Orthopaedic Journal of Sports Medicine最新文献

{"title":"Complications and Radiographic Outcomes of Tibial Tubercle Osteotomy at Minimum 5-Year Follow-up.","authors":"Sercan Yalcin, Karrington Seals, Peter Joo, John P Fulkerson, Lutul D Farrow","doi":"10.1177/23259671241278722","DOIUrl":"10.1177/23259671241278722","url":null,"abstract":"<p><strong>Background: </strong>Tibial tubercle osteotomy (TTO) is a commonly utilized surgery in the treatment of patellofemoral instability and chondrosis. A number of case series studies have reported on the mid- and long-term outcomes with varying complication rates.</p><p><strong>Purpose: </strong>To report the incidence of major complications after TTO and the rate of progression of knee osteoarthritis at midterm follow-up.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>All patients who underwent primary TTO between January 1, 2010 and December 31, 2015, and who had ≥5 years of clinical follow-up data were included. Patient demographics and clinical and radiographic outcomes were recorded. Risk factors for complications were identified using multivariate logistic regression analysis.</p><p><strong>Results: </strong>A total of 72 patients were included. The mean follow-up period was 104.8 months (range, 67-138 months). The overall complication rate was 38.9% (28/72 patients), and the incidence of major complications was 6.9%. Univariate logistic regression analysis revealed that patients with a history of smoking were more likely to experience a complication (odds ratio = 4.33 [95% CI, 1.29-14.53]; <i>P</i> = .02). Multivariate analysis with TTO as the main predictor indicated that complication rates were not affected by TTO procedure (TTO vs TTO+other), number of screws, or distalization. There was also no difference between anteromedialization and medialization TTO techniques. The rate of patients with Kellgren-Lawrence grade 3 to 4 increased from 12.0% preoperatively to 23.9% at the final follow-up. New osteophyte formation was detected in 5.8% of patients on anteroposterior radiographs and in 9.1% of patients on lateral radiographs.</p><p><strong>Conclusion: </strong>In the current study, TTO was found to have a major complication rate of 6.9% at midterm follow-up. Smoking was a risk factor for major complications. Only 11.9% of patients had progression in tibiofemoral osteoarthritis at midterm follow-up.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241278722"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11489970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471779","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":"A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.","authors":"Ryan T Conyer, Emmett J Cleary, Allen S Wang, Alex M Boos, Matthew M Crowe, Kostas J Economopoulos, Aaron J Krych, Bruce A Levy, Mario Hevesi","doi":"10.1177/23259671241277793","DOIUrl":"https://doi.org/10.1177/23259671241277793","url":null,"abstract":"<p><strong>Background: </strong>The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques.</p><p><strong>Purposes: </strong>To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022.</p><p><strong>Results: </strong>A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m²) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (<i>P</i> < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (<i>P</i> < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (<i>P</i> < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022.</p><p><strong>Conclusion: </strong>There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241277793"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471764","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 a Novel Modified PLA/HA Bioabsorbable Interference Screw With Conventional PLGA/β-TCP Screw: Effect on 1-Year Postoperative Tibial Tunnel Widening in a Canine ACLR Model.","authors":"Chuan Jiang, Huaming Peng, Yang Sun, Sicheng Xu, Weiping Li, Yucheng Huang, Dong Xiang, Xiaoshan Fan, Jinzhong Zhao, Chaobin He, Bin Song","doi":"10.1177/23259671241271710","DOIUrl":"https://doi.org/10.1177/23259671241271710","url":null,"abstract":"<p><strong>Background: </strong>Tibial bone tunnel widening (TW) is a common postoperative phenomenon after anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Purpose: </strong>To compare the physical, biomechanical, osteoinductive, and histological characteristics of 2 fabricated bioabsorbable interference screws: (1) a modified poly(l-lactide-<i>co</i>-d, l-lactide) and hydroxyapatite (mPLA/HA) screw and (2) a poly(l-lactide-<i>co</i>-glycolide) and β-tricalcium phosphate (PLGA/β-TCP) screw; and to evaluate the effect of the PLA/HA screw on ameliorating postoperative TW in a canine ACLR model.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>In vitro, the physical and biomechanical properties of the mPLA/HA and PLGA/β-TCP screws were tested. The osteoinductive activity of the screws was studied by cell experiments. In vivo, ACLR was performed on 48 beagle dogs, divided into the mPLA/HA group and the PLGA/β-TCP group. The femoral and tibial ends of the graft were both fixed with screws. Six animals in each group were sacrificed after live computed tomography (CT) scanning at 1, 3, 6, and 12 months postoperatively. For six knee samples of each group, three knee samples underwent biomechanical testing, and 1 of them, along with the other 3 samples, underwent micro-CT and histological examination to evaluate tibial TW.