American Journal of Sports Medicine最新文献

Background: Meniscal allograft transplantation (MAT) is often used to slow the progression of osteoarthritis and delay total knee arthroplasty (TKA). A comprehensive review summarizing the conversion rate to TKA after MAT is lacking in the literature.

Purpose: To evaluate and characterize the rate of conversion to TKA after MAT in the current literature.

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

Methods: Scopus, PubMed, and Web of Science were queried from database inception to August 2024 for studies investigating outcomes of MAT. Included studies had to (1) include patients undergoing primary MAT, (2) define failure as conversion to TKA, and (3) report numbers of patients specifically undergoing TKA. Exclusion criteria included systematic reviews, meta-analyses, case reports, biomechanical studies, cadaveric studies, technique articles with no outcomes, studies that reported failure but did not specifically report conversion to TKA, no full text available, animal studies, and studies not in English. Patient demographics, conversion to TKA, demographics of patients who converted to TKA, follow-up time, and concomitant procedures were collected.

Results: A total of 48 studies consisting of 4317 MATs in 4298 patients were included for analysis. Mean age ranged from 16.1 to 55.8 years old, mean body mass index ranged from 23.8 to 28.9 kg/m², and mean follow-up time was 6.9 years (range, 1.7-17.4 years). The range of conversion rates across the studies was 0% to 29.1%. The mean conversion rate in studies with mean follow-up time <5 years was 3.72% (n = 18), 5 to 10 years was 7.69% (n = 21), and >10 years was 12.82% (n = 9). In studies that reported the time to TKA conversion after MAT (n = 13), the mean was 10.1 years. The mean number of concomitant procedures per patient was 0.67 with the most common being chondral repair and ACL reconstruction. Zero studies evaluated only isolated MAT procedures.

Conclusion: This study found that MAT can be durable and delay TKA for ≥10 years for nearly 90% of patients. This data can better inform patients and clinicians on outcome expectations. Studies with longer follow-up times had higher reported conversion to TKA. Thus, our study provides new data regarding longitudinal failure rates. While heterogeneity in the reporting of concomitant procedures with MAT allows for better generalizability, it makes it difficult to determine what effect these additional procedures have on rate of conversion to TKA.

Background: While labral repair is the preferred treatment for labral tears, reconstruction using allografts is an emerging option when repair is not viable. The biomechanical performance of different reconstructive graft options is not fully understood.

Hypothesis: Segmental labral reconstructions using fresh meniscal allografts (MALs) or fresh-frozen anterior tibialis tendon allografts (TALs) would not be significantly different from native intact labrum with respect to contact areas, contact pressures, peak forces, and suction seal preservation.

Study design: Controlled laboratory study.

Methods: Eight human cadaveric hips were tested using a biomechanical robotic system in intact, tear, repair, resection, and segmental reconstruction with TAL or MAL states. Specimens were examined in neutral, 20° of extension, and 60° of flexion. In each labral state, contact pressure, contact area, and peak force were recorded using pressure sensors. Suction seal distraction tests were performed in each labral state. Data were normalized to the intact labrum state. Repeated-measures analysis of variance was used to identify differences in biomechanical parameters. Significance was set a priori at a P value <.05.

Results: Segmental labral reconstruction with fresh MAL produced significantly lower peak force than the intact labrum state at 60° of flexion (74.3% ± 13.6% vs 100%; P = .006). Segmental reconstruction with fresh-frozen TAL induced a significantly higher peak force at 60° of flexion compared with segmental reconstruction with fresh MAL (133% ± 53.7% vs 74.3% ± 13.6%; P = .045). Intact labrum (7/10; 70%), labral tear (9/10; 90%), labral repair (6/10; 60%), labral resection (1/10; 10%), segmental labral reconstruction with fresh-frozen TAL (4/5; 80%), and segmental labral reconstruction with fresh MAL (4/5; 80%) experienced reestablishment of suction seal after distraction.

Conclusion: Segmental labral reconstruction with fresh MAL resulted in a lower peak force at 60° of flexion and similar rates of suction seal preservation compared with intact labrum. Segmental labral reconstruction with fresh MAL resulted in a lower peak force at 60° of flexion compared with segmental reconstruction with fresh-frozen TAL. Biomechanically, segmental labral reconstruction with fresh MAL may be superior to fresh-frozen TAL in the cadaveric model.

Clinical relevance: Understanding the biomechanical performance of various labral reconstruction graft options may guide surgical decision-making in patients who require labral reconstruction.

Background: Prior research has shown that there are fewer women than men participants in sports and exercise medicine research.

Purpose: To determine how participation in sports and exercise medicine research has changed and compares between women and men, overall and by sport of participants.

Study design: Meta-analysis; Level of evidence, 4.

