Pub Date : 2025-01-07DOI: 10.1177/03635465241305411
Sarah M. Romereim, Matthew R. Smykowski, Elaina K. Ball, Edward Grant Carey, Mario Cuadra, Alicia Williams, Kate Hickson, Kara Haim, Meera Sumith, Ziqing Yu, Guangxu Jin, David Foureau, Nury Steuerwald, Susan Odum, Bailey V. Fearing, Jonathan C. Riboh
Background:Loss of motion and arthrofibrosis after anterior cruciate ligament (ACL) reconstruction (ACLR) can be devastating complications for athletes. The cellular and molecular pathogenesis of arthrofibrosis is poorly understood, limiting prevention and treatment options. Synovial inflammation may contribute to post-ACLR arthrofibrosis.Hypothesis:Higher synovial immune cell infiltration and inflammatory/catabolic gene expression patterns at the time of ACLR would correlate with poorer motion-related outcomes.Study Design:Case series; Level of evidence, 4.Methods:Patients aged 10 to 18 years undergoing primary ACLR were enrolled in a prospective pilot study, and synovial tissue biopsy specimens were obtained during ACLR. Flow cytometry and single-cell RNA sequencing explored synovial cell types/frequencies and gene expression. Principal component analysis was performed, followed by clustering which grouped patients into distinct immunophenotypes based on their synovial cell composition. Clinical follow-up data with knee range of motion (ROM), need for lysis of adhesions, and patient-reported outcome measures were collected and compared between immunophenotypes.Results:Enrolled patients (n = 17) underwent ACLR at a median of 37 days after injury. Analysis revealed 3 distinct immunophenotypes. Type 1 consisted of patients with the longest time between injury and surgery and the lowest hematopoietic and T-cell infiltration. Types 2 and 3 had similar times between injury and surgery; type 2 had intermediate while type 3 had the highest hematopoietic and T-cell percentages. Type 3 was associated with worse ROM at 2 and 6 weeks postoperatively; T-cell prevalence and ROM were inversely correlated at those time points. The only patient requiring lysis of adhesions for arthrofibrosis had a type 3 immunophenotype.Conclusion:Synovial immune infiltration after ACL injury shows variability between patients that clusters into 3 immunophenotypes correlating with early ROM and the risk of arthrofibrosis. T-cell recruitment and infiltration were the strongest factors correlated with ROM outcomes and present an exciting venue for future research on post-ACLR arthrofibrosis.
{"title":"Immunophenotyping of Synovial Tissue in Adolescents Undergoing ACL Reconstruction: What Is the Role of Synovial Inflammation in Arthrofibrosis?","authors":"Sarah M. Romereim, Matthew R. Smykowski, Elaina K. Ball, Edward Grant Carey, Mario Cuadra, Alicia Williams, Kate Hickson, Kara Haim, Meera Sumith, Ziqing Yu, Guangxu Jin, David Foureau, Nury Steuerwald, Susan Odum, Bailey V. Fearing, Jonathan C. Riboh","doi":"10.1177/03635465241305411","DOIUrl":"https://doi.org/10.1177/03635465241305411","url":null,"abstract":"Background:Loss of motion and arthrofibrosis after anterior cruciate ligament (ACL) reconstruction (ACLR) can be devastating complications for athletes. The cellular and molecular pathogenesis of arthrofibrosis is poorly understood, limiting prevention and treatment options. Synovial inflammation may contribute to post-ACLR arthrofibrosis.Hypothesis:Higher synovial immune cell infiltration and inflammatory/catabolic gene expression patterns at the time of ACLR would correlate with poorer motion-related outcomes.Study Design:Case series; Level of evidence, 4.Methods:Patients aged 10 to 18 years undergoing primary ACLR were enrolled in a prospective pilot study, and synovial tissue biopsy specimens were obtained during ACLR. Flow cytometry and single-cell RNA sequencing explored synovial cell types/frequencies and gene expression. Principal component analysis was performed, followed by clustering which grouped patients into distinct immunophenotypes based on their synovial cell composition. Clinical follow-up data with knee range of motion (ROM), need for lysis of adhesions, and patient-reported outcome measures were collected and compared between immunophenotypes.Results:Enrolled patients (n = 17) underwent ACLR at a median of 37 days after injury. Analysis revealed 3 distinct immunophenotypes. Type 1 consisted of patients with the longest time between injury and surgery and the lowest hematopoietic and T-cell infiltration. Types 2 and 3 had similar times between injury and surgery; type 2 had intermediate while type 3 had the highest hematopoietic and T-cell percentages. Type 3 was associated with worse ROM at 2 and 6 weeks postoperatively; T-cell prevalence and ROM were inversely correlated at those time points. The only patient requiring lysis of adhesions for arthrofibrosis had a type 3 immunophenotype.Conclusion:Synovial immune infiltration after ACL injury shows variability between patients that clusters into 3 immunophenotypes correlating with early ROM and the risk of arthrofibrosis. T-cell recruitment and infiltration were the strongest factors correlated with ROM outcomes and present an exciting venue for future research on post-ACLR arthrofibrosis.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"147 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-06DOI: 10.1177/03635465241260255
Mohamad Y. Fares, Mohammad Daher, Peter Boufadel, Adam Z. Khan, Joseph A. Abboud
Background:Liposomal bupivacaine (LB) is a relatively novel anesthetic agent used in the management of postoperative pain in patients who have undergone shoulder surgery.Purpose:To explore the literature on LB in the setting of shoulder surgery and assess its efficacy and utility in managing postoperative pain.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:PubMed, Cochrane, and Google Scholar (pp 1-20) were searched for articles published up to November 2023. Inclusion criteria consisted of randomized controlled trials comparing anesthetic modalities using LB with other anesthetic modalities using alternative drugs in patients who underwent shoulder surgery. Complications, pain levels in the first 24 hours postoperatively, and opioid consumption intraoperatively and in the first, second, and third 24 hours postoperatively were assessed.Results:A total of 15 randomized controlled trials were included in the meta-analysis. In 4 studies comparing periarticular injections of LB (196 patients) with nerve blocks of other anesthetic agents (201 patients), there was no significant difference in pain levels ( P = .74) and complication rates ( P = .37); however, intraoperative opioid consumption was significantly greater in patients with periarticular injections of LB ( P = .005). In 3 studies comparing single-injection LB nerve blocks (83 patients) with interscalene nerve block catheters (102 patients) and in 8 studies comparing single-injection LB nerve blocks (311 patients) with other nerve blocks (308 patients), single-injection LB nerve blocks demonstrated clinical superiority. Single-injection LB nerve blocks resulted in significantly lower pain levels and lower opioid consumption in the first, second, and third 24 hours postoperatively compared with other single-injection nerve blocks and both single-injection nerve blocks and interscalene catheters combined.Conclusion:LB is a promising anesthetic component with efficacy in providing analgesia after shoulder surgery. Single-injection LB nerve blocks were found to be superior in reducing pain levels and opioid consumption compared with other anesthetic modalities.
