American Journal of Sports Medicine最新文献

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.

Background: Bone grafting is a common and effective treatment for anterior shoulder instability. Graft healing is critical for the success of this procedure; however, few studies have investigated methods to enhance the healing process. Furthermore, suitable animal models are scarce for this type of surgery.

Purpose: To (1) establish an animal model of anterior shoulder instability, and (2) evaluate whether a surgical modification based on an inlay structure (creating a groove on the glenoid and shaping the graft to match it) along with postoperative administration of the bone anabolic agent parathyroid hormone 1-34 (PTH1-34) could accelerate graft healing.

Study design: Controlled laboratory study.

Methods: A rabbit model of anterior shoulder instability was established, and autologous iliac bone grafting was performed. Gross morphological observation, micro-computed tomography imaging and analysis, and histological staining and evaluation were employed to assess whether the inlay-based surgical modification and postoperative intermittent subcutaneous injection of PTH1-34 could enhance graft healing.

Results: The modified inlay technique increased the expression of Runx2 and type I collagen within the graft, accelerated graft integration with the glenoid, promoted more rapid callus remodeling and maturation, and reduced graft resorption. Additionally, for both the modified inlay and classic onlay bone grafting procedures, postoperative intermittent subcutaneous injection of PTH1-34 enhanced osteogenic capacity of the autograft and glenoid, increased new bone volume, and shortened the graft healing time.

Conclusion: We successfully developed an animal model of autologous bone grafting for anterior shoulder instability. Using this model, we demonstrated that the modified inlay bone grafting procedure improves osteogenic ability, shortens healing time, and promotes callus maturation. Intermittent subcutaneous administration of PTH1-34 after surgery further enhanced graft-glenoid healing.

Clinical relevance: The modified inlay technique and postoperative intermittent PTH1-34 administration may improve graft healing rates after bone grafting procedures for anterior shoulder instability.

Background: Hip arthroscopy has demonstrated favorable short- and mid-term outcomes for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD). However, long-term outcomes in patients with FAIS and BHD treated with hip arthroscopy remain understudied.

Purpose: To evaluate hip survivorship and patient-reported outcomes (PROs) in patients with FAIS and BHD compared with those without BHD at a minimum 10-year follow-up.

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

Methods: A retrospective matched-cohort study was conducted on patients undergoing primary hip arthroscopy for FAIS by a single surgeon (2012-2024). BHD was defined as a lateral center-edge angle (LCEA) of 20° to 25°. Patients with BHD were matched 1 to 2 to controls without BHD based on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Radiographic parameters (eg, alpha angle, LCEA) were assessed pre- and postoperatively. PROs-including mHHS, Non-Arthritic Hip Score (NAHS), and hip survivorship (revision arthroscopy, conversion to total hip arthroplasty [THA])-were compared.

Results: The study included 23 patients with BHD (mean age, 33.6 years; 69.6% women) and 46 controls (mean age, 32.7 years; 65.2% women). Both groups showed significant improvements in mHHS and NAHS at 10 years (all P < .001), with no differences in postoperative scores or minimal clinically important difference achievement (BHD group, 91.3% vs control group, 97.5%; P = .55). There were no conversions to THA in the BHD group and 2 in the control group (4.3%; P = .189). Revision arthroscopy rates were 0% in the BHD group and 8.7% in the control group (P = .549). Patients with BHD exhibited significantly greater reductions in alpha angles on 45° Dunn views (-13° vs -1.9°; P = .01).

Conclusion: At a minimum 10-year follow-up, patients with BHD who underwent hip arthroscopy for FAIS achieved comparable PROs and hip survivorship to those without BHD. These findings support the use of hip arthroscopy as a durable and effective treatment for FAIS in this population.

Background: Optimal graft selection for anterior cruciate ligament (ACL) reconstruction (ACLR) remains controversial, particularly regarding tendon-to-bone incorporation and biomechanical performance among autografts, allografts, and hybrid grafts.

Hypothesis: Autografts demonstrate superior tendon-to-bone healing, biomechanical strength, and functional recovery compared with allografts and hybrid grafts.

Study design: Controlled laboratory study.

Methods: A total of 84 rats underwent ACLR using autograft, allograft, or hybrid grafts (a construct combining autograft and allograft tissues) (n = 21 per group), with an intact group serving as the control group. Grafts were harvested from the peroneus longus tendon. Assessments at 1, 2, 4, and 8 weeks included histology (hematoxylin and eosin; the Masson trichrome staining; immunohistochemistry), gait analysis, micro-computed tomography, and biomechanical testing.

