American Journal of Sports Medicine最新文献

Background: Lateral ankle sprain (LAS) is the most common injury in basketball, and identifying at-risk players is of high importance.

Purpose: To evaluate the ability of the Ankle-GO score to identify elite basketball players who will suffer LAS during a competitive season as well as other potential predictive factors.

Study design: Cross-sectional study; Level of evidence, 2.

Methods: A total of 48 elite basketball players (22 male, 26 female; mean ± SD age, 17.9 ± 3.7 years) performed the Ankle-GO score on both limbs during a preseason session. This score is a cluster of functional tests and self-reported questionnaires evaluating ankle function. LAS incidence was recorded throughout the competitive season for each ankle of the players. Potential predictive variables (Ankle-GO, body mass index, history of previous LAS, and sex) associated with LAS were compared between injured and uninjured athletes. The areas under the receiver operating characteristic curve (AUCs) and multivariable logistic regression models with odds ratio (OR) and 95% CI were used to identify potential factors of LAS.

Results: A total of 17 occurrences of LAS occurred during the season. Ankle-GO score was lower among injured ankles (16.9 ± 3.6 points vs 19.6 ± 3.2; P = .004; d = 0.8) and was associated with probability to sustain an LAS (AUC, 0.71; 95% CI, 0.57-0.84; P = .008). Athletes with an Ankle-GO score <19 points and those who suffered an LAS during the previous years were more likely to experience a new LAS on the same ankle (OR, 5.5; 95% CI, 1.6-19.2; P = .007, and OR, 3.5; 95% CI, 1.1-10.9; P = .03, respectively).

Conclusion: The Ankle-GO score can help to identify elite basketball players who will suffer LAS during a competitive season.

Background: Fresh osteochondral allograft (OCA) transplantation effectively repairs cartilage and subchondral bone; however, the persisting shortage of available donor OCAs and their short shelf-life make scheduling surgeries and meeting patient demand challenging. Attempts have been made to develop tissue-engineered solutions to address the limitations of OCA; nonetheless, these have failed to progress beyond the preclinical stage.

Purpose: To assess the safety and efficacy of a tissue-engineered osteochondral allograft (TE-OCA) as compared with equine OCA in an equine osteochondral defect model.

Study design: Controlled laboratory study.

Methods: Bilateral critical-size (10 × 7.0-7.5 mm) osteochondral defects were surgically created on the femoral medial trochlear ridge of healthy, skeletally mature horses (2-5 years; n = 8). A TE-OCA was placed into 1 defect, and an OCA was placed into the contralateral defect as a positive control. At surgery, throughout the study, and at sacrifice (14 months), quantitative evaluation of lameness and synovial fluid composition was obtained, while radiographs, arthroscopies (4, 10, and 12 months), or gross images, and synovial membrane were qualitatively scored. Postmortem, joints and grafts were evaluated using T1- and T2-weighted magnetic resonance imaging, quantitative computed tomography, and biomechanical testing. Histology and immunohistochemistry were performed on osteochondral blocks that were qualitatively scored.

Results: TE-OCA exhibited better cartilage-cartilage integration on histology (97.1 ± 7.6 vs 41.7 ± 45; P = .03) and a lower T1ρ quantitative score (65.6 ± 10.6 vs 72.8 ± 5.5; P = .03) than OCA, indicative of an intact regeneration of cartilage matrix. TE-OCA matured in vivo, with biomechanical instantaneous and equilibrium compressive moduli improving to match that of OCA (1.74 ± 0.7 vs 1.96 ± 1.2 MPa [P≥.999], and 0.39 ± 0.2 vs 0.18 ± 0.2 MPa [P = .22], respectively). There were no differences between total radiographic scores (3.6 ± 2.7 vs 2.1 ± 1.7; P = .9), total International Cartilage Repair Society cartilage scores (5.1 ± 4.9 vs 2.8 ± 0.8; P = .6), and total morphologic MRI scores (8.9 ± 2.8 vs 6.2 ± 3.7; P = .3) at the study end. No off-target effects were seen.

Conclusion: TE-OCA is comparable to OCA in multiple safety and efficacy measures of osteochondral defect repair.

