Orthopaedic Journal of Sports Medicine最新文献

{"title":"Retrospective Clinical Outcomes of Ulnar Collateral Ligament Reconstruction in the Setting of an Ossified Ulnar Collateral Ligament.","authors":"Roger V Ostrander, Adam W Anz, Steve E Jordan, James Kee, Jessi Truett, Cooper Williams, James R Andrews","doi":"10.1177/23259671251344228","DOIUrl":"10.1177/23259671251344228","url":null,"abstract":"<p><strong>Background: </strong>The ulnar collateral ligament (UCL) plays a vital role in maintaining the stability of the elbow joint during overhead throwing activities. Stress to the UCL may lead to high-grade or full-thickness tears that require reconstruction or repair and lengthy rehabilitation in athletes. Workup of these injuries can sometimes reveal ossification in the ligament. It is unknown if ossification in the UCL affects postoperative outcomes.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to investigate whether different preoperative ossification conditions of the UCL might influence various clinical and return-to-play (RTP) outcomes in athletes undergoing UCL reconstruction (UCLR). It was hypothesized that patients with preoperative ossification conditions in the UCL who underwent reconstruction would experience comparable rates of RTP and level of competition compared with all players undergoing UCLR.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>An internal search was conducted to identify all cases of UCLR performed by 3 participating surgeons at the Andrews Institute between 2007 and 2022. Patients who had undergone primary UCLR and showed radiographic evidence of UCL ossification were included for analysis if they were ≥2 years after reconstruction. Retrospective chart reviews were performed for all included patients, and their radiographs were categorized by location of ossification. Differences in age, level of play, range of motion, and RTP status between patients with different ossification types were evaluated.</p><p><strong>Results: </strong>Between August 2007 and December 2022, 386 patients who underwent UCLR at the Andrews Institute were identified. Among these patients, 26% (n = 100) were found to have ossified UCLs. However, only 79 of these patients had complete medical records and were included in the analysis. Among the 79 athletes in this study with ossified ligaments, 71 (90%) who underwent UCLR returned to competitive sports. Athletes exhibited various classification conditions, including heavily calcified ligaments, calcified sublime tubercles, and humeral and/or ulnar-sided ossicles. No differences were found in the level of competitive RTP among the ossification groups.</p><p><strong>Conclusion: </strong>RTP rates in athletes with ossified ligaments are high and comparable with those in the literature across all ossification conditions.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251344228"},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485364","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":"Interposition Patches for Massive Rotator Cuff Tears: Helpful or Not? A Prospective Study of 164 Interposition Polytetrafluoroethylene Patches.","authors":"James Bilbrough, Ala Hawa, Mina Shenouda, Christyon Hayek, George A C Murrell","doi":"10.1177/23259671251333801","DOIUrl":"10.1177/23259671251333801","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;It is undetermined how well interposition polytetrafluoroethylene (PTFE) patch repairs for massive and irreparable rotator cuff tears perform in the longer term and whether the procedure can prevent proximal humeral migration, glenohumeral arthritis, and conversion to reverse total shoulder arthroplasty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To answer the following questions: (1) Do interposition PTFE patch repairs inserted for massive and irreparable rotator cuff tears improve patient pain and function, shoulder strength, and range of motion? (2) How long do interposition PTFE patches last? (3) Do interposition PTFE patches prevent proximal humeral migration and glenohumeral arthritis? (4) Do interposition PTFE patches prevent patient conversion to reverse total shoulder arthroplasty?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Case series; Level of evidence, 4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective cohort study of 164 consecutive patients with interposition PTFE patch repairs for massive and irreparable rotator cuff tears, with a median follow-up time of 26 months. Patient-reported pain and function, shoulder strength, and range of motion were assessed preoperatively, at 6 months postoperatively, and at the final follow-up. Ultrasound was used to assess PTFE patch integrity at 6 months postoperatively and at the final follow-up, and shoulder radiographs were taken at 6 months postoperatively and at the final follow-up. Kaplan-Meier survival analysis was used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients with intact PTFE patches on ultrasound had greater improvements in pain and function, strength, and range of motion at the final follow-up (median, 26 months; range, 6 months to 19 years) when compared with patients with nonintact PTFE patches (&lt;i&gt;P&lt;/i&gt; &lt; .05). Of 164 interposition PTFE patches, 50 (30%) functionally failed at a median time of 5 years. In the whole cohort, Kaplan-Meier analysis estimated that the median survivorship time of these PTFE patches was 7.4 years. Furthermore, patients with intact interposition PTFE patches demonstrated a 21% lower severity of glenohumeral arthritis (&lt;i&gt;P&lt;/i&gt; = .03) and a 46% lower incidence of proximal humeral migration (&lt;i&gt;P&lt;/i&gt; &lt; .001) than patients with nonintact interposition PTFE patches. At the final follow-up, 93% of participants were free from conversion to reverse total shoulder arthroplasty after interposition PTFE patch repair for a massive and irreparable rotator cuff tear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Based on the results of this study, interposition PTFE patch repairs for massive and irreparable rotator cuff tears were efficacious at improving patients' pain and function, strength, and range of motion. Patients with intact interposition PTFE patches were associated with reduced severity of glenohumeral arthritis and reduced incidence of proximal humeral migration. At the final follow-up, 93% of participants were free from conversion to reverse to","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251333801"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476230","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":"Biomechanical Comparison of Full-Thickness Versus Partial-Thickness Quadriceps Tendon Grafts for ACL Reconstruction.","authors":"Jalen Dansby, James Tibone, Dave T Huang, Andrew Nakla, Casey Batten, Melodie F Metzger","doi":"10.1177/23259671251342607","DOIUrl":"10.1177/23259671251342607","url":null,"abstract":"<p><strong>Background: </strong>The quadriceps tendon (QT) autograft is increasingly becoming the graft of choice for reconstructing of the anterior cruciate ligament (ACL), likely because recent clinical studies demonstrate low harvest-site morbidity and failure rates. Both full-thickness QT (FQT) and partial-thickness QT (PQT) graft techniques have been described for ACL reconstruction, but there is currently limited research to guide surgeons on which thickness is optimal.</p><p><strong>Purpose: </strong>To analyze and compare the material and mechanical properties of PQT and FQT grafts versus the standard patellar tendon (PT) graft.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 8 PQTs and 8 FQTs, each 10 mm wide, were harvested from the extensor mechanism from matched paired donors with a 10-mm PT graft. Specimens were loaded in tension to failure while load and displacement were continually recorded. Mechanical and material properties were calculated and compared using a 1-way analysis of variance.</p><p><strong>Results: </strong>FQT grafts had a greater cross-sectional area and were stronger and stiffer compared with PQT and PT grafts (<i>P</i> < .05). There were no significant differences in strength and stiffness between the PQT and PT grafts when loaded to failure. Both quadriceps grafts recorded a lower ultimate strain at failure compared with the PT grafts (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>The biomechanical results from this study demonstrate that PQT grafts have similar biomechanical properties to the current gold standard PT grafts.</p><p><strong>Clinical relevance: </strong>These results suggest PQT grafts are mechanically sufficient and may be preferred, as they do not carry concerns of residual postoperative weakness and knee pain that are associated with FQT and PT grafts, respectively.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251342607"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476227","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":"Validation of the Ligamentous-Fossa-Foveolar Complex (LFFC) Grading System With Clinical Correlation for Patients Undergoing Hip Arthroscopy.","authors":"Benjamin D Kuhns, Peter S Chang, Jarrod Brown, Vera M Stezelberger, Joseph J Ruzbarsky, Jonathan Godin, Leslie Vidal, Marc J Philippon","doi":"10.1177/23259671251340986","DOIUrl":"10.1177/23259671251340986","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pathology involving the acetabular fossa is often identified during hip arthroscopy, with many of the descriptive classification systems focusing on the ligamentum teres (LT). Recently, a novel grading system for ligamentous-fossa-foveolar complex (LFFC) lesions was introduced for open hip preservation surgery that included evaluation of the cotyloid fossa and perifoveal cartilage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To validate the LFFC grading system for hip arthroscopy and correlate these results with preoperative and intraoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study (diagnosis); Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;High-resolution arthroscopic images of the central compartment were obtained identifying the LT, cotyloid fossa, and perifoveal cartilage in a prospective series of patients undergoing hip arthroscopy. Each structure was graded according to increasing pathology on a scale of 0 to 4 based on a modified LFFC classification system to include the pulvinar intra-articular