American Journal of Sports Medicine最新文献

Platelet-rich plasma (PRP) is a blood-based orthobiologic used to treat a myriad of musculoskeletal conditions. While in vitro and preclinical studies on PRP have been promising, clinical results have been mixed. The heterogeneity in clinical benefits is attributable to both the complexity and variability of PRP as a biologic as well as the diversity of targeted tissues and ailments. Many variables have been proposed to affect PRP's bioactivity and clinical effects, with differing levels of evidence demonstrated for each variable. These variables can be broadly categorized as biological, technical, and abnormality-specific factors. Additionally, insufficient characterization of PRP in clinical studies has been a major limitation in both determining the efficacy of PRP for a given clinical condition and understanding the basic biology of PRP. This review highlights the current landscape of PRP as a treatment of musculoskeletal conditions, including both the regulatory environment and clinical applications, and considers the influence of numerous factors affecting PRP's bioactivity and clinical effects. Emerging technologies that may further enhance the utility of PRP as an orthobiologic are also discussed. Rigorous basic, translational, and clinical research remains fundamental to realize the promise of PRP treatment for musculoskeletal disease.

Background: The incidence of anterior cruciate ligament (ACL) injuries is increasing among the adolescent population, with a peak occurring in the high school age range.

Purpose: To (1) characterize recent epidemiologic trends of ACL injuries and graft failure rates in high school adolescents, and (2) determine variables associated with sustaining a secondary ACL injury.

Study design: Case-control study; Level of evidence, 4.

Methods: A retrospective review was performed for all patients ≤18 years who underwent primary ACL reconstruction (ACLR) between 2015 and 2020. Odds ratios were calculated for baseline patient characteristics and their association with the risk of recurrent tear. Multivariate Cox regression analysis was performed to identify the relationship between recurrent tear and specific categorical variables.

Results: A total of 431 patients were included, with a median follow-up of 64.9 months (range, 24-87 months). Recurrent primary graft failure was experienced in 9% of patients, and 11.1% sustained a contralateral ACL tear. The median time to postoperative graft failure was 14 months (interquartile range, 9-41.5 months). Patients with a secondary ACL injury (eg, graft failure or contralateral ACL injury) were younger than those who did not sustain a subsequent injury (mean age, 15.7 ± 1.8 years [graft failure] and 15.5 ± 1.3 [contralateral ACL injury] vs 16.2 ± 1.5 years, respectively; P = .007). Survival analysis demonstrated that younger age at primary ACLR and earlier time to return to sport (RTS) were significantly associated with an increased rate of secondary ACL injury (P < .05). With respect to combined secondary ACL injuries, as age at primary ACLR increases by 1 year, the rate of secondary ACL injury decreases by 27%. Similarly, for every subsequent 1-month delay in RTS, the risk of secondary ACL injury decreased by 13%.

Conclusion: Younger age and earlier time to RTS after ACL injury are independent risk factors associated with sustaining both primary ACL recurrent tear and contralateral ACL injury in the adolescent patient population. Counseling of adolescent athletes should include physical therapy compliance and allow for adequate healing and time to RTS.

Background: While arthroscopic stabilization for anterior glenohumeral instability is successful in preventing recurrent dislocations, progression to glenohumeral arthritis remains concerning. Age, anchor number, and capsular volume shrinkage have been previously established as risk factors for progression to arthritis in patients who underwent arthroscopic anterior stabilization. However, the rate of and risk factors for arthritis in young populations have not been well characterized.

Purpose: To evaluate the rate of progression to glenohumeral arthritis and identify potential risk factors after arthroscopic anterior stabilization in a young population.

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

Methods: This study included 287 patients who underwent an index primary arthroscopic anterior shoulder stabilization procedure at a single institution and had a minimum of 4 years of postoperative imaging available over a 12-year period. Patients were excluded if imaging or operative reports were unavailable. The presence of arthritis was defined using radiographic parameters. Kaplan-Meier survival curves were estimated for the development of arthritis and compared by patient characteristics using log-rank tests. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% CIs associated with patient characteristics as predictors of the development of glenohumeral arthritis, adjusted for confounders identified in univariate analyses.

Results: Among the 287 patients, 8% (23/287) developed glenohumeral arthritis. The mean patient age at the time of surgery was 22.7 years (SD, 5.26). The median time from surgery to diagnosis of arthritis was 8 years, and the median follow-up time was 9 years (interquartile range, 6-11). Kaplan-Meier curves revealed differences in time to arthritis among patient groups, with earlier arthritis observed when stratified by age >25 years, use of <3 anchors at index surgery, and undergoing revision surgery after index stabilization. Adjusted for potential confounders in a multivariable Cox regression model, risk factors for the development of glenohumeral arthritis included older age at index surgery (HR per 1-SD increase in years, 1.85 [95% CI, 1.34-2.55]), lower anchor number (HR, 1.54 [95% CI, 1.107-2.14]), and revision surgery (HR, 2.83 [95% CI, 1.150-.95]).

