Orthopaedic Journal of Sports Medicine最新文献

{"title":"Full-Construct Biomechanical Evaluation of Femoral Cortical Suspensory Fixation for Anterior Cruciate Ligament Reconstruction in a Porcine Knee Model.","authors":"Tomas F Vega, Juan Bernardo Villarreal Espinosa, Elizabeth Shewman, Zeeshan A Khan, Harsh Singh, Brady T Williams, Thomas Alter, Ron Gilat, Safa Gursoy, Andrew S Bi, Jorge Chahla","doi":"10.1177/23259671261445909","DOIUrl":"10.1177/23259671261445909","url":null,"abstract":"<p><strong>Background: </strong>Although recent studies show no clinical outcome differences between cortical button suspensory fixation devices for anterior cruciate ligament reconstruction (ACLR), biomechanical mechanisms of elongation and failure remain unclear for adjustable-loop devices (ALDs) and fixed-loop devices (FLDs).</p><p><strong>Purpose: </strong>To compare biomechanical outcomes of ALDs with button-locking device (BLD), suture-locking device (SLD), and dual-locking device (DLD) mechanisms relative to an industry-standard FLD.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Five femoral cortical suspension devices (n = 11 each; total = 55 constructs) were tested using porcine femurs and bovine tendons simulating doubled hamstring grafts: EndoButton (FLD), Infinity Button (BLD), ProCinch (SLD1), UltraButton (SLD2), and TightRope (DLD). Constructs underwent cyclic loading simulating early (10-250 N, 500 cycles) and late (10-400 N, 500 cycles) rehabilitation, followed by pull-to-failure at 50 mm/min. Outcomes included excursion over simulated early and late rehabilitation and the cumulative total of both loading protocols. Also assessed were maximum load, stiffness, energy to failure, and failure mode, categorized as bone, button, suture loop rupture, tendon, or locking mechanism failure.</p><p><strong>Results: </strong>No significant differences were observed in cyclic loading at 500 cycles of 10 to 250 N or across the cumulative 1000 loading cycles between any ALD and the FLD. During cyclic loading at 10 to 400 N specifically, the BLD (3.34 ± 1.71 mm) and DLD (3.63 ± 1.18 mm) demonstrated greater excursion than the FLD (1.49 ± 0.36 mm; both <i>P</i> < .01). SLD1 (1270.5 ± 204.7 N) and SLD2 (1232.7 ± 185.2 N) withstood higher maximum loads than the BLD (1011.4 ± 95.8 N) and DLD (1018.4 ± 63.1 N; <i>P</i> < .05), although no differences were observed between the FLD and all ALDs combined. Stiffness did not differ across groups. BLD and DLD constructs most often failed by suture rupture, whereas the FLD and SLDs failed by button failure. Suture rupture was associated with greater excursion during cyclic loading at 10 to 400 N, lower maximum load, and reduced energy absorption compared with button failure (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>All constructs exceeded forces expected during early and total rehabilitation after ACLR, confirming adequate initial biomechanical strength across ALDs and FLDs. Differences in excursion and load to failure were associated with locking mechanism design and resultant failure mode, although clinical implications remain uncertain.</p><p><strong>Clinical relevance: </strong>Although mechanical behavior varied by device mechanism, all systems provided fixation above physiologic loads, supporting that design-specific differences influence how devices fail but not their ability to provide adequate early postoperative stability in ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 9","pages":"23259671261445909"},"PeriodicalIF":2.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888052","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":"Comparative Postoperative Outcomes After Rotator Cuff Repair in Tobacco and Nontobacco Nicotine Users.","authors":"M Lane Moore, Alejandro M Holle, William H Rankin, Collin L Braithwaite, Eugenia Lin, Joseph C Brinkman, Jeffrey D Hassebrock","doi":"10.1177/23259671261470573","DOIUrl":"10.1177/23259671261470573","url":null,"abstract":"<p><strong>Background: </strong>Tobacco use is a known risk factor for poor healing after rotator cuff repair (RCR), but the effects of nontobacco nicotine products remain unclear.