Orthopaedic Journal of Sports Medicine最新文献

{"title":"Forearm Rotation at the Time of Elbow Ulnar Collateral Ligament Reconstruction Graft Tensioning Does Not Affect Postoperative Medial Elbow Joint Gapping.","authors":"Ryan S Selley, Cort D Lawton, Kwadwo Owusu-Akyaw, Kathleen N Meyers, Andreas Kontaxis, James B Carr","doi":"10.1177/23259671251326111","DOIUrl":"10.1177/23259671251326111","url":null,"abstract":"<p><strong>Background: </strong>The role of forearm rotation at the time of ulnar collateral ligament (UCL) reconstruction (UCLR) graft tensioning is poorly understood.</p><p><strong>Purpose: </strong>To compare postoperative medial elbow joint gapping in cadaveric elbows after UCLR graft tensioning with the forearm in supination versus pronation.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>A total of 18 full-arm human specimens were stripped of soft tissue except elbow ligamentous and capsular structures. Elbows with an intact, native ligament were tested for medial elbow gapping during valgus stress at 30°, 60°, and 90° with the forearm in neutral, maximal supination, and maximal pronation. Joint gapping was determined with a 3-dimensional motion capture system and calibrated digitized points on the ulna and humerus. The UCL was transected, and reconstruction was performed using a standard docking technique. Elbows were randomized to full supination or pronation at the time of final graft tensioning, and medial elbow joint gapping was again measured for the same positions and same technique. Analysis of variance test was used to compare differences in native and postoperative medial elbow joint gapping (<i>P</i> < .05).</p><p><strong>Results: </strong>The position of forearm rotation did not affect the amount of medial elbow joint gapping during valgus stress at all tested elbow flexion angles with an intact, native UCL. The position of forearm rotation during UCL graft tensioning also did not affect postoperative medial elbow joint gapping during valgus stress at all tested elbow flexion angles.</p><p><strong>Conclusion: </strong>Forearm rotation with an intact UCL and at the time of UCL graft tensioning did not affect the amount of medial elbow joint gapping during valgus torque.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251326111"},"PeriodicalIF":2.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12437179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081264","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":"Radiographic Risk Factors for Excessive Joint Line Obliquity After Knee Osteotomy for Medial Osteoarthritis: A Phenotype-Based Approach.","authors":"Jaejung Ryu, Bum-Sik Lee, Jong-Min Kim, Ju-Ho Song, Ho Yeon Kim","doi":"10.1177/23259671251351335","DOIUrl":"10.1177/23259671251351335","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In patients undergoing high tibial osteotomy (HTO), an excessive increase in joint line obliquity (JLO) after surgery leads to poor clinical outcomes. Phenotype analysis is a simple and intuitive method to classify knee alignment, including JLO. However, there are no studies investigating phenotype changes before and after surgery in patients undergoing realignment osteotomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate (1) the preoperative and postoperative phenotype distribution in patients undergoing primary realignment osteotomy for medial compartmental osteoarthritis and (2) the incidence and radiographic risk factors for excessive postoperative JLO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 348 knees (320 patients) undergoing primary realignment osteotomy for medial compartmental osteoarthritis with a varus deformity from January 2010 to July 2021 were included. Preoperatively and at 1 year postoperatively, we evaluated coronal-plane alignment on standing scanograms, classifying them into 9 phenotypes based on the modified Coronal Plane Alignment of the Knee classification. We identified changes in the preoperative and postoperative phenotype distribution through scatterplots and analyzed differences in excessive postoperative JLO (arithmetic JLO [aJLO] &gt;4°) based on the preoperative phenotype. Receiver operating characteristic analysis identified preoperative radiographic parameters and their cut-off values as risk factors for excessive postoperative JLO after HTO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The most common preoperative phenotype was type I (varus and apex distal; n = 149 [42.8%]), and the most common postoperative phenotype was type VI (valgus and apex neutral; n = 187 [53.7%]). The incidence of excessive postoperative JLO was significantly higher in preoperative type IV (varus and apex neutral; 14.5%) than in type I (0.7%), type II (neutral and apex distal; 0.0%), and type V (neutral and apex neutral; 10.4%). In receiver operating characteristic analysis for excessive postoperative JLO, the preoperative mechanical lateral distal femoral angle (mLDFA) and aJLO showed a high area under the curve of 0.916 and 