American Journal of Sports Medicine最新文献

Background: Synovial fluid (SF) biomarkers demonstrate time-dependent variation after acute knee injury, and it is postulated that persistently elevated inflammatory markers may mediate worse long-term outcomes.

Purpose: This study investigated the relationship between biomarkers in SF at the time of meniscectomy and long-term patient-reported outcomes in patients with acute versus chronic meniscal injuries.

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

Methods: This retrospective analysis included patients who underwent knee SF aspiration on the day of arthroscopic meniscectomy between October 2011 and October 2020 with minimum 4-year follow-up. SF aspirated from the operative knee was analyzed for 10 pro- and anti-inflammatory biomarkers. Patients completed the visual analog scale for pain, Lysholm Knee Questionnaire, Tegner Activity Scale, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) before surgery and at follow-up. Patients were categorized as having acute (<6 weeks) or chronic (>1 year) symptoms. K-means clustering analysis was performed using biomarker levels to group patients into distinct cohorts.

Results: Of 85 patients meeting inclusion criteria, 55 had chronic and 30 had acute meniscal pathology, with 62 (72.9%) completing patient-reported outcome surveys at a mean follow-up of 8.66 years (SD, 2.27). K-means clustering identified 2 distinct biomarker profiles: a high-inflammation cluster and a low-inflammation cluster. The high-inflammation cluster had higher levels of 7 proinflammatory biomarkers as compared with the low-inflammation cluster (P = .015). The low-inflammation cluster predominantly comprised chronic meniscal injuries (89.2%), whereas the high-inflammation cluster was divided between acute and chronic cases. There were no differences in postoperative outcomes between clusters in the overall cohort. However, within the chronic cohort, the high-inflammation cluster exhibited worse postoperative scores on the visual analog scale for pain (P = .035), Lysholm questionnaire (P = .007), KOOS-PS (P = .038), and Tegner scale (P = .049) and had a higher rate of postoperative injections (P = .020) than the low-inflammation cohort.

Conclusion: In patients with chronic meniscal injury, those with a more proinflammatory SF biomarker profile at the time of meniscectomy had worse outcomes than those who had a low inflammatory profile. In acute meniscal injuries, most patients demonstrate a high inflammatory profile, which was not associated with a difference in long-term outcomes.

Background: Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands.

Purpose: To evaluate the effect of previous LSS on the outcomes of primary hip arthroscopic surgery at a minimum 5-year follow-up.

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

Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopic surgery with previous LSS. Patients had completed a minimum of 5-year follow-up. A subanalysis based on the type of LSS was also conducted. Patients were matched to a control group that underwent hip arthroscopic surgery without previous LSS in a 1:3 ratio based on age at surgery, sex, acetabular Outerbridge grade, and body mass index. Comparisons of patient-reported outcome (PRO) scores, clinically relevant outcome thresholds, complications, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were performed.

Results: A total of 424 hips were included in the study: 106 hips with previous LSS and 318 control hips. Patients with previous LSS displayed improvements across all PRO measures. There were no differences in improvements in PRO scores or the percentage of patients reaching clinically relevant outcome thresholds based on the type of LSS. Compared with the control group, the LSS group started with significantly lower preoperative PRO scores. Yet, both groups experienced equivalent improvements in all PRO scores. Furthermore, the LSS group had worse postoperative scores for all PRO measures. Additionally, the LSS group reached the Patient Acceptable Symptom State at significantly lower rates for the mHHS (modified Harris Hip Score), NAHS (Non-Arthritic Hip Score), and HOS-SSS (Hip Outcome Score-Sports-Specific Subscale). There was no difference in the rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and control groups converting to THA at 27.43 ± 24.32 and 48.02 ± 37.61 months, respectively (P < .05).

Conclusion: Hip arthroscopic surgery for the treatment of femoroacetabular impingement and labral tears in patients with previous LSS yielded significant improvements at midterm follow-up, which were equivalent to those of a matched control group with no history of lumbar abnormalities. However, the LSS group had lower postoperative PRO scores and met the Patient Acceptable Symptom State for PRO measures at lower rates. Importantly, LSS did not influence the risk of revision arthroscopic surgery and conversion to THA. However, the LSS group converted to THA sooner than the control group.

