Orthopaedic Journal of Sports Medicine最新文献

{"title":"Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients Using an All-Epiphyseal Technique: A Prospective Cohort Study.","authors":"Jorge Knörr, Jérôme Sales de Gauzy, Pedro Doménech, Mikel Sánchez, Francisco Soldado, Carlos Barrios","doi":"10.1177/23259671251322771","DOIUrl":"10.1177/23259671251322771","url":null,"abstract":"<p><strong>Background: </strong>Transphyseal techniques are the most commonly used for anterior cruciate ligament (ACL) reconstruction in children. To mitigate the risk of growth disturbance, the tunnels should be positioned as vertically and centrally as possible in relation to the physis, potentially compromising the anatomic orientation of the graft and, therefore, its isometry. A graft rupture is frequent in this age group. Even though all-epiphyseal techniques have not clearly demonstrated better isometry, the authors propose an epiphyseal technique that aims for favorable anatomy, and therefore isometry, while avoiding physeal damage in young children with ACL ruptures.</p><p><strong>Purpose: </strong>To present the results of a modified all-epiphyseal technique in prepubertal patients, evaluating knee function, graft survival, and joint and growth protection.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A total of 74 skeletally immature patients with a traumatic ACL rupture underwent a physeal preserving technique using a semitendinosus-gracilis tendon graft fixed with intra-epiphyseal resorbable interference screws in the femur and tibia, along with associated minimal notchplasty. Preoperative, intraoperative, and postoperative assessments included clinical knee stability and meniscal status, magnetic resonance imaging, isometry measurements, comparative laximetry measurements with stress radiography using the Lerat method, full-length standing radiography, measurements of the axes of the lower limbs, Tegner and Lysholm scores, and patient satisfaction.</p><p><strong>Results: </strong>From 2004 to 2014, a total of 74 patients met our inclusion criteria and were followed up for a mean of 4.1 years (range, 2-7 years). Of these patients, 91.9% had an excellent/good postoperative Lysholm score, with similar preoperative and postoperative Tegner activity scores. Intraoperative isometry showed an intratunnel graft excursion <3 mm during extension in 95.9% of cases. Abnormal clinical laxity was observed in 4.1% at final follow-up, with an improvement in side-to-side laxity of 4.8 mm. There were 3 patients who experienced graft failure, with the salvage procedure employing a transphyseal technique in 1 patient. Meniscal tears occurred in 27.0%, with concomitant repair yielding a healing rate of 87.5%. No physeal alterations were observed, except for a tendency toward subtle overgrowth in the affected limb. Also, 90.5% of patients were satisfied or very satisfied with the outcome.</p><p><strong>Conclusion: </strong>The proposed all-epiphyseal technique in skeletally immature patients demonstrated excellent overall results with a low incidence of reruptures and meniscal degeneration, without relevant alterations related to growth.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251322771"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753766","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 Cryotherapy in Joints Other Than the Knee: A Systematic Review of Pain, Edema, Analgesic Use, and Blood Loss in the Shoulder, Hand, Hip, and Ankle Joints.","authors":"Karam Mark Karam, Mohamad K Moussa, Thibaut Noailles, Eugénie Valentin, Olivier Grimaud, Nicolas Lefèvre, Alain Meyer, Alexandre Hardy","doi":"10.1177/23259671251320132","DOIUrl":"10.1177/23259671251320132","url":null,"abstract":"<p><strong>Background: </strong>Cryotherapy has proven effective for pain reduction in the knee joint. However, its efficacy in other joints is less clear.</p><p><strong>Purpose: </strong>To explore the benefits of cryotherapy in joints excluding the knee.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>In June 2023, a review of EMBASE, PubMed MEDLINE, PROSPERO, ClinicalTrials.org, and the Cochrane Library was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Search terms were \"cryotherapy,\"\"cold application,\"\"postoperative,\" and \"postoperative period.\" Studies that assessed postoperative cryotherapy in joints excluding the knee were included. Spine, tumor, and pediatric studies were excluded. Outcomes evaluated were postoperative pain status, analgesic use, edema, and blood loss.