</p><p><strong>Purpose: </strong>To compare postoperative complications among nontobacco nicotine users, tobacco users, and nonusers undergoing RCR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Using the PearlDiver database, the authors identified patients who underwent arthroscopic RCR with ≥2 years of follow-up. Three 1:1 propensity-matched comparisons were conducted: nontobacco nicotine users versus nonusers (n = 4844), tobacco users versus nonusers (n = 19,182), and nontobacco nicotine users vs tobacco users (n = 4882). Outcomes included 90-day complications and 2-year revision surgeries.</p><p><strong>Results: </strong>Nontobacco nicotine users had mildly higher rates of lysis of adhesions than controls (0.7% vs 0.4%; OR, 1.95; <i>P</i> = .033) but no other significant differences. Tobacco users showed increased rates of acute kidney injury (AKI), pneumonia, infections, emergency department (ED) visits, readmissions, and revision surgery compared to controls. Compared to tobacco users, nontobacco nicotine users had moderately strong lower risks of pneumonia (0.6% vs 1.2%; OR, 0.46), ED visits (8.8% vs 13.6%; OR, 0.62), and readmissions (0.8% vs 1.5%; OR, 0.54) (all <i>P</i> < .01).</p><p><strong>Conclusion: </strong>While nontobacco nicotine use was associated with a modestly increased risk of lysis of adhesions after RCR, it did not significantly elevate the risk of major medical complications, infections, or revision surgery when compared to nonnicotine users. In contrast, tobacco users demonstrated consistently worse postoperative outcomes across multiple domains, including higher rates of AKI, pneumonia, surgical site infection, ED visits, readmissions, and revision procedures. Notably, when compared directly to tobacco users, nontobacco nicotine users had significantly lower rates of pneumonia, ED utilization, and readmissions. These findings suggest that although nontobacco nicotine products may not be entirely benign, their perioperative risk profile appears to be less severe than that of traditional tobacco use.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 9","pages":"23259671261470573"},"PeriodicalIF":2.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888074","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":"Dynamic Ultrasound Assessment of Axial Extensor Mechanism Alignment in Adolescents With and Without Patellofemoral Instability.","authors":"Elliot M Greenberg, Bridget DeSandis, Sean Owens, Caroline Kim, Naomi Brown, Brendan Williams, J Todd R Lawrence","doi":"10.1177/23259671261468156","DOIUrl":"10.1177/23259671261468156","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability (PFI) is common among adolescents. Dynamic evaluation of extensor mechanism alignment during early knee flexion may improve the understanding of recurrent instability risk.</p><p><strong>Purpose: </strong>To evaluate the use of point of care ultrasound (POCUS) to dynamically measure axial extensor mechanism alignment in patients with and without PFI.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>Patients diagnosed with either patellar subluxation or dislocation and aged between 10 and 18 years were eligible. Control participants included those without any knee pain, nor any history of PFI, fracture, or musculoskeletal developmental disorder. Axial extensor mechanism was visualized with POCUS and the distance between the midpoint of the patellar tendon and lateral trochlear ridge (MPT-LTR) and lateral edge of the patellar tendon and LTR (LPT-LTR) was measured under 4 conditions: (1) active knee hyperextension (ie, quadriceps set), (2) full passive extension, (3) 15° of knee flexion, and (4) 30° of knee flexion. Univariate statistical analyses compared MPT-LTR and LPT-LTR distances across cohorts and knee positions. The area under the curve (AUC) evaluated measurement performance.</p><p><strong>Results: </strong>The cohort (PFI; n = 19) and controls (n = 19) were similar with respect to age, height, and weight (<i>P</i> > .05). In both groups, the MPT-LTR and LPT-LTR were greatest in active hyperextension and progressively medialized with increasing knee flexion. Patients with PFI demonstrated statistically significantly more lateral MPT-LTR and LPT-LTR distance in all testing conditions (<i>P</i>≤ .01) when compared with controls. AUC analysis demonstrated acceptable performance across measures, ranging from 0.712 to 0.837.</p><p><strong>Conclusion: </strong>Patients with PFI consistently exhibited a more laterally oriented patella while performing active knee hyperextension and throughout the first 30° of knee flexion when measured using a novel POCUS evaluation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 9","pages":"23259671261468156"},"PeriodicalIF":2.