Pub Date : 2024-08-30DOI: 10.1177/03635465241271592
Jongjin Lee, Jong-Min Kim, Bum-Sik Lee, Seong-Il Bin, Taehyeon Jeon, Kinam Bae, Donghyok Kim
Background:Few studies have compared the characteristics of meniscal allograft tears between medial and lateral meniscal allograft transplantation (MAT) using bone fixation.Purpose:To investigate the prevalence, location, and patterns of allograft tears after MAT with the bone fixation technique and compare tear patterns between medial and lateral compartments according to the time elapsed after surgery.Study Design:Cohort study; Level of evidence, 3.Methods:The charts of consecutive patients who underwent primary medial or lateral MAT between December 1996 and June 2019 were retrospectively reviewed. The location, pattern, and postoperative periods during which allograft tears occurred were evaluated by reviewing all series of follow-up magnetic resonance imaging (MRI) scans, which were performed at 6 weeks, 3 months, 6 months, and 1 year postoperatively and every 2 years thereafter with the patient's agreement. Postoperative periods for allograft tears were defined as the time between surgery and the follow-up MRI scan in which the meniscal tear was first confirmed. Allograft tears were compared between the medial and lateral MAT groups.Results:A total of 327 consecutive patients who underwent MAT (55 medial, 272 lateral) with a minimum 2-year follow-up were retrospectively reviewed. The incidences of allograft tears after medial and lateral MATs were 32.7% and 30.9%, respectively. The mean times for tears were 80.1 ± 81.1 months and 48.9 ± 46.3 months in the medial and lateral MAT groups, respectively ( P = .130). In both the medial and lateral MAT groups, allograft tears were observed mainly in the posterior horn, with complex tears being the most commonly identified tear type. In medial MATs, root tears were the second most common at 27.8%, with a significantly higher proportion than the lateral MATs ( P = .014). On the other hand, in lateral MATs, meniscocapsular separation and radial tears were the second most common at 15.5% each, albeit not significantly more common than in medial MATs ( P = .123 and P = .454, respectively). All root tears in medial MATs and meniscocapsular separations in lateral MATs were observed within 1 year postoperatively.Conclusion:Significant differences in allograft tear patterns were identified between the medial and lateral MAT groups. The proportion of root tears in medial MATs was higher than that in lateral MATs; conversely, the proportion of meniscocapsular separation was more common in lateral MATs. Such tear patterns, which may require surgical repair or graft resection, were observed only within 1 year of surgery. Therefore, close observation and regular follow-up in the earlier postoperative period are necessary after medial or lateral MATs.
研究目的：调查使用骨固定技术进行半月板同种异体移植（MAT）后同种异体撕裂的发生率、位置和模式，并根据术后时间比较内侧和外侧间的撕裂模式。研究设计：队列研究；证据级别：3.方法：回顾性审查了1996年12月至2019年6月间接受初级内侧或外侧MAT的连续患者的病历。在患者同意的情况下，分别于术后 6 周、3 个月、6 个月和 1 年以及之后每 2 年进行一次磁共振成像（MRI）扫描，通过回顾所有系列的随访扫描，评估发生同种异体移植撕裂的位置、模式和术后时期。异体半月板撕裂的术后时间是指从手术到首次确认半月板撕裂的随访核磁共振扫描之间的时间。结果：共对 327 名连续接受 MAT（内侧 55 例，外侧 272 例）且至少随访 2 年的患者进行了回顾性研究。内侧和外侧MAT术后异体移植物撕裂的发生率分别为32.7%和30.9%。内侧和外侧 MAT 组的平均撕裂时间分别为 80.1 ± 81.1 个月和 48.9 ± 46.3 个月 ( P = .130)。在内侧和外侧 MAT 组中，异体移植物撕裂主要发生在后角，复杂性撕裂是最常见的撕裂类型。在内侧 MAT 中，根撕裂是第二常见的撕裂类型，占 27.8%，比例明显高于外侧 MAT（P = 0.014）。另一方面，在外侧 MATs 中，半月板囊分离和径向撕裂是第二常见的撕裂类型，分别占 15.5%，但并不明显高于内侧 MATs（分别为 P = .123 和 P = .454）。所有内侧 MATs 的根部撕裂和外侧 MATs 的半月板囊分离都是在术后 1 年内观察到的。内侧 MAT 的根部撕裂比例高于外侧 MAT；相反，外侧 MAT 的半月板瓣分离比例更高。只有在手术后 1 年内才能观察到这种可能需要手术修复或移植切除的撕裂模式。因此，在进行内侧或外侧 MAT 手术后，有必要在术后早期进行密切观察和定期随访。
{"title":"Differences in Graft Tear Configurations in Medial and Lateral Meniscal Allograft Transplantation: Objective Evaluations Using Magnetic Resonance Imaging","authors":"Jongjin Lee, Jong-Min Kim, Bum-Sik Lee, Seong-Il Bin, Taehyeon Jeon, Kinam Bae, Donghyok Kim","doi":"10.1177/03635465241271592","DOIUrl":"https://doi.org/10.1177/03635465241271592","url":null,"abstract":"Background:Few studies have compared the characteristics of meniscal allograft tears between medial and lateral meniscal allograft transplantation (MAT) using bone fixation.Purpose:To investigate the prevalence, location, and patterns of allograft tears after MAT with the bone fixation technique and compare tear patterns between medial and lateral compartments according to the time elapsed after surgery.Study Design:Cohort study; Level of evidence, 3.Methods:The charts of consecutive patients who underwent primary medial or lateral MAT between December 1996 and June 2019 were retrospectively reviewed. The location, pattern, and postoperative periods during which allograft tears