Pub Date : 2024-09-14DOI: 10.1177/03635465241273940
Marco-Christopher Rupp, Annabel R. Geissbuhler, Joan C. Rutledge, Marilee P. Horan, Phob Ganokroj, Peter Chang, Matthew T. Provencher, Peter J. Millett
Background:Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited.Purpose:To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression.Results:A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes ( P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so.Conclusion:The significant improvements in clinical and sport-sp
{"title":"Predictors of Clinical Outcomes and Quality of Life After Sternoclavicular Joint Reconstruction With Hamstring Tendon Autograft","authors":"Marco-Christopher Rupp, Annabel R. Geissbuhler, Joan C. Rutledge, Marilee P. Horan, Phob Ganokroj, Peter Chang, Matthew T. Provencher, Peter J. Millett","doi":"10.1177/03635465241273940","DOIUrl":"https://doi.org/10.1177/03635465241273940","url":null,"abstract":"Background:Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited.Purpose:To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression.Results:A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes ( P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so.Conclusion:The significant improvements in clinical and sport-sp","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233457","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 : 2024-09-14DOI: 10.1177/03635465241265085
Sang-Jin Shin, Sanghyeon Lee
Background:Graft failure is a common complication after superior capsule reconstruction (SCR). The graft in SCR is fixed on the greater tuberosity and superior glenoid, and graft failure has been reported on both sides.Purpose:To evaluate the clinical manifestations of patients with graft failure after SCR and identify the clinical and radiological differences between medial and lateral graft failure.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent SCR with a dermal allograft for symptomatic irreparable rotator cuff tears between March 2018 and September 2021 were retrospectively reviewed. All patients had minimum 2-year follow-up and underwent magnetic resonance imaging at 6 months postoperatively. Patients with graft failure were divided into 2 groups: those with lateral graft failure on the greater tuberosity side (group I) and those with medial graft failure on the glenoid side (group II). Patients with intact grafts were included in group III as a control group. Intergroup differences in clinical and radiological characteristics were analyzed, and multiple regression analysis was performed.Results:Among the 93 patients included, there were 18 patients in group I, 15 in group II, and 60 in group III. Overall, 11 patients (61.1%) in group I and 9 patients (60.0%) in group II had a partial graft rupture at one anchor. The postoperative graft volume was significantly lower in group I than in groups II and III (2514.0 ± 564.3 mm3, 3183.5 ± 547.1 mm3, and 3198.0 ± 584.8 mm3, respectively; P = .002 for group I vs II; P < .001 for group I vs III). The acromiohumeral distance (AHD) was significantly increased at 6 months postoperatively compared with before surgery in group I (6.6 ± 1.6 mm vs 4.3 ± 1.9 mm, respectively; P < .001) and group II (7.4 ± 1.3 mm vs 5.7 ± 1.7 mm, respectively; P = .002). However, group I exhibited a significantly greater decrease in the AHD over time than group II ( P < .001) and a significantly lower AHD at the final follow-up than the other groups ( P < .001). The postoperative American Shoulder and Elbow Surgeons score was significantly lower in group I than in the other groups ( P < .001). On multiple regression analysis, fatty infiltration of the infraspinatus muscle, Hamada grade, and graft width were independent factors for lateral graft failure.Conclusion:Patients with lateral graft failure had inferior clinical outcomes and lower postoperative graft volumes than those with medial graft failure after SCR using a dermal allograft. The AHD of patients with lateral graft failure improved postoperatively; however, it deteriorated over time.
