Orthopaedic Journal of Sports Medicine最新文献

{"title":"Fibulin-7 Promotes Short-term Histological Bone-Tendon Interface Healing in a Murine Rotator Cuff Repair Model.","authors":"Junhao Li, Huabin Chen, Weikun Zheng, Wende Xiao","doi":"10.1177/23259671251410200","DOIUrl":"10.1177/23259671251410200","url":null,"abstract":"<p><strong>Background: </strong>Aging is associated with degenerative changes in both bone and tendon tissues, leading to impaired healing at the bone-tendon interface (BTI) during rotator cuff repair. The role of fibulin-7 (FBLN7) in enhancing BTI healing in aged populations warrants an investigation because of its potential regenerative properties.</p><p><strong>Purpose: </strong>To determine whether FBLN7 can enhance tendon-bone healing and regeneration in a model of rotator cuff repair in aging mice.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 5 young (8 weeks old) and 5 aged (18 months old) C57BL/6 mice were used for a baseline supraspinatus tendon-humerus evaluation. Another 20 aged mice underwent rotator cuff repair and were allocated to either the FBLN7 (intervention) group (n = 10), receiving a fibrin sealant with FBLN7, or a control group (n = 10), receiving a standard fibrin sealant. Mice were euthanized at 4 (n = 5 per group) and 8 (n = 5 per group) weeks after surgery. The supraspinatus tendon-humerus complexes were harvested for micro-computed tomography, histological analysis, and biomechanical testing.</p><p><strong>Results: </strong>The expression of FBLN7 was significantly lower in aged mice at the BTI compared with young mice (<i>P</i> < .05). Histological and biomechanical assessments revealed that the FBLN7 group exhibited improved subchondral bone morphology (<i>P</i> < .05) and denser cortical bone (<i>P</i> < .05), along with significantly higher failure loads and stiffness (<i>P</i> < .05), compared with the control group. Additionally, the FBLN7 group demonstrated superior fibrocartilage formation (<i>P</i> < .05) and the upregulated expression of osteogenic (Runx2; <i>P</i> < .01 at week 4 and <i>P</i> < .05 at week 8), chondrogenic (Sox9; <i>P</i> < .01 at week 4 and <i>P</i> < .05 at week 8), and tenogenic (SCX; <i>P</i> < .05 at week 4) factors.</p><p><strong>Conclusion: </strong>FBLN7 significantly enhanced healing and regeneration at the BTI in aged mice, supporting its potential as a therapeutic intervention to improve rotator cuff repair outcomes.</p><p><strong>Clinical relevance: </strong>These findings highlight FBLN7's potential role in clinical sports medicine, suggesting that it could be utilized to promote better recovery and healing in aged patients undergoing rotator cuff repair, addressing a critical challenge in postoperative rehabilitation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251410200"},"PeriodicalIF":2.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513082","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":"Translational Cross-cultural Adaptation and Validation of the VISA-A Questionnaire for Arabic-Speaking Patients With Achilles Tendinopathy.","authors":"Nabeel Hamdan Alghamdi, Mohammad ALMohiza, Rana Abdullah Alghamdi, Karin Grävare Silbernagel","doi":"10.1177/23259671251405436","DOIUrl":"10.1177/23259671251405436","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendinopathy is a prevalent musculoskeletal condition that limits activity and performance. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is the gold-standard patient-reported outcome measure for symptom severity, but no comprehensive Arabic validation has been available.</p><p><strong>Purpose: </strong>To translate, culturally adapt, and validate the VISA-A into Arabic (VISA-A-Arabic) and to examine its psychometric properties in a broad population.</p><p><strong>Study design: </strong>Cohort study (diagnosis); Level of evidence, 3.</p><p><strong>Methods: </strong>The VISA-A was translated and culturally adapted following international guidelines. A total of 139 participants were recruited: 60 healthy participants, 47 healthy at-risk participants, and 32 patients with Achilles tendinopathy. All participants completed the VISA-A-Arabic and the 36-item Short Form Health Survey (SF-36) at baseline; the VISA-A-Arabic was re-administered after 1 to 3 days. Internal consistency, test-retest reliability, construct validity, measurement error, and known-group validity were evaluated.