Pub Date : 2024-10-14DOI: 10.1177/03635465241283463
Angelo Boffa,Luca De Marziani,Luca Andriolo,Alessandro Di Martino,Iacopo Romandini,Stefano Zaffagnini,Giuseppe Filardo
BACKGROUNDPlatelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients' clinical outcomes.PURPOSETo analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA.STUDY DESIGNCohort study; Level of evidence, 3.METHODSThis study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures.RESULTSAn overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months (P = .036; rho = 0.132), 6 months (P = .009; rho = 0.165), and 12 months (P = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events.CONCLUSIONThis study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.
{"title":"Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis.","authors":"Angelo Boffa,Luca De Marziani,Luca Andriolo,Alessandro Di Martino,Iacopo Romandini,Stefano Zaffagnini,Giuseppe Filardo","doi":"10.1177/03635465241283463","DOIUrl":"https://doi.org/10.1177/03635465241283463","url":null,"abstract":"BACKGROUNDPlatelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients' clinical outcomes.PURPOSETo analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA.STUDY DESIGNCohort study; Level of evidence, 3.METHODSThis study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures.RESULTSAn overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months (P = .036; rho = 0.132), 6 months (P = .009; rho = 0.165), and 12 months (P = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events.CONCLUSIONThis study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"84 1","pages":"3635465241283463"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436029","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 : 2024-10-14DOI: 10.1177/03635465241283054
Peter K Kriz,John P Kriz,Sarah B Willwerth,Danielle L Hunt,Michael A Beasley,Cynthia J Stein,Lyle J Micheli,Michael J O'Brien,Daniel J Hedequist,William P Meehan
BACKGROUNDRecent studies utilizing magnetic resonance imaging (MRI) for the evaluation of symptomatic lumbar spondylolysis in pediatric and adolescent athletes have indicated that upper level lumbar involvement has a higher incidence than previously reported. There has been a paucity of literature evaluating sport-specific patterns of lumbar spondylolysis, specifically upper versus lower level involvement.PURPOSETo assess the potential risk factors for upper level stress injuries of the lumbar spine in pediatric and adolescent athletes.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThe medical records of 902 pediatric and adolescent athletes (364 female, 538 male; mean age, 14.5 ± 2.1 years) diagnosed with symptomatic pedicle and pars interarticularis stress injuries at 2 academic medical centers (July 2016 to June 2021) were reviewed. All patients had undergone MRI at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding single-sport specialization, sport participation, sport category by biomechanics (axial rotation vs extension/axial loading), and vertebral level of injury over the 5-year period were analyzed. Stress reaction or active spondylolysis (SRAS) was the terminology used to designate grade 1, 2a, or 3 stress injuries according to the adapted Hollenberg classification system on MRI. Upper level vertebrae were defined as L3 or superior, whereas lower level vertebrae included L4 or inferior.RESULTSOf the 902 patients with SRAS injuries, most (n = 753 [83.5%]) had exclusively single-level lower stress injuries, while 67 (7.4%) had multilevel stress injuries. There were 82 athletes (9.1%) who had single-level upper stress injuries. Athletes with upper level pars/pedicle stress injuries were older at the time of diagnosis (15.8 ± 1.9 vs 14.3 ± 2.1 years, respectively; P < .001), had a shorter duration of low back pain before presentation (2.50 ± 2.70 vs 4.14 ± 6.73 months, respectively; P < .001), were more likely to specialize in a single sport (43.9% vs 32.3%, respectively; P = .046), and had a lower incidence of active spondylolysis on MRI at the time of diagnosis (42.7% vs 59.8%, respectively; P = .004) compared with athletes with lower level stress injuries. Athletes with lumbar stress injuries who specialized in a single sport had nearly twice the odds of having upper level involvement compared with multiple-sport athletes (adjusted odds ratio, 1.80 [95% CI, 1.06-3.04]; P = .03). Athletes with active spondylolysis on MRI at the time of diagnosis had nearly half the odds of having upper level involvement (adjusted odds ratio, 0.55 [95% CI, 0.33-0.91]; P = .02).CONCLUSIONAge at the time of diagnosis, duration of low back pain, single-sport specialization, and presence/absence of active spondylolysis on MRI at the time of diagnosis were primary predictors of whether an athlete's lumbar stress injury was classified as either upper or lower level involvement. Overall, the variable
