Orthopaedic Journal of Sports Medicine最新文献

{"title":"Clinical and Social Predictors of Surgical Treatment for Anterior Cruciate Ligament Injuries.","authors":"Rithika Ginjupalli, Endel J Orav, Nadine J McCleary, Harrison T Hubbell, Miho J Tanaka","doi":"10.1177/23259671251336395","DOIUrl":"10.1177/23259671251336395","url":null,"abstract":"<p><strong>Background: </strong>While anterior cruciate ligament (ACL) injury is often managed surgically in the young, active population, nonoperative management may be considered in older adults. Surgical decision-making in adults is usually based on patient preference, level of functional disability, and the presence of comorbidities. Understanding the role of clinical predictors in surgical decision-making can help identify disparities in treatment outcomes.</p><p><strong>Purpose: </strong>To report on clinical and social predictors of surgical versus nonsurgical treatment in patients with ACL injuries and quantify the influence of each factor.</p><p><strong>Study design: </strong>Case control study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients diagnosed with ACL injury and those who underwent subsequent ACL reconstruction at a single center were identified. Functional disability was determined using patient-reported outcome measure scores, including the Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and Patient-Reported Outcomes Measurement Information Systems Physical Function (PROMIS-PF) within 90 days of diagnosis and before surgery. Clinical and sociodemographic factors were collected, and comorbidities were recorded using the Charlson Comorbidity Index. Logistic regression analysis was performed to identify relationships between clinical and sociodemographic factors with the likelihood of undergoing surgery for their ACL injury.</p><p><strong>Results: </strong>A total of 3656 patients were identified with ACL tear; 1734 (47.4%) were female (mean age, 34.9 years; SD, 13.8 years) and 1922 (52.6%) were male (mean age, 32.8 years; SD, 13.1 years). Overall, 53.8% of female patients and 53.4% of male patients underwent surgical treatment. Women had lower KOOS-PS and PROMIS values compared with men (-4.1 [<i>P</i> < .001] and -2.0 [<i>P</i> < .001], respectively) at the time of initial evaluation. Older age (<i>P</i> < .001), greater body mass index (<i>P</i> = .014), greater comorbidities (<i>P</i> < .001), smoking (<i>P</i> = .06), and subsidized insurance (<i>P</i> < .001) were negative predictors of surgery.</p><p><strong>Conclusion: </strong>Older age, greater body mass index, greater comorbidities, smoking, and subsidized insurance were negative predictors of undergoing surgical management of ACL injuries. Clinical predictors are useful in highlighting disparities and understanding ACL reconstruction decision-making for patients.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251336395"},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691090","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":"Patient-Specific Cutting Guides for Alignment-Correcting Osteotomy About the Knee: A Study of Accuracy, Cost, and Surgical and Fluoroscopic Safety.","authors":"Ian Savage-Elliott, Zachary I Li, Naina Rao, Jairo Triana, Sharif Garra, Larry Chen, Anil S Ranawat, Michael J Alaia, Laith M Jazrawi","doi":"10.1177/23259671251339497","DOIUrl":"10.1177/23259671251339497","url":null,"abstract":"<p><strong>Background: </strong>The utility and safety of patient-specific cutting guides (PSCGs) in osteotomies about the knee is uncertain.</p><p><strong>Purpose: </strong>To compare the cost, accuracy of radiographic correction, and safety of PSCG versus standard cutting guide (SCG) corrective osteotomies about the knee.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients undergoing high tibial osteotomy (HTO) or distal femoral osteotomy (DFO) were retrospectively reviewed from 2017 to 2022. Those who underwent 3-dimensional PSCG osteotomy were propensity matched to patients undergoing traditional osteotomies. Procedure time and fluoroscopic details were extracted from operative notes. Hip-knee-ankle (HKA) angle, posterior tibial slope (PTS), and mechanical axis deviation were measured on pre- and postoperative radiographs. Intraclass correlation coefficients were calculated to determine the reliability between the intended and resultant correction of HKA. Time-driven activity-based costing (TDABC) analysis was performed to compare procedure costs.