occurred were evaluated by reviewing all series of follow-up magnetic resonance imaging (MRI) scans, which were performed at 6 weeks, 3 months, 6 months, and 1 year postoperatively and every 2 years thereafter with the patient's agreement. Postoperative periods for allograft tears were defined as the time between surgery and the follow-up MRI scan in which the meniscal tear was first confirmed. Allograft tears were compared between the medial and lateral MAT groups.Results:A total of 327 consecutive patients who underwent MAT (55 medial, 272 lateral) with a minimum 2-year follow-up were retrospectively reviewed. The incidences of allograft tears after medial and lateral MATs were 32.7% and 30.9%, respectively. The mean times for tears were 80.1 ± 81.1 months and 48.9 ± 46.3 months in the medial and lateral MAT groups, respectively ( P = .130). In both the medial and lateral MAT groups, allograft tears were observed mainly in the posterior horn, with complex tears being the most commonly identified tear type. In medial MATs, root tears were the second most common at 27.8%, with a significantly higher proportion than the lateral MATs ( P = .014). On the other hand, in lateral MATs, meniscocapsular separation and radial tears were the second most common at 15.5% each, albeit not significantly more common than in medial MATs ( P = .123 and P = .454, respectively). All root tears in medial MATs and meniscocapsular separations in lateral MATs were observed within 1 year postoperatively.Conclusion:Significant differences in allograft tear patterns were identified between the medial and lateral MAT groups. The proportion of root tears in medial MATs was higher than that in lateral MATs; conversely, the proportion of meniscocapsular separation was more common in lateral MATs. Such tear patterns, which may require surgical repair or graft resection, were observed only within 1 year of surgery. Therefore, close observation and regular follow-up in the earlier postoperative period are necessary after medial or lateral MATs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100833","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: 10.1177/03635465241271518
Mohamad K. Moussa, Badr El Hariri, Nicolas Lefèvre, Olivier Grimaud, Pierre Alban Bouché, Yoann Bohu, Zeinab Khalaf, Jean-David Werthel, Antoine Gerometta, Alexandre Hardy
Background:Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint.Purpose:To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS.Study Design:Cohort study; Level of evidence, 2.Methods:The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability–Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed.Results:A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s ( P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST ( P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities ( r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s ( r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s ( r = 0.30-0.38; P < .05).Conclusion:Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.
{"title":"Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study","authors":"Mohamad K. Moussa, Badr El Hariri, Nicolas Lefèvre, Olivier Grimaud, Pierre Alban Bouché, Yoann Bohu, Zeinab Khalaf, Jean-David Werthel, Antoine Gerometta, Alexandre Hardy","doi":"10.1177/03635465241271518","DOIUrl":"https://doi.org/10.1177/03635465241271518","url":null,"abstract":"Background:Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint.Purpose:To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS.Study Design:Cohort study; Level of evidence, 2.Methods:The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability–Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed.Results:A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s ( P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST ( P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities ( r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s ( r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s ( r = 0.30-0.38; P < .05).Conclusion:Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100834","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 : 2024-08-29DOI: 10.1177/03635465241270160
Ryan R. Thacher, Alexander E. White, Christopher L. Camp, Matthew J. Matava, Jeffrey R. Dugas, Anil S. Ranawat
Background:Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency.Purpose:To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows.Study Design:Case series; Level of evidence, 4.Methods:A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions.Results:Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( P < .001).Conclusion:This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.
