Orthopaedic Journal of Sports Medicine最新文献

{"title":"Hip Arthroscopic Management for Patients With Subchondral Stress Fractures of the Femoral Head: A Case-Control Study.","authors":"Yuki Okubo, Yoichi Murata, Hirotaka Nakashima, Makoto Kawasaki, Hitoshi Suzuki, Manabu Tsukamoto, Shinichiro Takada, Keisuke Nakayama, Akinori Sakai, Soshi Uchida","doi":"10.1177/23259671241294050","DOIUrl":"10.1177/23259671241294050","url":null,"abstract":"<p><strong>Background: </strong>A subchondral stress fracture of the femoral head (SSFFH) is managed with nonoperative treatment. There is a lack of knowledge regarding whether hip arthroscopic management is effective for active patients with SSFFHs.</p><p><strong>Purpose: </strong>To elucidate whether arthroscopic management of SSFFHs enables active patients to return to sports activity.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 22 patients undergoing hip arthroscopic management (labral repair/reconstruction and fragment fixation with hydroxyapatite and poly-L-lactic acid [HA/PLLA]-threaded pins) were enrolled and divided into 2 groups. The active group was defined as patients who participated in any kind of sports, regardless of the level of competition. The inactive group was defined as patients who did not participate in sports or any activity. Patient-reported outcome measure (PROM) scores, including the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively and at 6 months, 12 months, and the final follow-up (mean, 70.0 ± 36.6 months [range, 24-144 months]) after surgery. The authors performed chi-square and Mann-Whitney <i>U</i> tests to compare the PROM scores between the 2 groups.</p><p><strong>Results: </strong>There were 10 patients in the active group and 12 patients in the inactive group in the final analysis. Overall, 14 SSFFHs underwent internal fixation with HA/PLLA-threaded pins. The PROM scores significantly improved from preoperatively to the final follow-up. The active group had significantly better PROM scores than the inactive group at 6 months (mHHS: 96.6 ± 5.0 vs 85.3 ± 13.6, respectively [<i>P</i> = .033]; NAHS: 74.3 ± 6.4 vs 57.0 ± 15.6, respectively [<i>P</i> = .008]) and 1 year (mHHS: 98.8 ± 1.8 vs 92.7 ± 8.6, respectively [<i>P</i> = .040]; NAHS: 78.0 ± 2.1 vs 65.9 ± 11.7, respectively [<i>P</i> = .007]). Additionally, 9 of 10 patients in the active group returned to their sports activity.</p><p><strong>Conclusion: </strong>The study showed that arthroscopic management (femoroacetabular impingement correction, labral preservation, and stabilization with HA/PLLA-threaded pins) provided favorable clinical outcomes and a high rate of return to sports activity in active patients with SSFFHs. Active patients with SSFFHs had better postoperative results than inactive patients.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671241294050"},"PeriodicalIF":2.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143616718","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":"Resolution of Pain at Night and Improved Functional Outcomes After Arthroscopic Partial Meniscectomy.","authors":"Evan T Zheng, Koya Osada, Jillian L Mazzocca, Natalie A Lowenstein, Jamie E Collins, Elizabeth G Matzkin","doi":"10.1177/23259671251322749","DOIUrl":"10.1177/23259671251322749","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic partial meniscectomy (APM) is performed for symptomatic meniscal tears that fail conservative treatment. Patients often report pain at night, although little research has been done to evaluate corresponding outcomes.</p><p><strong>Purpose: </strong>To (1) evaluate patients with and without preoperative nighttime pain who underwent APM and (2) assess postoperative resolution of symptoms and associated patient-reported outcome measures (PROMs).</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Consecutive patients undergoing primary APM with or without chondroplasty at a tertiary academic center were prospectively enrolled in a database. Patient characteristics and PROMs were obtained pre- and postoperatively up to 2 years-including the visual analog pain scale, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Scale, and Veterans RAND 12-Item Health Survey (VR-12) physical and mental components. Patients were included if they had a minimum 3-month PROMs follow-up. Pain at night was defined as reporting greater than mild pain on KOOS P7. Intraoperatively, cartilage was assessed using the Outerbridge Classification.</p><p><strong>Results: </strong>A total of 587 patients were included, with 299 (50.9%) reporting preoperative pain at night, which corresponded with worse baseline PROMs. These patients were older and more likely to be women and smokers. No significant difference was observed in Outerbridge grade between patients with and without preoperative pain at night. Postoperatively, nighttime pain resolved by 2 years in 274 (91.6%) patients, 219 of whom (79.9%) reported improvement by 3 months. Patients whose pain at night persisted had a longer duration of symptoms preoperatively, higher body mass index, and a lack of baseline mechanical symptoms. PROMs significantly improved for patients with and without preoperative pain at night, although patients with baseline pain had worse scores compared with those without preoperative nighttime pain.