Orthopaedic Journal of Sports Medicine最新文献

{"title":"Trends in Ulnar Collateral Ligament Injuries and Surgery From 2010 to 2019: An Analysis of a National Medical Claims Database.","authors":"Matthew J Solomito, Regina O Kostyun, Joshua T Sabitsky, Carl W Nissen","doi":"10.1177/23259671241290532","DOIUrl":"10.1177/23259671241290532","url":null,"abstract":"<p><strong>Background: </strong>Ulnar collateral ligament (UCL) injuries have been on the rise for the past 3 decades. Current epidemiological studies on the incidence of UCL injuries have been limited to state or regional data.</p><p><strong>Purpose: </strong>To utilize a large national claims database to determine the rates of UCL injuries and UCL surgical procedures over the past decade (2010-2019) and whether there has been a change in UCL surgical procedure patterns in the United States.</p><p><strong>Study design: </strong>Descriptive epidemiology study.</p><p><strong>Methods: </strong>The PearlDiver patient claims database was used to identify UCL injuries occurring from 2010 and 2019 that were sustained by male patients between 10 and 34 years of age. The study cohort was divided into 5 age groups (10-14, 15-19, 20-24, 25-29, and 30-34 years). Primary outcomes included the number of patients in each age group who sustained a UCL injury, the number of patients in each age group who underwent surgery, and the mean time from injury to surgery.</p><p><strong>Results: </strong>A total of 19,348 UCL injuries occurred between 2010 and 2019, and 13% required a surgical intervention. Most of the injuries (54%) occurred in the 15- to 19-year group. Patients in the 20- to 24-year group were more likely to undergo surgery versus the 15- to 19-year group. Results demonstrated a trend toward delayed surgical interventions in patients in the 20- to 24-year group in the latter part of the decade.</p><p><strong>Conclusion: </strong>Data suggested that male patients <20 years account for the majority of UCL injuries, while male patients aged between 20 and 24 years are most likely to undergo surgery. Despite a number of targeted injury-prevention strategies and rule changes in sports, the UCL injury rate remained high. Therefore, there is a clear and present need to continue to develop UCL injury-prevention strategies for the younger population.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241290532"},"PeriodicalIF":2.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682442","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":"Return to Activity After Patellofemoral Osteochondral Fracture: A Comparison of Metallic Screw and Bioabsorbable Fixation.","authors":"Kevin J Orellana, Soroush Baghdadi, Daniel Yang, Julianna Lee, J Todd Lawrence, Kathleen Maguire, Brendan A Williams, Theodore Ganley","doi":"10.1177/23259671241292641","DOIUrl":"10.1177/23259671241292641","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patellofemoral osteochondral fractures (OCFs) have the potential to hinder patients' function and quality of life. Several fragment fixation techniques have been described, with both metallic screw and bioabsorbable fixation showing favorable functional outcomes. Despite the promising results associated with both fixation methods, no study has directly compared their functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the functional and radiographic outcomes between bioabsorbable and metallic screw patellofemoral OCF fixation in an adolescent cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was conducted identifying surgically treated pediatric patients (&lt;18 years of age) with OCFs of the patellofemoral joint. Inclusion criteria were treatment with metallic screw or bioabsorbable fixation (bioabsorbable compression screw, suture bridge, or chondral darts), with preoperative radiographs and operative notes available for review. Patient information, injury characteristics, treatments, and outcomes were collected with a specific focus on return-to-activity time and postoperative complications. Univariate analyses were conducted to compare radiographic and functional outcomes between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;According to the study criteria, 37 knees in 37 patients (84% male), with a mean age of 14.2 ± 1.8 years, were identified. A total of 24 patients were injured during sports participation, with basketball and football being the most common sports. OCF fixation cohorts consisted of 12 patients treated with metallic screw fixation and 25 with bioabsorbable fixation. No statistically significant differences were appreciated when comparing median time to full activity between the fixation groups (&lt;i&gt;P&lt;/i&gt; = .427). However, time to full activity was unequally distributed, with 66.7% of the metallic screw fixation group returning to activity