{"title":"The Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment","authors":"Ryan R. Thacher, Alexander E. White, Christopher L. Camp, Matthew J. Matava, Jeffrey R. Dugas, Anil S. Ranawat","doi":"10.1177/03635465241270160","DOIUrl":"https://doi.org/10.1177/03635465241270160","url":null,"abstract":"Background:Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency.Purpose:To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows.Study Design:Case series; Level of evidence, 4.Methods:A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions.Results:Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( P < .001).Conclusion:This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142101955","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 : 2024-08-29DOI: 10.1177/03635465241271900
Peter Balcarek, Alexander Zimmerer, Georgi I. Wassilew, Sebastian Gebhardt
Background:Medial patellofemoral ligament reconstruction (MPFL-R) aims to restore proper ligament function with minimal changes in length during range of motion, yet the ideal area for femoral fixation of the graft remains controversial.Purpose:To determine the region where the isometric circular path of a simulated MPFL graft (best-fit circle) follows the sagittal radius curvature of the trochlea in normal (nontrochlear dysplastic) knees and to evaluate the best-fit circle coverage of different femoral fixation points in knees with severe trochlear dysplasia (TD) and after deepening trochleoplasty.Study Design:Controlled laboratory study.Methods:Twelve patients (4 male, 8 female; mean age, 24 ± 8 years) who underwent surgical treatment for recurrent lateral patellar instability due to severe TD were prospectively enrolled in this study. Four previously defined reference points for the femoral MPFL-R (Schöttle, Fujino, Stephen, and Oka) were identified, and the best-fit circle was drawn along the sagittal trochlear groove curvature. The divergence between each best-fit circle and the trochlear groove was calculated, with negative values indicating relative slackening and positive values indicating relative tightening of the simulated MPFL graft. Measurements were made on true-lateral fluoroscopic images before and after deepening trochleoplasty and compared with those of a sex-matched control group.Results:The best-fit circle of the Schöttle point followed the sagittal curvature of the trochlea most closely in both the control and trochlear dysplastic knees, followed by the Fujino, Stephen, and Oka points. As the radius of the trochlear groove curvature increased, the divergence of all best-fit circles to the trochlear groove became negative (all P < .05). This effect was most pronounced at the Stephen and Oka points, followed by the Fujino and Schöttle points (all P < .05). After deepening trochleoplasty, the divergence of the Schöttle point changed toward positive values (11.6% at 40°; P < .001). Concurrently, the best-fit circle divergence of all other reference points improved toward baseline (all P < .05).Conclusion:The isometric circle of the Schöttle point provides the best congruence with the sagittal trochlear groove curvature in both the normal trochlea and the dysplastic trochlea. After trochleoplasty, the best-fit circles of more distal femoral fixation points resulted in better congruence with the deepened trochlear groove, whereas the best-fit circle of Schöttle indicated graft tension during flexion.Clinical Relevance:According to the present study, different femoral fixation points should be considered depending on whether the TD is corrected.
背景：髌股内侧韧带重建术（MPFL-R）旨在恢复韧带的正常功能，同时将运动范围内的长度变化减至最小，但移植物股骨固定的理想区域仍存在争议。研究目的：确定模拟MPFL移植物的等距环形路径（最佳拟合圆）在正常（非韧带发育不良）膝关节中遵循韧带矢状半径曲率的区域，并评估严重韧带发育不良（TD）膝关节和韧带成形术后不同股骨固定点的最佳拟合圆覆盖范围。研究设计：实验室对照研究。方法：本研究前瞻性地纳入了因严重TD导致复发性髌外侧不稳而接受手术治疗的12名患者（4名男性，8名女性；平均年龄为24 ± 8岁）。研究人员确定了四个先前定义的股骨MPFL-R参考点（Schöttle、Fujino、Stephen和Oka），并沿着矢状蹄状沟曲率绘制了最佳拟合圆。计算每个最佳拟合圆与蹄状沟之间的偏差，负值表示模拟 MPFL 移植相对松弛，正值表示相对收紧。结果：在对照组和套管发育不良膝关节中，Schöttle点的最佳拟合圆与套管的矢状弧度最为接近，其次是Fujino点、Stephen点和Oka点。随着蹄状沟曲率半径的增加，所有最佳拟合圆与蹄状沟的发散均变为负值（所有 P 均为 0.05）。这种效应在 Stephen 点和 Oka 点最为明显，其次是 Fujino 点和 Schöttle 点（均为 P <.05）。在加深套管成形术后，Schöttle点的发散向正值转变（40°时为11.6%；P < .001）。结论：在正常蹄骨和发育不良的蹄骨中，Schöttle点的等距圆与矢状蹄骨沟曲率的一致性最好。套管成形术后，股骨较远端固定点的最佳拟合圆与加深的蹄状沟的一致性更好，而Schöttle点的最佳拟合圆则表示屈曲时的移植物张力。临床意义：根据本研究，应根据是否矫正TD考虑不同的股骨固定点。
