Orthopaedic Journal of Sports Medicine最新文献

{"title":"Effect of Remnant Continuity on Postoperative Outcomes After Remnant Tensioning Anterior Cruciate Ligament Reconstruction in Respect to Clinical, Radiological, and Second-Look Arthroscopic Criteria.","authors":"Sung-Sahn Lee, Young Jin Choi, Juyong Oh, Dong Jin Ryu, Joon Ho Wang","doi":"10.1177/23259671251324218","DOIUrl":"https://doi.org/10.1177/23259671251324218","url":null,"abstract":"<p><strong>Background: </strong>Remnant tensioning (RT) anterior cruciate ligament (ACL) reconstruction has been reported to have excellent postoperative outcomes for femoral-side tears. However, the influence of remnant continuity (RC) on the postoperative results after RT ACL reconstruction remains unclear.</p><p><strong>Purpose: </strong>To investigate the effects of RC on the postoperative clinical, radiological, and second-look arthroscopic outcomes after RT ACL reconstruction for femoral-side ACL tears.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This study included 94 patients who underwent RT ACL reconstruction using the hamstring tendon for femoral-side ACL tears between 2015 and 2020. The patients were divided into 2 groups according to the continuity of the remnant tissue: RC (n = 50) and remnant discontinuity (RD) (n = 44). Stability tests, including the Lachman and pivot-shift tests, side-to-side difference on Telos stress radiographs and KT-2000 arthrometer, patient-reported outcome measurements (PROMs), and graft status on postoperative magnetic resonance imaging (MRI) and second-look arthroscopy were evaluated.</p><p><strong>Results: </strong>Results of all stability tests and PROMs significantly improved postoperatively. The mean follow-up periods were 35.3 and 36.8 months in the RC and RD group, respectively. The 2 groups showed no statistically significant differences in stability outcomes or PROMs. Furthermore, the RC and RD groups showed comparable postoperative graft status on postoperative MRI and second-look arthroscopy.</p><p><strong>Conclusion: </strong>RT ACL reconstruction for RD between the femoral insertion site and ACL tissue showed comparable postoperative outcomes, including stability test, PROMs, postoperative MRI, and second-look arthroscopic data, to surgery for RC in femoral-side tears.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324218"},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764512","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":"Complications and Return to Sport Between Screw Fixation and Suture Button Fixation for Arthroscopic Latarjet in a 2-year Follow-up: A Retrospective Cohort Study.","authors":"Justin A Magnuson, Gabriel Mozes, Nata Parnes, John P Scanaliato, Luke S Oh, John Ryan Tyler, Teja Yeramosu, Adam D Mozes","doi":"10.1177/23259671251321501","DOIUrl":"https://doi.org/10.1177/23259671251321501","url":null,"abstract":"<p><strong>Background: </strong>The Latarjet procedure may be performed arthroscopically or via an open approach, utilizing screws or suture buttons for graft fixation. There has been recent interest in suture button techniques in arthroscopic surgery, and proponents assert that these techniques may lead to fewer hardware-related complications while allowing for easier graft positioning.</p><p><strong>Hypothesis/purpose: </strong>This study aimed to compare the complication and return to sports (RTS) rates between screw fixation (SF) and suture button fixation (SB) for patients undergoing the arthroscopic Latarjet procedure. It was hypothesized that each group would have similar outcomes.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 112 patients underwent arthroscopic Latarjet procedures at a single center between January 2012 and December 2019. All patients had >20% glenoid bone loss, and 11.6% (n = 13) had previous arthroscopic Bankart repair. SF was utilized in 65 (58%) cases, and SB in 47 (42%) cases. Complications, reoperations, and RTS rates were analyzed. Patients were included for analysis if they had a 2-year follow-up and did not require conversion to open surgery.</p><p><strong>Results: </strong>Total complications were similar between SF and SB and occurred in 15.4% (n = 10) and 14.9% (n = 7) of cases, respectively (<i>P</i> = .943). Recurrent dislocation was noted in 3.1% (n = 2) of SF cases and 4.3% (n = 2) of SB cases (<i>P</i> = .740). Reoperations were required in 4.6% (n = 3) of the SF group and 4.3% (n = 2) of the SB group (<i>P</i> = .927). There were no hardware complications in the SB group compared with 1 hardware complication in the SF group. RTS was also similar between groups, with 92.3% and 93.6% returning to sports and 75.4% and 80.9% returning to the same level of sports in the SF and SB groups, respectively.</p><p><strong>Conclusion: </strong>Graft fixation using SF or SB yielded similar results for arthroscopic Latarjet procedures with respect to complications and RTS. The fixation method may be dictated by surgeon preference without an increased risk of complications.