Orthopaedic Journal of Sports Medicine最新文献

{"title":"Rest Before Physical Therapy Is Not Necessary to Achieve Bony Healing of Lumbar Spondylolysis in Adolescent Athletes.","authors":"Emily A Sweeney, Anastasia Fischer, Madison Brna, Lisa Martin, Jingzhen Yang, Mitchell Selhorst","doi":"10.1177/23259671261421595","DOIUrl":"https://doi.org/10.1177/23259671261421595","url":null,"abstract":"<p><strong>Background: </strong>Bony healing rates of spondylolysis on magnetic resonance imaging (MRI) are low, and it is unknown how timing of physical therapy (PT) affects healing.</p><p><strong>Hypothesis: </strong>It was hypothesized that (1) initiating PT immediately after spondylolysis diagnosis would not have a negative effect on the healing of active lumbar spondylolysis on MRI in adolescent athletes and (2) baseline characteristics, as well as follow-up measures of pain and function, would not be associated with healing on 3-month MRI.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 2.</p><p><strong>Methods: </strong>This multicenter trial randomized adolescent athletes with lumbar spondylolysis to Immediate PT or Rest Before PT. A blinded radiologist assessed changes in edema and lysis on the initial and 3-month MRIs to determine healing. No rigid bracing was used in any participant.</p><p><strong>Results: </strong>A total of 53 participants (25 in the Immediate PT group and 28 in the Rest Before PT group) completed a baseline and 3-month follow-up MRI. At 3 months, 81% of participants demonstrated healing on MRI, 8% demonstrated no change, and 11% demonstrated worsened findings. Participants in the Immediate PT group were not more likely to have worse findings on the 3-month MRI than the Rest Before PT group (<i>P</i> = .30). Participants who had healing on 3-month MRI were more likely to be pain-free at that time (97.6% pain-free) than those whose MRI findings did not change or worsened (67% pain-free; <i>P</i> = .01). Participants whose MRI demonstrated healing were less likely to experience a recurrence of pain within 12 months (7.3% recurrence of pain) compared with those whose MRI showed no change or worsened (50% recurrence pain; <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Prolonged rest may not be necessary to promote healing on MRI in adolescent athletes with lumbar spondylolysis. PT can begin immediately without negatively affecting healing of spondylolysis on MRI.</p><p><strong>Registration: </strong>NCT05505981.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261421595"},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of Knee Brace Versus Operative Medial Patellofemoral Ligament Repair in Children With First-Time Traumatic Patellar Dislocation: A 10-Year Follow-up From Skeletal Immaturity to Adulthood.","authors":"Johan von Heideken, Elizabeth Arendt, Marie Askenberger","doi":"10.1177/23259671261432589","DOIUrl":"https://doi.org/10.1177/23259671261432589","url":null,"abstract":"<p><strong>Background: </strong>Optimal management of first-time traumatic patellar dislocation (FTPD) in pediatric patients remains disputed. Nonoperative treatment avoids surgical risks and may be optimal for select patients, whereas operative medial patellofemoral ligament (MPFL) repair aims to prevent recurrent instability and reduce redislocation in the short term.</p><p><strong>Purpose: </strong>To compare the redislocation rate, subsequent surgical intervention, and subjective knee function between pediatric patients initially treated with a knee brace (KB) and those who underwent operative MPFL repair.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>This 10-year follow-up study of 74 participants from a previously conducted randomized controlled trial included 46 patients (62%) available for reassessment (KB, n = 25; MPFL repair, n = 21). The primary outcomes, redislocation and subsequent knee surgery, were collected from questionnaires and medical records. Subjective knee function was measured using the Knee injury and Osteoarthritis Outcome Score for children (KOOS-Child), Kujala Anterior Knee Pain Scale, and Tegner Activity Score. Key anatomic risk factors were taken from magnetic resonance imaging scans at baseline. Group comparisons were performed at 10-year follow-up.