Pub Date : 2026-01-09DOI: 10.1177/03635465251383039
César Romero Antunes Júnior, Ramon Sampaio Souza Santos, Eduardo Silva Reis Barreto, Guilherme Neves Azevedo, Ewerton Borges de Souza Lima, Paulo Henrique Schmidt Lara, Alberto de Castro Pochini, Carlos Vicente Andreoli, Benno Ejnisman, Paulo Santoro Belangero
Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial. Purpose: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs; Level of evidence: 1. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs). Results: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, –0.17 to 0.34; P = .526), 8 to 12 weeks (SMD, –0.36; 95% CI, –0.99 to 0.27; P = .263), or 24 to 26 weeks (MD, –1.58; 95% CI, –4.74 to 1.58; P = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, –0.18 to 0.37; P = .518), 12 weeks (SMD, –0.09; 95% CI, –0.39 to 0.21; P = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, –0.18 to 0.43; P = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; P = .287). Conclusion: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.
{"title":"Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials","authors":"César Romero Antunes Júnior, Ramon Sampaio Souza Santos, Eduardo Silva Reis Barreto, Guilherme Neves Azevedo, Ewerton Borges de Souza Lima, Paulo Henrique Schmidt Lara, Alberto de Castro Pochini, Carlos Vicente Andreoli, Benno Ejnisman, Paulo Santoro Belangero","doi":"10.1177/03635465251383039","DOIUrl":"https://doi.org/10.1177/03635465251383039","url":null,"abstract":"Background: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial. Purpose: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs). Study Design: Systematic review and meta-analysis of RCTs; Level of evidence: 1. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs). Results: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, –0.17 to 0.34; <jats:italic toggle=\"yes\">P</jats:italic> = .526), 8 to 12 weeks (SMD, –0.36; 95% CI, –0.99 to 0.27; <jats:italic toggle=\"yes\">P</jats:italic> = .263), or 24 to 26 weeks (MD, –1.58; 95% CI, –4.74 to 1.58; <jats:italic toggle=\"yes\">P</jats:italic> = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, –0.18 to 0.37; <jats:italic toggle=\"yes\">P</jats:italic> = .518), 12 weeks (SMD, –0.09; 95% CI, –0.39 to 0.21; <jats:italic toggle=\"yes\">P</jats:italic> = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, –0.18 to 0.43; <jats:italic toggle=\"yes\">P</jats:italic> = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; <jats:italic toggle=\"yes\">P</jats:italic> = .287). Conclusion: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1177/03635465251376655
Riccardo D’Ambrosi, Alessandro Carrozzo, Edoardo Monaco, Luca Maria Sconfienza, Elmar Herbst, Mirco Herbort, Elisabeth Abermann, Christian Fink
Background: Lateral extra-articular procedures (LEAPs) have gained increasing attention as an adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in individuals at high risk for reinjury. When combined with ACLR, LEAPs contribute to the restoration of normal knee kinematics and provide a significant reduction in residual anterior laxity compared with isolated ACLR. This added stability provides a protective effect on the intra-articular graft, promoting improved healing and integration while reducing mechanical stress on the reconstructed anterior cruciate ligament (ACL). As a result, these techniques have been demonstrated to result in improved performance after ACLR, higher graft survival, and lower revision rates, even in elite athletes who are at significant risk for reinjury. Purpose/Hypothesis: The aim of this study was to systematically compare the existing evidence on ACL rerupture rates by performing a meta-analysis comparing combined ACLR and LEAP versus isolated ACLR in elite athletes. The primary hypothesis of this systematic review and meta-analysis was that the addition of LEAP would reduce the rate of revision ACLR in elite athletes. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The method followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed rerupture rate in elite athletes after isolated ACLR versus ACLR plus LEAP. The MINORS (Methodological Index for Non-Randomized Studies) score was used for quality assessment. The main outcome measure was ipsilateral ACL rerupture. Results: A total of 586 elite athletes received an isolated ACLR, whereas 417 athletes received combined ACLR plus LEAP. Rerupture was reported by 9.3% (95% CI, 5.5%-14.0%) of athletes. In the ACLR group, 14.0% (95% CI, 7.9%-21.5%) reported a rerupture, whereas in the ACLR plus LEAP group, the reinjury rate was 5.0% (95% CI, 1.2%-10.8%), with a statistically significant difference between the 2 groups ( P = .042). Pooled odds ratio (OR) showed a 65% reduced risk of a new rupture episode in the ACLR plus LEAP group compared with the ACLR group, with an OR of 0.35 (95% CI, 0.20-0.59; P < .001). Conclusion: In elite athletes, adding an anterolateral procedure during ACLR significantly reduced the rerupture rate and reduced the risk of rerupture by >60%. Despite the few studies considered, our study seems to indicate that surgeons should carefully consider LEAP when treating an elite athlete in order to significantly reduce the risk of rerupture. Registration: PROSPERO: CRD42025637843.
