Orthopaedic Journal of Sports Medicine最新文献

{"title":"Correlation Between Synovial Coverage of the Reconstructed Anterior Cruciate Ligament and Healing of Bucket-Handle Medial Meniscal Tears After Combined ACL Reconstruction and Meniscal Repair.","authors":"Binyang Meng, Zi Zhang, Wenhe Li, Qi Wang, Fuji Ren, Rui Wang, Hao Pang, Zhilin Yue, Jiangang Cao","doi":"10.1177/23259671261472645","DOIUrl":"10.1177/23259671261472645","url":null,"abstract":"<p><strong>Background: </strong>Meniscal healing after repair of bucket-handle medial meniscal tear (BHMMT) concomitant with anterior cruciate ligament (ACL) reconstruction (ACLR) remains variable despite advances in surgical technique. The biological environment within the knee joint, particularly the degree of synovialization of the reconstructed ACL graft, may influence meniscal healing outcomes, but this relationship has not been systematically investigated.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate the arthroscopic relationship between synovial coverage of the reconstructed ACL and the healing of repaired BHMMTs following combined ACLR and meniscal repair. It was hypothesized that greater synovialization of the reconstructed ACL would be associated with higher rates of meniscal healing.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>A retrospective analysis was performed on patients who underwent ACLR combined with BHMMT repair between January 2020 and January 2025 and subsequently underwent tibial hardware removal with second-look arthroscopy (SLA). A total of 59 patients met the inclusion criteria. Functional outcomes were assessed preoperatively and before SLA using the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity scale. Arthroscopic videos obtained during SLA were reviewed to evaluate graft synovialization, categorized as good (>80%), fair (50%-80%), or poor (<50%) and to assess the healing status of the repaired meniscus. Meniscal healing was defined as the absence of retear or the need for additional repair or meniscectomy.</p><p><strong>Results: </strong>All functional outcome scores (KOOS, Lysholm, IKDC, and Tegner) improved significantly postoperatively compared with preoperative values (<i>P</i> < .05). A significant positive correlation was observed between the degree of synovial coverage of the reconstructed ACL and meniscal healing (<i>r</i> = 0.724; <i>P</i> < .001). Overall, meniscal healing was observed in 36 of 59 patients (61%). According to synovial coverage grade, healing rates were 100.0% in the good group, 44.4% in the fair group, and 0.0% in the poor group. A small 1- to 2-mm free-edge lesion, described in this study as a minor superficial fissure, was observed arthroscopically in 44 of 59 patients (75%).</p><p><strong>Conclusion: </strong>In patients undergoing ACLR combined with BHMMT repair, the degree of synovial coverage of the reconstructed ACL was significantly and positively associated with meniscal healing. Greater synovialization of the ACL graft was associated with a higher likelihood of meniscal healing. The extent of synovial coverage may serve as a useful arthroscopic indicator of intra-articular biological healing potential and may help inform postoperative evaluation and clinical decision-making.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261472645"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875684","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":"Association Between Computed Tomography-Derived Hounsfield Units of the Ulnar Collateral Ligament and Valgus Laxity in Professional Baseball Players.","authors":"Masaru Munemori, Kyosuke Numaguchi, Daisuke Momma, Akira Kodama, Keiko Goto, Eiji Kondo, Nobuo Adachi, Norimasa Iwasaki","doi":"10.1177/23259671261472961","DOIUrl":"10.1177/23259671261472961","url":null,"abstract":"<p><strong>Background: </strong>Ulnar collateral ligament (UCL) insufficiency in overhead athletes is thought to result from repetitive valgus loading that induces progressive microtrauma and structural attenuation. Although stress ultrasonography and magnetic resonance imaging are commonly used to evaluate UCL integrity, no imaging modality provides a widely accepted, objective, and quantitative marker of intrinsic ligament tissue quality.</p><p><strong>Purpose: </strong>To determine whether nonstress computed tomography (CT)-derived Hounsfield unit (HU) values of the UCL are associated with valgus laxity in professional baseball players and whether HU values serve as a quantitative marker of UCL insufficiency.