{"title":"The Use of Liposomal Bupivacaine for Pain Control After Shoulder Surgery: A Systematic Review and Meta-analysis","authors":"Mohamad Y. Fares, Mohammad Daher, Peter Boufadel, Adam Z. Khan, Joseph A. Abboud","doi":"10.1177/03635465241260255","DOIUrl":"https://doi.org/10.1177/03635465241260255","url":null,"abstract":"Background:Liposomal bupivacaine (LB) is a relatively novel anesthetic agent used in the management of postoperative pain in patients who have undergone shoulder surgery.Purpose:To explore the literature on LB in the setting of shoulder surgery and assess its efficacy and utility in managing postoperative pain.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:PubMed, Cochrane, and Google Scholar (pp 1-20) were searched for articles published up to November 2023. Inclusion criteria consisted of randomized controlled trials comparing anesthetic modalities using LB with other anesthetic modalities using alternative drugs in patients who underwent shoulder surgery. Complications, pain levels in the first 24 hours postoperatively, and opioid consumption intraoperatively and in the first, second, and third 24 hours postoperatively were assessed.Results:A total of 15 randomized controlled trials were included in the meta-analysis. In 4 studies comparing periarticular injections of LB (196 patients) with nerve blocks of other anesthetic agents (201 patients), there was no significant difference in pain levels ( P = .74) and complication rates ( P = .37); however, intraoperative opioid consumption was significantly greater in patients with periarticular injections of LB ( P = .005). In 3 studies comparing single-injection LB nerve blocks (83 patients) with interscalene nerve block catheters (102 patients) and in 8 studies comparing single-injection LB nerve blocks (311 patients) with other nerve blocks (308 patients), single-injection LB nerve blocks demonstrated clinical superiority. Single-injection LB nerve blocks resulted in significantly lower pain levels and lower opioid consumption in the first, second, and third 24 hours postoperatively compared with other single-injection nerve blocks and both single-injection nerve blocks and interscalene catheters combined.Conclusion:LB is a promising anesthetic component with efficacy in providing analgesia after shoulder surgery. Single-injection LB nerve blocks were found to be superior in reducing pain levels and opioid consumption compared with other anesthetic modalities.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-06DOI: 10.1177/03635465241255606
Sunny M. Trivedi, Charlotte F. Wahle, Yifan V. Mao, Dimpy Wraich, Kevin G. Shea, Kesavan Sadacharam, Zachary Stinson, Matthew Ellington, Emily Niu, Brendan Williams, Neeraj Patel, Henry Ellis, Allison Crepeau, Kelly Vanderhave, Sasha Carsen, Stephanie Mayer, Andy Pennock, Curtis Vandenberg, Jennifer J. Beck
Background:Peripheral nerve blocks (PNBs) are frequently utilized as a regional anesthetic in pediatric orthopaedic surgery for postoperative pain control and reduced time to discharge; however, short- and long-term complications after these procedures are variably reported.Purpose:To identify the frequency of long-term complications in pediatric patients who received regional anesthesia for a lower extremity orthopaedic procedure.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were collected on pediatric patients, which included the following: block type, block location, procedure type, patient age, experimental design, and reported outcomes. Full texts were then thoroughly examined to determine whether the article made specific references to long-term (≥6 weeks) complications in pediatric patients who received PNBs.Results:A total of 158 studies were assessed for eligibility. There were 16 of 158 (10%) studies that met inclusion criteria of having a discussion on follow-up to evaluate for long-term complications (≥6 weeks) from pediatric PNBs. Of these 16 studies, 9 documented long-term complications, while 7 reported no complications. The most common complications were motor deficits, chronic pain, reduced range of motion, and neurological paresthesia. Of the 9 studies reporting long-term complications related to PNBs, 16 of 352 patients across 2 studies (5%) reported chronic pain, 45 of 466 patients across 4 studies (10%) reported strength deficits, 16 of 135 patients across 2 studies (12%) reported reduced range of motion, and 11 of 15,387 patients across 4 studies (0.07%) reported sensory deficits.Conclusion:Persistent complications occurred in pediatric orthopaedic patients undergoing lower extremity procedures with PNBs; however, reports in the current literature were rare.