{"title":"Implications for Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction Considering the Sagittal Trochlear Groove Curvature in Severe Trochlear Dysplasia Before and After Deepening Trochleoplasty","authors":"Peter Balcarek, Alexander Zimmerer, Georgi I. Wassilew, Sebastian Gebhardt","doi":"10.1177/03635465241271900","DOIUrl":"https://doi.org/10.1177/03635465241271900","url":null,"abstract":"Background:Medial patellofemoral ligament reconstruction (MPFL-R) aims to restore proper ligament function with minimal changes in length during range of motion, yet the ideal area for femoral fixation of the graft remains controversial.Purpose:To determine the region where the isometric circular path of a simulated MPFL graft (best-fit circle) follows the sagittal radius curvature of the trochlea in normal (nontrochlear dysplastic) knees and to evaluate the best-fit circle coverage of different femoral fixation points in knees with severe trochlear dysplasia (TD) and after deepening trochleoplasty.Study Design:Controlled laboratory study.Methods:Twelve patients (4 male, 8 female; mean age, 24 ± 8 years) who underwent surgical treatment for recurrent lateral patellar instability due to severe TD were prospectively enrolled in this study. Four previously defined reference points for the femoral MPFL-R (Schöttle, Fujino, Stephen, and Oka) were identified, and the best-fit circle was drawn along the sagittal trochlear groove curvature. The divergence between each best-fit circle and the trochlear groove was calculated, with negative values indicating relative slackening and positive values indicating relative tightening of the simulated MPFL graft. Measurements were made on true-lateral fluoroscopic images before and after deepening trochleoplasty and compared with those of a sex-matched control group.Results:The best-fit circle of the Schöttle point followed the sagittal curvature of the trochlea most closely in both the control and trochlear dysplastic knees, followed by the Fujino, Stephen, and Oka points. As the radius of the trochlear groove curvature increased, the divergence of all best-fit circles to the trochlear groove became negative (all P < .05). This effect was most pronounced at the Stephen and Oka points, followed by the Fujino and Schöttle points (all P < .05). After deepening trochleoplasty, the divergence of the Schöttle point changed toward positive values (11.6% at 40°; P < .001). Concurrently, the best-fit circle divergence of all other reference points improved toward baseline (all P < .05).Conclusion:The isometric circle of the Schöttle point provides the best congruence with the sagittal trochlear groove curvature in both the normal trochlea and the dysplastic trochlea. After trochleoplasty, the best-fit circles of more distal femoral fixation points resulted in better congruence with the deepened trochlear groove, whereas the best-fit circle of Schöttle indicated graft tension during flexion.Clinical Relevance:According to the present study, different femoral fixation points should be considered depending on whether the TD is corrected.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100835","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 : 2024-07-24DOI: 10.1177/03635465241255331
Michael P. Klueh, Bryan O. Ren, Stefano R. Muscatelli, John A. Grant
Background:Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. The role of weightbearing alignment in the pathophysiology of OCD lesion development is not fully understood.Hypothesis:Lower extremity mechanical axis would be concordant with femoral condylar OCD lesion location.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Cases were identified from a single, large academic institutional database using International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes associated with OCD. Patients were included if they had a magnetic resonance imaging scan demonstrating the OCD lesion and lower extremity alignment radiographs. OCD lesion location was identified using Cahill and Berg zones. The primary outcome was the association of OCD lesion location with weightbearing mechanical axis. Secondary outcomes included the association of mechanical axis with skeletal maturity, OCD lesion stability, and treatment. For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities.Results:A total of 86 patients (95 knees) with an OCD lesion of the femoral condyle were identified. The population was 74% male, and the mean age was 21 years. In total, 65% of knees had closed physes, 82% of lesions were unstable, and 85% underwent a surgical procedure. Mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same compartment in 56% of cases. Spearman correlation coefficient demonstrated a moderate positive correlation (rs = 0.59). No significant differences were found in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condylar OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condylar OCD lesions, the mean lateral distal femoral angle was 89.9°, and medial proximal tibial angle was 85.4°; for valgus alignment and lateral femoral condylar lesions, the lateral distal femoral angle was 84.8°, and medial proximal tibial angle was 88.8°. Patients with unilateral medial femoral condylar OCD lesions were more likely to have varus alignment of the affected extremity compared with the contralateral extremity (59% vs 36%; P = .01).Conclusion:This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condylar OCD location. Patients with unilateral medial femoral condylar OCD lesions frequently had asymmetric varus alignment in the affected extremity.