</p><p><strong>Results: </strong>The VISA-A-Arabic demonstrated acceptable internal consistency (Cronbach α = 0.73 [95% CI, 0.65-0.80]) at baseline and good test-retest reliability (intraclass correlation coefficient = 0.76 [95% CI, 0.68-0.83]). Construct validity was confirmed by a strong correlation with the SF-36 Physical Component Summary (<i>r</i> = 0.63; <i>P</i> < .001) and a weak correlation with the SF-36 Mental Component Summary (<i>r</i> = 0.33; <i>P</i> = .02). Known-group validity showed significantly lower VISA-A-Arabic scores at baseline in patients with Achilles tendinopathy (54.8 ± 20.9) compared with healthy (85.9 ± 10.6) and healthy at-risk (92.7 ± 8.0) participants (<i>F</i>(2,136) = 87.6; <i>P</i> < .001; η² = 0.56). The standard error of measurement was 10.3, and the smallest detectable change at the individual level was 28.4. No floor effects were observed, and ceiling effects were minimal in the Achilles tendinopathy group.</p><p><strong>Conclusion: </strong>Our study showed that the VISA-A-Arabic is a reliable and valid instrument for assessing Achilles tendon-related symptoms and function. Unlike earlier Arabic validation efforts limited to patients, this study included a larger and more diverse cohort and incorporated additional psychometric analyses (standard error of measurement, smallest detectable change, Bland-Altman plot). These findings provide stronger evidence for the clinical and research application of the VISA-A-Arabic across Arabic-speaking populations.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251405436"},"PeriodicalIF":2.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513742","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":"Proposed Modified Bone Stress Injury Classification Score.","authors":"Anne Kuwabara, Aurelia Nattiv, Megan Deakins Roche, Michael Fredericson","doi":"10.1177/23259671251399815","DOIUrl":"10.1177/23259671251399815","url":null,"abstract":"<p><strong>Background: </strong>Given that there are 27 bone stress injury (BSI) severity classification and scoring systems described in the literature, most systems are based solely on imaging, while the literature stresses the importance of considering clinical risk factors for return to running.</p><p><strong>Purpose: </strong>To propose a modified BSI classification score incorporating clinical factors, bone location, Fredericson and Nattiv magnetic resonance imaging (MRI) grading systems, and bone type to improve prediction of return-to-running times.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>A 7-year prospective study of National Collegiate Athletic Association Division I cross-country and track and field athletes was conducted from 2013 to 2020. Participants completed an annual questionnaire about known risk factors for injury or impaired bone health. Information about BSIs and time to return to running was collected at team physician meetings, in discussions with athletes, from athlete questionnaires, and from medical chart review. A 0 to 7 score was calculated based on the Cumulative Risk Assessment (CRA) category (low, medium, and high risk of female athlete triad), bone location (low-, medium-, and high-risk locations), MRI grade, and type of bone (cortical vs trabecular). Generalized estimating equations accounting for correlated observations assessed the relationship between the score and return-to-running times.</p><p><strong>Results: </strong>In total, 83 athletes, including both men and women, experienced 140 BSIs. The average return-to-running time was 47.8 days for men and 64.8 days for women. Higher modified BSI classification scores were significantly associated with increased return-to-running times: each additional risk point was associated with an 8.5-day longer return-to-running time on average (<i>P</i> < .0001). When examining the individual components of the score, MRI grade and CRA score were most strongly associated with return-to-running times in men, and bone location and type were most strongly associated in women. However, return-to-running times were highly variable, and the modified BSI classification score explained only a small amount of the total variance in return-to-running times.