</p><p><strong>Results: </strong>The mPLA/HA screw exhibited better particle dispersion, bending strength, desirable self-locking effect, and optimized degradation behavior both in vivo and in vitro. Histologically, the mPLA/HA screw had comparative osteoinductive activity. There was good screw-bone integration using the mPLA/HA screw, while most fibrous scar healing was in the PLGA/β-TCP group. There were significant differences between the mPLA/HA and PLGA/β-TCP groups in tibial bone tunnel diameter at the screw body (6 months postoperatively: 5.09 ± 0.44 vs 7.12 ± 0.67; 12 months postoperatively: 4.83 ± 0.27 vs 6.23 ± 0.56; <i>P</i> < .01 for both) and the screw tail (6 months postoperatively: 4.84 ± 0.28 vs 5.97 ± 0.73; 12 months postoperatively: 4.77 ± 0.29 vs 5.92 ± 0.56; <i>P</i> < .01 for both).</p><p><strong>Conclusion: </strong>Compared with the PLGA/β-TCP screw commonly used in clinics at present, the mPLA/HA screw had comparative biosafety and mechanical properties, satisfactory biomechanical properties, and osteoinductive activity in vivo and in vitro. It effectively ameliorated the postoperative tibial TW in a canine ACLR model and increased the quality of screw-bone integration.</p><p><strong>Clinical relevance: </strong>The good mechanical and biological properties of the mPLA/HA screws may provide an option to reduce the incidence of complications after ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241271710"},"PeriodicalIF":2.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471778","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":"Determining the Patient Acceptable Symptom State (PASS) for Shoulder Strength After Subscapularis Arthroscopic Repair and Evaluating the Preoperative Predictors for PASS Achievement.","authors":"Diego Gonzalez-Morgado, Javier Ardebol, Ali Ihsan Kilic, Matthew B Noble, Lisa A Galasso, Mariano E Menendez, Patrick J Denard","doi":"10.1177/23259671241280736","DOIUrl":"10.1177/23259671241280736","url":null,"abstract":"<p><strong>Background: </strong>Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength.</p><p><strong>Purpose: </strong>To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths.</p><p><strong>Results: </strong>The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.</p><p><strong>Conclusion: </strong>This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241280736"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400901","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 Quadriceps Tendon Autograft Preparation and Fixation on Graft Laxity During Suspensory Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis.","authors":"Asheesh Bedi, Benjamin L Smith, Justin J Mitchell, Rachel M Frank, Oliver L Hauck, Coen A Wijdicks","doi":"10.1177/23259671241288578","DOIUrl":"10.1177/23259671241288578","url":null,"abstract":"<p><strong>Background: </strong>Favorable collagen fibril density and thickness combined with advances in graft preparation and fixation have significantly increased interest in the quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction. While various suspensory techniques have been described, the biomechanical profile of these constructs is largely undefined.</p><p><strong>Purpose: </strong>To compare the biomechanics of suspensory techniques for soft tissue QT autograft fixation in an in vitro model of ACL reconstruction.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Full-thickness QT grafts were harvested using a 9-mm graft blade. Adjustable-loop devices (ALDs) were secured to the graft (n = 6 per group) with a combination implant containing the ALD and suture tape-reinforced whipstitching (tape-reinforced [TR] group), tethered superficially to the graft with a whipstitch (onlay [OL] group), luggage-tagged through and around the graft (luggage tag [LT] group), or staggered behind superficial suturing (staggered [SG] group). Grafts were tested on an electromechanical testing machine following a validated in vitro reconstruction model of intraoperative workflow and postoperative ACL kinematics, cyclic loading, and load to failure.</p><p><strong>Results: </strong>The TR group had significantly less postcyclic tension loss (mean, 24%) compared with the OL (56%; <i>P</i> = .002), LT (69%; <i>P</i> < .001), and SG (90%; <i>P</i> < .001) constructs. Cyclic elongation was below the 3.0-mm threshold defined as clinical failure for TR (1.6 mm), but not for OL (3.3 mm), LT (7.9 mm), and SG (11.3 mm). All constructs were within native ACL stiffness limits (220 ± 72 N/mm) without significant differences. Ultimate loads significantly exceeded a normal ACL loading limit of 454 N for TR (739 N; <i>P</i> = .023), OL (547 N; <i>P</i> = .020), and LT (769 N; <i>P</i> = .001), but not for SG (346 N; <i>P</i> = .236).</p><p><strong>Conclusion: </strong>The TR ALD construct demonstrated the most favorable time-zero biomechanical properties of modern soft tissue QT suspensory constructs, with 32% less tension loss and 52% less cyclic elongation versus the closest construct. Failure loading of all constructs was acceptable with respect to the native ACL except for the SG group, which had suboptimal ultimate load.