{"title":"Lateral Extra-articular Procedures Reduce the Risk of Revision of Anterior Cruciate Ligament Reconstruction in Elite Athletes: A Systematic Review and Meta-analysis of Comparative Studies","authors":"Riccardo D’Ambrosi, Alessandro Carrozzo, Edoardo Monaco, Luca Maria Sconfienza, Elmar Herbst, Mirco Herbort, Elisabeth Abermann, Christian Fink","doi":"10.1177/03635465251376655","DOIUrl":"https://doi.org/10.1177/03635465251376655","url":null,"abstract":"Background: Lateral extra-articular procedures (LEAPs) have gained increasing attention as an adjunct to anterior cruciate ligament reconstruction (ACLR), particularly in individuals at high risk for reinjury. When combined with ACLR, LEAPs contribute to the restoration of normal knee kinematics and provide a significant reduction in residual anterior laxity compared with isolated ACLR. This added stability provides a protective effect on the intra-articular graft, promoting improved healing and integration while reducing mechanical stress on the reconstructed anterior cruciate ligament (ACL). As a result, these techniques have been demonstrated to result in improved performance after ACLR, higher graft survival, and lower revision rates, even in elite athletes who are at significant risk for reinjury. Purpose/Hypothesis: The aim of this study was to systematically compare the existing evidence on ACL rerupture rates by performing a meta-analysis comparing combined ACLR and LEAP versus isolated ACLR in elite athletes. The primary hypothesis of this systematic review and meta-analysis was that the addition of LEAP would reduce the rate of revision ACLR in elite athletes. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The method followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed rerupture rate in elite athletes after isolated ACLR versus ACLR plus LEAP. The MINORS (Methodological Index for Non-Randomized Studies) score was used for quality assessment. The main outcome measure was ipsilateral ACL rerupture. Results: A total of 586 elite athletes received an isolated ACLR, whereas 417 athletes received combined ACLR plus LEAP. Rerupture was reported by 9.3% (95% CI, 5.5%-14.0%) of athletes. In the ACLR group, 14.0% (95% CI, 7.9%-21.5%) reported a rerupture, whereas in the ACLR plus LEAP group, the reinjury rate was 5.0% (95% CI, 1.2%-10.8%), with a statistically significant difference between the 2 groups ( <jats:italic toggle=\"yes\">P</jats:italic> = .042). Pooled odds ratio (OR) showed a 65% reduced risk of a new rupture episode in the ACLR plus LEAP group compared with the ACLR group, with an OR of 0.35 (95% CI, 0.20-0.59; <jats:italic toggle=\"yes\">P</jats:italic> < .001). Conclusion: In elite athletes, adding an anterolateral procedure during ACLR significantly reduced the rerupture rate and reduced the risk of rerupture by >60%. Despite the few studies considered, our study seems to indicate that surgeons should carefully consider LEAP when treating an elite athlete in order to significantly reduce the risk of rerupture. Registration: PROSPERO: CRD42025637843.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"182 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145920501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1177/03635465251380278
Shiv Patel,Omkar S Anaspure,Anthony N Baumann,Troy M Manz,R Justin Mistovich
BACKGROUNDThe medial patellofemoral ligament (MPFL) serves as a major stabilizer in the knee, providing restraint against lateral patellar translation. The optimal approach for treating patients with first-time MPFL injuries remains uncertain, as the choice between operative and nonoperative treatment depends on the risks and variability associated with individual patient anatomy, activity, and presentation.PURPOSETo evaluate high-level literature on outcomes after operative and nonoperative treatment of MPFL injuries to guide decision-making.STUDY DESIGNMeta-analysis; Level of evidence, 1.METHODSThis systematic review and meta-analysis utilized PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus through November 25, 2024, to find randomized controlled trials that assess the outcomes associated with operative versus nonoperative treatment for MPFL tears. The primary outcomes were rates of recurrent dislocation and patient-reported outcomes. Statistical analysis included relative risk (RR) with 95% confidence intervals (95% CIs) along with trial sequential analysis (TSA) and assessment of fragility index.RESULTSA total of 306 patients (55.9% female) had a frequency-weighted mean ± SD age of 19.68 ± 4.24 years (range, 9-40) and follow-up time of 21.61 ± 5.34 months and underwent nonoperative (n = 147) or operative (n = 159) treatment. When compared with nonoperative treatment, operative treatment had a significantly lower rate of recurrent instability (10.69% vs 29.93%; RR, 2.49; 95% CI, 1.34-4.61; P = .004) with robust evidence (fragility index, 7 patients) but no difference in Kujala scores (79.02 ± 10.71 vs 88.78 ± 2.91; overall mean difference, -9.32; 95% CI, -19.45 to 0.81; P = .071). Subgroup analysis showed that repair had a significantly lower rate of recurrent instability as compared with nonoperative treatment (15.74% vs 35.42%; RR, 1.87; 95% CI, 1.11-3.17; P = .019). Similarly, reconstruction showed a significantly lower rate of recurrent instability as compared with nonoperative treatment (3.92% vs 33.33%; RR, 6.80; 95% CI, 1.93-23.95; P = .003). TSA for all primary outcomes demonstrated that the Z curve did not cross the required information size, suggesting that the current volume of data is not sufficient to draw definitive conclusions for each comparison.CONCLUSIONOperative treatment of MPFL injuries resulted in a robust and significantly lower rate of recurrent instability when compared with nonoperative treatment, although there was no difference in Kujala scores. Given the current evidence, operative treatment appears to be the more ideal approach to treating first-time patellar dislocations. However, the key to these findings is the need for further studies, as TSA showed that the current level of evidence is insufficient to draw definitive conclusions.