</p><p><strong>Conclusion: </strong>Over half of patients undergoing APM reported preoperative pain at night, which was associated with worse baseline functional scores. Postoperatively, >90% of patients with baseline pain at night noted resolution of symptoms by 2 years, with nearly 80% showing improvement by 3 months. Functional scores improved after surgery for patients with and without initial pain at night, remaining lower for patients who had preoperative nighttime pain.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251322749"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573374","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":"Periacetabular Osteotomy Improves Hip Microinstability Between Supine and Standing Radiographs in Symptomatic Hip Dysplasia.","authors":"Kenji Kitamura, Masanori Fujii, Satoshi Hamai, Daisuke Hara, Kensei Yoshimoto, Itaru Kawashima, Hongjia He, Adam H Biedrzycki, Shinya Kawahara, Goro Motomura, Yasuharu Nakashima, Scott A Banks","doi":"10.1177/23259671251319994","DOIUrl":"10.1177/23259671251319994","url":null,"abstract":"<p><strong>Background: </strong>Whether periacetabular osteotomy (PAO) improves hip microinstability in patients with symptomatic hip dysplasia remains poorly understood.</p><p><strong>Purpose: </strong>To assess the femoral head translation with static postural change, considered a potential indicator of hip microinstability, comparing dysplastic hips before and after PAO with normal hips.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>A total of 26 patients (30 hips) with hip dysplasia underwent PAO, and 18 healthy individuals (18 hips) were eligible. Using a 3-dimensional-to-2-dimensional registration technique, femoral head translation before and after PAO was quantified as the displacement of the center of the femoral head relative to the center of the acetabulum between supine and standing positions. Morphological factors on supine anteroposterior pelvic radiographs before and after PAO correlated with the femoral head translation, particularly lateral translation, were examined.</p><p><strong>Results: </strong>Femoral head translation decreased after PAO (1.5 ± 0.4 mm vs 1.0 ± 0.4 mm; <i>P</i> < .001) but remained larger than in controls (1.0 ± 0.4 mm vs 0.7 ± 0.3 mm; <i>P</i> = .01). The more severe the hip dysplasia before PAO was, the greater the femoral head translation. However, the femoral head translation improved after PAO with sufficient acetabular correction. The acetabular roof obliquity (ARO) showed the strongest correlation with lateral translation of the femoral head from the supine to standing position before PAO. In contrast, no correlation was found after PAO.</p><p><strong>Conclusion: </strong>This study demonstrates that the severity of hip dysplasia influences hip microinstability, that PAO mitigates hip microinstability with adequate acetabular correction, and that PAO does not normalize hip stability because of residual joint incongruity. In patients with a larger ARO, the femoral head has more lateral translation in the standing position. Therefore, weightbearing postural radiographs are crucial for understanding hip biomechanics in hip dysplasia and refining surgical corrections during PAO.</p><p><strong>Clinical relevance: </strong>PAO can make the hip more stable in hip dysplasia, but not as stable as the normal hip. In hip dysplasia, pre-PAO standing radiographs should be evaluated due to their accurately representing the femoral head position relative to the acetabulum.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251319994"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573404","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":"High Return to Competition Rate After On-Field Rehabilitation in Competitive Male Soccer Players After ACL Reconstruction: GPS Tracking in 100 Consecutive Cases.","authors":"Filippo Picinini, Francesco Della Villa, Jamie Tallent, Stephen David Patterson, Lorenzo Galassi, Matteo Parigino, Giovanni La Rosa, Gianni Nanni, Jesus Olmo, Matthew Stride, Fabrizio Aggio, Matthew Buckthorpe","doi":"10.1177/23259671251320093","DOIUrl":"10.1177/23259671251320093","url":null,"abstract":"<p><strong>Background: </strong>Despite published guidelines describing on-field rehabilitation (OFR) frameworks for soccer, available evidence for practitioners who work with players with anterior cruciate ligament reconstruction (ACLR) is limited.</p><p><strong>Purpose: </strong>To document the activity and workloads completed by a large cohort of amateur and professional soccer players during OFR following ACLR after completing their indoor rehabilitation and to establish their return to competition (RTC) outcomes.