</p><p><strong>Conclusion: </strong>A higher modified BSI classification score was associated with increased return-to-running times in both men and women; however, the predictive ability was only low to moderate. Adding CRA risk score, bone location, and bone type to MRI grade alone resulted in a moderate improvement in predicting return-to-running times in women, but adding these additional variables to MRI grade alone resulted in no improvement in men. Additional studies will be needed to determine whether this system results in better prediction than MRI grade alone.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251399815"},"PeriodicalIF":2.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513590","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 Basketball After Primary Hip Arthroscopy for Femoroacetabular Impingement: Minimum 5-Year Follow-up.","authors":"Angela M Mercurio, Sanathan Iyer, John-Rudolph Smith, Malik Dancy, Louis Kang, Bruce A Levy, Mario Hevesi, Aaron J Krych, Kelechi R Okoroha","doi":"10.1177/23259671251397529","DOIUrl":"10.1177/23259671251397529","url":null,"abstract":"<p><strong>Background: </strong>Femoroacetabular impingement (FAI) is a common injury experienced by basketball players. Surgical management with arthroscopic labral repair and femoral osteochondroplasty can lead to successful outcomes for athletes whose nonoperative management fails. Recent studies have demonstrated that athletes undergoing hip arthroscopy in the setting of FAI had favorable return-to-sport (RTS) and sport continuation outcomes.</p><p><strong>Purpose: </strong>To evaluate patient-reported outcome measures (PROMs) and RTS rates at minimum 5-year follow-up in basketball players after hip arthroscopy for FAI.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>All active basketball players at the recreational, high school, and collegiate levels who underwent primary hip arthroscopy with labral repair for FAI between August 2009 and December 2019 were identified. Postoperative RTS, revision rates, and surgery satisfaction at final follow-up were evaluated. PROMs were also analyzed as follows: visual analog scale, Tegner Activity Scale, modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sport.</p><p><strong>Results: </strong>Fifty-three patients (64 hips) were included with a mean ± SD age of 21.2 ± 6.0 years. Most athletes played recreational or high school basketball (85%), while 15% played college basketball. Forty-three patients attempted to return to basketball. Of these patients, 35 (81%) returned to basketball after surgery, with 32 (91%) returning to the same level of play. Patients who returned to basketball had significantly improved outcomes on the modified Harris Hip Score (<i>P</i> = .006), Hip Outcome Score-Activities of Daily Living (<i>P</i> = .007), Hip Outcome Score-Sport (<i>P</i> = .004), Tegner Activity Scale (<i>P</i> = .010), and visual analog scale with use (<i>P</i> = .041) as compared with those who did not return. High school athletes had decreased odds of RTS when compared with recreational athletes (<i>P</i> = .01). There was significant improvement in all PROMs from baseline to minimum 5-year follow-up (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>At minimum 5-year follow-up, basketball players demonstrated durable improvements in PROMs and an RTS rate of 81% after hip arthroscopy for FAI. The majority of athletes returned to the same level of competition. There were significantly improved PROMs in patients who returned to sport versus those who did not. High school athletes had decreased odds of RTS when compared with recreational athletes. However, body mass index, sex, age, alpha angle, and basketball position did not significantly correlate with RTS outcomes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251397529"},"PeriodicalIF":2.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513574","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":"Body Mass Index and the Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction Failure.","authors":"G Dillon Graham, Anna M Ifarraguerri, Alexander B White, Ainsley K Bloomer, Kennedy K Gachigi, Michael S Collins, Patrick Siparsky, Dana P Piasecki, James E Fleischli, Bryan M Saltzman","doi":"10.1177/23259671251407094","DOIUrl":"10.1177/23259671251407094","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in understanding the correlates of revision anterior cruciate ligament reconstruction (ACLR) failure, and conflicting evidence exists regarding body mass index (BMI) as a risk factor.</p><p><strong>Purpose: </strong>To evaluate the relationship between BMI and revision ACLR failure.