{"title":"Long-term Complications From Peripheral Nerve Blocks After Pediatric Orthopaedic Lower Extremity Procedures: A Systematic Review","authors":"Sunny M. Trivedi, Charlotte F. Wahle, Yifan V. Mao, Dimpy Wraich, Kevin G. Shea, Kesavan Sadacharam, Zachary Stinson, Matthew Ellington, Emily Niu, Brendan Williams, Neeraj Patel, Henry Ellis, Allison Crepeau, Kelly Vanderhave, Sasha Carsen, Stephanie Mayer, Andy Pennock, Curtis Vandenberg, Jennifer J. Beck","doi":"10.1177/03635465241255606","DOIUrl":"https://doi.org/10.1177/03635465241255606","url":null,"abstract":"Background:Peripheral nerve blocks (PNBs) are frequently utilized as a regional anesthetic in pediatric orthopaedic surgery for postoperative pain control and reduced time to discharge; however, short- and long-term complications after these procedures are variably reported.Purpose:To identify the frequency of long-term complications in pediatric patients who received regional anesthesia for a lower extremity orthopaedic procedure.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were collected on pediatric patients, which included the following: block type, block location, procedure type, patient age, experimental design, and reported outcomes. Full texts were then thoroughly examined to determine whether the article made specific references to long-term (≥6 weeks) complications in pediatric patients who received PNBs.Results:A total of 158 studies were assessed for eligibility. There were 16 of 158 (10%) studies that met inclusion criteria of having a discussion on follow-up to evaluate for long-term complications (≥6 weeks) from pediatric PNBs. Of these 16 studies, 9 documented long-term complications, while 7 reported no complications. The most common complications were motor deficits, chronic pain, reduced range of motion, and neurological paresthesia. Of the 9 studies reporting long-term complications related to PNBs, 16 of 352 patients across 2 studies (5%) reported chronic pain, 45 of 466 patients across 4 studies (10%) reported strength deficits, 16 of 135 patients across 2 studies (12%) reported reduced range of motion, and 11 of 15,387 patients across 4 studies (0.07%) reported sensory deficits.Conclusion:Persistent complications occurred in pediatric orthopaedic patients undergoing lower extremity procedures with PNBs; however, reports in the current literature were rare.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-06DOI: 10.1177/03635465241260271
Kyle N. Kunze, Steven Persaud, Juan Briano, Scott A. Rodeo, Russell F. Warren, Thomas L. Wickiewicz, Riley J. Williams
Background:Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature.Purpose:To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:The PubMed, OVID/MEDLINE, and Cochrane databases were queried in August 2023 for trials reporting on the outcomes of revision cartilage restoration procedures of the knee. Information pertaining to rates of failure, reoperations, graft-related complications, and patient-reported outcome measures were extracted. A meta-analysis using inverse-variance proportion models using Freeman-Tukey double-arcsine transformations and DerSimonian-Laird random-effects estimators was constructed to quantitatively describe the cumulative incidence of adverse events.Results:Sixteen studies (1361 patients; mean age, 35.7 ± 9.3 years) were included. The most frequently performed revision cartilage procedure was autologous chondrocyte implantation (ACI; n = 755 [55.5%]). The overall rate of failure was 25.1% (95% CI, 14.4%-37.3%) at a mean 6.5 years (range, 2-26 years). The majority of studies (n = 9) reported a failure rate exceeding 20%. A significant reduction in failure was observed in favor of the revision osteochondral allograft cohort (19.0% [75/395] vs 35.7% [273/764]; relative risk, 0.63; P < .0001) compared with the revision ACI cohort. The pooled all-cause reoperation event rate was 40.8%, which ranged between 18.2% and 71.4% (13 studies). Of these studies, 12 reported reoperation rates exceeding 20%, and 7 reported rates exceeding 40%. The pooled graft-related complication event rate was 27.2%, which ranged between 5.4% and 56.6% (11 studies). Notably, all analyses demonstrated considerable or moderate heterogeneity, potentially influencing the observed variability in pooled effect estimates.Conclusion:One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure. Revision using an osteochondral allograft may confer a meaningful reduction in the risk of failure relative to revision using ACI. High rates of graft-related complications and reoperations are also frequently observed in this population, highlighting the challenge of treating patients with failed primary treatment of chondral or osteochondral defects of the knee.
{"title":"Outcomes of Revision Cartilage Restoration Surgery for Failed Primary Treatment of Chondral or Osteochondral Defects of the Knee: A Systematic Review","authors":"Kyle N. Kunze, Steven Persaud, Juan Briano, Scott A. Rodeo, Russell F. Warren, Thomas L. Wickiewicz, Riley J. Williams","doi":"10.1177/03635465241260271","DOIUrl":"https://doi.org/10.1177/03635465241260271","url":null,"abstract":"Background:Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature.Purpose:To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:The PubMed, OVID/MEDLINE, and Cochrane databases were queried in August 2023 for trials reporting on the outcomes of revision cartilage restoration procedures of the knee. Information pertaining to rates of failure, reoperations, graft-related complications, and patient-reported outcome measures were extracted. A meta-analysis using inverse-variance proportion models using Freeman-Tukey double-arcsine transformations and DerSimonian-Laird random-effects estimators was constructed to quantitatively describe the cumulative incidence of adverse events.Results:Sixteen studies (1361 patients; mean age, 