American Journal of Sports Medicine最新文献

Background: Clinical studies have shown that the open Latarjet procedure (OLP) has lower recurrence rates than the isolated arthroscopic Bankart (IAB) procedure for recurrent anterior shoulder instability, but no long-term comparative studies exist for IAB in patients without bone loss.

Purpose/hypothesis: This study aimed to compare the outcomes of IAB in selected patients without bone loss versus OLP. The hypothesis was that OLP would be more successful in preventing recurrence, even in carefully selected patients for IAB.

Study design: Cohort study; Level of evidence 3.

Methods: An overall 774 patients who underwent surgical stabilization for recurrent anterior instability between January 2007 and December 2021 were analyzed. A total of 685 shoulders were followed up (89 patients were lost of follow-up: 11,4%), including 582 OLP, 45 IAB, and 58 other techniques (Trillat procedure, Arthroscopic Latarjet procedure, and revision Eden Hybinette procedure). The patients who underwent primary IAB were matched with patients who underwent OLP in a 1:1 ratio using propensity matching, resulting in 45 patients in each group. The main objective was to identify new episodes of instability, with a recurrence rate <5% considered acceptable. Kaplan-Meier analysis was used to evaluate patient survivorship, and logistic regression was performed to consider potential factors affecting recurrence rates. Data were collected on return-to-sport rate, Walch and Duplay score, visual analog scale score, and external rotation.

Results: The mean follow-up was 9 years and 3 months. A new episode of instability occurred in 2% of the OLP group and 20% of the IAB group (P = .04; odds ratio, 11; 95% CI, 1.91-63.4, Miettinen method). Regarding the rest of our analyses, there was no significant difference. Patients maintained good external rotation with low pain: 68° in the OLP group as compared with 72° in the IAB group (P = .325), with 1.2 out of 10 on the visual analog scale in the OLP group versus 1.5 in the IAB group (P = .433), respectively. Walch and Duplay score reached 79.9 in the OLP group and 78.9 in the IAB group (P = .496), and 89% of the OLP group returned to its previous sport level as compared with 73% of the IAB group (P = .104).

Conclusion: Patients who underwent an OLP had better long-term survivorship without recurrence when compared with those who underwent an IAB, even without bone loss. The odds of experiencing a new episode of instability recurrence was 11 times higher for patients who underwent IAB, with a mean follow-up of 9 years and 3 months.

Background: Anterior cruciate ligament reconstruction (ACLR) often involves harvesting a bone-patellar tendon-bone (BPTB) autograft. How graft harvest affects tendon strain across the 3 distinct regions (medial, lateral, and central) is not known.

Purpose: To (1) quantify strain in the 3 regions of the patellar tendon during 60% of maximum voluntary isometric contraction (MVIC) in 90° of knee flexion and (2) assess how effort level in 2 different knee joint angles (60° and 90°) impacts strain in the medial and lateral regions of the patellar tendon, in 2 cohorts of patients after ACLR using a BPTB autograft (one group <24 months after surgery and another group ≥24 months after surgery).

Study design: Descriptive laboratory study.

Methods: Effort levels ranging from 20% to 100% of MVIC were performed at 90° and 60° of knee flexion on an isokinetic dynamometer, with simultaneous ultrasound imaging of tendon length to calculate regional strain. Linear mixed-effects models were used to evaluate regional strain at 60% of MVIC in 90° of knee flexion. The fixed effects of percentage of MVIC, joint angles, and time from surgery groups on patellar tendon strain were evaluated using separate models for the medial and lateral regions.

Results: Fourteen participants in the short-term group (7.5 ± 1.9 months from surgery) and 15 participants in the long-term group (71.5 ± 16.5 months from surgery) were included. At 60% of MVIC in 90° of knee flexion, the short-term group demonstrated lower patellar tendon strain than the long-term group regardless of region (P < .01). The central region also had lower strain than the medial and lateral regions regardless of group (both P < .01). Finally, the rate at which strain increased with increasing effect levels differed between time from surgery groups in both medial and lateral regions.

Conclusion: The short-term group had lower strain in all regions of the patellar tendon after ACLR using BPTB autograft. The medial and lateral regions showed varying strain based on time from surgery and effort level. Varying knee joint angles and effort levels for graft site rehabilitation may have to be considered to target specific regions of the patellar tendon.

Clinical relevance: Clinicians should consider the time elapsed since surgery and the manipulation of knee angle as factors that can exert varying levels of strain on different regions of the patellar tendon after ACLR. Accelerating quadriceps strengthening to enhance strain distribution across the patellar tendon to promote tendon healing may be of benefit for optimizing postsurgery rehabilitation.

