American Journal of Sports Medicine最新文献

Background: Persistent knee pain can develop after anterior cruciate ligament injury with subsequent anterior cruciate ligament reconstruction (ACLR) despite a functionally intact graft.

Purpose: To identify the prevalence of clinically significant knee pain in patients at 2, 6, and 10 years after ACLR.

Study design: Cohort study; Level of evidence, 2.

Methods: 3272 patients were enrolled into the Multicenter Orthopaedic Outcomes Network (MOON) between 2002 and 2008 across 7 centers. Each patient completed a questionnaire at baseline that included demographic characteristics, injury factors, participation in sports, and validated outcome measures including the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale (scored 0-100 with higher scores signifying less pain). Each patient completed the questionnaire again at 2, 6, and 10 years postoperatively. Three different criteria were used to define clinically significant knee pain: KOOS pain ≤70 points, KOOS pain ≤80 points, or responding "moderate,""severe," or "extreme" to a KOOS pain question.

Results: Median age in the cohort was 23 years (interquartile range, 17-27 years) at the time of enrollment, and 44% of patients were female. A total of 2798 patients (85%) responded to the questionnaire at 2 years postoperatively, with 2759 (84%) responding at 6 years and 2526 (77%) at 10 years. The prevalence of those with KOOS pain ≤70 was 9.3%, 9.0%, and 9.1% at 2, 6, and 10 years after surgery, respectively. The prevalence of KOOS pain ≤80 was 16.6%, 16.3%, and 15.7% at each timepoint, respectively. When a KOOS pain response of "moderate,""severe," or "extreme" was used, the prevalence was 26.3%, 22.9%, and 22.6% at 2, 6, and 10 years, respectively. Interestingly, very few patients had persistent pain at all 3 follow-up points: 48 (1.6%) reported a KOOS pain score ≤70 points, 103 (3.5%) reported a KOOS pain score ≤80 points, and 161 (5.6%) reported moderate or severe pain.

Conclusion: The prevalence of clinically significant postoperative knee pain after ACLR was up to 26% at 2 years postoperatively, a percentage that remained unchanged or slightly decreased at 6- and 10-year follow-up. Despite this finding, it was uncommon for individual patients to report clinically significant knee pain at multiple follow-up timepoints.

Background: While both lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR) address rotational knee instability, their techniques and targeted anatomy differ, potentially leading to variations in effectiveness and stability.

Purpose: To conduct a systematic review and meta-analysis of basic science laboratory-based cadaveric studies comparing anterior tibial translation (ATT) and resistance to internal tibial rotation between ALLR and LET, both in combination with anterior cruciate ligament (ACL) reconstruction (ACLR).

Study design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: A systematic review of MEDLINE, Embase, Scopus, and Google Scholar, including all biomechanical studies comparing ALLR with LET in conjunction with ACLR published between 2000 and 2024, was conducted. Study quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research and the Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT). The I² statistic was used to assess heterogeneity within and between studies. The mean effect size was calculated, and a prediction interval was established to determine whether 95% of comparable populations would fall within the true effect size range. Publication bias was analyzed through funnel plots and the Egger test.

Results: The CASP checklist determined that all 7 studies were valuable. Based on the BOBQAT, 5 studies were classified as moderate quality, while 2 were rated as fair quality. The Egger regression intercept was -0.681 (P = .81), and the funnel plot displayed symmetry, indicating no publication bias. Comparisons of ATT between ALLR and LET across all flexion angles revealed no significant differences. Comparisons of internal tibial rotation resistance demonstrated significant differences at all flexion angles, favoring LET. When compared with the ACL-intact state, ALLR effectively restored knee stability for both ATT and internal tibial rotation resistance, close to the native state. In contrast, LET also restored knee stability for ATT and internal tibial rotation resistance but resulted in significant overconstraint of internal tibial rotation resistance at 30° and 60° of flexion.

Conclusion: This meta-analysis demonstrated that LET provided superior resistance to internal rotation but was associated with a degree of overconstraint. No significant biomechanical differences in ATT were observed between LET and ALLR when combined with ACLR. ALLR effectively restored both ATT and internal tibial rotation resistance to near-native knee levels.

Background: Cognitive load is an important factor influencing anterior cruciate ligament (ACL) injuries. However, few studies have systematically manipulated and quantified cognitive load to examine its biomechanical and neurophysiological consequences.

