In each element, the athlete's goals are defined and how the rehabilitation and performance teams work together to address them. In order for the athlete to progress within their rehabilitation program, they must demonstrate mastery of simple, controlled tasks and movements before performing complex, chaotic ones. This principle also applies to their reintroduction and progression in sports participation. In using these principles, we outline a progression that uses a criterion-based progression, coinciding with time after surgery, to minimize risk of reinjury and restore performance metrics during the rehabilitation and RTS and performance processes. This method also allows the rehabilitation and performance teams to assess, track, and improve upon key performance indicators throughout the rehabilitation process. Examples include, but are not limited to, objective strength testing, jump testing using force plates, volume ran and maximum velocity during rehabilitation and practice sessions, and psychological readiness.

Conclusions: This review demonstrates how the principles of the Control-Chaos Continuum, Return to Sport Continuum and Return to Sport Clearance Continuum help to navigate the sport-specific progression of rehabilitation. The review can be generalized to all sports, but there is a specific focus on basketball, football, soccer, and skiing.

Background and objective: Knee osteoarthritis (OA) is a debilitating condition that significantly impacts mobility and quality of life, particularly in younger, active patients. Medial unicompartmental knee arthroplasty (UKA) is becoming increasingly utilized as a joint-preserving alternative to total knee arthroplasty (TKA) for treating isolated medial compartment OA. This review evaluates current evidence on medial UKA in patients age 60 years or younger, assessing survivability, functional outcomes, and return to activity rates to provide insight into its viability for this patient population.

Methods: A literature search was conducted using PubMed, MEDLINE, SPORTDiscus identifying studies published from 2015 to 2025 evaluating outcomes of medial UKA. Inclusion criteria encompassed original studies in English that focused on medial UKA for knee OA in patients aged ≤60 years and studies that provided separate age-stratified data for this subgroup. Exclusion criteria included review articles, case reports, studies including concomitant procedures, and those analyzing lateral UKA, patellofemoral joint arthroplasty or patients >60 years of age. A total of 19 studies were selected, and the outcome variables of interest included implant survivability, patient-reported outcomes, range of motion (ROM), and return to activity.

Key content and findings: Medial UKA offers advantages over TKA, such as bone preservation, rapid recovery, and improved knee kinematics. Studies reported survivorship rates exceeding 90% at 10 and 15 years, with improved patient-reported outcomes and ROM. Short-term return-to-activity rates were high, with over 90% of patients resuming physical activity postoperatively. However, concerns regarding longer-term implant durability and performance under high functional demands are still present, particularly in young, athletic individuals engaging in high-impact sports.

Conclusions: Overall, medial UKA is a promising option for patients age 60 years and younger with isolated medial compartment OA, offering good long-term implant survivability and functional outcomes, relatively low complication rates and high rates of short-term return to activity. Future studies should review longer-term outcomes of medial UKA in patients age 60 years and younger.

Background: Total hip arthroplasty (THA) using robotic assistance aims to improve implant positioning and overall outcomes. However, emerging evidence reveals specific complications such as fractures related to temporary pin or screw placements in these procedures.

Case description: We describe two patients (a 74-year-old woman and a 74-year-old man) who underwent robotic-assisted THA (RA-THA) via a posterolateral approach following the MAKO hip protocol [Mako robotic-arm system (Stryker)]. Both had a relatively proximal femoral array screw placement, selected to avoid possible screw-stem interference as per the manufacturer's guidelines. Postoperative radiographs showed no immediate complications, but each patient returned within 2 weeks complaining of hip pain and difficulty ambulating in the absence of significant trauma. Imaging revealed trochanteric fractures originating through the prior pin or screw tract. One patient was treated conservatively; the other required two surgical interventions, complicated by periprosthetic joint infection. At their most recent follow-ups, both patients reported limping gait related to gluteus medius insufficiency but no persistent pain.

Conclusions: These cases highlight greater trochanter fractures as a complication related to femoral array screw placement in RA-THA. Our experiences suggest that current guidelines on "safe zones" for array fixation may require refinement to account for patient-specific bone structure. Additional biomechanical research is needed to identify optimal pin placement and minimize postoperative fractures.

Background and objective: Acromioclavicular (AC) joint sprain and sternoclavicular (SC) joint injuries commonly occur in contact athletes due to the direct-blow mechanism of injury. Despite the high prevalence in this patient population, a small degree of literature on AC and SC joint injuries specifically pertain to contact athletes. The goal of this narrative review is to analyze the literature pertaining to AC and SC joint injuries in both contact athletes and the general population and to provide treatment recommendations specifically for the contact athlete.

Methods: A review of PubMed and MEDLINE was completed to identify articles reporting on the surgical and nonoperative treatment of AC and SC joint injuries in athletes. In this initial screen, the authors excluded general reviews, case reports, duplicate studies between databases and publications in languages other than English. The quality of included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The authors then conducted a search for studies comparing non-operative to operative treatment of AC and SC joint injuries, in addition to studies comparing between operative technique.