</p><p><strong>Clinical relevance: </strong>TR ALD implants may protect soft tissue QT autografts before graft-bone healing in ACL reconstruction by minimizing time-zero laxity and fixation failure.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241288578"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400902","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":"Residual Performance and Biomechanical Asymmetries During Jumping Tasks in Female Athletes at 9 Months After Anterior Cruciate Ligament Reconstruction.","authors":"Berit Flora Warnecke, Chris Richter, Enda King, Florian Kurt Paternoster","doi":"10.1177/23259671241276826","DOIUrl":"10.1177/23259671241276826","url":null,"abstract":"<p><strong>Background: </strong>Biomechanics and anterior cruciate ligament injury mechanisms differ in males and females. There is a need for more data on between-limb biomechanical differences after anterior cruciate ligament reconstruction (ACLR) in females.</p><p><strong>Purpose: </strong>To explore biomechanical asymmetries throughout the kinetic chain during the single-legged (SL) and double-legged (DL) countermovement jump (CMJ) and drop jump (DJ) in female athletes after ACLR.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Kinematic and kinetic between-limb differences were analyzed during the SL and DL CMJ and DJ in 67 female athletes 9 months after ACLR. Biomechanical and performance asymmetries between limbs during the jumps and isokinetic strength testing were analyzed with statistical parametric mapping. The entire stance phase was used for the paired <i>t</i> tests of the biomechanical variables, with Cohen <i>d</i> effect sizes of significant portions of the stance phase (reported as % of stance) calculated in a point-by-point manner.</p><p><strong>Results: </strong>Decreased vertical ground-reaction force, internal knee abduction moment, knee internal rotation angle, hip external rotation angle, internal ankle eversion, and external rotation moments were seen in the ACLR limb during all 4 vertical jump tests. The greatest number and highest value of differences were found during the DLDJ, with asymmetries having medium to large effect sizes. They tended to appear more frequently in the concentric phase (50% to 100% of stance) during the SLCMJ and DLCMJ and in the eccentric (0% to 49% of stance) and concentric (50% to 100% of stance) phase during the SLDJ and DLDJ. For the SLCMJ, SLDJ, and quadriceps strength, performance asymmetries of >15% were detected but not for change of direction.</p><p><strong>Conclusion: </strong>The findings suggest that return-to-play testing in female athletes should examine the entire stance phase and include assessments of kinetic and kinematic variables throughout the kinetic chain. Greater deficits were highlighted in the DJ than in the CMJ, and greater performance asymmetries were evident in the SL tasks, with greater kinetic and kinematic and compensatory strategies evident in the DL tests.</p><p><strong>Clinical relevance: </strong>Biomechanical analysis focusing on contralateral compensation strategies and sex-specific interventions are necessary before return to play.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241276826"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400903","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":"Risk Factors for High Repair Tension During Rotator Cuff Repair.","authors":"Satoshi Miyake, Terufumi Shibata, Shunsuke Kobayashi, Kei Matsunaga, Naofumi Hata, Yozo Shibata, Teruaki Izaki, Takuaki Yamamoto","doi":"10.1177/23259671241276445","DOIUrl":"https://doi.org/10.1177/23259671241276445","url":null,"abstract":"<p><strong>Background: </strong>Excessively high repair tension, especially tension ≥10 N, can lead to unsuccessful rotator cuff repair.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to identify the preoperative risk factors for high repair tension in rotator cuff repair. It was hypothesized was that older age, longer symptom duration, nontraumatic (ie, degenerative) tear onset, progressive fatty degeneration, and larger tear size would be among the risk factors.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective study involved 80 patients (80 shoulders) diagnosed with rotator cuff tears by magnetic resonance imaging between July 2018 and August 2020. Repair tension was measured intraoperatively using a digital tension meter. Risk factors for high repair tension (≥10 N) were evaluated. The <i>t</i> test was used to assess the relationship of repair tension with patient characteristics and surgical parameters. Parameters with a <i>P</i> value of <.05 in the univariate analysis were entered into a multivariate logistic regression model to determine their relationship with repair tension ≥10 N.</p><p><strong>Results: </strong>Symptom duration of ≥4 months, nontraumatic tear onset, large/massive tears, mediolateral (ML) tear length of ≥20 mm, and anteroposterior (AP) tear length of ≥18 mm were associated with high odds of repair tension ≥10 N (<i>P</i>≤ .013 for all). Multivariate analysis showed that nontraumatic onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm were independent risk factors for repair tension ≥10 N (<i>P</i>≤ .035 for all).