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged 16 years or older who underwent revision ACLR between 2012 and 2021 with a minimum 2-year follow-up were included. Patients with inadequate follow-up, incomplete medical records, or concomitant lateral extra-articular tenodesis, anterolateral ligament reconstruction, osteotomy, osteochondral transplant, or multiligamentous injury were excluded. BMI was classified as normal (18.5 ≤ BMI < 25.0 kg/m²), overweight (25.0 ≤ BMI < 30.0 kg/m²), and obese 30.0 ≤ BMI < 35.0 kg/m²). Intraoperative data, concomitant injuries, complications, graft failure, and second revision ACLR data were collected.</p><p><strong>Results: </strong>A total of 174 patients who underwent revision ACLR were included; 37 (21.3%; 26 male, 11 female) experienced revision ACLR failure while 137 (78.7%; 83 male, 54 female) did not. The mean BMI did not differ between patients with and without revision ACLR failure. There was no difference in revision ACLR failure when stratifying patients by normal (n = 81), overweight (n = 57), or obese (n = 36) BMI.</p><p><strong>Conclusion: </strong>There is no significant relationship demonstrated between BMI and the risk of revision ACLR failure.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251407094"},"PeriodicalIF":2.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512914","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":"A Comparison of Postoperative Complications and Clinical Outcomes in Postless Versus Post-Assisted Hip Arthroscopy: A Systematic Review and Meta-analysis of Nonrandomized Comparative Studies.","authors":"Prabjit Ajrawat, Marina Nikolopoulos, Tim Dwyer, Graeme Hoit, Daniel B Whelan, Ananya Pathak, Jaskarndip Chahal","doi":"10.1177/23259671251407659","DOIUrl":"10.1177/23259671251407659","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hip arthroscopy with a perineal post (ie, post assisted) may contribute to postoperative nerve and soft tissue complications. Postless hip arthroscopy has been increasingly used as an alternative to limit these postoperative nerve-related complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the complication rates, such as pudendal nerve injury and perineal numbness, as well as any potentially reported clinical outcomes in patients undergoing postless versus perineal post-assisted hip arthroscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, MEDLINE, and Embase databases were searched until November 2024 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which yielded 2171 studies. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS) criteria, and postoperative complications (ie, visual analog scale [VAS], modified Harris Hip Score, the Hip Outcome Score-Sports Specific Subscale), and outcomes were compiled in a meta-analysis where appropriate. Continuous outcomes were obtained using the mean difference (MD) while dichotomous outcomes were reported as odds ratios (ORs) that were calculated using the Cochran-Mantel-Haenzel method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five studies, from 4 patient cohorts, were included that comprised a total of 707 patients (60% female) with a frequency-weighted mean age of 29.9 years (range, 26.1-34 years). The mean MINORS score was 19.4 ± 1.1 (range, 18-21) with studies ranging from low to moderate quality. The pooled incidence of nerve or soft tissue injury from 2 studies was 48.1% (74/154 patients) for post-assisted and 31.3% (40/128 patients) for postless groups. Meta-analysis indicated a significantly lower incidence of nerve or soft tissue injury associated with postless hip arthroscopy (OR, 0.50; 95% CI, 0.31 to 0.82; &lt;i&gt;P&lt;/i&gt; = .006). The pooled incidence of perineal numbness from 2 studies was 22.7% (35/154 patients) and 0.8% (1/128 patients) in the post-assisted and postless group, respectively. Meta-analysis demonstrated a significantly lower incidence of perineal numbness associated with postless hip arthroscopy (OR, 0.04; 95% CI, 0.01 to 0.21; &lt;i&gt;P&lt;/i&gt; = .0002). Postless hip arthroscopy required lower traction time (MD, -6.15 minutes; 95% CI, -8.23 to -4.07 minutes; &lt;i&gt;P&lt;/i&gt; = .00001) and holding traction force (MD, -12.12 kg; 95% CI, -15.32 to -8.93 kg; &lt;i&gt;P&lt;/i&gt; = .00001) compared with post-assisted hip arthroscopy. Two studies reported VAS, with both studies indicating no significant difference between groups at either the postanesthesia care unit period or at 2 years' follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our review showed that postless hip arthroscopy was associated with a significantly lower incidence of nerve or soft tissue injuries and perineal numbness, as well as reduced traction time","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251407659"},"PeriodicalIF":2.