American Journal of Sports Medicine最新文献

Background: Countermovement jump (CMJ) analyses can predict ulnar collateral ligament (UCL) injuries in professional baseball pitchers, yet a biomechanical determinant linking CMJ analytics to UCL sprains is unknown.

Purpose/hypothesis: The purpose of this study was to evaluate CMJ parameters in collegiate pitchers with high and low elbow varus torque (EVT) and investigate multilinear regression relationships between CMJ and EVT kinetics. It was hypothesized that pitchers with greater EVT would have greater CMJ measures, and CMJ kinetics would explain the variance in EVT kinetics.

Study design: Descriptive laboratory study.

Methods: Analyses of 19 Division I collegiate baseball pitchers (age, 19.9 ± 1.5 years; body height, 1.87 ± 0.08 m; body mass, 90.0 ± 13.4 kg) were performed with integrated ball release speed, 3-dimensional motion capture, and ground reaction force (GRF) technology. A 1-way between-participant analysis of variance was used to compare CMJ and ball velocity metrics, while Pearson correlations (r) were used to evaluate the association between EVT and CMJ kinetic variables. An alpha level of .05 indicated statistical significance for all tests that included effect size calculations (η²) for mean differences.

Results: The EVT rate of torque development (EVTRTD) was significantly greater in pitchers with a higher EVT (high EVT: 605 ± 74 vs low EVT: 353 ± 103 N·m·s^-1; P < .001; η² = 0.41). CMJ data were similar between groups, yet correlation models indicated that changes in peak CMJ GRF (r = 0.60, P < .001) and power (r = 0.53, P < .05) can explain variance in EVTRTD.

Conclusion: Compared with absolute EVT, CMJ kinetics were more associated with the rate of EVT in collegiate pitchers.

Clinical relevance: Therefore, as it relates to injury surveillance, identifying pitchers who display increases in peak GRF, concentric impulse, and peak CMJ power may provide early detection in protecting athletes from elbow valgus overload.

Background: Osteochondritis dissecans (OCD) lesions in the knee are most commonly found in the medial femoral condyle (MFC). However, a paucity of literature has explored the characteristics or morphology of patellar OCD lesions.

Purpose/hypothesis: The purpose of this study was to analyze patellar tracking and patellofemoral measurements of pediatric patients with patellar OCD compared with patients with MFC OCD. It was hypothesized that the patients with patellar OCD would demonstrate an increased bony sulcus angle, cartilaginous sulcus angle, and tibial tubercle-trochlear groove (TT-TG) distance compared with patients with MFC OCD.

Study design: Case series; Level of evidence, 3.

Methods: Patients aged ≤18 years diagnosed with either a patellar or MFC OCD lesion at a single tertiary care hospital between January 2016 and May 2023 were analyzed. Patients with a history of patellar instability were excluded. The Caton-Deschamps index, cartilaginous bony height, trochlear depth, patellar tilt, lateral patellar displacement, cartilaginous sulcus angle, bony sulcus angle, and TT-TG distance were assessed on magnetic resonance imaging (MRI). Patients were matched 1:2 based on sex and chronological age within 2 years between the patellar and MFC OCD groups.

Results: A total of 40 extremities in 34 patients with patellar OCD were matched to 80 extremities in 73 patients with MFC OCD. The mean age at the time of MRI was 14.1 ± 2.3 years, and 23% were female. Compared with patients with MFC OCD, patients with patellar OCD had a significantly greater TT-TG distance (11.55 ± 4.15 vs 13.35 ± 4.07 mm, respectively; P = .03). The cartilaginous sulcus angle (150.63°± 7.20° vs 128.09°± 14.07°, respectively; P < .001) and bony sulcus angle (144.70°± 7.78° vs 137.37°± 9.62°, respectively; P < .001) were higher in the patellar OCD group compared with the MFC OCD group. Of patients with patellar OCD, 40% had a TT-TG distance >15 mm, and of patients with MFC OCD, 20% had a TT-TG distance >15 mm. The patellar OCD group had 3.7 times the risk of having a patellar dislocation compared with the MFC OCD group.

Conclusion: An increased TT-TG distance and sulcus angle were associated with patellar OCD in pediatric patients. Patients with abnormal patellofemoral morphology who undergo treatment for a patellar OCD lesion may subsequently develop a patellar dislocation; in this study, patients with patellar OCD without a history of patellar dislocations demonstrated a nearly 4-fold higher dislocation rate compared with an age- and sex-matched group of patients with MFC OCD.