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251321501"},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764509","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":"Uniplanar Coronal Tibiofemoral Subluxation in Patients After Multiligament Knee Injuries: A Multicenter Retrospective Case Series.","authors":"Sarah Levitt, Soheil Sabzevari, Aaron Marcel, Isabel Chalem, Lee D Katz, Michael Hantes, Geoff Abrams, Michael J Alaia, Michael J Medvecky","doi":"10.1177/23259671251320981","DOIUrl":"https://doi.org/10.1177/23259671251320981","url":null,"abstract":"<p><strong>Background: </strong>Uniplanar coronal tibiofemoral subluxation (UCTFS) in the setting of multiple ligament knee injury (MLKI) or knee dislocation (KD) has rarely been discussed, and the potential for missed diagnosis may significantly impact long-term outcomes.</p><p><strong>Purpose: </strong>To describe the presentation, injury patterns, possible mechanical barriers for reduction, and management for isolated UCTFS after MLKI/KD.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective chart review was conducted at 4 institutions to identify patients with KD or MLKI who were evaluated with or developed subsequent UCTFS from January 2001 to January 2024. UCTFS was defined as medial or lateral translation of the tibial plateau in reference to the femoral condyle as seen on coronal imaging (radiograph, computed tomography scan, or magnetic resonance imaging scan), with normal alignment seen on the sagittal imaging. Medical records were reviewed for demographic data, clinical presentation, physical examination, diagnostic imagining, examination under anesthesia, surgical finding, and procedures performed.</p><p><strong>Results: </strong>A total of 15 cases were included. Of these, 12 patients were subluxed laterally and 3 medially. UCTFS was diagnosed at different time points with 10 patients within 1 week, 2 patients between 1 and 6 weeks, and 3 patients after 6 weeks from injury. The most common mechanism of injury was a fall (33%), and the most common pattern of injury was a KD-3L (26.6%). A mechanical blockage to reduction was found in 9 (60%) cases. These included medial soft tissue sleeve incarceration (n = 4), bucket-handle meniscal tears (n = 3), concomitant patellar dislocation (n = 2), and a displaced tibial spine fracture (n = 1). Some patients experienced subluxation due to several sources of mechanical block. Uniplanar external fixation was utilized in 7 patients for management of their initial ligamentous injuries, coronal instability, or a traumatic vascular injury. Hinged external fixation was utilized in 2 patients who presented in a chronic fashion to counter the propensity to subluxation while allowing early motion.</p><p><strong>Conclusion: </strong>UCTFS is a rare event that has several potential factors contributing to its cause, and ≥1 of these factors may need to be surgically addressed. Tibiofemoral subluxation can be found at various time points from injury, and awareness and monitoring for its development should be factored into the clinical decision-making. UCTFS is a challenging clinical dilemma that may require multiplanar or hinged external fixation to maintain reduction.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320981"},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764448","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":"Small, Short, Oblique Patellar Tunnels with Looped Graft Versus Suture Anchors for Patellar-Sided Graft Fixation During MPFL Reconstruction: A Study of Over 600 Knees.","authors":"Thomas E Moran, Brock J Manley, Neil P Blanchard, Adam J Tagliero, Pradip Ramamurti, Brad Reahl, David R Diduch","doi":"10.1177/23259671251320971","DOIUrl":"10.1177/23259671251320971","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of literature comparing clinical outcomes and complications between the use of 2 smaller (3.2 mm), short, oblique patellar tunnels with looped graft for patellar-sided graft fixation during medial patellofemoral ligament reconstruction (MPFLR) and the use of 2 suture anchors.</p><p><strong>Purpose: </strong>To compare clinical outcomes and complications in large series between the use of dual patellar suture anchors and dual, small, short, oblique bone tunnels for patellar-sided graft fixation during MPFLR.</p><p><strong>Study design: </strong>Retrospective cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective chart review identified all patients at a single academic institution who underwent primary MPFLR between March 2010 and December 2021, with a minimum 2-year follow-up. Operative notes, postoperative clinical follow-up notes, and radiographs were used to ascertain laterality, graft type, surgical technique, concomitant procedures, as well as the incidence of recurrent patellar instability, revision MPFLR, and patellar fracture. The follow-up was limited to a review of the postoperative clinic or emergency department visits, and patients were not contacted at the time of the study.