Pub Date : 2024-12-01DOI: 10.1177/03635465241298594
Bruce Reider
{"title":"In Gratitude","authors":"Bruce Reider","doi":"10.1177/03635465241298594","DOIUrl":"https://doi.org/10.1177/03635465241298594","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756103","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 : 2024-12-01DOI: 10.1177/03635465241294198
Jiawei Du, Jinghua Hou
{"title":"Strengthening the Evidence: Addressing Biases in Anterior Cruciate Ligament Reconstruction Studies: Letter to the Editor","authors":"Jiawei Du, Jinghua Hou","doi":"10.1177/03635465241294198","DOIUrl":"https://doi.org/10.1177/03635465241294198","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756099","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 : 2024-12-01DOI: 10.1177/03635465241294195
David Holmgren, Shiba Noory, Eva Moström, Hege Grindem, Anders Stålman, Tobias Wörner
{"title":"Strengthening the Evidence: Addressing Biases in Anterior Cruciate Ligament Reconstruction Studies: Response","authors":"David Holmgren, Shiba Noory, Eva Moström, Hege Grindem, Anders Stålman, Tobias Wörner","doi":"10.1177/03635465241294195","DOIUrl":"https://doi.org/10.1177/03635465241294195","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756098","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 : 2024-12-01DOI: 10.1177/03635465241295960
Dean C. Taylor
{"title":"Presidential Address of the American Orthopaedic Society for Sports Medicine","authors":"Dean C. Taylor","doi":"10.1177/03635465241295960","DOIUrl":"https://doi.org/10.1177/03635465241295960","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756104","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 : 2024-11-20DOI: 10.1177/03635465241289934
V. Claire Clark, Charles W. Wyatt, Nolan D. Hawkins, Robert L. Van Pelt, Sharon G. Huang, Benjamin L. Johnson, Henry B. Ellis, Philip L. Wilson
Background:There may be an association between repetitive stress on the elbow and capitellar osteochondritis dissecans (COCD). The influence of activity on the characteristics or specific location of the lesion within a capitellar zone of propensity remains unclear.Purpose/Hypothesis:The purpose of this study was to evaluate COCD in gymnasts and baseball players compared with a non–upper extremity (non-UE) sport COCD cohort. It was hypothesized that activity would influence presentation and lesion location and characteristics.Study Design:Cross-sectional study, Level of evidence, 3.Methods:Consecutive patients presenting with COCD treated in a tertiary sports medicine practice between March 2006 and March 2021 were reviewed. Demographic and imaging lesion characteristics were recorded. The sagittal inclination angle position of the lesion center relative to the humeral shaft was recorded. Intra- and interrater reliability was confirmed (intraclass correlation coefficient, 0.808; intraclass correlation coefficient, 0.824, respectively). Participants were analyzed by activity.Results:A total of 126 elbows were identified: 68 in gymnasts, 31 in baseball players, and 27 in patients with no history of UE sports. The mean age of the participants was 12.5 years (range, 8-18 years). All (100%) unilateral cases of osteochondritis dissecans (OCD) in baseball players occurred in the dominant throwing arm, compared with less hand-dominance correlation in gymnasts (64%) and non-UE athletes (67%). Significantly, 14 of the 20 (70%) patients with bilateral OCD were gymnasts ( P = .036). In non-UE athletes, lesions occurred at a mean sagittal inclination angle of 52.7° (±13.8°), with a mean lateral containment of 4.7 (±2.1) mm. In gymnasts, lesions occurred more posteriorly at 41.2° (±14.9°), with a lateral containment of 3.6 (±1.9) mm. In baseball players, COCDs occurred at 55.1° (±11.9°), with a lateral containment of 2.5 (±1.6) mm. These more posterior lesion positions in gymnasts ( P = .001) and lesser lesion containment noted in gymnasts ( P = .015) and baseball players ( P < .001) were significant.Conclusion:Compared with COCD lesions in adolescents with no history of UE sports, gymnastics participation (impact weightbearing) correlated with a higher rate of bilateral lesion formation and a more posterior (extended) lesion position. Baseball participation (resulting in valgus shear forces in the elbow) resulted in a sagittal position similar to non-UE lesions, but more lateral and with less containment.