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880900","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":"Evaluation of Spin Bias in the Use of Platelet-Rich Plasma for Augmentation of Meniscal Tear Repairs.","authors":"Christina Im, Al-Hassan Dajani, Aidan Marks, Timothy Liu, Christopher Hamad, Thomas J Kremen, Amanda Honsvall Hoefler, Edward C Cheung","doi":"10.1177/23259671261471384","DOIUrl":"10.1177/23259671261471384","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) is used as a biologic adjunct for meniscal repair (MR). Systematic reviews and meta-analyses are frequently used to inform treatment decisions, but their abstracts may contain spin bias, overstating benefits and misrepresenting the certainty of the evidence.</p><p><strong>Purpose: </strong>To determine the prevalence and patterns of spin in systematic reviews and meta-analyses evaluating PRP augmentation of MR.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>Relevant studies were reviewed and identified in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on July 14, 2025. Each abstract was assessed for 15 predefined spin bias categories, and their corresponding full text was evaluated for methodological quality using A Measurement Tool to Assess Systematic Reviews, Version 2 (AMSTAR 2). General information of the studies was also extracted. Descriptive statistics were used to summarize the incidence of spin bias types and AMSTAR 2 ratings and presented as percentages of total possible responses. Study characteristics, spin bias, and AMSTAR 2 associations were assessed using nonparametric statistical tests, with statistical significance set at <i>P</i> < .05.</p><p><strong>Results: </strong>Screening of 1047 records yielded 16 relevant studies that were included in this analysis. At least 1 form of spin bias was identified in 15 out of 16 (93.8%) of abstracts. The most frequent spin bias types included type 14 (failure to report a wide confidence interval of estimates), type 11 (conclusion focuses selectively on statistically significant efficacy outcome), and type 3 (selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention), which each appeared in 43.8% of studies. AMSTAR 2 ratings were critically low in 68.8% of studies. No significant associations emerged between study characteristics, spin type, or AMSTAR 2 (all <i>P</i> > .05).</p><p><strong>Conclusion: </strong>The study demonstrated that abstract-level spin bias is highly prevalent in reviews of PRP augmentation for MR, often alongside low methodological confidence. More transparent abstract reporting is needed to ensure clinicians accurately interpret the strength and uncertainty of the available evidence. Reducing spin may help clinicians avoid overestimating PRP benefits when counseling patients and selecting treatments.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261471384"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875721","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":"Inferior Outcomes after Subsequent Revision or Contralateral ACL Reconstruction: A Cross-Sectional Study.","authors":"Ramana Piussi, Rebecca Hamrin Senorski, Johan Högberg, Riccardo Cristiani, Roland Thomeé, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1177/23259671261470914","DOIUrl":"10.1177/23259671261470914","url":null,"abstract":"<p><strong>Background: </strong>Outcomes after revision anterior cruciate ligament (ACL) reconstruction (ACLR) have been reported as inferior to those after primary reconstruction, but evidence comparing revision and contralateral ACLR in physical activity and patient-reported outcomes (PROs) during early rehabilitation remains limited.</p><p><strong>Purpose: </strong>To describe and compare rates of return to preinjury physical activity, muscle strength, and PROs between 12 and 24 months of rehabilitation in patients after primary, revision, and contralateral ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients from a rehabilitation registry who underwent ACLR were included in this cross-sectional study. They were categorized into groups, defined as primary (n = 1317), revision (n = 111), or contralateral (n = 80) ACLR. Return to physical activity was assessed using the Tegner activity scale. Muscle function was measured via isokinetic strength testing. PROs were evaluated using different questionnaires. Outcomes were compared across groups at 12, 18, and 24 months. In addition, subgroup analysis was performed, dividing patients by sex.