</p><p><strong>Results: </strong>A total of 42 patients were included, with 11 HTOs and 10 DFOs in each group. Between the SCG and PSCG groups, respectively, final HKA (2.7° vs 1.9°; <i>P</i> = .36), PTS (9.6° vs 9.0°; <i>P</i> = .79), and mechanical axis deviation (10.2 vs 5.8 mm; <i>P</i> = .21) were similar. The intraclass correlation coefficient between the intended and measured HKA correction was 0.841 (good) in the PSCG group and 0.623 (moderate) in the SCG group. PSCG osteotomies had a mean procedure time that was 18.5 minutes shorter than SCG osteotomies (<i>P</i> = .39). Fluoroscopy time (43 vs 99 seconds; <i>P</i> < .001), tourniquet time (99.9 vs 116.6; <i>P</i> = .12), and radiation dose (2.9 vs 7.8 mGy; <i>P</i> = .01) were lower in the PSCG group. TDABC analysis demonstrated a total cost of $27,026 for PSCG and $27,100 for SCG. The rate of hinge fractures (9.5% vs 33.3%) and return to the operating room (4.8% vs 19.0%) were lower in the PSCG group, although these differences were nonsignificant.</p><p><strong>Conclusion: </strong>Both traditionally guided osteotomies and PSCG-guided osteotomies accurately corrected lower extremity malalignment. Utilization of PSCG resulted in similar procedure times and cost, as well as less fluoroscopy and lower tourniquet time, compared with conventional osteotomy. PSCG trended toward a decreased rate of postoperative complications.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251339497"},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691091","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":"Rotator Cuff Repair Augmentation by Direct Interlocking of an Overlayed Nonwoven Polyethylene Terephthalate Patch Substantially Increases Repair Strength: A Biomechanical Comparison in Ovine Shoulders.","authors":"Bettina Hochreiter, Ronja Senn, Elias Bachmann, Jess G Snedeker, Karl Wieser","doi":"10.1177/23259671251356629","DOIUrl":"10.1177/23259671251356629","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in surgical treatment of rotator cuff tears, such as the implementation of patches to reinforce repairs, the rate of retears remains high. Construct failure often occurs at the suture-tendon interface.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to compare the biomechanical properties of 3 types of rotator cuff repair (RCR): a nonaugmented transosseous-equivalent (TOE) repair, a conventional patch-augmented TOE repair, and a TOE repair augmented with a polyethylene terephthalate (PET) patch that directly interlocks with the underlying tendon across its entire interface. It was hypothesized that interlocked patch augmentation of RCR is biomechanically superior to conventional TOE.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 18 ovine infraspinatus tendons were detached, repaired (with TOE), and tested in 3 groups (n = 6): (1) nonaugmented TOE, (2) conventional patch-augmented TOE, and (3) interlocked patch-augmented TOE. In the second group, a commercial synthetic polyester patch was attached to the tendon via No. 2 FiberWire sutures and laterally attached to the humerus using No. 2 FiberWire sutures and 2 knotless anchors. In the third group, an interwoven patch-tendon interface was created using a microblade to push the fibers of the patch directly into the underlying tissue and to the humerus as described above. Each specimen underwent cyclic loading, followed by pull-to-failure testing. Ultimate tensile strength, cyclic and linear stiffness, peak-to-peak elongation, and gap formation were measured.</p><p><strong>Results: </strong>Direct patch interlocking resulted in significantly higher tendon purchase during pull to failure (587 ± 109 N vs 222 ± 48 N and 211 ± 52 N) as well as cyclic stiffness testing (44 ± 3 N/mm vs 25 ± 2 N/mm and 29 ± 2 N/mm) compared with the conventional patch-augmented and nonaugmented TOE, respectively (<i>P</i> < .0001 for all comparisons). Linear stiffness was also significantly higher compared with the conventional patch-augmented TOE (34 ± 6 N/mm vs 22 ± 2 N/mm; <i>P</i> = .007).