</p><p><strong>Results: </strong>Out of 6749 studies, 22 studies (1424 patients) were ultimately included. Postoperative pain was evaluated in 20 studies, analgesic consumption in 14 studies, edema in 8 studies, and blood loss in 6 studies. Cryotherapy showed significant benefits in pain reduction in 9 studies, decreased analgesic use in 7 studies, edema reduction in 4 studies, and decreased blood loss in 2 studies. The hip showed the most consistent benefits from cryotherapy, across all studied parameters. However, increased haloperidol consumption was noted in hip fractures. Cryotherapy benefits after wrist surgery (4 studies; 211 patients) varied by procedure. Particularly for carpal tunnel procedures, continuous cryotherapy showed significant reductions in pain, analgesic use, and postoperative edema. For ankle surgeries (4 studies; 301 patients), cryotherapy was beneficial for pain and analgesic consumption, but it was not the optimal edema-resolving method. Benefits in elbow surgery (1 study; 59 patients) were limited to pain and analgesia consumption. For shoulder surgery (6 studies; 311 patients), the evidence was not consistent regarding the benefits of cryotherapy on postoperative pain despite a general trend toward amelioration, with compression cryotherapy and continuous cryotherapy showing the best results.</p><p><strong>Conclusion: </strong>The effectiveness of cryotherapy appeared dependent on the specific surgical context and the protocol used. Pairing cryotherapy with compression led to better outcomes than cryotherapy alone. Special consideration should be given when implementing cryotherapy after hip fractures.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320132"},"PeriodicalIF":2.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753788","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 Outcomes of Trochleoplasty in the Treatment of Patellofemoral Instability in the Adolescent and Young Adult Knee With Severe Trochlear Dysplasia: A Minimum 2-Year Follow-up.","authors":"Adam Kreutzer, Remy Zimmerman, Charles Kim, Tracey Bastrom, John A Schlechter","doi":"10.1177/23259671251321499","DOIUrl":"10.1177/23259671251321499","url":null,"abstract":"<p><strong>Background: </strong>Recurrent patellofemoral joint instability in adolescent and young adult patients is associated with several anatomic risk factors. A lack of consensus exists as to which risk factor(s) should be addressed at the time of surgery, but the presence of a severely dysplastic femoral trochlea has been described as an indication for surgical intervention. Furthermore, literature has suggested that a severely dysplastic trochlea can be a contributing factor to a failed medial patellofemoral ligament reconstruction (MPFLR) alone.</p><p><strong>Purpose: </strong>To investigate the postoperative outcomes of patients <20 years of age who underwent primary trochleoplasty in combination with MPFLR and lateral retinacular lengthening (LRL), with some receiving concomitant tibial tubercle osteotomy (TTO).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data performed in patients <20 years old who underwent trochleoplasty with MPFLR with ≥2 years of follow-up. Demographics, concomitant procedures, patient-reported outcome (PRO) measures, magnetic resonance imaging, and radiographs were reviewed. Patients who also underwent TTO were compared with those who did not.</p><p><strong>Results: </strong>A total of 21 knees from 15 patients (11 female, 4 male) with mean age of 16.4 years (13.7-19.8 years) were included. All patients had severe trochlear dysplasia and were treated with trochleoplasty, MPFLR, and LRL. Ten knees underwent additional TTO and were compared with those who did not (n = 11). The Pediatric International Knee Documentation Committee, Kujala, and Lysholm scores collected at a mean of 3.3 years (range, 2-6 years) postoperatively did not differ significantly between groups. There were no patient-reported postoperative episodes of patellar instability by the final follow-up.</p><p><strong>Conclusion: </strong>At a minimum 2-year follow-up, there were no statistically significant differences observed in PROs between patients who underwent trochleoplasty and concomitant TTO and those who had trochleoplasty alone, with neither group having any reported episodes of postoperative patellar instability. Furthermore, at final follow-up favorable PROs were achieved in patients who underwent trochleoplasty for the treatment of their patellofemoral instability with severe trochlear dysplasia.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251321499"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753799","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":"Fatigue of the Dynamic Stabilizers of the Medial Elbow in Baseball Pitchers.","authors":"Michael Mullaney, Susan Kwiecien, Andrew Fink, Kenneth Brown, Malachy McHugh, Stephen Nicholas","doi":"10.1177/23259671241306435","DOIUrl":"10.1177/23259671241306435","url":null,"abstract":"<p><strong>Background: </strong>The flexor carpi ulnaris and flexor digitorum superficialis are thought to provide dynamic stability to the medial elbow during pitching. High medial elbow stress during pitching fatigues these dynamic stabilizers of the medial elbow. This fatigue of dynamic stabilizers could leave the ulnar collateral ligament more vulnerable to the stress of pitching.