Pub Date : 2025-03-04DOI: 10.1177/03635465251321005
Christopher P. Sherwood, Fintan Grogan, Timothy L. McMurry, James R. Funk, Jeff R. Crandall, Allen Sills, Gregory Tierney
Background:Concussions remain a major concern in football. A qualitative video review can provide contextual evidence supporting changes in rules and coaching techniques aimed at reducing the risk of players sustaining a concussion.Purpose:To identify tackling techniques and characteristics associated with concussions to the tackling player.Study Design:Case-control study; Level of evidence, 3.Methods:A qualitative review of 51 concussions sustained by tacklers in National Football League (NFL) games between the 2015 and 2019 seasons as well as 96 control tackles was performed using video from multiple perspectives. For each concussive case, 1 to 3 nonconcussive control tackles were matched based on player trajectory and closing speed as determined from on-field player tracking data from Next Gen Stats. Cases and controls were coded for 20 different tackle techniques and characteristics. The data were analyzed using conditional logistic regression models, and the results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) as well as adjusted and unadjusted P values.Results:Despite attempting to match cases and controls based on closing velocity, closing velocity was significantly associated with the concussion risk in every logistic regression model. Predictors that had the greatest effect on the increased risk of concussions were “tackler leading with helmet” (OR, 5.18 [95% CI, 1.87-14.33]; false discovery rate [FDR]–adjusted P = .0032) and “tackler primary loading” being the helmet as opposed to the shoulder (OR, 4.61 [95% CI, 1.41-15.05]; FDR-adjusted P = .0000). Important factors associated with a reduced concussion risk were the tackler’s “head placed on correct side” of the ball carrier (OR, 4.17 [95% CI, 1.58-11.01]; FDR-adjusted P = .0088) and “ball carrier primary loading,” with the torso having the lowest risk relative to all other body segments.Conclusion:The less a tackler involved his helmet in a tackle, the lower his risk of sustaining a concussion. This study supports teaching players to place their heads on the correct side of the ball carrier (neither into the ball carrier nor into the path of the ball carrier) when tackling to reduce their risk of a concussion, and players should target the torso of the ball carrier as their primary contact point.
{"title":"Tackle Techniques and Characteristics Associated With a Concussion in Tackling Players in the National Football League","authors":"Christopher P. Sherwood, Fintan Grogan, Timothy L. McMurry, James R. Funk, Jeff R. Crandall, Allen Sills, Gregory Tierney","doi":"10.1177/03635465251321005","DOIUrl":"https://doi.org/10.1177/03635465251321005","url":null,"abstract":"Background:Concussions remain a major concern in football. A qualitative video review can provide contextual evidence supporting changes in rules and coaching techniques aimed at reducing the risk of players sustaining a concussion.Purpose:To identify tackling techniques and characteristics associated with concussions to the tackling player.Study Design:Case-control study; Level of evidence, 3.Methods:A qualitative review of 51 concussions sustained by tacklers in National Football League (NFL) games between the 2015 and 2019 seasons as well as 96 control tackles was performed using video from multiple perspectives. For each concussive case, 1 to 3 nonconcussive control tackles were matched based on player trajectory and closing speed as determined from on-field player tracking data from Next Gen Stats. Cases and controls were coded for 20 different tackle techniques and characteristics. The data were analyzed using conditional logistic regression models, and the results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) as well as adjusted and unadjusted P values.Results:Despite attempting to match cases and controls based on closing velocity, closing velocity was significantly associated with the concussion risk in every logistic regression model. Predictors that had the greatest effect on the increased risk of concussions were “tackler leading with helmet” (OR, 5.18 [95% CI, 1.87-14.33]; false discovery rate [FDR]–adjusted P = .0032) and “tackler primary loading” being the helmet as opposed to the shoulder (OR, 4.61 [95% CI, 1.41-15.05]; FDR-adjusted P = .0000). Important factors associated with a reduced concussion risk were the tackler’s “head placed on correct side” of the ball carrier (OR, 4.17 [95% CI, 1.58-11.01]; FDR-adjusted P = .0088) and “ball carrier primary loading,” with the torso having the lowest risk relative to all other body segments.Conclusion:The less a tackler involved his helmet in a tackle, the lower his risk of sustaining a concussion. This study supports teaching players to place their heads on the correct side of the ball carrier (neither into the ball carrier nor into the path of the ball carrier) when tackling to reduce their risk of a concussion, and players should target the torso of the ball carrier as their primary contact point.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1177/03635465251315492
Daniel C. Touhey, Nikko D. Beady, Sina Tartibi, Robert H. Brophy, Matthew J. Matava, Matthew V. Smith, Derrick M. Knapik