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>OFR measurements/activities, global positioning system (GPS), and heart rate data were collected from 100 male 11-a-side soccer players with ACLR undergoing a criteria-based rehabilitation process, concluding with a 5-stage OFR program. Consent was obtained directly from the players involved in this study before completing a follow-up questionnaire to document RTC outcomes. Differences between the level of play (professional and amateur) and 5 OFR stages were investigated using separate linear mixed models.</p><p><strong>Results: </strong>A minimum 9-month follow-up was possible for 97 players (97%), with a median time of 2.3 years after ACLR and 84% RTC, with higher rates in professionals (100%) than amateurs (80%). Ten (10%) players sustained an ACL reinjury. Professionals completed more OFR sessions (20.6 ± 7.7 vs 13.2 ± 7.7; <i>P</i> < .001) over a shorter period (44.7 ± 30.3 vs 59.3 ± 28.5 days; <i>P</i> = .044) and achieved higher workloads mostly in the high-intensity GPS metrics in each OFR stage. Typical external workload outputs in the final OFR stage aligned with team training demands for the total distance (TD) (106%), high-intensity distance (HID) (104%), peak speed (PS) (88%), acceleration distance (ACC) (110%), and deceleration distance (DEC) (48%), but they were lower compared with match play demands (TD: 44%; HID: 51%; PS: 82%; ACC: 63%; and DEC: 26%).</p><p><strong>Conclusion: </strong>High RTC rates were reported in those players who participated in OFR after indoor rehabilitation. Completion of all five OFR stages almost prepared them for team training demands; however, workloads remain low compared to match play.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320093"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573340","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 Initial Graft Tension on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 15-Year Follow-up.","authors":"Anika N Breker, Gary J Badger, Ata M Kiapour, Meggin Q Costa, Emma N Fleming, Stacy L Ferrara, Cynthia A Chrostek, Paul D Fadale, Michael J Hulstyn, Robert M Shalvoy, Holly C Gil, Braden C Fleming","doi":"10.1177/23259671251320972","DOIUrl":"10.1177/23259671251320972","url":null,"abstract":"<p><strong>Background: </strong>The graft tension applied during anterior cruciate ligament (ACL) graft fixation (subsequently referred to as initial graft tension) could potentiate posttraumatic osteoarthritis (PTOA) and influence other outcomes.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to analyze the effects of initial graft tension on imaging and patient-reported outcomes related to PTOA 15 years postreconstruction surgery. Clinical and functional outcomes were also assessed. It was hypothesized that (1) the high-tension group would have improved imaging findings and outcomes compared with the low-tension group at 15-year follow-up and (2) the imaging findings and outcomes for the high-tension group would be equivalent to the sex-, race-, age-, and activity level matched control group.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 1.</p><p><strong>Methods: </strong>Consented patients underwent ACL reconstruction (ACLR) with bone-patellar tendon-bone or a 4-strand hamstring tendon autograft. A matched uninjured control group was assembled for comparison. Two laxity-based tensioning procedures were randomized: (1) tension set to restore normal anteroposterior (AP) laxity at time of surgery relative to the contralateral uninjured knee (low-tension group) or (2) tension set to overconstrain AP laxity at time of surgery relative to the contralateral knee (high-tension group). Baseline outcome measures, radiographs, and magnetic resonance imaging (MRI) scans were collected prior to surgery and at 15 years postoperatively.</p><p><strong>Results: </strong>For medial joint space width, the differences between limbs across the 3 groups were not significant. Within the tension groups, the Whole Organ MRI Score was significantly higher in the surgical knee relative to the contralateral knee in both groups, while the Osteoarthritis Research Society International radiographic scores were higher in the surgical knee in the low-tension group only. A total of 43% of patients in both tension groups met the Knee injury and Osteoarthritis Outcome Score composite criteria for a symptomatic knee compared with controls (10%; <i>P</i> = .01). Most other outcomes, including AP laxity, International Knee Documentation Committee knee examination score, and single-leg hop test were not significantly different between the 3 groups.</p><p><strong>Conclusion: </strong>The results do not support the hypotheses that patients in the high-tension group would have better chondroprotection compared with the low-tension group and have equivalent outcomes with the matched controls. Overall, the results show that patients undergoing ACLR are more likely to develop PTOA and display inferior outcomes compared with the uninjured matched control group, regardless of graft tension.