American Journal of Sports Medicine最新文献

Background: Traditional superior capsular reconstruction (SCR) with biceps tendon transposition (TB) alone for irreparable massive rotator cuff tears (IMRCTs) has demonstrated a high retear rate, highlighting the need for alternative approaches. Therefore, SCR using a peroneus longus tendon graft (PLG) combined with TB (PLG-TB) should be clinically studied.

Purpose: To compare the clinical and radiological outcomes of SCR using the PLG-TB technique versus the TB technique alone for IMRCT.

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

Methods: Between February 2017 and March 2022, 94 patients were diagnosed with IMRCT; 45 patients underwent SCR using the TB technique (group 1), and 49 patients underwent SCR using the PLG-TB technique (group 2). The choice of technique was based on tendon damage severity and patient preference. After a minimum follow-up period of 2 years, postoperative clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES); University of California, Los Angeles (UCLA); Constant; and visual analog scale (VAS) for pain scores as well as the shoulder range of motion. The integrity of tendons, acromiohumeral distance, and retear was evaluated through magnetic resonance imaging (MRI).

Results: The mean follow-up times were 35.2 ± 4.2 months for group 1 and 34.1 ± 3.2 months for group 2. There was a significant improvement observed in all clinical outcomes in both groups from the baseline preoperative evaluations to the final follow-up assessments (P = .001 for ASES score, UCLA score, Constant score, VAS score, forward flexion, abduction, and external rotation). Shoulder abduction in group 2 showed statistically significant mean improvements at the postoperative 3-month, 6-month, and final follow-ups compared with group 1 (3 months: 105.17°± 7.13° vs 89.34°± 7.34° [P = .001]; 6 months: 138.14°± 9.12° vs 107.35°± 8.54° [P = .001]; final follow-up: 157.35°± 8.11° vs 135.31°± 7.01° [P = .001]). The tendon integrity at the final follow-up (Sugaya MRI grades 1/2/3/4/5) was significantly better in group 2 (30/6/6/4/3) compared with group 1 (11/13/5/6/10) (P = .014). Additionally, the tendon retear rate was lower in group 2 (7/49; 14.29%) than in group 1 (16/45, 35.56%) (P = .015).

Conclusion: Both surgical techniques led to acceptable clinical outcomes in patients with IMRCT. However, using the PLG-TB technique for SCR was associated with lower retear rates and enhanced abduction function outcomes compared with the TB technique for SCR.

Background: Mental health is a contributing factor to the overall well-being of patients, and the 2-question Patient Health Questionnaire (PHQ-2) and 9-question Patient Health Questionnaire (PHQ-9) are reliable in-clinic tools to assess depression and self-harm. The prevalence of adolescents with depression symptoms within a pediatric orthopaedic sports clinic has not been assessed.

Hypothesis: That rates of depression and risk of self-harm would vary based on presenting pathology among adolescents sustaining a sports-related injury.

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

Methods: A query of the institutional electronic medical record was performed to identify all patients aged 12 to 21 years who were administered the PHQ-2 or PHQ-9 over a 2.3-year period within pediatric orthopaedic sports clinics. The rate of a positive screen prompting administration of PHQ-9 (PHQ-2 score ≥3), rate of depression risk (PHQ-9 score ≥10), and rate of patients indicating self-harm (affirmative score on question 9) were evaluated. Patients were placed into 4 broad diagnostic categories: knee instability, knee other, shoulder pathology, or other sports-related injuries. Multivariate binary logistic regression was performed to identify available patient and diagnosis predictors of self-harm risk.

Results: A total of 3298 patients were screened in pediatric orthopaedic sports clinics from 2018 to 2021. The overall positive screen rate (PHQ-2) was 4.2% (n = 138), the depression risk rate (PHQ-9) was 1.9% (n = 63), and the self-harm rate was 0.9% (n = 29). Self-harm showed a significant difference, with shoulder and knee instability having the highest rate. Black/African American race (OR, 3.8; 95% CI, 1.3-11; P = .02), female sex (OR, 3.0; 95% CI, 1.3-6.9; P = .01), public/government insurance (OR, 2.2; 95% CI, 1.03-4.8; P = .041), shoulder pathology (OR, 3.4; 95% CI, 1.3-9.4; P = .016), and knee instability diagnosis (OR, 2.8; 95% CI, 1.2-6.5; P = .02) were associated with an increased risk of self-harm.