Background: Recent biomechanical evidence for adjustable suture anchor (ASA)-based posterior medial meniscus root (PMMR) fixation has shown promising results compared with conventional transtibial pull-out repair (TPOR). However, ASA fixation has not been evaluated in human tissue to 100,000 cycles.

Hypothesis: ASA repair would lead to increased primary fixation strength and less cyclic displacement than conventional TPORs.

Study design: Controlled laboratory study.

Methods: A total of 32 human medial menisci were used, 8 of which were intact specimens and served as native controls. For the others, PMMR tears were created and repaired using 3 different techniques (n = 8 group). Two conventional PMMR repairs were prepared consisting of two No. 2 simple sutures (TSS) and two No. 2 sutures in a Mason-Allen (MA) configuration, all tied over a cortical button. The knotless ASA repair was fixed in MA with repair sutures tensioned at 120 N (MA-120). The repairs' initial force, stiffness, and relief displacement from the tensioned state toward repair unloading (2 N) were measured after fixation. All repair constructs were loaded for 100,000 cycles, with displacement and stiffness measured, and finally were pulled to failure.

Results: The TPORs demonstrated similar primary fixation and cyclic loading behavior except for initial cyclic displacement (cycle 10). The ASA repair provided a higher initial repair load (P < .001) and stiffness (P < .001) with relief displacement similar to conventional TPORs. Lower initial cyclic displacement (P < .011; cycle 10) with overall higher repair stiffness (P < .011) resulted in significantly lower displacement (P < .001) throughout testing for ASA repair. Although both TPORs were completely loose after 100,000 cycles, the ASA repair achieved near-native dynamic meniscal stabilization. The TSS repair had lower overall ultimate load (P < .001) and ultimate stiffness (P < .023) compared with the ASA repair. All repairs had lower ultimate stiffness and loads than the native meniscus (P < .001).

Conclusion: The ASA repair resulted in improved primary PMMR fixation that was stiffer with less cyclic displacement than conventional TPORs and approached that of the human meniscal function after 100,000 load cycles in a cadaveric model. However, all repair techniques had lower ultimate strength than the native human PMMR.

Clinical relevance: Knotless ASA meniscus root fixation resulted in higher tissue compression and less displacement in a cadaveric model; however, future clinical series with surveillance imaging will define the overall significance of healing rates.

Background: Lateral elbow pain, often attributed to lateral epicondylitis, presents diagnostic complexities. Lateral epicondylitis, or tennis elbow, is the most frequent cause of lateral elbow pain, but a differential diagnosis among all the potential causes of lateral elbow pain is not easy.

Purpose: To evaluate the rate of misdiagnoses in patients previously diagnosed with lateral epicondylitis, identify at-risk patient profiles, and determine sensitive clinical tests for a misdiagnosis.

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

Methods: A prospective analysis was conducted on 189 consecutive patients with a previous diagnosis of lateral epicondylitis and failed nonoperative treatment. According to medical history and a physical examination, patients were preliminarily classified into the typical or atypical lateral epicondylitis group. Atypical epicondylitis was defined as one of the following: atypical lateral pain location, history of trauma, limited range of motion (ROM), elbow swelling, negative Cozen test finding, and physical examination findings suggesting a misdiagnosis. Patients in the atypical group were further investigated for a potential lateral epicondylitis misdiagnosis using magnetic resonance imaging, computed tomography, and/or analysis of intraoperative samples according to suspected underlying abnormalities. Univariate and logistic regression analyses were conducted to assess the risk of a misdiagnosis. A standardized diagnostic analysis was performed to evaluate the clinical tests used during the physical examination to identify misdiagnosed patients.

Results: A misdiagnosis occurred in 21 of 189 (11%) patients. The most common misdiagnoses were posterolateral elbow instability in 6 patients; radial nerve compression and inflammatory osteoarthritis in 3 patients each; and osteochondritis dissecans, posterolateral plica, and primary osteoarthritis in 2 patients each. The variables associated with a misdiagnosis were young age (≤30 years; odds ratio [OR], 66.90; P < .001), history of trauma (OR, 17.85; P = .0027), history of a limitation of ROM and/or mechanical symptoms (OR, 16.68; P = .0278), history of elbow swelling (OR, 14.32; P = .0032), and number of corticosteroid injections (OR, 2.00; P = .0007). Atypical lateral pain location highly predicted a misdiagnosis, with a sensitivity of 90.5%.

