Orthopaedic Journal of Sports Medicine最新文献

{"title":"Comparison of Arthrofibrosis After ACL Reconstruction According to Graft Choice: Quadriceps Tendon Versus Bone-Patellar Tendon-Bone Autograft.","authors":"Bailey E Johnson, Chelsea L Smith, Cory D Smith, Edward J Quilligan, Viraj A Deshpande, Vance O Gardner, Kevin C Parvaresh, Michael F Shepard, Russell S Petrie, Carlos A Prietto, Robert C Grumet, David S Gazzaniga","doi":"10.1177/23259671241311916","DOIUrl":"10.1177/23259671241311916","url":null,"abstract":"<p><strong>Background: </strong>Arthrofibrosis is a complication of anterior cruciate ligament reconstruction (ACLR), and it is possible that graft choice such as the quadriceps tendon (QT) autograft may be a risk factor. With the increasing popularity of the QT autograft, it is important to compare it with other graft choices.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to identify whether graft choice, QT versus bone-patellar tendon-bone (BTB) autograft, is a risk factor for early return to the operating room for arthrofibrosis after ACLR. It was hypothesized that the rate of arthrofibrosis surgery would be higher for the QT autograft recipients.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A single-center retrospective chart review was conducted between January 2010 and November 2022. Skeletally mature patients who underwent primary ACLR with either QT or BTB autograft were considered for inclusion. Patients who received an alternate graft or those undergoing revision ACLR were excluded. The primary outcome of interest was return to the operating room for arthrofibrosis release (either manipulation under anesthesia or lysis of adhesions).</p><p><strong>Results: </strong>Of 1726 included patients (1155 receiving a BTB autograft and 571 receiving a QT autograft), 5.2% (n = 60) of BTB recipients and 6.5% (n = 37) of QT recipients required subsequent arthrofibrosis. There was no significant association between graft type and subsequent arthrofibrosis (<i>P</i> = .275). There was a significant association with graft type and presence of a cyclops lesion (65.0% of BTB grafts and 40.5% of QT grafts; <i>P</i> = .018). After removing those patients with chronic tears who underwent ACLR at >1 year, patients who required arthrofibrosis were found to have a significantly shorter time between injury and ACLR (mean, 59.23 ± 48.46 days) than those who did not require arthrofibrosis (mean, 81.7 ± 72.63 days) (<i>P</i>≤ .01). Significantly more female patients (9.25%) than male patients (2.79%) required arthrofibrosis (hazard ratio, 3.82; <i>P</i> < .001), and patients who required arthrosis were significantly younger (mean, 22.52 ± 9.35 years) than those who did not (mean, 25.74 ± 10.83 years) (<i>P</i> = .001).</p><p><strong>Conclusion: </strong>Study findings indicated no statistically significant difference in the rate of secondary arthrofibrosis surgery between patients who underwent ACLR with either QT or BTB autograft.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241311916"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441564","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":"The Role of Crutches and Bracing in Preventing Secondary Meniscal Tears After Anterior Cruciate Ligament Injury in Pediatric Patients.","authors":"Arjun Gupta, Daniel Badin, R Jay Lee","doi":"10.1177/23259671241309862","DOIUrl":"10.1177/23259671241309862","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Secondary meniscal tears are a well-described sequela of delay in anterior cruciate ligament (ACL) reconstruction (ACLR) after ACL injury. This study aimed to evaluate whether preoperative conservative interventions (ie, crutches, bracing, and physical therapy) are associated with a reduced risk of secondary meniscal pathology in pediatric patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;Preoperative conservative interventions of the ACL-deficient knee would be associated with fewer secondary meniscal tears in pediatric patients undergoing delayed (≥8 weeks postinjury) ACLR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All pediatric patients (age, &lt;18 years) undergoing primary ACLR with a single surgeon between October 1, 2013, and January 31, 2022, were retrospectively identified. The exclusion criteria were as follows: previous ipsilateral knee injury; multiligamentous knee injuries; or time frommagnetic resonance imaging to surgery ≥52 weeks. Adherence to conservative management recommendations (ie, crutches, bracing, and physical therapy) was assessed through medical record review. Secondary meniscal injuries were defined as major tears that were discovered intraoperatively and required repair or substantial meniscectomy. Meniscal tears that occurred concomitantly with ACL rupture and were detectable on the