{"title":"Osteochondritis Dissecans of the Capitellum: Influence of Activity on Lesion Location Within a Zone of Propensity","authors":"V. Claire Clark, Charles W. Wyatt, Nolan D. Hawkins, Robert L. Van Pelt, Sharon G. Huang, Benjamin L. Johnson, Henry B. Ellis, Philip L. Wilson","doi":"10.1177/03635465241289934","DOIUrl":"https://doi.org/10.1177/03635465241289934","url":null,"abstract":"Background:There may be an association between repetitive stress on the elbow and capitellar osteochondritis dissecans (COCD). The influence of activity on the characteristics or specific location of the lesion within a capitellar zone of propensity remains unclear.Purpose/Hypothesis:The purpose of this study was to evaluate COCD in gymnasts and baseball players compared with a non–upper extremity (non-UE) sport COCD cohort. It was hypothesized that activity would influence presentation and lesion location and characteristics.Study Design:Cross-sectional study, Level of evidence, 3.Methods:Consecutive patients presenting with COCD treated in a tertiary sports medicine practice between March 2006 and March 2021 were reviewed. Demographic and imaging lesion characteristics were recorded. The sagittal inclination angle position of the lesion center relative to the humeral shaft was recorded. Intra- and interrater reliability was confirmed (intraclass correlation coefficient, 0.808; intraclass correlation coefficient, 0.824, respectively). Participants were analyzed by activity.Results:A total of 126 elbows were identified: 68 in gymnasts, 31 in baseball players, and 27 in patients with no history of UE sports. The mean age of the participants was 12.5 years (range, 8-18 years). All (100%) unilateral cases of osteochondritis dissecans (OCD) in baseball players occurred in the dominant throwing arm, compared with less hand-dominance correlation in gymnasts (64%) and non-UE athletes (67%). Significantly, 14 of the 20 (70%) patients with bilateral OCD were gymnasts ( P = .036). In non-UE athletes, lesions occurred at a mean sagittal inclination angle of 52.7° (±13.8°), with a mean lateral containment of 4.7 (±2.1) mm. In gymnasts, lesions occurred more posteriorly at 41.2° (±14.9°), with a lateral containment of 3.6 (±1.9) mm. In baseball players, COCDs occurred at 55.1° (±11.9°), with a lateral containment of 2.5 (±1.6) mm. These more posterior lesion positions in gymnasts ( P = .001) and lesser lesion containment noted in gymnasts ( P = .015) and baseball players ( P < .001) were significant.Conclusion:Compared with COCD lesions in adolescents with no history of UE sports, gymnastics participation (impact weightbearing) correlated with a higher rate of bilateral lesion formation and a more posterior (extended) lesion position. Baseball participation (resulting in valgus shear forces in the elbow) resulted in a sagittal position similar to non-UE lesions, but more lateral and with less containment.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678522","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}
Background:Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively.Purpose/Hypothesis:The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position.Study Design:Cohort study (Diagnosis); Level of evidence, 2.Methods:This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated.Results:This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion ( P = .003 and P < .001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P < .001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases ( P < .05); however, no significant differences were observed in the chronic cases.Conclusion:The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position.
{"title":"Diagnostic Accuracy of Magnetic Resonance Imaging in the 120° Flexed-Knee Position for Detecting and Classifying Meniscal Ramp Lesion","authors":"Satoshi Nonaka, Kazuhisa Hatayama, Shintarou Tokunaga, Hibiki Kakiage, Satoshi Hirasawa, Masanori Terauchi, Hirotaka Chikuda","doi":"10.1177/03635465241290516","DOIUrl":"https://doi.org/10.1177/03635465241290516","url":null,"abstract":"Background:Detection of meniscal ramp lesions concomitant with anterior cruciate ligament (ACL) injury using conventional magnetic resonance imaging (MRI) has low sensitivity, and these lesions are currently difficult to diagnose preoperatively.Purpose/Hypothesis:The purpose of this study was to assess the accuracy of MRI in detecting the presence of meniscal ramp lesions in the 120° flexed-knee position compared with that in the near–extended-knee position. It was hypothesized that the diagnostic performance of MRI in the 120° flexed-knee position would be better than that in the extended-knee position.Study Design:Cohort study (Diagnosis); Level of evidence, 2.Methods:This retrospective study of prospectively collected data between February 2019 and January 2024 included 154 consecutive patients undergoing ACL reconstruction. All patients underwent 3-T MRI examination in the near extended- and 120° flexed-knee positions preoperatively. The presence and Thaunat classification of ramp lesions were separately detected on each MRI scan and confirmed via arthroscopy during ACL reconstruction. Diagnostic sensitivity, specificity, and conditional relative odds ratios for detecting ramp lesions and the classification accuracy were compared between 2 MRI modalities. The accuracies of these MRI scans in acute and chronic cases were also evaluated.Results:This study included 154 patients (79 male and 75 female; mean age, 29.0 ± 14.2 years). A total of 62 ramp lesions (40.3%) were observed on arthroscopy. The sensitivity and specificity of MRI in near extension were 69.4% and 77.2%, respectively, and those in flexion were 91.9% and 94.6%, respectively, with significant superiority in MRI at knee flexion ( P = .003 and P < .001, respectively). The conditional relative odds ratio between the MRI examinations at these 2 positions was 10.3 (95% CI, 4.82-21.8). The classification accuracy of MRI in flexion was significantly higher than that of MRI in near extension (accuracy, 49 vs 11; P < .001). The diagnostic accuracy of MRI in the 120° flexed-knee position was significantly higher than that in the near–extended-knee position in the acute cases ( P < .05); however, no significant differences were observed in the chronic cases.Conclusion:The diagnostic accuracy of MRI in the 120° flexed-knee position for detecting and classifying meniscal ramp lesions was superior to that of MRI in the near–extended-knee position.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142597133","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 : 2024-10-23DOI: 10.1177/03635465241285892
Choon Chiet Hong,Christel Charpail,Charles Kon Kam King,Stephane Guillo
BACKGROUNDShort-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking.PURPOSE/HYPOTHESISThe purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years.STUDY DESIGNCase series; Level of evidence, 4.METHODSA prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed.RESULTSThe study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%.CONCLUSIONThe current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.