Background:Management of symptomatic osteochondral defects of the knee remains challenging because of the limited inherent vascularity and healing potential of articular cartilage. Osteochondral allograft (OCA) transplantation has yielded satisfactory results in appropriate patients; however, the effect of OCA transplantation on athletes seeking to return to sport (RTS) remains largely unknown.Purpose:To systematically review the literature to better understand outcomes after OCA, focusing on RTS rate and timing, and the incidence of postoperative complications.Study Design:Systematic review; Level of evidence, 4.Methods:Studies included in the PubMed, EMBASE, and Cochrane Library databases from inception to August 2024 that reported on athletes participating at the recreational, high school, collegiate, and professional levels undergoing OCA transplantation for osteochondral defects in the knee were identified. Inclusion criteria included studies reporting on patients identified as athletes undergoing OCA transplantation with reported origin, lesion characteristics (size and location), RTS rate and timing, complications, reoperations, and patient-reported outcomes.Results:A total of 14 studies, consisting of 471 athletes undergoing OCA transplantation with a weighted mean follow-up of 51.1 months, were identified. The weighted mean patient age was 31.4 years (range, 15-69 years), with 61% of patients being male. Lesion origin was reported in 49% (230/471) of patients, with osteochondritis dissecans (OCD) reported in 44% (100/230). The medial femoral condyle was the most common defect location (44%; 68/153). Lesion size ranged from 1 to 13.94 cm2. Sixteen percent (75/471) of patients were classified as competitive athletes, with basketball (n = 21) being the most common sport. RTS was reported in 72% (338/468) of patients, with 84% (231/275) returning at an equal or higher level of play at a weighted mean of 11.1 months (range, 6-26 months) after OCA. Complications were reported in 12% (41/351) of patients, with graft failure accounting for 54% (22/41) of complications in 6% (22/351) of patients.Conclusion:For athletes undergoing OCA transplantation to the knee, OCD was the most commonly reported cause, with the medial femoral condyle most frequently affected. Successful RTS was reported in 72% of patients at a mean of 11.1 months, with graft failure representing the most common complication in 6%.
{"title":"Return to Sport in Athletes After Osteochondral Allograft Transplantation: A Systematic Review","authors":"Daniel C. Touhey, Nikko D. Beady, Sina Tartibi, Robert H. Brophy, Matthew J. Matava, Matthew V. Smith, Derrick M. Knapik","doi":"10.1177/03635465251315492","DOIUrl":"https://doi.org/10.1177/03635465251315492","url":null,"abstract":"Background:Management of symptomatic osteochondral defects of the knee remains challenging because of the limited inherent vascularity and healing potential of articular cartilage. Osteochondral allograft (OCA) transplantation has yielded satisfactory results in appropriate patients; however, the effect of OCA transplantation on athletes seeking to return to sport (RTS) remains largely unknown.Purpose:To systematically review the literature to better understand outcomes after OCA, focusing on RTS rate and timing, and the incidence of postoperative complications.Study Design:Systematic review; Level of evidence, 4.Methods:Studies included in the PubMed, EMBASE, and Cochrane Library databases from inception to August 2024 that reported on athletes participating at the recreational, high school, collegiate, and professional levels undergoing OCA transplantation for osteochondral defects in the knee were identified. Inclusion criteria included studies reporting on patients identified as athletes undergoing OCA transplantation with reported origin, lesion characteristics (size and location), RTS rate and timing, complications, reoperations, and patient-reported outcomes.Results:A total of 14 studies, consisting of 471 athletes undergoing OCA transplantation with a weighted mean follow-up of 51.1 months, were identified. The weighted mean patient age was 31.4 years (range, 15-69 years), with 61% of patients being male. Lesion origin was reported in 49% (230/471) of patients, with osteochondritis dissecans (OCD) reported in 44% (100/230). The medial femoral condyle was the most common defect location (44%; 68/153). Lesion size ranged from 1 to 13.94 cm<jats:sup>2</jats:sup>. Sixteen percent (75/471) of patients were classified as competitive athletes, with basketball (n = 21) being the most common sport. RTS was reported in 72% (338/468) of patients, with 84% (231/275) returning at an equal or higher level of play at a weighted mean of 11.1 months (range, 6-26 months) after OCA. Complications were reported in 12% (41/351) of patients, with graft failure accounting for 54% (22/41) of complications in 6% (22/351) of patients.Conclusion:For athletes undergoing OCA transplantation to the knee, OCD was the most commonly reported cause, with the medial femoral condyle most frequently affected. Successful RTS was reported in 72% of patients at a mean of 11.1 months, with graft failure representing the most common complication in 6%.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1177/03635465241313194
Audria Wood, Mathew Hargreaves, John N. Manfredi, Maxwell Harrell, Elizabeth Marks Benson, Clay Rahaman, Dev Dayal, Eugene W. Brabston, Thomas Evely, Aaron Casp, Amit M. Momaya