later than the total cohort's median, compared with 42.9% of the bioabsorbable fixation group (&lt;i&gt;P&lt;/i&gt; = .04). Two-thirds (8/12) of patients treated with metallic screws required return to the operating room for hardware removal compared with no patient treated with bioabsorbable fixation (&lt;i&gt;P&lt;/i&gt; &lt; .001). Two complications occurred with no significant differences appreciated between groups (&lt;i&gt;P&lt;/i&gt; = .202). However, both postoperative complications were recorded in the metallic screw fixation group: 1 patient with osteochondral malunion and another with arthrofibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study demonstrated that pediatric patellofemoral OCFs had good outcomes with high healing and low complication rates regardless of fixation type. Because of the high rate of secondary hardware removal procedures, metallic screw constructs delayed the return to sports and activity time. Patients treated with bioabsorbable fixation did not require a secondary operati","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241292641"},"PeriodicalIF":2.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682438","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":"Effect of Acetabular Labral Tear Orientation on Hip Joint Kinematics: A Comparison of Radial Tears, Chondrolabral Junction Tears and Complex Tears in Cadaveric Hips.","authors":"Andrew T Fithian, Hunter W Storaci, Calvin K Chan, Andrea K Finlay, Marc R Safran","doi":"10.1177/23259671241272493","DOIUrl":"10.1177/23259671241272493","url":null,"abstract":"<p><strong>Background: </strong>Acetabular labral tear morphology or orientation may influence hip stability.</p><p><strong>Hypothesis: </strong>A radial tear of the acetabular labrum would result in greater rotational and translational motion compared with a chondrolabral separation.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Included were 12 unpaired nonarthritic hip specimens, none of which had capsular laxity (8 male; mean age, 34.5 years). The specimens were stripped of all soft tissue except the hip capsule and labrum and, then potted using a custom jig. In 6 specimens, a 1-cm anterosuperior separation of the labrum from the acetabular rim (chondrolabral junction tear; CLJT) was created. In the other 6 specimens, a radial tear was created at the anterosuperior acetabulum. Subsequently, a complex labral tear was created in all specimens by adding a radial tear to the CLJT specimens and vice versa. The specimens were mounted on a load frame, and the femoral head displacement in the neutral and hyperextended positions was recorded at 5 N·m of internal/external rotation (IR/ER) torque and at 50 N of superior-inferior (S-I), anterior-posterior (A-P), and medial-lateral (M-L) force. Testing occurred at 0° extension and at maximal extension both before and after initial labral tear creation and again after creation of the complex labral tear. Before testing (intact state), the joint was vented to remove the effect of intra-articular pressure difference between the intact capsule and after capsulotomy for labral tear creation. The <i>t</i> test was used to calculate group differences by each range of motion measure (IR/ER and S-I, A-P, and M-L translations) for neutral and hyperextension.</p><p><strong>Results: </strong>Neither the radial labral injury nor the CLJT produced differences from the vented state in any combination of hip position or plane of motion. The complex labral tear showed increased IR/ER rotation at maximal hip extension. There was no difference between CLJT and radial labral tear in any combination of hip position or plane of motion.</p><p><strong>Conclusion: </strong>A simple labral tear did not affect hip joint stability when the capsule was intact, and no capsular laxity was present. A complex labral tear caused increased rotational laxity at maximal extension. Capsular laxity or a complex labral tear may be a prerequisite for labral injury to cause increased hip joint motion and/or translation.</p><p><strong>Clinical relevance: </strong>Study findings suggest that labral tears in the absence of capsular laxity may not play a role in producing microinstability by increasing motion or translation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241272493"},"PeriodicalIF":2.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682433","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 Opioid Reduction Using a Multimodal Pain Protocol for Outpatient Orthopaedic Sports Medicine Surgery.","authors":"Ethan M Bernstein, J Preston Van Buren, Kieran S M Wolf, Addison G Cantor, Wei Wei Wu, James R Bailey, Jennifer L Smith","doi":"10.1177/23259671241255353","DOIUrl":"10.1177/23259671241255353","url":null,"abstract":"<p><strong>Background: </strong>Orthopaedic surgery regularly employs opioids for postoperative pain management. Multimodal pain protocols have been shown to reduce opioid prescriptions in orthopaedic surgery.