initial (&lt;3 weeks after injury) magnetic resonance imaging scans were not considered secondary. In total, 71 pediatric patients (35 girls; 36 boys) were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 70 patients (99%) underwent ≥1 conservative interventions before ACLR-including 37 (52%) who used crutches, 47 (66%) who used bracing, and 69 (97%) who received physical therapy. There were no differences in use of conservative interventions between those who underwent early ACLR and those who had delayed ACLR (&lt;i&gt;P&lt;/i&gt; &gt; .05). Delayed ACLR was associated with a greater risk of medial, but not lateral, meniscal tears compared with early ACLR (&lt;i&gt;P&lt;/i&gt; = .04). Overall, 15 secondary meniscal tears were observed intraoperatively in 14 patients-including 4 medial and 11 lateral tears. Knee bracing was associated with fewer lateral meniscal tears in patients undergoing early ACLR (6% vs 35%; &lt;i&gt;P&lt;/i&gt; = .008), with multivariate regression analysis yielding an adjusted odds ratio of 0.06 (95% CI, 0.006-0.57; &lt;i&gt;P&lt;/i&gt; = .015). The use of crutches was associated with fewer medial meniscal tears in patients undergoing delayed ACLR (0% vs 37%; &lt;i&gt;P&lt;/i&gt; = .017). Since no new medial meniscal tears were observed in patients who used crutches, the adjusted odds ratio could not be calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Bracing and crutches were associated with the preservation of the menisci in the ACL-deficient knee in pediatric patients undergoing early and delayed ACLR, respectively. Surgeons should strongly encourage adherence to these conservative modali","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241309862"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409842","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":"Using Wearable Sensor Technology to Analyze Running Technique and Prospective Running-Related Injuries During United States Military Cadet Basic Training.","authors":"Amy N Weart, Lauren C Brown, Erin M Florkiewicz, Gregory M Freisinger, Kyle H East, Nicholas Reilly, Jinsup Song, Donald L Goss","doi":"10.1177/23259671241309273","DOIUrl":"10.1177/23259671241309273","url":null,"abstract":"<p><strong>Background: </strong>Running biomechanics have been linked to the development of running-related injuries in recreational and military runners.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to determine if personal characteristics or running biomechanical variables are associated with running-related injury incidence or time to injury in military cadets undergoing training. It was hypothesized that a rearfoot strike pattern, greater rate of impact, or a lower step rate would be related to a greater running-related injury incidence and a decreased time to injury.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>Military cadets wore an on-shoe wearable sensor that analyzed biomechanical variables of foot strike pattern, rate of impact, running pace, step rate, step length, and contact time during cadet basic training (60 days). Running-related injuries during cadet basic training were determined by medical record review. Personal and running variables between the injured and uninjured cadets were compared using independent <i>t</i> tests and chi-square analyses. Time to injury and hazard ratios (HRs) were estimated using Kaplan-Meier survival curves and Cox proportional hazard regression models, respectively.</p><p><strong>Results: </strong>Of the 674 cadets who completed the study, 11% sustained a running-related injury. A significantly greater proportion of the injured participants were female (χ² = 7.95; <i>P</i> = .005) and had a prior history of injury (χ² = 7.36; <i>P</i> = .007). Univariate Cox proportional hazard regression models revealed greater injury risk in females (HR, 1.96; 95% CI, 1.22-3.16; <i>P</i> = .005) and cadets with a prior injury history (HR, 1.86; 95% CI, 1.18-2.93; <i>P</i> = .008). After adjusting Cox models for prior injury, females were found to be at a 1.89 times (95% CI, 1.17-3.04; <i>P</i> = .009) greater risk of injury. Running biomechanical variables were not associated with injury risk.</p><p><strong>Conclusion: </strong>Study results indicated that non-modifiable risk factors such as female sex and prior injury history increased the risk of running-related injury in cadets undergoing military training. Running biomechanical variables measured by the wearable sensor were not associated with injury in this study.