Pub Date : 2026-03-08DOI: 10.1177/03635465261424877
J Lee Pace,Thomas R Carter,Andrew Nakla,Min-Shik Chung,Daniel Kwak,Gyurim Baek,Ryan Lew,Ryan S Beyer,Olubusola Brimmo,Michelle H McGarry,Jim Hsu,Thay Q Lee
BACKGROUNDRoot fixation for medial meniscal transplantation can be performed with or without bone plugs. Bone plug fixation has generally been shown to have superior time-zero biomechanical characteristics. Little is known about the biomechanics of peripheral stabilization for meniscal allograft transplantation (MAT) and its ability to improve time-zero biomechanics.PURPOSE/HYPOTHESISThe purpose was to compare the biomechanical effectiveness of modern soft tissue (ST) root fixation versus bone plug (BP) root fixation as well as peripheral stabilization in MAT. The hypothesis was that, while BP root fixation likely has better time-zero biomechanical characteristics with regard to contact forces and laxity, the addition of peripheral stabilization would mitigate these differences for either type of root fixation in a cadaveric model.STUDY DESIGNControlled laboratory study.METHODSA total of 8 matched-pair cadaveric knees with a mean age of 55 ± 10 years (5 female and 3 male) were used. The knees were tested in the following states: intact, meniscectomy, MAT (with either BP or ST root fixation) with peripheral stabilization, and MAT (with either BP or ST root fixation) without peripheral stabilization. Medial tibiofemoral joint contact area and pressure as well as knee laxity for anterior-posterior tibial translation, external-internal rotation, and varus-valgus were quantified at 0°, 30°, 60°, and 90° of knee flexion. A paired t test with a significance level at .05 was used for statistical analysis.RESULTSThere were small but significant differences between ST and BP MAT with or without peripheral stabilization in contact forces and most laxity measurements. While both groups demonstrated improved stability with peripheral stabilization, the BP MAT group exhibited greater influence from stabilization in laxity with internal-external rotation (P = .010), contact area with internal-external rotation (P = .022), and contact area with varus (P < .005).CONCLUSIONThis study demonstrated the slight superiority of BP versus ST root fixation and that the addition of peripheral stabilization for ST and BP MAT decreased medial tibiofemoral joint contact pressure and increased medial tibiofemoral joint contact area at time zero. While the time-zero biomechanical characteristics of BP MAT were more influenced by peripheral stabilization than the ST technique, this is most likely because of graft size mismatch.CLINICAL RELEVANCEWith current root fixation devices, both ST and BP MAT had generally similar biomechanical characteristics at time zero, and peripheral stabilization seemed to improve both modes of fixation.
{"title":"Biomechanical Properties of a Bone Plug Versus Soft Tissue Allograft for Medial Meniscus Root Fixation and the Effect of Peripheral Stabilization.","authors":"J Lee Pace,Thomas R Carter,Andrew Nakla,Min-Shik Chung,Daniel Kwak,Gyurim Baek,Ryan Lew,Ryan S Beyer,Olubusola Brimmo,Michelle H McGarry,Jim Hsu,Thay Q Lee","doi":"10.1177/03635465261424877","DOIUrl":"https://doi.org/10.1177/03635465261424877","url":null,"abstract":"BACKGROUNDRoot fixation for medial meniscal transplantation can be performed with or without bone plugs. Bone plug fixation has generally been shown to have superior time-zero biomechanical characteristics. Little is known about the biomechanics of peripheral stabilization for meniscal allograft transplantation (MAT) and its ability to improve time-zero biomechanics.PURPOSE/HYPOTHESISThe purpose was to compare the biomechanical effectiveness of modern soft tissue (ST) root fixation versus bone plug (BP) root fixation as well as peripheral stabilization in MAT. The hypothesis was that, while BP root fixation likely has better time-zero biomechanical characteristics with regard to contact forces and laxity, the addition of peripheral stabilization would mitigate these differences for either type of root fixation in a cadaveric model.STUDY DESIGNControlled laboratory study.METHODSA total of 8 matched-pair cadaveric knees with a mean age of 55 ± 10 years (5 female and 3 male) were used. The knees were tested in the following states: intact, meniscectomy, MAT (with either BP or ST root fixation) with peripheral stabilization, and MAT (with either BP or ST root fixation) without peripheral stabilization. Medial tibiofemoral joint contact area and pressure as well as knee laxity for anterior-posterior tibial translation, external-internal rotation, and varus-valgus were quantified at 0°, 30°, 60°, and 90° of knee flexion. A paired t test with a significance level at .05 was used for statistical analysis.RESULTSThere were small but significant differences between ST and BP MAT with or without peripheral stabilization in contact forces and most laxity measurements. While both groups demonstrated improved stability with peripheral stabilization, the BP MAT group exhibited greater influence from stabilization in laxity with internal-external rotation (P = .010), contact area with internal-external rotation (P = .022), and contact area with varus (P < .005).CONCLUSIONThis study demonstrated the slight superiority of BP versus ST root fixation and that the addition of peripheral stabilization for ST and BP MAT decreased medial tibiofemoral joint contact pressure and increased medial tibiofemoral joint contact area at time zero. While the time-zero biomechanical characteristics of BP MAT were more influenced by peripheral stabilization than the ST technique, this is most likely because of graft size mismatch.CLINICAL RELEVANCEWith current root fixation devices, both ST and BP MAT had generally similar biomechanical characteristics at time zero, and peripheral stabilization seemed to improve both modes of fixation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"31 1","pages":"3635465261424877"},"PeriodicalIF":0.0,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374241","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 : 2026-03-08DOI: 10.1177/03635465261426560
Tony Y Lee,Daniel C Touhey,Julia M Perugini,Robert H Brophy,Matthew J Matava,Matthew V Smith,Derrick M Knapik
BACKGROUNDBiceps tenodesis (BT) is performed to address symptomatic tendinopathy, partial tears, and instability of the long head of the biceps tendon to provide pain relief and improve function. Debate persists regarding which technique is optimal: arthroscopic suprapectoral BT (ASPBT) or open subpectoral BT (OSPBT).PURPOSETo systematically review the literature to evaluate clinical and patient-reported outcomes (PROs), complications, and reoperations after ASPBT versus OSPBT.STUDY DESIGNSystematic review; Level of evidence, 4Methods:Studies published in the PubMed, Embase, and Cochrane Library databases reporting outcomes of OSPBT or ASPBT from inception to August 2025 were identified. Inclusion criteria included studies reporting patients undergoing BT with lesion cause, surgical technique, concomitant procedures, complications, reoperations, and any PROs.RESULTSA total of 43 studies, consisting of 11,113 patients undergoing BT, with a weighted mean follow-up of 23.8 months (range, 0.7-133.20 months), were identified. The weighted mean patient age was 54.3 years (range, 16-91 years), and 66% of the patients were male. OSPBT was performed in 53.9% (5987/11,113) of patients, while 46.1% (5126/11,113) underwent ASPBT. A significantly higher percentage of superior labrum anterior to posterior (SLAP) lesions were reported in OSPBT patients (33.1%; 403/1217) (P < .001). Rotator cuff repair and subacromial decompression were the most common concomitant procedures. Fixation with interference screws was most common during OSPBT (69.9%; 2449/3503) and ASPBT (65.7%; 1548/2357), while suture anchor fixation was utilized in a higher percentage of ASPBT procedures (21.9% [517/2357] vs 11.6% [407/3503]; P < .001). Both techniques resulted in improvement in various PROs. Complications were reported in 5.6% (496/8784) of patients, with postoperative stiffness most frequent, occurring in a significantly greater proportion of ASPBT patients (2.5% [103/4048] vs 1.4% [66/4736]; P < .001). OSPBT was associated with a higher percentage of wound infections (1.1% [51/4736] vs 0.5% [22/4048]; P = .006) and nerve-related complications (1.1% [50/4736] vs 0.2% [7/4048]; P < .001). No significant differences were reported between groups in the incidence of "Popeye" deformities, implant failures, or overall complications. Reoperations were performed more frequently after ASPBT (1.9% [77/4048] vs 1.1% [52/4736]; P = .002).CONCLUSIONThis systematic review of 43 studies found that both ASPBT and OSPBT were associated with improvement in a variety of PROs, while complication rates were comparable between techniques. While ASPBT is associated with a higher incidence of postoperative stiffness and a greater rate of reoperations, OSPBT was reported to lead to a higher incidence of wound infections and iatrogenic nerve injuries.