</p><p><strong>Conclusion: </strong>While limiting but not eliminating tendon retraction, augmentation of a conventional TOE with direct interlocking of a nonwoven PET patch provided biomechanically superior results compared with conventionally augmented and nonaugmented TOE RCRs. The interlocked patch not only significantly improved time-zero force to failure but, compared with a conventional commercial patch design, also increased linear stiffness.</p><p><strong>Clinical relevance: </strong>Higher construct stiffness suggests that micromotion and gap formation were minimized, an aspect that is crucial for tendon-bone healing and for reducing early tendon retraction, thereby offering potential to improve retear rates in future clinical applications.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251356629"},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12280532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691092","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 Effect of Trauma History and Symptom Duration on Repair Integrity in 2335 Consecutive Arthroscopic Rotator Cuff Repairs.","authors":"Christyon Hayek, Patrick H Lam, Ala' Fayeq Mohamed Hawa, James P Bilbrough, George A C Murrell","doi":"10.1177/23259671251355125","DOIUrl":"10.1177/23259671251355125","url":null,"abstract":"<p><strong>Background: </strong>Few studies have assessed the impact of trauma history and preoperative symptom duration on cuff integrity after arthroscopic rotator cuff repair (RCR).</p><p><strong>Purpose: </strong>To assess the hypothesis that acute, traumatic rotator cuff tears are less likely to retear after arthroscopic RCR compared with chronic, atraumatic tears.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of prospectively collected data for 2335 consecutive patients who underwent primary arthroscopic RCR and were evaluated for retear on ultrasound 6 months postoperatively. A single-row knotless repair technique was used for all patients. The cohort was divided into patients who recalled a specific event that instigated their symptoms (\"traumatic\" group) and those who did not (\"atraumatic\" group). Chi-square test was utilized to assess the difference in retear rate between the traumatic and atraumatic groups. Multivariate logistic regression analyses were performed to identify independent predictors of retear, and receiver operating characteristic curve analysis was used to evaluate the accuracy of the regression equations.</p><p><strong>Results: </strong>The traumatic and atraumatic groups consisted of 1489 and 846 patients, respectively. There was no significant difference in retear rate between the traumatic and atraumatic groups (13% and 11%, respectively; <i>P</i> = .14). In the entire cohort, trauma history and preoperative symptom duration were not predictive of retear. In the traumatic group, larger tear size area was the strongest independent predictor of retear (area under the curve [AUC], 0.76; 99% CI, 0.70-81), followed by longer operative time (AUC, 0.69; 99% CI, 0.64-0.74), older patient age (AUC, 0.68; 99% CI, 0.63-0.73) and full-thickness tear (AUC, 0.66; 99% CI, 0.61-0.71). In the atraumatic group, larger tear size area was the strongest independent predictor (AUC, 0.76; 99% CI, 0.68-0.83), followed by older patient age (AUC, 0.67; 99% CI, 0.59-0.75) and full-thickness tear (AUC, 0.66; 99% CI, 0.58-0.73).</p><p><strong>Conclusion: </strong>Trauma history and preoperative symptom duration did not affect cuff integrity 6 months after arthroscopic RCR. More important factors associated with enhanced repair integrity included smaller tear size and younger patient age.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251355125"},"PeriodicalIF":2.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675413","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":"Difference in Characteristics of Patients Undergoing Revision MPFL Reconstruction and Those Undergoing Primary MPFL Reconstruction.","authors":"Jacob Ward, John Heyniger, Parker Cavendish, Eric Milliron, Christopher C Kaeding, David C Flanigan, Robert A Magnussen","doi":"10.1177/23259671251344937","DOIUrl":"10.1177/23259671251344937","url":null,"abstract":"<p><strong>Background: </strong>In recurrent patellar instability, medial patellofemoral ligament reconstruction (MPFLR), with or without concomitant bony procedures, has become the treatment of choice to stabilize the patellofemoral joint. In the setting of recurrent patellar instability after primary MPFLR, revision MPFLR can be considered. Numerous potential risk factors for failure of isolated primary MPFLR have been evaluated with mixed findings.