{"title":"Characteristics of Lumbar Pars Interarticularis and Pedicle Stress Injuries by Sport in 902 Pediatric and Adolescent Athletes: A Retrospective Study.","authors":"Peter K Kriz,John P Kriz,Sarah B Willwerth,Danielle L Hunt,Michael A Beasley,Cynthia J Stein,Lyle J Micheli,Michael J O'Brien,Daniel J Hedequist,William P Meehan","doi":"10.1177/03635465241283054","DOIUrl":"https://doi.org/10.1177/03635465241283054","url":null,"abstract":"BACKGROUNDRecent studies utilizing magnetic resonance imaging (MRI) for the evaluation of symptomatic lumbar spondylolysis in pediatric and adolescent athletes have indicated that upper level lumbar involvement has a higher incidence than previously reported. There has been a paucity of literature evaluating sport-specific patterns of lumbar spondylolysis, specifically upper versus lower level involvement.PURPOSETo assess the potential risk factors for upper level stress injuries of the lumbar spine in pediatric and adolescent athletes.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThe medical records of 902 pediatric and adolescent athletes (364 female, 538 male; mean age, 14.5 ± 2.1 years) diagnosed with symptomatic pedicle and pars interarticularis stress injuries at 2 academic medical centers (July 2016 to June 2021) were reviewed. All patients had undergone MRI at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding single-sport specialization, sport participation, sport category by biomechanics (axial rotation vs extension/axial loading), and vertebral level of injury over the 5-year period were analyzed. Stress reaction or active spondylolysis (SRAS) was the terminology used to designate grade 1, 2a, or 3 stress injuries according to the adapted Hollenberg classification system on MRI. Upper level vertebrae were defined as L3 or superior, whereas lower level vertebrae included L4 or inferior.RESULTSOf the 902 patients with SRAS injuries, most (n = 753 [83.5%]) had exclusively single-level lower stress injuries, while 67 (7.4%) had multilevel stress injuries. There were 82 athletes (9.1%) who had single-level upper stress injuries. Athletes with upper level pars/pedicle stress injuries were older at the time of diagnosis (15.8 ± 1.9 vs 14.3 ± 2.1 years, respectively; P < .001), had a shorter duration of low back pain before presentation (2.50 ± 2.70 vs 4.14 ± 6.73 months, respectively; P < .001), were more likely to specialize in a single sport (43.9% vs 32.3%, respectively; P = .046), and had a lower incidence of active spondylolysis on MRI at the time of diagnosis (42.7% vs 59.8%, respectively; P = .004) compared with athletes with lower level stress injuries. Athletes with lumbar stress injuries who specialized in a single sport had nearly twice the odds of having upper level involvement compared with multiple-sport athletes (adjusted odds ratio, 1.80 [95% CI, 1.06-3.04]; P = .03). Athletes with active spondylolysis on MRI at the time of diagnosis had nearly half the odds of having upper level involvement (adjusted odds ratio, 0.55 [95% CI, 0.33-0.91]; P = .02).CONCLUSIONAge at the time of diagnosis, duration of low back pain, single-sport specialization, and presence/absence of active spondylolysis on MRI at the time of diagnosis were primary predictors of whether an athlete's lumbar stress injury was classified as either upper or lower level involvement. Overall, the variable","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"97 1","pages":"3635465241283054"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436027","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}
BACKGROUNDThe effectiveness and safety of matrix-associated autologous chondrocyte implantation with an autologous periosteal flap (pMACI) remain unclear. The Japanese Ministry of Health, Labor, and Welfare requires postmarketing surveillance of all patients undergoing pMACI using the tissue-engineered product JACC.PURPOSETo evaluate the effectiveness and safety of pMACI for large articular cartilage defects (≥4 cm2) in the knee joint using real-world data analysis.STUDY DESIGNCase series; Level of evidence, 4.METHODSData were collected from patients who underwent pMACI between 2012 and 2019, with 2 years of follow-up. The primary outcomes were the Lysholm knee score and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months. Adverse events were assessed by physical examination, magnetic resonance imaging, and/or arthroscopy.RESULTSOverall, 232 knees in 225 patients who presented with trauma (198 knees) or osteochondritis dissecans (34 knees) in the medial (132 knees) and lateral (44 knees) femoral condyle, patella (25 knees), trochlea (86 knees), and tibial plateau (4 knees) were included. The mean age of the patients was 40.9 ± 15.0 years, with mean cartilage defects of 5.6 ± 2.4 cm2 in size. Concomitant surgeries, such as osteotomy (50 knees), ligament reconstruction (27 knees), meniscal procedures (28 knees), osteochondral autograft transplantation (24 knees), and microfracture (14 knees), were performed in 113 (48.7%) knees. The minimal clinically important difference in the Lysholm knee score and KOOS Symptoms subscale was achieved in 79.7% and 63.5% of patients, respectively, and the Patient Acceptable Symptom State was achieved in 90.1% and 73.7%, respectively. Substantial clinical benefit was achieved in the KOOS Sports/Recreation and Quality of Life subscales at 39.6% and 37.8%, respectively. Knees that underwent concomitant microfracture had significantly worse KOOS values than the remainder of the cohort. Complications, including effusion (16.8%), graft delamination (14.7%), knee contracture (9.1%), graft hypertrophy (8.2%), and ossification (3.4%), were observed in 86 (37.1%) knees. Osteochondritis dissecans was significantly associated with graft hypertrophy and ossification, whereas concomitant surgery was significantly associated with delamination and contracture. Treatment failure required additional cartilage procedures in 11 (4.7%) knees.CONCLUSIONTreatment of large cartilage defects (≥4 cm2) with pMACI resulted in improved outcome scores in approximately 75% of patients. However, complications occurred in one-third of patients, and 4.7% required reoperation.