{"title":"Effect of Medial or Lateral Graft Failure on Graft Volume and Clinical Outcomes After Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears","authors":"Sang-Jin Shin, Sanghyeon Lee","doi":"10.1177/03635465241265085","DOIUrl":"https://doi.org/10.1177/03635465241265085","url":null,"abstract":"Background:Graft failure is a common complication after superior capsule reconstruction (SCR). The graft in SCR is fixed on the greater tuberosity and superior glenoid, and graft failure has been reported on both sides.Purpose:To evaluate the clinical manifestations of patients with graft failure after SCR and identify the clinical and radiological differences between medial and lateral graft failure.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent SCR with a dermal allograft for symptomatic irreparable rotator cuff tears between March 2018 and September 2021 were retrospectively reviewed. All patients had minimum 2-year follow-up and underwent magnetic resonance imaging at 6 months postoperatively. Patients with graft failure were divided into 2 groups: those with lateral graft failure on the greater tuberosity side (group I) and those with medial graft failure on the glenoid side (group II). Patients with intact grafts were included in group III as a control group. Intergroup differences in clinical and radiological characteristics were analyzed, and multiple regression analysis was performed.Results:Among the 93 patients included, there were 18 patients in group I, 15 in group II, and 60 in group III. Overall, 11 patients (61.1%) in group I and 9 patients (60.0%) in group II had a partial graft rupture at one anchor. The postoperative graft volume was significantly lower in group I than in groups II and III (2514.0 ± 564.3 mm<jats:sup>3</jats:sup>, 3183.5 ± 547.1 mm<jats:sup>3</jats:sup>, and 3198.0 ± 584.8 mm<jats:sup>3</jats:sup>, respectively; P = .002 for group I vs II; P < .001 for group I vs III). The acromiohumeral distance (AHD) was significantly increased at 6 months postoperatively compared with before surgery in group I (6.6 ± 1.6 mm vs 4.3 ± 1.9 mm, respectively; P < .001) and group II (7.4 ± 1.3 mm vs 5.7 ± 1.7 mm, respectively; P = .002). However, group I exhibited a significantly greater decrease in the AHD over time than group II ( P < .001) and a significantly lower AHD at the final follow-up than the other groups ( P < .001). The postoperative American Shoulder and Elbow Surgeons score was significantly lower in group I than in the other groups ( P < .001). On multiple regression analysis, fatty infiltration of the infraspinatus muscle, Hamada grade, and graft width were independent factors for lateral graft failure.Conclusion:Patients with lateral graft failure had inferior clinical outcomes and lower postoperative graft volumes than those with medial graft failure after SCR using a dermal allograft. The AHD of patients with lateral graft failure improved postoperatively; however, it deteriorated over time.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231211","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 : 2024-09-14DOI: 10.1177/03635465241270152
Johannes Weishorn, Johanna Wiegand, Severin Zietzschmann, Kevin-Arno Koch, Christoph Rehnitz, Tobias Renkawitz, Tilman Walker, Yannic Bangert
Background:Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.Purpose:To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.Results:The defects had a mean size of 4.8 cm2 (range, 1.2-12 cm2) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% 6 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up ( P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 6 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS ( R2 = 0.41; f2 = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State ( χ2 = 10.93; P = .012).Conclusion:The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.
{"title":"Factors Influencing Long-term Outcomes After Matrix-Induced Autologous Chondrocyte Implantation: Long-term Results at 10 Years","authors":"Johannes Weishorn, Johanna Wiegand, Severin Zietzschmann, Kevin-Arno Koch, Christoph Rehnitz, Tobias Renkawitz, Tilman Walker, Yannic Bangert","doi":"10.1177/03635465241270152","DOIUrl":"https://doi.org/10.1177/03635465241270152","url":null,"abstract":"Background:Matrix-induced autologous chondrocyte implantation (MACI), the third-generation of the technique, is an established procedure for the treatment of focal cartilage defects in the knee. However, the literature lacks long-term results of MACI with good statistical power.Purpose:To determine long-term survival and patient-reported outcomes (PROs) in a representative cohort and to identify patient- and surgery-related parameters that may influence long-term clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 