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: Surgical options for septic arthritis include open arthrotomy or an arthroscopic procedure. The optimal surgical technique remains a matter of debate as acceptable results have been reported for both.

Purpose: To evaluate the efficacy of arthroscopy versus arthrotomy for the treatment of septic arthritis in large and intermediate-sized joints.

Study design: Systematic review; Level of evidence, 3.

Methods: A literature search was performed of the PubMed and Cochrane online databases through September 2023 identifying articles comparing arthroscopy with arthrotomy for the treatment of septic arthritis. Eligible articles included retrospective or prospective comparative studies investigating reoperation, perioperative complications, or clinical outcomes after arthroscopic or open treatment for septic arthritis of the shoulder, elbow, wrist, hip, knee, or ankle in adults.

Results: In total, 23 articles with 34,248 patients met the inclusion criteria comparing arthroscopy with arthrotomy. In 14 of the 20 (70%) studies that reported on reoperation rates, there was no significant difference in arthroscopic versus open surgical management for septic arthritis. Four (20%) studies reported lower reoperation rates when arthroscopy was utilized compared with open arthrotomy. One single-institution study found arthrotomy to be more effective for shoulder septic arthritis, and another favored open surgery only in the presence of erosions. In 11 of 23 (47.8%) studies, no difference in complications or clinical outcomes was found. However, 11 of 23 (47.8%) studies comprising the shoulder, wrist, hip, knee, and ankle reported a significant benefit to arthroscopy for improved outcomes.

Conclusion: Arthroscopic surgery for the treatment of septic arthritis involving the shoulder, wrist, hip, knee, and ankle appears to be safe and effective. Reoperation rates, short-term complications, and functional outcomes tend to be similar or in favor of arthroscopy when compared with arthrotomy.

Background: Continued advancements in cartilage surgery and an accumulating body of evidence warrants a contemporary synthesis of return to sport (RTS) outcomes to provide updated prognostic data and to better understand treatment response.

Purpose: To perform an updated systematic review of RTS in athletes after knee cartilage restoration surgery.

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

Methods: PubMed, OVID/Medline, and Cochrane databases were queried in October 2023 for studies reporting any RTS outcome after knee cartilage restoration surgery. Meta-analyses with inverse-variance proportion and DerSimonian-Laird random-effects estimators were applied to quantify overall RTS. Comparative proportional subgroup meta-analyses with relative odds ratios (ORs) were constructed to quantify (1) the influence of the procedure on RTS and (2) RTS ability (lower vs same/greater level of play) based on procedure, competition level, and specific sport.

Results: A total of 52 studies (n = 2387) were included. The overall pooled RTS was 80.3% (95% CI, 73.3%-86.5%). Matrix-assisted chondrocyte implantation (MACI) (OR, 2.15) and osteochondral autograft transplantation system (OATS) (OR, 1.83) demonstrated the highest likelihoods of RTS at the same/greater level, while microfracture (MF) (OR, 0.78) was the only treatment demonstrating a higher likelihood of RTS at a lower level. The fastest mean RTS was observed after OATS (6.6 ± 2.6 months). Professional athletes demonstrated an OR of 1.01 for RTS at the same/greater level, whereas recreational/amateur athletes demonstrated an OR of 1.63; however, all professional athletes underwent MF, and recreational/amateur athletes who underwent MF demonstrated lower likelihoods of RTS (OR, 0.78), indicating a consistent association between MF and low RTS propensity. Basketball players demonstrated the lowest likelihood of RTS at the same/greater level (OR, 1.1), while American football and soccer were associated with high likelihoods of RTS (OR, 3 and 2.4, respectively) across all procedure types.

Conclusion: Cartilage restoration allows for high overall RTS, with OATS and MACI conferring the greatest propensity for RTS, while OATS allowed for the fastest RTS. Undergoing MF was associated with consistently poor RTS ability. This study identified several important associations between the level of RTS and clinically relevant factors when discussing RTS, with recreational/amateur athletes, soccer players, and American football players demonstrating a higher relative propensity to RTS.

Background: Distal triceps tendon injuries are relatively rare injuries, often occurring in highly active patients with physically demanding jobs or lifestyles. Information on return to work, sport, and activity is essential for patient education and counseling after a distal triceps tendon rupture.

Purpose: To determine the rates of return to work, sport, and sport-related activity after distal triceps tendon repair.

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

Methods: PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus were queried from the earliest record through January 12, 2024. Articles were included if they examined return to various activities (exercise, sport, work, or military duty) after distal triceps tendon repair. Data on return to sport/work/activity were collected as well as information on patient satisfaction, pre-existing medical history or medication use (ie, anabolic steroids or corticosteroids), and complications. Article quality was assessed via the Methodological Index for Non-Randomized Studies (MINORS) scale.