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513933","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":"A Cost-Effectiveness Analysis of the Addition of Autograft Lateral Extra-Articular Procedures to Primary Anterior Cruciate Ligament Reconstruction.","authors":"Juan Bernardo Villareal-Espinosa, Omar Shalakhti, Morgan Angotti, Andrew S Bi, Zeeshan Khan, Melissa Carpenter, Rodrigo Saad-Berreta, Felipe Casanova, Nikhil N Verma, Jorge Chahla","doi":"10.1177/23259671251407259","DOIUrl":"https://doi.org/10.1177/23259671251407259","url":null,"abstract":"<p><strong>Background: </strong>Multiple clinical studies have highlighted the improved outcomes of ACLR in associated with LEAPs. However, such procedures are associated with increased costs and operating room time, thus questioning their cost-effectiveness.</p><p><strong>Purpose: </strong>To evaluate the cost-effectiveness of augmenting an anterior cruciate ligament reconstruction (ACLR) with autograft lateral extra-articular procedures (LEAP), either a modified Lemaire or anterolateral ligament reconstruction.</p><p><strong>Study design: </strong>Economic and decision analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>A cost-effectiveness analysis was developed using failure rates for ACLR with and without concomitant autograft LEAPs from existing level 1 and 2 studies. Institutional data were used to estimate costs, including hospital and surgeon fees for ACLR and additional implant costs for LEAP. Utility measures were derived by linear approximation of the European Quality of Life 5 Dimension from the Knee injury and Osteoarthritis Outcome Score to evaluate improvements in quality-adjusted life years (QALY), a standardized metric that combines quantity and quality of life into a single value, over 1 year. Cost-effectiveness was determined based on previous literature, with an intervention considered cost-effective if the incremental cost-effectiveness ratio (ICER) was <$50,000/QALY. Three 1-way sensitivity analyses were conducted to assess the effect of implant cost, LEAP failure rates, and surgical time on cost-effectiveness.</p><p><strong>Results: </strong>The total cost of an isolated ACLR was estimated at $14,000, increasing to $14,990 with LEAP augmentation. Cost-effectiveness analysis showed an ICER of $25,313/QALY with LEAP augmentation, remaining below the $50,000/QALY cost-effectiveness threshold. Implant costs could rise to $1265 while maintaining cost-effectiveness, given an LEAP operation time (OR) of 15 minutes. Additionally, the failure rate of LEAP-augmented ACLR could increase from 2.9% to 7.7% while still meeting cost-effectiveness criteria. Finally, time sensitivity analysis indicated that for the procedure to remain cost-effective, the maximum allowable additional operative time is 36 minutes, given an OR cost of $46/minute.</p><p><strong>Conclusion: </strong>Although LEAP increases the time and cost of ACLR, it remains a cost-effective strategy for patients who are suitable candidates for augmentation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251407259"},"PeriodicalIF":2.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468733","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 in Elite Versus Nonelite Athletes After Anterior Cruciate Ligament Reconstruction.","authors":"Timothy McAleese, Conor J Kilkenny, Jessie Barr, Enda King, Kieran A Moran, Mark Jackson, Daniel Withers, Ray Moran, Brian M Devitt","doi":"10.1177/23259671251378746","DOIUrl":"https://doi.org/10.1177/23259671251378746","url":null,"abstract":"<p><strong>Background: </strong>Psychological readiness encompasses fear of reinjury, confidence in performance, and risk appraisal. It is increasingly recognized as a critical factor influencing return to play (RTP) after anterior cruciate ligament (ACL) reconstruction (ACLR). Elite athletes typically exhibit high self-efficacy and a strong athletic identity while also facing intense external pressure to return. While these dynamics undoubtedly influence their response to injury and psychological recovery after ACLR, the precise differences in psychological readiness between elite and nonelite athletes have not been reported.