{"title":"Effectiveness and Safety of Matrix-Associated Autologous Chondrocyte Implantation for the Treatment of Articular Cartilage Defects: A Real-World Data Analysis in Japan.","authors":"Yuji Uchio,Ryosuke Kuroda,Yasuo Niki,Katsura Sugawara,Yasuyuki Ishibashi","doi":"10.1177/03635465241282671","DOIUrl":"https://doi.org/10.1177/03635465241282671","url":null,"abstract":"BACKGROUNDThe effectiveness and safety of matrix-associated autologous chondrocyte implantation with an autologous periosteal flap (pMACI) remain unclear. The Japanese Ministry of Health, Labor, and Welfare requires postmarketing surveillance of all patients undergoing pMACI using the tissue-engineered product JACC.PURPOSETo evaluate the effectiveness and safety of pMACI for large articular cartilage defects (≥4 cm2) in the knee joint using real-world data analysis.STUDY DESIGNCase series; Level of evidence, 4.METHODSData were collected from patients who underwent pMACI between 2012 and 2019, with 2 years of follow-up. The primary outcomes were the Lysholm knee score and Knee injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months. Adverse events were assessed by physical examination, magnetic resonance imaging, and/or arthroscopy.RESULTSOverall, 232 knees in 225 patients who presented with trauma (198 knees) or osteochondritis dissecans (34 knees) in the medial (132 knees) and lateral (44 knees) femoral condyle, patella (25 knees), trochlea (86 knees), and tibial plateau (4 knees) were included. The mean age of the patients was 40.9 ± 15.0 years, with mean cartilage defects of 5.6 ± 2.4 cm2 in size. Concomitant surgeries, such as osteotomy (50 knees), ligament reconstruction (27 knees), meniscal procedures (28 knees), osteochondral autograft transplantation (24 knees), and microfracture (14 knees), were performed in 113 (48.7%) knees. The minimal clinically important difference in the Lysholm knee score and KOOS Symptoms subscale was achieved in 79.7% and 63.5% of patients, respectively, and the Patient Acceptable Symptom State was achieved in 90.1% and 73.7%, respectively. Substantial clinical benefit was achieved in the KOOS Sports/Recreation and Quality of Life subscales at 39.6% and 37.8%, respectively. Knees that underwent concomitant microfracture had significantly worse KOOS values than the remainder of the cohort. Complications, including effusion (16.8%), graft delamination (14.7%), knee contracture (9.1%), graft hypertrophy (8.2%), and ossification (3.4%), were observed in 86 (37.1%) knees. Osteochondritis dissecans was significantly associated with graft hypertrophy and ossification, whereas concomitant surgery was significantly associated with delamination and contracture. Treatment failure required additional cartilage procedures in 11 (4.7%) knees.CONCLUSIONTreatment of large cartilage defects (≥4 cm2) with pMACI resulted in improved outcome scores in approximately 75% of patients. However, complications occurred in one-third of patients, and 4.7% required reoperation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"31 1","pages":"3635465241282671"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436036","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 : 2024-10-12DOI: 10.1177/03635465241282342
Jacob F. Oeding, William R. Schulz, Allen S. Wang, Aaron J. Krych, Dean C. Taylor, Kristian Samuelsson, Christopher L. Camp, Adam J. Tagliero
Background:Value-based decision-making regarding nonoperative management versus early surgical stabilization for first-time anterior shoulder instability (ASI) events remains understudied.Purpose:To perform (1) a systematic review of the current literature and (2) a Markov model–based cost-effectiveness analysis comparing an initial trial of nonoperative management to arthroscopic Bankart repair (ABR) for first-time ASI.Study Design:Economic and decision analysis; Level of evidence, 3.Methods:A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients (mean age, 20 years; range, 12-26 years) with first-time ASI undergoing nonoperative management versus ABR. Utility values, recurrence rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors’ institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER).Results:The Markov model with Monte Carlo microsimulation demonstrated mean (± standard deviation) 10-year costs for nonoperative management and ABR of $38,649 ± $10,521 and $43,052 ± $9352, respectively. Total QALYs acquired over the 10-year time horizon were 7.67 ± 0.43 and 8.44 ± 0.46 for nonoperative management and ABR, respectively. The ICER comparing ABR with nonoperative management was found to be just $5725/QALY, which falls substantially below the $50,000 willingness-to-pay (WTP) threshold. The mean numbers of recurrences were 2.55 ± 0.31 and 1.17 ± 0.18 for patients initially assigned to the nonoperative and ABR treatment groups, respectively. Of 1000 samples run over 1000 trials, ABR was the optimal strategy in 98.7% of cases, with nonoperative management the optimal strategy in 1.3% of cases.Conclusion:ABR reduces the risk for recurrent dislocations and is more cost-effective despite higher upfront costs when compared with nonoperative management for first-time ASI in the young patient. While all these factors are important to consider in surgical decision-making, ultimate treatment decisions should be made on an individual basis and occur through a shared decision-making process.