背景：髌股内侧韧带（MPFL）是膝关节的主要稳定物，可抑制髌骨外侧移位。治疗首次MPFL损伤患者的最佳方法仍然不确定，因为手术和非手术治疗的选择取决于个体患者解剖、活动和表现的风险和可变性。目的评价高水平的MPFL损伤手术和非手术治疗的预后，以指导决策。研究DESIGNMeta-analysis;证据等级：1。方法：本系统综述和荟萃分析利用PubMed、CINAHL、MEDLINE、Web of Science和SPORTDiscus，截至2024年11月25日，寻找随机对照试验，评估手术与非手术治疗MPFL撕裂的相关结果。主要结局是脱位复发率和患者报告的结局。统计分析包括95%置信区间的相对危险度（RR）、试验序贯分析（TSA）和脆弱性指数评估。结果306例患者（女性55.9%），频率加权平均±SD年龄19.68±4.24岁（范围9-40岁），随访时间21.61±5.34个月，分别接受了非手术治疗（n = 147）和手术治疗（n = 159）。与非手术治疗相比，手术治疗的复发不稳定率明显低于非手术治疗（10.69% vs 29.93%； RR, 2.49; 95% CI, 1.34-4.61; P = 0.004），证据可靠（脆弱性指数，7例），但Kujala评分无差异（79.02±10.71 vs 88.78±2.91；总平均差为-9.32;95% CI, -19.45 ~ 0.81; P = 0.071）。亚组分析显示，与非手术治疗相比，修复组的复发不稳定率明显降低（15.74% vs 35.42%； RR, 1.87; 95% CI, 1.11-3.17; P = 0.019）。同样，与非手术治疗相比，重建显示复发不稳定的发生率明显降低（3.92% vs 33.33%； RR, 6.80; 95% CI, 1.93-23.95; P = 0.003）。所有主要结果的TSA显示，Z曲线没有超过所需的信息大小，这表明当前的数据量不足以为每次比较得出明确的结论。结论与非手术治疗相比，手术治疗MPFL损伤的复发不稳定率明显降低，但Kujala评分无差异。鉴于目前的证据，手术治疗似乎是治疗首次髌骨脱位的更理想的方法。然而，这些发现的关键是需要进一步的研究，因为运输安全管理局表明，目前的证据水平不足以得出明确的结论。
{"title":"Operative Versus Nonoperative Treatment of Medial Patellofemoral Ligament Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis.","authors":"Shiv Patel,Omkar S Anaspure,Anthony N Baumann,Troy M Manz,R Justin Mistovich","doi":"10.1177/03635465251380278","DOIUrl":"https://doi.org/10.1177/03635465251380278","url":null,"abstract":"BACKGROUNDThe medial patellofemoral ligament (MPFL) serves as a major stabilizer in the knee, providing restraint against lateral patellar translation. The optimal approach for treating patients with first-time MPFL injuries remains uncertain, as the choice between operative and nonoperative treatment depends on the risks and variability associated with individual patient anatomy, activity, and presentation.PURPOSETo evaluate high-level literature on outcomes after operative and nonoperative treatment of MPFL injuries to guide decision-making.STUDY DESIGNMeta-analysis; Level of evidence, 1.METHODSThis systematic review and meta-analysis utilized PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus through November 25, 2024, to find randomized controlled trials that assess the outcomes associated with operative versus nonoperative treatment for MPFL tears. The primary outcomes were rates of recurrent dislocation and patient-reported outcomes. Statistical analysis included relative risk (RR) with 95% confidence intervals (95% CIs) along with trial sequential analysis (TSA) and assessment of fragility index.RESULTSA total of 306 patients (55.9% female) had a frequency-weighted mean ± SD age of 19.68 ± 4.24 years (range, 9-40) and follow-up time of 21.61 ± 5.34 months and underwent nonoperative (n = 147) or operative (n = 159) treatment. When compared with nonoperative treatment, operative treatment had a significantly lower rate of recurrent instability (10.69% vs 29.93%; RR, 2.49; 95% CI, 1.34-4.61; P = .004) with robust evidence (fragility index, 7 patients) but no difference in Kujala scores (79.02 ± 10.71 vs 88.78 ± 2.91; overall mean difference, -9.32; 95% CI, -19.45 to 0.81; P = .071). Subgroup analysis showed that repair had a significantly lower rate of recurrent instability as compared with nonoperative treatment (15.74% vs 35.42%; RR, 1.87; 95% CI, 1.11-3.17; P = .019). Similarly, reconstruction showed a significantly lower rate of recurrent instability as compared with nonoperative treatment (3.92% vs 33.33%; RR, 6.80; 95% CI, 1.93-23.95; P = .003). TSA for all primary outcomes demonstrated that the Z curve did not cross the required information size, suggesting that the current volume of data is not sufficient to draw definitive conclusions for each comparison.CONCLUSIONOperative treatment of MPFL injuries resulted in a robust and significantly lower rate of recurrent instability when compared with nonoperative treatment, although there was no difference in Kujala scores. Given the current evidence, operative treatment appears to be the more ideal approach to treating first-time patellar dislocations. However, the key to these findings is the need for further studies, as TSA showed that the current level of evidence is insufficient to draw definitive conclusions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"12 1","pages":"3635465251380278"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1177/03635465251360229
Udit Dave,Jared Rubin,Alexander Mamonov,Andrew S Bi,Myles Atkins,Johnathon R McCormick,Fernando Gómez-Verdejo,Jorge Chahla,Nikhil N Verma
BACKGROUNDThere are multiple techniques for femoral tunnel creation for anterior cruciate ligament (ACL) reconstruction, with most modern techniques revolving around retrograde drilling or anteromedial (AM) portal drilling.PURPOSETo compile and quantify patient-reported outcomes and complication rates in patients who undergo hamstring ACL reconstruction with femoral tunnel creation via AM portal drilling versus retrograde drilling techniques.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 1.METHODSIn accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they (1) were level 1 randomized controlled trials, (2) comprised patients who underwent primary ACL reconstruction utilizing hamstring tendon autograft, and (3) compared femoral tunnels created via AM portal antegrade drilling versus retrograde drilling techniques. Studies that were not written in English or did not directly compare patients being treated with either femoral tunnel technique were excluded. Data were pooled with a DerSimonian-Laird random effects model, and risk of bias was assessed with the Cochrane RoB 2 tool.RESULTSThe initial search identified 1003 studies, of which 5 randomized controlled trials were included in this study with a total of 557 patients: 280 in the AM portal cohort and 277 in the retrograde drilling cohort. Mean ages across the cohorts ranged from 26.4 to 34.2 years. All patients had a minimum 6 months of follow-up. Descriptive data were similar between graft cohorts, and studies had low risk of bias and low heterogeneity. The mean difference in International Knee Documentation Committee score for the retrograde drilling versus AM portal cohorts was 1.0 (95% CI, -0.3 to 2.3). The odds ratios (ORs) for retrograde drilling versus AM portal showed no significant differences for revision ACL (OR, 2.1; 95% CI, -0.5 to 8.9), overall reoperation (OR, 1.1; 95% CI, 0.5-2.4), and total complications (OR, 1.0; 95% CI, 0.5-2.0).CONCLUSIONPrimary ACL reconstruction has no significant differences in patient-reported outcomes, complications, or revision ACL rates when femoral tunnels are created via AM portal antegrade drilling versus retrograde drilling techniques. Decisions regarding ACL reconstruction technique should be tailored to individual patient needs and surgeon preference.