</p><p><strong>Purpose: </strong>To compare psychological readiness between elite and nonelite athletes after primary ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 756 participants were included in this study. There were 252 elite athletes and 504 propensity score-matched, nonelite athletes (1:2 ratio). Elite athletes were those who played professional sport, represented their country at international competitions, or played intercounty-level Gaelic Games. Psychological readiness was compared between groups preoperatively and at 3, 6, and 9 months postoperatively using the ACL Return to Sport after Injury scale (ACL-RSI). Participants were contacted at 1 year and 2 years postoperatively to record if they had returned to play. Multivariable analysis was used to identify factors (eg, age, sex, elite level) associated with ACL-RSI scores at 9 months.</p><p><strong>Results: </strong>Preoperative ACL-RSI scores did not differ significantly between elite and nonelite groups (50.6 ± 27.4 vs 48.1 ± 26.6; <i>P</i> = .28). However, elite athletes had higher scores at 3 months (58.6 ± 23.4 vs 53.1 ± 21.9; <i>P</i> < .001), 6 months (67.4 ± 19.9 vs 63.1 ± 19.4; <i>P</i> = .01) and 9 months (72.7 ± 19.9 vs 68.6 ± 19.2; <i>P</i> = .009). Elite athletes had significantly higher RTP rates at 1 year (86% vs 69%; <i>P</i> < .001) and 2 years (94.3% vs 86.7%; <i>P</i> < .002). Multivariate analysis revealed that International Knee Documentation Committee score at 9 months (β = 1.10; 95% CI, 0.95-1.25; <i>P</i> < .001) and male sex (β = 3.7; 95% CI, 0.8-6.6; <i>P</i> < .01) were most associated with increased ACL-RSI scores at 9 months. After adjusting for other factors, elite status was not an independent predictor of psychological readiness.</p><p><strong>Conclusion: </strong>Our study demonstrated that preoperative ACL-RSI scores were comparable between elite and nonelite athletes. However, elite athletes had consistently higher ACL-RSI scores during rehabilitation and ultimately greater RTP rates. Knee function and male sex are the strongest predictors of ACL-RSI score. Being an elite athlete is not a primary predictor of psychological readiness, and psychological intervention should be considered in all athletes.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251378746"},"PeriodicalIF":2.5,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468874","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":"Defining Minimal Clinically Important Difference Thresholds for Pediatric Knee Surgeries.","authors":"Amith Umesh, Joshua T Bram, Patrick P Nian, Ruth H Jones, Shae K Simpson, Daniel W Green, Peter D Fabricant","doi":"10.1177/23259671251413264","DOIUrl":"https://doi.org/10.1177/23259671251413264","url":null,"abstract":"<p><strong>Background: </strong>The minimal clinically important difference (MCID) has been established for adult questionnaires administered after pediatric anterior cruciate ligament reconstruction (ACLR) and medial patellofemoral ligament reconstruction (MPFLR), but the MCID remains unquantified in pediatric-specific patient-reported outcome (PRO) instruments.</p><p><strong>Purpose: </strong>To establish MCIDs for the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Pediatric International Knee Documentation Committee (Pedi-IKDC), and pediatric and parent-proxy Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), mobility, and physical activity scores in pediatric patients who underwent ACLR and MPFLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>The medical records of patients <18 years of age who underwent ACLR or MPFLR with 1 of 2 pediatric orthopaedic surgeons between 2016 and 2023 were retrospectively reviewed. Patient demographic and clinical factors were collected. Preoperative HSS Pedi-FABS, Pedi-IKDC, and pediatric and parent-proxy PROMIS pain interference (PI), physical activity, and mobility questionnaire scores were collected. The MCID was defined as one-half the standard deviation of preoperative scores. The MCIDs were calculated for patients undergoing ACLR and MPFLR.