</p><p><strong>Results: </strong>At 24 months, a significantly greater proportion of patients in the primary ACLR group had returned to their preinjury physical activity level compared with both the revision and contralateral ACLR groups (43.9% vs 27.1% and 25.7%, respectively). Patients in the primary ACLR group scored higher on different questionnaires compared to the other groups at all follow-up time points. Sex-specific analysis showed significant differences among female patients in future knee self-efficacy and quality of life, favoring primary ACLR.</p><p><strong>Conclusion: </strong>Revision and contralateral ACLR were associated with lower rates of return to preinjury physical activity levels and less favorable PROs between 12 and 24 months after reconstruction compared with primary ACLR. Differences in muscle strength were limited, and most statistically significant differences had small effect sizes, ranging from η² = 0.007 to 0.056 for continuous outcomes and ω = 0.122 for return to preinjury physical activity, suggesting that the clinical relevance of these findings should be interpreted cautiously.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261470914"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875657","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":"Midterm Outcomes After Suture Button Fixation for Arthroscopically Confirmed Concomitant Syndesmotic Instability in Chronic Lateral Ankle Instability: A Retrospective Cohort Study.","authors":"Pengtao Shi, Yu Wei, Shengxuan Li, Mengheng Liu, Chen Yang, Qi Quan, Yanpeng Zhao, Zhidong Zhao, Min Wei","doi":"10.1177/23259671261468979","DOIUrl":"10.1177/23259671261468979","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal tibiofibular syndesmosis instability (DTSI) often coexists with chronic lateral ankle instability and may delay recovery. Suture button fixation is widely used, but its benefit in this setting is uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate midterm outcomes of suture button fixation for DTSI with concomitant lateral ankle instability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent surgery for lateral ankle instability with arthroscopic syndesmosis assessment between 2017 and 2023 were retrospectively identified. Patients with an intact syndesmosis formed the intact group, whereas those with arthroscopically confirmed dynamic syndesmotic instability (≥2-mm diastasis) underwent additional suture button fixation and formed the instability group. All patients received standardized lateral ligament surgery and rehabilitation. Clinical assessments were performed preoperatively, at 12 months, and at final follow-up using Karlsson-Peterson, Foot and Ankle Ability Measure (FAAM), Tegner, Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI), visual analog scale (VAS) pain scores, and ankle range of motion. Group differences were analyzed with α = .05 and interpreted using minimal clinically important differences (MCIDs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 216 eligible patients, 154 completed follow-up at a mean of 67.3 ± 24.8 months (range, 24-113 months). No bilateral cases were included; therefore, the number of ankles was identical to the number of patients: 80 patients (80 ankles) in the intact syndesmosis group and 74 patients (74 ankles) in the syndesmotic instability group. Preoperatively, the instability group had lower Karlsson-Peterson scores than the intact group, with a median between-group difference of -4.00 points (95% CI, -6.00 to -2.00; &lt;i&gt;P&lt;/i&gt; &lt; .001). At 12 months, Karlsson-Peterson scores were comparable between groups (median between-group difference, 0.00 points; 95% CI, -1.00 to 1.00; &lt;i&gt;P&lt;/i&gt; = .63). At final follow-up, the instability group had a statistically higher Karlsson-Peterson score than the intact group, although the absolute difference was small (median between-group difference, 1.00 point; 95% CI, 0.00 to 2.00; &lt;i&gt;P&lt;/i&gt; = .02). The between-group difference in Karlsson-Peterson improvement was 4.88 points (95% CI, 3.13 to 6.63; &lt;i&gt;P&lt;/i&gt; &lt; .001), which did not exceed the MCID threshold of 13.50 points. After adjustment for preoperative Karlsson-Peterson score, sex, body mass index, age, anterior talofibular ligament surgical modality, and follow-up