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to identify the onset of fatigue in the dynamic elbow stabilizers during a pitching performance. It was hypothesized that middle finger (MF) and ring finger (RF) fatigue during a pitching performance would occur earlier and be more substantial than grip and 3 finger grip fatigue.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Eighteen baseball pitchers (age, 17 ± 4 years) threw 4 innings of a simulated game (16 pitches per inning plus 5 warm-up pitches per inning). Before the game and after each inning, MF flexion, RF flexion, and grip strength were recorded. A standard full grip (FG) and a modified 3-finger grip (3FG) test were employed. Fatigue was classified as marked (>20% loss), moderate (10%-20% loss) or minimal (<10% loss).</p><p><strong>Results: </strong>MF strength was greater on the dominant versus nondominant hand (7%; <i>P</i> = .04). There was no hand dominance effect for the other 3 tests (RF, <i>P</i> = .15; FG, <i>P</i> = .79; 3FG, <i>P</i> = .90). The fatigue responses differed significantly between tests (<i>P</i> < .001). After the fourth inning, MF fatigue (21%) was greater than RF (7%; <i>P</i> < .001), FG (5%; <i>P</i> < .002), and 3FG (5%; <i>P</i> < .001) fatigue. MF fatigue was evident early and was progressive. After the first inning, 4 pitchers (22%) had marked MF fatigue and 3 (17%) had moderate MF fatigue. By the end of the fourth inning, 10 pitchers (56%) had marked MF fatigue and 6 (33%) had moderate MF fatigue. By contrast, only 5 pitchers (28%) had marked RF fatigue after 4 innings, and only 3 pitchers (17%) had marked FG or 3FG fatigue. Pitchers with high valgus elbow torque during pitching had greater MF fatigue than pitchers with lower elbow valgus forces (22% vs 10%; <i>P</i> = .045).</p><p><strong>Conclusion: </strong>By the end of the fourth inning, 10 pitchers (56%) had marked MF fatigue and 6 (33%) had moderate MF fatigue. MF fatigue may be indicative of medial elbow dynamic stabilizer fatigue in pitchers.</p><p><strong>Clinical relevance: </strong>We recommend finger flexor strength training to help support the medial stabilizers of the elbow during pitching. In the future, MF fatigue testing could be an \"in-game\" measure of pitcher fatigue.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671241306435"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753811","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":"Predicting Surgical Outcomes in Patients With Recurrent Patellar Dislocations.","authors":"Dario De Caro, Nathan L Grimm, J Lee Pace, John A Curran, Clare K Fitzpatrick","doi":"10.1177/23259671251324527","DOIUrl":"10.1177/23259671251324527","url":null,"abstract":"<p><strong>Background: </strong>A lateral dislocation of the patella is a common injury in adolescents and young adults that is largely caused by underlying anatomic risk factors. Surgically managed patients have a significantly lower risk of recurrent dislocations. However, determining the optimal surgical treatment remains a challenge, with patients sometimes undergoing multiple surgical procedures before achieving successful stabilization.</p><p><strong>Purpose: </strong>To computationally evaluate patients who have undergone multiple surgical procedures to treat recurrent lateral patellar dislocations and predict their clinical outcomes.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Our cohort consisted of 16 patients with trochlear dysplasia and recurrent lateral patellar dislocations. We used magnetic resonance imaging to create 3-dimensional patient-specific finite element models of the knee joint and evaluated patellofemoral stability before and after surgery. We applied these models to computationally predict the clinical outcome of each surgical procedure. We simulated a knee extension activity coupled with external tibial torsion to assess patellofemoral stability. We also included a healthy control group of 12 participants in the computational evaluation. Finally, we developed and trained a logistic regression model based on anatomic risk factors and applied this model to classify whether patients had a likelihood of a dislocation to efficiently differentiate between surgical outcomes.</p><p><strong>Results: </strong>Of 12 control, 12 preoperative, and 9 postoperative scans, the finite element model correctly predicted 29 of 33 surgical outcomes (87.9% accuracy). Postoperative simulations predicted patellofemoral stability metrics similar to those of the control group. Specifically, patients after trochleoplasty were associated with increased constraint force on the patellar lateral facet and lower involvement of the medial patellofemoral ligament. The logistic regression model demonstrated 81.8% accuracy in classification.</p><p><strong>Conclusion: </strong>Preliminary results are promising, but an improvement of the model and a larger clinical dataset are necessary to increase accuracy and comprehensively validate model performance.