0.914, respectively, with cut-off values of 90.2° and -1.5°, respectively. In the preoperative mLDFA ≥90.2° group, the incidence of excessive postoperative JLO was significantly higher than in the preoperative mLDFA &lt;90.2° group (19.8% vs 0.4%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001). In the preoperative aJLO ≥-1.5° group, the incidence of excessive postoperative JLO was significantly higher than in the preoperative aJLO &lt;-1.5° group (35.1% vs 1.4%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Preoperative type IV (varus and apex neutral) had a higher risk of excessive postoperative JLO. Specifically, when the preoperative mLDFA was ≥90.2° or the preoperative aJLO was ≥-1.5°, there was an increased risk","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251351335"},"PeriodicalIF":2.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065291","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":"Psychological Readiness is the Main Barrier to Return to Play After Revision Anterior Cruciate Ligament Reconstruction.","authors":"Timothy McAleese, Enda King, Niamh Keane, Kieran A Moran, Mark Jackson, Daniel Withers, Ray Moran, Brian M Devitt","doi":"10.1177/23259671251371158","DOIUrl":"10.1177/23259671251371158","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite advances in modern surgical techniques, return-to-play (RTP) rates after revision anterior cruciate ligament reconstruction (R-ACLR) often fall short of patients' expectations. There is growing awareness that a patient's psychological recovery is as important as the functional recovery of their knee.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The primary purpose of this study was to determine the RTP rate and identify the barriers to RTP after R-ACLR. Secondarily, we compared the progression of psychological readiness (using the Anterior Cruciate Ligament-Return to Sport after Injury [ACL-RSI] scale) throughout rehabilitation between those who achieved RTP and those who did not. Finally, we assessed if RTP could be predicted for patients aged &lt;23 years and patients aged ≥23 years based on their ACL-RSI scores at different time points during rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Case-control study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This investigation included 301 patients who underwent R-ACLR at our institution. Preoperatively, patients completed a questionnaire detailing their demographic characteristics and target level of RTP. The ACL-RSI scale was also administered preoperatively and at 3 months, 6 months, and 9 months. At 2 years postoperatively, patients indicated whether or not they had returned to play. Those who did not return provided their reasons for not doing so.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age was 25.4 ± 6.3 years, and 84.5% of patients were male. Although 95.1% of patients undergoing R-ACLR intended to return to play before surgery, only 63.4% achieved this goal at 2-year follow-up. The main barriers to RTP were a fear of reinjury (44%), a lack of confidence in performance (13%), and ongoing knee pain (11%). The mean preoperative ACL-RSI score was significantly higher in patients who returned to play than in those who did not (51.2 ± 23.4 vs 42.6 ± 23.3, respectively; &lt;i&gt;P&lt;/i&gt; = .027), indicating greater psychological readiness to RTP. The mean ACL-RSI score was also significantly higher in those who achieved RTP at 3 months, 6 months, and 9 months. A preoperative ACL-RSI score of 42.9 points predicted RTP in patients aged &lt;23 years, with a sensitivity of 76% and a specificity of 77% (area under the curve = 0.73). The ACL-RSI score was able to predict RTP at all time points, demonstrating the most accuracy preoperatively and at 6 months postoperatively. At 6 months, a cut-off score of 60.4 points predicted RTP in patients aged &lt;23 years (sensitivity = 62%; specificity = 81%), and a cut-off score of 56.7 points predicted RTP in patients aged ≥23 years (sensitivity = 54%; specificity = 77%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Psychological readiness, especially fear of reinjury, was a significant barrier to RTP after R-ACLR. Patients with lower psychological readiness who were less likely to return to play could be detected using the ACL-RSI scale.","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251371158"},"PeriodicalIF":2.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065181","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":"Seven Elbows With Panner Disease Yielded Favorable Sports Return and Remodeling After Nonoperative Treatment.","authors":"Yusuke Ueda, Hiroyuki Sugaya, Norimasa Takahashi, Keisuke Matsuki, Morihito Tokai, Shota Hoshika, Hiroshige Hamada, Toru Omodani, Tomohiko Deguchi","doi":"10.1177/23259671251372617","DOIUrl":"10.1177/23259671251372617","url":null,"abstract":"<p><strong>Background: </strong>Panner disease is a condition characterized by osteochondrosis of the humeral capitellum. Because of its rarity, clinical outcomes, including return to sports, have not been well described in previous studies.