Background:Return to sport (RTS) is a common goal after anterior cruciate ligament (ACL) reconstruction (ACLR) but carries a relatively high risk of reinjury with up to 20% to 25% of athletes experiencing graft rupture or contralateral ACL tear. While there is increased emphasis on establishing safe RTS criteria for athletes to return to previous activity levels, studies show that even healthy individuals have difficulty passing RTS testing.Purpose:To synthesize data concerning whether healthy individuals can pass ACLR RTS rehabilitation tests.Study Design:Systematic review; Level of evidence, 4.Methods:Following the established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a systematic literature search in May 2023. Three databases were used in the search (PubMed, EMBASE, and SPORTDiscus) to retrieve all studies that conducted ACLR RTS rehabilitation tests on healthy individuals. Tests included were isometric strength, isokinetic strength, hop, and balance tests. The search was performed in duplicate, and a quality assessment of all studies was included.Results:A total of 1724 studies were retrieved, of which 32 were included, involving 1552 controls with no history of ACL injury. From the studies analyzed, 5.3% to 42.2% of healthy participants failed 6 different hop tests, 15.2% failed the Star Excursion Balance Test, 37% failed the isometric knee flexion test, 50% failed the isometric knee extension test, and 23.7% to 28.9% failed the drop vertical jump test. An asymmetry index ≥10% was found in 6 of the 18 isokinetic tests and 2 of the 14 isometric tests. Hop testing was the most common test in the included studies (56.3%), followed by balance testing (31.3%), isometric strength testing (31.3%), isokinetic strength testing (25%), and drop vertical jump (6.3%).Conclusion:Many healthy individuals fail ACLR RTS tests, with some having an inherent variation from side to side that is >10%. The passing threshold for RTS testing should be a value that is practical yet helps reduce reinjury rates.
{"title":"Anterior Cruciate Ligament Reconstruction Return to Sport Testing Passing Rates for Healthy People: A Systematic Review","authors":"Audria Wood, Mathew Hargreaves, John N. Manfredi, Maxwell Harrell, Elizabeth Marks Benson, Clay Rahaman, Dev Dayal, Eugene W. Brabston, Thomas Evely, Aaron Casp, Amit M. Momaya","doi":"10.1177/03635465241313194","DOIUrl":"https://doi.org/10.1177/03635465241313194","url":null,"abstract":"Background:Return to sport (RTS) is a common goal after anterior cruciate ligament (ACL) reconstruction (ACLR) but carries a relatively high risk of reinjury with up to 20% to 25% of athletes experiencing graft rupture or contralateral ACL tear. While there is increased emphasis on establishing safe RTS criteria for athletes to return to previous activity levels, studies show that even healthy individuals have difficulty passing RTS testing.Purpose:To synthesize data concerning whether healthy individuals can pass ACLR RTS rehabilitation tests.Study Design:Systematic review; Level of evidence, 4.Methods:Following the established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a systematic literature search in May 2023. Three databases were used in the search (PubMed, EMBASE, and SPORTDiscus) to retrieve all studies that conducted ACLR RTS rehabilitation tests on healthy individuals. Tests included were isometric strength, isokinetic strength, hop, and balance tests. The search was performed in duplicate, and a quality assessment of all studies was included.Results:A total of 1724 studies were retrieved, of which 32 were included, involving 1552 controls with no history of ACL injury. From the studies analyzed, 5.3% to 42.2% of healthy participants failed 6 different hop tests, 15.2% failed the Star Excursion Balance Test, 37% failed the isometric knee flexion test, 50% failed the isometric knee extension test, and 23.7% to 28.9% failed the drop vertical jump test. An asymmetry index ≥10% was found in 6 of the 18 isokinetic tests and 2 of the 14 isometric tests. Hop testing was the most common test in the included studies (56.3%), followed by balance testing (31.3%), isometric strength testing (31.3%), isokinetic strength testing (25%), and drop vertical jump (6.3%).Conclusion:Many healthy individuals fail ACLR RTS tests, with some having an inherent variation from side to side that is >10%. The passing threshold for RTS testing should be a value that is practical yet helps reduce reinjury rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-13DOI: 10.1177/03635465251315170
James J. McGinley, Henry B. Ellis, Bennett Propp, Matthew W. Veerkamp, Philip L. Wilson, Dennis E. Kramer, Benton E. Heyworth, Sabrina Strickland, Eric Wall, Jason Koh, Yi-Meng Yen, Matthew Halsey, Robert Magnussen, David Roberts, Jack Farr, Daniel Green, Peter Fabricant, Jacqueline Brady, Marc Tompkins, Lauren H. Redler, Adam B. Yanke, Seth L. Sherman, Shital N. Parikh, Beth E. Shubin Stein
Background:Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.Purpose:To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.Study Design:Case-control study; Level of evidence, 3.Methods:Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle–trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.Results:A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.Conclusion:Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.