{"title":"Anterior Cruciate Ligament Reconstruction With Femoral Tunnel Anteromedial Portal Antegrade Drilling Versus Retrograde Drilling Techniques Using Hamstring Graft Has No Difference in Clinical Outcomes or Complications: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Udit Dave,Jared Rubin,Alexander Mamonov,Andrew S Bi,Myles Atkins,Johnathon R McCormick,Fernando Gómez-Verdejo,Jorge Chahla,Nikhil N Verma","doi":"10.1177/03635465251360229","DOIUrl":"https://doi.org/10.1177/03635465251360229","url":null,"abstract":"BACKGROUNDThere are multiple techniques for femoral tunnel creation for anterior cruciate ligament (ACL) reconstruction, with most modern techniques revolving around retrograde drilling or anteromedial (AM) portal drilling.PURPOSETo compile and quantify patient-reported outcomes and complication rates in patients who undergo hamstring ACL reconstruction with femoral tunnel creation via AM portal drilling versus retrograde drilling techniques.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 1.METHODSIn accordance with PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they (1) were level 1 randomized controlled trials, (2) comprised patients who underwent primary ACL reconstruction utilizing hamstring tendon autograft, and (3) compared femoral tunnels created via AM portal antegrade drilling versus retrograde drilling techniques. Studies that were not written in English or did not directly compare patients being treated with either femoral tunnel technique were excluded. Data were pooled with a DerSimonian-Laird random effects model, and risk of bias was assessed with the Cochrane RoB 2 tool.RESULTSThe initial search identified 1003 studies, of which 5 randomized controlled trials were included in this study with a total of 557 patients: 280 in the AM portal cohort and 277 in the retrograde drilling cohort. Mean ages across the cohorts ranged from 26.4 to 34.2 years. All patients had a minimum 6 months of follow-up. Descriptive data were similar between graft cohorts, and studies had low risk of bias and low heterogeneity. The mean difference in International Knee Documentation Committee score for the retrograde drilling versus AM portal cohorts was 1.0 (95% CI, -0.3 to 2.3). The odds ratios (ORs) for retrograde drilling versus AM portal showed no significant differences for revision ACL (OR, 2.1; 95% CI, -0.5 to 8.9), overall reoperation (OR, 1.1; 95% CI, 0.5-2.4), and total complications (OR, 1.0; 95% CI, 0.5-2.0).CONCLUSIONPrimary ACL reconstruction has no significant differences in patient-reported outcomes, complications, or revision ACL rates when femoral tunnels are created via AM portal antegrade drilling versus retrograde drilling techniques. Decisions regarding ACL reconstruction technique should be tailored to individual patient needs and surgeon preference.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"130 1","pages":"3635465251360229"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1177/03635465251371330
Jelle P van der List,Cory Meixner,Christopher C Kaeding,Robert A Magnussen,David C Flanigan
BACKGROUNDAnterior cruciate ligament (ACL) injuries are common, and ACL reconstruction (ACLR) restores stability and enables return to sport. To date, however, studies have failed to show that ACLR prevents long-term osteoarthritis, but the role of timing of ACLR in osteoarthritis has not been extensively examined in meta-analyses.PURPOSETo compare the risk of long-term osteoarthritis after early versus delayed ACLR in the literature.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 4.METHODSThe PubMed, Embase, and Cochrane Library databases were searched from 2000 to August 2024 for studies comparing osteoarthritis between early and delayed ACLR at a minimum 5-year follow-up. Outcomes are reported as risk reduction with 95% confidence interval for osteoarthritis incidence, and odds ratio with 95% confidence interval for difference in time from injury to surgery. Random-effects models were used.RESULTSSeventeen studies (3953 ACLRs) were included (mean age, 28.8 years; 67% male; mean follow-up, 13.3 years; 52% meniscectomy; 31% osteoarthritis incidence). The quality of the studies was rated as moderate, with a Methodological Index for Non-Randomized Studies score of 78% of maximum. Overall, earlier ACLR led to a 10% reduction in osteoarthritis compared with delayed ACLR (95% CI, 6%-14%; P < .001). Two studies (1474 patients) reported a 6% incidence reduction when ACLR was performed within versus after 1 month (95% CI, 2%-10%; P = .005). Similarly, 4 studies (349 patients) reported a 16% incidence reduction when ACLR was performed within versus after 6 months (95% CI, 5%-26%; P = .004), and 5 studies (2248 patients) showed a 13% osteoarthritis reduction with ACLR within versus after 12 months (95% CI, 6%-20%; P = .003). Six studies (685 patients) reported that patients without osteoarthritis were operated on a mean 15 months earlier than patients who developed osteoarthritis (95% CI, 2-29 months; P = .03).CONCLUSIONThis systematic review with a 5-year minimum follow-up demonstrates that shorter time from injury to ACLR was associated with a decreased incidence of long-term osteoarthritis. This reduced risk was already seen when surgery was performed within 1 month but most pronounced within 6 months and 12 months.
前交叉韧带（ACL）损伤是常见的，ACL重建（ACLR）可以恢复其稳定性并使其能够恢复运动。然而，迄今为止，研究未能表明ACLR可预防长期骨关节炎，但ACLR在骨关节炎中的作用尚未在荟萃分析中得到广泛研究。目的比较文献中早期与延迟ACLR术后长期骨关节炎的风险。研究设计：系统评价和荟萃分析；证据等级，4级。方法检索PubMed， Embase和Cochrane图书馆数据库，从2000年到2024年8月，在至少5年的随访中比较早期和延迟ACLR骨关节炎的研究。结果报告为骨关节炎发病率的风险降低（95%置信区间），以及从损伤到手术时间差异的比值比（95%置信区间）。采用随机效应模型。结果纳入17项研究（3953例ACLRs），平均年龄28.8岁，男性67%，平均随访13.3年，半月板切除术52%，骨关节炎发生率31%。这些研究的质量被评为中等，非随机研究的方法学指数得分为最高的78%。总体而言，与延迟ACLR相比，早期ACLR导致骨关节炎减少10% （95% CI, 6%-14%; P < 0.001）。两项研究（1474例患者）报告，ACLR在1个月内与1个月后相比，发生率降低了6% （95% CI, 2%-10%; P = 0.005）。同样，4项研究（349例患者）报告ACLR在6个月内比6个月后发生率降低16% (95% CI, 5%-26%; P = 0.004)， 5项研究（2248例患者）显示ACLR在12个月内比12个月后骨关节炎发生率降低13% （95% CI, 6%-20%; P = 0.003）。6项研究（685例患者）报道，无骨关节炎患者的手术时间比有骨关节炎患者平均早15个月（95% CI， 2-29个月；P = .03）。结论：这项为期5年的系统综述表明，从损伤到ACLR的时间缩短与长期骨关节炎的发病率降低有关。这种降低的风险在1个月内进行手术时已经看到，但在6个月和12个月内最为明显。
{"title":"Early Anterior Cruciate Ligament Reconstruction Is Associated With Decreased Risk of Osteoarthritis Compared With Delayed Reconstruction: A Systematic Review and Meta-analysis.","authors":"Jelle P van der List,Cory Meixner,Christopher C Kaeding,Robert A Magnussen,David C Flanigan","doi":"10.1177/03635465251371330","DOIUrl":"https://doi.org/10.1177/03635465251371330","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament (ACL) injuries are common, and ACL reconstruction (ACLR) restores stability and enables return to sport. To date, however, studies have failed to show that ACLR prevents long-term osteoarthritis, but the role of timing of ACLR in osteoarthritis has not been extensively examined in meta-analyses.PURPOSETo compare the risk of long-term osteoarthritis after early versus delayed ACLR in the literature.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 4.METHODSThe PubMed, Embase, and Cochrane Library databases were searched from 2000 to August 2024 for studies comparing osteoarthritis between early and delayed ACLR at a minimum 5-year follow-up. Outcomes are reported as risk reduction with 95% confidence interval for osteoarthritis incidence, and odds ratio with 95% confidence interval for difference in time from injury to surgery. Random-effects models were used.RESULTSSeventeen studies (3953 ACLRs) were included (mean age, 28.8 years; 67% male; mean follow-up, 13.3 years; 52% meniscectomy; 31% osteoarthritis incidence). The quality of the studies was rated as moderate, with a Methodological Index for Non-Randomized Studies score of 78% of maximum. Overall, earlier ACLR led to a 10% reduction in osteoarthritis compared with delayed ACLR (95% CI, 6%-14%; P < .001). Two studies (1474 patients) reported a 6% incidence reduction when ACLR was performed within versus after 1 month (95% CI, 2%-10%; P = .005). Similarly, 4 studies (349 patients) reported a 16% incidence reduction when ACLR was performed within versus after 6 months (95% CI, 5%-26%; P = .004), and 5 studies (2248 patients) showed a 13% osteoarthritis reduction with ACLR within versus after 12 months (95% CI, 6%-20%; P = .003). Six studies (685 patients) reported that patients without osteoarthritis were operated on a mean 15 months earlier than patients who developed osteoarthritis (95% CI, 2-29 months; P = .03).CONCLUSIONThis systematic review with a 5-year minimum follow-up demonstrates that shorter time from injury to ACLR was associated with a decreased incidence of long-term osteoarthritis. This reduced risk was already seen when surgery was performed within 1 month but most pronounced within 6 months and 12 months.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":"3635465251371330"},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1177/03635465251357594