</p><p><strong>Purpose: </strong>To investigate the clinical and radiographic outcomes after nonoperative treatment of elbows affected by Panner disease.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>The inclusion criteria for this study were as follows: (1) elbows diagnosed with Panner disease between January 2007 and March 2021, and (2) elbows in patients who were followed until clinical and radiographic healing was confirmed. Patient background (sports participation, familial smoking, steroid use, and bone age), symptoms, radiographic findings, and outcomes after nonoperative treatment were analyzed.</p><p><strong>Results: </strong>Seven elbows in 7 patients (5 boys and 2 girls; 4 gymnasts and 3 baseball players) were included. The mean age at the initial examination was 10 years (range, 7-11 years), and bone age was younger than the chronological age in 3 patients (43%). All patients were treated nonoperatively with a mean follow-up of 37 months (range, 14-109 months). At the initial examination, all patients experienced elbow pain, and a limited range of motion was observed in 4 patients (57%). Familial smoking was reported in 2 patients (29%), and steroid use in 1 patient (14%). After a mean of 7 months (range, 2-15 months) of overhead motion restriction and cessation of upper extremity loading, all patients returned to sports at a mean of 15 months (range, 10-24 months). Complete healing of the epiphyseal nucleus of the capitellum was observed at a mean of 12 months (range, 10-18 months).</p><p><strong>Conclusion: </strong>Nonoperative treatment for Panner disease resulted in favorable outcomes in 7 patients. All patients fully returned to sports with well-remodeled capitella.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251372617"},"PeriodicalIF":2.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065297","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 Alta: Patellar Height Increases Over Time After Tibial Tubercle Osteotomy With Distalization.","authors":"Benjamin T Johnson, Collin D R Hunter, Robert T Burks, Justin J Ernat, Patrick E Greis, Travis G Maak, Stephen K Aoki","doi":"10.1177/23259671251369013","DOIUrl":"10.1177/23259671251369013","url":null,"abstract":"<p><strong>Background: </strong>For patients who have patellar instability with patella alta, distalizing the patella via tibial tubercle osteotomy (TTO-d) is one method used to surgically restore stability. Although this procedure is generally associated with favorable outcomes, the effects on maintaining postoperative patellar height remain inadequately understood.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to assess changes in patellar height after TTO-d in skeletally mature patients. It was hypothesized that the patella would eventually return to a state of alta after TTO-d.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Skeletally mature patients who underwent a TTO-d procedure with a follow-up lateral knee radiograph at ≥3 months after surgery were included. Caton-Deschamp (CD) and Blackburne-Peele (BP) indices were calculated at various time intervals: preoperative, immediate postoperative, 3-month, 6-month, and ≥1-year follow-up on lateral knee radiographs as available. Paired Student <i>t</i> tests were used to compare patellar height indices at different time points.</p><p><strong>Result: </strong>A total of 35 knees in 28 patients were included in this study, 20 of which had imaging ≥1 year postoperatively. The mean age of the cohort was 22.3 ± 7.95 years (range, 15.5-43.0 years), mean body mass index was 28.0 ± 7.86, mean tibial tubercle distalization was 10.8 ± 4.83 mm at time of surgery, and mean follow-up using the latest available lateral knee radiographs occurred at 2.83 ± 2.96 years postoperatively. Mean preoperative CD and BP indices were 1.46 ± 0.193 and 1.24 ± 0.196, respectively, which decreased to 1.13 ± 0.189 (<i>P</i> < .001) and 0.855 ± 0.209 (<i>P</i> < .001) on immediate postoperative films. In those with imaging ≥1 year out from surgery, mean CD and BP indices increased to 1.34 ± 0.196 (<i>P</i> < .001) and 1.13 ± 0.131, respectively. Additionally, 88% (15/17) of patients with a minimum 1-year radiographic follow-up transitioned from normal CD and BP indices immediately postoperatively to patella alta at latest follow-up.</p><p><strong>Conclusion: </strong>Nearly all patients who underwent TTO-d had progressive increases in both CD and BP indices over time, suggesting a return to a state of patella alta over time. Further studies are needed to compare clinical outcomes of patients who have a confirmed return to alta versus those who do not in order to better understand the clinical significance of this observation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251369013"},"PeriodicalIF":2.