</p><p><strong>Results: </strong>A total of 635 knees were included for final analysis. Patellar-sided graft fixation was achieved with small, short, oblique bone tunnels with looped grafts in 342 knees (53.9%) and suture anchors in 293 knees (46.1%). The small, oblique tunnels and suture anchor techniques both yielded a low incidence of patellar fracture, with rates of 0.3% and 0%, respectively. No significant difference in rates of patellar fracture existed between cohorts (<i>P</i>≥ .999). There were similar rates of recurrent patellar instability events in patients in whom patellar-sided graft fixation was performed with dual, small, short, oblique bone tunnels (n = 9; 2.6%) compared with dual suture anchors (n = 15; 5.1%; <i>P</i> = .103). Similarly, no significant difference was found in revision MPFLR rates between groups (dual small, short, oblique patellar tunnels: n = 5; 1.5%; dual suture anchors: n = 8; 2.7%).</p><p><strong>Conclusion: </strong>Two small (3.2 mm), short, oblique patellar tunnels with looped grafts and dual patellar suture anchors are similar in safety and efficacy for achieving patellar-sided graft fixation during MPFLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320971"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753838","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":"Approach to Osteochondral Lesions of the Posteromedial Talar Dome: A Review of Arthroscopic Videos.","authors":"Jun Young Choi, Jae-Hoo Lee, Kyeong Woo Park, Jin Soo Suh","doi":"10.1177/23259671251324176","DOIUrl":"10.1177/23259671251324176","url":null,"abstract":"<p><strong>Background: </strong>Osteochondral lesions of the talus (OLTs) most commonly occur in the posteromedial talar dome; however, there are no consensus guidelines on the appropriate approach to performing microfracture; that is, whether adequate visualization can be achieved solely through anterior ankle arthroscopy as well as the circumstances under which posterior ankle arthroscopy is required.</p><p><strong>Purpose: </strong>To ascertain whether (1) arthroscopic microfracture of posteromedial OLT can be accomplished solely through anterior ankle arthroscopy and (2) if there are specific conditions that may require posterior ankle arthroscopy.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>We retrospectively reviewed videos of patients who underwent primary arthroscopic microfractures for OLT on the posteromedial talar dome between January 2010 and June 2021. The enrolled patients were divided into 2 groups according to the direction of arthroscopy (anterior or posterior). Then, we focused on whether visualization of the posteromedial OLT was adequate through the anteromedial or anterolateral portal in the anterior ankle arthroscopy group (posteromedial or posterolateral portal in the posterior ankle arthroscopy group). Similarly, we assessed whether a sufficient microfracture technique was feasible during surgery.</p><p><strong>Results: </strong>A total of 79 patients were included in this study, among which 62 and 17 were assigned to the anterior and posterior ankle arthroscopy groups, respectively. Posteromedial OLTs were fully observed through the anteromedial portal in 79.0% of cases and better observed through the anterolateral portal (93.5%). Among the patients who underwent anterior ankle arthroscopy, only 4 (6.5%) experienced limited visualization, leading to an insufficient microfracture procedure. In 2 of these 4 patients, we observed challenges in advancing the arthroscopy and other devices owing to the narrow joint space, even with sufficient distraction, whereas the remaining 2 showed infeasibilities derived from the location extending posteriorly beyond the tibial plafond on preoperative magnetic resonance imaging. In contrast, microfracture of posteromedial OLT via posterior ankle arthroscopy was successfully performed in all patients.</p><p><strong>Conclusion: </strong>When surgically treating patients with posteromedial OLT, anterior ankle arthroscopy allowed for the successful performance of the microfracture procedure in most cases, unless there was a combined pathology necessitating surgical intervention on the posterior ankle. Posterior ankle arthroscopy can be selectively utilized only for far posteromedial OLT or in patients with narrow joint space, even with sufficient distraction.