Conclusion: This study demonstrated a 2% rate of depression risk and a 1% rate of self-harm risk in adolescents treated within pediatric orthopaedic sports clinics. Race, sex, and public/government insurance were found to be predictive factors. Knowledge of risk factors can help increase awareness and recognition of potential mental health conditions that may need to be addressed during treatment for adolescents with sports-related injuries. The authors recommend that adolescents >12 years of age complete this quick assessment at the start of their orthopaedic sports clinic encounter.

Background: Despite the effectiveness of remplissage in reducing instability recurrence, debate remains about the loss of external rotation (ER) after this procedure.

Purpose: To compare the loss of ER after primary isolated arthroscopic Bankart repair alone (BR), Bankart with remplissage (REMP), and Latarjet (LAT) procedures.

Study design: Meta-analysis; Level of evidence, 3.

Methods: A literature search of 4 databases was conducted to identify comparative studies reporting ER after BR, REMP, or LAT. ER loss with the arm at side was collected, along with postoperative Rowe score, return to previous sport level, instability recurrence, reintervention, and noninstability complications. Dichotomous variables were assessed using odds ratios with 95% CIs, and continuous variables were analyzed using mean differences (MDs) with 95% CIs. A random-effects meta-analysis was used for continuous outcomes and dichotomous outcomes.

Results: In total, 27 studies were included, consisting of 2100 patients: 824 in BR, 378 in REMP, and 898 in LAT groups. The mean ER loss was 6.8°± 11° after BR, 9.3°± 12.6° after REMP, and 0.8°± 20.4° after LAT. Comparing REMP and BR, the MD was 5.9° (P = .13); between REMP and LAT, the MD was 9.6° (P = .17). For Rowe scores, the MD was 3.46 (P = .49) between REMP and BR and 0.24 (P = .9) between REMP and LAT. Odds ratios for return to previous sport level were 1.08 (P = .84) for REMP versus BR and 1.62 (P = .09) for REMP versus LAT. Regarding instability recurrence, the odds ratio was 6.67 (P = .04) for REMP versus BR and 1.43 (P = .48) for REMP versus LAT. The odds ratio for reoperation for BR was 7.69 (P = .05) compared with REMP, and the odds ratio for complications for LAT was 6.25 (P = .02) compared with REMP.

Conclusion: Remplissage reduces instability recurrence compared with isolated Bankart repair without any statistically significant difference in postoperative ER deficit. Remplissage may reduce the risk of reoperation compared with Latarjet with no difference in postoperative ER deficit or recurrence.

Background: For patients with osteoporosis and rotator cuff tears, there is still no consensus on current treatment methods. The material, structure, and number of anchors have important effects on the repair outcome.

Purpose: To investigate the use of chitosan quaternary ammonium salt-coated nickel-titanium memory alloy (NTMA) anchors to treat rotator cuff injury in shoulders with osteoporosis in a rabbit osteoporosis model.

Study design: Controlled laboratory study.

Methods: A novel winged NTMA anchor was designed to test in normal and osteoporotic bone models in vitro. These models were assessed for maximum failure load and bone damage in various traction directions. A chitosan-sodium alginate composite was coated onto NTMA anchor surfaces using glutaraldehyde cross-linking and electrostatic layering techniques. An osteoporotic rabbit model was created using ovariectomy combined with glucocorticoid treatment. A rabbit model with acute injury to the supraspinatus muscle was established and repaired using titanium alloy anchors, NTMA anchors, and coated NTMA (CNTMA) anchors. To evaluate the efficacy of the anchors, biomechanical testing and staining with hematoxylin and eosin were performed 6 and 12 weeks after surgery. A micro-computed tomography scan was performed 12 weeks after surgery.