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241309273"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143409844","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":"Outcomes After Posterior Cruciate Ligament Reconstruction With Suture Tape Augmentation and an Accelerated Rehabilitation Protocol: A Retrospective Cohort Study.","authors":"Arthur Cardoso Paroneto, Pedro Soneghet Gomes, Paulo Vitor Carrijo, Moises Cohen, Leonardo Addeo Ramos","doi":"10.1177/23259671241308590","DOIUrl":"10.1177/23259671241308590","url":null,"abstract":"<p><strong>Background: </strong>Although posterior cruciate ligament (PCL) reconstruction is often performed for grade 3 PCL injuries, the effectiveness of different surgical techniques and rehabilitation protocols is a topic of debate.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate and compare functional outcomes and residual instability in patients who underwent PCL reconstruction with versus without suture tape augmentation. It was hypothesized was that adding high-resistance suture tape to PCL reconstruction would improve functional scores and reduce postoperative laxity.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 48 patients were included in the study; all patients underwent PCL reconstruction with an autologous quadriceps tendon graft and had a minimum follow-up of 2 years. Overall, 23 patients were treated with a graft only, while 25 were treated with a graft and suture tape. Patients in the suture tape augmentation group also underwent an accelerated rehabilitation program with earlier range of motion and weightbearing. Patient characteristics, Lysholm scores, posterior tibial laxity on stress radiographs at 90° of knee flexion, and postoperative complications were compared between treatment groups.</p><p><strong>Results: </strong>No statistically significant differences were found between groups in terms of patient characteristics. Similar results were seen in both groups in terms of postoperative complications. Furthermore, on average, the Lysholm score increased from 1- to 2-year follow-up by 6.99 points (standard error = 0.97 points; <i>P</i> < .001), indicating progressive functional improvement, and posterior tibial laxity decreased from preoperatively to postoperatively by 7.55 mm (standard error = 0.24 mm; <i>P</i> < .001), indicating an improvement in knee stability. Patients in both treatment groups saw significant improvements during the follow-up period in the Lysholm score and posterior tibial laxity (<i>P</i> < .001 for both).</p><p><strong>Conclusion: </strong>PCL reconstruction with suture tape augmentation and an accelerated rehabilitation protocol did not result in significantly improved functional scores or postoperative laxity compared with isolated PCL reconstruction. The results showed no disadvantage of a more aggressive rehabilitation protocol.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241308590"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382976","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":"The Preseason Functional Movement Screen as a Predictive Tool for Shoulder and Elbow Injuries in High School Baseball Pitchers: A Prospective Cohort Study.","authors":"Hitoshi Shitara, Noritaka Hamano, Tsuyoshi Tajika, Tsuyoshi Ichinose, Tsuyoshi Sasaki, Masataka Kamiyama, Ryosuke Miyamoto, Kurumi Nakase, Fukuhisa Ino, Yuhei Hatori, Koichiro Yanai, Hirotaka Chikuda","doi":"10.1177/23259671241305607","DOIUrl":"10.1177/23259671241305607","url":null,"abstract":"<p><strong>Background: </strong>The Functional Movement Screen (FMS) is used to evaluate fundamental movement patterns in patients. It is unknown whether the FMS can be used as a predictive tool for the occurrence of pitching injuries in baseball players.</p><p><strong>Purpose: </strong>To prospectively investigate the relationship between shoulder and elbow injuries and individual components of the FMS during the preseason in high school baseball pitchers and determine which components of the FMS can be used as screening tools to predict shoulder and elbow injuries.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>Eligible participants comprised 133 male high school baseball pitchers aged 15 to 17 years who underwent a preseason medical examination in 2017. Included participants were right-handed pitchers who had been involved in preseason practices without restrictions in baseball activities. The physical examination included assessments of background factors, bilateral shoulder and elbow range of motion, and grip and shoulder strength as well as the FMS. A shoulder or elbow injury was defined as any condition causing the inability to pitch for ≥8 days. Injuries occurring in the season immediately after the preseason medical examination were recorded. Logistic regression analysis was performed to identify risk factors associated with an injury.