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324176"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753779","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":"Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients Using an All-Epiphyseal Technique: A Prospective Cohort Study.","authors":"Jorge Knörr, Jérôme Sales de Gauzy, Pedro Doménech, Mikel Sánchez, Francisco Soldado, Carlos Barrios","doi":"10.1177/23259671251322771","DOIUrl":"10.1177/23259671251322771","url":null,"abstract":"<p><strong>Background: </strong>Transphyseal techniques are the most commonly used for anterior cruciate ligament (ACL) reconstruction in children. To mitigate the risk of growth disturbance, the tunnels should be positioned as vertically and centrally as possible in relation to the physis, potentially compromising the anatomic orientation of the graft and, therefore, its isometry. A graft rupture is frequent in this age group. Even though all-epiphyseal techniques have not clearly demonstrated better isometry, the authors propose an epiphyseal technique that aims for favorable anatomy, and therefore isometry, while avoiding physeal damage in young children with ACL ruptures.</p><p><strong>Purpose: </strong>To present the results of a modified all-epiphyseal technique in prepubertal patients, evaluating knee function, graft survival, and joint and growth protection.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A total of 74 skeletally immature patients with a traumatic ACL rupture underwent a physeal preserving technique using a semitendinosus-gracilis tendon graft fixed with intra-epiphyseal resorbable interference screws in the femur and tibia, along with associated minimal notchplasty. Preoperative, intraoperative, and postoperative assessments included clinical knee stability and meniscal status, magnetic resonance imaging, isometry measurements, comparative laximetry measurements with stress radiography using the Lerat method, full-length standing radiography, measurements of the axes of the lower limbs, Tegner and Lysholm scores, and patient satisfaction.</p><p><strong>Results: </strong>From 2004 to 2014, a total of 74 patients met our inclusion criteria and were followed up for a mean of 4.1 years (range, 2-7 years). Of these patients, 91.9% had an excellent/good postoperative Lysholm score, with similar preoperative and postoperative Tegner activity scores. Intraoperative isometry showed an intratunnel graft excursion <3 mm during extension in 95.9% of cases. Abnormal clinical laxity was observed in 4.1% at final follow-up, with an improvement in side-to-side laxity of 4.8 mm. There were 3 patients who experienced graft failure, with the salvage procedure employing a transphyseal technique in 1 patient. Meniscal tears occurred in 27.0%, with concomitant repair yielding a healing rate of 87.5%. No physeal alterations were observed, except for a tendency toward subtle overgrowth in the affected limb. Also, 90.5% of patients were satisfied or very satisfied with the outcome.</p><p><strong>Conclusion: </strong>The proposed all-epiphyseal technique in skeletally immature patients demonstrated excellent overall results with a low incidence of reruptures and meniscal degeneration, without relevant alterations related to growth.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251322771"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753766","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":"Postoperative Cryotherapy in Joints Other Than the Knee: A Systematic Review of Pain, Edema, Analgesic Use, and Blood Loss in the Shoulder, Hand, Hip, and Ankle Joints.","authors":"Karam Mark Karam, Mohamad K Moussa, Thibaut Noailles, Eugénie Valentin, Olivier Grimaud, Nicolas Lefèvre, Alain Meyer, Alexandre Hardy","doi":"10.1177/23259671251320132","DOIUrl":"10.1177/23259671251320132","url":null,"abstract":"<p><strong>Background: </strong>Cryotherapy has proven effective for pain reduction in the knee joint. However, its efficacy in other joints is less clear.</p><p><strong>Purpose: </strong>To explore the benefits of cryotherapy in joints excluding the knee.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>In June 2023, a review of EMBASE, PubMed MEDLINE, PROSPERO, ClinicalTrials.org, and the Cochrane Library was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Search terms were \"cryotherapy,\"\"cold application,\"\"postoperative,\" and \"postoperative period.\" Studies that assessed postoperative cryotherapy in joints excluding the knee were included. Spine, tumor, and pediatric studies were excluded. Outcomes evaluated were postoperative pain status, analgesic use, edema, and blood loss.</p><p><strong>Results: </strong>Out of 6749 studies, 22 studies (1424 patients) were ultimately included. Postoperative pain was evaluated in 20 studies, analgesic consumption in 14 studies, edema in 8 studies, and blood loss in 6 studies. Cryotherapy showed significant benefits in pain reduction in 9 studies, decreased analgesic use in 7 studies, edema reduction in 4 studies, and decreased blood loss in 2 studies. The hip showed the most consistent benefits from cryotherapy, across all studied parameters. However, increased haloperidol consumption was noted in hip fractures. Cryotherapy benefits after wrist surgery (4 studies; 211 patients) varied by procedure. Particularly for carpal tunnel procedures, continuous cryotherapy showed significant reductions in pain, analgesic use, and postoperative edema. For ankle surgeries (4 studies; 301 patients), cryotherapy was beneficial for pain and analgesic consumption, but it was not the optimal edema-resolving method. Benefits in elbow surgery (1 study; 59 patients) were limited to pain and analgesia consumption. For shoulder surgery (6 studies; 311 patients), the evidence was not consistent regarding the benefits of cryotherapy on postoperative pain despite a general trend toward amelioration, with compression cryotherapy and continuous cryotherapy showing the best results.