背景：骨软骨炎（OCD）是一种以软骨下骨异常和上覆关节软骨紊乱为特征的疾病。假设：下肢机械轴与股骨髁OCD病变位置一致。研究设计：横断面研究；证据等级，3。方法：使用与OCD相关的《国际疾病分类》第九版、第十版和《现行手术术语》代码，从一个大型学术机构数据库中确定病例。如果患者的磁共振成像扫描显示有 OCD 病变，且下肢对位X光片显示有 OCD 病变，则将其纳入研究范围。OCD病变位置通过卡希尔区和伯格区来确定。主要结果是 OCD 病变位置与负重机械轴的关系。次要结果包括机械轴与骨骼成熟度、OCD病变稳定性和治疗的关系。对于单侧OCD病变，对受累下肢和未受累下肢的机械轴进行了比较。其中74%为男性，平均年龄为21岁。65%的膝关节为闭合性髌骨，82%的病变不稳定，85%的患者接受了手术治疗。48%的病例的机械轴位于 OCD 病变的同一区域，56%的病例的机械轴位于同一室。斯皮尔曼相关系数呈中度正相关（rs = 0.59）。在对股骨髁内侧与外侧 OCD 病变、骨骼成熟度、病变稳定性或治疗组进行分组分析时，未发现机械轴与 OCD 病变位置的相关性存在明显差异。对于股骨外翻和股骨髁内侧OCD病变的患者，股骨远端外侧角的平均值为89.9°，胫骨近端内侧角的平均值为85.4°；对于股骨外翻和股骨髁外侧OCD病变的患者，股骨远端外侧角的平均值为84.8°，胫骨近端内侧角的平均值为88.8°。单侧股骨髁内侧OCD病变患者与对侧肢体相比，患侧肢体更容易出现屈曲对位（59% vs 36%; P = .01）。单侧股骨髁内侧OCD病变患者的患肢经常出现不对称的屈曲排列。
{"title":"Association of Mechanical Axis With Osteochondritis Dissecans of the Femoral Condyle","authors":"Michael P. Klueh, Bryan O. Ren, Stefano R. Muscatelli, John A. Grant","doi":"10.1177/03635465241255331","DOIUrl":"https://doi.org/10.1177/03635465241255331","url":null,"abstract":"Background:Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. The role of weightbearing alignment in the pathophysiology of OCD lesion development is not fully understood.Hypothesis:Lower extremity mechanical axis would be concordant with femoral condylar OCD lesion location.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Cases were identified from a single, large academic institutional database using International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes associated with OCD. Patients were included if they had a magnetic resonance imaging scan demonstrating the OCD lesion and lower extremity alignment radiographs. OCD lesion location was identified using Cahill and Berg zones. The primary outcome was the association of OCD lesion location with weightbearing mechanical axis. Secondary outcomes included the association of mechanical axis with skeletal maturity, OCD lesion stability, and treatment. For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities.Results:A total of 86 patients (95 knees) with an OCD lesion of the femoral condyle were identified. The population was 74% male, and the mean age was 21 years. In total, 65% of knees had closed physes, 82% of lesions were unstable, and 85% underwent a surgical procedure. Mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same compartment in 56% of cases. Spearman correlation coefficient demonstrated a moderate positive correlation (r<jats:sub>s</jats:sub> = 0.59). No significant differences were found in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condylar OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condylar OCD lesions, the mean lateral distal femoral angle was 89.9°, and medial proximal tibial angle was 85.4°; for valgus alignment and lateral femoral condylar lesions, the lateral distal femoral angle was 84.8°, and medial proximal tibial angle was 88.8°. Patients with unilateral medial femoral condylar OCD lesions were more likely to have varus alignment of the affected extremity compared with the contralateral extremity (59% vs 36%; P = .01).Conclusion:This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condylar OCD location. Patients with unilateral medial femoral condylar OCD lesions frequently had asymmetric varus alignment in the affected extremity.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"141 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755238","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 : 2024-05-18DOI: 10.1177/03635465241248819
Alison N. Agres, Nicholas M. Brisson, Georg N. Duda, Tobias M. Jung
Background:After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.Purpose:To assess long-term alterations in lower limb mechanics in patients after PCLR.Study Design:Descriptive laboratory study.Methods:A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.Results:Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee ( P = .005). During the sit-to-stand task, higher flexion angles during the midcycle ( P = .017) and lower external rotation angles ( P = .049) were found in the reconstructed knee; sagittal knee ( P = .001) and hip ( P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle ( P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task ( P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb ( P < .001).Conclusion:Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.Clinical Relevance:After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.
{"title":"Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries","authors":"Alison N. Agres, Nicholas M. Brisson, Georg N. Duda, Tobias M. Jung","doi":"10.1177/03635465241248819","DOIUrl":"https://doi.org/10.1177/03635465241248819","url":null,"abstract":"Background:After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.Purpose:To assess long-term alterations in lower limb mechanics in patients after PCLR.Study Design:Descriptive laboratory study.Methods:A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.Results:Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee ( P = .005). During the sit-to-stand task, higher flexion angles during the midcycle ( P = .017) and lower external rotation angles ( P = .049) were found in the reconstructed knee; sagittal knee ( P = .001) and hip ( P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle ( P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task ( P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb ( P < .001).Conclusion:Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.Clinical Relevance:After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140954665","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 : 2024-05-18DOI: 10.1177/03635465241251824
Safa Gursoy, Felipe Bessa, Navya Dandu, Zeeshan A. Khan, Hailey P. Huddleston, Brady T. Williams, Amar S. Vadhera, Ian M. Clapp, Philip Malloy, Elizabeth F. Shewman, Shane J. Nho, Jorge Chahla