背景：肱二头肌肌腱固定术（BT）用于治疗症状性肌腱病变、部分撕裂和肱二头肌肌腱长头不稳定，以缓解疼痛并改善功能。关节镜下胸骨上BT （ASPBT）和开放式胸骨下BT （OSPBT）孰优孰低，仍有争议。目的系统地回顾文献，评估ASPBT与OSPBT的临床和患者报告的预后（PROs）、并发症和再手术。研究设计：系统评价；方法：在PubMed， Embase和Cochrane图书馆数据库中发表的报告OSPBT或ASPBT从成立到2025年8月的结果的研究被确定。纳入标准包括报告BT患者病变原因、手术技术、伴随手术、并发症、再手术和任何优点的研究。结果共纳入43项研究，包括11,113例接受BT治疗的患者，加权平均随访时间为23.8个月（范围0.7-133.20个月）。患者加权平均年龄为54.3岁（范围16-91岁），66%为男性。53.9%（5987/11,113）的患者行OSPBT， 46.1%（5126/11,113）的患者行ASPBT。OSPBT患者出现上唇前后（SLAP）病变的比例显著高于其他患者（33.1%;403/1217）（P < 0.001）。肩袖修复和肩峰下减压是最常见的伴随手术。干涉螺钉固定在OSPBT（69.9%; 2449/3503）和ASPBT（65.7%; 1548/2357）中最为常见，而缝合锚钉固定在ASPBT手术中的比例更高（21.9% [517/2357]vs 11.6% [407/3503]; P < .001）。这两种技术都改善了各种优点。5.6%（496/8784）的患者报告了并发症，术后僵硬最为常见，在ASPBT患者中发生的比例明显更高（2.5% [103/4048]vs 1.4% [66/4736]; P < .001）。OSPBT与较高的伤口感染比例（1.1% [51/4736]vs 0.5% [22/4048]; P = 0.006）和神经相关并发症（1.1% [50/4736]vs 0.2% [7/4048]; P < 0.001）相关。在“大力水手”畸形、种植体失败或整体并发症的发生率方面，两组间无显著差异。ASPBT术后再手术发生率更高（1.9% [77/4048]vs 1.1% [52/4736]; P = .002）。结论对43项研究的系统回顾发现，ASPBT和OSPBT均可改善各种pro，而两种技术的并发症发生率相似。虽然OSPBT与较高的术后僵硬发生率和较高的再手术率相关，但据报道，OSPBT会导致较高的伤口感染和医源性神经损伤发生率。
{"title":"Outcomes Following Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis at Short- to Midterm Follow-up: A Systematic Review.","authors":"Tony Y Lee,Daniel C Touhey,Julia M Perugini,Robert H Brophy,Matthew J Matava,Matthew V Smith,Derrick M Knapik","doi":"10.1177/03635465261426560","DOIUrl":"https://doi.org/10.1177/03635465261426560","url":null,"abstract":"BACKGROUNDBiceps tenodesis (BT) is performed to address symptomatic tendinopathy, partial tears, and instability of the long head of the biceps tendon to provide pain relief and improve function. Debate persists regarding which technique is optimal: arthroscopic suprapectoral BT (ASPBT) or open subpectoral BT (OSPBT).PURPOSETo systematically review the literature to evaluate clinical and patient-reported outcomes (PROs), complications, and reoperations after ASPBT versus OSPBT.STUDY DESIGNSystematic review; Level of evidence, 4Methods:Studies published in the PubMed, Embase, and Cochrane Library databases reporting outcomes of OSPBT or ASPBT from inception to August 2025 were identified. Inclusion criteria included studies reporting patients undergoing BT with lesion cause, surgical technique, concomitant procedures, complications, reoperations, and any PROs.RESULTSA total of 43 studies, consisting of 11,113 patients undergoing BT, with a weighted mean follow-up of 23.8 months (range, 0.7-133.20 months), were identified. The weighted mean patient age was 54.3 years (range, 16-91 years), and 66% of the patients were male. OSPBT was performed in 53.9% (5987/11,113) of patients, while 46.1% (5126/11,113) underwent ASPBT. A significantly higher percentage of superior labrum anterior to posterior (SLAP) lesions were reported in OSPBT patients (33.1%; 403/1217) (P < .001). Rotator cuff repair and subacromial decompression were the most common concomitant procedures. Fixation with interference screws was most common during OSPBT (69.9%; 2449/3503) and ASPBT (65.7%; 1548/2357), while suture anchor fixation was utilized in a higher percentage of ASPBT procedures (21.9% [517/2357] vs 11.6% [407/3503]; P < .001). Both techniques resulted in improvement in various PROs. Complications were reported in 5.6% (496/8784) of patients, with postoperative stiffness most frequent, occurring in a significantly greater proportion of ASPBT patients (2.5% [103/4048] vs 1.4% [66/4736]; P < .001). OSPBT was associated with a higher percentage of wound infections (1.1% [51/4736] vs 0.5% [22/4048]; P = .006) and nerve-related complications (1.1% [50/4736] vs 0.2% [7/4048]; P < .001). No significant differences were reported between groups in the incidence of \"Popeye\" deformities, implant failures, or overall complications. Reoperations were performed more frequently after ASPBT (1.9% [77/4048] vs 1.1% [52/4736]; P = .002).CONCLUSIONThis systematic review of 43 studies found that both ASPBT and OSPBT were associated with improvement in a variety of PROs, while complication rates were comparable between techniques. While ASPBT is associated with a higher incidence of postoperative stiffness and a greater rate of reoperations, OSPBT was reported to lead to a higher incidence of wound infections and iatrogenic nerve injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"19 1","pages":"3635465261426560"},"PeriodicalIF":0.0,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374237","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 : 2026-03-08DOI: 10.1177/03635465261424875
Nesa Milan,Aboubacar Wague,Luke Sang,Alex Youn,Ryan Sadjadi,Yusef Samimi,Cristhian Montenegro,Miguel Lizarraga,Justin Lau,Allan I Basbaum,Michael R Davies,Hubert T Kim,Brian T Feeley,Jarret A P Weinrich,Xuhui Liu
BACKGROUNDRotator cuff (RC) tears are among the most common causes of shoulder dysfunction in sports medicine. Muscle atrophy and degeneration are important risk factors for RC tendon retearing and suboptimal recovery of shoulder function after tendon repair. Although blood flow restriction (BFR) can stimulate muscle regeneration after lower extremity trauma and anterior cruciate ligament reconstruction, the mechanisms that underlie BFR remain unknown, and its application to RC tears has not yet been explored.HYPOTHESISThe authors hypothesized that BFR induces transfer of mitochondria from intramuscular fibro-adipogenic progenitors (FAPs) to myocytes, enhances muscle regeneration, and improves shoulder function after RC injury.STUDY DESIGNControlled laboratory study.METHODSTo assess mitochondrial transfer after BFR, the authors used Prrx1-Cre/MitoTag reporter mice, in which FAP mitochondria are labeled. Mice underwent unilateral forelimb BFR, and supraspinatus (SS) muscles were collected at baseline and days 1, 2, 3, 5, and 7 for histology. To model massive RC tears, mice received unilateral SS and infraspinatus tendon transection with denervation (TT+DN) and then were randomized to a BFR (every 3 days) or control group. At 2 or 6 weeks after surgery, SS muscles were analyzed for mitochondrial transfer, fiber size, and fiber-type distribution. Additionally, forelimb gait and weightbearing were captured using the Blackbox system.RESULTSBFR was associated with increased FAP-mediated mitochondrial transfer in healthy SS muscle as early as 1 day after BFR treatment and lasted for up to 3 days after BFR. The authors observed an enhanced effect of BFR-induced FAP mitochondrial transfer in SS muscle after RC injury, compared with the control, at both 2 and 6 weeks after TT+DN. BFR-treated mice had significantly reduced muscle atrophy, fatty infiltration, and fibrosis after RC injury. They also observed a significant improvement in forepaw weightbearing ratio and ipsilateral forepaw stride length at 6 weeks after injury in BFR-treated mice compared with controls.CONCLUSIONBFR significantly improves muscle quality and shoulder function after RC injury. These effects occur alongside increased mitochondrial transfer from FAPs to myocytes.CLINICAL RELEVANCEUnderstanding the mechanism of BFR by which BFR enhances muscle regeneration could pave the way for its use as a novel rehabilitation strategy to improve recovery in patients with RC injuries and other muscle-related conditions.
