Orthopaedic Journal of Sports Medicine最新文献

{"title":"Comparison of Clinical Outcomes Between Nonoperative Treatment and Arthroscopically Assisted Stabilization in Patients With Acute Rockwood Type 5 Acromioclavicular Dislocation.","authors":"Doruk Akgün, Henry Gebauer, Alp Paksoy, Larissa Eckl, Agahan Hayta, Ata Ücertas, Nicolas Barthod-Tonnot, Rony-Orijit Dey Hazra, Lucca Lacheta, Philipp Moroder, Jonas Pawelke","doi":"10.1177/23259671241289117","DOIUrl":"10.1177/23259671241289117","url":null,"abstract":"<p><strong>Background: </strong>Currently, Rockwood type 3 acromioclavicular (AC) joint dislocations are initially treated nonoperatively, whereas surgery is recommended for Rockwood type 5 dislocations. However, multiple studies have been published favoring nonoperative approaches in patients with high-grade Rockwood injuries.</p><p><strong>Purpose: </strong>To compare the clinical and radiological outcomes of patients with acute Rockwood type 5 AC joint dislocations treated nonoperatively versus with arthroscopically assisted stabilization.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Included were 48 patients with acute Rockwood type 5 dislocation who were initially treated nonoperatively between June 2010 and June 2022 and 48 patients matched according to age, sex, affected side, and follow-up interval who underwent arthroscopically assisted coracoclavicular (CC) stabilization using a suture-button technique, with additional percutaneous AC tape cerclage. Clinical outcomes were assessed based on the Subjective Shoulder Value, Nottingham Clavicle Score, Constant score, and visual analog scale for pain. The radiographic assessment included the CC distance, CC difference ratio, and degree of horizontal instability at final follow-up (62 ± 43 months).</p><p><strong>Results: </strong>At the final follow-up, the Constant score was significantly higher in the nonoperative group (<i>P</i> = .02). The operative group had significantly higher pain levels on palpation of the AC joint (1.2 ± 2.2 vs 0.19 ± 0.5 for the nonoperative group; <i>P</i> = .003). In the operative group, the mean CC difference ratio was significantly higher at the latest follow-up compared with postoperatively (1.3 ± 0.3 vs 0.67 ± 0.3, respectively; <i>P</i> < .001), whereas the CC difference ratio of the nonoperative group was significantly reduced at the latest follow-up compared with postinjury (2.0 ± 0.5 vs 2.6 ± 0.8, respectively; <i>P</i> < .001). The operative group had a significantly lower CC difference ratio compared with the nonoperative group at final follow-up (<i>P</i> < .001). More than half of the patients (56%) who were treated operatively had a loss of reduction resulting in a Rockwood type 3 state at the latest follow-up, whereas 54% of patients treated nonoperatively had spontaneous reduction of injury severity from Rockwood type 5 to Rockwood type 3.</p><p><strong>Conclusion: </strong>Although 15% of the nonoperatively treated patients eventually required surgery, successful nonoperative treatment showed similar outcomes to initial operative treatment in patients with acute Rockwood type 5 dislocation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241289117"},"PeriodicalIF":2.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648056","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 Relationship Between Exogenous Testosterone Use and Risk for Primary Anterior Cruciate Ligament Rupture.","authors":"Matthew Quinn, Alex Albright, Nicholas J Lemme, Edward J Testa, Patrick Morrissey, Michel Arcand, Alan H Daniels, Paul Fadale","doi":"10.1177/23259671241291063","DOIUrl":"10.1177/23259671241291063","url":null,"abstract":"<p><strong>Background: </strong>In the United States, testosterone therapy has markedly increased in recent years. Currently, there is a paucity of evidence evaluating the risk of ligamentous injuries in patients taking testosterone replacement therapy (TRT).</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to quantify the association between TRT and the incidence of anterior cruciate ligament (ACL) injuries and the subsequent risk of ACL reconstruction (ACLR) failure. It was hypothesized that individuals receiving TRT would demonstrate an increased risk for index ACL injury and ACL rerupture.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This is a retrospective cohort study utilizing the PearlDiver database. Records were queried between 2011 and 2020 for patients aged 18 to 59 years who filled a testosterone prescription. A matched control group based on age, sex, Charlson Comorbidity Index, tobacco use, diabetes, and hypothyroidism consisted of patients aged 18 to 59 years who had never filled a prescription for exogenous testosterone. International Classification of Diseases, 9th and 10th Revisions and Current Procedural Terminology (CPT) codes were utilized to identify patients with ACL injuries and those undergoing reconstruction. Multivariable logistic regression was used to compare rates of ACL injury at 6 months, 1 year, and 2 years after initiating TRT. ACLR failure was also examined at 1-year intervals for 5 years for individuals filling a TRT prescription.