{"title":"Comparing Recurrence Rates and Cost-Effectiveness of Arthroscopic Labral Repair and Nonoperative Management for Primary Anterior Shoulder Dislocations in Young Patients","authors":"Jacob F. Oeding, William R. Schulz, Allen S. Wang, Aaron J. Krych, Dean C. Taylor, Kristian Samuelsson, Christopher L. Camp, Adam J. Tagliero","doi":"10.1177/03635465241282342","DOIUrl":"https://doi.org/10.1177/03635465241282342","url":null,"abstract":"Background:Value-based decision-making regarding nonoperative management versus early surgical stabilization for first-time anterior shoulder instability (ASI) events remains understudied.Purpose:To perform (1) a systematic review of the current literature and (2) a Markov model–based cost-effectiveness analysis comparing an initial trial of nonoperative management to arthroscopic Bankart repair (ABR) for first-time ASI.Study Design:Economic and decision analysis; Level of evidence, 3.Methods:A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients (mean age, 20 years; range, 12-26 years) with first-time ASI undergoing nonoperative management versus ABR. Utility values, recurrence rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors’ institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER).Results:The Markov model with Monte Carlo microsimulation demonstrated mean (± standard deviation) 10-year costs for nonoperative management and ABR of $38,649 ± $10,521 and $43,052 ± $9352, respectively. Total QALYs acquired over the 10-year time horizon were 7.67 ± 0.43 and 8.44 ± 0.46 for nonoperative management and ABR, respectively. The ICER comparing ABR with nonoperative management was found to be just $5725/QALY, which falls substantially below the $50,000 willingness-to-pay (WTP) threshold. The mean numbers of recurrences were 2.55 ± 0.31 and 1.17 ± 0.18 for patients initially assigned to the nonoperative and ABR treatment groups, respectively. Of 1000 samples run over 1000 trials, ABR was the optimal strategy in 98.7% of cases, with nonoperative management the optimal strategy in 1.3% of cases.Conclusion:ABR reduces the risk for recurrent dislocations and is more cost-effective despite higher upfront costs when compared with nonoperative management for first-time ASI in the young patient. While all these factors are important to consider in surgical decision-making, ultimate treatment decisions should be made on an individual basis and occur through a shared decision-making process.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142415645","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:Distal femoral varus osteotomy (DFVO) is an established surgical procedure for addressing valgus malalignment across various knee conditions. However, the effect of DFVO on stress distribution within the femorotibial joint has not been explored through in vivo studies.Purpose:To (1) explore the distribution pattern of subchondral bone density across the proximal tibia in nonarthritic knees without arthritis and in those of patients with valgus knees, (2) assess changes in the pattern of bone density distribution in patients with valgus knees before and after medial closing-wedge (MCW) DFVO, and (3) determine the correlation between leg alignment and changes in bone density distribution.Study Design:Cohort study; Level of evidence, 3.Methods:The authors retrospectively analyzed clinical and radiographic data from 14 patients (14 knees; mean age, 44 years; 3 men, 11 women) treated with MCW-DFVO for lateral compartment osteoarthritis (OA) due to valgus malalignment, alongside a control group of 18 patients (18 knees; mean age, 21 years; 4 men, 14 women) without OA. The distribution patterns of subchondral bone density distribution on the femorotibial articular surface of the tibia were examined both preoperatively and >1 year postoperatively using computed tomography osteoabsorptiometry. Quantitative analyses were conducted on the locations and percentages of the high-density areas (HDAs) on the articular surface. The mean time between surgery and the postoperative radiograph and computed tomography absorptiometry imaging was 13.6 months (range, 11-19 months). The mean length of clinical follow-up was 28.7 months (range, 14-62 months) after surgery.Results:The mean proportion of HDA in the lateral compartment relative to the total HDA (lateral ratio) was significantly greater in the preoperative OA group (58.8%) compared with the control group (41.1%) ( P < .001). After MCW-DFVO, the mean lateral ratio in the OA group notably declined to 45.3% ( P < .001). The lateral ratio exhibited a significant correlation with the hip-knee-ankle angle in both the control ( r = 0.630; P = .011) and OA ( r = 0.537; P = .047) groups. Moreover, the alteration in the lateral ratio after MCW-DFVO showed a significant relationship with changes in the hip-knee-ankle angle ( r = 0.742; P = .002) and the mechanical lateral distal femoral angle ( r = −0.752; P = .002). Within the lateral compartment, HDAs in the 3 lateral regions of the 4 lateral subregions diminished after MCW-DFVO, whereas in the medial compartment, HDAs in the 3 lateral subregions saw an increase.Conclusion:The mean lateral ratio was significantly greater in the preoperative OA group compared with the control group. MCW-DFVO resulted in a redistribution of HDA from the lateral to the medial compartment of the proximal tibial articular surface. The extent of alignment correction after MCW-DFVO was closely linked to the shifts in HDA distribution, reflecting changes in stress distribut
背景：股骨远端外翻截骨术（DFVO）是治疗各种膝关节外翻错位的成熟手术方法。然而，股骨远端外翻截骨术对股胫关节内应力分布的影响尚未通过活体研究进行探讨。目的：(1)探讨无关节炎的非关节炎膝关节和膝内翻患者胫骨近端软骨下骨密度的分布模式；(2)评估膝内翻患者在内侧闭合楔（MCW）DFVO前后骨密度分布模式的变化；(3)确定腿部排列与骨密度分布变化之间的相关性。研究设计：队列研究；证据级别：3。方法：作者回顾性分析了14名患者（14个膝关节；平均年龄44岁；3名男性，11名女性）的临床和影像学数据，这些患者因膝关节外翻导致外侧厢骨性关节炎（OA）而接受了MCW-DFVO治疗，同时还分析了18名无OA的对照组患者（18个膝关节；平均年龄21岁；4名男性，14名女性）的临床和影像学数据。采用计算机断层扫描骨吸收测量法对术前和术后一年胫骨股胫关节面软骨下骨密度分布模式进行了检查。对关节表面高密度区（HDA）的位置和百分比进行了定量分析。从手术到术后拍片和进行计算机断层扫描骨吸收测定成像的平均时间为13.6个月（11-19个月）。结果：与对照组（41.1%）相比，术前OA组（58.8%）外侧区HDA占总HDA的平均比例（外侧比）明显更高（P <.001）。MCW-DFVO 术后，OA 组的平均侧向比值明显下降至 45.3% ( P <.001)。对照组（r = 0.630; P = .011）和 OA 组（r = 0.537; P = .047）的外侧比率与髋关节-膝关节-踝关节角度呈显著相关。此外，MCW-DFVO 后外侧比率的改变与髋-膝-踝角度（r = 0.742；P = .002）和机械外侧股骨远端角度（r = -0.752；P = .002）的变化有显著关系。结论：与对照组相比，术前OA组的平均外侧比率显著增大。MCW-DFVO导致胫骨近端关节面的HDA从外侧向内侧重新分布。MCW-DFVO术后的对位矫正程度与HDA分布的变化密切相关，反映了应力分布的变化。