{"title":"Blood Flow Restriction Therapy Stimulates Intercellular Mitochondria Transfer and Improves Muscle Regeneration and Shoulder Function in a Murine Rotator Cuff Injury Model.","authors":"Nesa Milan,Aboubacar Wague,Luke Sang,Alex Youn,Ryan Sadjadi,Yusef Samimi,Cristhian Montenegro,Miguel Lizarraga,Justin Lau,Allan I Basbaum,Michael R Davies,Hubert T Kim,Brian T Feeley,Jarret A P Weinrich,Xuhui Liu","doi":"10.1177/03635465261424875","DOIUrl":"https://doi.org/10.1177/03635465261424875","url":null,"abstract":"BACKGROUNDRotator cuff (RC) tears are among the most common causes of shoulder dysfunction in sports medicine. Muscle atrophy and degeneration are important risk factors for RC tendon retearing and suboptimal recovery of shoulder function after tendon repair. Although blood flow restriction (BFR) can stimulate muscle regeneration after lower extremity trauma and anterior cruciate ligament reconstruction, the mechanisms that underlie BFR remain unknown, and its application to RC tears has not yet been explored.HYPOTHESISThe authors hypothesized that BFR induces transfer of mitochondria from intramuscular fibro-adipogenic progenitors (FAPs) to myocytes, enhances muscle regeneration, and improves shoulder function after RC injury.STUDY DESIGNControlled laboratory study.METHODSTo assess mitochondrial transfer after BFR, the authors used Prrx1-Cre/MitoTag reporter mice, in which FAP mitochondria are labeled. Mice underwent unilateral forelimb BFR, and supraspinatus (SS) muscles were collected at baseline and days 1, 2, 3, 5, and 7 for histology. To model massive RC tears, mice received unilateral SS and infraspinatus tendon transection with denervation (TT+DN) and then were randomized to a BFR (every 3 days) or control group. At 2 or 6 weeks after surgery, SS muscles were analyzed for mitochondrial transfer, fiber size, and fiber-type distribution. Additionally, forelimb gait and weightbearing were captured using the Blackbox system.RESULTSBFR was associated with increased FAP-mediated mitochondrial transfer in healthy SS muscle as early as 1 day after BFR treatment and lasted for up to 3 days after BFR. The authors observed an enhanced effect of BFR-induced FAP mitochondrial transfer in SS muscle after RC injury, compared with the control, at both 2 and 6 weeks after TT+DN. BFR-treated mice had significantly reduced muscle atrophy, fatty infiltration, and fibrosis after RC injury. They also observed a significant improvement in forepaw weightbearing ratio and ipsilateral forepaw stride length at 6 weeks after injury in BFR-treated mice compared with controls.CONCLUSIONBFR significantly improves muscle quality and shoulder function after RC injury. These effects occur alongside increased mitochondrial transfer from FAPs to myocytes.CLINICAL RELEVANCEUnderstanding the mechanism of BFR by which BFR enhances muscle regeneration could pave the way for its use as a novel rehabilitation strategy to improve recovery in patients with RC injuries and other muscle-related conditions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465261424875"},"PeriodicalIF":0.0,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374238","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 : 2026-03-06DOI: 10.1177/03635465261424876
Peter N Chalmers,John D'Angelo,Kevin Ma,Liz Hebert,Helen Casey,Nikhil Verma,Brandon J Erickson
BACKGROUNDUlnar collateral ligament (UCL) injuries have become common in professional baseball players. It is unclear if elbow arthroscopy to treat posteromedial impingement in these athletes is a precursor to UCL surgery.PURPOSE/HYPOTHESISThe purpose of this study was to determine the outcomes, performance, and future risk of UCL surgery in professional baseball players who underwent elbow arthroscopy with debridement. It was hypothesized that players would see no significant change in performance and would have a >10% chance of future UCL surgery after elbow arthroscopy.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSAll professional baseball players who underwent elbow arthroscopy for debridement between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Demographic and performance data (pre- and postsurgery) for each player were recorded. Future UCL surgery in any of these players was recorded. Performance metrics were then compared between cases and a group of matched controls.RESULTSThere were 354 elbow arthroscopies in players with no history of UCL surgery, of whom 43 (12.1%) underwent UCL surgery after elbow arthroscopy (39 pitchers and 4 position players). For pitchers, the mean time to return to play was 285 ± 185 days, while the mean time to return to the same level of play was 304 ± 201 days. In 8 pitchers (21%), the UCL surgery was performed before they were able to return to play after the arthroscopy, while in 31 pitchers (79%), they returned and then underwent UCL surgery. There was a mean of 2.7 ± 2.8 years (range, 0.2-10.8 years) between arthroscopy and UCL surgery. There were no significant differences in performance data between pre- and postarthroscopy except for fewer balls batted after arthroscopy. When matched to controls, there were significantly fewer balls batted in the arthroscopy group. The risk of future UCL surgery in controls was 10%.CONCLUSIONAfter elbow arthroscopy, professional baseball players saw an improvement in several performance metrics. Risk of future UCL surgery in players who underwent elbow arthroscopy was 12.1%, which was not significantly different from the risk of UCL surgery in control players who had not undergone elbow arthroscopy. Isolated elbow arthroscopy appears to be an effective treatment in professional baseball players without increasing the risk of future UCL surgery.
