Orthopaedic Journal of Sports Medicine最新文献

{"title":"Distal Biceps Tendon Repair in Competitive Strength Athletes: A Retrospective Series of 183 Athletes.","authors":"Sebastian Lappen, Lorenz Fritsch, Maximilian Hinz, Lucca Lacheta, Sebastian Siebenlist, Mathias Ritsch","doi":"10.1177/23259671251322700","DOIUrl":"10.1177/23259671251322700","url":null,"abstract":"<p><strong>Background: </strong>Elbow injuries are common among strength athletes, particularly distal biceps tendon ruptures. These injuries can significantly affect athletes' performance and require effective treatment strategies to ensure optimal recovery and return to sport.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this retrospective cohort study was to evaluate the patient-reported outcomes, return-to-sport rate, and postoperative strength of competitive strength athletes who underwent distal biceps tendon repair. It was hypothesized that patients would show excellent patient-reported outcomes on validated questionnaires and exhibit high rates of return to sport as well as high subjective strength levels.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective chart review was performed for cases of distal biceps tendon repair in athletes competing in strength sports, such as weightlifting and powerlifting, between August 2003 and July 2020. The preoperative and postoperative sporting activity, mechanism of injury, and complications were assessed. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Additionally, the athletes were asked to rate their elbow strength as a percentage compared with their uninjured side.</p><p><strong>Results: </strong>A total of 183 patients were included (88% follow-up rate), with a mean follow-up of 69.6 ± 61.0 months. Among them, 168 underwent primary repair, while 15 underwent revision procedures, of which 7 involved allograft augmentation. All athletes were able to return to sport, and 73% of patients achieved full subjective strength of their affected arm. The median MEPS score was 100 (interquartile range, 100-100), and the median SANE score was 100 (interquartile range, 95-100). Multivariate linear regression analysis showed that an increased time between injury and surgery was associated with a decrease in the MEPS score (standard error [SE] = 0.002; <i>t</i> = -2.113; <i>P</i> = .036) and self-assessed strength (SE = 0.053; <i>t</i> = -3.183; <i>P</i> = .002). Graft usage was associated with a nonsignificant decrease in the SANE score (SE = 1.538; <i>t</i> = -1.791; <i>P</i> = .075). There were 28 complications (15%) that occurred, including 5 tendon retears (3%) and 1 intraoperative brachial artery injury (1%).</p><p><strong>Conclusion: </strong>Distal biceps tendon repair in competitive strength athletes resulted in a high return-to-sport rate and excellent recovery. However, delayed surgery negatively affected outcomes, and 27% of patients experienced persistent subjective strength deficits. Future research is needed to further optimize treatment strategies for athletes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 4","pages":"23259671251322700"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780789","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 Tibial Tubercle Osteotomy in Adult Patients on Patellar Height and Patellar Tendon Length.","authors":"Natalya E McNamara, Elaine Z Shing, Ameen Z Khalil, Joseph Featherall, Reece M Rosenthal, Travis G Maak, Stephen K Aoki, Justin J Ernat","doi":"10.1177/23259671251327418","DOIUrl":"10.1177/23259671251327418","url":null,"abstract":"<p><strong>Background: </strong>Patellar height (PH) constitutes an important component of patellofemoral biomechanics. Iatrogenic decrease in PH after knee procedures has been demonstrated for arthroplasty and high tibial osteotomy, among others. However, alterations in PH resulting from tibial tubercle osteotomy (TTO) have yet to be described.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to compare pre- and postoperative PH ratios and patellar tendon length (PL) in adult patients who have received an anteromedialization or medialization TTO. The authors hypothesized that TTO would result in PH alterations with trends toward patella baja.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>This was a retrospective review of adult patients receiving primary TTO +/- medial patellofemoral ligament reconstruction from 2013 to 2020. All patients had a minimum 6-month radiographic follow-up. Pre- and postoperative PH measurements were assessed with the Blackburne-Peel Index (BPI), Caton-Deschamps Index (CDI), Insall-Salvati Ratio (ISR), and PL. Paired <i>t</i> tests were performed for each measurement index comparing pre- and postoperative radiographs.