35.7 ± 9.3 years) were included. The most frequently performed revision cartilage procedure was autologous chondrocyte implantation (ACI; n = 755 [55.5%]). The overall rate of failure was 25.1% (95% CI, 14.4%-37.3%) at a mean 6.5 years (range, 2-26 years). The majority of studies (n = 9) reported a failure rate exceeding 20%. A significant reduction in failure was observed in favor of the revision osteochondral allograft cohort (19.0% [75/395] vs 35.7% [273/764]; relative risk, 0.63; P < .0001) compared with the revision ACI cohort. The pooled all-cause reoperation event rate was 40.8%, which ranged between 18.2% and 71.4% (13 studies). Of these studies, 12 reported reoperation rates exceeding 20%, and 7 reported rates exceeding 40%. The pooled graft-related complication event rate was 27.2%, which ranged between 5.4% and 56.6% (11 studies). Notably, all analyses demonstrated considerable or moderate heterogeneity, potentially influencing the observed variability in pooled effect estimates.Conclusion:One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure. Revision using an osteochondral allograft may confer a meaningful reduction in the risk of failure relative to revision using ACI. High rates of graft-related complications and reoperations are also frequently observed in this population, highlighting the challenge of treating patients with failed primary treatment of chondral or osteochondral defects of the knee.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241305419
Mario Hevesi, Kyle R. Wagner, Ryan A. Quigley, Zach D. Meeker, Allen A. Yazdi, Alexander C. Weissman, Sara A. Muth, Nate S. Cohen, Adam B. Yanke, Brian J. Cole
Background:Mismatch between osteochondral allograft (OCA) donor and recipient sex has been shown to negatively affect outcomes. This study accounts for additional donor variables and clinically relevant outcomes.Purpose:To evaluate whether donor sex, age, donor-recipient sex mismatch, and duration of graft storage affect clinical outcomes and failure rates after knee OCA transplantation.Study Design:Cohort study; Level of evidence, 3.Methods:Patients undergoing knee OCA transplantation between 2003 and 2018 were prospectively followed. Inclusion criteria consisted of primary OCA transplantation and minimum 2-year follow-up. Patient descriptive data and allograft donor sex, age, and graft storage time before implantation were collected. Patients were evaluated for reoperation, failure, and achievement of clinically significant outcomes for International Knee Documentation Committee scores. Reoperation was defined as subsequent surgical intervention of the transplanted allograft, including second-look arthroscopy for graft evaluation, debridement, and loose body removal. Failure was defined as revision of the primary OCA transplantation or conversion to arthroplasty. A Kaplan-Meier curve determined cumulative survivability of OCA transplantations, and log-rank testing was used to compare survivorship between groups. Stepwise regression analysis was utilized to evaluate associations between donor variables and achievement of clinically significant outcomes, reoperation, and failure.Results:A total of 372 patients undergoing OCA transplantation were included and followed for a mean 5.4 years (SD, 2.7; range, 2.0-16.3). Isolated OCA transplantation was performed in 45% of cases (169/372). A mismatch in donor and recipient sex was present for more female patients (90%) than male patients (10%; P < .001). Those who had a sex-mismatched graft more frequently underwent concomitant tibial tubercle osteotomy ( P = .034). When controlling for patient sex, no other differences were seen between groups matched and mismatched by sex. Univariable and multivariable analysis found no significant difference in survival free from reoperation or failure on the basis of donor-recipient sex mismatch, donor age, or graft storage time before implantation.Conclusion:In contrast to previous historical data, no donor variables were associated with inferior clinical outcomes in patients who underwent OCA transplantation. These data can help inform graft selection, expedient recipient selection, and outcome optimization after OCA transplantation.
{"title":"No Association Between Donor Variables and Clinically Significant Outcomes, Reoperations, and Failure After Osteochondral Allograft Transplantation","authors":"Mario Hevesi, Kyle R. Wagner, Ryan A. Quigley, Zach D. Meeker, Allen A. Yazdi, Alexander C. Weissman, Sara A. Muth, Nate S. Cohen, Adam B. Yanke, Brian J. Cole","doi":"10.1177/03635465241305419","DOIUrl":"https://doi.org/10.1177/03635465241305419","url":null,"abstract":"Background:Mismatch between osteochondral allograft (OCA) donor and recipient sex has been shown to negatively affect outcomes. This study accounts for additional donor variables and clinically relevant outcomes.Purpose:To evaluate whether donor sex, age, donor-recipient sex mismatch, and duration of graft storage affect clinical outcomes and failure rates after knee OCA transplantation.Study Design:Cohort study; Level of evidence, 3.Methods:Patients undergoing knee OCA transplantation between 2003 and 2018 were prospectively followed. Inclusion criteria consisted of primary OCA transplantation and minimum 2-year follow-up. Patient descriptive data and allograft donor sex, age, and graft storage time before implantation were collected. Patients were evaluated for reoperation, failure, and achievement of clinically significant outcomes for International Knee Documentation Committee scores. Reoperation was defined as subsequent surgical intervention of the transplanted allograft, including second-look arthroscopy for graft evaluation, debridement, and loose body removal. Failure was defined as revision of the primary OCA transplantation or conversion to arthroplasty. A Kaplan-Meier curve determined cumulative survivability of OCA