Conclusion: A misdiagnosis can occur in patients affected by longstanding lateral elbow pain. Young patients and patients with a history of elbow trauma, a limitation of ROM, swelling, corticosteroid injections, and atypical lateral pain should be highly suspected for a misdiagnosis.

Background: In the presence of anterior glenoid bone loss (aGBL), options for bony glenoid augmentation include Latarjet procedures and free bone block transfers. Bone graft placement is challenging, and malposition causes complications, such as recurrent instability or osteoarthritis.

Hypothesis: With minimal changes in bone block positioning, osteochondral shoulder stability cannot be restored sufficiently.

Study design: Controlled laboratory study.

Methods: In a robotic test setup, 14 human cadaveric scapulae were included. Soft tissue was resected, and matching artificial humeri were selected for each specimen. Testing was performed in 60° of glenohumeral abduction with 50 N of glenohumeral compression and anterior-directed translational force to the humerus. Application of 20% aGBL and screw fixation of artificial bone blocks (artBBs) with different buildup shells allowed the following testing stages: (1) intact, (2) 20% aGBL, (3) flush artBB, (4) 1-mm medialized artBB, and (5) 1-mm lateralized artBB. The stability ratio (SR) and medial-lateral humeral head starting position were assessed.

Results: Specimens with 20% aGBL provided lower mean SRs than native joints (20.6% [SD, 4.7%] vs 27.8% [SD, 6.7%]; P < .0001). Flush artBB placement (mean, 35.4%; SD, 7.7%) led to an increased SR compared with both native joints (P = .002) and 20% aGBL (P < .0001). The mean SR in 1-mm medialized artBBs (21.5%; SD, 5.7%) did not differ compared with that for 20% aGBL (P = .908). One-millimeter lateralized artBBs (mean, 40.8%; SD, 5%) provided higher SR and more lateral humeral head starting positions compared with flush artBB (P = .003 and P = .003, respectively).

Conclusion: In the presence of aGBL, flush bone block placement restores osteochondral glenohumeral stability, while a 1-mm medialized bone block fails to increase stability. Bone block lateralization of 1 mm provides higher stability but is associated with humeral head lateralization.

Clinical relevance: Glenoid bone block augmentations are established in patients with glenohumeral instability and aGBL. In the case of bone block malposition, complications like recurrent instability or the development of osteoarthritis can occur. This study underlines the importance of accurate bone block placement since only minimum bone block malposition relevantly affects osteochondral shoulder biomechanics.

Background: Despite numerous studies examining subjective clinical scores after meniscal allograft transplantation (MAT), research focusing specifically on functional measures is lacking.

Purpose: To evaluate the serial changes in isokinetic muscle strength and dynamic balance during the first postoperative year after lateral MAT (LMAT).

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

Methods: A total of 55 patients who underwent LMAT underwent subjective functional assessment using the Lysholm and subjective International Knee Documentation Committee (IKDC) scores. The objective functions, evaluated using isokinetic muscle strength testing and the Y-balance test for dynamic postural stability, were recorded preoperatively and 6 and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed at 2 days and 12 months postoperatively to evaluate the meniscal allograft extrusion and cartilage condition in the lateral compartment. At 12 months, patients with graft extrusion >3 mm on MRI were assigned to the extrusion group.

Results: Significant improvements were observed in the Lysholm and subjective IKDC scores at 12 months postoperatively (both P < .001). The joint space width did not significantly increase (P = .054). Coronal graft extrusion increased significantly (P < .001). At 6 months postoperatively, isokinetic muscle strength tests indicated no significant reduction in the peak torque for knee extension (P = .911). However, at 12 months, the peak torque was significantly increased (P = .001), with the deficits improving from 38.3% to 18.1% (P < .001). No significant changes were noted in the knee flexion strength. Dynamic postural stability showed a significant decrease in the Limb Symmetry Index (LSI) for the anterior reach at 6 months (P = .004), but significant improvements were seen by 12 months, with the LSI values for the anterior, posteromedial, and posterolateral reaches all exceeding 90% (P < .001). No significant differences in muscle strength or dynamic balance were found between the nonextrusion (n = 41) and extrusion (n = 14) groups at 12 months.