{"title":"Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort","authors":"James J. McGinley, Henry B. Ellis, Bennett Propp, Matthew W. Veerkamp, Philip L. Wilson, Dennis E. Kramer, Benton E. Heyworth, Sabrina Strickland, Eric Wall, Jason Koh, Yi-Meng Yen, Matthew Halsey, Robert Magnussen, David Roberts, Jack Farr, Daniel Green, Peter Fabricant, Jacqueline Brady, Marc Tompkins, Lauren H. Redler, Adam B. Yanke, Seth L. Sherman, Shital N. Parikh, Beth E. Shubin Stein","doi":"10.1177/03635465251315170","DOIUrl":"https://doi.org/10.1177/03635465251315170","url":null,"abstract":"Background:Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.Purpose:To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.Study Design:Case-control study; Level of evidence, 3.Methods:Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle–trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.Results:A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.Conclusion:Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-11DOI: 10.1177/03635465251317502
Jason Silvestre, Harris S. Slone, John D. Kelly
Background:Accrediting bodies and professional societies for surgical education are increasingly recognizing the need for case minimum requirements to enhance standardized training.Purpose:To determine case volume benchmarks for operative training during Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic sports medicine fellowships in the United States.Study Design:Cross-sectional analysis; Level of evidence, 3.Methods:Case volume percentiles were calculated across ACGME-defined case categories and temporal changes analyzed with linear regression. Variability was defined as the fold difference between the 90th and 10th percentiles by case volume. Sensitivity analyses were performed to identify potential targets for case minimum requirements.Results:Case logs from 1281 orthopaedic sports medicine fellows were analyzed. There was an increase in the mean reported case volume over the study period (from 323.3 ± 125.0 to 375.6 ± 144.0; P = .049). Pediatric patients accounted for a minority of cases (annual range, 6%-7%). The bottom 10th and 30th percentiles of fellows reported a total of 179 and 239 cases, respectively. Most cases were reported in the rotator cuff (29%), meniscus (26%), and knee instability (21%) categories. Variability in the reported case volume was greatest in hip arthroscopic surgery (37.0), patellofemoral instability (15.5), the foot and ankle (12.9), and elbow instability (10.7). Variability decreased for knee instability ( P = .006) and total ( P = .028) cases over the study period but increased for foot and ankle ( P = .002), knee multiligament repair/reconstruction ( P = .008), and knee osteotomy ( P = .025) cases.Conclusion:Surgical benchmarks can assist future trainees and faculty identify areas to improve the operative experience and reduce variability during fellowship training. The operative experience of recent fellows suggests a potential case minimum target between 179 and 239 cases to achieve the 10th and 30th percentiles, respectively. However, further research is needed to establish evidence-based case minimum requirements for ACGME-accredited orthopaedic sports medicine fellowship training.
{"title":"Establishing Benchmarks for Case Minimum Requirements During Accreditation Council for Graduate Medical Education–Accredited Orthopaedic Sports Medicine Fellowship Training","authors":"Jason Silvestre, Harris S. Slone, John D. Kelly","doi":"10.1177/03635465251317502","DOIUrl":"https://doi.org/10.1177/03635465251317502","url":null,"abstract":"Background:Accrediting bodies and professional societies for surgical education are increasingly recognizing the need for case minimum requirements to enhance standardized training.Purpose:To determine case volume benchmarks for operative training during Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic sports medicine fellowships in the United States.Study Design:Cross-sectional analysis; Level of evidence, 3.Methods:Case volume percentiles were calculated across ACGME-defined case categories and temporal changes analyzed with linear regression. Variability was defined as the fold difference between the 90th and 10th percentiles by case volume. Sensitivity analyses were performed to identify potential targets for case minimum requirements.Results:Case logs from 1281 orthopaedic sports medicine fellows were analyzed. There was an increase in the mean reported case volume over the study period (from 323.3 ± 125.0 to 375.6 ± 144.0; P = .049). Pediatric patients accounted for a minority of cases (annual range, 6%-7%). The bottom 10th and 30th percentiles of fellows reported a total of 179 and 239 cases, respectively. Most cases were reported in the rotator cuff (29%), meniscus (26%), and knee instability (21%) categories. Variability in the reported case volume was greatest in hip arthroscopic surgery (37.0), patellofemoral instability (15.5), the foot and ankle (12.9), and elbow instability (10.7). Variability decreased for knee instability ( P = .006) and total ( P = .028) cases over the study period but increased for foot and ankle ( P = .002), knee multiligament repair/reconstruction ( P = .008), and knee osteotomy ( P = .025) cases.Conclusion:Surgical benchmarks can assist future trainees and faculty identify areas to improve the operative experience and reduce variability during fellowship training. The operative experience of recent fellows suggests a potential case minimum target between 179 and 239 cases to achieve the 10th and 30th percentiles, respectively. However, further research is needed to establish evidence-based case minimum requirements for ACGME-accredited orthopaedic sports medicine fellowship training.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-07DOI: 10.1177/03635465241313386
