American Journal of Sports Medicine最新文献

Background: The rate of patients failing to return to preinjury sport at the preinjury level after anterior cruciate ligament (ACL) reconstruction remains high (42%-63%), despite the use of the limb symmetry index (LSI) in knee strength and functional tests as part of return-to-sport (RTS) decision-making.

Purpose: To assess the ability of knee isokinetic strength and functional and psychological evaluations at 6 months after ACL reconstruction to predict successful RTS 2 years postoperatively.

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

Methods: Overall, 364 competitive athletes who underwent primary unilateral ACL reconstruction performed a battery of tests (ie, isokinetic, concentric, and eccentric strength of knee muscles; single, triple, crossover, and side hop tests for both lower limbs; and the Anterior Cruciate Ligament-Return to Sport after Injury [ACL-RSI] questionnaire) at 6 months postoperatively. The patients were contacted 2 years postoperatively to answer an RTS survey. The LSI, normalized performances of the strength and hop tests, conventional (concentric hamstring/concentric quadriceps) and functional ratios (eccentric hamstring/concentric quadriceps), and ACL-RSI score were included in a logistic regression to develop a predictive model for successful RTS (ie, returning to the preinjury sport at the preinjury level).

Results: In total, 179 patients were included in the analysis, with 53% achieving a successful RTS. The predictive model for successful RTS included the conventional ratio (odds ratio [OR], 0.68; 95% CI, 0.46 to 1.01; P = .053), side hop test performance (OR, 2.02; 95% CI, 1.01-4.03; P = .047), and normalized performance on the single hop test (OR, 0.21; 95% CI, 0.07-0.64; P = .006) for the involved knee; the eccentric quadriceps strength (OR, 1.76; 95% CI, 1.13-2.75; P = .013), conventional ratio (OR, 1.63; 95% CI, 1.09-2.43; P = .016), and normalized performance on the single (OR, 0.41; 95% CI, 0.15-1.14; P = .087) and triple hop tests (OR, 4.53; 95% CI, 1.70-12.06; P = .003) for the uninvolved limb; and the ACL-RSI score (OR, 2.73; 95% CI, 1.77-4.22; P = .001).

Conclusion: Functional symmetry between the involved and uninvolved knee was not predictive of successful RTS, but certain functional performances of the involved and uninvolved limbs, as well as psychological readiness, were predictive.

Background: Obesity is a recognized adverse prognostic factor across various surgical interventions.

Purpose: To evaluate long-term outcomes in patients with obesity who underwent hip arthroscopy for femoroacetabular impingement (FAI) and labral tears, compared with a control group with normal weight.

Study design: Retrospective cohort study; Level of evidence, 3.

Methods: This was a prospectively matched cohort study. Data were analyzed for patients who underwent primary hip arthroscopy for FAI and labral tears between October 2008 and October 2013, with a body mass index (BMI) of ≥30 kg/m². Included patients had completed pre- and postoperative patient-reported outcomes (PROs) and visual analog scale (VAS) questionnaires at a minimum 10-year follow-up or a documented endpoint within the study time. Rates of revision surgery and survivorship were compared. A subanalysis was performed based on BMI subgroups, and a secondary subanalysis was conducted based on sex. Patients were propensity-matched to a control group of normal-weight patients (BMI, 20-24.99 kg/m²) in a 1 to 1 ratio by sex, age at surgery, acetabular Outerbridge grade, and capsular treatment.

Results: A total of 266 patients were included in the study, with a mean follow-up time of 125.19 ± 43.07 months. The 2 groups demonstrated similar magnitudes of improvement at 10-year follow-up for the Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and visual analog scale for pain (VAS-Pain), achieving comparable postoperative scores. The 2 groups achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS), NAHS, and HOS-SSS at similar rates (P <0.05). Obese patients had a higher frequency of conversion to total hip arthroplasty (THA) (odds ratio, 2.19 [95% CI, 1.17-4.13]; P < .05). Obese patients started with significantly lower baseline preoperative scores for all PROs. Patients with morbid obesity (BMI ≥40 kg/m²) reached the MCID and PASS for the mHHS at significantly lower rates. No differences in terms of PROs, complications, and secondary surgeries were found in the sex-based subanalysis.

Conclusion: Hip arthroscopy for the treatment of FAI and labral tears in patients with obesity yielded significant and sustainable long-term improvements, which were equivalent to those of a benchmark matched control group of normal-weight patients. However, patients with obesity had >2-fold odds of conversion to THA. Patients with morbid obesity achieved clinical thresholds at lower rates and should therefore be approached with caution.