duration, syndesmotic instability treated with suture button fixation remained modestly associated with the final Karlsson-Peterson score (β = 1.525; 95% CI, 0.340 to 2.709; &lt;i&gt;P&lt;/i&gt; = .01). Final FAAM Activities of Daily Living, FAAM Sports, Tegner, ALR-RSI, and VAS scores showed no clinically meaningful between-group differences. Th","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261468979"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875670","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":"Correlation Between Changes in Subchondral Bone Density Distribution and Clinical Outcomes at 2 Years After Opening-Wedge High Tibial Osteotomy.","authors":"Taku Ebata, Koji Iwasaki, Dai Sato, Masatake Matsuoka, Tomohiro Onodera, Eiji Kondo, Norimasa Iwasaki","doi":"10.1177/23259671261444313","DOIUrl":"10.1177/23259671261444313","url":null,"abstract":"<p><strong>Background: </strong>High tibial osteotomy (HTO) for medial knee osteoarthritis corrects lower limb alignment, redistributing knee joint stress from the medial to the lateral compartment and improving clinical outcomes. Subchondral bone density reflects joint stress distribution. While redistribution of subchondral bone density after HTO has been reported, the relationship between computed tomography-osteoabsorptiometry (CT OAM)-derived changes in subchondral bone density distribution and postoperative clinical outcomes has not been well-established.</p><p><strong>Purpose: </strong>To investigate the relationship between subchondral bone density distribution across the knee joint and clinical outcomes at 2 years after opening-wedge HTO (OW HTO).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective study included 27 patients (27 knees) with medial knee osteoarthritis who underwent OW HTO. Radiographic parameters and clinical outcomes were assessed preoperatively and 2 years postoperatively. Subchondral bone density was evaluated using CT OAM, analyzing the high-density area (HDA) in the medial and lateral tibial compartments. The medial ratio was defined as the proportion of HDA in the medial compartment relative to total HDA. Correlations between changes in the medial ratio (Δ medial ratio) and clinical outcomes were analyzed.</p><p><strong>Results: </strong>Postoperative alignment and medial ratio were significantly altered, with a reduced medial ratio compared with preoperative values (preoperative, 82.2%; postoperative, 74.6%; <i>P</i> < .001). Change in medial ratio correlated with postoperative percentage of mechanical axis (%MA) (<i>r</i> = 0.414; <i>P</i> = .03) and change in hip-knee-ankle angle (ΔHKA angle) (<i>r</i> = 0.502; <i>P</i> = .008). Partial correlation analysis revealed that Δ medial ratio significantly correlated with postoperative Lysholm score (partial <i>r</i> = 0.463; <i>P</i> = .02) and Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation subscale (partial <i>r</i> = 0.538; <i>P</i> = .006), and Quality of Life subscales (partial <i>r</i> = 0.558; <i>P</i> = .004) and KOOS summary (42-item weighted mean) (partial <i>r</i> = 0.527; <i>P</i> = .006), after adjusting for postoperative %MA and Δ HKA angle.</p><p><strong>Conclusion: </strong>Our study demonstrated that a greater reduction in the medial ratio after OW HTO is associated with improved clinical outcomes, indicating that CT OAM-based subchondral bone density redistribution may reflect mechanical adaptation to postoperative load redistribution. Overall, Δ medial ratio may serve as a potential imaging marker of medial compartment unloading after OW HTO.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261444313"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875665","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":"BMI Serves as a Predictor of PROMIS Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement at Minimum 1-Year Follow-up.","authors":"Hashim J F Shaikh, Omkar N Prabhavalkar, Patrick Castle, Sarah Wegman, Nicholas Morriss, Justin Harrington, Jacob Waldron, Urvi Patel, Brian D Giordano","doi":"10.1177/23259671261471379","DOIUrl":"10.1177/23259671261471379","url":null,"abstract":"<p><strong>Background: </strong>Body mass index (BMI) and metabolic health are increasingly recognized as important predictors of recovery after hip arthroscopy for femoroacetabular impingement, yet limited data exist on how outcomes vary across the full BMI spectrum.