Background:The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated.Purpose:To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting.Study Design:Descriptive laboratory study.Methods:A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion.Results:The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o’clock labral position (14.1 ± 2.8 mm), and 3-o’clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing.Conclusion:The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbid
{"title":"Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction","authors":"Safa Gursoy, Felipe Bessa, Navya Dandu, Zeeshan A. Khan, Hailey P. Huddleston, Brady T. Williams, Amar S. Vadhera, Ian M. Clapp, Philip Malloy, Elizabeth F. Shewman, Shane J. Nho, Jorge Chahla","doi":"10.1177/03635465241251824","DOIUrl":"https://doi.org/10.1177/03635465241251824","url":null,"abstract":"Background:The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated.Purpose:To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting.Study Design:Descriptive laboratory study.Methods:A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion.Results:The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o’clock labral position (14.1 ± 2.8 mm), and 3-o’clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing.Conclusion:The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbid","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140954668","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 : 2024-05-06DOI: 10.1177/03635465241247289
Henry Kuechly, Sarah Kurkowski, Brian Johnson, Nihar Shah, Brian Grawe
Background:Pain and pain perception are influenced by patients’ thoughts. The short form Negative Pain Thoughts Questionnaire (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between NPTQ-SF scores and orthopaedic surgery outcomes is not known.Purpose/Hypothesis:The purpose was to assess the relationship between negative pain thoughts, as measured by the NPTQ-SF, and patient-reported outcomes in patients undergoing arthroscopic rotator cuff repair, as well as to compare NPTQ-SF scores and outcomes between patients with and without a history of chronic pain and psychiatric history. It was hypothesized that patients with worse negative pain thoughts would have worse patient-reported outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:In total, 109 patients undergoing arthroscopic rotator cuff repair were administered the 4-item NPTQ-SF, 12-item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Evaluation Form, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed ≥6 months postoperatively by 74 patients confirmed to have undergone arthroscopic rotator cuff repair.Results:Preoperative NPTQ-SF scores did not show any correlation with the postoperative patient-reported outcomes measured in this study. Postoperative NPTQ-SF scores were statistically significantly negatively correlated with postoperative SF-12 Physical Health Score, SF-12 Mental Health Score, ASES, and satisfaction scores ( P < .05). Postoperative NPTQ-SF scores were statistically significantly positively correlated with postoperative visual analog scale scores ( P < .001). Moreover, postoperative NPTQ-SF scores were statistically significantly negatively correlated with achieving a Patient Acceptable Symptom State and the minimal clinically important difference on the postoperative ASES form ( P < .001 and P = .009, respectively).Conclusion:Postoperative patient thought patterns and their perception of pain are correlated with postoperative outcomes after rotator cuff repair. This correlation suggests a role for counseling and expectation management in the postoperative setting. Conversely, preoperative thought patterns regarding pain, as measured by the NPTQ-SF, do not correlate with postoperative patient-reported outcome measures. Therefore, the NPTQ-SF should not be used as a preoperative tool to aid the prediction of outcomes after rotator cuff repair.
{"title":"Postoperative Negative Pain Thoughts and Their Correlation With Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair: An Observational Cohort Study","authors":"Henry Kuechly, Sarah Kurkowski, Brian Johnson, Nihar Shah, Brian Grawe","doi":"10.1177/03635465241247289","DOIUrl":"https://doi.org/10.1177/03635465241247289","url":null,"abstract":"Background:Pain and pain perception are influenced by patients’ thoughts. The short form Negative Pain Thoughts Questionnaire (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between NPTQ-SF scores and orthopaedic surgery outcomes is not known.Purpose/Hypothesis:The purpose was to assess the relationship between negative pain thoughts, as measured by the NPTQ-SF, and patient-reported outcomes in patients undergoing arthroscopic rotator cuff repair, as well as to compare NPTQ-SF scores and outcomes between patients with and without a history of chronic pain and psychiatric history. It was hypothesized that patients with worse negative pain thoughts would have worse patient-reported outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:In total, 109 patients undergoing arthroscopic rotator cuff repair were administered the 4-item NPTQ-SF, 12-item Short Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES) Shoulder Evaluation Form, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed ≥6 months postoperatively by 74 patients confirmed to have undergone arthroscopic rotator cuff repair.Results:Preoperative NPTQ-SF scores did not show any correlation with the postoperative patient-reported outcomes measured in this study. Postoperative NPTQ-SF scores were statistically significantly negatively correlated with postoperative SF-12 Physical Health Score, SF-12 Mental Health Score, ASES, and satisfaction scores ( P < .05). Postoperative NPTQ-SF scores were statistically significantly positively correlated with postoperative visual analog scale scores ( P < .001). Moreover, postoperative NPTQ-SF scores were statistically significantly negatively correlated with achieving a Patient Acceptable Symptom State and the minimal clinically important difference on the postoperative ASES form ( P < .001 and P = .009, respectively).Conclusion:Postoperative patient thought patterns and their perception of pain are correlated with postoperative outcomes after rotator cuff repair. This correlation suggests a role for counseling and expectation management in the postoperative setting. Conversely, preoperative thought patterns regarding pain, as measured by the NPTQ-SF, do not correlate with postoperative patient-reported outcome measures. Therefore, the NPTQ-SF should not be used as a preoperative tool to aid the prediction of outcomes after rotator cuff repair.