American Journal of Sports Medicine最新文献

Background: Patients with recurrent instability underwent isolated medial patellofemoral ligament (MPFL) reconstruction regardless of anatomic risk factors within the confines of strict exclusion criteria. Previous publications from this cohort have been limited in the ability to identify risk factors for failure of isolated MPFL reconstruction when recurrent instability was defined as the only mode of failure, likely because of the small patient numbers who experienced this outcome.

Purpose: To investigate whether persistence of postoperative apprehension and J-sign indicate suboptimal outcomes after isolated MPFL reconstruction and to determine if they may help identify patients who need bony realignment in addition to a soft tissue stabilization.

Study design: Case series; Level of evidence, 4Methods:Patients with recurrent patellar instability were prospectively enrolled from March 2014 to December 2019 and underwent primary, unilateral MPFL reconstruction by the senior author within the confines of strict exclusion criteria. Imaging measurements were obtained at baseline. Patient-reported outcome measures (PROMs) were collected at baseline and annually. Recurrent instability events (patellar dislocations or subluxations), return-to-sport (RTS) rates, presence of postoperative apprehension, and J-sign were collected at 1- and 2-year follow-ups.

Results: A total of 138 knees (72% female; mean age, 20.1 ± 6.1 years) underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean Beighton score was 5.3 ± 3.0, and knee hyperextension beyond 0° was 5.4° ± 2.8°. Of the knees evaluated, 95 (81%) had a preoperative J-sign and 89 (65%) had preoperative knee hyperextension. At 2 years, recurrent instability was reported in 6 knees (5%), postoperative apprehension in 9 knees (8%), and a postoperative J-sign in 44 knees (37%). No patients with postoperative apprehension reported recurrent instability. At 2 years, 89% of patients were able to RTS. Patients with both preoperative knee hyperextension and postoperative apprehension had worse RTS rates compared with patients without either (P = .034). Patients with postoperative J-signs had a significantly worse International Knee Documentation Committee score (P = .022), Knee injury and Osteoarthritis Outcome Score Physical Function Short Form score (P = .011), and Kujala score (P = .035) at the 2-year follow-up. For patients with recurrent instability or postoperative apprehension, the Kujala score was statistically significantly lower at 1 year compared with those without (84.9 vs 91.7; P = .019).

Conclusion: In this prospective study of knees undergoing isolated MPFL reconstruction for recurrent patellofemoral instability, patients with postoperative J-signs showed worse PROMs at 2 years, a higher percentage of patients with preoperative k

Background: The hamstring tendon autograft used for anterior cruciate ligament reconstruction commonly entails both the semitendinosus and gracilis (ST/G) tendons for sufficient graft thickness, but they may impair function. To mitigate this, a tendon-sparing ST-only graft has been explored. However, less is known of the mid- to long-term outcomes comparing these configurations.

Purpose/hypothesis: The purpose was to investigate differences between the quadrupled ST tendon graft and the doubled ST/G graft configuration. The primary hypothesis was that there would be no difference in the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC-SF) outcomes between groups. The secondary hypothesis was that there would be no differences in knee flexion strength, KT-1000 arthrometer side-to-side measurements, or need for secondary surgery (including revision) between the 2 techniques.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: At baseline, 98 patients were randomized to receive either the quadrupled ST tendon graft or the doubled ST/G graft configuration. Preoperatively and after 2 and median 8 years (range, 5-10 years) postoperatively, the investigators collected results for the IKDC-SF, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale, a sports and activity participation questionnaire, knee laxity (KT-1000 arthrometer) side-to-side measurements, Lachman test, and flexion rotation drawer test. Need for secondary knee surgery was evaluated 5 to 10 years postoperatively.

Results: Seventy-seven patients completed median 8-year follow-up (range, 5-10 years): 38 patients in the ST group and 39 patients in the ST/G group. No statistically significant differences were observed between the ST and ST/G groups in IKDC-SF scores (81.7 vs 82.1; P = .93), knee stability, or revision rates. Both groups demonstrated statistically significant improvements in self-reported function (P < .001) until final follow-up. The overall anterior cruciate ligament revision rate was 10.4%, and no increased risk of graft failure or excessive residual laxity was associated with the ST-only graft.

Conclusion: No statistically significant differences were found between the ST group and the ST/G group in terms self-reported function, knee laxity, or need for secondary surgery at median 8 years (range, 5-10 years) after surgery. The ST-only graft configuration did not increase the risk of graft failure or excessive residual laxity compared with the ST/G graft configuration.

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: Iliocapsularis (IC) muscle hypertrophy in borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) suggests a possible role as a dynamic hip stabilizer. However, its significance in hip microinstability (MI) without acetabular undercoverage remains unclear.

Purpose: To compare IC muscle dimensions and fatty infiltration between patients with MI, BDDH, and mixed-type femoroacetabular impingement (mFAI), and assess the association between IC muscle morphology and hip pathology.

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

Methods: A retrospective analysis was conducted on patients undergoing arthroscopic surgery for hip pathology between January 2014 and December 2022. Patients were categorized based on lateral center-edge angle (LCEA) into BDDH (18° to <25°), MI (25° to 39°), and mFAI (>39°) groups. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed, and IC muscle dimensions, including width, depth, cross-sectional area (CSA), IC fatty infiltration, and combined IC and iliopsoas (IP) (IC+IP) CSA, were measured by 3 independent observers. A priori power analysis was performed. Statistical analyses included parametric and nonparametric comparative tests, interobserver correlation coefficients, and receiver operating characteristic analysis.

