American Journal of Sports Medicine最新文献

Background: Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce.

Purpose: To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up.

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

Methods: Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18° and 25° from 2008 to 2018. The exclusion criteria were as follows: LCEA <18º or >25º, previous ipsilateral hip surgery or conditions, and Tönnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain and patient satisfaction were reported. Clinical benefit was assessed via minimal clinically important difference (MCID), the patient acceptable symptomatic state (PASS), and the maximum outcome improvement (MOI). Survivorship was defined as nonconversion to total hip arthroplasty. A sex-based propensity-matched comparison was made in a 1-to-1 ratio based on age, body mass index (BMI), and Tönnis grade.

Results: Propensity-score matching created a cohort of 152 hips, 76 per group. Significant and comparable improvements in all PROMs were observed at a minimum 5-year follow-up, with high achievement rates for the MCID, PASS, and MOI in both groups. However, improvements were significantly higher for women for MCID for the mHHS (86.8% vs 69.7%; P = .0105), MCID for the NAHS (88.2% vs 61.8%; P = .0002), MCID for the VAS for pain (84.2% vs 64.5%; P = .005), PASS for the mHHS (90.8% vs 78.9%; P = .041), and MOI for the NAHS (77.6% vs 55.3%; P = .0057). Survivorship was similar for men (94.74%) and women (89.47%) (P = .229).

Conclusion: At a minimum 5-year follow-up, a propensity-matched comparison of female and male patients with BHD who underwent primary hip arthroscopy demonstrated significant improvement and comparable PROMs and survivorship. Clinical benefit was significantly higher in women, as evidenced by higher achievement rates on the MCID, PASS, and MOI.

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: 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: 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: After rotator cuff repair, immobilization (IM) is routinely employed to limit mechanical loading at the repaired enthesis and reduce the risk of reinjury. However, prolonged IM can lead to stiffness, muscle atrophy, and impaired healing, including fatty degeneration and abnormal matrix remodeling.

Hypothesis/purpose: The purpose of this study was to determine whether adjunctive electrical stimulation (ES) during postoperative IM mitigates disuse-related impairments and promotes tendon-to-bone healing and functional recovery after rotator cuff repair in a rat model. ES applied during IM would mitigate IM-related impairments, enhance tendon-bone healing, and accelerate functional recovery.

Study design: Controlled laboratory study.

Methods: A total of 45 adult male Sprague-Dawley rats underwent unilateral supraspinatus repair and were randomized to the control, IM, or IM with ES (IM/ES) groups. IM was achieved by forelimb fixation, and the IM/ES group received daily transcutaneous ES. Outcomes at 2 and 4 weeks included histology, magnetic resonance imaging mapping, biomechanical testing, and gait analysis.

Results: Rats that underwent IM/ES exhibited a more mature tendon-bone interface with increased proteoglycan deposition and collagen organization compared with the control and IM groups (P < .001). Chondrogenic marker expression was upregulated, whereas fatty infiltration (FABP4) was suppressed. At 4 weeks, the IM/ES group demonstrated lower T2 relaxation times (140.2 ± 24.4 ms) and higher ultimate failure load (27.7 ± 2.1 N) versus the IM (16.6 ± 1.7 N) and control groups (13.9 ± 1.3 N) (P < .0001). Gait analysis confirmed superior functional recovery.

Conclusion: ES administered during IM improved tendon-bone healing by reducing FABP4 and enhancing fibrocartilaginous remodeling, resulting in superior structural, biomechanical, and functional outcomes.

Clinical relevance: These findings suggest that adjunctive ES during the IM after rotator cuff repair may offset the detrimental effects of disuse and promote earlier and stronger tendon-bone healing, supporting its potential translation to postoperative rehabilitation strategies.