Methods: The authors identified original research articles published in 2020 in 3 influential sports and exercise medicine journals (British Journal of Sports Medicine, American Journal of Sports Medicine, and Medicine & Science in Sports & Exercise). Articles were analyzed as a group overall and within subsets distinguishing sport-specific articles. For the complete set and each subset, the pooled proportions of participants by gender and the mean percentage of women participants per article were calculated.

Results: A total of 579 articles were included in the analysis. There were 1,693,304 participants pooled across all articles, of whom 54.4% were men and 45.6% were women. There was a mean of 37% women participants per article. Among all articles that included athletes of a single sport, 80% of the pooled participants were men and 20% were women, with a mean of 19.6% women participants per article.

Conclusion: There were fewer women than men participants in this sample overall and especially in sport-specific articles.

Background: Anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autograft is a common procedure for which interest is increasing regarding the use of platelet-rich plasma (PRP) to enhance surgical outcomes.

Purpose: To systematically review the effect of PRP augmentation on the clinical outcomes of ACLR using HT autografts through a meta-analysis of randomized controlled trials (RCTs).

Study design: Meta-analysis; Level of evidence, 2.

Methods: The PubMed, Embase, Cochrane Library, and Google Scholar databases were comprehensively searched for articles published up until November 1, 2024. The inclusion criteria were RCTs that reported clinical outcomes of patients undergoing ACLR with HT autografts involving PRP augmentation. The methodological quality of the selected studies was assessed using the Cochrane Collaboration's risk-of-bias tool.

Results: Among 1722 studies initially identified across databases, 11 studies with 583 patients were included in the analysis. The results of the meta-analysis indicated that PRP significantly improved residual anterior-posterior laxity at 3 months (mean difference [MD], -1.12; 95% CI, -1.64 to -0.60; P < .001) and 6 months (MD, -2.00; 95% CI, -3.17 to -0.83; P < .001) but not at 12 months (MD, 0.03; 95% CI, -0.31 to 0.38; P = .847). The Lysholm score did not differ significantly between the PRP and control groups at 3 months (MD, 0.34; 95% CI, -1.20 to 1.87; P = .666), 6 months (MD, -3.35; 95% CI, -10.68 to 3.98; P = .370), or 12 months (MD, 0.73; 95% CI, -1.41 to 2.88; P = .502). No significant heterogeneity was observed in any meta-analysis.

Conclusion: PRP augmentation in ACLR using HT autografts showed potential short-term benefits including reduced residual anterior-posterior laxity and improved radiological findings. However, these effects were not sustained in the long term, and no significant differences in patient-reported outcomes were observed over time.

Background: Tendon-bone healing after rotator cuff injury is, or remains, a clinical challenge.

Purpose: To examine the role of intraoperative use of purified exosome products (PEPs) in the treatment of rotator cuff injuries and to assess the effect of PEP on supraspinatus tendon-bone healing after rotator cuff repair in a rat model.

Study design: Controlled laboratory study.

Methods: This study used 120 Sprague-Dawley rats that underwent an acute supraspinatus tendon transection from the insertion, followed by repair using a single transosseous suture. They were divided into 3 groups: a control group that received only sutures, a TISSEEL group that used a commercially available fibrin sealant patch (TISSEEL) of approximately 0.5 cm², and a PEP-TISSEEL group that used a similarly sized TISSEEL patch combined with PEP. Autopsies were performed at 1, 3, 6, and 8 weeks after surgery. Analyses were performed using molecular biological, biomechanical, and histological techniques.

Results: At 6 weeks, the PEP-TISSEEL group achieved greater failure load (mean, 27.5 ± 5.3 N) than the control (mean, 16.4 ± 4.2 N; P = .012) and TISSEEL (mean, 23.4 ± 5.0 N; P = .041) groups, with superiority persisting at 12 weeks (27.2 ± 6.5 N vs 13.1 ± 2.6 N [P = .002] for the control group and 21.1 ± 5.8 N [P = .037] for the TISSEEL group). DigiGait showed earlier recovery of stride length and paw angle. Histology revealed organized collagen and reduced scarring, while molecular assays demonstrated early inflammatory modulation with subsequent upregulation of collagen type 1 or 3 and TGF-β, supporting accelerated tendon-bone healing.

Conclusion: Intraoperative application of PEP-TISSEEL enhanced tendon-bone healing in a rat model by improving biomechanical strength, promoting enthesis-specific histological regeneration, and accelerating functional recovery as evidenced by gait analysis.

Clinical relevance: The intraoperative application of PEP combined with TISSEEL significantly enhances rotator cuff tendon healing by modulating early inflammation, promoting collagen synthesis, and improving biomechanical properties in a rat model. These findings suggest that PEP-based therapies could offer a promising adjunct in surgical repair, potentially reducing retear rates and improving functional outcomes in patients with rotator cuff injuries. Further clinical studies are warranted to translate these benefits into human applications.