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to compare anatomic and demographic patient characteristics between patients undergoing primary and revision MPFLR. It was hypothesized that patients undergoing revision MPFLR will demonstrate a higher prevalence of anatomic risk factors and J-tracking and will demonstrate more articular cartilage damage than patients undergoing primary MPFLR.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective chart review was performed to identify patients who underwent primary MPFLR between 2009 and 2021 and revision MPFLR between 2009 and 2023. Patients were categorized into 2 groups based on whether they underwent primary or revision MPFLR. Demographic (age, sex, and body mass index [BMI]), anatomic characteristics (patellar height, trochlear morphology, and tibial tubercle-trochlear groove distance), physical examination findings (presence or absence of a J-sign), and intraoperative findings (articular cartilage damage of the patellofemoral joint) were compared between these groups.</p><p><strong>Results: </strong>A total of 164 patients who underwent MPFLR within this period, including 26 revision and 138 primary procedures, were evaluated. No difference in patient age, sex, or any measure of patellar height was noted between the 2 groups. The revision MPFLR group was noted to have a higher BMI (29.9 kg/m² vs 27.2 kg/m²; <i>P</i> = .036), a higher mean sulcus angle (145° vs 140°; <i>P</i> = .007), more frequent presence of a crossing sign (77% versus 18%; <i>P</i> < .001), and were more likely to have a J-sign (42% vs 22%; <i>P</i> = .048) than the primary MPFLR group. Intraoperatively, the revision MPFLR group had a higher prevalence of articular cartilage damage (81% versus 37%; <i>P</i> < .0001) than the primary MPFLR group.</p><p><strong>Conclusion: </strong>Patients undergoing revision MPFLR had more prior patellar dislocations, higher BMI, and more trochlear dysplasia (increased sulcus angle and more frequent crossing sign) than those undergoing primary MPFLR. The revision group was also more likely to have a J-sign on clinical examination and patellar articular cartilage damage at the time of arthroscopy.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251344937"},"PeriodicalIF":2.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675411","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":"Age and Sex Differences in Anterior Cruciate Ligament-Return to Sport after Injury Subscale Scores of Emotion, Risk Appraisal, and Confidence After ACL Reconstruction.","authors":"Dylan P Roman, Sophia Ulman, Lauren Butler, Cody Walker, Taylor Douthit, Christopher M Kuenze, Victor V Prati, Brant Sachleben, Lucy Phan, Stephen LaPlante, Lee Pace, Dhalston Cage, John Roaten, John Abt, Dustin Loveland, Elliot Greenberg, Meredith Link, Theodore Ganley, Adam Weaver, Nicholas Giampetruzzi, Brooke Farmer, Terry L Grindstaff, Edward Chang, Rachel Cherelstein, Corey D Grozier, Matthew Harkey, Arjun Parmar, Jessica Tolzman, Alexa Martinez, Jacob Landers, Kylee Rucinski, Chelsea Harrison, Steven DeFroda, Richard Ma, Natalie Kupperman, Xavier Thompson, Michelle Walaszek, Kevin Cross, Elaine Reiche, Caitlin Brinkman, Tom Birchmeier, Joseph M Hart, Shelby Baez","doi":"10.1177/23259671251356273","DOIUrl":"10.1177/23259671251356273","url":null,"abstract":"<p><strong>Background: </strong>The Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale is widely used after anterior cruciate ligament reconstruction (ACLR), but its 3 subscale domains of emotion, risk appraisal, and confidence are rarely considered when assessing readiness to return to sport (RTS). Current guidelines for ACL-RSI scores at time of RTS are derived from adult-only studies, and there is a need for age- and sex-specific data to guide RTS decision-making.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to investigate differences in ACL-RSI subscale scores by age and sex. It was hypothesized that males and teens would report higher scores on emotion, confidence, and risk appraisal subscales compared with females and adults.