Purpose: This study aimed to investigate the impact of varying cognitive load levels on biomechanical variables associated with ACL injury risk. The study further explored whether individual cognitive performance was related to alterations in ACL injury risk indicators and examined prefrontal cortical activity as an objective marker of mental workload.

Study design: Controlled laboratory study.

Methods: A total of 30 athletes engaged in team sports performed a single-leg drop vertical jump (SL-DVJ) under 5 cognitive conditions of varying complexity using a modified Go/No-Go task. Biomechanics, behavioral, and prefrontal hemodynamic data variables were recorded. Cognitive performance was assessed through a computerized Go/No-Go task.

Results: Higher cognitive load significantly increased peak ground-reaction forces and altered joint kinematics, specifically reducing knee flexion and increasing knee abduction during landing, especially in conditions that required high cognitive demand (P < .001). These changes were accompanied by increased prefrontal hemoglobin (OxyHb) concentrations, suggesting elevated cortical activation. Furthermore, lower cognitive performance, notably lower accuracy and higher precision-adjusted response time, was associated with more pronounced biomechanical patterns (such as greater ground-reaction forces) and an increase in the risk of ACL injury (r = -0.471, P < .01; r = 0.650, P < .001, respectively).

Conclusion: An increased cognitive load altered the biomechanics of movement during an SL-DVJ, leading to a potential for increased risk of ACL injury. Moreover, athletes with poorer cognitive control may have been more susceptible to these effects. Prefrontal cortex (PFC) activity increased under conditions of higher cognitive demand. The pattern of regional activation varied according to the type of stimulus (eg, higher OxyHb concentrations for the ventrolateral PFC were observed during the change goal-stimulus condition), suggesting a specific functional organization of the PFC according to the particular demands of executive control.

Clinical relevance: These findings highlight the importance of integrating cognitive challenges into injury prevention and rehabilitation strategies. The findings emphasize the need to consider cognitive load as a central variable in injury risk mitigation and to evaluate cognitive performance as a potential prognostic indicator.

Background: Bilateral hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has demonstrated favorable short-term outcomes. However, the long-term results remain unclear and warrant further investigation.

Hypothesis/purpose: To compare 10-year patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and reoperation-free survivorship between bilateral and unilateral HA. It was hypothesized that both groups would demonstrate comparable PROs, CSO achievement, and survivorship.

Study design: Cohort study; Level of evidence, 3.

Methods: A prospective repository was retrospectively reviewed to identify patients undergoing bilateral HA for FAIS between January 2012 and January 2015 with 10-year follow-up. Patients were propensity-matched 1:1 to unilateral HA patients controlling for age, sex, body mass index, and Tönnis grade. Exclusions included revision HA, concomitant procedures, congenital hip disorders, non-FAIS pathologies, staged periacetabular osteotomy, Tönnis grade >1, and missing 10-year follow-up. Hip Outcome Score (HOS) subscale for Activities of Daily Living and the HOS Sports Subscale (HOS-SS), International Hip Outcome Tool, modified Harris Hip Score, and visual analog scale (VAS) for pain/satisfaction were collected. Minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and reoperation-free survivorship were compared. Improvements from baseline to 10 years were correlated between hips. Analysis of variance evaluated differences based on bilateral HA timing.

Results: A total of 80 hips in 40 patients with bilateral HA were matched to 80 hips in 80 patients with unilateral HA. Mean follow-up was 10.4 ± 0.6 years. PROs at all time points were comparable. MCID and PASS achievement rates were similar between groups. Reoperation-free survivorship was comparable (P = .70). Change in index hip scores positively correlated with contralateral hip changes. A 0- to 3-month interval demonstrated superior preoperative HOS-SS compared with 6 to 12 months, whereas a 3- to 6-month interval demonstrated superior 10-year VAS-Pain score compared with 0 to 3 months.

Conclusions: Bilateral HA achieved long-term outcomes and reoperation-free survivorship comparable to those of unilateral HA. Index and contralateral hip outcomes were positively correlated. Shorter intervals between procedures were associated with better preoperative function, whereas intermediate intervals were associated with lower long-term pain, but finding this requires further investigation with larger sample sizes.

Background: Authorship patterns in medical journals continue to evolve with expanding team science, academic incentives, and updated authorship guidance. Previous American Journal of Sports Medicine (AJSM) work (1994-2014) reported rising author counts and a growing share of international contributors.