</p><p><strong>Purpose: </strong>To evaluate the impact of BMI-from underweight to morbidly obese-on Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF), pain interference (PI), and depression (Dep) scores following hip arthroscopy.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A single-institution review was performed for patients undergoing hip arthroscopy for femoroacetabular impingement from 2015 to 2024. Patients were stratified by BMI: underweight (<18.5), normal (18.5 ≤ to <30), obese (30 ≤ to ≤40), and morbidly obese (>40). PROMIS PF, PI, and Dep scores were collected preoperatively and ≥1 year postoperatively. Wilcoxon tests evaluated within-group changes; analysis of variance and regression analyses compared outcomes between BMI groups, adjusting for demographic covariates.</p><p><strong>Results: </strong>A total of 415 patients (mean follow-up, 28.1 ± 15.8 months) met inclusion criteria. Both normal and obese BMI groups demonstrated significant improvements across all PROMIS domains from pre- to postoperative assessments (<i>P</i> < .05). However, compared with the normal group, the obese group had significantly worse scores pre- and postoperatively in PF (<i>P</i> = .0004 and <i>P</i> = .005, respectively), PI (<i>P</i> = .01 and <i>P</i> = .03, respectively), and Dep (<i>P</i> = .002 and <i>P</i> = .007, respectively). Underweight patients had significantly lower preoperative PF scores (<i>P</i> = .02) but showed greater improvement in postoperative Dep scores (<i>P</i> = .04) compared with the other groups. Within-group analysis revealed that underweight patients improved only in PF (<i>P</i> = .005), while morbidly obese patients showed no significant improvement in any PROMIS domain.</p><p><strong>Conclusion: </strong>Extremes of BMI are associated with diminished recovery following hip arthroscopy for femoroacetabular impingement, particularly in pain and mental health domain improvement. These findings highlight the need for targeted preoperative optimization and patient counseling for individuals with metabolic or nutritional risk factors.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261471379"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875681","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":"Correlation Between Synovial Coverage of the Reconstructed Anterior Cruciate Ligament and Healing of Bucket-Handle Medial Meniscal Tears After Combined ACL Reconstruction and Meniscal Repair.","authors":"Binyang Meng, Zi Zhang, Wenhe Li, Qi Wang, Fuji Ren, Rui Wang, Hao Pang, Zhilin Yue, Jiangang Cao","doi":"10.1177/23259671261472645","DOIUrl":"10.1177/23259671261472645","url":null,"abstract":"<p><strong>Background: </strong>Meniscal healing after repair of bucket-handle medial meniscal tear (BHMMT) concomitant with anterior cruciate ligament (ACL) reconstruction (ACLR) remains variable despite advances in surgical technique. The biological environment within the knee joint, particularly the degree of synovialization of the reconstructed ACL graft, may influence meniscal healing outcomes, but this relationship has not been systematically investigated.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate the arthroscopic relationship between synovial coverage of the reconstructed ACL and the healing of repaired BHMMTs following combined ACLR and meniscal repair. It was hypothesized that greater synovialization of the reconstructed ACL would be associated with higher rates of meniscal healing.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>A retrospective analysis was performed on patients who underwent ACLR combined with BHMMT repair between January 2020 and January 2025 and subsequently underwent tibial hardware removal with second-look arthroscopy (SLA). A total of 59 patients met the inclusion criteria. Functional outcomes were assessed preoperatively and before SLA using the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity scale. Arthroscopic videos obtained during SLA were reviewed to evaluate graft synovialization, categorized as good (>80%), fair (50%-80%), or poor (<50%) and to assess the healing status of the repaired meniscus. Meniscal healing was defined as the absence of retear or the need for additional repair or meniscectomy.