</p><p><strong>Results: </strong>A total of 851,816 patients were enrolled, with 425,908 patients in the TRT and control groups, respectively. The TRT cohort was significantly more likely to experience an ACL tear during 6-month (OR, 2.66; 95% CI, 2.17-3.26), 1-year (OR, 2.46; 95% CI, 2.11-2.86), and 2-year (OR, 2.22; 95% CI, 1.98-2.48) periods. The rate of reconstruction failure did not differ between the 2 cohorts at up to 5 years of follow-up (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>Patients receiving TRT were significantly more likely to sustain a primary ACL rupture but were not at a statistically significant increased risk of reconstruction failure.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241291063"},"PeriodicalIF":2.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648088","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":"Alterations to the Kinetic Chain Sequence After a Shoulder Injury in Throwing Athletes.","authors":"Liam P Owens, Ginny Coyles, Omid Khaiyat","doi":"10.1177/23259671241288889","DOIUrl":"10.1177/23259671241288889","url":null,"abstract":"<p><strong>Background: </strong>Kinetic chain (KC) sequencing is essential for efficient energy translation through the body in overhead-throwing sports. A sequencing breakdown can result in injuries to the throwing shoulder and thus the management of athlete recovery in an attempt to minimize the impact on both training and performance.</p><p><strong>Purpose: </strong>To determine kinematic differences in KC sequencing, imperative for the prevention and rehabilitation of a shoulder injury, during maximal throwing in overhead athletes with and without a shoulder injury.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Kinematic data were collected and analyzed for 36 male overhead athletes with (symptomatic) and without (asymptomatic) a shoulder injury (18 participants per group) during maximal overhead-throwing trials using 3-dimensional motion analysis (100 Hz). Peak angular velocities and associated timing of the throwing shoulder, throwing elbow, thorax, pelvis, lead hip, and rear hip were calculated to determine the KC sequence in both groups. Kinematic data were compared using independent <i>t</i> tests, and relationships between variables were assessed using the Pearson correlation coefficient (both <i>P</i> < .05).</p><p><strong>Results: </strong>The KC sequence in overhead athletes with or without a shoulder injury was the same, except for peak elbow extension and shoulder flexion angular velocities. These angular velocities occurred simultaneously in asymptomatic throwers (both 0.17 % before ball release [BR]) but sequentially in symptomatic throwers (0.06 % before BR and 0.67 % after BR, respectively). No differences were evident in stride length (m) or resultant ball velocity (m/s) between the groups, despite differences in key joint angular velocities across KC segments (<i>P</i> range, <.001-.035). Relationships between resultant ball velocity and all key joint angular velocities were evident for symptomatic but not asymptomatic throwers (<i>P</i> range, <.001-.026).</p><p><strong>Conclusion: </strong>Our study demonstrated that overhead athletes, regardless of their shoulder injury history, had similar KC sequencing across the lower limb and lumbopelvic-hip complex segments before differences in the timing of peak elbow extension and shoulder flexion angular velocities of the throwing arm approaching BR. Further research investigating muscle activity changes and technique parameters during overhead throwing may present explanations as to how we can ensure that the KC sequence is not altered as a result of an injury.</p><p><strong>Clinical relevance: </strong>This study provides a new perspective on the KC and how an injury may not change the sequence itself in overhead-throwing performance.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241288889"},"PeriodicalIF":2.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648151","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":"Slovenian Translation, Cross-Cultural Adaptation, and Content Validation of the Updated Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2).","authors":"Kristina Drole, Kathrin Steffen, Armin Paravlic","doi":"10.1177/23259671241287767","DOIUrl":"10.1177/23259671241287767","url":null,"abstract":"<p><strong>Background: </strong>The updated Oslo Sports Trauma Research Questionnaire on Health Problems (OSTRC-H2) has been translated into a limited set of languages and lacks full validation of its new measures.