Sports Medicine and Arthroscopy Review最新文献

Abstract: Despite increasing rates of posterior shoulder instability surgery, return-to-play (RTP) rates vary widely. There is little available literature regarding specific criteria used to allow unrestricted RTP. We aimed to identify and describe the criteria used in the existing literature for the unrestricted RTP of individuals after posterior shoulder instability surgery. A systematic review was performed from inception through September 2024, including 1366 shoulders. The criteria used and their associated frequencies were identified as follows: time (56%), strength (48%), range of motion (41%), sport-specific protocol (11%), proprioception (4%), and other (15%). Many studies used a combination of the above-listed criteria. We demonstrated there is little consensus regarding post-operative RTP criteria for posterior shoulder instability. Time, strength, and range of motion were the most used criteria, yet even within these categories there was variation in the length of time and degree of strength/range of motion used to guide RTP.

Level of evidence: Level-IV.

With increasing age, rotator cuff tears are common in symptomatic and asymptomatic patients. Yet, there remains a limited understanding of the etiology of pain associated with rotator cuff pathology. Recent research has associated patient perception, resilience, repair integrity, tear size, biomechanics of the humeral head, and muscle kinematics with pain levels. However, the evidence remains largely inconclusive in answering the fundamental question regarding why some patients experience symptoms severe enough to warrant surgery and others remain completely asymptomatic. A deeper understanding of the causes of pain with a rotator cuff tear can guide treatments to optimize pain relief in symptomatic individuals seeking treatment.

In the past 20 years, the research hotspots and trends in hip arthroscopy have been explored through bibliometric analysis. The Web of Science Core Collection database was searched for hip arthroscopy articles published between January 1, 2004, and December 31, 2023. Cite Space (Drexel University, version 6.1.6), VOS viewer (Leiden University, version 1.6.20), the Bibliometric online website ( https://bibliometric.com/ ) and Origin (version 2024) were used. The results showed an overall increasing trend in the number of publications. Hip arthroscopy has remained a future research hotspot for the treatment of hip injuries. Femoroacetabular impingement syndrome and labral tear were identified as research hotspots. However, there are relatively few studies on functional recovery and quality of life improvement in patients 10, 20, or even more years after surgery, representing a potential future research gap. The United States has been an international leader. It is advisable to establish a data exchange mechanism among countries, institutions, and scholars to enhance academic collaboration and advance the progress of hip arthroscopy. Level of Evidence: A bibliometric analysis.

Level of evidence: Level IV case series.

This review synthesizes recent advancements in surgical innovations and biological augmentation strategies aimed at enhancing bone tunnel healing after ACL reconstruction. Anterior cruciate ligament (ACL) reconstruction remains the gold standard for restoring knee function, yet suboptimal bone tunnel healing impedes graft integration and functional recovery; this biologically complex process-involving osteoblast activation, fibrovascular tissue formation, and endochondral/intramembranous ossification-is critically modulated by biomechanical and biochemical factors. We critically evaluate emerging surgical techniques (e.g., tunnel positioning optimization, fixation methods) and biological interventions (e.g., growth factor delivery, stem cell therapy), highlighting their mechanistic roles in accelerating osteointegration and mitigating healing failure risks. Evidence-based integration of these innovations demonstrates significant potential to improve graft stability, accelerate rehabilitation, and optimize long-term patient outcomes. (Level of Evidence: Level V).

The purpose of this study is to systematically review and analyze the clinical outcomes of all suture anchors (ASA) compared to conventional suture anchors (CSA) in patients undergoing arthroscopic Bankart repair (ABR) for anterior shoulder instability. A systematic review following PRISMA guidelines was performed from inception through March 2024. Studies reporting clinical outcomes of patients who underwent ABR with ASA for anterior shoulder instability were included. The meta-analysis on each outcome measure is presented in forest plots detailing the mean difference for continuous variables or odds ratio for dichotomous variables. 13 articles assessing 878 patients were included, with 497 and 381 utilizing ASA and CSA, respectively. There were no significant differences between the ASA and CSA groups across recurrent instability, redislocation, or patient-reported outcome scores. At 2-year follow-up, ASA demonstrates equivalent recurrent instability rates, reoperation rates, and patient-reported outcomes in patients undergoing ABR for anterior instability.

Ankle sprains can damage the lateral ankle ligament complex, resulting in lateral ankle instability or intra-articular cartilage damage, like osteochondral defects (OCD). Both ankle instability and OCD can lead to ankle osteoarthritis, resulting in substantial disability and negatively impacting patients' quality of life. Treating these lesions could be challenging, and various surgical procedures have been described in the literature, including allografts, which have gained popularity and shown promising results in the last few years. The main advantages of allografts include the absence of donor site morbidity, the single-stage procedure, the reduced surgical time, and the alleviation of the possible iatrogenic weakening of the graft. In addition, in cases of OCD, allografts can effectively replace the subchondral bone and are suitable for irregularly shaped defects. Recent literature has demonstrated that allografts significantly improve functional scores and patient-reported outcomes measures and, therefore, are a valuable option to cope with these ankle pathologies.

The choice of graft for primary anterior cruciate ligament reconstruction (ACLR) is still controversial. Traditionally, allografts were reserved for revision cases. However, their use is constantly increasing in standard primary ACLRs. The main benefits of allografts include no donor-site morbidity, larger graft sizes, shorter operative times, and reduced postoperative pain. Recent literature has demonstrated that allografts are effective and safe, but studies have reported inferior or similar clinical outcomes. Compared with irradiated allografts, a low failure rate was observed when using nonirradiated allografts. Allograft ACLR showed comparable failure rates between sexes but displayed suboptimal graft failure outcomes in younger and active patients. Donor age does not seem to influence the biomechanical properties of allografts negatively. In addition, within the first year of recovery after ACLR, patients who receive allografts and autografts may have significantly different perceived abilities to perform activities or return to sports. Finally, the cost is higher with allografts, so if autografts are available, allografts are not cost-effective.