Background: Therapeutic peptides are short-chain amino acids that regulate cellular functions and facilitate biochemical processes. In recent years, there has been significant growth in the global market for therapeutic peptides and thus its popularity among patients. Given the increase in the development of peptides and increased marketing to patients for orthopaedic injuries, it is critical for orthopaedic surgeons to understand the current evidence behind these therapeutic peptides.

Purpose: To evaluate the current evidence and applications of injectable peptide therapy, focusing on its potential in regenerative medicine and sports performance, to help orthopaedic providers better understand the current state of different therapeutic peptide approaches.

Study design: Narrative review.

Methods: A comprehensive literature search was conducted using PubMed to identify biochemical and clinical studies on the most popular types of injectable peptide therapy. Key peptides evaluated included BPC-157, TB-4, TB-500, CJC-1295 + ipamorelin, tesamorelin, and GHK-Cu.

Results: BPC-157 demonstrated potential benefits in tendon and muscle repair, but these findings are largely unvalidated in human trials. A single human case series reported improvements in pain after intra-articular knee injections of BPC-157, although significant methodological flaws and a lack of controls limit its applicability and reliability. TB-4 and its derivative TB-500 promoted angiogenesis and tissue repair in preclinical models, but human orthopaedic data are lacking, and both remain banned substances in sports. CJC-1295 combined with ipamorelin showed significantly improved maximum tetanic tension in murine models with glucocorticoid-induced muscle loss, but these findings are limited to animal studies. Tesamorelin, approved for treating HIV-associated lipodystrophy, has no supporting orthopaedic evidence. GHK-Cu showed promise in wound healing and anti-inflammatory effects, but no clinical data support its use for musculoskeletal conditions.

Conclusion: While peptide therapy may possess significant therapeutic and regenerative potential, it is critical that orthopaedic and sports medicine providers understand the current lack of evidence to support the clinical use of these peptides. Importantly, information regarding the indications, dosing, frequency, and duration of treatment remains unknown. Despite the popularity of these peptides in mainstream media and among patients, significant research regarding the safety and efficacy of these therapeutic methods is required before definitive recommendations can be made to patients.

Background: The meniscotibial ligament (MTL) attaches to the posterior horn of the medial meniscus, which is essential in knee joint stability. Yet, its histological characteristics remain understudied. Understanding the histological composition of the MTL holds significant implications for comprehending its role in meniscal function and knee stability.

Purpose: To histologically analyze the MTL from its tibial insertion to its attachment to the meniscus, providing a 3-dimensional perspective.

Study design: Descriptive laboratory study.

Methods: Twelve paired glycerin-conserved knee specimens from 6 male cadavers were utilized. The posterior horn of the medial meniscus and the location of the meniscotibial attachment were identified. Measurements based on relevant landmarks were performed to coordinate fragment dissections. Laterality was systematically and randomly chosen to perform histological sections: sagittal, horizontal, or coronal. Postprocessing, histological sections were obtained and carefully analyzed.

Results: Histological analysis identified the MTL in all samples, exhibiting dense connective tissue with well-aligned type I collagen fibers extending from the tibia to a transition zone between the meniscus and the MTL. The MTL showed a higher collagen fiber density at its tibial attachment as compared with its body. At the ligament-meniscus transition zone, fiber continuity was not observed, with a collagen fiber distribution similar to that of the joint capsule. In the inferior portion of the meniscus, collagen fibers were more compact and organized, whereas in the rest of the meniscus, the transition zone and the joint capsule displayed fibers that were more disorganized and oriented in multiple directions.

Conclusion: This study identified 3 distinct zones within the MTL: its tibial insertion, characterized by dense, parallel collagen fibers; the MTL itself; and a transition zone with disorganized collagen fibers. Although the inferior surface of the meniscus shares histological similarities with the MTL, no anatomic continuity was observed. However, the transition zone appears to be a mechanically weak point.

Clinical relevance: Understanding the role of the meniscotibial complex and the fragility of the transition zone is key to managing ramp lesions. Repair should address the MTL and meniscal tissue for stability and be seen as a ligamentous, not just meniscal, repair.

Background: Clinicians increasingly rely on abstracts to assist with clinical decision-making. Spin is a bias that misrepresents research findings. The presence of spin in abstracts may mislead surgeons to believe a treatment is more effective than data suggest.

Purpose: To evaluate the presence of spin in abstracts of systematic reviews and meta-analyses on free bone block (FBB) procedures for glenohumeral instability.

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

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, Scopus, and Web of Science databases were queried with the terms "bone block" and "shoulder." Studies were included if they met the following criteria: systematic reviews and/or meta-analyses regarding FBB procedures published in the English language in peer-reviewed journals. Abstracts were analyzed for 15 spin types. Study quality was assessed using AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews Version 2) categories. Study characteristics including year of publication, journal impact factor and CiteScore, and level of evidence were collected, and Fisher exact test was used to find correlations between spin and study characteristics. Statistical significance was defined as a P value ≤.05.