103 patients were clinically evaluated at the current follow-up of 8.1 years (range, 5-11.9 years). PRO measures (PROMs) included the Knee injury and Osteoarthritis Outcome Score (KOOS), EQ-5D, visual analog scale for pain, and Tegner Activity Scale. Magnetic resonance imaging results were evaluated by using the AMADEUS (area measurement and depth and underlying structures) and MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 knee score classification systems. Potential factors influencing PROs were first identified univariately and investigated in a multivariate regression model.Results:The defects had a mean size of 4.8 cm<jats:sup>2</jats:sup> (range, 1.2-12 cm<jats:sup>2</jats:sup>) and were predominantly femorotibial (66%). The mean Kaplan-Meier survival rate of revision for any reason was 97.2% 6 1.6% at 10 years. In comparison to preoperative values, all PROMs were significantly improved at the current follow-up ( P < .05). The MOCART 2.0 score peaked at 12 months (mean, 80.2 6 15.3 months) and showed no significant change at 96 months (mean, 76.1 ± 19.5 months; P = .142). The linear multivariate regression model identified an association of body mass index (BMI), MOCART 2.0 score, and number of previous knee surgeries with KOOS ( R<jats:sup>2</jats:sup> = 0.41; f<jats:sup>2</jats:sup> = 0.69). Further analysis of the individual determinants revealed an optimal BMI range of 20 to 29 for favorable PROs at 96 months. Significant correlations of MOCART subscores with the overall KOOS were found for graft surface and structure, bony reaction, and subchondral detectable changes. Only 30% of patients with 2 previous surgeries and 20% of patients with 3 previous surgeries achieved a Patient Acceptable Symptom State ( χ<jats:sup>2</jats:sup> = 10.93; P = .012).Conclusion:The present study shows consistently good long-term clinical outcomes after MACI with a low revision rate and high patient satisfaction. BMI and number of previous knee surgeries may influence clinical outcomes and should be considered in patient selection and education. There is a correlation between graft structure, subchondral bone changes on magnetic resonance imaging, and long-term PROMs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231210","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 : 2024-09-14DOI: 10.1177/03635465241272077
Jonathan S. Lee, Rohit R. Rachala, Stephen M. Gillinov, Bilal S. Siddiq, Kieran S. Dowley, Nathan J. Cherian, Scott D. Martin
Background:Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy.Purpose:To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADILow and ADIHigh cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction.Results:A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADILow cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADIHigh cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADIHigh cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool.Conclusion:Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.
{"title":"Relationship Between Neighborhood-Level Socioeconomic Status and Functional Outcomes After Hip Arthroscopy","authors":"Jonathan S. Lee, Rohit R. Rachala, Stephen M. Gillinov, Bilal S. Siddiq, Kieran S. Dowley, Nathan J. Cherian, Scott D. Martin","doi":"10.1177/03635465241272077","DOIUrl":"https://doi.org/10.1177/03635465241272077","url":null,"abstract":"Background:Despite the growing volume of neighborhood-level health disparity research, there remains a paucity of prospective studies investigating the relationship between Area Deprivation Index (ADI) and functional outcomes for patients undergoing hip arthroscopy.Purpose:To investigate the relationship between neighborhood-level socioeconomic status and functional outcomes after hip arthroscopy.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed on patients aged ≥18 years with minimum 1-year follow-up who underwent hip arthroscopy for the treatment of symptomatic labral tears. The study population was divided into ADI<jats:sub>Low</jats:sub> and ADI<jats:sub>High</jats:sub> cohorts according to ADI score: a validated measurement of neighborhood-level socioeconomic status standardized to yield a score between 1 and 100. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, 33-item International Hip Outcome Tool, visual analog scale for pain, and patient satisfaction.Results:A total of 228 patients met inclusion criteria and were included in the final analysis. After patients were stratified by ADI score (mean ± SD), the ADI<jats:sub>Low</jats:sub> cohort (n = 113; 5.8 ± 3.0; range, 1-12) and ADI<jats:sub>High</jats:sub> cohort (n = 115; 28.0 ± 14.5; range, 13-97) had no differences in baseline patient demographics. The ADI<jats:sub>High</jats:sub> cohort had significantly worse preoperative baseline scores for all 5 PROMs; however, these differences were not present by 1-year follow-up. Furthermore, the 2 cohorts achieved similar rates of the minimal clinically important difference for all 5 PROMs and the Patient Acceptable Symptom State for 4 PROMs. When controlling for patient demographics, patients with higher ADI scores had greater odds of achieving the minimal clinically important difference for all PROMs except the 33-item International Hip Outcome Tool.Conclusion:Although hip arthroscopy patients experiencing a greater neighborhood-level socioeconomic disadvantage exhibited significantly lower preoperative baseline PROM scores, this disparity resolved at 1-year follow-up. In fact, when adjusting for patient characteristics including ADI score, more disadvantaged patients achieved greater odds of achieving the minimal clinically important difference. The present study is merely a first step toward understanding health inequities among patients seeking orthopaedic care. Further development of clinical guidelines and health policy research is necessary to advance care for patients from disadvantaged communities.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233463","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 : 2024-09-14DOI: 10.1177/03635465241275668
Andrew T. Pennock
{"title":"Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers: Response","authors":"Andrew T. Pennock","doi":"10.1177/03635465241275668","DOIUrl":"https://doi.org/10.1177/03635465241275668","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231208","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 : 2024-09-14DOI: 10.1177/03635465241275671
Jingzhi Wang, Yulu Rao, Yuanmin Zhang
{"title":"Nonoperative Treatment of Completely Displaced Midshaft Clavicular Fractures in Teenagers: Letter to the Editor","authors":"Jingzhi Wang, Yulu Rao, Yuanmin Zhang","doi":"10.1177/03635465241275671","DOIUrl":"https://doi.org/10.1177/03635465241275671","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231209","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 : 2024-09-14DOI: 10.1177/03635465241280561
Braden C. Fleming
{"title":"The Sensational ACL","authors":"Braden C. Fleming","doi":"10.1177/03635465241280561","DOIUrl":"https://doi.org/10.1177/03635465241280561","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231207","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 : 2024-08-30DOI: 10.1177/03635465241270291
Benjamin G. Domb, Jade S. Owens, Ajay C. Lall, W. Taylor Harris, Benjamin D. Kuhns
Background:Arthroscopic labral repair has been shown to result in favorable short- and midterm outcomes; however, the durability of outcomes specifically in older patients remains underreported.Purpose:To (1) report prospectively collected hip preservation rates and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in patients aged ≥40 years after primary hip arthroscopy with labral repair and (2) perform a matched analysis comparing patients aged ≥40 years with patients aged <40 years.Study Design:Cohort study; Level of evidence, 3.Methods:Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between February 2008 and December 2011. Patients aged ≥40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up scores were collected for multiple PROMs. Propensity score matching was utilized to compare these patients with a cohort of patients <40 years.Results:Of the 113 hips eligible, 91 hips (80.5%) on 85 patients (6 bilateral) had a minimum 10-year follow-up. There were 58 women (68%) and 27 men (32%) with a mean age and body mass index of 47.8 years and 25.8, respectively. The hip preservation rate for patients aged ≥40 years was 78%, with 20 patients requiring arthroplasty during the study period. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up with high rates of achieving the minimal clinically important difference and Patient Acceptable Symptom State clinical outcome thresholds. In total, 69 patients aged ≥40 years were propensity matched to 107 patients <40 years. Patients ≥40 tended to have a lower hip preservation rate (81.2% vs 91.6%; P = .06), while patients in the younger cohort had significantly higher rates of secondary hip arthroscopy (14% vs 3%; P = .02). Improvement in PROMs was comparable between the groups.Conclusion:Patients ≥40 years who underwent primary hip arthroscopy with labral repair demonstrated a hip preservation rate of 78%, significant and durable improvement in PROMs, and high rates of satisfaction at a minimum 10-year follow-up. Matched analysis with patients <40 years revealed comparable improvement in patient-reported outcomes between the 2 groups, with a tendency to a higher level of arthroplasty in patients ≥40 years.