</p><p><strong>Purpose: </strong>To analyze the impact of a division-level multimodal pain protocol for orthopaedic sports medicine surgery on opioid prescription reduction and pain level postoperatively.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>All orthopaedic sports medicine procedures at a military treatment facility were categorized into 1 of 3 pain tiers. A pain protocol emphasizing multimodal pain control was implemented for each tier. A retrospective cohort study compared pre- and postprotocol pain groups for each respective tier (n = 40 in each) for visual analog scale (VAS) for pain scores 2 weeks postoperatively, postoperative opioid prescription, and time to discontinuation of postoperative opioids.</p><p><strong>Results: </strong>The mean number of opioid pills prescribed for all tiers decreased by 43.6% (preprotocol 35.7 ± 3.1; postprotocol 20.1 ± 1.5; <i>P</i> < .0001) after pain protocol implementation. Of the total opioids prescribed in the postprotocol cohort, a mean of 64.1% were consumed. There was no significant difference in overall visual analog scale for pain scores at 2 weeks postoperatively (preprotocol 2.72 ± 0.41; postprotocol 2.99 ± 0.43; <i>P</i> = .40). At 2 weeks postoperatively, only 1 patient continued opioids in the postprotocol group compared with 20 patients with continued opioid use in the preprotocol group (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>A division-level multimodal pain protocol applied to orthopaedic sports medicine procedures led to decreased opioid prescription postoperatively with no significant difference in 2-week postoperative pain scores compared with more opioid reliant and variable protocols in a cohort of military service members. Despite the reduced prescription, patients consumed a mean of 64.1% of pills, indicating continued overprescription.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241255353"},"PeriodicalIF":2.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682435","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 Tibiofemoral Bone Shape Features and Retears After Anterior Cruciate Ligament Reconstruction.","authors":"Karsyn N Bailey, Kenneth T Gao, Ryan T Halvorson, Jacob F Oeding, Sharmila Majumdar, Valentina Pedoia, Drew A Lansdown","doi":"10.1177/23259671241289096","DOIUrl":"10.1177/23259671241289096","url":null,"abstract":"<p><strong>Background: </strong>A retear after anterior cruciate ligament (ACL) reconstruction remains a common and devastating complication. Knee bone morphology is associated with the risk of ACL injuries, ACL retears, and osteoarthritis, and a combination of tools that derive bone shape from clinical imaging, such as magnetic resonance imaging (MRI) and statistical shape modeling, could identify patients at risk of developing these joint conditions.</p><p><strong>Purpose: </strong>To identify bone shape features before primary ACL reconstruction in patients with an eventual retear compared to those with a known intact ACL graft.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>Bone was automatically segmented on 2-dimensional proton density-weighted MRI of the knee in patients at the time of the initial ACL injury using deep convolutional neural networks. Patients with a subsequent retear after reconstruction within 3 years (22 femurs, 19 tibias) were compared with those with an intact ACL graft at 3 years (20 femurs, 22 tibias) using statistical shape modeling to identify preoperative bone shape features predictive of a retear after ACL reconstruction.</p><p><strong>Results: </strong>Statistical shape modeling revealed 2 specific bone shape features (modes) in the femur and 1 mode in the tibia that demonstrated significant differences at the time of the initial injury in patients with subsequent retears. In the femur, a narrower intercondylar notch width, a widened medial condylar width, an increased femoral condylar offset ratio, increased surface area along the lateral femoral condyle relative to the medial condyle, and a more prominent trochlear sulcus at the time of the initial injury were associated with retears after ACL reconstruction. In the tibia, a diminished ACL facet prominence, a squared lateral and medial tibial plateaus, and a broader and flattened tibial spine at the time of the initial injury were associated with retears after ACL reconstruction.</p><p><strong>Conclusion: </strong>Using the automatic bone segmentation pipeline on preoperative MRI, the authors identified bone shape features associated with a retear after ACL reconstruction. The use of this pipeline enables large-scale studies of bone shape on MRI and could predict patients at risk of ACL retears to alter treatment decisions.