Conclusion: The significant improvements in isokinetic muscle strength and dynamic postural stability achieved only by 12 months after LMAT underscores the necessity of a comprehensive rehabilitation program and caution against premature sports resumption.

Background: Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.

Purpose: To determine if a patient's lived environment is associated with better or worse postoperative outcomes using the area deprivation index (ADI).

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

Methods: Patients undergoing hip arthroscopy between January 1, 2015, and June 30, 2022, at a single institution were identified using Current Procedural Terminology codes. Patients' zip codes were utilized to identify ADI measures. Patients were divided into quartiles of ADI, and the most deprived (ADI_High) and least deprived (ADI_Low) quartiles were compared. Pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Pain Interference (PI), Physical Function (PF), and Depression domains were obtained. For the PF and PI domains, the minimal clinically important difference (MCID) was defined using an anchor-based approach using previously established cutoffs. For the Depression domain, the MCID was defined using a distribution-based approach and calculated as one-half of the standard deviation of the preoperative PROMIS score. Multivariable logistic regression models were estimated to characterize the association of the ADI with MCID attainment along PROMIS domains.

Results: A total of 170 patients were included in the analysis of the ADI_High (n = 85) and ADI_Low (n = 85) cohorts. Age, body mass index, smoking status, and race did not significantly vary between groups. No significant differences in MCID attainment were observed at any time point in the PF, PI, or Depression domains. However, the ADI_High cohort had higher mean PI (worse) scores compared with the ADI_Low cohort at the preoperative, 1-year, and final follow-up (mean, 2.52 years) time points. In multivariable logistic regression analyses, ADI was not associated with the odds of MCID attainment.

Conclusion: For patients undergoing hip arthroscopy, increased social disadvantage measured by the ADI was not associated with the odds of MCID attainment in any PROMIS domain. This information provides guidance for care providers, researchers, and policymakers to seek and identify other mechanisms that may affect outcomes after hip arthroscopy.

Background: Chaotic sporting environments require the performance of concurrent cognitive and motor tasks. A reduced capacity for either or both of the tasks when performed concurrently is known as cognitive-motor interference (CMi) and is believed to increase the injury risk. A greater susceptibility to CMi after a rupture of the anterior cruciate ligament (ACL) has been suggested to be caused by central nervous system adaptations, thus possibly contributing to high secondary ACL injury rates.

Purpose: To investigate whether patients after ACL reconstruction (ACLR) demonstrate greater CMi than noninjured controls when adding secondary cognitive tasks to the drop vertical jump (DVJ) and explore the potential influence of sex on CMi.

Study design: Controlled laboratory study.

Methods: A total of 40 (50% male) sports-active patients who had undergone ACLR (mean, 24.9 ± 16.1 months after surgery) and 40 (50% male) sports-active noninjured controls performed DVJs with and without secondary cognitive tasks targeting short-term memory, attention, fast decision-making, and inhibitory control. Outcomes included a letter position recall task and 3 motor variables: (1) correct action (landing or landing with a subsequent vertical jump), (2) relative jump height (relative between DVJs), and (3) relative peak vertical ground-reaction force (relative between DVJs). Participants also completed isolated cognitive tests (CANTAB) included as covariates in multivariate analysis.

Results: Multivariate analysis of variance revealed that the ACLR group had greater CMi than the control group (P < .001), as manifested by more incorrect answers for the cognitive letter recall task (mean difference [MD], -13.3% [95% CI, -20.8% to -5.9%]; P < .001), more incorrect motor actions (MD, -7.5% [95% CI, -12.4% to -2.6%]; P = .003), and a reduced relative jump height (MD, -4.5% [95% CI, -7.9% to -1.2%]; P = .010). No difference in relative peak vertical ground-reaction force was found (MD, 2.8% [95% CI, -7.7% to 13.3%]; P = .59). Isolated cognitive outcomes did not affect these results, and there were no significant differences between male and female participants.

Conclusion: Patients after ACLR showed greater CMi than noninjured controls, which was unrelated to isolated cognitive outcomes, thus indicating aberrant neurocognitive function.

Clinical relevance: Clinicians should consider cognitive and dual-task training and screening during ACL rehabilitation to better prepare patients for chaotic and uncontrolled sporting environments in which dual tasking is prevalent. Such interventions may help to reduce the risk of secondary ACL injuries.