{"title":"Elbow Arthroscopy and the Risk of Future Ulnar Collateral Ligament Surgery in Professional Baseball Pitchers.","authors":"Peter N Chalmers,John D'Angelo,Kevin Ma,Liz Hebert,Helen Casey,Nikhil Verma,Brandon J Erickson","doi":"10.1177/03635465261424876","DOIUrl":"https://doi.org/10.1177/03635465261424876","url":null,"abstract":"BACKGROUNDUlnar collateral ligament (UCL) injuries have become common in professional baseball players. It is unclear if elbow arthroscopy to treat posteromedial impingement in these athletes is a precursor to UCL surgery.PURPOSE/HYPOTHESISThe purpose of this study was to determine the outcomes, performance, and future risk of UCL surgery in professional baseball players who underwent elbow arthroscopy with debridement. It was hypothesized that players would see no significant change in performance and would have a >10% chance of future UCL surgery after elbow arthroscopy.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSAll professional baseball players who underwent elbow arthroscopy for debridement between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Demographic and performance data (pre- and postsurgery) for each player were recorded. Future UCL surgery in any of these players was recorded. Performance metrics were then compared between cases and a group of matched controls.RESULTSThere were 354 elbow arthroscopies in players with no history of UCL surgery, of whom 43 (12.1%) underwent UCL surgery after elbow arthroscopy (39 pitchers and 4 position players). For pitchers, the mean time to return to play was 285 ± 185 days, while the mean time to return to the same level of play was 304 ± 201 days. In 8 pitchers (21%), the UCL surgery was performed before they were able to return to play after the arthroscopy, while in 31 pitchers (79%), they returned and then underwent UCL surgery. There was a mean of 2.7 ± 2.8 years (range, 0.2-10.8 years) between arthroscopy and UCL surgery. There were no significant differences in performance data between pre- and postarthroscopy except for fewer balls batted after arthroscopy. When matched to controls, there were significantly fewer balls batted in the arthroscopy group. The risk of future UCL surgery in controls was 10%.CONCLUSIONAfter elbow arthroscopy, professional baseball players saw an improvement in several performance metrics. Risk of future UCL surgery in players who underwent elbow arthroscopy was 12.1%, which was not significantly different from the risk of UCL surgery in control players who had not undergone elbow arthroscopy. Isolated elbow arthroscopy appears to be an effective treatment in professional baseball players without increasing the risk of future UCL surgery.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":"3635465261424876"},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368387","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 : 2026-03-06DOI: 10.1177/03635465261426355
Michael Tim-Yun Ong,Tian-Yi Zang,Mingde Cao,Pauline Po-Yee Lui,Bruma Sai-Chuen Fu,Dennis Cham-Kit Wong,Rex Wang-Fung Mak,Jonathan Patrick Ng,Patrick Shu-Hang Yung
BACKGROUNDThe biological healing of the bone tunnel is crucial for success in anterior cruciate ligament reconstruction (ACLR). Nonetheless, conventional imaging cannot assess the key microarchitectural properties of the healing bone, resulting in a gap in our understanding of early recovery.PURPOSE/HYPOTHESISThis study aimed to identify the specific bone structure and density measurements most closely associated with successful recovery during the first 6 months. It was hypothesized that the microarchitectural properties of the bone tunnel, quantified by high-resolution peripheral quantitative computed tomography (HR-pQCT), would be directly correlated with functional and patient-reported outcomes in the early postoperative phase.STUDY DESIGNCohort study; Level of evidence, 2.METHODSIn a prospective cohort study, 50 patients undergoing primary hamstring ACLR were assessed at 4 and 6 months postoperatively. HR-pQCT was used to quantify bone tunnel parameters-including bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and tunnel enlargement ratio. The isokinetic muscle strength test, single-leg hop test, ultrasound muscle thickness assessment, and patient-reported outcomes were assessed for clinical performance. The Spearman correlation was used to examine the relationship between knee joint clinical performance and bone tunnel conditions. Receiver operating characteristic (ROC) analysis was performed to identify predictive thresholds for good functional recovery.RESULTSHR-pQCT data revealed that at 4 months, femoral BV/TV (r = 0.361) and Tb.Th (r = 0.333) were positively correlated with knee extension strength, while the tibial tunnel enlargement ratio was negatively correlated (r = -0.380). Tibial Tb.N (r = 0.339) correlated positively with the International Knee Documentation Committee score, while tibial Tb.Sp (r = -0.367) correlated negatively. Femoral BV/TV at 4 months emerged as a significant predictor of early functional recovery (area under the ROC curve = 0.680; P = .027), with an optimal cutoff value of 0.2607.CONCLUSIONThe microarchitectural quality of the bone tunnel, as assessed by HR-pQCT, is modestly correlated with the early functional recovery after ACLR, particularly at the 4-month postoperative time period.
{"title":"Bone Tunnel Microarchitecture and Early Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Prospective HR-pQCT Cohort Study.","authors":"Michael Tim-Yun Ong,Tian-Yi Zang,Mingde Cao,Pauline Po-Yee Lui,Bruma Sai-Chuen Fu,Dennis Cham-Kit Wong,Rex Wang-Fung Mak,Jonathan Patrick Ng,Patrick Shu-Hang Yung","doi":"10.1177/03635465261426355","DOIUrl":"https://doi.org/10.1177/03635465261426355","url":null,"abstract":"BACKGROUNDThe biological healing of the bone tunnel is crucial for success in anterior cruciate ligament reconstruction (ACLR). Nonetheless, conventional imaging cannot assess the key microarchitectural properties of the healing bone, resulting in a gap in our understanding of early recovery.PURPOSE/HYPOTHESISThis study aimed to identify the specific bone structure and density measurements most closely associated with successful recovery during the first 6 months. It was hypothesized that the microarchitectural properties of the bone tunnel, quantified by high-resolution peripheral quantitative computed tomography (HR-pQCT), would be directly correlated with functional and patient-reported outcomes in the early postoperative phase.STUDY DESIGNCohort study; Level of evidence, 2.METHODSIn a prospective cohort study, 50 patients undergoing primary hamstring ACLR were assessed at 4 and 6 months postoperatively. HR-pQCT was used to quantify bone tunnel parameters-including bone volume/total volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and tunnel enlargement ratio. The isokinetic muscle strength test, single-leg hop test, ultrasound muscle thickness assessment, and patient-reported outcomes were assessed for clinical performance. The Spearman correlation was used to examine the relationship between knee joint clinical performance and bone tunnel conditions. Receiver operating characteristic (ROC) analysis was performed to identify predictive thresholds for good functional recovery.RESULTSHR-pQCT data revealed that at 4 months, femoral BV/TV (r = 0.361) and Tb.Th (r = 0.333) were positively correlated with knee extension strength, while the tibial tunnel enlargement ratio was negatively correlated (r = -0.380). Tibial Tb.N (r = 0.339) correlated positively with the International Knee Documentation Committee score, while tibial Tb.Sp (r = -0.367) correlated negatively. Femoral BV/TV at 4 months emerged as a significant predictor of early functional recovery (area under the ROC curve = 0.680; P = .027), with an optimal cutoff value of 0.2607.CONCLUSIONThe microarchitectural quality of the bone tunnel, as assessed by HR-pQCT, is modestly correlated with the early functional recovery after ACLR, particularly at the 4-month postoperative time period.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"24 1","pages":"3635465261426355"},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147368386","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}
BACKGROUNDPosterolateral tibial fractures (PLTFs) are common concomitant injuries of an anterior cruciate ligament (ACL) rupture resulting in a loss of osseous support of the posterior horn of the lateral meniscus. It is unknown if the additional treatment of the PLTF brings a benefit in the treatment of symptomatic ACL-deficient knees.PURPOSETo evaluate the kinematic effects of various reconstruction states in an ACL-deficient knee with PLTF, compared to the native knee.STUDY DESIGNControlled laboratory study.METHODSEight unpaired knees were tested using a 6 degrees of freedom robotic system equipped with a force-torque sensor in the following states: intact, ACL-deficient, ACL-deficient with PLTF, ACL reconstruction (ACLR) with PLTF, ACLR with lateral extra-articular tenodesis (LET) and PLTF, and ACLR with reconstructed PLTF states. Simulated laxity tests were performed at 0°, 30°, 60°, and 90° of flexion under constant loading: anterior tibial translation (ATT), internal rotation (IR), and external rotation (ER). The simulated pivot-shift (PS) test was performed at 0°, 15°, 30°, and 45° of flexion. A linear mixed model with post hoc Bonferroni corrections for multiple comparisons was performed for statistical analysis.RESULTSCompared with the native state for ATT in 0° to 90°, no ACLR state showed any significant differences. ACLR with reconstructed PLTF compared to the native state presented a significant increase in IR at 60°. ACLR with LET presented a significant reduction of IR at 30° and 90° compared to the native state. In the simulated PS test, the ACLR with reconstructed PLTF showed a significantly higher ATT compared with the native state at 15° to 45°. In comparison, the ACLR with LET showed no significant differences to the native state at 0° to 45°. In line with clinical and biomechanical literature, differences in ATT ≥3 mm and rotational changes ≥3° were considered clinically meaningful thresholds.CONCLUSIONACLR combined with LET provides superior restoration of anterior translational and rotational stability compared to ACLR alone or ACLR with PLTF repair, particularly in the PS test. Based on this biomechanical study, adding PLTF repair to ACLR for PLTFs ≤3 mm does not improve knee stability compared to standard ACLR alone.CLINICAL RELEVANCEFrom a biomechanical point of view, there is no indication that PLTF fragments ≤3 mm should be repaired when performing ACLR.