</p><p><strong>Results: </strong>Overall, 90 high school baseball pitchers were enrolled in this study. The incidence of injuries was 22.2%. A comparison of FMS scores revealed significantly higher values for shoulder mobility on both sides (dominant side: <i>P</i> = .025; nondominant side: <i>P</i> = .034) and lower values for rotary stability on the dominant side (<i>P</i> < .001) in the injured versus noninjured group. Logistic regression analysis identified poor rotary stability on the dominant side as a significant independent risk factor for baseball injuries (odds ratio, 5.30; <i>P</i> = .009).</p><p><strong>Conclusion: </strong>In right-handed high school baseball pitchers, a low FMS score for rotary stability on the dominant side during the preseason was a significant independent risk factor for injuries in the following season. The FMS score for rotary stability may be used as a predictive tool for the occurrence of pitching injuries in high school baseball pitchers.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241305607"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383005","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":"Management of Isolated Partial ACL Tears: A Survey of International ACL Surgeons.","authors":"Christopher S Frey, Kinsley J Pierre, Nicole S Pham, Geoffrey D Abrams, Seth L Sherman, Tim Spalding, Marc R Safran","doi":"10.1177/23259671241311603","DOIUrl":"10.1177/23259671241311603","url":null,"abstract":"<p><strong>Background: </strong>Partial anterior cruciate ligament (ACL) tears, particularly injuries detected with magnetic resonance imaging (MRI) but stable on ligamentous examination, appear to be recognized more frequently; however, there remains no consensus management for this complex pathology.</p><p><strong>Purpose: </strong>To present the results of a survey of a group of international ACL experts on the management of partial ACL injuries.</p><p><strong>Study design: </strong>Survey study; Level of evidence, 5.</p><p><strong>Methods: </strong>The ACL Study Group is an international group of orthopaedic surgeons with a special interest in the ACL. There are 169 members overall, with 135 clinically active surgeons. A branching logic survey was developed and circulated to members of the ACL Study Group via electronic mail. Categories included member demographics as well as recommended management strategies of partial ACL injuries, including recommendations on return to play.</p><p><strong>Results: </strong>Of the 135 clinically active surgeon members, 113 responded to the survey (84%). Nonoperative management of partial ACL injuries was selected by 92% of respondents. Of those who managed nonoperatively, 75% indicated they would not restrict weightbearing and 59% would not recommend a knee brace. When those who managed the patient nonoperatively determined criteria for return to sports (RTS), 33% would use differential knee laxity, 87% would assess functional testing, 26% would utilize imaging, and 40% selected time from injury. When using time as a guide for RTS, 13% chose RTS between 7 and 11 weeks postinjury, 56% selected no sport before 3 months, and 22% favored waiting 4 to 6 months before allowing an athlete with a partial ACL injury to RTS. With regard to function as a tool to determine RTS, painless Lachman, strength, swelling, and functional performance tests were all chosen by a majority of respondents.</p><p><strong>Conclusion: </strong>This study presented the results of a survey on partial ACL injury management administered to ACL Study Group active surgical members. The majority favored nonoperative management for partial ACL injuries (stable ligament examination but MRI changes in the ligament). Nonoperative treatment and RTS protocols varied and must be customized to the patient.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241311603"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391440","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":"Incidence of Heterotopic Ossification Without Additional Long-Term NSAID Prophylaxis After Periacetabular Osteotomy and Concomitant Hip Arthroscopy.","authors":"J Matthew Helm, Omar Stocks, Brian Crowley, Alexis Aboulafia, Jacob Siahaan, Alfred A Mansour","doi":"10.1177/23259671241310230","DOIUrl":"10.1177/23259671241310230","url":null,"abstract":"<p><strong>Background: </strong>Periacetabular osteotomy (PAO) is an established treatment for hip dysplasia and has been increasingly combined with concomitant hip arthroscopy to address additional intra-articular hip pathology. Heterotopic ossification (HO) is a complication of arthroscopic and open hip procedures. Nonsteroidal anti-inflammatory drugs (NSAIDs) have become an established form of HO prophylaxis, but their use may delay bone healing.</p><p><strong>Purpose: </strong>To examine the incidence of HO without NSAID prophylaxis in patients after PAO with concomitant hip arthroscopy and to evaluate the impact of other variables on the development of HO in these patients.