研究目的：(1)报告前瞻性收集的髋关节保留率和患者报告的结局指标（PROMs），至少随访10年，随访对象为接受初级髋关节镜和髋关节唇修复术后年龄≥40岁的患者；(2)进行配对分析，比较年龄≥40岁的患者和年龄<40岁的患者。研究设计：队列研究；证据级别：3.方法：对2008年2月至2011年12月期间接受初级髋关节镜手术的所有患者的数据进行前瞻性收集和回顾性审查。年龄≥40岁且接受过唇缘修复术的患者均包括在内。收集了多个PROMs的术前评分和至少10年的随访评分。结果：在符合条件的113个髋关节中，85名患者（6名双侧）的91个髋关节（80.5%）接受了至少10年的随访。其中有 58 名女性（68%）和 27 名男性（32%），平均年龄和体重指数分别为 47.8 岁和 25.8。年龄≥40岁的患者髋关节保留率为78%，研究期间有20名患者需要进行关节置换术。从基线到最短10年随访期间，所有PROM指标均有明显改善，达到最小临床重要性差异和患者可接受症状状态临床结果阈值的比例很高。共有 69 名年龄≥40 岁的患者与 107 名年龄 <40 岁的患者进行了倾向匹配。≥40岁患者的髋关节保留率往往较低（81.2% vs 91.6%; P = .06），而年轻组群患者的二次髋关节镜检查率明显较高（14% vs 3%; P = .02）。结论：≥40 岁的患者在接受初次髋关节镜手术和唇修补术后，髋关节保留率为 78%，PROMs 得到显著而持久的改善，在至少 10 年的随访中满意度较高。与 40 岁患者进行的配对分析显示，两组患者的患者报告结果改善程度相当，≥40 岁患者的关节置换水平更高。
{"title":"Ten-Year Outcomes in Patients Aged 40 Years and Older After Primary Arthroscopic Treatment of Femoroacetabular Impingement With Labral Repair","authors":"Benjamin G. Domb, Jade S. Owens, Ajay C. Lall, W. Taylor Harris, Benjamin D. Kuhns","doi":"10.1177/03635465241270291","DOIUrl":"https://doi.org/10.1177/03635465241270291","url":null,"abstract":"Background:Arthroscopic labral repair has been shown to result in favorable short- and midterm outcomes; however, the durability of outcomes specifically in older patients remains underreported.Purpose:To (1) report prospectively collected hip preservation rates and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in patients aged ≥40 years after primary hip arthroscopy with labral repair and (2) perform a matched analysis comparing patients aged ≥40 years with patients aged <40 years.Study Design:Cohort study; Level of evidence, 3.Methods:Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between February 2008 and December 2011. Patients aged ≥40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up scores were collected for multiple PROMs. Propensity score matching was utilized to compare these patients with a cohort of patients <40 years.Results:Of the 113 hips eligible, 91 hips (80.5%) on 85 patients (6 bilateral) had a minimum 10-year follow-up. There were 58 women (68%) and 27 men (32%) with a mean age and body mass index of 47.8 years and 25.8, respectively. The hip preservation rate for patients aged ≥40 years was 78%, with 20 patients requiring arthroplasty during the study period. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up with high rates of achieving the minimal clinically important difference and Patient Acceptable Symptom State clinical outcome thresholds. In total, 69 patients aged ≥40 years were propensity matched to 107 patients <40 years. Patients ≥40 tended to have a lower hip preservation rate (81.2% vs 91.6%; P = .06), while patients in the younger cohort had significantly higher rates of secondary hip arthroscopy (14% vs 3%; P = .02). Improvement in PROMs was comparable between the groups.Conclusion:Patients ≥40 years who underwent primary hip arthroscopy with labral repair demonstrated a hip preservation rate of 78%, significant and durable improvement in PROMs, and high rates of satisfaction at a minimum 10-year follow-up. Matched analysis with patients <40 years revealed comparable improvement in patient-reported outcomes between the 2 groups, with a tendency to a higher level of arthroplasty in patients ≥40 years.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100830","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 : 2024-08-30DOI: 10.1177/03635465241264211
Luiz Felipe Ambra, Alexandre Barbieri Mestriner, Jakob Ackermann, Enzo S. Mameri, Andreas H. Gomoll
Background:Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.Hypothesis:Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.Study Design:Controlled laboratory study.Methods:Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.Results:Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05).Conclusion:The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.Clinical Relevance:Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.