Background: Subchondral insufficiency fracture of the knee (SIFK) is commonly associated with medial meniscus posterior root tears (MMPRTs). However, there is limited research investigating risk factors for SIFK in patients with MMPRTs.

Purpose/hypothesis: The purpose of this investigation was to identify the risk factors for SIFK in patients with MMPRTs. It was hypothesized that age, body mass index, and extent of meniscal extrusion would emerge as significant risk factors for SIFK.

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

Methods: Patients with a primary isolated MMPRT confirmed via magnetic resonance imaging were included. Data on patient demographics, medical and surgical history, and imaging parameters were assessed for associations with SIFK. Imaging parameters included mechanical axis, medial tibial slope, tibiofemoral joint space, and meniscal extrusion. Patients were identified and divided into 2 groups based on the presence or absence of findings of SIFK on magnetic resonance imaging. Continuous variable distribution normality was assessed using the Shapiro-Wilk test. Demographic comparisons were made by t tests and chi-square tests. Multivariable logistic regression was used to identify SIFK risk factors. The threshold of joint space for predicting SIFK was determined through receiver operating characteristic analysis. The optimal threshold was determined with the Youden index.

Results: A total of 153 patients were included (mean ± SD age, 56.2 ± 9.1 years): 90 patients (26 male, 64 female) in the non-SIFK group and 63 patients (16 male, 47 female) in the SIFK group. There were no differences in patient demographics between the cohorts. Patients with SIFK had a greater incidence of previous knee injections (P = .047), a significantly smaller tibiofemoral joint space (P < .001), and a significantly greater degree of meniscal extrusion (P = .041). Multivariable logistic regression analysis identified diminished joint space as the only independent predictor of SIFK (odds ratio, 0.41; P = .017). Receiver operating characteristic analysis determined a predictive threshold for joint space <3.93 mm, yielding an acceptable area under the curve of 0.766.

Conclusion: The development of SIFK is likely multifactorial; however, decreased tibiofemoral joint space is a significant independent risk factor for SIFK in patients with MMPRTs, with a greater risk in patients with a tibiofemoral joint space <3.93 mm.

Background: The zonal organization of articular cartilage is critical for the biphasic mechanical properties of the tissue. Current treatments for articular cartilage have yet to regenerate this zonal architecture, compromising the functional efficacy of the repaired tissue, which could account for tissue failure in the long term. Autologous chondrocyte implantation (ACI) still suffers from inconsistent efficacy and a long recovery period stemming from implantation of a heterogeneous chondrocyte mixture.

Hypothesis: Stratified implantation of zonal chondrocytes would facilitate the recapitulation of articular cartilage zonal properties and improve the repair efficacy of ACI treatment.

Study design: Controlled laboratory study.

Methods: Autologous chondrocytes extracted from porcine articular cartilage were subjected to dynamic microcarrier expansion followed by size-based segregation using a spiral microfluidic device for the enrichment of zonal chondrocytes. Zonal chondrocytes were implanted into a chondral defect as a bilayered hydrogel construct consisting of superficial zone chondrocytes overlaying middle/deep zone chondrocytes (n = 6). Twelve months after implantation, the repair efficacy was compared against implantation of full-thickness cartilage-derived heterogeneous chondrocytes expanded on tissue culture plates (n = 5) or microcarriers (n = 6).

Results: Quantitative assessment of the repair tissues, including gross morphology, histological analysis, micro-computed tomography (micro-CT), compression modulus, and surface lubrication analysis, at 12 months demonstrated statistically significant improvement in cartilage and subchondral bone repair with zonal chondrocyte bilayered implantation. Magnetic resonance imaging (MRI) T2 mapping indicated progressive improvement in graft maturation as early as 3 months, reaching normalcy at 9 months.

Conclusion: This study demonstrates that with appropriate expansion and isolation of zonal chondrocytes, stratified zonal chondrocyte implantation is able to facilitate restoration of articular cartilage zonal architecture and significantly enhance the functional repair as compared with current ACI treatment.

Clinical relevance: With appropriate expansion and enrichment of zonal chondrocytes, stratified zonal chondrocyte implantation could represent a significant advancement over current ACI-based cartilage repair, with the potential to support quicker and better recovery.