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Of 243 hips that underwent PAO with concomitant hip arthroscopy by a single surgeon over 11 years, 182 met the study inclusion criteria. No patients were discharged on NSAIDs for HO prophylaxis, although most took up to 6 weeks of aspirin 81 mg as part of the prophylaxis protocol for deep venous thrombosis. Radiographic images at 2 weeks, 6 weeks, and 3 months postoperatively were reviewed and graded for HO using the Brooker classification. Patient characteristics and surgical variables were recorded. The chi-square and <i>t</i> tests were used to determine HO incidence rates, compare groups, and identify variables associated with the presence of HO.</p><p><strong>Results: </strong>The incidence of radiographic HO was 6.6% (12/182 hips). Nine hips were Brooker grade 1, 2 were grade 2, and 1 was grade 3. Four patients experienced clinical symptoms of HO- including pain and restricted motion. Only 1 patient required a return trip to the operating room for surgical excision. Male patients were significantly more likely to develop HO than female patients (<i>P</i> = .01). No other demographic or surgical factor influenced the development of HO. There were no cases of nonunion.</p><p><strong>Conclusion: </strong>There was a low incidence of HO and symptomatic HO in patients who underwent PAO with concomitant hip arthroscopy without using NSAIDs for HO prophylaxis. HO was significantly more likely to develop in male patients. Given the potential risk of NSAID use on bony union, the low incidence found in this study may obviate the need for postoperative HO prophylaxis.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241310230"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414526","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":"Is Ulnar Collateral Ligament Strength Proportional to Height and Weight?","authors":"David P Beason, Ricardo E Colberg, Brandon K Kimbrel, Marcus A Rothermich, Jonathan S Slowik, Glenn S Fleisig","doi":"10.1177/23259671241312211","DOIUrl":"10.1177/23259671241312211","url":null,"abstract":"<p><strong>Background: </strong>The rates of surgeries for ulnar collateral ligament (UCL) injuries continue to rise for baseball pitchers. The physical size of pitchers has also increased, bringing into question whether today's larger pitchers have proportionally bigger and stronger UCLs able to withstand greater elbow varus torque. Furthermore, controversy exists in biomechanics literature regarding whether kinetics during pitching should be reported as torque (in N·m) or normalized torque (scaled by body weight and height).</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to quantify the relationships between body size and mechanical properties of the UCL measured directly on cadaveric specimens. It was hypothesized that greater body weight and height would correlate with greater UCL strength, stiffness, and cross-sectional area.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>UCL thickness and length were measured by ultrasound for 20 cadaveric right elbows from young adult (mean age, 33 ± 6 years) male donors. Each elbow was then dissected, potted, and placed into a mechanical test frame at 90° of flexion. The specimen was then tested to failure at a rate of 1° of valgus rotation per second. Correlations between geometric and biomechanical data were tested by linear regressions (<i>P</i> < .05).</p><p><strong>Results: </strong>The mean UCL failure torque was 45.0 ± 10.5 N·m, and the mean stiffness was 2.72 ± 0.48 N·m/deg. Correlations between failure torque and height (<i>P</i> = .25), weight (<i>P</i> = .85), and height × weight (<i>P</i> = .72) were nonsignificant. Similarly, stiffness showed no significant correlation with height (<i>P</i> = .24), weight (<i>P</i> = .21), or height × weight (<i>P</i> = .18). UCL cross-sectional area did not significantly correlate with body height (<i>P</i> = .34), height × weight (<i>P</i> = .064), or weight (<i>P</i> = .065).</p><p><strong>Conclusion: </strong>Body size is not correlated with UCL strength and stiffness.</p><p><strong>Clinical relevance: </strong>Clinicians should not assume that bigger athletes have a stronger UCL. Furthermore, elbow varus torque during throwing for adult athletes should not be normalized by body weight and height.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241312211"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414682","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":"Racial Concordance Between NBA and MLB Players and Their Team Physicians.","authors":"Andrew Gaetano, Krishin Shivdasani, Andrew Chen, Nickolas Garbis, Dane Salazar","doi":"10.1177/23259671241310472","DOIUrl":"10.1177/23259671241310472","url":null,"abstract":"<p><strong>Background: </strong>Recent efforts aim to determine whether patient-provider race concordance improves health outcomes for minority patient populations. Patient-physician race discordance is uniquely elevated in professional athletics.