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065367","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 Increased Age at Anterior Cruciate Ligament Reconstruction and Metabolic Syndrome.","authors":"Anthony Mantor, Sonu Bae, Michael Burton, Jessica Sheldon, Chase Tzagournis, Christopher C Kaeding, Robert A Magnussen, David C Flanigan, Tyler Barker","doi":"10.1177/23259671251371291","DOIUrl":"10.1177/23259671251371291","url":null,"abstract":"<p><strong>Background: </strong>Metabolic syndrome (MetSy) is a global pandemic characterized by a cluster of interrelated abnormalities and risk factors. The prevalence of MetSy increases with advancing age. It is unknown whether increased age at the time of anterior cruciate ligament reconstruction (ACLR) is associated with an increased prevalence of MetSy.</p><p><strong>Purpose: </strong>To identify the association of age at ACLR with MetSy.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged ≥18 years who underwent ACLR, with available blood pressure, blood lipids, hemoglobin A1c (HbA1c), and basic descriptive data, were included. All data were extracted from the medical records at a single academic institution. MetSy was defined as meeting any 3 of the following 5 criteria: (1) body mass index (BMI) ≥30 kg/m²; (2) triglycerides ≥150 mg/dL; (3) high-density lipoprotein (HDL) <40 mg/dL in men and <50 mg/dL in women; (4) systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥85 mmHg; or (5) fasting (estimated) glucose of ≥100 mg/dL. Patients were also separated into groups based on age at the time of ACLR: (1) 18-29, (2) 30-39, (3) 40-49, and (4) ≥50 years.</p><p><strong>Results: </strong>The final analysis consisted of 493 patients (age, 18-29 years [n = 139]; 30-39 years [n = 158]; 40-49 years [n = 135]; and ≥50 years [n = 61]). Based on the criteria, 190 (38.5%) patients who underwent ACLR displayed MetSy. The prevalence of MetSy was not significantly different between age groups (<i>P</i> = .70). The proportion of patients meeting the individual BMI (<i>P</i> = .41), triglyceride (<i>P</i> = .05), HDL (<i>P</i> = .41), and blood pressure (<i>P</i> = .82) criteria of MetSy was not significantly different between age groups. In contrast, approximately 59% (n = 82) of patients in the 18-29 years age group compared with 88.5% (n = 54) in the ≥50 years age group had an estimated fasting glucose of ≥100 mg/dL (<i>P</i> < .01). HbA1c% was also significantly increased in the ≥50 years age group compared with the younger age groups (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>Increased age at ACLR was not associated with MetSy but may be associated with an elevated HbA1c and estimated fasting glucose.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251371291"},"PeriodicalIF":2.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065213","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":"Pediatric Meniscotibial Ligament Complex Anatomy and Biomechanics.","authors":"Willemijn H van Deursen, Thomas M Johnstone, Annelisse Cuellar-Montes, David Rogerson Williams Baird, Calvin K Chan, Ian Hollyer, Matthew S Rohde, Marc Tompkins, Henry B Ellis, Theodore J Ganley, Yi-Meng Yen, Matthew R Schmitz, Nicole S Pham, Seth L Sherman, Marc Levenston, Kevin G Shea","doi":"10.1177/23259671251367060","DOIUrl":"10.1177/23259671251367060","url":null,"abstract":"<p><strong>Background: </strong>Meniscal repair is increasingly performed in pediatric patients, with capsular-based techniques remaining the gold standard despite limitations such as high failure rates and risk of meniscal extrusion. Recent studies highlight the potential role of accessory knee ligaments in improving meniscal stability and repair outcomes. The meniscotibial ligament complex (MTLC) has emerged as a potential area of interest to produce more normal anatomic and biomechanical meniscal function in meniscal repair.</p><p><strong>Purpose: </strong>To evaluate the native anatomy and biomechanical strength of the MTLC of the medial and lateral meniscus of pediatric knees.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Fourteen fresh-frozen pediatric human knees (mean age, 7.5 years; range, 5-10 years; 6 male, 8 female) were used in this study. The depth of the recess between the MTLC and the meniscocapsular complex was measured. Subsequently, the medial and lateral menisci were divided into approximate thirds, creating anterior, central, and posterior testing zones for each meniscus. Each meniscus/MTLC complex underwent monotonic load-to-failure testing on an Instron 5944 test frame with a 2-kN load cell with load applied superiorly. Biomechanical properties were analyzed using linear mixed models with donor as a random factor and aspect (medial/lateral) and position (anterior/central/posterior) as fixed factors.</p><p><strong>Results: </strong>The posterior recess depth was significantly larger (mean, 5.4 mm; 95% CI, 4.6-6.3 mm) than anterior (mean, 3.4 mm; 95% CI, 2.6-4.2 mm) (<i>P</i> = .049). Maximal load to failure in the posterior MTLC (mean, 93.5 N; 95% CI, 80.0-107.0 N) was significantly higher than anterior (mean, 69.2 N; 95% CI, 56.7-81.7 N) (<i>P</i> = .01).