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251320972"},"PeriodicalIF":2.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonoperative Treatment of Anterior Cruciate Ligament Tears With 5-Year Follow-up.","authors":"Caitlin M Rugg, Lue-Yen Tucker, David Y Ding","doi":"10.1177/23259671251314441","DOIUrl":"10.1177/23259671251314441","url":null,"abstract":"<p><strong>Background: </strong>It remains unknown whether anterior cruciate ligament (ACL) reconstruction (ACLR) alters the natural history of degenerative changes or prevents further injury compared with nonoperative treatment.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate the midterm risk of knee surgery in patients who sustained an ACL tear treated with initial nonoperative management. It was hypothesized that the majority of patients who pursue initial nonoperative treatment after ACL rupture will not undergo further surgery within 5 years.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>An electronic health record search was performed for all patients aged 12 to 65 years from 2011 to 2012 with magnetic resonance imaging-confirmed ACL tear. Patients who did not undergo ACLR within 6 months after diagnosis comprised our initial cohort. Patients were longitudinally followed until August 31, 2017. The primary outcome was an occurrence of ipsilateral knee surgery, including ACLR and non-ACLR procedures.</p><p><strong>Results: </strong>A total of 932 patients with a mean age of 36.2 ± 13.6 years were included. The mean follow-up time was 57.9 ± 7.4 months. During the follow-up period, 365 patients (39.2%) had ipsilateral knee surgery, with a mean time from ACL tear diagnosis to the first procedure of 11.9 ± 13.0 months. Overall, 67% of surgeries occurred within 12 months of diagnosis. ACLR was performed in 211 patients (22.6%); 284 patients had non-ACLR knee procedures, with 130 undergoing ACLR and non-ACLR surgery and 154 patients undergoing non-ACLR procedures alone. After adjusting for demographic and clinical factors, younger age remained a significant risk factor for undergoing ACLR: patients aged 12 to 18 years and those aged 19 to 30 years had similar adjusted hazard ratios compared with patients aged 51 to 65 years (5.49 [95% CI, 2.78-10.88] and 5.48 [95% CI, 2.85-10.53], respectively; <i>P</i> < .001 for both).</p><p><strong>Conclusion: </strong>In this universally insured, contained patient cohort, 39.2% of the patients underwent a subsequent surgical procedure on the ipsilateral knee within 5 years of ACL injury, with 22.6% of patients opting to undergo delayed ACLR. Younger age was an independent risk factor for undergoing ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251314441"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573379","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":"Investigating Injuries to the Anterolateral Corner of the Knee: Imaging Insights Into Kaplan Fibers and the Anterolateral Ligament in Anterior Cruciate Ligament Tears.","authors":"Mohammad Ayati Firoozabadi, Seyed Mohammad Javad Mortazavi, Madjid Shakiba, Davood Dehghaniashkezari, Diana Zarei, Hani AziziKia, Sara Parviz, Shahriar Kolahi","doi":"10.1177/23259671251319504","DOIUrl":"10.1177/23259671251319504","url":null,"abstract":"<p><strong>Background: </strong>The intricate relationship between anterolateral ligament (ALL) and Kaplan fibers (KF) injuries in acute traumatic anterior cruciate ligament (ACL) tears presents a diagnostic challenge. Understanding these associations is crucial for enhancing therapeutic strategies and patient outcomes.</p><p><strong>Purpose: </strong>To elucidate the prevalence of ALL and KF injuries among patients with acute ACL tears and examine their correlations with other imaging findings.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective review of magnetic resonance imaging (MRI) was performed for patients with knee pain or instability, leading to an MRI evaluation between April and August 2022. The inclusion criteria were primary ACL tears diagnosed via MRI within 6 weeks after injury, excluding cases with concurrent posterior cruciate ligament, medial collateral ligament, or lateral collateral ligament injuries. Out of the initial cohort, 51 patients met the inclusion criteria, all with recent trauma and timely imaging.</p><p><strong>Results: </strong>Our results highlighted that 21.6% of these patients had ALL injuries, whereas a notably higher proportion (33.3%) exhibited KF injuries. We observed bone contusions on the medial and lateral femoral condyles in 3.9% and 41.2% of patients, respectively. Similarly, the medial and lateral tibial condyles presented contusions in 31.4% and 49% of the cases, respectively, with a subset of 29.4% demonstrating both tibial condyle involvement.Contusions on the lateral femoral and tibial condyles were used as indicators of pivot-shift injuries, identified in 41.2% of cases (n = 21). Subgroup analysis revealed a significant association between these injuries and KF damage, present in 71.4% of cases (odds ratio, 33.8 [95% CI, 6.04-188.53; <i>P</i> < .001), compared with a lower incidence of ALL injuries at 28.6% (<i>P</i> = .31). This suggests a stronger link between KF injuries and pivot-shift mechanisms, emphasizing the role of KF in knee trauma. In addition, KF injuries were more common in patients with lateral meniscal injuries, although this finding was not statistically significant (<i>P</i> = .10).