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>ACL-RSI data were obtained from a multisite clinical outcome registry. Participants were included if they were between 6 and 12 months after primary, unilateral ACLR. Sex subgroups (female, male) and age subgroups (teen: 14-18 years; adult: 19-30 years) were established and compared to identify potential sex- and age-related differences in the ACL-RSI scale (total, subscales, and item scores). Descriptive statistics were computed and multiple 2-way analyses of variance were used to determine main effects and interactions between sex and age group. The significance level (α) was set to .05.</p><p><strong>Results: </strong>A total of 154 participants (mean age, 20.2 ± 3.8 years; 53.9% female; mean time after ACLR, 8.7 ± 2.1 months) were included. The mean ACL-RSI total score across the cohort was 67.92 ± 24.65. A significant main effect of age group on ACL-RSI total score was found as teens exhibited significantly greater psychological readiness compared with adults (mean difference, 10.91 points). A significant main effect of age group on the confidence subscale score was found, with teens reporting significantly higher confidence in returning to sport compared with adults (mean difference, 14.05 points). The main effect of sex on ACL-RSI total score was not significant (<i>P</i> = .337).</p><p><strong>Conclusion: </strong>Teens demonstrated significantly higher total scores and confidence on the ACL-RSI scale compared with adults. Therefore, when assessing a teen athlete's psychological preparedness to RTS, target scores determined from adult data may not be appropriate. Sex was not found to influence ACL-RSI scores. Future work should strive to create age- and sex-specific ACL-RSI cutoff scores for successful RTS after ACLR in teen athletes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251356273"},"PeriodicalIF":2.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675410","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":"Recurrence of Cyclops Syndrome After Initial Arthrolysis: Characteristics and Risk Factors After ACL Reconstruction.","authors":"Victor Meissburger, Nicolas Lefèvre, Mohamad K Moussa, Yoann Bohu, Antoine Gerometta, Olivier Grimaud, Alain Meyer, Frederic Khiami, Alexandre Hardy","doi":"10.1177/23259671251355126","DOIUrl":"10.1177/23259671251355126","url":null,"abstract":"<p><strong>Background: </strong>Cyclops syndrome is a complication of anterior cruciate ligament (ACL) reconstruction (ACLR). Its recurrence (recyclops) after surgical treatment is poorly understood, with limited research on risk factors and characteristics.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study is to determine the recurrence rate of cyclops syndrome after previous surgery and identify associated risk factors. It was hypothesized that the recyclops rate is significant and is associated with certain modifiable and nonmodifiable risk factors.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This study included all patients who underwent knee arthrolysis for cyclops syndrome after ACLR at a sports surgery center between 2005 and 2022. The primary outcome was the rate of recurrent cyclops syndrome and its associated risk factors. Secondary outcomes included knee range of motion, measured using a goniometer, both preoperatively and 6 weeks postoperatively, with comparisons made between patients with primary and recurrent cyclops cases.</p><p><strong>Results: </strong>During the study timeframe, 12,200 primary ACLRs were performed, from which a total of 359 patients with cyclops syndrome were found (2.9%), with a mean age of 25.34 ± 6.12 years and a male predominance of 57.38%. The recyclops rate was 6.9% (25 out of 359 patients). Risk factors identified in multivariate analysis were as follows: (1) age (patients >27 years, odds ratio [OR], 11.63 [95% CI, 3.41-39.73]; <i>P</i> < .001); (2) type of graft (quadrupled semitendinosus graft: OR, 5.09 [95% CI, 1.05-24.74]; <i>P</i> = .044); (3) bone-patellar tendon-bone grafts (OR, 26.01 [95% CI, 6.52-103.82]; <i>P</i> < .001); (4) absence of lateral extra-articular procedure (LEAP) (OR, 8.49 [95% CI, 1.64-43.97]; <i>P</i> = .011); and (5) time from ACL surgery to initial cyclops surgery of <7 months (OR, 13.62 [95% CI, 4.07-45.66]; <i>P</i> < .001). At 6 weeks postoperatively, the mean residual extension deficit, after initial arthrolysis, was significantly higher in the relapse group than in the no relapse group, with a median of 5° compared with 0° in the no relapse group (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Recyclops syndrome occurred in 6.9% of patients after cyclops arthrolysis. Significant risk factors include age, type of graft, absence of LEAP, and shorter time from ACL surgery to initial cyclops surgery. Among patients who underwent operation for the first time for cyclops, those who had residual extension deficit at 6 weeks postoperatively were more likely to experience recyclops.