Eric Y. Hu, Thomas E. Moran, Jesus E. Cervantes, Kyleen Jan, Shane J. Nho
Background: The fragility index has been utilized in the literature to better characterize the limited categorical interpretation of the traditional P value in randomized controlled trials (RCTs). The reverse continuous fragility index (rCFI) aims to broaden this metric to include the analysis of nonsignificant, continuous outcome results, specifically on the topic of capsular closure versus nonclosure during hip arthroscopy. Purpose/Hypothesis: The purpose was to characterize the rCFI of statistically nonsignificant results in RCTs comparing capsular repair versus noncapsular repair in hip arthroscopy for the treatment of FAIS. It was hypothesized that (1) nonsignificant differences in clinical outcomes between the capsular closure and noncapsular closure groups would be statistically robust, as demonstrated by rCFI values exceeding the rate of loss to follow-up, and (2) rCFI would be greater than traditional rFI values and CFI values reported in the sports medicine literature. Study Design: Meta-analysis; Level of evidence, 2 Methods: The PubMed, Cochrane, and Embase databases were queried from inception to October 2024 with combinations of the following search terms: “hip arthroscopy,” “capsule, “capsular,” and “randomized controlled trials.” Studies were included if they were randomized trials that compared capsular closure with nonclosure and had at least 1 nonsignificant outcome reported. The rCFI calculation was performed on primary nonsignificant outcomes across all studies to obtain a mean rCFI. Multivariate linear regression was performed to determine study characteristics and variables associated with higher rCFI values. Results: Six studies with 416 patients were included in this analysis. A total of 136 outcomes with nonsignificant results were identified across 6 studies, with 6 of these outcomes representing each study’s primary outcome. The mean rCFI across all studies was 16.333 (SD, 6.121). A mean of 11.03% (SD, 5.79%) of patients were lost to follow-up. The rCFI exceeded the number of patients lost to follow-up for all analyzed studies. Multivariate regression showed that sample size was significantly predictive of high rCFI ( P = .018). Conclusion: Provisional assessment of rCFI suggests that the nonsignificant differences reported by RCTs comparing hip capsular closure versus nonclosure after interportal capsulotomies are relatively robust. Increased sample sizes in RCTs are associated with greater robustness of nonsignificant results.
{"title":"The Reverse Continuous Fragility Index of Randomized Controlled Trials Comparing Capsular Closure Versus Noncapsular Closure During Hip Arthroscopy","authors":"Eric Y. Hu, Thomas E. Moran, Jesus E. Cervantes, Kyleen Jan, Shane J. Nho","doi":"10.1177/03635465251357594","DOIUrl":"https://doi.org/10.1177/03635465251357594","url":null,"abstract":"Background: The fragility index has been utilized in the literature to better characterize the limited categorical interpretation of the traditional <jats:italic toggle=\"yes\">P</jats:italic> value in randomized controlled trials (RCTs). The reverse continuous fragility index (rCFI) aims to broaden this metric to include the analysis of nonsignificant, continuous outcome results, specifically on the topic of capsular closure versus nonclosure during hip arthroscopy. Purpose/Hypothesis: The purpose was to characterize the rCFI of statistically nonsignificant results in RCTs comparing capsular repair versus noncapsular repair in hip arthroscopy for the treatment of FAIS. It was hypothesized that (1) nonsignificant differences in clinical outcomes between the capsular closure and noncapsular closure groups would be statistically robust, as demonstrated by rCFI values exceeding the rate of loss to follow-up, and (2) rCFI would be greater than traditional rFI values and CFI values reported in the sports medicine literature. Study Design: Meta-analysis; Level of evidence, 2 Methods: The PubMed, Cochrane, and Embase databases were queried from inception to October 2024 with combinations of the following search terms: “hip arthroscopy,” “capsule, “capsular,” and “randomized controlled trials.” Studies were included if they were randomized trials that compared capsular closure with nonclosure and had at least 1 nonsignificant outcome reported. The rCFI calculation was performed on primary nonsignificant outcomes across all studies to obtain a mean rCFI. Multivariate linear regression was performed to determine study characteristics and variables associated with higher rCFI values. Results: Six studies with 416 patients were included in this analysis. A total of 136 outcomes with nonsignificant results were identified across 6 studies, with 6 of these outcomes representing each study’s primary outcome. The mean rCFI across all studies was 16.333 (SD, 6.121). A mean of 11.03% (SD, 5.79%) of patients were lost to follow-up. The rCFI exceeded the number of patients lost to follow-up for all analyzed studies. Multivariate regression showed that sample size was significantly predictive of high rCFI ( <jats:italic toggle=\"yes\">P</jats:italic> = .018). Conclusion: Provisional assessment of rCFI suggests that the nonsignificant differences reported by RCTs comparing hip capsular closure versus nonclosure after interportal capsulotomies are relatively robust. Increased sample sizes in RCTs are associated with greater robustness of nonsignificant results.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145903680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1177/03635465251376670
Samantha L. Watson, Chetan Gohal, Madeline M. Owen, Pranav M. Bajaj, Mark A. Plantz, Vehniah K. Tjong
Background: Approximately 400,000 anterior cruciate ligament (ACL) reconstructions are performed each year in the United States. Effective ACL injury prevention programs may be paramount in reducing this significant injury burden. Purpose: To determine the effectiveness of ACL injury prevention programs and generate updated guidelines to protect athletes from these injuries. Study Design: Meta-analysis, Level of evidence, 2. Methods: The Embase, PubMed, and Ovid (MEDLINE) databases were searched in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies focused on ACL injury prevention as opposed to treatment and provided data on ACL injury rates after intervention implementation. Using random-effects models, the authors generated the pooled risk ratio (RR) for all data and female-only data, <18 years versus ≥18 years of age data, handball data, soccer data, and balance board data. Results: Eighteen articles were identified (9 randomized controlled trials, 9 prospective cohort studies). The 25,166 studied athletes (mean age, 19.3 ± 3.6 years; >85% female) played handball, soccer, basketball, or volleyball. All interventions were studied for a minimum of 1 season (mean, 1.3 ± 0.59). Athletes who participated in an ACL injury prevention program were significantly less likely to sustain an ACL rupture with a pooled RR of 0.46 (95% CI, 0.36-0.57). When analyzed by age, there was a significant risk reduction in ACL rupture for both athletes <18 years and ≥18 years (RR, 0.35 [95% CI, 0.22-0.55] and RR, 0.50 [95% CI, 0.38-0.64], respectively). The pooled RR was also statistically significant for female players (RR, 0.57 [95% CI, 0.43-0.74]), soccer and handball athletes (RR, 0.30 [95% CI, 0.19-0.46] and RR, 0.66 [95% CI, 0.46-0.96], respectively), and players participating in programs including balance boards (RR, 0.49 [95% CI, 0.35-0.67]). Conclusion: Athletes who did not partake in an ACL injury prevention program were nearly twice as likely to sustain an ACL rupture compared with those who did. This study provides strong support for using neuromuscular training programs to significantly reduce the risk of ACL rupture among athletes.