</p><p><strong>Results: </strong>The KB group demonstrated a higher overall redislocation rate (80%) compared with the MPFL repair group (62%), although the difference was not statistically significant (<i>P</i> = .175). Early redislocations (≤2 years) were more frequent in the KB group (52% vs 29%; <i>P</i> = .108), whereas rates for late (>2 years) redislocations (28% vs 33%) were similar. Among patients with redislocation, 45% (KB) and 54% (MPFL repair) underwent subsequent knee surgery. Surgery occurred earlier in the KB group (a mean of 25 vs 62 months). Long-term functional scores were similar between groups. However, patients who sustained any redislocation reported significantly lower KOOS-Pain, KOOS-Quality of Life, and Kujala scores than those who remained stable. Anatomic patellar instability factors were common in both groups.</p><p><strong>Conclusion: </strong>The long-term redislocation rate in FTPD for patients with MPFL repair was nearly as high as for patients treated nonoperatively. Subjective knee function was comparable between the 2 treatments. Given the high rate of recurring instability in children, the authors do not support routine MPFL repair for FTPD, nor do they support nonoperative treatment as the gold standard for every child. However, when nonoperative treatment is used, a structured follow-up should be mandatory.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261432589"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfer Learning From Hand-Trained Deep Learning Models to Estimate Bone Age From Knee Radiographs.","authors":"Joshua T Bram, Ayoosh Pareek, Amir Daliliyazdi, M Moein Shariatnia, Samuel A Beber, Ruth H Jones, Olivia C Tracey, Daniel W Green, Peter D Fabricant","doi":"10.1177/23259671261424923","DOIUrl":"https://doi.org/10.1177/23259671261424923","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgeons treating skeletally immature patients with knee pathology rely on an accurate evaluation of skeletal age. Although the Greulich and Pyle atlas remains the gold standard for bone age estimation, it requires additional hand imaging and radiation exposure for patients who already have readily available knee imaging.</p><p><strong>Purpose: </strong>To develop a deep learning (DL) model for bone age estimation based on knee radiographs.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>This was an institutional review board-approved study. A total of 2374 cropped knee images-80% for training and 20% for a test set-from patients aged ≤18 years at an orthopaedic specialty hospital with paired hand films obtained within 3 months of knee imaging were used. Patients with previous physeal trauma about the knee, genetic disorders including skeletal dysplasias and endocrinopathies affecting maturation, were excluded. A ConvNeXT model was trained on sex, skeletal age, and chronological age as input values using 5-fold validation. Model performance was evaluated using mean absolute error (MAE) and gradient-based saliency maps to assess model interpretability.</p><p><strong>Results: </strong>The model achieved an MAE of 5.02 months relative to the assigned ground-truth bone ages, nearly half that of the abbreviated Fels method (9.59 months). An even lower MAE of 3.43 months was observed relative to the pretrained pseudo-labels generated by a hand DL model used to annotate the training set. Bland-Altman analysis revealed near-zero bias, indicating close agreement between predicted and ground truth bone age. This model outperformed both prior simple and artificial intelligence-based skeletal maturity estimation tools of the knee.</p><p><strong>Conclusion: </strong>This highly accurate DL model for knee skeletal maturity estimation demonstrates that automated bone age estimation from routine knee radiographs is feasible. We anticipate that this model can serve as a valuable diagnostic assistant for orthopaedic surgeons and radiologists evaluating skeletally immature patients and help to augment their clinical decision-making. External validation and model refinement are important for adoption into everyday practice.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261424923"},"PeriodicalIF":2.