Results: Of 164 articles initially retrieved, 10 retrospective studies were included. Patients (n = 318; 74.2% male, 25.8% female) who underwent distal triceps tendon repair had a mean age of 44.7 ± 5.5 years with a mean follow-up time of 52.6 ± 21.4 months. After distal triceps tendon repair, 93.3% of patients (112/120) returned to sport, 95.3% (81/85) returned to military duty, and 92.6% (100/108) returned to work. Of the studies that evaluated satisfaction, the majority of patients reported high satisfaction after surgery. The overall complication rate (ranging from persistent pain and wound complications to nerve injuries and reruptures) after distal triceps tendon repair was 18.0%, the rerupture rate (complete and partial) was 7.2%, and the reoperation rate was 3.9%, with all partial reruptures undergoing nonoperative care.

Conclusion: A distal triceps tendon rupture is a rare but potentially challenging injury, traditionally occurring in an active population, and often requires surgical repair. Importantly, >90% of an active-duty military population, athletes, and the general workforce was able to return to sport or their respective activity after surgery. Furthermore, there was high patient satisfaction and low rates of complications and reoperations after distal triceps tendon repair.

Background: Superior labral tears are common shoulder injuries among athletes, and for athletes undergoing surgical intervention, one of the main priorities is to return to preinjury levels of activity in a timely manner. However, the literature surrounding return to play after superior labral repair presents inconsistent results, with limited studies evaluating the timing of return to play.

Purpose: To systematically review the rate and timing of return to play in athletes after arthroscopic superior labral repair.

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

Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the PubMed, EMBASE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after arthroscopic superior labral repair. Subgroup analysis was conducted for overhead and collision athletes as well as for return to duty among military personnel. Meta-analysis was performed using Review Manager to compare superior labral repair to biceps tenodesis in the subset of studies comparing these treatments directly. A P value <.05 was considered to be statistically significant.

Results: This review identified 42 studies including 1759 unique cases meeting the inclusion criteria. The majority of patients were male (76.7%), with a mean age of 31.5 years (range, 15-75 years) and a mean follow-up of 50.4 months. The overall rate of return to sport was 77.5%, with 68.2% returning to the same level at a mean of 8.2 months. In overhead athletes, the overall rate of return to play was 69.9% and the rate of return to preinjury level was 55.5%. In collision and contact athletes, the overall rate of return to play was 77.2% and the rate of return to preinjury level was 70.2%. Among military personnel, the overall rate of return to duty was 83.4%, and 81.7% returned to preinjury level at a mean of 4.4 months. In the studies comparing return to play after superior labral repair and biceps tenodesis, a nonsignificant difference was found (risk ratio, 0.92; 95% CI, 0.85-1.00; I² = 13%; P = .05).

Conclusion: Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair. However, a high rate of return to duty was found among the military population treated with arthroscopic superior labral repair.

Background: Microfragmented adipose tissue has been proposed for intra-articular treatment of knee osteoarthritis. There are little data comparing the outcomes of treatment between microfragmented adipose tissue and other biological treatments.

Purpose: To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics, hyaluronic acid, and corticosteroid injections for symptomatic knee osteoarthritis.

Study design: Systematic review and meta-analysis; Level of evidence, 2.

Methods: A systematic review of the literature was performed to identify pertinent publications in the MEDLINE, Embase, Scopus, and Google Scholar databases, including all level 1 to 3 studies from 2000 to 2023. Validated knee scores (visual analog scale [VAS] for pain, Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, International Knee Documentation Committee) were included as outcome measures. Risk of bias was assessed using Cochrane tools. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of the body of evidence and the modified Coleman Methodology Score was used to assess study quality. Heterogeneity was assessed using χ² and I² statistics.

Results: Five studies were included in the analysis. One study had a high risk of bias; 4 studies had some risk of bias. The overall study quality was fair, and the certainty of evidence was low. The pooled estimate for VAS scores did not demonstrate significant differences at 3, 6, and 12 months. The pooled estimate for the KOOS Pain, Symptoms, Activities of Daily Living, Sport and Recreation, and Quality of Life subscales did not demonstrate significant differences at 3, 6, and 12 months.

Conclusion: The results of this systematic review and meta-analysis demonstrated that there were no statistically significant differences for both the clinical outcomes and pain scores between microfragmented adipose tissue and other orthobiologics for the treatment of knee osteoarthritis. However, modest study quality, some risk of bias, and low certainty of evidence reduce external validity, and these results must be viewed with some caution.