{"title":"All-Inside Endoscopic Classic Bröstrom-Gould Technique: Medium-term Results.","authors":"Choon Chiet Hong,Christel Charpail,Charles Kon Kam King,Stephane Guillo","doi":"10.1177/03635465241285892","DOIUrl":"https://doi.org/10.1177/03635465241285892","url":null,"abstract":"BACKGROUNDShort-term results after arthroscopic/endoscopic lateral ligament repair for chronic lateral ankle instability have been satisfactory, although medium- to longer-term results are lacking.PURPOSE/HYPOTHESISThe purpose of this study was to report the medium-term results of an all-inside endoscopic classic Bröstrom-Gould procedure where both the both lateral ligaments and the inferior extensor retinaculum can be approached directly, interchanging between arthroscopy for intracapsular structures and endoscopy for extracapsular structures. It was hypothesized that the all-inside endoscopic classic Bröstrom-Gould procedure would produce sustainable good outcomes at a medium term of 5 years.STUDY DESIGNCase series; Level of evidence, 4.METHODSA prospective database for 43 patients who underwent an all-inside endoscopic classic Bröstrom-Gould repair of the anterior talofibular ligament and calcaneofibular ligament with inferior extensor retinaculum augmentation was reviewed. Patient details, American Orthopaedic Foot & Ankle Society score, Karlsson score, ankle activity score (AAS), and patient satisfaction were collected and analyzed.RESULTSThe study cohort of 43 patients with a mean age of 29.4 years (SD, 11.9 years) were reviewed at a mean follow-up of 63.1 months (SD, 8.5 months). The American Orthopaedic Foot & Ankle Society scores showed significant improvement from a mean of 69.6 (SD, 13.9) to 93.7 (SD, 10.7), while the Karlsson score improved from 59.7 (SD, 14.5) to 91.5 (SD, 14.5) at the final follow-up. The AAS showed that 32 (74.4%) patients maintained or had improvement in the AAS, from a mean of 5.38 (SD, 2.8) to 5.41 (SD, 2.8), with a mean satisfaction rate of 9.1 (SD, 1.3). Although the remaining 11 patients had a reduced AAS, at a mean of 4.6 (SD, 2.6), they reported a mean satisfaction rate of 7.4 (SD, 2.9). There were no surgical complications or reoperations reported in this cohort, although there were 3 patients with recurrent instability at their last follow-up, resulting in a failure rate of 7%.CONCLUSIONThe current study is the first to report the medium-term outcomes of an all-inside endoscopic classic Bröstrom-Gould procedure. Overall, 93% of the patients had good functional outcomes, but approximately 25% of patients had decreased ankle activity levels at a mean of 5 years postoperatively, albeit with good satisfaction rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"31 1","pages":"3635465241285892"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488209","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 : 2024-10-23DOI: 10.1177/03635465241287474
Erik Gerlach,Richard W Nicolay,Rusheel Nayak,Carly L Williams,Daniel J Johnson,Mark Plantz,Guido Marra
BACKGROUNDThe critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs.PURPOSE/HYPOTHESISThe purpose of this study was to define the relationship between full-thickness RCTs and the CSA. It was hypothesized that patients with full-thickness RCTs would have an increased CSA compared with matched controls.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThis retrospective case-control study identified patients with magnetic resonance imaging scans showing full-thickness RCTs between 2009 and 2019. A 1 to 1 propensity score match was performed to identify a control group with normal rotator cuffs while controlling for baseline participant characteristics-including age, sex, body mass index, and tobacco use. A total cohort of 532 was identified, with 266 cases and 266 controls. Two independent observers measured CSAs on true anteroposterior shoulder radiographs.RESULTSThere was no difference in baseline participant characteristics between the RCT and the non-RCT groups (P > .05). The mean CSA for the entire cohort was 33.6°± 4.2°. The CSA did not significantly vary by sex (P = .088) or tobacco usage (P = .16). The mean CSA for the RCT case group, 36.2°± 3.3°, was significantly different from the mean CSA for the control group, 30.9°± 3.3° (P < .0001). The receiver operating characteristic curve analysis produced an area under the curve of 0.88 (P < .0001). At CSAs ≥35°, there was a 67.7% sensitivity and 89.4% specificity for having a full-thickness RCT. Last, each degree of increase in the CSA increased the risk of having an associated RCT by 1.7 times (OR, 1.7 [95% CI, 1.551-1.852]; P < .0001).CONCLUSIONPatients with RCTs had significantly higher CSAs compared with matched controls. Increased CSA was an independent risk factor for RCTs, with an odds ratio of 1.7 per degree. The CSA is an accurate test (area under the curve, 0.88) with good sensitivity (67.7%) and specificity (89.4%) at values ≥35°. The CSA is a simple, reproducible measurement that can assist in clinical decision-making regarding full-thickness RCTs.
{"title":"The Critical Shoulder Angle as a Highly Specific Predictor of a Full-Thickness Rotator Cuff Tear: A Case-Control Study.","authors":"Erik Gerlach,Richard W Nicolay,Rusheel Nayak,Carly L Williams,Daniel J Johnson,Mark Plantz,Guido Marra","doi":"10.1177/03635465241287474","DOIUrl":"https://doi.org/10.1177/03635465241287474","url":null,"abstract":"BACKGROUNDThe critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs.PURPOSE/HYPOTHESISThe purpose of this study was to define the relationship between full-thickness RCTs and the CSA. It was hypothesized that patients with full-thickness RCTs would have an increased CSA compared with matched controls.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThis retrospective case-control study identified patients with magnetic resonance imaging scans showing full-thickness RCTs between 2009 and 2019. A 1 to 1 propensity score match was performed to identify a control group with normal rotator cuffs while controlling for baseline participant characteristics-including age, sex, body mass index, and tobacco use. A total cohort of 532 was identified, with 266 cases and 266 controls. Two independent observers measured CSAs on true anteroposterior shoulder radiographs.RESULTSThere was no difference in baseline participant characteristics between the RCT and the non-RCT groups (P > .05). The mean CSA for the entire cohort was 33.6°± 4.2°. The CSA did not significantly vary by sex (P = .088) or tobacco usage (P = .16). The mean CSA for the RCT case group, 36.2°± 3.3°, was significantly different from the mean CSA for the control group, 30.9°± 3.3° (P < .0001). The receiver operating characteristic curve analysis produced an area under the curve of 0.88 (P < .0001). At CSAs ≥35°, there was a 67.7% sensitivity and 89.4% specificity for having a full-thickness RCT. Last, each degree of increase in the CSA increased the risk of having an associated RCT by 1.7 times (OR, 1.7 [95% CI, 1.551-1.852]; P < .0001).CONCLUSIONPatients with RCTs had significantly higher CSAs compared with matched controls. Increased CSA was an independent risk factor for RCTs, with an odds ratio of 1.7 per degree. The CSA is an accurate test (area under the curve, 0.88) with good sensitivity (67.7%) and specificity (89.4%) at values ≥35°. The CSA is a simple, reproducible measurement that can assist in clinical decision-making regarding full-thickness RCTs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"4 1","pages":"3635465241287474"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488322","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 : 2024-10-23DOI: 10.1177/03635465241287146
Ajay C Lall,Benjamin L Smith,Ady H Kahana-Rojkind,Anthony N Khoury,Coen A Wijdicks,Benjamin G Domb
BACKGROUNDThe essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique.HYPOTHESES(1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force.STUDY DESIGNControlled laboratory study.METHODSEight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance (P < .05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state.RESULTSPeak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact (P < .001), moderate-tension CLR (P = .016), and high-tension CLR (P = .002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration (P < .05).CONCLUSIONCLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces.CLINICAL RELEVANCEThese findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration.
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