{"title":"Lateral Extra-articular Tenodesis Provides Superior Stability in ACL Reconstruction With Posterolateral Tibial Fracture.","authors":"Grégoire Thürig,Niklas Braun,Elmar Herbst,Adrian Deichsel,Matthias Klimek,Michael J Raschke,Christoph Kittl","doi":"10.1177/03635465261423212","DOIUrl":"https://doi.org/10.1177/03635465261423212","url":null,"abstract":"BACKGROUNDPosterolateral tibial fractures (PLTFs) are common concomitant injuries of an anterior cruciate ligament (ACL) rupture resulting in a loss of osseous support of the posterior horn of the lateral meniscus. It is unknown if the additional treatment of the PLTF brings a benefit in the treatment of symptomatic ACL-deficient knees.PURPOSETo evaluate the kinematic effects of various reconstruction states in an ACL-deficient knee with PLTF, compared to the native knee.STUDY DESIGNControlled laboratory study.METHODSEight unpaired knees were tested using a 6 degrees of freedom robotic system equipped with a force-torque sensor in the following states: intact, ACL-deficient, ACL-deficient with PLTF, ACL reconstruction (ACLR) with PLTF, ACLR with lateral extra-articular tenodesis (LET) and PLTF, and ACLR with reconstructed PLTF states. Simulated laxity tests were performed at 0°, 30°, 60°, and 90° of flexion under constant loading: anterior tibial translation (ATT), internal rotation (IR), and external rotation (ER). The simulated pivot-shift (PS) test was performed at 0°, 15°, 30°, and 45° of flexion. A linear mixed model with post hoc Bonferroni corrections for multiple comparisons was performed for statistical analysis.RESULTSCompared with the native state for ATT in 0° to 90°, no ACLR state showed any significant differences. ACLR with reconstructed PLTF compared to the native state presented a significant increase in IR at 60°. ACLR with LET presented a significant reduction of IR at 30° and 90° compared to the native state. In the simulated PS test, the ACLR with reconstructed PLTF showed a significantly higher ATT compared with the native state at 15° to 45°. In comparison, the ACLR with LET showed no significant differences to the native state at 0° to 45°. In line with clinical and biomechanical literature, differences in ATT ≥3 mm and rotational changes ≥3° were considered clinically meaningful thresholds.CONCLUSIONACLR combined with LET provides superior restoration of anterior translational and rotational stability compared to ACLR alone or ACLR with PLTF repair, particularly in the PS test. Based on this biomechanical study, adding PLTF repair to ACLR for PLTFs ≤3 mm does not improve knee stability compared to standard ACLR alone.CLINICAL RELEVANCEFrom a biomechanical point of view, there is no indication that PLTF fragments ≤3 mm should be repaired when performing ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465261423212"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350832","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 : 2026-03-05DOI: 10.1177/03635465261428684
Yang Chen,Yexin Li,Dilihumaer Aili,Jiafei Li,Chenyang Zhang,Chunfeng Zhao,Qian Liu
BACKGROUNDHealing of the tendon-bone interface (TBI) after rotator cuff injury is limited, often leading to scar-mediated repair. Decellularized tendon fibrocartilage-bone composite (dTFBC) and bone marrow mesenchymal stem cell sheets (BMSCS) improve repair in preclinical models, but full scaffold encapsulation with mechanical preconditioning remains unexplored.PURPOSETo evaluate TBI regeneration using mechanically preconditioned, BMSCS-encapsulated dTFBC scaffolds in a rabbit model.STUDY DESIGNControlled laboratory study.METHODSA total of 48 male New Zealand White rabbits were randomized into 4 groups (n = 12 each): (1) standard repair (control); (2) repair with dTFBC; (3) repair with dTFBC-BMSCS; and (4) repair with mechanically preconditioned dTFBC-BMSCS (mdTFBC-BMSCS). Healing at 12 weeks was assessed via gross observation, histomorphological and immunohistochemical analyses, and biomechanical testing.RESULTSThe mdTFBC-BMSCS group demonstrated a higher ultimate failure load (mean, 203.9 ± 65.6 N) than both the control (118 ± 37.4 N; P = .003) and dTFBC groups (127 ± 44.1 N; P = .008), with no significant difference between the 2 BMSCS-treated groups. Histological analysis revealed enhanced fibrocartilage formation, improved collagen fiber organization, and reduced inflammation infiltration at the TBI in the mdTFBC-BMSCS group. Immunohistochemical analysis showed greater collagen type 2 alpha 1 chain-, interleukin 10-, and arginase 1-positive areas in the mdTFBC-BMSCS group than in the control and dTFBC groups.CONCLUSIONMechanically preconditioned, fully BMSCS-encapsulated dTFBC scaffolds promoted TBI regeneration, with enhanced cellular integration, fibrocartilage formation, and favorable biomechanical performance.CLINICAL RELEVANCEThis biomimetic scaffold strategy may enhance biological healing and reduce the risk of retear after rotator cuff repair.