{"title":"Stress Distribution Patterns of the Femorotibial Joint After Medial Closing-Wedge Distal Femoral Varus Osteotomy: An Evaluation Using Computed Tomography Osteoabsorptiometry","authors":"Masanari Hamasaki, Eiji Kondo, Koji Iwasaki, Yuki Suzuki, Masatake Matsuoka, Tomohiro Onodera, Koji Yabuuchi, Daisuke Momma, Masayuki Inoue, Kazunori Yasuda, Tomonori Yagi, Norimasa Iwasaki","doi":"10.1177/03635465241285909","DOIUrl":"https://doi.org/10.1177/03635465241285909","url":null,"abstract":"Background:Distal femoral varus osteotomy (DFVO) is an established surgical procedure for addressing valgus malalignment across various knee conditions. However, the effect of DFVO on stress distribution within the femorotibial joint has not been explored through in vivo studies.Purpose:To (1) explore the distribution pattern of subchondral bone density across the proximal tibia in nonarthritic knees without arthritis and in those of patients with valgus knees, (2) assess changes in the pattern of bone density distribution in patients with valgus knees before and after medial closing-wedge (MCW) DFVO, and (3) determine the correlation between leg alignment and changes in bone density distribution.Study Design:Cohort study; Level of evidence, 3.Methods:The authors retrospectively analyzed clinical and radiographic data from 14 patients (14 knees; mean age, 44 years; 3 men, 11 women) treated with MCW-DFVO for lateral compartment osteoarthritis (OA) due to valgus malalignment, alongside a control group of 18 patients (18 knees; mean age, 21 years; 4 men, 14 women) without OA. The distribution patterns of subchondral bone density distribution on the femorotibial articular surface of the tibia were examined both preoperatively and >1 year postoperatively using computed tomography osteoabsorptiometry. Quantitative analyses were conducted on the locations and percentages of the high-density areas (HDAs) on the articular surface. The mean time between surgery and the postoperative radiograph and computed tomography absorptiometry imaging was 13.6 months (range, 11-19 months). The mean length of clinical follow-up was 28.7 months (range, 14-62 months) after surgery.Results:The mean proportion of HDA in the lateral compartment relative to the total HDA (lateral ratio) was significantly greater in the preoperative OA group (58.8%) compared with the control group (41.1%) ( P < .001). After MCW-DFVO, the mean lateral ratio in the OA group notably declined to 45.3% ( P < .001). The lateral ratio exhibited a significant correlation with the hip-knee-ankle angle in both the control ( r = 0.630; P = .011) and OA ( r = 0.537; P = .047) groups. Moreover, the alteration in the lateral ratio after MCW-DFVO showed a significant relationship with changes in the hip-knee-ankle angle ( r = 0.742; P = .002) and the mechanical lateral distal femoral angle ( r = −0.752; P = .002). Within the lateral compartment, HDAs in the 3 lateral regions of the 4 lateral subregions diminished after MCW-DFVO, whereas in the medial compartment, HDAs in the 3 lateral subregions saw an increase.Conclusion:The mean lateral ratio was significantly greater in the preoperative OA group compared with the control group. MCW-DFVO resulted in a redistribution of HDA from the lateral to the medial compartment of the proximal tibial articular surface. The extent of alignment correction after MCW-DFVO was closely linked to the shifts in HDA distribution, reflecting changes in stress distribut","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142415644","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 : 2024-10-12DOI: 10.1177/03635465241283500
Iacopo Romandini, Angelo Boffa, Alessandro Di Martino, Luca Andriolo, Annarita Cenacchi, Elena Sangiorgi, Simone Orazi, Valeria Pizzuti, Stefano Zaffagnini, Giuseppe Filardo
Background:Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules.Purpose:To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA.Hypothesis:That leukocytes could influence results both in terms of adverse events and clinical outcomes.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol–visual analog scale, the EuroQol–5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures.Results:An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P = .046), as well as for active ( P = .021) and passive ( P = .040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index ( P = .042) and contralateral ( P = .045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group ( P < .0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group ( P = .001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group.Conclusion:This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, with
{"title":"Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial","authors":"Iacopo Romandini, Angelo Boffa, Alessandro Di Martino, Luca Andriolo, Annarita Cenacchi, Elena Sangiorgi, Simone Orazi, Valeria Pizzuti, Stefano Zaffagnini, Giuseppe Filardo","doi":"10.1177/03635465241283500","DOIUrl":"https://doi.org/10.1177/03635465241283500","url":null,"abstract":"Background:Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules.Purpose:To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA.Hypothesis:That leukocytes could influence results both in terms of adverse events and clinical outcomes.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol–visual analog scale, the EuroQol–5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures.Results:An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P = .046), as well as for active ( P = .021) and passive ( P = .040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index ( P = .042) and contralateral ( P = .045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group ( P < .0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group ( P = .001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group.Conclusion:This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, with","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142415646","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 : 2024-09-26DOI: 10.1177/03635465241273947
Tim Wang,Sean L Gao,Julie C McCauley,Sebastian M Densley,William D Bugbee
BACKGROUNDFresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized.PURPOSETo evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC).STUDY DESIGNCohort study; Level of evidence, 3.METHODSA total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné-Postel score, and overall patient satisfaction score.RESULTSThe mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%.CONCLUSIONPatients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.