Results: In the osteoporotic bone model, NTMA anchors exhibited greater failure loads than titanium anchors under 45° and 90° traction forces (P < .05). The surface-modified material showed a lower contact angle compared with unmodified material. Cell Counting Kit-8 (CCK-8) assays showed that the composite coating promoted osteoblast proliferation. The CNTMA anchor group exhibited the greatest maximum failure load at each time point. Hematoxylin and eosin staining revealed greater trabecular thickness in the CNTMA anchor group than in the other groups at 6 and 12 weeks after surgery. At 12 weeks after surgery, micro-computed tomography revealed an increased number and thickness of bone trabeculae in the NTMA anchor group, along with a widened trabecular gap (P < .05). After the NTMA anchor biplane unfolded, the gap between the biplane and anchor showed bone tissue growth.

Conclusion: Chitosan quaternary ammonium salt-coated NTMA anchors enhanced fixation strength and promoted local osteogenesis during osteoporotic rotator cuff repair, suggesting that the use of these anchors facilitates the repair of osteoporotic rotator cuff injuries in osteoporotic bones.

Clinical relevance: Innovations in anchor nailing may be effective in reducing rates of repair failure for rotator cuff tears combined with osteoporosis.

Background: Anterior cruciate ligament (ACL) injury often leads to posttraumatic osteoarthritis (PTOA), despite ACL reconstruction (ACLR). Medial meniscal extrusion (MME) is implicated in PTOA progression but remains understudied after ACL injury and ACLR.

Hypothesis/purpose: It was hypothesized that MME would increase longitudinally after ACL injury and ACLR, with greater changes in the ipsilateral knee compared with the contralateral knee, leading to cartilage degeneration. The study aimed to assess MME 3 years after ACLR and its relationship with magnetic resonance imaging (MRI) T1ρ and T2 as cartilage degeneration markers.

Study design: Cohort study; Level of evidence, 2.

Methods: MME and relative percentage of extrusion (RPE) were measured on 3 coronal slices of 3-dimensional fast spin-echo images and the mean values were used. T1ρ and T2 sequences were obtained and cartilage compositional measurements were performed using in-house developed software with MATLAB. Mixed models were used to assess the longitudinal changes and linear regression was used to assess the relationships between RPE and T1ρ and T2 values.

Results: A total of 54 participants with unilateral ACL injuries underwent preoperative bilateral knee MRI. A total of 36 participants completed MR scans at 6 months and 3 years after ACLR. MME and RPE measurements demonstrated high reliability (ICC > 0.88 and > 0.91, respectively). The predicted values of MME and RPE from the mixed models showed that the ipsilateral side had significantly greater MME and RPE than the contralateral side at all 3 time points (P = .023 for MME; P = .013 for RPE at baseline; and P < .001 at 6 months and P < .001 at 3 years for both MME and RPE). The rate of change of MME and RPE on the ipsilateral side was significantly greater than that on the contralateral side (P < .001). Postoperative RPE was associated with T1ρ and T2 values in the posterior medial femoral condyle.

Conclusion: MME and RPE obtained pre- and postoperatively after ACLR on the ipsilateral side were significantly greater than those on the contralateral side, and the longitudinal increases on the ipsilateral side were greater than those on the contralateral side. Postoperative RPE was significantly associated with cartilage degeneration in the posterior medial femoral condyle.

Background: Arthroscopic repair with the biceps rerouting (BR) technique has been determined to lead to promising clinical and biomechanical outcomes for treating large-to-massive rotator cuff tears (LMRCTs). However, the in vivo effects of BR on glenohumeral kinematics during functional shoulder movements have not been fully elucidated.

Purpose: To investigate whether BR provides a better restoration of shoulder kinematics compared with conventional rotator cuff repair (RCR).

Study design: Controlled laboratory study.

Methods: Patients who underwent either repair with the BR technique (BR group) or RCR alone (RCR group) for treating LMRCTs between January 2021 and May 2022 were enrolled. They underwent a 1-year postoperative kinematic evaluation of bilateral shoulders by performing scapular-plane abduction with a dual fluoroscopic imaging system. Glenohumeral translation in the superior-inferior (S-I) and anterior-posterior (A-P) directions was assessed in shoulder abduction at 10° increments. Moreover, the mean, maximum, minimum, and range of glenohumeral translation were calculated throughout the entire movement.