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Quadriceps Strength Recovery at 6 and 12 Months After Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Bone, Bone-Patellar Tendon-Bone, and Hamstring Tendon Autografts.","authors":"Nozomi Aibara, Yusuke Hashimoto, Shinya Yamasaki, Ikuhisa Yanagida, Koshi Asaka, Shingo Otsuki","doi":"10.1177/23259671261432666","DOIUrl":"https://doi.org/10.1177/23259671261432666","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) using a quadriceps tendon with bone (QTB) autograft has been associated with reduced quadriceps strength at 6 months postoperatively compared to other autograft options. However, limited studies have assessed strength recovery after return to sports after ACLR, particularly involving QTB autografts.</p><p><strong>Purpose: </strong>To examine factors influencing quadriceps strength recovery at 6 and 12 months after ACLR using QTB, bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) autografts.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Individuals who underwent primary ACLR using QTB, BPTB, or HT autografts, had a preinjury Tegner activity scale (TAS) score >5, and completed at least 12 months of follow-up were included. Participants were classified into recovery (>90%) and nonrecovery (≤90%) groups based on the limb symmetry index of quadriceps strength compared to the contralateral leg at 6 and 12 months post-ACLR. Variables associated with quadriceps strength recovery at these time points were analyzed.</p><p><strong>Results: </strong>A total of 154 participants were included. Multivariable logistic regression showed that use of QTB (OR, 0.11; <i>P</i> < .001) or BPTB (OR, 0.12; <i>P</i> < .001) autografts, meniscal repair (OR, 0.34; <i>P</i> = .013), and lower preinjury TAS score (OR, 1.68; <i>P</i> = .011) were associated with a significantly increased risk of quadriceps strength deficit at 6 months after ACLR. At 12 months after ACLR, lower preinjury TAS score (OR, 1.48; <i>P</i> = .046) and lower Knee injury and Osteoarthritis Outcome Score (KOOS) pain at 3 months (OR, 1.09; <i>P</i> = .002) were associated with a significantly increased risk of quadriceps strength deficit. The receiver operating characteristic curve showed that a KOOS pain value at 3 months after ACLR of 83.1 points was the cutoff for indicating a strength deficit at 12 months (sensitivity, 78.4%; specificity, 59.1%).</p><p><strong>Conclusion: </strong>Use of QTB or BPTB autografts, meniscal repair, and lower preinjury TAS score were factors associated with quadriceps strength deficit at 6 months after ACLR. At 12 months, lower preinjury TAS score and lower KOOS pain at 3 months were factors associated with persistent strength deficit.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261432666"},"PeriodicalIF":2.5,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ACL Reconstruction with Quadriceps Tendon Graft Based on Graft Diameter Relative to Notch Width.","authors":"Sahil Dadoo, Romed P Vieider, Camila Grandberg, Nicholas P Drain, Fritz Steuer, Luke T Mattar, Jacob Hartline, Jonathan D Hughes, James J Irrgang, Volker Musahl","doi":"10.1177/23259671261433007","DOIUrl":"https://doi.org/10.1177/23259671261433007","url":null,"abstract":"<p><strong>Background: </strong>While quadriceps tendon (QT) autograft is being increasingly utilized for primary anterior cruciate ligament reconstruction (ACLR), there remains limited evaluation of how QT autograft diameter and the ratio of graft diameter to femoral notch width (D-N ratio) affect clinical outcomes, such as rates of symptomatic knee stiffness or revision ACLR.</p><p><strong>Hypothesis: </strong>Larger QT autograft diameter and D-N ratio would be associated with higher rates of subsequent surgery for knee stiffness, whereas a smaller QT autograft diameter and D-N ratio would be associated with higher rates of revision ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>All consecutive patients age ≥14 years who underwent primary QT autograft ACLR between 2011 and 2021 were analyzed. Exclusion criteria were <6-month follow-up, double-bundle ACLR, and concomitant procedures other than meniscal repair. Rates of subsequent surgery for knee stiffness and revision ACLR were evaluated at minimum 6-month and 24-month follow-up, respectively. Demographic and surgical