背景：肩袖损伤后肌腱-骨界面（TBI）的愈合是有限的，通常导致疤痕介导的修复。脱细胞肌腱纤维-软骨-骨复合材料（dTFBC）和骨髓间充质干细胞片（BMSCS）在临床前模型中改善了修复，但机械预处理的全支架封装仍未被探索。目的评价机械预处理、骨髓间充质干细胞包封的dTFBC支架在兔创伤性脑损伤模型中的再生效果。研究设计：对照实验室研究。方法48只雄性新西兰大白兔随机分为4组（每组12只）：(1)标准修复组（对照组）；(2) dTFBC修复；(3) dTFBC-BMSCS修复；(4)机械预处理dTFBC-BMSCS （mdTFBC-BMSCS）修复。通过大体观察、组织形态学和免疫组织化学分析以及生物力学测试评估12周的愈合情况。结果mdTFBC-BMSCS组的最终衰竭负荷（平均203.9±65.6 N）高于对照组（118±37.4 N, P = 0.003）和dTFBC组（127±44.1 N, P = 0.008），两组间差异无统计学意义。组织学分析显示，mdTFBC-BMSCS组TBI的纤维软骨形成增强，胶原纤维组织改善，炎症浸润减少。免疫组织化学分析显示，mdTFBC-BMSCS组的2型α - 1链、白细胞介素- 10和精氨酸酶1阳性区域大于对照组和dTFBC组。结论机械预处理、完全bmscs包封的dTFBC支架促进TBI再生，增强细胞整合、纤维软骨形成和良好的生物力学性能。临床意义这种仿生支架策略可以增强生物愈合并降低肩袖修复后再撕裂的风险。
{"title":"Mechanically Preconditioned Biomimetic Gradient Scaffold for Tendon-to-Bone Regeneration in a Rabbit Rotator Cuff Tear Model.","authors":"Yang Chen,Yexin Li,Dilihumaer Aili,Jiafei Li,Chenyang Zhang,Chunfeng Zhao,Qian Liu","doi":"10.1177/03635465261428684","DOIUrl":"https://doi.org/10.1177/03635465261428684","url":null,"abstract":"BACKGROUNDHealing of the tendon-bone interface (TBI) after rotator cuff injury is limited, often leading to scar-mediated repair. Decellularized tendon fibrocartilage-bone composite (dTFBC) and bone marrow mesenchymal stem cell sheets (BMSCS) improve repair in preclinical models, but full scaffold encapsulation with mechanical preconditioning remains unexplored.PURPOSETo evaluate TBI regeneration using mechanically preconditioned, BMSCS-encapsulated dTFBC scaffolds in a rabbit model.STUDY DESIGNControlled laboratory study.METHODSA total of 48 male New Zealand White rabbits were randomized into 4 groups (n = 12 each): (1) standard repair (control); (2) repair with dTFBC; (3) repair with dTFBC-BMSCS; and (4) repair with mechanically preconditioned dTFBC-BMSCS (mdTFBC-BMSCS). Healing at 12 weeks was assessed via gross observation, histomorphological and immunohistochemical analyses, and biomechanical testing.RESULTSThe mdTFBC-BMSCS group demonstrated a higher ultimate failure load (mean, 203.9 ± 65.6 N) than both the control (118 ± 37.4 N; P = .003) and dTFBC groups (127 ± 44.1 N; P = .008), with no significant difference between the 2 BMSCS-treated groups. Histological analysis revealed enhanced fibrocartilage formation, improved collagen fiber organization, and reduced inflammation infiltration at the TBI in the mdTFBC-BMSCS group. Immunohistochemical analysis showed greater collagen type 2 alpha 1 chain-, interleukin 10-, and arginase 1-positive areas in the mdTFBC-BMSCS group than in the control and dTFBC groups.CONCLUSIONMechanically preconditioned, fully BMSCS-encapsulated dTFBC scaffolds promoted TBI regeneration, with enhanced cellular integration, fibrocartilage formation, and favorable biomechanical performance.CLINICAL RELEVANCEThis biomimetic scaffold strategy may enhance biological healing and reduce the risk of retear after rotator cuff repair.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"11 1","pages":"3635465261428684"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359327","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 : 2026-03-04DOI: 10.1177/03635465261426334
Kuo Hao,Lingce Kong,Yuepeng Qi,Fei Wang,Huijun Kang
BACKGROUNDTrochlear dysplasia is a critical risk factor for patellar instability, and existing animal models focus on indirect mechanical intervention and fail to replicate its pathological process.PURPOSETo describe a novel trochlear dysplasia model in rats and investigate changes in external morphology and internal architecture of the trochlea in this model.STUDY DESIGNControlled laboratory study.METHODSTwenty immature 4-week-old Sprague-Dawley rats were subjected to targeted injury of the anterior distal femoral epiphysis in the left knee, with the right knee used as the control group. All rats were evaluated by gross observation and micro-computed tomography. Macroscopic measurements included sulcus angle (SA), trochlear groove depth (TGD), trochlear width, medial condylar height, lateral condylar height, medial trochlear inclination (MTI), lateral trochlear inclination (LTI), and trochlear bump height. Trabecular microarchitectural parameters of the distal femoral epiphysis included bone mineral density (BMD), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp).RESULTSThe surgical group exhibited growth arrest at the anterior distal femoral epiphysis and 4 distinct types of trochlear dysplastic manifestations with a flat, shallow trochlea and bump deformity at the entrance of the trochlea, whereas the control group showed normally deepened trochlear grooves. Compared with the control group, the surgical group had significantly larger SA (136.13°± 7.32° vs 122.45°± 8.28°; P = .020) and smaller TGD (0.49 ± 0.15 mm vs 0.67 ± 0.10 mm; P = .033), MTI (17.15°± 7.96° vs 24.32°± 4.27°; P = .018), and LTI (26.72°± 4.72° vs 34.65°± 6.04°; P = .012). No significant differences were observed in BMD, BV/TV, Tb.N, Tb.Th, and Tb.Sp between the 2 groups.CONCLUSIONA novel trochlear dysplasia animal model similar to humans was established in immature rats via targeted injury of the anterior distal femoral epiphysis, which exhibited growth arrest at the anterior distal femoral epiphysis and key pathological features of human trochlear dysplasia.CLINICAL RELEVANCEThe model is a potential platform for investigating the basic mechanisms of trochlear dysplasia and developing therapeutic treatments.