Results: A total of 9 patients were enrolled in each group for final analysis, and baseline characteristics were comparable between the groups. In the RCR group, compared with contralateral shoulders, the operative shoulders showed increased superior humeral head translation during lower abduction angles of 30° to 50° (all P≤ .004), with a greater maximum (P = .014) and a larger range (P = .002) for S-I translation throughout the entire movement. In the BR group, no significant differences between operative and contralateral shoulders were detected in any kinematic variables for S-I translation (all P≥ .132); however, the operative shoulders exhibited a larger maximum (P = .031), a smaller minimum (P = .008), and a larger range (P < .001) for A-P translation throughout the entire movement compared with the contralateral shoulders.

Conclusion: BR successfully reduced residual superior humeral head translation compared with conventional RCR and restored normal S-I glenohumeral kinematics in the treatment of LMRCTs. However, A-P glenohumeral kinematics was not fully restored after BR, and its effect on long-term clinical outcomes requires further investigation.

Clinical relevance: BR can be a promising technique to treat LMRCTs. However, its potential adverse effects on A-P glenohumeral kinematics should not be ignored, requiring further clinical evidence to determine long-term outcomes.

Background: The surgical management of bursal-sided partial-thickness rotator cuff tendon tears is controversial. The 2 methods used are in situ repair (ISR), preserving the contingent of intact articular tendon fiber, or tear completion before repair (TCBR) according to the operating surgeon's usual technique. No study with sufficient power has demonstrated a superior technique.

Hypothesis: The 2 techniques are equivalent in terms of clinical outcome and tendon healing.

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

Methods: A systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations on the PubMed, Embase, and Cochrane Library databases from January 2003 through March 2023. Only articles dealing with Ellman grade 3 bursal-sided tears with a minimum follow-up of 1 year were included. Primary endpoints were American Shoulder and Elbow Surgeons and Constant-Murley scores, pain on a visual analog scale, and retear rate. The secondary endpoint was recovery of active mobility.

Results: Twelve studies were included with overlap of 3, leaving 8 ISR studies (360 patients; mean follow-up, 30 months) and 7 TCBR studies (224 patients; mean follow-up, 51 months) for statistical analysis. No significant clinical differences were found when comparing mean American Shoulder and Elbow Surgeons (92.2 [95% CI, 88.1-96.2] vs 88.9 [95% CI, 85.8-92.0]; P = .21), Constant-Murley (86.3 [95% CI, 81.5-91.0] vs 91.8 [95% CI, 88.1-95.6]; P = .07), and visual analog scale (0.8 [95% CI, 0.2-1.4] vs 1.0 [95% CI, 0.5-1.4]; P = .63) scores in the TCBR and ISR groups, respectively. The retear rate was 6.8% (95% CI, 3.1%-14.3%) in the TCBR group and 9.5% (95% CI, 6.1%-14.3%) in the ISR group (P = .46). Active mobility was also comparable.

Conclusion: This meta-analysis suggests that ISR and TCBR provide comparable results in the surgical management of Ellman grade 3 bursal-sided partial-thickness rotator cuff tears.

Background: A lateral extra-articular tenodesis (LET) is increasingly being utilized to augment an anterior cruciate ligament reconstruction because it has been shown to reduce the risk of postreconstruction graft failure or recurrent rotatory instability. Various femoral fixation techniques are available, including the use of an interference screw, staple, or suture anchor.

Purpose: To determine and compare the biomechanical properties of an LET graft when using an interference screw, staple, or suture anchor for the femoral fixation for a modified Lemaire LET.

Study design: Controlled laboratory study.

Methods: Eighteen fresh-frozen cadaveric knees were obtained and randomly assigned via a random group generator to undergo a modified Lemaire LET using either an interference screw, a staple, or a suture anchor for femoral fixation. The specimen underwent load-to-failure testing at 20 mm/min until graft failure. The maximum failure load, stiffness, and failure mode for each specimen were recorded.

Results: The mean failure load was highest for the interference screw (252.7 ± 131.2 N), followed by the staple (151.8 ± 34.1 N) and the suture anchor (105.7 ± 16.4 N). There was a significant difference in failure load between the interference screw and the suture anchor (P = .015). There was no significant difference between the staple and the interference screw (P = .101) or the suture anchor (P = .577). There was no significant difference in graft stiffness across all fixation methods (P = .089).

Conclusion: All 3 femoral fixation methods achieved adequate failure loads, although the interference screw had a greater failure load than the suture anchor and there was no significant difference between these implants and the staple. There were no significant differences in stiffness between the fixation methods.