Background: Master athletes (MAs), defined as those aged ≥35 years actively participating in sports, have demonstrated superior short-term outcomes and reoperation-free survivorship after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) compared with nonathletic counterparts; however, their mid- and long-term outcomes remain unclear.

Purpose/hypothesis: The purpose was to evaluate patient-reported outcomes (PROs), achievement of clinically significant outcomes (CSOs), and reoperation-free survivorship at long-term follow-up after primary HA for FAIS in MAs in comparison with a propensity-matched control group of nonmaster athletes (NMAs), defined as those aged ≥35 years who denied weekly sports activity. We hypothesized that MAs would demonstrate superior PROs, CSO achievement, and reoperation-free survivorship compared with NMAs.

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

Methods: Patients with minimum weekly preoperative sports participation aged ≥35 years who underwent HA for FAIS between January 2012 and October 2014 with long-term follow-up were propensity-matched 1:1 to patients aged ≥35 years who denied weekly preoperative sports participation, controlling for age, sex, and body mass index (BMI). PROs collected preoperatively and at 2-, 5-, and 10-year follow-up time points included the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports Subscale (HOS-SS), 12-item International Hip Outcome Tool (iHOT-12) score, modified Harris Hip Score (mHHS), and visual analog scale scores for pain and satisfaction. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were compared. Survivorship was compared using Kaplan-Meier analysis.

Results: In total, 70 MAs were matched to 70 NMAs. Patient characteristics were similar between MAs and NMAs, including age (44.89 ± 7.7 vs 45.77 ± 6.9 years; P = .473), sex (60.0% vs 58.6% female; P = .496), and BMI (26.19 ± 4.9 vs 26.79 ± 4.4 kg/m²; P = .444). The mean follow-up duration was 10.32 ± 0.3 years. Preoperative PROs were similar between groups (P ≥ .114). MAs demonstrated superior 2-year HOS-ADL and iHOT-12 values (P ≤ .049). By the 5-year follow-up with durability to 10-year follow-up, PROs were similar between groups (P ≥ .065). Both groups demonstrated similar MCID and PASS achievement for all PROs (P ≥ .111). Both groups demonstrated similar time-dependent reoperation-free survivorship (P = .6).

Conclusions: MAs undergoing primary HA for FAIS achieve comparable PROs, CSOs, and reoperation-free time-dependent survivorship to NMAs at long-term follow-up.

Background: Despite the clinical and functional improvements exhibited by ulnar collateral ligament (UCL) reconstruction (UCLR), there is little published in vivo information pertaining to how UCLR affects medial ulnohumeral joint space gapping seen on stress ultrasound (SUS), which has been used as a surrogate for quantifying clinical instability.

Purpose: To determine if UCLR results in a decrease in ulnohumeral joint space gapping as measured on postoperative SUS examination.

Study design: Prospective cohort study; Level of evidence, 2.

Methods: Overhead throwing athletes were identified within an existing institutional review board-approved single-blinded, prospective, randomized controlled trial designed to assess treatment outcomes after modified Jobe or docking UCLR. Patients underwent a uniform surgical approach with pre- and postoperative (minimum of 1 year) radiographic assessment with SUS. Postoperative SUS ulnohumeral joint space gapping (delta) of the affected extremity was compared with the ipsilateral and contralateral preoperative values.

Results: SUS results were available for 41 of 80 (51.2%; 20 modified Jobe and 21 Docking) patients with a mean age of 19.2 ± 1.9 years, including 93% baseball players. Joint space gapping as a result of the stress examination (delta) was 0.83 ± 0.53 mm for the contralateral reference elbow, 2.28 ± 1.26 mm for preoperative affected elbow baseline, and 0.69 ± 0.44 mm for the postoperative elbow at a minimum of 1 year after UCLR. UCLR resulted in a 330% decrease in the magnitude of joint gapping measured on postoperative SUS, with a mean decrease of 1.55 mm, and significant improvement irrespective of modified Jobe or docking technique (P < .001).

Conclusion: UCLR returned average ulnohumeral joint space gapping to normal values on postoperative SUS. UCLR results in a mean decrease of joint space gapping from 2.28 ± 1.26 mm to 0.69 ± 0.44 mm. Regardless of technique, UCLR restored delta values to those comparable to the contralateral, unaffected elbow (0.83 ± 0.53 mm). Both techniques yielded mean gapping values <1.0 mm. These findings provide surgeons with the expected change in joint space gapping after UCLR, as measured on SUS. By providing a reference, surgeons can better interpret SUS results in patients with concern for recurrent UCL injury after reconstruction where magnetic resonance studies alone may be challenging to interpret.