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 44 professional baseball players underwent non-contrast-enhanced CT of the dominant elbow. HU values of the anterior bundle of the UCL were measured on reconstructed oblique coronal images using polygonal regions of interest for the whole ligament as well as proximal, midsubstance, and distal thirds. Valgus laxity was assessed using stress ultrasonography (stress delta difference) and stress CT (stress delta). Associations between HU values and valgus laxity were evaluated using Spearman correlation, group comparisons, receiver operating characteristic (ROC) analysis, and multivariable logistic regression. Exploratory analyses examined relationships between HU values and age, baseball experience, and playing position.</p><p><strong>Results: </strong>Lower proximal UCL HU values were significantly associated with greater valgus laxity on stress ultrasonography (<i>r</i> = -0.424; <i>P</i> = .005) and stress CT (<i>r</i> = -0.331; <i>P</i> = .030). On stress ultrasonography, whole-ligament HU values also demonstrated a significant negative association with valgus laxity, whereas midsubstance and distal HU values were not significantly related to laxity. Proximal HU values showed acceptable discrimination of increased valgus laxity (area under the ROC curve, 0.755), and ROC analysis identified an optimal cutoff of 65.5 HU with 85.7% sensitivity and 71.4% specificity. Proximal HU values remained significant after adjusting for age (odds ratio per 1-HU increase, 0.91; <i>P</i> = .049). Proximal HU values were not associated with age, years of baseball experience, age at baseball initiation, or playing position.</p><p><strong>Conclusion: </strong>CT-derived HU values of the proximal UCL were associated with valgus laxity in professional baseball players with structurally intact ligaments. A reduction in proximal HU values may reflect localized structural attenuation that is functionally relevant to medial elbow stability.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261472961"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875626","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":"Prevalence of ACL Injury Prevention Protocols in Girls' High School Athletics: A Metro Detroit Survey Study With Socioeconomic Analysis.","authors":"Alexandria Chrumka, Isabella Strickler, Annabella Jensen, Christopher Nikolopoulos, P Tyler Roskos, Jaysen Jensen, Betina Hinckel","doi":"10.1177/23259671261470580","DOIUrl":"10.1177/23259671261470580","url":null,"abstract":"<p><strong>Background: </strong>Female athletes sustain anterior cruciate ligament (ACL) injuries at higher rates than male athletes, particularly in pivoting sports. Although neuromuscular prevention programs reduce ACL injury risk, implementation of these programs in high school athletics remains inconsistent.</p><p><strong>Purpose: </strong>To determine the prevalence of ACL injury prevention protocols (IPPs) in girls' high school athletics in Metro Detroit and evaluate whether socioeconomic status (SES), school type, and access to athletic trainers (ATs) are associated with implementation.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted from August 2022 to July 2023 among girls' basketball, soccer, and volleyball coaches at 131 Metro Detroit high schools. Surveys were distributed through athletic directors at all eligible schools. Survey items assessed coaching characteristics, AT access, awareness of ACL injury risk and prevention programs, and use of general and ACL-specific IPPs. School-level SES and school type were obtained from public education reports. Descriptive statistics summarized responses, and Spearman correlations evaluated associations between SES and prevention-related outcomes.</p><p><strong>Results: </strong>A total of 28 of 131 schools (21%) responded, yielding 57 coach responses. Among the 57 responding coaches, 68.4% reported AT access, 77.2% recognized increased ACL injury risk in female athletes, and 73.7% were aware of ACL prevention programs. General injury prevention programs were used by 70.2% of coaches, whereas 47.4% reported an ACL-specific IPP. Lower SES was significantly associated with reduced awareness of ACL prevention programs (ρ = -0.26; <i>P</i> = .0036).</p><p><strong>Conclusion: </strong>Our study showed that, despite widespread awareness of the increased risk of ACL injury in female athletes, fewer than half of responding coaches reported implementing ACL-specific prevention programs. Lower-SES schools demonstrated reduced awareness of prevention strategies, highlighting opportunities for targeted educational outreach and resource support.