Key content and findings: Non-operative management of AC and SC joint injuries offer an acceptable return-to-play timeline. Despite persistent pathologic radiographic appearance in certain cases of non-operative management, clinical outcomes are generally equivalent between athletes treated non-operatively as compared to operatively. In cases of a failed course of nonoperative treatment, surgical management can achieve high return-to-sport rates, though is generally associated with longer recovery intervals. Despite mechanism of injury, rate of successful return to previous level does not appear to correlate with degree of contact in a sport, but instead with overhead demand of the sport.

Conclusions: Contact athletes with AC and SC joint injuries should be trialed with a course of nonoperative management, even in higher grade injuries, with some exceptions. Athletes should be appropriately counseled, with particular attention paid to positions requiring increased overhead demand. When surgery is required, non-rigid anatomic fixation allows for a high rate of return to sport with less complications compared to rigid fixation.

Background: The primary goal of total knee arthroplasty (TKA) is to relieve pain, improve function, and thereby enhance the quality of life. This study compares TKA using conventional mechanical alignment (MA) versus Intelligent Knee Planning and Alignment System (IKPAS) navigation-assisted soft tissue balancing that preserves key factors of knee natural asymmetry, evaluating differences in postoperative functional recovery and overall patient satisfaction.

Methods: A retrospective analysis was conducted on 60 patients with American College of Rheumatology (ACR)-diagnosed, K-L grade III-IV knee osteoarthritis undergoing primary unilateral TKA at Guizhou Hospital of Beijing Jishuitan Hospital, between March 2024 and June 2024. According to the surgical methods, the patients were categorized into the study and control groups. Among them, 30 patients in the study group underwent unilateral TKA using the IKPAS navigation and a new method of soft tissue balancing technique to maintain the key factors of natural knee asymmetry. All surgeries were performed by a single senior surgeon. Simultaneously, the other 30 patients in the control group underwent unilateral TKA using the guided traditional MA and gap-tension equality balancing technique. The first ambulation time, hospital stay duration, and operative time were compared between the two groups. Knee Joint Clinical Score (KJCS), Knee Joint Functional Score (KJFS), knee extension-flexion range of motion (ROM), and Forgotten Joint Score (FJS) were assessed at the 1-, 3-, and 6-month postoperative follow-up visits.

Results: All patients were followed for 1 to 9 months, with a mean follow up duration of 7±1.5 months. No surgical site complications (including infection or wound dehiscence) were reported in either group. Baseline characteristics, including age, sex, body mass index (BMI), preoperative KJCS, KJFS, and ROM, demonstrated no statistically significant differences between the kinematic alignment (KA) and MA groups (P>0.05). The study group demonstrated shorter first ground walking time and hospitalization time than the control group (P<0.05), with statistical significance. No statistically significant difference was noted between the two groups in terms of surgical time (P>0.05). At the 1-, 3-, and 6-month postoperative follow-ups, the study group exhibited higher KJCS, KJFS, knee extension-flexion ROM, and FJS than the control group (P<0.05), with statistical significance.

Conclusions: The new method of soft tissue balancing in TKA by maintaining the natural knee asymmetry shows better clinical outcomes than the traditional gap-tension symmetric balancing TKA in a preliminary short-term follow-up study. The superior clinical outcomes of asymmetry-maintained TKA compared to traditional gap-tension equaled TKA implicated that the real balance of TKA is not simply defined as symmetry.

Background: Rotator cuff tears (RCTs) with shoulder stiffness have a high association rate; however, the mechanism and possible risk factors are unclear. This study aims to collect the factors that may affect RCT and shoulder stiffness, screen out the relevant risk factors through statistical analysis, and establish a simple model to predict the risk of RCT combined with shoulder stiffness.

Methods: A retrospective analysis was conducted on 406 patients diagnosed with RCT through arthroscopic surgery at the Department of Joint and Sports Medicine, the First Affiliated Hospital of Dalian Medical University, from December 2019 to June 2023. The analysis comprised two groups: 213 patients with both RCT and shoulder stiffness, and 193 patients without shoulder stiffness. A total of 21 potential risk factors associated with RCT and shoulder stiffness were considered, and a prediction model was developed using single-focus logistic regression analysis and multifocal logistic regression analysis in the training set (N=284), which was presented as nomograms. The validation set (N=122) was used to assess the model's discrimination, calibration and clinical practicability. The proportion of patients with RCT combined with shoulder stiffness in both the training set and the validation set was 52.5%.

Results: The study identified eight pertinent risk factors: gender, dominant side, smoking, hypothyroidism, depression, hyperlipidemia, type III acromion, and partial tear. Based on these factors, a clinical prediction model was developed. The model demonstrated excellent predictive performance with an area under the receiver operating characteristic curve (AUROC) of 0.856 [95% confidence interval (CI): 0.812-0.900] for the training set and 0.867 (95% CI: 0.807-0.928) for the validation set. Calibration curves exhibited strong agreement between the actual disease probabilities and predicted probabilities using the model in both datasets. Decision curve analysis (DCA) further confirmed the clinical utility of the model.

Conclusions: Based on routine data, the prediction model offers clinicians a simple and reliable tool for predicting the combination of RCT and shoulder stiffness.