Timothy McAleese, Neil Welch, Enda King, Davood Roshan, Niamh Keane, Kieran A. Moran, Mark Jackson, Daniel Withers, Ray Moran, Brian M. Devitt
Background:Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping.Purpose:To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively.Study Design:Cohort study; Level of evidence, 2.Methods:A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared.Results:The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone–patellar tendon–bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years.Conclusion:Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries.Registration:NCT02771
{"title":"Primary Anterior Cruciate Ligament Reconstruction in Level 1 Athletes: Factors Associated With Return to Play, Reinjury, and Knee Function at 5 Years of Follow-up","authors":"Timothy McAleese, Neil Welch, Enda King, Davood Roshan, Niamh Keane, Kieran A. Moran, Mark Jackson, Daniel Withers, Ray Moran, Brian M. Devitt","doi":"10.1177/03635465241313386","DOIUrl":"https://doi.org/10.1177/03635465241313386","url":null,"abstract":"Background:Favorable outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) are often gauged by successful return to play (RTP), a low incidence of subsequent ACL injury, and positive patient-reported outcomes. Level 1 sports place the highest demands on the knee by requiring frequent pivoting, changes in direction, and jumping.Purpose:To analyze the outcomes of primary ACLR in level 1 athletes and identify pre- and intraoperative factors associated with RTP, ipsilateral ACL reinjury, contralateral ACL injury, and International Knee Documentation Committee (IKDC) score at 5 years postoperatively.Study Design:Cohort study; Level of evidence, 2.Methods:A consecutive cohort of 1432 patients who underwent primary ACLR by 2 orthopaedic surgeons were prospectively evaluated. The RTP rate, incidence of ipsilateral/contralateral ACL injury, and IKDC score were analyzed at 5 years. Comparative analysis of clinical variables was performed between those who achieved favorable outcomes and those who did not. Outcomes at 5 and 2 years were also compared.Results:The mean age was 24.3 ± 7.3 years (males: 75%, females: 25%). Gaelic football was the predominant sport (40%), followed by soccer (19%). The RTP rate was 87.4%, with 59.8% of athletes still playing at an equivalent or higher level at 5 years. The incidence of ipsilateral reinjury for athletes who resumed level 1 sport was 4.3% for bone–patellar tendon–bone (BPTB) autografts with screw fixation and 19.7% for hamstring tendon (HT) autografts with EndoButton and screw fixation. The incidence of contralateral ACL injury was 13.7%. The mean IKDC score at 5 years (86.6 ± 10.9) was comparable to that at 2 years (86.8 ± 10.1). Patients were more likely to RTP with each year of decreasing age (OR, 1.06; P < .001), with a higher preoperative Marx score (OR, 1.08; P < .001) or a higher 5-year IKDC score (OR, 1.06; P < .001). The risk of ipsilateral ACL reinjury increased each year of decreasing age (OR, 1.11; P < .001) or when an HT autograft was used (OR, 5.56; P < .001). Younger age was also associated with contralateral ACL injury (OR, 1.1; P < .001). Female sex, older age, concomitant meniscal/chondral injuries, and lower preoperative Anterior Cruciate Ligament Return to Sport after Injury scores were associated with lower IKDC scores at 5 years.Conclusion:Most patients could return to level 1 sports, although their performance level was impacted. Those who returned to sport maintained their performance level over the 5 years. The ipsilateral reinjury rate for BPTB autografts with screws was significantly lower than that for HT autografts with EndoButton and screw fixation. Most ACL reinjuries occurred between 2 and 5 years of follow-up. Younger patients had an increased risk of a subsequent ACL injury to either knee, regardless of graft type. IKDC scores were lower in female patients, older patients, and those with concomitant meniscal/cartilage injuries.Registration:NCT02771","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1177/03635465251314882
Laurie A. Hiemstra, Alexis Rousseau-Saine, Mark R. Lafave, Sarah Kerslake
Background:Trochlear dysplasia is present in 68% to 85% of patients with recurrent lateral patellofemoral instability (LPI) compared with 3% to 6% of healthy controls. Trochlear dysplasia has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign.Purpose:To assess the clinical and patient-reported outcomes after patella-stabilizing surgery, including thin flap sulcus deepening trochleoplasty, and to explore the influence of pathoanatomic variables on postoperative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty.Study Design:Case series; Level of evidence, 4.Methods:A total of 63 consecutive knees in 46 patients with recurrent LPI and high-grade trochlear dysplasia who underwent MPFL reconstruction with thin flap trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. The t test was used to determine changes in QOL. Multiple linear regression was conducted to determine significant pathoanatomic variables that affected outcomes after MPFL reconstruction.Results:Overall, 63 knees with a mean follow-up of 32.9 ± 17.0 months (range, 12-84 months) were included. All patients