Clinical relevance: This preclinical study indicates that TE-OCA provides an alternative solution to OCA and addresses the long-standing issues of limited supply and short shelf-life.

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.

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: Meniscal allograft transplantation (MAT) has been established as a safe, effective treatment for meniscal deficiency. However, questions remain regarding pre- and perioperative factors that affect MAT outcomes.

Purpose: To assess predictive factors for preoperative to postoperative change in Lysholm score (ΔLysholm) and nonfailure reoperations after MAT.

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

Methods: The Ovid Medline, Embase, Scopus, and Clinicaltrials.gov databases were systematically searched for studies investigating clinical outcomes after MAT, including Lysholm scores, failure, complications, or reoperations. Study characteristics, predictive factors, and outcomes were extracted. The primary outcomes included ΔLysholm scores and nonfailure reoperations. Nonfailure reoperation was defined as any nonfailure meniscus-related procedure after primary MAT aiming to improve knee function. Failure was defined as conversion to total/unilateral knee arthroplasty, total or subtotal meniscectomy/allograft removal, or revision MAT. Relationships between predictive factors and outcomes were analyzed by meta-analysis or by weighted linear regression. Significant factors were included in a multivariable meta-regression.

Results: Of 2347 screened titles, 154 met inclusion criteria. A total of 11,413 patients and 11,548 transplanted menisci were identified. The estimated pooled ΔLysholm score was 24.2 (SD, 6.08), and the nonfailure reoperation incidence rate was 3.36% (SD, 7.46%). No prognostic factors were significantly associated with differing ΔLysholm scores from meta-analysis. Lateral MATs had greater risk of nonfailure reoperation than medial MATs (ln[RR], -0.74; 95% CI, -1.37 to -0.108; P = .022). From multivariable regression, shorter time between meniscectomy and MAT (P = .007) and older age (P = .02) predicted less favorable cohort ΔLysholm scores. Longer intervals between injury and MAT (P = .039) and bone-bridge graft fixation for medial MAT compared with bone-plug fixation (P < .001) predicted higher risk of nonfailure reoperation.

Conclusion: This systematic review and meta-analysis identified lateral MAT as a significant risk factor for nonfailure reoperation. Older age and shorter time interval between meniscectomy and MAT were significantly associated with less favorable ΔLysholm scores. A longer meniscal injury-MAT time interval and bone-bridge compared with bone-plug fixation technique for medial MAT were significantly associated with higher reoperation risk.

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: Spin is a form of reporting bias in which study results are presented more favorably than justified by the data. It often appears in abstracts and conclusions, where selective emphasis or misleading interpretation can distort readers' understanding and influence clinical decision-making.

Purpose: To identify the prevalence of spin, a reporting bias in which authors overemphasize beneficial or significant results and underreport weaknesses, in abstracts of systematic reviews and meta-analyses on meniscal allograft transplantation (MAT), as well as to investigate associations between spin and study characteristics.

Study design: Systematic review, Level of evidence, 4.

Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, Web of Science, and Medscape databases were searched using the terms "menisc^* transplant" OR "menisc^* transplantation." Studies were included if they were systematic reviews or meta-analyses published in the English language and in peer-reviewed journals. Studies excluded were case reports, case series, animal or cadaveric studies, studies not published in the English language, and studies without an accessible full text. Data extracted included year of publication, journal, level of evidence, funding, Scopus CiteScore, and Clarivate impact factor. Abstracts were then analyzed for the 15 most common types of spin. Statistical analyses were performed using the Fisher exact test and linear regression with significance set at a P value <.05.

Results: After search screening, 41 studies met the inclusion criteria. Spin was identified in 19 (46.3%) abstracts. Type 3 spin ("Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") was the most common type of spin, seen in 7 (17.1%) abstracts. Misleading reporting was the most common category of spin, found in 20 (48.8%) abstracts. Studies from earlier years of publication had significantly more spin than studies published more recently (P = .005).

Conclusion: Spin is found in nearly half of abstracts of systematic reviews and meta-analyses investigating MAT, with misleading reporting being the most common modality of spin. Early studies on MAT exhibited a higher prevalence of spin in comparison with more recent investigations. Clinicians should be aware of the presence of spin and exercise judgment before making conclusions from study abstracts without assessing the full text.

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.