</p><p><strong>Purpose: </strong>To (1) translate, cross-culturally adapt, and evaluate the measurement properties of the OSTRC-H2 for the Slovenian population and (2) investigate the construct validity for the severity score and time lost due to a health problem.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>The OSTRC-H2 was translated from English to Slovenian (OSTRC-H2-SLO) according to international guidelines. A 15-week study was conducted among 188 elite athletes, with a test-retest performed in the 10th week. Internal consistency, reliability, content validity, feasibility, and potential ceiling effects were investigated. Internal consistency was measured using the Cronbach alpha coefficient, while reliability was measured with the intraclass correlation coefficient (ICC). Construct validity was measured with the Spearman rank correlation coefficient (<i>r</i> _S).</p><p><strong>Results: </strong>There was a 95% response rate and an 18% mean weekly prevalence of health problems. The OSTRC-H2-SLO showed excellent test-retest reliability (ICC, 0.94 [95% CI, 0.67-0.99]), with a Cronbach α of .93. A strong positive correlation was found between the OSTRC-H2-SLO severity score and days lost due to an acute injury (<i>r</i> _S = 0.754), overuse injury (<i>r</i> _S = 0.785), and illness (<i>r</i> _S = 0.894) (<i>P</i> < .001 for all). Moderate to strong negative correlations were observed between severity score and total load (training and competition load in hours) as well as between days lost and total load (<i>P</i> < .001 for all).</p><p><strong>Conclusion: </strong>The OSTRC-H2-SLO was found to be valid, reliable, and well accepted among Slovenian athletes. The authors confirmed the questionnaire's construct validity and identified total load as an indicator of an increase in the severity score.</p><p><strong>Registration: </strong>NCT05471297 (ClinicalTrials.gov identifier).</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241287767"},"PeriodicalIF":2.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625084","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":"Economic and Performance Analysis of Achilles Tendon Rupture in the National Basketball Association.","authors":"Kristopher Meadows, Fei Ye, Abram Qiu, Osasu Iyawe, Kenneth Kenneth-Nwosa","doi":"10.1177/23259671241279388","DOIUrl":"10.1177/23259671241279388","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendon ruptures are common and potentially career-ending injuries for National Basketball Association (NBA) players. Many studies have reviewed the impact of Achilles tendon ruptures on return to play (RTP) and performance, but there are no studies on their economic significance.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to analyze the economic and performance consequences of Achilles tendon ruptures usingthe cost of recovery (COR) for NBA franchises as well as preinjury salary/career success. It was hypothesized that players with higher preinjury salaries or performance would have an increased COR, higher rates of RTP, and more career success after their injury.</p><p><strong>Study design: </strong>Descriptive epidemiology study.</p><p><strong>Methods: </strong>Publicly available data of NBA players who sustained an Achilles tendon rupture between 1990 and 2023 were analyzed. Data were retrospectively gathered by R software code to include players' ages, positions, salaries, pre- and postinjury player efficiency rating, time missed after injury, and RTP. Performance impact was measured by advanced statistics: player efficiency rating, Win Shares per 48 Minutes, and Value Over Replacement Player. Two groups of 3 cohorts were created: All-Star, Starter, and Reserve versus group A (<$3,999,999), group B (≥$3,999,999 to ≤$8,999,999), and group C (>$8,999,999). Analysis of variance with post hoc Tukey tests for continuous data and Fisher exact tests for categorical data was used. Significance levels were set at <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 37 players met the inclusion criteria and played between the years of 1992 through 2019. The mean COR that NBA teams faced was $4 million per player. The cumulative economic loss from Achilles tendon ruptures in the NBA between 1992 and 2019 was $117,578,851. Overall RTP was 78.38%, and 31.03% of players who returned to play were out of the NBA within 3 years. RTP to the highest playing level was highest in group B (45.5%), followed by group A (40%) then group C (12.5%). The COR of All-Star players, Starter players, and Reserve players averaged $5.7 million, $3.4 million, and $3 million, respectively.</p><p><strong>Conclusion: </strong>This study investigated the financial and performance implications of Achilles tendon ruptures among NBA athletes. Most players struggled to restore their preinjury performance, except for Reserve players. The findings provide valuable insights into the complexities of COR and postinjury performance.