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251355126"},"PeriodicalIF":2.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675412","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":"Efficacy of Fibrin Clot Implantation for Reduction of Bone Tunnel Enlargement in Double-Bundle ACL Reconstruction Using Autogenous Hamstring Graft.","authors":"Nobuyoshi Suzuki, Shintaro Onishi, Ryo Kanto, Hiroshi Nakayama, Shinichi Yoshiya, Toshiya Tachibana, Tomoya Iseki","doi":"10.1177/23259671251349750","DOIUrl":"10.1177/23259671251349750","url":null,"abstract":"<p><strong>Background: </strong>Although previous reports have stated that the addition of a fibrin clot to an allograft can effectively inhibit femoral bone tunnel enlargement (BTE) after anterior cruciate ligament reconstruction (ACLR), no relevant study has quantitatively evaluated the chronological changes in the cross-sectional area (CSA) of the bone tunnel on 3-dimensional computed tomography (3D-CT) images in double-bundle ACLR (DB-ACLR) with hamstring tendon autografts.</p><p><strong>Purpose: </strong>To evaluate whether adding a fibrin clot to a hamstring autograft would reduce postoperative femoral BTE by means of 3D-CT image analysis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Method: </strong>A total of 21 patients with fibrin clot who underwent anatomic DB-ACLR using hamstring tendon autografts and 24 control patients without fibrin clot were included in the study. In preparing the graft, a fibrin clot was placed between the 2 strands of the graft end to be inserted into the femoral bone tunnel. The CSAs of the anteromedial (AM) and posterolateral (PL) femoral bone tunnels at the intra-articular aperture, 5 mm and 10 mm from the tunnel aperture, were measured on 3D-CT images at 1 week and 1 year postoperatively, and the difference between the 2 time points was defined as the BTE.</p><p><strong>Results: </strong>In the autograft group with fibrin clot, a significantly smaller BTE ratio was observed in the AM tunnel 5 mm (<i>P</i> = .003; with fibrin clot: 29.3% ± 58.1%; autograft alone: 58.8% ± 57.8%) and 10 mm (<i>P</i> < .001; with fibrin clot: -8.0% ± 43.7%; autograft alone: 42.3% ± 39.7%) from the intra-articular tunnel aperture and in the PL tunnel at all levels (<i>P</i> = .048, <i>P</i> < .001, and <i>P</i> < .001; with fibrin clot: 49.1% ± 89.3%, 7.9% ± 28.4%, and -5.1% ± 25.6%; autograft alone: 89.8% ± 57.0%, 28.9% ± 26.8%, and 51.4% ± 38.6%, respectively) compared with controls who received only autograft.</p><p><strong>Conclusion: </strong>Adding a fibrin clot to the autograft of an anatomic DB-ACLR was associated with a decreased BTE at 1 year. This effect was more evident in the PL tunnel and the midportion of the AM tunnel.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251349750"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659759","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 Effect of Mild Residual Rotational Laxity on Performance After Anterior Cruciate Ligament Reconstruction.","authors":"Jingyi Sun, Yingqi Zhao, Feng Gao, Yi Qian, Jingbin Zhou","doi":"10.1177/23259671251352205","DOIUrl":"10.1177/23259671251352205","url":null,"abstract":"<p><strong>Background: </strong>Some patients still experience mild residual rotational laxity of the knee after anterior cruciate ligament reconstruction (ACLR). The clinical symptoms of this residual rotational laxity are controversial, and methods for evaluating the symptoms have become a focus of academic interest in recent years. It is unclear whether there is a correlation between mild residual rotational laxity after ACLR and performance.</p><p><strong>Purpose: </strong>To investigate the influence of residual mild rotational laxity after ACLR on subjective outcomes, performance, psychological readiness, and return to sports (RTS).