</p><p><strong>Conclusion: </strong>The independent risk factors for high repair tension (≥10 N) during rotator cuff repair were nontraumatic tear onset, ML tear length of ≥20 mm, and AP tear length of ≥18 mm. Symptom duration of ≥4 months and large/massive tears were associated with high odds of repair tension ≥10 N, although they were not considered independent risk factors. Prospective cohort studies with larger sample sizes are needed to confirm the clinical value of the risk factors identified in this study.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241276445"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471803","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":"Ratio of Tibial Tubercle-Trochlear Groove Distance to Patellar Width as a Predictor of Patellar Dislocation: Analysis of Individualized Tibial Tubercle Lateralization Parameters.","authors":"Yurou Chen, Wei Tian, Mao Yuan, Haitao Yang, Fajin Lv, Furong Lv, Jia Li","doi":"10.1177/23259671241276446","DOIUrl":"10.1177/23259671241276446","url":null,"abstract":"<p><strong>Background: </strong>Available conventional tibial tubercle lateralization (TTL) parameters fail to account for individual patient size or anatomy.</p><p><strong>Purposes: </strong>To evaluate the predictive ability of individualized TTL parameters and clarify the best predictor of patellar dislocation (PD) and to determine the relationship of the best predictor with other risk factors of PD with quadriceps isotonic contraction.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 2.</p><p><strong>Methods: </strong>A total of 15 patients with PD (28 knees) and 14 controls (28 knees) underwent 4-dimensional computed tomography, and the image with the knee fully extended and quadriceps isotonically contracted was selected for evaluation. The following TTL parameters were measured on the images: tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-Roman arch distance, and tibial tubercle-posterior cruciate ligament distance, as well as their ratios to femoral condylar width and patellar width (PW). In addition, the following parameters were measured: Insall-Salvati ratio, Blackburne-Peel ratio, Caton-Deschamps ratio, modified Insall-Salvati ratio, bisect offset index, congruence angle, lateral patellar tilt, lateral trochlear inclination, sulcus depth, sulcus angle, trochlear groove medialization, patella-patellar tendon angle, patellofemoral axis angle (P-FAA), patellar articular facet-patellar tendon angle, patellar articular facet-femoral axis angle (PA-FAA), and patellar shape according to Wiberg type. The area under the receiver operating characteristic curve (AUC) was calculated to access the diagnostic accuracy of the TTL parameters for PD, and the TTL parameters with high diagnostic ability were evaluated for correlation with the remaining parameters.</p><p><strong>Results: </strong>The TT-TG/PW ratio had the best diagnostic ability for PD (AUC = 0.890). The TT-TG/PW ratio was positively correlated with bisect offset index, congruence angle, lateral patellar tilt, P-FAA and PA-FAA (<i>r</i> = 0.610, 0.465, 0.635, 0.553 and 0.418, respectively; <i>P</i>≤ .027 for all), and TT-TG/PW ratio was greater in knees with type II versus type III patella (<i>P</i> = .017).</p><p><strong>Conclusion: </strong>With the knee fully extended and quadriceps isotonically contracted, the TT-TG/PW ratio was found to be the best predictor of PD and reflected individualized TTL, which helps with clinical preoperative planning.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241276446"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With a Successful Return to Performance After Anterior Cruciate Ligament Reconstruction: A Multiparametric Evaluation in Soccer Players.","authors":"Michele Mercurio, Simone Cerciello, Katia Corona, Germano Guerra, Roberto Simonetta, Filippo Familiari, Olimpio Galasso, Giorgio Gasparini","doi":"10.1177/23259671241275663","DOIUrl":"10.1177/23259671241275663","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) is highly recommended in patients with ACL deficiency who must perform at a high physical level. A combination of functional and psychological outcome measures is necessary to provide a comprehensive evaluation of functional status after successful return to sport after ACLR.</p><p><strong>Purpose: </strong>To identify factors associated with higher functional outcomes among soccer players who had returned to full sports participation after ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 168 out of 231 patients who underwent primary unilateral arthroscopic anatomic single-bundle ACLR were available at follow-up. Postoperatively, knee function, generic health outcomes, and psychological impact were assessed using the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm Knee Scoring Scale, the 12-item Short Form Health Survey (SF-12), and the ACL-Return to Sport after Injury scale.