adipose tissue. Five surgeons graded the images, which were then randomized and regraded for intraobserver reliability. Agreement was quantified by the intraclass correlation coefficient (ICC) and kappa (κ) statistic to determine inter- and intraobserver reliability. Grading discrepancies were resolved in conference with the senior author, and final LFFC grades were compared with preoperative clinical and radiographic data as well as intraoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 93 patients were included in the study. LFFC component intraobserver reliability for 2 rounds of grading resulted in an LT ICC of 0.78 to 0.90, cotyloid fossa ICC of 0.85 to 0.93, and perifoveal cartilage ICC of 0.78 to 0.87 with an LFFC total score ICC of 0.87 to 0.95. Interobserver reliability resulted in an LT ICC of 0.73 to 0.91, cotyloid fossa ICC of 0.84 to 0.95, perifoveal cartilage ICC of 0.83 to 0.91, and LFFC total score ICC of 0.89 to 0.96. Severe central compartment pathology (LFFC total score &gt;6) was significantly associated with age (48.2 vs 34.4; &lt;i&gt;P&lt;/i&gt; = .0002), preoperative Tönnis grade 1 (43% vs 4%; &lt;i&gt;P&lt;/i&gt; &lt; .0001), preoperative Tönnis angle (8.7 vs 5.2; &lt;i&gt;P&lt;/i&gt; = .002), and intraoperative femoral head weightbearing chondral lesions (14% vs 0%; &lt;i&gt;P&lt;/i&gt; = .02) when compared to patients with an LFFC score &lt;6.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The modified LFFC grading system demonstrated satisfactory intraobserver and interobserver reliability for patients undergoing hip arthroscopy that compares favorably with existing arthroscopic classification systems for the acetabular fossa. The addition of a descriptive classification system for the pulvinar intra-articular adipose tissue did not decrease the reliability of the grading system. Increasing LFFC scores were found to be associated with known risk factors for inferior outcomes after hip arthroscopy providing enhanced clinical uti","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251340986"},"PeriodicalIF":2.4,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476232","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":"Comparative Outcomes After Bone-Patellar Tendon-Bone Allograft Reconstruction of the Anterior Cruciate Ligament Using Various Allograft Processing Protocols.","authors":"Benjamin Miltenberg, Randall Timothy Kreulen, Gaston Davis, William L Johns, Rahul Muchintala, Jonathan Berg, Fotios P Tjoumakaris, Kevin B Freedman","doi":"10.1177/23259671251345676","DOIUrl":"10.1177/23259671251345676","url":null,"abstract":"<p><strong>Background: </strong>Graft choice in anterior cruciate ligament reconstruction (ACLR) is determined by surgeon preference, patient factors, and graft characteristics. An allograft is a viable option with benefits such as decreased operative times and no donor site morbidities, and it can be the preferred graft choice in certain patient populations. Despite this, there is no established standard for allograft processing.</p><p><strong>Purpose: </strong>To determine whether allograft processing techniques influence the risk of graft failure, patient-reported outcomes, and revision surgery in patients undergoing ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Consecutive patients from 3 fellowship-trained sports medicine surgeons undergoing ACLR with patellar tendon allografts from January 1, 2016, to January 1, 2022, were identified. Descriptive data, mechanism of injury, graft processing technique, revision history, and patient-reported outcome scores were collected. The primary endpoint was aseptic failure as defined by graft rupture on magnetic resonance imaging. Statistical analysis was performed with the χ² test or the Fisher exact test as indicated for categorical variables and with the <i>t</i> test and analysis of variance as indicated for continuous variables. The significance level for statistical tests was set at 5%.</p><p><strong>Results: </strong>A total of 189 patients who underwent ACLR and met the inclusion/exclusion criteria were identified, with 103 Musculoskeletal Transplant Foundation (MTF), 55 Allowash XG, and 31 BioCleanse allografts. The mean age of patients was 43.4 ± 10.5 years, and 60.9% were women. No significant difference was observed between the groups with regard to sex and body mass index (<i>P</i> = .25 and <i>P</i> = .64, respectively). However, age at the time of surgery was significantly different between groups (<i>P</i> = .03). The mean patient follow-up time was 4.65 ± 1.40 years. Four patients experienced graft failure (MTF 1% [1/103]; Allowash XG 5.5% [3/55]; BioCleanse 0% [0/31]), with no significant difference in graft failure between groups (<i>P</i> = .20). There were no reported infections. Postoperative International Knee Documentation Committee (IKDC) scores (MTF, 82.6; Allowash XG, 81.7; BioCleanse, 80.2) were not different between groups (<i>P</i> = .60).