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261470580"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875643","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":"Increased Posterior Tibial Slope as a Risk Factor for Failure of Healing of Medial Meniscal Root Tears After All-Inside Suture Anchor Repair.","authors":"Nam-Hong Choi, Bong-Seok Yang, Dong-Min Lee, Brian N Victoroff","doi":"10.1177/23259671261477913","DOIUrl":"10.1177/23259671261477913","url":null,"abstract":"<p><strong>Background: </strong>Investigating the possible association between medial posterior tibial slope (PTS) and healing of repaired medial meniscal posterior root tear (MMPRT) is very limited in the relevant literature.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to investigate the association between medial PTS and healing of MMPRTs after all-inside suture anchor repair. We hypothesized that there would be a significant difference in the medial PTS between the healing and nonhealing groups.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>From March 2008 to December 2023, consecutive patients who underwent MMPRT repair using the all-inside repair technique with suture anchors were selected. MMPRTs were repaired in patients with grade 1 or 2 chondromalacia according to the Outerbridge classification of the medial compartment, minimal extrusion (<3 mm), normal limb alignment (hip-knee-ankle angle <3°), and minimally displaced root tears. The patients were divided into 2 (healed and nonhealed) groups according to the magnetic resonance imaging (MRI) appearance of the repaired MMPRT at 6 months after surgery. The medial PTS was measured on the mid-central slice of the sagittal MRI. The 2 groups were compared according to age, body mass index (BMI), and PTS.</p><p><strong>Results: </strong>There were 47 patients in the healed group and 25 patients in the nonhealed group. Age and BMI did not differ significantly between the 2 groups (<i>P</i> = .763 and <i>P</i> = .073). PTS of the nonhealed group was significantly higher than that of the healed group (5.9 ± 2.2 vs 4.4 ± 2.5; <i>P</i> = .017). Logistic regression analysis demonstrated that the PTS was associated with failure to heal after the MMPRT repair (odds ratio [OR], 1.31; 95% CI, 1.04-1.73; <i>P</i> = .022). However, age and BMI were not associated with nonhealing after the MMPRT repair (OR = 0.99; 95% CI, 0.93-1.08; <i>P</i> = .759; OR = 0.85; 95% CI, 0.70-1.02; <i>P</i> = .079).</p><p><strong>Conclusion: </strong>Increased PTS was associated with failure to heal MMPRT after all-inside suture anchor repair. This factor should be considered when counseling patients undergoing MMPRT repair.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261477913"},"PeriodicalIF":2.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875667","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":"Built Environment Portends Poor Outcomes for Hip Arthroscopy Patients at 2-Year Follow-up.","authors":"Rishi P Earla, Jackson G Woodrow, Rachel L Poutre, Brandon J Allen, Srish Chenna, Jeffrey S Mun, Stephen M Gillinov, Bilal S Siddiq, Scott D Martin","doi":"10.1177/23259671261451219","DOIUrl":"10.1177/23259671261451219","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is a paucity of research on how factors within the social determinants of health (SDOHs), specifically built environment (recreational parks, housing built pre-1980s, and walkability), affect outcomes after hip arthroscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the effect of the built environment on patient-reported outcome measures (PROMs) and rates of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS).&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;Patients who underwent hip arthroscopy for symptomatic labral tears were enrolled in this study. Study participants prospectively completed PROM surveys preoperatively and at 3, 6, 12, and 24 months after surgery. Patients were excluded if they were &lt;18 years of age, had radiographic evidence of hip dysplasia (lateral center-edge angle &lt;20°), had Tönnis grade &gt;1, or had prior ipsilateral hip surgery. Patients were retrospectively stratified into built environment (BE; BE&lt;sub&gt;Good&lt;/sub&gt;, BE&lt;sub&gt;Average&lt;/sub&gt;, and BE&lt;sub&gt;Poor&lt;/sub&gt;) cohorts according to the Centers for Disease Control and Prevention's