</p><p><strong>Results: </strong>A total of 42 patients (64% women), with a mean age of 26.5 years (range, 18-51 years) and a mean radiographic follow-up of 19 months (6 -110 months) met the inclusion criteria. The mean preoperative PH using the BPI, CDI, and ISR were 0.99 ± 0.239, 1.20 ± 0.240, and 1.29 ± 0.206, respectively. The mean preoperative PL was 54.52 ± 7.23 mm. The mean postoperative PH using the BPI, CDI, and ISR were 0.95 ± 0.24, 1.16 ± 0.21, and 1.20 ± 0.19, respectively. The mean postoperative PL was 52.79 ± 7.25 mm. The mean differences between the pre- and postoperative were as follows: BPI: 0.04; CDI: 0.04; ISR: 0.08; and PL: 1.73 mm, none of which were statistically significant.</p><p><strong>Conclusion: </strong>While changes were observed in approximately 50% of patients, there were no statistically significant, nor predictable, alterations in PH after TTO using the BPI, CDI, ISR, or PL measurements at a minimum 6-month follow-up. Further large-scale studies are needed to determine the reliability of these PH findings and whether the changes are clinically impactful on surgeon decision-making and patient outcomes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 4","pages":"23259671251327418"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780791","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 Variations in Shoulder Biomechanics and Kinematics in the Abduction and External Rotation Position After Remplissage With Bankart Repair for Anterior Glenohumeral Instability: A Finite Element Analysis.","authors":"Shoulong Song, Fei Zhang, Xianhao Sheng, Wentao Xiong, Yuxin Xie, Yingguan Zhu, Ji Li, Yaqiong Zhu, Yangmu Fu, Yutong Sun, Yan Wang, Qiang Zhang, Ziang Li","doi":"10.1177/23259671251319509","DOIUrl":"10.1177/23259671251319509","url":null,"abstract":"<p><strong>Background: </strong>Remplissage with Bankart repair (RMBR) is an arthroscopic procedure performed on <25% of Bankart lesions with off-track Hill-Sachs lesions (HSLs) that alters the insertion of the infraspinatus muscle into the humeral head. However, the effects of RMBR surgery on humeral head displacement due to changes in biomechanics and kinematics have not been fully elucidated.</p><p><strong>Purpose: </strong>To evaluate how the biomechanical and kinematic effects of the post-RMBR glenohumeral joint influence humeral head displacement using the finite element analysis (FEA) method.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Biomechanical and kinematic experiments were performed on 24 established finite element (FE) models, which included 12 normal glenohumeral joint models and 12 post-RMBR glenohumeral joint models at the abduction and external rotation (ABER) position. FEA was used to compute the total displacement of the humeral head during passive anteroinferior loading and active contraction of the infraspinatus muscle.</p><p><strong>Results: </strong>Under passive anteroinferior loading, the humeral heads showed less total anterior displacement after RMBR than did normal glenohumeral joints in the ABER position (1.94 ± 0.48 vs 5.19 ± 1.91 mm; <i>P</i> = .003). When the infraspinatus muscle was stimulated to contract, the humeral heads of post-RMBR glenohumeral joints exhibited greater total posterior displacement in the ABER position than did the normal glenohumeral joints (4.22 ± 0.23 vs 2.44 ± 0.56 mm; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>Displacement of the humeral head is influenced by changes in the insertion of the infraspinatus tendon after RMBR surgery, which consequently affects the lever arm and torque generated by the infraspinatus muscle on the humeral head.</p><p><strong>Clinical relevance: </strong>The FEA results confirmed that a change in the insertion of the infraspinatus tendon alters the lever arm and torque produced by the infraspinatus muscle on the humeral head. This leads to changes in the displacement of the humeral head in the ABER position after the RMBR procedure. These findings deepen the understanding of RMBR surgery in clinical practice and can assist physicians in deciding whether to choose this surgical approach in patients with combined HSL.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 4","pages":"23259671251319509"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780805","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":"Psychometric Validation of the Persian Version of the Lysholm Score.","authors":"Fardis Vosoughi, Iman Menbari Oskouie, Mir Saeed Yekaninejad, Yelverton Tegner, Arash Sherafat Vaziri, Sohrab Keyhani, Mehran Soleymanha","doi":"10.1177/23259671251327682","DOIUrl":"10.1177/23259671251327682","url":null,"abstract":"<p><strong>Background: </strong>The Lysholm Knee Score (LKS) is a widely utilized patient-reported outcome measure for knee injury patients, due to its robust psychometric properties. It has been translated and validated in several languages, but it has not been translated into Persian.</p><p><strong>Purpose: </strong>To perform psychometric validation and cultural adaptation for the Persian version of the LKS (P-LKS) in patients with anterior cruciate ligament tears.