</p><p><strong>Conclusion: </strong>Bone-patellar tendon-bone allografts processed using BioCleanse, Allowash XG, and the MTF protocol had similar rates of graft failure and postoperative IKDC scores. Although underpowered, the data suggest that each of these techniques can be used safely with low failure rates and good functional outcomes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251345676"},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476228","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":"Comparative Results After Latarjet Procedure for Shoulder Instability Management Between Primary and Revision Cases After Failed Arthroscopic Bankart Procedure: A Midterm Follow-up Study.","authors":"Efstathios Konstantinou, Nikolaos Stefanou, Theodoros Mylonas, Alexandros Koskiniotis, Georgios Komnos, Socratis Varitimidis, Michael Hantes","doi":"10.1177/23259671251343807","DOIUrl":"10.1177/23259671251343807","url":null,"abstract":"<p><strong>Background: </strong>Anterior shoulder dislocation is often complicated by recurrent instability, with reported rates being as high as 70% in young patients. Bony lesions, young age, and contact sports have been correlated with higher rates of recurrent instability. The optimal surgical modality remains debatable, with the majority of surgeons preferring the arthroscopic Bankart procedure as the primary repair for recurrent instability.</p><p><strong>Purpose: </strong>To compare the outcomes of the Latarjet procedure performed as a primary procedure versus the Latarjet procedure in the setting of a previously failed Bankart repair.</p><p><strong>Study design: </strong>Cohort study; Level of evidence 3.</p><p><strong>Methods: </strong>A retrospective comparative study was conducted of patients with traumatic anterior shoulder instability who underwent an open Latarjet as primary or revision surgery between 2012 and 2019. Outcomes were assessed using the Rowe score, Oxford Shoulder Instability (OSI) score, visual analog scale (VAS) score, and rate of recurrent instability. All patients had at least 4 years of follow-up. Radiographs were analyzed using the Samilson and Pietro classification.</p><p><strong>Results: </strong>In total, 43 and 17 patients were included in the primary and revision groups, respectively. Mean follow-up was 7.7 years for the primary group and 7.9 years for the revision group. Postoperatively, Rowe and VAS scores were not significantly different between groups, but OSI scores were significantly worse for the revision group versus the primary group (40.6 ± 1.3 vs 42.1 ± 1.4, respectively). The difference in OSI scores was less than the minimal clinically important difference (8.6), indicating limited clinical relevance. Return to daily activities, including sports activities, was comparable between the 2 groups. One patient from each group had recurrent instability (<i>P</i> = .34). No major complication was recorded in either group during the follow-up. Seven (16%) patients from the primary group and 4 (23%) patients from the revision group showed preoperatively radiographic signs of mild (grade I) osteoarthritis.</p><p><strong>Conclusion: </strong>The Latarjet procedure effectively prevented chronic anterior shoulder instability and was associated with high patient satisfaction as both a primary and a revision procedure. OSI scores were marginally lower in patients with previous failed Bankart repair compared with primary Latarjet. Similar outcomes were observed for shoulder stability and arthritis development, although these findings are limited to midterm follow-up. These findings support the use of primary arthroscopic Bankart repair with revision Latarjet as a realistic surgical option for previous surgical failure.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251343807"},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476229","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 Association of Tibia:Femur Ratio and Anterior Cruciate Ligament Injury.","authors":"Jonathan McKeeman, Ryan DeLeon, Daniel Heckman","doi":"10.1177/23259671251343811","DOIUrl":"10.1177/23259671251343811","url":null,"abstract":"<p><strong>Background: </strong>The tibia:femur ratio (TFR) is an anatomic proportion describing the length of the tibia relative to the femur, with an established normative mean of 0.78 in skeletally mature individuals. Variation in TFR affects lower extremity biomechanics, and there is an association between elevated TFR and hip/knee osteoarthritis and patellar instability.</p><p><strong>Hypothesis: </strong>TFR variation may also be associated with anterior cruciate ligament (ACL) injury; thus, the purpose of this study is to determine if the mean TFR in patients with ACL injury is different from the mean normative TFR in the general population.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 50 patients with magnetic resonance imaging-confirmed ACL injury underwent full-length lower extremity scanograms. Femoral length was measured from the most superior point of the femoral head to the center point of the medial femoral condyle. Tibial length was measured from the center point of the medial tibial plateau to the center point of the tibial plafond. The TFR was calculated by dividing the tibial length by the femoral length. The mean TFR of the study group was compared with the previously published mean TFR for normative controls with a 2-tailed <i>t</i> test.