</p><p><strong>Clinical relevance: </strong>The aim of this study was to provide surgeons with a useful computational tool that can predict the likelihood of a patellar dislocation and differentiate, before a clinical intervention, between successful versus unsuccessful surgery to determine the optimal treatment pathway for individual patients.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324527"},"PeriodicalIF":2.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753837","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":"Predicting ACL Reconstruction Failure with Machine Learning: Development of Machine Learning Prediction Models.","authors":"Rafael Krasic Alaiti, Caio Sain Vallio, Andre Giardino Moreira da Silva, Riccardo Gomes Gobbi, José Ricardo Pécora, Camilo Partezani Helito","doi":"10.1177/23259671251324519","DOIUrl":"10.1177/23259671251324519","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) is the predominant and widely accepted treatment modality for ACL injury. However, recurrence of ACL rupture or failure of the reconstruction remains a significant challenge. Despite several studies in the literature that have developed prediction models to address this issue by identifying prognostic factors for treatment outcomes using classical statistical methods, the predictive efficacy of these models is frequently suboptimal.</p><p><strong>Purpose: </strong>To (1) evaluate the predictive performance of different machine learning algorithms for the occurrence of failure in ACLR and (2) identify the most relevant predictors associated with this outcome.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 680 patients who underwent ACLR between January 2012 and July 2021 were evaluated. The study outcome was ACLR failure-defined as a complete tear confirmed by magnetic resonance imaging, arthroscopy, or clinical ACL insufficiency-evaluated at a minimum 2-year follow-up. Routinely collected data were used to train 9 machine learning algorithms-including k-nearest neighbors classifier, decision tree classifier, random forest classifier, extra trees classifier, gradient boosting classifier, eXtreme Gradient Boosting, CatBoost classifier, and logistic regression. A random sample of 70% of patients was used to train the algorithms, and 30% were left for performance assessment, simulating new data. The performance of the models was evaluated with the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The predictive performance of most models was good, with AUCs ranging from 0.71 to 0.85. The models with the best AUC metric were the CatBoost classifier (0.85 [95% CI, 0.81-0.89]) and the random forest classifier (0.84 [95% CI, 0.77-0.90). Knee hyperextension consistently emerged as the primary predictor for ACLR failure across all models subjected to our analysis.</p><p><strong>Conclusion: </strong>Machine learning algorithms demonstrated good performance in predicting ACLR failure. Moreover, knee hyperextension consistently emerged as the primary predictor for failure across all models subjected to our analysis.</p><p><strong>Clinical relevance: </strong>The findings of this study highlight the potential of machine learning as a valuable clinical tool for decision-making on surgical intervention. By offering nuanced insights, these algorithms may contribute to the evolving landscape of orthopaedic practice. Also, this study confirms knee hyperextension as an important risk factor for ACLR failure.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324519"},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720926","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":"Mechanical Properties of Tibialis Tendon Grafts Are Unchanged by Soaking in Tobramycin.","authors":"Michael Burton, Tyler Barker, Zachary Burnett, Robert Magnussen, Christopher Kaeding, Eric Milliron, Parker Cavendish, Franco Piscitani, Jeremy Seidt, David Flanigan","doi":"10.1177/23259671251325663","DOIUrl":"10.1177/23259671251325663","url":null,"abstract":"<p><strong>Background: </strong>Tendon graft soaking in vancomycin solution minimizes surgical infection risk and has no effect on graft strength, but the intermittent vancomycin shortages, presence of vancomycin-resistant organisms, and treatment needs of patients with vancomycin hypersensitivity merit investigation of alternative antibiotics. Tobramycin prevents infection at low concentrations and is a cost-effective alternative, but it is unknown if tobramycin alters graft mechanical properties.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to investigate the effects of tobramycin soaking on tendon graft mechanical properties. It was hypothesized that tobramycin soaking will not affect tendon graft mechanical properties.