transplantations, and log-rank testing was used to compare survivorship between groups. Stepwise regression analysis was utilized to evaluate associations between donor variables and achievement of clinically significant outcomes, reoperation, and failure.Results:A total of 372 patients undergoing OCA transplantation were included and followed for a mean 5.4 years (SD, 2.7; range, 2.0-16.3). Isolated OCA transplantation was performed in 45% of cases (169/372). A mismatch in donor and recipient sex was present for more female patients (90%) than male patients (10%; P < .001). Those who had a sex-mismatched graft more frequently underwent concomitant tibial tubercle osteotomy ( P = .034). When controlling for patient sex, no other differences were seen between groups matched and mismatched by sex. Univariable and multivariable analysis found no significant difference in survival free from reoperation or failure on the basis of donor-recipient sex mismatch, donor age, or graft storage time before implantation.Conclusion:In contrast to previous historical data, no donor variables were associated with inferior clinical outcomes in patients who underwent OCA transplantation. These data can help inform graft selection, expedient recipient selection, and outcome optimization after OCA transplantation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241252435
Nikhil Vasireddi, Henrik A. Hahamyan, Heath P. Gould, Andrew J.M. Gregory, Elizabeth B. Gausden, Christopher C. Dodson, James E. Voos, Jacob G. Calcei
Background:Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.Purpose:(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.Results:A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects—including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied “illicit drug use,” implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.Conclusion:The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body—including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athle
{"title":"Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review","authors":"Nikhil Vasireddi, Henrik A. Hahamyan, Heath P. Gould, Andrew J.M. Gregory, Elizabeth B. Gausden, Christopher C. Dodson, James E. Voos, Jacob G. Calcei","doi":"10.1177/03635465241252435","DOIUrl":"https://doi.org/10.1177/03635465241252435","url":null,"abstract":"Background:Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.Purpose:(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.Results:A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects—including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied “illicit drug use,” implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.Conclusion:The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body—including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athle","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241252805
Bader Majed Aljadaan, Mohammed Saad A. Alhakbani, Shahd Hamza Almonaie, Peter M.B. Cahusac
Background:Patellar instability is frequently encountered by orthopaedic surgeons. One of the major risk factors of this condition is underlying trochlear dysplasia (TD). Recent trends have indicated the use of multiple procedures to correct patellar instability under these conditions. Medial patellofemoral ligament reconstruction (MPFLR) and trochleoplasty (TP) are surgical strategies that have demonstrated successful outcomes. However, it is unclear whether isolated MPFLR suffices for patellar instability in the presence of severe TD. Furthermore, the need for TP or a combined approach, considering its invasiveness and technical demands, to achieve better clinical outcomes and patellofemoral stability remains uncertain.Purpose:To compare the outcomes of 3 surgical interventions for addressing patellar instability due to TD: MPFLR, TP, and combined MPFLR and TP.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:Studies reporting the clinical outcomes of MPFLR, TP, and both in combination, regardless of additional procedures, were identified using the MEDLINE, PubMed, Embase, Scopus, Cochrane Library, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases. An important inclusion criterion was that studies should include the mean preoperative and postoperative Kujala scores and any complications. A random-effects model was used for the meta-analysis.Results:Overall, 30 studies were included: 10 describing the outcomes of TP, 13 describing the outcomes of MPFLR, and 7 describing the outcomes of combined TP and MPFLR. Furthermore, 1457 patients (1571 knees) were evaluated with a mean follow-up of 42.4 ± 32.8 months. No statistically significant differences were found between the 3 methods regarding the mean difference using the Kujala score. However, combined MPFLR and TP had the highest weighted mean difference compared with the other 2 procedures (28.5 points; P < .001). Evidential analysis revealed a robust log-likelihood ratio ( S = 3.2) supporting the superiority of the combined procedure when comparing this mean and the weighted grand mean of 23.7. The redislocation rate after patellar stabilization remained minimal, irrespective of the surgical procedure (mean, 0.7%). However, the rate of residual patellar instability was the highest in the TP group (mean, 13.5%).Conclusion:This study found no statistically significant difference between the outcomes of the 3 procedures. However, the combined approach of MPFLR and TP was associated with the most promising clinical outcomes and a low redislocation rate in patients with varying severities of TD.