</p><p><strong>Results: </strong>In the ACLR group (505 patients; mean age, 14.5 ± 2.0 years), the MCIDs were established for the HSS Pedi-FABS (-5.0); Pedi-IKDC (8.7); pediatric PROMIS PI (-5.2), mobility (2.2), and physical activity (5.6); and parent-proxy PROMIS PI (-4.3), mobility (4.3), and physical activity (5.0) questionnaires. In the MPFLR group (253 patients; mean age, 14.4 ± 2.1 years), the MCIDs were established for the HSS Pedi-FABS (-5.1); Pedi-IKDC (9.1); pediatric PROMIS PI (-5.7), mobility (4.9), and physical activity (5.6); and parent-proxy PROMIS PI (-4.3), mobility (4.5), and physical activity (5.9) questionnaires. Negative MCIDs were reported for activity and pain scores to indicate MCID thresholds for decreased postoperative pain (i.e., pain improvement) and activity levels (i.e., decreased activity levels compared to healthiest and most active condition, absence of full recovery).</p><p><strong>Conclusion: </strong>This study establishes novel MCIDs for the HSS Pedi-FABS, Pedi-IKDC, and pediatric and parent-proxy PROMIS PI, physical activity, and mobility questionnaires in pediatric patients undergoing ACLR and MPFLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671251413264"},"PeriodicalIF":2.5,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12979866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468763","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":"No Postoperative Difference Between Bone-Block Versus All-Soft Tissue Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.","authors":"Aaron D Therien, Timothy Kouo, Isabel Prado, Emily J Luo, Cooper Williams, Jake Reed, Santita Ebangwese, Christian Zirbes, Kevin A Wu, Clark Bulleit, Stephanie Hendren, Brian C Lau","doi":"10.1177/23259671261418051","DOIUrl":"https://doi.org/10.1177/23259671261418051","url":null,"abstract":"<p><strong>Background: </strong>Quadriceps tendon autografts are increasingly used for anterior cruciate ligament reconstruction (ACLR), harvested either with a patellar bone block (quadriceps tendon bone block [QTBB]) or as an all-soft tissue graft (quadriceps tendon soft tissue [QTST]). However, comparative data on outcomes remain limited and heterogeneous.</p><p><strong>Hypothesis: </strong>It was hypothesized that there would be no significant differences in patient-reported outcomes, objective stability, return to sports, or complication rates between QTBB and QTST grafts used for primary ACLR.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>A systematic review of 4 databases (PubMed, Embase, Scopus, and SportDISCUS) was conducted through November 2024. Studies reporting outcomes after primary ACLR using QTBB or QTST autografts were included (Levels 1-4 evidence). Random-effects meta-analyses pooled outcomes for each graft; meta-regression compared grafts while adjusting for follow-up duration and publication year. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>A total of 44 studies (n = 2083; QTBB = 1104; QTST = 979) met the inclusion criteria with a mean follow-up of 29 months. International Knee Documentation Committee scores averaged 79.7 (95% CI, 74.8-84.6) for QTBB and 85.4 (95% CI, 80.9-89.8) for QTST autografts (β = 5.2; <i>P</i> = .11). There were no significant between-group differences in Lysholm, Tegner, or Knee injury and Osteoarthritis Outcome Score subscale scores. Instrumented laxity (KT-1000/2000) was higher for QTBB (1.75 mm [1.30-2.21]) versus QTST grafts (0.50 mm [0.35-0.65]) (β = -1.25 mm; <i>P</i> = 0.087), although this difference was not statistically significant and QTST results were driven by a single high-volume cohort. No significant differences were found in Lachman, pivot-shift, or anterior drawer grades. Return to sports (RTS) rates were 82% for QTBB and 81% for QTST grafts (<i>P</i> = .82). Graft failure (both 6%), anterior knee pain (8% vs 7%), and infection (~1%) rates were comparable (all <i>P</i> > .70). Heterogeneity was high for patient-reported outcome measures (<i>I²</i> >75%) but low for complications. Most studies had a moderate risk of bias, and the certainty of evidence was graded as very low across outcomes due to inconsistency, imprecision, and the observational nature of included studies.</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis found no clinically meaningful differences in short-term patient-reported outcomes, graft integrity, RTS rates, or complications between QTBB and QTST grafts in primary ACLR.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 3","pages":"23259671261418051"},"PeriodicalIF":2.5,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12979880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468828","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}