{"title":"A Systematic Review and Meta-analysis of Anterior Cruciate Ligament Injury Prevention Programs: Training to Stay in the Game","authors":"Samantha L. Watson, Chetan Gohal, Madeline M. Owen, Pranav M. Bajaj, Mark A. Plantz, Vehniah K. Tjong","doi":"10.1177/03635465251376670","DOIUrl":"https://doi.org/10.1177/03635465251376670","url":null,"abstract":"Background: Approximately 400,000 anterior cruciate ligament (ACL) reconstructions are performed each year in the United States. Effective ACL injury prevention programs may be paramount in reducing this significant injury burden. Purpose: To determine the effectiveness of ACL injury prevention programs and generate updated guidelines to protect athletes from these injuries. Study Design: Meta-analysis, Level of evidence, 2. Methods: The Embase, PubMed, and Ovid (MEDLINE) databases were searched in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies focused on ACL injury prevention as opposed to treatment and provided data on ACL injury rates after intervention implementation. Using random-effects models, the authors generated the pooled risk ratio (RR) for all data and female-only data, <18 years versus ≥18 years of age data, handball data, soccer data, and balance board data. Results: Eighteen articles were identified (9 randomized controlled trials, 9 prospective cohort studies). The 25,166 studied athletes (mean age, 19.3 ± 3.6 years; >85% female) played handball, soccer, basketball, or volleyball. All interventions were studied for a minimum of 1 season (mean, 1.3 ± 0.59). Athletes who participated in an ACL injury prevention program were significantly less likely to sustain an ACL rupture with a pooled RR of 0.46 (95% CI, 0.36-0.57). When analyzed by age, there was a significant risk reduction in ACL rupture for both athletes <18 years and ≥18 years (RR, 0.35 [95% CI, 0.22-0.55] and RR, 0.50 [95% CI, 0.38-0.64], respectively). The pooled RR was also statistically significant for female players (RR, 0.57 [95% CI, 0.43-0.74]), soccer and handball athletes (RR, 0.30 [95% CI, 0.19-0.46] and RR, 0.66 [95% CI, 0.46-0.96], respectively), and players participating in programs including balance boards (RR, 0.49 [95% CI, 0.35-0.67]). Conclusion: Athletes who did not partake in an ACL injury prevention program were nearly twice as likely to sustain an ACL rupture compared with those who did. This study provides strong support for using neuromuscular training programs to significantly reduce the risk of ACL rupture among athletes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"259 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The use of postoperative magnetic resonance imaging (MRI) to investigate the effect of concomitant lateral extra-articular procedures (LEAPs) is not well documented in the literature. Few studies have assessed the MRI signal intensity—measured by the signal-to-noise quotient (SNQ)—of the anterior cruciate ligament (ACL) graft between individuals who underwent ACL reconstruction (ACLR) with simultaneous LEAP and those who did not. These comparative studies have produced conflicting results, though, which makes the topic particularly relevant. Purpose: To systematically compare existing evidence on graft maturation by performing a meta-analysis of combined ACLR and LEAP versus isolated ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The methodology adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed postoperative graft maturation, at least 10 months after surgery, using MRI with SNQ after isolated ACL or ACL plus LEAP. The Methodological Index for Non-Randomized Studies was used for quality assessment. Results: A total of 542 patients were included, with 307 receiving isolated ACLR and 235 undergoing combined ACL plus LEAP. Meta-analysis revealed no statistical difference between the groups regarding SNQ ( P = .574), with a mean difference of −0.58 (95% CI, –2.62 to 1.45). Neither the rank correlation test nor the linear regression test indicated any funnel plot asymmetry ( P = .272 and P = .642 respectively). Conclusion: Adding a lateral extra articular procedure to ACLR does not improve graft remodeling and maturation. Furthermore, graft maturation is not influenced by the time from surgery, age, or sex. Despite the limited number of studies considered, these findings suggest that a lateral extra-articular procedure does not play a significant role in graft maturation and should be performed selectively.