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 3.</p><p><strong>Method: </strong>The LKS was translated into Persian using a forward-backward translation procedure. To assess the reliability and validity of the P-LKS, responses were gathered from 100 consecutive patients (mean age, 35 ± 13 years; 91 male and 9 female). These participants also fulfilled the Persian versions of the International Knee Documentation Committee Subjective Form (IKDC-SF) and the 36-Item Short Form Health Survey (SF-36). Construct validity was evaluated by correlating the scores from the P-LKS with those from the Persian IKDC-SF and SF-36. Reliability was determined by examining test-retest reliability and internal consistency. Additionally, floor and ceiling effects, as well as measurement errors, were assessed. The Bland-Altman method was utilized to evaluate absolute agreement.</p><p><strong>Results: </strong>Construct validity was strong, as >80% of the predetermined hypotheses regarding correlations between the P-LKS and other measures were verified. The P-LKS exhibited a high correlation with the Persian IKDC-SF (<i>r</i> = 0.92) and the physical component of the Persian SF-36 (<i>r</i> = 0.85). Bland-Altman analysis indicated no systematic bias among the test and retest phases. The test-retest reliability and internal consistency for the P-LKS were excellent (ICC = 0.97; Cronbach alpha = 0.88). Floor and ceiling effects for the overall score of the P-LKS were <15% (0% and 2%, respectively). The standard error of measurement was 1.04; the minimal detectable change at the individual level was 2.88, and at the group level, it was 0.29.</p><p><strong>Conclusion: </strong>The study demonstrated that the P-LKS successfully preserved the attributes of the original version. It can be regarded as a reliable tool for Persian-speaking patients with complete anterior cruciate ligament tear.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 4","pages":"23259671251327682"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The In Situ Force and Contribution of Each Ligamentous Band of the Deltoid Ligament in Ankle Joint Stability: A Cadaveric Biomechanical Study.","authors":"Katsunori Takahashi, Atsushi Teramoto, Yasutaka Murahashi, Kousuke Shiwaku, Tomoaki Kamiya, Makoto Emori, Kota Watanabe, Hiromichi Fujie","doi":"10.1177/23259671251327406","DOIUrl":"10.1177/23259671251327406","url":null,"abstract":"<p><strong>Background: </strong>Each band of the deltoid ligament cooperatively contributes to stability of the medial side of the ankle joint. Investigating the function of each band of the deltoid ligament is essential to assess abnormalities and develop treatment options.</p><p><strong>Purpose: </strong>To evaluate the changes in ankle kinematics when each band of the deltoid ligament is injured and to measure the in situ force of each ligamentous band in intact ankle kinematics.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>A total of 8 healthy fresh-frozen cadaveric legs were examined by applying forces through eversion and external rotation of the ankle joint using a 6 degrees of freedom robotic system. The deltoid ligament was separated into 6 discrete bands: tibionavicular ligament, tibiospring ligament, tibiocalcaneal ligament (TCL), anterior tibiotalar ligament, superficial posterior tibiotalar ligament (sPTTL), and deep posterior tibiotalar ligament; the bands were then sequentially transected. A loading test was performed in each model, and the changes in ankle motion and in situ force of each ligamentous band were measured using the robotic system.</p><p><strong>Results: </strong>When an eversion force was applied to the intact ankle, the in situ force of the sPTTL was 21.6 N in dorsiflexion and that of the TCL was 19.4 N in plantarflexion, both of which were significantly greater than those of the other ligamentous bands. Additionally, the amount of eversion under eversion loading increased significantly by 3.3° with sPTTL resection in dorsiflexion and by 4.2° with TCL resection in plantarflexion.</p><p><strong>Conclusion: </strong>The TCL and sPTTL play important roles among the ligamentous bands of the deltoid ligament. The sPTTL played a more significant role in ankle dorsiflexion, whereas the TCL played a more significant role in ankle plantarflexion.</p><p><strong>Clinical relevance: </strong>The TCL and sPTTL should receive attention in the treatment of deltoid ligamentous injuries.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 4","pages":"23259671251327406"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780876","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 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":"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":"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":"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}