BE percentile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 203 patients (108 male and 95 female) met the inclusion criteria and were stratified into 3 cohorts: BE&lt;sub&gt;Good&lt;/sub&gt; (mean BE: 20.4% ± 9.5%), BE&lt;sub&gt;Average&lt;/sub&gt; (mean BE: 47.8% ± 10.0%), and BE&lt;sub&gt;Poor&lt;/sub&gt; (mean BE: 74.4% ± 6.0%). At baseline, the BE&lt;sub&gt;Good&lt;/sub&gt; reported significantly higher scores in all PROMs compared with the BE&lt;sub&gt;Poor&lt;/sub&gt; cohort (all &lt;i&gt;P&lt;/i&gt; &lt; .05). At 2 years, both BE&lt;sub&gt;Good&lt;/sub&gt; and BE&lt;sub&gt;Average&lt;/sub&gt; reported significantly higher PROM scores compared with BE&lt;sub&gt;Poor&lt;/sub&gt; (all &lt;i&gt;P&lt;/i&gt; &lt; .05). There were no significant differences between cohorts in achieving MCID values (&lt;i&gt;P&lt;/i&gt; &gt; .05). BE&lt;sub&gt;Good&lt;/sub&gt; reported significantly higher PASS achievement for Hip Outcome Score-Activities of Daily Living (&lt;i&gt;P&lt;/i&gt; = .042), Hip Outcome Score-Sports Specific Subscale (&lt;i&gt;P&lt;/i&gt; = .013), and Non-Arthritic Hip Score (&lt;i&gt;P&lt;/i&gt; = .021) compared with BE&lt;sub&gt;Poor&lt;/sub&gt;. At 24 months, both BE&lt;sub&gt;Good&lt;/sub&gt; and BE&lt;sub&gt;Average&lt;/sub&gt; reported significantly higher rates of achieving PASS for all PROMs (all &lt;i&gt;P&lt;/i&gt; &lt; .05), except for the modified Harris Hip Score (&lt;i&gt;P&lt;/i&gt; = .156 and &lt;i&gt;P&lt;/i&gt; = .410, respectively), compared with BE&lt;sub&gt;Poor&lt;/sub&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients undergoing hip arthroscopy who reside in a poor built environment reported significantly lower preoperative baseline scores, and this disparity continued at the 24-month follow-up, with lower rates of PASS achievement. However, patients across built environment cohorts improved and achieved MCID at similar rates. These findings suggest that a poor built environment may negatively influence preoperative PROMs but that hip arthroscopy is still beneficial for patients regardless of the bui","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261451219"},"PeriodicalIF":2.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866214","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":"Association of Persistent Interlimb Kinetic Asymmetry at Return to Sport With Increased Risk of Contralateral Anterior Cruciate Ligament Injury.","authors":"Horacio Rivarola, Cristian Collazo, Marcos Palanconi, Marcos Meninato, Carlos Peñaherrera-Carrillo, Alejandro Barros Castro, Francisco Endara Urresta","doi":"10.1177/23259671261477570","DOIUrl":"10.1177/23259671261477570","url":null,"abstract":"<p><strong>Background: </strong>Return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) reconstruction (ACLR) is primarily based on clinical and functional criteria. Despite meeting these criteria, a substantial proportion of athletes sustain a second ACL injury, most commonly involving the contralateral knee, suggesting a persistent gap between clinical clearance and biomechanical recovery.</p><p><strong>Purpose: </strong>To determine whether interlimb kinetic asymmetry at the time of RTS is associated with an increased risk of subsequent contralateral ACL injury and whether kinetic asymmetry provides incremental prognostic value beyond conventional RTS criteria.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 500 patients who underwent primary unilateral ACLR and completed biomechanical testing at RTS clearance were included. Interlimb kinetic asymmetry was assessed during a standardized single-leg landing task using force-platform-derived peak vertical ground-reaction force (vGRF) and loading rate. Patients were followed for a mean of 36 months. The primary outcome was contralateral ACL injury. Associations were evaluated using Cox proportional hazards regression. Prognostic performance was assessed using the Harrell concordance index (C-index), time-dependent receiver operating characteristic analysis, calibration plots, and decision curve analysis.</p><p><strong>Results: </strong>During follow-up, 120 patients (24%) sustained a contralateral ACL injury, corresponding to an incidence rate of 8.1 injuries per 100 person-years.Greater interlimb asymmetry in peak vGRF at RTS was independently associated with increased contralateral injury risk (adjusted hazard ratio per 1-SD increase, 1.47 [95% CI, 1.23-1.75]; <i>P</i> < .001). The combined model incorporating conventional RTS variables and kinetic asymmetry demonstrated improved discrimination (C-index, 0.76) compared with the conventional RTS model alone (C-index, 0.64; <i>P</i> < .001). Decision curve analysis showed greater net benefit for the combined model across clinically relevant risk thresholds.