</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 81 patients who underwent ACLR at our sports medicine center were observed for >2 years. The follow-up included KT-2000 measurements, the pivot shift test (PST), subjective outcome scores (Lysholm, International Knee Documentation Committee Subjective Knee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], ACL-Return to Sport after Injury Score [ACL-RSI], Tegner score, and Marx score), and performance evaluations, such as isokinetic testing at 60 deg/sec, hop tests, and Y-balance tests (YBT). Patients were grouped based on the results of the last PST follow-up on the operated knee. The stable group (SG) consisted of 42 patients with negative PST results, while the mild rotational laxity group (MIG) comprised 39 patients with PST grade 1. Statistical analysis was conducted to compare patient characteristics, subjective outcome scores, and performance between the 2 groups.</p><p><strong>Results: </strong>Significant differences were observed between the 2 groups in the single-leg hop test, the triple hop test, and the cross-over hop limb symmetry index, respectively (<i>P</i> = .013; <i>P</i> = .017; <i>P</i> = .046). In addition, the SG had significantly higher ACL-RSI scores than the MIG (69.54 ± 21.34 vs 53.60 ± 21.66; <i>P</i> = .006); and postoperative Tegner scores were significantly higher in the SG compared with the MIG (5.81±1.70 vs 4.95 ± 1.93; <i>P</i> = .036). No significant differences were observed in Lysholm, IKDC, KOOS score, postoperative Marx, or KT-2000 side-to-side difference scores, and no significant differences were found in isokinetic testing at 60 deg/sec, hamstring-to-quadriceps ratio, or YBT results between the 2 groups.</p><p><strong>Conclusion: </strong>Residual mild rotational laxity in the knee after ACLR leads to poorer performance in hop tests and a lower level of activity, and poor psychological readiness. Furthermore, in short- to medium-term follow-up after ACLR, regardless of knee rotational laxity, the return to preinjury activity rate remains low, with the majority not meeting the safe RTS criteria.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251352205"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659760","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":"Effects of Weight, Height, and Related Parameters on Elbow Varus Torque in Collegiate and Professional Baseball Pitchers.","authors":"Jonathan S Slowik, Kyle D Planchard, James R Andrews, Glenn S Fleisig","doi":"10.1177/23259671251356244","DOIUrl":"10.1177/23259671251356244","url":null,"abstract":"<p><strong>Background: </strong>Ulnar collateral ligament (UCL) injuries are prevalent in baseball pitchers. Epidemiological research has identified body weight as a risk factor.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate the influence of anthropometric characteristics (ie, height, weight, and related measures) on elbow varus torque in adult baseball pitchers. It was hypothesized that weight and height would each be correlated with elbow varus torque.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Anthropometric and fastball pitching biomechanical data from 627 collegiate and professional pitchers were analyzed. Elbow varus torque during pitching was computed using the pitcher's weight, height, pitching biomechanics, and inverse dynamics. Pearson correlation coefficients were calculated between individual anthropometric characteristics and elbow varus torque. Stepwise multivariate regression was also performed.</p><p><strong>Results: </strong>There was a strong correlation of elbow varus torque with weight and weight × height; a moderate correlation with body mass index; and a weak correlation with forearm length, height, and upper arm length. Stepwise regression explained 38% of elbow varus torque, with weight as the main contributor.</p><p><strong>Conclusion: </strong>Larger pitchers, particularly heavier pitchers, produced greater elbow varus torque.</p><p><strong>Clinical relevance: </strong>Pitchers with a greater weight may be at a higher risk of UCL injuries.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 7","pages":"23259671251356244"},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12267919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659758","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}