had preoperative high-grade trochlear dysplasia (Dejour type B: 46%; Dejour type D: 54%), with a mean trochlear bump height of 6.1 ± 1.8 mm (range, 3.2-10.5 mm). The BPII 2.0 score increased significantly from preoperatively (29.3 ± 12.4) to postoperatively (71.8 ± 17.4) ( P < .001), with a large effect size (Cohen d = −2.41). There was 1 redislocation (1.6%) and 3 reoperations (4.8%). Persistent apprehension and the J-sign were present in 8.5% and 13.6% of the knees, respectively. Multiple linear regression analysis demonstrated no statistically significant predictive relationship between the 24-month postoperative BPII 2.0 score and the preoperative BPII 2.0 score, tibiofemoral rotation, the Beighton score, or trochlear bump height ( R = 0.47; R2 = 0.22; F = 5.23; P = .13).Conclusion:Thin flap trochleoplasty combined with MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in low redislocation and reoperation rates at a mean of 33 months. Disease-specific QOL scores were statistically significantly improved from preoperatively to postoperatively.
{"title":"Thin Flap Trochleoplasty With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellofemoral Instability With High-Grade Trochlear Dysplasia: A Series of 63 Consecutive Cases","authors":"Laurie A. Hiemstra, Alexis Rousseau-Saine, Mark R. Lafave, Sarah Kerslake","doi":"10.1177/03635465251314882","DOIUrl":"https://doi.org/10.1177/03635465251314882","url":null,"abstract":"Background:Trochlear dysplasia is present in 68% to 85% of patients with recurrent lateral patellofemoral instability (LPI) compared with 3% to 6% of healthy controls. Trochlear dysplasia has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign.Purpose:To assess the clinical and patient-reported outcomes after patella-stabilizing surgery, including thin flap sulcus deepening trochleoplasty, and to explore the influence of pathoanatomic variables on postoperative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty.Study Design:Case series; Level of evidence, 4.Methods:A total of 63 consecutive knees in 46 patients with recurrent LPI and high-grade trochlear dysplasia who underwent MPFL reconstruction with thin flap trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. The t test was used to determine changes in QOL. Multiple linear regression was conducted to determine significant pathoanatomic variables that affected outcomes after MPFL reconstruction.Results:Overall, 63 knees with a mean follow-up of 32.9 ± 17.0 months (range, 12-84 months) were included. All patients had preoperative high-grade trochlear dysplasia (Dejour type B: 46%; Dejour type D: 54%), with a mean trochlear bump height of 6.1 ± 1.8 mm (range, 3.2-10.5 mm). The BPII 2.0 score increased significantly from preoperatively (29.3 ± 12.4) to postoperatively (71.8 ± 17.4) ( P < .001), with a large effect size (Cohen d = −2.41). There was 1 redislocation (1.6%) and 3 reoperations (4.8%). Persistent apprehension and the J-sign were present in 8.5% and 13.6% of the knees, respectively. Multiple linear regression analysis demonstrated no statistically significant predictive relationship between the 24-month postoperative BPII 2.0 score and the preoperative BPII 2.0 score, tibiofemoral rotation, the Beighton score, or trochlear bump height ( R = 0.47; R<jats:sup>2</jats:sup> = 0.22; F = 5.23; P = .13).Conclusion:Thin flap trochleoplasty combined with MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in low redislocation and reoperation rates at a mean of 33 months. Disease-specific QOL scores were statistically significantly improved from preoperatively to postoperatively.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-06DOI: 10.1177/03635465251314868
Georgios Neopoulos, Lukas Jud, Lazaros Vlachopoulos, Sandro F. Fucentese
Background:Distal femoral osteotomy (DFO) can be used to simultaneously correct coronal and rotational deformities. Patient-specific instruments (PSIs) are known to be helpful in such complex osteotomies, but data on surgical accuracy for the combined correction of coronal and rotational deformities of the femur are missing.Purpose:To investigate the radiological results of DFO for simultaneous correction of coronal and rotational deformities using PSIs.Study Design:Case series; Level of evidence, 3.Methods:All included patients underwent DFO (34 patients, 36 knees) using PSIs for combined correction of coronal and rotational deformities. The hip-knee-ankle angle (HKA) was measured in weightbearing long-leg radiographs, and the femoral torsion was assessed using computed tomography scans, both pre- and postoperatively. The achieved corrections of HKA and femoral torsion were determined for each knee, and surgical accuracy was calculated.Results:HKA and femoral torsion changed significantly from preoperatively to postoperatively (from 2.4° ± 3.6° vs 0.1° ± 1.8° [ P < .001] and 31.2° ± 17.2° vs 18.7° ± 7.4° [ P < .001]). The difference from planned to achieved correction was statistically greater for HKA (–2.9° ± 3.8° vs –2.3° ± 3.5°; P = .018) than for femoral torsion (–12.4° ± 11.8° vs –12.3° ± 12.2°; P = .771), which did not reach significance. The accuracies of HKA and femoral torsion correction were 1.1° ± 1° and 2.4° ± 1.9°, respectively.Conclusion:Coronal and rotational deformities of the femur can accurately be corrected simultaneously by a DFO, utilizing PSIs. High accuracy was achieved for the correction of both coronal and rotational deformities, with absolute mean differences from planned to achieved correction of 1.1° and 2.4°, respectively.