背景：髌骨不稳是骨科医生经常遇到的问题。这种情况的主要危险因素之一是潜在的滑车发育不良（TD）。最近的趋势表明，在这种情况下，使用多种手术来纠正髌骨不稳定。髌股内侧韧带重建（MPFLR）和滑车成形术（TP）是已经证明成功的手术策略。然而，目前尚不清楚在存在严重TD的情况下，孤立的MPFLR是否足以治疗髌骨不稳定。此外，考虑到TP的侵入性和技术要求，是否需要TP或联合入路来获得更好的临床结果和髌骨稳定性仍不确定。目的：比较MPFLR、TP和MPFLR和TP联合治疗TD所致髌骨不稳的3种手术干预的结果。研究设计：系统评价和荟萃分析；证据等级，4级。方法：使用MEDLINE、PubMed、Embase、Scopus、Cochrane Library、Cochrane Central Register of Controlled Trials以及护理和联合健康文献数据库的累积索引对报道MPFLR、TP以及两者联合使用的临床结果的研究进行识别，而不考虑其他程序。一个重要的纳入标准是研究应包括术前和术后的平均Kujala评分和任何并发症。meta分析采用随机效应模型。结果：总共纳入30项研究：10项研究描述TP的结果，13项研究描述MPFLR的结果，7项研究描述TP和MPFLR联合的结果。随访1457例患者（1571个膝关节），平均随访42.4±32.8个月。使用Kujala评分，三种方法的平均差异无统计学意义。然而，MPFLR和TP联合治疗与其他2种手术相比，加权平均差异最大(28.5分；P & lt;措施)。证据分析显示，稳健的对数似然比（S = 3.2）在比较该平均值和23.7的加权均数时支持联合程序的优越性。髌骨稳定后的再脱位率保持最低，与手术方式无关（平均为0.7%）。然而，残余髌骨不稳定率在TP组最高（平均13.5%）。结论：本研究发现3种手术的结果无统计学差异。然而，MPFLR和TP联合方法在不同严重程度的TD患者中具有最有希望的临床结果和较低的再脱位率。
{"title":"Outcomes of Surgical Interventions for Patellofemoral Instability in the Presence of Trochlear Dysplasia: A Systematic Review and Meta-analysis","authors":"Bader Majed Aljadaan, Mohammed Saad A. Alhakbani, Shahd Hamza Almonaie, Peter M.B. Cahusac","doi":"10.1177/03635465241252805","DOIUrl":"https://doi.org/10.1177/03635465241252805","url":null,"abstract":"Background:Patellar instability is frequently encountered by orthopaedic surgeons. One of the major risk factors of this condition is underlying trochlear dysplasia (TD). Recent trends have indicated the use of multiple procedures to correct patellar instability under these conditions. Medial patellofemoral ligament reconstruction (MPFLR) and trochleoplasty (TP) are surgical strategies that have demonstrated successful outcomes. However, it is unclear whether isolated MPFLR suffices for patellar instability in the presence of severe TD. Furthermore, the need for TP or a combined approach, considering its invasiveness and technical demands, to achieve better clinical outcomes and patellofemoral stability remains uncertain.Purpose:To compare the outcomes of 3 surgical interventions for addressing patellar instability due to TD: MPFLR, TP, and combined MPFLR and TP.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:Studies reporting the clinical outcomes of MPFLR, TP, and both in combination, regardless of additional procedures, were identified using the MEDLINE, PubMed, Embase, Scopus, Cochrane Library, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases. An important inclusion criterion was that studies should include the mean preoperative and postoperative Kujala scores and any complications. A random-effects model was used for the meta-analysis.Results:Overall, 30 studies were included: 10 describing the outcomes of TP, 13 describing the outcomes of MPFLR, and 7 describing the outcomes of combined TP and MPFLR. Furthermore, 1457 patients (1571 knees) were evaluated with a mean follow-up of 42.4 ± 32.8 months. No statistically significant differences were found between the 3 methods regarding the mean difference using the Kujala score. However, combined MPFLR and TP had the highest weighted mean difference compared with the other 2 procedures (28.5 points; P < .001). Evidential analysis revealed a robust log-likelihood ratio ( S = 3.2) supporting the superiority of the combined procedure when comparing this mean and the weighted grand mean of 23.7. The redislocation rate after patellar stabilization remained minimal, irrespective of the surgical procedure (mean, 0.7%). However, the rate of residual patellar instability was the highest in the TP group (mean, 13.5%).Conclusion:This study found no statistically significant difference between the outcomes of the 3 procedures. However, the combined approach of MPFLR and TP was associated with the most promising clinical outcomes and a low redislocation rate in patients with varying severities of TD.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241305742
Jae Soo Kim, Su Cheol Kim, Jong Hun Park, Hyun Gon Kim, Hyoung Seok Jung, Sang Min Lee, Jae Chul Yoo
Background:Studies are still limited on the isolated effect of retear after arthroscopic rotator cuff repair (ARCR) on functional outcomes after the midterm period.Purpose:To assess the effect of retear at midterm follow-up after ARCR and to identify factors associated with the need for revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted on patients who underwent ARCR between 2014 and 2018, with a minimum 5-year follow-up. The structural integrity was evaluated using magnetic resonance imaging. After propensity score matching, 65 patients for the retear group and 65 for the healed group were included. Functional outcomes, including visual analog scale for pain and function (PVAS and FVAS) and American Shoulder and Elbow Surgeons (ASES) score, were compared between the groups at 1 year and final follow-up. Multivariate analysis was conducted on the retear group to identify factors associated with the final ASES score.Results:The mean ± SD follow-up period was 6.9 ± 1.4 years. All outcomes at the final follow-up improved as compared with the preoperative status, regardless of retear (all P < .001). In the retear group, PVAS at the final follow-up showed deterioration when compared with postoperative 1 year ( P = .044). While there were no significant differences in all outcomes at 1 year postoperatively between the groups (all P > .05), the retear group demonstrated significantly worse outcomes than the healed group in scores on the PVAS (2.5 ± 1.5 vs 1.9 ± 1.5; P = .011), FVAS (7.3 ± 1.4 vs 7.8 ± 1.3; P = .020), and ASES (73.2 ± 12.7 vs 79.9 ± 15.4; P = .008) at the final follow-up. The revision rate in the retear group was 12.8%, and multivariate analysis showed that larger anteroposterior retear size ( P = .017) and retear of the subscapularis ( P = .047) were negatively associated with the final ASES score.Conclusion:Functional outcomes after ARCR improved during midterm follow-up, regardless of retear. While the effect of retear itself on functional outcomes was minimal in the short term, it became more pronounced after the midterm period. A retear involving the subscapularis or with a larger anteroposterior size was associated with a poorer functional outcome.