</p><p><strong>Conclusion: </strong>Persistent interlimb kinetic asymmetry at RTS is independently associated with an increased risk of subsequent contralateral ACL injury. Athletes demonstrating greater asymmetry at the time of RTS appear to be at increased risk despite successful clinical recovery, suggesting that persistent loading asymmetry may represent a clinically relevant marker of incomplete biomechanical restoration after ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261477570"},"PeriodicalIF":2.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857539","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":"Differential Arterial Supply of the ACL and PCL Revealed by 7T-qMRI, Histology, and Micro-CT.","authors":"Maximilian M Mueller, Sebastian Conner-Rilk, Craig E Klinger, Jerry Wang, Fidelius von Rehlingen-Prinz, Valentin Hingsamer, Kevin G Shea, Gregory S DiFelice, Ryan Brown, Scott A Rodeo, Daniel W Green","doi":"10.1177/23259671261464702","DOIUrl":"10.1177/23259671261464702","url":null,"abstract":"<p><strong>Background: </strong>Qualitative anatomical studies have reported ligament-specific differences in vascular organization in the anterior and posterior cruciate ligaments (ACL and PCL).</p><p><strong>Purpose: </strong>(1) To quantitatively map the regional arterial vascular supply of the ACL and PCL across standardized anatomical regions using 7-Tesla quantitative magnetic resonance imaging (7T-qMRI), histology, and high-resolution computed tomography (micro-CT) in a fresh-frozen human cadaveric model; and (2) to directly compare vascular distribution patterns between cruciate ligaments.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Seven fresh-frozen human cadaveric knee specimens (mean ± SD age, 41.9 ± 15.5 years) underwent pre- and postcontrast 7T-qMRI to quantify ligamentous vascularity by measuring contrast enhancement. Ligament zones were categorized based on relative distance from distal insertion as follows: 1 (≥90%), 2 (>75% to 90%), 3 (>25% to 75%), 4 (>10% to 25%), and 5 (≤10%). Subsequent quantitative algorithm-based histologic analysis with hematoxylin and eosin staining followed, and an additional specimen underwent micro-CT (98 μm) for qualitative assessment.</p><p><strong>Results: </strong>7T-qMRI found relative arterial contributions as follows: for the ACL, zone 1, 10.2%; zone 2, 25.9%; zone 3, 24.8%; zone 4, 10.3%; and zone 5, 17.6%. For the PCL, zone 1, 9.3%; zone 2, 13.2%; zone 3, 16.7%; zone 4, 21.8%; and zone 5, 39.5%. Analysis revealed significant differences in overall contribution within soft tissue zones between the ACL and PCL (8.3% vs 27.1%; <i>P</i> = .02). Zone-by-zone analysis identified significant interligament differences in zone 2 and zone 4 (<i>P</i> = .046 for both). Both tibial entheses (ACL, 87.7%; PCL, 76.9%) demonstrated higher vascularity compared with the femoral (ACL, 12.3%; PCL, 23.1%) (ACL, <i>P</i> = .02; PCL, <i>P</i> = .87). A 3-zone 7T-qMRI and histologic sensitivity analysis confirmed the distribution pattern.</p><p><strong>Conclusion: </strong>This study demonstrates a distinct, region-specific arterial distribution in the ACL and PCL. The ACL exhibited predominantly proximal vascular supply, whereas the PCL showed greater distal and overall arterial contribution. These quantitative differences in vascular organization provide a biological basis that may help explain ligament-specific healing behavior.</p><p><strong>Clinical relevance: </strong>This study establishes 7T-qMRI as a methodology for quantitative comparison of vascularity between the ACL and PCL to support future translational studies investigating the relationship between vascular supply, ligament-specific healing patterns, and injury-specific treatment strategies.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261464702"},"PeriodicalIF":2.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857503","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":"Return to Athletic Activity Following Sesamoidectomy: A Systematic Review of Time Frames and Clinical Outcomes.","authors":"Nour-Maria Bouzid, Mohini Johri, Claire Simpson, Benjamin P Cassidy, Andrew S Cuthbert, Joshua Setliff, John W Cyrus, Christopher D Murawski, Annunziato Amendola, Conor N O'Neill","doi":"10.1177/23259671261477555","DOIUrl":"10.1177/23259671261477555","url":null,"abstract":"<p><strong>Background: </strong>Hallux sesamoid pathology can cause persistent forefoot pain and loss of push-off strength in athletically active individuals, and sesamoidectomy is commonly performed when prolonged nonoperative management fails.