背景：股骨远端截骨术（DFO）可用于同时矫正冠状畸形和旋转畸形。研究设计：病例系列；证据等级：3。方法：所有纳入的患者均接受了股骨远端截骨术（34例患者，36个膝关节），并使用PSI同时矫正了冠状畸形和旋转畸形。术前和术后均通过负重长腿X光片测量髋膝踝角（HKA），并通过计算机断层扫描评估股骨扭转情况。结果：HKA和股骨扭转从术前到术后发生了显著变化（从2.4° ± 3.6° vs 0.1° ± 1.8° [ P < .001]和31.2° ± 17.2° vs 18.7° ± 7.4° [ P < .001]）。在统计学上，HKA（-2.9° ± 3.8° vs -2.3° ± 3.5°；P = .018）与股骨扭转（-12.4° ± 11.8° vs -12.3° ± 12.2°；P = .771）的计划矫正与实际矫正之间的差异更大，但未达到显著性。结论：股骨冠状和旋转畸形可通过 DFO 同时使用 PSI 准确矫正。股骨冠状畸形和旋转畸形的矫正精度都很高，计划矫正与实际矫正的绝对平均差分别为1.1°和2.4°。
{"title":"Combined Correction of Coronal and Rotational Deformities of the Femur With Distal Femoral Osteotomy Using Patient-Specific Instrumentation","authors":"Georgios Neopoulos, Lukas Jud, Lazaros Vlachopoulos, Sandro F. Fucentese","doi":"10.1177/03635465251314868","DOIUrl":"https://doi.org/10.1177/03635465251314868","url":null,"abstract":"Background:Distal femoral osteotomy (DFO) can be used to simultaneously correct coronal and rotational deformities. Patient-specific instruments (PSIs) are known to be helpful in such complex osteotomies, but data on surgical accuracy for the combined correction of coronal and rotational deformities of the femur are missing.Purpose:To investigate the radiological results of DFO for simultaneous correction of coronal and rotational deformities using PSIs.Study Design:Case series; Level of evidence, 3.Methods:All included patients underwent DFO (34 patients, 36 knees) using PSIs for combined correction of coronal and rotational deformities. The hip-knee-ankle angle (HKA) was measured in weightbearing long-leg radiographs, and the femoral torsion was assessed using computed tomography scans, both pre- and postoperatively. The achieved corrections of HKA and femoral torsion were determined for each knee, and surgical accuracy was calculated.Results:HKA and femoral torsion changed significantly from preoperatively to postoperatively (from 2.4° ± 3.6° vs 0.1° ± 1.8° [ P < .001] and 31.2° ± 17.2° vs 18.7° ± 7.4° [ P < .001]). The difference from planned to achieved correction was statistically greater for HKA (–2.9° ± 3.8° vs –2.3° ± 3.5°; P = .018) than for femoral torsion (–12.4° ± 11.8° vs –12.3° ± 12.2°; P = .771), which did not reach significance. The accuracies of HKA and femoral torsion correction were 1.1° ± 1° and 2.4° ± 1.9°, respectively.Conclusion:Coronal and rotational deformities of the femur can accurately be corrected simultaneously by a DFO, utilizing PSIs. High accuracy was achieved for the correction of both coronal and rotational deformities, with absolute mean differences from planned to achieved correction of 1.1° and 2.4°, respectively.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"207 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1177/03635465241309282
Jan Zabrzyński, Adam Kwapisz, Jakub Erdmann, Maria Zabrzyńska, Michał Błachowski, Jakub Ohla, Michalina Adamczyk, Maciej Sokołowski, Bartosz Majchrzak, Gazi Huri
Background:The anterior cruciate ligament (ACL) is a major sagittal plane stabilizer of the knee joint. Even if anterior laxity can be brought under control by utilizing modern surgical techniques, internal rotational instability may not always be controlled adequately. Various surgical techniques are used to prevent this coronal or rotational instability, such as lateral extra-articular tenodesis (LET). Despite an abundance of articles in recent decades discussing LET in ACL reconstruction, no definitive indicators for extra-articular tenodesis have been described in the literature.Purpose:Given the scarcity of literature assessing the indications in LET, the purpose of this study was to conduct a systematic review of the described indications for this operation in the context of concurrent ACL reconstruction.Study Design:Systematic review; Level of evidence, 4.Methods:We searched PubMed, Cochrane Central, ScienceDirect, Web of Science, and Embase using the following key terms with no limits regarding the year of publication: (extraarticular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament). We included clinical human studies based on levels of evidence 