Sports Medicine and Arthroscopy Review最新文献

Objective: To analyze the effectiveness of combined early rehabilitation therapy and repetitive transcranial magnetic stimulation (rTMS) in the postoperative rehabilitation of patients with sports knee injuries (SKIs).

Methods: A total of 62 SKI patients from June 2021 to June 2022 were randomly selected by computer and divided into group A (31 cases, early rehabilitation therapy) and group B (31 cases, early rehabilitation therapy + rTMS) by numbered envelope method. The effects of the 2 groups were compared.

Results: After treatment, the pain frequency and pain intensity in group B were lower than in group A, whereas the completion of knee movements without significant pain, the degree of knee swelling, and the impact of the knee on activities were higher in group B than in group A; the Lysholm score and inflammatory factor indicators in group B were superior to those in group A (all P <0.05).

Conclusion: The combination of early rehabilitation therapy and rTMS in postoperative rehabilitation of SKI patients has better effects on knee joint function and inflammation.

Abstract: Several medical conditions (diabetes, cardiovascular diseases, hypercholesterolemia, etc) or modifiable behavioral habits (smoking habit and alcohol assumption) capable of causing damage to the peripheral microcirculation are considered potential risk factors for degeneration/tear of the rotator cuff. The aim of the study was to analyze and quantify how the association of multiple known risk factors is more effective than the predisposing action of a single factor. Three hundred eight consecutive patients who underwent arthroscopic repair of a full-thickness rotator cuff tear (RCT) represented the case group. The control group included 388 consecutive healthy asymptomatic subjects for shoulder pathologies. A multivariable prognostic model for the prediction of RCT has been performed to analyze the mutual effect of multiple risk factors. With a correct classification estimated at 70.6%, a smoker patient [odds ratio (OR) = 2.405; 95% CI = 1.645-3.516] with hypercholesterolemia (OR = 1.976; 95% CI = 1.408-2.771), diabetes (OR = 2.362; 95% CI = 1.241-4.493), and arterial hypertension (OR = 1.630; 95% CI = 1.156-2.300) has a higher chance of developing a RCT surgery compared with a peer nonsmoker healthy subject. The probability of a smoker patient suffering from hypercholesterolemia, diabetes, and arterial hypertension undergoing rotator cuff repair surgery is not given by the sum of the probabilities of each condition but increases dramatically. Each pathology interacts with each other; dramatically increasing the risk of developing a cuff tear.

Level of evidence: Level III-retrospective study.

This study was to investigate the efficacy of ultrasound-guided genicular nerve block for patients who underwent knee arthroscopy. Patients were randomized into 2 groups: (1) nerve block group: ultrasound-guided genicular nerve block (superomedial, superolateral, and inferomedial genicular nerve, 2 ml 0.5% ropivacaine each nerve.) before the general anesthesia, (2) control group: no intervention before the general anesthesia. The measurements were pain severity at 3,6, 12, 24, 48, and 72 hours after surgery at rest and at activity (Pain severity was primary outcome at 3 hours after surgery at rest); the time for first ambulation; straight leg raise; mechanical pain threshold of the block areas; time of the surgery, anesthesia and extubation; the use of analgesics in the perioperative period and 72 hours after the surgery; the number of patients awakening from pain on the first 2 nights after the surgery; the length of hospital stay; postoperative adverse effects. The pain severity was measured by visual analogue scale (VAS) (A 10-point VAS, 0 points painless, 10 points severe pain) and median (interquartile range). A total of 70 patients (median age: 53 y, 32 men; 35 per group) were included. Compared with the control group, the nerve block group had a lower pain VAS score at rest [2 (2-2) vs. 3 (2-4), P <0.01] at 3 hours, and lower pain VAS score at rest persisted for 24 hours and activity persisted for 12 hours after the surgery, also had a lower intraoperative dosage of sufentanil (20±4.8 vs. 28.5±5.1 mg; P <0.001), lower requirement for analgesics for pain and lower postoperative nausea and vomiting throughout the 72-hour observation period. There were no significant differences in the incidence of postoperative adverse effects and straight leg raise. In conclusion, ultrasound-guided genicular nerve block could reduce the pain severity after knee arthroscopy and decrease the use of intraoperative sufentanil without affecting motor function.

Bridging allograft reconstruction (BAR) and reverse shoulder arthroplasty (RSA) are 2 approaches for managing massive, irreparable rotator cuff tears, both yielding satisfactory functional results. A systematic review of 28 studies encompassing 1125 cases treated with either technique revealed significant improvement in range of motion and functional scores across all patients. However, BAR led to a notably greater improvement in external rotation. RSA exhibited significantly higher complication rates (18.6%) and an increased likelihood of reoperation (7.9%). Patients younger than 70 undergoing RSA faced higher complication and reoperation risks at 26% and 12.5%, respectively. In summary, BAR offers comparable functional outcomes with fewer complications compared with RSA for managing massive, irreparable rotator cuff tears. Patients under age 70 being considered for RSA should understand their heightened risks.

The aim of this paper is to establish consensus among subject area experts on readiness criteria for return to dance (RTD) in female dancers after forced time loss due to lower extremity injury. Recommendations for RTD protocols have previously been published, which generally guide the dancer to progress from barre work to center. However, the question of when to initiate an RTD protocol can be a complex decision itself. We performed a modified, 2-round Delphi study among a diverse group of experts who work closely with preprofessional and professional dancers. Criteria for RTD that achieved ≥75% agreement were included in the final consensus recommendations. Fleiss Kappa was utilized to determine the overall rater agreement. Experts agree on the importance of certain functional tests, such as the single-leg sauté test, the 30-second single-leg balance test, and the airplane test for establishing RTD readiness after various lower extremity injuries.

Patients with brachial plexus birth injuries commonly develop problems at the shoulder. These problems include posterior subluxation of the shoulder, internal rotation contractures, and weakness of external rotation. The most common technique for the treatment of these is the release of the shoulder joint, the release of the internal rotators, and the transfer of latissimus teres and teres major tendons. In this article, we present a detailed technique with an accompanying step-by-step video to demonstrate how to perform these procedures.

As a population, transgender and gender-diverse (TGD) adolescents face higher rates of discrimination than their cisgender peers, both in their personal lives and while seeking health care. Negative experiences with health care can be discouraging for minority populations and can result in poorer health maintenance and outcomes. As health care providers, it is imperative that we educate ourselves on providing culturally competent care for this community. This includes an understanding of gender identity, hormonal therapy, impact on athletics, musculoskeletal health, and surgical considerations in this population. In this article, we offer a perspective on providing expert care to TGD adolescent patients through the lens of sports medicine.

Anterior Cruciate Ligament (ACL) injuries in pediatric patients are rising and present unique challenges for orthopedic surgeons due to skeletal immaturity and risk for physeal damage during ACL reconstruction. This review aims to share insights from pediatric cadaveric anatomic studies and related research to inform surgical management of ACL injuries in skeletally immature patients. We highlight age-dependent variations in the distances between the ACL and medial collateral ligament and their respective physes, developmental variability in the anterolateral structures of the pediatric knee, and variability in the proximity of the neurovascular bundle's proximity to the iliotibial band graft pathway during ACL reconstruction. In addition, we review biomechanical properties of different grafts to assess their strength and suitability for ACL reconstruction. Our findings emphasize the importance of age-specific surgical approaches that consider individual anatomic differences of pediatric patients, collectively advancing our understanding of pediatric knee anatomy and its relevance to successful ACL reconstruction.