variables were compared between knee stiffness and revision ACLR groups. Significance was set to <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 374 patients (mean ± SD age, 22 ± 7 years; 42% female) met inclusion criteria, of which 209 patients (mean age: 23 ± 7 years; 49% female) had minimum 24-month follow-up. The rate of subsequent surgery for knee stiffness was 9.9% (37/374 patients), and the rate of revision ACLR was 9.6% (20/209 patients). Lateral meniscal repair (odds ratio [OR], 2.5; 95% CI, 1.2-5.2; <i>P</i> = .02) and D-N ratio >0.55 (OR, 3.4; 95% CI, 1.2-9.7; <i>P</i> = .02) were identified as independent predictors of subsequent surgery for knee stiffness. There was no significant difference in QT autograft diameter (9.2 vs 9.5 mm; <i>P</i> = .17), femoral notch width (17.3 vs 17.7 mm; <i>P</i> = .64), nor D-N ratio (0.54 vs 0.54; <i>P</i> = .87) between patients who underwent revision ACLR versus no revision ACLR.</p><p><strong>Conclusion: </strong>D-N ratio >0.55 and concomitant LM repair were associated with significantly higher odds of undergoing subsequent surgery for knee stiffness after QT autograft ACLR. Conversely, QT autograft diameter and D-N ratio were not associated with undergoing revision ACLR. Avoiding overstuffing of the femoral notch may reduce risk of subsequent surgery for knee stiffness without increasing the risk of undergoing revision ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261433007"},"PeriodicalIF":2.5,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship of Baseline Physical Activity and Morphologic Factors in Patients With Lateral Patellar Instability.","authors":"Yuka Kimura, Hikaru Kristi Ishibashi, Kyota Ishibashi, Eiji Sasaki, Lin Cheng, Eiichi Tsuda, Yasuyuki Ishibashi","doi":"10.1177/23259671261434246","DOIUrl":"https://doi.org/10.1177/23259671261434246","url":null,"abstract":"<p><strong>Background: </strong>Lateral patellar instability is more common in adolescents and young adults, and morphologic factors contribute to patellar dislocation. However, the relationship between baseline physical activity and morphologic risk factors in this population remains unclear.</p><p><strong>Purpose: </strong>To investigate the association between baseline physical activity and morphologic factors in patients with lateral patellar instability.</p><p><strong>Study design: </strong>Cohort study; Level of evidence 3.</p><p><strong>Methods: </strong>A total of 111 knees of 75 patients (mean ± SD age, 20.4 ± 10.0 years) undergoing medial patellofemoral ligament reconstruction for lateral patellar instability were retrospectively analyzed. Patients were stratified into the competitive sports (n = 34), recreational sports (n = 18), and nonsports (n = 23) groups based on presymptom activity. Imaging parameters included trochlear depth (TD), Dejour classification and patellar height (Insall-Salvati ratio [ISR]) on preoperative lateral radiographs; congruence angle (CA), sulcus angle (SA), and tilt angle (TA) on Merchant view; and tibial tuberosity-trochlear groove (TT-TG) distance on preoperative computed tomography. To compare morphological parameters among the 3 groups, generalized estimating equations were used to account for within-patient clustering.</p><p><strong>Results: </strong>The nonsports group had a significantly higher mean age (<i>P</i> < .01). Bilateral knee surgeries were more frequent in competitive and nonsports groups (<i>P</i> = .04). Mean TD was 1.9 mm (95% CI, 1.4-2.3 mm) in the competitive group, 1.0 mm (0.3-1.6 mm) in the recreational group, and 1.1 mm (0.6-1.6 mm) in the nonsports group; TD was significantly higher in the competitive group than in the other groups (<i>P</i> = .02). Mean CA was 8.4° (7.3°-9.5°), 9.1° (7.8°-10.4°), and 6.8° (5.5°-8.0°), respectively, with a significant difference between the recreational and nonsports groups (<i>P</i> = .03). No group differences were observed for ISR, SA, TA, TT-TG, and Dejour classification.</p><p><strong>Conclusion: </strong>Many competitive athletes demonstrated greater TD but nonetheless frequently underwent bilateral surgical procedures. Similarly, nonsports participants also showed a high rate of bilateral procedures, which may reflect more severe trochlear dysplasia rather than activity-related demand alone. These findings highlight the importance of considering both baseline activity level and trochlear morphology when determining surgical indications in young patients with lateral patellar instability.