</p><p><strong>Results: </strong>The mean TFR for the entire cohort of patients with ACL injury was 0.759 (SD, 0.029), which was significantly lower than the mean normative TFR of 0.781 (<i>P</i> = .0001). There were 29 (58.0%) male and 21 (42.0%) female patients. The mean TFR was similar for male (0.760) and female (0.757) patients (<i>P</i> = .77).</p><p><strong>Conclusion: </strong>Patients with ACL injury demonstrated a significantly lower TFR than the previously published TFR for normative controls, which suggests that an association between TFR and ACL injury may exist. It is possible that decreasing tibial length relative to femoral length alters lower extremity biomechanics in such a manner that places the ACL at risk for injury.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251343811"},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12179483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476231","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":"Hip Joint Intercartilage Space, Range of Motion, and Lateral Differences in Elite and Subelite Ice Hockey Players: A Case-Control Trial.","authors":"Jitka Mala, Tomas Hybner, Petr Stastny","doi":"10.1177/23259671251344240","DOIUrl":"10.1177/23259671251344240","url":null,"abstract":"<p><strong>Background: </strong>Ice hockey players experience groin pain and imbalances in the muscles of the hip joint, possibly because of the condition of the intercartilage space (ICS).</p><p><strong>Purpose: </strong>To describe the lateral differences in size of the articular ICS, range of motion, and adductor/abductor muscle strength between elite and subelite ice hockey players and a control group of participants who did not play ice hockey.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>33 elite hockey players, 26 subelite hockey players, and 30 non-ice hockey player controls were compared in terms of ICS thickness, isometric hip abductor muscle strength, hip range of motion, functional test results, and pain score. Two-way analysis of variance was used to identify differences in laterality and performance levels.</p><p><strong>Results: </strong>The ICS of the hip joint was smaller (<i>P</i> < .001) in both groups of ice hockey players than in the control group (0.97 ± 0.11 mm) and smaller (<i>P</i> = .005) on the backhand side (elite 0.66 ± 0.24 mm; subelite 0.65 ± 0.15 mm) than on the forehand side (elite 0.78 ± 0.18 mm; subelite 0.74 ± 0.24 mm) in both groups of hockey players. Compared with the control (41.6°± 4°) and subelite groups, the elite group had less (<i>P</i> < .001) hip external rotation (elite 30.4°± 6.1°; subelite 35°± 6.5°) and internal rotation (elite 31.5°± 5.1°; subelite 35.1°± 6.5°), with no differences in laterality (<i>P</i> > .05). Both hockey groups had positive hip pain provocation tests and greater (<i>P</i> < .001) hip adduction (elite 457 ± 85 N; subelite 450 ± 82 N) and abduction (elite 429 ± 60 N; subelite 422 ± 63 N) muscle strength than the controls (adduction 347 ± 70 N; abduction 346 ± 75 N). Elite players had a greater (<i>P</i> = .008) adductor strength ratio on the backhand side (1.16 ± 19) than the control group (1.02 ± 0.15).</p><p><strong>Conclusion: </strong>Ice hockey players had a smaller ICS of the hip joint, particularly on the backhand side. These structural changes were accompanied by reduced range of motion in the hip joint, increased pain, and asymmetries in muscle strength. Hip range of motion and symmetry of adductor/abductor muscle strength should be considered when diagnosing ice hockey players. ICS assessment via sonography might become a useful tool for the evaluation of structural changes in the hip. Research on ice hockey-related injuries should focus more on the structural and functional condition of the backhand side of the hip.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251344240"},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333656","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":"Improvement of Accuracy of Femoral Tunnel Positioning in ACL Surgery for Low-Volume Surgeons Using Intraoperative Fluoroscopy.","authors":"Maximilian M Mueller, Nico Hinz, Tobias Drenck, Lena Eggeling, Karl-Heinz Frosch, Juergen Hoeher, Ralph Akoto","doi":"10.1177/23259671251346647","DOIUrl":"10.1177/23259671251346647","url":null,"abstract":"<p><strong>Background: </strong>Less experienced surgeons have an increased risk for tunnel malpositioning as a predominant risk factor for failure of anterior cruciate ligament reconstruction (ACLR). Fluoroscopic guidance can improve the precision of tunnel positioning.</p><p><strong>Purpose: </strong>To investigate whether low-volume surgeons can achieve precise femoral tunnel placement in ACLR under fluoroscopic control comparable to that of experienced mid- and high-volume surgeons.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This study retrospectively included 150 patients who underwent primary ACLR between January 2021 and March 2023 and were prospectively enrolled in an in-clinic registry. Three groups were defined: high-volume surgeon (1 surgeon with >100 ACLRs per year; 50 images), mid-volume surgeon (1 surgeon with >10 to <50 ACLRs per year; 50 images), and low-volume surgeon (5 surgeons with ≤10 ACLRs per year; 50 images). The analysis of the femoral tunnel position was performed digitally on strictly lateral fluoroscopic images by determining the depth and height relations according to the quadrant method of Bernard and Hertel.