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241289096"},"PeriodicalIF":2.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682431","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":"Translation and Cross-cultural Adaptation of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score Into Japanese and Comparison of Visual Analog Scale and 10-Point Scale Formats.","authors":"Tomonobu Ishigaki, Hirotake Yokota, Hiroshi Akuzawa, Noriko Akiho-Toyoda, Keisuke Ushiro, Yuki Ebihara, Shigeharu Tanaka, Tadashi Wada, Hirofumi Jigami, Hisashi Matsumoto, Yu Ito, Takanori Kikumoto, Yuiko Matsuura, Ryo Hirabayashi, Chie Sekine, Noriaki Yamamoto, Go Omori, Mutsuaki Edama","doi":"10.1177/23259671241291861","DOIUrl":"10.1177/23259671241291861","url":null,"abstract":"<p><strong>Background: </strong>The Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score (KJOC) is sensitive enough to detect subtle changes in the functional level of the shoulder or elbow in overhead athletes. However, a Japanese version of the KJOC is not yet available. Moreover, the original KJOC uses a visual analog scale (VAS) assessment format that requires a print version so that users can add a check mark along a horizontal line. The KJOC can be completed using online tools such as Google Forms if a 10-point scale format can be used with comparable results.</p><p><strong>Purposes: </strong>To (1) translate and cross-culturally adapt the KJOC into Japanese (KJOC-J) and assess its validity and (2) evaluate the correlation between a standard VAS format and a 10-point scale format (KJOC-J10).</p><p><strong>Study design: </strong>Cohort study (Diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>In total, 318 athletes participated in the validation study, 255 in the test-retest reliability study for the KJOC-J, and 273 in the validation study for the KJOC-J10. Internal consistency was evaluated using the Cronbach alpha. Validity was evaluated by calculating the correlation between the KJOC-J and the Disability of the Arm, Shoulder and Hand (DASH). Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The validity of the KJOC-J10 was evaluated by calculating the correlation between the KJOC-J10 and KJOC-J.</p><p><strong>Results: </strong>The Cronbach alpha was 0.914, indicating good internal consistency. The KJOC-J was moderately correlated with the DASH (<i>r</i> = -0.581; <i>P</i> < .001) and had good test-retest reliability (ICC, 0.874). A strong correlation was found between the KJOC-J and KJOC-J10 (<i>r</i> = 0.846; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>The study results demonstrated good internal consistency, validity, and reliability for the KJOC-J, indicating that it is a valid assessment tool for shoulder and elbow functions in Japanese overhead athletes. Moreover, a strong correlation was found between the VAS and 10-point formats of the KJOC-J.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241291861"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Elbow Flexion in Youth Baseball Pitchers With and Without Throwing-Arm Pain.","authors":"Adam R Nebel, Anthony W Fava, Nicole M Bordelon, Gretchen D Oliver","doi":"10.1177/23259671241290841","DOIUrl":"10.1177/23259671241290841","url":null,"abstract":"<p><strong>Background: </strong>More than half of all youth baseball pitchers report throwing-related pain in their throwing arm throughout a season.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to investigate differences in elbow flexion throughout the pitching cycle between youth baseball pitchers with and without throwing-arm pain. It was hypothesized that pitchers with throwing-arm pain would have decreased elbow flexion throughout the pitching cycle compared with those who were pain-free.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 38 youth baseball pitchers (mean age, 13.3 ± 1.7 years; height, 164.4 ± 12.9 cm; weight, 57.1 ± 14 kg) were retrospectively selected from a database. Based on responses to a health history questionnaire, the pitchers were placed into a pain group if they indicated they were experiencing throwing-arm pain. Pitchers who indicated they were not experiencing throwing-arm pain were matched according to age, height, and weight to the pain group. All pitchers threw 3 fastballs to a catcher at the regulation distance. The mean elbow flexion of the 3 trials was used during analysis to investigate peak elbow flexion and time-normalized (0%-100%) elbow flexion across the pitch cycle (stride-foot contact to ball release). Elbow flexion was compared between the pain and pain-free groups using 1-dimensional statistical nonparametric mapping, and the mean peak elbow flexion between groups was compared using the Mann-Whitney <i>U</i> test.