</p><p><strong>Conclusion: </strong>Surgeons should focus more on detecting KF injuries than ALL injuries when ACL tears are accompanied by lateral femoral and tibial condyle contusions, as these may play a crucial role in the injury mechanism.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251319504"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573376","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":"Identifying Risk Zones for Neurovascular Injury in Pediatric All-Inside Arthroscopic Lateral Meniscal Repair.","authors":"Annat Houston, Casey McDonald, Andrew Eck, Travis Kotzur, David Momtaz, David Heath, Grant D Hogue, Thomas DeBerardino","doi":"10.1177/23259671241304817","DOIUrl":"10.1177/23259671241304817","url":null,"abstract":"<p><strong>Background: </strong>All-inside techniques for meniscal repairs offer comparable outcomes and healing rates with reduced operative time and fewer incisions; however, iatrogenic neurovascular injuries during arthroscopic meniscal repairs are a significant concern.</p><p><strong>Purpose: </strong>To identify the zones of risk and incidence of injury concerning the common peroneal nerve (CPN) and popliteal artery in relation to the popliteal tendon (PT) from the anterolateral (AL) and anteromedial (AM) portals during a simulated all-inside technique in the pediatric population.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Using axial knee magnetic resonance imaging scans of 124 patients, the all-inside technique was simulated by drawing direct lines from the AM and AL portals to the medial and lateral borders of the PT. If the line came into contact with the CPN, a risk of projected iatrogenic CPN injury was found. Measurements were then recorded to assess and define \"risk zones.\" A similar simulation was performed in relation to the popliteal artery to assess distance to projected iatrogenic injury.</p><p><strong>Results: </strong>The risk of CPN injury was significantly higher when using the AL portal (45%) compared with the AM portal (19%) when simulating repair at the lateral edge of the PT (<i>P</i> < .001). Similarly, there was a significantly higher risk of peroneal nerve injury when using the AM portal (29%) compared with the AL portal (8.9%) when simulating repair from the medial edge of the PT (<i>P</i> < .001). The risk of injury when repairing the body of the lateral meniscus through the AM portal extended 2.20 ± 0.98 mm laterally from the lateral edge of the PT and 3.14 ± 1.92 mm medially from the medial edge of the PT. The risk of injury when repairing the body of the lateral meniscus through the AL portal extended 2.58 ± 1.31 mm lateral to the lateral edge of the PT and 2.02 ± 1.61 mm medial to the medial edge of the PT.</p><p><strong>Conclusion: </strong>The authors found that the AM portal was safer for repairing the body of the lateral meniscus while simulating repair at the lateral edge of the PT, while the AL portal was safer for repairing the lateral meniscus while simulating repair from the medial edge of the PT.</p><p><strong>Clinical relevance: </strong>By understanding these risk profiles, surgeons can adopt safer approaches for meniscal repairs in pediatric patients, thereby minimizing the likelihood of injuring sensitive neurovascular structures.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671241304817"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573351","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":"Preoperative Platelet-Rich Plasma Injections Decrease Inflammatory and Chondrodegenerative Biomarkers in Patients With Acute Anterior Cruciate Ligament Tears: A Pilot Randomized Controlled Trial.","authors":"Adam W Anz, Eric A Branch, Steve E Jordan, Roger V Ostrander, Brett J Kindle, James C Presley, Joshua G Hackel, Emily Maggi, Hillary A Plummer","doi":"10.1177/23259671241312754","DOIUrl":"10.1177/23259671241312754","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic osteoarthritis occurs at an alarming rate after anterior cruciate ligament (ACL) injury and reconstruction (ACLR).</p><p><strong>Purpose/hypothesis: </strong>The purpose of this pilot randomized controlled trial was to evaluate the preoperative effect of a 2-injection series of platelet-rich plasma (PRP) on the progression of inflammatory and chondrodegenerative biomarkers before ACLR. It was hypothesized that preoperative PRP injections would decrease the chondrotoxicity of the presurgical knee fluid.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 1.