背景新鲜骨软骨异体移植（OCA）是治疗膝关节局灶性软骨和骨软骨缺损的有效技术。冠状面错位会导致隔间内的接触力增加，进而增加软骨修复部位的接触力，并可能导致更高的失败率。目的评估股骨内侧髁（MFC）孤立 OCA 移植后，曲度对位如何影响移植物存活率和患者报告的结果。研究设计队列研究；证据级别，3.方法2005年至2019年期间，共有70名患者（74个膝关节）接受了股骨内侧髁原发性OCA移植手术，这些患者均来自前瞻性收集的、至少随访2年的单一外科医生软骨登记处。利用站立髋关节至踝关节X光片评估冠状面对齐情况。记录了OCA失败（定义为移除移植物或转为关节成形术）和再手术情况。术前和术后使用国际膝关节文献委员会评分、膝关节损伤和骨关节炎结果评分、改良Merle d'Aubigné-Postel评分和患者总体满意度评分获得患者报告结果。结果胫骨与股骨的平均机械对位角度为3.9°（范围为1.1°至8.9°），非胫骨与股骨的平均机械对位角度为0.02°（范围为3.6°至4.6°）。术后5年，内翻组的移植存活率为95.3%，非内翻组的移植存活率为95.8%（P = .918）。OCA移植术后再次手术的比例在外翻组为14.0%，在非外翻组为22.6%（P = .336）。屈曲组的国际膝关节文献委员会平均总分从术前的45.2分提高到最近随访时的74.8分，非屈曲组从术前的40.5分提高到最近随访时的72.3分。结论接受 MFC 孤立 OCA 移植的患者移植物存活率很高（>90%），疼痛和功能也有显著改善。与无屈曲对位的患者相比，已有轻度屈曲对位的患者在失败率或临床结果上没有差异。
{"title":"Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment.","authors":"Tim Wang,Sean L Gao,Julie C McCauley,Sebastian M Densley,William D Bugbee","doi":"10.1177/03635465241273947","DOIUrl":"https://doi.org/10.1177/03635465241273947","url":null,"abstract":"BACKGROUNDFresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized.PURPOSETo evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC).STUDY DESIGNCohort study; Level of evidence, 3.METHODSA total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigné-Postel score, and overall patient satisfaction score.RESULTSThe mean mechanical tibiofemoral angle for patients with varus alignment was 3.9° of varus (range, 1.1° to 8.9°) and for patients with nonvarus alignment it was 0.02° of valgus (range, 3.6° varus to 4.6° valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%.CONCLUSIONPatients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":"3635465241273947"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325149","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 : 2024-09-26DOI: 10.1177/03635465241274797
Valentina Greco,Jules Descamps,Natalia-Martinez Catalan,Mikaël Chelli,Christopher D Joyce,Pascal Boileau
BACKGROUNDContact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates.PURPOSETo evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations.STUDY DESIGNCase series; Level of evidence, 4.METHODSA retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors.RESULTSIn 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button-related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS.CONCLUSIONThe arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a
{"title":"High Rate of Return to Sport in Contact and Collision Athletes After Arthroscopic Latarjet With Cortical Button Fixation.","authors":"Valentina Greco,Jules Descamps,Natalia-Martinez Catalan,Mikaël Chelli,Christopher D Joyce,Pascal Boileau","doi":"10.1177/03635465241274797","DOIUrl":"https://doi.org/10.1177/03635465241274797","url":null,"abstract":"BACKGROUNDContact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates.PURPOSETo evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations.STUDY DESIGNCase series; Level of evidence, 4.METHODSA retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors.RESULTSIn 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button-related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS.CONCLUSIONThe arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a ","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"38 1","pages":"3635465241274797"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325144","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 : 2024-09-26DOI: 10.1177/03635465241279406
Kevin Giordano,Adam R Nebel,Anthony Fava,Gretchen D Oliver
BACKGROUNDDepending on anthropometrics and coaching style, pitchers are taught to pitch with a stride strategy that are traditionally classified as "tall and fall" or "drop and drive" for the purpose of maximizing pitch velocity.PURPOSE/HYPOTHESISThe purpose of this study was to determine the effects of stride strategy (tall and fall vs drop and drive) in college baseball pitching on pitch velocity and elbow valgus torque. It was hypothesized that pitch velocity and elbow valgus torque would increase as pitchers aligned more with the tall and fall technique.STUDY DESIGNControlled laboratory study.METHODSMarkerless motion capture data were recorded on 64 collegiate pitchers (height, 1.89 ± 0.06 m; weight, 93.06 ± 9.44 kg) during game play at the host institution during the 2023 season. Peak magnitudes of body center of mass (COM) vertical displacement were determined using a straight-line trajectory between peak knee height and lead foot contact and used as a continuous variable. Pitchers were required to throw ≥4 fastballs during their outing to be included in the analysis. Multilevel modeling was used to determine associations between peak magnitudes of positive and negative vertical displacement of COM on pitch velocity and elbow valgus torque. Every fastball throughout the season with biomechanics data for each pitcher was included in the multilevel model.RESULTSFastball velocity was mean ± SD 90.68 ± 2.90 mph (40.54 ± 1.29 m/s). Mean maximal negative vertical COM displacement was -0.91 ± 0.47 inches (-0.023 ± 0.012 m), which occurred 18.1% ± 5.75% of the way between peak knee height and stride foot contact. Mean maximal positive vertical COM displacement was 1.73 ± 1.14 inches (0.044 ± 0.029 m), which occurred 65.7% ± 7.8% of the time from peak knee height to stride foot contact. Positive COM displacement (β = 0.54; P < .001) and timing of peak positive