</p><p><strong>Results: </strong>No significant differences were observed between the groups in elbow flexion throughout the pitching cycle (<i>P</i> > .05) and no group differences in peak elbow flexion (<i>U</i> = 122; <i>P</i> = .09).</p><p><strong>Conclusion: </strong>Study findings indicated no significant differences in elbow flexion between youth baseball pitchers with versus without throwing-arm pain, unlike previous research reporting that pitchers with a history of medial elbow pain had altered elbow flexion and higher pitch velocities compared with those without a history of pain.</p><p><strong>Clinical relevance: </strong>Clinicians should consider other potential factors related to throwing-arm pain beyond elbow flexion. Moreover, it is advisable to focus on evidence-based modifiable factors shown to increase the risk of pain and injury in youth pitchers, such as exceeding pitch counts, number of innings pitched, increased training time, range-of-motion, and strength deficits.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241290841"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676254","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 Impact of Biological Augmentation on Failure Rates and Complications in Acute Patellar Tendon Rupture Surgery Compared With Isolated Repair.","authors":"Rodrigo Olivieri, José Ignacio Laso, Nicolás Franulic, José T Muñoz, Jaime Ugarte, Piero Innocenti","doi":"10.1177/23259671241288848","DOIUrl":"10.1177/23259671241288848","url":null,"abstract":"<p><strong>Background: </strong>Patellar tendon ruptures are infrequent but disabling injuries. Surgical treatment is the gold standard to obtain good outcomes, and numerous techniques have been described. Biomechanical studies report better results when augmented techniques are used. However, there is a lack of consensus regarding the best standard technique.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to assess a cohort of patients with acute patellar tendon rupture that was surgically treated and to compare the clinical outcomes of 2 groups: isolated repair and biological augmentation techniques with autograft or allograft. It was hypothesized that the biological augmentation group would have better clinical outcomes than the isolated repair group.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>All patients with acute patellar tendon rupture surgically treated in our center between 2016 and 2022 were retrospectively reviewed. Patient and rupture characteristics, surgical technique, clinical outcomes, and complications were recorded. The primary outcome was rerupture rate, and secondary outcomes were infection rate, stiffness >15° of knee flexion deficit, and extensor mechanism lag >5°.</p><p><strong>Results: </strong>The study included 34 patients with 36 operated knees (2 patients with bilateral rupture). The mean age was 44.9 years. Isolated repair was performed in 20 knees (55.6%), and 16 knees underwent repair and biological augmentation with autograft or allograft. Both groups were comparable in terms of their demographic characteristics. A statistically significant association was found between the type of surgery and tendon rerupture. Of the patients in the isolated repair group, 5 of 20 (25%) experienced a failure, whereas in the biological augmentation group, no reruptures were recorded (<i>P</i> = .031). However, no statistically significant associations were found between the type of surgery and other complications, such as the development of stiffness (<i>P</i> = .54), residual extension lag >5° (<i>P</i> = .87), or the development of infection (<i>P</i> = .25).</p><p><strong>Conclusion: </strong>In this cohort of patients, biological augmentation reduced the rate of surgical failure for acute patellar tendon rupture without being associated with a higher risk of complications such as stiffness, residual extension lag, or the development of infection.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241288848"},"PeriodicalIF":2.4,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676265","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 Pain Control After ACL Reconstruction With Semitendinosus Tendon Graft: A Randomized Controlled Trial Comparing Adductor Canal Block to Local Infiltration Analgesia.","authors":"Sermsak Sumanont, Khananut Jaruwanneechai, Aumjit Wittayapairoj, Punyawat Apiwatanakul, Artit Boonrod","doi":"10.1177/23259671241292604","DOIUrl":"10.1177/23259671241292604","url":null,"abstract":"<p><strong>Background: </strong>Both adductor canal block (ACB) and local infiltration (LI) are effective for postoperative pain management after arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction (ACLR). While LI is a more straightforward procedure, its effectiveness remains debated.