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241279388"},"PeriodicalIF":2.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624667","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 Affecting Outcomes and Complications of Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Study of 110 Patients.","authors":"Mohammad Alkhatatba, Micheal Atallah, Baha' Awad, Bashar Araiqat, Ammar Aloqaily, Hasan Awad, Mathew Atallah, Marwan Ahmed","doi":"10.1177/23259671241279423","DOIUrl":"10.1177/23259671241279423","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament injury poses a major effect on the quality of life of patients. Anterior cruciate ligament reconstruction (ACLR) remains the mainstay of treatment.</p><p><strong>Purposes: </strong>To (1) test for the correlation of patients' characteristics such as body mass index (BMI), age, smoking status, and postoperative infrapatellar numbness with the subjective outcome of primary ACLR and (2) investigate whether postsurgical complications can be related to the studied patients' characteristics.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Demographic data and operational notes from patients who underwent primary ACLR at the institute between 2011 and 2022 were extracted. Patients' surgical outcomes were evaluated subjectively using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scoring were completed at postoperative follow-up in December of 2022, patients completed both the IKDC and the KOOS questionnaires. Patients were asked to rate their knee function out of 10 before and after surgery. This rating was based on the patients' self-assessment of their functional ability without the use of a formal instrument. Knee function was assigned as better, worse, or the same through a comparison of patients' reported scores before and after surgery.</p><p><strong>Results: </strong>Male patients comprised 108 (98.2%) of the total cohort, the mean ± SD age at the time of surgery was 27.92 ± 7.39 years, and BMI was 26.54 ± 3.89. The mean follow-up time was 48.92 ± 27.99 months. Most patients did not need postsurgical intervention (n = 97; 88.2%), while 4 (3.6%), 7 (6.4%), and 2 (1.8%) needed revision, debridement, or both, respectively. The mean IKDC score and KOOS, respectively, were 74.37 ± 20.17 and 85.50 ± 14.83. Patients' BMI had a significant effect on IKDC score (74.68 ± 20.0; <i>P</i> < .001), and infrapatellar numbness after surgery also affected patients' IKDC score (<i>P</i> = .002) and KOOS (<i>P</i> = .043). The age at the time of ACLR was associated with contralateral leg surgery (<i>P</i> = .017).</p><p><strong>Conclusion: </strong>This study showed that higher BMI and infrapatellar numbness negatively affect the subjective outcomes after primary ACLR. Older age at the time of primary ACLR was associated with a higher likelihood of surgery in the contralateral leg.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241279423"},"PeriodicalIF":2.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625053","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":"Nonoperative Management of Sublime Tubercle Fractures in Adolescent Throwing Athletes: Improved Results With Cast Immobilization.","authors":"Sarah A Fogleman, Eric W Edmonds, Jan Fronek, Bryan T Leek, Tracey P Bryan, Andrew T Pennock","doi":"10.1177/23259671241287778","DOIUrl":"10.1177/23259671241287778","url":null,"abstract":"<p><strong>Background: </strong>Avulsion fractures of the sublime tubercle of the ulna are a cause of medial elbow pain and instability in overhead athletes.</p><p><strong>Purpose: </strong>To compare outcomes after sublime tubercle avulsion fracture managed as a fracture (with cast immobilization) versus a soft tissue injury (without immobilization and with early range of motion [ROM]) to determine how to achieve the best outcomes for these injuries in adolescent throwing athletes.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A multicenter retrospective review using an institutional database query of radiology reports to identify sublime tubercle fractures between July 2005 and December 2020 was performed. Inclusion criteria were baseball players aged ≤19 years, fracture identified on ≥1 imaging study (radiograph, computed tomography, or magnetic resonance imaging), and ≥24 months of follow-up (unless failure of management occurred earlier). Fractures were classified as simple or complex injuries and then grouped according to management strategy: cast or early ROM. Data collected included patient characteristics, clinical presentation (injury mechanism and acuity), initial treatment, and outcomes (complications, final ROM, patient-reported symptoms, radiographic union, and return to activities or sport).