Clinical relevance: The maximum failure load occurred with an interference screw for femoral fixation of a modified Lemaire LET; however, because of socket size, this implant may be at greater risk of anterior cruciate ligament reconstruction tunnel collision compared to a smaller-diameter suture anchor drill hole. The failure load of the suture anchor was the lowest; however, it appears sufficient for stable fixation based on the force experienced by an LET graft reported in the literature.

Background: Sex differences exist in injury rates, and one contributing factor may be sex hormone effects on the musculoskeletal system.

Purpose/hypothesis: The goal of this systematic review and meta-analysis was to understand the effects of sex hormones on ligaments in females as determined by preclinical and clinical studies. The hypothesis was that sex hormones would affect ligament mechanical properties, histological features, cellular function, and clinically measurable outcomes.

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

Methods: A literature search of PubMed, PEDro, CINAHL, and CENTRAL was performed to identify preclinical and clinical studies assessing sex hormone effects on ligament properties. Overall, 2 independent reviewers performed title, abstract, and full-text screening. Rigor and reproducibility were assessed using the ARRIVE guidelines and the modified Downs and Black checklist. Meta-analyses were also performed.

Results: There were 54 articles included in this review. The majority of studies focused on the anterior cruciate ligament (ACL; n = 27), the menstrual cycle (n = 23), and 17β-estradiol (n = 35). Meta-analyses revealed that there was no effect of the menstrual cycle on knee laxity or anterior tibial translation but that 17β-estradiol decreased the production of types I and III procollagen in ACL fibroblasts in vitro. In examining other ligaments, data suggest that sex hormone changes may affect the mechanical and cellular properties of the medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum. Additionally, the literature suggests that hormonal shifts that occur with oral contraceptive pill use, pregnancy, and menopause can affect ligament properties. These effects appear to be mediated, at least in part, by the hormone relaxin.

Conclusion: Of the sex hormones examined in this body of literature, 17β-estradiol and relaxin appear to have the most effect on both the mechanical and cellular properties of ligaments in females. The ACL, medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum may be impacted by changes in sex hormone concentrations. The menstrual cycle does not likely affect ligament laxity in a clinically meaningful way, but pregnancy, oral contraceptive pill use, and menopause may.

Background: A discoid lateral meniscus (DLM) is the most common meniscus variant and is commonly treated with arthroscopic saucerization. There are mixed data regarding long-term results after surgery, especially in terms of radiological parameters.

Purpose/hypothesis: The aim was to evaluate the functional and radiological results of patients who underwent arthroscopic saucerization for a symptomatic DLM. It was hypothesized that successful outcomes can be achieved by avoiding excessive resection while reshaping only to an extent that prevents mechanical symptoms.

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

Methods: This study retrospectively analyzed pediatric and adult patients who had a symptomatic discoid meniscus between 2000 and 2018, who underwent arthroscopic saucerization with at least 10 mm of peripheral length, and who had at least 5 years of follow-up. Radiological parameters were measured on both preoperative and follow-up radiographs. Patient-reported outcome measure scores were recorded at follow-up.

Results: The study included 57 knees of 53 patients (mean age, 27.6 years [range, 6-65 years]). The mean follow-up duration was 12.1 years (range, 5.0-23.1 years). There were 31 knees in the pediatric group and 26 knees in the adult group. No significant difference was found between the groups or between preoperative and follow-up values for the femorotibial angle (P > .05). When the preoperative and follow-up Kellgren-Lawrence grades were compared, no change was observed in the pediatric group (P = .125), while grades were shown to progress in the adult group (P < .001). The mean Lysholm score was 94.61 ± 7.61 and 84.23 ± 14.90 for the pediatric and adult groups, respectively (P = .001). Overall, 2 patients underwent arthroscopic surgery because of a symptomatic recurrence of symptoms, and 2 patients underwent arthroplasty because of osteoarthritis. The 10-year survival rate was 90.6%.

Conclusion: Limited saucerization of a DLM helped to preserve coronal-plane knee joint alignment. Functional and radiological results were superior in the pediatric patients. Even when alignment was more varus in older patients, preoperative and follow-up femorotibial angles were not statistically significant. This outcome may be used to guide treatment in appropriately selected cases.