Hypothesis/purpose: To update AJSM authorship trends (2014, 2019, 2020, and 2024) and test whether the past decade shows greater mean authors per article, more international and/or academic groups, and a higher proportion of nonphysician first authors.

Study design: Cross-sectional bibliometric analysis.

Methods: We reviewed AJSM articles in 2014, 2019, 2020, and 2024 via the journal archive; editorials, letters, society news, and corrigenda were excluded. For each article, we recorded the first/last author's highest degree and sex, the number of authors, country (United States vs international), and institution type (academic vs nonacademic). Articles with >20 authors were excluded. Differences across years were tested with a chi-square test (Bonferroni-adjusted α = .0083) and a 1-way analysis of variance with the Tukey honest significant difference post hoc test.

Results: A total of 1482 articles met the inclusion criteria (2014: n = 336; 2019: n = 383; 2020: n = 383; and 2024: n = 380). Article volume did not differ significantly across years (χ²[3] = 4.30; P = .23). From 2014 to 2024, article volume increased by 13.1%. Mean authors per article increased from 5.82 (2014) to 6.47 (2019), 6.55 (2020), and 7.02 (2024) (F[3,1470] = 15.69; P < .0001); all but the 2019 versus 2020 pairwise contrasts were significant. International groups increased from 42.6% (2014) to 51.3% (2024) (χ²[3] = 8.92; P = .03). No pairwise comparison met the Bonferroni threshold (α =.0083); the lowest P value was .0097 (2014 vs 2019). Bachelor of Arts/Bachelor of Science first authorship rose (χ²[3] = 13.78; P = .003), reaching 9% (2020) and 11% (2024). Sex distributions for first and last authors did not change (all P > .05). Twelve articles exceeded the >20-author cutoff and were excluded.

Conclusion: From 2014 to 2024, AJSM authorship shows expanding team size, increased international participation, and a higher proportion of bachelor's-level first authors-largely medical trainees-while sex representation remained stable. These patterns underscore the need for transparent contributorship and mentorship to maintain rigor as collaboration intensifies.

Background: In 2023, the first North American Hip Arthroscopy Registry was released: the Hip Surgical Treatment Registry (HipSTR). HipSTR is a prospective web-based data collection registry designed to gather baseline patient information, procedural data, and surgical outcomes.

Purpose: To present the initial demographic and surgical overview data for patients enrolled in 2023.

Study design: Cohort study; Level of evidence, 3.

Methods: Beta testing of HipSTR occurred between February 2023 and July 23, 2023, by 7 surgeons on >400 patients. Starting July 23, 2023, HipSTR was made available for enrollment by North American orthopaedic surgeons. HipSTR is a free, digitally administered registry integrated with cloud-based (Patient IQ) outcome database capturing preoperative demographics, patient-reported outcome (PRO) measures, and intraoperative surgical data.

Results: As of December 31, 2023, 14 surgical sites with 21 participating surgeons were enrolling hip arthroscopy patients, totaling 1098 patients in the calendar year 2023. The registry included 65% female patients and 34% male patients, with a mean age of 36.6 ± 14 years. Baseline compliance was 90%. Mean preoperative PRO measures (the 12-item International Hip Outcome Tool, EuroQol 5 Dimension 5 Level Visual Analog Scale, and Hip Single Assessment Numeric Evaluation scores) were 39.7 ± 19.0, 69.6 ± 19.6 and 39.1 ± 21.7, respectively, indicating the significant impact of their hip pain. In total, 315 patients described themselves as an athlete. Surgical findings revealed a variety of hip pathology, including 45% CAM lesions, 43% labral tears, 38% acetabular chondral lesions, 26% pincer morphology. Among patients with CAM and pincer/anterior inferior iliac spine morphology, 98% and 75% underwent femoral osteoplasty and acetabuloplasty, respectively. Additionally, 56% of all patients with acetabular cartilage injury underwent acetabular chondroplasty and 9% underwent microfracture. Notably, 16% of patients had prior surgery on their affected hip. Formal capsulotomies were performed in 68.3% of patients and of these, 83% had their capsulotomy fully repaired.

Conclusion: These findings provide initial insights into the demographics and clinical profiles of North American patients undergoing hip arthroscopy as well as the types of procedures performed. These data, along with future contributions as the registry expands, will enhance understanding of the pathologies managed with hip arthroscopy, evaluate PRO measures to assess procedural efficacy, and guide efforts in the prevention and management of hip pain.