</p><p><strong>Results: </strong>All surgeons, regardless of experience, achieved high precision of femoral tunnel placement (depth relation: SD, 3.41% [1.58 mm]; height relation: SD, 5.33% [1.33 mm]). The variances of the tunnel placements did not show significant differences between the 3 groups with the Brown-Forsythe test (depth relation: probability (<i>Pr</i>) > <i>F</i> = 0.332; height relation: <i>Pr</i> > <i>F</i> = 0.081; <i>P</i> < .05). The precision of the high-volume surgeon (depth relation: SD, 3.29%; height relation: SD, 4.92%) was comparable to that of the mid-volume surgeon (depth relation: SD, 2.98%; height relation: SD, 5.9%) and low-volume surgeon (depth relation: SD, 3.58%; height relation: SD, 4.62%).</p><p><strong>Conclusion: </strong>In this study, fluoroscopically guided tunnel placement allowed low-volume surgeons to achieve a level of precision comparable to that of the experienced surgeons. Fluoroscopy might especially help low-volume surgeons to achieve a standardized and highly reproducible femoral tunnel position and thus avoid tunnel malpositioning.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251346647"},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333657","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":"Tibial Tuberosity-Trochlear Groove Ratio Adjusts for Sex Differences and Improves Accuracy in Assessing Patellofemoral Instability.","authors":"Tomas Pineda, Nicolas Cance, Michael J Dan, Sophie Putman, Guillaume Demey, David H Dejour","doi":"10.1177/23259671251344227","DOIUrl":"10.1177/23259671251344227","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tibial tuberosity-trochlear groove (TT-TG) distance has typically been used to determine the need for a tibial tuberosity medialization. However, because it is an absolute value, TT-TG distance does not consider the patient's size and, therefore, has the potential to over- or underestimate the need for a medialization of the tibial tuberosity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The aim of the study was to propose a ratio combining the TT-TG distance and the posterior bicondylar width (PBCW) of the femur as a representation of patient size. It was hypothesized that this ratio would provide a more accurate assessment of patellofemoral instability than the TT-TG distance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study (diagnosis); Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A consecutive series of patients with recurrent patellofemoral instability between 2020 and 2022 was reviewed and compared with a consecutive cohort of patients with isolated meniscal tears. The TT-TG distance and PBCW were assessed using magnetic resonance imaging, and the ratio created using both measurements (TT-TG ratio was calculated by expressing the TT-TG distance as a percentage of the PBCW) was compared to the TT-TG distance alone to evaluate differences in diagnostic accuracy and differences based on femoral size and sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 129 patients with objective patellofemoral instability (OPI) and 105 controls were included in this study. The mean TT-TG distance was 15 ± 5.2 mm in the OPI group and 8.6 ± 3.6 mm in the control group (&lt;i&gt;P&lt;/i&gt; &lt; .001), with a cutoff value of 11.15 mm for distinguishing between the 2 groups. The TT-TG ratio was 22.3% ± 3% in the OPI group and 11.7% ± 4.6% in the control group (&lt;i&gt;P&lt;/i&gt; &lt; .001), with a cutoff value of 16%. The TT-TG distance had an area under the curve of 0.848, whereas the TT-TG ratio had an area under the curve of 0.892. Subgroup analysis indicated that the TT-TG distance (&lt;i&gt;P&lt;/i&gt; = .02) and PBCW (&lt;i&gt;P&lt;/i&gt; &lt; .001) were significantly different based on sex in the OPI group; however, the TT-TG ratio did not show significant differences (&lt;i&gt;P&lt;/i&gt; = .84).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The TT-TG ratio provides an enhanced discriminant value compared with the TT-TG distance in distinguishing patients with patellofemoral instability from controls. This ratio accounts for inherent sex- and size-based differences associated with the TT-TG distance, offering a more individualized assessment when considering the need for tibial tuberosity osteotomy and the extent of medialization required.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;This study highlights the importance of the TT-TG ratio in the analysis of patients with patellofemoral instability, providing improved diagnostic accuracy while accounting for sex and size-based differences. This allows for a more personalized treatment approach and can lead to better decision making regarding tibial","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 6","pages":"23259671251344227"},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333658","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}