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261434246"},"PeriodicalIF":2.5,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13121489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Physical Therapy, Corticosteroid Injections, and Ultrasound-Guided Barbotage for Nonoperative and Operative Management of Calcific Tendinitis.","authors":"Ryan Gilbert, Sahil Dadoo, Ryan Lin, Neel Bhardwaj, Sophia McMahon, Fritz Steuer, Luilly Vargas, Bryson P Lesniak, Mark Rodosky, Albert Lin","doi":"10.1177/23259671261434919","DOIUrl":"https://doi.org/10.1177/23259671261434919","url":null,"abstract":"<p><strong>Background: </strong>Calcific tendinitis of the shoulder is a common, painful rotator cuff disorder with both nonoperative and operative treatment options. The optimal nonoperative modality remains unclear, and it is not well understood how previous nonoperative treatments influence eventual surgical outcomes.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to compare success rates, defined as avoidance of surgery, among 3 nonoperative treatments for calcific tendinitis: physical therapy (PT), corticosteroid injection (CSI), and ultrasound-guided barbotage (USB). For patients who underwent surgery, outcomes were compared according to previous nonoperative management. It was hypothesized that success rates and postoperative outcomes would not differ significantly between modalities.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective review of patients diagnosed with calcific tendinitis from 2009 to 2023 was performed. Exclusion criteria were lack of radiographic confirmation, <6 months follow-up, or incomplete electronic medical record data. Patients were categorized by attempted nonoperative treatment (none, PT, CSI, USB, multiple) and by final management (nonoperative vs operative). Patient-reported outcomes included the visual analog scale (VAS), Subjective Shoulder Value (SSV), and range of motion (ROM), collected at initial and final presentation. Radiographic findings were extracted from radiology reports. Statistical testing used parametric or nonparametric methods as well as a multivariable Cox proportional hazards model to predict nonoperative failure. Significance was set at <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 257 patients (mean age 55 ± 11 years) were analyzed with a mean follow-up of 18 ± 16 months with an overall nonoperative success rate of 63%. Success rates did not differ significantly among PT (59%), CSI (75%), and USB (72%), but patients with multiple tendon involvement or calcifications >3 cm were more likely to fail nonoperative management. Patients completing successful nonoperative management improved in VAS, SSV, and ROM, with no between-group differences. All patients who attempted multiple modalities (18/18; 100%) required surgery (<i>P</i> < .01). Among 121 patients undergoing surgery, final VAS, SSV, and ROM outcomes did not differ based on previous nonoperative management.</p><p><strong>Conclusion: </strong>PT, CSI, and USB demonstrate similar rates of avoiding surgery for calcific tendinitis. For patients ultimately requiring surgery, outcomes are not influenced by previous nonoperative management. Surgical intervention may be indicated after failure of a single nonoperative modality.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261434919"},"PeriodicalIF":2.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Based Automatic Glenohumeral Joint Segmentation for Determining Whether the Hill-Sachs Lesion Is On-Track or Off-Track.","authors":"Fangzheng Zhou, Yaohui Yang, Zhiyao Zhao, Hairui Zhang, Xiaoning Liu","doi":"10.1177/23259671261436434","DOIUrl":"https://doi.org/10.1177/23259671261436434","url":null,"abstract":"<p><strong>Background: </strong>Accurate quantification of the glenoid track is critical for determining optimal treatment strategies in patients with anterior shoulder instability. However, conventional computed tomography (CT)-based assessment methods require approximately 2 hours of manual segmentation and suffer from limited interobserver consistency, which may compromise diagnostic accuracy and surgical planning. Deep learning has demonstrated significant potential in medical image analysis.