Background: The number of meniscal repairs being completed each year is increasing; however, the optimal, cost-effective postoperative assessment to determine the success or failure of a meniscal repair is not well known.

Purpose/hypothesis: The purpose of this systematic review was to identify the clinical examination testing that correlates with objective magnetic resonance imaging (MRI) or second-look arthroscopy (SLA) findings to determine an optimal clinical workup for assessing postoperative meniscal repair healing. It was hypothesized that specific clinical tests would correlate with meniscal repairs that did not heal.

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

Methods: This systematic review included all clinical studies investigating meniscal repairs, meniscal repair outcomes, and meniscal healing with clinical findings, MRI, and/or SLA, published in a peer-reviewed journal and with full English text available. All included studies were evaluated for bias using the Methodological Index for Non-Randomized Studies (MINORS). The clinical tests included those using "Barrett's criteria," with the assessment of effusion, joint line tenderness, locking, McMurray testing, and radiographs. This parameter has also been abbreviated to "modified Barrett's criteria" to include only joint line tenderness, effusion, and McMurray testing.

Results: No significant correlations were found between clinical tests and MRI or SLA. A subgroup meta-analysis between Barrett's and non-Barrett's studies reported no significant subgroup differences (χ₁² = 0.24; P = .62). A meta-analysis of diagnostic accuracy using a group of 7 studies that reported on true-positive, true-negative, false-positive, and false-negative data for SLA demonstrated that only a lack of joint line tenderness had a high specificity for a healed meniscal repair, with a log diagnostic odds ratio of 2.62 (95% CI, 0.47-4.76).

Conclusion: This study found no significant correlation with any specific clinical test for meniscal repair healing status using postoperative MRI and/or SLA findings. However, it was found that no healing (when compared with complete or incomplete healing) on MRI and joint line tenderness should be considered when assessing the status of postoperative meniscal repair healing. In addition, a subgroup meta-analysis found that a lack of joint line tenderness was highly correlated with a healed meniscal repair.

Background: Score cutoffs of clinically important outcome values such as the minimal clinically important improvement (MCII), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) are population and treatment specific. In patients with nonarthritic hip-related pain, numerous score cutoffs have been calculated for use after surgical treatment, but they have not been established for patients who pursue nonoperative care.

Purpose: To determine the MCII, SCB, and PASS score cutoffs for the 12-item International Hip Outcome Tool (iHOT-12), the Hip Disability and Osteoarthritis Outcome Score (HOOS), and an 8-item abbreviated version of the HOOS (HOOS_global) among patients with nonarthritic hip-related pain who were managed nonoperatively.

Study design: Cohort study; Level of evidence, 4.

Methods: The cohort included 15- to 40-year-old patients who were diagnosed with nonarthritic hip-related pain by a surgical or nonsurgical orthopaedic clinician and were advised to pursue nonoperative management at the time of evaluation. At baseline and 12-month follow-up, patients completed the iHOT-12, HOOS, and HOOS_global. Receiver operating characteristic curves were used to generate MCII, SCB, and PASS score cutoffs using an anchor-based approach as well as score changes between baseline and 12 months. The anchor question for the MCII and SCB utilized a 9-item global rating of change scale. The anchor question for the PASS was as follows ("yes"/"no" response): "Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?"

Results: Among 61 patients (mean age, 28 ± 8 years; 50 [82%] female), for the iHOT-12, the MCII score cutoff was 14, the SCB score cutoff was 18, and the PASS score cutoff was 63. For the HOOS subscales, the MCII score cutoffs ranged from 4 (Activities of Daily Living) to 13 (Sport and Recreation), the SCB score cutoffs ranged from 10 (Symptoms and Activities of Daily Living) to 25 (Quality of Life), and the PASS score cutoffs ranged from 50 (Quality of Life) to 87 (Activities of Daily Living). For the HOOS_global, the MCII score cutoff was 5, the SCB score cutoff was 12, and the PASS score cutoff was 65. The models mostly had good responsiveness (area under the curve = 0.73-0.94).

Conclusion: These clinically important outcome values can assist clinicians and researchers with interpreting patients' clinical change during nonoperative treatment for nonarthritic hip-related pain.