</p><p><strong>Conclusion: </strong>This study defines a clear space in which the MTLC is distinct from the joint capsule, which is deepest in the posterior third of the medial and lateral meniscus. Our results demonstrate that the posterior region of the MTLC can withstand higher loads than the anterior region in pediatric knees.</p><p><strong>Clinical relevance: </strong>These findings offer foundational insights into the native anatomy and biomechanics of the MTLC, guiding future studies involving the MTLC in meniscal repair. This knowledge may be particularly relevant to ramp lesions, other posterior meniscal tear patterns, and meniscal transplants.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251367060"},"PeriodicalIF":2.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065194","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":"Sex Differences in Foot and Ankle Sports Injury Rates in Elite Athletes: A Systematic Review and Meta-analysis of 25,687,866 Athlete Exposures.","authors":"Adrian J Talia, Nicholas A Busuttil, Andrew Hotchen, Adrian R Kendal, Rick Brown","doi":"10.1177/23259671251364261","DOIUrl":"10.1177/23259671251364261","url":null,"abstract":"<p><strong>Background: </strong>Female sports participation is at an all-time high, from amateur to professional levels. There has been recent media and scientific focus on the higher rates of injury to the anterior cruciate ligament and head injuries in female athletes compared with male athletes. A similar association has not been emphasized in the foot and ankle. Hence, this research aims to establish the rate of foot and ankle injury at the professional level in female athletes compared with their male counterparts.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to understand the rate of foot and ankle injuries in professional and semiprofessional athletes. It was hypothesized that female athletes are injured at higher rates compared with their male counterparts.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 3.</p><p><strong>Methods: </strong>A systematic review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Ovid EMBASE, and Ovid MEDLINE were searched for relevant papers up until October 23, 2023. Papers reporting on rates of foot and ankle injuries in female professional or semiprofessional athletes were included, along with a male comparison group. A total of 2510 papers were screened. A meta-analysis was performed on 4 separate subgroups using common and random-effects models.</p><p><strong>Results: </strong>A total of 53 papers met the inclusion criteria, and a meta-analysis of proportions was performed. Of this total, 21 records reported absolute elite athlete numbers and 32 reported athletic exposures. Meta-analyses were performed on these 2 subgroups separately. The literature was found to have a high risk of bias. The rate of injuries to the foot and ankle in female athletes was higher than their male counterparts overall (log odds ratio). Professional female athletes had significantly more injuries compared with their male counterparts using a common-effects model (odds ratio, 1.52 [1.44-1.61]) Chi-square testing demonstrated significant heterogeneity.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis demonstrated that female athletes suffer foot and ankle injuries at professional and semiprofessional competition levels at higher rates than their male counterparts. The literature on this topic is limited to large observational studies with significant risk of bias and heterogeneity. The current research provided an understanding of the significant effects of foot and ankle injury rates, detailing the increased exposures that are present in female semiprofessional and elite sports.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251364261"},"PeriodicalIF":2.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065294","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":"Medial Epicondylar Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow.","authors":"Evan T Zheng, Donald S Bae, Yi-Meng Yen, Carley B Vuillermin, Patricia E Miller, Benton E Heyworth","doi":"10.1177/23259671251365974","DOIUrl":"10.1177/23259671251365974","url":null,"abstract":"<p><strong>Background: </strong>Medial epicondylar apophyseal avulsion fractures of the distal humerus represent an understudied severe variant of elbow overuse injury in youth throwers.</p><p><strong>Purpose: </strong>To characterize medial epicondylar apophyseal avulsion fractures in a population of youth throwers, as well as to describe outcomes after both operative and nonoperative treatment.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Skeletally immature athletes with a medial epicondylar apophyseal avulsion fracture sustained during throwing from 2003 to 2017 at a tertiary care pediatric referral center were identified. Exclusion criteria were injuries sustained during nonthrowing events or previous elbow fractures. Patients treated operatively were compared with those treated nonoperatively, and the overall study population was compared with a control group of patients diagnosed with medial epicondylar apophysitis only, with no fracture.