背景：关于关节镜下肩袖修复（ARCR）后再撕裂对中期后功能结局的孤立影响的研究仍然有限。目的：评估翻修手术在ARCR术后中期随访中的效果，并确定需要翻修手术的相关因素。研究设计：队列研究；证据水平，3。方法：回顾性分析2014 - 2018年间接受ARCR的患者，随访时间至少为5年。采用磁共振成像评估结构完整性。倾向评分匹配后，包括65例复发组和65例愈合组。功能结果，包括疼痛和功能视觉模拟量表（PVAS和FVAS）和美国肩肘外科医生（ASES）评分，在1年和最后随访时进行比较。对retear组进行多变量分析，以确定与最终as评分相关的因素。结果：平均±SD随访时间为6.9±1.4年。与术前相比，最终随访的所有结果均有所改善，无论是否复发(所有P <；措施)。与术后1年相比，治疗组最后一次随访时PVAS出现恶化（P = 0.044）。而两组术后1年的所有结果均无显著差异(P >；.05)，愈合组在PVAS评分上明显差于愈合组(2.5±1.5 vs 1.9±1.5；P = 0.011)， FVAS(7.3±1.4 vs 7.8±1.3；P = 0.020)，而ASES(73.2±12.7 vs 79.9±15.4；P = 0.008)。复习组复习率为12.8%，多因素分析显示，较大的正侧复习大小（P = 0.017）和肩胛下肌复习大小（P = 0.047）与最终的as评分呈负相关。结论：在中期随访中，无论复发与否，ARCR术后的功能结局均有所改善。虽然retear本身在短期内对功能结果的影响很小，但在中期后它变得更加明显。累及肩胛下肌或前后肌较大的撕裂与较差的功能预后相关。
{"title":"Midterm Functional Outcomes After Retear of an Arthroscopic Rotator Cuff Repair: A Propensity Score–Matched Comparative Study","authors":"Jae Soo Kim, Su Cheol Kim, Jong Hun Park, Hyun Gon Kim, Hyoung Seok Jung, Sang Min Lee, Jae Chul Yoo","doi":"10.1177/03635465241305742","DOIUrl":"https://doi.org/10.1177/03635465241305742","url":null,"abstract":"Background:Studies are still limited on the isolated effect of retear after arthroscopic rotator cuff repair (ARCR) on functional outcomes after the midterm period.Purpose:To assess the effect of retear at midterm follow-up after ARCR and to identify factors associated with the need for revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted on patients who underwent ARCR between 2014 and 2018, with a minimum 5-year follow-up. The structural integrity was evaluated using magnetic resonance imaging. After propensity score matching, 65 patients for the retear group and 65 for the healed group were included. Functional outcomes, including visual analog scale for pain and function (PVAS and FVAS) and American Shoulder and Elbow Surgeons (ASES) score, were compared between the groups at 1 year and final follow-up. Multivariate analysis was conducted on the retear group to identify factors associated with the final ASES score.Results:The mean ± SD follow-up period was 6.9 ± 1.4 years. All outcomes at the final follow-up improved as compared with the preoperative status, regardless of retear (all P < .001). In the retear group, PVAS at the final follow-up showed deterioration when compared with postoperative 1 year ( P = .044). While there were no significant differences in all outcomes at 1 year postoperatively between the groups (all P > .05), the retear group demonstrated significantly worse outcomes than the healed group in scores on the PVAS (2.5 ± 1.5 vs 1.9 ± 1.5; P = .011), FVAS (7.3 ± 1.4 vs 7.8 ± 1.3; P = .020), and ASES (73.2 ± 12.7 vs 79.9 ± 15.4; P = .008) at the final follow-up. The revision rate in the retear group was 12.8%, and multivariate analysis showed that larger anteroposterior retear size ( P = .017) and retear of the subscapularis ( P = .047) were negatively associated with the final ASES score.Conclusion:Functional outcomes after ARCR improved during midterm follow-up, regardless of retear. While the effect of retear itself on functional outcomes was minimal in the short term, it became more pronounced after the midterm period. A retear involving the subscapularis or with a larger anteroposterior size was associated with a poorer functional outcome.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241303704
Jordan H. Larson, Sachin Allahabadi, Daniel Kaplan, Reagan Chapman, Omair Kazi, Christopher M. Brusalis, Shane J. Nho
Background:Many studies have examined the prevalence of acetabular version (AV) and femoral version (FV) abnormalities and their effect on patient-reported outcomes (PROs) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), but few have explored the prevalence and influence of combined version (CV) abnormalities.Purpose:To (1) describe the distribution of AV, FV, and CV in the largest cohort to date and (2) determine the relationship between AV, FV, and CV and PROs after hip arthroscopy for FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were identified who underwent primary hip arthroscopy for FAIS between 2012 and 2018 and received computed tomography containing the pelvis and transcondylar knee slices. AV and FV were assessed on computed tomography, with CV calculated as their sum. PROs were collected preoperatively and 2 years postoperatively. The distributions of AV, FV, CV, and combinations thereof were described based on published ranges. The relationships between version measurements and PROs were analyzed based on a given measurement's distance from a normative value, defined as the mean within the study population (eg, relative acetabular anteversion [AAr]). These relationships were first assessed using univariate natural (restricted) cubic regression splines to account for nonlinearity. The relationship between each relative version group (to the mean) and PROs was then assessed using multiple linear regression, with the other 2 version measurements held constant.Results:In total, 566 patients were included (66.4% female; mean age, 32.6 ± 11.9 years; mean body mass index, 25.2 ± 5.1). The mean follow-up was 28.0 months. The mean AV, FV, and CV were 17.1°± 5.2°, 12.1°± 9.2°, and 29.3°± 11°, respectively. Univariate natural cubic regression splines demonstrated that AAr had a significant negative association with 4 of 5 PROs preoperatively and 3 of 5 PROs 2 years postoperatively ( P≤ .018). All other relative version groups did not have a significant relationship with any PRO at either time point ( P > .05). The association between AAr and relatively worse PROs was maintained after controlling for relative FV and CV via multiple linear regression, particularly in patients with relative femoral retroversion.Conclusion:FV and CV, as distinct measures, are not associated with outcomes after hip arthroscopy for FAIS. AAr is associated with worse preoperative status and less improvement at 2 years postoperatively, particularly in patients with relative femoral retroversion.