Background: Static posterior shoulder subluxation (SPSL) is associated with both glenoid retroversion and altered acromial morphology. Although abnormal glenoid anatomy has been considered a crucial etiological factor, the biomechanical role of acromial anatomy remains incompletely understood.

Hypothesis: Combined acromial and glenoid malalignment would produce greater posterior humeral head translation than either deformity alone, and targeted corrections could restore posterior stability.

Study design: Controlled laboratory study.

Methods: Six fresh-frozen cadaveric shoulders underwent testing in a 6 degrees of freedom, 8-muscle actuated ex vivo cadaveric simulator. Seven conditions were tested: (1) intact, (2) posterior labral detachment, (3) isolated glenoid malalignment (-15° retroversion), (4) isolated acromial malalignment (high/flat), (5) combined malalignment, (6) acromial malalignment + glenoid correction + posterior acromial bone graft (PABG), (7) combined malalignment + PABG. Humeral head translation was measured during forward flexion at 30°, 50°, and 70° of elevation and normalized to glenoid width. Statistical analysis used repeated-measures analysis of variance with Bonferroni correction.

Results: Posterior labral detachment showed minimal effect (1.3% ± 2.4% translation). On average, isolated glenoid malalignment increased posterior translation by 29%, whereas isolated acromial malalignment produced 31% posterior translation. Combined malalignment resulted in 54% posterior translation (P < .05 for all comparisons), demonstrating additive effects. Glenoid correction with PABG partially restored humeral head translation, but did not restore glenohumeral centering, with a residual 20% posterior translation compared with the intact shoulder. Adding a PABG to the combined malalignment led to a measurable reduction in posterior translation. However, although the graft decreased translation by approximately 13%, it did not restore native kinematics.

Conclusions: Glenoid as well as acromial malalignment alone is associated with pathological posterior translation of the humeral head across the glenoid upon simulated active elevation. Combined acromial and glenoid malalignment produces significantly greater posterior translation than either deformity alone.

Clinical relevance: Complete anatomic correction of both deformities is necessary to restore normal posterior shoulder kinematics, supporting a comprehensive surgical approach for SPSL treatment.

Background: Previous studies have shown good mid-term outcomes of hip labral tear treatment with arthroscopy. However, long-term results are limited within the young adult population.

Purpose: To report survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in young adult patients after primary hip arthroscopy with labral repair or debridement.

Study design: Case Series; Level of evidence, 4.

Methods: Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between June 2008 and August 2012. Young adult patients, aged >19 and <40 years, who underwent labral debridement repair or reconstruction and concomitant procedures were included. Preoperative and minimum 10-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), iHOT-12 (International Hip Outcome Tool), and visual analog scale for pain (VAS-Pain) were collected. The exclusion criteria were previous ipsilateral hip surgery/conditions, Tönnis grade >1, hip dysplasia, workers' compensation status, or femoral head and acetabular Outerbridge scores of 4. Rates of achieving the minimal clinically important difference (MCID) and the patient acceptable symptomatic state (PASS), as well as hip joint survival from conversion to total hip arthroplasty and progression to subsequent ipsilateral revision hip arthroscopy, were reported.

Results: Of the 241 hips eligible for analysis, 194 hips (80.5%) had a minimum 10-year follow-up. A total of 122 women (62.9%) and 72 men (37.1%) were included in the present analysis, with a mean age of 28.9 years and a mean body mass index of 24.8 kg/m². The 10-year survivorship for young adult patients was 91.8%, and 12.9% of patients underwent subsequent ipsilateral arthroscopy at a mean of 36.8 months after the initial procedure. Significant improvements were observed in all PROMs from baseline to a minimum 10-year follow-up-including the mHHS, NAHS, HOS-SSS, VAS-Pain, iHOT-12, and patient satisfaction (P < .05). Patients aged 19 to 40 years achieved high rates of MCID, for mHHS, NAHS, and VAS-Pain, as well as high rates of PASS for the mHHS.

Conclusion: Young adults who underwent primary hip arthroscopy with labral treatment demonstrated an overall 10-year survivorship of 91.8%, significant improvements in PROMs, and high achievement rates of PASS for the mHHS and MCID for the mHHS, NAHS, and VAS-Pain.