</p><p><strong>Conclusion: </strong>The effectiveness of cryotherapy appeared dependent on the specific surgical context and the protocol used. Pairing cryotherapy with compression led to better outcomes than cryotherapy alone. Special consideration should be given when implementing cryotherapy after hip fractures.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320132"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753788","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":"Evaluating the Outcomes of Trochleoplasty in the Treatment of Patellofemoral Instability in the Adolescent and Young Adult Knee With Severe Trochlear Dysplasia: A Minimum 2-Year Follow-up.","authors":"Adam Kreutzer, Remy Zimmerman, Charles Kim, Tracey Bastrom, John A Schlechter","doi":"10.1177/23259671251321499","DOIUrl":"10.1177/23259671251321499","url":null,"abstract":"<p><strong>Background: </strong>Recurrent patellofemoral joint instability in adolescent and young adult patients is associated with several anatomic risk factors. A lack of consensus exists as to which risk factor(s) should be addressed at the time of surgery, but the presence of a severely dysplastic femoral trochlea has been described as an indication for surgical intervention. Furthermore, literature has suggested that a severely dysplastic trochlea can be a contributing factor to a failed medial patellofemoral ligament reconstruction (MPFLR) alone.</p><p><strong>Purpose: </strong>To investigate the postoperative outcomes of patients <20 years of age who underwent primary trochleoplasty in combination with MPFLR and lateral retinacular lengthening (LRL), with some receiving concomitant tibial tubercle osteotomy (TTO).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data performed in patients <20 years old who underwent trochleoplasty with MPFLR with ≥2 years of follow-up. Demographics, concomitant procedures, patient-reported outcome (PRO) measures, magnetic resonance imaging, and radiographs were reviewed. Patients who also underwent TTO were compared with those who did not.</p><p><strong>Results: </strong>A total of 21 knees from 15 patients (11 female, 4 male) with mean age of 16.4 years (13.7-19.8 years) were included. All patients had severe trochlear dysplasia and were treated with trochleoplasty, MPFLR, and LRL. Ten knees underwent additional TTO and were compared with those who did not (n = 11). The Pediatric International Knee Documentation Committee, Kujala, and Lysholm scores collected at a mean of 3.3 years (range, 2-6 years) postoperatively did not differ significantly between groups. There were no patient-reported postoperative episodes of patellar instability by the final follow-up.</p><p><strong>Conclusion: </strong>At a minimum 2-year follow-up, there were no statistically significant differences observed in PROs between patients who underwent trochleoplasty and concomitant TTO and those who had trochleoplasty alone, with neither group having any reported episodes of postoperative patellar instability. Furthermore, at final follow-up favorable PROs were achieved in patients who underwent trochleoplasty for the treatment of their patellofemoral instability with severe trochlear dysplasia.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251321499"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753799","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":"Fatigue of the Dynamic Stabilizers of the Medial Elbow in Baseball Pitchers.","authors":"Michael Mullaney, Susan Kwiecien, Andrew Fink, Kenneth Brown, Malachy McHugh, Stephen Nicholas","doi":"10.1177/23259671241306435","DOIUrl":"10.1177/23259671241306435","url":null,"abstract":"<p><strong>Background: </strong>The flexor carpi ulnaris and flexor digitorum superficialis are thought to provide dynamic stability to the medial elbow during pitching. High medial elbow stress during pitching fatigues these dynamic stabilizers of the medial elbow. This fatigue of dynamic stabilizers could leave the ulnar collateral ligament more vulnerable to the stress of pitching.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to identify the onset of fatigue in the dynamic elbow stabilizers during a pitching performance. It was hypothesized that middle finger (MF) and ring finger (RF) fatigue during a pitching performance would occur earlier and be more substantial than grip and 3 finger grip fatigue.