Background: There is growing interest in sagittal plane malalignment as a risk factor for patellofemoral chondral wear and, correspondingly, as an important measure to correct when performing certain tibial tubercle osteotomy (TTO) procedures. However, a radiographic method to measure anteriorization after TTO has not been described.

Purpose: To develop and validate a radiographic method of measuring anteriorization after TTO.

Study design: Cross-sectional study (diagnosis); Level of evidence, 3.

Methods: Patients treated by 2 high-volume sports medicine surgeons at a single institution who underwent a TTO from 2015 to 2023 with available pre- and postoperative radiographic and magnetic resonance imaging (MRI) scans were identified. Approximately 10 mm and 0 mm of operative anteriorization were targeted for the anteromedializing and straight distalizing TTOs, respectively. Two methods to assess anteriorization after TTO on lateral knee radiographs were developed, using the preoperative to postoperative difference in distance between the anterior-most aspect of the tibial tubercle and either the center of the tibial shaft or the anterior tibial plateau. To validate the radiographic techniques, intraclass correlation coefficients (ICCs) were calculated between each method of radiographic measurement and the gold standard MRI measurement (preoperative to postoperative difference in sagittal tibial tubercle-trochlear groove distance).

Results: There were 70 patients (52 [74%] women) with a mean age of 31.5 ± 9.2 years. The mean anteriorization amount among the 57 anteriorizing TTOs was 4.9 ± 2.5 mm on the x-ray (XR) shaft technique, 4.6 ± 2.6 mm on the XR plateau technique, and 5.3 ± 2.7 mm on MRI (P = .35). The mean anteriorization amount among the 13 straight distalizing TTOs was 0.1 ± 2.5 mm on the XR shaft technique, -0.3 ± 2.2 mm on the XR plateau technique, and 0.6 ± 2.6 mm on MRI (P = .66). There was excellent agreement with MRI for both the XR shaft (ICC, 0.89) and XR plateau (ICC, 0.82) techniques. Interrater reliability was excellent for both techniques (ICC, 0.94-0.95).

Conclusion: Anteriorization after TTO can be measured using routine pre- and postoperative radiographs. Additionally, the amount of anteriorization achieved with modern anteromedializing TTO techniques was less than that traditionally targeted. Moving forward, surgeons can assess the amount of anteriorization achieved during TTO on standard radiographs, while researchers may investigate the potential role of anteriorization on postoperative outcomes.

Background: Tendons have a limited blood supply and form inferior scar tissue during repair, which increases the risk of reruptures, causes complications, and limits regenerative capacity. Current methods to repair injured tendon tissue use solid scaffolds, which carry the risk of contamination (infections) and require open surgery for transplantation.

Hypothesis: Alginate-cell cross-linked gels, which can be applied by a percutaneous injection and transmit mechanical stress to cells via direct cell interaction, could induce tendon tissue regeneration.

Study design: Controlled laboratory study.

Methods: A cross-linked gel was prepared to suspend azide-modified mesenchymal stromal cells (MSCs) in a dibenzocyclooctyne-modified branched alginic acid solution. The cross-linked gel was cultured in a bioreactor. In vivo, the Achilles tendon defects of 104 Lewis rats were injected with saline (control group), alginate gel alone (alginate group), alginate gel with MSCs (MSC group), and cross-linked gel (cross-link group). At 2 and 4 weeks postoperatively, histological and biochemical evaluations were performed. The biomechanical properties of repaired tissue were assessed at 4 weeks.

Results: In the bioreactor culture, the cell orientation in the cross-linked gel was parallel to the direction of tension. Histological analysis of the cross-link group showed significantly more repaired tendon tissue and improved collagen fiber orientation compared with the alginate group or MSC group. The biomechanical properties of the cross-link group included higher stiffness.

Conclusion: The cross-linked gel was injectable at the injury site and was able to induce tissue regeneration with cell-oriented adaptability to the mechanical environment of tissue defects.

Clinical relevance: Intercellular cross-linking technology holds the potential for clinical application as a minimally invasive therapeutic approach that can contribute to the qualitative improvement of tendon tissue regeneration.