{"title":"Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study","authors":"Luiz Felipe Ambra, Alexandre Barbieri Mestriner, Jakob Ackermann, Enzo S. Mameri, Andreas H. Gomoll","doi":"10.1177/03635465241264211","DOIUrl":"https://doi.org/10.1177/03635465241264211","url":null,"abstract":"Background:Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.Hypothesis:Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.Study Design:Controlled laboratory study.Methods:Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.Results:Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05).Conclusion:The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.Clinical Relevance:Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100831","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 : 2024-08-30DOI: 10.1177/03635465241272401
Changqi Sun, Kenny Chang, Braden C. Fleming, Brett D. Owens, Jillian E. Beveridge, Yu Zhao, Guoxuan Peng, Lei Wei
Background:Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α<jats:sub>2</jats:sub>M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA.Purpose:(1) To investigate the therapeutic potential of intra-articular α<jats:sub>2</jats:sub>M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α<jats:sub>2</jats:sub>M injections have greater chondroprotective effects compared with 1 intra-articular injection.Study Design:Controlled laboratory study.Methods:A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α<jats:sub>2</jats:sub>M injection (mIAD +α<jats:sub>2</jats:sub>M-1), (3) mIAD and 3 α<jats:sub>2</jats:sub>M injections (mIAD +α<jats:sub>2</jats:sub>M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system.Results:Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05) and similar to those in the sham group ( P > .05). Synovial membrane scores of the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups were lower than that of the mIAD + saline group ( P < .05) and higher than that of the sham group ( P < .05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05). No significant differences were observed between the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups for all measured outcomes. There were early changes in gait ( P < .05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α<jats:sub>2</jats:sub>M-1, and mIAD +α<jats:sub>2</jats:sub>M-3 groups that normalized by 15 weeks.Conclusion:Animals receiving early α<jats:sub>2</jats:sub>M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α<jats:sub>2</jats:sub>M treatment. These results exemplify the early anti-inflammatory effects of α<jats:sub>2</jats:sub>M and prov
{"title":"Alpha-2-Macroglobulin Attenuates Posttraumatic Osteoarthritis Cartilage Damage by Inhibiting Inflammatory Pathways With Modified Intra-articular Drilling in a Yucatan Minipig Model","authors":"Changqi Sun, Kenny Chang, Braden C. Fleming, Brett D. Owens, Jillian E. Beveridge, Yu Zhao, Guoxuan Peng, Lei Wei","doi":"10.1177/03635465241272401","DOIUrl":"https://doi.org/10.1177/03635465241272401","url":null,"abstract":"Background:Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α<jats:sub>2</jats:sub>M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA.Purpose:(1) To investigate the therapeutic potential of intra-articular α<jats:sub>2</jats:sub>M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α<jats:sub>2</jats:sub>M injections have greater chondroprotective effects compared with 1 intra-articular injection.Study Design:Controlled laboratory study.Methods:A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α<jats:sub>2</jats:sub>M injection (mIAD +α<jats:sub>2</jats:sub>M-1), (3) mIAD and 3 α<jats:sub>2</jats:sub>M injections (mIAD +α<jats:sub>2</jats:sub>M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system.Results:Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05) and similar to those in the sham group ( P > .05). Synovial membrane scores of the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups were lower than that of the mIAD + saline group ( P < .05) and higher than that of the sham group ( P < .05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05). No significant differences were observed between the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups for all measured outcomes. There were early changes in gait ( P < .05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α<jats:sub>2</jats:sub>M-1, and mIAD +α<jats:sub>2</jats:sub>M-3 groups that normalized by 15 weeks.Conclusion:Animals receiving early α<jats:sub>2</jats:sub>M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α<jats:sub>2</jats:sub>M treatment. These results exemplify the early anti-inflammatory effects of α<jats:sub>2</jats:sub>M and prov","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100832","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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