COM displacement (β = 1.82; P = .023) reduced interpitcher variance by 9.9% and improved the ability of our model to predict fastball velocity. Negative COM displacement improved the ability of our model to predict ball velocity (β = -0.45; P = .021). Vertical COM displacement did not influence elbow valgus torque.CONCLUSIONIncreasing vertical COM displacement in either the positive or the negative direction resulted in increased fastball velocity but did not result in greater elbow valgus torque. This indicates that the stride method may be used for performance enhancement but is unlikely to influence ulnar collateral ligament injury risk in college baseball pitchers.CLINICAL RELEVANCEClinicians should not use stride mechanics as an injury risk indicator or diagnostic factor in injury etiology for college baseball pitchers.
{"title":"Tall and Fall Versus Drop and Drive Strategy in College Baseball Pitchers for Velocity and Elbow Valgus Torque.","authors":"Kevin Giordano,Adam R Nebel,Anthony Fava,Gretchen D Oliver","doi":"10.1177/03635465241279406","DOIUrl":"https://doi.org/10.1177/03635465241279406","url":null,"abstract":"BACKGROUNDDepending on anthropometrics and coaching style, pitchers are taught to pitch with a stride strategy that are traditionally classified as \"tall and fall\" or \"drop and drive\" for the purpose of maximizing pitch velocity.PURPOSE/HYPOTHESISThe purpose of this study was to determine the effects of stride strategy (tall and fall vs drop and drive) in college baseball pitching on pitch velocity and elbow valgus torque. It was hypothesized that pitch velocity and elbow valgus torque would increase as pitchers aligned more with the tall and fall technique.STUDY DESIGNControlled laboratory study.METHODSMarkerless motion capture data were recorded on 64 collegiate pitchers (height, 1.89 ± 0.06 m; weight, 93.06 ± 9.44 kg) during game play at the host institution during the 2023 season. Peak magnitudes of body center of mass (COM) vertical displacement were determined using a straight-line trajectory between peak knee height and lead foot contact and used as a continuous variable. Pitchers were required to throw ≥4 fastballs during their outing to be included in the analysis. Multilevel modeling was used to determine associations between peak magnitudes of positive and negative vertical displacement of COM on pitch velocity and elbow valgus torque. Every fastball throughout the season with biomechanics data for each pitcher was included in the multilevel model.RESULTSFastball velocity was mean ± SD 90.68 ± 2.90 mph (40.54 ± 1.29 m/s). Mean maximal negative vertical COM displacement was -0.91 ± 0.47 inches (-0.023 ± 0.012 m), which occurred 18.1% ± 5.75% of the way between peak knee height and stride foot contact. Mean maximal positive vertical COM displacement was 1.73 ± 1.14 inches (0.044 ± 0.029 m), which occurred 65.7% ± 7.8% of the time from peak knee height to stride foot contact. Positive COM displacement (β = 0.54; P < .001) and timing of peak positive COM displacement (β = 1.82; P = .023) reduced interpitcher variance by 9.9% and improved the ability of our model to predict fastball velocity. Negative COM displacement improved the ability of our model to predict ball velocity (β = -0.45; P = .021). Vertical COM displacement did not influence elbow valgus torque.CONCLUSIONIncreasing vertical COM displacement in either the positive or the negative direction resulted in increased fastball velocity but did not result in greater elbow valgus torque. This indicates that the stride method may be used for performance enhancement but is unlikely to influence ulnar collateral ligament injury risk in college baseball pitchers.CLINICAL RELEVANCEClinicians should not use stride mechanics as an injury risk indicator or diagnostic factor in injury etiology for college baseball pitchers.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":"3635465241279406"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325211","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 : 2024-09-26DOI: 10.1177/03635465241279848
Hansel E Ihn,Heather A Prentice,Tadashi T Funahashi,Gregory B Maletis
BACKGROUNDPosterior tibial slope (PTS) has been identified as a possible modifiable risk factor for anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) failure. However, the findings in the literature are inconsistent. This may be explained by several different reasons, including different measurement methods, differing definitions of ACLR failure, and possible inclusion of suboptimal films.PURPOSETo compare PTS values obtained using plain radiographs (XR-PTS) in a young (≤21 years of age), skeletally mature patient population with those obtained using magnetic resonance imaging (MRI), as well as to quantify the number of suboptimal lateral knee radiographs obtained across an integrated health care system and determine the potential effect of including these radiographs on summary statistics of XR-PTS.