</p><p><strong>Purpose: </strong>To propose a deep learning-based framework for automated CT segmentation and bone defect quantification in anterior shoulder dislocation to enhance diagnostic efficiency and consistency.</p><p><strong>Study design: </strong>Cohort Study (diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>A deep learning model was developed by adapting the TotalSegmentator framework to perform automated segmentation and 3-dimensional (3D) reconstruction of CT images from 43 patients with anterior shoulder dislocation. Glenoid track width (GTW) and Hill-Sachs interval (HSI) were manually assessed using the Two-Thirds Glenoid Height Technique by 1 senior shoulder and elbow surgeon and 2 junior physicians. Semi-automated determination of the on-track/off-track status was also performed. Segmentation performance and measurement method reliability were evaluated using the Dice similarity coefficient and intraclass correlation coefficient (ICC), respectively.</p><p><strong>Results: </strong>The model achieved excellent segmentation accuracy, with mean Dice similarity coefficients exceeding 0.95 for both the scapula and humerus. Segmentation time was significantly reduced compared with manual segmentation, requiring only 30 seconds per case. Based on the segmented images, the GTW measured using the Two-Thirds Glenoid Height Technique demonstrated almost perfect intra- and interobserver agreement (ICC > 0.90). HSI measurements showed almost perfect intraobserver reliability (ICC > 0.90) and substantial interobserver agreement (ICC ≥ 0.80). The semi-automated determination of on-track/off-track status improved workflow efficiency, saving approximately 2 hours compared with the fully manual approach.</p><p><strong>Conclusion: </strong>This study integrates deep learning techniques into the entire diagnostic workflow for shoulder dislocation, enabling rapid, accurate quantification of bony defects. The reliability of using the Two-Thirds Glenoid Height Technique for measuring glenoid parameters on 3D models was validated, offering an efficient tool for surgical planning.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261436434"},"PeriodicalIF":2.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Head of the Biceps Tendon Augmentation in Massive Irreparable Rotator Cuff Tears Offers Good Clinical Results and Pain Relief With a Low Failure Rate.","authors":"Adrian Góralczyk, Krzysztof Kaliszuk, Piotr Depta, Ksawery J Kordecki, Piotr Kaluta, Michał Chojnowski, Shahbaz S Malik, Adam Kwapisz, Piotr Jancewicz, Krzysztof Hermanowicz","doi":"10.1177/23259671261434219","DOIUrl":"https://doi.org/10.1177/23259671261434219","url":null,"abstract":"<p><strong>Background: </strong>Techniques incorporating the long head of the biceps tendon (LHBT) into repair of massive irreparable rotator cuff tears (MIRCTs) have been reported to present good clinical outcomes in a short-term follow-up, but there is a lack of studies with longer observation.</p><p><strong>Purpose: </strong>To assess clinical and radiologic results of LHBT redirection with margin convergence repair in patients with MIRCTs in a longer follow-up.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Patients with at least 2 years of follow-up were enrolled in this retrospective study.Shoulder range of motion, pain per the numeric rating scale, Constant score, and American Shoulder and Elbow Surgeons questionnaire were assessed. True anteroposterior radiographs were assessed regarding acromiohumeral distance and cuff tear arthropathy per Hamada and Favard classifications. Magnetic resonance imaging scans were analyzed regarding fatty infiltration of supraspinatus (SST) and infraspinatus (IST) according to Goutallier classification and LHBT-rotator cuff construct features.