{"title":"No Evidence of Superior Graft Remodeling and Maturation When Adding a Lateral Extra-articular Procedure to Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Comparative Studies","authors":"Riccardo D’Ambrosi, Edna Skopljak, Domenico Albano, Carmelo Messina, Salvatore Gitto, Francesca Serpi, Luca Maria Sconfienza","doi":"10.1177/03635465251376662","DOIUrl":"https://doi.org/10.1177/03635465251376662","url":null,"abstract":"Background: The use of postoperative magnetic resonance imaging (MRI) to investigate the effect of concomitant lateral extra-articular procedures (LEAPs) is not well documented in the literature. Few studies have assessed the MRI signal intensity—measured by the signal-to-noise quotient (SNQ)—of the anterior cruciate ligament (ACL) graft between individuals who underwent ACL reconstruction (ACLR) with simultaneous LEAP and those who did not. These comparative studies have produced conflicting results, though, which makes the topic particularly relevant. Purpose: To systematically compare existing evidence on graft maturation by performing a meta-analysis of combined ACLR and LEAP versus isolated ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The methodology adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched to identify potentially relevant comparative studies that analyzed postoperative graft maturation, at least 10 months after surgery, using MRI with SNQ after isolated ACL or ACL plus LEAP. The Methodological Index for Non-Randomized Studies was used for quality assessment. Results: A total of 542 patients were included, with 307 receiving isolated ACLR and 235 undergoing combined ACL plus LEAP. Meta-analysis revealed no statistical difference between the groups regarding SNQ ( <jats:italic toggle=\"yes\">P</jats:italic> = .574), with a mean difference of −0.58 (95% CI, –2.62 to 1.45). Neither the rank correlation test nor the linear regression test indicated any funnel plot asymmetry ( <jats:italic toggle=\"yes\">P</jats:italic> = .272 and <jats:italic toggle=\"yes\">P</jats:italic> = .642 respectively). Conclusion: Adding a lateral extra articular procedure to ACLR does not improve graft remodeling and maturation. Furthermore, graft maturation is not influenced by the time from surgery, age, or sex. Despite the limited number of studies considered, these findings suggest that a lateral extra-articular procedure does not play a significant role in graft maturation and should be performed selectively.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1177/03635465251401158
Bradley A. Lezak, Griffith G. Gosnell, Nicholas C. Parody, Heath P. Gould, Abigail L. Campbell, Alexander Golant, Michael J. Alaia
Background: Genu valgum is a known risk factor for recurrent patellar instability, and surgical correction of deformity can be utilized as part of the management strategy to improve tracking and optimize outcomes. Tibial tuberosity–trochlear groove (TT-TG) distance is a widely used objective measurement of the lateral quadriceps force vector in patients with patellar instability. The evidence documenting the effect of lateral opening wedge distal femoral osteotomy (LOWDFO) and medial closing wedge high tibial osteotomy (MCWHTO) on TT-TG is limited, with minimal data directly comparing the biomechanical implications of one versus the other. Purpose/Hypothesis: The purpose of this study was to directly compare LOWDFO and MCWHTO using a computer model to determine the effect of each osteotomy on TT-TG distance. It was hypothesized that LOWDFO would have a greater effect on TT-TG distance, given the position farther away from the tibial tubercle. Study Design: Descriptive laboratory study. Methods: A total of 22 knees from 21 patients with patellar instability and valgus malalignment were processed using 3D Slicer (Version 5.4.0) to convert their respective DICOM images into .stl mesh files to be used with Fusion (Autodesk; Version 2601.1.37) computer-aided design software. LOWDFOs and MCWHTOs were then simulated from 0° to 12° in 2° increments. TT-TG distance was then measured after each osteotomy. Results: The mean native TT-TG distance for patients included in this cohort was 15.97 mm. TT-TG distance decreased by a mean of 1.83 mm for every 2° in the LOWDFO group and 0.46 mm for every 2° in the MCWHTO group, with all comparisons meeting statistical significance ( P < .001). LOWDFO demonstrated the following incremental TT-TG changes for a 2° to 12° coronal plane correction: 1.81 mm, 3.63 mm, 5.46 mm, 7.31 mm, 9.18 mm, and 10.96 mm. In comparison, MCWHTO demonstrated the following TT-TG changes for the same degrees of coronal correction: 0.52 mm, 1.03 mm, 1.53 mm, 2.00 mm, 2.45 mm, and 2.80 mm ( P < .001). Conclusion: LOWDFO results in a significantly larger magnitude of change in the TT-TG compared with MCWHTO, with distal femoral osteotomy at almost a 1:1 change with TT-TG compared with the correction angle, and high tibial osteotomy about 1:4. Clinical Relevance: The LOWDFO may be a more effective procedure in reducing the TT-TG distance, which is important when addressing patellar instability in patients with valgus malalignment.
背景：膝外翻是复发性髌骨不稳定的已知危险因素，手术矫正畸形可以作为改善跟踪和优化结果的管理策略的一部分。胫骨结节-滑车沟（TT-TG）距离是髌骨不稳患者外侧股四头肌力矢量的一个广泛使用的客观测量。关于外侧开口楔形股骨远端截骨术（LOWDFO）和内侧闭合楔形胫骨高位截骨术（MCWHTO）对TT-TG影响的证据是有限的，直接比较两者生物力学意义的数据很少。目的/假设：本研究的目的是通过计算机模型直接比较LOWDFO和MCWHTO，确定每次截骨术对TT-TG距离的影响。假设LOWDFO对TT-TG距离的影响更大，因为位置离胫骨结节更远。研究设计：描述性实验室研究。方法：采用3D切片机（5.4.0版本）对21例髌骨不稳和外翻错位患者的22个膝关节进行处理，将其各自的DICOM图像转换为。stl网格文件与Fusion （Autodesk; Version 2601.1.37）计算机辅助设计软件一起使用。然后模拟从0°到12°的低dfo和mcwho，增量为2°。每次截骨后测量TT-TG距离。结果：该队列中患者的平均原始TT-TG距离为15.97 mm。LOWDFO组TT-TG距离每2°平均减少1.83 mm， MCWHTO组TT-TG距离每2°平均减少0.46 mm，所有比较均具有统计学意义（P < .001）。LOWDFO显示，在冠状面2°至12°矫正时，TT-TG的增量变化如下：1.81 mm、3.63 mm、5.46 mm、7.31 mm、9.18 mm和10.96 mm。相比之下，MCWHTO显示相同冠状面矫正程度的TT-TG变化如下：0.52 mm, 1.03 mm, 1.53 mm, 2.00 mm， 2.45 mm和2.80 mm （P < 0.001）。结论：与MCWHTO相比，LOWDFO导致TT-TG的变化幅度明显更大，股骨远端截骨与TT-TG的变化与矫正角度相比几乎为1:1，胫骨高位截骨约为1:4。临床意义：在减小TT-TG距离方面，LOWDFO可能是一种更有效的手术，这在解决外翻错位患者的髌骨不稳定时很重要。