</p><p><strong>Results: </strong>A total of 13 baseball players (6 in the cast cohort and 7 in the early ROM cohort) with a mean age of 16.5 years (range, 15-19 years) met the inclusion criteria, with a mean follow-up of 4.1 years (range, 2.0-6.7 years) in the cast cohort and 3.8 years (range, 2.1-7.4 years) in the early ROM cohort. All injuries were classified as simple fractures. Five patients (83%) in the cast cohort achieved radiographic union, return to sports, and symmetric ROM, compared with only 2 patients (29%) in the early ROM cohort who achieved the same without having to undergo ulnar collateral ligament reconstruction (<i>P</i> = .026).</p><p><strong>Conclusion: </strong>The present study demonstrated that, whereas management of sublime tubercle avulsion fractures in adolescents via early ROM had a high failure rate, a mean of 4 weeks of immobilization led to a high rate of return to sports with successful union of the avulsed fragment. Unlike purely ligamentous injuries, bony avulsions may not necessarily require surgical intervention for adolescent patients to return to baseball.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241287778"},"PeriodicalIF":2.4,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625080","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":"Examining the Reliability and Validity of Coding Perceived Force Severity and Bracing in the NHL Concussion Spotter Program.","authors":"Kaitlin E Riegler, Ruben Echemendia, Willem Meeuwisse, Paul Comper, Michael G Hutchison, J Scott Delaney, Jared M Bruce","doi":"10.1177/23259671241285075","DOIUrl":"https://doi.org/10.1177/23259671241285075","url":null,"abstract":"<p><strong>Background: </strong>Data obtained from the National Hockey League (NHL) have shown that a risk prediction model, including both visible signs and mechanisms of injury, improves the identification of possible concussion. However, only about half of concussions diagnosed by club medical staff in the NHL exhibit visible signs. At present, the NHL concussion spotter protocol does not include central league spotters' subjective judgments of the severity of forces associated with a direct hit to the head (perceived force severity [PFS]) or whether players brace before a hit (bracing).</p><p><strong>Purpose: </strong>To examine the interrater reliability, preliminary validity, and association with concussion diagnosis of central league spotter determinations of PFS and bracing.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>Video footage of 1071 events after a direct or indirect blow to the head were observed from the 2020-2021 and 2021-2022 NHL seasons. These events were classified into 4 groups: concussion with visible signs; concussion without visible signs; no concussion with visible signs; and no concussion without visible signs. A total of 50 events were randomly selected from the total events in each group. Then, 2 raters (NHL central league spotters) coded PFS for each of the 200 video events as low, medium, or high. Bracing was coded as no bracing, insufficient bracing, or full bracing.</p><p><strong>Results: </strong>Interrater reliability was fair to moderate for the categorical and continuous ratings of both PFS (κ = 0.36 and 0.45, respectively) and bracing (κ = 0.40 and 0.49, respectively). There was no significant association between concussion diagnosis and either PFS (<i>Z</i> = 0.00, <i>P</i> = .99) or bracing (<i>Z</i> = 0.77, <i>P</i> = .44). Exploratory, post hoc analyses suggested a possible relationship between bracing and reduced concussion risk among a select subsample of events with no visible signs (<i>r</i> = -0.29, <i>P</i> < .01).</p><p><strong>Conclusion: </strong>The interrater reliability for PFS and for bracing was fair to moderate. Neither PFS nor bracing were significantly related to concussion diagnosis, but they were significantly associated with other visible signs and mechanisms of injury.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241285075"},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625026","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":"Effects of Conditioned Media From Human Umbilical Cord-Derived Mesenchymal Stem Cells on Tenocytes From Degenerative Rotator Cuff Tears in an Interleukin 1β-Induced Tendinopathic Condition.","authors":"Min Ji Lee, Kyungtaek Park, Seung Yeon Lee, Kwi-Hoon Jang, Sungho Won, Chris Hyunchul Jo","doi":"10.1177/23259671241286412","DOIUrl":"https://doi.org/10.1177/23259671241286412","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that mesenchymal stem cells (MSCs) are safe for treating different tendinopathies. Synovial fluid is a pooled environment of biomarkers from the inflammatory and degenerative joint cavity. Understanding the effects of synovial fluid on MSCs is important, as it is the first microenvironment that administered MSCs encounter. Several studies have reported that exposure to osteoarthritic synovial fluid-activated MSCs increased the release of soluble factors; however, the paracrine effects of shoulder synovial fluid-stimulated umbilical cord-derived MSCs (SF-UC-MSCs) on tendinopathy have yet to be investigated.