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Eighteen baseball pitchers (age, 17 ± 4 years) threw 4 innings of a simulated game (16 pitches per inning plus 5 warm-up pitches per inning). Before the game and after each inning, MF flexion, RF flexion, and grip strength were recorded. A standard full grip (FG) and a modified 3-finger grip (3FG) test were employed. Fatigue was classified as marked (>20% loss), moderate (10%-20% loss) or minimal (<10% loss).</p><p><strong>Results: </strong>MF strength was greater on the dominant versus nondominant hand (7%; <i>P</i> = .04). There was no hand dominance effect for the other 3 tests (RF, <i>P</i> = .15; FG, <i>P</i> = .79; 3FG, <i>P</i> = .90). The fatigue responses differed significantly between tests (<i>P</i> < .001). After the fourth inning, MF fatigue (21%) was greater than RF (7%; <i>P</i> < .001), FG (5%; <i>P</i> < .002), and 3FG (5%; <i>P</i> < .001) fatigue. MF fatigue was evident early and was progressive. After the first inning, 4 pitchers (22%) had marked MF fatigue and 3 (17%) had moderate MF fatigue. By the end of the fourth inning, 10 pitchers (56%) had marked MF fatigue and 6 (33%) had moderate MF fatigue. By contrast, only 5 pitchers (28%) had marked RF fatigue after 4 innings, and only 3 pitchers (17%) had marked FG or 3FG fatigue. Pitchers with high valgus elbow torque during pitching had greater MF fatigue than pitchers with lower elbow valgus forces (22% vs 10%; <i>P</i> = .045).</p><p><strong>Conclusion: </strong>By the end of the fourth inning, 10 pitchers (56%) had marked MF fatigue and 6 (33%) had moderate MF fatigue. MF fatigue may be indicative of medial elbow dynamic stabilizer fatigue in pitchers.</p><p><strong>Clinical relevance: </strong>We recommend finger flexor strength training to help support the medial stabilizers of the elbow during pitching. In the future, MF fatigue testing could be an \"in-game\" measure of pitcher fatigue.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671241306435"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753811","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":"Predicting Surgical Outcomes in Patients With Recurrent Patellar Dislocations.","authors":"Dario De Caro, Nathan L Grimm, J Lee Pace, John A Curran, Clare K Fitzpatrick","doi":"10.1177/23259671251324527","DOIUrl":"10.1177/23259671251324527","url":null,"abstract":"<p><strong>Background: </strong>A lateral dislocation of the patella is a common injury in adolescents and young adults that is largely caused by underlying anatomic risk factors. Surgically managed patients have a significantly lower risk of recurrent dislocations. However, determining the optimal surgical treatment remains a challenge, with patients sometimes undergoing multiple surgical procedures before achieving successful stabilization.</p><p><strong>Purpose: </strong>To computationally evaluate patients who have undergone multiple surgical procedures to treat recurrent lateral patellar dislocations and predict their clinical outcomes.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Our cohort consisted of 16 patients with trochlear dysplasia and recurrent lateral patellar dislocations. We used magnetic resonance imaging to create 3-dimensional patient-specific finite element models of the knee joint and evaluated patellofemoral stability before and after surgery. We applied these models to computationally predict the clinical outcome of each surgical procedure. We simulated a knee extension activity coupled with external tibial torsion to assess patellofemoral stability. We also included a healthy control group of 12 participants in the computational evaluation. Finally, we developed and trained a logistic regression model based on anatomic risk factors and applied this model to classify whether patients had a likelihood of a dislocation to efficiently differentiate between surgical outcomes.</p><p><strong>Results: </strong>Of 12 control, 12 preoperative, and 9 postoperative scans, the finite element model correctly predicted 29 of 33 surgical outcomes (87.9% accuracy). Postoperative simulations predicted patellofemoral stability metrics similar to those of the control group. Specifically, patients after trochleoplasty were associated with increased constraint force on the patellar lateral facet and lower involvement of the medial patellofemoral ligament. The logistic regression model demonstrated 81.8% accuracy in classification.</p><p><strong>Conclusion: </strong>Preliminary results are promising, but an improvement of the model and a larger clinical dataset are necessary to increase accuracy and comprehensively validate model performance.</p><p><strong>Clinical relevance: </strong>The aim of this study was to provide surgeons with a useful computational tool that can predict the likelihood of a patellar dislocation and differentiate, before a clinical intervention, between successful versus unsuccessful surgery to determine the optimal treatment pathway for individual patients.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324527"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753837","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}