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 30 tibialis tendon grafts were wrapped in saturated gauze swabs containing saline (control; n = 10), vancomycin (n = 10; 5 mg/mL), or tobramycin (n = 10; 1 mg/mL) for 10 minutes. Grafts were then removed from the treated gauze swab wraps and mechanically tested under uniaxial tension loading conditions. Grafts were pulled at a rate of 10 mm/min to failure. Force and displacement data from each test were used to calculate the Young modulus (MPa), ultimate tensile stress (MPa), and elasticity limit (MPa).</p><p><strong>Results: </strong>There were no significant differences in Young modulus (552 ± 108, 583 ± 98, and 660 ± 237 MPa; <i>P</i> = .62), ultimate tensile stress (91.5 ± 20.8, 96.6 ± 17.8, and 99.7 ± 33.3 MPa; <i>P</i> = .85), or elasticity limit (51.7 ± 16.4, 53.2 ± 13.8, and 52.3 ± 15.3 MPa; <i>P</i> = .98) between the control, vancomycin, and tobramycin groups, respectively.</p><p><strong>Conclusion: </strong>Soaking of tibialis tendon grafts with tobramycin does not appear to alter mechanical properties of the tendon graft under uniaxial load conditions.</p><p><strong>Clinical relevance: </strong>If vancomycin use is not possible or contraindicated for certain patients, surgeons can soak grafts in tobramycin to achieve similarly effective infection mitigation without weakening the graft.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251325663"},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Outcomes in Application of Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF) in Medial Collateral Ligament Recovery: An Animal Study.","authors":"Muhammad Sakti, Henry Yurianto, Dave Kennedy","doi":"10.1177/23259671251324472","DOIUrl":"10.1177/23259671251324472","url":null,"abstract":"<p><strong>Background: </strong>The medial collateral ligament (MCL) is one of the most commonly injured ligaments in the knee, accounting for 40% of all knee injuries. Autologous platelet concentrate, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), has been proposed as a novel therapy in ligament injury.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of PRP and PRF in recovery after MCL injury.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>This study was a randomized, single-blind, in vivo study on MCL injury in Wistar rats (<i>Rattus norvegicus</i>). Rats that were sick, had a decrease in body weight of >10% after adaptation in the laboratory, or died were excluded. A total of 30 male Wistar rats were divided into 3 groups: group 1 (n=10) received no intervention, group 2 (n=7) received PRP, and group 3 (n=10) received PRF. The variables that were investigated included tensile strength and histopathological appearance. All statistical analysis was performed using SPSS 22.0 using the appropriate test based on the variable.</p><p><strong>Results: </strong>This study found that there was a significant difference in tensile strength across all groups (<i>P</i> = .004), with a significantly higher value in the PRF group compared with the PRP group (mean difference, 2.76; <i>P</i> = .003). There was no significant correlation between tensile strength and ligament length (<i>P</i> = .34). Based on the histopathological data, this study found that PRF resulted in a higher amount of collagen cell orientation when compared with PRP and control (<i>P</i> = .049).</p><p><strong>Conclusion: </strong>This study found that PRF was associated with greater tensile strength when compared with PRP and control. However, more studies with a longer observation period and further trials, especially in humans, should be conducted to confirm this finding.</p><p><strong>Clinical relevance: </strong>PRF injection can be a novel therapy consideration for ligament injury, with a better result in both function and histological appearance when compared with PRP.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251324472"},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720924","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":"Surgical Stabilization Results in Superior Clinical Outcome, Lower Recurrent Instability, and Reduced Risk of Meniscal Tears Relative to Nonoperative Treatment of ACL Rupture: A 3-Year Prospective Controlled Cohort Study.","authors":"Mark D Porter, Bruce Shadbolt","doi":"10.1177/23259671251320647","DOIUrl":"10.1177/23259671251320647","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There has been renewed interest in nonoperative treatment of anterior cruciate ligament (ACL) rupture following research suggesting that some ACL ruptures can heal naturally. However, the research is based on magnetic resonance imaging grading of ACL injuries rather than clinical signs, and the accuracy of the grading system is unknown. Nonoperative treatment of ACL ruptures has been associated with a higher risk of meniscal tears and recurrent instability, both of which may have long-term implications for the knee in terms of degeneration and the need for more complex stabilization surgery. More research into the nonoperative management of clinically significant ACL injuries is indicated before consideration for use in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;Operative