Conclusion: Progression to glenohumeral arthritis after anterior stabilization occurred in 8% of a young patient population. The age and number of anchors used are statistically significant risk factors for progression to arthritis. Additionally, revision surgery was identified as a risk factor, which has not been previously reported in the literature.

Background: The chondrolabral junction (CLJ) plays an important role in maintaining hip dynamics, and there is a paucity in the literature examining the effect of CLJ breakdown on long-term outcomes after hip arthroscopy.

Purpose: To identify patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation rates at 10-year follow-up in patients with severe CLJ breakdown undergoing hip arthroscopy for femoroacetabular impingement.

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

Methods: PROs were obtained preoperatively and at 10-year follow-up for patients undergoing surgery between January 2012 and June 2014. PROs included the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, and visual analog scale for pain. Clinically significant outcomes included the minimal clinically important difference and Patient Acceptable Symptom State. Patients were categorized as having severe CLJ breakdown if their Beck classification was between 3 and 4 and mild if their classification was 1 to 2. Those with severe breakdown were propensity matched 1:1 to patients who had mild breakdown, controlling for age, sex, and body mass index (BMI). Independent t tests and Fisher exact tests were used to compare PROs and rates of hip arthroscopy revision and total hip arthroplasty conversion between groups, respectively.

Results: In this study, 53 patients with severe CLJ breakdown (25 females; mean ± SD age, 38.6 ± 12.2 years; BMI, 25.9 ± 4.9 kg/m²) were matched successfully 1:1 by age, sex, and BMI to 53 patients with mild CLJ breakdown (27 females; age, 37.8 ± 11.3 years; BMI, 25.9 ± 4.9 kg/m²). Preoperatively, there were no differences in PROs between patients with severe and mild CLJ breakdown. At final 10-year follow-up, PRO scores were also similar between groups. However, at 10 years, patients with severe CLJ breakdown underwent conversion to total hip arthroplasty at significantly higher rates than those with mild breakdown (28.4% vs 5.7%; P = .003).

Conclusion: Patients with severe CLJ junction breakdown undergoing hip arthroscopy for femoroacetabular impingement achieve similar PROs at long-term follow-up but undergo hip arthroplasty significantly more often when compared with patients with mild breakdown.

Background: Clinical outcomes after surgical repair of the distal triceps tendon are scarce and represented in small, heterogeneous case series.

Purpose: To evaluate clinical and cosmetic outcomes after double-row repair in a high-demand athlete population.

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

Methods: All patients who participated in regular weight lifting and underwent distal triceps tendon repairs between 2000 and 2021 in 2 centers were retrospectively contacted for informed consent and follow-up examination. Patients who received distal triceps tendon repair in double-row fashion with a minimum follow-up of 24 months were included. The American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Mayo Elbow Performance Score (MEPS; without instability), and Disabilities of the Arm, Shoulder and Hand (DASH) score were surveyed. General satisfaction on a scale from 0 (very unsatisfied) to 10 (very satisfied) was evaluated. In addition, a customized sporting activities questionnaire including subjective strength perception (0%-100%), time to return to sport, sports performance (bench and triceps press), visual analog scale (VAS) pain score, cosmetic results, complications, and failures (rerupture or reoperation) was administered.

Results: A total of 70 patients (all male) with a mean age of 50.9 ± 8.7 years were included in this study. The mean follow-up was 86.9 ± 51.4 months. The postoperative outcome scores were as follows: 97.8 ± 4.8 for the ASES score, 93.6 ± 10.9 for the SANE score, 2.2 ± 5.5 for the DASH score, and 98.1 ± 6.4 points for the MEPS. The median satisfaction score was 10 (IQR, 10-10). Postoperatively, patients subjectively achieved a 94% return of prior strength after a median of 7 months. In bench and triceps press, pre- to postoperative weight loads were a mean of 162.03 ± 53.1 kg to 134.7 ± 52.1 kg (P = .001) and a median of 70 kg (IQR, 50-85 kg) to 60 kg (IQR, 50-60 kg) (P = .001), respectively. The preoperative VAS score was 5.7 ± 2.7 versus 0.2 ± 0.6 postoperatively (P = .001). Overall, 85.7% of patients were satisfied with the cosmetic result. In total, 6 reruptures (8.6%) and 1 infection (1.4%) were observed. All 7 patients underwent surgical revision.

Conclusion: Double-row reconstruction of distal triceps tendon ruptures achieved good clinical and cosmetic results with a low complication rate in this high-demand patient population. Subjectively, maximum strength was regained after a median of 7 months; however, selective triceps strength during bench and triceps press resulted in significantly reduced weight loads postoperatively.

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.