</p><p><strong>Results: </strong>After a mean follow-up of 35.5 ± 22.6 months, 85% of soccer players returned to performance. Midfielder position was associated with a better SF-12 Physical Component Summary (PCS) score (<i>P</i> = .013), IKDC (<i>P</i> = .003), total KOOS (<i>P</i> < .001), KOOS Symptoms (<i>P</i> = .004), KOOS Pain (<i>P</i> = .029), KOOS Activities of Daily Living (ADL) (<i>P</i> = .044), KOOS Sport and Recreation (Sport/Rec) (<i>P</i> = .001), KOOS Quality of Life (QoL) (<i>P</i> < .001), and Lysholm score (<i>P</i> = .008). Playing only on natural grass was associated with lower SF-12 PCS scores (<i>P</i> = .003), total KOOS (<i>P</i> = .001), and KOOS Sport/Rec (<i>P</i> = .011). Playing only on artificial turf was associated with lower Lysholm score (<i>P</i> = .018) and total KOOS (<i>P</i> = .014). The contact mechanism was associated with higher IKDC (<i>P</i> = .044) and KOOS QoL (<i>P</i> = .048), and injury affecting the dominant limb was associated with lower SF-12 Mental Component Summary scores (<i>P</i> = .012). Playing at a nonprofessional level was associated with lower total KOOS (<i>P</i> = .028), KOOS Symptoms (<i>P</i> = .002), KOOS ADL (<i>P</i> = .033), and KOOS Sport/Rec (<i>P</i> = .016).</p><p><strong>Conclusion: </strong>Professional soccer players and the midfielder position are associated with better functional scores upon returning to the sport. A history of noncontact ACL injury and playing on a single type of surface are associated with lower functional outcomes upon returning to the sport. Lower mental health scores can be expected after injury of the dominant limb.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241275663"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142471794","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":"Clinical Effects of Additional Platelet-Rich Plasma Application to Exercise Therapy in Patients with Subacromial Impingement Syndrome: A Double-Blind Randomized Controlled Trial.","authors":"Nezih Ziroglu, Yasemin Şahbaz","doi":"10.1177/23259671241276368","DOIUrl":"10.1177/23259671241276368","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Exercise therapy (ET) is the main and initial treatment modality for treating subacromial impingement syndrome (SIS). The isolated or combined use of platelet-rich plasma (PRP) applications in treating SIS is increasing and promising. A comparison was made on the effectiveness of ET alone and in combination with PRP on pain, functionality, and quality of life (QoL) in patients with SIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purposes/hypothesis: &lt;/strong&gt;The purposes of this study were to (1) investigate the possible positive effects of PRP injections combined with ET in treating SIS on pain, functionality, and QoL and (2) propose an alternative treatment protocol. It was hypothesized that the group receiving PRP applications in addition to ET would have a better QoL due to less pain and higher functionality 6 months after treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Randomized controlled trial; Level of evidence, 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Volunteer patients diagnosed with SIS were included based on history and physical examination findings. All participants underwent magnetic resonance imaging to confirm the diagnosis and exclude possible accompanying pathologies. The patients were randomly divided into 2 groups. The first group underwent ET at home for 8 weeks (ET group), and the second group received the same ET program and an additional 2 PRP injections, at the beginning of the study and the end of the fourth week (PRP group). Patients were evaluated initially and 6 months after the treatment using the visual analog scale (VAS) for pain score, Constant-Murley Score (CMS), and the 36-Item Short Form Health Survey (SF-36). The Kolmogorov-Smirnov test determined the conformity of the data to a normal distribution, chi-square analysis was used to compare categorical variables between groups, and the Mann-Whitney &lt;i&gt;U&lt;/i&gt; test was used to compare continuous and intergroup variables. Intragroup changes before and after treatment were evaluated with the Wilcoxon signed-rank test. &lt;i&gt;P&lt;/i&gt; &lt; .05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 67 patients were initially enrolled; 5 were excluded and 6 were lost to follow-up (1 because of a COVID diagnosis). Thus, 56 patients (56 shoulders) were included for analysis. There were 28 patients in the ET group and 28 patients in the PRP group. There were no statistical differences between groups regarding participant characteristics and clinical evaluations before treatment. A statistically significant improvement was observed in pain (VAS subgroups), functionality (CMS subgroups), and QoL (SF-36 subgroups) evaluations of patients in both the ET and the PRP groups compared with before the treatment and 6 months after treatment (&lt;i&gt;P&lt;/i&gt; &lt; .05). At the 6-month posttreatment evaluation, the PRP group was statistically significantly superior to isolated ET in terms of VAS rest (&lt;i&gt;P&lt;/i&gt; = .001) and night (&lt;i&gt;P&lt;/i&gt; = .004) scores. This superiority was als","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 10","pages":"23259671241276368"},"PeriodicalIF":2.4,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392253","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}