{"title":"Exploring the Relationship Between Combined, Acetabular, and Femoral Version on Postoperative Outcomes 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome","authors":"Jordan H. Larson, Sachin Allahabadi, Daniel Kaplan, Reagan Chapman, Omair Kazi, Christopher M. Brusalis, Shane J. Nho","doi":"10.1177/03635465241303704","DOIUrl":"https://doi.org/10.1177/03635465241303704","url":null,"abstract":"Background:Many studies have examined the prevalence of acetabular version (AV) and femoral version (FV) abnormalities and their effect on patient-reported outcomes (PROs) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), but few have explored the prevalence and influence of combined version (CV) abnormalities.Purpose:To (1) describe the distribution of AV, FV, and CV in the largest cohort to date and (2) determine the relationship between AV, FV, and CV and PROs after hip arthroscopy for FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were identified who underwent primary hip arthroscopy for FAIS between 2012 and 2018 and received computed tomography containing the pelvis and transcondylar knee slices. AV and FV were assessed on computed tomography, with CV calculated as their sum. PROs were collected preoperatively and 2 years postoperatively. The distributions of AV, FV, CV, and combinations thereof were described based on published ranges. The relationships between version measurements and PROs were analyzed based on a given measurement's distance from a normative value, defined as the mean within the study population (eg, relative acetabular anteversion [AAr]). These relationships were first assessed using univariate natural (restricted) cubic regression splines to account for nonlinearity. The relationship between each relative version group (to the mean) and PROs was then assessed using multiple linear regression, with the other 2 version measurements held constant.Results:In total, 566 patients were included (66.4% female; mean age, 32.6 ± 11.9 years; mean body mass index, 25.2 ± 5.1). The mean follow-up was 28.0 months. The mean AV, FV, and CV were 17.1°± 5.2°, 12.1°± 9.2°, and 29.3°± 11°, respectively. Univariate natural cubic regression splines demonstrated that AAr had a significant negative association with 4 of 5 PROs preoperatively and 3 of 5 PROs 2 years postoperatively ( P≤ .018). All other relative version groups did not have a significant relationship with any PRO at either time point ( P > .05). The association between AAr and relatively worse PROs was maintained after controlling for relative FV and CV via multiple linear regression, particularly in patients with relative femoral retroversion.Conclusion:FV and CV, as distinct measures, are not associated with outcomes after hip arthroscopy for FAIS. AAr is associated with worse preoperative status and less improvement at 2 years postoperatively, particularly in patients with relative femoral retroversion.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-05DOI: 10.1177/03635465241254520
Sina Tartibi, Garrett R. Jackson, Tanya Boghosian, Robert H. Brophy, Matthew V. Smith, Matthew J. Matava, Derrick M. Knapik
Background:Knee injuries resulting in purely cartilaginous defects are rare, and controversy remains regarding the reliability of chondral-only fixation.Purpose:To systematically review the literature for fixation methods and outcomes after primary fixation of chondral-only defects within the knee.Study Design:Systematic review; Level of evidence, 5.Methods:A literature search was conducted following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using keywords and Boolean phrases in PubMed, Embase, Cochrane, and Scopus on October 10, 2023. Human studies reporting fixation methods and outcomes after primary fixation of chondral-only defects within the knee were included in this systematic review. Studies reporting subchondral bone involvement were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Postoperative outcomes, reoperations, and return to sport/activity were evaluated. Failure was defined as chondral fragment dislodgement or failure of healing postoperatively.Results:A total of 18 studies (N = 93 patients) were identified. The mean patient age was 16 years (mean range, 11-32 years), with a mean final follow-up of 42.4 months (mean range, 5-61.2 months). Men comprised 81% (n = 59/73) of patients. Bioabsorbable implants (n = 13 studies) were the most commonly reported fixation method. Complications related to fixation of the chondral fragment occurred in 10.8% of patients (n = 10/93), with all other complications occurring in 9.8% (n = 9/93) of patients. Revision surgery directly associated with the chondral fragment was reported in 10.8% (n = 10/93) of patients. Successful return to sport/activity was observed in 90% (n = 60/67) of patients. Intact fixation was reported in 85% (n = 75/88) of patients undergoing postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy.Conclusion:Primary fixation of chondral-only defects can lead to low rates of failure and revision surgery with a high return to sport/activity in young patients, even with relatively large lesions. Bioabsorbable implants and absorbable sutures were the most common fixation methods, primarily performed via open arthrotomy after diagnostic arthroscopy. Failure of fixation and implant irritation were the most commonly reported complications related to fixation, with reoperations directly related to fragment fixation performed in 10.8% of patients. Healing of the chondral fragment as evaluated using postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy was reported in 85% of patients.
{"title":"Fixation Methods, Complications, and Outcomes After Primary Fixation of Isolated Chondral Fragments in the Knee: A Systematic Review","authors":"Sina Tartibi, Garrett R. Jackson, Tanya Boghosian, Robert H. Brophy, Matthew V. Smith, Matthew J. Matava, Derrick M. Knapik","doi":"10.1177/03635465241254520","DOIUrl":"https://doi.org/10.1177/03635465241254520","url":null,"abstract":"Background:Knee injuries resulting in purely cartilaginous defects are rare, and controversy remains regarding the reliability of chondral-only fixation.Purpose:To systematically review the literature for fixation methods and outcomes after primary fixation of chondral-only defects within the knee.Study Design:Systematic review; Level of evidence, 5.Methods:A literature search was conducted following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using keywords and Boolean phrases in PubMed, Embase, Cochrane, and Scopus on October 10, 2023. Human studies reporting fixation methods and outcomes after primary fixation of chondral-only defects within the knee were included in this systematic review. Studies reporting subchondral bone involvement were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Postoperative outcomes, reoperations, and return to sport/activity were evaluated. Failure was defined as chondral fragment dislodgement or failure of healing postoperatively.Results:A total of 18 studies (N = 93 patients) were identified. The mean patient age was 16 years (mean range, 11-32 years), with a mean final follow-up of 42.4 months (mean range, 5-61.2 months). Men comprised 81% (n = 59/73) of patients. Bioabsorbable implants (n = 13 studies) were the most commonly reported fixation method. Complications related to fixation of the chondral fragment occurred in 10.8% of patients (n = 10/93), with all other complications occurring in 9.8% (n = 9/93) of patients. Revision surgery directly associated with the chondral fragment was reported in 10.8% (n = 10/93) of patients. Successful return to sport/activity was observed in 90% (n = 60/67) of patients. Intact fixation was reported in 85% (n = 75/88) of patients undergoing postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy.Conclusion:Primary fixation of chondral-only defects can lead to low rates of failure and revision surgery with a high return to sport/activity in young patients, even with relatively large lesions. Bioabsorbable implants and absorbable sutures were the most common fixation methods, primarily performed via open arthrotomy after diagnostic arthroscopy. Failure of fixation and implant irritation were the most commonly reported complications related to fixation, with reoperations directly related to fragment fixation performed in 10.8% of patients. Healing of the chondral fragment as evaluated using postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy was reported in 85% of patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925076","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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