</p><p><strong>Methods: </strong>A total of 24 participants were randomized to either a control or an intervention group. Both groups received joint aspirations within the first 10 days after ACL injury (visit 1). In addition to joint aspiration at visit 1, the PRP group received a leukocyte-poor, nonactivated PRP injection at visit 1 and an additional PRP injection 5 to 12 days after the initial visit (visit 2). Joint fluid samples were harvested in both groups at the time of ACLR (visit 3). The joint fluid and PRP samples were subject to inflammatory and chondrodegenerative biomarker analysis for the following: interleukin (IL)-1ß, IL-10, IL-6, granulocyte-macrophage colony-stimulating factor, IL-5, interferon (IFN)-γ, tumor necrosis factor-α, IL-2, IL-4, and IL-8.</p><p><strong>Results: </strong>The final analysis was completed on 8 participants in the control group and 8 in the intervention group. At visit 1, no significant differences were observed in cytokine concentrations between the control and intervention groups. Between visits 1 and 3, the control group demonstrated significant decreases in IL-8 (<i>P</i> = .007) and IFN-γ (<i>P</i> = .007), whereas the intervention group demonstrated significant decreases in all cytokine concentrations (<i>P</i> < .05) except for IL-8 (<i>P</i> = .08). At visit 3, similar to visit 1, no significant group differences were observed in cytokine concentrations. The PRP products in the intervention group were analyzed using complete blood counts and were consistent with defined concentrations found in leukocyte-poor PRP product.</p><p><strong>Conclusion: </strong>Intervention with aspiration combined with a 2-injection series of leukocyte-poor PRP in the acute ACL-injured knee resulted in a significant reduction in effusion inflammatory markers, whereas the control aspiration (without PRP injections) did not show such marker reduction.</p><p><strong>Registration: </strong>NCT04088227 (ClinicalTrials.gov identifier).</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671241312754"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573371","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":"Survival Analysis of ACL Graft and Contralateral ACL Ruptures in Patients Younger Than 18 Years.","authors":"Kate E Webster, Julian A Feller","doi":"10.1177/23259671251317490","DOIUrl":"10.1177/23259671251317490","url":null,"abstract":"<p><strong>Background: </strong>Although high rates of graft and contralateral anterior cruciate ligament (ACL) ruptures have been reported in younger patients after ACL reconstruction (ACLR), recent evidence suggests that previously reported crude event rates underestimate the actual event risk.</p><p><strong>Purpose: </strong>To report rates of graft and contralateral ACL rupture after ACLR in a large series of younger patients using survival analysis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged <18 years at the time of primary ACLR were identified from a single-surgeon database over 12 years ending January 2018. Patients with a previous contralateral ACL rupture or bilateral ACL ruptures were excluded. Overall, 388 patients (204 males, 184 females) were included in the final dataset. Bespoke survey data and clinic follow-up data were used to record graft rupture and contralateral ACL rupture events. Rates of graft and contralateral ACL rupture were calculated using Kaplan-Meier survival analysis. Log-rank tests were used to compare survival functions between several subgroups.</p><p><strong>Results: </strong>According to Kaplan-Meier survival analysis, the cumulative rates at 2, 5, and 10 years for graft rupture were 11%, 17%, and 22%, and the cumulative rates for contralateral ACL injury were 7%, 19%, and 33%. Males had significantly greater rates of graft rupture than females throughout a 10-year follow-up period (<i>P</i> < .001). Contralateral ACL rupture survival functions were not significantly different between the sexes, although rates were higher in females until 5 years postoperatively, after which contralateral ACL ruptures increased in males, with a cumulative rate of 39% at 10 years compared with 29% for females. Survival rates did not vary between different age groups (<16 vs ≥16 years), but females with a graft diameter of <7 mm on the femoral side had significantly greater graft rupture rates than females with grafts ≥7 mm (<i>P</i> = .04).</p><p><strong>Conclusion: </strong>The present study is one of the largest consecutive series of younger patients, with one of the longest follow-up periods, reporting a high risk for a second ACL injury. Over time, the cumulative risk for contralateral ACL rupture was higher than for graft rupture. In males, the risk for contralateral ACL rupture continued to increase after 5 years.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 3","pages":"23259671251317490"},"PeriodicalIF":2.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573538","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}