滑车发育不良是髌骨不稳定的重要危险因素，现有的动物模型多集中于间接机械干预，未能复制其病理过程。目的建立一种新型大鼠滑车发育不良模型，观察滑车外部形态和内部结构的变化。研究设计：对照实验室研究。方法选择20只4周龄未成熟的Sprague-Dawley大鼠，采用左膝股骨前远端骨骺定向损伤，右膝为对照组。所有大鼠均采用大体观察和显微计算机断层扫描进行评估。宏观测量包括沟角（SA）、滑车沟深度（TGD）、滑车宽度、内侧髁高度、外侧髁高度、内侧滑车倾斜度（MTI）、外侧滑车倾斜度（LTI）、滑车碰撞高度。股骨远端骨骺骨小梁微结构参数包括骨密度（BMD）、骨体积分数（BV/TV）、骨小梁数(Tb。N)，小梁厚度（Tb）。Th)和小梁间距（Tb.Sp）。结果手术组股骨远端骨骺前部生长停止，滑车发育异常表现为滑车扁平、浅、滑车入口凹凸畸形，4种不同类型，对照组滑车沟正常加深。与对照组相比，手术组SA（136.13°±7.32°）比122.45°±8.28°（P = 0.020）明显增大，TGD（0.49±0.15 mm）比0.67±0.10 mm （P = 0.033）、MTI（17.15°±7.96°）比24.32°±4.27°（P = 0.018）、LTI（26.72°±4.72°比34.65°±6.04°）明显减小。BMD、BV/TV、Tb均无显著差异。N,结核病。Th和Tb。两组之间的Sp。结论通过对股骨前远端骨骺的靶向损伤，在未成熟大鼠身上建立了一种类似于人类的新型滑车发育不良动物模型，该模型具有股骨前远端骨骺生长停止和人类滑车发育不良的关键病理特征。该模型为研究滑车发育不良的基本机制和开发治疗方法提供了一个潜在的平台。
{"title":"A Novel Trochlear Dysplasia Model in Immature Rats via Targeted Injury of the Anterior Distal Femoral Epiphysis.","authors":"Kuo Hao,Lingce Kong,Yuepeng Qi,Fei Wang,Huijun Kang","doi":"10.1177/03635465261426334","DOIUrl":"https://doi.org/10.1177/03635465261426334","url":null,"abstract":"BACKGROUNDTrochlear dysplasia is a critical risk factor for patellar instability, and existing animal models focus on indirect mechanical intervention and fail to replicate its pathological process.PURPOSETo describe a novel trochlear dysplasia model in rats and investigate changes in external morphology and internal architecture of the trochlea in this model.STUDY DESIGNControlled laboratory study.METHODSTwenty immature 4-week-old Sprague-Dawley rats were subjected to targeted injury of the anterior distal femoral epiphysis in the left knee, with the right knee used as the control group. All rats were evaluated by gross observation and micro-computed tomography. Macroscopic measurements included sulcus angle (SA), trochlear groove depth (TGD), trochlear width, medial condylar height, lateral condylar height, medial trochlear inclination (MTI), lateral trochlear inclination (LTI), and trochlear bump height. Trabecular microarchitectural parameters of the distal femoral epiphysis included bone mineral density (BMD), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp).RESULTSThe surgical group exhibited growth arrest at the anterior distal femoral epiphysis and 4 distinct types of trochlear dysplastic manifestations with a flat, shallow trochlea and bump deformity at the entrance of the trochlea, whereas the control group showed normally deepened trochlear grooves. Compared with the control group, the surgical group had significantly larger SA (136.13°± 7.32° vs 122.45°± 8.28°; P = .020) and smaller TGD (0.49 ± 0.15 mm vs 0.67 ± 0.10 mm; P = .033), MTI (17.15°± 7.96° vs 24.32°± 4.27°; P = .018), and LTI (26.72°± 4.72° vs 34.65°± 6.04°; P = .012). No significant differences were observed in BMD, BV/TV, Tb.N, Tb.Th, and Tb.Sp between the 2 groups.CONCLUSIONA novel trochlear dysplasia animal model similar to humans was established in immature rats via targeted injury of the anterior distal femoral epiphysis, which exhibited growth arrest at the anterior distal femoral epiphysis and key pathological features of human trochlear dysplasia.CLINICAL RELEVANCEThe model is a potential platform for investigating the basic mechanisms of trochlear dysplasia and developing therapeutic treatments.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465261426334"},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350689","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 : 2026-03-02DOI: 10.1177/03635465261422619
Tyler D Perleberg,Joseph T Featherall,Taylor K Calibo,Justin Hollenbeck,Madeline Blankenship,Onur Hapa,Jonathan A Godin,Marc J Philippon
BACKGROUNDGluteus medius tears are an increasingly recognized cause of lateral hip pain in active individuals, yet no gold standard repair technique has been established, and failure and retear rates remain high. Iliotibial band (ITB) graft augmentation is a validated option in rotator cuff and hip labral repairs for stronger repair construct, but its biomechanical utility in gluteus medius repairs has not been investigated.HYPOTHESISIt was hypothesized that ITB-augmented gluteus medius repairs would demonstrate superior ultimate load to failure and increased repair stiffness as compared with nonaugmented repairs.STUDY DESIGNControlled laboratory study.METHODSFourteen unpaired fresh-frozen cadaveric hemipelvises with intact gluteus medius tendons were randomized into ITB-augmented and nonaugmented groups and tested biomechanically with a tensile testing machine. Native stiffness was assessed as follows: 10-N preload for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing, followed by a quasistatic load to 60 N at 1 mm/s. Tendons were then elevated from their anatomic footprint on the greater trochanter and repaired using double-row suture bridge configurations, with augmented repair incorporating ITB graft fixation. After preconditioning (10 N for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing), specimens were loaded to failure at a constant displacement rate of 31 mm/min. Failure load, repair stiffness, and mode of failure were recorded. Data analysis included Shapiro-Wilk test, independent samples 2-tailed t tests, and paired t tests.RESULTSITB-augmented repairs demonstrated a 98% stronger failure load (mean ± SD, 294.6 ± 87.9 N) than nonaugmented repairs (149.0 ± 40.4 N; P = .002) and were significantly less stiff to their native state (28.1 ± 6.7 vs 137.6 ± 98.1 N/mm; P = .023). The stiffnesses of the native tendons were not different from each other (P = .773).CONCLUSIONGluteus medius repairs augmented with ITB grafts led to greater failure load than nonaugmented repairs and were less stiff than the native state.CLINICAL RELEVANCEUtilization of ITB-augmented double-row repairs when treating tears of the gluteus medius tendon can potentially reduce high failure rates.
背景：臀中肌撕裂越来越被认为是运动个体髋外侧疼痛的原因，但目前还没有建立起黄金标准的修复技术，而且失败率和再入率仍然很高。髂胫束（ITB）移植物增强是一种有效的选择，用于肩袖和髋唇修复，以获得更强的修复结构，但其在臀中肌修复中的生物力学应用尚未研究。假设与非增强修复相比，itb增强的臀中肌修复表现出更好的极限负荷和更高的修复刚度。研究设计：对照实验室研究。方法将14例未配对的新鲜冷冻尸体半骨盆与完整的臀中肌腱随机分为itb增强组和非itb增强组，用拉力试验机进行生物力学试验。原生刚度的评估方法如下：10-N预加载2分钟，从10到125 N在0.8 Hz下循环150次，以模拟早期部分承重，然后以1毫米/秒的速度加载到60 N。然后将肌腱从大转子上的解剖足迹中抬起，使用双排缝合桥配置进行修复，并结合ITB移植物固定进行增强修复。预处理后（10 N， 2分钟，从10到125 N，在0.8 Hz下循环150次，模拟早期部分负重），试样以恒定的位移速率31 mm/min加载至失效。记录失效载荷、修复刚度和失效模式。数据分析采用Shapiro-Wilk检验、独立样本双尾t检验和配对t检验。结果sitb增强修复体的失效载荷（平均±SD， 294.6±87.9 N）比非增强修复体（149.0±40.4 N, P = 0.002）高98%，其硬度明显低于原始状态（28.1±6.7 vs 137.6±98.1 N/mm, P = 0.023）。原生肌腱的刚度差异无统计学意义（P = .773）。结论：与非增广修复体相比，经移植物增强的中黄肌修复体具有更大的失效负荷，且其僵硬程度低于原生状态。临床意义在治疗臀中肌腱撕裂时，应用itb增强双排修复术可以潜在地降低高失败率。