Results: A total of 23 studies were included in this study. Spin was identified in 21 (91.3%) studies, and the number of spin types present in a single study ranged from 0 to 7. Spin type 6 (selective reporting of or overemphasis on harm outcomes or analysis favoring the safety of the experimental intervention) was identified most frequently (17; 73.9%). A significant association was found between spin type 5 (the conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies) and scientific journal (P = .013), and between spin 9 (the conclusion claims the beneficial effect of the experimental treatment despite reporting bias) and year of publication (P = .010).

Conclusion: Spin is highly prevalent in abstracts of systematic reviews and meta-analyses investigating FBB for glenohumeral instability. Associations between spin and both year and journal of publication were identified. These results suggest that surgeons should use full texts to help inform conclusions when using systematic reviews and meta-analyses to determine the efficacy and safety of FBB for glenohumeral instability.

Background: Lateral extra-articular tenodesis (LET) can reduce the risk of graft failure after anterior cruciate ligament (ACL) reconstruction in adolescents and young adults. It is unclear whether the use of this procedure increases risks of complications such as arthrofibrosis after ACL reconstruction using hamstring autograft in adolescents.

Hypothesis: Adolescents treated with ACL reconstruction using hamstring autograft with and without modified Lemaire LET have similar rates of arthrofibrosis after surgery.

Study design: Retrospective cohort study; Level of evidence, 3.

Methods: Cases of ACL reconstruction using hamstring autograft performed by the senior author from January 1, 2012, to May 20, 2024, in patients aged 10 to 19 years were retrospectively reviewed. LET was not used before 2022 but was routinely used after 2022 based on accruing evidence supporting it. Baseline patient variables were recorded, as were surgical variables, including meniscal repair or meniscectomy, inclusion of LET, and femoral socket drilling method. Complications requiring return to the operating room (RTOR) were identified. Causes for RTOR were noted, including arthrofibrosis, which was defined as a range of motion deficit ≥5° of extension or ≥15° of flexion requiring lysis of adhesions and manipulation under anesthesia within 1 year of surgery.

Results: A total of 569 cases were included. Arthrofibrosis rates were similar for patients who underwent hamstring autograft ACL reconstruction with LET (1.2%; 95% CI, 0.03%-6.4%) versus those without LET (3.7%; 95% CI, 2.2%-5.8%) (P = .34).

Conclusion: The rate of arthrofibrosis requiring surgical intervention after hamstring ACL reconstruction is low (<6.5%). The addition of LET to hamstring ACL reconstruction in adolescent patients did not increase the risk of arthrofibrosis in this study.

Background: Distal tibial allograft (DTA) reconstruction has emerged as an effective option for the treatment of recurrent shoulder instability with glenoid bone loss (GBL). However, the ideal location for capsular repair during the procedure remains undetermined.

Purpose: To evaluate the effect of capsular repair location on humeral head positioning and anterior translation after DTA.

Study design: Controlled laboratory study.

Methods: Nine human cadaveric specimens (mean age, 62.2 years [range, 52-69 years]) underwent biomechanical testing in a simulated bone loss model. The rotator cuff tendons were loaded, and anterior stability testing was performed using a Kuka robot with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head position and anterior translation. GBL (mean, 32%) was created, and a DTA graft was prepared to restore 100% of the native glenoid width. The following conditions were tested: intact, soft tissue Bankart lesion, DTA without capsular repair (DTA), DTA with capsule repaired to the graft (intra-articular), and DTA with capsule repaired to the glenoid (extra-articular). A repeated measures analysis of variance was performed to compare the translation and humeral head resting position between the five capsulolabral conditions.

Results: There was no difference in anterior translation when comparing DTA without capsular repair and the DTA with the capsule repaired to the graft (5.1 vs 5.3 mm; P > .999), and there was no difference in anterior translation between either of these conditions and the intact state (P > .999 for both). However, capsular repair to the glenoid demonstrated a significantly decreased anterior translation (0.7 vs 7 mm; P < .001) as well as a statistically significant posterior shift in the resting position (-2.5 vs 1.8 mm; P = .004) when compared with the intact state.

Conclusion: When performing a DTA reconstruction for large GBL, capsular repair to the native glenoid results in a more posterior resting humeral head position and less maximum anterior translation of the humeral head during time-zero biomechanical testing in cadaveric specimens. DTA without capsular repair and DTA with capsular repair to the graft restore glenohumeral position and motion closer to the native state.

Clinical relevance: Capsular repair to the native glenoid may overconstrain the glenohumeral joint when performing distal tibial allograft reconstruction in the setting of large glenoid bone loss, but further study is required to determine the impact on patient-reported outcomes or long-term arthritis risk.