</p><p><strong>Results: </strong>The study group involved 45 patients (11 female, 34 male) with a mean age of 65 years (range, 50-77) and mean follow-up of 52 months (range, 24-100). One patient was excluded for reverse shoulder arthroplasty. The mean range of motion was 150° of flexion, 148° of abduction, and 35° of external rotation. The mean pain was 1.0. The mean results were 83.9 in American Shoulder and Elbow Surgeons questionnaire and 71.2 in Constant score. The mean acromiohumeral distance was 5.6 mm (range, 2.0-8.7). On radiographs, cuff tear arthropathy was assessed as grade 1 in 23 patients, grade 2 in 14, grade 3 in 3, and grade 4 in 4. Mild glenoid erosion was observed in 9 patients. Among 35 patients, significant fatty infiltration was observed and graded as 3 in 7 patients for SST and 10 patients for IST and graded as 4 in 1 for SST and 2 for IST. The LHBT was presented intra-articularly in 31 of 35 analyzed magnetic resonance imaging scans and as running directly to the greater tuberosity in 10 of 35. The SST was healed proximally to the LHBT in 28 of 35 patients. One complication (2.2%) and 4 (8.9%) clinical failures were observed.</p><p><strong>Conclusion: </strong>At follow-up >2 years, LHBT redirection provided excellent pain-free range of movement, even though muscle strength deficit persisted. The rate of complications and clinical failures seems to be lower than for other nonarthroplasty treatment options for MIRCT.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671261434219"},"PeriodicalIF":2.5,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Athlete-Specific Factors on Time to Return to Sport Clearance Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Division I Collegiate Athletes.","authors":"Matthew L Kuik, Matthew B Blomquist, Keith A Knurr, Andrea M Spiker","doi":"10.1177/23259671251413259","DOIUrl":"https://doi.org/10.1177/23259671251413259","url":null,"abstract":"<p><strong>Background: </strong>High-level athletes who undergo hip arthroscopy for femoroacetabular impingement syndrome (FAIS) return to sport (RTS) at a high rate. However, the influence of athlete-specific factors, including sport, sex, and clinical and surgical findings, on the time to RTS remains unclear.</p><p><strong>Purpose: </strong>To determine if the time to RTS clearance is influenced by sport and sex in collegiate athletes following hip arthroscopy, as well as determine if the time to RTS is impacted by clinical and surgical factors.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>In total, 62 Division I collegiate athletes (26 female; 89 hips) who underwent hip arthroscopy for FAIS between January 2017 and July 2024 were included in this analysis of routinely collected health and performance data. Demographic information included sport, sex, age, body mass index, and whether unilateral or staged bilateral hip arthroscopy was performed. Preoperative and intraoperative findings included radiographic measures of hip morphology, the number of anchors used during labral repair, and chondral injury grade. RTS clearance was defined as the date of clearance from a member of the medical team for return to full activity. Time-to-event analyses examined the relationship between time to RTS clearance and athlete-specific factors.</p><p><strong>Results: </strong>There were significant differences in time to RTS clearance among different sports (<i>P</i> = .002). Athletes in track (median [IQR]: 3.4 [3.2-4.2] months) and wrestling (3.8 [3.2-3.9] months) required less time to RTS clearance than athletes in football (4.9 [4.4-5.4] months; <i>P</i> = .003 and <i>P</i> = .04, respectively). No significant difference was identified between female (4.2 [3.5-5.6] months) and male (4.8 [3.6-5.5] months) athletes regarding median time to RTS clearance (hazard ratio, 0.91; 95% CI, 0.51-1.61; <i>P</i> = .74). No clinical or surgical factors significantly impacted time to RTS clearance (all <i>P</i> values >.05).</p><p><strong>Conclusion: </strong>Collegiate athletes in wrestling and track who undergo hip arthroscopy for FAIS demonstrated quicker time to RTS clearance than those in football. There was no difference in time to RTS clearance between sexes. Despite variations in clinical and surgical factors, no variables within these categories significantly impacted time to RTS clearance.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 4","pages":"23259671251413259"},"PeriodicalIF":2.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}