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140845443","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 : 2024-05-06DOI: 10.1177/03635465241246262
Max F.R. Merkel, Rene B. Svensson, Jens R. Jakobsen, Abigail L. Mackey, Peter Schjerling, Robert B. Herzog, S. Peter Magnusson, Lars Konradsen, Michael R. Krogsgaard, Michael Kjær, Finn E. Johannsen
Background:Plantar fasciitis is a painful tendinous condition (tendinopathy) with a high prevalence in athletes. While a healthy tendon has limited blood flow, ultrasound has indicated elevated blood flow in tendinopathy, but it is unknown if this is related to a de facto increase in the tendon vasculature. Likewise, an accumulation of glycosaminoglycans (GAGs) is observed in tendinopathy, but its relationship to clinical pain is unknown.Purpose:To explore to what extent vascularization, inflammation, and fat infiltration were present in patients with plantar fasciitis and if they were related to clinical symptoms.Study Design:Descriptive laboratory study.Methods:Biopsy specimens from tendinopathic plantar fascia tissue were obtained per-operatively from both the primary site of tendon pain and tissue swelling (“proximal”) and a region that appeared macroscopically healthy at 1 to 2 cm away from the primary site (“distal”) in 22 patients. Biopsy specimens were examined with immunofluorescence for markers of blood vessels, tissue cell density, fat infiltration, and macrophage level. In addition, pain during the first step in the morning (registered during an earlier study) was correlated with the content of collagen and GAGs in tissue.Results:High vascularization (and cellularity) was present in both the proximal (0.89%) and the distal (0.96%) plantar fascia samples, whereas inconsistent but not significantly different fat infiltration and macrophage levels were observed. The collagen content was similar in the 2 plantar fascia regions, whereas the GAG content was higher in the proximal region (3.2% in proximal and 2.8% in distal; P = .027). The GAG content in the proximal region was positively correlated with the subjective morning pain score in the patients with tendinopathy (n = 17).Conclusion:In patients with plantar fasciitis, marked tissue vascularization was present in both the painful focal region and a neighboring nonsymptomatic area. In contrast, the accumulation of hydrophilic GAGs was greater in the symptomatic region and was positively correlated with increased clinical pain levels in daily life.Clinical Relevance:The accumulation of GAGs in tissue rather than the extent of vascularization appears to be linked with the clinical degree of pain symptoms of the disease.
{"title":"Widespread Vascularization and Correlation of Glycosaminoglycan Accumulation to Tendon Pain in Human Plantar Fascia Tendinopathy","authors":"Max F.R. Merkel, Rene B. Svensson, Jens R. Jakobsen, Abigail L. Mackey, Peter Schjerling, Robert B. Herzog, S. Peter Magnusson, Lars Konradsen, Michael R. Krogsgaard, Michael Kjær, Finn E. Johannsen","doi":"10.1177/03635465241246262","DOIUrl":"https://doi.org/10.1177/03635465241246262","url":null,"abstract":"Background:Plantar fasciitis is a painful tendinous condition (tendinopathy) with a high prevalence in athletes. While a healthy tendon has limited blood flow, ultrasound has indicated elevated blood flow in tendinopathy, but it is unknown if this is related to a de facto increase in the tendon vasculature. Likewise, an accumulation of glycosaminoglycans (GAGs) is observed in tendinopathy, but its relationship to clinical pain is unknown.Purpose:To explore to what extent vascularization, inflammation, and fat infiltration were present in patients with plantar fasciitis and if they were related to clinical symptoms.Study Design:Descriptive laboratory study.Methods:Biopsy specimens from tendinopathic plantar fascia tissue were obtained per-operatively from both the primary site of tendon pain and tissue swelling (“proximal”) and a region that appeared macroscopically healthy at 1 to 2 cm away from the primary site (“distal”) in 22 patients. Biopsy specimens were examined with immunofluorescence for markers of blood vessels, tissue cell density, fat infiltration, and macrophage level. In addition, pain during the first step in the morning (registered during an earlier study) was correlated with the content of collagen and GAGs in tissue.Results:High vascularization (and cellularity) was present in both the proximal (0.89%) and the distal (0.96%) plantar fascia samples, whereas inconsistent but not significantly different fat infiltration and macrophage levels were observed. The collagen content was similar in the 2 plantar fascia regions, whereas the GAG content was higher in the proximal region (3.2% in proximal and 2.8% in distal; P = .027). The GAG content in the proximal region was positively correlated with the subjective morning pain score in the patients with tendinopathy (n = 17).Conclusion:In patients with plantar fasciitis, marked tissue vascularization was present in both the painful focal region and a neighboring nonsymptomatic area. In contrast, the accumulation of hydrophilic GAGs was greater in the symptomatic region and was positively correlated with increased clinical pain levels in daily life.Clinical Relevance:The accumulation of GAGs in tissue rather than the extent of vascularization appears to be linked with the clinical degree of pain symptoms of the disease.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140845454","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 : 2024-05-04DOI: 10.1177/03635465241247288