</p><p><strong>Purpose: </strong>To evaluate racial concordance between rostered players and their respective team physicians in 2 major professional sports leagues in the United States-the National Basketball Association (NBA) and Major League Baseball (MLB).</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>Publicly available data were collected in June of 2023 to identify NBA and MLB players and team physicians. The sex and reported or perceived race of the players and team physicians were determined by 2 independent observers who analyzed reported demographic data, photographs, and names of these individuals, with disagreements resolved by a third independent observer. Team physicians' medical training, medical specialty, languages spoken, and years in practice were obtained using publicly available internet-based sources or by contacting the clinical staff directly.</p><p><strong>Results: </strong>In both the NBA and the MLB, there was a statistically significant difference in racial composition between players and team physicians (<i>P</i> < .0001 for both). In addition, despite a high percentage (30.7%) of Hispanic/Latino players in the MLB, just 11.6% of MLB team physicians spoke Spanish, and >50% (18/30) of MLB organizations lacked a team physician who spoke Spanish.</p><p><strong>Conclusion: </strong>Substantial race discordance was found between professional athletes and head team physicians. Physicians more closely mirroring the patient populations that we treat-including professional athletes-may positively affect health care relationships and improve patient/provider barriers.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241310472"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414686","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":"Reasons for and Complications Following Revision Tibial Tubercle Osteotomy.","authors":"Nathan H Varady, Tyler J Uppstrom, Aakash Shah, Morgan Rizy, Ava G Neijna, Andreas H Gomoll, Sabrina M Strickland","doi":"10.1177/23259671241312232","DOIUrl":"10.1177/23259671241312232","url":null,"abstract":"<p><strong>Background: </strong>While tibial tubercle osteotomy (TTO) is a highly effective treatment for patellofemoral malalignment, some patients may have recurrent symptoms after surgery. To date, there are little data on revision TTO (rTTO) and its outcomes.</p><p><strong>Purpose: </strong>To evaluate the (1) reasons for and (2) complications following rTTO.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>This was a retrospective review of patients who underwent rTTO from a single high-volume patellofemoral surgeon between 2016 and 2023. All included patients had a minimum of 3 months of follow-up data. Demographic characteristics, indications for primary and revision surgery, operative characteristics, concomitant procedures, range of motion at 6 and 12 weeks postoperatively, radiographic data, and complications were collected.</p><p><strong>Results: </strong>There were 16 knees (14 patients) that underwent rTTO, including 10 (63%) for persistent malignment (all of which had chondral damage requiring concomitant intervention) and 6 (38%) for fracture/nonunion. The knees undergoing rTTO for malalignment were 90% female, compared with 33% female for fracture/nonunion (<i>P</i> = .04). For persistent malalignment rTTO, the only complication (10% [1/10]) was arthrofibrosis (0°-65° at 6 weeks postoperatively), requiring arthroscopic lysis of adhesions (0°-140° at 12 weeks postoperatively). Within the follow-up available (median, 2.2 years; range, 9 months-5.3 years), there were no cases of new or recurrent patellar instability after rTTO. Similarly, at a median follow-up of 1.2 years (range, 4 months-3.0 years), all 6 knees that underwent rTTO for fracture/nonunion achieved union, with delayed union requiring percutaneous bone marrow grafting at 4 months postoperatively being the only complication in this cohort.</p><p><strong>Conclusion: </strong>Patients who underwent rTTO demonstrated low complication rates and high union rates in this study. There was a high prevalence of chondral damage requiring concomitant intervention among patients undergoing rTTO for persistent malalignment. While rTTO is a relatively rare procedure, these data suggest that it can be a safe and effective option for patients with recurrent symptoms or fracture/nonunion after primary TTO.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"13 2","pages":"23259671241312232"},"PeriodicalIF":2.4,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441566","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}