</p><p><strong>Purpose: </strong>To assess the effects of the conditioned media from SF-UC-MSCs on tenocytes from degenerative rotator cuff tears in an interleukin-1β (IL-1β)-induced tendinopathic condition.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>UC-MSCs were isolated and cultured from healthy, full-term deliveries by cesarean section. Tenocytes were isolated and cultured from patients with degenerative rotator cuff tears. Conditioned media were obtained from UC-MSCs stimulated with synovial fluid. To evaluate the gene expression of proinflammatory and anti-inflammatory cytokines, enzymes and their inhibitors, matrix molecules, and growth factors, the tenocytes were cultured with IL-1β and 50% of the conditioned media from the SF-UC-MSCs; quantitative, real-time, reverse transcriptase polymerase chain reaction was also performed. A prostaglandin E2 (PGE2) assay was performed to investigate the PGE2 level secreted by the tenocytes. Western blotting was performed to examine protein synthesis of collagen type I and III. Cell viability, senescence, and apoptosis assays were also performed.</p><p><strong>Results: </strong>The conditioned media from the SF-UC-MSCs interfered with the inflammatory gene expression on tenocytes induced by IL-1β, but it increased the gene expression of tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-3. Meanwhile, the conditioned media decreased the PGE2 level on cells induced by IL-1β. It did increase the type I/III ratio of gene expression and protein synthesis, mainly through the induction of type I collagen. Conditioned media of SF-UC-MSCs reversed senescence and apoptosis induced by IL-1β.</p><p><strong>Conclusion: </strong>Study findings indicated that the conditioned media from SF-UC-MSCs had anti-inflammatory effects and cytoprotective effects on IL-1β-treated tenocytes from degenerative rotator cuff tears.</p><p><strong>Clinical relevance: </strong>UC-MSCs have useful potential for the treatment of tendinopathy in practice.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241286412"},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624696","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":"Local Infiltration Analgesia Versus Adductor Canal Block for Managing Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.","authors":"Shaheer Nadeem, Reza Ojaghi, Partha Patel, Eric Locke, Andrew McGuire, Michael A Pickell","doi":"10.1177/23259671241292029","DOIUrl":"https://doi.org/10.1177/23259671241292029","url":null,"abstract":"<p><strong>Background: </strong>Adductor canal block (ACB) and local infiltration analgesia (LIA) are frequently used to manage pain in patients after anterior cruciate ligament reconstruction (ACLR).</p><p><strong>Purpose: </strong>To compare the difference in pain scores and opioid consumption between ACB and LIA for ancillary pain management in patients after ACLR.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 3.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed, MEDLINE, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that compared pain scores at 2, 6, 12, or 24 hours after ACLR or provided information on 24-hour opioid consumption were included. Of 240 publications initially screened by abstract and title, 4 studies were included, and data related to participant characteristics, anesthetic technique, and pain-related outcomes were extracted. The standardized mean difference (MD) in pain scores and morphine milligram equivalents consumed in 24 hours was compared using a random-effects model.</p><p><strong>Results: </strong>In all studies, ropivacaine was the primary anesthetic used for LIA and ACB, with 1 study also employing bupivacaine as an alternative. The difference in pain scores between LIA and ACB was not significant at 2 hours (MD, 0.04 [95% CI, -0.22 to 0.29]; <i>P</i> = .79), 6 hours (MD, 0.16 [95% CI, -0.20 to 0.52]; <i>P</i> = .39), 12 hours (MD, 0.54 [95% CI, -0.49 to 1.56]; <i>P</i> = .31), or 24 hours (MD, 0.12 [95% CI, -0.10 to 0.34]; <i>P</i> = .28). The difference in morphine milligram equivalents was also not statistically significant (MD, -0.07 [95% CI, -0.25 to 0.11]; <i>P</i> = .68).</p><p><strong>Conclusion: </strong>From this review, the authors suggest considering LIA over ACB because of its potential to offer comparable pain relief and opioid consumption while being less time intensive. However, the study results should be interpreted with caution, given the limited number of studies included.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"12 11","pages":"23259671241292029"},"PeriodicalIF":2.4,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625087","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}