</p><p><strong>Purpose: </strong>To evaluate return to athletic activity, return to preoperative performance, and postoperative complications following partial or complete hallux sesamoidectomy in athletically active individuals.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>PubMed, Embase, and CENTRAL were searched through October 2025 for studies reporting outcomes in athletically active individuals undergoing sesamoidectomy. Data extraction included demographics, pathology, operative details, follow-up duration, return-to-sport metrics, return to preoperative performance, and complications.</p><p><strong>Results: </strong>Six studies met inclusion criteria, representing 193 patients. Female patients comprised 72.2% of reported cases. The weighted mean return-to-sport rate was 91.9%. The weighted mean time to return to sport was 12.2 weeks. Return to preoperative performance occurred in 83.6% of patients. Complication rates ranged from 0% to 29.2%, with a weighted mean complication rate of 12.5%.</p><p><strong>Conclusion: </strong>Sesamoidectomy allows most athletically active individuals to return to athletic activity within 3 to 4 months postoperatively, although approximately 16% fail to return to their preoperative level of performance. Postoperative complications occurred in 12.5% of patients and should be considered during preoperative counseling. These findings may help guide shared decision-making for patients considering sesamoidectomy after failed conservative treatment.</p><p><strong>Registration: </strong>CRD420251170096 (PROSPERO).</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261477555"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840920","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":"Functional and Neurotrophic Outcomes After Physical Therapy and Injection-Based Treatments for Rotator Cuff Tendinopathy: The FORTIS Pilot Randomized Trial.","authors":"Natalia Pawłuś, Szymon Turkiewicz, Jędrzej Lesman, Agata Gabryelska, Marcin Domżalski, Michał Kanak","doi":"10.1177/23259671261468532","DOIUrl":"10.1177/23259671261468532","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tendinopathy (RCT) causes chronic shoulder pain, functional limitation, and sleep disturbance. Although physical therapy (PT) and injection-based interventions are widely used, their comparative clinical effects and neurotrophic mechanisms remain insufficiently defined.</p><p><strong>Purpose: </strong>To compare clinical and neurotrophic outcomes of PT alone versus PT combined with injection-based interventions in patients with chronic RCT.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 2.</p><p><strong>Methods: </strong>A total of 29 patients (29 shoulders) with MRI-confirmed supraspinatus tendinopathy and sleep disturbance (Pittsburgh Sleep Quality Index score ≥5) were randomized to 1 of 4 groups: PT (n = 7), PT with subacromial steroid injection (PT + SSI; n = 6), PT with suprascapular nerve block (PT + SSNB; n = 8), or PT with platelet-rich plasma injection (PT + PRP; n = 8). All participants completed a standardized 12-week PT program. Clinical outcomes were assessed at baseline (time zero [T0]), 1 month (T1), and 3 months (T3). Serum brain-derived neurotrophic factor (BDNF) was measured at T0 and T1. Wilcoxon and Kruskal-Wallis tests assessed within- and between-group differences.</p><p><strong>Results: </strong>All groups demonstrated clinical improvement, most consistently in pain, insomnia severity, shoulder function, and cognitive performance. PT + PRP improved across pain, insomnia, and shoulder function outcomes (<i>P</i>≤ .03). PT showed significant improvements in pain, insomnia severity, shoulder function, and processing speed (all <i>P</i>≤ .04). PT + SSI demonstrated early pain reduction at 1 month (<i>P</i> = .03), whereas PT + SSNB showed selective improvements in sleep quality (<i>P</i> = .02) and executive function (<i>P</i> = .04). No significant between-group differences were observed in serum BDNF levels. Only PT demonstrated significant correlations between BDNF changes and reductions in pain and insomnia severity (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>Our study demonstrated that PT alone was associated with coordinated short-term clinical improvement and neurotrophic correlates, supporting its role as a core component of nonoperative management of RCT. Injection-based adjuncts produced selective, time-limited effects. These findings suggest that structured PT should remain the cornerstone of nonoperative management, while injections may serve as adjuncts to facilitate short-term symptom relief and rehabilitation engagement rather than as stand-alone treatments.