{"title":"A Biomechanical Comparison of Gluteus Medius Repair With and Without Iliotibial Band Autograft Augmentation.","authors":"Tyler D Perleberg,Joseph T Featherall,Taylor K Calibo,Justin Hollenbeck,Madeline Blankenship,Onur Hapa,Jonathan A Godin,Marc J Philippon","doi":"10.1177/03635465261422619","DOIUrl":"https://doi.org/10.1177/03635465261422619","url":null,"abstract":"BACKGROUNDGluteus medius tears are an increasingly recognized cause of lateral hip pain in active individuals, yet no gold standard repair technique has been established, and failure and retear rates remain high. Iliotibial band (ITB) graft augmentation is a validated option in rotator cuff and hip labral repairs for stronger repair construct, but its biomechanical utility in gluteus medius repairs has not been investigated.HYPOTHESISIt was hypothesized that ITB-augmented gluteus medius repairs would demonstrate superior ultimate load to failure and increased repair stiffness as compared with nonaugmented repairs.STUDY DESIGNControlled laboratory study.METHODSFourteen unpaired fresh-frozen cadaveric hemipelvises with intact gluteus medius tendons were randomized into ITB-augmented and nonaugmented groups and tested biomechanically with a tensile testing machine. Native stiffness was assessed as follows: 10-N preload for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing, followed by a quasistatic load to 60 N at 1 mm/s. Tendons were then elevated from their anatomic footprint on the greater trochanter and repaired using double-row suture bridge configurations, with augmented repair incorporating ITB graft fixation. After preconditioning (10 N for 2 minutes, 150 cycles at 0.8 Hz from 10 to 125 N to simulate early partial weightbearing), specimens were loaded to failure at a constant displacement rate of 31 mm/min. Failure load, repair stiffness, and mode of failure were recorded. Data analysis included Shapiro-Wilk test, independent samples 2-tailed t tests, and paired t tests.RESULTSITB-augmented repairs demonstrated a 98% stronger failure load (mean ± SD, 294.6 ± 87.9 N) than nonaugmented repairs (149.0 ± 40.4 N; P = .002) and were significantly less stiff to their native state (28.1 ± 6.7 vs 137.6 ± 98.1 N/mm; P = .023). The stiffnesses of the native tendons were not different from each other (P = .773).CONCLUSIONGluteus medius repairs augmented with ITB grafts led to greater failure load than nonaugmented repairs and were less stiff than the native state.CLINICAL RELEVANCEUtilization of ITB-augmented double-row repairs when treating tears of the gluteus medius tendon can potentially reduce high failure rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":"3635465261422619"},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329260","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 : 2026-03-02DOI: 10.1177/03635465261422717
Pavithr S Goli,Daniel C Touhey,Robert H Brophy,Matthew J Matava,Matthew V Smith,Derrick M Knapik
BACKGROUNDManagement of tibial plateau osteochondral (TP-OC) lesions remains challenging due to limited reported treatment options and outcomes.PURPOSETo systematically review the literature to better understand current operative indications, techniques, and outcomes for TP-OC lesions.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSStudies reporting on the treatment of TP-OC lesions from inception to August 2025 were identified using the Cochrane Library, EMBASE, and PubMed databases. Inclusion criteria included studies reporting on patients undergoing operative management with injury cause, lesion size and location, reported technique (repair vs restoration), and postoperative outcomes, including complications and patient-reported outcome measures (PROMs).RESULTSA total of 24 studies, consisting of 581 patients (mean age, 42.2 years; range, 12-77 years), were identified. Weighted mean follow-up was 106.0 months (range, 3-408 months). Traumatic injury was reported in 82.6% (n = 256/310) of patients. Lesions were most commonly located on the lateral tibial plateau (65.8%; n = 340/517), with a weighted mean lesion area of 2.29 cm2 (range, 0.80-6.00 cm2). Operative treatments included osteochondral allograft transplant (OCAT) (80.2%; n = 466/581), microfracture (6.7%; n = 39/581), osteochondral autograft transfer (OAT) (6.4%; n = 37/581), autologous chondrocyte implant (4.8%; n = 28/581), and osteochondral scaffold placement (1.9%; n = 11/581). Meniscal allograft transplant (MAT) was the most common concomitant procedure, reported in 54.0% (n = 210/389) of patients. Treatment failure, including graft failure, was the most common postoperative complication, reported in 26.0% (n = 106/408) of patients. Specifically, failure occurred in 30.1% (n = 96/318) of patients undergoing OCAT, 6.3% (n = 1/16) undergoing microfracture, and 6.3% (n = 2/32) undergoing OAT. Improvements in weighted mean PROM scores were reported for International Knee Documentation Committee (from 39.5 to 66.2), Lysholm (from 62.1 to 91.7), and Tegner (from 3.6 to 5.9) scores.CONCLUSIONTibial plateau osteochondral lesions most commonly occurred secondary to trauma and frequently involved the lateral compartment. OCAT was the most frequently performed surgical treatment, whereas MAT was the most commonly performed concomitant procedure. Improvements were noted in several PROMs. Graft failure was the most frequently reported complication, reported in 30% of patients after OCAT.
{"title":"Management of Osteochondral Lesions of the Tibial Plateau: A Systematic Review of Operative Techniques and Reported Outcomes.","authors":"Pavithr S Goli,Daniel C Touhey,Robert H Brophy,Matthew J Matava,Matthew V Smith,Derrick M Knapik","doi":"10.1177/03635465261422717","DOIUrl":"https://doi.org/10.1177/03635465261422717","url":null,"abstract":"BACKGROUNDManagement of tibial plateau osteochondral (TP-OC) lesions remains challenging due to limited reported treatment options and outcomes.PURPOSETo systematically review the literature to better understand current operative indications, techniques, and outcomes for TP-OC lesions.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSStudies reporting on the treatment of TP-OC lesions from inception to August 2025 were identified using the Cochrane Library, EMBASE, and PubMed databases. Inclusion criteria included studies reporting on patients undergoing operative management with injury cause, lesion size and location, reported technique (repair vs restoration), and postoperative outcomes, including complications and patient-reported outcome measures (PROMs).RESULTSA total of 24 studies, consisting of 581 patients (mean age, 42.2 years; range, 12-77 years), were identified. Weighted mean follow-up was 106.0 months (range, 3-408 months). Traumatic injury was reported in 82.6% (n = 256/310) of patients. Lesions were most commonly located on the lateral tibial plateau (65.8%; n = 340/517), with a weighted mean lesion area of 2.29 cm2 (range, 0.80-6.00 cm2). Operative treatments included osteochondral allograft transplant (OCAT) (80.2%; n = 466/581), microfracture (6.7%; n = 39/581), osteochondral autograft transfer (OAT) (6.4%; n = 37/581), autologous chondrocyte implant (4.8%; n = 28/581), and osteochondral scaffold placement (1.9%; n = 11/581). Meniscal allograft transplant (MAT) was the most common concomitant procedure, reported in 54.0% (n = 210/389) of patients. Treatment failure, including graft failure, was the most common postoperative complication, reported in 26.0% (n = 106/408) of patients. Specifically, failure occurred in 30.1% (n = 96/318) of patients undergoing OCAT, 6.3% (n = 1/16) undergoing microfracture, and 6.3% (n = 2/32) undergoing OAT. Improvements in weighted mean PROM scores were reported for International Knee Documentation Committee (from 39.5 to 66.2), Lysholm (from 62.1 to 91.7), and Tegner (from 3.6 to 5.9) scores.CONCLUSIONTibial plateau osteochondral lesions most commonly occurred secondary to trauma and frequently involved the lateral compartment. OCAT was the most frequently performed surgical treatment, whereas MAT was the most commonly performed concomitant procedure. Improvements were noted in several PROMs. Graft failure was the most frequently reported complication, reported in 30% of patients after OCAT.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":"3635465261422717"},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329261","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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