1 to 4 that were written in English. We excluded studies not written in English, case studies, reviews, letters to editors, conference abstracts, or studies containing incomplete or irrelevant data.Results:The analysis evaluated 29 articles published between 1999 and 2023. We evaluated mostly level 3 (n = 13) and level 4 (n = 12) evidence; however, there were 4 articles with level 1 evidence. The majority of the studies were retrospective (n = 21), although there were prospective studies (n = 8). The mean age of the participants was 24.4 years. The most prevalent indications for LET were high-risk sports (16 articles), medial meniscal repair/excision (11 articles), and pivot-shift test grades 2 and 3 (11 articles).Conclusion:The reviewed articles showed reduced pivoting and laxity, improved clinical outcomes, and decreased revision rates after primary ACL reconstruction. The main frequent and repeated indications for using LET in ACL reconstruction are meniscal surgery, sports activity, and grade 2 and 3 pivoting.
{"title":"Indications for Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction: A Systematic Review","authors":"Jan Zabrzyński, Adam Kwapisz, Jakub Erdmann, Maria Zabrzyńska, Michał Błachowski, Jakub Ohla, Michalina Adamczyk, Maciej Sokołowski, Bartosz Majchrzak, Gazi Huri","doi":"10.1177/03635465241309282","DOIUrl":"https://doi.org/10.1177/03635465241309282","url":null,"abstract":"Background:The anterior cruciate ligament (ACL) is a major sagittal plane stabilizer of the knee joint. Even if anterior laxity can be brought under control by utilizing modern surgical techniques, internal rotational instability may not always be controlled adequately. Various surgical techniques are used to prevent this coronal or rotational instability, such as lateral extra-articular tenodesis (LET). Despite an abundance of articles in recent decades discussing LET in ACL reconstruction, no definitive indicators for extra-articular tenodesis have been described in the literature.Purpose:Given the scarcity of literature assessing the indications in LET, the purpose of this study was to conduct a systematic review of the described indications for this operation in the context of concurrent ACL reconstruction.Study Design:Systematic review; Level of evidence, 4.Methods:We searched PubMed, Cochrane Central, ScienceDirect, Web of Science, and Embase using the following key terms with no limits regarding the year of publication: (extraarticular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament). We included clinical human studies based on levels of evidence 1 to 4 that were written in English. We excluded studies not written in English, case studies, reviews, letters to editors, conference abstracts, or studies containing incomplete or irrelevant data.Results:The analysis evaluated 29 articles published between 1999 and 2023. We evaluated mostly level 3 (n = 13) and level 4 (n = 12) evidence; however, there were 4 articles with level 1 evidence. The majority of the studies were retrospective (n = 21), although there were prospective studies (n = 8). The mean age of the participants was 24.4 years. The most prevalent indications for LET were high-risk sports (16 articles), medial meniscal repair/excision (11 articles), and pivot-shift test grades 2 and 3 (11 articles).Conclusion:The reviewed articles showed reduced pivoting and laxity, improved clinical outcomes, and decreased revision rates after primary ACL reconstruction. The main frequent and repeated indications for using LET in ACL reconstruction are meniscal surgery, sports activity, and grade 2 and 3 pivoting.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-04DOI: 10.1177/03635465241296835
Melissa L. Carpenter, Jorge Chahla
{"title":"Knee Stability in Remnant-Preserving ACL Reconstruction: Response","authors":"Melissa L. Carpenter, Jorge Chahla","doi":"10.1177/03635465241296835","DOIUrl":"https://doi.org/10.1177/03635465241296835","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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