Results: A total of 95 hips were included in this study. IC depth, width, and CSA and IC+IP CSA were significantly smaller in the MI group (P < .05 for all). Interobserver agreement was good to excellent for IC width (IRC, 0.87), IC CSA (IRC, 0.87), and IC+IP CSA (IRC, 0.96), but poor for IC depth (IRC, 0.26). The alpha angle did not significantly differ among groups (P = .093). The MI group had a higher proportion of female patients (P = .003). No significant differences were noted in radiographic markers, including the ischial spine sign (P = .083), crossover sign (P = .130), and posterior wall sign (P = .41).

Conclusion: No detectable IC hypertrophy was observed in the MI group compared with the BDDH and mFAI groups, with patients with MI showing smaller IC width, depth, and CSA. The study offers a reproducible measurement technique with good interobserver agreement. IC muscle mass has limited prognostic value in predicting hip MI.

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: The amount of glenoid bone loss (GBL) in anterior shoulder instability helps determine management options. Unfortunately, there is no consensus on how to accurately measure GBL.

Hypothesis: The best-fit circle missing area method has better accuracy and interrater reliability than the ratio and diameter methods.

Study design: Controlled laboratory study.

Methods: Three-dimensional computed tomography shoulder scans were collected and segmented on 4 healthy male participants (mean age, 22.5 ± 3.4 years). For each scapula, 5 GBL models were created with known levels of GBL (5%-30%) in the anteroinferior glenoid rim. Ground-truth GBL was determined using the glenoid fossa edge and best-fit circle of the anteroinferior edge. Six blinded reviewers with varying expertise measured GBL for 20 randomized models using 3 different best-fit circle methods (missing area, ratio, and diameter). Accuracy was assessed by root mean square error and obtained by comparing measured and ground truth for bone loss for each model. Interrater reliability was assessed using intraclass correlation coefficients (ICCs) with a 2-way random-effects model with consistency.

Results: On average, the missing area method overestimated GBL by 1%, while the ratio method and diameter method overestimated GBL by 2.4% and 6.3%, respectively. The interrater reliabilities of the missing area (ICC, 0.89), ratio (ICC, 0.91), and diameter (ICC, 0.90) methods were good, excellent, and good, respectively. For all reviewers, the overall root mean square error of the missing area method (3.6%) was better than that of the ratio (5%) and diameter (7.9%) methods. When stratifying reviewer accuracy by level of training, the missing area method remained superior at all levels when compared with the ratio and diameter methods (attending [3.1% vs 3.8% and 8.9%], fellow [4.2% vs 6.3% and 8.4%], and resident [3.5% vs 4.6% and 6.3%]).

Conclusion: The best-fit circle missing area method was reliable and more accurate at measuring GBL than the other methods. This held true at all levels of surgical experience (resident, fellow, and attending).

Clinical relevance: The best-fit circle missing area method is accurate, has good reliability, and is simple. This can enhance preoperative planning for shoulder surgeons.

Background: Synovial fluid (SF) biomarkers demonstrate time-dependent variation after acute knee injury, and it is postulated that persistently elevated inflammatory markers may mediate worse long-term outcomes.

Purpose: This study investigated the relationship between biomarkers in SF at the time of meniscectomy and long-term patient-reported outcomes in patients with acute versus chronic meniscal injuries.

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

Methods: This retrospective analysis included patients who underwent knee SF aspiration on the day of arthroscopic meniscectomy between October 2011 and October 2020 with minimum 4-year follow-up. SF aspirated from the operative knee was analyzed for 10 pro- and anti-inflammatory biomarkers. Patients completed the visual analog scale for pain, Lysholm Knee Questionnaire, Tegner Activity Scale, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) before surgery and at follow-up. Patients were categorized as having acute (<6 weeks) or chronic (>1 year) symptoms. K-means clustering analysis was performed using biomarker levels to group patients into distinct cohorts.

Results: Of 85 patients meeting inclusion criteria, 55 had chronic and 30 had acute meniscal pathology, with 62 (72.9%) completing patient-reported outcome surveys at a mean follow-up of 8.66 years (SD, 2.27). K-means clustering identified 2 distinct biomarker profiles: a high-inflammation cluster and a low-inflammation cluster. The high-inflammation cluster had higher levels of 7 proinflammatory biomarkers as compared with the low-inflammation cluster (P = .015). The low-inflammation cluster predominantly comprised chronic meniscal injuries (89.2%), whereas the high-inflammation cluster was divided between acute and chronic cases. There were no differences in postoperative outcomes between clusters in the overall cohort. However, within the chronic cohort, the high-inflammation cluster exhibited worse postoperative scores on the visual analog scale for pain (P = .035), Lysholm questionnaire (P = .007), KOOS-PS (P = .038), and Tegner scale (P = .049) and had a higher rate of postoperative injections (P = .020) than the low-inflammation cohort.

Conclusion: In patients with chronic meniscal injury, those with a more proinflammatory SF biomarker profile at the time of meniscectomy had worse outcomes than those who had a low inflammatory profile. In acute meniscal injuries, most patients demonstrate a high inflammatory profile, which was not associated with a difference in long-term outcomes.