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSSkeletally mature adolescent and young adult patients ≤21 years of age were identified from the ACLR registry of Kaiser Permanente. The cases of concern were patients requiring revision ACLR. The controls were patients who had an ACLR and did not require a revision procedure. The XR-PTS measurements were made on plain radiographs by a single blinded reviewer. These results were compared with measurements obtained using MRI. The quality of each plain radiograph was evaluated by measuring posterior/distal femoral condylar overlap and length of tibial diaphysis captured on the radiograph. Summary statistics with and without inclusion of measurements made on suboptimal radiographs were calculated.RESULTSOf the initial 634 patients with ACLR (317 case-control pairs), 561 (88.5%) had radiographs available and were included for the analysis comparing radiograph to MRI slope measurements. For the evaluation of slope between case and control pairs with radiograph information available, there were 257 case-control pairs; there were 124 pairs when those with suboptimal radiographs were excluded. There was no difference in MRI-measured lateral tibial posterior slope or medial tibial posterior slope for the 257 case-control pairs with XR-PTS information and for the 124 pairs with optimal radiographs. XR-PTS in the revision cohort was significantly steeper than in the control group when suboptimal radiographs were included in the analysis. There was no difference when patients with suboptimal radiographs were excluded. PTS measurements made on plain radiographs were larger than those made on MRI. There was a poor correlation between measurements made using these 2 modalities (r = 0.22 for radiograph and medial PTS).CONCLUSIONThis study did not find a significantly steeper XR-PTS in patients who had to undergo revision ACLR when suboptimal radiographs were not included in the analysis. The present study's results confirmed the findings from a previous study of the same patient population that used MRI. However, there was poor correlation between PTS measurements made using plain radiogra
{"title":"Posterior Tibial Slope Measured on Plain Radiograph Versus MRI and Its Association With Revision Anterior Cruciate Ligament Reconstruction: A Matched Case-Control Study.","authors":"Hansel E Ihn,Heather A Prentice,Tadashi T Funahashi,Gregory B Maletis","doi":"10.1177/03635465241279848","DOIUrl":"https://doi.org/10.1177/03635465241279848","url":null,"abstract":"BACKGROUNDPosterior tibial slope (PTS) has been identified as a possible modifiable risk factor for anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) failure. However, the findings in the literature are inconsistent. This may be explained by several different reasons, including different measurement methods, differing definitions of ACLR failure, and possible inclusion of suboptimal films.PURPOSETo compare PTS values obtained using plain radiographs (XR-PTS) in a young (≤21 years of age), skeletally mature patient population with those obtained using magnetic resonance imaging (MRI), as well as to quantify the number of suboptimal lateral knee radiographs obtained across an integrated health care system and determine the potential effect of including these radiographs on summary statistics of XR-PTS.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSSkeletally mature adolescent and young adult patients ≤21 years of age were identified from the ACLR registry of Kaiser Permanente. The cases of concern were patients requiring revision ACLR. The controls were patients who had an ACLR and did not require a revision procedure. The XR-PTS measurements were made on plain radiographs by a single blinded reviewer. These results were compared with measurements obtained using MRI. The quality of each plain radiograph was evaluated by measuring posterior/distal femoral condylar overlap and length of tibial diaphysis captured on the radiograph. Summary statistics with and without inclusion of measurements made on suboptimal radiographs were calculated.RESULTSOf the initial 634 patients with ACLR (317 case-control pairs), 561 (88.5%) had radiographs available and were included for the analysis comparing radiograph to MRI slope measurements. For the evaluation of slope between case and control pairs with radiograph information available, there were 257 case-control pairs; there were 124 pairs when those with suboptimal radiographs were excluded. There was no difference in MRI-measured lateral tibial posterior slope or medial tibial posterior slope for the 257 case-control pairs with XR-PTS information and for the 124 pairs with optimal radiographs. XR-PTS in the revision cohort was significantly steeper than in the control group when suboptimal radiographs were included in the analysis. There was no difference when patients with suboptimal radiographs were excluded. PTS measurements made on plain radiographs were larger than those made on MRI. There was a poor correlation between measurements made using these 2 modalities (r = 0.22 for radiograph and medial PTS).CONCLUSIONThis study did not find a significantly steeper XR-PTS in patients who had to undergo revision ACLR when suboptimal radiographs were not included in the analysis. The present study's results confirmed the findings from a previous study of the same patient population that used MRI. However, there was poor correlation between PTS measurements made using plain radiogra","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"22 1","pages":"3635465241279848"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325206","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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