</p><p><strong>Results: </strong>A total of 50 patients with medial epicondylar avulsion fractures (100% male; 49 baseball pitchers, 1 football quarterback) were identified. These patients had higher body mass index (BMI) than the control group with medial epicondylar apophysitis only. Of the 37 avulsion fracture patients with documentation regarding presence or absence of preoperative symptoms, 31 patients (84%) reported preexisting elbow pain before their acute injury. Of the 12 patients who underwent shoulder exams at presentation, 5 (42%) demonstrated glenohumeral internal rotation deficit (GIRD). Of the total 50 patients, 22 (44%) underwent open reduction and internal fixation (ORIF) with a single cannulated screw, 1 (2%) patient underwent suture-based fixation, and 27 (54%) patients were treated nonoperatively. For each additional millimeter of displacement, the odds of surgical intervention increased by 6.4 times (odds ratio, 6.36; 95% CI, 1.83-22.07; <i>P</i> = .004) when controlling for age and BMI. All patients returned to sports, with no significant difference in recurrent elbow pain between cohorts, although 41% of applicable ORIF patients (9 of 22) underwent secondary screw removal.</p><p><strong>Conclusion: </strong>Displaced medial epicondylar apophyseal avulsion fractures in youth throwers may be effectively treated with operative screw fixation, although >40% of patients may require secondary screw removal. Nonoperative treatment may be appropriate for minimally displaced cases. Given that a large majority of patients reported preexisting elbow pain, and a substantial cohort demonstrated GIRD, this severe presentation of Little League elbow may be preventable.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251365974"},"PeriodicalIF":2.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Marijuana Use on Pain Management and Return to Sport After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Matched Control Study.","authors":"Helena Franco, Alexander R Farid, Shanika De Silva, Borna Guevel, Mininder S Kocher, Grant D Hogue","doi":"10.1177/23259671251369015","DOIUrl":"10.1177/23259671251369015","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of marijuana usage has prompted research into the potential medical effects. Yet, there is a paucity of literature surrounding the impact on perioperative outcomes after orthopaedic surgeries among pediatric and adolescent populations.</p><p><strong>Purpose: </strong>To compare perioperative outcomes between pediatric and adolescent patients who underwent anterior cruciate ligament reconstruction (ACLR) and attested to marijuana use compared with those who did not attest to marijuana use, and whether sociodemographic factors were associated with positive self-reported marijuana attestation.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This study evaluated perioperative outcomes in patients aged ≤20 years who underwent primary ACLR between January 2011 and December 2017. Patients were divided based on self-reported positive marijuana attestation on forms collected during the surgical intake process. Propensity score matching (3:1 ratio) was used to select matched controls based on age, sex, surgeon, and graft type. Perioperative outcomes and complications were compared between those who self-reported positive marijuana attestation and those who did not report marijuana use.</p><p><strong>Results: </strong>Of 4358 eligible patients, 42 self-reported positive marijuana use on attestation forms (0.96% [95% CI, 0.70-1.30]), with 126 patients in the matched cohort. The mean follow-up was 25.26 months (SD, 27.17 [range, 1-125 months). Patients who self-reported positive marijuana use (n = 42) experienced significantly higher rates of overnight admission for pain (90% vs 29%; <i>P</i> = .004), greater estimated blood loss (10 vs 3 mL; <i>P</i> < .001), lower maximum heart rate in the postanesthesia care unit (74.3 ± 12.8 vs 80.2 ± 14.8 beats per min; <i>P</i> = .04). Time to return to sports (RTS) was 76 days longer in the self-reported positive marijuana attestation cohort (95% CI, 1.1-1.5; <i>P</i> < .001). Higher odds of positive self-reported marijuana attestation were observed in patients living in lower Child Opportunity Index neighborhoods, those identifying as races other than White, and those of Hispanic ethnicity.</p><p><strong>Conclusion: </strong>Positive self-reported marijuana attestation in pediatric and adolescent patients undergoing ACLR was associated with higher rates of overnight admission for pain and prolonged time to RTS, suggesting potential implications for perioperative management and recovery.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 9","pages":"23259671251369015"},"PeriodicalIF":2.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041009","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}