management of ACL rupture improves clinical outcome relative to nonoperative management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Covid-19 pandemic temporarily stopped elective surgery during 2020. For 2 months, those patients with isolated ACL ruptures underwent nonoperative treatment with bracing and physical therapy (Nonop group) were compared with a matched cohort undergoing ACL reconstruction (ACLR group) immediately before this period. Groups were compared at baseline with regard to age, gender, body mass index (BMI), lateral posterior tibial slope (LPTS), and the following patient-reported outcome measures (PROMs)-Tegner Activity Scale (TAS), International Knee Documentation Committee (IKDC), Sport and Recreation subscale (Sport/Rec) of the Knee injury and Osteoarthritis Outcome Score (KOOS), Knee Related Quality of Life (KR QoL) subscale of the KOOS, and Lysholm Knee Score (LKS)-as well as recurrent instability and meniscal tears, over a period of 3 years. Pearson chi-square test and analysis of variance were used for baseline characteristics, generalized linear models and multivariate tests for changes in PROMs, and chi-square tests for meniscal tears and recurrent instability. Statistical significance was accepted at &lt;i&gt;P&lt;/i&gt; &lt; .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 82 patients were recruited, 41 in each group. The ACLR group and the Nonop group were similar with regard to all baseline variables, with the following mean ± SD values, respectively: age in years (22.1 ± 3.8 vs 21.3 ± 3.4; &lt;i&gt;P&lt;/i&gt; = .23), BMI in kg/m&lt;sup&gt;2&lt;/sup&gt; (21.0 ± 2.0 vs 20.4 ± 2.5; &lt;i&gt;P&lt;/i&gt; = .39), LPTS (8.1° ± 1.3° vs 7.9° ± 2.0°; &lt;i&gt;P&lt;/i&gt; = .65), and preinjury TAS (8.2 ± 1.1 vs 8.7 ± 1.0; &lt;i&gt;P&lt;/i&gt; = .33). The male:female ratio was 15:26 vs 17:24 (&lt;i&gt;P&lt;/i&gt; = .71), respectively. At 3-year follow-up, the ACLR group had greater improvement in all PROMs than the Nonop group: TAS, 8.0 ± 1.0 vs 5.5 ± 0.9; IKDC, 90.9 ± 3.8 vs 65.0 ± 8.1; Sport/Rec, 92.4 ± 7.6 vs 66.6 ± 6.1; KR QoL, 91.1 ± 5.5 vs 74.3 ± 6.6; and LKS, 92.2 ± 4.9 vs 66.9 ± 6.1, respectively (all &lt;i&gt;P&lt;/i&gt; &lt; .001). There was","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320647"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692969","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":"Midterm Outcomes After Revision Posterior Labral Repair in Active-Duty Military Patients.","authors":"John P Scanaliato, Amy Thompson, Clare K Green, Alexis B Sandler, Cole M Patrick, John R Tyler, Nata Parnes","doi":"10.1177/23259671251322695","DOIUrl":"10.1177/23259671251322695","url":null,"abstract":"<p><strong>Background: </strong>Active-duty military service members experience posterior glenohumeral instability at a rate that far outpaces that of nonmilitary populations. While the outcomes after primary posterior labral repair (PLR) in this population are promising, the outcomes after revision procedures remain poorly described.</p><p><strong>Purpose: </strong>To report midterm outcomes after revision PLR in a population of active-duty military patients.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Patients who underwent revision PLR from January 2011 through December 2018 by the senior surgeon with a minimum of 5 years of follow-up were deemed eligible for inclusion. Preoperative and postoperative outcome scores for the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Rowe instability score as well as the rates of return to active duty and sports and the rate of recurrent instability were collected and pooled for analysis.</p><p><strong>Results: </strong>Overall, 21 patients with a mean follow-up of 77.95 ± 39.54 months met inclusion criteria and were available for analysis. At midterm follow-up, patients who underwent revision PLR experienced significantly improved VAS (from 7.3 ± 1.8 to 2.9 ± 2.4), ASES (from 49.5 ± 12.6 to 79.7 ± 16.7), SANE (from 45.0 ± 14.8 to 80.2 ± 20.3), and Rowe (from 37.6 ± 9.4 to 79.4 ± 24.7) scores. Over 80% of patients also achieved the minimal clinically important difference for these outcome measures; however, only 52% to 62% of patients achieved the Patient Acceptable Symptom State. The return-to-sport rate was 66.67%, and the return to active-duty rate was 80.95%.</p><p><strong>Conclusion: </strong>While patients who underwent revision PLR experienced improvements in outcomes and a decrease in pain on average, they exhibited rates of return to active-duty and sports that lagged behind those demonstrated in a previous cohort that underwent a primary procedure. Furthermore, the achievement of clinically significant outcomes after revision PLR was less consistent compared with that after primary PLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251322695"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692963","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}