American Journal of Sports Medicine最新文献

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.

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.