</p><p><strong>Registration: </strong>NCT06631976 (ClinicalTrials.gov identifier).</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261468532"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840943","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":"Sidearm Deliveries Are Associated With Lower Shoulder and Elbow Injury Burden and a Favorable Performance Profile in Major League Baseball: A Cohort Study of 927 Pitchers (2020-2025).","authors":"Morgan R Dillon, Michael A Mastroianni, Nicholas Frappa, Joseph Manzi, Samuel I Fuller, William Curtis, Frank J Alexander, Robert Ablove, Peter N Chalmers, Christopher S Ahmad","doi":"10.1177/23259671261470537","DOIUrl":"10.1177/23259671261470537","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pitching-related shoulder and elbow injuries continue to rise in baseball despite workload restrictions and biomechanics-informed coaching.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate associations between arm slot and shoulder/elbow injured list (IL) time-loss burden and performance in Major League Baseball (MLB) pitchers.&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;Publicly available data were aggregated for 927 MLB pitchers who threw ≥1000 pitches during 2020 to 2025 and had arm angle data available from the MLB Hawk-Eye tracking system. Arm slot was defined as the throwing-arm angle relative to horizontal at ball release and averaged per pitcher (mean ± SD, 39.0°± 10.9°). Based on the distribution of arm slot values in the cohort, pitchers were categorized as sidearm (&lt;33.5°; n = 255), three-quarters (33.5°-44.4°; n = 373), or overhand (&gt;44.4°; n = 299). Primary outcomes were cumulative shoulder+elbow, shoulder, and elbow IL days accrued during the 2020 to 2025 study period. Performance outcomes included run prevention metrics, FanGraphs \"plus\" metrics (Stuff+ reflects pitch quality indexed to league average), strikeout and walk rates, hard-hit percentage (frequency of high-exit-velocity contact), and expected fielding independent pitching (xFIP; pitcher-controlled run prevention estimate). Group comparisons used 1-way analysis of variance with Tukey testing. Continuous associations with performance metrics reaching group-level significance were assessed with linear regression. Injury burden was modeled using negative binomial regression with log (total pitches) and percentage of games started as covariates; the primary analysis additionally adjusted for Stuff+ and 4-seam fastball velocity to test for independent associations after accounting for established risk factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Pitchers accumulated 86,412 combined IL days (25,710 shoulder; 60,702 elbow). Shoulder injury burden increased linearly with more overhand arm slots, whereas combined and elbow burden were nonlinear, peaking within the overhand group (45°-57°). Per 1 SD (10.9°) toward a more overhand delivery, injury burden increased for combined (incidence rate ratio [IRR] = 1.09; &lt;i&gt;P&lt;/i&gt; = .01), shoulder (IRR = 1.11; &lt;i&gt;P&lt;/i&gt; = .002), and elbow (IRR = 1.08; &lt;i&gt;P&lt;/i&gt; = .03). After adjustment for Stuff+ and 4-seam velocity, arm slot remained independently associated with higher injury burden (IRR = 1.12-1.14; all &lt;i&gt;P&lt;/i&gt; &lt; .001). Performance profiles favored sidearm deliveries: per 1-SD more overhand slot, Stuff+ decreased (β = -1.09; &lt;i&gt;P&lt;/i&gt; &lt; .001), while xFIP (β = 0.05; &lt;i&gt;P&lt;/i&gt; = .02) and hard-hit percentage (β = 0.50; &lt;i&gt;P&lt;/i&gt; &lt; .001) increased. Sidearm pitchers used fewer 4-seam fastballs/cutters and more sinkers/sweepers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this MLB cohort, sidearm deliveries were associated with lower shoulder/elbow time-loss burden, superi","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 8","pages":"23259671261470537"},"PeriodicalIF":2.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840934","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}