</p><p><strong>Results: </strong>All functional outcome scores (KOOS, Lysholm, IKDC, and Tegner) improved significantly postoperatively compared with preoperative values (<i>P</i> < .05). A significant positive correlation was observed between the degree of synovial coverage of the reconstructed ACL and meniscal healing (<i>r</i> = 0.724; <i>P</i> < .001). Overall, meniscal healing was observed in 36 of 59 patients (61%). According to synovial coverage grade, healing rates were 100.0% in the good group, 44.4% in the fair group, and 0.0% in the poor group. A small 1- to 2-mm free-edge lesion, described in this study as a minor superficial fissure, was observed arthroscopically in 44 of 59 patients (75%).</p><p><strong>Conclusion: </strong>In patients undergoing ACLR combined with BHMMT repair, the degree of synovial coverage of the reconstructed ACL was significantly and positively associated with meniscal healing. Greater synovialization of the ACL graft was associated with a higher likelihood of meniscal healing. The extent of synovial coverage may serve as a useful arthroscopic indicator of intra-articular biological healing potential and may help inform postoperative evaluation and clinical decision-making.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261472645"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875684","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":"Association Between Computed Tomography-Derived Hounsfield Units of the Ulnar Collateral Ligament and Valgus Laxity in Professional Baseball Players.","authors":"Masaru Munemori, Kyosuke Numaguchi, Daisuke Momma, Akira Kodama, Keiko Goto, Eiji Kondo, Nobuo Adachi, Norimasa Iwasaki","doi":"10.1177/23259671261472961","DOIUrl":"10.1177/23259671261472961","url":null,"abstract":"<p><strong>Background: </strong>Ulnar collateral ligament (UCL) insufficiency in overhead athletes is thought to result from repetitive valgus loading that induces progressive microtrauma and structural attenuation. Although stress ultrasonography and magnetic resonance imaging are commonly used to evaluate UCL integrity, no imaging modality provides a widely accepted, objective, and quantitative marker of intrinsic ligament tissue quality.</p><p><strong>Purpose: </strong>To determine whether nonstress computed tomography (CT)-derived Hounsfield unit (HU) values of the UCL are associated with valgus laxity in professional baseball players and whether HU values serve as a quantitative marker of UCL insufficiency.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 44 professional baseball players underwent non-contrast-enhanced CT of the dominant elbow. HU values of the anterior bundle of the UCL were measured on reconstructed oblique coronal images using polygonal regions of interest for the whole ligament as well as proximal, midsubstance, and distal thirds. Valgus laxity was assessed using stress ultrasonography (stress delta difference) and stress CT (stress delta). Associations between HU values and valgus laxity were evaluated using Spearman correlation, group comparisons, receiver operating characteristic (ROC) analysis, and multivariable logistic regression. Exploratory analyses examined relationships between HU values and age, baseball experience, and playing position.</p><p><strong>Results: </strong>Lower proximal UCL HU values were significantly associated with greater valgus laxity on stress ultrasonography (<i>r</i> = -0.424; <i>P</i> = .005) and stress CT (<i>r</i> = -0.331; <i>P</i> = .030). On stress ultrasonography, whole-ligament HU values also demonstrated a significant negative association with valgus laxity, whereas midsubstance and distal HU values were not significantly related to laxity. Proximal HU values showed acceptable discrimination of increased valgus laxity (area under the ROC curve, 0.755), and ROC analysis identified an optimal cutoff of 65.5 HU with 85.7% sensitivity and 71.4% specificity. Proximal HU values remained significant after adjusting for age (odds ratio per 1-HU increase, 0.91; <i>P</i> = .049). Proximal HU values were not associated with age, years of baseball experience, age at baseball initiation, or playing position.</p><p><strong>Conclusion: </strong>CT-derived HU values of the proximal UCL were associated with valgus laxity in professional baseball players with structurally intact ligaments. A reduction in proximal HU values may reflect localized structural attenuation that is functionally relevant to medial elbow stability.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261472961"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875626","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}