Chi Zhang, Jia-Le Jin, Cong-Hui Zhou, Cheng-Xing Ruan, Peng-Fei Lei, You-Zhi Cai
Background:The tendon-bone interface (TBI) in the rotator cuff has a poor intrinsic capacity for healing, which increases the risk of retear after rotator cuff repair (RCR). However, facilitating regeneration of the TBI still remains a great clinical challenge. Herein, the authors established a novel strategy based on magnetic seeding to enhance the TBI regeneration.Hypothesis:Magnetic seeding bone marrow mesenchymal stem cells labeled with superparamagnetic iron oxide (SPIO-BMSCs) into a biphasic scaffold can promote tendon-bone healing after RCR.Study Design:Controlled laboratory study.Methods:BMSCs were labeled with SPIOs. Prussian blue staining, CCK-8 tests, Western blot, and quantitative reverse transcription polymerase chain reaction (PCR) were used to determine the optimal effect concentration of SPIOs on cell bioactivities and abilities. Then SPIO-BMSCs were magnetically seeded into a biphasic scaffold under a magnetic field. The seeding efficacy was assessed by a scanning electron microscope, and the potential mechanism in chondrogenic differentiation after seeding SPIO-BMSCs into the scaffold was evaluated by Western blot and PCR. Furthermore, the effect of SPIO-BMSC/biphasic scaffold on tendon-bone healing after RCR using a rat model was examined using histological analysis, enzyme-linked immunosorbent assay, and biomechanical evaluation.Results:BMSCs labeled with 100 μg/mL SPIO had no effect on cell bioactivities and the ability of chondrogenic differentiation. SPIO-BMSCs were magnetically seeded into a biphasic scaffold, which offered a high seeding efficacy to enhance chondrogenic differentiation of SPIO-BMSCs via the CDR1as/miR-7/FGF2 pathway for TBI formation in vitro. Furthermore, in vivo application of the biphasic scaffold with magnetically seeded SPIO-BMSCs showed their regenerative potential, indicating that they could significantly accelerate and promote TBI healing with superior biomechanical properties after RCR in a rat rotator cuff tear model.Conclusion:Magnetically seeding SPIO-BMSCs into a biphasic scaffold enhanced seeding efficacy to promote cell distribution and condensation. This construct enhanced the chondrogenesis process via the CDR1as/miR-7/FGF2 pathway and further promoted tendon-bone healing after RCR in a rat rotator cuff tear model.Clinical Relevance:This study provides an alternative strategy for improving TBI healing after RCR.
{"title":"Magnetic Seeding of SPIO-BMSCs Into a Biphasic Scaffold Can Promote Tendon-Bone Healing After Rotator Cuff Repair","authors":"Chi Zhang, Jia-Le Jin, Cong-Hui Zhou, Cheng-Xing Ruan, Peng-Fei Lei, You-Zhi Cai","doi":"10.1177/03635465241247288","DOIUrl":"https://doi.org/10.1177/03635465241247288","url":null,"abstract":"Background:The tendon-bone interface (TBI) in the rotator cuff has a poor intrinsic capacity for healing, which increases the risk of retear after rotator cuff repair (RCR). However, facilitating regeneration of the TBI still remains a great clinical challenge. Herein, the authors established a novel strategy based on magnetic seeding to enhance the TBI regeneration.Hypothesis:Magnetic seeding bone marrow mesenchymal stem cells labeled with superparamagnetic iron oxide (SPIO-BMSCs) into a biphasic scaffold can promote tendon-bone healing after RCR.Study Design:Controlled laboratory study.Methods:BMSCs were labeled with SPIOs. Prussian blue staining, CCK-8 tests, Western blot, and quantitative reverse transcription polymerase chain reaction (PCR) were used to determine the optimal effect concentration of SPIOs on cell bioactivities and abilities. Then SPIO-BMSCs were magnetically seeded into a biphasic scaffold under a magnetic field. The seeding efficacy was assessed by a scanning electron microscope, and the potential mechanism in chondrogenic differentiation after seeding SPIO-BMSCs into the scaffold was evaluated by Western blot and PCR. Furthermore, the effect of SPIO-BMSC/biphasic scaffold on tendon-bone healing after RCR using a rat model was examined using histological analysis, enzyme-linked immunosorbent assay, and biomechanical evaluation.Results:BMSCs labeled with 100 μg/mL SPIO had no effect on cell bioactivities and the ability of chondrogenic differentiation. SPIO-BMSCs were magnetically seeded into a biphasic scaffold, which offered a high seeding efficacy to enhance chondrogenic differentiation of SPIO-BMSCs via the CDR1as/miR-7/FGF2 pathway for TBI formation in vitro. Furthermore, in vivo application of the biphasic scaffold with magnetically seeded SPIO-BMSCs showed their regenerative potential, indicating that they could significantly accelerate and promote TBI healing with superior biomechanical properties after RCR in a rat rotator cuff tear model.Conclusion:Magnetically seeding SPIO-BMSCs into a biphasic scaffold enhanced seeding efficacy to promote cell distribution and condensation. This construct enhanced the chondrogenesis process via the CDR1as/miR-7/FGF2 pathway and further promoted tendon-bone healing after RCR in a rat rotator cuff tear model.Clinical Relevance:This study provides an alternative strategy for improving TBI healing after RCR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"2018 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140826285","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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