American Journal of Sports Medicine最新文献

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.

Background: Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands.

Purpose: To evaluate the effect of previous LSS on the outcomes of primary hip arthroscopic surgery at a minimum 5-year follow-up.

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

Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopic surgery with previous LSS. Patients had completed a minimum of 5-year follow-up. A subanalysis based on the type of LSS was also conducted. Patients were matched to a control group that underwent hip arthroscopic surgery without previous LSS in a 1:3 ratio based on age at surgery, sex, acetabular Outerbridge grade, and body mass index. Comparisons of patient-reported outcome (PRO) scores, clinically relevant outcome thresholds, complications, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were performed.

Results: A total of 424 hips were included in the study: 106 hips with previous LSS and 318 control hips. Patients with previous LSS displayed improvements across all PRO measures. There were no differences in improvements in PRO scores or the percentage of patients reaching clinically relevant outcome thresholds based on the type of LSS. Compared with the control group, the LSS group started with significantly lower preoperative PRO scores. Yet, both groups experienced equivalent improvements in all PRO scores. Furthermore, the LSS group had worse postoperative scores for all PRO measures. Additionally, the LSS group reached the Patient Acceptable Symptom State at significantly lower rates for the mHHS (modified Harris Hip Score), NAHS (Non-Arthritic Hip Score), and HOS-SSS (Hip Outcome Score-Sports-Specific Subscale). There was no difference in the rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and control groups converting to THA at 27.43 ± 24.32 and 48.02 ± 37.61 months, respectively (P < .05).

Conclusion: Hip arthroscopic surgery for the treatment of femoroacetabular impingement and labral tears in patients with previous LSS yielded significant improvements at midterm follow-up, which were equivalent to those of a matched control group with no history of lumbar abnormalities. However, the LSS group had lower postoperative PRO scores and met the Patient Acceptable Symptom State for PRO measures at lower rates. Importantly, LSS did not influence the risk of revision arthroscopic surgery and conversion to THA. However, the LSS group converted to THA sooner than the control group.

Background: Subchondral insufficiency fracture of the knee (SIFK) is commonly associated with medial meniscus posterior root tears (MMPRTs). However, there is limited research investigating risk factors for SIFK in patients with MMPRTs.

Purpose/hypothesis: The purpose of this investigation was to identify the risk factors for SIFK in patients with MMPRTs. It was hypothesized that age, body mass index, and extent of meniscal extrusion would emerge as significant risk factors for SIFK.

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

Methods: Patients with a primary isolated MMPRT confirmed via magnetic resonance imaging were included. Data on patient demographics, medical and surgical history, and imaging parameters were assessed for associations with SIFK. Imaging parameters included mechanical axis, medial tibial slope, tibiofemoral joint space, and meniscal extrusion. Patients were identified and divided into 2 groups based on the presence or absence of findings of SIFK on magnetic resonance imaging. Continuous variable distribution normality was assessed using the Shapiro-Wilk test. Demographic comparisons were made by t tests and chi-square tests. Multivariable logistic regression was used to identify SIFK risk factors. The threshold of joint space for predicting SIFK was determined through receiver operating characteristic analysis. The optimal threshold was determined with the Youden index.

Results: A total of 153 patients were included (mean ± SD age, 56.2 ± 9.1 years): 90 patients (26 male, 64 female) in the non-SIFK group and 63 patients (16 male, 47 female) in the SIFK group. There were no differences in patient demographics between the cohorts. Patients with SIFK had a greater incidence of previous knee injections (P = .047), a significantly smaller tibiofemoral joint space (P < .001), and a significantly greater degree of meniscal extrusion (P = .041). Multivariable logistic regression analysis identified diminished joint space as the only independent predictor of SIFK (odds ratio, 0.41; P = .017). Receiver operating characteristic analysis determined a predictive threshold for joint space <3.93 mm, yielding an acceptable area under the curve of 0.766.

Conclusion: The development of SIFK is likely multifactorial; however, decreased tibiofemoral joint space is a significant independent risk factor for SIFK in patients with MMPRTs, with a greater risk in patients with a tibiofemoral joint space <3.93 mm.

Background: The zonal organization of articular cartilage is critical for the biphasic mechanical properties of the tissue. Current treatments for articular cartilage have yet to regenerate this zonal architecture, compromising the functional efficacy of the repaired tissue, which could account for tissue failure in the long term. Autologous chondrocyte implantation (ACI) still suffers from inconsistent efficacy and a long recovery period stemming from implantation of a heterogeneous chondrocyte mixture.

Hypothesis: Stratified implantation of zonal chondrocytes would facilitate the recapitulation of articular cartilage zonal properties and improve the repair efficacy of ACI treatment.

Study design: Controlled laboratory study.

Methods: Autologous chondrocytes extracted from porcine articular cartilage were subjected to dynamic microcarrier expansion followed by size-based segregation using a spiral microfluidic device for the enrichment of zonal chondrocytes. Zonal chondrocytes were implanted into a chondral defect as a bilayered hydrogel construct consisting of superficial zone chondrocytes overlaying middle/deep zone chondrocytes (n = 6). Twelve months after implantation, the repair efficacy was compared against implantation of full-thickness cartilage-derived heterogeneous chondrocytes expanded on tissue culture plates (n = 5) or microcarriers (n = 6).

Results: Quantitative assessment of the repair tissues, including gross morphology, histological analysis, micro-computed tomography (micro-CT), compression modulus, and surface lubrication analysis, at 12 months demonstrated statistically significant improvement in cartilage and subchondral bone repair with zonal chondrocyte bilayered implantation. Magnetic resonance imaging (MRI) T2 mapping indicated progressive improvement in graft maturation as early as 3 months, reaching normalcy at 9 months.

Conclusion: This study demonstrates that with appropriate expansion and isolation of zonal chondrocytes, stratified zonal chondrocyte implantation is able to facilitate restoration of articular cartilage zonal architecture and significantly enhance the functional repair as compared with current ACI treatment.

Clinical relevance: With appropriate expansion and enrichment of zonal chondrocytes, stratified zonal chondrocyte implantation could represent a significant advancement over current ACI-based cartilage repair, with the potential to support quicker and better recovery.