</p><p><strong>Purpose: </strong>To evaluate morphine consumption within 48 hours after ACLR with a semitendinosus tendon graft, comparing ACB and LI; secondary objectives: to evaluate pain levels, patient satisfaction, quadriceps strength, range of knee motion, and complications.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 1.</p><p><strong>Methods: </strong>Patients undergoing primary ACLR with a semitendinosus tendon graft were randomized to receive either ACB (0.25% bupivacaine; 20 mL) or LI at the surgical wound, graft harvest area, and intra-articular injection. The LI group received morphine (3 mg), ketorolac (30 mg), and tranexamic acid (1 g). Morphine consumption within 48 hours was monitored using an intravenous patient-controlled analgesia device.</p><p><strong>Results: </strong>A total of 48 patients were analyzed (n = 24 in each group); baseline characteristics were similar between groups. The LI group consumed significantly less morphine than the ACB group at 6 hours (median [interquartile range, IQR], 3 mg [0-4.8 mg] for the LI group vs 5.5 mg [2-9] for the ACB group; <i>P</i> = .003). However, no significant differences were observed in morphine consumption at other time points. Additionally, no significant difference was found in cumulative morphine consumption at 48 hours between the groups (median [IQR], 21.5 mg [11-34.5 mg] for the ACB group vs 16.5 mg [8.5-21.8 mg] for the LI group; <i>P</i> = .137). Postoperative pain scores, quadriceps strength, and patient satisfaction were similar between the 2 groups.</p><p><strong>Conclusion: </strong>Morphine consumption at 48 hours postoperatively was comparable between the LI and ACB groups, and no significant group differences were found in postoperative pain, quadriceps strength, or patient satisfaction.</p><p><strong>Registration: </strong>TCTR20190320003 (Thai Clinical Trial Registry).</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241292604"},"PeriodicalIF":2.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648063","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 of the Universal Designated Hitter Rule With Changes to Injuries in Major League Baseball Pitchers.","authors":"Eric Kholodovsky, Dylan Luxenburg, Blake Hodgens, Kevin Liebmann, Michael Baraga","doi":"10.1177/23259671241292655","DOIUrl":"10.1177/23259671241292655","url":null,"abstract":"<p><strong>Background: </strong>In 2022, Major League Baseball (MLB) implemented the universal designated hitter (DH) rule, thus allowing the pitcher to focus solely on defense while the DH, who bats for the pitcher, focuses solely on offense.</p><p><strong>Purpose/hypothesis: </strong>The purpose of our study was to determine if implementation of the universal DH rule affected the incidence of injuries in MLB pitchers when compared with before implementation. It was hypothesized that the shift to the universal DH rule would be associated with a decrease in the rate of offense-related pitcher injuries.</p><p><strong>Study design: </strong>Descriptive epidemiology study.</p><p><strong>Methods: </strong>Using publicly available data, we identified injuries sustained by MLB pitchers during the 2021 (before the DH rule change) and 2022 (after the rule change) regular seasons. Pitchers placed on the injured list for non-gameplay related reasons were excluded. Statistical analysis was performed with the chi-square and independent <i>t</i> tests.</p><p><strong>Results: </strong>The injury incidence rate decreased significantly from before to after the rule change for MLB pitchers overall (from 6.58 to 5.60 injuries/1000 athlete game-exposures [AGE]; <i>P</i> = .02) and for National League pitchers (from 7.62 to 6.26 injuries/1000 AGE; <i>P</i> = .04). No significant changes were seen in American League pitchers (<i>P</i> = .20). Injury locations that decreased from before to after the rule change were the thigh (from 0.52 to 0.21 injuries/1000 AGE; <i>P</i> = .003) and the hand/finger/wrist (from 0.63 to 0.30 injuries/1000 AGE; <i>P</i> = .01). Total time lost decreased from 9471 days before the rule change to 8857 days after the rule change (<i>P</i> = .00001).</p><p><strong>Conclusion: </strong>Implementation of the universal DH rule was associated with a decrease in pitcher injuries overall and within the National League. Injuries to the thigh and hand/finger/wrist also decreased overall and within the National League. Furthermore, total days lost decreased from before to after the rule change. These findings may be due to the elimination of offensive gameplay requirements for pitchers, which highlights a positive consequence of the universal DH rule, but further studies are needed.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241292655"},"PeriodicalIF":2.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648153","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}