{"title":"Comparing the Effects of Lateral Opening Wedge Distal Femoral Osteotomy and Medial Closing Wedge High Tibial Osteotomy on Tibial Tubercle–Trochlear Groove Distance: A 3D Computed Tomography Simulation Study","authors":"Bradley A. Lezak, Griffith G. Gosnell, Nicholas C. Parody, Heath P. Gould, Abigail L. Campbell, Alexander Golant, Michael J. Alaia","doi":"10.1177/03635465251401158","DOIUrl":"https://doi.org/10.1177/03635465251401158","url":null,"abstract":"Background: Genu valgum is a known risk factor for recurrent patellar instability, and surgical correction of deformity can be utilized as part of the management strategy to improve tracking and optimize outcomes. Tibial tuberosity–trochlear groove (TT-TG) distance is a widely used objective measurement of the lateral quadriceps force vector in patients with patellar instability. The evidence documenting the effect of lateral opening wedge distal femoral osteotomy (LOWDFO) and medial closing wedge high tibial osteotomy (MCWHTO) on TT-TG is limited, with minimal data directly comparing the biomechanical implications of one versus the other. Purpose/Hypothesis: The purpose of this study was to directly compare LOWDFO and MCWHTO using a computer model to determine the effect of each osteotomy on TT-TG distance. It was hypothesized that LOWDFO would have a greater effect on TT-TG distance, given the position farther away from the tibial tubercle. Study Design: Descriptive laboratory study. Methods: A total of 22 knees from 21 patients with patellar instability and valgus malalignment were processed using 3D Slicer (Version 5.4.0) to convert their respective DICOM images into .stl mesh files to be used with Fusion (Autodesk; Version 2601.1.37) computer-aided design software. LOWDFOs and MCWHTOs were then simulated from 0° to 12° in 2° increments. TT-TG distance was then measured after each osteotomy. Results: The mean native TT-TG distance for patients included in this cohort was 15.97 mm. TT-TG distance decreased by a mean of 1.83 mm for every 2° in the LOWDFO group and 0.46 mm for every 2° in the MCWHTO group, with all comparisons meeting statistical significance ( <jats:italic toggle=\"yes\">P</jats:italic> < .001). LOWDFO demonstrated the following incremental TT-TG changes for a 2° to 12° coronal plane correction: 1.81 mm, 3.63 mm, 5.46 mm, 7.31 mm, 9.18 mm, and 10.96 mm. In comparison, MCWHTO demonstrated the following TT-TG changes for the same degrees of coronal correction: 0.52 mm, 1.03 mm, 1.53 mm, 2.00 mm, 2.45 mm, and 2.80 mm ( <jats:italic toggle=\"yes\">P</jats:italic> < .001). Conclusion: LOWDFO results in a significantly larger magnitude of change in the TT-TG compared with MCWHTO, with distal femoral osteotomy at almost a 1:1 change with TT-TG compared with the correction angle, and high tibial osteotomy about 1:4. Clinical Relevance: The LOWDFO may be a more effective procedure in reducing the TT-TG distance, which is important when addressing patellar instability in patients with valgus malalignment.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1177/03635465251380851
Cole R. Morrissette, Charles T. Borchers, Kevin Margarucci, Michelle R. Popkin, Steven J. Stylianos, Michael J. Stuart, Charles A. Popkin
Background: Neck lacerations sustained while playing ice hockey are rare but potentially fatal. Neck laceration protectors (NLPs) have been around for decades but only lately are becoming required by leagues given recent fatalities. Purpose: To outline the relevant neck anatomy at risk, describe rink-side evaluation and management techniques, review historical and contemporary NLP mandates, and conclude with evidence-based recommendations. Study Design: Narrative review; Level of evidence, 5. Methods: A review of the literature regarding neck lacerations in ice hockey was utilized for content collection. Google Scholar and PubMed were queried for peer-reviewed articles relevant to the topic. Keywords including “ice hockey,” “neck lacerations,” “neck laceration protector,” and combinations thereof were used to identify relevant literature. Results: Neck lacerations are rare but can be fatal given that they often damage zone II neurovascular structures. While numerous international leagues require mandates for NLPs, notable holdouts include the National Hockey League and the National Collegiate Athletic Association. Numerous materials and builds for NLPs are capable of withstanding penetration from a skate slash, although they possess differences in comfort and neck range of motion. Conclusion: NLPs have the capacity to prevent significant and potentially fatal laceration injuries in ice hockey. Based on the available data, implementing NLP mandates appears to be in the interest of player safety.
背景：在玩冰球时持续的颈部撕裂伤是罕见的，但可能致命。颈部撕裂保护（nlp）已经存在了几十年，但直到最近才被联盟要求，因为最近的死亡事件。目的：概述相关的危险颈部解剖，描述溜冰场侧评估和管理技术，回顾历史和当代NLP授权，并得出基于证据的建议。研究设计：叙述性回顾；证据等级，5。方法：回顾有关冰上曲棍球颈部撕裂伤的文献，收集内容。b谷歌Scholar和PubMed查询了与该主题相关的同行评审文章。关键词包括“冰球”、“颈部撕裂伤”、“颈部撕裂伤保护器”及其组合，对相关文献进行识别。结果：颈部撕裂伤是罕见的，但可能是致命的，因为它们经常损害II区神经血管结构。虽然许多国际联盟都要求nlp的授权，但值得注意的是，美国国家冰球联盟（National Hockey League）和美国国家大学体育协会（National Collegiate Athletic Association）都拒绝了。尽管它们在舒适度和颈部活动范围上有所不同，但许多用于nlp的材料和构造都能够承受滑板划伤的穿透。结论：nlp有能力预防冰球运动中严重和潜在致命的撕裂伤。根据现有数据，执行NLP指令似乎符合玩家安全的利益。
{"title":"Neck Lacerations in Ice Hockey: A Current Concepts Review From On-Ice Treatment to Prevention","authors":"Cole R. Morrissette, Charles T. Borchers, Kevin Margarucci, Michelle R. Popkin, Steven J. Stylianos, Michael J. Stuart, Charles A. Popkin","doi":"10.1177/03635465251380851","DOIUrl":"https://doi.org/10.1177/03635465251380851","url":null,"abstract":"Background: Neck lacerations sustained while playing ice hockey are rare but potentially fatal. Neck laceration protectors (NLPs) have been around for decades but only lately are becoming required by leagues given recent fatalities. Purpose: To outline the relevant neck anatomy at risk, describe rink-side evaluation and management techniques, review historical and contemporary NLP mandates, and conclude with evidence-based recommendations. Study Design: Narrative review; Level of evidence, 5. Methods: A review of the literature regarding neck lacerations in ice hockey was utilized for content collection. Google Scholar and PubMed were queried for peer-reviewed articles relevant to the topic. Keywords including “ice hockey,” “neck lacerations,” “neck laceration protector,” and combinations thereof were used to identify relevant literature. Results: Neck lacerations are rare but can be fatal given that they often damage zone II neurovascular structures. While numerous international leagues require mandates for NLPs, notable holdouts include the National Hockey League and the National Collegiate Athletic Association. Numerous materials and builds for NLPs are capable of withstanding penetration from a skate slash, although they possess differences in comfort and neck range of motion. Conclusion: NLPs have the capacity to prevent significant and potentially fatal laceration injuries in ice hockey. Based on the available data, implementing NLP mandates appears to be in the interest of player safety.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897368","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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