Results: Histologically, compared with allografts and hybrid grafts, autografts exhibited significantly improved synovial coverage, lower cartilage degeneration (score, autograft vs allograft vs hybrid graft: 10.80 ± 0.84 vs 3.20 ± 0.84 vs 4 ± 0.71; P < .001), improved collagen alignment, reduced inflammation, and enhanced vascularization and tenogenesis, whereas allografts and hybrid grafts exhibited distinct necrosis. Autografts exhibited superior value of bone volume per total volume (femur, autograft vs allograft vs hybrid graft: 5.40 ± 0.55 vs 2.60 ± 0.86 vs 2.69 ± 0.25; P < .001). Gait parameters, including stride length and step height, were restored to near-control levels only in the autograft group (intact control vs autograft: stride length, 3.09 ± 0.40 vs 2.96 ± 0.35; P = .899; step height, 2.67 ± 0.31 vs 2.26 ± 0.35; P = .199). Biomechanically, autografts demonstrated superior stress (autograft vs allograft: 14.86 ± 4.26 vs 2.64 ± 1.35; P < .001), stiffness (autograft vs allograft: 11.21 ± 5.55 vs 3.15 ± 1.55; P = .027), and tensile modulus (autograft vs allograft vs hybrid graft: 31.71 ± 10.35 vs 3.71 ± 1.83 vs 15.07 ± 4.51; P < .001).

Conclusion: Autografts provided superior tendon-to-bone integration, biomechanical performance, and functional outcomes compared with allograft and hybrid grafts in a rat ACLR model.

Clinical relevance: This preclinical study, conducted in a rat model, provides mechanistic evidence that autografts exhibit superior biological incorporation and mechanical integrity, supporting the existing clinical preference for autograft in ACLR and helping inform graft selection.

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.

Background: Quadriceps tendon (QT) autografts are increasingly used worldwide in anterior cruciate ligament (ACL) reconstruction (ACLR). However, comparative outcome studies across graft types, particularly by sex, remain limited.

Purpose: To compare patient-reported outcomes (PROs) and revision rates after primary ACLR with QT autografts in relation to patellar tendon (PT) and hamstring tendon (HT) autografts, stratified by sex.

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

Methods: Patients who underwent primary ACLR (2008-2022) were identified in the Swedish Knee Ligament Registry. The primary outcome was 2-year patient-reported knee function, assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Clinical relevance was evaluated using the KOOS4 (mean of KOOS Pain, Symptoms, Sports/Recreation, and Quality of Life subscales), with thresholds for minimal important change (MIC, ≥9), patient acceptable symptom state (PASS, ≥79), and treatment failure (TF, ≤42). Adjusted logistic regression analyses assessed factors associated with MIC, PASS, and TF. The secondary outcome was 2-year revision ACLR, reported as rates and analyzed using Cox regression to estimate hazard ratios.

Results: A total of 18,920 patients (44%) had 2-year KOOS data available. Women receiving QT grafts had a lower proportion of MICs achieved than those with HT grafts (61% vs 71%; P = .027). Among men, PASS was more frequently achieved with QT (51%) and HT grafts (48%) than with PT grafts (40%) (both P≤ .030). In the regression analyses, women with HT grafts had higher odds of achieving MIC (odds ratio [OR], 1.69 [95% CI, 1.19-2.42]; P = .004) and PASS (OR, 1.81 [95% CI, 1.28-2.58]; P < .001), and lower odds of TF (OR, 0.53 [95% CI, 0.31-0.88]; P = .015) compared with QT grafts. Additionally, no significant differences were observed between QT and PT grafts in women or among graft types in men.Of 44,513 patients, 1019 (2.3%) underwent revision ACLR within 2 years: QT graft, 2.2% (28/1274); PT graft, 2.5% (50/2019); and HT graft, 2.3% (941/41,220) (P = .830). QT revision rates were 2.7% in women and 1.8% in men (P = .288). Graft type was not associated with revision hazard in adjusted Cox regression.

Conclusion: QT autografts were associated with lower PROs compared with HT autografts in women, whereas no such differences were observed when compared with PT autografts or among men. Revision rates were similar across graft types, both overall and by sex.